Assistive Robotic Hand Augmentation during temporary immobilisation

手功能对日常生活的几乎每个方面都至关重要，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，英国目前每年因骨科损伤导致的临时手臂固定病例的发生率为68，000例，预计由于脆性骨折而显著增加，这尤其影响了不断增长的老年人口。与轮椅和拐杖等下肢辅助选择不同，目前没有用于暂时上肢固定的辅助技术。我们寻求针对这一未满足的临床需求，并提供一种完全不同的方法来改善手部受伤后的功能。为了智能地满足患者需求，同时支持受影响手的愈合和康复，我们建议在固定期间增加未受损手的功能。在受伤的急性期，活动受伤的手将是痛苦和不切实际的。因此，增强未受损的手将立即增强功能，以帮助减轻暂时的残疾。这将通过使用由项目贡献者Dani Clode Design开发的名为“第三拇指”的额外机器人设备进行运动增强来完成。作为一个额外的拇指假肢，专门设计用于扩展已经功能齐全的手的运动能力，该设备允许人们执行复杂的日常任务，通常需要双手协调。该项目受益于我们对健康参与者手部增强的神经基础的初步研究的基础证据。我们证明，第三拇指设备允许直观的控制，高水平的实施例，具有最少培训（<10分钟）的非专业用户的基本功能水平，以及通过额外的定制培训提高的灵活性和运动控制水平。拟议的研究项目将准备这种独特且易于实施的辅助技术的开发和临床翻译，以提高暂时固定患者的独立性。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。为了确保患者满意度和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化的初始用户群体的初始设备控制来更好地了解用户体验。我们将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，旨在创建一个针对目标人群的不同需求量身定制的原型。为了提高运动能力，我们将为潜在用户制定家庭训练方案，以适应他们的个人需求，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，以证明该设备的安全性和在健康参与者中的成功整合，重点是“预防”体验。在这里，我们将检查设备实施例的潜在神经生物标志物，并解决拇指密集使用的可能“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，我们将介绍并记录拇指在具有更复杂需求的个体患者（青少年和老年女性）中的使用，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，我们的目标是为基本上未满足的临床需求提供定制的解决方案，并有可能从根本上改善全球每年数百万短暂性手部残疾者的日常功能。

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.