Hybrid Functional Electrical Stimulation and Robotic Assistance for Wrist Motion Training After Stroke: Preliminary Results.

This work presents preliminary results of a clinical study with sub-acute stroke patients using a hybrid system for wrist rehabilitation. The patients trained their wrist flexion/extension motion through a target tracking task, where electrical stimulation and robotic torque assisted them proportionally to their tracking error. Five sub-acute stroke patients have completed the training for 3 sessions on separate days. The preliminary results show hybrid assistance improves tracking performance and motion smoothness in most participants. In each session, patients' tracking performances before and after training were evaluated in unassisted tracking trials, without assistance. Their unassisted performance was compared across sessions and the results suggest that moderately to severely impaired patients might benefit more from hybrid training with our system than mildly impaired patients. Subjective assessments from all sessions show that the patients found the use of the device very comfortable and the training enjoyable. More data is being collected and future work will aim at verifying these trends.

Hybrid Robotic and Electrical Stimulation Assistance Can Enhance Performance and Reduce Mental Demand.

Combining functional electrical stimulation (FES) and robotics may enhance recovery after stroke, by providing neural feedback with the former while improving quality of motion and minimizing muscular fatigue with the latter. Here, we explored whether and how FES, robot assistance and their combination, affect users' performance, effort, fatigue and user experience. 15 healthy participants performed a wrist flexion/extension tracking task with FES and/or robotic assistance. Tracking performance improved during the hybrid FES-robot and the robot-only assistance conditions in comparison to no assistance, but no improvement is observed when only FES is used. Fatigue, muscular and voluntary effort are estimated from electromyographic recording. Total muscle contraction and volitional activity are lowest with robotic assistance, whereas fatigue level do not change between the conditions. The NASA-Task Load Index answers indicate that participants found the task less mentally demanding during the hybrid and robot conditions than the FES condition. The addition of robotic assistance to FES training might thus facilitate an increased user engagement compared to robot training and allow longer motor training session than with FES assistance.

Integrating hand exoskeletons into goal-oriented clinic and home stroke and spinal cord injury rehabilitation.

Introduction: Robotic exoskeletons are emerging as rehabilitation and assistive technologies that simultaneously restore function and enable independence for people with disabilities. Aim: We investigated the feasibility and orthotic and restorative effects of an exoskeleton-supported goal-directed rehabilitation program for people with hand impairments after stroke or Spinal Cord Injury (SCI). Method: A single-arm case-series feasibility study was conducted using a wearable untethered hand exoskeleton during goal-directed therapy programs with in-clinic and at-home components. Therapists trained stroke and SCI patients to use a hand exoskeleton during rehabilitation exercises, activities of daily living and patient-selected goals. Each patient received a 1-hour in-clinic training session on five consecutive days, then took the exoskeleton home for two consecutive days to perform therapist-recommended tasks. Goal Attainment Scaling (GAS) and the Box and Block Test (BBT) were administered at baseline, after in-clinic therapy and after home use, with and again without wearing the exoskeleton. The System Usability Scale (SUS), Motor Activity Log, and Fugl-Meyer Assessment were also administered to assess the intervention's acceptability, adherence, usability and effectiveness. Results: Four stroke patients (Chedoke McMaster Stage of Hand 2-4) and one SCI patient (ASIA C8 Motor Stage 1) 23 ± 19 months post-injury wore the hand exoskeleton to perform 280 ± 23 exercise repetitions in the clinic and additional goal-oriented tasks at home. The patients performed their own goals and the dexterity task with higher performance following the 7-days therapy program in comparison to baseline for both exoskeleton-assisted (ΔGAS: 18 ± 10, ΔBBT: 1 ± 5) and unassisted (ΔGAS: 14 ± 14, ΔBBT: 3 ± 4) assessments. Therapists and patients provided 'good' SUS ratings of 78 ± 6 and no harmful events were reported. Conclusions: The exoskeleton-supported stroke and SCI therapy program with in-clinic and at-home training components was feasible.

Short Time Delay Does Not Hinder Haptic Communication Benefits.

Haptic communication, the exchange of force and tactile information during dancing or moving a table together, has been shown to benefit the performance of human partners. Similarly, it could also be used to improve the performance of robots working in contact with a human operator. As we move to more robot integrated workspaces, how common network features such as delay or jitter impact haptic communication need to be better understood. Here using a human-like interactive robotic controller, that has been found to be indistinguishable by humans to human interaction, we evaluate how subjects' performance and perception is altered by varying levels of transmission delay. We find that subjects are able to recognise haptic delay at very small levels within haptic interaction. However, while they are consciously aware of the delay they can only compensate for it up until a certain point, after which they perceive it as the addition of noise/impedance into the system.

3-Dimensional printing in rehabilitation: feasibility of printing an upper extremity gross motor function assessment tool.

BACKGROUND: Use of standardized and scientifically sound outcome measures is encouraged in clinical practice and research. With the development of newer rehabilitation therapies, we need technology-supported upper extremity outcome measures that are easily accessible, reliable and valid. 3-Dimensional printing (3D-printing) has recently seen a meteoric rise in interest within medicine including the field of Physical Medicine and Rehabilitation. The primary objective of this study was to evaluate the feasibility of designing and constructing a 3D printed version of the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT). The TRI-HFT is an upper extremity gross motor function assessment tool that measures function at the intersection of the International Classification of Function's body structure and function, and activity domain. The secondary objective was to assess the preliminary psychometrics of this test in individuals with stroke. RESULTS: 3D design files were created using the measurements of the original TRI-HFT objects. The 3D printed objects were then compared to the original test objects to ensure that the original dimensions were preserved. All objects were successfully printed except the sponge and paper which required some modification. The error margin for weight of the objects was within 10% of the original TRI-HFT for the rest of the objects. Nine participants underwent the following assessments: the Chedoke Arm and Hand Activity Inventory (CAHAI), Fugl Meyer Assessment-Hand (FMA-Hand), Chedoke McMaster stages of recovery of the arm (CMSA-Arm) and Chedoke McMaster stages of recovery of the hand (CMSA-Hand) and the 3D TRI-HFT for assessment of psychometric properties of the test. The video recorded assessment of the 3D TRI-HFT was used for reliability testing. Construct validity was assessed by comparing the scores on 3D TRI-HFT with the scores on CAHAI, CMSA-Arm, CMSA-Hand and FMA-Hand. The 3D TRI-HFT had high inter-rater reliability (Intra-Class Correlation Co-efficient (ICC) of 0.99; P < 0.000), high intra-rater reliability (ICC of 0.99; P < 0.000) and moderate-to-strong correlation with the CMSA-Arm, CMSA-Hand and FMA-Hand scores. CONCLUSIONS: The TRI-HFT could be successfully 3D printed and initial testing indicates that the test is a reliable and valid measure of upper extremity motor function in individuals with stroke.

Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke.

BACKGROUND: The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable. METHODS: Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1-4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove. RESULTS: The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were 'more or less satisfied' with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands. CONCLUSIONS: The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.

Myoelectric untethered robotic glove enhances hand function and performance on daily living tasks after stroke.

INTRODUCTION: Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently. METHODS: We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance. RESULTS: The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines. CONCLUSIONS: People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.

Hand Extension Robot Orthosis (HERO) Glove: Development and Testing With Stroke Survivors With Severe Hand Impairment.

The hand extension robot orthosis (HERO) glove was iteratively designed with occupational therapists and stroke survivors to enable stroke survivors with severe hand impairment to grasp and stabilize everyday objects, while being portable, lightweight, and easy to set up and use. The robot consists of a batting glove with artificial tendons embedded into the glove's fingers. The tendons are pulled and pushed by a linear actuator to extend and flex the fingers. The robot's finger extension and grasp assistance are automated using inertial measurement unit signal thresholds. Five stroke survivors (Chedoke McMaster Stroke Assessment - Stage of Hand 1-3) put on the HERO Glove in 1-3 minutes, with assistance. The stroke survivors performed significantly better on the Box and Block Test (2.8 more blocks transferred, ) while wearing the HERO Glove than when not wearing the glove. Four stroke survivors could only transfer blocks while wearing the HERO Glove. The HERO Glove enabled these stroke survivors to more fully extend their index finger (an increase of 97.5°, ) and three of five stroke survivors were better able grasp a water bottle. Therapists and stroke survivors suggested increasing the HERO Glove's grip force assistance and valued the glove's portability, lightweight design and potential usefulness in assisting with task-based therapy.