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Shi XQ, Ti CHE, Lu HY, Hu CP, Xie DS, Yuan K, Heung HL, Leung TWH, Li Z, Tong RKY. Task-Oriented Training by a Personalized Electromyography-Driven Soft Robotic Hand in Chronic Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2024; 38:595-606. [PMID: 38812378 DOI: 10.1177/15459683241257519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Intensive task-oriented training has shown promise in enhancing distal motor function among patients with chronic stroke. A personalized electromyography (EMG)-driven soft robotic hand was developed to assist task-oriented object-manipulation training effectively. Objective. To compare the effectiveness of task-oriented training using the EMG-driven soft robotic hand. METHODS A single-blinded, randomized controlled trial was conducted with 34 chronic stroke survivors. The subjects were randomly assigned to the Hand Task (HT) group (n = 17) or the control (CON) group (n = 17). The HT group received 45 minutes of task-oriented training by manipulating small objects with the robotic hand for 20 sessions, while the CON group received 45 minutes of hand-functional exercises without objects using the same robot. Fugl-Meyer assessment (FMA-UE), Action Research Arm Test (ARAT), Modified Ashworth Score (MAS), Box and Block test (BBT), Maximum Grip Strength, and active range of motion (AROM) of fingers were assessed at baseline, after intervention, and 3 months follow-up. The muscle co-contraction index (CI) was analyzed to evaluate the session-by-session variation of upper limb EMG patterns. RESULTS The HT group showed more significant improvement in FMA-UE (wrist/hand, shoulder/elbow) compared to the CON group (P < .05). At 3-month follow-up, the HT group demonstrated significant improvements in FMA-UE, ARAT, BBT, MAS (finger), and AROMs (P < .05). The HT group exhibited a more significant decrease in muscle co-contractions compared to the CON group (P < .05). CONCLUSIONS EMG-driven task-oriented training with the personalized soft robotic hand was a practical approach to improving motor function and muscle coordination. CLINICAL TRIAL REGISTRY NAME Soft Robotic Hand System for Stroke Rehabilitation. CLINICAL TRIAL REGISTRATION-URL https://clinicaltrials.gov/. UNIQUE IDENTIFIER NCT03286309.
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Affiliation(s)
- Xiang-Qian Shi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun-Hang Eden Ti
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hsuan-Yu Lu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheng-Peng Hu
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Di-Sheng Xie
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho-Lam Heung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Wai-Hong Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zheng Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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Kamper D, Bansal N, Barry A, Seo NJ, Celian C, Vidakovic L, Stoykov ME, Roth E. Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial. Arch Phys Med Rehabil 2024:S0003-9993(24)01125-0. [PMID: 39033950 DOI: 10.1016/j.apmr.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/11/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DESIGN Double-blind, randomized controlled trial. SETTINGS Laboratory within a free-standing rehabilitation hospital. PARTICIPANTS A total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. INTERVENTIONS Participants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play "serious" computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. MAIN OUTCOME MEASURES Hand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. RESULTS Across the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. CONCLUSIONS Despite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.
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Affiliation(s)
- Derek Kamper
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC; Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC.
| | - Naveen Bansal
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI
| | | | - Na Jin Seo
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC
| | | | | | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Jayavel P, Karthik V, Mathunny JJ, Jothi S, Devaraj A. Hand assistive device with suction cup (HADS) technology for poststroke patients. Proc Inst Mech Eng H 2024; 238:160-169. [PMID: 38189258 DOI: 10.1177/09544119231221190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
A stroke is a neurological disease that primarily causes paralysis. Besides paraplegia, all other types of paralysis affect the upper extremity. Advanced technologies, such as wearable devices and rehabilitation regimens, are also being developed to enhance the functional ability of a stroke person to grasp and release daily living objects. In this research, we developed a rehabilitation functional assist device combining a flexion and extension mechanism with suction cup technology (hybrid technology) to help post-stroke patients improve their hand grip strength in day-to-day grasping activities. Ten poststroke hemiplegia patients were studied to test the functional ability of the impaired hand by wearing and not wearing the device. The outcomes were validated by three standard clinical tests, such as the Toronto Rehabilitation Institute - Hand Functional Test (TRI-HFT), the Chedoke Arm Hand Activity Inventory (CAHAI-9), and the Fugl-Meyer Assessment (FMA) with overall score improvements of 14.5 ± 3.8-25 ± 2.2 (p = 0.005), 5.4 ± 2.8-10 ± 1.6 (p = 0.008), and 9.6 ± 2.6-17 ± 2.4 (p = 0.005) respectively. The p-value for each of the three evaluations was less than 0.05, indicating significantly improved results and the average feedback score of the participants was 3.8 out of 5. The proposed device significantly increased impaired hand functionality in post-stroke patients. The subjects could complete some of the grasping tasks that they could not grasp without the device.Clinical trial registrationThe Clinical Trial Registry of India approved the work CTRI/2022/02/040495 described in this manuscript.
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Affiliation(s)
- Porkodi Jayavel
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Varshini Karthik
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Jaison Jacob Mathunny
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Suresh Jothi
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
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Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
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Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Bates M, Sunderam S. Hand-worn devices for assessment and rehabilitation of motor function and their potential use in BCI protocols: a review. Front Hum Neurosci 2023; 17:1121481. [PMID: 37484920 PMCID: PMC10357516 DOI: 10.3389/fnhum.2023.1121481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/01/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Various neurological conditions can impair hand function. Affected individuals cannot fully participate in activities of daily living due to the lack of fine motor control. Neurorehabilitation emphasizes repetitive movement and subjective clinical assessments that require clinical experience to administer. Methods Here, we perform a review of literature focused on the use of hand-worn devices for rehabilitation and assessment of hand function. We paid particular attention to protocols that involve brain-computer interfaces (BCIs) since BCIs are gaining ground as a means for detecting volitional signals as the basis for interactive motor training protocols to augment recovery. All devices reviewed either monitor, assist, stimulate, or support hand and finger movement. Results A majority of studies reviewed here test or validate devices through clinical trials, especially for stroke. Even though sensor gloves are the most commonly employed type of device in this domain, they have certain limitations. Many such gloves use bend or inertial sensors to monitor the movement of individual digits, but few monitor both movement and applied pressure. The use of such devices in BCI protocols is also uncommon. Discussion We conclude that hand-worn devices that monitor both flexion and grip will benefit both clinical diagnostic assessment of function during treatment and closed-loop BCI protocols aimed at rehabilitation.
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King EC, Pedi E, Stoykov ME, Corcos DM, Urday S. Combining high dose therapy, bilateral motor priming, and vagus nerve stimulation to treat the hemiparetic upper limb in chronic stroke survivors: a perspective on enhancing recovery. Front Neurol 2023; 14:1182561. [PMID: 37448744 PMCID: PMC10336216 DOI: 10.3389/fneur.2023.1182561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Stroke is a leading cause of disability worldwide and upper limb hemiparesis is the most common post-stroke disability. Recent studies suggest that clinically significant motor recovery is possible in chronic stroke survivors with severe impairment of the upper limb. Three promising strategies that have been investigated are (1) high dose rehabilitation therapy (2) bilateral motor priming and (3) vagus nerve stimulation. We propose that the future of effective and efficient upper limb rehabilitation will likely require a combination of these approaches.
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Affiliation(s)
- Erin C. King
- Northwestern University, Evanston, IL, United States
| | - Elizabeth Pedi
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel M. Corcos
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sebastian Urday
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Cisnal A, Gordaliza P, Pérez Turiel J, Fraile JC. Interaction with a Hand Rehabilitation Exoskeleton in EMG-Driven Bilateral Therapy: Influence of Visual Biofeedback on the Users' Performance. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23042048. [PMID: 36850650 PMCID: PMC9964655 DOI: 10.3390/s23042048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
The effectiveness of EMG biofeedback with neurorehabilitation robotic platforms has not been previously addressed. The present work evaluates the influence of an EMG-based visual biofeedback on the user performance when performing EMG-driven bilateral exercises with a robotic hand exoskeleton. Eighteen healthy subjects were asked to perform 1-min randomly generated sequences of hand gestures (rest, open and close) in four different conditions resulting from the combination of using or not (1) EMG-based visual biofeedback and (2) kinesthetic feedback from the exoskeleton movement. The user performance in each test was measured by computing similarity between the target gestures and the recognized user gestures using the L2 distance. Statistically significant differences in the subject performance were found in the type of provided feedback (p-value 0.0124). Pairwise comparisons showed that the L2 distance was statistically significantly lower when only EMG-based visual feedback was present (2.89 ± 0.71) than with the presence of the kinesthetic feedback alone (3.43 ± 0.75, p-value = 0.0412) or the combination of both (3.39 ± 0.70, p-value = 0.0497). Hence, EMG-based visual feedback enables subjects to increase their control over the movement of the robotic platform by assessing their muscle activation in real time. This type of feedback could benefit patients in learning more quickly how to activate robot functions, increasing their motivation towards rehabilitation.
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Affiliation(s)
- Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
- Correspondence:
| | - Paula Gordaliza
- Basque Center for Applied Mathematics (BCAM), 48009 Bilbo, Spain
| | - Javier Pérez Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
| | - Juan Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
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8
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Park CB, Park HS. Portable 3D-printed hand orthosis with spatial stiffness distribution personalized for assisting grasping in daily living. Front Bioeng Biotechnol 2023; 11:895745. [PMID: 36815899 PMCID: PMC9932545 DOI: 10.3389/fbioe.2023.895745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Stroke survivors having limited finger coordination require an active hand orthosis to assist them with grasping tasks for daily activities. The orthosis should be portable for constant use; however, portability imposes constraints on the number, size, and weight of the actuators, which increase the difficulty of the design process. Therefore, a tradeoff exists between portability and the assistive force. In this study, a personalized spatial stiffness distribution design is presented for a portable and strengthful hand orthosis. The spatial stiffness distribution of the orthosis was optimized based on measurements of individual hand parameters to satisfy the functional requirements of achieving sufficient grip aperture in the pre-grasping phase and minimal assistive force in the grasping phase. Ten stroke survivors were recruited to evaluate the system. Sufficient grip aperture and high grip strength-to-weight ratio were achieved by the orthosis via a single motor. Moreover, the orthosis significantly restored the range of motion and improved the performance of daily activities. The proposed spatial stiffness distribution can suggest a design solution to make strengthful hand orthoses with reduced weight.
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9
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Kabir R, Sunny MSH, Ahmed HU, Rahman MH. Hand Rehabilitation Devices: A Comprehensive Systematic Review. MICROMACHINES 2022; 13:mi13071033. [PMID: 35888850 PMCID: PMC9325203 DOI: 10.3390/mi13071033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/20/2022]
Abstract
A cerebrovascular accident, or a stroke, can cause significant neurological damage, inflicting the patient with loss of motor function in their hands. Standard rehabilitation therapy for the hand increases demands on clinics, creating an avenue for powered hand rehabilitation devices. Hand rehabilitation devices (HRDs) are devices designed to provide the hand with passive, active, and active-assisted rehabilitation therapy; however, HRDs do not have any standards in terms of development or design. Although the categorization of an injury’s severity can guide a patient into seeking proper assistance, rehabilitation devices do not have a set standard to provide a solution from the beginning to the end stages of recovery. In this paper, HRDs are defined and compared by their mechanical designs, actuation mechanisms, control systems, and therapeutic strategies. Furthermore, devices with conducted clinical trials are used to determine the future development of HRDs. After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.
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Affiliation(s)
- Ryan Kabir
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
- Correspondence:
| | - Md Samiul Haque Sunny
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
| | - Helal Uddin Ahmed
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
| | - Mohammad Habibur Rahman
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
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10
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Stoykov ME, Biller OM, Wax A, King E, Schauer JM, Fogg LF, Corcos DM. Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial. Trials 2022; 23:523. [PMID: 35733202 PMCID: PMC9214193 DOI: 10.1186/s13063-022-06465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has potential to significantly change clinical practice. Bilateral motor priming uses the Exsurgo priming device (Exsurgo Rehabilitation, Auckland, NZ) so that the less affected limb drives the more affected limb in bilateral symmetrical wrist flexion and extension. The aim of this study is to determine the effects of a 5-week protocol of bilateral motor priming in combination with task-specific training on motor impairment of the affected limb, bimanual motor function, and interhemispheric inhibition in moderate to severely impaired people with stroke. METHODS Seventy-six participants will be randomized to receive either 15, 2-h sessions, 3 times per week for 5 weeks (30 h of intervention) of bilateral motor priming and task-specific training (experimental group) or the same dose of control priming plus the task-specific training protocol. The experimental group performs bilateral symmetrical arm movements via the Exsurgo priming device which allows both wrists to move in rhythmic, symmetrical wrist flexion and extension for 15 min. The goal is one cycle (wrist flexion and wrist extension) per second. The control priming group receives transcutaneous electrical stimulation below sensory threshold for 15 min prior to the same 45 min of task-specific training. Outcome measures are collected at pre-intervention, post-intervention, and follow-up (8 weeks post-intervention). The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function. The secondary outcome is the Chedoke Arm and Hand Activity Index-Nine, an assessment of bimanual functional tasks. DISCUSSION To date, there are only 6 studies documenting the efficacy of priming using bilateral movements, 4 of which are pilot or feasibility studies. This is the first large-scale clinical trial of bilateral priming plus task-specific training. We have previously completed a feasibility intervention study of bilateral motor priming plus task-specific training and have considerable experience using this protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT03517657 . Retrospectively registered on May 7, 2018.
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Affiliation(s)
- Mary Ellen Stoykov
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Olivia M Biller
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexandra Wax
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Think & Speak Lab, Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, USA
| | - Erin King
- Interdepartmental Institution of Neuroscience, Northwestern University, Chicago, USA
| | - Jacob M Schauer
- Department of Preventive Medicine - Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Louis F Fogg
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Xiong D, Zhang D, Zhao X, Chu Y, Zhao Y. Learning Non-Euclidean Representations With SPD Manifold for Myoelectric Pattern Recognition. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1514-1524. [PMID: 35622796 DOI: 10.1109/tnsre.2022.3178384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
How to learn informative representations from Electromyography (EMG) signals is of vital importance for myoelectric control systems. Traditionally, hand-crafted features are extracted from individual EMG channels and combined together for pattern recognition. The spatial topological information between different channels can also be informative, which is seldom considered. This paper presents a radically novel approach to extract spatial structural information within diverse EMG channels based on the symmetric positive definite (SPD) manifold. The object is to learn non-Euclidean representations inside EMG signals for myoelectric pattern recognition. The performance is compared with two classical feature sets using accuracy and F1-score. The algorithm is tested on eleven gestures collected from ten subjects, and the best accuracy reaches 84.85%±5.15% with an improvement of 4.04%~20.25%, which outperforms the contrast method, and reaches a significant improvement with the Wilcoxon signed-rank test. Eleven gestures from three public databases involving Ninapro DB2, DB4, and DB5 are also evaluated, and better performance is observed. Furthermore, the computational cost is less than the contrast method, making it more suitable for low-cost systems. It shows the effectiveness of the presented approach and contributes a new way for myoelectric pattern recognition.
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12
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Chen J, Black I, Nichols D, Chen T, Sandison M, Casas R, Lum PS. Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke. FRONTIERS IN REHABILITATION SCIENCES 2021; 2. [PMID: 35419565 PMCID: PMC9004134 DOI: 10.3389/fresc.2021.728753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impaired use of the hand in functional tasks remains difficult to overcome in many individuals after a stroke. This often leads to compensation strategies using the less-affected limb, which allows for independence in some aspects of daily activities. However, recovery of hand function remains an important therapeutic goal of many individuals, and is often resistant to conventional therapies. In prior work, we developed HEXORR I, a robotic device that allows practice of finger and thumb movements with robotic assistance. In this study, we describe modifications to the device, now called HEXORR II, and a clinical trial in individuals with chronic stroke. Fifteen individuals with a diagnosis of chronic stroke were randomized to 12 or 24 sessions of robotic therapy. The sessions involved playing several video games using thumb and finger movement. The robot applied assistance to extension movement that was adapted based on task performance. Clinical and motion capture evaluations were performed before and after training and again at a 6-month followup. Fourteen individuals completed the protocol. Fugl-Meyer scores improved significantly at the 6 month time point compared to baseline, indicating reductions in upper extremity impairment. Flexor hypertonia (Modified Ashworth Scale) also decreased significantly due to the intervention. Motion capture found increased finger range of motion and extension ability after the intervention that continued to improve during the followup period. However, there was no change in a functional measure (Action Research Arm Test). At the followup, the high dose group had significant gains in hand displacement during a forward reach task. There were no other significant differences between groups. Future work with HEXORR II should focus on integrating it with functional task practice and incorporating grip and squeezing tasks. Trial Registration:ClinicalTrials.gov, NCT04536987. Registered 3 September 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04536987.
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Affiliation(s)
- Ji Chen
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC, United States
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Iian Black
- MedStar National Rehabilitation Network, Washington, DC, United States
- Biomedical Engineering Department, Florida International University, Miami, FL, United States
| | - Diane Nichols
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Tianyao Chen
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
| | - Melissa Sandison
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Rafael Casas
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
| | - Peter S. Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, United States
- MedStar National Rehabilitation Network, Washington, DC, United States
- *Correspondence: Peter S. Lum
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13
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Casas R, Sandison M, Chen T, Lum PS. Clinical Test of a Wearable, High DOF, Spring Powered Hand Exoskeleton (HandSOME II). IEEE Trans Neural Syst Rehabil Eng 2021; 29:1877-1885. [PMID: 34478375 PMCID: PMC8462990 DOI: 10.1109/tnsre.2021.3110201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In previous work, we developed an exoskeleton, Hand Spring Operated Movement Enhancer (HandSOME II), that allows movement at 15 hand degrees of freedom (DOF). Eleven separate elastic elements can be added to customize the extension assistance for individuals with impaired hand function. In this pilot study of twelve individuals with stroke, we measured the immediate improvements in range of motion (ROM) and upper extremity function when wearing the device. Index finger ROM was significantly improved at the PIP (p=.01) and DIP joints (p=.026), and the max extension was significantly increased at the MCP (p<.001), PIP (p=.013) and DIP joints (p=.016). The thumb CMC abduction max (p=.017) and CMC flexion/extension ROM also increased (p=.04). In a grip and release task involving various objects, six subjects were unable to complete the tasks without assistance. Across these 6 subjects, 13 of 42 tasks were completed without assistance, while 36 of 42 tasks were completed when wearing HandSOME II. Despite the extension assistance provided by the device, flexion grip force was not statistically decreased. HandSOME II can potentially increase the effectiveness of repetitive task practice in patients with moderate-severe hand impairment by allowing completion of grasp and release tasks that are impossible to complete unassisted.
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14
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Wireless Manipulation Mechanism and Analysis for Actively Assistive Pinch Movements. SENSORS 2021; 21:s21186216. [PMID: 34577427 PMCID: PMC8472932 DOI: 10.3390/s21186216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
Pinching motions are important for holding and retaining objects with precision. Therefore, training exercises for the thumb and index finger are extremely important in the field of hand rehabilitation. Considering the need for training convenience, we developed a device and a driving system to assist pinching motions actively via a lightweight, simple, and wireless mechanism driven by the magnetic forces and torques generated by magnets attached to the tip of these two fingers. This device provides accurate pinching motions through the linking structures connecting the two magnets. The fabricated device has minimal mechanical elements with an ultralightweight of 57.2 g. The magnetic field, the intensity of which is based on the time variant, generates a pinching motion between the thumb and index finger, thus rendering it possible to achieve repetitive training. To verify the generation of an active pinching motion, we fabricated a finger model using a 3D printer and a rubber sheet and observed the active motions generated by the newly developed device. We also verified the performance of the proposed mechanism and driving method via various experiments and magnetic simulations. The proposed mechanism represents an important breakthrough for patients requiring hand rehabilitation and wearable assistive motion devices.
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15
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Effects of a Soft Robotic Hand for Hand Rehabilitation in Chronic Stroke Survivors. J Stroke Cerebrovasc Dis 2021; 30:105812. [PMID: 33895427 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/11/2021] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Soft robotic hands are proposed for stroke rehabilitation in terms of their high compliance and low inherent stiffness. We investigated the clinical efficacy of a soft robotic hand that could actively flex and extend the fingers in chronic stroke subjects with different levels of spasticity. METHODS Sixteen chronic stroke subjects were recruited into this single-group study. Subjects underwent 20 sessions of 1-hour EMG-driven soft robotic hand training. Training effect was evaluated by the pre-training and post-training assessments with the clinical scores: Action Research Arm Test(ARAT), Fugl-Meyer Assessment for Upper Extremity(FMA-UE), Box-and-Block test(BBT), Modified Ashworth Scale(MAS), and maximum voluntary grip strength. RESULTS For all the recruited subjects (n = 16), significant improvement of upper limb function was generally observed in ARAT (increased mean=2.44, P = 0.032), FMA-UE (increased mean=3.31, P = 0.003), BBT (increased mean=1.81, P = 0.024), and maximum voluntary grip strength (increased mean=2.14 kg, P < 0.001). No significant change was observed in terms of spasticity with the MAS (decreased mean=0.11, P = 0.423). Further analysis showed subjects with mild or no finger flexor spasticity (MAS<2, n = 9) at pre-training had significant improvement of upper limb function after 20 sessions of training. However, for subjects with moderate and severe finger flexor spasticity (MAS=2,3, n = 7) at pre-training, no significant change in clinical scores was shown and only maximum voluntary grip strength had significant increase. CONCLUSION EMG-driven rehabilitation training using the soft robotic hand with flexion and extension could be effective for the functional recovery of upper limb in chronic stroke subjects with mild or no spasticity.
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16
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Stoykov ME, King E, David FJ, Vatinno A, Fogg L, Corcos DM. Bilateral motor priming for post stroke upper extremity hemiparesis: A randomized pilot study. Restor Neurol Neurosci 2021; 38:11-22. [PMID: 31609714 DOI: 10.3233/rnn-190943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bilateral priming, device assisted bilateral symmetrical wrist flexion/extension, is a noninvasive neuromodulation technique that can be used in the clinic. OBJECTIVE We examined the additive effect of bilateral motor priming and task specific training in individuals with severe upper limb hemiparesis. METHODS This is a parallel assignment, single-masked, randomized exploratory pilot study with three timepoints (pre-/post-intervention and follow up). Participants received either bilateral motor priming or health care education followed by task specific training. Sixteen participants who were at least 6 months post-stroke and had a Fugl Meyer Upper Extremity (FMUE) score between 23 and 38 were randomized. Our primary and secondary measures were Chedoke Arm & Hand Activity Index 9 (CAHAI-9) and the FMUE respectively. We determined changes in interhemispheric inhibition using transcranial magnetic stimulation. We hypothesized that improvement in the priming group would persist at follow up. RESULTS There was no between-group difference in the CAHAI. The improvement in the FMUE was significantly greater in the experimental group at follow up (t = 2.241, p = 0.045). CONCLUSIONS Both groups improved in the CAHAI. There was a significant between-group difference in the secondary outcome measure (FMUE) where the bilateral priming group had an average increase of 10 points from pre-intervention to follow up.
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Affiliation(s)
- Mary Ellen Stoykov
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Erin King
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Amanda Vatinno
- Department of Health Sciences and Research, Medical College of South Carolina, Charleston, SC, USA
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Daniel M Corcos
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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17
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TAŞAR BEYDA, TATAR AHMETBURAK, TANYILDIZI ALPERKADIR, YAKUT OGUZ. DESIGN, DYNAMIC MODELING AND CONTROL OF WEARABLE FINGER ORTHOSIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human hands and fingers are of significant importance in people’s capacity to perform daily tasks (touching, feeling, holding, gripping, writing). However, about 1.5 million people around the world are suffering from injuries, muscle and neurological disorders, a loss of hand function, or a few fingers due to stroke. This paper focuses on newly developed finger orthotics, which is thin, adaptable to the length of each finger and low energy costs. The aim of the study is to design and control a new robotic orthosis using for daily rehabilitation therapy. Kinematic and dynamic analysis of orthosis was calculated and the joint regulation of orthosis was obtained. The Lagrange method was used to obtain dynamics, and the Denavit–Hartenberg (D–H) method was used for kinematic analysis of hand. In order to understand its behavior, the robotic finger orthotics model was simulated in MatLab/Simulink. The simulation results show that the efficiency and robustness of proportional integral derivative (PID) controller are appropriate for the use of robotic finger orthotics.
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Affiliation(s)
- BEYDA TAŞAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - AHMET BURAK TATAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - ALPER KADIR TANYILDIZI
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - OGUZ YAKUT
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
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18
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Dittli J, Hofmann UAT, Bützer T, Smit G, Lambercy O, Gassert R. Remote Actuation Systems for Fully Wearable Assistive Devices: Requirements, Selection, and Optimization for Out-of-the-Lab Application of a Hand Exoskeleton. Front Robot AI 2021; 7:596185. [PMID: 33585573 PMCID: PMC7876397 DOI: 10.3389/frobt.2020.596185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/06/2020] [Indexed: 01/26/2023] Open
Abstract
Wearable robots assist individuals with sensorimotor impairment in daily life, or support industrial workers in physically demanding tasks. In such scenarios, low mass and compact design are crucial factors for device acceptance. Remote actuation systems (RAS) have emerged as a popular approach in wearable robots to reduce perceived weight and increase usability. Different RAS have been presented in the literature to accommodate for a wide range of applications and related design requirements. The push toward use of wearable robotics in out-of-the-lab applications in clinics, home environments, or industry created a shift in requirements for RAS. In this context, high durability, ergonomics, and simple maintenance gain in importance. However, these are only rarely considered and evaluated in research publications, despite being drivers for device abandonment by end-users. In this paper, we summarize existing approaches of RAS for wearable assistive technology in a literature review and compare advantages and disadvantages, focusing on specific evaluation criteria for out-of-the-lab applications to provide guidelines for the selection of RAS. Based on the gained insights, we present the development, optimization, and evaluation of a cable-based RAS for out-of-the-lab applications in a wearable assistive soft hand exoskeleton. The presented RAS features full wearability, high durability, high efficiency, and appealing design while fulfilling ergonomic criteria such as low mass and high wearing comfort. This work aims to support the transfer of RAS for wearable robotics from controlled lab environments to out-of-the-lab applications.
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Affiliation(s)
- Jan Dittli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Urs A. T. Hofmann
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Tobias Bützer
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Gerwin Smit
- Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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19
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Kim D, Kang BB, Kim KB, Choi H, Ha J, Cho KJ, Jo S. Eyes are faster than hands: A soft wearable robot learns user intention from the egocentric view. Sci Robot 2021; 4:4/26/eaav2949. [PMID: 33137763 DOI: 10.1126/scirobotics.aav2949] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/12/2018] [Indexed: 11/02/2022]
Abstract
To perceive user intentions for wearable robots, we present a learning-based intention detection methodology using a first-person-view camera.
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Affiliation(s)
- Daekyum Kim
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea.,Neuro-Machine Augmented Intelligence Laboratory, School of Computing, KAIST, Daejeon 34141, Korea
| | - Brian Byunghyun Kang
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea.,Biorobotics Laboratory, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea.,Institute of Advanced Machines and Design, Seoul National University, Seoul 08826, Korea
| | - Kyu Bum Kim
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea.,Biorobotics Laboratory, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea.,Institute of Advanced Machines and Design, Seoul National University, Seoul 08826, Korea
| | - Hyungmin Choi
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea.,Biorobotics Laboratory, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea.,Institute of Advanced Machines and Design, Seoul National University, Seoul 08826, Korea
| | - Jeesoo Ha
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea.,Neuro-Machine Augmented Intelligence Laboratory, School of Computing, KAIST, Daejeon 34141, Korea
| | - Kyu-Jin Cho
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea. .,Biorobotics Laboratory, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea.,Institute of Advanced Machines and Design, Seoul National University, Seoul 08826, Korea
| | - Sungho Jo
- Soft Robotics Research Center, Seoul National University, Seoul 08826, Korea. .,Neuro-Machine Augmented Intelligence Laboratory, School of Computing, KAIST, Daejeon 34141, Korea
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20
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Yun Y, Na Y, Esmatloo P, Dancausse S, Serrato A, Merring CA, Agarwal P, Deshpande AD. Improvement of hand functions of spinal cord injury patients with electromyography-driven hand exoskeleton: A feasibility study. WEARABLE TECHNOLOGIES 2021; 1:e8. [PMID: 39050268 PMCID: PMC11265402 DOI: 10.1017/wtc.2020.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/31/2020] [Accepted: 10/10/2020] [Indexed: 07/27/2024]
Abstract
We have developed a one-of-a-kind hand exoskeleton, called Maestro, which can power finger movements of those surviving severe disabilities to complete daily tasks using compliant joints. In this paper, we present results from an electromyography (EMG) control strategy conducted with spinal cord injury (SCI) patients (C5, C6, and C7) in which the subjects completed daily tasks controlling Maestro with EMG signals from their forearm muscles. With its compliant actuation and its degrees of freedom that match the natural finger movements, Maestro is capable of helping the subjects grasp and manipulate a variety of daily objects (more than 15 from a standardized set). To generate control commands for Maestro, an artificial neural network algorithm was implemented along with a probabilistic control approach to classify and deliver four hand poses robustly with three EMG signals measured from the forearm and palm. Increase in the scores of a standardized test, called the Sollerman hand function test, and enhancement in different aspects of grasping such as strength shows feasibility that Maestro can be capable of improving the hand function of SCI subjects.
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Affiliation(s)
- Youngmok Yun
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Youngjin Na
- Department of Mechanical Systems Engineering, Sookmyung Women’s University, Seoul, Republic of Korea
| | - Paria Esmatloo
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Sarah Dancausse
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Alfredo Serrato
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Curtis A. Merring
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Priyanshu Agarwal
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ashish D. Deshpande
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
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21
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Yurkewich A, Kozak IJ, Ivanovic A, Rossos D, Wang RH, Hebert D, Mihailidis A. Myoelectric untethered robotic glove enhances hand function and performance on daily living tasks after stroke. J Rehabil Assist Technol Eng 2020; 7:2055668320964050. [PMID: 33403121 PMCID: PMC7745545 DOI: 10.1177/2055668320964050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently. Methods We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance. Results The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines. Conclusions People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.
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Affiliation(s)
- Aaron Yurkewich
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Bioengineering, Imperial College London, London, UK
| | - Illya J Kozak
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada
| | - Andrei Ivanovic
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
| | - Daniel Rossos
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Debbie Hebert
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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22
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Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke. J Neuroeng Rehabil 2020; 17:115. [PMID: 32831097 PMCID: PMC7444058 DOI: 10.1186/s12984-020-00746-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hand function is often impaired after stroke, strongly affecting the ability to perform daily activities. Upper limb robotic devices have been developed to complement rehabilitation therapy offered to persons who suffered a stroke, but they rarely focus on the training of hand sensorimotor function. The primary goal of this study was to evaluate whether robot-assisted therapy of hand function following a neurocognitive approach (i.e., combining motor training with somatosensory and cognitive tasks) produces an equivalent decrease in upper limb motor impairment compared to dose-matched conventional neurocognitive therapy, when embedded in the rehabilitation program of inpatients in the subacute stage after stroke. Methods A parallel-group, randomized controlled trial was conducted on subjects with subacute stroke receiving either conventional or robot-assisted neurocognitive hand therapy using a haptic device. Therapy was provided for 15, 45-min sessions over four weeks, nested within the standard therapy program. Primary outcome was the change from baseline in the upper extremity part of the Fugl-Meyer Assessment (FMA-UE) after the intervention, which was compared between groups using equivalence testing. Secondary outcome measures included upper limb motor, sensory and cognitive assessments, delivered therapy dose, as well as questionnaires on user technology acceptance. Results Thirty-three participants with stroke were enrolled. 14 subjects in the robot-assisted and 13 subjects in the conventional therapy group completed the study. At the end of intervention, week 8 and week 32, the robot-assisted/conventional therapy group improved by 7.14/6.85, 7.79/7.31, and 8.64/8.08 points on the FMA-UE, respectively, establishing that motor recovery in the robot-assisted group is non-inferior to that in the control group. Conclusions Neurocognitive robot-assisted therapy of hand function allows for a non-inferior motor recovery compared to conventional dose-matched neurocognitive therapy when performed during inpatient rehabilitation in the subacute stage. This allows the early familiarization of subjects with stroke to the use of such technologies, as a first step towards minimal therapist supervision in the clinic, or directly at home after hospital discharge, to help increase the dose of hand therapy for persons with stroke. Trial registration EUDAMED database (CIV-13-02-009921), clinicaltrials.gov (NCT02096445). Registered 26 March 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02096445
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23
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Upper Limb Movement Classification Via Electromyographic Signals and an Enhanced Probabilistic Network. J Med Syst 2020; 44:176. [DOI: 10.1007/s10916-020-01639-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
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24
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Dávila-Vilchis JM, Ávila-Vilchis JC, Vilchis-González AH, LAZ-Avilés. Design Criteria of Soft Exogloves for Hand Rehabilitation-Assistance Tasks. Appl Bionics Biomech 2020; 2020:2724783. [PMID: 32802156 PMCID: PMC7416241 DOI: 10.1155/2020/2724783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
This paper establishes design criteria for soft exogloves (SEG) to be used as rehabilitation or assistance devices. This research consists in identifying, selecting, and grouping SEG features based on the analysis of 91 systems that have been proposed during the last decade. Thus, function, mobility, and usability criteria are defined and explicitly discussed to highlight SEG design guidelines. Additionally, this study provides a detailed description of each system that was analysed including application, functional task, palm design, actuation type, assistance mode, degrees of freedom (DOF), target fingers, motions, material, weight, force, pressure (only for fluids), control strategy, and assessment. Such characteristics have been reported according to specific design methodologies and operating principles. Technological trends are contemplated in this contribution with emphasis on SEG design opportunity areas. In this review, suggestions, limitations, and implications are also discussed in order to enhance future SEG developments aimed at stroke survivors or people with hand disabilities.
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Affiliation(s)
| | - Juan C. Ávila-Vilchis
- Faculty of Engineering, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
| | | | - LAZ-Avilés
- Faculty of Engineering, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
- Cátedras CONACYT, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
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25
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Proulx CE, Beaulac M, David M, Deguire C, Haché C, Klug F, Kupnik M, Higgins J, Gagnon DH. Review of the effects of soft robotic gloves for activity-based rehabilitation in individuals with reduced hand function and manual dexterity following a neurological event. J Rehabil Assist Technol Eng 2020; 7:2055668320918130. [PMID: 32435506 PMCID: PMC7223210 DOI: 10.1177/2055668320918130] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022] Open
Abstract
Despite limited scientific evidence, there is an increasing interest in soft robotic gloves to optimize hand- and finger-related functional abilities following a neurological event. This review maps evidence on the effects and effectiveness of soft robotic gloves for hand rehabilitation and, whenever possible, patients' satisfaction. A systematized search of the literature was conducted using keywords structured around three areas: technology attributes, anatomy, and rehabilitation. A total of 272 titles, abstracts, and keywords were initially retrieved, and data were extracted out of 13 articles. Six articles investigated the effects of wearing a soft robotic glove and eight studied the effect or effectiveness of an intervention with it. Some statistically significant and meaningful beneficial effects were confirmed with the 29 outcome measures used. Finally, 11 articles also confirmed users' satisfaction with regard to the soft robotic glove, while some articles also noticed an increased engagement in the rehabilitation program with this technology. Despite the heterogeneity across studies, soft robotic gloves stand out as a safe and promising technology to improve hand- and finger-related dexterity and functional performance. However, strengthened evidence of the effects or effectiveness of such devices is needed before their transition from laboratory to clinical practice.
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Affiliation(s)
- Camille E Proulx
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Myrka Beaulac
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Mélissa David
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catryne Deguire
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catherine Haché
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Florian Klug
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Mario Kupnik
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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26
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Hameed HK, Wan Hasan WZ, Shafie S, Ahmad SA, Jaafar H, Inche Mat LN. Investigating the performance of an amplitude-independent algorithm for detecting the hand muscle activity of stroke survivors. J Med Eng Technol 2020; 44:139-148. [PMID: 32396756 DOI: 10.1080/03091902.2020.1753838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
To make robotic hand devices controlled by surface electromyography (sEMG) signals feasible and practical tools for assisting patients with hand impairments, the problems that prevent these devices from being widely used have to be overcome. The most significant problem is the involuntary amplitude variation of the sEMG signals due to the movement of electrodes during forearm motion. Moreover, for patients who have had a stroke or another neurological disease, the muscle activity of the impaired hand is weak and has a low signal-to-noise ratio (SNR). Thus, muscle activity detection methods intended for controlling robotic hand devices should not depend mainly on the amplitude characteristics of the sEMG signal in the detection process, and they need to be more reliable for sEMG signals that have a low SNR. Since amplitude-independent muscle activity detection methods meet these requirements, this paper investigates the performance of such a method on people who have had a stroke in terms of the detection of weak muscle activity and resistance to false alarms caused by the involuntary amplitude variation of sEMG signals; these two parameters are very important for achieving the reliable control of robotic hand devices intended for people with disabilities. A comparison between the performance of an amplitude-independent muscle activity detection algorithm and three amplitude-dependent algorithms was conducted by using sEMG signals recorded from six hemiparesis stroke survivors and from six healthy subjects. The results showed that the amplitude-independent algorithm performed better in terms of detecting weak muscle activity and resisting false alarms.
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Affiliation(s)
- Husamuldeen Khalid Hameed
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Selangor, Malaysia
| | - Wan Zuha Wan Hasan
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Selangor, Malaysia
| | - Suhaidi Shafie
- Institute of Advanced Technology (ITMA), Universiti Putra Malaysia, Selangor, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Selangor, Malaysia
| | - Haslina Jaafar
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Selangor, Malaysia
| | - Liyana Najwa Inche Mat
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Yurkewich A, Kozak IJ, Hebert D, Wang RH, Mihailidis A. Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke. J Neuroeng Rehabil 2020; 17:33. [PMID: 32102668 PMCID: PMC7045638 DOI: 10.1186/s12984-020-00659-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable. METHODS Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1-4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove. RESULTS The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were 'more or less satisfied' with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands. CONCLUSIONS The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.
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Affiliation(s)
- Aaron Yurkewich
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada.
- Bioengineering, Imperial College London, London, UK.
| | - Illya J Kozak
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
| | - Debbie Hebert
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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28
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A Finger Grip Force Sensor with an Open-Pad Structure for Glove-Type Assistive Devices. SENSORS 2019; 20:s20010004. [PMID: 31861271 PMCID: PMC6982706 DOI: 10.3390/s20010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
This paper presents a fingertip grip force sensor based on custom capacitive sensors for glove-type assistive devices with an open-pad structure. The design of the sensor allows using human tactile sensations during grasping and manipulating an object. The proposed sensor can be attached on both sides of the fingertip and measure the force caused by the expansion of the fingertip tissue when a grasping force is applied to the fingertip. The number of measurable degrees of freedom (DoFs) are the two DoFs (flexion and adduction) for the thumb and one DoF (flexion) for the index and middle fingers. The proposed sensor allows the combination with a glove-type assistive device to measure the fingertip force. Calibration was performed for each finger joint angle because the variations in the expansion of the fingertip tissue depend on the joint angles. The root mean square error (RMSE) for fingertip force estimation ranged from 3.75% to 9.71% after calibration, regardless of the finger joint angles or finger posture.
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Ghassemi M, Ochoa JM, Yuan N, Tsoupikova D, Kamper D. Development of an Integrated Actuated Hand Orthosis and Virtual Reality System for Home-Based Rehabilitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:1689-1692. [PMID: 30440720 DOI: 10.1109/embc.2018.8512704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke survivors often require a lengthy and costly rehabilitation regimen to regain some of the hand function lost due to stroke. Financial, travel, and scheduling issues can limit access to clinical therapy, thereby depriving individuals of care. Interventions are needed which can extend from the clinic into the home. Home-based rehabilitation strategies, however, must promote sensorimotor learning while maintaining user engagement. Virtual reality, in combination with actuated orthoses, has the potential to provide solutions to these issues. The orthosis can facilitate appropriate therapy while the virtual reality can provide a conduit for maintaining human interaction and engagement in the home environment. In this paper, we describe the development of such an integrated system for hand and upper extremity rehabilitation.
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Yurkewich A, Hebert D, Wang RH, Mihailidis A. Hand Extension Robot Orthosis (HERO) Glove: Development and Testing With Stroke Survivors With Severe Hand Impairment. IEEE Trans Neural Syst Rehabil Eng 2019; 27:916-926. [DOI: 10.1109/tnsre.2019.2910011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Park S, Meeker C, Weber LM, Bishop L, Stein J, Ciocarlie M. Multimodal Sensing and Interaction for a Robotic Hand Orthosis. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2018.2890199] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shahid T, Gouwanda D, Nurzaman SG, Gopalai AA. Moving toward Soft Robotics: A Decade Review of the Design of Hand Exoskeletons. Biomimetics (Basel) 2018; 3:E17. [PMID: 31105239 PMCID: PMC6352684 DOI: 10.3390/biomimetics3030017] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022] Open
Abstract
Soft robotics is a branch of robotics that deals with mechatronics and electromechanical systems primarily made of soft materials. This paper presents a summary of a chronicle study of various soft robotic hand exoskeletons, with different electroencephalography (EEG)- and electromyography (EMG)-based instrumentations and controls, for rehabilitation and assistance in activities of daily living. A total of 45 soft robotic hand exoskeletons are reviewed. The study follows two methodological frameworks: a systematic review and a chronological review of the exoskeletons. The first approach summarizes the designs of different soft robotic hand exoskeletons based on their mechanical, electrical and functional attributes, including the degree of freedom, number of fingers, force transmission, actuation mode and control strategy. The second approach discusses the technological trend of soft robotic hand exoskeletons in the past decade. The timeline analysis demonstrates the transformation of the exoskeletons from rigid ferrous materials to soft elastomeric materials. It uncovers recent research, development and integration of their mechanical and electrical components. It also approximates the future of the soft robotic hand exoskeletons and some of their crucial design attributes.
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Affiliation(s)
- Talha Shahid
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia.
| | - Darwin Gouwanda
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia.
| | - Surya G Nurzaman
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia.
| | - Alpha A Gopalai
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia.
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33
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Chu CY, Patterson RM. Soft robotic devices for hand rehabilitation and assistance: a narrative review. J Neuroeng Rehabil 2018; 15:9. [PMID: 29454392 PMCID: PMC5816520 DOI: 10.1186/s12984-018-0350-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design's therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction. METHODS A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation. RESULTS In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted. CONCLUSION The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.
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Affiliation(s)
- Chia-Ye Chu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, 76107 TX USA
| | - Rita M. Patterson
- Department of Family and Manipulative Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, 76107 TX USA
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Yap HK, Lim JH, Nasrallah F, Yeow CH. Design and Preliminary Feasibility Study of a Soft Robotic Glove for Hand Function Assistance in Stroke Survivors. Front Neurosci 2017; 11:547. [PMID: 29062267 PMCID: PMC5640819 DOI: 10.3389/fnins.2017.00547] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Various robotic exoskeletons have been proposed for hand function assistance during activities of daily living (ADL) of stroke survivors. However, traditional exoskeletons involve the use of complex rigid systems that impede the natural movement of joints, and thus reduce the wearability and cause discomfort to the user. The objective of this paper is to design and evaluate a soft robotic glove that is able to provide hand function assistance using fabric-reinforced soft pneumatic actuators. These actuators are made of silicone rubber which has an elastic modulus similar to human tissues. Thus, they are intrinsically soft and compliant. Upon air pressurization, they are able to support finger range of motion (ROM) and generate the desired actuation of the finger joints. In this work, the soft actuators were characterized in terms of their blocked tip force, normal and frictional grip force outputs. Combining the soft actuators and flexible textile materials, a soft robotic glove was developed for grasping assistance during ADL for stroke survivors. The glove was evaluated on five healthy participants for its assisted ROM and grip strength. Pilot test was performed in two stroke survivors to evaluate the efficacy of the glove in assisting functional grasping activities. Our results demonstrated that the actuators designed in this study could generate desired force output at a low air pressure. The glove had a high kinematic transparency and did not affect the active ROM of the finger joints when it was being worn by the participants. With the assistance of the glove, the participants were able to perform grasping actions with sufficient assisted ROM and grip strength, without any voluntary effort. Additionally, pilot test on stroke survivors demonstrated that the patient's grasping performance improved with the presence and assistance of the glove. Patient feedback questionnaires also showed high level of patient satisfaction and comfort. In conclusion, this paper has demonstrated the possibility of using soft wearable exoskeletons that are more wearable, lightweight, and suitable to be used on a daily basis for hand function assistance of stroke survivors during activities of daily living.
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Affiliation(s)
- Hong Kai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Jeong Hoon Lim
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Fatima Nasrallah
- Queensland Brain Institute, University of Queensland, St. Lucia, QLD, Australia
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
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