Interactive rehabilitation device restores vet’s use of hand after stroke

After suffering from four strokes in two years, the right side of David Villareal’s body was completely debilitated. The 53-year-old retired Marine could no longer play music, his profession and passion, and was often left immobile from painful muscle spasms.

Now, three years after his first stroke, he has regained mobility— and reignited his love for music— thanks to an innovative upper extremity rehabilitation device, the MusicGlove.

“For so long I kept hearing that whatever you have after six months after your stroke, that’s what you’re going to have the rest of your life. I don’t believe those things,” Villareal, of Temple, Texas, told “Here I am, three years out and I’m able to move my hands, my arms, able to snap my fingers.”

The MusicGlove was invented by Nizan Friedman when he was a biomedical engineering postdoctorate student at the University of California, Irvine. While studying, Friedman worked under David Reinkensmeyer, a leader in the field of neurorehabilitation and Mark Bachman, a leader in miniaturized bionic and assistive devices. Friedman and his advisors created the MusicGlove to fill the gap between expensive arm training devices purchased by hospitals for upwards of $60,000 and home rehabilitation and he founded Flint Rehabilitation in 2011.

The device, which looks like a glove made with strings, has sensors on the fingerpads to detect movements connected with a game similar to Guitar Hero, in which patients must make hand gestures to “play” music notes. As a user progresses, the degree of difficulty increases with more grips and notes. The MusicGlove movements are designed to mimic functional movements, such as a key pinch and finger opposition. The team’s studies have resulted in patients reporting the regained ability to do everyday tasks, such as tying shoes, washing dishes, using a remote control, and using the bathroom independently.

“Many people were crying or breaking down saying, ‘I haven’t used my hand in so long.’ It really enables them to… take control of their life again,” Friedman told

Mobility after stroke
Because a stroke deprives part of the brain from blood and oxygen, the motor areas of the brain are particularly vulnerable. It’s common for patients to experience weakness on one side of their bodies, especially in their hands, and loss of coordination occurs, as well.

About 80 percent of stroke sufferers have initial arm or leg weakness and about 50 percent have persistent debilitating weakness on one side of the body, Reinkensmeyer told

Exercising and practicing with the muscles on the injured side helps the brain figure out how to make the muscles move.

“Over the last 20 years, there’s been increasing realization that the brain can reorganize itself, so damaged areas can repair and find new ways to communicate with muscle,” Reinkensmeyer said.

However, traditional therapy, especially when a patient is very weak, can be discouraging when they’re unable to move well. Conventional therapy typically takes place over two to three weeks of one-on-one sessions at the hospital, which usually only require an average of 30 repetitions of the movements, which Reinkensmeyer said is not enough to drive brain elasticity. Upon release, the patient is sent home with a book of exercises.

“One of our study volunteers, when asked why she liked each type of therapy, said, ‘If I can’t do it once, why would I do it 100 times?’ It’s very important to make practice tasks that are doable,” he said.

Training like an athlete
Stroke patients, ideally, should train with the intensity of elite athletes, Reinkensmeyer said, citing how children take about a million steps when they’re learning how to walk.  The MusicGlove sets a target practice of 1,000 repetitions a week and their studies have found that by week two, patients voluntarily do more than that. Patients report about 20 percent average improvement in hand function three years after stroke—a time when progress is thought to have stalled.

After a stroke, it’s thought that the most recovery occurs in the first three months, then plateaus after six months, Reinkensmeyer said. However, research has shown that the brain continues to improve and continuously has the ability to rewire itself. The MagicGlove team found that even patients 10 years after the onset of stroke were able to use their injured hand more than ever, after using the device.

“There’s no magic bullet with rehab, just like going to the gym, if you really do your workout and do high-intensity, with a lot of reps, you are going to improve,” Friedman said.

MusicGlove has undergone three clinical studies so far. The second, randomized control trial of 12 individuals more than six months after stroke onset, found that those who used the device significantly improved more than when they did conventional exercises.  Ninety percent of participants improved some amount during the study.

In their third study, funded by the National Institutes of Health (NIH), patients took the device home for three weeks or did conventional exercises. With no therapist instruction, MusicGlove patients were still highly compliant, doing at least two to three times their recommended regimen. The control group tapered off after the first week.

Their next trial, also funded by NIH, a multi-site study at the Rehabilitation Institute of Chicago and UC Irvine, will include 60 patients within three weeks of stroke onset.

“The question is, if you really push after the first few weeks, months, and they have a useful tool, will they recover even more?” Friedman said. They are also testing individuals who have had a spinal cord injury, as that affects hand mobility.

MusicGlove is currently being used for patients with brain injuries, but has also been used in some children with multiple sclerosis (MS).

The company is aiming to have the device in as many clinics as possible, so patients can use and interact with it. A therapist can guide them through what they would recommend as a regime and then the patient can use it at home when their therapy sessions are over.

“At the end of the day, I think what’s most important to people is to maintain their ability to be independent,” Friedman said.

“If you water a plant, it grows.”
For Villareal, finding and buying the MusicGlove— which sells for $1,099 to $1,949 for the home version— had an immediate impact on his motivation.

“That very first day I can’t express the excitement of listening to the music and working on my hand,” he said. “I do therapy all the time; it’s never as fun as this. It keeps my mind busy.”

The veteran was a member of the the United States Marine Drum & Bugle Corps and played 32 different instruments as a professional recording artist, until his first stroke. While he’s pushed himself physically with therapy exercises and riding a hand cycle for the past two years, the MusicGlove has motivated him in a fresh way. The MusicGlove made it possible for Villareal to hold his flag again and he’s hoping to play the bongos and saxophone again soon.

“For all that to be taken from me and not being able to play anything and then this comes along, even though it’s just me working on my hand for therapy… it’s like what it feels like when I play,” he said.

Every morning, Villareal rides his hand cycle, then works with the MusicGlove for an hour, plus an additional thirty minutes in the evening.

“I think it got beyond that plateau it was on and it’s starting to wake up. If you water a plant, it grows. I’m watering,” he said.

Villareal, who is living on disability, understands the MusicGlove is costly, but for him, the financial sacrifice is worth the gain in quality of life.

“I’ll give up anything that’s not necessary for me to make me better,” he said.

“It’s a way to get your life back— these are not just meaningless words to people like us,” Villareal said. “Those words are so deep and so beautiful.”