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Stroke Research and Treatment
Volume 2017, Article ID 3603860, 13 pages
Research Article

Improving Upper Extremity Function and Quality of Life with a Tongue Driven Exoskeleton: A Pilot Study Quantifying Stroke Rehabilitation

1Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
2School of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, USA
3School of Nursing & Health Professions, Georgia State University, Atlanta, GA, USA
4Department of Veteran’s Affairs, Atlanta Rehabilitation Research and Development Center of Excellence, Decatur, GA, USA
5School of Medicine, Emory University, Atlanta, GA, USA
6School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
7Neuroscience Institute, Joint Center for Advanced Brain Imaging, Center for Behavioral Neuroscience, Georgia State University, Atlanta, GA, USA

Correspondence should be addressed to Andrew J. Butler; ude.usg@reltubwerdna

Received 24 November 2016; Revised 29 April 2017; Accepted 13 November 2017; Published 18 December 2017

Academic Editor: Tauheed Ishrat

Copyright © 2017 Stephen N. Housley et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Stroke is a leading cause of long-term disability around the world. Many survivors experience upper extremity (UE) impairment with few rehabilitation opportunities, secondary to a lack of voluntary muscle control. We developed a novel rehabilitation paradigm (TDS-HM) that uses a Tongue Drive System (TDS) to control a UE robotic device (Hand Mentor: HM) while engaging with an interactive user interface. In this study, six stroke survivors with moderate to severe UE impairment completed 15 two-hour sessions of TDS-HM training over five weeks. Participants were instructed to move their paretic arm, with synchronized tongue commands to track a target waveform while using visual feedback to make accurate movements. Following TDS-HM training, significant improvements in tracking performance translated into improvements in the UE portion of the Fugl-Meyer Motor Assessment, range of motion, and all subscores for the Stroke Impact Scale. Regression modeling found daily training time to be a significant predictor of decreases in tracking error, indicating the presence of a potential dose-response relationship. The results of this pilot study indicate that the TDS-HM system can elicit significant improvements in moderate to severely impaired stroke survivors. This pilot study gives preliminary insight into the volume of treatment time required to improve outcomes.