Title: Advancing the Functionality and Wearability of Robotic Hand Orthoses Towards Activities of Daily Living in Stroke Patients
Description: Post stroke rehabilitation is effective when a large number of motor repetitions are provided to patients. However, conventional physical therapy or traditional desktop-size robot aided rehabilitation do not provide sufficient number of repetitions due to cost and logistical barriers. Our vision is to realize a wearable and functional hand orthosis that could be used outside of controlled, clinical settings, thus allowing for more training repetitions. Furthermore, if such a device can prove effective for Activities of Daily Living (ADLs) while actively worn, this can incentivize patients to increase its use, further enhancing rehabilitative effects. However, in order to provide such clinical benefits, the device must be completely wearable without obtrusive features, and intuitive to control even for non-experts. In this thesis, we thus focus on wearability, functionality, and intuitive intent detection technology for a novel hand robot, and assess its performance when used both as a rehabilitative device and an assistive tool.

A fully wearable device must deliver meaningful manipulation capability in small and lightweight package. In this context, we investigate the capability of single-actuator devices to assist whole hand movement patterns through a network of exotendons. Our prototypes combine a single linear actuator (mounted on a forearm splint) with a network of exotendons (routed on the surface of a soft glove). We investigate two possible tendon network configurations: one that produces full finger extension (overcoming flexor spasticity) and one that combines proximal flexion with distal extension at each finger. In experiments with stroke survivors, we measure the force levels needed to overcome various levels of spasticity and to open the hand for grasping using the first of these configurations, and qualitatively demonstrate the ability to execute fingertip grasps using the second. Our results support the feasibility of developing future wearable devices able to assist a range of manipulation tasks.

In order to further improve the wearability of the device, we propose two designs that provide effective force transmission by increasing moment arms around finger joints. We evaluate the designs with geometric models and experiment using a 3D-printed artificial finger to find force and joint angle characteristics of the suggested structures. We also perform clinical tests with stroke patients to demonstrate the feasibility of the designs. The testing supports the hypothesis that the proposed designs efficiently elicit extension of the digits in patients with spasticity as compared to existing baselines. With the suggested transmission designs, the device can deliver sufficient extension force even when the users have increased muscle tone due to fatigue. The vision of an orthotic device used for ADLs can only be realized if the patients are able to operate the device themselves. However, the field is generally lacking effective methods by which the user can operate the device: such controls must be effective, intuitive, and robust to the wide range of possible impairment patterns.

The variety of encountered upper limb impairment patterns in stroke patients means that a single sensing modality, such as electromyography, might not be sufficient to enable controls for a broad range of users. To address this significant gap, we introduce a multimodal sensing and interaction paradigm for an active hand orthosis. In our proof-of-concept implementation, EMG is complemented by other sensing modalities, such as finger bend and contact pressure sensors. We propose multimodal interaction methods that utilize this sensory data as input, and show they can enable tasks for stroke survivors who exhibit different impairment patterns. We then assess the performance of the robotic orthosis for two possible roles: as a therapeutic tool that facilitates device mediated hand exercises to recover neuromuscular function, or as an assistive device for use in everyday activities to aid functional use of the hand. 11 chronic stroke (> 2 years) patients with moderate muscle tone (Modified Ashworth Scale ≤ 2 in upper extremity) engage in a month-long training protocol using the orthosis.

Individuals are evaluated using standardized outcome measures, both with and without orthosis assistance. The results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke. The advances proposed in this thesis have the potential to enable robotic based hand rehabilitation during daily activities (as opposed to isolated hand exercises with limited upper limb engagement) and over extended periods of time, even in a patient’s home environment. Numerous challenges must still be overcome in order to achieve this vision, related to design (compact devices with easier donning/doffing), control (robust yet intuitive intent inferral), and effectiveness (improved functionality in a wider range of metrics). However, if these challenges can be addressed, wearable robotic devices have the potential to greatly extend the use and training of the affected upper limb after stroke, and help improve the quality of life for a large patient population.