In this paper, we propose and demonstrate the functionality of a novel exoskeleton which provides variable resistance training for human hands. It is intended for people who suffer from diminished hand strength and low dexterity due to non-severe forms of neuropathy or other ailments. A new variable-stiffness mechanism is designed based on the concept of aligning three different sized springs to produce four different levels of stiffness, for variable kinesthetic feedback during an exercise. Moreover, the design incorporates an interactive computer game and a flexible sensor-based glove that motivates the patients to use the exoskeleton. The patients can exercise their hands by playing the game and see their progress recorded from the glove for further motivation. Thus the rehabilitation training will be consistent and the patients will re-learn proper hand function through neuroplasticity. The developed exoskeleton is intrinsically safe when compared with active exoskeleton systems since the applied compliance provides only passive resistance. The design is also comparatively lighter than literature designs and commercial platforms.
Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients’ motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients’ wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.
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Stroke is one of the main causes of death worldwide,
more precisely, in the UK, stroke is classified as the
fourth cause of death; around 7% (40,000 people per
year) of all deaths are caused by stroke [1-2]. Survivors,
estimated between 55% and 75%, suffer from a number
of disabilities, including those affecting the upper limbs.
In order to recover the lost ability or parts of it, a
rehabilitation programme is usually recommended. In
order to improve their mobility, patients affected by
neurological disorders caused by stroke need assisted
rehabilitation therapy; indeed, physiotherapists plan a
rehabilitation programmes based on intensive daily
training of repetitive movements.
In the last decade, a large number of ‘roboticists’ focused
their research on the development of devices that could
be used for post-stroke rehabilitation.
Different approaches have been explored, the three main
concepts are based on robotic assisted devices, pneumatic
devices and Virtual Reality (VR) based devices or a
combination of them.
Hadi et al.  developed a wearable glove for hand
rehabilitation and assistance using shape memory alloys,
able to exert more than 40N at the finger’s tip. While,
Connelly et al.  used a different approach creating a
pneumatic glove that works with pressurized air up to
10psi, paired with a virtual environment representation
(using a VR headset) allowing patients to perform
different exercises. Along similar lines, Alamri et al. 
proposed 5 different VR based exercises that could be
performed employing the CyberGrasp System 
composed of three different hardware pieces: the
CyberGlove, which allows to read the spatial hand
coordinates and recreates a realistic virtual avatar; the
CyberGrasp providing force feedback at the fingers tips
of the patient, and the CyberForce armature that
simulates inertia in order to give a more realistic
experience to the patient.
A simpler solution has been presented by Sebastian et al.
 where a soft robotic haptic interface with variable
stiffness, made of silicon material combined with a
Kevlar threading is used; this system is grabbed by the
patient and can work in two different modalities (1)
isometric and (2) constant pressure.
In our paper, a similar approach to the last presented will
be introduced – a low-cost and user-friendly design of a
soft inflatable structure with adjustable stiffness has been
chosen that can be used in clinical or home settings. […]
Figure 1 Soft Inflatable Device; Folded state (left), inflated state (right)
The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable.
Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1–4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove.
The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were ‘more or less satisfied’ with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands.
The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.
Fifteen million individuals worldwide experience a stroke each year with 50,000 of these cases occurring in Canada . Approximately two-thirds of these individuals will experience neurological deficit  and half will never fully recover the hand function required to perform activities of daily living independently . Stroke survivors with severe hand impairment have difficulty producing hand motion and grip force and their increased muscle tone, spasticity and contractures keep their hand clenched in a fist. These stroke survivors have the potential to attain functional improvements years after their stroke by constantly incorporating the affected hand into activities of daily living (ADLs) and additional goal-directed tasks during their therapy exercises and daily routines [4,5,6].
There are many barriers to incorporating the affected hand into exercises and daily routines including time, discomfort, safety risks and mental and physical effort. Personalized, high-intensity, coaching and motion assistance is required to overcome these barriers but is often inaccessible to stroke survivors. The time and resource commitments are too substantial for many clinics to supply at a sufficient intensity and additional rehabilitation technologies and services can be inaccessible due to high cost, location and availability [7, 8]. As a result, stroke survivors often do not regain the hand range of motion (ROM), strength and coordination required to perform ADLs independently. Affordable and accessible rehabilitation technologies and services that enable stroke survivors with severe hand impairment to incorporate their affected hand into ADLs are needed to maximize neuromuscular recovery and daily independence.
Design targets for wearable hand robots
A main goal for wearable hand robots is to provide the hand function assistance and rehabilitation required to enable people after stroke to perform ADLs independently. Able-bodied individuals move their fingers through a ROM of 164o during activities of daily living, as calculated by summing the differences between the extension and flexion joint angles of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints . The thumb moves through a ROM of 40o, as calculated by summing the differences between the extension and flexion joint angles of the thumb’s interphalangeal (IP) and MCP joints . Grip forces averaging 67 N are exerted  and a combination of hand postures are used (i.e. a tripod pinch was used during 38% of the activities of daily living evaluated, extended hand (13%), cylindrical grasp (12%), lumbrical grasp (10%), lateral pinch (9%)) .
Capabilities of wearable hand robots
Wearable hand robots have manipulated able-bodied participants’ relaxed hands to provide 129o of index finger ROM, 83 N of grip strength as measured using a hand dynamometer, and 7 hand postures in Rose et al. . However, when these robots are evaluated with impaired hands the assistive capabilities have been much lower. For studies by Cappello et al. and Soekadar et al. with six and nine persons with impaired hands following a spinal cord injury, wearable hand robots have increased grip strength to 4 N  and ADL performance to 5.5 out of 7 on the Toronto Rehabilitation Institute – Hand Function Test by assisting pinch and palmar grasp postures [12, 13]. For a study by Yurkewich et al. with five persons with severely impaired hands following stroke (no voluntary index finger extension), a previous version of the HERO Grip Glove named the HERO Glove increased ROM to 79o and improved water bottle and block grasping performance . Refer to  for a supplementary table detailing recently developed wearable hand robots, their capabilities and their evaluation results. Hand robots need to be improved to generate strong extension and grip forces that overcome muscle tone and securely stabilize various object geometries, such as a water bottle and a fork. These robots should also be easy to put on clenched hands, comfortable during multiple hours of use, lightweight so as not to affect the motion of weak arms and affordable so they are accessible to people with limited income even though these considerations create design tradeoffs that sacrifice assistive capabilities [14, 15].
A number of sensor types (i.e. button [12, 14, 16], electromyography [17, 18], motion [10, 14], force , voice , vision [21, 22] and electroencephalography  have been selected to control robot assistance based on varied motivations such as robust operation or motivating neuromuscular activation. However, other than button control, these control strategies are still in an experimental stage that requires experts to manually tune each user’s orthosis .
A single study evaluating two stroke survivors’ satisfaction with a wearable hand robot was completed by Yap et al.  to understand their needs and preferences in wearable hand robot design. More rigorous studies would further inform designers on how to adapt their wearable hand robots to maximize the intended users’ satisfaction and arm and hand use.
This article presents the portable Hand Extension Robot Orthosis (HERO) Grip Glove, including its novel design features and the evaluation of its assistive capabilities and usability with 11 stroke survivors with severe hand impairments. The HERO Grip Glove, shown in Fig. 1, assists five-finger extension, thumb abduction and tripod pinch grasping using particular cable materials and routing patterns and only two linear actuators. A fold-over wrist brace is used to mount the electronic components, support the wrist, and ease donning. The robot is controlled by hand motion or a button. The robot is open source for broad access, untethered and lightweight for unencumbered use throughout daily routines, and soft to conform to hands and objects of varying geometries. The HERO Grip Glove increases range of motion and ADL performance with large and small objects and increases grip strength for those without grip strength. The participants’ quantitative and qualitative feedback from their user satisfaction questionnaires provides guidance for assistive technology developers and motivation for deploying the HERO Grip Glove to stroke survivors for use throughout their daily routines.
The HERO Grip Glove assists finger and thumb extension and flexion to enable users to grasp large and small objects. The HERO Grip Glove consists of (a) cable tie guides, (b) an open-palm glove, (c) cable tie tendons for extension, (d) a 9 V battery case with the battery inside and the microcontroller with an inertial measurement unit mounted between the case and the glove, (e) buttons to control the manual mode and select between the manual and automatic modes used in , (f) a linear actuator, (g) a foldable wrist brace, (h) cable tie pawls for pre-tensioning, (i) fishing wire tendons for flexion, (j) tendon anchor points on the wrist brace and (k) Velcro straps to secure the glove. The glove folds open to ease donning. The dorsal and palmar tendons’ routing paths are highlighted in yellow
In this paper, we present the development of a hybrid system which supports an active rehabilitation of the closing and the opening of the hand. The particularity of this system is to combine a soft exoskeleton glove, the SEM Glove™, and functional electrical stimulations (FES) to perform both types of hand movements. The created system is also a suggestion of improvement for the SEM Glove™ that is already commercialized by the BIOSERVO company and usable for hand closing rehabilitation only. In our study, a FES system was associated to this glove in order to provide the missing hand opening rehabilitation. To engage the patient in his rehabilitation, our system is electromyogram (EMG)-controlled and is activated according to the patient movement intentions. EMG signals of the muscles involved in the extension and flexion of the fingers were recorded and then processed in order to detect muscle activations. The control of the different elements of the system was then executed based on the results of this detection. The preliminary results demonstrated that the designed hybrid system shows good performances in detecting correctly the intention of a healthy user. Some improvements could still be made in the signal processing to increase the sensitivity of detection, but we proved that the hybrid system is already operational to assist the hand movements of a healthy user.
NIRS was designed to detect effect of stimulation on cortical activation response.
Multisensory environment can induce cortical activation in most brain regions.
Multisensory stimuli are more beneficial to neural activities and cognitive control.
Activation of the motor cortex is closely related to the cognitive performance.
This study aimed to assess the effects of the multisensory rehabilitation product for stroke patients on cortical activation response through near-infrared spectroscopy (NIRS).
The music rehabilitation glove (MRG), multisensory rehabilitation product, was developed with a user-centered design concept. The 40-channel NIRS system monitored the cortical activation changes in the motor cortex (MC), prefrontal cortex (PFC), temporal lobe (TL) and occipital lobe (OL) of 22 young subjects during “sequential finger-to-thumb opposition movements (SFTOM)” phase of traditional training and “musical finger-to-thumb opposition movements (MFTOM)” phase of MRG training.
The two phases of training showed significant activation (P < 0.05) in the cerebral cortex compared with baseline, with more activation during MFTOM in the MC, PFC and TL. Compared with SFTOM, there were 22 channels of cortical activation in MFTOM that had significant enhancements (P < 0.05). There was also a significant positive correlation between the prefrontal cortex and motor cortex in the cortical activation.
According to these results, MFTOM-induced cortical activation in the MC, PFC and TL with visual, auditory and tactile stimuli was stronger than SFTOM, providing evidence that the multisensory stimulation is more beneficial to cortical activation and cognitive control to promote neurological recovery.
For individuals with hand hemiparesis following a stroke, rehabilitation strategies are predominantly founded on the principles of neuroplasticity and automaticity  to regain optimal hand-related functional abilities and facilitate participation in everyday activities. Such an approach requires to engage these individuals into meaningful activity-specific exercises and to repeat those intensively on a daily basis. Adhering to these principles  remains challenging in clinical practice for rehabilitation professionals, especially given various time and productivity constraints. To overcome this challenge, the development of soft robotic gloves to facilitate hand rehabilitation have progressed substantially in the last decade. Moreover, these soft robotic gloves are foreseen as promising rehabilitation intervention to potentiate the effects of conventional rehabilitation interventions and are now about to transition into clinical practice, although their effects remain uncertain given the paucity of evidence. In this context, this review aims to map evidence on the effects of the different rehabilitation interventions using a soft robotic device for sensorimotor hand impairments and, whenever possible, the satisfaction related to their use.
Eligibility Criteria, Information Sources, And Search
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines . A review of the literature published in English and French from 2000 to October 2018 using a combination of search terms was conducted in Medline, EMBASE, and CINAHL. The search strategy included a combination of search terms related to three key domains: technology attributes (robotics, bionics, exoskeleton device, robot*, exoskelet*, motorized, motor-driven, motor assisted), anatomy of the hand (hand, hands, wrist*, finger*, prehension, dexterity), and rehabilitation domains (rehabilitation, exercise*, exercise therapy, physical therapy modalities, physical therapy speciality, physical therapists, occupational therapy, occupational therapist, therap*, physiothrap*). Search terms related to amputation, surgery, computer-assisted device, and teleoperation were excluded. From this initial search, 1870 articles were found and only 1206 articles remained after eliminating all duplicates. To narrow down the number of articles, a new domain was added (i.e., technology= glove, soft, wearable) and the search among the keywords, title, and abstracts was continued in EndNote. Thereafter, 181 articles remained and were imported into the web-based software platform Covidence where 9 additional duplicates were found.
SELECTION OF SOURCES OF EVIDENCE
The articles title, abstract and full text of 172 articles were screened by two rehabilitation professionals to identify the articles qualifying for a subsequent full review. To be considered for full review the article has to target 1) the effects or effectiveness of rehabilitation interventions using soft robotic gloves to optimize hand-related functional abilities and facilitate participation in everyday activities in people with sensorimotor disorders via randomized controlled trials (RCTs), non-randomized controlled trials (non-RCT), and other types of research designs (cohort studies, pre- and post-case interventions, case series, case-control studies and case reports) and 2) the users satisfaction and stakeholder views on the use of soft robotic gloves. For this review, in order to be considered a soft robotic glove, the technology had to generate assisted pinching or gripping movements soliciting multiple joints involving at least the thumb and the index finger and middle fingers. Interventions using a soft robotic glove could be performed in a hospital, rehabilitation center or at home with the direct or indirect supervision of a rehabilitation professional. The use of the soft robotic glove could also be combined with other technologies (e.g., virtual reality). Research protocols or manuscripts that did not include participants with sensorimotor impairment were excluded. All scientific manuscripts and conference abstracts focusing on upper limb exoskeleton including the elbow or shoulder joint were excluded.
Data Extraction And Charting Process
Studies that met the inclusion and exclusion criteria were read by a single rehabilitation professional and the following information were extracted on project-specific forms data extraction tables organized within an excel file: author-related information’s, journals and publication year, soft robotic glove attributes, study design, population and sample size, intervention, measurement instruments, results and interpretations, and user’s satisfaction. At the end, to establish if the use of a soft robotic glove yield to positive, neutral or negative effect, the p-value and effect size of each outcome measures from each article were determined.
Characteristics Of Sources Of Evidence
Ten articles included in this study originated from European or American countries; USA (5/10) [4-8], Italy (2/10) [9,10], United Kingdom (2/10) [11,12], and Netherlands (1/10) . The majority of these studies were published in 2017 (6/10) [6,8-12] or 2018 (3/10) [5,7,13]. Only one study was published in 2011 .
Study Designs And Populations
Both experimental (3/10) [8,10,12] and quasi-experimental studies (7/10) [4-7,9,11,13] were selected with mean sample sizes of 12,4 participants and ranging from 2 to 27. Most studies investigated individuals with hemiparesis following a stroke (9/10) [4-6,8-13] whereas one article investigated individuals with of a traumatic spinal cord injury .
Synthesis Of Findings
Soft robotic gloves
Eight different soft robotic gloves (i.e., HandSOME [4,6], FES Hand Glove , Gloreha Light Glove , Gloreha Professional , VAEDA , HandinMind [12,13] and two others without names) with different types of assistance (i.e., motor [7,8,9,10,12,13], elastic [4,6], and pneumatic [5,11]) were identified.
Four studies [4,5,11,13] used a transversal design to compare hand function with and without the use of a soft robotic device glove whereas three studies used an experimental design [8,10,12] and three used a quasi-experimental design [6,7,9] to compare hand sensorimotor integrity and functional abilities before and after an intervention with the soft robotic glove. No concomitant therapy was used in all of the studies. The intervention protocols of the experimental and quasi-experimental design studies varied in length from 4 to 8 weeks, in frequency from 3 to 6 times a week and training sessions duration from 40 to 90 minutes.
The outcome measures included: Ashworth Spasticity Index  or Ashworth modified scale , edema , Hand pain VAS , Barthel , Motricity index [9,10], Nine hole peg test (NHPT) [9,10], grip strength [4,6,8-10], active range of motion (AROM) , Velocity of movements , Box and blocks test , Fugl-Meyer Assessment of Upper Extremity (FMA-UE) [6,8], Fugl-Meyer Hand (FMH) , The Action Research Arm Test (ARAT) [6,8], The Motor Activity Log , time to execute tasks , Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) , pinch strength [8,10,12], JTFHT , Activity of Daily Living (ADL) , Functional Independence Measure (FIM) , Wolf Motor Function Test (WMFT) , Chedoke McMaster Stroke Assessment Hand (CMSAH)  and the Quick-DASH . Then, each outcomes measure have been classified according to the International Classification of Functioning, Disability and Health (ICF)  (Figure. 1).
Effects and effectiveness
The results in terms of effects and effectiveness of the interventions are listed in the Figure 1. Mostly, the use of robotic gloves increased joint mobility and functional capacity of the upper limb in terms of performance rapidity. According to muscular strength, functional capacity of the upper limb assessed by questionnaire, and global functional capacity, the results are heterogeneous and do not allow conclusion on the effectiveness of intervention using this technology.
Usability, feasibility and satisfaction
Four studies also assessed the usability, feasibility or satisfaction of the users after trying the soft robotic glove [10-13] using the Usefulness-Satisfaction-and-Ease-of-Use questionnaire , observations [4,10], System Usability Scale [12,13], Intrinsic Motivation Inventory , cost analysis . Studies concluded that the use of soft robotic gloves is foreseen as being feasible and acceptable by participants and rehabilitation professionals [10-13] and as increasing engagement in rehabilitation program [11,13]. Most of the studies support the fact that the soft robotic gloves are easy to use [10, 1,13]. However, the robotic glove was found to be more useful when performing gross motor tasks when compared to fine motor tasks , the presence of a zipper on the glove made it difficult to put on , and the choice of material, especially its thickness, was found to interfere with hand and finger sensations . A preference for the rental of these devices has been demonstrated . The most important features highlighted in the studies included: easy to clean, comfortable, easy to put on and take off. Last, a decreased in rehabilitation cost linked to the use of a soft robotic device at home may be anticipated .
This systematic review of the literature confirms an increased interest over the last decade in the development and use of soft robotic gloves for rehabilitation of individuals with hand hemiparesis following a neurological event. Overall, the use of soft robotics devices in rehabilitation treatment is feasible, safe, and acceptable by patients while its effects and effectiveness appear promising. However, the strength of the currently available evidence remains limited and given the wide variety of soft robotic glove attributes, study designs and interventions, and outcomes measures alongside the small sample sizes tested, it is impossible to highlight which soft robotic glove or intervention protocol would be the most appropriate to obtain the best clinical results. Stronger evidence linked to the effects or effectiveness, in addition to comprehensive stakeholder perspectives (e.g., patients, rehabilitation professionals), especially on the usability, are needed to ensure a successful transition from the laboratory to clinical practice.
This systematic review maps currently available evidence on the use of soft robotic gloves as a rehabilitation intervention while considering effectiveness and usability. This technology is a promising solution to optimize sensorimotor capabilities, hand-related functional abilities and facilitate participation in everyday activities while overcoming some clinical constraints. Additional research in this area should be encouraged to strengthen current evidence.
 Chollet, F., DiPiero, V., Wise, R. J. S., Brooks, D. J., Dolan, R. J., & Frackowiak, R. S. J. (1991). The functional anatomy of motor recovery after stroke in humans: a study with positron emission tomography. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 29(1), 63-71.
 Hubbard, I. J., Parsons, M. W., Neilson, C., & Carey, L. M. (2009). Task‐specific training: evidence for and translation to clinical practice. Occupational therapy international, 16(3‐4), 175-189.
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Brokaw, E. B., Black, I., Holley, R. J., & Lum, P. S. (2011). Hand Spring Operated Movement Enhancer (HandSOME): a portable, passive hand exoskeleton for stroke rehabilitation. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 19(4), 391-399.
 Cappello, L., Meyer, J. T., Galloway, K. C., Peisner, J. D., Granberry, R., Wagner, D. A., … & Walsh, C. J. (2018). Assisting hand function after spinal cord injury with a fabric-based soft robotic glove. Journal of neuroengineering and rehabilitation, 15(1), 59.
 Chen, J., Nichols, D., Brokaw, E. B., & Lum, P. S. (2017). Home-based therapy after stroke using the hand spring operated movement enhancer (HandSOME). IEEE Transactions on Neural Systems and Rehabilitation Engineering, 25(12), 2305-2312.
 Scott, S., Yu, T., White, T. K., Van Harlinger, W., Ganzalez, Y., Llanos, I., & Kozel, A. F. (2018). A robotic hand device safety study for people with cervical spinal cord injury. Federal practitioner, 35(3), S21-S24.
 Thielbar, K. O., Triandafilou, K. M., Fischer, H. C., O’Toole, J. M., Corrigan, M. L., Ochoa, J. M., … & Kamper, D. G. (2017). Benefits of using a voice and EMG-Driven actuated glove to support occupational therapy for stroke survivors. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 25(3), 297-305.
 Bernocchi, P., Mulè, C., Vanoglio, F., Taveggia, G., Luisa, A., & Scalvini, S. (2018). Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study. Topics in stroke rehabilitation, 25(2), 114-119.
Vanoglio, F., Bernocchi, P., Mulè, C., Garofali, F., Mora, C., Taveggia, G., … Luisa, A. (2017). Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: a randomized pilot-controlled study. Clinical rehabilitation, 31(3), 351-360.
 Yap, H. K., Lim, J. H., Nasrallah, F., & Yeow, C. H. (2017). Design and preliminary feasibility study of a soft robotic glove for hand function assistance in stroke survivors. Frontiers in neuroscience, 11, 547.
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Supported by the Initiative for the Development of New Technologies and Innovative Practices in Rehabilitation and by the Université de Montréal (Direction des affaires internationales).
Objective: This article describes the findings of a study examining the ability of persons with strokes to use home virtual rehabilitation system (HoVRS), a home-based rehabilitation system, and the impact of motivational enhancement techniques on subjects’ motivation, adherence, and motor function improvements subsequent to a 3-month training program.
Materials and Methods: HoVRS integrates a Leap Motion controller, a passive arm support, and a suite of custom-designed hand rehabilitation simulations. For this study, we developed a library of three simulations, which include activities such as flexing and extending fingers to move a car, flying a plane with wrist movement, and controlling an avatar running in a maze using reaching movements. Two groups of subjects, the enhanced motivation (EM) group and the unenhanced control (UC) group, used the system for 12 weeks in their homes. The EM group trained using three simulations that provided 8–12 levels of difficulty and complexity. Graphics and scoring opportunities increased at each new level. The UC group performed the same simulations, but difficulty was increased utilizing an algorithm that increased difficulty incrementally, making adjustments imperceptible.
Results: Adherence to both the EM and UC protocols exceeded adherence to home exercise programs described in the stroke rehabilitation literature. Both groups demonstrated improvements in upper extremity function. Intrinsic motivation levels were better for the EM group and motivation levels were maintained for the 12-week protocol.
Conclusion: A 12-week home-based training program using HoVRS was feasible. Motivational enhancement may have a positive impact on motivation, adherence, and motor outcome.
The present research presents the construction of a robotic equipment used in the rehabilitation of the fingers for people after an Ictus, the equipment is constituted by a sliding crank mechanism in connection for each finger independently, the static and dynamic characteristic of the parts were designed with anthropometric measures. In addition, an architecture control based on PID-Fuzzy is proposed that achieves an adaptive control for each patient, which allows to have a software with personalized therapies for each patient, incorporates with a database for recording the stages in their rehabilitation according to the type of motor activity, number of repetitions and execution time; finally, the robotic equipment is evaluated in patients with follow-up in a defined time interval.