A hand exoskeleton driven by myoelectric pattern recognition was designed for stroke rehabilitation. It detects and recognizes the user’s motion intent based on electromyography (EMG) signals, and then helps the user to accomplish hand motions in real time. The hand exoskeleton can perform six kinds of motions, including the whole hand closing/opening, tripod pinch/opening, and the “gun” sign/opening. A 52-year-old woman, 8 months after stroke, made 20×2-hour visits over 10 weeks to participate in robot-assisted hand training. Though she was unable to move her fingers on her right hand before the training, EMG activities could be detected on her right forearm. In each visit, she took 4×10-minute robot-assisted training sessions, in which she repeated the aforementioned six motion patterns assisted by our intent-driven hand exoskeleton. After the training, her grip force increased from 1.5 kg to 2.7 kg, her pinch force increased from 1.5 kg to 2.5 kg, her score of Box & Block test increased from 3 to 7, her score of Fugl-Meyer (Part C) increased from 0 to 7, her hand function increased from Stage 1 to Stage 2 in Chedoke-McMaster assessment. The results demonstrate the feasibility of robot-assisted training driven by myoelectric pattern recognition after stroke.
Robot-assisted upper limb training is considered to be more efficient (1) and economic (2) than conventional therapy in neurorehabilitation. Controlling the robot with the user’s own electromyography (EMG) signals connects the user’s intended motion and his actual movements. It can therefore enhance therapeutic effects and promote motor learning (3–5). Various EMG-driven robots and exoskeletons have been developed for neurorehabilitation (6–8), primarily based on one-to-one mapping, which typically maps one channel of EMG signal to a corresponding single degree-of-freedom (DOF) or variable such as speed and torque using a conventional “on-off” or proportional strategy. Robots based on such control strategy work well on training joints with only a few DOFs such as elbow and wrist. However, a human hand has up to 27 DOFs (9) and is controlled by complex temporal and spatial coordination of multiple muscles. It is therefore not feasible to regain hand dexterity through conventional control strategies. Myoelectric pattern-recognition techniques have been developed to extract motion intentions from EMG signals (10, 11). The extracted intentions can then be used to control a multiple-DOF robot such as a prosthesis (12). Previous studies have also shown that motion intentions can still be extracted after neurological impairment (13–15). We therefore developed an intent-driven hand training system. The system employs an exoskeleton hand, which is controlled by myoelectric pattern recognition. As soon as the user’s intention is detected (usually within 250 ms), the system is able to assist to accomplish the intended motions (16).
A 52-year-old woman participated in this robotic hand-assisted training 8 months after stroke. She was right-handed before stroke and had hemiplegia on her right side after her stroke. She was able to walk independently with an ankle foot orthosis but had difficulties in moving her right arm. Her fingers were flexed naturally. She was unable to move any of the fingers on her right hand, but EMG signals were able to be recorded from her forearm. Her Fugl–Meyer score (Part A–D, max 66) was 16, with a 0 in Part C (Hand, max 14). She had no pain when her whole hand was passively opened or closed. She did not receive any other hand or upper limb therapies while participating in this study. During her visits, she was able to understand and follow all the instructions.
The exoskeleton hand, Hand of Hope (Rehab-Robotics, Hong Kong), was used in this study to help the subject move her hand (Figure 1). The exoskeleton hand has five individual fingers. Each finger is actuated by a linear actuator that can pull and push linearly. The mechanical design of the fingers converts these linear movements into the rotations of a virtual metacarpophalangeal (MCP) joint and a virtual proximal interphalangeal (PIP) joint. Both joints rotate together to help the hand perform closing and opening movements (7). The motion range is 55° and 65° for MCP and PIP joints, respectively. The subject’s palm and five fingers are fixed to the exoskeleton hand with Velcro belts. Each finger can be bent or straightened individually by the exoskeleton hand. The exoskeleton hand stands on a brace, which also supports the subject’s forearm, so that the subject can be totally relaxed when attached to the exoskeleton. The exoskeleton hand used in this study can perform six different motion patterns, including hand closing (HC); hand opening (HO); thumb, index, and middle fingers closing (TIMC or tripod pinch); thumb, index, and middle fingers opening; middle, ring, and little fingers closing (MRLC or the “gun” sign); and middle, ring, and little fingers opening. The exoskeleton hand can perform HC, TIMC, or MRLC when it is open. However, after performing any one from these three patterns, it can only return to the original open status (e.g., there is no direct way from the “tripod pinch” to the “gun” sign).