Objective: This randomized controlled feasibility study investigates the ability for clinical application of the Brain-Computer Interface-based Soft Robotic Glove (BCI-SRG) incorporating activities of daily living (ADL)-oriented tasks for stroke rehabilitation. Methods: Eleven recruited chronic stroke patients were randomized into BCI-SRG or Soft Robotic Glove (SRG) group. Each group underwent 120-minute intervention per session comprising 30-minute standard arm therapy and 90-minute experimental therapy (BCI-SRG or SRG). To perform ADL tasks, BCI-SRG group used motor imagery-BCI and SRG, while SRG group used SRG without motor imagery-BCI. Both groups received 18 sessions of intervention over 6 weeks. Fugl-Meyer Motor Assessment (FMA) and Action Research Arm Test (ARAT) scores were measured at baseline (week 0), post- intervention (week 6), and follow-ups (week 12 and 24). In total, 10/11 patients completed the study with 5 in each group and 1 dropped out. Results: Though there were no significant intergroup differences for FMA and ARAT during 6-week intervention, the improvement of FMA and ARAT seemed to sustain beyond 6-week intervention for BCI-SRG group, as compared with SRG control. Incidentally, all BCI-SRG subjects reported a sense of vivid movement of the stroke-impaired upper limb and 3/5 had this phenomenon persisting beyond intervention while none of SRG did. Conclusion: BCI-SRG suggested probable trends of sustained functional improvements with peculiar kinesthetic experience outlasting active intervention in chronic stroke despite the dire need for large-scale investigations to verify statistical significance. Significance: Addition of BCI to soft robotic training for ADL-oriented stroke rehabilitation holds promise for sustained improvements as well as elicited perception of motor movements.

In this paper, we present a soft robotic glove designed to augment hand rehabilitation for stroke patients with clenched fist deformity. The robotic glove provides active finger extension for hand rehabilitative training, through its embedded inflatable actuators that are fabricated by heat bonding of flexible plastic sheets. Upon pressurization, the actuators inflate, stiffen, and extend the fingers. The actuators were embedded in the finger pockets of a glove. In this work, the device was evaluated in terms of its extension torque generated on the metacarpophalangeal (MCP) joint of a dummy finger model and a healthy subject. A stroke patient with finger spasticity was recruited to demonstrate the feasibility of the device to assist in finger extension. Preliminary results showed that the device was able to generate significant extension torques to provide assistance in finger extension for both healthy and stroke participants.

Neurological diseases including stroke and neurodegenerative disorders cause a hefty burden on the healthcare system. Survivors experience significant impairment in mobility and daily activities, which requires extensive rehabilitative interventions to assist them to regain lost skills and restore independence. The advent of remote rehabilitation architecture and enabling technology mandates the elaboration of sensing mechanisms tailored to individual clinical needs. This study aims to review current trends in the application of sensing mechanisms in remote monitoring and rehabilitation in neurological diseases, and to provide clinical insights to develop bespoke sensing mechanisms. A systematic search was performed using the PubMED database to identify 16 papers published for the period between 2018 to 2022. Teleceptive sensors (56%) were utilized more often than wearable proximate sensors (50%). The most commonly used modality was infrared (38%) and acceleration force (38%), followed by RGB color, EMG, light and temperature, and radio signal. The strategy adopted to improve the sensing mechanism included a multimodal sensor, the application of multiple sensors, sensor fusion, and machine learning. Most of the stroke studies utilized biofeedback control systems (78%) while the majority of studies for neurodegenerative disorders used sensors for remote monitoring (57%). Functional assessment tools that the sensing mechanism may emulate to produce clinically valid information were proposed and factors affecting user adoption were described. Lastly, the limitations and directions for further development were discussed.

Deep vein thrombosis (DVT) is a severe medical condition that affects many patients around the world, where one of the main causes is commonly associated with prolonged immobilization. Current mechanical prophylaxis systems, such as the compression stockings and intermittent pneumatic compression devices, have yet to show strong efficacy in preventing DVT. The current study aimed to develop a soft pneumatic sock prototype that uses soft extension pneumatic actuators to provide assisted ankle dorsiflexion–plantarflexion motion, so as to prevent the occurrence of DVT. The prototype was evaluated for its efficacy to provide the required dorsiflexion–plantarflexion motion by donning and actuating the prototype on simulated ankle–foot models with various ankle joint stiffness values. Our results showed that the soft extension actuators in the sock prototype provided controllable assisted ankle plantarflexion through actuator extension and ankle dorsiflexion through actuator contraction, where in our study, the actuations extended to 129.9–146.8% of its original length. Furthermore, the sock was able to achieve consistent range of motion at the simulated ankle joint across different joint stiffness values (range of motion: 27.5 ± 6.0 deg). This study demonstrated the feasibility of using soft extension pneumatic actuators to provide robot-assisted ankle dorsiflexion–plantarflexion motion, which will act as an adjunct to physiotherapists to optimize therapy time for bedridden patients and therefore may reduce the risk of developing DVT.

In recent years, the advent of soft robotics has changed the landscape of wearable technologies. Soft robots are highly compliant and malleable, thus ensuring safe human-machine interactions. To date, a wide variety of actuation mechanisms have been studied and adopted into a multitude of soft wearables for use in clinical practice, such as assistive devices and rehabilitation modalities. Much research effort has been put into improving their technical performance and establishing the ideal indications for which rigid exoskeletons would play a limited role. However, despite having achieved many feats over the past decade, soft wearable technologies have not been extensively investigated from the perspective of user adoption. Most scholarly reviews of soft wearables have focused on the perspective of service providers such as developers, manufacturers, or clinicians, but few have scrutinized the factors affecting adoption and user experience. Hence, this would pose a good opportunity to gain insight into the current practice of soft robotics from a user’s perspective. This review aims to provide a broad overview of the different types of soft wearables and identify the factors that hinder the adoption of soft robotics. In this paper, a systematic literature search using terms such as “soft”, “robot”, “wearable”, and “exoskeleton” was conducted according to PRISMA guidelines to include peer-reviewed publications between 2012 and 2022. The soft robotics were classified according to their actuation mechanisms into motor-driven tendon cables, pneumatics, hydraulics, shape memory alloys, and polyvinyl chloride muscles, and their pros and cons were discussed. The identified factors affecting user adoption include design, availability of materials, durability, modeling and control, artificial intelligence augmentation, standardized evaluation criteria, public perception related to perceived utility, ease of use, and aesthetics. The critical areas for improvement and future research directions to increase adoption of soft wearables have also been highlighted.

Objective. Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. Approach. In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30 min treatment of continuous passive motion (CPM) using a robotic glove. Main results. On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. Significance. This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.