Arm Use With Soft-robotic Glove

The maximal handgrip strength will be measured with a Jamar dynamometer (Patterson medical, Warrenville, IL, USA), in accordance with American Society of Hand Therapist guidelines. Each participant is sitting comfortably with the elbow of the affected arm close to their body, flexed 90 degrees, holding the dynamometer in the affected hand. The other parts of the body is not allowed to move or help to give more strength. The participant has to squeeze the handgrip of the dynamometer maximally for 5 seconds. There will be three attempts and between the different attempts are at least 60 seconds rest. The best of the three attempts will count.

The original MHQ (total of 57 items) asks a patient's opinion about his hands and his health. This list is used to find out how the patient feels and to what extent he is capable of carrying out daily activities. The problem is mapped out within 6 domains: total hand function, ADL, work situation, work performance, pain, aesthetics and satisfaction. For repeated home assessment, we only ask question 2 A/B (most affected right or left hand) and 2 C (bimanual activities) of the domain ADL. This item consists of a total of 12 statements to rate on a 5-points Likert scale. The scores are normalized afterwards to a range of 0 to 100.

Huber et al. studied how people think about health. They concluded that the concept of health no longer fits within the definition of the World Health Organization (health as complete wellbeing and absence of disease). The Institute for Positive Health created a tool to gain insight into the positive health of a person. This tool consists of 6 dimensions: bodily functions, mental wellbeing, meaningfulness, quality of life, participation, and daily functioning. Participants complete the questionnaire, resulting in a score between 0 and 10 for each dimension [19]. In our study, an adapted version will be used. Instead of completing a questionnaire consisting of 42 questions, the participants score each of the six dimensions from 0 to 10, as reported by van Velsen et al.

During the intervention phase, glove use time will be automatically recorded in the Carbonhand system, representing objective, cumulative duration of glove activation (recording is stopped after 2 min of inactivity).

Diary for subjective reports on amount of use and type of activities performed with affected hand with glove, during the six weeks of glove use.

The MAL is a semi-structured questionnaire to explore the self-perceived amount of use (AOU) and quality of movement (QOM) of the affected arm and hand by stroke patients during ADL. This questionnaire consists of 26 activities and has excellent test-retest reliability for both scores of each activity. Each activity is rated by the participant for quality of movement and amount of use of the upper extremity. The possible scores for both aspects ranges from 0 to 5.

The JTHFT is a reliable and valid test to evaluate functional hand motor function in different patient groups and healthy people of various ages. The test consists of 7 different unilateral hand skill tasks related to ADL: (1) writing a sentence of 24 characters, (2) turning over 7.6- x 12.7-cm cards, (3) picking up small, common objects (e.g., paper clips, coins and bottle caps) and move these to a box, (4) stacking checkers (test of eye-hand coordination), (5) simulated feeding (e.g. teaspoon with beans), (6) picking up large empty cans and (7) moving weighted (450 g) cans. The time of each different task will be recorded in seconds and the different times summed is the total score for the test.

The NPRS measures the subjective intensity of pain. The NPRS is an 11-point scale from 0-10: '0'= no pain, '10'= the most intense pain imaginable. Patients select a value that is most in line with the intensity of pain that they have experienced in the last 24 hours. The NPRS has good sensitivity, while producing data that can be statistically analysed.

The full MHQ-DLV with a total of 57 items [17,18] is administered as questionnaire during each lab visit (pre, post and follow-up). It asks a patient's opinion about his hands and his health. This list is used to find out how the patient feels and to what extent he is capable of carrying out daily activities. The problem is mapped out within 6 domains: total hand function, ADL, work situation, work performance, pain, aesthetics and satisfaction.

The EQ-5D generic health index is a standardized instrument that is applicable to a wide range of health conditions and treatments. The first part records self-reported problems on the domains mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain is divided into five levels of severity corresponding to no problems, slight problems, moderate problems, severe problems and extreme problems. The second part comprises a visual analogue scale (VAS), described as a "feeling thermometer" rated from 0 (worst imaginable health state) to 100 (best imaginable health state).The EQ-5D is designed for self-completion by respondents. In the present study, the EQ-5D will be used to calculate a preference-based summary index based on TTO techniques in which the value 0 represents death and 1 represents perfect health.

The SF-36 is a 36-item questionnaire to assess health perception of people. It is a well-validated and reliable assessment for measuring health perception. The questionnaire consists of multi-item dimensions about physical and mental well-being of the participant. The scores for all dimensions will be calculated and also the physical and mental component summary scores will be calculated, referred to as PCS-36 (average score of the domains physical functioning, physical role functioning, bodily pain and general health) and MCS-36 (average score of the domains vitality, emotional role functioning, social functioning and mental health), respectively. The scores of the questionnaire will be converted to a 0-100 scale, where a higher score indicates a better quality of life.

A qualitative interview with open-ended questions to get a more thorough understanding about the experience of the participants of using the Carbonhand system during ADL at home and the user-friendliness of the system, will be administered after the glove use period (so only during the post assessment).