Search Results (17)

Arm and hand function play a critical role in the successful completion of everyday tasks. Lost function due to neurological impairment impacts millions of lives worldwide. Despite improvements in the ability to assess and rehabilitate arm deficits, knowledge about underlying sources of impairment and related sequela remains limited. The comprehensive assessment of function requires the measurement of both biomechanics and neuromuscular contributors to performance during the completion of tasks that often use multiple joints and span three-dimensional workspaces. To our knowledge, the complexity of movement and diversity of measures required are beyond the capabilities of existing assessment systems. To bridge current gaps in assessment capability, a new exoskeleton instrument is developed with comprehensive bilateral assessment in mind. The development of the BiLateral Upper-limb Exoskeleton for Simultaneous Assessment of Biomechanical and Neuromuscular Output (BLUE SABINO) expands on prior iterations toward full-arm assessment during reach-and-grasp tasks through the development of a dual-arm and dual-hand system, with 9 active degrees of freedom per arm and 12 degrees of freedom (six active, six passive) per hand. Joints are powered by electric motors driven by a real-time control system with input from force and force/torque sensors located at all attachment points between the user and exoskeleton. Biosignals from electromyography and electroencephalography can be simultaneously measured to provide insight into neurological performance during unimanual or bimanual tasks involving arm reach and grasp. Design trade-offs achieve near-human performance in exoskeleton speed and strength, with positional measurement at the wrist having an error of less than 2 mm and supporting a range of motion approximately equivalent to the 50th-percentile human. The system adjustability in seat height, shoulder width, arm length, and orthosis width accommodate subjects from approximately the 5th-percentile female to the 95th-percentile male. Integration between precision actuation, human–robot-interaction force-torque sensing, and biosignal acquisition systems successfully provide the simultaneous measurement of human movement and neurological function. The bilateral design enables use with left- or right-side impairments as well as intra-subject performance comparisons. With the resulting instrument, the authors plan to investigate underlying neural and physiological correlates of arm function, impairment, learning, and recovery. Full article

This paper examined the mechanical properties of wrist–hand orthoses made from polylactic acid (PLA) and polyethylene terephthalate glycol (PETG), produced through material extrusion with infill densities of 55% and 80%. These orthoses, commonly prescribed for wrist injuries, were 3D-printed flat and subsequently thermoformed to fit the user’s hand. Experimental and numerical analyses assessed their mechanical resistance to flexion after typical wear conditions, including moisture and long-term aging, as well as their moldability. Digital Imaging Correlation investigations were performed on PLA and PETG specimens for determining the characteristics required for running numerical analysis of the mechanical behavior of the orthoses. The results indicated that even the orthoses with the lower infill density maintained suitable rigidity for wrist immobilization, despite a decrease in their mechanical properties after over one year of shelf life. PLA orthoses with 55% infill density failed at a mean load of 336 N (before aging) and 215 N (after aging), while PETG orthoses did not break during tests. Interestingly, PLA and PETG orthoses with 55% infill density were less influenced by aging compared to their 80% density counterparts. Additionally, moisture and aging affected the PLA orthoses more, with thermoforming, ongoing curing, and stress relaxation as possible explanations related to PETG behavior. Both materials proved viable for daily use, with PETG offering better flexural resistance but posing greater thermoforming challenges. Full article

This paper investigated the feasibility of using 3D printing processes, specifically material extrusion (MEX) and vat photopolymerization (DLP—Digital Light Processing), to produce customized wrist–hand orthoses. Design, printability, and usability aspects were addressed. It was found that minimizing printing time for orthoses with intricate shapes, ventilation pockets, and minimal thickness is difficult. The influence of build orientation and process parameters, such as infill density, pattern, layer thickness, and wall thickness, on printing time for ten parameter configurations of orthoses in both ready-to-use and flat thermoformed shapes was examined. The findings revealed that the optimized orientations suggested by Meshmixer and Cura (Auto-orient option) did not reliably yield reduced printing times for each analyzed orthoses. The shortest printing time was achieved with a horizontal orientation (for orthoses manufactured in their ready-to-use form, starting from 3D scanning upper limb data) at the expense of surface quality in contact with the hand. For tall and thin orthoses, 100% infill density is recommended to ensure mechanical stability and layer fill, with caution required when reducing the support volume. Flat and thermoformed orthoses had the shortest printing times and could be produced with lower infill densities without defects. For the same design, the shortest printing time for an orthosis 3D-printed in its ready-to-use form was 8 h and 24 min at 60% infill, while the same orthosis produced as flat took 4 h and 37 min for the MEX process and half of this time for DLP. Usability criteria, including perceived immobilization strength, aesthetics, comfort, and weight, were evaluated for seven orthoses. Two healthy users, with previous experience with traditional plaster splints, tested the orthoses and expressed satisfaction with the 3D-printed designs. While the Voronoi design of DLP orthoses was visually more appealing, it was perceived as less stiff compared to those produced by MEX. Full article

This article proposes the integration of two novel aspects into the production of 3D-printed customized wrist-hand orthoses. One aspect involves the material, particularly Colorfabb varioShore thermoplastic polyurethane (TPU) filament with an active foaming agent, which allows adjusting the 3D-printed orthoses’ mechanical properties via process parameters such as printing temperature. Consequently, within the same printing process, by using a single extrusion nozzle, orthoses with varying stiffness levels can be produced, aiming at both immobilization rigidity and skin-comfortable softness. This capability is harnessed by 3D-printing the orthosis in a flat shape via material extrusion-based additive manufacturing, which represents the other novel aspect. Subsequently, the orthosis conforms to the user’s upper limb shape after secure attachment, or by thermoforming in the case of a bi-material solution. A dedicated design web app, which relies on key patient hand measurement input, is also proposed, differing from the 3D scanning and modeling approach that requires engineering expertise and 3D scan data processing. The evaluation of varioShore TPU orthoses with diverse designs was conducted considering printing time, cost, maximum flexion angle, comfort, and perceived wrist stability as criteria. As some of the produced TPU orthoses lacked the necessary stiffness around the wrist or did not properly fit the palm shape, bi-material orthoses including polylactic acid (PLA) inserts of varying sizes were 3D-printed and assessed, showing an improved stiffness around the wrist and a better hand shape conformity. The findings demonstrated the potential of this innovative approach in creating bi-material upper limb orthoses, capitalizing on various characteristics such as varioShore properties, PLA thermoforming capabilities, and the design flexibility provided by additive manufacturing technology. Full article

This article presents the process of development, testing, and use of wrist–hand orthosis in the hand therapy of a teen patient with congenital paresis disease. A regular 3D-printed anatomically adjusted orthosis is modified with a set of sensors, to work as motion and interaction controller in virtual reality (VR). As the patient with this condition cannot operate VR controllers due to wrist and hand defects, the corrective orthosis was converted to a VR controller, by introducing custom-made electronics and commercially available motion trackers, linking them to the orthosis. A VR game scenario, with typical input from the VR controllers replaced by input from the custom-made controllers is then designed. The VR game scenario is prepared with involvement of physiotherapists, to incorporate the most important exercises for patients with the same condition. The scenario is tested with a group of human patients and assessed by an expert physiotherapist, for determining its efficiency, as well as to determine a set of necessary improvements for future development of the orthosis. Full article

Limb injuries frequently necessitate orthotic bracing, and the utilization of material extrusion (MEX) additive manufacturing (AM) or 3D printing offers a rapid and cost-effective means of producing orthoses. These characteristics are highly sought after in today’s orthotic market. The study focused on the mechanical strength analysis of the wrist-hand orthosis (WHO) made of PET-G filament. Experimental testing and simulation were employed to assess the properties of individualized wrist orthoses fabricated through the MEX AM process. Standard three-point bending samples were manufactured using PET-G filament on a low-cost MEX 3D printer, alongside orthotic fragments and complete orthosis. Experimental testing was performed using a universal testing machine, and results were juxtaposed with those from a finite element simulation model created in the Abaqus environment. This comprehensive research approach facilitates the comparison of the modulus of elasticity of the fabricated components, enabling a comparison between the mechanical properties of the complete wrist-hand orthosis (WHO) product and those of a conventional bending sample. Full article

Additive manufacturing (AM) technologies enable the production of customized and personalized medical devices that facilitate users’ comfort and rehabilitation requirements according to their individual conditions. The concept of a tailor-made orthopedic device addresses the accelerated recovery and comfort of the patient through the utilization of personalized rehabilitation equipment. Direct modeling, with an increasing number of approaches and prototypes, has provided many successful results until now. The modeling procedure for 3D-printed orthoses has emerged as the execution of steady and continuous tasks with several design selection criteria, such as cutting, thickening the surface, and engraving the shell of the orthosis. This publication takes into consideration the aforementioned criteria and proposes the creation of a holistic methodology and automated computational design process for the customization of orthotic assistive devices, considering aspects such as material properties, manufacturing limitations, recycling, and patients’ requirements. This proposal leads to the designing and manufacturing of a wrist orthopedic device based on reverse engineering, Design for AM (DfAM), and Design for Recycling (DfR) principles. The proposed methodology can be adjusted for different limbs. A dual-material approach was attained utilizing rigid, mechanically enhanced feedstock material and soft elastic material with reduced skin irritation risks to achieve both mechanical requirements and adequate cushioning for user comfort during rehabilitation. Recyclable thermoplastic matrices were selected, which also allow for the option to create washable devices for product life extension. Then, 3D scanning procedures were implemented to acquire the initial anatomic measurements for the design of the WHO and ensure and assess the dimensional accuracy of the final product. Physical mechanical testing was implemented to evaluate the WHO’s mechanical behavior and verify its functionality during basic wrist movements. The extracted dimensional data for the two main orthosis components that indicated approximately 50% and 25% of the tolerance values, respectively, were within the range (−0.1 mm, 0.1 mm). Full article

Motor neuron disease (MND) patients often experience hand-wrist muscle atrophy resulting in severe social consequences and hampering their daily activities. Although hand-wrist orthosis is commonly used to assist weakened muscles, its effectiveness is limited due to the rapid progression of the disease and the need for customization to suit individual patient requirements. To address these challenges, this study investigates the application of three-dimensional (3D) printing technology to design and fabricate two lattice structures inspired by silkworm cocoons, using poly-ε-caprolactone as feedstock material. Finite element method (FEM) analysis is employed to study the mechanical behavior, enabling control over the geometric configuration incorporated into the hand-wrist orthosis. Through tensile displacement and three-point bending simulations, the stress distribution is examined for both lattice geometries. Geometry-1 demonstrates anisotropic behavior, while geometry-2 exhibits no strict directional dependence due to its symmetry and uniform node positioning. Moreover, the biocompatibility of lattices with human skin fibroblasts is investigated, confirming excellent biocompatibility. Lastly, the study involves semi-structured interviews with MND patients to gather feedback and develop prototypes of form-fitting 3D-printed lattice-based hand-wrist orthosis. By utilizing 3D printing technology, this study aims to provide customized orthosis that can effectively support weakened muscles and reposition the hand for individuals with MND. Full article

Additively manufactured wrist–hand orthoses (3DP-WHOs) offer several advantages over traditional splints and casts, but their development based on a patient’s 3D scans currently requires advanced engineering skills, while also recording long manufacturing times as they are commonly built in a vertical position. A proposed alternative involves 3D printing the orthoses as a flat model base and then thermoforming them to fit the patient’s forearm. This manufacturing approach is faster, cost-effective and allows easier integration of flexible sensors as an example. However, it is unknown whether these flat-shaped 3DP-WHOs offer similar mechanical resistance as the 3D-printed hand-shaped orthoses, with a lack of research in this area being revealed by the literature review. To evaluate the mechanical properties of 3DP-WHOs produced using the two approaches, three-point bending tests and flexural fatigue tests were conducted. The results showed that both types of orthoses had similar stiffness up to 50 N, but the vertically built orthoses failed at a maximum load of 120 N, while the thermoformed orthoses could withstand up to 300 N with no damages observed. The integrity of the thermoformed orthoses was maintained after 2000 cycles at 0.5 Hz and ±2.5 mm displacement. It was observed that the minimum force occurring during fatigue tests was approximately −95 N. After 1100–1200 cycles, it reached −110 N and remained constant. The outcomes of this study are expected to enhance the trust that hand therapists, orthopedists, and patients have in using thermoformable 3DP-WHOs. Full article

People with mid-cervical spinal cord injury (SCI) often have difficulty in performing activities of daily living due to weakness or paralysis in the flexor muscles. The inability to perform activities requiring fine motor control, such as eating, brushing, writing, unlocking doors, etc., affects overall quality of life negatively. To perform such tasks, appropriate movement of the hands, specifically at the wrist, is essential. For SCI patients, wrist orthotics are considered a viable option with which to perform general tasks. Wrist orthotics, used for rehabilitating people with SCI, help to maintain proper wrist and hand positioning; however, patients must frequently change these orthotic devices as per separate activity requirements. This becomes difficult and cumbersome for such patients. In this work, a passive 3D-printed upper-extremity dynamic orthosis was developed to assist SCI patients in their activities of daily living. The orthosis works on the principle of a worm-gear-based mechanism to produce pronation/supination motions at the wrist. To test the developed multipurpose customized orthosis, ten patients with cervical SCI were recruited and prescribed the 3D-printed splint for a period of four weeks. It was assessed through the QUEST questionnaire and a task completion assessment for its performance. The developed multipurpose customized orthotic device was found to provide an appropriate range of motion, ease in performing tasks, and took less time to complete tasks compared to previous works. The results indicated satisfactory performance, thereby improving quality of life. The multipurpose customized orthotic device successfully assisted the subjects with their daily activities, thus making them more independent in their rehabilitative period. Full article

In this research, the mechanical properties of 3D-printed polycaprolactone (PCL), a biocompatible and biodegradable semi-crystalline polyester, available as feedstock for additive manufacturing technology based on the material extrusion process, were determined. The influence of the infill pattern (zig-zag vs. gyroid) and ultraviolet (UV-B) exposure over the specimens’ mechanical performances were also investigated to gather relevant data on the process parameter settings for different applications. Specimens and samples of 3D-printed PCL were analyzed through tensile and flexural tests. The experimental data showed the good repeatability of the manufacturing process, as well as a mechanical behavior independent of the specimens’ infill pattern at full density. No differences between the failure patterns of the tensile specimens were recorded. UV-B exposure proved to have a significant negative impact on the specimens’ tensile strength. The 3D printing of PCL and PCL blends is reported mainly for use in scaffold manufacturing or drug delivery applications. As another novelty, the suitability of commercial PCL filaments for producing patient-customized wrist–hand orthoses was also assessed in this study. Semi-cylindrical PCL samples mimicking the forearm part of a wrist–hand orthosis with hexagonal open pockets were 3D-printed and mechanically tested. The results were discussed in comparison to samples with a similar design, made of polylactic acid. The experiments revealed the need to carefully calibrate the manufacturing parameters to generate defect-free, good quality prints. Once settings were established, promising results were obtained when producing orthoses in a ready-to-use form. On the other hand, the attempts to thermoform flat 3D-printed PCL orthoses proved unsuccessful. Full article

Brain–computer interfaces (BCIs) are becoming more popular in the neurological rehabilitation field, and sensorimotor rhythm (SMR) is a type of brain oscillation rhythm that can be captured and analyzed in BCIs. Previous reviews have testified to the efficacy of the BCIs, but seldom have they discussed the motor task adopted in BCIs experiments in detail, as well as whether the feedback is suitable for them. We focused on the motor tasks adopted in SMR-based BCIs, as well as the corresponding feedback, and searched articles in PubMed, Embase, Cochrane library, Web of Science, and Scopus and found 442 articles. After a series of screenings, 15 randomized controlled studies were eligible for analysis. We found motor imagery (MI) or motor attempt (MA) are common experimental paradigms in EEG-based BCIs trials. Imagining/attempting to grasp and extend the fingers is the most common, and there were multi-joint movements, including wrist, elbow, and shoulder. There were various types of feedback in MI or MA tasks for hand grasping and extension. Proprioception was used more frequently in a variety of forms. Orthosis, robot, exoskeleton, and functional electrical stimulation can assist the paretic limb movement, and visual feedback can be used as primary feedback or combined forms. However, during the recovery process, there are many bottleneck problems for hand recovery, such as flaccid paralysis or opening the fingers. In practice, we should mainly focus on patients’ difficulties, and design one or more motor tasks for patients, with the assistance of the robot, FES, or other combined feedback, to help them to complete a grasp, finger extension, thumb opposition, or other motion. Future research should focus on neurophysiological changes and functional improvements and further elaboration on the changes in neurophysiology during the recovery of motor function. Full article

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive neuromodulation technique. Magnetic fields induced by rPMS pass through almost all materials, and it has clinical applications for neurorehabilitation. However, the effects of rPMS through clothing and orthosis on induced movement and corticospinal excitability remain unclear. The aim of this study was to determine whether rPMS induces movement and enhances corticospinal excitability through hand splint materials. rPMS was applied directly to the skin (L0) and through one (L1) or two (L2) layers of splint material in 14 healthy participants at 25-Hz, 2-s train per 6 s for a total of 20 min. rPMS was delivered to the forearm with the stimulus intensity set to 1.5-times the train intensity-induced muscle contractions under the L0 condition. We recorded induced wrist movements during rPMS and motor-evoked potentials of the extensor carpi radialis pre- and post-application. The results showed that rPMS induced wrist movements in L0 and L1, and it facilitated corticospinal excitability in L0 but not in L1 and L2. This suggests that rPMS can make electromagnetic induction on periphery even when applied over clothing and orthosis and demonstrates the potential clinical applications of this technique for neurorehabilitation. Full article

Humans typically fixate on objects before moving their arm to grasp the object. Patients with ALS disorder can also select the object with their intact eye movement, but are unable to move their limb due to the loss of voluntary muscle control. Though several research works have already achieved success in generating the correct grasp type from their brain measurement, we are still searching for fine controll over an object with a grasp assistive device (orthosis/exoskeleton/robotic arm). Object orientation and object width are two important parameters for controlling the wrist angle and the grasp aperture of the assistive device to replicate a human-like stable grasp. Vision systems are already evolved to measure the geometrical attributes of the object to control the grasp with a prosthetic hand. However, most of the existing vision systems are integrated with electromyography and require some amount of voluntary muscle movement to control the vision system. Due to that reason, those systems are not beneficial for the users with brain-controlled assistive devices. Here, we implemented a vision system which can be controlled through the human gaze. We measured the vertical and horizontal electrooculogram signals and controlled the pan and tilt of a cap-mounted webcam to keep the object of interest in focus and at the centre of the picture. A simple ‘signature’ extraction procedure was also utilized to reduce the algorithmic complexity and system storage capacity. The developed device has been tested with ten healthy participants. We approximated the object orientation and the size of the object and determined an appropriate wrist orientation angle and the grasp aperture size within 22 ms. The combined accuracy exceeded 75%. The integration of the proposed system with the brain-controlled grasp assistive device and increasing the number of grasps can offer more natural manoeuvring in grasp for ALS patients. Full article

Background: This paper presents a novel approach for a hand prosthesis consisting of a flexible, anthropomorphic, 3D-printed replacement hand combined with a commercially available motorized orthosis that allows gripping. Methods: A 3D light scanner was used to produce a personalized replacement hand. The wrist of the replacement hand was printed of rigid material; the rest of the hand was printed of flexible material. A standard arm liner was used to enable the user’s arm stump to be connected to the replacement hand. With computer-aided design, two different concepts were developed for the scanned hand model: In the first concept, the replacement hand was attached to the arm liner with a screw. The second concept involved attaching with a commercially available fastening system; furthermore, a skeleton was designed that was located within the flexible part of the replacement hand. Results: 3D-multi-material printing of the two different hands was unproblematic and inexpensive. The printed hands had approximately the weight of the real hand. When testing the replacement hands with the orthosis it was possible to prove a convincing everyday functionality. For example, it was possible to grip and lift a 1-L water bottle. In addition, a pen could be held, making writing possible. Conclusions: This first proof-of-concept study encourages further testing with users. Full article