Meta-Learning for Fast Adaptation in Intent Inferral on a Robotic Hand Orthosis for Stroke

We propose MetaEMG, a meta-learning approach for fast adaptation in intent inferral on a robotic hand orthosis for stroke. One key challenge in machine learning for assistive and rehabilitative robotics with disabled-bodied subjects is the difficulty of collecting labeled training data. Muscle tone and spasticity often vary significantly among stroke subjects, and hand function can even change across different use sessions of the device for the same subject. We investigate the use of meta-learning to mitigate the burden of data collection needed to adapt high-capacity neural networks to a new session or subject. Our experiments on real clinical data collected from five stroke subjects show that MetaEMG can improve the intent inferral accuracy with a small session- or subject-specific dataset and very few fine-tuning epochs. To the best of our knowledge, we are the first to formulate intent inferral on stroke subjects as a meta-learning problem and demonstrate fast adaptation to a new session or subject for controlling a robotic hand orthosis with EMG signals.

Grasp Force Assistance via Throttle-based Wrist Angle Control on a Robotic Hand Orthosis for C6-C7 Spinal Cord Injury

Individuals with hand paralysis resulting from C6-C7 spinal cord injuries frequently rely on tenodesis for grasping. However, tenodesis generates limited grasping force and demands constant exertion to maintain a grasp, leading to fatigue and sometimes pain. We introduce the MyHand-SCI, a wearable robot that provides grasping assistance through motorized exotendons. Our user-driven device enables independent, ipsilateral operation via a novel Throttle-based Wrist Angle control method, which allows users to maintain grasps without continued wrist extension. A pilot case study with a person with C6 spinal cord injury shows an improvement in functional grasping and grasping force, as well as a preserved ability to modulate grasping force while using our device, thus improving their ability to manipulate everyday objects. This research is a step towards developing effective and intuitive wearable assistive devices for individuals with spinal cord injury.

Volitional Control of the Paretic Hand Post-Stroke Increases Finger Stiffness and Resistance to Robot-Assisted Movement

Increased effort during use of the paretic arm and hand can provoke involuntary abnormal synergy patterns and amplify stiffness effects of muscle tone for individuals after stroke, which can add difficulty for user-controlled devices to assist hand movement during functional tasks. We study how volitional effort, exerted in an attempt to open or close the hand, affects resistance to robot-assisted movement at the finger level. We perform experiments with three chronic stroke survivors to measure changes in stiffness when the user is actively exerting effort to activate ipsilateral EMG-controlled robot-assisted hand movements, compared with when the fingers are passively stretched, as well as overall effects from sustained active engagement and use. Our results suggest that active engagement of the upper extremity increases muscle tone in the finger to a much greater degree than through passive-stretch or sustained exertion over time. Potential design implications of this work suggest that developers should anticipate higher levels of finger stiffness when relying on user-driven ipsilateral control methods for assistive or rehabilitative devices for stroke.

Towards Tenodesis-Modulated Control of an Assistive Hand Exoskeleton for SCI

Restoration of hand function is one of the highest priorities for SCI populations. In this work, we present a prototype of a robotic assistive orthosis capable of implementing tenodesis user control. The underactuated device provides active grasping assistance while preserving free wrist mobility through the use of Bowden cables. This device enables force modulation during grasping, which was effectively leveraged by a participant with C6 SCI to demonstrate improved grasping abilities using the orthosis, scoring 11 on the Grasp and Release Test using the device compared to 1 without it.

Design of Spiral-Cable Forearm Exoskeleton to Provide Supination Adjustment for Hemiparetic Stroke Subjects

We present the development of a cable-based passive forearm exoskeleton, designed to assist supination for hemiparetic stroke survivors, that uniquely provides torque sufficient for counteracting spasticity within a below-elbow apparatus. The underactuated mechanism consists of a spiral single-tendon routing embedded in a rigid forearm brace and terminated at the hand and upper-forearm. A spool with an internal releasable-ratchet mechanism allows the user to manually retract the tendon and rotate the hand to counteract involuntary pronation synergies due to stroke. We performed device characterization with two healthy subjects, and conducted a feasibility test of the forearm mechanism in maintaining a neutral hand position with a single chronic stroke subject having no volitional supination capacity. Our preliminary assessment on an impaired subject suggests comparative performance in supination assistance between our implementation and a commercial passive splint, and shows promise in improving capabilities of existing robotic exoskeletons for stroke.

Thumb Assistance Via Active and Passive Exotendons in a Robotic Hand Orthosis for Stroke

We present a tendon-driven, active-extension thumb exoskeleton adding opposition/reposition capabilities to a robotic hand orthosis designed for individuals with chronic upper-limb hemiparesis after stroke. The orthosis uses two actuators to assist hand-opening, with one tendon network controlling simultaneous four-finger extension and one separately driving thumb extension. When combined with a passive palmar abduction constraint, the thumb network can counteract spasticity and provide stable thumb opposition for manipulating objects in a range of sizes. We performed a preliminary assessment with five chronic stroke survivors presenting with arm-hand motor deficits and increased muscle tone (spasticity). Experiments consisted of unimanual resistive-pull tasks and bimanual twisting tasks with simulated real-world objects; these explored the effects of thumb assistance on grasp stability and functional range of motion. We specifically compare functional performance of actuation against static thumb-splinting and against no device. The addition of active-extension to the thumb improves positioning ability when reaching for objects, and improves consistency and duration of maintaining stable grasps.

Semi-Supervised Intent Inferral Using Ipsilateral Biosignals on a Hand Orthosis for Stroke Subjects

In order to provide therapy in a functional context, controls for wearable orthoses need to be robust and intuitive. We have previously introduced an intuitive, user-driven, EMG based orthotic control, but the process of training a control which is robust to concept drift (changes in the input signal) places a substantial burden on the user. In this paper, we explore semi-supervised learning as a paradigm for wearable orthotic controls. We are the first to use semi-supervised learning for an orthotic application. We propose a K-means semi-supervision and a disagreement-based semi-supervision algorithm. This is an exploratory study designed to determine the feasibility of semi-supervised learning as a control paradigm for wearable orthotics. In offline experiments with stroke subjects, we show that these algorithms have the potential to reduce the training burden placed on the user, and that they merit further study.

User-Driven Functional Movement Training with a Wearable Hand Robot after Stroke

We studied the performance of a robotic orthosis designed to assist the paretic hand after stroke. This orthosis is designed to be wearable and fully user-controlled, allowing it to serve two possible roles: as a rehabilitation device, designed to be integrated in device-mediated rehabilitation exercises to improve performance of the affected upper limb without device assistance; or as an assistive device, designed to be integrated into daily wear to improve performance of the affected limb with grasping tasks. We present the clinical outcomes of a study designed as a feasibility test for these hypotheses. 11 participants with chronic stroke engaged in a month-long training protocol using the orthosis. Individuals were evaluated using standard outcome measures, both with and without orthosis assistance. Fugl-Meyer scores (unassisted) showed improvement focused specifically at the distal joints of the upper limb, and Action Research Arm Test (ARAT) scores (unassisted) also showed a positive trend. These results suggest the possibility of using our orthosis as a rehabilitative device for the hand. Assisted ARAT and Box and Block Test scores showed that the device can function in an assistive role for participants with minimal functional use of their hand at baseline. We believe these results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke.

Multimodal Sensing and Interaction for a Robotic Hand Orthosis

Wearable robotic hand rehabilitation devices can allow greater freedom and flexibility than their workstation-like counterparts. However, the field is generally lacking effective methods by which the user can operate the device: such controls must be effective, intuitive, and robust to the wide range of possible impairment patterns. Even when focusing on a specific condition, such as stroke, the variety of encountered upper limb impairment patterns means that a single sensing modality, such as electromyography (EMG), might not be sufficient to enable controls for a broad range of users. To address this significant gap, we introduce a multimodal sensing and interaction paradigm for an active hand orthosis. In our proof-of-concept implementation, EMG is complemented by other sensing modalities, such as finger bend and contact pressure sensors. We propose multimodal interaction methods that utilize this sensory data as input, and show they can enable tasks for stroke survivors who exhibit different impairment patterns. We believe that robotic hand orthoses developed as multimodal sensory platforms with help address some of the key challenges in physical interaction with the user.

Design and Development of Effective Transmission Mechanisms on a Tendon Driven Hand Orthosis for Stroke Patients

Tendon-driven hand orthoses have advantages over exoskeletons with respect to wearability and safety because of their low-profile design and ability to fit a range of patients without requiring custom joint alignment. However, no existing study on a wearable tendon-driven hand orthosis for stroke patients presents evidence that such devices can overcome spasticity given repeated use and fatigue, or discusses transmission efficiency. In this study, we propose two designs that provide effective force transmission by increasing moment arms around finger joints. We evaluate the designs with geometric models and experiment using a 3D-printed artificial finger to find force and joint angle characteristics of the suggested structures. We also perform clinical tests with stroke patients to demonstrate the feasibility of the designs. The testing supports the hypothesis that the proposed designs efficiently elicit extension of the digits in patients with spasticity as compared to existing baselines.