Development and initial testing of a shoulder-hand active-passive exoskeleton (SHAPE) to assist individuals with chronic upper-extremity impairments after stroke.

The PI, Joseph Kopke, is a PT and Ph.D., trained at Northwestern University after serving in the US Air Force for 8-years. His dissertation research focused on understanding control of the shoulder and the feasibility of using machine learning to control a powered device to support the shoulder against gravity after stroke. His

immediate goal is to develop a hybrid exoskeletal system utilizing a passive shoulder and an active hand (Shoulder-Hand Acitve-Passive Exoskeleton, SHAPE) to assist individuals after stroke. He would like to advance this project towards a follow-on efficacy study as part of a CDA-2. Ultimately, his goal is to bridge the gap between

the clinic, neuroscience, engineering, and the patient and bring simple, smart, intuitive devices to Veterans to address impairments and increase function after neuro insult. He is supported by a strong and experienced team of mentors including Dr’s Matthew Major (Ph.D.), Levi Hargrove (Ph.D.), Elliott Roth (MD), Stefania Fatone (Ph.D., BPO) and poised between three top-tier institutions

Jesse Brown VAMC, Northwestern University, and Shirley Ryan AbilityLab. His mentorship team offers him a breadth and depth of knowledge and experience essential to the success of his proposal. His primary mentor, Dr. Major will provide oversight of the project and Dr. Kopke’s training and development; Dr. Hargrove provides

the expertise in pattern recognition and imbedded control while Dr Roth provides over 30-years experience as a clinician scientist working with individuals with stroke and other neurological impairment; Dr. Fatone will offer insight and guidance as a trained orthotist with years of upper-extremity device development experience.

Together they offer Dr. Kopke the opportunity to develop towards an independent VA movement scientist committed to bettering the function and quality of life of Veterans through orthotic technology. This proposal focuses on the development of the Shoulder-Hand Active-Passive Exoskeleton (SHAPE) for individuals with chronic upper-extremity impairment after stroke. Common impairments after a cerebrovascular

accident, or stroke, include extreme weakness throughout the shoulder, arm, wrist, and hand, limiting their use. Additionally, increased abnormal tone that presents during effortful tasks further impairs the individual by causing unintentional and abnormal muscle activation throughout the limb. Supporting the shoulder to move the arm

against gravity minimizes this abnormal tone and enables better elbow, wrist, and hand function. Combining shoulder support with a hand device designed to facilitate extension and grip will then address both the weakness experienced in these areas as well as minimize secondary negative effects caused by use of the shoulder.

The purpose of Aim 1 is to design and refine a wearable passive shoulder support device to help compensate for gravity. A prototype to passively support glenohumeral elevation has already been designed and fabricated using low-cost materials. An iterative phase-gate approach incorporating user feedback will be implemented to

advance this design from prototype to a more definitive device that is comfortable and effective. Functionality will be assessed in a small number of participants with and without the shoulder portion of SHAPE through measuring shoulder range of motion, Fugl-Myer upper-extremity assessment, and the box and blocks test.

The purpose of Aim 2 is to develop a functional pattern recognition controller for a wearable hand device assisting gross hand -opening and –closing. Control of the open-source Hand Extension Robot Orthoses (HERO) grip glove, a powered orthosis to support hand function, will be advanced. Decoded movement intentions from a real-

time and online pattern recognition myoelectric controller will be incorporated into the control scheme. User functionality will be assessed with and without the hand portion of SHAPE through measuring hand range of motion, Fugl-Myer upper-extremity assessment, and the box and blocks test. The same measures will then be assessed using both aspects of SHAPE simultaneously to detect possible

additional improvements. It is hoped SHAPE can improve function and quality of life for Veterans with stroke.