Active, Actuated, and Assistive: a Scoping Review of Exoskeletons for the Hands and Wrists

BACKGROUND

Assistive technology is often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force to the joints of users with muscle weakness. Actuated devices allow dynamic movement compared to splints, therefore improving the ability to complete activities of daily living. However, these devices are not often prescribed and are underrepresented in research and clinical settings.

OBJECTIVE

This review examined the existing literature on devices developed to support hand and wrist functionality in daily activities. Focusing on active, powered, and actuated devices, to gain a clearer understanding of the current limitations in their design and prescription.

METHODOLOGY

The scoping review was conducted using the PRISMA-ScR guidelines. A systematic search was done on MEDLINE, EMBASE, Scopus, Web of Science, and NHS the Knowledge Network from inception to May 2023. Articles were included if the device was portable; supported the hands and wrist actively using an actuator; and could be used for assistive living during or post-rehabilitation period.

FINDINGS

A total of 135 studies were included in the analysis of which 34 were clinical trials. The design and control methods of 121 devices were analyzed. Electrical stimulation and direct mechanical transmission were popular actuation methods. Electromyography (EMG) and joint movement detection were highly used control methods to translate user intentions to device actuation. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often not conducted in operational environments with 69% at technology readiness levels ≤ 6, indicating that further development and testing is required.

CONCLUSION

The existing literature on hand and wrist exoskeletons presents large variations in validation methods and technical requirements for user-specific characteristics. This suggests a need for well-defined testing protocols and refined reporting of device designs. This would improve the significance of clinical outcomes and new assistive technology.

Experimental Characterization of A-AFiM, an Adaptable Assistive Device for Finger Motions

Robot rehabilitation devices are attracting significant research interest, aiming at developing viable solutions for increasing the patient’s quality of life and enhancing clinician’s therapies. This paper outlines the design and implementation of a low-cost robotic system that can assist finger motion rehabilitation by controlling and adapting both the position and velocity of fingers to the users′ needs. The proposed device consists of four slider-crank mechanisms. Each slider-crank is fixed and moves one finger (from the index to the little finger). The finger motion is adjusted through the regulation of a single link length of the mechanism. The trajectory that is generated corresponds to the natural flexion and extension trajectory of each finger. The functionality of this mechanism is validated by experimental image processing. Experimental validation is performed through tests on healthy subjects to demonstrate the feasibility and user-friendliness of the proposed solution.

A topology optimization method for collaborative robot lightweight design based on orthogonal experiment and its applications

Topology optimization is an effective method for the lightweight of collaborative robots. The extreme working conditions of the robot for the existing topology optimization approach are usually determined by design experience, which may cause mismatch between the chosen load boundary condition of the parts to be optimized and the actual maximum one. In this article, a kind of topology optimization method based on orthogonal experiment was proposed to avoid this mismatch. For this method, the extreme working condition of robots was determined by finding out the combination of robot joint angles when the stress of the part was maximum based on orthogonal experiment. And then, the structure of the part was optimized with the objective of minimizing mass and the constraint of the maximum end displacement of the robots. Finally, the proposed method and the existing method were applied to the lightweight design of a 7 degree of freedom upper limb powered exoskeleton robot, and the results demonstrated that the presented approach can reduce 6.78% maximum end displacement of the robot on average compared with the existing one. It can be concluded that the proposed method in this article is more reasonable and applicable to the structure optimization of collaborative robots.