Michelangelo is an ergonomically designed rehabilitative device for patients suffering from Peripheral Nerve Injury (PNI) and Complex Regional Pain Syndrome (CRPS) in their hands.
It is intended to be used both in early stage rehabilitation starting in the six weeks following surgery, and to last through the entire rehabilitation journey. It has been created both for a therapist-guided clinical setting and for independent use at home.
“Sensory and cortical feedback is more key for quality of life; make the brain work by making it do specific task orientated problems to engage the brain.”
Michelangelo was developed with consistent input from Donna Kennedy, Clinical Specialist in Hand Therapy at Imperial College Healthcare NHS Trust, to ensure the output was clinically relevant and complemented current practice in physiotherapy.
The primary focus of Michelangelo is to maintain, facilitate and restore function in the hand using cortical retraining. When a part of the body is immobilised, the corresponding cortical mapping in the somatosensory cortex shrinks1. Maintaining and expanding this mapping is the key to recovery from PNI, and Michelangelo achieves this through individual finger feedback during repetitive tasks.
Through research we found that patients with peripheral nerve injuries often develop CRPS. The main symptom of CRPS is severe, continuous debilitating pain in the affected limb, which can include worse responses to cold, hard surfaces vs. soft, warmer textures2. This prompted us to use less conductive materials such wood and silicon in the design of Michelangelo.
Training weight bearing through the affected limb has been shown to reduce both swelling and pain, so a therapeutic programme of stress loading through the palm improves quality of life for affected patients3. Michelangelo encourages incremental improvement in hand strength with a force sensor in the palm pad.
Top left and right: Ideation sketches for prototypes
Above: Full view of Michelangelo
The individual finger buttons are easy to press with immediate visual feedback, invaluable for patients who need to correlate effort with productive movement. Buttons can be removed and sterilised, useful for a clinical setting.
Buttons are on adjustable tracks to accommodate a range of finger lengths and also those whose palsies don’t allow for the full extension of their hands.
The device can be used as is, with a simple ‘chase the light’ game prompting patients to flex individual fingers and improving cortical mapping. The palm pad glows brighter as more weight is applied.
Alternatively, patient reflex times and weight bearing ability can be tracked wirelessly using an app. The data transmitted to the app is private and can only be viewed by the appropriate healthcare professional. Daily, weekly and monthly averages are calculated to give an overview of progress.
Clinical Specialist in Hand Therapy at Imperial College Healthcare NHS Trust
- Lissek, S., Wilimzig, C., Stude, P., Pleger, B., Kalisch, T., Maier, C., Peters, S.A., Nicolas, V., Tegenthoff, M. and Dinse, H.R., 2009. Immobilization impairs tactile perception and shrinks somatosensory cortical maps. Current Biology, 19(10), pp.837-842.
- Bruehl, S., Harden, R.N., Galer, B.S., Saltz, S., Backonja, M. and Stanton-Hicks, M., 2002. Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?. Pain, 95(1-2), pp.119-124.
- Carlson, L.K. and Watson, H.K., 1988. Treatment of reflex sympathetic dystrophy using the stress-loading program. Journal of Hand Therapy, 1(4), pp.149-154.