# Design Methodology for Soft Wearable Devices--The MOSAR Case
## 3 Methodology Implementation: The MOSAR Case
### Phase 1: Identification of the Necessity  
To start with the MOSAR development, assessments from a neurologist and a physical therapist, together with EMG tests, were carried out on the patient to evaluate his clinical condition, as follows. 1. **Neurologist's diagnosis. ** The specialist confirmed that hemiplegia on the right side of the patient was caused by a perinatal stroke that affected the left hemisphere due to the lack of oxygen. This specialist also reported that hemiplegia is currently on a chronic phase and the patient presents intellectual disability. Furthermore, patient's muscles are still functional but spastic. The neurologist recommends arm, hand and face rehabilitation to stimulate the cortex since they have the highest mobility impact. Additionally, psychological and pedagogical assistance are recommended to improve his cognitive skills. 2. **Therapist's examination. ** During this assessment, the patient was identified to have problems to walk since the patient drags his right leg. It was also diagnosed that the patient's right upper limb presents more muscular atrophy than the impaired lower limb due to the lack of use. Several assessments were performed to identify critical joints in the impaired upper limb. The therapist asserted that the patient does not present stiffness yet. However, his elbow, forearm and wrist joints present high levels of spastic hypertonia due to his minimal use causing clenched fist deformity. The specialists highly recommended urgent rehabilitation of the upper limb proximal segment (the right arm) to increase the work space of the patient prior to starting with manipulation tasks. Otherwise, the ROM will be still limited for executing activities of daily living. 3. **EMG tests. ** The therapist defined to measure the electrical activity of following muscles: biceps, triceps, pronator, supinator, wrist flexor and wrist extensor to evaluate the ROM of elbow, forearm and wrist. As it can be observed in Figure 6 the impairment was more severe at the proximal segment than at the distal one since the child has natural elbow flexion and forearm pronation. Elbow extension and forearm supination are absent. Also, flexion activity was reflected at the wrist due to its over flexed position. Ulnar and radial deviations along with fingers flexion-extension motions were nor detected even when the muscular activity of the associated muscles were measured. These assessments match with the well known hemiplegic clinical condition characterized by (1) a fallen and protracted shoulder, (2) an inward rotated arm attached to the trunk, (3) a flexed and over pronated forearm and (4) a clenched fist [46]. After the case study was analyzed, two contexts were identified: (a) to mobilize the elbow-forearm-wrist region or (b) to mobilize the hand for object manipulation. According to the results from three previous assessments, elbow and wrist were identified as critical joints that need to be, urgently, rehabilitated in order to prevent joint stiffness and improve hand mobility. It was concluded that it was not feasible to start a rehabilitation process at the distal segment since the proximal one has no mobility. Besides, the muscles acting on the distal segment are inserted to the proximal one. Hence the MOSAR, endowed with four DOF, focuses on the mobilization of the joints by exerting flexion-extension at the elbow, pronation-supination on the forearm and flexion-extension along with ulnar-radial deviations at the wrist of the patient. The rehabilitation protocol associated with these movements will help to regain strength, decrease spasticity and prevent joint stiffness. MOSAR is aimed to reproduce this rehabilitation protocol in an assisted strategy. Moreover, the increase of the ROM at the proximal region would benefit the distal segment for further manipulation tasks. Manipulation assessment, performed by the therapist, revealed that the patient is able to open-close his fist. He can grab objects with low precision in a restricted area due to his medical condition.