Soft robotic devices for hand rehabilitation and assistance: a narrative review

Task-Oriented Training by a Personalized Electromyography-Driven Soft Robotic Hand in Chronic Stroke: A Randomized Controlled Trial

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.

Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis

PURPOSE

Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care.

METHODS

In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video.

RESULTS

154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time.

CONCLUSIONS

Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.

The impact of a soft robotic glove on activity performance and body function for brachial plexus birth injury patients-A longitudinal case series

BACKGROUND

A brachial plexus birth injury (BPBI) can cause reduced ability to use the arm and hand in daily activities due to reduced grip strength and endurance. A soft robotic glove can increase the number of activities performed and improve activity performance for patients with neurological disease. The use of a soft robotic glove for patients with BPBI has not been studied.

PURPOSE

To investigate if a soft robotic glove can improve activity performance and body function for patients with BPBI.

STUDY DESIGN

Longitudinal Case Series.

METHODS

A convenience sample of patients with BPBI, treated by the Brachial plexus injury service in Umeå, Sweden were studied. Eight patients used a soft robotic glove, (Carbonhand®), at home for three months. Data on activity performance and satisfaction with activity performance, active range of motion and strength were collected at baseline, and at three and four months. A patient evaluation form was filled out at three months, all patients kept a diary for three out of 12 weeks.

RESULTS

Six out of eight patients wanted to continue using the device and improved their self-perception of activity performance and satisfaction with the performance due to a more secure grip, compared to when not using the device. All patients had improved maximum strength and endurance in elbow flexion at three months. The device was useful as an assisting device and as a training tool.

CONCLUSION

A soft robotic glove (Carbonhand) may improve activity performance and perceived satisfaction and increase the number of activities that a person with BPBI can perform in everyday life. It is possible to increase strength in elbow flexion after using such a device. Due to this limited material, more research is needed.

Integration of music-based game approaches with wearable devices for hand neurorehabilitation: a narrative review

BACKGROUND

Restoring hand functionality is critical for fostering independence in individuals with neurological disorders. Various therapeutic approaches have emerged to address motor function restoration, with music-based therapies demonstrating notable advantages in enhancing neuroplasticity, an integral component of neurorehabilitation. Despite the positive effects observed, there remains a gap in the literature regarding implementing music treatments in neurorehabilitation, such as Neurologic Music Therapy (NMT), especially in conjunction with emerging fields like wearable devices and game-based therapies.

METHODS

A literature search was conducted in various databases, including PubMed, Scopus, IEEE Xplore, and ACM Digital Library. The search was performed using a literature search methodology based on keywords. Information collected from the studies pertained to the approach used in music therapy, the design of the video games, and the types of wearable devices utilized.

RESULTS

A total of 158 articles were found, including 39 from PubMed, 34 from IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from other sources. Duplicate entries, of which there were 41, were eliminated. In the first screening phase, 152 papers were screened for title and abstract. Subsequently, 89 articles were removed if they contained at least one exclusion criterion. Sixteen studies were considered after 63 papers had their full texts verified.

CONCLUSIONS

The convergence of NMT with emerging fields, such as gamification and wearable devices designed for hand functionality, not only expands therapeutic horizons but also lays the groundwork for innovative, personalized approaches to neurorehabilitation. However, challenges persist in effectively incorporating NMT into rehabilitation programs, potentially hindering its effectiveness.

Tunable Light-Responsive Polyurethane-urea Elastomer Driven by Photochemical and Photothermal Coupling Mechanism

Light-driven soft actuators based on photoresponsive materials can be used to mimic biological motion, such as hand movements, without involving rigid or bulky electromechanical actuations. However, to our knowledge, no robust photoresponsive material with desireable mechanical and biological properties and relatively simple manufacture exists for robotics and biomedical applications. Herein, we report a new visible-light-responsive thermoplastic elastomer synthesized by introducing photoswitchable moieties (i.e., azobenzene derivatives) into the main chain of poly(ε-caprolactone) based polyurethane urea (PAzo). A PAzo elastomer exhibits controllable light-driven stiffness softening due to its unique nanophase structure in response to light, while possessing excellent hyperelasticity (stretchability of 575.2%, elastic modulus of 17.6 MPa, and strength of 44.0 MPa). A bilayer actuator consisting of PAzo and polyimide films is developed, demonstrating tunable bending modes by varying incident light intensities. Actuation mechanism via photothermal and photochemical coupling effects of a soft-hard nanophase is demonstrated through both experimental and theoretical analyses. We demonstrate an exemplar application of visible-light-controlled soft "fingers" playing a piano on a smartphone. The robustness of the PAzo elastomer and its scalability, in addition to its excellent biocompatibility, opens the door to the development of reproducible light-driven wearable/implantable actuators and lightweight soft robots for clinical applications.

Design Optimization of a Soft Robotic Rehabilitation Glove Based on Finger Workspace Analysis

The finger workspace is crucial for performing various grasping tasks. Thus, various soft rehabilitation gloves have been developed to assist individuals with paralyzed hands in activities of daily living (ADLs) or rehabilitation training. However, most soft robotic glove designs are insufficient to assist with various hand postures because most of them use an underactuated mechanism for design simplicity. Therefore, this paper presents a methodology for optimizing the design of a high-degree-of-freedom soft robotic glove while not increasing the design complexity. We defined the required functional workspace of the index finger based on ten frequently used grasping postures in ADLs. The design optimization was achieved by simulating the proposed finger-robot model to obtain a comparable workspace to the functional workspace. In particular, the moment arm length for extension was optimized to facilitate the grasping of large objects (precision disk and power sphere), whereas a torque-amplifying routing design was implemented to aid the grasping of small objects (lateral pinch and thumb-two-finger pinch). The effectiveness of the optimized design was validated through testing with a stroke survivor and comparing the assistive workspace. The observed workspace demonstrated that the optimized glove design could assist with nine out of the ten targeted grasping posture functional workspaces. Furthermore, the assessment of the grasping speed and force highlighted the glove's usability for various rehabilitation activities. We also present and discuss a generalized methodology to optimize the design parameters of a soft robotic glove that uses an underactuated mechanism to assist the targeted workspace. Overall, the proposed design optimization methodology serves as a tool for developing advanced hand rehabilitation robots, as it offers insight regarding the importance of routing optimization in terms of the workspace.

Soft Sensors and Actuators for Wearable Human-Machine Interfaces

Haptic human-machine interfaces (HHMIs) combine tactile sensation and haptic feedback to allow humans to interact closely with machines and robots, providing immersive experiences and convenient lifestyles. Significant progress has been made in developing wearable sensors that accurately detect physical and electrophysiological stimuli with improved softness, functionality, reliability, and selectivity. In addition, soft actuating systems have been developed to provide high-quality haptic feedback by precisely controlling force, displacement, frequency, and spatial resolution. In this Review, we discuss the latest technological advances of soft sensors and actuators for the demonstration of wearable HHMIs. We particularly focus on highlighting material and structural approaches that enable desired sensing and feedback properties necessary for effective wearable HHMIs. Furthermore, promising practical applications of current HHMI technology in various areas such as the metaverse, robotics, and user-interactive devices are discussed in detail. Finally, this Review further concludes by discussing the outlook for next-generation HHMI technology.

Combining soft robotics and telerehabilitation for improving motor function after stroke

Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients' home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.

REHABS: An Innovative and User-Friendly Device for Rehabilitation

Rehabilitation is a complex set of interventions involving the assessment, management, and treatment of injuries. It aims to support and facilitate an individual's recovery process by restoring a physiological function, e.g., limb movement, compromised by physical impairments, injuries or diseases to a condition as close to normal as possible. Innovative devices and solutions make the rehabilitation process of patients easier during their daily activities. Devices support physicians and physiotherapists in monitoring and measuring patients' physical improvements during rehabilitation. In this context, we report the design and implementation of a low-cost rehabilitation system, which is a programmable device designed to support tele-rehabilitation of the upper limbs. The proposed system includes a mechanism to acquire and analyze data and signals related to rehabilitation processes.

Human-Powered Master Controllers for Reconfigurable Fluidic Soft Robots

Fluidic soft robots have the advantages of inherent compliance and adaptability, but they are significantly restricted by complex control systems and bulky power devices, including fluidic valves, fluidic pumps, electrical motors, as well as batteries, which make it challenging to operate in narrow space, energy shortage, or electromagnetic sensitive situations. To overcome the shortcomings, we develop portable human-powered master controllers to provide an alternative solution for the master-slave control of the fluidic soft robots. Each controller can supply multiple fluidic pressures to the multiple chambers of the soft robots simultaneously. We use modular fluidic soft actuators to reconfigure soft robots with various functions as control objects. Experimental results show that flexible manipulation and bionic locomotion can be simply realized using the human-powered master controllers. The developed controllers which eliminate energy storage and electronic components can provide a promising candidate of soft robot control in surgical, industrial, and entertainment applications.

Modeling multi-contact point physical interaction between the anthropomorphic finger and soft robotic exo-digit for wearable rehabilitation robotics applications

Introduction: Effective control of rehabilitation robots requires considering the distributed and multi-contact point physical human-robot interaction and users' biomechanical variation. This paper presents a quasi-static model for the motion of a soft robotic exo-digit while physically interacting with an anthropomorphic finger model for physical therapy. Methods: Quasi-static analytical models were developed for modeling the motion of the soft robot, the anthropomorphic finger, and their coupled physical interaction. An intertwining of kinematics and quasi-static motion was studied to model the distributed (multiple contact points) interaction between the robot and a human finger model. The anthropomorphic finger was modeled as an articulated multi-rigid body structure with multi-contact point interaction. The soft robot was modeled as an articulated hybrid soft-and-rigid model with a constant bending curvature and a constant length for each soft segment. A hyperelastic constitute model based on Yeoh's 3rdorder material model was used for modeling the soft elastomer. The developed models were experimentally evaluated for 1) free motion of individual soft actuators and 2) constrained motion of the soft robotic exo-digit and anthropomorphic finger model. Results and Discussion: Simulation and experimental results were compared for performance evaluations. The theoretical and experimental results were in agreement for free motion, and the deviation from the constrained motion was in the range of the experimental errors. The outcomes also provided an insight into the importance of considering lengthening for the soft actuators.

Changes in Corticospinal Excitability and Motor Control During Cerebellar Transcranial Direct Current Stimulation in Healthy Individuals

Cerebellar transcranial direct current stimulation (ctDCS) modulates the primary motor cortex (M1) via cerebellar brain inhibition (CBI), which affects motor control in humans. However, the effects of ctDCS on motor control are inconsistent because of an incomplete understanding of the real-time changes in the M1 excitability that occur during ctDCS, which determines motor output under regulation by the cerebellum. This study investigated changes in corticospinal excitability and motor control during ctDCS in healthy individuals. In total, 37 healthy individuals participated in three separate experiments. ctDCS (2 mA) was applied to the cerebellar hemisphere during the rest condition or a pinch force-tracking task. Motor-evoked potential (MEP) amplitude and the F-wave were assessed before, during, and after ctDCS, and pinch force control was assessed before and during ctDCS. The MEP amplitudes were significantly decreased during anodal ctDCS from 13 min after the onset of stimulation, whereas the F-wave was not changed. No significant changes in MEP amplitudes were observed during cathodal and sham ctDCS conditions. The MEP amplitudes were decreased during anodal ctDCS when combined with the pinch force-tracking task, and pinch force control was impaired during anodal ctDCS relative to sham ctDCS. The MEP amplitudes were not significantly changed before and after all ctDCS conditions. Motor cortical excitability was suppressed during anodal ctDCS, and motor control was unskilled during anodal ctDCS when combined with a motor task in healthy individuals. Our findings provided a basic understanding of the clinical application of ctDCS to neurorehabilitation.

Reconfigurable Soft Pneumatic Actuators Using Extensible Fabric-Based Skins

The development of the field of soft robotics has led to the exploration of novel techniques to manufacture soft actuators, which provide distinct advantages for wearable assistive robotics. One subset of these soft pneumatic actuators is conventionally developed from silicone, fabrics, and thermoplastic polyurethane (TPU). Each of these materials in isolation possesses limitations of low-stress capacity, low-design complexity, and high-input pressure requirements, respectively. Combining these materials can overcome some limitations and maintain their desirable properties. In this article, we explore one such composite design scheme using a combination of silicone polymer-based bladder and reconfigurable fabric skin made from an anisotropic extensible fabric. The silicone polymer bladder acts as the hermetic seal, while this skin acts as the constraint. Bending and torsional actuators were designed utilizing the anisotropy of these fabrics. The torsional actuator designs can achieve over 540° of twist, significantly larger than previously reported in the literature, owing to the lower mechanical impedance of the extensible fabrics. Actuators with 360° of bending were also fabricated using this method. In addition, the lack of TPU-backed or inextensible fabrics reduces the actuator's stiffness, leading to lower actuation pressures. Skin-based designs also confer the advantage of modularity, reconfigurability, and the ability to achieve complex motions by tuning the properties of the bladder and the skin. For applications with high-force requirements, such as wearable exoskeletons, we demonstrate the utility of multilayer design schemes. A multilayer bending actuator generated 190 N of force at 100 kPa and was shown to be a candidate for wearable assistive devices. In addition, torsional designs were shown to have utility in practical scenarios such as screwing on a bottle cap and turning knobs. Thus, we present a novel fabric-skin-based design concept that is highly versatile and customizable for various application requirements.

Development of a novel hybrid securing actuator for a self-securing soft robotic hand exoskeleton

The development of soft robotic hand exoskeletons for rehabilitation has been well-reported in the literature, whereby the emphasis was placed on the development of soft actuators for flexion and extension. Little attention was focused on developing the glove interface and attachments of actuators to the hand. As these hand exoskeletons are largely developed for personnel with impaired hand function for rehabilitation, it may be tedious to aid the patients in donning and doffing the glove, given that patients usually have stiff fingers exhibiting high muscle tone. To address this issue, a hybrid securing actuator was developed and powered pneumatically to allow for rapid securing and release of a body segment. As a proof of concept, the actuator was further adapted into a self-securing glove mechanism and assembled into a complete self-securing soft robotic hand exoskeleton with the attachment of bidirectional actuators. Our validation tests show that the self-wearing soft robotic hand exoskeleton can easily conform and secure onto the human hand and assist with manipulation tasks.

Initial Testing of Robotic Exoskeleton Hand Device for Stroke Rehabilitation

The preliminary test results of a novel robotic hand rehabilitation device aimed at treatment for the loss of motor abilities in the fingers and thumb due to stroke are presented. This device has been developed in collaboration with physiotherapists who regularly treat individuals who have suffered from a stroke. The device was tested on healthy adults to ensure comfort, user accessibility, and repeatability for various hand sizes in preparation for obtaining permission from regulatory bodies and implementing the design in a full clinical trial. Trials were conducted with 52 healthy individuals ranging in age from 19 to 93 with an average age of 58. A comfort survey and force data ANOVA were performed to measure hand motions and ensure the repeatability and accessibility of the system. Readings from the force sensor (p < 0.05) showed no significant difference between repetitions for each participant. All subjects considered the device comfortable. The device scored a mean comfort value of 8.5/10 on all comfort surveys and received the approval of all physiotherapists involved. The device has satisfied all design specifications, and the positive results of the participants suggest that it can be considered safe and reliable. It can therefore be moved forward for clinical trials with post-stroke users.

A variable-stiffness and healable pneumatic actuator

Pneumatic-powered actuators are receiving increasing attention due to their widespread applications. However, their inherent low stiffness makes them incompetent in tasks requiring high load capacity or high force output. On the other hand, soft pneumatic actuators are susceptible to damage caused by over-pressuring or punctures by sharp objects. In this work, we designed and synthesized a coordination adaptable network (PETMP-AIM-Cu) with high mechanical rigidity (Young's modulus of 1.9 GPa and elongation <2% before fracturing) as well as excellent variable stiffness property (soft-rigid switching ability σ as high as 3 268 000 when ΔT = 90 °C). Combining PETMP-AIM-Cu with a self-healing elastomer based on dynamic disulfide bonds (LP-PDMS), we fabricated a new pneumatic actuator which shows high load capacity at room temperature, but can also easily deform upon heating and thus can be actuated pneumatically. Benefiting from the excellent self-healing ability of PETMP-AIM-Cu and LP-PDMS, the entire pneumatic actuator can still be actuated after being cut and healed. Such a variable-stiffness and healable pneumatic actuator would be useful for complex environmental applications.

Soft Robotic Glove with Sensing and Force Feedback for Rehabilitation in Virtual Reality

Many diseases, such as stroke, arthritis, and spinal cord injury, can cause severe hand impairment. Treatment options for these patients are limited by expensive hand rehabilitation devices and dull treatment procedures. In this study, we present an inexpensive soft robotic glove for hand rehabilitation in virtual reality (VR). Fifteen inertial measurement units are placed on the glove for finger motion tracking, and a motor-tendon actuation system is mounted onto the arm and exerts forces on fingertips via finger-anchoring points, providing force feedback to fingers so that the users can feel the force of a virtual object. A static threshold correction and complementary filter are used to calculate the finger attitude angles, hence computing the postures of five fingers simultaneously. Both static and dynamic tests are performed to validate the accuracy of the finger-motion-tracking algorithm. A field-oriented-control-based angular closed-loop torque control algorithm is adopted to control the force applied to the fingers. It is found that each motor can provide a maximum force of 3.14 N within the tested current limit. Finally, we present an application of the haptic glove in a Unity-based VR interface to provide the operator with haptic feedback while squeezing a soft virtual ball.

Lightweight Bioinspired Exoskeleton for Wrist Rehabilitation Powered by Twisted and Coiled Artificial Muscles

Stroke, cerebral palsy, and spinal cord injuries represent the most common leading causes of upper limb impairment. In recent years, rehabilitation robotics has progressed toward developing wearable technologies to promote the portability of assistive devices and to enable home rehabilitation of the upper extremities. However, current wearable technologies mainly rely on electric motors and rigid links or soft pneumatic actuators and are usually bulky and cumbersome. To overcome the limitations of existing technologies, in this paper, a first prototype of a lightweight, ungrounded, soft exoskeleton for wrist rehabilitation powered by soft and flexible carbon fibers-based twisted and coiled artificial muscles (TCAMs) is proposed. The device, which weighs only 0.135 kg, emulates the arrangement and working mechanism of skeletal muscles in the upper extremities and is able to perform wrist flexion/extension and ulnar/radial deviation. The range of motion and the force provided by the exoskeleton is designed through simple kinematic and dynamic theoretical models, while a thermal model is used to design a thermal insulation system for TCAMs during actuation. The device’s ability to perform passive and active-resisted wrist rehabilitation exercises and EMG-based actuation is also demonstrated.

A Pilot Study of Compensatory Strategies for Reach-to-Grasp-Pen in Patients with Stroke

Coordinated reaching and grasping movements may be impaired in patients with poststroke hemiplegia. Patients frequently adopt compensatory strategies, which require investigation. This pilot study used kinematic parameters to examine compensatory strategies by assessing the reach-to-grasp-pen movements in patients with stroke and unaffected participants. Twelve patients with stroke with mild impairment (45.16 ± 12.62 years, 2.41 ± 1.97 months), twelve with moderate impairment (50.41 ± 12.92 years, 3.83 ± 3.58 months), and ten healthy individuals (20.6 ± 0.69 years) performed a reach-to-grasp-pen task. Kinematics parameters of upper limb and fingers, such as movement time, number of movement units, index of curvature, spectral arc length, trunk forward transition, trunk lateral transition, elbow extension, shoulder flexion, shoulder abduction, trunk rotation, arm-plane angle, the joint angles of interphalangeal joints of the thumb, index, middle, ring, and little fingers were examined in the study. These parameters were evaluated with two Microsoft Azure Kinect and Leap Motion, which belong to markerless motion capture systems. Patients with stroke showed longer reaching movement time, less smooth movement trajectories, and more trunk rotation ( $P<0.05$ ). In patients with stroke, the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) of the thumb were flexed in the starting position; the MCP and PIP joints of the index finger in the stroke group were more extended during pen grasp; the range of motion of the MCP of the middle finger and the PIP joints of the middle, ring, and little fingers became greater, suggesting a larger peak aperture ( $P<0.05$ ). The more significant extension was observed in the index finger at the end of the grasp, suggesting inadequate flexion ( $P<0.05$ ). In clinical practice, the reach-to-grasp-pen task using markless sensing technology can effectively distinguish patients with stroke from healthy individuals and evaluate the recovery and compensation strategies of upper limb and hand functions. It can potentially become an evaluation tool in hospital and community scenes. Accurate identification of abnormal trunk, arm, and finger strategies is crucial for therapists to develop targeted upper limb treatment methods and evaluate treatment effects.

Vibrotactile enhancement in hand rehabilitation has a reinforcing effect on sensorimotor brain activities

Objective

Stroke patients often suffer from hand dysfunction or loss of tactile perception, which in turn interferes with hand rehabilitation. Tactile-enhanced multi-sensory feedback rehabilitation is an approach worth considering, but its effectiveness has not been well studied. By using functional near-infrared spectroscopy (fNIRS) to analyze the causal activity patterns in the sensorimotor cortex, the present study aims to investigate the cortical hemodynamic effects of hand rehabilitation training when tactile stimulation is applied, and to provide a basis for rehabilitation program development.

Methods

A vibrotactile enhanced pneumatically actuated hand rehabilitation device was tested on the less-preferred hand of 14 healthy right-handed subjects. The training tasks consisted of move hand and observe video (MO), move hand and vibration stimulation (MV), move hand, observe video, and vibration stimulation (MOV), and a contrast resting task. Region of interest (ROI), a laterality index (LI), and causal brain network analysis methods were used to explore the brain’s cortical blood flow response to a multi-sensory feedback rehabilitation task from multiple perspectives.

Results

(1) A more pronounced contralateral activation in the right-brain region occurred under the MOV stimulation. Rehabilitation tasks containing vibrotactile enhancement (MV and MOV) had significantly more oxyhemoglobin than the MO task at 5 s after the task starts, indicating faster contralateral activation in sensorimotor brain regions. (2) Five significant lateralized channel connections were generated under the MV and MOV tasks (p < 0.05), one significant lateralized channel connection was generated by the MO task, and the Rest were not, showing that MV and MOV caused stronger lateralization activation. (3) We investigated all thresholds of granger causality (GC) resulting in consistent relative numbers of effect connections. MV elicited stronger causal interactions between the left and right cerebral hemispheres, and at the GC threshold of 0.4, there were 13 causal network connection pairs for MV, 7 for MO, and 9 for MOV.

Conclusion

Vibrotactile cutaneous stimulation as a tactile enhancement can produce a stronger stimulation of the brain’s sensorimotor brain areas, promoting the establishment of neural pathways, and causing a richer effect between the left and right cerebral hemispheres. The combination of kinesthetic, vibrotactile, and visual stimulation can achieve a more prominent training efficiency from the perspective of functional cerebral hemodynamics.

Predictive nomogram for soft robotic hand rehabilitation of patients with intracerebral hemorrhage

Background

Few studies focused on the risk factors for hand rehabilitation of intracerebral hemorrhage (ICH) using of soft robotic hand therapy (SRHT). The aim of this study was to establish a predictive nomogram for soft robotic hand rehabilitation in patients with ICH.

Methods

According to the Brunnstrom motor recovery (BMR) stage, the patients were grouped into poor and good motor function groups. The data of patient demographic information and serum level of C-terminal Agrin Fragment (CAF), S100B and neurofilament light (NfL) were collected. The logistic regression was used to analyze the risk factors for poor hand function.

Results

Finally, we enrolled 102 and 103 patients in the control and SRHT groups. For the SRHT group, there were 17 and 86 cases with poor and good motor function at 6-months follow-up respectively. In the good motor function group, the Fugl-Meyer Assessment-Wrist and Hand (FMA-WH score) and BMR score at admission were all better than that in the poor motor function group respectively (p < 0.001). The mean serum level of CAF, S100B and NfL in the good motor function group were 2.5 ± 0.82 ng/mL, 286.6 ± 236.4 ng/L and 12.1 ± 10.4 pg/mL respectively, which were lower than that in the poor motor function group (p < 0.001, Table 3). The multivariate logistic regression showed that hematoma volume (OR = 1.47, p = 0.007), FMA-WH score admission (OR = 0.78, p = 0.02), S100B (OR = 1.32, p = 0.04), and NfL (OR = 1.24, p = 0.003) were all significant predictors of poor motor function.

Conclusions

We found that Soft robotic hands therapy benefited in hand function in patients with ICH and hematoma volume, FMA-WH score admission, S100B, and NfL were all significant predictors for poor motor function of patients with ICH.

A wearable textile-based pneumatic energy harvesting system for assistive robotics

Wearable assistive, rehabilitative, and augmentative devices currently require bulky power supplies, often making these tools more of a burden than an asset. This work introduces a soft, low-profile, textile-based pneumatic energy harvesting system that extracts power directly from the foot strike of a user during walking. Energy is harvested with a textile pump integrated into the insole of the user's shoe and stored in a wearable textile bladder to operate pneumatic actuators on demand, with system performance optimized based on a mechano-fluidic model. The system recovered a maximum average power of nearly 3 W with over 20% conversion efficiency-outperforming electromagnetic, piezoelectric, and triboelectric alternatives-and was used to power a wearable arm-lift device that assists shoulder motion and a supernumerary robotic arm, demonstrating its capability as a lightweight, low-cost, and comfortable solution to support adults with upper body functional limitations in activities of daily living.

Effects of an active hand exoskeleton on forearm muscle activity in industrial assembly grips

BACKGROUND: The Bioservo Ironhand® is a commercially available active hand exoskeleton for reducing grip-induced stress. OBJECTIVES: The study aimed at quantifying the effect of the Ironhand® exoskeleton on the myoelectric muscle activity of forearm flexor and extensor muscles in three relevant assembly grip tasks: 2-Finger-grip (2Finger), 5-Finger-grip (5Finger) and Full grip (FullGrip). METHODS: Twenty-two subjects were tested in three different exoskeleton conditions for each grip task (overall 3×3×10 = 90 repetitions in randomized order): Exoskeleton off (Off), Exoskeleton on, “locking tendency” 0% (On_LT0), and Exoskeleton on, “locking tendency” 85% (On_LT85). Muscle activity was measured at 25% of the participant’s maximum grip force using two EMG sensors at the M. flexor digitorum superficialis (M.FDS) and one at the M. extensor digitorum (M.ED). RESULTS: The effect of the Ironhand® exoskeleton varied depending on the grip task and the participant’s sex. A statistically significant reduction in muscle activity of the M.FDS was found only for male subjects in the FullGrip condition. No reduction of muscular activity in the M.FDS was found for the other grip tasks (2Finger, 5Finger). For the females in the 2Finger condition, mean muscle activity of M.FDS even increased significantly in On_LT0 compared to Off. Besides differences between grip tasks and sex, the current study revealed substantial individual differences. CONCLUSIONS: In addition to testing for statistical significance, a detailed exploratory analysis of exoskeleton effects at subject level should be performed to evaluate these from a safety and regulatory perspective.

Upper limb soft robotic wearable devices: a systematic review

INTRODUCTION

Soft robotic wearable devices, referred to as exosuits, can be a valid alternative to rigid exoskeletons when it comes to daily upper limb support. Indeed, their inherent flexibility improves comfort, usability, and portability while not constraining the user's natural degrees of freedom. This review is meant to guide the reader in understanding the current approaches across all design and production steps that might be exploited when developing an upper limb robotic exosuit.

METHODS

The literature research regarding such devices was conducted in PubMed, Scopus, and Web of Science. The investigated features are the intended scenario, type of actuation, supported degrees of freedom, low-level control, high-level control with a focus on intention detection, technology readiness level, and type of experiments conducted to evaluate the device.

RESULTS

A total of 105 articles were collected, describing 69 different devices. Devices were grouped according to their actuation type. More than 80% of devices are meant either for rehabilitation, assistance, or both. The most exploited actuation types are pneumatic (52%) and DC motors with cable transmission (29%). Most devices actuate 1 (56%) or 2 (28%) degrees of freedom, and the most targeted joints are the elbow and the shoulder. Intention detection strategies are implemented in 33% of the suits and include the use of switches and buttons, IMUs, stretch and bending sensors, EMG and EEG measurements. Most devices (75%) score a technology readiness level of 4 or 5.

CONCLUSION

Although few devices can be considered ready to reach the market, exosuits show very high potential for the assistance of daily activities. Clinical trials exploiting shared evaluation metrics are needed to assess the effectiveness of upper limb exosuits on target users.

3D-Printed Soft Pneumatic Robotic Digit Based on Parametric Kinematic Model for Finger Action Mimicking

A robotic digit with shape modulation, allowing personalized and adaptable finger motions, can be used to restore finger functions after finger trauma or neurological impairment. A soft pneumatic robotic digit consisting of pneumatic bellows actuators as biomimetic artificial joints is proposed in this study to achieve specific finger motions. A parametric kinematic model is employed to describe the tip motion trajectory of the soft pneumatic robotic digit and guide the actuator parameter design (i.e., the pressure supply, actuator material properties, and structure requirements of the adopted pneumatic bellows actuators). The direct 3D printing technique is adopted in the fabrication process of the soft pneumatic robotic digit using the smart material of thermoplastic polyurethane. Each digit joint achieves different ranges of motion (ROM; bending angles of distal, proximal, and metacarpal joint are 107°, 101°, and 97°, respectively) under a low pressure of 30 kPa, which are consistent with the functional ROM of a human finger for performing daily activities. Theoretical model analysis and experiment tests are performed to validate the effectiveness of the digit parametric kinematic model, thereby providing evidence-based technical parameters for the precise control of dynamic pressure dosages to achieve the required motions.

Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions

Background

Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI.

Methods

A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes.

Results

A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests.

Conclusion

SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.

A Scientometric Review of Soft Robotics: Intellectual Structures and Emerging Trends Analysis (2010–2021)

Within the last decade, soft robotics has attracted an increasing attention from both academia and industry. Although multiple literature reviews of the whole soft robotics field have been conducted, there still appears to be a lack of systematic investigation of the intellectual structure and evolution of this field considering the increasing amount of publications. This paper conducts a scientometric review of the progressively synthesized network derived from 10,504 bibliographic records using a topic search on soft robotics from 2010 to 2021 based on the Web of Science (WoS) core database. The results are presented from both the general data analysis of included papers (e.g., relevant journals, citation, h-index, year, institution, country, disciplines) and the specific data analysis corresponding to main disciplines and topics, and more importantly, emerging trends. CiteSpace, a data visualization software, which can construct the co-citation network maps and provide citation bursts, is used to explore the intellectual structures and emerging trends of the soft robotics field. In addition, this paper offers a demonstration of an effective analytical method for evaluating enormous publication citation and co-citation data. Findings of this review can be used as a reference for future research in soft robotics and relevant topics.

Effectiveness of a Soft Robotic Glove to Assist Hand Function in Stroke Patients: A Cross-Sectional Pilot Study

Purpose

Stroke patients have difficulty performing tasks using their paretic hands. There are limited data on the effects of using a soft robotic glove to assist with hand function. The objective of this study was to investigate the effectiveness of a soft robotic glove in assisting hand function in stroke patients.

Methods

This study was a cross-sectional pilot study. Twenty stroke patients with partial or complete hand weakness were recruited from a rehabilitation centre. The Box and Block Test (BBT) and the Action Research Arm Test (ARAT) were performed under two conditions: with and without use of the soft robotic glove. The order of the conditions was randomly assigned by a computer-generated program.

Results

BBT scores increased 6.4 blocks when using the soft robotic glove (p < 0.001). ARAT grasp, grip, pinch, and overall scores increased by 27.08% (p < 0.01), 28.75% (p < 0.001), 15.89% (p < 0.01), and 21.15% (p < 0.001), respectively, using the glove versus not using the glove.

Conclusions

The findings of this study suggest that using a soft robotic glove can assist a poststroke paretic hand in executing grasp, grip, and pinch.

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective

BACKGROUND

The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.

METHODS

A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.

RESULTS

Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.

CONCLUSIONS

Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.

TRIAL REGISTRATION

PROSPERO registration ref. CRD42021224141 .

Design, modeling and control of an index finger exoskeleton for rehabilitation

With diverse areas of applications, wearable robotic exoskeleton devices have gained attention in the past decade. These devices cover one or more human limbs/joints and have been presented for rehabilitation, strength augmentation and interaction with virtual reality. This research is focused towards design, modeling and control of a novel series elastic actuation (SEA) based index finger exoskeleton with a targeted torque rendering capability of 0.3 Nm and a force control bandwidth of 3 Hz. The proposed design preserves the natural range of motion of the finger by incorporating five passive and two actively actuated joints and provides active control of metacarpophalangeal and proximal interphalangeal joints. Forward and inverse kinematics for both position and velocity have been solved using closed loop vector analysis by including human finger as an integral part of the system. For accurate force control, a cascaded control structure has been presented. Force controlled trajectories have been proposed to guide the finger along preprogrammed virtual paths. Such trajectories serve to gently guide the finger towards the correct rehabilitation protocol, thus acting as an effective replacement of intervention by a human therapist. Extensive computer simulations have been performed before fabricating a prototype and performing experimental validation. Results show accurate modeling and control of the proposed design.

Soft actuators for real-world applications

Inspired by physically adaptive, agile, reconfigurable and multifunctional soft-bodied animals and human muscles, soft actuators have been developed for a variety of applications, including soft grippers, artificial muscles, wearables, haptic devices and medical devices. However, the complex performance of biological systems cannot yet be fully replicated in synthetic designs. In this Review, we discuss new materials and structural designs for the engineering of soft actuators with physical intelligence and advanced properties, such as adaptability, multimodal locomotion, self-healing and multi-responsiveness. We examine how performance can be improved and multifunctionality implemented by using programmable soft materials, and highlight important real-world applications of soft actuators. Finally, we discuss the challenges and opportunities for next-generation soft actuators, including physical intelligence, adaptability, manufacturing scalability and reproducibility, extended lifetime and end-of-life strategies.

Intention Detection Strategies for Robotic Upper-Limb Orthoses: A Scoping Review Considering Usability, Daily Life Application, and User Evaluation

Wearable robotic upper limb orthoses (ULO) are promising tools to assist or enhance the upper-limb function of their users. While the functionality of these devices has continuously increased, the robust and reliable detection of the user's intention to control the available degrees of freedom remains a major challenge and a barrier for acceptance. As the information interface between device and user, the intention detection strategy (IDS) has a crucial impact on the usability of the overall device. Yet, this aspect and the impact it has on the device usability is only rarely evaluated with respect to the context of use of ULO. A scoping literature review was conducted to identify non-invasive IDS applied to ULO that have been evaluated with human participants, with a specific focus on evaluation methods and findings related to functionality and usability and their appropriateness for specific contexts of use in daily life. A total of 93 studies were identified, describing 29 different IDS that are summarized and classified according to a four-level classification scheme. The predominant user input signal associated with the described IDS was electromyography (35.6%), followed by manual triggers such as buttons, touchscreens or joysticks (16.7%), as well as isometric force generated by residual movement in upper-limb segments (15.1%). We identify and discuss the strengths and weaknesses of IDS with respect to specific contexts of use and highlight a trade-off between performance and complexity in selecting an optimal IDS. Investigating evaluation practices to study the usability of IDS, the included studies revealed that, primarily, objective and quantitative usability attributes related to effectiveness or efficiency were assessed. Further, it underlined the lack of a systematic way to determine whether the usability of an IDS is sufficiently high to be appropriate for use in daily life applications. This work highlights the importance of a user- and application-specific selection and evaluation of non-invasive IDS for ULO. For technology developers in the field, it further provides recommendations on the selection process of IDS as well as to the design of corresponding evaluation protocols.

Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement

BACKGROUND

Children and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability.

METHODS

Children and adolescents aged 6-18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events.

RESULTS

Eleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5-83) than without (55; IQR: 37.5-80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred.

CONCLUSIONS

PEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device. Trial registration Not appropriate.

Therapeutic Effects of a Newly Developed 3D Magnetic Finger Rehabilitation Device in Subacute Stroke Patients: A Pilot Study

We developed a magnetic-force-based three-dimensional (3D) rehabilitation device that can perform motor rehabilitation treatment for paralyzed fingers, regardless of upper extremity movement and position, and investigated the therapeutic effects of the device. An end-effector type rehabilitation device that can generate magnetic fields in three directions was developed using electromagnets and permanent magnetics. A double-blinded randomized controlled pilot study was conducted with a total of 12 patients. The intervention group had rehabilitation treatment using the developed magnetic finger rehabilitation device for 30 min a day for four weeks. The control group underwent exercise rehabilitation treatment. The control group received conventional occupational therapy on the upper limbs, including hands, from an occupational therapist, for the same amount of time. Adverse effects were monitored, and the patient’s sensory or proprioceptive deficits were examined before the intervention. No participants reported safety concerns while the intervention was conducted. The Wolf Motor Function Test (WMFT) scores were significantly improved in the intervention group (from 13.4 ± 3.6 to 20.9 ± 4.0 points) compared to the control group (from 13.1 ± 4.0 to 15.2 ± 3.8 points) (p = 0.016). The patients in the intervention group (from 88 ± 12 to 67 ± 13 s) showed greater improvement of WMFT times compared to the control group (from 89 ± 10 to 73 ± 11 s) (p = 0.042). The Manual Function Test and the upper limb score of the Fugl-Meyer Assessment were significantly improved in the intervention group compared with the control group (p = 0.038 and p = 0.042). The patients in the intervention group also showed significantly greater enhancement of the Korean version of the modified Barthel Index than the control group (p = 0.042). Rehabilitation treatment using the 3D magnetic-force-driven finger rehabilitation device helped improve finger motor function and activities of daily living in subacute stroke patients.

Design of Wearable Hand Rehabilitation Glove With Bionic Fiber-Reinforced Actuator

Background: The hand motor function is lost and activities in daily life (ADLs) are affected due to some illnesses such as stroke and hemiplegia. As a coping way, we present a wearable rehabilitation glove with the bionic actuator for restoring the hand function and the motor control ability lost by stroke patients. Methods: The soft pneumatic bionic actuator (SPBA) is developed on the basis of the research of human hand bone structure and finger joint characteristics and a series of tests are conducted. Besides, we built the rehabilitation glove system based on the proposed SPBAs to verify the availability due to typical gesture, mirror therapy (MT) and grasping experiment for irregular objects. Result: The bending angle of SPBA can reach 260°. The output force of it can reach 5.1N with 0.25 MPa air pressure input. The maximum variance of the bending angle can be concluded at 5.1° in MT. The grasping experiments of the glove worn on the hand or not shows the proposed glove is flexible, the grip force is large and achieve stable grasping of objects. Conclusion: The designed SPBA is satisfied with the requirements of rehabilitation training and the proposed glove restore the normal hand motion of patients in ADLs.

Biomimetic Artificial Joints Based on Multi-Material Pneumatic Actuators Developed for Soft Robotic Finger Application

To precisely achieve a series of daily finger bending motions, a soft robotic finger corresponding to the anatomical range of each joint was designed in this study with multi-material pneumatic actuators. The actuator as a biomimetic artificial joint was developed on the basis of two composite materials of different shear modules, and the pneumatic bellows as expansion parts was restricted by frame that made from polydimethylsiloxane (PDMS). A simplified mathematical model was used for the bending mechanism description and provides guidance for the multi-material pneumatic actuator fabrication (e.g., stiffness and thickness) and structural design (e.g., cross length and chamber radius), as well as the control parameter optimization (e.g., the air pressure supply). An actuation pressure of over 70 kPa is required by the developed soft robotic finger to provide a full motion range (MCP = 36°, PIP = 114°, and DIP = 75°) for finger action mimicking. In conclusion, a multi-material pneumatic actuator was designed and developed for soft robotic finger application and theoretically and experimentally demonstrated its feasibility in finger action mimicking. This study explored the mechanical properties of the actuator and could provide evidence-based technical parameters for pneumatic robotic finger design and precise control of its dynamic air pressure dosages in mimicking actions. Thereby, the conclusion was supported by the results theoretically and experimentally, which also aligns with our aim to design and develop a multi-material pneumatic actuator as a biomimetic artificial joint for soft robotic finger application.

Modeling and Evaluation of a Novel Hybrid-Driven Compliant Hand Exoskeleton Based on Human-Machine Coupling Model

This paper presents the modeling design method for a novel hybrid-driven compliant hand exoskeleton based on the human-machine coupling model for the patients who have requirements on training and assisting. Firstly, the human-machine coupling model is established based on the kinematics characteristics of human fingers and the Bernoulli beam formula. On this basis, the variable stiffness flexible hinge (VSFH) is used to drive the finger extension and the cable-driven mechanism is used to implement the movement of the finger flexion. Here, a hand orthosis is designed in the proposed hand exoskeleton to act as the base and maintain the function position of the hand for patients with hand dysfunction. Then, a final design prototype is fabricated to evaluate the proposed modeling method. In the end, a series of experiments based on the prototype is proceeded to evaluate its capabilities on stretching force for extension, bio-imitability, finger flexion capability, and fingertip force. The results show that the prototype has a significant improvement in all aspects of the ability mentioned above, and has good bionics. The proposed design method can be utilized to implement the rapid design of the hybrid-driven compliant hand exoskeleton with the changed requirements. The novel modeling method can be easily applied in personalized design in rehabilitation engineering.

Operation Safety of a 2-DoF Planar Mechanism for Arm Rehabilitation

The operation safety of rehabilitation devices must be addressed early in the development process and before being tested on people. In this paper, the operation safety of a 2-DoF (degrees of freedom) planar mechanism for arm rehabilitation is addressed. Then, the safety and efficiency of the device operation is assessed through the Transmission Index (TI) distribution in its workspace. Furthermore, the produced stresses on the human arm are assessed via the FEM (finite element method) when the rehabilitation device reaches five critical positions within its workspace. The TI distribution showed that the proposed design has a proper behaviour from a force transmission point of view, avoiding any singular configuration that might cause a control failure and subsequent risk for the user and supporting the user’s motion with a good efficiency throughout its operational workspace. The FEM analysis showed that Nurse operation is safe for the human arm since a negligible maximum stress of 6.55 × 103 N/m2 is achieved by the human arm when the device is located on the evaluated critical positions.

Wearable Robots: An Original Mechatronic Design of a Hand Exoskeleton for Assistive and Rehabilitative Purposes

Robotic devices are being employed in more and more sectors to enhance, streamline, and augment the outcomes of a wide variety of human activities. Wearable robots arise indeed as of-vital-importance tools for telerehabilitation or home assistance targeting people affected by motor disabilities. In particular, the field of “Robotics for Medicine and Healthcare” is attracting growing interest. The development of such devices is a primarily addressed topic since the increasing number of people in need of rehabilitation or assistive therapies (due to population aging) growingly weighs on the healthcare systems of the nation. Besides, the necessity to move to clinics represents an additional logistic burden for patients and their families. Among the various body parts, the hand is specially investigated since it most ensures the independence of an individual, and thus, the restoration of its dexterity is considered a high priority. In this study, the authors present the development of a fully wearable, portable, and tailor-made hand exoskeleton designed for both home assistance and telerehabilitation. Its purpose is either to assist patients during activities of daily living by running a real-time intention detection algorithm or to be used for remotely supervised or unsupervised rehabilitation sessions by performing exercises preset by therapists. Throughout the mechatronic design process, special attention has been paid to the complete wearability and comfort of the system to produce a user-friendly device capable of assisting people in their daily life or enabling recorded home rehabilitation sessions allowing the therapist to monitor the state evolution of the patient. Such a hand exoskeleton system has been designed, manufactured, and preliminarily tested on a subject affected by spinal muscular atrophy, and some results are reported at the end of the article.

Visually-guided Grip Selection for Soft-Hand Exoskeleton

This paper presents a visually-guided grip selection based on the combination of object recognition and tactile feedback of a soft-hand exoskeleton intended for hand rehabilitation. A pre-trained neural network is used to recognize the object in front of the hand exoskeleton, which is then mapped to a suitable grip type. With the object cue, it actively assists users in performing different grip movements without calibration. In a pilot experiment, one healthy user completed four different grasp-and-move tasks repeatedly. All trials were completed within 25 seconds and only one out of 20 trials failed. This shows that automated movement training can be achieved by visual guidance even without biomedical sensors. In particular, in the private setting at home without clinical supervision, it is a powerful tool for repetitive training of daily-living activities.

Design of sensing system for experimental modeling of soft actuator applied for finger rehabilitation

Safe interaction and inherent compliance with soft robots have motivated the evolution of soft rehabilitation robots. Among these, soft robotic gloves are known as an effective tool for stroke rehabilitation. This research proposed a pneumatically actuated soft robotic for index finger rehabilitation. The proposed system consists of a soft bending actuator and a sensing system equipped with four inertial measurement unit sensors to generate kinematic data of the index finger. The designed sensing system can estimate the range of motion (ROM) of the finger’s joints by combining angular velocity and acceleration values with the standard Kalman filter. The sensing system is evaluated regarding repeatability and reliability through static and dynamic experiments in the first step. The root mean square error attained in static and dynamic states are 2 $^\circ$ and 3 $^\circ$ , sequentially, representing an efficient function of the fusion algorithm. In the next step, experimental models have been developed to analyze and predict a soft actuator’s behavior in free and constrained states using the sensing system’s data. Thus, parametric system identification methods, artificial neural network—multilayer perceptron (ANN-MLP), and artificial neural network—radial basis function algorithms (ANN-RBF) have been compared to achieve an optimal model. The results reveal that ANN models, particularly RBF ones, can predict the actuator behavior with reasonable accuracy in the free and constrained state (<1 $^\circ$ ). Hence, the need for intricate analytical modeling and material characterization will be eliminated, and controlling the soft actuator will be more practical. Besides, it assesses the ROM and finger functionality.

Pilot Test of Dosage Effects in HEXORR II for Robotic Hand Movement Therapy in Individuals With Chronic Stroke

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.

Probabilistic Model-based Learning Control of a Soft Pneumatic Glove for Hand Rehabilitation

OBJECTIVE

Stroke survivors are usually unable to perform activities of daily living (ADL) independently due to loss of hand functions. Soft pneumatic gloves provide a promising assistance approach for stroke survivors to conduct ADL tasks. However, few studies have explored effective control strategies for the 'human-soft robot' integrated system due to challenges in the nonlinearities of soft robots and uncertainties of human intentions. Therefore, this work aims to develop control approaches for the system to improve stroke survivors hand functions.

METHODS

Firstly, a soft pneumatic glove was utilized to aid with stroke-impaired hands. Secondly, a probabilistic model-based learning control approach was proposed to overcome the challenges. Then a task-oriented intention-driven training modality was designed. Finally, the control performance was evaluated on three able-bodied subjects and three stroke survivors who attended 20-session rehabilitation training.

RESULTS

The proposed approach could enable the soft pneumatic glove to provide adaptive assistance for all participants to accomplish different tasks. The tracking error and muscle co-contraction index showed decreasing trends while the hand gesture index showed an increasing tendency over training sessions. All stroke survivors showed improved hand functions and better muscle coordination after training.

CONCLUSION

This work developed a learning-based soft robotic glove training system and demonstrated its potential in post-stroke hand rehabilitation.

SIGNIFICANCE

This work promotes the application of soft robotic training systems in stroke rehabilitation.

Robotic devices for paediatric rehabilitation: a review of design features

Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.

Smart Skin: Vision-Based Soft Pressure Sensing System for In-Home Hand Rehabilitation

We introduce a novel in-home hand rehabilitation system for monitoring hand motions and assessing grip forces of stroke patients. The overall system is composed of a sensing device and a computer vision system. The sensing device is a lightweight cylindrical object for easy grip and manipulation, which is covered by a passive sensing layer called "Smart Skin." The Smart Skin is fabricated using soft silicone elastomer, which contains embedded microchannels partially filled with colored fluid. When the Smart Skin is compressed by grip forces, the colored fluid rises and fills in the top surface display area. Then, the computer vision system captures the image of the display area through a red-green-blue camera, detects the length change of the liquid through image processing, and eventually maps the liquid length to the calibrated force for estimating the gripping force. The passive sensing mechanism of the proposed Smart Skin device works in conjunction with a single camera setup, making the system simple and easy to use, while also requiring minimum maintenance effort. Our system, on one hand, aims to support home-based rehabilitation therapy with minimal or no supervision by recording the training process and the force data, which can be automatically conveyed to physical therapists. In contrast, the therapists can also remotely instruct the patients with their training prescriptions through online videos. This study first describes the design, fabrication, and calibration of the Smart Skin, and the algorithm for image processing, and then presents experimental results from the integrated system. The Smart Skin prototype shows a relatively linear relationship between the applied force and the length change of the liquid in the range of 0-35 N. The computer vision system shows the estimation error <4% and a relatively high stability in estimation under different hand motions.