Assistive Robotic Hand Augmentation during temporary immobilisation

手功能几乎对日常生活的方方面面都至关重要，即使是暂时的损伤也会对患者的独立性和就业产生巨大的经济和社会影响。据估计，目前英国每年因骨科损伤而导致的暂时性手臂固定病例达6.8万例，预计由于脆性骨折的发生率将大幅上升，这对日益增长的老年人口造成的影响尤其严重。与轮椅和拐杖等下肢辅助选择不同，目前还没有用于临时固定上肢的辅助技术。我们寻求针对这一未得到满足的临床需求，并为手部损伤后改善功能的现有选择提供一种截然不同的方法。为了智能地满足患者的需要，同时支持患手的愈合和康复，我们建议在制动期间增加非受损手的功能。在受伤的急性期，动员受伤的手将是痛苦和不切实际的。因此，增加未受损的手将立即增强功能，帮助缓解暂时性残疾。这将通过使用由项目贡献者Dani Clode Design开发的名为Third Thumb的多余机器人设备来实现。作为一种专门设计的额外拇指假体，旨在扩展已经完全功能的手的运动能力，这种设备允许人们执行复杂的日常任务，这些任务通常需要双手协调。该项目得益于我们对健康参与者手增强的神经基础的初步研究的基础证据。我们展示了第三个拇指设备允许直观的控制、高水平的实施、只需最少训练(10分钟)的外行用户的基本功能水平，以及通过额外的定制训练提高灵巧度和运动控制水平。拟议的研究项目将准备这一独特且易于实施的辅助技术的开发和临床翻译，以提高接受临时制动的患者的独立性。我们将与临床合作伙伴合作，通过提供第一个定制原型来评估这种辅助技术的可行性和安全性。为了确保患者满意和我们的辅助技术的可行实施，我们将首先通过记录患者群体的日常需求和评估广泛而多样的幼稚用户群体的初始设备控制来更好地了解用户体验。我们将把通过用户体验分析获得的知识转化为可操作的见解，用于辅助技术开发，目的是创建一个适合我们目标人群不同需求的原型。为了增强运动能力，我们将制定家庭训练方案，供潜在用户根据其个人需求进行调整，以最大限度地提高他们的独立性。接下来，我们将进行一项纵向试验，以产生证据，证明该设备在健康参与者中的安全性和成功整合，重点放在“体现”的体验上。在这里，我们将检查设备体现的潜在神经生物标志物，并解决拇指密集型使用可能的“副作用”，以确保其作为辅助技术的实施是有效和无风险的。最后，我们将介绍并记录具有更复杂需求的个体患者(青少年和老年女性)的拇指使用情况，以提供在动态现实生活挑战下流畅控制的临床前概念验证。通过我们的整体方法，我们的目标是为在很大程度上未得到满足的临床需求提供定制的解决方案，有可能从根本上改善全球数百万每年经历一过性手残疾的人的日常功能。

Hand function is crucial for almost every aspect of daily life, and even temporary impairment can have massive financial and societal implications on both patients independence and employment. The UK is currently estimated to sustain an annual incident rate of 68,000 temporary arm immobilisation cases due to orthopaedic injury, with a projection for a significant increase due to fragility fractures which are particularly impacting the rising older population. Unlike lower-limb assistive options, such as wheelchairs and crutches, there are currently no assistive technologies for temporary upper-limb immobilisation. We seek to target this unmet clinical need and offer a radically different approach to existing options for improving functionality following hand injury. To intelligently meet patient needs while supporting healing and rehabilitation of the affected hand, we propose to increase the functionality of the non-damaged hand during the immobilisation period. During the injury's acute phase, mobilising the injured hand will be painful and impractical. Thus, augmenting the unimpaired hand will immediately enhance functionality to help alleviate temporary disability. This will be done via motor augmentation using a supernumerary robotic device called the Third Thumb, developed by the project contributor Dani Clode Design. As an extra thumb prosthetic specifically designed to extend the motor abilities of an already fully functional hand, this device allows people to carry out complex daily tasks that normally require bimanual coordination. The project benefits from foundational evidence of our initial research on the neural basis of hand augmentation in healthy participants. We demonstrated that the Third Thumb device allows intuitive control, high levels of embodiment, basic levels of functionality for a lay user with minimal training (<10 minutes), and increased levels of dexterity and motor control with additional customised training. The proposed research project will prepare the development and clinical translation of this unique and easily implemented assistive technology to improve the independence of patients undergoing temporary immobilisation. In collaboration with clinical partners, we will assess the feasibility and safety of this assistive technology by providing a first bespoke prototype.To ensure patient satisfaction and a feasible implementation of our assistive technology, we will first develop a better understanding of user-experience, by documenting the daily needs of our patient group and by assessing initial device control in a broad and diverse group of naïve users. We will translate the knowledge gained through user-experience analysis into actionable insights for assistive technical development, with the aim to create a prototype tailored to our target population's diverse needs. To enhance motor capabilities, we will develop at-home training protocols for potential users to adapt according to their individual needs, to maximise their independence. Next, we will run a longitudinal trial to generate evidence for the device's safety and successful integration in healthy participants, with emphasis on the experience of 'embodiment'. Here, we will examine potential neural biomarkers for device embodiment and address possible 'side effects' of Thumb intensive use, to ensure its implementation as assistive technology is effective and risk-free. Finally, we will introduce and document Thumb use in individual patients with more complex needs (teenagers and older women) to provide a pre-clinical proof-of-concept for fluent control under dynamic real-life challenges. With our holistic approach, we aim to provide a bespoke solution to a largely unmet clinical need, with the potential to radically improve the daily functionality of the millions of individuals who experience transient hand disabilities annually around the world.