With recent improvements in healthcare, individuals with Duchenne muscular dystrophy (DMD) have prolonged life expectancy, and it is therefore vital to preserve their independence. Hand function plays a central role in maintaining independence in daily living. This requires sufficient grip force and the ability to modulate it with no substantially added effort. Individuals with DMD have low residual grip force and its modulation is challenging and fatiguing. To assist their hand function, we developed a novel dynamic hand orthosis called SymbiHand, where the user's hand motor intention is decoded by means of surface electromyography, enabling the control of an electrohydraulic pump for actuation. Mechanical work is transported using hydraulic transmission and flexible structures to redirect interaction forces, enhancing comfort by minimizing shear forces. This paper outlines SymbiHand's design and control, and a case study with an individual with DMD. Results show that SymbiHand increased the participant's maximum grasping force from 2.4 to 8 N. During a grasping force-tracking task, muscular activation was decreased by more than 40% without compromising task performance. These results suggest that SymbiHand has the potential to decrease muscular activation and increase grasping force for individuals with DMD, adding to the hand a total mass of no more than 241 g. Changes in mass distributions and an active thumb support are necessary for improved usability, in addition to larger-scale studies for generalizing its assistive potential.

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Upper extremity function is affected by a variety of neurological conditions. Robotic exoskeletons offer a potential solution for motor restoration. However, their systematic adoption is limited by challenges relative to human intention detection and device control. This position article offers a focused perspective on this topic. That is, on how knowledge gained from the design and implementation of human-machine interfaces (HMIs) for bionic arms can benefit the field of rehabilitation exoskeletons. Three broadly used HMIs in bionic arms are here investigated, including surface electromyography, impedance, and body-powered control. We propose that combinations of these HMIs could push forward upper extremity exoskeleton development. In this context, we provide concrete applicative examples in two selected clinical scenarios, including post-stroke and Duchenne muscular dystrophy individuals. The discussed solutions can open new avenues for the translation of robotic exoskeletons in a large set of clinical settings and enable a class of exoskeleton technologies that could support a broader range of impairment and disease types.@en

People with Duchenne muscular dystrophy are currently in need of assistive robotics to improve their hand function and have a better quality of life. However, none of the available active hand orthoses is able to address to their specific needs. In this study, the use of hydraulic technology is proposed in the design of an active hand orthosis. Commercially available components were used to identify where customization is necessary for a new electrohydraulic hand orthosis. The presented prototype was able to move four finger modules with a single actuator. The finger modules were separable and had a total mass of only 150 g, whereas the valve manifold added another 250 g. Results revealed that the prototype was able to function well with full flexion/extension cycles up to 2 Hz, but with hysteretic losses between 37-81% of the total input energy. Specialized valves and slave cylinders are required to increase efficiency at higher speeds and to obtain more robust sealing performance.

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