RESUMEN
We have developed a passive and lightweight wearable hand exoskeleton (HandSOME II) that improves range of motion and functional task practice in laboratory testing. For this longitudinal study, we recruited 15 individuals with chronic stroke and asked them to use the device at home for 1.5 h per weekday for 8 weeks. Subjects visited the clinic once per week to report progress and troubleshoot problems. Subjects were then given the HandSOME II for the next 3 months, and asked to continue to use it, but without any scheduled contact with the project team. Clinical evaluations and biomechanical testing was performed before and after the 8 week intervention and at the 3 month followup. EEG measures were taken before and after the 8 weeks of training to examine any recovery associated brain reorganization. Ten subjects completed the study. After 8 weeks of training, functional ability (Action Research Arm Test), flexor tone (Modified Ashworth Test), and real world use of the impaired limb (Motor Activity Log) improved significantly (p < 0.05). Gains in real world use were retained at the 3-month followup (p = 0.005). At both post-training and followup time points, biomechanical testing found significant gains in finger ROM and hand displacement in a reaching task (p < 0.05). Baseline functional connectivity correlated with gains in motor function, while changes in EEG functional connectivity paralleled changes in motor recovery. HandSOME II is a low-cost, home-based intervention that elicits brain plasticity and can improve functional motor outcomes in the chronic stroke population.
RESUMEN
We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.