Of the 658,000 stroke survivors in the U.S. annually, an overwhelming majority are left with impaired movement of one or both upper extremities (UEs), requiring long-term rehabilitative therapy to regain UE function [1]. Current robot-assisted technology for the UE requires patients who are able to actively initiate hand motion before the robot can help to complete the movement task [2].

We investigated the use of an innovative control system, tongue drive system (TDS) [3] that utilizes the tongue to indirectly drive movement of the hand through an existing robotic device, hand mentor (HM) [4]. The combined TDS-HM technology enables an individual with little or no active hand movement to participate in therapy and has the potential to remodel the brain's neural pathways. The theoretical construct that underpins this notion is that by linking the extensive motor cortical...

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