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This study does not describe a success-story. Instead, it describes an exploratory process and the lessons learned while designing a compliant mechanism for a dynamic hand orthosis. Tools from engineering optimization and rapid prototyping techniques were used, with the goal to design a mechanism to compensate for hypertonic or contracted finger muscles. Results show that the mechanism did not reach its design constraints, mostly because it could not provide for the necessary stiffness and compliance at the same time. Hence, the presented approach is more suited for design problems with either lower forces or less displacement. It was concluded that physiological stiffness models are an important part when modeling hand orthoses. Moreover, further research on compliant mechanisms in dynamic hand orthoses should focus on the feasibility of implementing more complex three-dimensional shapes, i.e., compliant shell mechanisms.

\ud Background\ud \ud Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke.\ud Methods\ud \ud A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up.\ud Results\ud \ud Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log.\ud Conclusions\ud \ud Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings.\ud Trial registration\ud \ud This study has been registered at the Netherlands Trial Registry (NTR): NTR3669.\ud

Email Print Request Permissions Save to Project With changes in life expectancy across the world, technologies enhancing well-being of individuals, specifically for older people, are subject to a new stream of research and development. In this paper we present the ACCOMPANY project, a pan-European project which focuses on home companion technologies. The projects aims to progress beyond the state of the art in multiple areas such as empathic and social human-robot interaction, robot learning and memory visualisation, monitoring persons and chores at home, and technological integration of these multiple approaches on an existing robotic platform, Care-O-Bot®3 and in the context of a smart-home environment utilising a multitude of sensor arrays. The resulting prototype from integrating these developments undergoes multiple formative cycles and a summative evaluation cycle towards identifying acceptable behaviours and roles for the robot for example role as a butler or a trainer. Furthermore, the evaluation activities will use an evaluation grid in order to assess achievement of the identified user requirements, formulated in form of distinct scenarios. Finally, the project considers ethical concerns and by highlighting principles such as autonomy, independence, enablement, safety and privacy, it embarks on providing a discussion medium where user views on these principles and the existing tension between some of these principles for example tension between privacy and autonomy over safety, can be captured and considered in design cycles and throughout project developments.

After stroke, intensive and active training is important to regain functional use of the arm and hand. By applying a telerehabilitation system (SCRIPT1) supporting active, distal arm practice at home, a patient can practice independently, which enables a larger dosage of treatment than possible during one-to-one supervised rehabilitation. Currently one of the major, but rarely addressed, questions concerning telerehabilitation is whether patients actually use such a system in a self-administered training approach. This paper presents preliminary results about feasibility of self-administered post-stroke home-based SCRIPT1 training. So far, data of 20 chronic stroke patients is available, who have trained for six weeks at home using interactive gaming exercises and a passive wrist/hand orthosis supporting hand opening (SCRIPT1). Findings so far indicated positive perceptions of usability and showed actual use of the system with a mean training duration of 107 min/week. This was accompanied by modest improvements in motor function and dexterity, correlated positively with training duration. These preliminary findings indicate that self-administered, technology-supported distal arm training at home is feasible for chronic stroke patients.