ORIGINAL RESEARCH

published: 09 October 2017

doi: 10.3389/fnins.2017.00547

Design and Preliminary Feasibility

Study of a Soft Robotic Glove for
Hand Function Assistance in Stroke
Survivors
Hong Kai Yap 1, 2 , Jeong Hoon Lim 3 , Fatima Nasrallah 4 and Chen-Hua Yeow 1*
1
Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore, 2 NUS Graduate School for
Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore, 3 Department of Medicine,
National University of Singapore, Singapore, Singapore, 4 Queensland Brain Institute, University of Queensland, St. Lucia,
QLD, Australia
Edited by:
Venketesh N. Dubey,
Various robotic exoskeletons have been proposed for hand function assistance during
Bournemouth University,
United Kingdom activities of daily living (ADL) of stroke survivors. However, traditional exoskeletons involve
Reviewed by: the use of complex rigid systems that impede the natural movement of joints, and thus
Brent Winslow, reduce the wearability and cause discomfort to the user. The objective of this paper is to
Design Interactive (United States),
United States
design and evaluate a soft robotic glove that is able to provide hand function assistance
Victor Manuel Pulgar, using fabric-reinforced soft pneumatic actuators. These actuators are made of silicone
Wake Forest School of Medicine,
rubber which has an elastic modulus similar to human tissues. Thus, they are intrinsically
United States
Arturo Forner-Cordero, soft and compliant. Upon air pressurization, they are able to support finger range of
University of São Paulo, Brazil motion (ROM) and generate the desired actuation of the finger joints. In this work, the soft
Agnes Roby-Brami,
Institut National de la Santé et de la
actuators were characterized in terms of their blocked tip force, normal and frictional grip
Recherche Médicale, France force outputs. Combining the soft actuators and flexible textile materials, a soft robotic
*Correspondence: glove was developed for grasping assistance during ADL for stroke survivors. The glove
Chen-Hua Yeow
was evaluated on five healthy participants for its assisted ROM and grip strength. Pilot
[email protected]
test was performed in two stroke survivors to evaluate the efficacy of the glove in assisting
Specialty section: functional grasping activities. Our results demonstrated that the actuators designed in
This article was submitted to
this study could generate desired force output at a low air pressure. The glove had a
Neural Technology,
a section of the journal high kinematic transparency and did not affect the active ROM of the finger joints when
Frontiers in Neuroscience it was being worn by the participants. With the assistance of the glove, the participants
Received: 31 March 2017 were able to perform grasping actions with sufficient assisted ROM and grip strength,
Accepted: 20 September 2017
Published: 09 October 2017
without any voluntary effort. Additionally, pilot test on stroke survivors demonstrated that
Citation:
the patient’s grasping performance improved with the presence and assistance of the
Yap HK, Lim JH, Nasrallah F and glove. Patient feedback questionnaires also showed high level of patient satisfaction and
Yeow C-H (2017) Design and comfort. In conclusion, this paper has demonstrated the possibility of using soft wearable
Preliminary Feasibility Study of a Soft
Robotic Glove for Hand Function exoskeletons that are more wearable, lightweight, and suitable to be used on a daily basis
Assistance in Stroke Survivors. for hand function assistance of stroke survivors during activities of daily living.
Front. Neurosci. 11:547.
doi: 10.3389/fnins.2017.00547 Keywords: soft robotic, hand exoskeleton, rehabilitation, activities of daily living, soft actuators

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Yap et al. Robotic Glove for Hand Assistance

INTRODUCTION the hand (Nilsson et al., 2012; Ying and Agrawal, 2012; Sangwook
et al., 2014; Varalta et al., 2014). By providing actuations on both
The ability to perform basic activities of daily living (ADL) dorsal and palmar sides of the hand, bi-directional cable-driven
impacts a person’s quality of life and independence (Katz, movements are possible (Kang et al., 2016). These cables mimic
1983; Andersen et al., 2004). However, an individual’s the capability of the tendons of the human hand and they are able
independence to perform ADLs is jeopardized due to hand to transmit the required pulling force to induce finger flexion and
motor impairments, which can be observed in patients with extension. However, the friction of the cable, derailment of the
neurological disorders such as stroke. In order to improve hand tendon, and inaccurate routing of the cable due to different hand
motor functions in terms of strength and range of motion (ROM) dimensions can affect the efficiency of force transmission in the
(Kutner et al., 2010), stroke survivors undergo rehabilitation system.
programs comprising repetitive practice of simulated ADL On the other hand, examples of the soft inflatable actuators
tasks (Michaelsen et al., 2006). Normally, patients undergo are McKibben type muscles (Feifei et al., 2006; Tadano et al.,
rehabilitation exercises in a specialized rehabilitation center 2010), sheet-like rubber muscles (Sasaki et al., 2004; Kadowaki
under the guidance of physiotherapists or occupational et al., 2011), and soft elastomeric actuators (Polygerinos et al.,
therapists. However, due to increasing patient population, it is 2015b,c; Yap et al., 2015); amongst which, soft elastomeric
foreseen that there will be a shortage of physiotherapists to assist actuators have drawn increasing research interest due to their
in the rehabilitative process. Thus, there will be comparatively high compliance (Martinez et al., 2013). This approach typically
less therapy time, which will eventually lead to a slower recovery embeds pneumatic chamber networks in elastomeric constructs
process for the patients. Over the past decade, technological to achieve different desired motions with pressurized air or
developments in robotics have facilitated the rehabilitative water (Martinez et al., 2012). Soft elastomeric actuators are
process and have shown potential to assist patients in their daily highly customizable. They are able to achieve multiple DOFs
life (Maciejasz et al., 2014). One example of such a device is the and complex motions with a single input, such as fluid
hand exoskeleton, which is secured around the hand to guide pressurization. The design of a wearable hand exoskeleton that
and assist the movement of the encompassed joints. However, utilizes soft elastomeric actuators is usually simple and does not
due to the complexity of the hand, designing a hand exoskeleton require precise routing for actuation, compared to the cable-
remains a challenging task. driven mechanism. Thus, the design reduces the possibility of
Traditional hand exoskeletons involve the use of rigid linkage- misalignment and the setup time. These properties allow the
based mechanisms. In this kind of mechanism, rigid components, development of hand exoskeletons that are more compliant
such as linear actuators, rotary motors, racks, and pinions as and wearable, with the ability to provide safe human-robot
well as rigid linkages are normally involved (Worsnopp et al., interaction. Additionally, several studies have demonstrated that
2007; Rotella et al., 2009; Martinez et al., 2010). To assist compactness and ease of use of an assistive device critically
hand movements that have high degrees of freedom (DOFs), affect its user acceptance (Scherer et al., 2005, 2007). Thus, these
traditional exoskeletons can be incorporated with a substantial exoskeletons provide a greater chance of user acceptance.
number of actuators to achieve the requirement. However, this Table 1 summarizes the-state-of-art of soft robotic assistive
means that their application is limited due to the increasing glove driven by inflatable actuators. Several pioneer studies on
bulkiness for higher DOFs. Therefore, these devices are normally inflatable assistive glove have been conducted by Sasaki et al.
restricted in clinical settings and not suitable for performing (2004); Kadowaki et al. (2011) and Polygerinos et al. (2015a,b,c).
home therapy. Additionally, their rigidity, weight and constraint Sasaki et al. have developed a pneumatically actuated power
on the non-actuated DOFs of the joints pose complications. As assist glove that utilizes sheet-like curved rubber muscle for
a result, the level of comfort and safety of patients is reduced. In hand grasping applications. Polygerinos et al. have designed a
view of this, there is an apparent need for the development of hydraulically actuated grip glove that utilizes fiber-reinforced
exoskeletons that may be used in both clinical and home settings. elastomeric actuators that can be mechanically programmed to
A lightweight and wearable exoskeleton may allow patients to generate complex motion paths similar to the kinematics of the
bring back home to continue daily therapy or to serve as an human finger and thumb. Fiber reinforcement has been proved
assistive device for the ADLs. to be an effective method to constrain the undesired radial
The development of wearable robotic exoskeletons serves to expansion of the actuators that does not contribute to effective
provide an alternative approach toward addressing this need. motion during pressurization. However, this method limits the
Instead of using rigid linkage as an interface between the hand bending capability of the actuators (Figure S1); as a result, higher
and the actuators, wearable exoskeletons typically utilize flexible pressure is needed to achieve desired bending.
materials such as fabric (Sasaki et al., 2004; Yap et al., 2016a) This paper presents the design and preliminary feasibility
and polymer (Kang et al., 2016), driven by compliant actuators study of a soft robotic glove that utilizes fabric-reinforced soft
such as cables (Sangwook et al., 2014; Xiloyannis et al., 2016) pneumatic actuators. The intended use of the device is to support
and soft inflatable actuators (Polygerinos et al., 2015d; Yap et al., the functional tasks during ADLs, such as grasping, for stroke
2016c). Therefore, they are more compliant and lightweight survivors. The objectives of this study were to characterize the
compared to the rigid linkage-based mechanism. Cable-driven soft actuators in terms of their force output and to evaluate the
based exoskeletons involve the use of cables that are connected performance of the glove with healthy participants and stroke
to actuators in the form of electrical motors situated away from survivors. The glove was evaluated on five healthy participants

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Yap et al. Robotic Glove for Hand Assistance

TABLE 1 | Hand assistive exoskeletons driven by inflatable actuators.

Device/references Actuators (all pneumatic-driven unless stated Weight (g) DOF Operating
otherwise) pressure (kPa)

Power-Assist Glove/Sasaki et al., 2004 Sheet-like rubber muscles N.A. 1 500

Power-Assist Glove/Noritsugu et al., 2008 Curved-type rubber artificial muscle 120 1 500
Power-Assist Glove/Kadowaki et al., 2011 Sheet-like rubber muscles 135 4 100
Power-Assist Glove/Toya et al., 2011 Bend-type rubber artificial muscles 180 4 350
Yap et al., 2016c Elastomeric actuators 200 1 180
ExoGlove/Yap et al., 2015 Elastomeric actuators with variable stiffness 200 5 160
MR-Glove/Yap et al., 2017 Fabric-reinforced actuators 180 5 120
Grip Glove/Maeder-York et al., 2014; Polygerinos et al., 2015a,b,c Fiber-reinforced actuators (Pneumatic or Hydraulic) <500 5 345
Nordina et al., 2016 Fiber-reinforced actuators N.A. 5 300
Haghshenas-Jaryani et al., 2016 Bellow-type soft-rigid hybrid actuators N.A. 6 165
Exo-Glove PM/Yun et al., 2017 Modular elastomeric actuators N.A. 5 300
Lobster-inspired Robotic Glove/Chen et al., 2017 Soft actuators with rigid shells 150 5 250
Kline et al., 2005 Rigidizing air bladders 100 1 34
PneuGlove/Connelly et al., 2010; Thielbar et al., 2014 Rigidizing air bladders N.A. 5 69
Coffey et al., 2014 Rigidizing air bladders N.A. 1 69
Yap et al., 2016b Plastic rigidizing actuators 150 5 100

in order to determine the ROM of individual finger joints and weight of device on the hand, which is in the range of 400–500 g
grip strength achieved with the assistance of the glove. Pilot (Aubin et al., 2013; Gasser and Goldfarb, 2015). Cable-driven,
testing with two stroke survivors was conducted to evaluate the hydraulic, and pneumatic driven mechanisms are found to be
feasibility of the glove in providing grasping assistance for ADL suitable options to meet the criteria. To develop a fully portable
tasks. We hypothesized that with the assistance of the glove, the system for practical use in home setting, reduction in the weight
grasping performance of stroke patients improved. of the glove as well as the control system is required. The total
Specific contributions of this work are listed as follows: weight of the control system should not exceed 3 kg (Polygerinos
et al., 2015a,b,c). In this work, the criteria for the weight of the
(a) Presented fabric-reinforcement as an alternative method
glove and control system are defined as: (a) the weight of the glove
to reinforce soft actuators, which enhanced the bending
should be <200 g, and (b) the weight of the control system should
capability and reduced the required operating pressure of the
be <1.5 kg.
actuators,
Considering the weight requirement, hydraulic systems are
(b) Utilized the inherence compliance of soft actuators and
not ideal for this application, as the requirement of a water
allowed the actuators to achieve multiple motions to support
reservoir for hydraulic control systems and actuation of the
ROM of the human fingers,
actuators with pressurized water will add extra weight to the
(c) Integrated elastic fabric with soft actuators to enhance the
hand. The second consideration is that the hand exoskeleton
extension force for finger extension,
should allow fast setup time. Therefore, it is preferable for
(d) Designed and characterized a soft robotic glove using fabric-
the hand exoskeleton to fit the hand anatomy rapidly without
reinforced soft actuators with the combination of textile
precise joint alignment. Compared to cable-driven mechanisms,
materials, and
soft pneumatic actuators are found to be more suitable as
(e) Conducted pilot tests with stroke survivors to evaluate the
they allow rapid customization to different finger length.
feasibility of the glove in providing functional assistance for
Additionally, they do not require precise joint alignment and
ADL tasks.
cable routing for actuation as the attachment of the soft
pneumatic actuators on the glove is usually simple. Therefore,
in this work, pneumatic mechanisms were selected. Using
DESIGN REQUIREMENTS AND pneumatic mechanism, Connelly et al. and Thielbar et al. have
RATIONALE developed a pneumatically actuated glove, PneuGlove that is
able to provide active extension assistance to each finger while
The design requirements of the glove presented in this paper are allowing the wearer to flex the finger voluntarily (Connelly
similar to those presented by Polygerinos et al. (2015a,b,c) in et al., 2010; Thielbar et al., 2014). The device consists of five
terms of design considerations, force requirements, and control air bladders on the palmar side of the glove. Inflation of the air
requirements. For design considerations, weight is the most bladders due to air pressurization created an extension force that
important design criterion when designing a hand exoskeleton. extends the fingers. However, due to the placement of the air
Previous studies have identified the threshold for acceptable bladders on the palmar side, grasping activities such as palmar

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Yap et al. Robotic Glove for Hand Assistance

and pincer grasps were more difficult. Additionally, this device fabric-reinforced actuators can be found in the Supplementary
is limited to stroke survivors who are able to flex their fingers Material.
voluntarily. Upon air pressurization, the top surface of the actuators
In this work, the soft robotic glove is designed to provide expands due to the inflation of the embedded pneumatic
functional grasping assistance for stroke survivors with muscle chamber (Figure 1B). With inextensible layers attached at the
weakness and impairments in grasping by promoting finger bottom of the actuators, bending motion can be obtained due
flexion. While the stroke survivors still preserve the ability to to asymmetrical strain along the length of the actuators. To
modulate grip force within their limited force range, the grip support a complete hand closure, previous studies, including
release (i.e., hand opening) is normally prolonged (Lindberg our group, have developed multi-segment soft actuators that are
et al., 2012). Therefore, the glove should assist with grip mechanically programmed to achieve bending and extending
release by allowing passive finger extension via reinforced elastic motions by controlling the placement of the inextensible
components, similar to Saeboflex (Farrell et al., 2007) and bottom layers at different localities along the length of the
HandSOME (Brokaw et al., 2011). The elastic components of actuators (Polygerinos et al., 2015b,c; Yap et al., 2017).
these devices pull the fingers to the open hand state due to The bending motion supports finger joint flexion while the
increased tension during finger flexion. Additionally, the glove extending motion offsets the increased distance due to skin
should generate the grasping force required to manipulate and stretching during finger flexion. Bending and extending segments
counteract the weight of the objects of daily living, which are can be pre-designed to conform to the finger anatomy
typically below 1.07 kg (Smaby et al., 2004). Additionally, the of different patients. This feature demonstrates the high
actuators in the glove should be controlled individually in order customizability of the soft actuators. However, as the hand
to achieve different grasping configurations required in simulated dimension varies for different patients, pre-designing actuators
ADL tasks, such as palmar grasp, pincer grasp, and tripod pinch. with different lengths and controlling the placement of the
For the speed of actuation, the glove should reach full grasping bending and extending segments for each patient can be time
motion in <4 s during simulated ADL tasks and rehabilitation consuming.
training. Therefore, in this work, we have designed the actuators
For the actuators, we have recently developed a new type of without pre-programmed bending and extending motions.
soft fabric-reinforced pneumatic actuator with a corrugated top Instead of controlling the placement of the inextensible bottom
fabric layer (Yap et al., 2016a) that could minimize the excessive layers to achieve bending and extending motions, a single
budging and provide better bending capability compared to elastic fabric with higher elastic modulus (0.5 N/mm) than
fiber-reinforced soft actuators developed in previous studies the silicone rubber is placed at the bottom of the actuators.
(Polygerinos et al., 2015c,d). This corrugated top fabric layer With the elastic fabric, the actuators are able to achieve both
allows a small initial radial expansion to initiate bending and bending and extending motions (Figure 1B). As the actuators
then constrains further undesired radial expansion (Figure 1). are compliant, they are able to conform to the shape of the
The detailed comparison of the fiber-reinforced actuators and object during actuation. A bending motion is preferred at the

FIGURE 1 | (A) A fabric-reinforced soft actuators with a corrugated fabric layer and an elastic fabric later [Actuator thickness, T = 12 mm, and length, L = 160 mm
(Thumb), 170 mm (Little Finger), 180 mm (Index & Ring Fingers), 185 mm (Middle Finger)]. (B) Upon air pressurization, the corrugated fabric layer unfolds and expands
due to the inflation of the embedded pneumatic chamber. Radial budging is constrained when the corrugated fabric layer unfolds fully. The elastic fabric elongates
during air pressurization and stores elastic energy. The actuator achieves bending and extending motions at the same time. (C) A bending motion is preferred at the
finger joints (II, IV, VI). An extending motion is preferred over the bending motion at the finger segments (I, III, V) and the opisthenar (VII).

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Yap et al. Robotic Glove for Hand Assistance

location with lower impedance, i.e., the finger joints. At the finger exerted by the actuator was measured over increasing pressures
segments that possess higher impedance, the bending motion using a customized force measurement system (Figure 2A). The
of the actuators is limited and thus the extending motion is system consisted of a compression load cell (FC22, Measurement
preferred (Figure 1C). Specialties Inc., USA) and a mounting platform. The proximal
end of the actuator was mounted on the platform and connected
MATERIALS AND METHODS to the air source. The distal end of the actuator was in contact
with the load cell. A constraining platform was positioned
Actuator Fabrication on top of the actuator. During pressurization, the actuator
A two-part 3D-printed mold is used to fabricate the actuators. A flexed and the tip of the actuator came into contact with the
lower-part mold (chamber mold) is used to create a pneumatic constraining platform, which constrained the height and the
chamber inside the actuators, which will inflate upon air curvature of the actuator. This force measurement setup was
pressurization. An upper-part mold (top layer mold) is used to similar to the setup presented in previous studies (Polygerinos
impose a corrugated outer layer for the placement of fabric at the et al., 2015c,d). Constraining the top surface of the actuator
top of the actuators (Figure 1A). The detailed description of the minimized the non-linear effects caused by the bending of the
fabrication process as well as the mold dimension can be found actuator when pressurized (Polygerinos et al., 2015d). Thus, this
in the Supplementary Material. setup could measure the maximum blocked tip force generated
by the actuator regardless of the bending angle. The pressure was
Actuator Characterization increased from 0 to 120 kPa. The experiment was repeated three
The actuators were characterized in terms of their blocked tip times. Additionally, a theoretical model was adapted from the
force and grip force upon pressurization. The blocked tip force model presented by Polygerinos et al. (2015d) and Wang et al.
(2017) to predict the tip force output of the actuators at this
configuration (Figure S4).
For hand exoskeleton application, the force that is of particular
interest is the normal grip force (Figure 2B) generated by the
gripping of the actuators on an object and the frictional grip force
(Figure 2C) that counteracts the weight of that particular object
to prevent it from falling. Both the normal and frictional grip
forces were measured using a universal testing machine (Model
3345, Instron, MA, USA). Four actuators, which corresponded to
four fingers, were pressurized to 120 kPa to enclose and grasp
a cylinder, which was of 50 and 75 mm in diameter, in two
orientations (i.e., horizontal orientation to measure the normal
grip force and vertical orientation to measure the frictional grip
force). The cylinder was pulled upward by the Instron at a
fixed velocity (8 mm/s) until the cylinder was released from the
actuators’ grip. The setup was similar to the setup reported in
previous literature (Galloway et al., 2016).
Both the normal and frictional grip forces were measured
when they were resisting the upward motion of the cylinder.
The normal grip force is the sum of the forces applied by four
actuators normal to the cylinder surface. The measured force
was that resisting the upward motion of the cylinder, which
tried to pull the actuators straight from the default bending
state (Figure 2B). The frictional grip force is the force exerted
by the actuators as the cylinder moves and slides across them
(Figure 2C). The experiment was repeated three times and the
results were averaged.

Integration and Evaluation of Soft

Wearable Robotic Glove
The overall structure of the soft robotic glove is a glove with five
finger-actuator pockets attached on the dorsal side (Figure 3A).
The actuators are integrated to the glove via the actuator pockets
(Figure 3B). Open palm design is adopted for easy donning and
FIGURE 2 | Schematic of the force measurement system for (A) blocked tip
force, (B) normal grip force, and (C) frictional grip force measurement.
doffing of the glove. The glove is secured to the wearer’s hand via
the finger pockets and a wrist strap. The finger pocket consists of

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Yap et al. Robotic Glove for Hand Assistance

FIGURE 3 | (A) Outer view and (B) inner view of the soft robotic glove. (C) Actuators are inserted into actuator pockets. (D) The length of the finger-actuator pockets
can be adjusted and attached to the base of the glove via Velcro.

anti-slip material to enhance the grip strength. To wear the glove, miniature solenoid valves (X-Valve, Parker, USA), and five air
the wearer just needs to insert the fingers into the finger pockets pressure sensors (MPX5500DP, Freescale, USA) (Figure 4B). The
and secure the glove to the wrist via the wrist strap. The glove microcontroller regulated the measured air pressure (P) to track
base serves as a compliant interface between the actuators and the desired pressure (Pref ) and used pulse width modulation
the human hand, providing minimal mechanical impedance to (PWM) to control the activation and deactivation of the valves
the finger motion when it is being worn and ensuring kinematic and pump based on the readings of the pressure sensors.
transparency. The control system could be powered by a 12 V rechargeable
The actuators can be easily inserted into the actuator pockets, lithium polymer battery (DC12300, China). The total weight
which are made from stretchable lycra fabrics (Figure 3C). The of the control system was ∼1.26 kg, which was lighter than
lycra fabrics serve as second constraining layers for the actuators, the control system (3.3 kg) presented by Polygerinos et al.
which further prevent over expansion of the actuators. Each (2015c).
actuator is isolated with respect to the others. The assistance A Proportional Integral Derivative (PID) control algorithm
of each finger can be achieved independently, which allows was used to ensure that the measured air pressure (P) of the
execution of different simulated ADL tasks. The length of the actuators was close to desired air pressure (Pref ). The PID control
finger-actuator pockets can be adjusted and attached to the base scheme was implemented on the microcontroller with a sampling
of the glove via Velcro, in order to accommodate different finger frequency of 100 Hz. The valves have a nominal response time
lengths (Figure 3D). Both the Velcro loop and the glove cover of 20 ms and a PWM frequency of 50 Hz was used. The control
constrain the bending movement of the actuators at the proximal parameters were selected as Kp = 10, Ki = 0.7, and Kd = 0.1.
part of the hand (Figure 3D). The desired pressure Pref was set at 120 kPa, which was the
The total weight of the glove is ∼180 g, which is much pressure that corresponded to full finger flexion based on the
lower than the design requirement. The thickness of the glove results from ROM test. The actuator for the index finger was
(including the actuators) and the width of each finger-actuator pressurized from 0 to 120 kPa. The control loop was tested in
pocket is <2 cm. Additionally, as the actuators work under air a step response experiment (Figure 4C). The closed-loop system
pressure, inflation of the actuators does not add a significant had a rise time of 1.36 s and a settling time (5%) of 1.63 s.
amount of extra weight to the hand, as compared to hydraulically The closed-loop system bandwidth was found to be 0.342 Hz
actuated actuators. (Figure S5).

Pump-Valve Control System Glove-Assisted Range of Motion

To realize isolated control of each actuator, a pump-valve Five healthy participants (3 males, 2 females, age: 26.2 ± 2.4
control system was assembled and integrated into a portable yr) were recruited in order to evaluate the performance of the
waist belt pack (Figure 4A). The control system consisted of glove in terms of its assisted-finger ROM and grip strength. All
a a microcontroller (Arduino Mega, Arduino), a miniature participants gave written informed consent in accordance with
diaphragm pneumatic pump (D737-23-01, Parker, USA), five the Declaration of Helsinki. The study protocol was approved

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Yap et al. Robotic Glove for Hand Assistance

FIGURE 4 | (A) Pump-valve control system integrated into a waist belt pack. (B) Inner view of the control system. (C) Step response of the controller implemented on
the pump-valve control system.

by the Institutional Review Board of the National University of

Singapore.
Two sessions were conducted for each participant. In the first
session, which consisted of three active trials, the participants
were instructed to close and open their right hand with the
presence of the glove. The length of the finger-actuator pockets
was adjusted to fit the finger length of the specific subject. In
the second session, which consisted of three glove-assisted trials,
the participants were instructed to relax their muscles and not to
exert any voluntary finger action. The hand closing and opening
were assisted by the actuation of the soft actuators. EMG signals
of the finger flexors and extensors were recorded during the trials
to identify whether the subject was exerting voluntary control of
the hand during glove-assisted trials.
The assisted-finger ROM and the EMG data were obtained
through the test method reported in our previous study (Yap
et al., 2016c). Additional details regarding the test method are
reported in the “Test Method for Glove-assisted ROM” section
of the Supplementary Material.

Glove-Assisted Grip Strength

A portable setup with a digital dynamometer (HF-50, China)
was developed to measure the glove-assisted grip strength of
the participants (Figure 5A). Upon pressurization to 120 kPa,
the glove assisted participants with grasping a cylinder (50 FIGURE 5 | (A) Schematic and (B) the real setup of a portable setup with
dynamometer to measure the glove-assisted grip strength. Maximum frictional
and 75 mm in diameter) (Figure 5B). The participants were grip force was recorded before the cylinder released from the actuators’ grip.
instructed to not exert voluntary force and hence, the grasping
of the cylinder would be solely due to the force generated by
the inflated actuators. The cylinder was tied to a Kevlar cable Pilot Test with Stroke Survivors
attached to the dynamometer. As the participants grasp and lift A pilot test that evaluated the feasibility of the glove in providing
the cylinder upwards, the cylinder would be slowly released from hand grasping assistance for ADL tasks was performed on
the actuators’ grip, when the tension in the cable became larger two stroke survivors. All participants gave written informed
than the frictional force applied by the actuators (Figure 5C). consent in accordance with the Declaration of Helsinki.
This setup allowed the measurement of frictional grip force The study protocol was approved by the NHG Domain
applied by the actuators, with the glove worn by the participants. Specific Review Board. The subject demographics are shown in
The setup and the mechanism of the slip of the cylinder from Table 2.
the hand are similar to those reported in previous literature The patients were instructed to use their affected hand to grasp
(Westling and Johansson, 1984; Johansson and Westling, 1988; an empty water bottle (Weight: 20 g, Diameter: 60 mm) and a tin
In et al., 2017). can (Weight: 454 g, Diameter: 75 mm) typically used in Jebsen

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Yap et al. Robotic Glove for Hand Assistance

TABLE 2 | Stroke patients’ demographic data.

Sex (age) Time post stroke (months) Type of stroke Affected side Fugl-meyer motor assessment (Upper extremity) Modified ashworth scale

F (50) 13 Infarct Left 4 1

M (40) 10 Infarct Left 5 1+

Hand Function Tests (Beebe and Lang, 2009). The same task
was repeated having the patients wear the glove. The task was
considered successful if the patient was able to grasp, lift, and put
down the object. The participants were allowed to use their non-
paretic hand to support their paretic forearm if they could not lift
their paretic arm. The time taken to complete the tasks (grasp,
lift, and put down the bottle or can) was recorded. The maximum
time allowed to complete the task was 90 s. The experiment was
repeated three times for each object and the results were averaged
across six trials for each patient in each condition (i.e., with and
without glove assistance).
In this work, we employed a straightforward button control
strategy to control the glove. A phone application with three
virtual buttons, (namely grasping, pinching, and tripod pinching)
was built to interface with the control system through wireless
Bluetooth communication (Figure S7). The patients were
instructed to click the virtual buttons using their non-paretic
hand to activate the glove for grasping activities. To deactivate
the glove, the patients just simply clicked the specific activated
button again.
After the test, the patients’ feedback on the device was
obtained. The patients were instructed to fill in the Usefulness-
Satisfaction-and-Ease-of-use questionnaire (USE) (Lund, 2001)
and a questionnaire focusing on comfort level, desire to use,
and desire to purchase the device. Both questionnaires use a
seven-point Likert rating scale that focuses on the experience and
feedback of the system.

RESULTS
Blocked Tip Force Output
The average values of the experimental force and the force
obtained from a theoretical model were compared and shown
in Figure 6. The force increased with increased pressure
(Figure 6A). The soft actuators could generate a maximum tip
force of 9.12 N at 120 kPa. Similarly, the force values obtained
from the theoretical model increased with increased pressure,
with a tip force value of 9.47 N at 120 kPa.

Normal and Frictional Grip Force Output FIGURE 6 | (A) Experimental and theoretical blocked tip force values over
Figures 6B,C plotted the force (normal/frictional grip force)— increasing pressures. (B) Normal and (C) frictional grip force
displacement of the cylinder (distance traveled by the cylinder output-displacement of the cylinder relationships of four actuators gripping
cylinder with diameter D = 75 mm and D = 50 mm at a fixed pressure
from initial position) characteristics of the force measurement
(120 kPa).
scenario. The average values of the normal and frictional grip
force applied by the actuators are shown in Figures 6B,C. The
results showed that four actuators could generate a normal grip
force of up to 36.2 ± 4.5 N (Diameter: 75 mm) and 28.1 ± 3.6 N frictional grip forces decreased with decreased cylinder diameter.
(Diameter: 50 mm) (Figure 6B). The actuators could generate a As the objects of daily living do not weigh more than 1.5 kg
frictional grip force of up to 18.7 ± 0.9 N (Diameter: 75 mm) and (Matheus and Dollar, 2010), the frictional force was found to be
12.4 ± 1.7 N (Diameter: 50 mm) (Figure 6C). The normal and sufficient to lift most of the objects.

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Yap et al. Robotic Glove for Hand Assistance

Glove-Assisted Range of Motion minimal voluntary movement during the glove-assisted trials.
During active trials, the maximum achievable joint angles were The hand closing and opening motions were completely assisted
82.3 ± 6.8◦ , 84.1 ± 7.9◦ , and 44.8 ± 4.4◦ at MCP, PIP, and by the glove.
DIP joints. The sums of finger joint angles during active trials
were measured to be ∼211◦ . During glove-assisted trials, the Glove-Assisted Grip Strength
maximum achievable joint angles were 73.9 ± 10.4◦ , 79.9 ± 4.2◦ , When the glove was worn by the participants, the glove could
and 46.0 ± 3.3◦ at MCP, PIP, and DIP joints. The sums of finger generate a frictional grip force up to 8.4 ± 1.8N (Cylinder
joint angles were measured to be ∼200◦ (Figure 7A). Statistical diameter: 75 mm) and 5.8 ± 1.7 N (Cylinder diameter: 50 mm)
analysis was conducted using the non-parametric Wilcoxon’s to counteract the weight of an object. Statistical analysis was
Signed-Rank tests. The tests showed no significant difference conducted using the Wilcoxon’s Signed-Rank tests. The frictional
between active and glove-assisted trials (p = 0.38 for MCP joint, grip force decreased with decreased cylinder diameter. Significant
P = 0.32 for PIP joint, and P = 1.25 for DIP joint). was concluded (P = 0.03).

Muscle Activation Simulated ADL Tasks

The muscle activation signals showed clear differences between Figure 8 demonstrates the ability of the glove to hold and lift
active and glove-assisted trials (Figure 7B). During the a 454 g-weighted tin can in vertical (Figure 8A) and horizontal
glove-assisted trials, the amplitude of the normalized EMG (Figure 8B) orientation. Additionally, we demonstrated that the
signal confirmed that the participants exerted minimal muscle glove was also able to assist with palmar grasp and pincer grasp
effort. Therefore, we concluded that the participants exerted that are required for simulated ADL tasks, such as grasping and
pinching (Figures 8C,D).

Pilot Test with Stroke Survivors

Both patients were able to activate the glove using the
phone application with virtual buttons (Figure 9). Without the
assistance of the glove, patient S1 was able to finish the tasks in
an average time of 9.0 ± 1.4 s (Figure 9B). When patient S1 was
grasping and lifting the water bottle, the patient could not grasp
the bottle effectively and the bottle toppled. With the assistance
of the glove, patient S1 could finish the tasks in an average time
of 8.0 ± 0.7 s (Figure 9C).
The hand of the patient S2 was slightly clenched. As a result,
the patient could not finish the tasks within 90 s as the patient
could not grasp both objects (Figure 9B). The patient could finish
the tasks in an average time of 12.3 ± 2.7 s with the assistance of
the glove (Figure 9C).
Statistical analysis was conducted using the non-parametric
tests. Due to poststroke heterogeneity and small sample size,
Wilcoxon’s Signed-Rank tests on individual participant data
were used to determine each patient’s improved time-taken to
complete the task with the assistance of the glove. Significance
was concluded on patient S2 (p = 0.02). Although significance
was not concluded on patient S1 (p = 0.06), we could still observe
that patient S1 could grasp the bottle more effectively with the
assistance of the glove. Therefore, as hypothesized, the grasping
performance of stroke patients improved with the assistance of
the glove.
For patients’ feedback, the mean and standard deviation
(SD) of the questionnaire parameters are presented in Table 3.
Generally, the patients reported scale of at least five out of
seven-point Likert rating.

FIGURE 7 | (A) Averaged range of motion of individual finger joints of five DISCUSSION
participants during active and glove-assisted trials. MCP,
Metacarpophalangeal joint; PIP, Proximal interphalangeal joint; DIP, Distal Compared to the fiber reinforced actuators developed for soft
interphalangeal joint. (B) Averaged muscle activation profiles of finger flexors robotic glove application in previous studies, which operate at
and extensors of one representative subject (Subject 2) during active and
glove-assisted trials. Exercise Cycle, Hand closing followed by opening.
the pressure range of 275–375 kPa (Polygerinos et al., 2015c), the
fabric-reinforced soft actuators designed in this study required

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Yap et al. Robotic Glove for Hand Assistance

FIGURE 8 | The glove generated sufficient force to lift a 454 g-weighted can in the (A) vertical and (B) horizontal orientation. (C) Palmar grasp, (D) Pincer grasp
achieved with the assistance of the glove.

FIGURE 9 | Evaluation of the glove with stroke patient S1 and S2. (A) Hand conditions of patients. (B) Comparison of grasping performances with and without
assistance of glove. (C) Time taken to complete the grasping tasks (n = 6 for each patient; P = 0.06 for S1, P = 0.02 for S2, paired t test, *p < 0.05.). The actuators
of the glove were pressurized at 120 kPa.

a lower range of operating pressures to achieve similar force might be due to the joint stiffness of the participants that imposed
output. With this advantage, we can select pumps and valves that an opposing torque that the actuators needed to overcome during
operate at a lower pressure range and consume less power, which finger flexion. Nevertheless, the force generated was considered
will lead to a more portable system. sufficient to grasp and achieve most of the ADLs (Matheus
Compared to the frictional grip force applied by the actuators and Dollar, 2010; Polygerinos et al., 2015c). The frictional grip
when the glove was not worn (section Normal and Frictional Grip force is dependent on the object size, which can be observed
Force Output), the frictional grip force reduced when the glove from the grip force experiment. The experiment showed that
was worn by the participants (section Muscle Activation). This the force output decreased with smaller cylinder diameter. This

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Yap et al. Robotic Glove for Hand Assistance

TABLE 3 | Questionnaire parameters and relative ratings of the USE questionnaire replaced with valves with faster flow rate in the future to increase
and a questionnaire focusing on comfort level, desire to use, and desire to the bandwidth of the actuators.
purchase the device.
The limitation of the previous soft actuator design is that the
Parameters Mean (SD) actuators apply forces to flex the finger upon air pressurization.
Upon depressurization, the actuators assist finger extension
USE QUESTIONNAIRES passively with the elastic properties of the actuators and the
Usefulness 5.9 ± 0.3 elastic textile materials of the actuator pockets (Polygerinos et al.,
Ease of use 6.4 ± 0.4 2015b,c; Yap et al., 2016a, 2017). The extension force might not
Ease of learning 6.6 ± 0.2 be enough for patients with hypertonicity and increased finger
Satisfaction 6.6 ± 0.5 flexor tone. In this work, the bottom elastic fabric layer is able to
PATIENTS’ FEEDBACK further enhance the extension force required to bring the fingers
Comfort level 6.0 ± 1.4 to the open hand state. The elastic modulus of the elastic fabric
Desire to use 6.5 ± 0.7 (0.45 N/mm) was chosen to match the elastic modulus of the
Desire to purchase 5.0 ± 1.4 elastic cords described in previous devices that allow the patients
to flex their fingers voluntarily and provide assistance in the hand
SD, standard deviation.
opening (Brokaw et al., 2011). The elastic cords are attached to
the distal phalanx of each finger at the dorsal side. The tensions in
was because the force exerted by the actuators changed with the elastic cords increase with increasing finger flexion and pull
the distance (i.e., the force decreased with increasing actuator the fingers to the open hand state. Assuming an offset distance
bending angle). Additionally, the frictional grip force is also of 10 mm due to skin stretching during finger flexion, the elastic
affected by the friction coefficient of the surface of the object fabric is able to provide an estimated 4.5 N of extension force to
and the anti-slip material of the finger pockets on the glove. The pull the fingers to the open hand state when the actuators are
friction coefficient between the anti-slip material on the finger depressurized.
pocket and the surface of the cylinder could be estimated from Pilot testing with two stroke survivors demonstrated the
the relationship between normal grip force and frictional grip feasibility of the glove in providing functional grasp assistance
force. In the measurement scenario described in this work, the for ADL. The glove is suitable for stroke survivors with a flaccid
coefficient was estimated at between 0.4 and 0.5. hand and without increased flexor tone (Modified Ashworth
The average functional ROM of the hand, which are sufficient Scale > 2). Without the assistance of the glove, the patients
to perform more than 90% of daily functional activities, at MCP, could not grasp cylindrical objects effectively, due to weak grasp
PIP, and DIP are 61, 60, and 39◦ , respectively (Hume et al., 1990). strength and contracture. With the presence of the glove, the
Additionally, as the actuators designed in this study are able to patients could then grasp the objects more effectively as the
extend to offset the increased distance due to skin stretching fingers were slightly more extended due to the elastic components
during finger flexion, the reported assisted ROM at MCP is higher of the glove. When the actuators were pressurized, the glove
than the assisted ROM reported in our previous study (Yap et al., provided an additional grasping force to the patients’ hand and
2016c). The EMG experiment confirmed that the participants assisted with the grasping activities. Therefore, the preliminary
exerted no voluntary effort during the glove-assisted trials and results showed that with the presence and assistance of the glove,
the hand grasping action was completely assisted by the glove. the patients’ grasping performance improved. The results of the
Therefore, our results demonstrated that the glove could achieve USE questionnaire and the patients’ feedback revealed that the
sufficient ROM and provide assistance with grasping motions patients were generally satisfied with the glove. Additionally,
typically found in ADL, in the absence of voluntary muscle patients reported high level of comfort and ease of use. The
control. parameter with the lowest rating is “Desire to purchase”. The
The choice of pneumatic over hydraulic allows the control patients pointed out that they would purchase if the selling
system to be more portable and lightweight than the control price was within their affordable range, which was between 500
system presented by Polygerinos et al. (2015b,c), as it does and 1,000 USD. Otherwise, they would prefer rental. The most
not require a water reservoir. However, the limitation of the positive aspects that the patients pointed out included (1) The
pneumatic system is that it suffers from slow dynamics due glove serves the purposes of mobilizing the finger joints and
to slow valve discharging speed and slow response times when assisting their grasping activities and (2) The glove motivates the
depressurizing, as presented in previous related works on soft patient to do rehabilitation exercises. On the other hand, the most
robotic gloves (Polygerinos et al., 2015c; Yap et al., 2017). In this negative aspect is that the fabric of the glove should be able to be
work, the closed-loop system bandwidth of the control system sanitized and washed easily for hygiene purpose.
was found to be 0.342 Hz. The value (0.342 Hz) is similar to
the bandwidth of the control system presented by Polygerinos
et al. (0.25 Hz). Although the bandwidth was less than the CONCLUSION
common bandwidth of rigid linkage-based and cable-driven
hand exoskeletons (Agarwal et al., 2015; Xiloyannis et al., 2016), This paper presented a soft robotic glove designed to assist
it can be considered sufficient for patients to conduct functional stroke survivors with grasping tasks during their ADLs. Fabric-
tasks for ADLs. The valves used in current system could be reinforced actuators with a corrugated fabric layer and a

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Yap et al. Robotic Glove for Hand Assistance

reinforced elastic layer were developed and experimental results Their study has shown that incorporation of the glove into the
have shown that the actuators could support finger motions with rehabilitation therapy has the potential for clinical use to improve
desired force output at lower operating air pressure, compared hand function.
to the required operating pressure of previously developed For stroke patients with increased flexor tone and spasticity
actuators. A control system was built to allow isolated control (Modified Ashworth Scale > 2), the passive extension mechanism
of each actuator and integrated into a portable waist belt back. might not have enough force to extend the fingers. For
Both the glove and the control system are more lightweight than these patients, soft robotic glove that is capable of providing
previously developed glove systems. The glove was evaluated active flexion and extension will be preferable. Finally, a
with five healthy participants in terms of the assisted ROM larger clinical study will be conducted in order to evaluate
and grip strength. Our results demonstrated that the glove was and improve the actuator and glove design, and to study
able to achieve sufficient ROM and provided assistance with the long-term efficacy of the glove-assisted intervention in
motions typically found in ADL, in the absence of voluntary rehabilitation.
muscle control. A pilot test on two stroke survivors with
reduced hand function also demonstrated that the glove allowed ETHICS STATEMENT
the patients to perform functional grasping activities more
effectively. This study was carried out in accordance with the
recommendations of Institutional Review Board of the National
FUTURE WORK University of Singapore (B-14-141) and the NHG Domain
Specific Review Board (2015/00975) with written informed
In this work, the experiments on grip force, glove-assisted ROM, consent from all subjects. All subjects gave written informed
and pilot tests with stroke survivors were conducted at a fixed consent in accordance with the Declaration of Helsinki. The
actuator pressure (120 kPa). While the results from section protocol was approved by the Institutional Review Board of
Blocked Tip Force Output have shown that the actuator force the National University of Singapore (B-14-141) and the NHG
increased with increased pressure, it is possible to conduct Domain Specific Review Board (2015/00975).
a more extensive study in the future by obtaining objective
measurements, such as force, ROM, and grip strength, as a AUTHOR CONTRIBUTIONS
function of actuator pressure and presenting the time course
of the pressure during each task. The force, ROM and grip HY, JL, FN, and CY designed the study. HY collected, processed
strength can be controlled by adjusting the air pressure according and analyzed the data and drafted the manuscript. JL,
to patient’s condition. This feature will be further explored in FN, and CY contributed to the interpretation of findings.
subsequent work. CY oversaw its coordination and helped to draft the
Future iterations of the glove will include sensor components, manuscript. All authors read, edited and approved the final
such as joint angle sensors and force sensors, which can provide manuscript.
joint angle and grasp force feedback. Joint angle feedback
allows closed-loop position control and will enable the pump- FUNDING
valve control system to identify whether the desired hand-
finger posture has been achieved. The grasp force feedback This work was funded by the A∗ STAR Medtech Innovation Grant
will permit us to examine the force output of the glove and (R397-000-260-305) and the National University Health System
to facilitate impedance control strategies (Marchal-Crespo and (NUHS)-Clinical Imaging Research Center (CIRC) Seed Funding
Reinkensmeyer, 2009). Grant (R-172-000-323-511).
While stroke survivors are the target patient population of the
glove presented in this work, the glove can also potentially assist ACKNOWLEDGMENTS
patients with incomplete spinal cord injuries or amyotrophic
lateral sclerosis. Apart from serving as an assistive device for The authors wish to thank all the participants and their family
ADLs, the glove described in this work can potentially serve members who volunteered to take part to the experiment. The
as a rehabilitative device, providing task-specific rehabilitation authors would like to express their appreciation NUS Graduate
training. Several research groups working on hand exoskeletons School for Integrative Sciences and Engineering for providing
have shown that incorporation of these devices into hand therapy scholarship support to HY.
can benefit the stroke survivors. Significant improvements in
functional outcome have been observed with the combination SUPPLEMENTARY MATERIAL
of assist-as-needed control strategy and user intent detection
strategy (Hu et al., 2013; Thielbar et al., 2014, 2017). For example, The Supplementary Material for this article can be found
Theilbar et al. have developed a cable-driven robotic glove with online at: https://www.frontiersin.org/articles/10.3389/fnins.
the combination of voice and EMG to detect user intention. 2017.00547/full#supplementary-material

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Yap et al. Robotic Glove for Hand Assistance

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Frontiers in Neuroscience | www.frontiersin.org 14 October 2017 | Volume 11 | Article 547