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Soft Exoskeleton With Fully Actuated Thumb Movements for Grasping

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DOI: 10.1109/TRO.2022.3148909

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2194
Soft Exoskeleton With Fully Actuated Thumb
Movements for Grasping Assistance
Wenyuan Chen , Guangyong Li , Member, IEEE, Ning Li , Wenxue Wang , Member, IEEE, Peng Yu,
Ruiqian Wang, Xiujuan Xue, Xingang Zhao , Member, IEEE, and Lianqing Liu , Member, IEEE
Abstract—It has been clinically proven that exoskeletons are ef-
fective self-training rehabilitation or daily living assistance devices
for patients with hand dysfunctions. However, exoskeleton-assisted
hand exercises with high degrees-of-freedom are considered as
challenging tasks because the digit space, especially the thumb,
cannot accommodate enough actuators. In this article, we report
a tendon-driven soft hand exoskeleton with a hybrid configuration
for thumb actuation. The soft hand exoskeleton system uses the
least number of actuators to realize full degrees-of-freedom actu-
ation for all digits. It is tested on a stroke patient with hemiplegia
and a healthy subject. The experimental results show that the hand
exoskeleton could assist the stroke patient to accomplish various
training tasks, such as thumb encircling, grasping, pinching, re-
leasing, and writing. It was found that digit trajectories and joint
angle changes of the stroke patient were close to those of the healthy
subject. Especially, the range of motion of the stroke patient shows
significant improvement with the hand exoskeleton assistance com-
pared to that without the hand exoskeleton assistance. The research
in this article paves the way to develop fully actuated soft hand
exoskeleton that can be eventually integrated with an electroen-
cephalogram or electromyography for self-training rehabilitation
or daily living assistance.
Index Terms—Exercise-assisted, hand exoskeleton, rehabilita-
tion robot, soft wearable robot, tendon-driven.
Manuscript received 12 August 2021; revised 9 December 2021; accepted
27 January 2022. Date of publication 1 March 2022; date of current version
8 August 2022. This work was supported in part by the National Key R&D
Program of China under Grant 2018YFB1304700, in part by the National Natural
Science Foundation of China under Grant 61925307, Grant 61821005, and Grant
91748212, in part by the Key Research Program of Frontier Sciences, CAS, under
Grant QYZDB-SSW-JSC008, and in part by the Sichuan Science and Technol-
ogy Program under Grant 2020YFSY0012. This paper was recommended for
publication by Associate Editor Qingsong Xu and Editor Eiichi Yoshida upon
evaluation of the reviewers’ comments. (Corresponding authors: Guangyong
Li; Lianqing Liu.)
Wenyuan Chen, Ning Li, and Ruiqian Wang are with the State Key Laboratory
of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences,
Shenyang 110016, China, with the Institutes for Robotics and Intelligent Man-
ufacturing, Chinese Academy of Sciences, Shenyang 110016, China, and also
with the University of the Chinese Academy of Sciences, Beijing 100049, China
(e-mail: chenwenyuan@sia.cn; lining3@sia.cn; wangruiqian@sia.cn).
Guangyong Li is with the Department of Electrical and Computer Engineer-
ing, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
15261 USA (e-mail: gul6@pitt.edu).
Wenxue Wang, Peng Yu, Xingang Zhao, and Lianqing Liu are with the
State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese
Academy of Sciences, Shenyang 110016, China (e-mail: wangwenxue@sia.cn;
yupeng@sia.cn; zhaoxingang@sia.cn; lqliu@sia.cn).
Xiujuan Xue is with the Rehabilitation Center for the Disabled, Shenyang
110015, China (e-mail: xxj190003@163.com).
This article has supplementary material provided by the au-
thors and color versions of one or more figures available at
https://doi.org/10.1109/TRO.2022.3148909.
Digital Object Identifier 10.1109/TRO.2022.3148909
1552-3098 © 2022 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
See https://www.ieee.org/publications/rights/index.html for more information.
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IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022
I. INTRODUCTION
TROKES have become the leading cause of disability,
S causing the loss of hand function of many patients, with
more than 13.7 million new stroke patients worldwide each year.
Approximately 40% of stroke victims are from China [1], [2],
whilst in the United States, approximately 0.8 million people
suffer from strokes each year [3]. Studies have revealed that
rehabilitation training in the first three months after stroke is
critical, and most patients can recover 48%–91% of their motor
functions during this period [4]. After discharged from the
hospital, 85% of patients can walk without assistance; however,
motion of the upper limbs and hands usually cannot be fully
recovered for most patients. Therefore, continuous rehabilitation
training through repetitive movements is needed in order to
further recover hand functions. Rehabilitation training usually
heavily relies on occupational therapists, who may not be con-
veniently available. To alleviate the demand for intensive care
from occupational therapists, a variety of rehabilitation hand
exoskeleton devices have been developed [5]–[8].
Hand motion plays a dominant role in upper limb function
with approximately 90% of upper limb function coming from
hand motion. Among all the digits in a hand, the thumb is con-
siderably different in size and kinematics from and independent
of the other four fingers, and plays the most significant role in
hand motion with 40% being from thumb movement [9], [10].
The index and middle finger each accounts for 20% of hand
motion, whereas the remaining two account for only 10% of
hand motion [11]. During a grasping operation, the thumb needs
to adjust its gesture according to the shape of the object [12].
Therefore, the carpometacarpal (CMC) joint of the thumb needs
to make the motion of not only flexion and extension, but
also abduction and adduction to accomplish different types of
grasping and pinching, such as power grasping, tripod grasping,
precision pinching, and lateral pinching [13]. The actuation of
hand exoskeletons requires multiple degrees-of-freedom (DoF)
to accomplish these operations; however, it is very challenging
to design a hand exoskeleton with multiple DoFs because of
the compact and narrow digit space, especially for the thumb.
To accommodate the limited digit space, most hand exoskeleton
designs have to reduce their DoFs significantly.
Currently, hand exoskeletons are typically classified into two
categories: rigid link-based ones with joints driven by tendons
through remote motors and soft glove-based ones driven either
hydraulically, pneumatically or by tendons through remote
motors. To achieve higher DoF motion from a rigid link-based
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE
exoskeleton, more external redundant joint structures are
needed, which increases the complexity and cost. In addition,
the rigid link-based exoskeleton often hurts human digits due to
the misalignment between the rigid joints and human digit joints.
One design of rigid link-based exoskeleton adopts a mechanical
structure to self-align its joints with human finger joints to avoid
damaging the fingers during its operation [14]. However, such
design makes the exoskeleton very bulky and heavy. Soft gloves
driven by hydraulic or pneumatic actuators can perform motion
trajectories close to those of biological fingers. However, it is
very challenging to generate motion trajectories that match natu-
ral thumb motion, which involves multijoint bending, extending,
and twisting. One design of hydraulic-driven soft glove uses
segmented fiber reinforcement to generate multiple forms of
motion using a single soft actuator [15]. Unfortunately, such de-
sign exhibits very limited dexterity because it can only generate
a single motion trajectory based on the distribution of segmented
fiber reinforcement, making arbitrary motion impossible.
Tendon-driven soft glove-based exoskeletons have been ex-
tensively studied because of their lightweight, flexibility, and
simple actuation mechanism. However, tendons are not bidirec-
tionally drivable; thus, more actuators are needed in the system
to implement more DoFs. Therefore, very few tendon-driven
glove-based hand exoskeletons can match natural thumb motion,
which involves multiple DoFs. Most tendon-driven soft hand ex-
oskeletons, such as Exo-Glove [16] and Exo-Glove Poly II [17],
can only perform some simple tasks involving thumb motion
because the position of the thumb is not directly controlled. One
soft glove reported in [18] uses four exotendons to generate
dexterous motion of the thumb. However, the location of the
exotendon attachment points on the thumb is prone to shift due
to the nonuniform shape of the thenar eminence and exoskeleton
deformation and may restrict thumb movements or generate
inconsistent CMC motion. To prevent attachment point shifting,
another soft glove reported in [19] uses the adductor tendon to
wrap around the thenar eminence. Unfortunately, such wrapping
configuration significantly limits the range of abduction and
adduction motion of the thumb.
To mitigate the aforementioned problems in existing
hand exoskeletons for thumb motions, a hybrid soft hand
exoskeleton is proposed herein that combines a flexible link
with a tendon-driven soft glove to drive thumb motion. The
exoskeleton is designed based on the analysis of the human
musculoskeletal anatomy as well as the basic motion types of
the thumb. At least two DOFs of motions [flexion/extension
(F/E) and abduction/adduction (AB/AD)] are needed in order to
generate arbitrary thumb motions. Therefore, four biomimetic
tendons (flexor, extensor, abductor, and adductor) are needed
for generating the thumb motions. The route of the thumb
flexor and extensor tendons is consistent with that of the thumb
muscles generating flexion and extension motions. A flexible
link attached to the proximal phalange of the thumb generates
abduction and adduction motion by abductor and adductor
tendons. Such hybrid configuration significantly minimizes the
problem of attachment point shifting. To reduce the number of
actuators, a simple pulley mechanism is employed to generate
bidirectional motions (F/E and AB/AD). As a result, this hybrid
configuration can perform dexterous thumb operations (such
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2195
as thumb encircling) with only two actuators. In addition, the
motion of the other fingers is driven by tendons using another
two actuators. The entire system is therefore able to realize full
actuation of the thumb and fingers using only four actuators.
The design of the hybrid soft hand exoskeleton has been
validated experimentally. With the hybrid soft hand exoskeleton,
a stroke patient can complete lots of training tasks, such as
grasping wooden blocks, pinching pins, and writing letters.
Especially, the experimental results show that the range of mo-
tion (ROM) of the patient improved significantly with the hand
exoskeleton compared with that of his voluntary movements,
from 20% to 80% for thumb encircling and from 12% to 60%
for bottle grasping. In addition, the level of fingertip force has
been improved by over twofold, and as a result, the patient can
perform stable grasping and pinching, which cannot be done
without the hand exoskeleton.
The main contribution of this article is summarized as follows.
A hybrid actuation mechanism that combines tendons and a
flexible link is proposed to perform the complex thumb motions
using only two actuators. To the best of our knowledge, this is the
first soft hand exoskeleton that is able to perform dexterous oper-
ations, such as thumb encircling. A thumb model was established
to control the hand exoskeleton, considering the CMC joint of the
thumb as a spherical hinge joint and providing the measurement
approach of thumb angles. The soft hand exoskeleton has been
tested in a stroke patient, and its clinic effect has been vali-
dated by ROM and two proposed indicators, AREA for thumb-
encircling task and ARC LENGTH for bottle grasping task.
The rest of this article is organized as follows. Section II
describes the design of the exoskeleton; Section III introduces
the modeling and measurements of the thumb joint angles;
Section IV provides the experimental methods and results. The
discussion is presented in Section V. Finally, Section VI con-
cludes this article.
II. EXOSKELETON DESIGN
A. Hand Exoskeleton Design Requirements
The main objective of the exoskeleton design is to achieve the
most routine hand movements, especially for the thumb, with the
expectation that the hand exoskeleton can not only perform the
rehabilitation training but also assist activities of daily living
(ADLs) for stroke patients. To meet the design goal, several
guidelines have been summarized in the literature [7], [20]–[23],
and the two most important requirements are summarized as
follows.
1) Achieving multiple gesture types: Apart from driving
four fingers separately, it is necessary to drive the thumb
AB/AD and F/E independently to perform various gesture
types.
2) Providing sufficient fingertip force: It is also necessary
to generate sufficient fingertip force to complete various
functional tasks, such as grasping and pinching.
Besides these two main requirements, other indispensable
requirements include light weight and compact size, easy don-
ning and doffing, low cost, rapid personalization for individuals,
low power consumption to ensure a long running time, and
safety [23].
2196
Fig. 1. Hand exoskeleton is composed of three systems: wearable glove, wear-
able backpack-type remote actuation system, and a computer control system.
B. Overview of Hand Exoskeleton System
The hand exoskeleton is composed of three main systems, as
shown in Fig. 1: 1) a wearable glove that includes two modules
(finger module and thumb module); 2) a backpack-type remote
actuation system (RAS) that drives the wearable glove through
the tendon tubes; and 3) a computer control system that plans
the motions and commands the RAS.
The tendon-driven wearable glove is very light, with a total
weight of less than 200 g. Fishing lines with high output force
are used as tendons for tension transmission. A single actuator
is used to pull both index flexor and extensor tendons for index
flexion and extension. Three flexor tendons for the other three
fingers are tied together, as well as the three extensor tendons.
Similarly, both are driven by a single actuator for flexion and
extension. Considering that the thumb accounts for 40% of
hand function, the actuation mechanism for the thumb module
is relatively complex. A hybrid configuration that combines a
flexible link and tendons to realize the dexterous motion of the
thumb is employed. Two actuators are used to generate thumb
motion, one to drive the flexible link for AB/AD and another to
drive tendons for F/E. The design details of the thumb module
are explained in Section II-C. The wearable glove is fastened by
a soft watch band so the patient can don and doff the exoskeleton
in approximately 2 min with the help from another person.
The majority parts of the wearable glove were manufactured
by a multimaterial 3-D printer (J735, Stratasys, USA), which
allows parts of the exoskeleton with different hardness to be
manufactured seamlessly into one part. The surfaces contacting
the skin are made of soft materials to ensure safety, whereas the
palm/back support and pipelines are made of rigid materials to
carry enough load. The primary benefit of 3-D printing technol-
ogy is that wearable gloves can be customized for individuals.
The RAS, placed on the backpack, is composed of four
linear actuators, a driver board, and a Li-battery. In addition,
a computer control system is used to control the exoskeleton
motion, which is commanded by manual operation using a touch
screen. The details of the actuation and control system will be
introduced in Section II-D.
C. Design of the Active Thumb Module
Most soft gloves reported in the pieces of literature usually
have no direct control over thumb motions as we discussed in
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IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022
Fig. 2. Schematic of the musculoskeletal model and 3-D motion of the thumb.
(a) Joints of the thumb include CMC, MCP, and IP joints. The CMC joint is
considered as a special spherical hinge joint, which mainly contributes to the
complexity of thumb motion. (b) Basic types of thumb motion. (c) Intrinsic and
extrinsic muscles of the thumb.
Section I. Only a few studies reported that thumb motions can
be actively controlled using exotendons [18], [19]. However,
they either have a shifting problem of attachment points or have
a limited ROM. The main goal of our proposed exoskeleton
design is to enable dexterous hand motions, especially thumb
motions, and to solve the problems of attachment point shifting
and limited motion range. In this section, we will explain the
detailed design of the thumb module, which is based on the
analysis of thumb musculoskeletal anatomy.
The anatomical thumb joints include CMC, metacarpopha-
langeal (MCP), and interphalangeal (IP) joints, as shown in
Fig. 2(a). MCP and IP joints can be considered as planar hinge
joints that are similar to the index joints; however, the CMC joint
is difficult to be categorized because of its complex anatomy and
sophisticated kinematic nature. Some researchers categorize the
CMC joint as a universal joint [24], [25], which has been proven
to be inaccurate because the CMC joint of the thumb has two
axes of rotation that are nonintersecting and nonperpendicular
to each other [25], [26]. To model the motions of the thumb
more accurately, the CMC joint of the thumb was considered
as a special spherical hinge joint constrained within the range
of thumb motion space, whose twisted motion is coupled with
AB/AD motion. As shown in Fig. 2(b), the basic types of thumb
motion include AB/AD, F/E, and opposition [27], among which
the opposition can be considered as the combination of AB/AD
and F/E. Therefore, the key design of the thumb exoskeleton
was to enable AB/AD and F/E motions independently.
The muscles of the thumb are classified into external muscles
and internal muscles, as shown in Fig. 2(c) [10]. Internal muscles
include the adductor pollicis for adduction, flexor pollicis brevis
for flexion, abductor pollicis brevis for abduction, and opponens
pollicis for opposition. External muscles include the flexor pol-
licis longus for flexion, abductor pollicis longus for abduction,
and extensor pollicis longus/brevis for extension. Obviously, it
is impossible to completely match the thumb motion using a
limited number of tendons. In the proposed exoskeleton, this
problem is solved by a hybrid configuration that combines a
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE
Fig. 3. (a) Schematic of the active thumb module. (b) Thumb active module
is highlighted in the palmar view and dorsal view of the hand exoskeleton.
tendon-driven flexible link and another two tendons directly at-
tached to the thumb end to generate complex motion of the CMC
joint, as shown in Fig. 3. Specifically, the route of the designed
thumb flexor tendon is consistent with the flexor pollicis brevis
and pollicis longus of the thumb and that of the extensor tendon
is consistent with the extensor pollicis longus and extensor
pollicis brevis to generate thumb flexion and extension motions,
respectively. In addition to these two biomimetic tendons, a
flexible link is driven by the designed thumb abduction tendon
and thumb adduction tendon to generate the thumb abduction
and adduction motions. The tendon-driven flexible link is used
as an actuation mechanism because of the following advantages:
1) Given that the flexible link can provide mutiple DOF motions,
the ring hinged to the flexible link automatically self-aligns with
proximal phalange of the thumb, and therefore the problem of
attachment point shifting is alleviated; 2) it is easy to accomplish
the large range of thumb motions while causing no discomfort to
the user; 3) the hybrid configuration can significantly reduce the
number of tendons required; as a result, the hybrid configuration
enables complex and large ROMs of the soft glove to match the
natural thumb motion using only four tendons and two actuators
in total.
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2197
Fig. 4. Serial element actuation (SEA) mechanism: A simple pulley is added
to pull one tendon and simultaneously release another one, and vice versa.
Fig. 5. Control flow of the hand exoskeleton: The user chooses a training task
and sets the duration and frequency through the GUI; then, the computer control
system commands SEA actuators to drive the hand exoskeleton to perform the
corresponding training task; meanwhile, the real-time tension force is acquired
through the force sensor to avoid accidents and damage.
D. Remote Actuation System and Computer Control System
A serial element actuation (SEA) mechanism with springs
integrated into actuators is widely employed in tendon-driven
exoskeletons [28], [29]. The RAS in the proposed exoskeleton
uses the SEA mechanism to control the tension of the tendons
through micro servo linear motors (LAF50, INSPIRE-ROBOTS,
China). The motors, driven by a custom-made driver board
(AES-LA-31-06, INSPIRE- ROBOTS, China), can output a
maximum force of 50 N and maximum linear travel distance
of 50 mm. To reduce the number of actuators needed, a simple
pulley is added to pull one tendon and simultaneously release
another one, and vice versa, as shown in Fig. 4. Consequently,
the dexterous motion of the whole hand can be generated using
only four actuators. In addition, a Li-battery with the capacity
to power the driver board and motors for over half a day is used
to ensure long enough usage duration.
The control flow of the hand exoskeleton is shown in Fig. 5.
The computer control system provides a graphical user interface
2198 IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022

as the coordinates of the wrist, CMC, MCP, and IP joints, and

→ −
− → − →
the endpoint of the thumb, respectively. Four vectors, S0 , S1 , S2 ,
−
→
and S3 , are then defined to represent the first metacarpal bone
and three phalanxes of the thumb
−
→
S0 = J 1 − J 0 (1)
−
→
S1 = J 2 − J 1 (2)
−
→
S2 = J 3 − J 2 (3)
−
→
S3 = EJ − J3 . (4)
−
→ −
→
The MCP joint is modeled by the angle between S2 and S1 ,
−
→ −
→
and the IP joint by the angle between S3 and S2 . To model the
angles of the CMC joint, i.e., CMC(x) and CMC(z), the base
coordinate system with its origin at J1 is constructed and its
directions are defined as follows:
−
→
z = S0 (5)
→ 
−
x = Proj S1N P (6)
Fig. 6. Modeling of thumb joints and definition of thumb joint angles.
y = z × x (7)

(GUI) through a touch screen for patients to set the duration
and frequency of each training paradigm, such as grasping and
opening, pinching and releasing, as well as thumb encircling.
The trajectory planner constructs motion trajectories according
to the training paradigm selected, and the thumb angles will be
calculated by the kinematic model proposed in Section III. A
table controller obtained from a healthy subject experimentally
in advance converts the thumb angles into the position command
of the SEA actuators (position profile of trajectories). The cor-
responding motions are then generated by the SEA actuators.
To avoid accidents and damage, the allowable maximum force
is set by the GUI to prevent excessive interaction force applied
to the user, and an emergency button in the GUI can halt all
actuators when the user encounters an unexpected incident.
III. MODELING AND MEASUREMENT OF THE THUMB JOINT
ANGLES
To plan the motion trajectories of our proposed soft hand
exoskeleton, the kinematics model is developed in this section. In
addition, the measurement method of the thumb motions is also
introduced, which will be used in Section IV when conducting
the experiments.
Based on the analysis of the thumb motion as described in
Section II-C, we model the MCP and IP joints of the thumb
as simple planar hinge joints and the CMC joint as a spherical
hinge joint. As shown in Fig. 6, the blue dots and lines represent
the neutral posture (NP) of the thumb, which is treated as the
reference, whereas the red dots and lines represent an arbitrary
posture. Given that the basic CMC motion is not orthogonal,
two special angles are defined, namely, CMC(z) and CMC(x),
to represent the posture of the CMC joint, as shown in Fig. 6. To
model all these joint angles, J0 , J1 , J2 , J3 , and EJ are defined
where Proj(m)  represents the unit projection vector of the m  on
a plane (Base), which passes through J1 and is perpendicular to
−
→ −→
z. The S1N P represents when the vector S1 is in a NP. CMC(x)
−
→
is then defined as the angle between Proj(S1 ) and the x axis
−
→
and CMC(z) as the angle between S1 and the z axis.
The coordinates of J0 , J1 , J2 , J3 , and EJ are measured by
an optical capture system (OptiTrack, LEYARO, China), which
captures the location of the joints with markers attached to them.
With the obtained coordinates, all joint angles are calculated
based on their definition; however, the directions of all axes
in the base coordinate system are constantly changing owing
to the upper limb’s translation and rotation, especially for the
wrist. The current direction of the z axis could be obtained from
measurement, whereas the current direction of the x axis is not
measurable. Therefore, the current direction of the x axis is
estimated based on the current and initial position of J0 (J0
and J0init ), the current and initial direction of the z axis (z and
(zinit ), as well as the initial direction of the x axis (xinit ) using
the following formula:
x = vrot · xinit + t (8)
where t is the translation matrix from initial posture to current
posture; vrot is the corresponding rotation matrix according to
Rodrigues’ rotation formula
t = J0 − J0init (9)
vrot = cos θ + (1 − cos θ) · k · k T + sin θ · S(k) (10)
where θ is the rotation angle between the initial and current z
axis, k is the rotation axis, and S(k) is a matrix according to the
value of k; they are each determined by the following formulas,

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CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE 2199

TABLE I
INFORMATION OF THE SUBJECTS

correspondingly:
 
z · zinit
θ = acos (11)
z · zinit 
 
k = (z)init × z = kx ky kz T (12)
⎡ ⎤
0 −kz ky
S(k) = ⎣ kz 0 −kx ⎦ . (13)
−ky kx 0
Therefore, all joint angles can be calculated using the follow- Fig. 7. Evaluation of thumb fingertip force levels. (a) Without and (b) with
ing formulas: the hand exoskeleton.

S1 · z
CMC(z) = acos (14)
S1  · z
⎛ →
− ⎞
Proj S1 · x
CMC(x) = acos ⎝ −→
⎠ (15)
 Proj S1  · x

S2 · S1
MCP = acos (16)
S2  · S1 

S3 · S2
IP = acos . (17) Fig. 8. Experimental results of thumb fingertip force of the stroke patient.
S3  · S2 

Red curve (without EXO): The patient presses and releases the sensor using his
thumb without the assistance of exoskeleton; the interval between the actions is
In summary, the kinematic model of the thumb has been 7 s. Blue curve (with EXO): The patient presses and releases the sensor using his
established to calculate the thumb angles, and is used to control thumb with the assistance of the exoskeleton; the interval between the actions
the soft hand exoskeleton and analyze the clinic performance of is 7 s.
the soft hand exoskeleton for the stroke patient in Section IV.

IV. EXPERIMENT
The hand exoskeleton was evaluated experimentally by a
stroke patient who is 46 years old and has suffered from the
stroke for 6 years. This patient is unable to lift his right upper
limb, and the right hand is hardly able to generate any motion.
Additionally, one healthy subject participated in the experimen-
tal study for the comparison with the stroke patient. All exper-
iments were conducted under the supervision and guidance of
doctors from the Rehabilitation Center for the Disabled of Liao
Ning province. The information of the subjects is summarized
in Table I.
Three experiments were conducted to confirm the effective-
ness of the hand exoskeleton as a rehabilitation and/or assistance
device. In the first experiment, the thumb fingertip force levels
of the patient were evaluated with and without the hand ex-
oskeleton, suggesting that the hand exoskeleton could provide
sufficient fingertip force for stable grasping that is not achievable
without the hand exoskeleton. In the second experiment, the
patient’s thumb trajectories for two tasks (thumb encircling and
bottle grasping) were measured and compared with those of a
healthy subject. The comparison of their trajectories suggested
a high degree of similarity between the healthy subject and the
patient assisted by the hand exoskeleton. In the last experiment,
the hand exoskeleton was tested under some real rehabilitation
scenarios. The results validate that the hand exoskeleton is an
effective rehabilitation and/or assistance device.
A. Evaluation of Thumb Fingertip Force Level
Thumb fingertip forces with and without the hand exoskeleton
were measured by asking the patient to press on a pressure sensor
(LSB200, FUTEK, USA) using their thumb, as shown in Fig. 7.
The measurement results are shown in Fig. 8.

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2200
Fig. 9. Trajectories of thumb motions: Thumb encircling (a), (c), and bottle
grasping (b), (d) are measured through the motion capture system (e) with marker
points on the hand (f).
Three primary observations from the measurement results
were obtained.
1) The patient was able to exert a maximum force of approx-
imately 5 N by the thumb fingertip without any assistance.
In comparison, they could exert a force of more than 10 N
by the thumb fingertip with the assistance of the hand
exoskeleton.
2) The patient was only able to exert impulsive force vol-
untarily. In contrast, they were able to exert a continuous
force with the assistance of the hand exoskeleton.
3) A base force of approximately 2 N was observed from
the measurement without the hand exoskeleton, indicating
that the patient cannot release their thumb from the sensor
voluntarily. The base force went to zero for measurement
with the hand exoskeleton, suggesting that the hand ex-
oskeleton could assist the patient to fully release their
thumb from the sensor.
B. Measurements of Thumb Motion Trajectories
The thumb trajectories during thumb encircling [see Fig. 9(a)
and (c)] and bottle grasping [see Fig. 9(b) and (d)] were measured
by the optical capture system introduced in Section III. Both
tasks require complex motions which involve precise control
of F/E and AB/AD. To evaluate the improvements by the hand
exoskeleton, the thumb trajectories for the stroke patient and
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IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022
TABLE II
EVALUATION RESULTS OF THE THUMB MOTION TRAJECTORIES
a healthy subject were compared. The experimental setup for
the thumb trajectory measurements is shown in Fig. 9(e) for the
healthy subject and stroke subject; Marker points on the hand
are shown in Fig. 9(f).
For each task (thumb encircling or bottle grasping), thumb
trajectories under three scenarios were measured and com-
pared: 1) Health-vol: voluntary motion of the healthy subject,
2) Stroke-vol: voluntary motion of the stroke patient, 3) Stroke-
exo: exoskeleton-driven motion of the stroke patient. As ex-
plained in Section III, the tracking markers were attached to the
wrist joint, CMC joint, MCP joint, IP joint, and the endpoint
of the thumb to acquire thumb motion trajectories, as shown
in Fig. 9(f). To evaluate the improvement of hand function
with the assistance of the hand exoskeleton, three indicators,
AREA for thumb encircling, ARC LENGTH for bottle grasping,
and the ROM of both tasks were calculated and compared
for both subjects. ROM is an indictor commonly used in the
literatures, while AREA and ARC LENGTH, representing the
area surrounded by thumb fingertip trajectories and arc length of
thumb fingertip trajectories, are the two indexes we proposed in
this study to quantitatively assess the clinic performance of the
stroke patient. Their mathematical definition will be introduced
in Sections IV-B1 and IV-B2.
1) Thumb Encircling: The thumb motion trajectories as
well as joint angles (CMC, MCP, and IP joint angles) during
thumb encircling are shown in Fig. 10(a1)–(a5) for Health-vol,
Fig. 10(b1)–(b5) for Stroke-vol, and Fig. 10(c1)–(c5) for Stroke-
exo.
To compare the performance of the stroke patient with the
healthy subject, the area surrounded by thumb fingertip trajecto-
ries is used as an index to evaluate the degree of perfection during
thumb encircling. To calculate the thumb fingertip encircling
area, the thumb fingertip trajectories are fitted onto a surface
(z = f (x, y)) using MATLAB software and the area is then
calculated using the following formula:
  2  2

∂z ∂z
AREA = 1+ + dxdy (18)
Dxy ∂x ∂y
where xyz are the coordinates of thumb fingertip trajectories and
Dxy represents the domain of the surface function. As shown
in Table II, the thumb fingertip encircling area of Health-vol is
approximately 128.9 cm2 , which can be treated as a reference for
the comparison. In contrast, the thumb fingertip encircling area
of Stroke-vol is only 0.53 cm2 , which suggests that the stroke
patient can only generate limited motion without any assistance.
The thumb fingertip encircling area of Stroke-exo is 48.7 cm2 ,
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE 2201

Fig. 10. Experimental results of thumb encircling. Thumb trajectories and joint angles of (a1)–(a5) Health-vol, (b1)–(b5) Stroke-vol, and (c1)–(c5) Stroke-exo.
Thumb trajectories are shown in the first column with label 1; CMC(z) joint angles are shown in the second column with label 2; CMC(x) joint angles are shown
in the second column with label 3; MCP joint angles are shown in the third column with label 4; IP joint angles are shown in the last column with label 5.

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2202
close to that of Health-vol. These results demonstrate that the
thumb encircling motion of the patient has been improved dra-
matically by the hand exoskeleton.
To compare motion similarity between the stroke patient and
the healthy subject, joint angles were measured and compared.
The thumb joint angles of Health-vol, shown in Fig. 10(a2)–(a5),
were considered as a reference. In comparison, the thumb joint
angles of Stroke-vol, shown in Fig. 10(b2)–(b5), suggested that
the stroke patient generated abnormal motion from the following
two observations: First, only the MCP joint was involved in the
motion but the other joints were not; Second, the MCP and IP
joint angles were significantly larger than those of Health-vol.
With the assistance of the hand exoskeleton, the stroke patient
was able to generate motion that was similar to that of Health-
vol, as shown in Fig. 10(c2)–(c5). These results demonstrate that
normal motion can be restored by the hand exoskeleton.
To further compare motion similarity between the stroke
patient and the healthy subject during thumb encircling, the
ROMs of the joint angles were measured and compared, as
shown in Fig. 12(a). Using the ROM of Health-vol as a reference,
the degree of similarity is defined as
 
abs (ROMhealth − ROMpatient )
SI = 1 − × 100%. (19)
ROMhealth
Compared with the ROM of Stroke-vol, the ROM of Stroke-
exo shows a high degree of similarity to the ROM of Health-
vol and the degree of similarity increased from 1% to 93% for
CMC(z), from 1% to 62% for CMC(x), from 41% to 87% for
MCP, from 21% to 74% for IP, and from 20% to 80% for average
ROM. The results show that the thumb encircling motion of the
patient was significantly improved by the hand exoskeleton.
2) Bottle Grasping: The thumb motion trajectories as well
as joint angles (CMC, MCP, and IP joint angles) during bot-
tle grasping are shown in Fig. 11(a1)–(a5) for Health-vol,
Fig. 11(b1)–(b5) for Stroke-vol, and Fig. 11(c1)–(c5) for Stroke-
exo.
To compare the performance of the stroke patient with the
healthy subject, the arc length of thumb fingertip trajectories
is used as an index to evaluate the degree of perfection during
bottle grasping. To calculate the arc length, the thumb fingertip
trajectories are fitted onto a curve (z = f (x, y)) using MATLAB
software. The arc length is then calculated using the following
formula:
 
ARC LENGTH = (dx)2 + (dy)2 + (dz)2 (20)
D
where xyz are the coordinates of the thumb fingertip trajectories
and D represents the domain of the curve function. As shown in
Table II, the arc length of Health-vol is approximately 7.85 cm,
which can be used as a reference for the comparison. In contrast,
the thumb arc length of Stroke-vol is only 0.67 cm, suggesting
that the stroke patient could only generate limited thumb motion
without any assistance. The arc length of Stroke-exo is 5.46 cm,
comparable to that of Health-vol. These results demonstrate that
the bottle grasping motion of the patient has been dramatically
improved by the hand exoskeleton.
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IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022
To compare motion similarity between the stroke patient
and the healthy subject, the joint angles were measured and
compared. The thumb joint angles of Health-vol, shown in
Fig. 11(a2)–(a5), were considered as references. In comparison,
the thumb joint angles of Stroke-vol, shown in Fig. 11(b2)–(b5),
suggested that the stroke patient was hardly able to generate
thumb motion during bottle grasping. However, with the assis-
tance of the hand exoskeleton, the stroke patient was able to
generate motion that is similar to that of Health-vol, as shown in
Fig. 11(c1)–(c5). These results demonstrate that normal motion
can be restored by the hand exoskeleton.
To further compare motion similarity between the stroke
patient and the healthy subject during bottle grasping, the ROMs
of the joint angles were measured and compared, as shown in
Fig. 12(b). Using the ROM of Health-vol as a reference, the
degree of similarity is defined from (19). Compared with the
ROM of Stroke-vol, the ROM of Stroke-exo showed a high degree
of similarity to the ROM of Health-vol; the degree of similarity
increased from 6% to 52% for CMC(z), from 28% to 98% for
CMC(x), from 7% to 36% for MCP, from 9% to 51% for IP,
and from 12% to 60% for average ROM. The results show that
the bottle grasping motion of the patient has been significantly
improved by the hand exoskeleton.
C. Hand Exoskeleton Performance in Real Rehabilitation
Scenarios
To confirm that the hand exoskeleton is an effective rehabili-
tation and/or assistance device for patients, the patient was asked
to perform the following tasks with/without the assistance of the
hand exoskeleton:
a) holding a wooden block and throwing it into a box;
b) pinching a card and putting it back on a shelf;
c) pinching a key and inserting it into a hole;
d) moving a pin and throwing it into a can;
e) turning a paper over;
f) writing the English letters A, B, C, and D.
For each task, the thumb trajectories of the healthy subject
were measured and recorded first, and were considered as the
references. Then, the patient performed each task without assis-
tance. Finally, the patient performed the tasks with assistance
from the hand exoskeleton to track the references to complete
the tasks.
All tasks were accomplished by the stroke patient with the
hand exoskeleton, as shown in Fig. 13, whereas none of them
were completed without the hand exoskeleton (the detailed
results are shown in the supplementary video). These results
suggest that the hand exoskeleton is an effective rehabilitation
and/or assistance device for stroke patients.
As illustrated by the results of Section IV-B, the trajectories
generated by the hand exoskeleton for the patient are different
from those for the healthy one. This mismatch can be seen from
the differences between Fig. 10(a1) and (c1), as well as between
Fig. 11(a1) and (c1). To further explain how the mismatch affects
the performance, the motion similarity between both subjects for
the Tasks (a–d and f) were measured and compared using the
same method as in the Section IV-B. Because marker points
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE 2203

Fig. 11. Experimental results of bottle grasping. Thumb trajectories and joint angles of (a1)–(a5) Health-vol, (b1)–(b5) Stroke-vol, and (c1)–(c5) Stroke-exo.
Thumb trajectories are shown in the first column with label 1; CMC(z) joint angles are shown in the second column with label 2; CMC(x) joint angles are shown
in the second column with label 3; MCP joint angles are shown in the third column with label 4; IP joint angles are shown in the last column with label 5.

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2204
TABLE III
MOTION SIMILARITY OF ARC LENGTH AND ROM BETWEEN STROKE PATIENT AND HEALTHY SUBJECT DURING PERFORMING TRAINING TASKS
Fig. 12. Range of motion (ROM) during (a) thumb encircling and (b) bottle
grasping.
were blocked when the hand was turned over in Task (e), the
trajectories in this task were not measured in this subsection.
The motion similarity of ROM is defined by (19). The motion
similarity of ARC LENGTH can also be defined similarly. The
motion similarity of ARC LENGTH and ROM is summarized
in Table III. Some mismatches exist in all tasks; for example, the
similarity index of ARC LENGTH is 79% and that of average
ROM is 66% for Task (a). However, the stroke patient can still
accomplish the tasks successfully with the assistance of the hand
exoskeleton. Therefore, a small number of mismatches will not
impede the completion of training tasks for the patient. More
discussion of this mismatch will be included in Section V.
V. DISCUSSION
Because of the complexity of thumb musculoskeletal
anatomy, it is very difficult to control the thumb motions by the
soft glove-based exoskeleton; therefore, most studies in the liter-
ature adopt a fixed thumb strategy. However, a fixed thumb is not
suitable for complex motions that require constantly adjusting
thumb postures, such as precisely pinching small objects. For
this reason, we proposed a hand exoskeleton with fully actuated
thumb motions using a hybrid configuration, which combines
a flexible link with a few tendons. Dexterous thumb motions
can be generated through such hybrid configuration using only
two actuators, with one actuator performing F/E and another
one performing AB/AD. The benefits of fully actuated thumb
motion for rehabilitation and/or assistance have been confirmed
experimentally. First, sufficient thumb fingertip forces were
provided for stable grasping. Second, the thumb motion of the
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IEEE TRANSACTIONS ON ROBOTICS, VOL. 38, NO. 4, AUGUST 2022
patient assisted by the hand exoskeleton exhibited a high degree
of similarity to that of the healthy subject. Finally, the patient
was able to accomplish real rehabilitation tasks with the hand
exoskeleton. As a result, patients with the hand exoskeleton
will be more independent of their occupational therapists. In
summary, the proposed hand exoskeleton is an effective device
to recover and/or assist patients’ hand function, especially thumb
motion.
It is observed that the stroke patient’s thumb motion trajecto-
ries with the assistance of the hand exoskeleton are comparable
to those of the healthy participant in this article. And the mis-
match of their trajectories has been evaluated by some metrics
(thumb encircling AREA, ARC LENGTH, and ROM). It is
worth noting that this mismatch is inevitable due to the following
reasons: 1) The kinetic model of the patient differs from that of
the healthy subject. The properties of the patient’s joints were
altered as a result of the stroke injury (such as spasticity). In
particular, the stiffness of several joints was increased. 2) The
underactuated hand exoskeleton system cannot guarantee that
the trajectories of all joints are matched with the target trajec-
tories. Nevertheless, the small amount of mismatches will not
affect the completion of training tasks for patients, as illustrated
in Section IV. There could be some possible ways to reduce the
mismatch and we will further explore this issue in future study.
Nowadays, a large number of stroke patients missed their
best rehabilitation period due to the scarcity of medical re-
sources, such as occupational therapists. Hand exoskeletons are
considered as alternatives to occupational therapists for self-
rehabilitation training. However, most available commercial
hand exoskeletons are either very expensive or too simple to
generate complex motions, and they usually cannot fit well with
individual patients because of the size difference of their hands.
These problems have been significantly alleviated in our design.
The cost and weight of the system are significantly reduced
by minimizing the number of actuators without sacrificing the
dexterity of the system using the hybrid configuration for thumb
actuation. In addition, customized soft gloves for patients can be
rapidly manufactured in a few hours by the multimaterial 3-D
printing technology.
There are, however, several limitations to this article. First,
the stroke patients needed to lift their weak arm using their
other one because the exoskeleton ignores the assistance of the
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE
Fig. 13. Rehabilitation tasks are performed by the stroke patient with the assistance of the hand exoskeleton. (a) Holding a wooden block. (b) Pinching a card.
(c) Pinching a key. (d) Moving and throwing pins. (e) Turning a paper over. (f) Writing English letters.
arm motion. Therefore, this patient was only able to perform
some rehabilitation tasks without involving arm functions. In
the future, the hand exoskeleton and the proposed soft upper
limb exoskeleton can be combined for better utility [30] to assist
the motion of the whole hand and arm. Additionally, the hand
exoskeleton was commanded only by a touch screen in this
article. Active control of the hand exoskeleton with biological
signals, such as electroencephalogram (EEG) or electromyog-
raphy (EMG), was not introduced in this article and it is beyond
the scope of this article. It is generally believed that the active
control with the biological signals can significantly improve the
effectiveness of rehabilitation training [31], [32]. However, there
exist some problems with the active control with EEG and EMG
signals. On the one hand, EEG signals are hard to be used to
control the hand exoskeleton due to their low signal-to-noise
ratio. Only a few devices in the pieces of literature use EEG
to control limited hand gestures [33], [34]. On the other hand,
the control methods based on EMG signals are only suitable for
patients with high-level muscle activation. In summary, active
control based on biological signals has not been successfully
implemented yet in dexterous operations of soft hand exoskele-
ton for stroke patients. In the future, we will investigate the
EEG- and EMG-based active controls in the operations of our
soft hand exoskeleton in the tasks of rehabilitation training for
stroke patients.
VI. CONCLUSION
In this article, a soft tendon-driven hand exoskeleton with
fully actuated thumb motion was designed through a hybrid
configuration that combines with a flexible link and soft tendons.
Complex thumb motion was enabled using only two actuators.
With two additional actuators to drive other fingers, dexterous
motion of the hand was achieved. The effectiveness of the hybrid
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2205
soft exoskeleton as a rehabilitation and/or assistance device
was validated through experiments. With the hand exoskeleton,
the thumb fingertip force level was improved to ensure stable
grasping, and motion similarity between the stroke patient and
the healthy subject was improved. Real rehabilitation tasks, such
as grasping wooden blocks, pinching pins, and writing letters,
were accomplished by the patient with the hand exoskeleton.
The hand exoskeleton developed in this article shows promising
rehabilitation and/or assistance for patients to recover their hand
function without relying heavily on occupational therapists.
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Wenyuan Chen received the B.Eng. degree in me-
chanical engineering and automation from Yanshan
University, Qinhuangdao, China, in 2017. He is cur-
rently working toward the Ph.D. degree in mecha-
tronic engineering with the State Key Laboratory of
Robotics, Shenyang Institute of Automation, Chinese
Academy of Sciences, Shenyang, China.
His research interests include exoskeleton robot,
intelligent control, and systems.
Guangyong Li (Member, IEEE) received the B.S.
degree in mechanical engineering from the Nanjing
University of Aeronautics and Astronautics, Nan-
jing, China, in 1992, the M.S. degree in aerospace
engineering from the Beijing Institute of Control
Engineering, China Academy of Space Technology,
Beijing, China, in 1999, and the Ph.D. degree in elec-
trical engineering from Michigan State University,
East Lansing, MI, USA, in 2006.
He is currently an Associate Professor with the
Department of Electrical and Computer Engineer-
ing, University of Pittsburgh, Pittsburgh, PA, USA. His research interests in-
clude micro/nanorobotic systems; fabrication of microelectromechanical sys-
tems/nanoelectromechanical systems, nanodevices, and biosensors; control the-
ory and applications, real-time system design, implementation, and integration;
and neural network control.
Ning Li received the B.Eng. degree in mechanical
engineering and automation from the Wuhan Univer-
sity of Technology, Wuhan, China, in 2015. He is
currently working toward the Ph.D. degree in pattern
recognition and intelligent systems with the State Key
Laboratory of Robotics, Shenyang Institute of Au-
tomation, Chinese Academy of Sciences, Shenyang,
China.
His research interests include exoskeleton robot,
intelligent control, and systems.
Wenxue Wang (Member, IEEE) received the B.Sc.
degree in automatic control from the Beijing Insti-
tute of Technology, the M.Sc. degree in control the-
ory from the Institute of Systems Science, Chinese
Academy of Sciences, Beijing, China, and the D.Sc.
degree in systems science and mathematics from
Washington University, Saint Louis, MO, USA, in
1996, 1999, and 2006, respectively.
He is currently a Professor with the Shenyang In-
stitute of Automation, Chinese Academy of Sciences.
His research interests include robotics, bio-syncretic
robotics, intelligent control, compressive sensing, and computational and sys-
tems biology.
CHEN et al.: SOFT EXOSKELETON WITH FULLY ACTUATED THUMB MOVEMENTS FOR GRASPING ASSISTANCE
Peng Yu received the B.Eng. and M.S. degrees in
marine engineering from Dalian Maritime University,
Dalian, China, in 2002 and 2005, respectively. He is
currently an Associate Professor with the State Key
Laboratory of Robotics, Shenyang Institute of Au-
tomation, Chinese Academy of Sciences, Shenyang,
China. His research interests include exoskeleton
robot and tactile sensors.
Ruiqian Wang received the B.Eng. degree in me-
chanical engineering and automation from Yantai
University, Yantai, China, in 2017. He is currently
working toward the Ph.D. degree in mechatronic en-
gineering with the State Key Laboratory of Robotics,
Shenyang Institute of Automation, Chinese Academy
of Sciences, Shenyang, China.
His research interests include bionic robot, soft
actuator, and robot.
Xiujuan Xue received the M.S. degree in rehabil-
itation medicine from Jinzhou Medical University,
Jinzhou, China, in 2005.
She is currently a Chief Physician with the Reha-
bilitation Center for the Disabled, Shenyang, China.
Her research interests include robotic exoskeleton
robot, tactile rehabilitation of stroke, paraplegia, and
children with cerebral palsy.
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Xingang Zhao (Member, IEEE) received the B.E.
and M.E. degrees in mechanics from Jilin University,
Changchun, China, in 2000 and 2004, respectively,
and the Ph.D. degree in pattern recognition and intelli-
gent systems from the Chinese Academy of Sciences,
Shenyang, China, in 2008.
From 2015 to 2016, he was a Visiting Scientist
with the Rehabilitation Institute of Chicago, Chicago,
IL, USA. He is currently a Professor with the State
Key Laboratory of Robotics, Shenyang Institute of
Automation, Chinese Academy of Sciences. His re-
search interests include medical robots, rehabilitation robots, robot control, and
pattern recognition.
Lianqing Liu (Senior Member, IEEE) received the
B.S. degree in industry automation from Zhengzhou
University, Zhengzhou, China, in 2002, and the Ph.D.
degree in pattern recognition and intelligent systems
from the Shenyang Institute of Automation, Chinese
Academy of Sciences, Shenyang, China, in 2009.
He is currently a Professor with the Shenyang In-
stitute of Automation, Chinese Academy of Sciences.
His research interests include micro/nanorobotics,
biosyncretic robotics, and intelligent control.