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Proceedings of the 2007 IEEE

International Conference on Robotics and Biomimetics


December 15 -18, 2007, Sanya, China

Design and Development of a Portable Exoskeleton


Based CPM Machine for Rehabilitation of
Hand Injuries*
Yili Fu, Peng Wang, Shuguo Wang, Hongshan Liu and Fuxiang Zhang
Robotics Institute
Harbin Institute of Technology
Harbin, Heilongjiang Province, China
wangpeng.hit@gmail.com
Abstract - Human hand is easy to be injured. As physical
rehabilitation therapy after a hand operation always takes a long
time, the curative effect gets worse and the social and financial
hardship with physical deterioration can be caused. A CPM
machine is a mechanism based on the rehabilitation theory of
continuous passive motion (CPM). To improve rehabilitation
results and validate the CPM theory we have developed a
portable exoskeleton based CPM machine. The device can be
easily attached and also be adjusted to fit different hand sizes.
And during the fingers flexion and extension motion the
machine can always exert perpendicular forces on the finger
phalanges. It can achieve the precise control of scope, force and
speed of the moving fingers. Finally based on its mechanical
structure, a kinematic validation and simulation including
kinematic simulation and dynamic simulation have been carried
out.
Index Terms - CPM machine, Exoskeleton, Kinematic
validation

I. INTRODUCTION
The incidence of hand injuries has risen dramatically in
the recent years. More than 20 percent and about 40 percent of
the cases in the emergency treatment of surgery and
orthopaedics are hand trauma. Most of these cases result in
loss some of sensation or motion to the arms and hands. Hand
therapy is one of great importance because of little muscles all
over the hands. So the rehabilitation of the injured hands is a
tough task, and the rehabilitation session is long and the
recovery of the hand function is not effectively. The
impairment of the hand can be the cause of social and
financial hardship and a serious cause of physical and
emotional deterioration. Now there are mainly three categories
of methods for the treatment of hand motion dysfunction
during the rehabilitation session. One is physiotherapy, the
second is driving movement or passive movement through
using the elastic brace. The third takes the method of restoring
the injured nerves, relieving the pressures, transplanting and
transferring the wholesome muscles and tendons.
In recent years, with the development of Continuous
Passive Motion (CPM) [1], CPM machines based on this
rehabilitation theory have been used widely in the clinical
practice. There are various types CPM machines in the market,
not only aimed at the function training of big joints such as

wrists, elbow joints and hocks, but also used for the
rehabilitation of little joints such as knuckles. However, most
of these machines are limited in the number of independently
actuated degrees of freedom and dont integrate sensors. They
cannot do the function training such as adduction and
abduction exercise and some dexterous motions such as
grasping and holding. Also the rehabilitation therapy of the
CPM machines is rest on the level of empiricism. No exact
and scientific data can prove their curative effect. So for the
reasons above, a new CPM machine is urgent needed to be
developed, not only offers a means of hand function
rehabilitation, but also offers a means of quantitative detection
and evaluation of hand function rehabilitation.
So far, most of the hand exoskeletons have been
developed for the use as haptic interfaces in master-slave
systems. CyberGrasp is one of the commercially available
master hands, which can exert feedback forces during flexion
at five fingertips [2]. It consists of an exoskeleton and uses
cables with brakes on their distant end for force transmission.
The exoskeleton developed by scientists of the University of
Tokyo can covers wide workspace of an operators finger [3].
The exoskeleton has an encounter-type force feedback feature
which enables unconstrained motion of the operators finger
and natural contact sensation. There is a question that the force
exerted at the finger phalanges by the hand exoskeleton
developed for virtual reality often exert in one direction, but
for rehabilitation therapy a bidirectional motion is needed.
And sometimes the force is too small to move the finger joints
for rehabilitation therapy.
Exoskeleton based CPM machine such as arm
exoskeleton and leg exoskeleton have much been used for the
rehabilitation of human big joints. But because of the subtle
anatomic structure and so many little joints of the hand, the
research on hand exoskeletons becomes very difficult. The
hand exoskeleton generally consists of rigid molded plastic as
a basic support and hard metal link mechanism as the
manipulation method.
Rutgers Master is an exoskeleton actuated by
pneumatic piston which can exert feedback forces against
flexion at four fingertips [4]. It was employed in a study for
the rehabilitation of stroke patients. Another exoskeleton

*
This work is supported by the National Natural Science Foundation of China (Grant No.60275033) and Key technologies research & development project of
Heilongjiang Province in China (Grant No.2006G0845-00).

978-1-4244-1758-2/08/$25.00 2008 IEEE.

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actuated by pneumatic piston which can provide assistive


force to the users fingers was developed by scientists of the
Carnegie Mellon University [5]. The device can provide a
coupled active degree of freedom for the DIP and PIP
flexion/extension and an active degree of freedom for the
MCP flexion/extension for the index finger. Recently a new
hand exoskeleton consisted of pulleys and a link mechanism is
presented [6]. The exoskeleton can support of four degrees of
freedom for each finger and fulfil bidirectional movement.
Hall sensors are attached on each lever to measure the angle of
the finger joints. The University of Salford has developed an
exoskeleton based system for the physical and occupational
therapy of the hand in an interactive VR environment [7]. It
give the introduction of accurate and repeatable finger motion
and force measurement, interactivity, potential for great
exercise assortment and statistical registration and evaluation.
All the exoskeleton based CPM machine introduced above
cannot exert forces, perpendicular on the finger phalanges,
during the complete flexion and extension motion. So the
forces pulling or pushing the human joints in a wrong
direction would make the injured joints condition worse.
The device presented in [8] is similar to the hand
exoskeleton presented in this paper. As the authors know, its
application is haptic interaction with a virtual reality, but not
for rehabilitation purposes.
This paper is organized as follows: Section II proposed
the design goals and requirements of the CPM machine.
Section III describes the mechanical construction of the device.
The kinematic validation of the CPM machine is discussed in
section . Finally the conclusion of the current work and the
possible future improvements are described in the last section.

Experiments are carried out to determine the functional


modules of human index fingers. Therefore, the length of each
knuckle, the moving scope of each knuckle and the driving
force for movement of each knuckle of sixty persons at
different age groups are measured. The values of the
measurement are listed in Table I and Table II.

II. DESIGN GOALS AND REQUIREMENTS

TABLE
FLEXION/EXTENSION FUNCTIONAL MODULES OF HUMAN INDEX FINGERS
Joints
Moving scope
Driving force [N]
87.6
Max
16.1
DIP
50.1
Min
7.0
117.7
Max
20.0
PIP
85.2
Min
9.0
95.0
Max
35.0
MP
69.5
Min
11.0

We set our goals and requirements for designing the CPM


machine as follows:
z fit variation of hand sizes
z exerts perpendicular forces on finger phalanges
during the complete flexion and extension motion
z bidirectional movement
z mount on dorsal side of the hand and free the palms
space
Furthermore the device should be light weight, low
friction forces high backdrivability during free motion and
easy to control.

B. Conceptual Design
The flexion/extension driving mode consists of three parts:
an actuator module, two flexible cables and an exoskeleton,
see Fig.2. The actuator module consists of a brushed DCmotor that pulls the flexible cables through a pair of bevel
gear. Two flexible spring tubes guide the flexible cables to the
exoskeleton. A bidirectional movement is created by looping
the cables around a small pulley which has common axis with
th e spur gear of th e exoskel et on. Un der th e force
MP 2
MP 2
MP 2
MP 2 MP 1

PIP

MP 1
PIP

MP 1
PIP

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DIP
DIP

IP

MCP

Fig. 1 Human hand physiology


TABLE
MEASURED LENGTHS OF THE INDEX FINGER KNUCKLES
Max
Min
Average
Phalanx
[mm]
[mm]
[mm]
DIP
29.0
18.0
24.9
PIP
38.0
29.0
32.8
MP
62.0
43.0
53.0

Spur
gear

Brushed
DC-motor

A. Function Structure
Human hand has a complex structure. There are three
joints and four degrees of freedom for per finger and two
joints, four degrees of freedom for the thumb. From the distal
end for fingers, there are one DOF per DIP (distal
interphalangeal) and per PIP (proximal interphalangeal), and
two DOF per MCP (metacarpo-phalangeal). For the thumb,
there are three DOF for the MCP and one DOF for the IP
(interpahlangeal). The flexion/extension of the DIP and PIP
joints are coupled, but the DIP/PIP and MCP flexion/extension
are independent. Fig.1 shows a human hand physiology.

DIP

PIP

Flexible cable

III. MECHANICAL DESIGN

DIP

MP 1

Hall
sensor

Circular rack

Bevel gear
MP1

PIP

Fig 2 Driving mode of flexion joint

Brushed Bevel gear Rack


DC-motor

Spur gear

Fig.3 Driving mode of MP2 joint

transferred from the spur gear, the circular rack drives the
finger phalange to rotate about the finger joint. The joint angle
is measured at the spur gear.
The abduction/adduction driving mode also consists of a
DC-motor that drives a spur gear though a pair of bevel gears
and a rack, see Fig.3. The spur gear is fixed directly on the
fingers MP2 joint, which results a rotation of finger phalange.
C. Embodiment Design
Fig.4 shows a CAD drawing of the exoskeleton for one
finger. It is connected to the actuator unit and each phalanx of
the finger attachment. To adjust for variations in phalanx
length, the circular rack can slide in the guide slot of the force
sensor. Exertion of force is possible in both directions. Each
circular rack goes into mesh with a spur gear. Each phalanx
uses the preceding phalanx as base point for its motion. The
circular racks are designed to allow nearly full flexion and
extension in all joints. Perpendicular forces are easily realized
for all joint angles. They were also designed to be crossed so
that the neighbouring circular racks for different phalanxes do
not interfere. All joints of the mechanical construction are
supported by ball bearings.
Fig.5 shows a CAD drawing of the CPM machines
actuator module. In order to simplify the actuator unit, the
actions of the DIPPIP and MCP joints of per finger are
coupled together. Abduction and adduction in MCP joint are
supported independently. In order to make the mechanism
lighter and smaller, driving motors must be placed far from the
joints. Therefore, we used wire-driver method. Since one wire
can only produce a force in one direction, we use two wires
for one joint to produce a bidirectional force. So for one finger
six wires are needed. One ends of the six wires are attached to
the small pulleys which are placed on the force sensors, and
the other ends are attached to another small pulley which is
moved by one DC motor with a pair of bevel gears (with 2:1
transmission rate). Considering of the performance, the weight
and the noise, finally we choose Portescaps 17N78-216E as
the actuating motor. The weight of the motor is 17 g, and the
rated power of the motor is 3.2W. The planetary gearhead is
built in motor with 88:1 transmission rate. The maximum
rotation speed of the fingers MP joint actuated by the CPM
machine is 17.7 rpm. The time of the fingers one period
motion is 1.48s. The output torque of the actuator unit can
reach up to 1 Nm which is enough to actuate the finger.
Fig.6 (a) and (b) show the side view of finger with CPM
machine in stretched and bent position. Fig.7 (a) and (b) show
the top view of finger with CPM machine in normal and
abduction position. Close-up view of finger with exoskeleton
and actuator module of the CPM machine is shown separately
in Fig.8 (a) and (b).
D. Sensors of the System
A CPM machine needs many force and position sensors
to be controlled accurately. The distributing of the sensors can
be seen in Table .

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MP module
PIP module
DIP module

(a)
MP
PIP
DIP
Force sensor
Hall sensor
Spur gear
Circular rack

(c)
2 flexible
cables

Guide slot

(b)

(d)

2 bearings

Gear axis
Small pulley

Fig. 4 Exoskeleton of the CPM machine: (a) exoskeleton with stretched finger
model, (b) exoskeleton with bent finger, (c) flexion/extension unit of the
exoskeleton, (d) exploded view of the flexion/extension unit.

Brushed
DC-motor (5)
Small pulley (5)

(a)
Motor of A

Rack

Motor of B

Spur gears (4)

Bearing
bracket2

(b)

Bevel gears
of B
Bevel gears
of A
(c)

Bearing
bracket1

Gear
axis,
bearing
Spur
gear

Fig. 5 Actuator module of the CPM machine: (a) actuator module, (b) and (c)
flexion/extension unit (A) and abduction/adduction unit (B) of the actuator
module and an exploded view.

T1

O1
Fr

r1 1
Ft

Fn

2
O2

(a)

l1

(b)
(a)

Fig.6 Side view of finger with CPM machine: (a) in stretched position, (b) in
bent position.

r2

(b)

l2

Fig. 9 Schematic diagram of two structure types in exoskeleton: (a) driving


structure of one DOF, (b) driving structure of two DOF

peripheral force Ft the circumferential force F and the


rotation angle 2 of the joint are gotten as follows:
Ft = Ft 1 = Ft 2 =
(a)

(b)

F = Ft 2 =

Fig.7 Top view of finger with CPM machine: (a) in normal position, (b) in
abduction position.

2T1 2T2
=
d1
d2

2T1 19.1106 P1
=
d1
n1d1

2 =

1r1
r2

(1)
(2)
(3)

Where T1 T2 are torque of the gears, d1 d 2 are reference


diameter of the gears, P is transmission power, n1 is rotate
(a)

speed of the small gear, r1 r2 are reference radius of the


gears.
2) Driving Structure of Two DOF
Fig.9 (b) shows the schematic diagram of the driving
structure of two DOF. The relationships of the rehabilitation
angle and the rotation angle of AF and the rotation
angle of the joint is:

(b)

Fig.8 Close-up view of finger with CPM machine: (a) exoskeleton of the CPM
machine, (b) actuator module of the CPM machine
TABLE
THE DISTRIBUTING OF THE SENSORS
Sensor type
Numbers of sensors per finger
Joint position sensor
4
Joint force sensor
3
Motor position sensor
1

l1 sin
l2 cos

(4)
+

For MP joint there is = 0 , so the rehabilitation angle is


gotten as below:
l sin
= arcsin 1
(5)
+
l2

= arcsin

The force sensors we used are the traditional strain gage.


The mechanical elastic structure of the force sensor, as a
mechanical component, mounted inside the flexion/extension
module which is shown in Fig.4.
The hall joint position sensor fits in the joints of the CPM
machine. We use the two-axis Sentron hall sensor 2SA-10 as
the sensing element of the position sensors.
The motor position sensor is a MR-encoder mounted to
the motor shafts which can produce feedback information
about the rotation speed of the motor. It can be used in
position control loop of the motor.
E. Structure Types Analysis
We will analyze the structure types from the point of view
of the theory of mechanisms.
1) Driving Structure of One DOF
Driving structure of one DOF is fixed at DIP and PIP. We
suppose that the finger attachments and the phalanges are
linked with no relative sliding. Fig.9 (a) shows the schematic
diagram of the driving structure of one DOF. The kinematic
link has a certain movement. If the small gear rotates with a
constant speed, the moment at O2 comes into balance. The

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. KINEMATIC VALIDATION
In order to demonstrate the CPM machine suitability to
develop the task it has been designed for, a kinematic
validation has been performed. This validation consists of
calculation of Forward Kinematics and inverse kinematics.
Finally, simulation based on kinematics and dynamics are
carried out. The reference coordinates of robot joint is shown
in Fig.10.
AForward Kinematics
For the CPM machine, the D-H parameters provide
additional information about the types and the sequences of
joints in the robot. Kinematics parameters of the robot are
shown as Table .
The position coordinates of the robots tip is gotten as
bellow:

A = 2l1 p z s0 2
l1
1

Z1

Z 1

2
X1

X0

Z0

Z2
Y2

X2

l3

Z3

3
X3

Y3

Y1
Fig.10 Reference coordinates frames of robot joint

Joint

TABLE
KINEMATICS PARAMETERS OF ROBOT
Range of joint
i
i 1
ai
di

2
3

0D

20D ~ 20D

0D ~ 90D

l1

0D ~ 110D

0D

l2

0D ~ 70D

90

Notation: ai , di represent the length of link i , i , i 1


represents the angle between joint i and joint i 1
c0c123 c0s123 s0 l2c0c12 + l1c0c1
s c s s
c0 l2s0c12 + l1s0c1
0 123
0
T3 = 1A0 0 A1 1A2 2A3 = 0 123
s123 c123
0
l2s12 l1s1

0
0
1
0

Notation: s123 = sin (1 + 2 + 3 ) , c123 = cos (1 + 2 + 3 ) ,


s12 = sin (1 + 2 ) , c12 = cos (1 + 2 ) , s1 = sin 1 , c1 = cos 1 ,

s0 = sin 0 , c0 = cos 0 .
BInverse Kinematics
It is important to calculate the inverse kinematics of the
robot for analysis of workspace and control of the robot.
Analytic solution and numeric solution are main methods to
calculate the inverse kinematics of the robot. The
homogeneous transform matrix is shown as below:
nx ox ax p x
n o a
p y
y
y
0
T3 = y
nz oz a z p z

0 0 0 1
through the Analytic solution, 0 , 1 , 2 , 3 are gotten as
follows:
0 = arcsin ax
(6)
1 = 2arctan
(7)
2 = arccos 2 arctan
(8)
(9)
3 = arcsin nx arccos 2arctan
Cp x Bl1c0
Cl2 c0

(10)

A A2 + B 2 C 2
B +C

(11)

(13)

C = l2 s0 p z s0 l1 s0
2

Y1

Y0 X1

(12)

B = 2l1 p y s0

l2

(14)

CSimulation Results
The simulation consists of two parts: kinematic simulation
and dynamic simulation. It should be noticed that there are
two basic functions must be provided by the CPM machine:
during the safety range it can offer sufficient driving force to
make the finger phalanges fulfill bidirectional movement and
can make the injured finger do exercise within the maximum
angle range to get the best curative effect. Thus, typical
functions of robot mentioned above are validated by means of
simulation tools (ADAMS software) which permit checking
design compatibility with rehabilitation tasks. Two types of
rehabilitation exercise in simulation are showed as below,
Fig.11(a) and (b) show the fingers flexion exercise and the
fingers adduction and abduction exercise.
1) Kinematic Simulation
The angular position, velocity are simulated of the robot
joints. The simulation time is 5 sec and the values are given as
function of the time in Fig.12 (a) and (b). The graph shows
that the maximal flexion angle of PIPMP1DIP and MP2
joint is 110D 90 D 70D and 20D . This value is in
conformance with the design requirements and is also
sufficient for normal rehabilitation exercise.
2) Dynamic Simulation
At first torques are loaded on the gears of MP1PIP
DIP and MP2 joint in ADAMS as the CPM machines driving
torque, and the torque value is 0.9Nm0.1Nm0.1Nm and
0.8Nm. Second torques are loaded on the finger MP1PIP
DIP and MP2 joint as the resistance torque, and the torque
value is 0.16Nm0.1Nm0.1Nm and 0.15Nm. Then the
MARK points are created on P1P2 and P3 finger phalanges
before the resultant torques of finger joints are measured. The
values are shown in Fig.13. The graphs shows that for MP1
PIPDIP and MP2 joint, the maximal torque is 0.82Nm
0.21Nm 0.31Nm and 0.92Nm, the minimal torque is
0.51Nm0.20Nm0.20Nm and 0.60Nm. So during the
safety torque range, the CPM machine can drive the finger
phalanges to move easily.

(a)

(b)
Fig.11 (a) Schematic diagram of flexion finger, (b) Schematic diagram of
adduction and abduction finger

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2
3
4

(a)

(d)
Fig. 13 (a) Fexion and extension torque of the MP1 joint. (b) Fexion and
extension torque of the PIP joint, (c) Fexion and extension torque of the DIP
joint, (d) Adduction and abduction torque of the MP2 joint.

. CONCLUSIONS AND FUTURE WORK

Next step we will assemble the other three finger


exoskeletons to support all four fingers. The thumb module
will also be designed and included in the existing mechanism.
After integrating sensors for all joints, we will do some
experiments such as position control and impedance control.
And then we will do clinical testing in hospital shortly.
Meanwhile we will get more data of the rehabilitation of
injured fingers at different cases, so we can improve the
controlling method applicable to the CPM machine, and make
it better meet the requirement of the patients and at the same
time promote the development of rehabilitation theory.

2
4

(b)
Fig. 12 (a) Angular position of the DIP(3)PIP(1)MP1(2) and MP2(4)
joint, (b) Angular velocity of the DIP(3)PIP(1)MP1(2) and MP2(4) joint.

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(a)

(b)

(c)

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