Design, modeling, and preliminary evaluation of a simple wrist-hand stretching orthosis for neurologically impaired patients

This work studies upper-limb impairment resulting from stroke or traumatic brain injury and presents a simple technological solution for a subset of patients: a soft, active stretching aid for at-home use. To better understand the issues associated with existing associated rehabilitation devices, customer discovery conversations were conducted with 153 people in the healthcare ecosystem (60 patients, 30 caregivers, and 63 medical providers). These patients fell into two populations: spastic (stiff, clenched hands) and flaccid (limp hands). Focusing on the first category, a set of design constraints was developed based on the information collected from the customer discovery. With these constraints in mind, a powered wrist-hand stretching orthosis (exoskeleton) was designed and prototyped as a preclinical study (T0 basic science research) to aid in recovery. The orthosis was tested on two patients for proof-of-concept, one survivor of stroke and one of traumatic brain injury. The prototype was able to consistently open both patients’ hands. A mathematical model was developed to characterize joint stiffness based on experimental testing. Donning and doffing times for the prototype averaged 76 and 12.5 s, respectively, for each subject unassisted. This compared favorably to times shown in the literature. This device benefits from simple construction and low-cost materials and is envisioned to become a therapy device accessible to patients in the home. This work lays the foundation for phase 1 clinical trials and further device development.