title: Development and pilot testing of HEXORR: hand EXOskeleton rehabilitation robot.
abstract: BACKGROUND
  Following 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  For 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Center for Applied Biomechanics and Rehabilitation Research, National Rehabilitation Hospital, 102 Irving Street, NW Washington, DC 20010, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Schabowsky
authors.forename: Sasha B
authors.initials: SB
authors.lastname: Godfrey
authors.forename: Rahsaan J
authors.initials: RJ
authors.lastname: Holley
authors.forename: Peter S
authors.initials: PS
authors.lastname: Lum
mesh_terms: D000328:Adult; D000465:Algorithms; D016022:Case-Control Studies; D002908:Chronic Disease; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D010865:Pilot Projects; D016059:Range of Motion, Articular / Q000502:physiology; D012371:Robotics / Q000295:instrumentation*; D012984:Software; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013933:Thumb / Q000503:physiopathology; D019415:Torque; D055815:Young Adult