2009 IEEE 11th International Conference on Rehabilitation Robotics
Kyoto International Conference Center, Japan, June 23-26, 2009
Developing a whole-arm exoskeleton robot with hand opening and
closing mechanism for upper limb stroke rehabilitation
Yupeng Ren, Hyung-Soon Park, and Li-Qun Zhang, Sr. Member, IEEE
Abstract—There is a lack of enough attention to the
patients’ hand posture. When robots implement assistive
training, patients are often asked to grip a handle tightly,
which may induce strong hand muscle contractions with
the hand at an abnormal posture. If we ignore proper
control of the muscle tension of subject’s hand, the
flexibility of hand/fingers may decrease and the robot
training may potentially cause abnormal muscle tone. On
the other hand, since the patient’s fingers are already in
an abnormal posture, properly aligning the joint and
making the robot easy to attach is important. However, an
existing multi-DOF hand exoskeleton systems may be
difficult for the patients to put it on. the purpose of this
paper was to design a patient-friendly mechanism drive
by a single motor and attached to the whole-arm rehab
robot for the hand and finger opening and closing
functions.
Using our 8+2 DOF whole-arm robot including this
hand opening and closing mechanism, a novel integrated
rehabilitation is performed including 1) strenuous
stretching of the MCP-thumb joints and other spastic
joints of the upper limb; 2) active assistive exercise is
provided to improve voluntary neuromuscular control by
using robot-computer games with a griping task; 3)
outcome evaluations including the cross-coupling torques
between the fingers/thumb and the other joints during
hand opening/closing and other upper limb movements.
I. INTRODUCTION
F OR effective and advanced stroke rehabilitation, this
paper represents a novel exoskeleton rehabilitation robot
for upper arm rehabilitation with hand grasp training
function. This exoskeleton rehabilitation robot (called
IntelliArm) is capable of controlling shoulder, elbow, wrist,
and finger. Stroke is the leading cause of adult disability and
Manuscript received February 07, 2009. This work was supported in part
by the National Institutes of Health, National Science Foundation, and
National Institute on Disability and Rehabilitation Research.
Yupeng Ren is with the Rehabilitation Institute of Chicago, Chicago, IL
60611, USA.
Hyung-Soon Park is with the Rehabilitation Institute of Chicago and the
Department of Physical Medicine and Rehabilitation, Northwestern
University, Chicago, IL 60611 USA.
Li-Qun Zhang is with the Rehabilitation Institute of Chicago and
Departments of Physical Medicine and Rehabilitation, Orthopedic Surgery,
and Biomedical Engineering, Northwestern University, Chicago, IL 60611
USA. (e-mail: l-zhang@northwestern.edu, phone: +1-312-238-4767, fax:
+1-312-238-2208).
9781-4244-3789-4/09/$25.00 ©2009 IEEE 761
the third leading cause of death (killing 160,000
Americans/year) in the United States; about 750,000
first-ever and recurrent strokes occur in the United States each
year. Motor impairments in stroke survivors affect the
shoulder, elbow, wrist, and hand simultaneously. Patients may
develop spastic hypertonia and reduced range of motion
(ROM) at multiple joints. Several stereotypical patterns of
arm impairment with multiple joints involved are commonly
seen in patients with neurological impairments, including
adducted/internally rotated shoulder, flexed elbow, pronated
forearm, flexed wrist, and clenched fist. Furthermore,
impaired arms of stroke survivors commonly develop
abnormal coupling among the multiple joints and multiple
degrees of freedoms (DOF) (e.g., shoulder abduction, flexion,
and rotation) at each joint, and patients lose independent
control of individual joints (loss of individuation) and
coordination among the joints.
Multi-DOF rehab-Robot devices have been developed in
recent years to help improve active movement control and
motor recovery of the upper limb after stroke and other
neurological impairments [1-5]. Hogan et al. pioneered in
developing a novel robot (MIT MANUS) which provided
guiding assistance to arm reaching movement during
simplified target-matching games and helped patients to
recover post stroke[3,6]. Reinkensmeyer et al. developed the
ARM Guide robot which assisted active arm reaching along a
linear guide to treat and evaluate patients post stroke [4].
Burgar et al. developed the mirror image motion enabler
(MIME) robot which used an industrial robot attached to a
forearm splint to move the impaired shoulder and elbow
passively or provide assistance/constraint during patient’s
active movement, and use the unimpaired arm (movement
measured by a six DOF digitizer) to guide the impaired arm
driven by the industrial robot [7].
ARMin, a semi-exoskeleton robot with four DOFs and
recently expanded to six DOFs, was developed for arm
therapy applicable to the training of activities of daily living in
clinics [8,9]. The robot used impedance/admittance control
and allowed the machine to comply with forces exerted by the
patient for better interaction, and could be used to assist,
enhance, evaluate, and document neurological and orthopedic
rehabilitation. The arm of the patient was supported by
balancing weights through two cable-pulley systems.
But in the designs of rehab-robot mentioned above, there
is a lack of thoughtful attention of the patients’ hand posture.
When robots implement an assistive training, the patients are
usually asked to grip the handle very tightly and thus their
hands may cause more muscle contractions in an abnormal
posture. According to our previous experiments, we found
that if we ignore a proper control of the muscle tension of
subject’s hand, the robot training may lower hand/fingers
flexibility and potentially cause an abnormal muscle tone.
This paper emphasizes on the design of the hand/fingers
open-close solution and presents the development of a 8+2
DOF exoskeleton type robot system (named IntelliArm) ,
which is capable of controlling the shoulder, elbow, wrist and
hand individually/simultaneously and help to achieve
effective stroke (or other neurological impairments)
rehabilitation.
II. DESIGN OF INTELLIARM WITH HAND GRASPING
MECHANISM
A. Mechanical Design
A novel 8+2 DOF robot (called IntelliArm) was developed
to diagnose the biomechanical changes and abnormal
couplings at the shoulder, elbow, wrist, and finger joints of the
impaired arm of stroke survivors (e.g., which part of the
passive or active workspace is deficient, which joints and
which DOFs are stiff, and which joints at what arm postures
are coupled abnormally).
Fig. 1 A novel 8+2 DOF robot with the hand close/opening
control
The IntelliArm had four active DOFs and two passive
DOFs at the shoulder, two DOFs at the elbow, and one DOF at
the wrist. The shoulder (glenohumeral) movement included
four active DOFs in horizontal abduction/adduction,
flexion/extension, internal/external rotation and the vertical
displacement of the glenohumeral joint, and two passive
DOFs in anterior/posterior and medial/lateral displacement of
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glenohumeral joint. The elbow movement included elbow
flexion/extension, and forearm supination /pronation while
the wrist included flexion/extension. One active DOF was
designed to drive hand to open/grasp at MCP and thumb joints
– synchronized hand-opening/closing motion, as shown in Fig.
1.
The 2 passive DOF motion in the horizontal plane and
active vertical displacement at shoulder were included to keep
the glenohumeral joint of a subject aligned with the shoulder
joint of the IntelliArm considering the human scapular and
trunk movements. The glenohumeral joint moves up/down
and laterally/medially due to the scapular
elevation/depression. The glenohumeral joint was also
allowed to translate forward/backward and up/down to
accommodate the trunk movements [10].
The shoulder platform can move in the horizontal plane
(free sliding in the anteroposterior (A-P) and mediolateral
(M-L) directions) relative to the base along linear guides in the
X-Y directions, which allows trunk movements during the
tests. The active vertical displacement at shoulder has
designed to align the glenohumeral joint of a subject with the
shoulder joint of the IntelliArm considering the human
scapular and trunk movements. The glenohumeral joint moves
up/down and laterally/medially due to the scapular
elevation/depression. The glenohumeral joint was also
allowed to translate forward/backward and up/down to
accommodate the trunk movements [11].
B. Mechanical Design for the hand and finger
In the field of mechanical design for multi-DOF finger and
hand exoskeleton robots, there are lots of delicate and
complicated multi-motor systems; however, for the appliance
of rehabilitation robotic arm, the complicated and
cumbersome hand exoskeleton system would be attached on
the end of robot arm, and thus it could potentially reduce the
driven ability and motility of the whole robot arm because of
its weight and inertia. In that case, the robot arms need to
provide more motor powers to compensate for the weight load
from hand exoskeleton system. On the other hand, since the
patient’s fingers are already in a diseased posture, properly
aligning the joint and making the wearing easy will be quite
important. However, the multi-DOF hand exoskeleton system
causes the patients difficulty in wearing it.
Experiments indicate that in the hand rehab training, the
hand opening and closing training plays a key role, followed
by the training of other small finger joints. Based on the above
discussion, this project aims to design a patient-friendly
structure with single-motor drive attached to the robotic arm.
Considering the limited room for the hand part design and
the weight and moment inertia of robot system, we utilize the
principle of four-bar linkage to generate the hand grasping
combined motion with the single motor driven. As shown in
Fig. 2, the motor will rotate the link L1 to open MCP joints of
all four fingers; link L3 will push the thumb away
synchronously. The combined motion between L1 and L3 will
simulate a hand opening and closing motion. Therefore, the
MCP joints of all four fingers are driven by one motor while
the thumb is driven by a coupled MCP joint motion.
(a) Hand closing posture (b) hand opening posture
Fig. 2 The mechanism of a four-bar linkage used to generate
hand opening and closing motion.
Furthermore, the length of L1 and L2 is adjustable in order
to get the different rotation ratio between thumb and MCP
joints. Link L1 is driven by the motor via the cable and pulley
where torque sensor was integrated inside, as shown in Figure
3. Therefore, this sensor will measure the composition of
torque from the hand motion, not the one from the individual
finger joint.
(a) 3D view of hand open-close structure
(b) Hand motion system with single motor driven
Fig. 3 Mechanical design for hand/finger rehabilitation
Because of adducted contracture, thumb may be difficult to
be strapped into the device without any guiding. As shown in
Fig. 4, we design the arch-shape support (black) to correct
stroke patient’s thumb posture and use an adjustable soft band
to fix the thumb on the arch surface. In order to guide the MCP
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joint, other brace will be mounted on and hold other four
fingers with a soft band. While subject’s hand opens or closes,
the tight band still allows his/her fingers to get proper
adjustment for the joint misalignment.
Fig. 4 Attachment of the subject hand to the device with the
finger posture guided/corrected by the braces.
C. Rehabilitation games for hand motion training with
assistance/resistance training strategy.
In order to motivate stroke patients in the active
movement training and enhance the therapy, the
IntelliStretch system will provide assistance when patients
need to finish the desired movement in the games.
Fig. 5 the strategy of the assistance/resistance training
Fig. 6 A hand gripping task in VR. Patients are asked to move
their arm (shoulder, elbow, wrist joints) to reach a desired
position where the object is displayed, and they try to control
their hand to grip the object.
Motor impairment is associated with both neural and
peripheral biomechanical changes. As shown in Figure.5,
after a passive intelligent stretching reduces the abnormal
joint stiffness, the neural command may be able to better
control the muscles and move the joint. The rehab robot will
run back-drivable mode first, so that patients can move their
finger joints more freely and only sense little resistance from
the device. Training target is displayed on a monitor during
the movement training; If the patient can not finish the
movement or make the desired movement within a specific
time period, the assistive control will be implemented by the
robot; If the subject can accomplish the desired task easily,
the assistive mode will be switched to resistive mode
gradually by increasing the movement resistance. The whole
training can be done by playing rehabilitation games, which
motivates the patients and enhances their motor function
recovery.
Based on the design of the hand open/grasp setup, we create a
VR training system to allow patients to choose an object,
grasp it and move it. As shown in Figure.6, the patient was
asked to move his/her upper limb first and try to catch the
target (a red apple). Our rehab-robot arm will calculate the
desired position and the patient’s current arm position to get
the error vector, and the error vector will be sent back to the
IntelliStretch robot controller to decide which mode need to
run. The controller can potentially assist or resist the
individual joint of the patient to train them to complete the
tasks. If patients with severe impairment are not able to play
the game at all, the game play function may discourage them.
For those patients with severe impairment, an assistive
controller has been developed to help them to achieve the
goal during the game. The level of assistance will be
adjustable depending on the error vector and the performance
of patient’s game playing. As a subject improves his/her
performance, the level of assistance will be decreased
gradually. For those with minor impairment, the controller
can even increase the challenge level to expedite
rehabilitation training, as shown in the Fig. 5.
Fig. 7 Robot-assisted games for the individual joint
Fig. 7 shows a typical assistive control strategy for a
patient’s impaired arm. The black line indicates the target
joint position in the game. As shown in the top of Fig. 7, our
control program can directly communicate with the existing
games, such as driving direction of a motorcycle, the racket
position, shooting positions and direction. The blue line
indicates the impaired limb’s actual joint position. There are
two phases in the actual joint movement represented by the
blue line. In phases I (indicated by the red circle 1), the patient
could move his/her joins partially to the target under the
back-drivable control mode and the relative assistive torque
(red curve) is low. In phases II (indicated by the green circle 2),
the assistance provided by the IntelliStretch helps the patient
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to reach the target and the relative assistive torque (red curve)
is high.
III. EXPERIMENT
A. Passive Stretching Treatment for the hand /finger
open-close motion
The passive biomechanical properties such as the passive
ROM and the passive stiffness at the individual joints, and
coupled joint torques and stiffness among multiple joints
could be measured. Accordingly, we could determine the
abnormality in the patient’s arm by comparing the arm
properties between the patient and the healthy subject. After a
subject’s arm was securely strapped in the device, the passive
biomechanical properties are measured in two different
passive stretching modes: individual joint passive stretching
and the simultaneous stretching of all joints. The
stiffness/resistance of the hand open/grasp motion could be
calculated by the slope in the torque-angle curve. Coupled
torque and stiffness could be measured by stretching
individual joint and monitoring the resistance torques at the
hand part.
The IntelliArm can stretch hand/fingers between
position/torque limits. During the stretching treatment, the
patient’s arm was held at the extreme positions for a period of
time (e.g. 5 seconds). After the individual joint stretching, the
IntelliArm stretched multiple joints simultaneously based on
the diagnostic results of the abnormal coupling among
multiple joints. Moving into joint extreme positions
manifested the passive mechanical changes in the soft tissues
at the joints, while the very slow speed was controlled to
minimize the undesirable reflex contributions.
Fig. 8 The stiffness/resistance during passive hand
Open/grasp motion
Fig. 8 shows the motor drives the thumb and MCP joint
simultaneously to implement a passive hand stretching
procedure. X-axis means hand opening angle, Y-axis means
the stretching torque generated by the motor to open the
thumb and MCP joint. More hand motion parameters will be
provided for the clinician or researcher by using this hand
setup. Additionally, the open/grasp torque and hand posture
can be monitored to guide other joint, so we can make a
correct hand/finger posture during upper arm robot-rehab and
also control a proper the open/grasp torque of the hand.
 B. Cross-coupling torque of the hand /finger open/grasp
posture during the other joint movement
Cross-couplings between the hand and other joints can be
analyzed under the control stretching movement by the
IntelliArm. From the patient-specific diagnosis, the joints with
excessive coupling and/or increased stiffness and the
associated arm posture could be identified.
As shown in Fig. 9, when the wrist was moved back and
forth by the IntelliArm between controlled flexion and
extension torque limits with the shoulder and elbow held at
constant positions, there appeared a coupled torque generated
at the hand. Comparing (Fig. 9a) with (Fig. 9b), the torque
sensor attached to the hand setup can measure the hand
coupling torques on different hand postures. When the subject
keeps his/her hand open and moves the wrist joint passively,
the hand generates the higher coupling torque (a. blue line.
right) than when they keep the hand closed. (b: red line, right).
1.5
Wrist Extension Tq [Nm]
Hand Coupling Tq. [Nm]
1 experimental results among the rich capability of the
0.5
0 0.1
-0.5
-1
-1.5
-50 0 50
Wrist Extension Angle [deg]
(a) Opening the hand during passive wrist movements
1.5
Wrist Extension Tq [Nm]
Hand Coupling Tq. [Nm]
1 on motor recovery following stroke. Archives Neurology. 54, 443-446.
0.5
0 0.1
-0.5
-1
-1.5
-50 0 50
Wrist Extension Angle [deg]
(b) Closing the hand during passive wrist movements
Fig. 9 Cross-couplings at different hand postures.
IV. DISCUSSIONS AND CONCLUSIONS
This paper presented the mechanical design of hand
open/grasp function, rehabilitation games design and control
strategy of the 8+2 DOF IntelliArm for effective rehabilitation.
The robot system was designed to allow anatomically natural
motions in the upper limb especially at hand/finger joints, and
to perform the tasks required for diagnosis, treatment, training
and outcome evaluation. The experimental results showed
part of the capabilities of the IntelliArm and demonstrated the
feasibility and benefits of the developed system.
Compared to the diagnosis performed by an experienced
clinician, the IntelliArm could provide more accurate and
quantitative diagnosis. Some diagnostic results provided by
the IntelliArm have not been available in the clinical practice.
For example, it is very difficult to know the amount of passive
coupling from finger joints only during the manual
examination. The abnormal passive coupling between joints
and abnormal synergy found during the active motion may
play an important role in the underlying mechanisms of the
impairments. The IntelliArm with hand function may help
better understand the underlying hand mechanisms and thus
allow us to propose enhanced rehabilitation protocols.
In the clinical rehabilitation, eliciting the cooperation in the
stroke patients and motivating them to exercise the impaired
joints actively are challenged. Both of the factors should be
considered: insure the training intensity and avoid frustrating
the patients. The robot control and VR game programming
technique have the advantages to offer more biofeedback and
interaction function. The rehab-robot can sense the participant
level from the patients and provide different training strategies
with various measurement and control.
This paper focused on the feasibility of the proposed hand
0.3
opening and closing system and presented a part of the
0.2
IntelliArm. In addition, the relation between the quantitative
measurements by the IntelliArm and the clinical scales that are
commonly used in clinics will be investigated further to better
0 utilize the capability of the IntelliArm in the clinical
researches.
-0.1
-50 0 50
Wrist Extension Angle [deg]
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