VIBES: Vibro-Inertial Bionic Enhancement System in a Prosthetic Socket.

The use of vibrotactile feedback is of growing interest in the field of prosthetics, but few devices fully integrate this technology in the prosthesis to transmit high-frequency contact information (such as surface roughness and first contact) arising from the interaction of the prosthetic device with external items. This study describes a wearable vibrotactile system for high-frequency tactile information embedded in the prosthetic socket. The device consists of two compact planar vibrotactile actuators in direct contact with the user's skin to transmit tactile cues. These stimuli are directly related to the acceleration profiles recorded with two IMUS placed on the distal phalanx of a soft under-actuated robotic prosthesis (Soft-Hand Pro). We characterized the system from a psychophysical point of view with fifteen able-bodied participants by computing participants' Just Noticeable Difference (JND) related to the discrimination of vibrotactile cues delivered on the index finger, which are associated with the exploration of different sandpapers. Moreover, we performed a pilot experiment with one SoftHand Pro prosthesis user by designing a task, i.e. Active Texture Identification, to investigate if our feedback could enhance users' roughness discrimination. Results indicate that the device can effectively convey contact and texture cues, which users can readily detect and distinguish.

EMG-Based Control Strategies of a Supernumerary Robotic Hand for the Rehabilitation of Sub-Acute Stroke Patients: Proof of Concept.

One of the most frequent and severe aftermaths of a stroke is the loss of upper limb functionality. Therapy started in the sub-acute phase proved more effective, mainly when the patient participates actively. Recently, a novel set of rehabilitation and support robotic devices, known as supernumerary robotic limbs, have been introduced. This work investigates how a surface electromyography (sEMG) based control strategy would improve their usability in rehabilitation, limited so far by input interfaces requiring to subjects some level of residual mobility. After briefly introducing the phenomena hindering post-stroke sEMG and its use to control robotic hands, we describe a framework to acquire and interpret muscle signals of the forearm extensors. We applied it to drive a supernumerary robotic limb, the SoftHand-X, to provide Task-Specific Training (TST) in patients with sub-acute stroke. We propose and describe two algorithms to control the opening and closing of the robotic hand, with different levels of user agency and therapist control. We experimentally tested the feasibility of the proposed approach on four patients, followed by a therapist, to check their ability to operate the hand. The promising preliminary results indicate sEMG-based control as a viable solution to extend TST to sub-acute post-stroke patients.

An Experimental Setup to Test Obstacle-Dealing Capabilities of Prosthetic Feet.

Small obstacles on the ground often lead to a fall when caught with commercial prosthetic feet. Despite some recently developed feet can actively control the ankle angle, for instance over slopes, their flat and rigid sole remains a cause of instability on uneven grounds. Soft robotic feet were recently proposed to tackle that issue; however, they lack consistent experimental validation. Therefore, this paper describes the experimental setup realized to test soft and rigid prosthetic feet with lower-limb prosthetic users. It includes a wooden walkway and differently shaped obstacles. It was preliminary validated with an able-bodied subject, the same subject walking on commercial prostheses through modified walking boots, and with a prosthetic user. They performed walking firstly on even ground, and secondly on even ground stepping on one of the obstacles. Results in terms of vertical ground reaction force and knee moments in both the sagittal and frontal planes show how the poor performance of commonly used prostheses is exacerbated in case of obstacles. The prosthetic user, indeed, noticeably relies on the sound leg to compensate for the stiff and unstable interaction of the prosthetic limb with the obstacle. Therefore, since the limitations of non-adaptive prosthetic feet in obstacle-dealing emerge from the experiments, as expected, this study justifies the use of the setup for investigating the performance of soft feet on uneven grounds and obstacle negotiation.

Functional assessment of current upper limb prostheses: An integrated clinical and technological perspective.

Although recent technological developments in the field of bionic upper limb prostheses, their rejection rate remains excessively high. The reasons are diverse (e.g. lack of functionality, control complexity, and comfortability) and most of these are reported only through self-rated questionnaires. Indeed, there is no quantitative evaluation of the extent to which a novel prosthetic solution can effectively address users' needs compared to other technologies. This manuscript discusses the challenges and limitations of current upper limb prosthetic devices and evaluates their functionality through a standard functional assessment, the Assessment of Capacity for Myoelectric Control (ACMC). To include a good representation of technologies, the authors collect information from participants in the Cybathlon Powered Arm Prostheses Race 2016 and 2020. The article analyzes 7 hour and 41 min of video footage to evaluate the performance of different prosthetic devices in various tasks inspired by activities of daily living (ADL). The results show that commercially-available rigid hands perform well in dexterous grasping, while body-powered solutions are more reliable and convenient for competitive environments. The article also highlights the importance of wrist design and control modality for successful execution of ADL. Moreover, we discuss the limitations of the evaluation methodology and suggest improvements for future assessments. With regard to future development, this work highlights the need for research in intuitive control of multiple degrees of freedom, adaptive solutions, and the integration of sensory feedback.

Evaluating the effect of non-invasive force feedback on prosthetic grasp force modulation in participants with and without limb loss.

Grasping an object is one of the most common and complex actions performed by humans. The human brain can adapt and update the grasp dynamics through information received from sensory feedback. Prosthetic hands can assist with the mechanical performance of grasping, however currently commercially available prostheses do not address the disruption of the sensory feedback loop. Providing feedback about a prosthetic hand's grasp force magnitude is a top priority for those with limb loss. This study tested a wearable haptic system, i.e., the Clenching Upper-Limb Force Feedback device (CUFF), which was integrated with a novel robotic hand (The SoftHand Pro). The SoftHand Pro was controlled with myoelectrics of the forearm muscles. Five participants with limb loss and nineteen able-bodied participants completed a constrained grasping task (with and without feedback) which required modulation of the grasp to reach a target force. This task was performed while depriving participants of incidental sensory sources (vision and hearing were significantly limited with glasses and headphones). The data were analyzed with Functional Principal Component Analysis (fPCA). CUFF feedback improved grasp precision for participants with limb loss who typically use body-powered prostheses as well as a sub-set of able-bodied participants. Further testing, that is more functional and allows participants to use all sensory sources, is needed to determine if CUFF feedback can accelerate mastery of myoelectric control or would benefit specific patient sub-groups.

The SoftHand Pro platform: a flexible prosthesis with a user-centered approach.

BACKGROUND: Among commercially-available upper-limb prostheses, the two most often used solutions are simple hook-style grippers and poly-articulated hands, which present a higher number of articulations and show a closer resemblance to biological limbs. In their majority, the former type of prostheses is body-powered, while the second type is controlled by myoelectric signals. Body-powered grippers are easy to control and allow a simple form of force feedback, frequently appreciated by users. However, they present limited versatility. Poly-articulated hands afford a wide range of grasp and manipulation types, but require enough residual muscle activation for dexterous control. Several factors, e.g. level of limb loss, personal preferences, cost, current occupation, and hobbies can influence the preference for one option over the other, and is always a result of the trade-off between system performance and users' needs. METHODS: The SoftHand Pro (SHP) is an artificial hand platform that has 19 independent joints (degrees-of-freedom), but is controlled by a single input. The design of this prosthesis is inspired by the concept of postural synergies in motor control and implemented with soft-robotic technologies. Their combination provides increased robustness, safe interaction and the execution of diverse grasps. The potential of the SHP is fully unleashed when users learn how to exploit its features and create an intimate relationship between the technical aspects of the prosthesis design and its control by the user. RESULTS: The great versatility of the SoftHand Pro (a reasearch protpotype) permitted its adaptation to the user requirements. This was experienced by the SoftHand Pro Team during the preparation for different CYBATHLON events (from 2016 to 2020). The mixed power and dexterous hand operations required by each task of the race is inspired by everyday tasks. Our prosthesis was driven by different pilots, with different habits and backgrounds. Consequently, the hand control modality was customized according to the user's preferences. Furthermore, the CYBATHLON tasks had some variations in this period, promoting the continuous development of our technology with a user-centered approach. In this paper, we describe the participation and preparation of the SoftHand Pro Team from 2016 to 2020 with three pilots and two different activation modalities, hybrid body-controlled and myoelectric control. CONCLUSIONS: We introduced our pilots, the implementation of the two control modalities, and describe the successful participation in all CYBATHLON events. This work proves the versatility of the system towards the user's preferences and the changes in the race requirements. Finally, we discussed how the CYBATHLON experience and the training in the real-world scenario have driven the evolution of our system and gave us remarkable insights for future perspectives.

A soft supernumerary hand for rehabilitation in sub-acute stroke: a pilot study.

In patients with subacute stroke, task specific training (TST) has been shown to accelerate functional recovery of the upper limb. However, many patients do not have sufficient active extension of the fingers to perform this treatment. In these patients, here we propose a new rehabilitation technique in which TST is performed through a soft robotic hand (SoftHand-X). In short, the extension of the robotic fingers is controlled by the patient through his residual, albeit minimal, active extension of the fingers or wrist, while the patient was required to relax the muscles to achieve full flexion of the robotic fingers. TST with SoftHand-X was attempted in 27 subacute stroke patients unable to perform TST due to insufficient active extension of the fingers. Four patients (14.8%) were able to perform the proposed treatment (10 daily sessions of 60 min each). They reported an excellent level of participation. After the treatment, both clinical score of spasticity and its electromyographic correlate (stretch reflex) decreased. In subacute stroke patients, TST using SoftHand-X is a well-accepted treatment, resulting in a decrease of spasticity. At present, it can be applied only in a small proportion of the patients who cannot perform conventional TST, though extensions are possible.

A method to benchmark the balance resilience of robots.

Robots that work in unstructured scenarios are often subjected to collisions with the environment or external agents. Accordingly, recently, researchers focused on designing robust and resilient systems. This work presents a framework that quantitatively assesses the balancing resilience of self-stabilizing robots subjected to external perturbations. Our proposed framework consists of a set of novel Performance Indicators (PIs), experimental protocols for the reliable and repeatable measurement of the PIs, and a novel testbed to execute the protocols. The design of the testbed, the control structure, the post-processing software, and all the documentation related to the performance indicators and protocols are provided as open-source material so that other institutions can replicate the system. As an example of the application of our method, we report a set of experimental tests on a two-wheeled humanoid robot, with an experimental campaign of more than 1100 tests. The investigation demonstrates high repeatability and efficacy in executing reliable and precise perturbations.

Comparison between rigid and soft poly-articulated prosthetic hands in non-expert myo-electric users shows advantages of soft robotics.

Notwithstanding the advancement of modern bionic hands and the large variety of prosthetic hands in the market, commercial devices still present limited acceptance and percentage of daily use. While commercial prostheses present rigid mechanical structures, emerging trends in the design of robotic hands are moving towards soft technologies. Although this approach is inspired by nature and could be promising for prosthetic applications, there is scant literature concerning its benefits for end-users and in real-life scenarios. In this work, we evaluate and assess the role and the benefits of soft robotic technologies in the field of prosthetics. We propose a thorough comparison between rigid and soft characteristics of two poly-articulated hands in 5 non-expert myo-electric prosthesis users in pre- and post-therapeutic training conditions. The protocol includes two standard functional assessments, three surveys for user-perception, and three customized tests to evaluate the sense of embodiment. Results highlight that rigid hands provide a more precise grasp, while soft properties show higher functionalities thanks to their adaptability to different requirements, intuitive use and more natural execution of activities of daily living. This comprehensive evaluation suggests that softness could also promote a quick integration of the system in non-expert users.

Usability Assessment of Body Controlled Electric Hand Prostheses: A Pilot Study.

Poly-articulated hands, actuated by multiple motors and controlled by surface myoelectric technologies, represent the most advanced aids among commercial prostheses. However, simple hook-like body-powered solutions are still preferred for their robustness and control reliability, especially for challenging environments (such as those encountered in manual work or developing countries). This study presents the mechatronic implementation and the usability assessment of the SoftHand Pro-Hybrid, a family of poly-articulated, electrically-actuated, and body-controlled artificial hands, which combines the main advantages of both body-powered and myoelectric systems in a single device. An assessment of the proposed system is performed with individuals with and without limb loss, using as a benchmark the SoftHand Pro, which shares the same soft mechanical architecture, but is controlled using surface electromyographic sensors. Results indicate comparable task performance between the two control methods and suggest the potential of the SoftHand Pro-Hybrid configurations as a viable alternative to myoelectric control, especially in work and demanding environments.

A Supernumerary Soft Robotic Limb for Reducing Hand-Arm Vibration Syndromes Risks.

The most common causes of the risk of work-related musculoskeletal disorders (WMSD) have been identified as joint overloading, bad postures, and vibrations. In the last two decades, various solutions ranging from human-robot collaborative systems to robotic exoskeletons have been proposed to mitigate them. More recently, a new approach has been proposed with a high potential in this direction: the supernumerary robotic limbs SRLs are additional robotic body parts (e.g., fingers, legs, and arms) that can be worn by the workers, augmenting their natural ability and reducing the risks of injuries. These systems are generally proposed in the literature for their potentiality of augmenting the user's ability, but here we would like to explore this kind of technology as a new generation of (personal) protective equipment. A supernumerary robotic upper limb, for example, allows for indirectly interacting with hazardous objects like chemical products or vibrating tools. In particular, in this work, we present a supernumerary robotic limbs system to reduce the vibration transmitted along the arms and minimize the load on the upper limb joints. For this purpose, an off-the-shelf wearable gravity compensation system is integrated with a soft robotic hand and a custom damping wrist, designed starting from theoretical considerations on a mass-spring-damper model. The real efficacy of the system was experimentally tested within a simulated industrial work environment, where seven subjects performed a drilling task on two different materials. Experimental analysis was conducted according to the ISO-5349. Results showed a reduction from 40 to 60% of vibration transmission with respect to the traditional hand drilling using the presented SRL system without compromising the time performance.

An Open-Source ROS-Gazebo Toolbox for Simulating Robots With Compliant Actuators.

To enable the design of planning and control strategies in simulated environments before their direct application to the real robot, exploiting the Sim2Real practice, powerful and realistic dynamic simulation tools have been proposed, e.g., the ROS-Gazebo framework. However, the majority of such simulators do not account for some of the properties of recently developed advanced systems, e.g., dynamic elastic behaviors shown by all those robots that purposely incorporate compliant elements into their actuators, the so-called Articulated Soft Robots ASRs. This paper presents an open-source ROS-Gazebo toolbox for simulating ASRs equipped with the aforementioned types of compliant actuators. To achieve this result, the toolbox consists of two ROS-Gazebo modules: a plugin that implements the custom compliant characteristics of a given actuator and simulates the internal motor dynamics, and a Robotic Operation System (ROS) manager node used to organize and simplify the overall toolbox usage. The toolbox can implement different compliant joint structures to perform realistic and representative simulations of ASRs, also when they interact with the environment. The simulated ASRs can be also used to retrieve information about the physical behavior of the real system from its simulation, and to develop control policies that can be transferred back to the real world, leveraging the Sim2Real practice. To assess the versatility of the proposed plugin, we report simulations of different compliant actuators. Then, to show the reliability of the simulated results, we present experiments executed on two ASRs and compare the performance of the real hardware with the simulations. Finally, to validate the toolbox effectiveness for Sim2Real control design, we learn a control policy in simulation, then feed it to the real system in feed-forward comparing the results.

A Configurable Architecture for Two Degree-of-Freedom Variable Stiffness Actuators to Match the Compliant Behavior of Human Joints.

Living beings modulate the impedance of their joints to interact proficiently, robustly, and safely with the environment. These observations inspired the design of soft articulated robots with the development of Variable Impedance and Variable Stiffness Actuators. However, designing them remains a challenging task due to their mechanical complexity, encumbrance, and weight, but also due to the different specifications that the wide range of applications requires. For instance, as prostheses or parts of humanoid systems, there is currently a need for multi-degree-of-freedom joints that have abilities similar to those of human articulations. Toward this goal, we propose a new compact and configurable design for a two-degree-of-freedom variable stiffness joint that can match the passive behavior of a human wrist and ankle. Using only three motors, this joint can control its equilibrium orientation around two perpendicular axes and its overall stiffness as a one-dimensional parameter, like the co-contraction of human muscles. The kinematic architecture builds upon a state-of-the-art rigid parallel mechanism with the addition of nonlinear elastic elements to allow the control of the stiffness. The mechanical parameters of the proposed system can be optimized to match desired passive compliant behaviors and to fit various applications (e.g., prosthetic wrists or ankles, artificial wrists, etc.). After describing the joint structure, we detail the kinetostatic analysis to derive the compliant behavior as a function of the design parameters and to prove the variable stiffness ability of the system. Besides, we provide sets of design parameters to match the passive compliance of either a human wrist or ankle. Moreover, to show the versatility of the proposed joint architecture and as guidelines for the future designer, we describe the influence of the main design parameters on the system stiffness characteristic and show the potential of the design for more complex applications.

Integrating Wearable Haptics and Obstacle Avoidance for the Visually Impaired in Indoor Navigation: A User-Centered Approach.

Recently, in the attempt to increase blind people autonomy and improve their quality of life, a lot of effort has been devoted to develop technological travel aids. These systems can surrogate spatial information about the environment and deliver it to end-users through sensory substitution (auditory, haptic). However, despite the promising research outcomes, these solutions have met scarce acceptance in real-world. Often, this is also due to the limited involvement of real end users in the conceptual and design phases. In this article, we propose a novel indoor navigation system based on wearable haptic technologies. All the developmental phases were driven by continuous feedback from visually impaired persons. The proposed travel aid system consists of a RGB-D camera, a processing unit to compute visual information for obstacle avoidance, and a wearable device, which can provide normal and tangential force cues for guidance in an unknown indoor environment. Experiments with blindfolded subjects and visually impaired participants show that our system could be an effective support during indoor navigation, and a viable tool for training blind people to the usage of travel aids.

A wearable wrist haptic display for motion tracking and force feedback in the operational space.

Force feedback is often beneficial for robotic teleoperation, as it enhances the user's remote perception. Over the years, many kinesthetic haptic displays (KHDs) have been proposed for this purpose, which have different types of interaction and feedback, depending on their kinematics and their interface with the operator, including, for example, grounded and wearable devices acting either at the joint or operational space (OS) level. Most KHDs in the literature are for the upper limb, with a majority acting at the shoulder/elbow level, and others focusing on hand movements. A minority exists which addresses wrist motions. In this paper, we present the Wearable Delta (W), a proof-of-concept wearable wrist interface with hybrid parallel-serial kinematics acting in the OS, able to render a desired force directly to the hand involving just the forearm-hand subsystem. It has six degrees of freedom (DoFs), three of which are actuated, and is designed to reduce the obstruction of the range of the user's wrist. Integrated with positions/inertial sensors at the elbow and upper arm, the W allows the remote control of a full articulated robotic arm. The paper covers the whole designing process, from the concept to the validation, as well as a multisubject experimental campaign that investigates its usability. Finally, it presents a section that, starting from the experimental results, aims to discuss and summarize the W advantages and limitations and look for possible future improvements and research directions.

A novel mechatronic system for evaluating elbow muscular spasticity relying on Tonic Stretch Reflex Threshold estimation.

Muscular spasticity represents one of the most common motor disorder associated to lesions of the Central Nervous System, such as Stroke, and affects joint mobility up to the complete prevention of skeletal muscle voluntary control. Its clinical evaluation is hence of fundamental relevance for an effective rehabilitation of the affected subjects. Standard assessment protocols are usually manually performed by humans, and hence their reliability strongly depends on the capabilities of the clinical operator performing the procedures. To overcome this limitation, one solution is the usage of mechatronic devices based on the estimation of the Tonic Stretch Reflex Threshold, which allows for a quite reliable and operator-independent evaluation. In this work, we present the design and characterization of a novel mechatronic device that targets the estimation of the Tonic Stretch Reflex Threshold at the elbow level, and, at the same time, it can potentially act as a rehabilitative system. Our device can deliver controllable torque/velocity stimulation and record functional parameters of the musculo-skeletal system (joint position, torque, and multi-channel ElectroMyoGraphyc patterns), with the ultimate goals of: i) providing significant information for the diagnosis and the classification of muscular spasticity, ii) enhancing the recovery evaluation of patients undergoing through therapeutic rehabilitation procedures and iii) enabling a future active usage of this device also as therapeutic tool.Clinical relevance- The contribution presented in this work proposes a technological advancement for a device-based evaluation of motion impairment related to spasticity, with a major potential impact on both the clinical appraisal and the rehabilitation procedures.

Exploring augmented grasping capabilities in a multi-synergistic soft bionic hand.

BACKGROUND: State-of-the-art bionic hands incorporate hi-tech devices which try to overcome limitations of conventional single grip systems. Unfortunately, their complexity often limits mechanical robustness and intuitive prosthesis control. Recently, the translation of neuroscientific theories (i.e. postural synergies) in software and hardware architecture of artificial devices is opening new approaches for the design and control of upper-limb prostheses. METHODS: Following these emerging principles, previous research on the SoftHand Pro, which embeds one physical synergy, showed promising results in terms of intuitiveness, robustness, and grasping performance. To explore these principles also in hands with augmented capabilities, this paper describes the SoftHand 2 Pro, a second generation of the device with 19 degrees-of-freedom and a second synergistic layer. After a description of the proposed device, the work explores a continuous switching control method based on a myoelectric pattern recognition classifier. RESULTS: The combined system was validated using standardized assessments with able-bodied and, for the first time, amputee subjects. Results show an average improvement of more than 30% of fine grasp capabilities and about 10% of hand function compared with the first generation SoftHand Pro. CONCLUSIONS: Encouraging results suggest how this approach could be a viable way towards the design of more natural, reliable, and intuitive dexterous hands.

Evaluation of a Simultaneous Myoelectric Control Strategy for a Multi-DoF Transradial Prosthesis.

While natural movements result from fluid coordination of multiple joints, commercial upper-limb prostheses are still limited to sequential control of multiple degrees of freedom (DoFs), or constrained to move along predefined patterns. To control multiple DoFs simultaneously, a probability-weighted regression (PWR) method has been proposed and has previously shown good performance with intramuscular electromyographic (EMG) sensors. This study aims to evaluate the PWR method for the simultaneous and proportional control of multiple DoFs using surface EMG sensors and compare the performance with a classical direct control strategy. To extract the maximum number of DoFs manageable by a user, a first analysis was conducted in a virtually simulated environment with eight able-bodied and four amputee subjects. Results show that, while using surface EMG degraded the PWR performance for the 3-DoFs control, the algorithm demonstrated excellent achievements in the 2-DoFs case. Finally, the two methods were compared on a physical experiment with amputee subjects using a hand-wrist prosthesis composed of the SoftHand Pro and the RIC Wrist Flexor. Results show comparable outcomes between the two controllers but a significantly higher wrist activation time for the PWR method, suggesting this novel method as a viable direction towards a more natural control of multi-DoFs.

Exploring Stiffness Modulation in Prosthetic Hands and Its Perceived Function in Manipulation and Social Interaction.

To physically interact with a rich variety of environments and to match situation-dependent requirements, humans adapt both the force and stiffness of their limbs. Reflecting this behavior in prostheses may promote a more natural and intuitive control and, consequently, improve prostheses acceptance in everyday life. This pilot study proposes a method to control a prosthetic robot hand and its impedance, and explores the utility of variable stiffness when performing activities of daily living and physical social interactions. The proposed method is capable of a simultaneous and proportional decoding of position and stiffness intentions from two surface electro-myographic sensors placed over a pair of antagonistic muscles. The feasibility of our approach is validated and compared to existing control modalities in a preliminary study involving one prosthesis user. The algorithm is implemented in a soft under-actuated prosthetic hand (SoftHand Pro). Then, we evaluate the usability of the proposed approach while executing a variety of tasks. Among these tasks, the user interacts with other 12 able-bodied subjects, whose experiences were also assessed. Several statistically significant aspects from the System Usability Scale indicate user's preference of variable stiffness control over low or high constant stiffness due to its reactivity and adaptability. Feedback reported by able-bodied subjects reveal a general tendency to favor soft interaction, i.e., low stiffness, which is perceived more human-like and comfortable. These combined results suggest the use of variable stiffness as a viable compromise between firm control and safe interaction which is worth investigating further.

A Novel Soft Robotic Supernumerary Hand for Severely Affected Stroke Patients.

Upper limb functions are severely affected in 23% of the chronic stroke patients, compromising their life quality. To re-enable hand use, providing a degree of functionality and motivating against learned non-use, we propose a robotic supernumerary limb, the SoftHand X (SHX), consisting of a robotic hand, a gravity support system, and different sensors to detect the patient's intent for controlling the robotic hand. In this paper, this novel compensational approach is introduced and experimentally evaluated in stroke patients, assessing its efficacy, usability and safety. Ten patients were asked to perform tasks of a modified Action Research Arm Test with the SHX, by using three input methods. The mARAT scores rated the potentiality of the system. Usability was evaluated with the System Usability Scale, while spasticity before and after use was measured by the modified Ashworth Scale (mAS). Nine patients, not able to perform any tasks without external support, completed the whole experimental procedure using the proposed system with a median score greater than 12/30. Among the three input methods tested, the usability of one was rated as "good" while the other two were rated as "ok". Seven patients exhibited a reduction of the mAS. All nine patients stated that they would use the system frequently. Results obtained suggest that the SHX has the potential to partially compensate severely impaired hand function in stroke patients.