[ARTICLE] Soft robotic devices for hand rehabilitation and assistance: a narrative review – Full Text

Abstract

Introduction

The debilitating effects on hand function from a number of a neurologic disorders has given rise to the development of rehabilitative robotic devices aimed at restoring hand function in these patients. To combat the shortcomings of previous traditional robotics, soft robotics are rapidly emerging as an alternative due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design’s therapeutic abilities. Therefore, a global review of devices that have been previously attempted could facilitate the development of new and improved devices in the next step towards obtaining clinical proof of the rehabilitative effects of soft robotics in hand dysfunction.

Methods

A literature search was performed in SportDiscus, Pubmed, Scopus, and Web of Science for articles related to the design of soft robotic devices for hand rehabilitation. A framework of the key design elements of the devices was developed to ease the comparison of the various approaches to building them. This framework includes an analysis of the trends in portability, safety features, user intent detection methods, actuation systems, total DOF, number of independent actuators, device weight, evaluation metrics, and modes of rehabilitation.

Results

In this study, a total of 62 articles representing 44 unique devices were identified and summarized according to the framework we developed to compare different design aspects. By far, the most common type of device was that which used a pneumatic actuator to guide finger flexion/extension. However, the remainder of our framework elements yielded more heterogeneous results. Consequently, those results are summarized and the advantages and disadvantages of many design choices as well as their rationales were highlighted.

Conclusion

The past 3 years has seen a rapid increase in the development of soft robotic devices for hand rehabilitative applications. These mostly preclinical research prototypes display a wide range of technical solutions which have been highlighted in the framework developed in this analysis. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. It is our goal that this review will guide future developers through the various design considerations in order to develop better devices for patients with hand impairments.

Background

Imagine tying your shoes or putting on a pair of pants while having limited use of your hands. Now imagine the impact on your daily life if that limitation was permanent. The ability to perform activities of daily living (ADL) is highly dependent on hand function, leaving those suffering with hand impairments less capable of executing ADLs and with a reduced quality of life. Unfortunately, the hand is often the last part of the body to receive rehabilitation.

According to a 2015 National Health Interview Survey, there were approximately 4.7 million adults in the United States that found it “Very difficult to or cannot grasp or handle small objects” [1]. Hand impairments are commonly observed in neurological and musculoskeletal diseases such as arthritis, Cerebral Palsy, Parkinson’s Disease, and stroke. A summary of motor impairment prevalence associated with these diseases may be seen in Table 1. Fortunately, physical rehabilitation has been shown to promote motor recovery through repetitive isolated movements [25]. This is largely due to neuroplasticity – the ability for the brain to reorganize itself by establishing new neural connections. Occupational and physical therapists thus attempt to take advantage of neuroplasticity in order to re-map motor function in the brain through repeated exercise. Currently, however, there is no consensus on the best mode and dosing to facilitate neuroplasticity [6]. Additionally, recovery success relies heavily on a patient’s ability to attend therapy, which can be deterred by the frequency, duration, or cost of the therapy. Robotic devices could enhance access to repeated exercise. As such, they have been developed and investigated for their utilization as an adjunctive therapy to improve patient access, compliance and subsequent outcomes of rehabilitation efforts. An overview of the designs with comparisons between the different approaches will help future development of these tools. […]

 

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