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Innovation is all about problem-solving and this is achieved through the groundbreaking breakthroughs. The radical advances are usually characterized by a preexisting problem that has been very hard to solve (Christiansen et al., 2005). One such breakthrough has been experienced in the field of healthcare service delivery especially in the treatment of post-stroke victims. Advancement in the robotics technology has gone a long way to ensuring stroke is no longer the primary cause of the adult disability as we know it today (Olsen, 2011). Disabled adults have a limited life as their neurological and motor systems are affected the most. The skillful art of hand is most important in carrying out the daily routine in the livelihood of individuals. Hence, there should be efforts to mitigate the disability of the hand's dexterity as a result of experiencing a stroke. This was made possible by the groundbreaking work of the hand exoskeletons which with time has undergone through a series of small improvements into what we know today as the Magnetic Resonance Compatible hand exoskeletons that have revolutionized post-stroke treatment.
The incremental innovation of the Hand Exoskeleton
Hand exoskeletons have been developed in the recent past for assistance and rehabilitation works of the individuals affected by stroke. The basic mechanism in the development of the rehabilitation hand exoskeletons is to enhance exercise for the patients thereby helping them to recover the motor function of the hand in time. The previous hand exoskeletons were either through passive movement, whereby the exoskeleton is used to drive the movement, or active movement, whereby the hand of the patient drives the movement against an exoskeleton offering variable resistance (Kim et al., 2015). The following criteria classified the development of the exoskeletons: the class of actuator, the degree of freedom, sensing method and intention, and control method. This brings us to the analysis of the various innovations into the early hand exoskeletons to be developed.
This type of hand exoskeleton was developed to be driven by the use of a passive actuator. This actuator gives a moment of extension throughout the joints of the finger compensating for the flexor effect that is lost in case of a stroke. The design follows the conventional trajectory kinematics of the hand during the function of pinch-pad grasping (Hong et al., 2015). This action provides the much-needed torque profile extension which works to compensate for the hypertonia of the finger flexor. The design for the hand exoskeleton thumb required a four-bar mechanism of linkage. Consequently, the finger parts were also developed to help in the coordination of the natural grasping properties of the hand. The point of attachment of the spring is not fixed as there is the need for torque profile adjustment.
This hand exoskeleton was developed to be used for the physical hand therapy. It works by the principle of continuous passive movement (CPM) with the help of an electric motor for actuation. It is, therefore, able to achieve a full range of motion of extension and flexion by the use of a dive bar and attachments of fingers to be able to achieve the fingers to take the natural path of grasping. This device is exceptionally lightweight hence portable. Therefore, it can be worn for a greater period with ease. Another critical attribute of WaveFlex32 is its ability to be adjusted to various lengths of the finger by the use of finger clips which are attached to it (Hong et al., 2015). Moreover, measurement of the interaction force can be achieved by this device. The movement to the reverse direction is achieved when there is the exceeding of a particular threshold of force during the movement of the hand, therefore, a function termed 'reverse-on-load' takes over to control the device making it move in the opposite direction to the original. This is especially significant in the prevention of the overload felt by the user to their fingers. One setback of the WaveFlex32 can be considered to be the inadequacy of being possible to move the fingers and the thumb simultaneously.
Kinetic Maestra Portable Hand CPM33
This device was developed to be used commercially in the rehabilitation of the hand post stroke. It works by the incorporation of the bilateral Alumafoam splint for attaching the device to the forearm of the user (Hong et al., 2015). The movements of extension and flexion are made possible by the drive bar, whereby, there is the connection between the four fingers except for the thumb. An electric motor is used in the actuation of the drive bar. One key attribute of the Kinetic Maestra Portable Hand is its ability to achieve the full flexion and the hyperextension of the fingers; however, like its predecessors, there is no involvement of the thumb movement during the extension of the fingers.
Mulas et al.34
The development of this hand exoskeleton was by Mulas and colleagues. Actuation of the drive bar is made possible by two electric motors. The electric motors work to drive the wires to achieve the flexion of the thumb in combination with the other fingers. The extension of the fingers is by the work of the springs. The control of this device is seen to be different to the previous CPM devices, as this device is run by electromyography signal for the initiation of the hand movement as a result of the volition by the user; Exceeding a particular set threshold by the electromyography signal works to initiate the movement of the hand exoskeleton (Hong et al., 2015).
Tong et al.
The development of the hand exoskeleton by Tong and colleagues ensured a device consisting of the five finger assemblies. Each of the fingers in the assembly consisted of one active DOF. Each of the active DOF is then actuated with the help of a linear actuator that causes the coupled movement by the PIP and MCP joints. The operation of the hand exoskeleton is in four modes. The first one is the CPM then EMG triggered motion followed by continuous EMG motion driven, and the fourth one is the free running mode. The EMG triggered motion mode works behind the principle of exceeding a certain threshold by the corresponding signal, therefore, making the device to initiate the extension or flexion motion. The mode of continuous EMG motion is when there is a continuation of the movement provided the effort by the user is present. The last mode, free running, choose between the flexion and the extension of the device in comparison to the signals of the EMG emancipating from the flexion and extension muscles.
Iqbal and principals gave out a proposal for a hand exoskeleton system with the ability to actuate two fingers for rehabilitation. Either of the fingers is driven by the use of linkage which is undercut an electric motor drives that. They adopted a linkage which is in the structure of a three-planar mechanism that is underactuated and has one point of attachment. It also has a force sensor that is custom made which is integrated into the device.
This is the Hand Exoskeleton Rehabilitation Robot that was developed by Schabowsky and colleagues. The device is made up of two components which are modular. One component is designated for the fingers whereas the other one is for the thumb. The module for the finger is done with a four-bar linkage which is capable of providing rotations that are coupled to the PIP and MCP joints. An electric motor drives either of the modules. Sensing of the user volition is with the help of a torque sensor. HEXORR's operation is by three modes. The first is the CPM then the Active unassisted motion followed by the active force assisted motion. In the Active unassisted movement, there is the compensation of the friction and movement of the device on its own. Consequently, there is the rejection of unintended motion commands. The extension movements are provided for by the assisted motion mode.
Chiri and colleagues developed this hand exoskeleton. This device has five modules of the fingers which are independent of each other. Either of the finger modules is made up of three links for the fingers. The rotation center for either of the connections matches with the similar joint of the human finger. A slider-crank mechanism is used for the driving of MCP joint flexion and extension activities. However, Bowden cable transmissions are used to drive the DIP and PIP joints. There is an under actuation of the three joints of either finger by the use of a simple unit of actuation. For instance, in the module of the finger, there is the mounting of three sensors to the motion on the inner side surface of either of the three planar shell. These sensors work to sense the force of interaction. The MCP rotation linear slider is reinforced with strain gauges for the measurement of the transmitted force by the driving cable.
Breakthrough into Magnetic Resonance Compatibility
The move to integrate MR in hand exoskeletons was prompted by the idea of being more clinical rather than technical to enhance the rehabilitation of post-stroke victims (Heo et al., 2015). There have been trials on the clinical aspect of the hand exoskeletons to get to know the impact of the robots in the process of rehabilitation. The productivity of the previous robots used in treatment procedures has been put into question because of the motor recovery mechanisms. As a result, currently, there is no conclusive intervention for the neural dynamism and their robotics rehabilitation implementation. A proper understanding of the various rehabilitation interventions, there has to be developments in the neuroimaging techniques that allow conclusive analysis of the brain's strategy of motor recovery. Proper brain neuroimaging was achieved by integration of functional magnetic resonance imaging (fMRI) in clinical works. The move enables the proper investigation of activity in the brain. Consequently, reorganization in response to the ever-changing environment can be achieved.
The development of the MR compatible hand exoskeletons faces some design challenges. For instance, the compatibility of the device to the environment is very difficult to be realized. Also, the conventional sensors and actuators potentially release energy in the form of radio frequency disturbing the MR image quality. Consequently, artifacts are introduced to the image making the originality of the MR image to be compromised (Hong et al., 2015). There are some proposals towards making of MR compatible hand exoskeletons. For example, the MR steered delivery of drugs, rehabilitation and hepatic devices for the fMRI studies. This was the idea of Reiner who proposed a hepatic interface for the application in neuroscience. MR-compatible is interesting in a way that it can span the assistance torque range given by the modern rehabilitation hand exoskeletons. It has enabled the investigation of the brain activity in the time of the various rehabilitation processes.
The future rehabilitation hand exoskeletons are proposed to be light in weight hence portable thereby broadening the potential applications of the device (Croslin, 2010). The portability of the hand exoskeleton is significant such that it can be used for prosthetics as well as assisting with the daily hand operations by an individual. The future hand exoskeletons should also be integrated with the virtual reality technology to bring the room for reality during the hand exercises. This includes the introduction of virtual games to aid in training therapy in some hand exoskeletons.
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