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This paper presents the development of a robotic ankle exoskeleton for human walking assistance. First, the biomechanical properties of a human ankle joint during walking are presented. Next, design of the robotic ankle exoskeleton is introduced. The exoskeleton is actuated by a novel parallel nonlinear elastic actuator. The cam-spring mechanism in the actuator can function as a parallel nonlinear spring with an adjustable stiffness, and the design of the cam profile curve is described. Additionally, an adaptive controller is proposed for the exoskeleton to generate a desired assistive torque according to the wearer's total weight. Finally, experiments are conducted to validate the effectiveness of the developed robotic ankle exoskeleton. The experimental results demonstrate that during a gait cycle, reductions of 42.7% and 40.1% of the peak and average currents of the driving motor in the actuator are observed, respectively, with the designed cam-spring mechanism. A peak assistive torque of 23.9 Nm can be provided for the wearers by the exoskeleton during walking. With the assistance provided by the exoskeleton, the average and peak soleus activities of the wearers during a gait cycle are decreased by 25.42% and 31.94%, respectively. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATION DOCUMENT\nPRACTITIONER SUMMARYPurpose of the article: As technologies continue to advance, designing wearable exoskeletons that are comfortable, safe, reliable, and engaging for users is an arduous task. The integration of HCD principles in exoskeleton development significantly contributes to ensuring that the product meets the needs and preferences of users. This study systematically reviews the application of human-centred design (HCD) principles in the development of wearable exoskeletons.Methodology: It synthesizes existing literature, identifies key HCD concepts and assesses their impact on exoskeleton usability, comfort, and safety. The findings of the study revealed a moderate application of HCD in many of the studies; however, the concepts were found to play a crucial role in enhancing the usability, safety, and comfort of wearable exoskeleton technology implementation. Challenges revealed in the study include limited stakeholder involvement, a lack of standardized evaluation metrics, non-consideration of ethical, legal, and social issues, and a lack of studies on the potential adverse effects of exoskeleton use. Besides identifying the challenges faced in integrating HCD principles into exoskeleton development, the study also proposed pragmatic approaches to overcome them.Results: The study underscores the significance of incorporating human-centred design principles in the design and development of wearable exoskeletons. This has implications for industry, rehabilitation, health, and agriculture to churn out positive outcomes. The research contributes to the expanding literature on wearable exoskeletons and HCD, offering valuable insights into the advancement of this technology in various domains and suggesting areas for future studies to address identified gaps.Wearable exoskeleton use in rehabilitation can revolutionize the field by providing enhanced support and assistance to individuals with mobility impairments.Applying HCD to exoskeleton development for rehabilitation ensures their effectiveness and can significantly improve the user’s ability to walk, regain independence, and participate in daily activities.The HCD approach enables the customization of exoskeletons to meet the unique needs and abilities of users, which in turn promotes comfort, usability, and overall user satisfaction.Rehabilitation professionals can create soft exoskeleton devices that are cost-effective, accessible, and sustainable for users to improve overall outcomes.Enhanced marketability and profitability of wearable exoskeletons can result in heightened investment and innovation within the sector.Wearable exoskeleton use in rehabilitation can revolutionize the field by providing enhanced support and assistance to individuals with mobility impairments.Applying HCD to exoskeleton development for rehabilitation ensures their effectiveness and can significantly improve the user’s ability to walk, regain independence, and participate in daily activities.The HCD approach enables the customization of exoskeletons to meet the unique needs and abilities of users, which in turn promotes comfort, usability, and overall user satisfaction.Rehabilitation professionals can create soft exoskeleton devices that are cost-effective, accessible, and sustainable for users to improve overall outcomes.Enhanced marketability and profitability of wearable exoskeletons can result in heightened investment and innovation within the sector.Our systematic literature review focused on applying HCD principles to develop wearable exoskeletons. The findings emphasized the significance of prioritizing user needs and preferences. The study has practical implications, for guiding product development, enhancing user experience, innovation, healthcare/rehabilitation, and some livelihood practices, influencing policy and regulation, and advancing future research. [ABSTRACT FROM AUTHOR]

Background: Walking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation. Methods: This prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis. Discussion: This study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation. Trial registration: NCT06430632. [ABSTRACT FROM AUTHOR]

Background: Robotic exoskeletons have changed rehabilitation care available to people after spinal cord injury (SCI). Yet, the current evidence base is insufficient to identify the optimal dose and neurophysiological mechanism of robotic exoskeleton gait training (RGT) as an effective rehabilitation approach. This study will (1) examine whether the frequency of RGT after motor incomplete SCI impacts function and health outcomes, (2) analyze the neuroplastic effects of RGT dose, and (3) evaluate the safety, tolerability, and feasibility of delivering RGT. Methods: We will enroll 144 participants with motor incomplete SCI admitted to inpatient rehabilitation within 6 months of SCI. Participants will be randomized based on injury severity and level into one of 3 RGT frequency groups (high, moderate, low) or none/usual care only. Participants will complete 24 RGT sessions and be assessed at admission and discharge to inpatient rehabilitation, post-RGT intervention, 1-month post-RGT, and 9-month post-SCI. Outcomes include Walking Index for Spinal Cord Injury-II, health outcomes (gait speed, Spinal Cord Independence Measure, pain, fatigue, spasticity, general health, quality of life, physical activity), and motor evoked potential amplitudes obtained using transcranial magnetic stimulation. Discussion: Successful completion of this study will provide an evidence-based intervention, specifically tailored to meet the unique needs of people with SCI, which supports walking recovery; maximizing health, function, and ultimately participation. The intervention will further support widespread clinical implementation of exoskeleton use during acute rehabilitation. Trial registration: ClinicalTrials.gov NCT05218447. Registered on June 23, 2022. [ABSTRACT FROM AUTHOR]

The synthesis of soft matter intelligence with circuit‐driven logic has enabled a new class of robots that perform complex tasks or conform to specialized form factors in unique ways that cannot be realized through conventional designs. Translating this hybrid approach to fluidic systems, the present work addresses the need for sheet‐based circuit materials by leveraging the innate porosity of foam—a soft material—to develop pneumatic components that support digital logic, mixed‐signal control, and analog force sensing in wearables and soft robots. Analytical tools and experimental techniques developed in this work serve to elucidate compressible gas flow through porous sheets, and to inform the design of centimeter‐sized foam resistors with fluidic resistances on the order of 109 Pa s m−3. When embedded inside soft robots and wearables, these resistors facilitate diverse functionalities spanning both sensing and control domains, including digital logic using textile logic gates, digital‐to‐analog signal conversion using ladder networks, and analog sensing of forces up to 40 N via compression‐induced changes in resistance. By combining features of both circuit‐based and materials‐based approaches, foam‐enabled fluidic circuits serve as a useful paradigm for future hybrid robotic architectures that fully embody the sensing and computing capabilities of soft fluidic materials. [ABSTRACT FROM AUTHOR]

AbstractOccupational exoskeletons constitute a new assistive technology for industrial workers. In the social context of the workplace, colleagues are likely to react to the noticeable appearance of these devices. Drawing on established technology acceptance theories and recent exoskeleton research, we addressed the following issues: (1) What is the effect of co-worker feedback and self-perceived attractiveness on workers’ intention to use an exoskeleton over time? And (2) do these variables predict intention to use beyond perceived usefulness and ease of use? We examined these questions in a one-week diary study with 22 industrial workers. They tested passive exoskeletons during their regular work for six consecutive days and completed a short questionnaire including evaluations of perceived usefulness, ease of use, attractiveness, and social feedback received on a daily basis. The collected data were analyzed using hierarchical linear models (HLM). Results showed that usefulness (but not ease of use) significantly predicted intention to use an exoskeleton. Over and above, self-perceived attractiveness significantly affected initial intention to use, whereas the effects of social feedback unfolded over time. Our study contributes to a better understanding of the social dynamics experienced by users of wearable technology. [ABSTRACT FROM AUTHOR]

Background/Aims: Gait training for patients with lateropulsion after stroke improves outcomes (eg reduced lateropulsion and improved function) but can be burdensome on the physical therapist. This study describes the physical therapist burden and performance of a patient with moderate lateropulsion during three gait training approaches during inpatient rehabilitation. Methods: A physical therapist delivered gait training (one session each of overground robotic exoskeleton, overground supported walking, and body weight-supported treadmill training) for a patient with lateropulsion (scoring 8 out of 17 on the Burke Lateropulsion Scale). Outcomes were physiological burden (heart rate, metabolic equivalents, respiratory exchange ratio and energy expenditure), which were measured via a wearable metabolic system and perceptual burden (National Aeronautics and Space Administration Task Load Index) on the physical therapist. Patient performance (step count, time walking, time spent upright and time in moderate-to-vigorous intensity) was recorded. Results: During overground robotic exoskeleton gait training, the physical therapist's physiological metrics included an average heart rate of 116 beats per minute (minimum–maximum: 98–127, time in moderate-to-vigorous intensity was 0%), average metabolic equivalents of 3.2 (minimum–maximum: 1.7–4.3), a respiratory exchange ratio of 0.79 (minimum–maximum: 0.70–0.93), an energy expenditure of 228 kcal/hour and a perceptual burden of 33.3. The patient walked 228 steps, spent 15.4 minutes upright, 8.7 minutes walking and achieved 0% in moderate-to-vigorous intensity. During overground supported walking, the physical therapist's metrics included an average heart rate of 145 beats per minute (minimum–maximum: 113–164, time in moderate-to-vigorous intensity was 87%), average metabolic equivalents of 4.7 (minimum–maximum: 2.7–6.0), a respiratory exchange ratio of 0.96 (minimum–maximum: 0.81–1.16), an energy expenditure of 343 kcal/hour and a perceptual burden of 60.8. The patient walked 588 steps, spent 19.6 minutes upright, 10.5 minutes walking and achieved 38% in moderate-to-vigorous intensity. During body weight-supported treadmill training, the physical therapist's metrics included an average heart rate of 112 beats per minute (minimum–maximum: 69–137, time in moderate-to-vigorous intensity was 34%), average metabolic equivalents of 3.9 (minimum–maximum: 3.2–4.4), a respiratory exchange ratio of 0.89 (minimum–maximum: 0.82–0.95), an energy expenditure of 281 kcal/hour and a perceptual burden of 32.5. The patient walked 682 steps, spent 16.0 minutes upright, 10.0 minutes walking and achieved 0% in moderate-to-vigorous intensity. Conclusions: As concordance between physical therapist burden and patient gait performance was low in this study, future efforts to identify gait training approaches that minimise therapist burden while maximising outcomes for the patient with lateropulsion are necessary for the health of both. Implications for practice: Physical therapists may consider advanced technology use such as overground robotic exoskeletons to reduce the burden during the provision of gait training for patients with lateropulsion. Gait training performance of patients with lateropulsion may vary across different gait training approaches with low correspondence to therapist burden. [ABSTRACT FROM AUTHOR]

In this editorial, Massimiliano Polastri discusses the potential of artificial intelligence in healthcare. [ABSTRACT FROM AUTHOR]

Soft pneumatic actuators/robotics have received significant interest in the medical and health fields, due to their intrinsic elasticity and simple control strategies for enabling desired interactions. However, current soft hand pneumatic exoskeletons often exhibit uniform deformation, mismatch the profile of the interacting objects, and seldom quantify the assistive effects during activities of daily life (ADL), such as extension angle and predicted joint stiffness. The lack of quantification poses challenges to the effective and sustainable advancement of rehabilitation technology. This paper introduces the design, modeling, and testing of pneumatic bioinspired segmented composite proprioceptive bending actuators (SCPBAs) for hand rehabilitation in ADL tasks. Inspired by human finger anatomy, the actuator's soft-joint–rigid-bone segmented structure provides a superior fit compared to continuous structures in traditional fiber-reinforced actuators (FRAs). A quasi-static model is established to predict the bending angles based on geometric parameters. Quantitative evaluations of predicted joint stiffness and extension angle utilizing proprioceptive bending are performed. Additionally, a soft under-actuated hand exoskeleton equipped with SCPBAs demonstrates their potential in ADL rehabilitation scenarios. [ABSTRACT FROM AUTHOR]

This study aimed to identify whether the combined use of functional electrical stimulation (FES) reduces the motor torque of a gait exercise rehabilitation robot in spinal cord injury (SCI) and to verify the effectiveness of the developed automatic assist level adjustment in people with paraplegia. Acute and chronic SCI patients (1 case each) performed 10 min of gait exercises with and without FES using a rehabilitation robot. Reinforcement learning was used to adjust the assist level automatically. The maximum torque values and assist levels for each of the ten walking cycles when walking became steady were averaged and compared with and without FES. The motor's output torque and the assist level were measured as outcomes. The assist level adjustment allowed both the motor torque and assist level to decrease gradually to a steady state. The motor torque and the assist levels were significantly lower with the FES than without the FES under steady conditions in both cases. No adverse events were reported. The combined use of FES attenuated the motor torque of a gait exercise rehabilitation robot for SCI. Automatic assistive level adjustment is also useful for spinal cord injuries. [ABSTRACT FROM AUTHOR]

Stroke often causes neuromotor disabilities, impacting index finger function in daily activities. Due to the role of repetitive, even passive, finger movements in neuromuscular re-education and spasticity control, this study aims to design a rehabilitation exoskeleton based on the pulp pinch movement. The exoskeleton uses an underactuated RML topology with a single degree of mobility, customized from 3D scans of the patient's hand. It consists of eight links, incorporating two consecutive four-bar mechanisms and the third inversion of a crank–slider. A two-stage genetic optimization was applied, first to the location of the intermediate joint between the two four-bar mechanisms and later to the remaining dimensions. A targeted genetic optimization process monitored two quality metrics: average mechanical advantage from extension to flexion, and its variability. By analyzing the relationship between these metrics and key parameters at different synthesis stages, the population evaluated is reduced by up to 96.2%, compared to previous studies for the same problem. This custom-fit exoskeleton uses a small linear actuator to deliver a stable 12.45 N force to the fingertip with near-constant mechanical advantage during flexion. It enables repetitive pulp pinch movements in a flaccid finger, improving rehabilitation consistency and facilitating home-based therapy. [ABSTRACT FROM AUTHOR]

(1) Exoskeletons offer potential benefits for overhead working tasks, but gender effects or differences are unclear. This study aimed to compare the performance as well as subjective body strain and comfort of men and women using an upper-body exoskeleton. (2) n = 20 female and n = 16 male participants performed an overhead drilling task with and without a passive upper-body exoskeleton in a randomized cross-over study. The task performance of different movement phases, perceived exertion, and ease of use were measured to compare gender differences. One- and two-way analyses were used to compare genders in the different conditions. The body mass index (BMI) was included as a covariate. (3) Gender differences in task performance were found for error integrals (p < 0.001) with higher values in male participants. Moreover, there was a significant interaction effect for gender x exoskeleton use. While females showed performance decrements in aiming with exoskeleton use, the males' performance increased (p = 0.025). No other gender differences were observed. (4) Gender differences in task performance using an upper-body industrial exoskeleton were less detectable than expected, indicating that body composition and anthropometrics might be valuable indicators for performance including assisting devices. Moreover, future studies should also integrate the examination of muscle activity to gain more insights into potential gender movement control patterns. [ABSTRACT FROM AUTHOR]

Motorised arm supports for individuals with severe arm muscle weakness require precise compensation for arm weight and elevated passive joint impedance (e.g., joint stiffness as a result of muscle atrophy and fibrosis). Estimating these parameters in vivo, along with the arm's centre of mass, is challenging, and human evaluations of assistance can be subjective. To address this, a dummy arm was designed to replicate the human arm's anthropometrics, degrees of freedom, adjustable segment masses, and passive elbow joint impedance (eJimp). This study presents the design, anthropometrics, and verification of the dummy arm. It successfully mimics the human arm's range of motion, mass, and centre of mass. The dummy arm also demonstrates the ability to replicate various eJimp torque-angle profiles. Additionally, it allows for the tuning of the segment masses, centres of mass, and eJimp to match a representative desired target population. This simple, cost-effective tool has proven valuable for the development and verification of the Duchenne ARm ORthosis (DAROR), a motorised arm support, or 'exoskeleton'. This study includes recommendations for practical applications and provides insights into optimising design specifications based on the final design. It supplements the CAD design, enhancing the dummy arm's application for future arm-assistive devices. [ABSTRACT FROM AUTHOR]

Background: Effective rehabilitation following total knee arthroplasty (TKA) is crucial for enhancing both range of motion (ROM) and functional outcomes. While robotics has demonstrated its potential in various medical contexts, the evidence on its application in TKA rehabilitation is still scarce. The marsi active knee (MAK), a robotic device that has already proven to be safe and beneficial in people with neurological disease, has been tested to facilitate the rehabilitation of TKA patients. Objective: This study aims to evaluate the safety, patient satisfaction, and clinical impact of integrating the MAK into an early rehabilitation regimen for TKA patients. Methods: The intervention comprised 14 one‐hour sessions administered thrice a week, utilizing the MAK within 48 h post‐TKA surgery. The rehabilitation sessions incorporated exercises involving passive mobilizations, sit‐to‐stand transitions, and gait training. Comprehensive data encompassing safety parameters, patient satisfaction, and clinical outcomes were meticulously collected and analyzed. Results: Six participants successfully completed the rehabilitation protocol with the MAK device. Notably, no significant adverse events were documented. Application of the device corresponded to perceptible reductions in self‐reported pain levels. Vital signs remained within minimal variance pre‐ and post‐rehabilitation. Participants proficiently engaged in all assisted exercises facilitated by the device, culminating in a high overall satisfaction rating of 4.6 ± 0.5 out of 5. Conclusion: The findings indicate that the MAK device exhibits a commendable level of safety while obtaining considerable patient satisfaction during the early rehabilitation phase following TKA, suggesting this device may be a reliable adjunct to TKA protocols. [ABSTRACT FROM AUTHOR]

Exoskeletons are technologies that can help to increase or improve mobility, dexterity, and strength. They can be used as assistive devices, to restore lost affordances, or for rehabilitation. While mechanical exoskeletons are passive and rely on the body's power for movement, powered exoskeletons are active mechanical systems that can assist or enhance a user's capacity, including in strength and performance. They also offer scope to augment or enhance beyond simple medical support, with potential in the future for superhuman power and strength. While these technologies present promising clinical opportunities, including for those who want to regain walking capacity, they also bring ethical questions, such as about data privacy and accessibility. In addition, the physical features of the technology can prove mentally, physically, and financially demanding, and may be deployed in contexts where user choice and autonomy is constrained. In this article, we discuss these issues, and raise some pertinent ethical questions, not all of which can be easily answered. We touch upon medical and therapeutic uses, for industrial and workplace settings, and in military contexts specially, given these are contexts where such technology may be required or even imposed. We argue that reasonable optimism for such technologies needs to be tempered by sufficient ethical assessment to identify and address barriers to research, development, and use. As well as managing any impacts and expectations for the health and wellbeing of users, the potential impact on autonomy and the risk of coercion, we have to consider what kind of data may be recorded or used, and the risk that these technologies could exacerbate existing inequalities or harms. [ABSTRACT FROM AUTHOR]

Workers in factories, construction sites, and farms are often exposed to the risk of physical disability and injury. Particularly, the lower back and shoulders require assistance, as injuries can make it difficult to continue working. While social concern about back injuries is high and preventive measures are taken, lesser attention is paid to shoulders, resulting in inadequate assistance and prevention mechanisms. Therefore, wearable, low-cost, and lightweight upper limb assistive devices that can be used in multiple scenarios are desired by workers. In this study, we proposed a device that uses a remote center of motion (RCM) mechanism, enabling the device to support user's upper arm from below, and the rotational center of device to correspond with shoulder joint. The theoretical assist torque is designed to be sufficient for arm gravity compensation of Japanese males of standard body size. The calculated theoretical assist torque for each shoulder joint is about 8 Nm and maximum assist force for each arm was about 36.3 N (3.7 kgf). Experimental evaluation using a prototype of this device on three healthy adult males demonstrated a decrease in muscle activity of approximately 38% in the anterior deltoid, 31% in the middle deltoid, and 11% in the posterior deltoid as an average of all results in a dynamic experiment in which the participants performed the indicated movements. [ABSTRACT FROM AUTHOR]

Providing the human body with smooth and natural assistance through lower limb exoskeletons is crucial. However, a significant challenge is identifying various locomotion modes to enable the exoskeleton to offer seamless support. In this study, we propose a method for locomotion mode recognition named Convolution‐enhanced Vision Transformer (Conv‐ViT). This method maximizes the benefits of convolution for feature extraction and fusion, as well as the self‐attention mechanism of the Transformer, to efficiently capture and handle long‐term dependencies among different positions within the input sequence. By equipping the exoskeleton with inertial measurement units, we collected motion data from 27 healthy subjects, using it as input to train the Conv‐ViT model. To ensure the exoskeleton's stability and safety during transitions between various locomotion modes, we not only examined the typical five steady modes (involving walking on level ground [WL], stair ascent [SA], stair descent [SD], ramp ascent [RA], and ramp descent [RD]) but also extensively explored eight locomotion transitions (including WL‐SA, WL‐SD, WL‐RA, WL‐RD, SA‐WL, SD‐WL, RA‐WL, RD‐WL). In tasks involving the recognition of five steady locomotions and eight transitions, the recognition accuracy reached 98.87% and 96.74%, respectively. Compared with three popular algorithms, ViT, convolutional neural networks, and support vector machine, the results show that the proposed method has the best recognition performance, and there are highly significant differences in accuracy and F1 score compared to other methods. Finally, we also demonstrated the excellent performance of Conv‐ViT in terms of generalization performance. [ABSTRACT FROM AUTHOR]

Robotic walking devices can be used for intensive exercises to enhance gait rehabilitation therapies. Mixed Reality (MR) techniques may improve engagement through immersive and interactive environments. This article introduces an MR-based multimodal human–robot interaction strategy designed to enable shared control with a Smart Walker. The MR system integrates virtual and physical sensors to (i) enhance safe navigation and (ii) facilitate intuitive mobility training in personalized virtual scenarios by using an interface with three elements: an arrow to indicate where to go, laser lines to indicate nearby obstacles, and an ellipse to show the activation zone. The multimodal interaction is context-based; the presence of nearby individuals and obstacles modulates the robot's behavior during navigation to simplify collision avoidance while allowing for proper social navigation. An experiment was conducted to evaluate the proposed strategy and the self-explanatory nature of the interface. The volunteers were divided into four groups, with each navigating under different conditions. Three evaluation methods were employed: task performance, self-assessment, and observational measurement. Analysis revealed that participants enjoyed the MR system and understood most of the interface elements without prior explanation. Regarding the interface, volunteers who did not receive any introductory explanation about the interface elements were mostly able to guess their purpose. Volunteers that interacted with the interface in the first session provided more correct answers. In future research, virtual elements will be integrated with the physical environment to enhance user safety during navigation, and the control strategy will be improved to consider both physical and virtual obstacles. [ABSTRACT FROM AUTHOR]

This paper presents a study on developing a new exoskeleton for ankle joint rehabilitation with three degrees of freedom (3 DOFs). The primary attention is paid to the process of designing and modelling the device aimed at restoring the lost functions of joint mobility. The authors conducted a complex analysis of the functional requirements of the exoskeleton based on research into the potential user's needs, which allowed for the development of a conceptual model of the proposed device. In this study, a prototype of the exoskeleton is designed using modern additive technologies. The prototype underwent virtual testing in conditions maximally close to reality, which confirmed its effectiveness and comfort of use. The main results of this study indicate the promising potential of the proposed solution for application in rehabilitation practices, especially for patients with ankle joint injuries and diseases. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities. Objective: We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb. Methods: 20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability). Results: Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment. Conclusions: Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONExoskeleton technology has the potential to enhance the functional abilities of individuals with upper or lower limb dysfunction, including stroke survivors. However, its adoption in Malaysia has been limited due to its restricted availability in rehabilitation centres and hospitals. In this study, we aim to explore the perceptions and opinions of physiotherapists and stroke survivors regarding exoskeleton technology, focusing on identifying desired design features and investigating their views on its use in rehabilitation. An online survey was conducted to assess the preferred features of exoskeleton technology among physiotherapists and stroke survivors. Subsequently, one-to-one online in-depth interviews were carried out with physiotherapists who had experience using exoskeleton technology. Data were analysed using descriptive, thematic, and triangulation analysis methods. The analysis included 81 survey questionnaires from physiotherapists and 122 from stroke survivors. Both groups highlighted cost-effectiveness, safety, comfort, and ease of use as key features of exoskeletons. Additional insights from in-depth interviews with five physiotherapists emphasized the importance of a user-friendly interface, adjustability, and a lightweight design. Physiotherapists also expressed that exoskeleton technology could reduce their workload, minimize musculoskeletal-related disorders, and enhance their confidence. The main desired features identified by both physiotherapists and stroke survivors for exoskeleton technology include cost-effectiveness, safety, comfort, and ease of use. Physiotherapists further viewed it as a valuable tool to alleviate their workload and reduce musculoskeletal-related disorders while boosting confidence. These findings offer valuable guidance to developers, engineers, and manufacturers in the country, aiding in the development of client-centred exoskeleton features.Insights from users of exoskeleton technology can improve its design and usability, particularly in rehabilitation settings.Addressing specific functionalities and user needs will help enhance rehabilitation outcomes for stroke survivors and physiotherapists. However, challenges, such as accessibility and affordability need to be addressed to fully integrate exoskeleton technology into clinical practice.This study offers valuable guidance for developers and manufacturers to create user-friendly, cost-effective designs that are adaptable to the unique requirements of local healthcare systems and users.Insights from users of exoskeleton technology can improve its design and usability, particularly in rehabilitation settings.Addressing specific functionalities and user needs will help enhance rehabilitation outcomes for stroke survivors and physiotherapists. However, challenges, such as accessibility and affordability need to be addressed to fully integrate exoskeleton technology into clinical practice.This study offers valuable guidance for developers and manufacturers to create user-friendly, cost-effective designs that are adaptable to the unique requirements of local healthcare systems and users. [ABSTRACT FROM AUTHOR]

Occupational exoskeletons are not yet frequently used at work. Previous research has indicated multiple factors (physiological, implementation-related, work-related, policy, and psycho-social) that can explain this lack of adoption. However, there is a lack of specific requirements related to these themes to improve exoskeletons and their adoption. Therefore, the goal of our research is to formulate concrete requirements for the design and implementation of exoskeletons. We used a design ethnography approach (focus groups, an interview, observations, surveys, and group interviews) with multiple stakeholders (users, designers, and potential future users). Our data suggest that potential future users of exoskeletons believe that existing exoskeletons should be improved to be adopted. Exoskeletons should be more comfortable to wear and flexible enough to support a wider range of tasks. We have formulated 49 requirements for occupational exoskeletons, and we validated and extended an existing framework. Our work encourages the improved design of future or existing exoskeletons. [ABSTRACT FROM AUTHOR]

Rehabilitation exoskeleton robots play a crucial role in restoring functional lower limb movements for individuals with locomotor disorders. Numerous research studies have concentrated on adapting the control of these rehabilitation robotic systems. In this study, we investigate an affine state-feedback control law for robust position control of a knee exoskeleton robot, taking into account its nonlinear dynamic model that includes solid and viscous frictions. To ensure robust stabilization, we employ the Lyapunov approach and propose three methods to establish stability conditions using the Schur complement, the Young inequality, the matrix inversion lemma, and the S-procedure lemma. These conditions are formulated as Linear Matrix Inequalities (LMIs). Furthermore, we conduct a comprehensive comparison among these methods to determine the most efficient approach. At the end of this work, we present simulation results to validate the developed LMI conditions and demonstrate the effectiveness of the adopted control law in achieving robust position control of the knee exoskeleton robot. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate how gait kinematics and muscle activity during robot-assisted gait training are affected by different combinations of parameter settings and a number of instruction types, ranging from no instructions to goal-specific instructions. Design: Robots for gait therapy provide a haptic guidance, but too much guidance can limit the active participation. Therapists can stimulate this active participation either with instructions or by adapting device parameters. How these two factors interact is still unknown. In the present study, we test the interaction of three different parameter settings and four instruction types in a cross-sectional study with 20 children and adolescents without impairment. Gait kinematics and surface electromyography were measured to evaluate the immediate effects. Results: We found that only goal-specific instructions in combination with a low guidance led to a moderate but significant change in gait kinematics. The muscle activity was altered by all instructions, but the biggest effect was found for goal-specific instructions with a 2.5 times higher surface electromyography amplitude compared to no instruction. Conclusions: Goal-specific instructions are a key element of robot assisted gait therapy interventions and device parameter adjustments may be used to modulate their effects. Therapists should pay close attention to how they instruct patients. [ABSTRACT FROM AUTHOR]

The motion control system of a lower-limb exoskeleton rehabilitation robot (LLERR) is designed to assist patients in lower-limb rehabilitation exercises. This research designed a motion controller for an LLERR-based on the Twin Delayed Deep Deterministic policy gradient (TD3) algorithm to control the lower-limb exoskeleton for gait training in a staircase environment. Commencing with the establishment of a mathematical model of the LLERR, the dynamics during its movement are systematically described. The TD3 algorithm is employed to plan the motion trajectory of the LLERR's right-foot sole, and the target motion curve of the hip (knee) joint is deduced inversely to ensure adherence to human physiological principles during motion execution. The control strategy of the TD3 algorithm ensures that the movement of each joint of the LLERR is consistent with the target motion trajectory. The experimental results indicate that the trajectory tracking errors of the hip (knee) joints are all within 5°, confirming that the LLERR successfully assists patient in completing lower-limb rehabilitation training in a staircase environment. The primary contribution of this study is to propose a non-linear control strategy tailored for the staircase environment, enabling the planning and control of the lower-limb joint motions facilitated by the LLERR. [ABSTRACT FROM AUTHOR]

Forecasting can be utilized to predict future trends in physiological demands, which can be beneficial for developing effective interventions. This study implemented forecasting models to predict fatigue level progression when performing exoskeleton (EXO)-assisted tasks. Specifically, perceived and muscle activity data were utilized from nine recruited participants who performed 45° trunk flexion tasks intermittently with and without assistance until they reached medium-high exertion in the low-back region. Two forecasting algorithms, Autoregressive Integrated Moving Average (ARIMA) and Facebook Prophet, were implemented using perceived fatigue levels alone, and with external features of low-back muscle activity. Findings showed that univariate models without external features performed better with the Prophet model having the lowest mean (SD) of root mean squared error (RMSE) across participants of 0.62 (0.24) and 0.67 (0.29) with and without EXO-assisted tasks, respectively. Temporal effects of BSIE on delaying fatigue progression were then evaluated by forecasting back fatigue up to 20 trials. The slope of fatigue progression for 20 trials without assistance was ~48–52% higher vs. with assistance. Median benefits of 54% and 43% were observed for ARIMA (with external features) and Prophet algorithms, respectively. This study demonstrates some potential applications for forecasting models for workforce health monitoring, intervention assessment, and injury prevention. [ABSTRACT FROM AUTHOR]

Proprioceptive impairments occur in approximately 50–64% of people following stroke. While much is known about the grey matter structures underlying proprioception, our understanding of the white matter correlates of proprioceptive impairments is less well developed. It is recognised that behavioural impairments post-stroke are often the result of disconnection between wide-scale brain networks, however the disconnectome associated with proprioception post-stroke is unknown. In the current study, white matter disconnection was assessed in relation to performance on a robotic arm position matching (APM) task. Neuroimaging and robotic assessments of proprioception were collected for 203 stroke survivors, approximately 2-weeks post-stroke. The robotic assessment was performed in a KINARM Exoskeleton robotic device and consisted of a nine-target APM task. First, the relationship between white matter tract lesion load and performance on the APM task was assessed. Next, differences in the disconnectome between participants with and without impairments on the APM task were examined. Greater lesion load to the superior longitudinal fasciculus (SLF II and III), arcuate fasciculus (all segments) and fronto-insular tracts were associated with worse APM task performance. In those with APM task impairments, there was, additionally, disconnection of the posterior corpus callosum, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus and optic radiations. This study highlights an important perisylvian white matter network supporting proprioceptive processing in the human brain. It also identifies white matter tracts, important for relaying proprioceptive information from parietal and frontal brain regions, that are not traditionally considered proprioceptive in nature. [ABSTRACT FROM AUTHOR]

Recent years have witnessed breakthroughs in assistive exoskeletons; both passive and active devices have reduced metabolic costs near preferred walking speed by assisting muscle actions. Metabolic reductions at multiple speeds should thus also be attainable. Musculoskeletal simulation can potentially predict the interaction between assistive moments, muscle-tendon mechanics, and walking energetics. In this study, we simulated devices' optimal assistive moments based on minimal muscle activations during walking with prescribed kinematics and dynamics. We used a generic musculoskeletal model with tuned muscle-tendon parameters and computed metabolic rates from muscle actions. We then simulated walking across multiple speeds and with two ideal actuation modes–motor-based and spring-based–to assist ankle plantarflexion, knee extension, hip flexion, and hip abduction and compared computed metabolic rates. We found that both actuation modes considerably reduced physiological joint moments but did not always reduce metabolic rates. Compared to unassisted conditions, motor-based ankle plantarflexion and hip flexion assistance reduced metabolic rates, and this effect was more pronounced as walking speed increased. Spring-based hip flexion and abduction assistance increased metabolic rates at some walking speeds despite a moderate decrease in some muscle activations. Both modes of knee extension assistance reduced metabolic rates to a small extent, even though the actuation contributed with practically the entire net knee extension moment during stance. Motor-based hip abduction assistance reduced metabolic rates more than spring-based assistance, though this reduction was relatively small. Our study also suggests that an assistive strategy based on minimal muscle activations might result in a suboptimal reduction of metabolic rates. Future work should experimentally validate the effects of assistive moments and refine modeling assumptions accordingly. Our computational workflow is freely available online. Author summary: We used simulation to identify ideal assistance at major lower limb joints that can potentially be produced by motor-based or spring-based assistive devices in slow, normal, and fast walking. We found that assistance from both actuation modes decreased muscle activations and net muscle moments to varying extents, depending on joint and walking speed, but they did not always reduce metabolic energy of muscles. Motor-based assistance was overall more effective than spring-based assistance, and spring-based assistance at times increased the metabolic energy. The largest metabolic energy reductions occurred with motor-based plantarflexion assistance, followed by motor-based hip flexion assistance, both more notably at higher speeds. Motor-based hip abduction assistance also reduced metabolic energy, somewhat inversely with walking speed. Spring-based assistance was overall less effective than motor-based assistance but did reduce metabolic energy with plantarflexion assistance in slow walking and with hip flexion assistance in fast walking. Knee extension assistance, regardless of actuation mode or walking speed, had little to no influence on metabolic energy. Our simulation findings do not support knee extension assistance at all, nor spring-based hip flexion assistance in slow walking or hip abduction assistance at any speed if a device goal is to reduce muscle activations. [ABSTRACT FROM AUTHOR]

Effective training programs are essential for safely integrating exoskeletons (EXOs) in industrial workplaces. Since the effects of wearable systems depend highly upon their proper use, lack of training of end-users may cause adverse effects on users. We reviewed articles that incorporated training and familiarization protocols to train novices on proper operation/use of EXOs. Findings showed variation in training methods that were implemented to train study participants in EXO evaluation studies. Studies also indicate that multiple (up to four) sessions may be needed for novice EXO wearers to match movement patterns of experts, and training can offer benefits in enhancing motor learning in novices. Biomechanical assessments and ergonomic evaluations can be helpful in developing EXO-specific training protocols by determining training parameters (duration/number of sessions and task difficulty). Future directions include development of personalized training approaches by assessing user behavior/performance through integration of emerging sensing technologies. Application of simulators and use of data-driven approaches for customizing training protocols to individuals, tasks, and EXO design are provided along with a comprehensive training framework. Discussed elements in this article can be helpful to exoskeleton researchers in familiarizing novice users to EXOs prior to evaluation, and to practitioners in developing protocols for training workforce. [ABSTRACT FROM AUTHOR]

BACKGROUND: Human gait pattern recognition and compliance control are key technologies for achieving high coordination and assistance between exoskeleton robots and human movements. OBJECTIVE: In order to improve the adaptability of exoskeleton robots to the human body, this paper proposes an exoskeleton compliance control strategy based on dual interaction torque phase separation control method. METHODS: A support phase swing phase split control strategy based on dual interaction torque is proposed. Utilize the interaction force of human joints and adopt a model-based method to control the support phase. By utilizing the interaction force of exoskeleton joints and using a torque closed-loop method to control the swing phase, a multi-state control method of motion is achieved. RESULTS: A lower limb exoskeleton knee joint testing platform is built to verify the proposed human gait recognition The effectiveness of human-machine interaction force identification and human-machine coupling system compliance control technology. CONCLUSION: The proposed control method can effectively adjust joint torque, enabling the exoskeleton robot to maintain balance and stability during the entire walking phase. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR. [ABSTRACT FROM AUTHOR]

Lower-limb exoskeletons (LLEs) can provide rehabilitation training and walking assistance for individuals with lower-limb dysfunction or those in need of functionality enhancement. Adapting and personalizing the LLEs is crucial for them to form an intelligent human–machine system (HMS). However, numerous LLEs lack thorough consideration of individual differences in motion planning, leading to subpar human performance. Prioritizing human physiological response is a critical objective of trajectory optimization for the HMS. This paper proposes a human-in-the-loop (HITL) motion planning method that utilizes surface electromyography signals as biofeedback for the HITL optimization. The proposed method combines offline trajectory optimization with HITL trajectory selection. Based on the derived hybrid dynamical model of the HMS, the offline trajectory is optimized using a direct collocation method, while HITL trajectory selection is based on Thompson sampling. The direct collocation method optimizes various gait trajectories and constructs a gait library according to the energy optimality law, taking into consideration dynamics and walking constraints. Subsequently, an optimal gait trajectory is selected for the wearer using Thompson sampling. The selected gait trajectory is then implemented on the LLE under a hybrid zero dynamics control strategy. Through the HITL optimization and control experiments, the effectiveness and superiority of the proposed method are verified. [ABSTRACT FROM AUTHOR]

A common challenge for exoskeleton control is discerning operator intent to provide seamless actuation of the device with the operator. One way to accomplish this is with joint angle estimation algorithms and multiple sensors on the human–machine system. However, the question remains of what can be accomplished with just one sensor. The objective of this study was to deploy a modular testing approach to test the performance of two joint angle estimation models—a kinematic extrapolation algorithm and a Random Forest machine learning algorithm—when each was informed solely with kinematic gait data from a single potentiometer on an ankle exoskeleton mock-up. This study demonstrates (i) the feasibility of implementing a modular approach to exoskeleton mock-up evaluation to promote continuity between testing configurations and (ii) that a Random Forest algorithm yielded lower realized errors of estimated joint angles and a decreased actuation time than the kinematic model when deployed on the physical device. [ABSTRACT FROM AUTHOR]

Rehabilitation is necessary for those with restricted arm mobility to enhance arm movement efficiency and offer dynamic stability. Recent research initiatives are aimed at supporting the rehabilitation of individuals with disabilities or injuries that limit arm movement. Accordingly, the RRSS (Revolute-Revolute-Spherical-Spherical) exoskeleton mechanism for circumduction motion is proposed in this study. The objective is to ascertain the parameters of the mechanism required to accomplish or approximate a sequence of prescribed circumduction positions. When a rigid body needs to operate according to a precise displacement sequence, this design is appropriate which is considered as a nonlinear kinostatic optimization problem. The problem can be formulated with constraints concerning driven link buckling, driver static torque, and driver elastic deflection. The suggested RRSS circumduction motion production process is used to simulate and analyze the workspace of the arm and shoulder as well as muscle activity. Significant changes in the reactions of the muscles, bones, and joints movement were noted during virtual testing of the suggested exoskeleton on a human arm. Some tremendous results of exoskeleton joints and human arm fusion were found. Some computations were made for the deltoid muscles, which control arm movement in the scapular plane, the FCU (Flexor Carpi Ulnaris) muscle, which is located in the forearm and controls hand flexion and adduction, and the caput breve, a short head of biceps brachii muscles. [ABSTRACT FROM AUTHOR]

• Understanding the costs and benefits of exoskeleton is a major facilitator. • Incompatibility of exoskeletons with other devices can be a major barrier. • Exoskeletons require adjustments to suit the construction industry. • Training and communication plans are essential in exoskeleton implementation. Introduction: Active back-support exoskeletons are gaining more awareness as a solution to the prevalence of work-related musculoskeletal disorders in the construction industry. This study aims to understand the factors that influence the adoption of active back-support exoskeletons in the construction industry. Method: A literature review was conducted to gather relevant adoption factors related to exoskeleton implementation. Building on the TOE (Technology, Organization, and Environment) framework, two rounds of the survey via the Delphi technique were administered with 13 qualified industry professionals to determine the most important adoption factors using the relative importance index. Through semi-structured interviews, the professionals expressed their perspectives on the impact of active back-support exoskeletons on the construction industry. Results: Important factors included 18 facilitators and 21 barriers. The impact of the exoskeletons in the construction industry was categorized into expected benefits, barriers, solutions, adjustment to technology, implementation, and applicable tasks. Conclusions: This study identified the factors to be considered in the adoption and implementation of active back-support exoskeletons in the construction industry from the perspective of stakeholders. The study also elucidates the impact of active exoskeletons on construction organizations and the broader environment. Practical Applications : This study provides useful guidance to construction companies interested in adopting active back-support exoskeletons. Our results will also help manufacturers of active back-support exoskeletons to understand the functional requirements and adjustments required for utilization in the construction industry. Lastly, the study expands the application of the TOE framework to the adoption of active back-support exoskeletons in the construction industry. [ABSTRACT FROM AUTHOR]

• An active hand Exoskeleton (H-EXO) was assessed for a drilling task. • H-EXO reduced peak muscle activation in the forearm by up to 27% • H-EXO minimally affected perceived discomfort in controlled experiment. • H-EXO reduced perceived exertion up to 11% in uncontrolled observation. • Users indicated that H-EXO was a valuable intervention. Introduction: Several studies have assessed and validated the impact of exoskeletons on back and shoulder muscle activation; however, limited research has explored the role that exoskeletons could play in mitigating lower arm-related disorders. This study assessed the impact of Ironhand, an active hand exoskeleton (H-EXO) designed to reduce grip force exertion, on worker exertion levels using a two-phase experimental design. Method: Ten male participants performed a controlled, simulated drilling activity, while three male participants completed an uncontrolled concrete demolition activity. The impact of the exoskeleton was assessed in terms of muscle activity across three different muscles using electromyography (EMG), perceived exertion, and perceived effectiveness. Results: Results indicate that peak muscle activation decreased across the target muscle group when the H-EXO was used, with the greatest reduction (27%) observed in the Extensor Carpi Radialis (ECR). Using the exoskeleton in controlled conditions did not significantly influence perceived exertion levels. Users indicated that the H-EXO was a valuable technology and expressed willingness to use it for future tasks. Practical Applications: This study showcases how glove-based exoskeletons can potentially reduce wrist-related disorders, thereby improving safety and productivity among workers. Future work should assess the impact of the H-EXO in various tasks, different work environments and configurations, and among diverse user groups. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to assess the efficacy of robot-assisted rehabilitation training on upper and lower limb motor function and fatigue in Parkinson's disease (PD), and to explore the best-acting robotic rehabilitation program. Methods: We searched studies in seven databases and the search period was from the build to 30 June 2023. Two researchers independently screened studies and assessed the quality of the studies for data extraction. Results: A total of 21 studies were included, 18 studies related to lower limbs rehabilitation and 3 studies related to upper limbs rehabilitation, involving a total of 787 participants. The results showed that robot-assisted rehabilitation significantly improved indicators of lower limb motor function UPDRS Part III (WMD = −3.58, 95% CI = −5.91 to −1.25, p = 0.003) and BBS (WMD = 4.24, 95% CI = 2.88 to 5.54, p < 0.001), as well as non-motor symptoms of fatigue (WMD = −13.39, 95% CI = −17.92 to −8.86, p < 0.001) in PD patients. At the level of upper limb function, there was no statistically significant difference in the outcome measures of PFS (WMD = −0.25, 95% CI = −4.44 to 3.93, p = 0.9) and BBT (WMD = 1.73, 95% CI = −2.85 to 6.33, p = 0.458). Conclusion: Robot-assisted rehabilitation significantly improved motor function, fatigue, and balance confidence in PD patients, but current evidence doesn't show that intelligent rehabilitation systems improve upper limb function. In particular, robotics combined with virtual reality worked best. IMPLICATIONS OF REHABILITATION: Robot-assisted rehabilitation significantly improves motor symptoms, lower limb motor function, fatigue, and balance confidence in Parkinson's disease (PD) patients. Robotics combined with virtual reality is the most effective application and should be encouraged. In the robotic rehabilitation of PD patients, the focus needs to be on the duration of the training and the long-term benefits it provides. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, artificial intelligence has gradually emerged and has been applied in various fields such as spinal cord nerve injury and repair, which has a positive impact on clinical treatment. OBJECTIVE: To study the application progress of artificial intelligence in the diagnosis, treatment, and rehabilitation of spinal cord nerve injury and repair, clarify the research hotspots and shortcomings in this field, and provide suggestions for future research work. METHODS: Relevant literature on artificial intelligence in the field of spinal cord nerve injury and repair was retrieved on the Web of Science core collection database until 2023. CiteSpace 6.1.R6 and VOSviewer 1.6.19 software was used to perform general literature analysis, co-citation of literature, co-citation of journals, double image overlay of journals, keyword clustering, and other visual analysis on the literature data. RESULTS AND CONCLUSION: (1) A total of 1 713 articles were selected, and the annual publication volume in this field showed a fluctuating upward trend, with the United States taking the lead, and Kadone and Hideki being the authors with the highest publication volume. ARCH PHYS MED REHAB was the journal with the highest number of citations. (2) Keyword co-occurrence and cluster analysis showed that after removing keywords similar to the search terms, the main keywords were divided into three main clusters: Exoskeleton and exercise rehabilitation (the largest core hotspot); machine learning and neural plasticity; robotics and rehabilitation training. (3) Keyword burst analysis showed that deep learning and artificial intelligence had become burst terms in the past five years. (4) The results of in-depth analysis of co cited and highly cited literature showed that the hotspots of artificial intelligence in the field of spinal cord nerve injury and repair were mainly focused on powered exoskeletons, gaits, electrical nerve stimulation, intracortical brain-computer interface (IBCI), robots, and polymer biomaterials, and neural stem cell. (5) The research on artificial intelligence in the field of spinal cord nerve injury and repair has shown an upward trend in recent years. The focus of this field had gradually shifted from single treatment methods such as exoskeletons and electrical stimulation to intelligent, precise, and personalized directions. (6) There were some limitations in this field, such as the consequences of missing or imbalanced data, low data accuracy and reproducibility, and ethical issues (such as privacy, research transparency, and clinical reliability). Future research should address the issue of data collection, requiring large sample, high-quality clinical datasets to establish effective artificial intelligence models. At the same time, the research on genomics and other mechanisms in this field is very weak. In the future, various machine learning technologies such as brain chips can be used, and gene editing therapy, single-cell spatial transcriptome and other methods can be used to study the basic mechanisms of regeneration-related gene upregulation and axon growth structural protein production. [ABSTRACT FROM AUTHOR]

Background: Compliant pneumatic actuators possess many characteristics that are desirable for wearable robotic systems. These actuators can be lightweight, integrated with clothing, and accommodate uncontrolled degrees of freedom. These attributes are especially desirable for hand exoskeletons, where the soft actuator can conform to the highly variable digit shape. In particular, locating the pneumatic actuator on the palmar side of the digit may have benefits for assisting finger extension and resisting unwanted finger flexion, but this configuration requires suppleness to allow digit flexion while retaining sufficient stiffness to assist extension. Methods: To meet these needs, we designed an actuator consisting of a hollow chamber long enough to span the joints of each digit while sufficiently narrow not to inhibit finger adduction. We explored the geometrical design parameter space for this chamber in terms of shape, dimensions, and wall thickness. After fabricating an elastomer-based prototype for each actuator design, we measured active extension force and passive resistance to bending for each chamber using a mechanical jig. We also created a finite element model for each chamber to enable estimation of the impact of chamber deformation, caused by joint rotation, on airflow through the chamber. Finally, we created a prototype hand exoskeleton with the chamber parameters yielding the best outcomes. Results: A rectangular cross-sectional area was preferable to a semi-obround shape for the chamber; wall thickness also impacted performance. Extension joint torque reached 0.33 N-m at a low chamber pressure of 48.3 kPa. The finite element model confirmed that airflow for the rectangular chamber remained high despite deformation resulting from joint rotation. The hand exoskeleton created with the rectangular chambers enabled rapid movement, with a cycle time of 1.1 s for voluntary flexion followed by actuated extension. Conclusions: The developed soft actuators are feasible for use in promoting finger extension from the palmar side of the hand. This placement utilizes pushing rather than pulling for digit extension, which is more comfortable and safer. The small chamber volumes allow rapid filling and evacuation to facilitate relatively high frequency finger movements. [ABSTRACT FROM AUTHOR]

Based on the previously designed hand rehabilitation exoskeleton structure, we propose a wearable soft hand rehabilitation device (HRD) actuated by shape memory alloy (SMA) wires. In order to accommodate the force and strain required for finger flexion and extension, the HRD with SMA wires-driven range extension mechanism has been redesigned to be 36.7% less long than the previous structure. In addition, we also designed the supporting structure for the SMA wires to stabilize the length of SMA wires and keep them tight to ensure the best actuation effect. Compared to previous work, the Coupled statics model is justified by analyzing the relationship between finger joint angles and fingertip forces during grasping. The experimental results show that the maximum sum of joint angle of the metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (DIP) joint of the index finger is about 150°. The maximum fingertip forces of different fingers are different, ranging from 2 N to 7 N, depending on the geometrical size of each finger. The maximum operating temperature of the device is 31.7°C, which is within the safe range. This study demonstrates the feasibility of using the HRD to assist hand function rehabilitation. [ABSTRACT FROM AUTHOR]

In this study, a hybrid impedance control-based portable ankle rehabilitation robot that can perform therapeutic exercises for the ankle has been developed. This 1-DOF robot can perform plantar flexion and dorsiflexion movements for the ankle. The capacity of the robotic system to perform therapeutic exercises was tested with subjects. Isotonic and resistive exercises were tested with 10 healthy subjects and stretching exercise was tested with a patient. The results showed that the hybrid impedance controlled robotic system can successfully perform passive stretching, active isotonic and active resistive exercises by providing a safe human-robot interaction. Especially when a sudden resistance increase occurs in the joint, the hybrid impedance controller acts like a physiotherapist and performs the movement without damaging the joint. [ABSTRACT FROM AUTHOR]

Using lower limb exoskeletons provides potential advantages in terms of productivity and safety associated with reduced stress. However, complex issues in human–robot interactions are still open, such as the physiological effects of exoskeletons and the impact on the user's subjective experience. In this work, an innovative exoskeleton, the Wearable Walker, is assessed using the EXPERIENCE benchmarking protocol from the EUROBENCH project. The Wearable Walker is a lower-limb exoskeleton that enhances human abilities, such as carrying loads. The device uses a unique control approach called Blend Control that provides smooth assistance torques. It operates two models simultaneously, one in the case in which the left foot is grounded and another for the grounded right foot. These models generate assistive torques combined to provide continuous and smooth overall assistance, preventing any abrupt changes in torque due to model switching. The EXPERIENCE protocol consists of walking on flat ground while gathering physiological signals, such as heart rate, its variability, respiration rate, and galvanic skin response, and completing a questionnaire. The test was performed with five healthy subjects. The scope of the present study is twofold: to evaluate the specific exoskeleton and its current control system to gain insight into possible improvements and to present a case study for a formal and replicable benchmarking of wearable robots. [ABSTRACT FROM AUTHOR]

Background: Seniors wearing a passive hip exoskeleton (Exo) show increased walking speed and step length but reduced cadence. We assessed the test–retest reliability of seniors' gait characteristics with Exo. Methods: Twenty seniors walked with and without Exo (noExo) on a 10 m indoor track over two sessions separated by one week. Speed, step length, cadence and step time variability were extracted from one inertial measurement unit (IMU) placed over the L5 vertebra. Relative and absolute reliability were assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC). Results: The relative reliability of speed, step length, cadence and step time variability ranged from "almost perfect to substantial" for Exo and noExo with ICC values between 0.75 and 0.87 and 0.60 and 0.92, respectively. The SEM and MDC values for speed, step length cadence and step time variability during Exo and noExo were <0.002 and <0.006 m/s, <0.002 and <0.005 m, <0.30 and <0.83 steps/min and <0.38 s and <1.06 s, respectively. Conclusions: The high test–retest reliability of speed, step length and cadence estimated from IMU suggest a robust extraction of spatiotemporal gait characteristics during exoskeleton use. These findings indicate that IMUs can be used to assess the effects of wearing an exoskeleton on seniors, thus offering the possibility of conducting longitudinal studies. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of a back-support exoskeleton on the trunk and hip joint angles, lower back muscle activity and heart rate during four patient handling tasks: assisting a patient from sitting to lying, laterally repositioning the patient and turning the patient in two directions. Eight participants performed these tasks with and without the exoskeleton. Results demonstrated a significant reduction in the lower back muscle activity, but less pronounced effects for other tasks involving minimal trunk flexion. Hip flexion angles were reduced for all tasks when the exoskeleton was worn. The amount of reduction in the muscle activity and changes in the trunk and hip angles varied by task. The exoskeleton did not affect the heart rate across all tasks. The exoskeleton appeared to be more effective in tasks requiring substantial trunk flexion, indicating its potential benefits for reducing lower back muscle strain during such activities. [ABSTRACT FROM AUTHOR]