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The loss of the grasp function in cervical spinal cord injured (SCI) patients leads to life-long dependency on caregivers and to a tremendous decrease of the quality of life. This article introduces the novel non-invasive modular hybrid neuro-orthosis OrthoJacket for the restoration of the restricted or completely lost hand and arm functions in high tetraplegic SCI individuals. The primary goal of the wearable orthosis is to improve the paralysed upper extremity function and, thus, to enhance a patient's independence in activities of daily living. The system combines the advantage of orthotics in mechanically stabilising joints together with the possibilities of functional electrical stimulation for activation of paralysed muscles. In patients with limited capacity, for force generation, flexible fluidic actuators are used to support the movement. Thus, the system is not only intended for functional restoration but also for training. Several sensor systems together with an intelligent signal processing allow for automatic adaptation to the anatomical and neurological individualities of SCI patients. The integration of novel user interfaces based on residual muscle activities and detection of movement intentions by real-time data mining methods will enable the user to autonomously control the system in a natural and cooperative way.

The novel "OrthoJacket" device aims at restoring restricted or completely lost hand and arm functions in highly tetraplegic spinal cord-injured (SCI) individuals. This system is based on the combination of a hybrid orthosis with integrated fluidic actuators and functional electrical stimulation (FES). Its primary goal is the improvement of paralyzed upper extremity functions and, thus, to enhance a patient's independence in activities of daily living (ADL).A crucial issue of the FES of paralyzed muscles in the orthosis is the precise and stable control of the artificially generated movements under varying conditions. The reproducibility of the movements necessary for restoring hand and wrist joint functions can be improved by the use of a self-adhesive multi-electrode array. Since motor deficits vary considerably among tetraplegic individuals, the new orthosis has to be adapted to each handicapped subject prior to the its application in everyday life. This paper will present a system that allows for an automatic adaptation of the multi-electrode array to the paralyzed limbs of upper extremities such that a given joint movement is executed optimally. A new assessment scheme is introduced for the precise measurement of graduated joint movements generated by stimulation via the electrode array. Additionally, criteria have been developed for evaluating the quality and the deviation of the artificially generated movement from a given reference movement.

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