Neurorehabilitation research suggests that not only high training intensity, but also somatosensory information plays a fundamental role in the recovery of stroke patients. Yet, there is currently a lack of easy-to-use robotic solutions for sensorimotor hand rehabilitation. We addressed this shortcoming by developing a novel clinical-driven robotic hand rehabilitation device, which is capable of fine haptic rendering, and that supports physiological full flexion/extension of the fingers while offering an effortless setup. Our palmar design, based on a parallelogram coupled to a principal revolute joint, introduces the following novelties: (1) While allowing for an effortless installation of the user's hand, it offers large range of motion of the fingers (full extension to 180° flexion). (2) The kinematic design ensures that all fingers are supported through the full range of motion and that the little finger does not lose contact with the finger support in extension. (3) We took into consideration that a handle is usually comfortably grasped such that its longitudinal axis runs obliquely from the metacarpophalangeal joint of the index finger to the base of the hypothenar eminence. (4) The fingertip path was optimized to guarantee physiologically correct finger movements for a large variety of hand sizes. Moreover, the device possesses a high mechanical transparency, which was achieved using a backdrivable cable transmission. The transparency was further improved with the implementation of friction and gravity compensation. In a test with six healthy participants, the root mean square of the human-robot interaction force was found to remain as low as 1.37 N in a dynamic task. With its clinical-driven design and easy-to-use setup, our robotic device for hand sensorimotor rehabilitation has the potential for high clinical acceptance, applicability and effectiveness.
In order to identify the clinical requirements for a novel upper-limb robotic device for sensorimotor neurorehabilitation, a survey with 33 participants (including physiotherapists, occupational therapists, speech therapists, nurses and physicians) was conducted. The results show that grasping, eating and personal hygiene are amongst the most important activities of daily living to be exercised. Hand/finger extension were reported as crucial movements. In serious games for neurorehabilitation, adjustable quantity of virtual objects as well as adjustable game difficulty are highly demanded features. The majority of the participants would like to spend less than 10 minutes for the setup of a robotic device.
Sensorimotor impairments of the hand after stroke can drastically reduce the ability to perform activities of daily living. Recently, there has been an increased interest in minimally supervised and unsupervised rehabilitation to increase therapy dosage and to complement conventional therapy. Several devices have been developed that are simple to use and portable. Yet, they do not incorporate diversified somatosensory feedback, which has been suggested to promote sensorimotor recovery. Here we present the prototype of a portable onedegree-of-freedom hand trainer based on a novel compliant shell mechanism. Our solution is safe, intuitive, and can be used for various hand sizes. Importantly, it also provides rich sensory feedback through haptic rendering. We complement our device with a rehabilitation game, where we leverage interactive tangible game elements with diverse haptic characteristics to provide somatosensory training and foster recovery.
To address the clinical need for high-intensity, repetitive sensorimotor hand training after stroke, we developed in a first step a novel haptic device for practicing finger movements. Because the thumb plays a fundamental role in the loss of autonomy and prehensile functions after stroke, we present here the development of a thumb module that complements our previous design. The novelties of our device are that it reduces the complexity to a minimum from a user perspective while still allowing anatomical thumb flexion/extension and circumduction movements with a highly functional range of motion. Moreover, it enables sensorimotor training thanks to its backlash-free and backdrivable actuation that allows for high-quality haptic rendering. Our device was co-created together with clinicians to incorporate clinical and anatomical requirements, and therefore, maximize its clinical relevance.
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