UCI Study Provides Helping Hands

Howard is not tall, or handsome, or daunting. He is small and delicate, his every intricacy exposed. He is a thin white and gray skeleton flecked with soft, dark strips that hang like flesh off his reptilian physique. He is cold to the touch. Howard directs, instructs, and heals. He is strong when others are weak.

Howard is the name of the Hand-Wrist Assisting Robotic Device (HWARD) that researchers at UCI use in stroke therapy studies. The device is a robotic hand splint into which a subject places their hand. The robotic arm has three degrees of movement, and assists the hand in grasping and releasing movements that are affected by paralysis that often accompanies moderate to severe strokes.

Doctor Steven Cramer is in charge of the third phase of experiments with Howard. He, along with a mechanical engineer post-doctoral student, a software engineer, and UC Irvine Medical Center Occupational Therapist Lucy Der-Yeghiaian, created Howard. The process took about two years, and the robotic therapy study is currently in its third phase. This particular phase focuses on a loss of hand and wrist functions resulting from a stroke that occurred within the last 11 to 26 weeks. The clinical study is essentially free therapy for those who qualify. The team of therapists, which includes occupational therapist Der-Yeghiaian, is responsible for screening hopeful subjects.

Participants slip their right wrist into the robotic device as researchers secure it with three soft, flesh-colored Velcro straps. They sit in front of a Dell computer screen that generates instructions such as “open,” “get ready,” “rest,” and “close.”

More advanced stages of the therapy also include virtual reality games where patients perform realistic motor functions with the computer. These games vary: one has the patient physically squeezing a plastic yellow mustard bottle while the computer displays the same mustard bottle floating over a hot dog. He squeezes, and mustard oozes atop the virtual hot dog.

At 9:45 a.m. on the warm, sunny morning of Nov. 16, a subject, (who goes by the pseudonym E.B. due to the confidential nature of medical records during this ongoing study) and his wife sit in a small office in Hewitt Hall on the Irvine campus. E.B. is seventy-one years old. He is here to see if Howard can help him recover the use of his paralyzed right arm, a casualty of his recent stroke.

A team of therapists is overseeing the trail screening for the third phase of this study. After the paperwork begin the tests. These tests are mentally and physically challenging. One therapist places two small glasses on the table that sits between her and E.B. One is full of water, the other is empty. She covers the table, and E.B.’s lap, with large white trash bags.

His task: pour the water from one glass into the other.

E.B.’s right hand trembles. His eyes wince slightly, almost unnoticeably. His arm is leaden. His fingers cannot move. They’re stuck, unable to grasp the thin, clear glass. His pale mouth twists into a grimace. The glass tilts sideways, teetering at a 45 degree angle. It sways gracefully: left, then right. Right, then left. It falls on its side with a delicate clink.

Water spills onto the table, running onto E.B.’s lap, trickling down to the carpet. He breathes a deep, heavy sigh as his wife pats him gently on his back. “It’s ok,” the therapist reassures him.

By the following week, Dr. Cramer and his team have decided that E.B. is an ideal candidate for the study. His therapy begins the first week of December. At 10:15 a.m. on Dec. 4, a therapist straps ’s arm into the robot. The white foam padding that rests on the gray metal of Howard’s skeleton molds snugly to E. B.’s hand and wrist. She fastens the black Velcro straps over his hand and elbow.

An empty lemonade pitcher pops up on the screen, surrounded by lemons. Cheerful Caribbean-infused steel drum music plays as a hand, accompanied by a sunny yellow lemon, hovers over the empty pitcher. As J moves his hand, bright green drops plop from the virtual lemon into the pitcher, which slowly fills up. When the pitcher fills up to the top, an invisible chorus of voices cheers and whoops at E.B.’s success. The game ends with E.B. scoring 256 points. He beat his last score.

It is 11:50 a.m., and E.B.’s therapy session is almost over. His hand is tired from several other games including Jewel Match and Balloon Inflate. The therapists, Lucy and Alison, compare their notes, running their fingers over a clipboard.

Their hands are deft, quick, and able, where Howard is meticulous, controlled, and cold. These are the hands E.B. puts his faith in. They are the hands that will help him, challenge him, and hopefully heal him. They are the hands that push him, that make him try. This team of hands is his right hand team. His hope rests in them.

For more about Dr. Cramer’s study or to participate, please visit www.strokerobot.com.