A user-friendly automatic toolbox for hand kinematic analysis, clinical assessment and postural synergies extraction

The clinical assessment of the human hand is typically conducted through questionnaires or tests that include objective (e.g., time) and subjective (e.g., grasp quality) outcome measures. However, there are other important indicators that should be considered to quantify grasp and movement quality in addition to the time needed by a subject to execute a task, and this is essential for human and artificial hands that attempt to replicate the human hand properties. The correct estimation of hand kinematics is fundamental for computing these indicators with high fidelity, and a technical background is typically required to perform this analysis. In addition, to understand human motor control strategies as well as to replicate them on artificial devices, postural synergies were widely explored in recent years. Synergies should be analyzed not only to investigate possible modifications due to musculoskeletal and/or neuromuscular disorders, but also to test biomimetic hands. The aim of this work is to present an open source toolbox to perform all-in-one kinematic analysis and clinical assessment of the hand, as well as to perform postural synergies extraction. In the example provided in this work, the tool takes as input the position of 28 retroreflective markers with a diameter of 6 mm, positioned on specific anatomical landmarks of the hand and recorded with an optoelectronic motion capture system, and automatically performs 1) hand kinematic analysis (i.e., computation of 23 joint angles); 2) clinical assessment, by computing indicators that allow quantifying movement efficiency (Peak Grip Aperture), smoothness (Normalized Dimensionless Jerk Grasp Aperture) and speed (Peak Velocity of Grasp Aperture), planning capabilities (Time to Peak Grip Aperture), spatial posture (Wrist and Finger Joint Angles) and grasp stability (Posture of Hand Finger Joints), and 3) postural synergies extraction and analysis through the Pareto, Scree and Loadings plots. Two examples are described to demonstrate the applicability of the toolbox: the first one aiming at performing a clinical assessment of a volunteer and the second one aiming at extracting and analyzing the volunteer's postural synergies. The tool allows calculating joint angles with high accuracy (reconstruction errors below 4 mm and 3.2 mm for the fingers and wrist respectively) and automatically performing clinical assessment and postural synergies extraction. Results can be visually inspected, and data can be saved for any desired post processing analysis. Custom-made protocols to extract joint angles, based on different markersets, could be also integrated in the toolbox. The tool can be easily exploitable in clinical contexts, as it does not require any particular technical knowledge to be used, as confirmed by the usability evaluation conducted (perceived usability = 94.2 ± 5.4). In addition, it can be integrated with the SynGrasp toolbox to perform grasp analysis of underactuated virtual hands based on postural synergies.