An Integrated Portable Device for the Hand Functional Assessment in the Clinical Practice - Biomedical Engineering Systems and Technologies - page 77

In particular, rheumatic diseases, such as Rheumatoid Arthritis (RA) and Systemic
Sclerosis (SSc) could led to lesions localized on the hands, thus producing the afore-
mentioned invalidating effects, requiring an integrated therapy including kinesitherapy
and a pharmacological protocol. Differently from RA, where movement limitation is
prevalently caused by arthritis, patients with SSc suffer a skin thickening whose conse-
quence is a limited mobility which in turn exacerbates the problem. For these patients,
the functional deficit is evaluated in a clinical setting using physician assessed biome-
chanical measurements such as the Range Of Movement (ROM), the hand extension
and strength. Furthermore, physician-administered questionnaires are used to obtain the
subject's perception of its disability, i.e. the Dreiser test [4] and the Health Assessment
Questionnaire (HAQ) [11]. Only for some evaluations (e.g. grip and pinch strength or
ROM) some digital devices are able to provide one-shot measurements but there is a
lack of commercial functional evaluation tools able to measure the interesting param-
eters associated to the execution of typical rehabilitation exercises prescribed to these
patients. They would probably help in the assessment procedures, especially if all the
devices are integrated on the same hardware platform.
This chapter presents a system for the real-time assessment of the hand functional-
ity on rehabilitation exercises usually exploited with patients affected by RA and SSc.
Compared to the typical procedures at the state of the art for such evaluation, exploit-
ing either subjective scores or one-shot measurements, the proposed system extracts the
relevant information from the real-time monitoring of exercise repetitions with hitherto
unavailable precision, reducing the background noise due to fatigue and distraction. The
microcontroller-based device exploits 4 sensorized custom-made aids for the evaluation
of the hand agility (finger tapping and dynamic rotation) and strength/mobility (isomet-
ric rotation and hand extension with counter resistance) and can be easily controlled
by a PC connected via a Bluetooth link. A stand-alone C++ graphical user interface
(GUI) has been implemented exploiting the Qt 4.7 framework to provide a license-free
physician support for the real-time control of the device. The device has been evaluated
in a real outpatient rheumatology clinic on 6 voluntary subjects affected either by SSc
or RA and the preliminary results reveal the potentialities of the proposed approach.
The remainder of this paper is organized as follows. In Sect. 2 a brief analysis of
the related works is provided. Sect. 3 provides an overview of the proposed device and
the relative hardware implementation details, whereas the physician GUI is presented
in Sect. 4. Sect. 5 presents the results of the device application in an outpatient clinic.
Conclusions are presented in Sect. 6.

2 Related Works

For functional assessment of the human hand, the most common evaluation techniques
involve pinch and grip exercises. Both the Jamar dynamometer (isometric) and the Vig-
orimeter (dynamic) represent well established instruments for the clinical evaluation
of the grip strength [10]. Commercial devices such as Pablo by Tyromotion GmbH or
the H500 Hand Kit by Biometrics Ltd. allow monitoring also the single finger pinch
force. In principle, isometric wrist dynamometer can be also used to estimate the torque
applied with the finger when the wrist is in a fixed position, in order to evaluate the
hand performance with respect to this task. Usually the digital versions of these devices