One of the hottest topics in rehabilitation robotics is that of proper control of prosthetic devices. Despite decades of research, the state of the art is dramatically behind the expectations. To shed light on this issue, in June, 2013 the first international workshop on Present and future of non-invasive peripheral nervous system (PNS)–Machine Interfaces (MI; PMI) was convened, hosted by the International Conference on Rehabilitation Robotics. The keyword PMI has been selected to denote human–machine interfaces targeted at the limb-deficient, mainly upper-limb amputees, dealing with signals gathered from the PNS in a non-invasive way, that is, from the surface of the residuum. The workshop was intended to provide an overview of the state of the art and future perspectives of such interfaces; this paper represents is a collection of opinions expressed by each and every researcher/group involved in it.

BackgroundFollowing acute therapeutic interventions, the majority of stroke survivors are left with a poorly functioning hemiparetic hand. Rehabilitation robotics has shown promise in providing patients with intensive therapy leading to functional gains. Because of the hand's crucial role in performing activities of daily living, attention to hand therapy has recently increased.MethodsThis paper introduces a newly developed Hand Exoskeleton Rehabilitation Robot (HEXORR). This device has been designed to provide full range of motion (ROM) for all of the hand's digits. The thumb actuator allows for variable thumb plane of motion to incorporate different degrees of extension/flexion and abduction/adduction. Compensation algorithms have been developed to improve the exoskeleton's backdrivability by counteracting gravity, stiction and kinetic friction. We have also designed a force assistance mode that provides extension assistance based on each individual's needs. A pilot study was conducted on 9 unimpaired and 5 chronic stroke subjects to investigate the device's ability to allow physiologically accurate hand movements throughout the full ROM. The study also tested the efficacy of the force assistance mode with the goal of increasing stroke subjects' active ROM while still requiring active extension torque on the part of the subject.ResultsFor 12 of the hand digits'15 joints in neurologically normal subjects, there were no significant ROM differences (P > 0.05) between active movements performed inside and outside of HEXORR. Interjoint coordination was examined in the 1st and 3rd digits, and no differences were found between inside and outside of the device (P > 0.05). Stroke subjects were capable of performing free hand movements inside of the exoskeleton and the force assistance mode was successful in increasing active ROM by 43 ± 5% (P < 0.001) and 24 ± 6% (P = 0.041) for the fingers and thumb, respectively.ConclusionsOur pilot study shows that this device is capable of moving the hand's digits through nearly the entire ROM with physiologically accurate trajectories. Stroke subjects received the device intervention well and device impedance was minimized so that subjects could freely extend and flex their digits inside of HEXORR. Our active force-assisted condition was successful in increasing the subjects' ROM while promoting active participation.

This paper proposes a teleimpedance controller with tactile feedback for more intuitive control of the Pisa/IIT SoftHand. With the aim to realize a robust, efficient and low-cost hand prosthesis design, the SoftHand is developed based on the motor control principle of synergies, through which the immense complexity of the hand is simplified into distinct motor patterns. Due to the built-in flexibility of the hand joints, as the SoftHand grasps, it follows a synergistic path while allowing grasping of objects of various shapes using only a single motor. The DC motor of the hand incorporates a novel teleimpedance control in which the user's postural and stiffness synergy references are tracked in real-time. In addition, for intuitive control of the hand, two tactile interfaces are developed. The first interface (mechanotactile) exploits a disturbance observer which estimates the interaction forces in contact with the grasped object. Estimated interaction forces are then converted and applied to the upper arm of the user via a custom made pressure cuff. The second interface employs vibrotactile feedback based on surface irregularities and acceleration signals and is used to provide the user with information about the surface properties of the object as well as detection of object slippage while grasping. Grasp robustness and intuitiveness of hand control were evaluated in two sets of experiments. Results suggest that incorporating the aforementioned haptic feedback strategies, together with user-driven compliance of the hand, facilitate execution of safe and stable grasps, while suggesting that a low-cost, robust hand employing hardware-based synergies might be a good alternative to traditional myoelectric prostheses.

The goal of this review was to discuss the impairments in hand function after stroke and present previous work on robot-assisted approaches to movement neurorehabilitation. Robotic devices offer a unique training environment that may enhance outcomes beyond what is possible with conventional means. Robots apply forces to the hand, allowing completion of movements while preventing inappropriate movement patterns. Evidence from the literature is emerging that certain characteristics of the human-robot interaction are preferable. In light of this evidence, the robotic hand devices that have undergone clinical testing are reviewed, highlighting the authors' work in this area. Finally, suggestions for future work are offered. The ability to deliver therapy doses far higher than what has been previously tested is a potentially key advantage of robotic devices that needs further exploration. In particular, more efforts are needed to develop highly motivating home-based devices, which can increase access to high doses of assisted movement therapy.