A dexterous soft hand exoskeleton restores intentional grasping in individuals with severe hand impairment

Soft hand exoskeletons have emerged as promising assistive devices for individuals with impaired hand function. However, most existing systems provide limited dexterity and primarily target users with moderate hand ability, leaving individuals with severe hand paralysis without effective solutions for reliable grasping of diverse objects. Here we report the translational development of a lightweight, textile-based soft robotic exoskeleton glove with wrist dorsiflexion and an active opposable and abductable thumb, designed to restore hand function in a patient with severe right-hand impairment due to amyotrophic lateral sclerosis. We followed a co-creation approach, enhancing dexterity by increasing hand articulations based on patient needs. Furthermore, to enhance the patient's sense of control, a non-invasive surface electromyography-based grasp predictor (97% sensitivity) was combined with motion data and machine learning-based error correction to compensate for weak, noisy muscle signals, compared with healthy controls (n = 15). The exoskeleton enabled the patient to grasp objects, achieve a Box-and-Blocks Test score of 5 and perform meaningful tasks, including feeding himself. We further validated the exoskeleton in patients with stroke (n = 6). While exoskeleton assistance on average reduced Action Research Arm Test scores of moderately impaired patients by 9, severely impaired patients scored 17 points higher when using the exoskeleton. These results indicate that the dexterous soft hand exoskeleton is particularly effective for individuals with severe to near-complete hand paralysis, while its utility for patients with moderate residual function is limited and task dependent.