Neuro-ExoHeal: Utilizing neuroplasticity to retrain the brain and rehabilitate patients with hand stroke/paralysis.

Summary

Globally more than 200 million people live with some type of disability. Among them are a large number of people with motor disabilities. The current rehabilitation devices are often bulky, expensive, and require manual interaction with physical therapists that makes the procedure labor‐intensive and raises costs. This renders rehabilitation a primary challenge.

By observing the limitations of approaches introduced by previous models, we aim to create Neuro-ExoHeal - an Exoskeleton capable of providing faster rehabilitation to stroke patients and those with muscular degenerative diseases.

During our research for a potential cure, we discovered neuroplasticity. By studying its concepts, we came up with a rehabilitation routine: giving hope, overcoming learned non-use and neurogenesis. As it becomes impractical to travel large distances for the patient's sessions, we made an app that drastically reduces costs and improves recovery time by acting as a means of communication between the patient and the doctor.

Neuro-ExoHeal, unlike its predecessors, is designed to feel like a second skin. It is divided into a wireless skeletal and sensory hand. A movement executed by the working hand forces the paralyzed hand to mirror the exact motion. This incremental training rewires the brain by triggering plastic changes, resulting in increased strength.

By combining ideas from previously built models, we have created a hand exoskeleton, which is truly wireless, precise, portable and one that increases the rate of rehabilitation by 30%.

In the near future, we aim to make Neuro-ExoHeal available to the common people.

Believing is the key to success

Question / Proposal

Context

We were successful in making a prosthetic hand which could be used by amputees as an alternative. During our research, We realized that more patients were diagnosed with hand paralysis and hand stroke. We decided to take this up as a challenge and create a cure or an alternative for these people.

upon extensive research, We realized that a machine is yet to be built which is affordable, portable and user-friendly. When it comes to a medical issue, it doesn’t matter if you are a millionaire or under poverty, we are all in the same boat.

How is it Curable?

Neuroplasticity is the key.

Hypothesis

We hypothesize; by using the concepts of neuroplasticity and the intricate movements of the hand, combined with an exoskeleton capable of performing bilateral movement training, will enable the impaired hand of the patient to recover at a faster rate. This combined with an app capable of acting as a means of communication between the doctor and the patient will cure the hardships faced by stroke patients and those with muscular degenerative diseases and help patients recover faster.

Neuro-ExoHeal comprises three section.

  1. The device - A wireless Exoskeleton that will be worn on both hands such that when a movement is performed by the good hand, the paralyzed hand will mimic the same movement.
  2. The app - Available in multiple languages will allow the user to use the device comfortably at home.
  3. Rehabilitation routine - A three-step routine involving hope, overcoming learned non-use and neurogenesis.

Research

Others have felt the need for rehabilitation hand exoskeletons. Presently Festo's Exohand, Assisted Finger Orthosis, HEXORR, NASA K-Glove, Robo-Glove, Hand of Hope, etc have already been created, but a majority of them are yet to be put to practical use and cost upwards of $10,000.

The Festo Company developed the ExoHand, a hand exoskeleton whose main characteristic is the individual finger motion applied principally to increase user strength, transferring skills from human to robot and BCI. It is a pneumatically actuated robot and as such, it is robust and not especially portable due to the heavy equipment.

Researchers at Curtin University have made a hand exoskeleton called the Assisted Finger Orthosis; the hand exoskeleton can be customized for an individual using 48 parameters. The battery-powered device uses small linear motors that can be programmed to move the finger. However, the fingers are unable to move quickly due to the slow RPM. Although it is cost effective, it fails to achieve independent movement in each of the phalanxes of the fingers and so the fingers do not get much benefit out of the training. The Exoskeleton is bulky, heavy and not portable.

Many more rehabilitation hand Exoskeletons have been built, but they all more or less possess the same problems: they tend to work slowly, are bulky and not portable, which negates the possibility for them to be used in everyday life, hindering motor recovery.

While researching we came across neuroplasticity. It is defined as the ability of the central nervous system (CNS) to undergo the structural and functional change in response to new experiences. Despite major progress in the understanding of neuroplasticity, very few new treatment mechanisms have been developed. After looking deeper into the matter, we realized that rehabilitation of stroke patients requires the effective use of neuroplasticity for functional recovery. Studies indicate that if two hands simultaneously work to complete a task, with the influence of both psychological and neural mechanism, the task would be completed with a better outcome due to interactions in between resulting in better action.

The primary causes of hand disabilities are neuromusculoskeletal diseases such as the tetraplegia, hemiplegia, tendonitis and degenerative illnesses like arthritis. To be treated, these illnesses require opportune active and passive physiotherapy treatments to avoid permanent damage to the joints.

Our research helped us to design and develop an affordable, precise, portable, light-weight solution, with independent motion on each phalanx to fulfill the specifications obtained for particular rehabilitation protocols for those with hand paralysis, hand stroke, and muscular degenerative diseases. Neuro-ExoHeal's rehabilitation routine will be capable of accelerating their rate of recovery. Many patients are unable to afford overall expenses and it becomes impractical to travel large distances for a 1-2 hour session. In order to counter this delay in recovery, we made an app that helps to drastically reduce the costs and improve recovery time by bridging the gap between the patient and the doctor. Thus allowing the patient to use the device comfortably at home.

Method / Testing and Redesign

ExoHeal Analysis

ExoHeal consists of a sensory glove and a skeletal hand, that work together along with an app and rehabilitation routine.

Sensory Hand

This hand will operate as a sensory input and will be fixed with flex sensors that detect precise movements performed by the phalanxes. These sensors use this information to perceive the movement; the patient is trying to perform and transmits it to the microcontroller which in turn processes the analog data and sends it to a wireless receiver module connected to a second microcontroller, this data is then processed by the second microcontroller to actuate  servos and mirror the movements performed by the flex sensors.

The signals undergo a process of voltage division for them to be calibrated through a 10KOhm resistor which limits current flow and adjusts signal levels and a capacitor smoothens the supplied voltage.

Skeletal Hand

We have prototyped an exoskeleton for the paralyzed hand. The exoskeleton consists of electronics and servo motors that actuate based on the data perceived by the microcontroller, which receives this information via a wireless receiver module from the numerous variable resistors stationed on the sensory hand. The skeletal hand is an exoskeleton based on a design that's portable, lightweight, automated and functional. It was created using PLA and SLA as it was tough, flexible and allowed for design modification. 

Power

The two microcontrollers receive electricity from an inbuilt 10,000mAh and 1000mAh power source. 

The App

An app was created to work with ExoHeal. Available in multiple languages, it is divided into a doctor's and patient's app. The doctor's app allows the physician to remotely monitor the progress and guide various patients from anywhere around the world. It allows the physician to program the patient’s device to operate as per the user’s condition.


The patient’s app was programmed to work based on user feedback. Exercise routines were pre-programmed to activate in accordance with the different stages of the rehabilitation routine. The app works as a guide in the absence of a physician and sends statistical results to the doctor.

Rehabilitation Routine

ExoHeal V1 Testing:

The first prototype was designed to fit our sister's hand. During testing, it determined the minor flaws in the design.

ExoHeal V2 Testing:

In the second prototype, all of the electronics are housed in containers and the exoskeleton is able to mimic the movement performed by the phalanxes. The exoskeleton is mounted on top of a glove, thereby increasing comfortability.

ExoHeal V3 Testing:

In the third prototype, the circuitry has been further simplified. A smaller microcontroller has been used to reduce the bulk of the device. The device is 30%lighter, 40%smaller and twice as responsive.

Neuro-ExoHeal Testing:

This final prototype was designed to feel like a second skin. The electronics have been further simplified. The device is now cordless, thereby allowing the user to comfortably use the device at home. It is accompanied by the app.

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Various tests have been conducted using the device over the course of 2 years, all producing positive results.

 

Results

1. RESPONSE TEST

The device underwent a response test so as to ensure minimum time delay between the Sensory glove and the skeletal hand. It is imperative to test this in order to ensure the successful activation of the mirror neuron.

GRAPH 1: ExoHeal is quite responsive with a minimal average time delay of 0.01 seconds between the action of the sensory glove and the mirroring reaction of the skeletal hand.

VIDEO 1: There is a very short delay of approximately 100 microseconds in the response time of the Exoskeleton in comparison with the sensory hand. 

2. PRECISION TEST

After prototyping the proposed device it was crucial to test the precision to precisely mimic the movements performed by the phalanxes on the sensing hand; in order for the mirror neuron to activate. To accurately measure the precision of the exoskeleton, The angle of movement was measured.

GRAPH 2: It can be said with certainty that the Exoskeleton can mimic the movements of the phalanxes on the sensory hand precisely.

VIDEO 2: From the above video, it is noticeable that the movements of ExoHeal are very precise.

3. FUNCTIONALITY TEST

It is imperative for the Exoskeleton to remain functional for longer periods of time. To test the duration of the power bank, a looped command was given to the microcontroller; the device was left until the power bank was exhausted and the time was recorded. A voltmeter was used to detect the voltage at 1 hour time intervals. The device was tested after 8 hours of continuous use:

GRAPH 3: From the above graph, it can be noted that the power bank can work for an approximate period of 16 hours without any problem. The average voltage received by the servo motors is 4.9 volts.

4. REAL LIFE FUNCTIONALITY TEST

TABLE 1: Exoheal is able to function as a device to aid the patients in their routine tasks. Its capable of grasping everyday objects and is comfortable enough for patients to use the device for long periods of time.

5. ASSISTED/UNASSISTED – Finger comparison

                                                   

GRAPH 5: Mean finger extension torque.  The mean torque for Subject 3 was negative. This indicates that the assistance forces were too high and extended the finger

GRAPH 6: Finger metacarpal proximal phalanx. The provided assistance increased finger flexion by 41% and reduced finger extension torque by 35%. During both the active-unassisted and active force-assisted conditions, any involuntary flexion movement was halted during a designated extension movement and the stroke subjects were able to try to extend their phalanxes further from this point. Providing this 'flexion catch' greatly increased the active extension degree of movement for all the fingers.

6. APP OVERVIEW

VIDEO 3: The video explains the major functions of the app.

7. COMPARISON WITH OTHER REHABILITATION ROUTINES

GRAPH 7: The results revealed that the rehabilitation routine is capable of accelerating the rate of recovery by approximately 30%.

Conclusion

Neuro-ExoHeal will improve the medical rehabilitation process by introducing an affordable paralysis treatment. The patients after wearing the device for an extended period and by recording the observable changes, we were able to notice an improvement in the movement of their fingers suggesting the generation of useful neuroplasticity. Hence providing assistive forces inherently helps to counteract the muscle weakness. The rehabilitation routine is capable of accelerating the rate of recovery by approximately 30%. It solves the problems lacking in the already existent rehabilitation devices. The device with an emphasis on portability and functionality was capable of providing sufficient output force, comfortability and enough battery life to last a full day’s use. The sensory glove was able to accurately read and process the angle of flex in each phalanx with enough positional accuracy, which enabled the exoskeleton to assist the impaired hand in mirroring the same movement. The modular design of the exoskeletal hand created using a 3d printer allows for a device which can be reconfigured, re-positioned, and expanded upon to meet user requirements.

Thus, these results, along with the noticeable improvements and changes, support our hypothesis.

SETBACKS:

  • During testing, while using Neuro-ExoHeal in routine activities, the rate of improvement was slower in subject 3. After careful testing it was found that the average torque values were negative, indicating that the assistive forces were responsible for the flexion/extension the phalanxes open. This is not ideal as providing too much assistance can cause patients to decrease their own physical effort during therapy which only hinders motor learning.
  • Although the device can perform the extension/flexion movement, it cannot perform abduction/ adduction movement.

These arise the need for a more complex and sophisticated algorithm and design.

FUTURE IMPACT:

Globally, many people do not possess the ability to use their limbs, unable to perform simple tasks, they are forced to lead tough lives. The current rehabilitation devices are often bulky, slow, non-portable and require manual interaction with physical therapists that make the procedure labor‐intensive and raises costs. Neuro-ExoHeal solves these problems by being a portable device that works with the doctor's assistance via an app in multiple languages to bring it within reach of the highest fraction of individuals in need. As ExoHeal’s latest version Neuro-ExoHeal brings the cost to less than $200, it can help decrease expenses/increase family income, help patients get back their self-confidence and self-respect, as it allows them to use their limbs and gives them hope to lead normal lives. To summarize Neuro-ExoHeal possess the potential to change the world by substantially improving the lives of the paralyzed human being.

WHAT'S NEXT:

The next step is the extensive clinical evaluation of the device’s capabilities and recording the observable changes in neuroplasticity using state of the art machinery. Comfortability/compatibility can be further enhanced by using flexible materials such as “ninja flex”, providing the exoskeleton with the ability to conform to the patient’s hand over time. Complex mechanisms will be developed to achieve complete 21 Degrees of freedom(DOF) of the hand fingers.

About me

Hi, my Name is Zain Ahmed Samdani. I am 18 years old, and I live in Riyadh, Saudi Arabia. 

My interest in Robotics began with my mother. Seeing her busy with her household schedule and taking care of us which resulted in less time for herself, inspired me to create robots which could lessen her burden.

I'd describe myself as a robotic enthusiast and an expressive artist sparked by cartoons to make fiction a reality, and aid humanity. Believing is key! I also have a passion for poetry; It gives meaning to my thoughts and serves as motivation in tough times. I am also fascinated by the works of Leonardo Da Vinci.

Hello, My name is Faria Zubair. I am 16 years old, and I live in Riyadh Saudi Arabia.

I love Arts and Fashion designing,  l would like to incorporate my passion with STEM to innovate unique apparels that help create solutions for a variety of problems. My idols include my mother and my brother. I’m also inspired by Sir Albert Einstein. His quote “Imagination encircles the world” motivates me to think differently.

I’m also an athlete. I was able to bag some medals at the India-Saudi Chapter CBSE Cluster Meet.

Winning an award in the Google Science Fair would undoubtedly be a huge step towards making a significant difference in the lives of paralyzed human beings. It'll bring us one step closer towards making hand disabilities less alarming.

Health & Safety

Safety Procedures followed at Make Real's workplace

We have worked at Make Real's workplace to 3D print the project.

  • Hot surfaces – print head block and UV lamp.
  • High voltage – UV lamp connector, electric outlet safety certified and ground wire.
  • Ultraviolet radiation – UV lamp. Don’t look at the lamp; make sure the UV screen is intact.
  • Moving parts – printing assembly.
  • Keep model and support materials away from areas where food and drink are stored, prepared or consumed.
  • Once a printing job has been started, do not open the cover, defeat or override the interlock switch.
  • Notify coworkers before beginning non-routine and hazardous work. 
  • Contact Details: Mohammed Al Ibrahim

  Email Id: Rami@makereal.net

Safety procedures used at home:

  • Our mom supervised us throughout the project at home.
  • Access to first aid kit in case of emergency.
  • Adult supervision and proper protection while working with solder, electrical and drilling instruments.
  • Proper eye protection and insulating gloves to be worn.
  • Electrical components were handled with care and checked for breaks before use.
  • The voltage and current were properly controlled and kept within the working limit.
  • Practice patience throughout the project.
  • Do not overwork on the project.
  • All tools were switched off when not in use.
  • A clean workplace had to be maintained. 

Bibliography, references, and acknowledgements

"If you are thankful, what do you do? You share"

W. Clement Stone

Acknowledgments:

We would like to thank the following people for their valuable contribution to the growth of our project: 

  • Our parents have supported us (morally & financially) from the day we started showing interest in our capabilities. They never failed to inspire and support us during both our crucial and good times. They motivated us to thrive for success and to never lose hope. They were our biggest support. Next, to our Parents, our sister was supportive all the time. She kept encouraging us and heeded to our requests. Also, we have been supported by our Grandparents.
  • Our uncles and aunts who have suggested their views and ideas at the early stages of our project.
  • Make Real have given us a platform to explore the possibilities of 3D printing. They have given life to our project and have sponsored it.
  • Dr. Fawaz Abdulaziz Al-Hussain(Consultant Neurologist & stroke subspecialist) has provided his invaluable support throughout the course of the project. He has introduced the project at the King Khalid University Hospital research center and will hopefully be a part of Neuro-ExoHeal's extensive clinical trials.
  • Our friends who kept on encouraging us.

Bibliography

  • Stats about paralysis: 2013 Study: Christopher and Dana Reeve Foundation
  • Stroke Statistic: 2009 Update Centennial, CO: National Stroke Association; 2009.
  • New scope for interaction between humans and machines - https://www.festo.com/net/SupportPortal/Files/156734/Brosch_FC_ExoHand_EN_lo_L.pdf
  • Norman Doidge, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, 2007, United States
  • Jeffrey M. Schwartz, Sharon Begley, The Mind and the Brain: Neuroplasticity and the Power of Mental Force, October 14, 2003
  • José L. Pons, Wearable Robots, Biomechatronic Exoskeletons, March 5, 2008
  • José L. Pons, Eduardo Rocon, Exoskeletons in Rehabilitation Robotics: Tremor Suppression, January 19, 2011
  • Raymond Tong, Biomechatronics in Medicine and Health Care, August 29, 2011
  • Kip Burkman MD, The Stroke Recovery Book: A Guide for Patients and Families, October 1, 2010
  • Peter G. Levine, Stronger After Stroke: Your Roadmap to Recovery, January 1, 2008
  • The Brain That Changes Itself - https://www.youtube.com/watch?v=bFCOm1P_cQQ
  • Cauraugh, J.H. & Summers, J.J., 2005. Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke, Progress in Neurobiology 75, pp. 309-320.
  • https://www.youtube.com/watch?v=bFCOm1P_cQQ
  • http://www.makezine.com/
  • www.unicef.org/protection/World_report_on_disability_eng.pdf
  • https://www.thingiverse.com/
  • http://www.roboticstrends.com/article/3d_printed_hand_exoskeleton_simplifies_rehab/wearable
  • https://www.festo.com/group/en/cms/10233.htm
  • https://www.festo.com/net/SupportPortal/Files/156734/Brosch_FC_ExoHand_EN_lo_L.pdf
  • www.instructables.com/
  • www.arduinobasics.blogspot.com/
  • Arduino Robotic Arm - https://www.youtube.com/watch?v=ppMuu1X08T8
  • iTOUCH robotic hand MARK II-https://www.youtube.com/watch?v=57-ttvPf0OY
  • iTOUCH robotic hand MARK III-https://www.youtube.com/watch?v=uR_nIi5fYFw
  • A hand exoskeleton robot for rehabilitation using a three-layered sliding spring mechanism - https://www.youtube.com/watch?v=2eauUq2tl6I
  • https://en.wikipedia.org/wiki/Servo_control
  • https://cdn.sparkfun.com/datasheets/Sensors/ForceFlex/FLEXSENSORREVA1.pdf
  • https://www.adafruit.com/

References

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  2. Pekna M, Pekny M, Nilsson M. Modulation of neural plasticity as a basis for stroke rehabilitation. Stroke. 2012;43:2819–2828.
  3. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322.
  4. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51: S225–S239
  5. Zhang W, Linden DJ. 2003. The other side of the engram: experience-driven changes in neuronal intrinsic excitability. Nat. Rev. Neurosci. 4, 885–900
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  7. Cacchio A, De Blasis E, De Blasis V, Santilli V, Spacca G. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil Neural Repair. 2009;6(8):792–799. Doi: 1177/1545968309335977.
  8. de Vries S, Tepper M, Otten B, Mulder T. Recovery of motor imagery ability in stroke patients. Rehabil ResPract. 2011;6:283840.
  9. de Vries S, Mulder T. Motor imagery and stroke rehabilitation: a critical discussion. J Rehabil Med. 2007;6(1):5–13. doi: 10.2340/16501977-0020.
  10. Garrison KA, Winstein CJ, Aziz-Zadeh L. The mirror neuron system: a neural substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair. 2010;6(5):404–412. doi: 10.1177/1545968309354536.
  11. Gloreha Light. Idrogenet srl [Online]. Available: http://www.gloreha.com/index.php/en/versions/gloreha-lite01, accessed on Aug. 21, 2015.
  12. P. Polygerinos, Z. Wang, K. C. Galloway, R. J. Wood, and C. J. Walsh, “Soft robotic glove for combined assistance and at-home rehabilitation,” in Proc. Robot. Auton. Syst., 2014, pp. 135-143.
  13. Kamper DG, Fischer HC, Cruz EG, Rymer WZ: Weakness is the primary contributor to finger impairment in chronic stroke. Arch Phys Med Rehabil 2006,87(9):1262-1269. 10.1016/j.apmr.2006.05.013
  14. Lum PS, Burgar CG, Shor PC: Evidence for strength imbalances as a significant contributor to abnormal synergies in hemiparetic subjects. Muscle Nerve 2003,27(2):211-221. 10.1002/mus.10305
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  16. Wolbrecht ET, Chan V, Le V, Cramer SC, Reinkensmeyer DJ, Bobrow JE.  International IEEE/EMBS Conference on Neural Engineering, CNE. 3. 2007. Real-time computer modeling of weakness following stroke optimizes robotic assistance for movement therapy; pp. 152–158. Full_text.
  17. M. Centini, M. Cortese and N. Vitiello, “A Powered Finger--Thumb Wearable Hand Exoskeleton With Self-Aligning Joint Axes,” IEEE/ASME Trans. Mechatronics, vol. PP, no. 99, pp. 1-12, 2014.
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Facilities used:

  • We have used MakeReal's workspace to 3d print the project.
  • Discussions took place at the King Khalid University Hospital & research centre.

Electronic components used:

  • Arduino Nano microcontroller
  • MG90 metal gear micro servo
  • Flex sensor 4.5”
  • Flex sensor 2.2”
  • nrf24l01 Wireless transceiver
  • HC-06 Bluetooth module

Equipment used:

  • Drilling machine
  • Hot glue gun
  • Soldering Iron
  • ProJet 3500 3D printer (From Make Real)
  • Power banks
  • Cell phone camera

Software used:

  • Autodesk Maya
  • AutoCAD
  • Arduino
  • Fritzing
  • Final Cut Pro
  • Android Studio
  • Photoshop CS6