Development of 3D-printed myoelectric hand orthosis for patients with spinal cord injury

Hyun-Joon Yoo, Sangbaek Lee, Jongheon Kim, Chanki Park, Boreom Lee, Hyun-Joon Yoo, Sangbaek Lee, Jongheon Kim, Chanki Park, Boreom Lee

Abstract

Background: Spinal cord injury (SCI) is a severe medical condition affecting the hand and locomotor function. New medical technologies, including various wearable devices, as well as rehabilitation treatments are being developed to enhance hand function in patients with SCI. As three-dimensional (3D) printing has the advantage of being able to produce low-cost personalized devices, there is a growing appeal to apply this technology to rehabilitation equipment in conjunction with scientific advances. In this study, we proposed a novel 3D-printed hand orthosis that is controlled by electromyography (EMG) signals. The orthosis was designed to aid the grasping function for patients with cervical SCI. We applied this hand exoskeleton system to individuals with tetraplegia due to SCI and validated its effectiveness.

Methods: The 3D architecture of the device was designed using computer-aided design software and printed with a polylactic acid filament. The dynamic hand orthosis enhanced the tenodesis grip to provide sufficient grasping function. The root mean square of the EMG signal was used as the input for controlling the device. Ten subjects with hand weakness due to chronic cervical SCI were enrolled in this study, and their hand function was assessed before and after wearing the orthosis. The Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) was used as the primary outcome measure. Furthermore, improvements in functional independence in daily living and device usability were evaluated.

Results: The newly developed orthosis improved hand function of subjects, as determined using the TRI-HFT (p < 0.05). Furthermore, participants obtained immediate functionality on eating after wearing the orthosis. Moreover, most participants were satisfied with the device as determined by the usability test. There were no side effects associated with the experiment.

Conclusions: The 3D-printed myoelectric hand orthosis was intuitive, easy to use, and showed positive effects in its ability to handle objects encountered in daily life. This study proved that combining simple EMG-based control strategies and 3D printing techniques was feasible and promising in rehabilitation engineering.

Trial registration: Clinical Research Information Service (CRiS), Republic of Korea. KCT0003995. Registered 2 May 2019 - Retrospectively registered.

Keywords: Assistive wearable robots; Orthosis; Spinal cord injury; Three-dimensional printing.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic design of the hand orthosis. a Ring part. A total of 8 ring parts were printed for each phalange of the thumb, index, and middle finger. b Hand part. c Dorsal forearm splint. d Volar forearm splint. Note that cable guide structures were designed to the volar side of each finger ring part and hand part to guide the nylon thread
Fig. 2
Fig. 2
Each motion of the 3D-printed orthosis. a When the linear motor is activated by sEMG signals, the wrist is extended, which causes the tenodesis grip. Also, the nylon thread connected to the tip of each finger ring part is tightened as the wrist extended, which enhances grip strength. b When the motor goes back into the place, the extended wrist and tension of the nylon thread are released, and the hand becomes in a neutral position. c-e A subject is using the orthosis to pick up a pop can, dice, and wooden block, which were used in TRI-HFT. f Top view of the orthosis. g Bottom view of the orthosis. The arrows indicate nylon thread that connects each finger ring and volar forearm splint
Fig. 3
Fig. 3
Control mode change of the device according to sEMG signal. a Raw and RMS sEMG signal in each situation. Note that the sEMG of usual muscle movements, such as picking up objects and bringing them to oneself, rarely exceeds the preset value (for example, 80% of the maximal RMS value). Therefore, the orthosis was not activated in such contraction level. b When the RMS value of the sEMG signal exceeds the threshold value, the myoelectric orthosis activates and the hand is closed by the exoskeleton. If the signal exceeds the threshold again, then the orthosis turns back and the hand opens
Fig. 4
Fig. 4
Overview of the control scheme. sEMG signals recorded from the surface electrodes were processed through some acquisition steps such as amplification and band pass filtering in order to improve the signal quality. Then, RMS values of the processed sEMG signals were compared with the customized threshold. The Arduino board classified whether to operate the orthosis according to the magnitude of the RMS value

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