Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors.

OBJECTIVE: Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. APPROACH: In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30-minute treatment of continuous passive motion (CPM) using a robotic glove. MAIN RESULTS: On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. SIGNIFICANCE: This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.

Functional connectivity of brain associated with passive range of motion exercise: Proprioceptive input promoting motor activation?

Soft robotics have come to the forefront of devices available for rehabilitation following stroke; however, objective evaluation of the specific brain changes following rehabilitation with these devices is lacking. In this study, we utilized functional Magnetic Resonance Imaging (fMRI) and dynamic causal modeling (DCM) to characterize the activation of brain areas with a MRI compatible glove actuator compared to the conventional manual therapy. Thirteen healthy volunteers engaged in a motor-visual fMRI task under four different conditions namely active movement, manual passive movement, passive movement using a glove actuator, and crude tactile stimulation. Brain activity following each task clearly identified the somatosensory motor area (SMA) as a major hub orchestrating activity between the primary motor (M1) and sensory (S1) cortex. During the glove-induced passive movement, activity in the motor-somatosensory areas was reduced, but there were significant increases in motor cortical activity compared to manual passive movement. We estimated the modulatory signaling from within a defined sensorimotor network (SMA, M1, and S1), through DCM and highlighted a dual-gating of sensorimotor inputs to the SMA. Proprioceptive signaling from S1 to the SMA reflected positive coupling for the manually assisted condition, while M1 activity was positively coupled to the SMA during the glove condition. Importantly, both the S1 and M1 were shown to influence each other's connections with the SMA, with inhibitory nonlinear modulation by the M1 on the S1-SMA connection, and similarly S1 gated the M1-SMA connection. The work is one of the first to have applied effective connectivity to examine sensorimotor activity ensued by manual or robotic passive range of motion exercise, crude tactile stimulation, and voluntary movements to provide a basis for the mechanism by which soft actuators can alter brain activity.

Corrigendum: Design and Preliminary Feasibility Study of a Soft Robotic Glove for Hand Function Assistance in Stroke Survivors.

[This corrects the article on p. 547 in vol. 11, PMID: 29062267.].

Stiffness Customization and Patterning for Property Modulation of Silicone-Based Soft Pneumatic Actuators.

Soft pneumatic actuators (SPAs), as novel types of motion drivers for robotic devices, excel in many applications, such as rehabilitation and biomimicry, which demand compliance and softness. To further expand their scope of utilization, the SPAs should be customizable to meet the distinctive requirements of different applications. This article proposes a novel perspective on the SPA working mechanism based on stiffness distribution and then presents a versatile method called stiffness customization and patterning (SCP) for SPA body stiffness layout as a novel attempt to customize SPAs with distinctive properties. We fabricated a hybrid type of material combining unstretchable material and silicone with customizable aggregated elasticity. The tensile results showed that embedding unstretchable material directly increases the stiffness of the hybrid material sample, and our stress-strain model for SCP is able to adequately predict the elasticity of hybrid samples with specific material ratios. By applying this approach to bending-type SPAs, we are able to mitigate SPA buckling, a main failure mode of SPAs, and improve the SPA tip force by using hybrid material with globally increased stiffness. We also diversify bending modalities with different stiffness configurations in the hybrid material. SCP offers numerous ways to engineer SPAs for more applications.

Design of a Soft Robotic Elbow Sleeve with Passive and Intent-Controlled Actuation.

The provision of continuous passive, and intent-based assisted movements for neuromuscular training can be incorporated into a robotic elbow sleeve. The objective of this study is to propose the design and test the functionality of a soft robotic elbow sleeve in assisting flexion and extension of the elbow, both passively and using intent-based motion reinforcement. First, the elbow sleeve was developed, using elastomeric and fabric-based pneumatic actuators, which are soft and lightweight, in order to address issues of non-portability and poor alignment with joints that conventional robotic rehabilitation devices are faced with. Second, the control system was developed to allow for: (i) continuous passive actuation, in which the actuators will be activated in cycles, alternating between flexion and extension; and (ii) an intent-based actuation, in which user intent is detected by surface electromyography (sEMG) sensors attached to the biceps and triceps, and passed through a logic sequence to allow for flexion or extension of the elbow. Using this setup, the elbow sleeve was tested on six healthy subjects to assess the functionality of the device, in terms of the range of motion afforded by the device while in the continuous passive actuation. The results showed that the elbow sleeve is capable of achieving approximately 50% of the full range of motion of the elbow joint among all subjects. Next, further experiments were conducted to test the efficacy of the intent-based actuation on these healthy subjects. The results showed that all subjects were capable of achieving electromyography (EMG) control of the elbow sleeve. These preliminary results show that the elbow sleeve is capable of carrying out continuous passive and intent-based assisted movements. Further investigation of the clinical implementation of the elbow sleeve for the neuromuscular training of neurologically-impaired persons, such as stroke survivors, is needed.

Design and Preliminary Feasibility Study of a Soft Robotic Glove for Hand Function Assistance in Stroke Survivors.

Various robotic exoskeletons have been proposed for hand function assistance during activities of daily living (ADL) of stroke survivors. However, traditional exoskeletons involve the use of complex rigid systems that impede the natural movement of joints, and thus reduce the wearability and cause discomfort to the user. The objective of this paper is to design and evaluate a soft robotic glove that is able to provide hand function assistance using fabric-reinforced soft pneumatic actuators. These actuators are made of silicone rubber which has an elastic modulus similar to human tissues. Thus, they are intrinsically soft and compliant. Upon air pressurization, they are able to support finger range of motion (ROM) and generate the desired actuation of the finger joints. In this work, the soft actuators were characterized in terms of their blocked tip force, normal and frictional grip force outputs. Combining the soft actuators and flexible textile materials, a soft robotic glove was developed for grasping assistance during ADL for stroke survivors. The glove was evaluated on five healthy participants for its assisted ROM and grip strength. Pilot test was performed in two stroke survivors to evaluate the efficacy of the glove in assisting functional grasping activities. Our results demonstrated that the actuators designed in this study could generate desired force output at a low air pressure. The glove had a high kinematic transparency and did not affect the active ROM of the finger joints when it was being worn by the participants. With the assistance of the glove, the participants were able to perform grasping actions with sufficient assisted ROM and grip strength, without any voluntary effort. Additionally, pilot test on stroke survivors demonstrated that the patient's grasping performance improved with the presence and assistance of the glove. Patient feedback questionnaires also showed high level of patient satisfaction and comfort. In conclusion, this paper has demonstrated the possibility of using soft wearable exoskeletons that are more wearable, lightweight, and suitable to be used on a daily basis for hand function assistance of stroke survivors during activities of daily living.

Design and characterization of low-cost fabric-based flat pneumatic actuators for soft assistive glove application.

We present the design of low-cost fabric-based Hat pneumatic actuators for soft assistive glove application. The soft assistive glove is designed to assist hand impaired patients in performing activities of daily living and rehabilitation. The actuators consist of flexible materials such as fabric and latex bladder. Using zero volume actuation concept, the 2D configuration of the actuators simplifies the manufacturing process and allows the actuators to be more compact. The actuators achieve bi-directional flexion and extension motions. Compared to previously developed inflatable soft actuators, the actuators generate sufficient force and torque to assist in both finger flexion and extension at lower air pressure. Preliminary evaluation results show that the glove is able to provide both active finger flexion and extension assistance for activities of daily living and rehabilitative training.

Characterisation and evaluation of soft elastomeric actuators for hand assistive and rehabilitation applications.

Various hand exoskeletons have been proposed for the purposes of providing assistance in activities of daily living and rehabilitation exercises. However, traditional exoskeletons are made of rigid components that impede the natural movement of joints and cause discomfort to the user. This paper evaluated a soft wearable exoskeleton using soft elastomeric actuators. The actuators could generate the desired actuation of the finger joints with a simple design. The actuators were characterised in terms of their radius of curvature and force output during actuation. Additionally, the device was evaluated on five healthy subjects in terms of its assisted finger joint range of motion. Results demonstrated that the subjects were able to perform the grasping actions with the assistance of the device and the range of motion of individual finger joints varied from subject to subject. This work evaluated the performance of a soft wearable exoskeleton and highlighted the importance of customisability of the device. It demonstrated the possibility of replacing traditional rigid exoskeletons with soft exoskeletons that are more wearable and customisable.