Upper Limb Exosuit for Clinic Assistance
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Aim is to do a feasibility and refinement trial to assess the safety and comfort of the
      robotic device and their preliminary effect on muscular activity during the performance of
      activities of daily living.

      The study was carried out with 10 stroke participants who had to carry out a series of 10
      functional tasks with and without the suit over 3 sessions.

      The results are encouraging and show the potential of using wearable robotic devices in a
      clinical setting.
    

Detailed description: 
      Each participant completed 3 ninety-minute long sessions at CART over the course of a week.
      All participants were closely supervised by 1 occupational therapist and 1 engineer involved
      in the development of the devices. In the first session, screening of the patient was
      performed, where the patient's demographics and clinical parameters were collected, including
      the grip strength of the affected hand measured by a hand dynamometer taking the mean of 2
      attempts, and MOCA, FMA and MAS scores. Afterwards, a familiarisation phase was conducted,
      where the participant trialled the robotic devices to understand their mechanisms and learn
      how to use them. This phase also allowed the researchers to adjust the fitting of the
      exoskeletons and tuning the control algorithm of the elbow exoskeleton to the biomechanics of
      each user, in order to achieve best comfort and assistance.

      The participants were instructed to perform a series of elbow/finger flexion and extension
      movements to understand how to control the exoskeletons. The participants also interacted
      with different objects (cup, cube, ball) to adjust the positioning of the anchor points in
      the glove to the position the participants felt most comfortable with. Once the optimised
      fitting of the devices was identified, the obtained parameters were stored, and the
      configuration of the devices was left unchanged for reuse in the next session.

      In the 2 remaining sessions, participants performed a series of 10 functional tasks. The
      tasks were performed without assistance (NO-EXO condition) and with assistance (EXO
      condition) of the exoskeletons. The tasks were performed first in the unpowered condition to
      allow the participants to familiarise themselves with the tasks before performing them with
      the assistance of the devices.

      The participants were instructed to start every attempt at a task from a position marked on
      the floor, and with their arms fully relaxed. This was to ensure that variability from
      unknown factors was minimised. The participants then awaited the instruction from the
      researchers to commence the task, given in the form of a spoken command triggered by the
      press of a button. The button was pressed again to signal the end of the task, defined by the
      following in order of priority: 1) participant decided to stop; 2) the participant dropped
      the object; 3) therapist decided to stop after deciding the participant was experiencing
      difficulties and further attempts would not contribute to a successful performance of the
      task; 4) task is successfully completed.

      In addition to the performance of functional tasks, the standing horizontal fingertip
      reaching distance and the elbow ROM were measured using a measuring tape and a goniometer,
      respectively.

      At the end of the 3rd session, the participants were asked to fill up a questionnaire to
      provide their subjective feedback regarding comfort, ergonomics, ease of use, overall
      clinical benefit and user satisfaction.
    

Intervention name(s): Custom-made upper limb exosuit and hand exoskeleton
Intervention type(s): Device
Intervention description(s): Participants go through 3 90-min sessions in a clinic setting and perform a series of functional tasks adapted from motor activity log and bilateral upper limb tasks with and without the device.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Device Feasibility
Keywords: exoskeleton; robot; stroke; upper limb; hand; assistance