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.
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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.
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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.
The Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits.
A pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test.
Almost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved.
The 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.
Stroke is a global public health problem that leads to significant disabilities (World Health Organization, 2014). After discharge from a hospital, patients who have experienced stroke return to the community and many do not have access to physical therapy. Around 65% of patients who had experienced a stroke were unable to use their hemiparetic upper limb (Bruce and Dobkin, 2005). Those with moderate to severe arm deficits have difficulty in reaching to grasp, delay in time to maximal grip aperture, prolonged movement time, and a lack of accuracy (Michaelsen et al, 2009). A number of interventions have been proven to be effective in improving upper limb function post-stroke. However, there is little evidence of the effectiveness of these interventions for those with severe deficits.
The therapy programme based on the Bobath concept has been shown to improve upper limb function in individuals who have experienced chronic stroke (Huseyinsinoglu et al, 2012; Carvalho et al, 2018). The Bobath concept has been in evolution and the present clinical framework incorporates the integration of postural control and quality of task performance, selective movement, and the role of sensory information to promote normal movement pattern. Therapeutic activities involved movement facilitation together with patient’s active participation in practice to improve motor learning; nevertheless, implementation time varied across studies (Vaughan-Graham et al, 2009; Vaughan-Graham and Cott, 2016).
Among the few studies of patients with chronic stroke, none focused on the rehabilitation of patients with different degrees of deficit severity in the community. Moreover, previous studies using the Bobath concept were all conducted in clinical settings (Platz et al, 2005; Huseyinsinoglu et al, 2012).[…]
The purpose of this paper is to propose a variable impedance control method of finger exoskeleton for hand rehabilitation using the contact forces between the finger and the exoskeleton, making the output trajectory of finger exoskeleton comply with the natural flexion-extension (NFE) trajectory accurately and adaptively.
This paper presents a variable impedance control method based on fuzzy neural network (FNN). The impedance control system sets the contact forces and joint angles collected by sensors as input. Then it uses the offline-trained FNN system to acquire the impedance parameters in real time, thus realizing tracking the NFE trajectory. K-means clustering method is applied to construct FNN, which can obtain the number of fuzzy rules automatically.
The results of simulations and experiments both show that the finger exoskeleton has an accurate output trajectory and an adaptive performance on three subjects with different physiological parameters. The variable impedance control system can drive the finger exoskeleton to comply with the NFE trajectory accurately and adaptively using the continuously changing contact forces.
The finger is regarded as a part of the control system to get the contact forces between finger and exoskeleton, and the impedance parameters can be updated in real time to make the output trajectory comply with the NFE trajectory accurately and adaptively during the rehabilitation.
Wrist and hand rehabilitation are common as people suffer injuries during work and exercise. Typically, the rehabilitation involves the patient and the therapist, which is both time consuming and cost burdening. It is desirable to use advanced telemedicine technologies such that the patient is able to enjoy the freedom of performing the required exercise at their own time and pace, while the healthcare system can operate more efficiently. The Leap Motion Controller (LMC), an inexpensive motion detection device, seems to be a good candidate for remote wrist rehabilitation. In this paper, the functionality and capability of the LMC are examined. Experiments are carried out with a total of twelve people performing twelve different movements. From the experimental results, the feasibility of using the LMC as a rehabilitation device is discussed.
Zhang, L., Li, K.F., Lin, J., Ren, J.: Leap motion for telerehabilitation: a feasibility study. In: Advances on Broadband and Wireless Computing, Communication and Applications, 13th International Conference on BWCCA, pp. 213–223 (2018)Google Scholar
When spasticity from a stroke holds muscles in one position, muscle fibers become short which restricts motion. Lannin (1) concluded “splinting has little or no effect on the loss of range of motion” (p. 113). Unfortunately, Lannin told therapists to stop all passive stretching and restrict active hand exercises to 10 minutes a day. So the data does not tell us if a resting night splint is a useful addition to standard therapy.
I wondered what would happen if I continued to do passive stretching and active hand exercises, but stopped wearing my resting splint at night. After a month of not wearing this splint I could feel my thumb getting tighter. I resumed wearing my splint and the next morning I woke up with a wicked ache in my thumb. My thumb is tight by bedtime so my splint has not eliminated spasticity. Placing the hand in one static position does not retrain the brain to produce active range of motion (AROM). Yet I believe my splint has prevented a painful permanent contracture.
I love my new SaeboStretch resting splint I wear at night. The new soft straps do not cut into my skin the way the old plastic straps did. This version also uses a new kind of “Velcro” that does not have spiky hooks that scratch my bare thigh. Notice that there are now two finger straps and two thumb straps. The cover zips off so it can be washed.
1. Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after stroke. Stroke. 2009;38:111-116.