Technology to enhance arm and hand function

About 2% of people have weak or paralysed upper limbs (ULs) due to stroke or spinal cord injury (SCI). Physiotherapy involving exercise can improve motor function in many such cases, but the time and resources required are often unavailable. Adherence to repeated intensive exercise tends to decline, especially after participants leave the clinical environment. There is a need for technology that can restore neuromuscular control and improve motivation by making exercise therapy enjoyable, and that extends the therapy into the home with the use of remote communication (e.g. ‘tele-coaching’). Over the last 20 years many devices have been developed and tested. Neuroprostheses (NPs) that activate UL muscles with functional electrical stimulation (FES) either via surface or implanted electrodes are now commercially available or in clinical trials. The use of robotic devices to enhance exercise therapy has been an active area of research and development. Recent studies indicate that improvements in motor function depend largely on the efforts made by the participant. This chapter reviews conventional exercise therapy, FES, and robotic and passive exercise devices that improve motor function and enhance engagement in UL rehabilitation. It is suggested that important developments in the next few years will include the widespread availability of affordable FES and in-home exercise devices, and the gradual adoption of tele-coaching over the internet.