After Stroke: Regaining Muscle Control

A “music glove” based on the video game Frets on Fire makes rehabilitation more fun

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This segment is part of the IEEE Spectrum series “The New Medicine

Susan Hassler: Strokes are the largest cause of adult disability in the United States. A person has a stroke, on average, about every 35 seconds. That adds up to around 800 000 people a year. Many stroke survivors are left with limited control over their bodies and long recovery periods. To regain muscle control, stroke patients must retrain their bodies and brains to connect by doing many of the same movements over and over. To make this tedious rehabilitation work more fun, researchers at University of California, Irvine, have invented a new device. It mixes movement with music, as Caitlan Carroll reports.

[ambient sounds of talking in laboratory]

Caitlan Carroll: Josh Gray sits in a laboratory filled with computers and robotic-looking machines. He’s part of a sample group of stroke survivors testing out a new rehabilitation device at the University of California, Irvine, or UCI. As I walk into the lab, the first thing I notice about Josh is his big, big laugh.

[ambient sound from laboratory; laughing]
Caitlan Carroll: The second thing I notice is that Josh is unable to open his right hand wide enough to shake my hand. So we do a kind of fist bump instead. At 16, Josh was a typical teenager. He played basketball and liked hanging out with friends. But on the morning of June 9, 2009, life changed. He woke up and couldn’t feel part of his body.

Josh Gray: Something happened, like I couldn’t move my right arm. Dad comes in and says, “Josh, what happened? You’re supposed to be at school.” And I couldn’t say anything. I was impaired.

Caitlan Carroll: Josh had injured his knee while playing basketball. The doctors think that this injury may have created the blood clots that eventually traveled to his brain and caused a stroke as he slept. Now Josh is 19 years old and still struggling to reclaim movement on the right side of his body. Nizan Friedman checks Josh’s grip on his right hand.

[ambience in laboratory; talking: “Good work. That hand strength is really getting there.”]

Caitlan Carroll: Friedman, a biomedical engineer at UCI, is one of the designers of the product Josh is testing. Friedman says even though Josh is unusually young to have a stroke, his physical problems are similar to those of many patients.

Nizan Friedman: When someone experiences a stroke, it normally occurs on one side of their body, and essentially what happens with a stroke is a part of your body, a part of your motor cortex, gets destroyed. So the goal is for the brain to reorganize itself so it can now attach new parts of the neurons to the damaged areas.

Caitlan Carroll: Friedman says to build up those neural connections, a stroke patient must do repetitive exercises over a long period of time.

Nizan Friedman: Essentially, the more you try to work on it, the more it kind of happens. So when you really try to move your arm a thousand times, eventually your brain will get it.

Caitlan Carroll: But trying to move your arm a thousand times when it doesn’t want to can be frustrating and boring work. That’s why Friedman and UCI professors Mark Bachman and David Reinkensmeyer created a device called the Music Glove. It’s designed to encourage stroke survivors to make the kinds of hand movements they need in daily living—so they can button a shirt, for instance.

Nizan Friedman: The way this device works is the patient using it has to put on a glove, a sensorized glove, that they need to make specific movements with. And we have this device plugged into a PC, and when they make a movement on the device, they are also using it as a controller for a Guitar Hero–like game.

Caitlan Carroll: The Music Glove is made of a lightweight, stretchy material and has sensors in the fingertips. A stroke patient can easily attach it with Velcro strips and then boot up the video game on any computer. The video game that goes with the Music Glove is called Frets on Fire. The computer screen shows a guitar fret board. As the music starts, colored dots appear on different strings at different times. A player must move each finger in the glove like he’s playing notes on a guitar. A player gets points when he moves the right finger at the right time. Josh Gray demonstrates for me. First he picks a song. Then he puts on the glove...

[Velcro sound]

Caitlan Carroll: ...and starts up the game.

Caitlan Carroll: So, do you have a favorite song? Is that it?

Josh Gray: Yeah, that is it—“I Walk the Line,” by Johnny Cash.

Caitlan Carroll: Nice! I like it too. Cool. So, we’re going to see how this works.

Josh Gray: All right—brace yourself [laughs].

Caitlan Carroll: Josh is smiling while he plays. But when Josh first tried the Music Glove, he was a little doubtful.

Josh Gray: My first reaction was, what can I do with this? As the procedure kept going, I started to move my right thumb and my index finger, and I thought, Hey, this is pretty cool. And at the end, I was, like, “One more song, one more song...two more songs...” And I could just not let it go.

Gary Gray: In the month—six weeks—we’ve been involved, we’ve already seen drastic improvement in his right hand.

Caitlan Carroll: Josh’s dad, Gary Gray.

Gary Gray: And knowing that the brain and the hand are talking and responding to one another has really been just extremely eye opening.

Caitlan Carroll: Like many families, Josh and his dad, Gary, have limited health insurance. So the Music Glove is appealing because it’s a potentially inexpensive form of therapy. UCI’s Nizan Friedman says he hopes that with low-cost devices like the Music Glove, patients like Josh will be able to easily and cheaply continue their rehab after returning home from the hospital.

Nizan Friedman: With this device, we are really trying to target it to the at-home setting and also the clinic, so we would like this device [to] cost hundreds rather than thousands of dollars.

Caitlan Carroll: Nizan says the music is a key element to the device’s possible success. He says studies have shown listening to music helps stimulate the brain’s cortex—and also, the stroke patients like it. Josh Gray already has his favorite set list.

Josh Gray: Oh! Johnny Cash, Nirvana, Ray Charles...

[Ray Charles singing: Well, I got a woman, way over town that’s good to me...oh yeah]

Caitlan Carroll: When the Music Glove goes on sale, in a year or more, Gary wants to buy it for Josh. He hopes this kind of easy-to-use technology may help his son take some big steps toward a more independent future.

Gary Gray: That’s our big end game: Is Josh to feel that independence and to know that he is independent, working his way through his life, you know, paying his own bills, having his own place, driving his car, things of this nature. It’s all geared toward being independent again.

Caitlan Carroll: And for Josh, the thought of an independent future...well, that’s music to his ears. In Irvine, California, I’m Caitlan Carroll.

Photo: Caitlan Carroll