Design a solution and a prototype for hand rehabilitation after trauma injures and post stroke

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POLITECNICO DI MILANO

Faculty of Design

Master of Science in Design Engineering

Design a solution and a prototype for hand

rehabilitation after trauma injures and

Post Stroke.

Master Thesis

Tutor:Professor Mario Covarrubias Rodrguez

Co-tutor: Professor Matteo Oreste Ingaramo

Student

Sofya Komarova No.860496/10512823

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Abstract

Hand injuries are common but if left untreated, it may result in loss of func-tion. Common causes of upper limb injuries are Post Stroke or Trauma. Trauma include falls, cuts from knives or glass as well as workplace injuries. The impairment of finger movements after injures results in a significant deficit in hands everyday performances.

Rehabilitation helps the patient to regain the hands full functionality [37]. Hand therapy is the art that fills the gap between surgery and prac-tical life. It helps the patient to regain the hands full functionality after a certain injury, surgery or Stroke. Hand therapy could be a very te-dious process that implies physical exhaustion. Rehabilitation at home is a long process and it should be done under therapist control. Also finding appointments with the therapist frequent enough for an efficient healing process, is difficult and costly. Since trying new technologies is usually exciting to people, using the advancements in the field of artificial intelli-gence could be a solution to this. Different rehabilitation techniques have been developed, nevertheless, they require the presence of a tutor to be executed. To overcome this issue have been designed several apparatuses that allow the patient to perform the training by itself [32].

Trying new technologies is exciting to people. Hand exoskeleton was im-plemented to help the patients do their exercises at home in an engaging gamified environment. The objective is to design a portable, lightweight exoskeleton with adjustment fast assemble system. The device support fingers and excluding second injuries. It reproduce pinch exercise. Thus, an easy to use and effective device is needed to provide the right training and complete the rehabilitation techniques in the best way. In this paper, a review of state of the art in this field is provided, along with an introduc-tion to the problems caused by a hand injuries and the consequences for the mobility of the hand. Then follows a complete review of the exoskele-ton project design. The objective is to design a device that can be used at home, with a lightweight and affordable structure and a fast mount-ing system. For implementmount-ing all these features, many aspects have been analysed, starting from the rehabilitation requirements and the ergonomic issues. This device should be able to reproduce the training movements on an injured hand without the need for assistance by an external tutor. The control system is based on Arduino UNO board, and the user interface is

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based on UNITY, the objective is to create an online media that allows the patient to exploit the capabilities of the exoskeleton, following the in-dication of its medic. On the other side, this interface should provide all the data related to the performances of the patient to allow a more precise therapy.

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Riassunto

Le lesioni alle mani sono eventi comuni , ma se non trattati possono causare la perdita della funzione. Le cause comuni delle lesioni degli arti superiori sono il Post Ictus, oppure il Trauma. I Traumi includono le cadute, i tagli da coltelli o vetro, cosi come anche gli infortuni sul posto di lavoro. La compromissione dei movimenti delle dita dopo gli infortuni si traduce in un significativo deficit nelle prestazioni quotidiane delle mani. La riabil-itazione aiuta il paziente a riguadagnare la piena funzionalita delle mani. Provare nuove tecnologie é eccitante per le persone. L’esoscheletro della mano é stato implementato per aiutare i pazienti a svolgere i loro esercizi a casa in un ambiente gamificato coinvolgente. L’obiettivo é progettare un esoscheletro portatile e leggero con un sistema di regolazione rapida. Il dispositivo supporta le dita ed esclude le seconde ferite. Riproduce un pizzico di esercizio. Pertanto, é necessario un dispositivo facile da usare ed efficace per fornire il giusto allenamento e completare le tecniche di riabilitazione nel modo migliore. In questo documento viene fornita una revisione dello stato dell’arte in questo campo, insieme a un’introduzione ai problemi causati da lesioni alle mani e alle conseguenze per la mobilita della mano. Segue quindi una revisione completa del progetto del esoscheletro. L’obiettivo é progettare un dispositivo che possa essere utilizzato a casa, con una struttura leggera e conveniente e un sistema di montaggio rapido. Per l’implementazione di tutte queste funzionalita, sono stati analizzati molti aspetti, a partire dai requisiti di riabilitazione e dalle questioni er-gonomiche. Questo dispositivo dovrebbe essere in grado di riprodurre i movimenti di allenamento su una mano ferita senza la necessita di assis-tenza da parte di un tutor esterno. Il sistema di controllo é basato sulla scheda Arduino UNO e l’interfaccia utente é basata su UNITY, l’obiettivo e creare un media online che permetta al paziente di sfruttare le capacita dell’esoscheletro, seguendo l’indicazione del suo medico. D’altra parte, questa interfaccia dovrebbe fornire tutti i dati relativi alle prestazioni del paziente per consentire una terapia piu precisa.

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Acknowledgements

I would like to thank Professor Mario Covarrubias Rodriguez for the full support during my thesis work in terms of product development and over-all guidance. Thanks to his flexibility and experience as an expert, it was possible to find an appropriate compromise between aesthetics and func-tionality.

I would like to express my gratitude to Professor Matteo Oreste In-garamo for the support. I appreciate the personal approach and respect to my work and ideas. It left the space for creativity and enabled learning process.

Finally, I would like to thank a few individuals for their technical sup-port from different fields: Prof. Mauro Rossini, Bio engineering depart-ment @ Villa Beretta Rehabilitation Center, in the rehabilitation field and patients analysis. Ta-Chun Lin (MSc. Mechanical Engineering) in the overall support regarding technical solutions, Naveen Krishnan (MSc. Design Engineering) in the overall support regarding technical solutions and material selection.

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List of Figures

1.1 Functions of the Brain.. . . 3

1.2 Stroke Typologies, Ischemic(left) Hemorrhagic (right). . . 4

1.3 Percentage of the consequences of a stroke. . . 5

1.4 Rehabilitation exercises. Finger motion. Grasp ball, cylinder. . . 6

1.5 Rehabilitation exercises. Finger motion. Pinch. . . 7

1.6 Rehabilitation exercises. Finger motion. Flexion/extension. . . 7

1.7 Rehabilitation exercise. Forearm motion.. . . 7

1.8 Rehabilitation exercise. Forearm motion. Flexion/extension . . . 8

1.9 Rehabilitation exercise. Forearm motion. Radial/Ulnar Deviation. . . 8

2.1 Gloreha components. . . 10 2.2 Gloreha passive. . . 10 2.3 Gloreha active. . . 11 2.4 AMADEO . . . 11 2.5 AMADEO components. . . 12 2.6 Dexmo DK1 . . . 13 2.7 Dexmo DK1 prototypes . . . 14

2.8 Context of use Dexmo DK1 . . . 14

2.9 Hands-on experience . . . 15

2.10 Hand of Hope . . . 16

2.11 How does Hand of Hope works . . . 16

2.12 MEDI TOUCH - HAND TUTOR components . . . 17

2.13 HandTutor working process . . . 17

2.14 Hand Tutor parts . . . 18

2.15 Rapael app . . . 18

2.16 Rapael smart glove . . . 19

2.17 Digital Rehabilitation ? Anytime, Anywhere. . . 19

2.18 Portable device . . . 20

2.19 Gamification: Rehabilitation through Engagement . . . 20

2.20 Harp telerehabilitation. . . 24

2.21 Storyboard of App for Oculus . . . 24

3.1 Question No.1 of Online Survey . . . 27

3.4 Question No.6 of Online Survey . . . 28 VIII

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3.15 Patient 1 . . . 35

3.16 Patient 1. Identity information. . . 36

3.17 Patient 2. Augusto Zerbi . . . 39

3.18 Patient 2. Identity information. . . 40

3.19 Human Architecture. Ink on paper. art drawing. Augusto Zerbi . . . 42

3.20 Patient 3 Ta-Chun Lin . . . 43

3.21 Patient 3. Identity information . . . 44

3.22 Injure . . . 49

3.23 Proximal Interphalangeal Joint (PIPJ) Fracture and Dislocation . . . 49

3.24 A conceptual model of the biopsychosocial interactive processes in-volved in health and illness. . . 50

3.25 Peripheral and central pain pathways. . . 51

3.26 Flow chart depicting the numbers of included and excluded studies. . 54

3.27 Bones joints. A. condylar joint B. plane joint C. ball-and-socket joint D. saddle joint E. pivot joint F. hinge joint . . . 56

3.28 Bones names . . . 56

3.29 Anthropometric estimates for the hand . . . 57

3.30 All dimensions in mm . . . 58

3.31 The three link planar manipulator mimicking the human index finger [19] 59 3.32 Classification of hand exoskeletons according to the various criteria . . 61

3.33 Mechanisms for matching the centre of rotation or eliminating the need for precise alignment . . . 61

3.34 Typical hand motion posture of Stroke patients . . . 62

3.35 Finger motion limit of patients with upper limb disability after trauma injures . . . 62

3.36 Home use . . . 64

3.37 Home use. Watching TV. . . 64

3.38 Home use. Cooking. . . 64

3.39 Home use. Making housework . . . 65

3.40 Office. On the working place . . . 66

3.41 Office. On the conference . . . 66

3.42 Outdoor. On-the-go . . . 67

3.43 Outdoor. Entertainment . . . 68

4.1 Parallax servo motor 360deg. . . 74

4.2 Liner actuator. . . 74 IX

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4.3 Pulley and Flex Tendor Anatomy . . . 75

4.4 Transmission system actuator . . . 76

4.5 Architecture . . . 77

4.6 Lego Bricks . . . 78

4.7 Rigid phalanges support.. . . 78

4.8 Polylactic acid (PLA) propertis . . . 79

4.9 Interphalangeal joints of the hand (American Academy of Family Physi-cians. Meko) . . . 79

4.10 Thermoplastic Polyurethane (TPU) Properties . . . 80

4.11 Sharebot NG . . . 80

4.12 Part in Slic3r Software . . . 81

4.13 Structure 1 . . . 82

4.14 Structure development. . . 82

4.15 Flexible finger support structure. Prototype N2 . . . 83

4.18 Testing sticks. 1. Cooper o.5 mm, 2. Composite material (thermo-plastic 1mm + aluminum), 3. Composite material (thermo(thermo-plastic 1mm + Sheet steel 0.5 mm), 4. Composite material (thermoplastic 1mm + Cooper 0.3 mm), 5. Steel wire, 6. 2 glue steel wire, 7. Thermoplastic H shape, 8. Thermoplastic 0.5 mm, 9. Thermoplastic 1 mm . . . 86

4.19 FEM Analysis in Abaqus . . . 86

4.20 Rigid phalanges support.. . . 87

4.21 Healthy People Test Result. . . 88

4.22 SUS - System Usability Scale. Patient Test Result. . . 88

5.1 Exoskeleton for upper limb rehabilitation S3. . . 91

5.2 S3 kit . . . 91

5.3 The components of the system . . . 92

5.4 Explosion view of Finger module component and flexible base . . . 93

5.5 Exoskeleton for upper limb rehabilitation S3. Main dimensions . . . . 93

5.6 Shell for servomotor . . . 94

5.7 Finger flexible structure . . . 95

5.8 Rigid phalanges support . . . 96

5.9 Flexible phalanges support . . . 96

5.10 Hand flexible structure. . . 97

5.11 Arm bracelet . . . 97

5.12 Arduino Nano microcontroller. . . 98

5.13 Arduino Nano 3.0 Specifications. . . 99

5.14 Arduino Nano 3.0 pinout. . . 99

5.15 HC-06 Bluetooth module. . . 101

5.16 HC-06 Bluetooth module specifications. . . 101

5.17 ZNTER 9V rechargeable battery with Micro USB connection. . . 102

5.18 Pin Descriptions. . . 103

5.19 Configuration for one injured finger. . . 104

5.20 Configuration for 2 injured fingers. . . 105 X

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5.21 Configuration for 3 injured fingers. . . 106

5.22 Configuration for 4 injured fingers. . . 107

5.23 Configuration for patients who have problems with all upper limb. . . 108

5.24 Assemble full glove.. . . 109

6.1 CES analysis. Elastic limit. . . 112

6.2 CES analysis. Price. . . 113

6.3 CES analysis. Elastic limit. . . 114

6.4 CES analysis. Price. . . 115

6.5 CES analysis. Flexural modulus. . . 117

6.6 CES analysis. Tear strength. . . 119

6.7 Modal frequency response analysis results. Structure 1 . . . 121

7.1 Registration in hospital database . . . 124

7.2 Choice of therapist. Login . . . 125

7.3 Connection to Exoskeleton. Fail. . . 126

7.4 Connection to Exoskeleton. Done . . . 126

7.5 Set Exoskeleton on starting position . . . 127

7.6 Assemble Exoskeleton on the hand . . . 127

7.7 Start rehabilitation . . . 128

7.8 Morning repetition . . . 128

7.9 Save data . . . 129

7.10 Patient account data . . . 130

A.1 Main Assemble . . . 137

A.2 Sub assemble 1 . . . 138

A.3 Sub assemble 2 . . . 139

A.4 Main dimensions . . . 140

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Chapter 1

Introduction

1.1 Issue description

The topic is the development of an exoskeleton able to provide rehabilitation exercises to treat patients injuries and restore function of the hand. It was observed that mechatronic devices are effective, but the problem is that they are not adjustment and can fit on different hand size. Furthermore user should allocate time for rehabilitation exercises [22]. Also existing mechanical systems have the common factor of being too heavy to be practical to offer for a patient to use for home therapy. Consequently, if the intention is to look for a device that a patient could utilize at home, it needs to be both lightweight and easy to put on [41], [34]. An aim of rehabilitation is the improvement of range movement, straight of muscles and acceleration of callus formation. It is very important to restore proprioception in a region of trauma. Our device provide passive and active macro region rehabilitation technique. In the passive rehabilitation, the movement of finger is provided be exoskeleton structure. Active task practice provide activating of device by muscle excitation [25]. Depends of the injures patient can change modular structure of the exoskeleton. Through the combination of rigid (PLA) and flexible (TPU) materials the device is able to fit on different hand size. At the same time it is possible to apply different levels of the exercises due to different circumstance. The automatic control system allows patients

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2 Chapter 1. Introduction

to do daily work in parallel with rehabilitation exercises. It save time and enable fast-moving back to practical life. In addition, exoskeleton enables to use VR applications which can further improve rehabilitation efficiency and application which the therapist can directly monitor patient status.

1.2 Involved Diseases

1.2.1 Finger, Hand, and Wrist Injuries

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or an injury. Finger, hand, or wrist injuries most commonly occur during:

• Sports or recreational activities, • Work-related tasks,

• Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools,

• Accidental falls, • fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury. Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing. Sudden (acute) injury. An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity,

• Injuries to ligaments, such as a skier’s thumb injury, • Injuries to tendons, such as mallet finger,

• Injuries to joints (sprains), • Pulled muscles (strains),

• Broken bones (fractures), such as a wrist fracture, • Dislocations,

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1.2. Involved Diseases 3

• Crushing injury, which can lead to compartment syndrome.

Overuse injuries Overuse injuries occur when too much stress is placed on a joint or other tissue, often by ”overdoing” an activity or repeating the same activity. Overuse injuries include the following:

• Carpal tunnel syndrome is caused by pressure on a nerve (median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand.

• Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.

• De Quervain’s disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become in-flamed.

1.2.2 Stroke Effects

A stroke occurs whenever the flow of oxygen to a region of the brain is obstructed. Without oxygen, brain cells die after a few minutes. Bleeding of a vascular body that irrorates the brain can also cause a stroke if it brings to oxygen starvation. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Consequences may be weakness, paralysis, numbness trouble speaking and understanding [21]. According to Figure 1.1

Figure 1.1: Functions of the Brain.

The two main types of stroke are ischemic and hemorrhagic. Ischemic is the more common with a percentage of 87 percent of occurrence. Ischemic strokes occur when blood is forbidden to flow because of an obstruction of a blood vessel that interrupts

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the flow of blood to a part of the brain [1]. The main cause is atherosclerosis, that is the development of a thick vascular wall in a region that does not allow the proper flow of blood and thus cause the development of fatty deposit. These fatty deposits can cause two types of obstruction Figure 1.2 [2].

Figure 1.2: Stroke Typologies, Ischemic(left) Hemorrhagic (right).

In most of the case, only one side of the brain is struck by the stroke as the hemispheres do not share the same vascular system. The region struck is mostly the one supplied by the cerebral artery, and this brings to the death of the neurons associated with the movement [3]. The obstruction brings to the loss of the voluntary movement function in the opposite part of the body concerning the side affected by the stroke, as the fibre cross at the brainstem (a stroke in the right side of the brain affects functions in the left side, and vice-versa). During the first phase, the numbness of the muscles is the most relevant, they show weakness and are uncontrollable in a large area. After some days, sometimes a few weeks the paralysis stabilises. Some regions of the muscles gain back their tone and ability to contract while the struck fibre show a strong spasticity. Apraxia is a typical condition of this phase; it is the loss of the ability to execute purposeful movements. Not all the movements characteristics of a region of the body are affected, but usually, just some specific moves result difficult. For example, may be difficult to open and close the arm, but not to rotate it. The physical consequences of a stroke may be different; the most common is the weakness of the upper limb/arm that affect the 77 percent of people who undergo a stroke. As

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shown on Figure ??.

Figure 1.3: Percentage of the consequences of a stroke.

1.2.3 Treatment strategies

Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; ”buddy-taping” for support; application of a brace, splint, or cast; Physiotherapy; and in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury. • How long ago the injury occurred.

• Age, health condition, and activities (such as work, sports, or hobbies).

In this thesis, however, the focus will be on the treatment of one of these disabilities: the development of an exoskeleton for the most complex and effective manipulator system that we are given, the hand. In the field of upper limbs rehabilitation, thus hands and arms, several methods have been proposed and tested: Impairment-oriented training (IOT)–scientific concept and evidence-based treatment strategies. (Klinik Berlin, Abteilung fr Neurologische Rehabilitation, Campus Benjamin Franklin, Charit-Universittsmedizin Berlin, Berlin, Germany.) Everyday activities can be affected by many different body dysfunctions (impairments). A multi-modal analysis of electric brain activity revealed that movement-related brain activity is differentially altered in patients with different impairments, i.e. paresis, somatosensory deficits, and apraxia. Each body dysfunction has its own characteristics in terms of the resulting sensorimo-tor control deficits. The Impairment-oriented Training concept intends to characterise the resulting sensorimotor control deficits for each impairment. Based on such analyses

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two specific training techniques have been developed for stroke patients with mild and severe arm paresis: (1.) The Arm Ability training for mild arm paresis trains different sensorimotor abilities such as dexterity, speed of isolated hand and finger movements, steadiness, aiming, or tracking under visual guidance. Improvement of these motor abilities leads to improved motor performance in every day life circumstances. (2.) The Arm BASI S training for severe arm paresis intends to restore more basic motor control, i.e. the full range of active non-segmented motion of all limb segments, both postural activities and dynamic motion control, interjoint-coordination, and adequate motor control when external forces are applied. Clinical trials with representative study populations supported both techniques’ clinical efficacy.

1.2.4 Physiotherapy exercises

Hand therapy exercise is combining occupational and physical therapy modalities to help rehabilitate the hands, fingers, and wrist disorders and injuries by using physical methods and devices such as grips, balls, bands, stacking cones, and weight bars. Hand therapy exercise is used for a variety of applications in rehabilitation centers, sports medicine facilities, hospitals and clinics for such conditions as arthritis, nerve damage, carpal tunnel syndrome, fractures and muscles/tendon tears. Below on Figures 1.4,

1.5, 1.6, 1.7, 1.8, 1.9, it is shown types of traditional rehabilitation exercises.

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Figure 1.5: Rehabilitation exercises. Finger motion. Pinch.

Figure 1.6: Rehabilitation exercises. Finger motion. Flexion/extension.

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Figure 1.8: Rehabilitation exercise. Forearm motion. Flexion/extension

Figure 1.9: Rehabilitation exercise. Forearm motion. Radial/Ulnar Deviation

1.3 Document structure

The document is organized in the following way:

Rehabilitation Devices is a state of the art review about the existing technology that regards exoskeleton devices. In the subchapters Telerehabilitation an overview of this new technology is presented, and in System Overview the overall presentation of the system can be found.

The Exoskeleton is the central chapter of the thesis, its content is about the design phase of the exoskeleton, and here all the technical data regarding the components can be found. In the beginning, the Requirements are presented along with an overall Description of the System. Then the aspects of the Anatomy of the hand and the Hand Articulation are analyzed.

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Chapter 2

Market

research/Rehabilitation

devices

2.1 Engine transmission system

2.1.1 GLOREHA

Gloreha is desk system [4]. It is used in hospitals or pacient can rent it directly in the company. Gloreha system consists from:

• one/two gloves with cable connection,

• controller with engine that connect with glove throw cable, • PC with real time hand protection,

• application.

It is shown on Figure 2.1

Process of use. Before started to use Glorena therapist masseuse hand of the patient. Depend of the finger length, volume of the hand, therapist pick up right size of the glove.

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10 Chapter 2. Market research/Rehabilitation devices

Figure 2.1: Gloreha components.

Gloreha has two types of glove as can be seen from Figures 2.2, 2.3.

Figure 2.2: Gloreha passive.

• 1-st type - patient use 2 glove BILATERAL .Trening in which the Gloreha Sensor Glove detects healthy hand flexion and extension. The device can be set according to healthy hand movements to flex and extend fingers joints with motor deficit. Patient involvement and stimulation of brain cortical areas are amplified in three ways: a mirror motor mechanism; the observation of two moving 3D hands; the bilateral interaction with real objects to complete functional tasks.

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2.1. Engine transmission system 11

Figure 2.3: Gloreha active.

• 2-nd type - patient use 1 glove ACTION-OBSERVATION THERAPY Patient wear glove on injury hand. Therapist activate rehabilitation program.Setting of the program depend of the therapist recommendation. Glove in this case work to support patient to make movement. This operation principle suppose that patient can apply a small effort. After watching the video preview, the patient is supported by the rehabilitation glove during the ongoing motor exercise. The supporting level is regulated according to residual motor skills.

2.1.2 Amadeo

Figure 2.4: AMADEO

The AMADEO is suitable for all phases of finger-hand-rehabilitation [5]. The AMADEO can be adapted to the needs of each individual patient as can be seen in Figure 2.4. Small or big hands. All or single fingers. For neurological, orthopaedic and paediatric applications. In cases of limited mobility of the fingers, specific exer-cises on the therapy device help improve motor- and sensory functions. The finger

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movements stimulate the brain and thus the neoformation of synapses. Functionality the AMADEO simulates the natural grasping motion and executes automated move-ment sequences. Depending on the degree of neurological damage, the patient can be treated passively or actively. The therapist can devise a therapy program suited for the individual patient:

• CPM (Continuous Passive Motion) Therapy: The passive hand is stimulated • Assistive Therapy: The hand displays function and permits active training at

the patient’s limit of performance.

• Interactive Therapy: active training with specifically developed virtual therapy games.

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2.2. Servo motor transmission system 13

The AMADEO also includes:

• Improved evaluation of the force actively exerted by the patient, as well as the active Range of Motion (ROM)

• Tonus and spasticity measurement • Spasticity therapy and sensitivity training

2.2 Servo motor transmission system

2.2.1 Dexmo

D

K1

Figure 2.6: Dexmo DK1

Dexmo captures full range of the hand motion and provides force feedback [6]. With it patient can feel the size, shape and stiffness of virtual objects. Compare to other force feedback devices, Dexmo is very light as can be seen from Figure 2.7. It can run on battery power and work wirelessly for a relatively long time. Dexmo captures 11 DoF of users’ hand motion. The mechanical linkage nature makes the readings much more robust compared to IMUs.

The force feedback ability allows the user to feel the size and shape of any digital object, which greatly improves immersion as can be seen from Figure 2.8. Variable stiffness is achieved by precise motor control.

With this feature, each virtual object can have their own stiffness. It can be used for:

• alternative input device, • medical rehabilitation, • music production,

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Figure 2.7: Dexmo DK1 prototypes

Figure 2.8: Context of use Dexmo DK1

• VR operation system control,

• animation with detailed finger movement, • robotics manipulation,

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2.3. Linear actuators 15

Figure 2.9: Hands-on experience

2.3 Linear actuators

2.3.1 Hand of Hope

Hand of Hope is an international award-winning, surface Electromyography (EMG) driven robotic hand rehabilitation system. It is shown below on Figure 2.10. Com-bining advances in robotics and neuroscience, it helps stroke patients regain hand mobility through motor relearning [7].

Features of Hand of Hope:

• 1st sEMG-Driven Hand Robot Exoskeleton. Detects sEMG (surface Electromyo-graphy) signals from patient’s muscles and assists to perform rehabilitation train-ing

• Hand and Arm Training. Patients can perform hand and arm training at differ-ent rehabilitation stages

• Active and Passive Modes. Provides active and passive modes for training hand opening and closing. It is shown on Figure 2.9

• Interactive Games. Interesting interactive games with adjustable difficulty levels to enhance patients’ motivation

How does Hand of Hope works: The Hand of Hope works by patient?s self-initiated movement, recognized via surface EMG electrodes located on the affected forearm. Patients see and understand their own capability throughout displayed feedback which help to increase motivation and engagement in the therapy. Patient’s effort is displayed real time on the screen as can be seen from Figure 2.11.

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Figure 2.10: Hand of Hope

Figure 2.11: How does Hand of Hope works

1. Brain - Intention to move

2. Motor Neuron - Motor signal travels 3. EMG Sensors - Motor signal is captured

4. Hand of Hope - Captured signal drives robotic hand 5. Positive Feedback - Speed up motor recovery

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2.4. Sensor Technology 17

2.4 Sensor Technology

2.4.1 MEDI TOUCH - HAND TUTOR

MediTouch designed the HandTutor [8]. An innovative physical therapy rehabilitation product that combines play with treatment in order to achieve maximum results as can be seen from Figure 2.12.

Figure 2.12: MEDI TOUCH - HAND TUTOR components

Designing the HandTutor was an exciting challenge. The device was developed to allow functional and fine motor rehabilitation of the hand. The system consists of a wearable glove and corresponding physical therapy rehabilitation software. This meant that the design was required to be highly ergonomic and user friendly. The glove needed to be compatible with men, women and children, and the operation of the glove needed to convey an accessible yet professional feeling. As shown on Figure

2.13.

Figure 2.13: HandTutor working process

The Hand Tutor system allows for a range of bio-mechanical evaluation including speed, passive and active range of motion and motion analysis of the fingers and wrist. Quantitative bio-mechanical data allow for objective evaluation and physical therapy treatment follow up. To understand the field better we conducted in-depth research on similar products in the market as well as similar procedures and treatments. This gave us a better understanding of the ergonomic requirements in terms of comfort and compatibility to a range of users. The HandTutor is comprised of a glove with sensors and a hub connected by wires with all the electronic components on the wrist. Combining textile and plastic it were able to create a comfortable, easy to operate and durable device. Internal components shown on Figure 2.14. It used for rehabilitation.

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Figure 2.14: Hand Tutor parts

2.4.2 RAPAEL

RAPAEL Smart Glove is a high-tech rehab device as can be seen on Figure 2.15. Starting the training is as simple as wearing the glove, connecting to the RAPAEL app and proceeding to play the rehabilitation games [9].

Figure 2.15: Rapael app

1. Sensor Technology that Captures Patients Movement and Transferring the data. The Bending Sensor is a variable resistor that changes as it is bent. The sensor is a 9-axis movement position sensor that consists of 3 acceleration channels, 3 angular rate channels and 3 magnetic field channels that measures wrist move-ments. They are connected to a computer system which can accurately compute the amount of individual finger movements. It is shown on Figure 2.16. 2. Ergonomic design for patient experience

RAPAEL Smart Glove is lightweight and can be worn effortlessly so it allows for various joint movements with ease. The elastomer material is easy to clean and maintain. (ergonomic design, light weight, elastomer material)

The RAPAEL Smart Rehabilitation Solutions was developed for patients with neu-rological and musculoskeletal injuries. RAPAEL uses portable, lightweight equipment for continued home training. Patients can also enjoy our rehab programs based on

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2.4. Sensor Technology 19

Figure 2.16: Rapael smart glove

Figure 2.17: Digital Rehabilitation ? Anytime, Anywhere

gamified training contents. We provide a clinically proven rehab program customized to each patient for a faster recovery.

RAPAEL devices are lightweight ,portable. Patient scan carry tablet and smart Glove anywhere, he/she can perform training exercises wherever they are. RAPAEL products are priced with affordability in mind-we want all patients to be able to perform training exercises without the stress of cost

RAPAEL Smart Rehabilitation Solutions were designed to allow therapy training through games. Our contents have been carefully designed with the help of expert therapists to give patients the full therapy experience. Each game invigorates the muscles, and stimulates visual and auditory senses, all of which reinforce cognitive functions and accelerate neuroplasticity.

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Figure 2.18: Portable device

Figure 2.19: Gamification: Rehabilitation through Engagement

2.5 Comparison

As it was shown previously, the market of telerehabilitation glove is in the embryo stage. Having the overview and general data given by producers, I would like to ana-lyze deeply and compare the technical information, efficiency, and physical features.

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2.5. Comparison 21

Table 2.1: Comparison of benchmarket.

ROBOTICS SENSORS

Gloreha Dexmo DK1 AMADEO

MEDI TOUCH - HAND TUTOR RAPAEL Size Dimensions of Gloreha Lite: 60 x 24 x 15 cm Y155x100x7.5mm (L x W x D) (in mm):1160 x 754 x 1209 extended (in mm): 1160 x 754 x 1589 350x120x70 (L x W x D) -Weight Weight of Glo-reha Lite: 5 kg Weight of Glo-reha Brace: 45 g - Weight of Glo-reha Glove: 35 g 320 g 60kg 350g 132g Working tem-perature - -10C 60C 10 ... 30 C +150 C to +300 C -Connection USB cable Bluetooth

SMART

USB

CA-BLE USB cable

Bluetooth SMART Power USB Battery LiPo USB USB 1.1 Battery

Battery Capac-ity - 2000 mAh - - -Charge Time - 6 hrs - - -Power Con-sumption (Max.) - Y25000 mW - - -Power Con-sumption (Avg.) - 5000 mW - - -Adaptor Input - 100-240 V (50-60 Hz) 110 ? 240V alternating current 50 / 60Hz - -Adaptor Output - 5V - 6V - 5 V

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-22 Chapter 2. Market research/Rehabilitation devices

ROBOTICS SENSORS

Gloreha Dexmo DK1 AMADEO

MEDI TOUCH - HAND TUTOR RAPAEL MOTOR Torque (Max.) - 3 kg.cm (0.3 N.m) - - -Current (Max.) - 1 A 1,83 - 4A - -Power Con-sumption (Max.) - 4000 mW 440W - -SENSOR Sensitivity - - - 0.05 mm -Motion capture speed - - -up to 1 m/sec -Wireless Communication Communication Range (Opti-mal) - 2 m - - -Communication Range (Max.) - 5 m - - -Frequency Transmission Range (Max.) - 2.5G Hz - -

-2.6

TELEREHABILITATION

2.6.1 HEAD PROJECT

The HEAD project (Human Employment Aging and Disability) is dedicated to the generation of an innovative and sustainable ”remote rehabilitation” model to respond, with innovative contents and technologies, to the needs of complexity and continuity of home care, for people with motor and cognitive complexes problems.

Project goal is improving patient cognitive and motor skills. Project is located in: Hospital Valduce - Villa Beretta, Fondazione Opera San Camillo - San Camillo Hospital in Turin and Don Carlo Gnocchi Foundation in Milan; technological support from RAI (Research Centre and Technological Innovation) and the ASPHI Foundation. Collaboration are: Politecnico di Torino, the Department of Psychology of the University of Turin and CINI, the National Technological Inter-University Consortium for Informatics - Assistive Technology Lab Torino, which in particular will deal with technological research.

The objective of the project:

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2.6. TELEREHABILITATION 23

the specific territorial context

2. the technological point of view: which technologies can follow the person with remote disabling? what is their level of development? what costs? what bene-fits?

3. an operational point of view: what role for clinical and technological? what kind of service? what benefits and what costs at a health and social level? what role for service providers?

4 phases:

Phase 1: Technologies are for:

1. telecommunication (platform type); 2. telerehabilitation;

3. rehabilitation with mechatronic and robotic devices;

4. physical activity; profiling of users / patients; identification of television content useful for clinical purposes

Phase 2: The technology has been identified to:

1. Definition and configuration of the technological infrastructure for telecommu-nication and data management

2. Definition of mechatronic and robotic devices for upper and lower limb exercise procedures

3. Definition of programs for Tablet / Touch Screen use for cognitive and / or motor exercise

4. Identification of cross-media rehabilitation exercises Phase 3: The technologies are for rehabilitation activities: 1. motor (upper limb / lower limb)

2. patient / environment interactions for daily life activities 3. balance

4. communication (verbal-comprehension production)

5. superior cortical functions (attention, sustained attention, divided attention, memory, problem-solving)

Phase 4: Home technology network for rehabilitation. 1. 100 end-users

2. Save data of process of rehabilitation 3. Coast of the system

4. System based on common disabilities

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2.6.2 Harp therapy

Harp therapy is one of the expressive therapies, consisting of a process in which a music therapist uses music and all of its facets physical, emotional, mental, social, aesthetic, and spiritual, to help clients improve their physical and mental health.

In Harp telerehabilitation project took part Post Stroke patients. Explanation of the project

Musician played on Harp, patient in Oculus have walk in VR reality as can be seen on Figure 2.20.

Figure 2.20: Harp telerehabilitation.

Harp telerehabilitation easily controlled by PC. Patient have to follow 3 simple steps. First were and connect Oculus with PC, second start rehabilitation exercises, third made repetition. It is shown on Figure 2.21.

Figure 2.21: Storyboard of App for Oculus

1. Where your Oculus 2. Click on Start

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2.7. Market research resume 25

3. Listening Harp and relaxing

2.7 Market research resume

Most of the structures that exploits wires have a problem in common: actuators are placed outside the device, on a fixed structure that can barely follow the movement of the patient. In this way, the user is constrained in a position during all the training session. It may naturally result in a degradation to the patient approach to the therapy and a bad execution of the exercises. There are some applications concerning devices the patient can be given for self-training at home, in these cases, the apparatus should be easy-to-use and affordable, and provide in a quasi-automatic way the therapy assigned.

Therefore, one of the primary objectives is to design an exoskeleton that has the actuation functions directly on the hand support, allowing the user to move freely.

The ergonomic aspect plays a vital role in the realisation of a device that should be mounted and operated on articulations. Most of the methods consist of a glove-shaped support or a rod apparatus. That is because in that way the equipment is easy and efficient; however, besides the development of its function, the user- experience should also be considered as the objective is to create a self-training device. These devices do not provide a reasonable apparatus regarding an easy-to-use experience as they are suitable only for application where an assistant is helping and following the patient during the therapy. As one of the objectives is to develop a system that is effective even when actuated just by the user the device should be comfortable to wear and to activate. The disability resulting from a trauma injure or stroke is the first reason why the exoskeleton should be user-friendly: the therapy needs to be as less invasive as possible, without frustrating the patient, even under the physical point of view as movements of injured hand always cause pain. State of the art in this field is represented by the exoskeleton Gloreha Hand Rehabilitation Glove . The actuation system of this kind of devices, however, is enormous and heavy. A smaller version, which the patient can use at home, is available but it still is very bulky. Another problem of the Gloreha is that is mandatory the assistance of a second person that helps the patient to set up the therapy.

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Chapter 3

User Study

3.1 User Analysis

3.1.1 Survey

First, I made survey. It gave me general information about my target user. Information about Patient Questionnaires:

1. Title: Patient Questionnaires (Questionari pazienti) 2. Text of survey: Attached in the appendix

3. Type of survey: Online survey 4. Quantity of questions: 18 5. Period: March August, 2017 6. Total answer: 42

7. Language: English, Italian

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3.1. User Analysis 27

Figure 3.1: Question No.1 of Online Survey

Main aim of Questionnaire is to figure out cause and effect of the hand injures. Questions are formulated to identify target user preferences depends of hand injures and age, duration of rehabilitation process at home and in hospital and what can be improved in it.

Based on Figure 3.2 our potential user divided into two groups: patients with trauma injuries and patients with diseases. The itemized result show that 16 served patient has trauma injuries and 8 has diseases. Also on Figure ?? is shown that majority of respondents are in age from 20-40. Older groups in total had diseases and as a result of it temporary upper limb disability.

According to Figure 3.3 that shows which kind of accident patients with upper limb injuries had. 25 percent responds that they had home accident, 25 percent had street accident, 25 percent had private transport accident and 25 percent had sport accident.

50 percent of the respondents with upper limb disability after diseases are Post Stroke. 25 percent of the respondents had peripheral nerve injuries, while the rest had muscle weakness. As shown on Figure 3.4

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28 Chapter 3. User Study

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hospital has significant differences. Our respondents divided for two groups, and according to individual responds it is shown that patients with trauma hand injures had rehabilitation process from 0 ( 16,7 percent respondents) up to 5-6 weeks (16,7 percent responds). Patients with diseases had rehabilitation process up to 3 month ( 16,7 percent of responds).

In Question No.8 Figure 3.6is shown duration of rehabilitation process at home. It is up to 5-6 month (16,7 percent) for patients with trauma injures and up to 5 years for respondents with diseases.

From Figure 3.7 c we can see than both group of patients had rehabilitation practices from 1 time per day (33,3 percents) up to more then 3 time per day (33,3 percents).

The majority of respondents from both group on Figure 3.8made rehabilitation exercises more then 3 time per day.

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Safety (83,3 percent ) from physical properties of rehabilitation equipment that exist in hospital. On the second place it is Usability ( 66,7 percents). Another physical properties can be improved since 50 percents and less choose it. For instance nobody select Appearance, Hygiene have only 16,7 percents and for Simple Design and Low price is only 33,3 percent. Users were more pleased with Usability of the equipment. The lowest grades are for Appearance that need improvement in simplicity.

Respondents more pleasure with analyzed progress equipment. It is shown on Figure 3.10

Most respondents supposed that rehabilitation exercises in hospital are boring 66.7 percents (Figure 3.11). The last 3 Questions was about Tele-rehabilitation. Only 33 percents of respondent tried it. Therefore we have only 8 respondents who made Tele-rehabilitation. It is shown on Figure 3.12. Most of them had home exercise program to help with movement and strength 3.13. Half of respondents used Gloreha for upper limb Tele-rehabilitation. 25 percent used HEAD for Tele-reabilitation. It is seen from

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3.1.2 Patients Questionnaires Conclusion

Patients Questionnaires gives us general information about our target user. Conclusion about general information can be seen below in Table 3.1

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3.2. Experts interview 33

Table 3.1: Patients Questionnaires Conclusion. Patients with upper limb dis-ability after trauma injures

Patients with upper limb dis-ability after diseases

Age 20-40 40-80

Cause of upper limb disability Accident (home, street,

sport, private transport) Post Stroke Rehabilitation process in

Hospital From 0 up to 5-6 weeks up to 3 month Rehabilitation process at

home up to 5-6 month up to 5 years Rehabilitation exercises

repe-tition in Hospital from 1 up to more then 3 from 1 up to more then 3 Rehabilitation exercises

repe-tition at home more then 3 more then 3 What can be improved in

physical properties of rehabil-itation equipment

Hygiene, Simple Design, Weight, Wearability, Appear-ance

What can be improved in feedback of equipment

Real time direct link between therapist and patient, making rehabilitatin process fun

3.2 Experts interview

Individual adjustment of the controls, that are part of the exoskeleton, for people with different temporary upper limb disability requires a specific design approach. Individualization in this respect may result in a larger group of people being able to come back to normal life after temporary disability. To achieve this goal we used a mixed-methods study utilizing qualitative (e.g. interview) and quantitative data (e.g. self-report and performance measures). Subject 1, a Student, had a trauma injures. Both were made therapy in rehabilitation Center Villa Beretta and after at home. Subject 1, a Student, had a trauma injures.Descriptive analyses of processes and outcomes were conducted.

We have positive patients, because we choose that don’t have cognitive problems. In general patients that don’t have cognitive problems, even if they are major impairment, they are positive in term of recover function and to try to make work to recover func-tion. There are also patients that have negative approach but in this case they have also cognitive problems. And in this case is very difficult to interview them, because they are not able to explain exactly their condition, because the cognitive impairment doesn’t allow them to give information. They are very close patients. Is very difficult to have information about them. Another aspect that we have that our patients are not forced but encouraged in using technology, because in this center the use of technology is one of the part of the mission. So it’s quit often difficult to found patient who is negative to technology and patient who made only additional rehabilitation. We have

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some experience with patients who start from additional rehabilitation and continue with technology rehabilitation, for instance the girl that had accident in Naples then she performed traditional rehabilitation, and after she decided that this kind of rehabil-itation didn’t give her good results, and she tried to found some thing better. And now, in Villa Beretta she found technology and she is happy with it. She is positive, may be the past was negative because she didn’t use technology. Because when you don’t know technology you are more or less afraid about it. If they work in proper way or not, you compare it to additional rehabilitation. But now she test technology, she found that it’s working for her. We can not have impression about before, because now thinking about new situation that is rehabilitation with technology. We don’t have patients who never use technology yet. Each patient in rehabilitation center Villa Beretta more or less use technology. The girl is traumatic brain injure. She was delivering pizza, and the man give hit to her had. She had brain trauma. In the end functional situation is very similar to Stroke. But the starting point is different. Hit broke the bone and made a hemorrhargic situation like Hemorrhargic Stroke. The difference is the hemorrhagic Stroke is the broken in cardiovascular system in her case the Hemorrhage is after the hit. But in the end it is the same condition after. And I think that one of the reason of this change in social relationship are memories about accident. And also because she is a young lady and for older people taking accounted that you gonna not have had this problems. Older peoples are preparing that they can have audiological neurological diseases. When you are younger you never imagine that you have a diseases. And a diseases that give you a disability. So this is a big impact on young peoples. The reason because she cut the relation with the friends is because she needs to be more or less like before the accident before restart relation with friends. Because it was not a good felling for her to have relation and to be not able to performs some movement. Also very simple movement like take a spoon or take a cup. Her rehabilitation period is already 2 years and she has good results. Now she is in a good condition, because she is more or less doesn’t need help to perform daily activity and can manage every daily activity by herself without any problems. When she arrived here the situation was lower in term of functional recovery. During the rehabilitation year she improve her functional ability. Mauro Rossini, Bio engineering department @ Villa Beretta Rehabilitation Center.

3.3 Identity interview

3.3.1 Subject 1

Gender : female Age: 29 Nationality: Italian

Are you living alone or with family? She lives with family (parents and sister) Have you got children?

No Children

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3.3. Identity interview 35

Figure 3.15: Patient 1

She is a student. She have to finish her Master degree in Economy. She already done her fist stage of degree (bachelor). On rehabilitation period she suspend the study. She stand by it. She was at home during rehabilitation period.

How are you using free time now?

She reads in a free time, goes around for walking. She doesn’t need support or help during walking. She is autonomous. She prefers to be with some other, for instance with her sister. Is not to help to walk, but just for safety.

What is your position?

Before the accident she works as Administrator in the company. She made her stage. After accident she suspended her internship too.

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After the accident she suspend every things study, internship and she started rehabilitation. After the accident she was in Naples , because she lives there. She stood a lot of time in rehabilitation hospital to recover herself and for this reason the day activities are changed. She doesn’t go with her friends, because she has problems to walk and so on. She prefer to stay alone. She had accident 2 years ago, first she stood in hospital in Naple after in rehabilitation center there. After some period she decide to come in Villa Beretta for another kind of rehabilitation. Try to improve there the rehabilitation.

Figure 3.16: Patient 1. Identity information.

What was the main reason of suspending your relationship with friends?

It started for her not comfortable to stay with friends related to the accident. The reason is not healthy problem, it’s about self comfortable. She fell different before and after accident. She prefer to stay with her relatives. She started to be more sensitive after accident. She started to be close inside herself, because in first period she had to understand the reaction of her body, how she can recover the functions that she lost after the accident.

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Tell as about your experience with rehabilitation devices

She is in good relationship with technology and rehabilitation devices. She was very positive and engage with the proposed training that doctor and physiotherapist asked her to performed. For her technology is good way to well understand the movement to do during the train and she felled that recovery is faster then in traditional way. Is the perception of faster recovery of the functions by using technology.

What was the most difficult problem you faced with this device? Or if you hadn’t got problems, explain us difference between rehabilitation in hospital with therapist and you home rehabilitation alone.

She made rehabilitation at home and in hospital with therapist. At home she found that technology are not so complete, so it could be difficult, because she have to manage all the aspects of technology and she is alone. So when you perform rehabilitation with technology at hospital, you have the therapist that follow you, that guide you and can support you in understanding how to use the technology. Of course, it is the problem that you have to come to the hospital to perform this kind of technology, this kind of rehabilitation. So if the therapist is able to transfer to her the right instruction, the right guideline to use technology. This is the safe goal. Because you can use technology alone in the right way. Than it is important the figure of therapist, because there is the felling between the patient and therapist , and if you have a positive felling to this people, it is improve the result of rehabilitation.

Had you got any problems or misunderstanding during rehabilitation at home? For her home rehabilitation is very important but a condition to be effectiveness the home rehabilitation is the motivation of the patient. So if the patient is motivated, and she was motivated, she was able to reach the goal. But if patient is not motivated, the problem could be that at home rehabilitation it is not direct contact with therapist and patient is not well motivated the risk is to lost time, because patient is not able to perform the required task. In her situation she was able to manage technology, also with difficulty, because the motivation give her the right way to solve some little problems that can happened during the use of technology.

How you manage you rehabilitation repetition with daily activities?

She was able to manage according to other activities that she want to perform. And the required time was one hour and a half, but if she want, she performed more than the required time, because she felled that it was important to do more. She decided day by day rehabilitation schedule. She made not single slot, but different slots according to her felling. Generally she visited therapist twice or three times per week. In her experience a continues feedback between her and therapist. And therapist change the settings of the exercise of the device according to improvement in her ability. Also if exercise is more or less the same, the movement is the same, but there are some settings that could be changed by the therapist. And this process is continue during home rehabilitation period.

How you manage trebles with device, for instance if you couldn’t on or off it? The device that she used didn’t give information about the progress of patient. The therapist that checked her progress when she come to the center with clinical or other kind of test and then decide how to change the parameters of the device. In her experience it is no direct feedback to her or to therapist with information for changing

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the settings for the device that she used.

In previews answer you told that you divide daily activities and rehabilitation. Can you Imagine situation when you making your daily activities in the same time with rehabilitation? What you think about it?

She don’t have an experience about using the device for rehabilitation during daily activities. But she thinks that it could be a good idea to have a device that is able to help you to perform your rehabilitation exercises, also during your activities, so that support your activity and support in your activity in perform rehabilitation training. During what kind of daily activity can you use rehabilitation device for upper limb? ( imaginary scenario)

It could be every kind of daily activities, for instance home work, house keeping activities, or driving a car. So in every kind of this situation she think that it could be useful to have a devise that works during the activity.

Last problem that you had during rehabilitation period. Can you tell us about it? The problem for her is to cut the met, also she can’t open the fingers. For her every kind of device that is able to open the fingers will be useful for her, because otherwise she can’t manage grasp objects. So every time that she have to interact grasping an object for her is a problem.

3.3.2 Subject 2

Gender: Male Age: 76

Nationality: Italian Have u got children?

He have 3 children. They lives separate, one lives in Melbourne, second in Vienna and the third in Como. He lives together with his wife.

Where are you working/study/retired? Retired

What was your position? Architect

How you using your free time?

He making a lot of personal activities such as drawing, painting. He was graduated in Politecnico di Milano.

After accident, can you continue with your painting?

He reduce the activity but he available, because his hand dominant is right. He explain philosophy of his paintings and drawings. They are very particular, because he is Interested in relation between the conic, curve and elliptic, parabolic, cube in the drawing and so on. And he is able to perform again after the Stroke this kind of activity, because he had a left Stroke. So the motor problems are on the left side. But he is right dominant, so the right hand is preserved.

Is something change in your daily activities?

In general, he don’t think that something change, may be in some little details. He doesn’t have cognitive problems, so on this point of view he able to perform exactly what he was able to perform before the accident, because the cognitive function is preserved.

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Figure 3.17: Patient 2. Augusto Zerbi

Can you remember the last problem that you had during the drawing?

In general he has not got any kind of problems, because he draw with the right hand the problem is on the left. There is no major problems. He is able to perform exactly drawing now like before the Stroke.

Are duration of your painting practice the same as was before Stroke?

He has very detailed approach to the drawing, and this approach is preserved. So he is able to perform a drawing exactly how he was abale to perform it before Stroke. He is more an Artist than a drawer. Because there is a philosophy in his drawings. And this kind of drawings he will be able to maintain the same time of activity that performed before the Stroke. Because is not quickly or faster activity, it something that coming from interior. It’s take time to perform a draw. There is all geometric

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Figure 3.18: Patient 2. Identity information.

lines, he apply this kind this kind of geometric figures on the drawing that he want to perform. is very slow process. from this point of view he imagine that Stroke doesn’t impact on the activities. So the time that he want to use for draw will be the same that he use before the Stroke.

If drawing activities help you in your rehabilitation?

It is very useful this kind of activities, because it is before a mental activity, so to perform it help in all rehabilitation process in term of cognitive, mental, in approach the new stage of function that he have after Stroke. In this way this activity for him is very important, very useful for rehabilitation. In general he is interested in aesthetic of the things. He is saying that the computer is like an overview of universe, because you can put on the screen what ever you want. It’s like an universe in the machine.

How you interact with new technology? You had some problems with them? Are they helpful for you in daily life?

He is very interested in using technology and have no problems in interaction with them. He lies an interaction with technology in any fields. So for him in rehabilitation field is very important to have a technology.

You making rehabilitation in hospital now?

He is. He had Stroke 2 month ago, and he come directly from Stroke unit to Villa Beretta. Stroke started with a problems with stability, and then after 2 days he went to hospital. His diagnose was Stroke. And when we come out from the Stroke unit, he arrived in rehabilitation center. And tomorrow he gonna go home. Tomorrow gonna be first time when he arrive home after the Stroke.

In Hospital all patients have schedule. Is it exist free time in schedule? How are you spending it?

It is not a lot of opportunities in hospital to spend free time. He is very interested in technology, so he watch technological channel on TV, read newspapers to stay in format of the news in the world.

If it gonna be another opportunity to spend free time in hospital, how you would like to spend it?

Before the Stroke he spend a lot of time in philosophical reflection, and for example one of the issue that he was interesting is the relation between aesthetic and moral.

Design a solution and a prototype for hand rehabilitation after trauma injures and post stroke

POLITECNICO DI MILANO

Faculty of Design

Master of Science in Design Engineering

Design a solution and a prototype for hand

rehabilitation after trauma injures and

Post Stroke.

Master Thesis

Tutor:Professor Mario Covarrubias Rodrguez

Co-tutor: Professor Matteo Oreste Ingaramo

Student

Sofya Komarova No.860496/10512823

Abstract

Riassunto

Acknowledgements

Contents

List of Figures

Chapter 1

Introduction

1.1

Issue description

1.2

Involved Diseases

1.2.1

Finger, Hand, and Wrist Injuries

1.2.2

Stroke Effects

1.2.3

Treatment strategies

1.2.4

Physiotherapy exercises

1.3

Document structure

Chapter 2

Market

research/Rehabilitation

devices

2.1

Engine transmission system

2.1.1

GLOREHA

2.1.2

Amadeo

2.2

Servo motor transmission system

2.2.1

Dexmo

K1

2.3

Linear actuators

2.3.1

Hand of Hope

2.4

Sensor Technology

2.4.1

MEDI TOUCH - HAND TUTOR

2.4.2

RAPAEL

2.5

Comparison

-2.6

TELEREHABILITATION

2.6.1

HEAD PROJECT

2.6.2

Harp therapy

2.7

Market research resume

Chapter 3

User Study

3.1

User Analysis

3.1.1

Survey

3.1.2

Patients Questionnaires Conclusion

3.2

Experts interview

3.3

Identity interview