Functional and usability assessment of a robotic exoskeleton arm to support activities of daily life

An assistive device for upper limb support was developed and evaluated in terms of usability, user satisfaction and motor performance on six end-users affected by neuro-motor disorders (three spinal cord injury; one multiple sclerosis; two Friedreich's ataxia). The system consisted of a lightweight 3-degrees-of-freedom robotic exoskeleton arm for weight relief, equipped with electromagnetic brakes. Users could autonomously control the brakes using a USB-button or residual electromyogram activations. The system functionally supported all of the potential users in performing reaching and drinking tasks. For three of them, time, smoothness, straightness and repeatability were also comparable to healthy subjects. An overall high level of usability (system usability score, median value of 90/100) and user satisfaction (Tele-healthcare Satisfaction Questionnaire - Wearable Technology, median value of 104/120) were obtained for all subject

Feasibility of a second iteration wrist and hand supported training system for self-administered training at home in chronic stroke

Telerehabilitation allows continued rehabilitation at home after discharge. The use of rehabilitation technology supporting wrist and hand movements within a motivational gaming environment could enable patients to train independently and ultimately serve as a way to increase the dosage of practice. This has been previously examined in the European SCRIPT project using a first prototype, showing potential feasibility, although several usability issues needed further attention. The current study examined feasibility and clinical changes of a second iteration training system, involving an updated wrist and hand supporting orthosis and larger variety of games with respect to the first iteration. Nine chronic stroke patients with impaired arm and hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility and arm and hand function were assessed before and after training. Median weekly training duration was 113 minutes. Participants accepted the six weeks of training (median Intrinsic Motivation Inventory = 4.4 points and median System Usability Scale = 73%). After training, significant improvements were found for the Fugl Meyer assessment, Action Research Arm Test and self-perceived amount of arm and hand use in daily life. These findings indicate that technology-supported arm and hand training can be a promising tool for self-administered practice at home after stroke.Final Accepted Versio

Acceptance of Assistive Technology by Users with Motor Disabilities Due to Spinal Cord or Acquired Brain Injuries: A Systematic Review

: Acquired motor limits can be provoked by neurological lesions. Independently of the aetiologies, the lesions require patients to develop new coping strategies and adapt to the changed motor functionalities. In all of these occasions, what is defined as an assistive technology (AT) may represent a promising solution. The present work is a systematic review of the scientific AT-related literature published in the PubMed, Cinahl, and Psychinfo databases up to September 2022. This review was undertaken to summarise how the acceptance of AT is assessed in people with motor deficits due to neurological lesions. We review papers that (1) dealt with adults (≥18 years old) with motor deficits due to spinal cord or acquired brain injuries and (2) concerned user acceptance of hard AT. A total of 615 studies emerged, and 18 articles were reviewed according to the criteria. The constructs used to assess users' acceptance mainly entail people's satisfaction, ease of use, safety and comfort. Moreover, the acceptance constructs varied as a function of participants' injury severity. Despite the heterogeneity, acceptability was mainly ascertained through pilot and usability studies in laboratory settings. Furthermore, ad-hoc questionnaires and qualitative methods were preferred to unstandardized protocols of measurement. This review highlights the way in which people living with acquired motor limits greatly appreciate ATs. On the other hand, methodological heterogeneity indicates that evaluation protocols should be systematized and finely tuned

Mixed methods usability evaluation of an assistive wearable robotic hand orthosis for people with spinal cord injury

BACKGROUND Robotic hand orthoses (RHO) aim to provide grasp assistance for people with sensorimotor hand impairment during daily tasks. Many of such devices have been shown to bring a functional benefit to the user. However, assessing functional benefit is not sufficient to evaluate the usability of such technologies for daily life application. A comprehensive and structured evaluation of device usability not only focusing on effectiveness but also efficiency and satisfaction is required, yet often falls short in existing literature. Mixed methods evaluations, i.e., assessing a combination of quantitative and qualitative measures, allow to obtain a more holistic picture of all relevant aspects of device usability. Considering these aspects already in early development stages allows to identify design issues and generate generalizable benchmarks for future developments. METHODS We evaluated the short-term usability of the RELab tenoexo, a RHO for hand function assistance, in 15 users with tetraplegia after a spinal cord injury through a comprehensive mixed methods approach. We collected quantitative data using the Action Research Arm Test (ARAT), the System Usability Scale (SUS), and timed tasks such as the donning process. In addition, qualitative data were collected through semi-structured interviews and user observations, and analyzed with a thematic analysis to enhance the usability evaluation. All insights were attributed and discussed in relation to specifically defined usability attributes such as comfort, ease of use, functional benefit, and safety. RESULTS The RELab tenoexo provided an immediate functional benefit to the users, resulting in a mean improvement of the ARAT score by 5.8 points and peaking at 15 points improvement for one user (clinically important difference: 5.7 points). The mean SUS rating of 60.6 represents an adequate usability, however, indicating that especially the RHO donning (average task time = 295 s) was perceived as too long and cumbersome. The participants were generally very satisfied with the ergonomics (size, dimensions, fit) of the RHO. Enhancing the ease of use, specifically in donning, increasing the provided grasping force, as well as the availability of tailoring options and customization were identified as main improvement areas to promote RHO usability. CONCLUSION The short-term usability of the RELab tenoexo was thoroughly evaluated with a mixed methods approach, which generated valuable data to improve the RHO in future iterations. In addition, learnings that might be transferable to the evaluation and design of other RHO were generated, which have the potential to increase the daily life applicability and acceptance of similar technologies

Robotics for rehabilitation of hand movement in stroke survivors

This article aims to give an overall review of research status in hand rehabilitation robotic technology, evaluating a number of devices. The main scope is to explore the current state of art to help and support designers and clinicians make better choices among varied devices and components. The review also focuses on both mechanical design, usability and training paradigms since these parts are interconnected for an effective hand recovery. In order to study the rehabilitation robotic technology status, the devices have been divided in two categories: end-effector robots and exoskeleton devices. The end-effector robots are more flexible than exoskeleton devices in fitting the different size of hands, reducing the setup time and increasing the usability for new patients. They suffer from the control of distal joints and haptic aspects of object manipulation. In this way, exoskeleton devices may represent a new opportunity. Nevertheless their design is complex and a deep investigation of hand biomechanics and physical human–robot interaction is required. The main hand exoskeletons have been developed in the last decade and the results are promising demonstrated by the growth of the commercialized devices. Finally, a discussion on the complexity to define which design is better and more effective than the other one is summarized for future investigations

Upper limb soft robotic wearable devices: a systematic review

Introduction: Soft robotic wearable devices, referred to as exosuits, can be a valid alternative to rigid exoskeletons when it comes to daily upper limb support. Indeed, their inherent flexibility improves comfort, usability, and portability while not constraining the user’s natural degrees of freedom. This review is meant to guide the reader in understanding the current approaches across all design and production steps that might be exploited when developing an upper limb robotic exosuit. Methods: The literature research regarding such devices was conducted in PubMed, Scopus, and Web of Science. The investigated features are the intended scenario, type of actuation, supported degrees of freedom, low-level control, high-level control with a focus on intention detection, technology readiness level, and type of experiments conducted to evaluate the device. Results: A total of 105 articles were collected, describing 69 different devices. Devices were grouped according to their actuation type. More than 80% of devices are meant either for rehabilitation, assistance, or both. The most exploited actuation types are pneumatic (52%) and DC motors with cable transmission (29%). Most devices actuate 1 (56%) or 2 (28%) degrees of freedom, and the most targeted joints are the elbow and the shoulder. Intention detection strategies are implemented in 33% of the suits and include the use of switches and buttons, IMUs, stretch and bending sensors, EMG and EEG measurements. Most devices (75%) score a technology readiness level of 4 or 5. Conclusion: Although few devices can be considered ready to reach the market, exosuits show very high potential for the assistance of daily activities. Clinical trials exploiting shared evaluation metrics are needed to assess the effectiveness of upper limb exosuits on target users