imanu revised

8/17/2019 IManu Revised

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University of Malaya

Faculty of Engineering

KUEP 3181

Prosthetic & Orthotic Engineering Design III

Session 2015/2016, Semester I

Project Proposal

Robotic Upper Limb Exoskeleton (Orthosis)

Students:

HARMONY TAN SHI LE KED130002

SYAHIRAH BINTI MOHAMAD NIZAM KED130016

Lecturer:

DR. NASRUL ANUAR BIN ABD RAZAK


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COMPANY SUMMARY

Company Name : La Espérance SDN. BHD.

Registration Number : KED1300-0216

Date of Incorporation : 26th October 2015

Address : Department of Biomedical Engineering

University of Malaya

Telephone : +603-1234 5678

E-mail : [email protected]

La Espérance SDN. BHD. will manufacture and market novel prosthetic and orthotic devices.

Current company developmental activities consist of design, preliminary construction, market

analyses and safety analyses.

The founding team members of La Espérance SDN. BHD. are Harmony Tan Shi Le and

Syahirah Binti Mohamad Nizam. Each serves as an active participant with equal

contributions to the overall functioning of the company. Specific tasks are delegated as seen

fit by the team as a whole, based on knowledge, experience and backgrounds. The various

strengths of each member will combine to ultimately achieve our unifying goal.

The company was recently formed and wishes to recruit a programmer, production staff andalso sales person immediately. It is expected a fourth person will be required later in the year.

The structure of La Espérance SDN. BHD. consists primarily of two biomedical engineers in

prosthetic and orthotic, but we intend to increase this to three in the near future :

! Harmony Tan Shi Le

! Syahirah Binti Mohamad Nizam

Professional and production consultation is carried out by a business professional within the

medical device industry :

! Syahirah Binti Mohamad Nizam

Clinical consultation is handled by :

! Harmony Tan Shi Le


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iManu USER MANUAL

1. Who is the product intended for?

The product is intended for those who have high risk of developing hand contractures due to

muscle weakness, especially for stroke patients that wish to regain at least minimal function

of hand for common daily tasks such as opening doors and holding cups steady. This product

is also for hospitals and rehabilitation centres to help the patient during their recovery state.

2. What appealing features would it have?

iManu comes with 5 different colors: black, metallic, pink, baby blue and cream, for patients

or buyers to choose from according to their preference. With a spiral-shaped shell, the

orthosis is ensured to look stylish and presentable on the patient arm. It is versatile and will

follow the shape and the size of the patient’s arm, hence it can be worn by anyone. It is light

weight, easy to use and also user friendly.

3. What are its functions?

" Develop simple fine motor motion." Reduce risk of developing contracture in the hand and wrist

" Preserve the functional position of the hand and wrist, keeping it in a neutral position.

4. How will you ensure that the product is safe?

50 people who suffer from post-stroke upper-limb disabilities have been using the prototype

for 3 months, during which a survey was conducted and 95% commented that they are

satisfied with the usage of the orthosis. Furthermore, the device has been certified by Jabatan

Keselamatan dan Kesihatan Pekerja (JKKP).


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EXECUTIVE SUMMARY

Stroke, also known as a “brain attack” can happen to anyone, including children, but the vast

majority of stroke cases affect adults. It occurs when blood flow to part of the brain is

interrupted or severely reduced, depriving the brain tissue of oxygen and nutrients. Hence,

within minutes, brain cells begin to die. Therefore, stroke is considered as a medical

emergency (National Stroke Association, 2015).

How does having a stroke affect a person? It depends on where the stroke occurs in the brainand how much of the brain is damaged. For some, the effects are relatively minor and short-

lived such as temporary weakness of an arm or leg, however people who suffer from severe

stroke will have long term disabilities such as permanent paralysis on one side of their body

or speech difficulties.

According to the National Stroke Association of Malaysia (NASAM), stroke is the third

largest cause of death in Malaysia. It is considered to be the single most common cause of

severe disability, and every year an estimated 40,000 people in Malaysia suffer from stroke.

Most stroke patients will suffer from paralysis or loss of voluntary muscle movement. The

body will be paralyzed on one side of the face or on one arm. Fortunately with rehabilitationtherapy, about 25% of victims recover with slight impairments and an additional 10% recover

completely.

La espérance SDN BHD is a medical prosthetic and orthotic company that proposes to

manufacture and market novel devices that can help stroke patients. iManu is a low-cost hand

orthosis that help stroke patients during therapy to enable them to do their usual life activities.

The unique design will allow more widespread implementation of non-invasive means of

therapy with improved clinical results at minimal cost to the patient.


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OBJECTIVES

The design iManu incorporates features that allow it to be competitive and marketable as a

form of non-surgical treatment for stroke patients as well as a cost effective device for

patients undergoing upper limb rehabilitation therapy. The design features assist with:

! Regaining simple fine motor motions in the hand and wrist

! Decreasing tendency of contracture in the distal interphalangeal (DIP), proximal

interphalangeal (PIP), metacarpophalangeal (MCP), carpometacarpal (CMC), and

radiocarpal (wrist) joints

! Preserving the functional architecture of the hand and wrist, keeping it in a neutral

(resting) position when user’s hand is inactive

MOTIVATION

Most stroke patients have difficulties in handling simple daily life activities such as holding a

glass of water, opening a door, buttoning up their shirt and so on. They will need assistance

from others just to complete those common tasks. Requesting for help in performing those

simple tasks will make them feel dependent on others and useless. This can lead to depression

and other psychological effects. With iManu you can train your hand to regain simple fine

motor function, enabling them to do those tasks. The main reason why patients attend

rehabilitation therapy is to heal and regain normal function. However, the average out-patient

attends physiotherapy at most once a week, others even less frequently like twice a month.

The probability that the patient will practice what they were taught in therapy at home is low,

especially when there is no one to actively supervise or support them. The exercises

conducted in therapy will be ineffective, most of the time even useless, because patients

develop muscle and joint contractures when they do not practice they rehabilitation exercises

properly. By using iManu, not only can the patient prevent the development of further

contracture, they can even relax their mind and emotions while exercising their hands since

iManu will be doing it for them.


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LITERATURE REVIEW

Development of designs of robotic orthotic devices for hand rehabilitation and

functional fine motor assistance are steadily gaining more attention in the last decade or so

(Heo, Gu, Lee, Rhee, & Kim, 2012), trailing behind the much more rapid progress of lower

and upper limb exoskeletal robotic devices that assist paralysed patients with walking.

Advances in robotic orthotic devices that assist hand function are increasing in popularity

because hand function is an incredibly important ability for individuals to live comfortably

and independently. Among the many illnesses and disabling medical conditions that hinder

motor function in the hands and wrist, the most common and prevalent is stroke. Like all

other types of brain injury, the recovery of functional motor skills is highly dependent on the

individual’s sensorimotor experience after the injury because of the complexity of

rehabilitating neurological ailments. To provide both the sensory and motor stimuli necessary

for improving recovery, the patient must consistently undergo sessions of physiotherapy.

Unfortunately, conventional rehabilitation and physiotherapy requires the patient to be

directly supervised and manually assisted by certified physical therapists, making the process

of stroke rehabilitation both labor-intensive, expensive, and often inconvenient in terms of

accessibility, especially for the working middle-class low-income population. Additionally, it

is also hard to quantify the effectiveness of treatment and empirically monitor the patient’s

progress. To overcome these challenges to hand rehabilitation, researchers are turning to

robotic rehabilitation. Robotic rehabilitation systems can provide more effective treatment

because of their portability, ability to quantitatively monitor progress and recovery goals, and

reduced need for patients to actively remember the exercise routine. The rate and degree of

success of recovery varies between individuals; some may regain full function, while many

others (66%) do not show much progress even after 6 months of intensive rehab. For those in

the later, robotic assistive devices allow them to perform basic activities despite of their own

physical limitations. Similarly, robotic hand exoskeletons are not only applicable to those

who wish to regain hand function, but those who suffer from progressive degenerative

diseases such as Parkinson’s disease (PD) and multiple sclerosis (MS), and those whose line

of work increase the high likelihood of developing a musculoskeletal disorder such as jobs in

the military, heavy industries, and construction.

In developing a robotic hand exoskeleton, there are several factors that must be

considered. First of all, of course, is the biomechanics of the hand e.g. the range of motion of

the various joints in the hand, the various segment lengths of the part of the hand, the line ofaction and orientation of the intrinsic and extrinsic hand muscles, pressure tolerance and

pressure sensitive areas, variations in ligamentous laxity between individuals etc. Note that

the exact specifications of the functional and neutral resting positions of the hand in static

hand orthoses and the recommended joint positions vary across different studies and practices

(Coppard & Lohman, 2014). Another important requirement for robotic hand exoskeletons is

safety. Any potential malfunctions in the device can seriously injure users, therefore one

suggested safety feature is including mechanical stoppers or other structural designs that limit

the range of motion to prevent excessive motions beyond what the user can tolerate (Heo et

al., 2012). Injury can also occur if the rotational axes of the exoskeleton differ from the

biological rotational axes of the user’s hand. Hence, it is crucial for the mechanical design ofthe device to coincide with the centers of rotation of the various hand and wrist joints.


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Methods of eliminating the need for directly matching the joint centers are by redundant

linkage structures, tendon-driven mechanism, or serial linkage attached to the distal segment

only, as shown in Figure 1 below.

(a) (b)

(c) (d)

Figure 1: Mechanisms for matching the center of rotation directly or remotely (Heo et al.,

2012); (a) direct matching, (b) remote matching: redundant linkage structure, (c) remote

matching: tendon-driven mechanism, (d) remote matching: serial linkage attached to distalsegment only

Other essential design factors in hand exoskeletons are:

1.

Power / force transmission method, e.g. linkage, cable, gear, crank-slider, steel belt, flexible

shaft, directly attached to glove

2. Actuation mechanisms, e.g. electric motors (AC or DC), pneumatic actuator, linear, shape

memory alloy, electroactive polymer (ionic or electronic)

3.

Intention-sensing method, e.g. EMG, torque sensor, joint angles, force sensor, force-sensing

resistors, tactile sensor, bending sensor, muscle hardness sensor, pneumatic pressure sensor,

strain gauge sensor

4. Control method

5.

Active degrees of freedom (DOF), of which current designs range from 1 to 20

For the purpose of rehabilitation, the exoskeleton can either provide passive exercise, in

which the movements are powered by the exoskeleton itself, or provide active exercise, in

which the movements are resisted by the exoskeleton. For purely passive rehabilitation

exercises, it is not necessary to use sensors and intention-sensing systems (Heo et al., 2012).


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Table 1 briefly describes the pros and cons of each type of actuation mechanism.

Table 1

Type ofactuator Advantages Disadvantages

Electric

motor

Easily available, reliable, easy to control

• PMSM (permanent-magnetsynchronous motor has highertorque and improved power densityefficiency

• DC motor has a simple structure

• DC motor requires regularmaintenance

• Requires transmissionmechanisms to transmit

power of motors to each jointin exoskeleton

Pneumatic

actuator

Does not require power transmissionmechanisms

Noisy due to air compressor. Toeliminate noise issue, pre-compressed air storage chamberincreases bulk of device.

Electroactive

polymer

(EAP)

Light-weight, flexible, low powerconsumption.

• IPMC (ionic polymer-metalcomposites) uses low drive voltageand does not require powertransmission mechanism

• Electronic EAP have rapidresponses and produce relativelylarge actuation force

• IPMC have slow responseand relatively low actuationforce

• Electronic EAP requiresheavy components and hasrisk of material breakdown.

• Dielectric elastomer needs power transmissionmechanism

Shape

memory

alloy (SMA)

Light-weight, high power-to-weightratio, can be used in both actuators andsensors

Difficulty with precise control


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MARKET REVIEW

Table 2 describes three different robotic/mechatronic hand exoskeletons available in the

market for stroke hand rehabilitation.

Table 2

Product Features Materials & components

ExoHand

by Festo

Price:

N/A

(assume

extremelyexpensive after

imported fromGermany)

• Can be worn like a glove

• Enhance strength and endurance of

the hand

• Precise orientation of finger joints

(direct matching) – customised to

each individual user• Pneumatic actuators for increased

gripping force and flexible movement

through all degrees of freedom

• Can be used for remote control of a

robotic hand in hazardous, industrial

settings

• Force feedback provides feeling and

motion without direct contact

•

Integrated with brain-computer-interface (BCI) that reads EEG signals

• Exoskeletal framemanufactured from polyamidevia selective laser sintering(SLS) process, through 3Dscanning and printing

• 8 double-acting pneumatic

actuators (DFK-10 cylindersfrom Festo)

• 8 linear potentiometers asdisplacement sensors

• 16 pressure sensors (integratedinto the valve terminals)

• CoDeSys-compliant controllerevaluates force, position,cylinder pressure

• VPWP proportional directional

control valve

Hand of Hope

by Rehab-Robotics

Price:

RM47,000

• Provide assistive function for hand

motion

• Patient relearns hand function through

positive feedback

• Two CPM patterns hand opening &

grasping (Trigger & Go, Trigger &

Maintain)

•

Individual patient setting and trainingdetails are stored and can be recalled

at anytime

• Forearm support with comfortable

position

• Compact and portable in carry case

• Patient with moderate spasticity can

still use the system. Product not

suitable for extensor or flexor

digitorum that is greater than 3 on theModified Ashworth Scale (MAS).

• Made of a lightweight metal

frame

•

2 surface EMG sensorsattached on extensor muscle

and flexor muscle, respectively

• Velcro straps

• Hex key is provided to adjust

the finger length


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MusicGloveTM

by FlintRehabilitationDevices

Price

RM4900

• Senses the finger and thumb

movements used in occupational hand

therapy, allowing users to practice

these movements while playing a fun,therapy-based music game. The game

tracks performance over time, making

it easy for users to reach their goals

• Helps increase users’ attention span,

neuropsychological scores, cognitive

functioning, well-being and recovery,

empowers them to regain their

independence by delivering a

motivating therapy regimen that

significantly restores hand function in just two weeks (Friedman, 2014)

• Portable, easy-to-setup and easy-to-

use so users can practice effective

rehabilitation from the comfort of

their home or on the go

• FDA approved

• Sensorized glove that tracks a

user’s hand movement

• Electrical leads on thefingertips or lateral aspect ofthe index finger; leads are

positioned so as to requirefunctional grips such as pincer

grip or key pinch grip

Figure 2: ExoHand (Festo) Figure 3: Hand of Hope (Rehab-Robotics)

Figure 4: MusicGloveTM (Flint Rehabilitation Devices)


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PRODUCT DESIGN

Three modes of operation:

1.

Resting position mode, during hand-wrist inactivity.(i) Position A : Functional resting position based on (Coppard & Lohman, 2014;

Heo et al., 2012; Hertling & Kessler, 1996; Norkin & Levangie, 1992)

(ii) Position B: Functional resting position based on (Coppard & Lohman, 2014;

Mediroyal, 2010)

(iii)

Position C: Anti-deformity / protected / safe position based on (Coppard &

Lohman, 2014)

(iv) Position D: Neutral resting position based on BioApps Sdn. Bhd. (UMMC)

standard practices and (Mediroyal, 2010)

Table 3 describes the various hand joint angles for each of the resting position modes pre- programmed into the iManu.

Table 3

Joint angle A B C D

Radiocarpal

(wrist)

20! extension 30! extension 15! extension 12! extension;midway between

pronation andsupination

MCPJ

(knuckles)

45! flexion 50! flexion 60! flexion 40! flexion

PIPJ 45! flexion 30! flexion Fullextension

(0!)

20! flexion

DIPJ 20! flexion 10! flexion Fullextension(0!)

20! flexion

Thumb Partiallyabducted andopposed;

MCPJ at 10!

flexion; IPJ at5! flexion

45! palmarabduction

Midway betweenradial and

palmar

abduction;IPJ in fullextension

Partial opposition;midway betweenradial and palmarabduction

2. Continuous passive movement (CPM) mode, for which all exercises begin from

position A.

(i) Open-close motion: Makes a fist for 10 seconds, then slowly releases smoothly,

extending the thumb and finger joints to full extension.

(ii)

Fan motion: Pulls fingers together, then slowly spreads fingers apart

(iii)

Wrist stretch motion: Wrist flexes to 70!, and slowly extends to 70!, followed by extension of the MCPJ to 10!, and PIPJ and DIPJ to 0!.


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(a) (b)

(c)

Figure 5: Various passive stretching exercises pre-programmed into the iManu; (a) open-

close, (b) fan, (c) wrist stretch.

3. Free-running mode, in which the actuators allow free active motion in the hand and

do not apply any forces on the hand

The advantage of our design compared to other products in the market is that it is free size, sothat a wider range of clients and patients can be accommodated almost immediately i.e. they

do not have to wait for their size to be ordered, manufactured, and shipped to them. This is

achieved by making the hand components adjustable for different finger lengths using

detachable finger clips and a adjustable forearm suspension spiral-shaped shell for different

forearm lengths and widths. The forearm spiral-shaped shell consists of layered, flexible

stainless steel bistable spring bands sealed within a silicone cover. The forearm “bracelet”

can be straightened out, making tension within the springy metal bands. The straightened

bracelet is then slapped against the wearer's forearm, causing the bands to spring back into a

curve that wraps around the forearm, securing the bracelet to the wearer.

According to (Georgia Tech, 2007), the average minimum hand breadth is 69cm. Therefore

the wrist unit holding the various electronic components should not be larger than 69cm to

accommodate a wider range of individuals. Similarly, the average thumb breadth ranges from

1cm to 2.7cm. Our design will set the width of the rigid finger shells to 2cm wide, 3mm

thick. According to (NASA, 2000), the average forearm-hand length ranges from 37.3cm to

44.6cm, wrist circumferences from 13.7cm to 19.3cm, and forearm circumferences from

19.9cm to 32.7cm. Therefore a length of 85cm for the forearm snap band should be sufficient

for both small and large-sized people (adjustable by cutting off the excess or by spiralling it

closer).


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Table 4 describes the materials used to manufacture the iManu.

Table 4

Material Advantages Disadvantages

Acrylonitrile butadiene

styrene (ABS)

For rigid finger shells

(suspension)

• Easily machined, tough, low cost rigid

thermoplastic material with high impact

strength.

• Ideal for turning, drilling, milling, sawing, die-

cutting, shearing.

• Good chemical and stress cracking resistance to

inorganic salt solutions, alkalis, acids, and some

oils.

• Excellent abrasion resistance; electrical

properties, moisture and creep resistance.

• May cause

voids, bubbles

or sink during

production.

• Low heat

resistance.

• Limited

weathering

resistance

Memory foam

For secure and snug fit

between user’s fingers

and rigid finger shells

• Exerts low level pressure on skin

• After certain period, retains shape appliedHeat retention

VELCRO® straps (2cm

wide)

For finger shells

(suspension)

• Conforms to the shape of the item secured

• Stretches tight for a snug fit

• Fully adjustable closure

May requirereplacing afterseveral years of

donning and

doffingNarrow braided elastic

4-cord (3mm wide)

For tension cables (power

transmission system) in

finger abduction and

thumb motion

• Industrial strength and durability; rubber andfiber material are braided so closely that the

elastic still appears opaque even when stretched

• Lasts 6 times longer than standard latex rubber

• Withstands testing up to 40 degrees below zero

May require

replacing afterseveral years ofuse

Slap bands

(Flexible stainless steel bistable spring bands

sealed within a siliconecover)

For forearm-wrist

suspension

• Can be straightened out for each transport and

shipping

• Springs back into a curve that wraps securely

around the forearm

Prolonged contact

with skin in hothumid conditions

causes sweating

Hardened, cold rolled,

special steel strip (Arata

et al., 2013)

For three-layer sliding

spring mechanism in

finger extension-flexion

• High elasticity

• High strength

• Homogeneous and extremely flat – optimal

break resistance

• Resistant to high and repeated tensile loads

Relative poorresistance tocorrosion


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Other components (e-NABLE, 2014; Ohlmus, 2012) :

! Arduino Micro (microcontroller board) – 1 per hand

(Arduino Pro Mini 328 - 5V/16MHz)

! Lithium-polymer battery battery – 1 per hand

(7.4V 800mAh 25C continuous discharge LiPo battery)

! Servo motor – 5 per hand

(RC Micro Servo Motor)

Each motor performs one of the following hand motions:

(i)

Thumb abduction (tension cable running along lateral/radial side of thumb)(ii)

Thumb flexion (tension cable running along palmar side of thumb)

(iii) Index finger / 2nd ray abduction (tension cable running along the radial side of the index

finger)

(iv) Ring finger / 4th ray abduction (tension cable running along the ulnar side of the ring

finger)

(v)

Little finger / 5th ray abduction (tension cable running along the ulnar side of the little

finger)

!

Linear actuator(Firgelli L12 EV3 50mm - Lego Compatible Linear Actuator 50mm)


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PRODUCTION COST

SUPPLIES

Material Supplier

ABS Dongguan Pioneer Trading Co. in China.

Velcro straps Velcro USA Inc. Consumer Pdts.; made in Mexico

Memory foam Libra International Ltd. in India

Braided elastic 4-cord SupplyDivision Ltd registered in Wales (UK)

Slap bands Yiwu Tian Tiao Craft Factory in China

RC Micro Servo Motor MyDuino (authorised Arduino distributor) in Malaysia

800mAh 25C continuous discharge LiPo

battery

Giant-Power

Arduino Pro Mini 328 - 5V/16MHz SparkFun Electronics Inc.

Firgelli L12 EV3 50mm - LegoCompatible Linear Actuator 100mm

Effectual Robotics

Hardened, cold rolled, special steel strip Nucor Sheet Mills (US)

Wires and screws Pertama Metal Industries SDN BHD, Malaysia.

PRICING (Per Unit)

Table 5

1. Material Unit Price Quantity Total (RM)

Acrylonitrile Butadiene Styrene (ABS) RM20/kg 0.5 kg 10.00Velcro RM0.60/cm 126 cm 75.60

Memory foam RM99/m 42cm 41.58

Braided elastic 4-cord RM0.20/m 1.25 m 0.25

Slap bands RM0.10/cm 85 cm 8.50

RC Micro Servo Motor RM28/unit 5 units 140.00

LiPo battery (800mAh 25C 7.4V) RM28/unit 1 unit 28.00

Arduino Pro Mini 328 - 5V/16MHz RM37/unit 1 unit 37.00

Firgelli L12 EV3 50mm - Lego Compatible

Linear Actuator 50mm

RM230/unit 1 unit 230.00

Hardened, cold rolled, special steel strip RM3/kg 0.5 kg 1.50

Wires and screws RM5/kg 0.3 kg 1.50

TOTAL MATERIAL COST 573.93

2. Labor (Category) Est. hrs / unit RM/hr Total (RM)

Assembly 12 6.00 72.00

Fitting and Consultation 1 10.00 10.00

TOTAL LABOR COST 82.00

3. Tax

Pricing without 6% GST 655.93

GST (6%) 39.36

TOTAL ESTIMATED COST 695.29

Selling price : RM 840.00 per unit (approx. 20%)


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REFERENCES

Arata, J., Ohmoto, K., Gassert, R., Lambercy, O., Fujimoto, H., & Wada, I. (2013). A newhand exoskeleton device for rehabilitation using a three-layered sliding spring

mechanism. IEEE Internattional Conference on Robotics and Automation (ICRA).Coppard, B. M., & Lohman, H. (2014). Introduction to Orthotics: A Clinical Reasoning and

Problem-Solving Approach: Elsevier Health Sciences.

e-NABLE. (2014). The Limbitless Arm. from http://enablingthefuture.org/upper-limb- prosthetics/the-limbitless-arm/

Friedman, N., Chan, V., Reinkensmeyer, A. N., Beroukhim, A., Zambrano, G. J., Bachman,M., & Reinkensmeyer, D. J. (2014). Retraining and assessing hand movement afterstroke using the MusicGlove: comparison with conventional hand therapy andisometric grip training. Journal of neuroengineering and rehabilitation, 11(1), 76.

Georgia Tech. (2007). Hand Anthropometry. from

http://usability.gtri.gatech.edu/eou_info/hand_anthro.php Heo, P., Gu, G., Lee, S.-j., Rhee, K., & Kim, J. (2012). Current hand exoskeletontechnologies for rehabilitation and assistive engineering. International Journal of

Precision Engineering and Manufacturing, 13(5), 807-824. doi: 10.1007/s12541-012-0107-2

Hertling, D., & Kessler, R. M. (1996). Management of common musculoskeletal disorders: Physical therapy principles and methods. (3rd ed.). Philadelphia: J.B. Lippincott.

Mediroyal. (2010). Pre-shaped Splints. fromhttp://www.mediroyal.se/sites/default/files/110105_Splints_TH1004_TH1600-P_TH1005_ENG.pdf

NASA. (2000). Anthropometry and Biomechanics Vol. 1. Man-Systems IntegrationStandards Retrieved from http://msis.jsc.nasa.gov/sections/section03.htm

NASAM. Stroke in Malaysia. from http://www.nasam.org/english/prevention-what_is_a_stroke.php

National Stroke Association. (2015). What is stroke? , fromhttp://www.stroke.org/understand-stroke/what-stroke

Norkin, C. C., & Levangie, P. K. (1992). Joint structure and function (2nd ed.). Philadelphia:F.A. Davis.

Ohlmus, P. (Producer). (2012). Arduino Robot Hand - for under $300 complete. Retrievedfromhttps://www.youtube.com/watch?v=t52edTD9RA0&index=1&list=FLTNUo25Dl2w7

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