Increased effort during use of the paretic arm and hand can provoke involuntary abnormal synergy patterns and amplify stiffness effects of muscle tone for individuals after stroke, which can add difficulty for user-controlled devices to assist hand movement during functional tasks. We study how volitional effort, exerted in an attempt to open or close the hand, affects resistance to robot-assisted movement at the finger level. We perform experiments with three chronic stroke survivors to measure changes in stiffness when the user is actively exerting effort to activate ipsilateral EMG-controlled robot-assisted hand movements, compared with when the fingers are passively stretched, as well as overall effects from sustained active engagement and use. Our results suggest that active engagement of the upper extremity increases muscle tone in the finger to a much greater degree than through passive-stretch or sustained exertion over time. Potential design implications of this work suggest that developers should anticipate higher levels of finger stiffness when relying on user-driven ipsilateral control methods for assistive or rehabilitative devices for stroke.

What are you doing right now other than scrolling through this article? Do you have a cup of coffee in one hand, your phone in the other? Maybe your right hand is using your laptop mouse and your left hand is holding a snack. Have you ever thought about how often we are using both of our hands? Having two healthy human hands allows us to carry too many grocery bags in one hand and unlock our apartment door with the other, and perform complex bimanual coordination like playing Moonlight Sonata by Beethoven on the piano (well, maybe not all of us can do that). Having two hands also allows us to do some of the most simple tasks in our daily lives, like holding a jar of peanut butter and unscrewing the lid, or putting our hair up in a ponytail.

Survivors of central nervous system injury commonly present with spastic hypertonia. The affected muscles are hyperexcitable and can display involuntary static muscle tone and an exaggerated stretch reflex. These symptoms affect posture and disrupt activities of daily living. Symptoms are typically measured using subjective manual tests such as the Modified Ashworth Scale; however, more quantitative measures are necessary to evaluate potential treatments. The hands are one of the most common targets for intervention, but few investigators attempt to quantify symptoms of spastic hypertonia affecting the fingers. We present the isometric force pillow (IFP) to quantify involuntary grip force. This lightweight, computerized tool provides a holistic measure of finger flexion force and can be used in various orientations for clinical testing and to measure the impact of assistive devices.