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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]

Exoskeleton robots have the potential to augment human motor capabilities. however, current control strategies often require task-specific control laws tailored for different scenarios, which limits the applicability of exoskeletons. In this study, we propose a control strategy for exoskeleton robots that is adaptable across various scenarios. We employ adaptive oscillators (AO) with feedback control to rapidly estimate the wearer'smotion phase and subsequently provide torque assistance to the wearer's hip joint based on a TCN-LSTM model. During experiments, we collected surface electromyographic (sEMG) signals from the tibialis anterior, gastrocnemius, and rectus muscles of seven groups of subjects performing treadmill walking and inclined treadmill exercises. We utilized the short-time Fourier transform to extract frequency characteristics of the signals and statistically analyzed the rate of frequency change in each muscle group under different strategies. The results indicate that when wearing the exoskeleton, the overall muscle frequency changes more slowly, suggesting that subjects can maintain activity for a longer duration before fatigue sets in. This control strategy effectively reduces the energetic cost of lower limb work for the wearer and enhances the exoskeleton's versatility in various applications. [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]

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]

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]

This field study explores construction workers' perceptions of using a passive shoulder exoskeleton to better understand how to improve its adoption in construction. We provided forty-one construction workers with an exoskeleton to perform their regular work activities for two days. Workers' feedback of the tool was collected at the end of each day. Two-thirds indicated they would likely or very likely use an exoskeleton if their employer provided it. Participants felt exoskeletons were helpful for specific overhead tasks, such as installing upper tracks, framing and drywalling bulkheads, taping and mudding ceilings, and installing light fixtures. To improve their adoption within the construction industry, exoskeletons should be designed to be compatible with harnesses and toolbelts, be close-fitting to allow working in tight spaces, be easily adjustable (for fit and level of support), be rugged and easy to clean, and should not encumber workers in performing their tasks. [ABSTRACT FROM AUTHOR]

This work proposes a novel robotic exoskeleton for rehabilitation of the index finger. Though all motions of index finger are essential, the major range of motion is covered by flexion/extension motion. Hence, a Stephenson III six-bar mechanism has been synthesized for the robotic exoskeleton device for a pre-defined trajectory to address post stroke rehabilitation of patients. The flexion/extension trajectory was obtained experimentally using image processing. Based on the trajectory, a mathematical model was formulated which was used as the objective function for the optimization problem. To eliminate any defects that may be encountered during the synthesis, "loop-by-loop defect rectification" procedure was implemented along with well-established optimization algorithms such as TLBO, BWP, GWO and PSO for synthesis of the desired mechanism. It has been found that TLBO outperformed all the others as it could reduce the objective function value to 0.69849. whereas, BWP reduced it to 8.9952, GWO reduced it to 13.1388, and PSO could only reduce it to 6 × 105. Therefore, the design obtained using TLBO was considered for developing the prototype of the device. The device was validated experimentally using image processing, and it is found to cover the prescribed range of motion. Thus, the proposed exoskeleton is deemed to be a viable solution for post stroke index-finger rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: To investigate the dynamics of the motor control system during walking by examining the complexity, stability, and causal relationships of leg motions. Specifically, the study focuses on gait under both bilateral and unilateral constraints induced by a passive exoskeleton designed to replicate gastrocnemius contractures. Methods: Kinematic data was collected as 10 healthy participants walked at a self-selected speed. A new Complexity-Instability Index (CII) of the leg motions was defined as a function of the Correlation Dimension and the Largest Lyapunov Exponent. Causal interactions between the leg motions are explored using Convergent Cross Mapping. Results: Normal walking is characterized by a high mutual drive of each leg to the other, where CII is lowest for both legs (complexity of each leg motion is low and stability high). The effect of the bilateral emulated contractures is a reduced drive of each leg to the other and an increased CII for both legs. With unilateral emulated contracture, the mechanically constrained leg strongly drives the unconstrained leg, and CII was significantly higher for the constrained leg compared to normal walking. Conclusion: Redundancy in limb motions is used to support causal interactions, reducing complexity and increasing stability in our leg dynamics during walking. The role of redundancy is to allow adaptability above being able to satisfy the overall biomechanical problem; and to allow the system to interact optimally. From an applied perspective, important characteristics of functional movement patterns might be captured by these nonlinear and causal variables, as well as the biomechanical aspects typically studied. [ABSTRACT FROM AUTHOR]

Introduction: Wearable exoskeletons assist individuals with mobility impairments, enhancing their gait and quality of life. This study presents the iP3T model, designed to optimize gait phase prediction through the fusion of multimodal time-series data. Methods: The iP3T model integrates data from stretch sensors, inertial measurement units (IMUs), and surface electromyography (sEMG) to capture comprehensive biomechanical and neuromuscular signals. The model's architecture leverages transformer-based attention mechanisms to prioritize crucial data points. A series of experiments were conducted on a treadmill with five participants to validate the model's performance. Results: The iP3T model consistently outperformed traditional single-modality approaches. In the post-stance phase, themodel achieved an RMSE of 1.073 and an R2 of 0.985. The integration of multimodal data enhanced prediction accuracy and reduced metabolic cost during assisted treadmill walking. Discussion: The study highlights the critical role of each sensor type in providing a holistic understanding of the gait cycle. The attention mechanisms within the iP3T model contribute to its interpretability, allowing for effective optimization of sensor configurations and ultimately improving mobility and quality of life for individuals with gait impairments. [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]

Featured Application: This paper proposes a protocol for researchers, ergonomists, and industrial practitioners to design and carry out well-structured experiments that allow for reliable and valid comparisons between different exoskeleton designs or configurations, considering factors such as user characteristics, task demands, environmental conditions, and subjective user perceptions. This paper proposes a modular protocol for the designing of experimental studies to analyze exoskeletons used in industrial settings to support manual material handling (MMH). Despite exoskeleton technologies starting to be highly commercialized and present in workplaces, research still lacks a standardized procedure for analyzing the impact of these devices on workers. The protocol presented in this paper outlines a step-by-step procedure, including the parameters to be collected and analyzed in a research study. Moreover, the approach could be easily adapted to meet the specificity of a wide range of exoskeletons. The main novelty of the protocol is thus to support the experimental design and analysis of studies assessing the overall impact of exoskeletons on workers. To implement the protocol, the selected case study concerned a palletizing task involving the MMH of 12 cardboard boxes, weighing 10 kg. The results from physiological signals and pressure insoles show that the protocol is comprehensive and can be utilized by researchers evaluating different occupational exoskeletons for assistance during MMH (both active and passive), with modifications to specific parts based on the type of exoskeleton being assessed or the variables of interest. [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]

Introduction: Wearable exoskeletons are emerging technologies for providing movement assistance and rehabilitation for people with motor disorders. In this study, we focus on the specific gait pathology dropfoot, which is common after a stroke. Dropfoot makes it difficult to achieve foot clearance during swing and heel contact at early stance and often necessitates compensatory movements. Methods: We developed a soft ankle exoskeleton consisting of actuation and transmission systems to assist two degrees of freedom simultaneously: dorsiflexion and eversion, then performed several proof-of-concept experiments on non-disabled persons. The actuation system consists of two motors worn on a waist belt. The transmission system provides assistive force to the medial and lateral sides of the forefoot via Bowden cables. The coupling design enables variable assistance of dorsiflexion and inversion at the same time, and a force-free controller is proposed to compensate for device resistance. We first evaluated the performance of the exoskeleton in three seated movement tests: assisting dorsiflexion and eversion, controlling plantarflexion, and compensating for device resistance, then during walking tests. In all proof-of-concept experiments, dropfoot tendency was simulated by fastening a weight to the shoe over the lateral forefoot. Results: In the first two seated tests, errors between the target and the achieved ankle joint angles in two planes were low; errors of <1.5° were achieved in assisting dorsiflexion and/or controlling plantarflexion and of <1.4° in assisting ankle eversion. The force-free controller in test three significantly compensated for the device resistance during ankle joint plantarflexion. In the gait tests, the exoskeleton was able to normalize ankle joint and foot segment kinematics, specifically foot inclination angle and ankle inversion angle at initial contact and ankle angle and clearance height during swing. Discussion: Our findings support the feasibility of the new ankle exoskeleton design in assisting two degrees of freedomat the ankle simultaneously and show its potential to assist people with dropfoot and excessive inversion. [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]

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]

This paper deals with the design and kinematic analysis of a novel mechanism for the elbow joint of an upper-limb exoskeleton, with the aim of helping operators, in terms of effort and physical resistance, in carrying out heavy operations. In particular, the proposed eight-bar elbow joint exoskeleton mechanism consists of a motorized Watt I six-bar linkage and a suitable RP dyad, which connects mechanically the external parts of the human arm with the corresponding forearm by hook and loop velcro, thus helping their closing relative motion for lifting objects during repetitive and heavy operations. This relative motion is not a pure rotation, and thus the upper part of the exoskeleton is fastened to the arm, while the lower part is not rigidly connected to the forearm but through a prismatic pair that allows both rotation and sliding along the forearm axis. Instead, the human arm is sketched by means of a crossed four-bar linkage, which coupler link is considered as attached to the glyph of the prismatic pair, which is fastened to the forearm. Therefore, the kinematic analysis of the whole ten-bar mechanism, which is obtained by joining the Watt I six-bar linkage and the RP dyad to the crossed four-bar linkage, is formulated to investigate the main kinematic performance and for design purposes. The proposed algorithm has given several numerical and graphical results. Finally, a double-parallelogram linkage, as in the particular case of the Watt I six-bar linkage, was considered in combination with the RP dyad and the crossed four-bar linkage by giving a first mechanical design and a 3D-printed prototype. [ABSTRACT FROM AUTHOR]

The current rehabilitation evaluation methods for patients with hand dysfunction face issues such as inconsistent standards and incomplete quantification processes. To address these challenges, this paper introduces a rehabilitation evaluation system that integrates various rehabilitation training modes and leverages an exoskeleton finger rehabilitation robot. This system is carefully designed and thoroughly analyzed based on the diverse training modes offered by the rehabilitation robot. Twenty stroke patients and six healthy subjects were recruited to perform grasping of static objects and gesture movement experiments, which were evaluated by Brunnstrom's motor evaluation and rehabilitation evaluation tests, respectively, and the results were compared. The experimental results showed that the results of the robotic rehabilitation evaluation of the 20 patients were consistent with the clinical Brunnstrom motor grades, which verified the accuracy of the rehabilitation evaluation system that was designed in this study. [ABSTRACT FROM AUTHOR]

Industrial wool textile production exposes workers mainly to the biomechanical loading of the shoulder joint. In this work context, which is characterized by poor machine ergonomics, exposure to biomechanical risk factors, and variable work organization, exoskeletons could facilitate work processes or could be a valuable means to protect workers from overuse injuries. Field evaluation is essential to verify the suitability of specific devices and their acceptance by users. As part of a pilot study, we examined the short-term subjective effects of a passive Arm-Support Exoskeleton (ASE) on workers performing repetitive overhead tasks. In a textile factory, eight workers participated in the study, answering questionnaires after carrying out a work session with (ASE) and without an exoskeleton (FREE). Participants had been using the Paexo exoskeleton for 4.2 ± 5.8 months (min 0–max 12). Subjective evaluations were collected regarding the workload (NASA-TLX) and relief (Borg's CR10 scale) obtained from the use of the exoskeleton, satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)), usability (System Usability Scale (SUS)), and opinions on the ergonomics of the device (Ergonomics questionnaire). Workers reported a high workload (NASA 7.2 ± 1.0 ) and assessed a 46% reduction in effort on the CR10 in ASE conditions compared to FREE. They expressed high satisfaction with most characteristics of the ASE (100% satisfied with durability and effectiveness), high level of usability (62% of scores above 80, out of a maximum score of 100), and ergonomics of the device ( 88 ± 12 , out of a maximum score of 110). In addition to the objective effects (electromyography (EMG) reduction) already demonstrated in a previous publication, these qualitative results demonstrate a positive perception by textile workers regarding the effectiveness, usability, and suitability of the exoskeleton. The adoption of ASE in the textile industry appears beneficial in the short term, but the impact associated with individual variables and long-term effects remains to be explored. [ABSTRACT FROM AUTHOR]

Logistics activities involve significant risk factors for the development of work-related musculoskeletal disorders (WMSD), particularly low back pain. Exoskeletons have emerged as potential solutions to mitigate these risks. This study assesses the short-term effects of dual passive back-support exoskeletons (Auxivo and Htrius) on WMSD risk factors in logistics operations. Two workstations were evaluated using self-report ratings, postural assessment, and surface electromyography (EMG). The results indicate that both exoskeletons provided relief and support during tasks, with Htrius showing a slight advantage. Exoskeletons reduced perceived exertion, especially during trunk flexion tasks, and improved posture, particularly in tasks involving manual lifting loads at lower height levels. While variations in muscular activity were observed, the Htrius exoskeleton showed a trend of reducing lumbar muscle activity. Overall, Htrius demonstrated promise in improving workers' comfort, safety, and efficiency, potentially reducing WMSD risk and muscular fatigue. However, individual preferences and workplace-specific characteristics should be considered when selecting exoskeleton models. Future research should explore the effects on different loads, genders, and EMG of different muscles to further enhance the understanding and application of exoskeletons in occupational contexts. [ABSTRACT FROM AUTHOR]

The restoration of fine motor function in the hand is crucial for stroke survivors with hemiplegia to reintegrate into daily life and presents a significant challenge in post-stroke rehabilitation. Current mirror rehabilitation systems based on wearable devices require medical professionals or caregivers to assist patients in donning sensor gloves on the healthy side, thus hindering autonomous training, increasing labor costs, and imposing psychological burdens on patients. This study developed a low-load wearable hand function mirror rehabilitation robotic system based on visual gesture recognition. The system incorporates an active visual apparatus capable of adjusting its position and viewpoint autonomously, enabling the subtle monitoring of the healthy side's gesture throughout the rehabilitation process. Consequently, patients only need to wear the device on their impaired hand to complete the mirror training, facilitating independent rehabilitation exercises. An algorithm based on hand key point gesture recognition was developed, which is capable of automatically identifying eight distinct gestures. Additionally, the system supports remote audio–video interaction during training sessions, addressing the lack of professional guidance in independent rehabilitation. A prototype of the system was constructed, a dataset for hand gesture recognition was collected, and the system's performance as well as functionality were rigorously tested. The results indicate that the gesture recognition accuracy exceeds 90% under ten-fold cross-validation. The system enables operators to independently complete hand rehabilitation training, while the active visual system accommodates a patient's rehabilitation needs across different postures. This study explores methods for autonomous hand function rehabilitation training, thereby offering valuable insights for future research on hand function recovery. [ABSTRACT FROM AUTHOR]

Relearning to walk requires progressive training in real scenarios—overground—along with assistance in basic tasks, such as balancing. In addition, user ability must be maximized through compliant robotic assistance as needed. Despite decades of research, gait rehabilitation robotic devices yield controversial results. This article presents the conceptual design of a novel walking assistance and rehabilitation robot, the NIMBLE robot, aimed at providing ambulatory, bodyweight-supported gait training, assisting the user's center of mass trajectory to aid weight transfer and dynamic balance during walking. NIMBLE consists of a robotic mobile frame, a partial bodyweight support (PBWS) system, an ambulatory lower-limb exoskeleton (Exo-H3) and a cable-driven pelvis-assisting robot. Designed as a modular structure, it differentiates hierarchical communication levels through a Robot Operating System (ROS) 2 network. We present the mechatronic design and experimental results assessing the impact of the mechatronic coupling between the robotic modules on the walking kinematics and the frame movement control performance. The robotic frame hardly affects the walking kinematics up to 2 degrees in both the sagittal and frontal planes, making it feasible for lateral balance and weight translation training. Moreover, it successfully tracks and follows user trajectories. The NIMBLE robotic frame assessment shows promising results for ambulatory gait rehabilitation. [ABSTRACT FROM AUTHOR]

The lower limb exoskeleton (LLE) plays an important role in production activities requiring assistance and load bearing. One of the challenges is to propose a control strategy that can meet the requirements of LLE trajectory tracking in different scenes. Therefore, this study proposes a control strategy (DBO–FPID) that combines the dung beetle optimizer (DBO) with feedforward proportional–integral–derivative controller (FPID) to improve the performance of LLE trajectory tracking in different scenes. The Lagrange method is used to establish the dynamic model of the LLE rod, and it is combined with the dynamic equations of the motor to obtain the LLE transfer function model. Based on the LLE model and target trajectory compensation, the feedforward controller is designed to achieve trajectory tracking in different scenes. To obtain the best performance of the controller, the DBO is utilized to perform offline parameter tuning of the feedforward controller and PID controller. The proposed control strategy is compared with the DBO tuning PID (DBO–PID), particle swarm optimizer (PSO) tuning FPID (PSO–FPID), and PSO tuning PID (PSO–PID) in simulation and joint module experiments. The results show that DBO–FPID has the best accuracy and robustness in trajectory tracking in different scenes, which has the smallest sum of absolute error (IAE), mean absolute error (MEAE), maximum absolute error (MAE), and root mean square error (RMSE). In addition, the MEAE of DBO–FPID is lower than 1.5 degrees in unloaded tests and lower than 3.6 degrees in the hip load tests, with only a few iterations, showing great practical potential. [ABSTRACT FROM AUTHOR]

Arm and hand function play a critical role in the successful completion of everyday tasks. Lost function due to neurological impairment impacts millions of lives worldwide. Despite improvements in the ability to assess and rehabilitate arm deficits, knowledge about underlying sources of impairment and related sequela remains limited. The comprehensive assessment of function requires the measurement of both biomechanics and neuromuscular contributors to performance during the completion of tasks that often use multiple joints and span three-dimensional workspaces. To our knowledge, the complexity of movement and diversity of measures required are beyond the capabilities of existing assessment systems. To bridge current gaps in assessment capability, a new exoskeleton instrument is developed with comprehensive bilateral assessment in mind. The development of the BiLateral Upper-limb Exoskeleton for Simultaneous Assessment of Biomechanical and Neuromuscular Output (BLUE SABINO) expands on prior iterations toward full-arm assessment during reach-and-grasp tasks through the development of a dual-arm and dual-hand system, with 9 active degrees of freedom per arm and 12 degrees of freedom (six active, six passive) per hand. Joints are powered by electric motors driven by a real-time control system with input from force and force/torque sensors located at all attachment points between the user and exoskeleton. Biosignals from electromyography and electroencephalography can be simultaneously measured to provide insight into neurological performance during unimanual or bimanual tasks involving arm reach and grasp. Design trade-offs achieve near-human performance in exoskeleton speed and strength, with positional measurement at the wrist having an error of less than 2 mm and supporting a range of motion approximately equivalent to the 50th-percentile human. The system adjustability in seat height, shoulder width, arm length, and orthosis width accommodate subjects from approximately the 5th-percentile female to the 95th-percentile male. Integration between precision actuation, human–robot-interaction force-torque sensing, and biosignal acquisition systems successfully provide the simultaneous measurement of human movement and neurological function. The bilateral design enables use with left- or right-side impairments as well as intra-subject performance comparisons. With the resulting instrument, the authors plan to investigate underlying neural and physiological correlates of arm function, impairment, learning, and recovery. [ABSTRACT FROM AUTHOR]

The fabric‐based pneumatic exosuit is now a hot research topic because it is lighter and softer than traditional exoskeletons. Existing research focuses more on the mechanical properties of the exosuit (e.g., torque and speed), but less on its wearability (e.g., appearance and comfort). This work presents a new design concept for fabric‐based pneumatic exosuits: volume transfer, which means transferring the volume of pneumatic actuators beyond the garment's profile to the inside. This allows for a concealed appearance and a larger stress area while maintaining adequate torques. In order to verify this concept, a fabric‐based pneumatic exosuit is developed for knee extension assistance. Its profile is only 26 mm and its stress area wraps around almost half of the leg. A mathematical model and simulation is used to determine the parameters of the exosuit, avoiding multiple iterations of the prototype. Experiment results show that the exosuit can generate a torque of 7.6 Nm at a pressure of 90 kPa and produce a significant reduction in the electromyography activity of the knee extensor muscles. It is believed that volume transfer can be utilized prevalently in future fabric‐based pneumatic exosuit designs to achieve a significant improvement in wearability. [ABSTRACT FROM AUTHOR]

Textiles are promising candidates for use in soft robots and wearable devices due to their inherent compliance, high versatility, and skin comfort. Planar fluidic textile‐based actuators exhibit low profile and high conformability, and can seamlessly integrate additional components (e.g., soft sensors or variable stiffness structures [VSSs]) to create advanced, multifunctional smart textile actuators. In this article, a new class of programmable, fluidic soft textile muscles (STMs) that incorporate multilayered silicone sheets with embedded fluidic channels is introduced. The STMs are scalable and fabricated by apparel engineering techniques, offering a fabrication approach able to create large‐scaled multilayered structures that can be challenging for current microfluidic bonding methods. They are also highly automation compatible due to no manual insertion of elastic tubes/bladders into textile structures. Liquid metal is employed for creating fluidic channels. It is not only used for actuation but also used as channels for additional features such as soft piezoresistive sensors with enhanced sensitivity to STMs' pressure‐induced elongation, or VSSs of either low‐melting‐point alloys or a new thermo‐responsive epoxy with low viscosity and transition temperature. The STMs hold promising prospects for soft robotic and wearable applications, which is demonstrated by an example of a textile‐based wearable 3D skin‐stretch haptic interface. [ABSTRACT FROM AUTHOR]

As the global prevalence of motor disabilities continues to rise, there is a pressing need for advanced solutions in physical rehabilitation. This systematic review examines the progress and challenges of implementing robotic technologies in the motor rehabilitation of patients with physical disabilities. The integration of robotic technologies such as exoskeletons, assistive training devices, and brain–computer interface systems holds significant promise for enhancing functional recovery and patient autonomy. The review synthesizes findings from the most important studies, focusing on the clinical effectiveness of robotic interventions in comparison to traditional rehabilitation methods. The analysis reveals that robotic therapies can significantly improve motor function, strength, co-ordination, and dexterity. Robotic systems also support neuroplasticity, enabling patients to relearn lost motor skills through precise, controlled, and repetitive exercises. However, the adoption of these technologies is hindered by high costs, the need for specialized training, and limited accessibility. Key insights from the review highlight the necessity of personalizing robotic therapies to meet individual patient needs, alongside addressing technical, economic, social, and cultural barriers. The review also underscores the importance of continued research to optimize these technologies and develop effective implementation strategies. By overcoming these challenges, robotic technologies can revolutionize motor rehabilitation, improving quality of life and social integration for individuals with motor disabilities. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted upper-limb rehabilitation has been studied for many years, with many randomised controlled trials (RCTs) investigating the effects of robotic-assisted training on affected limbs. The current trend directs towards end-effector devices. However, most studies have focused on the effectiveness of rehabilitation devices, but studies on device sizes are relatively few. Goal: Systematically review the effect of a portable rehabilitation robot (PRR) on the rehabilitation effectiveness of paralysed upper limbs compared with non-robotic therapy. Methods: A meta-analysis was conducted on literature that included the Fugl-Meyer Assessment (FMA) obtained from the PubMed and Web of Science (WoS) electronic databases until June 2023. Results: A total of 9 studies, which included RCTs, were completed and a meta-analysis was conducted on 8 of them. The analysis involved 295 patients. The influence on upper-limb function before and after treatment in a clinical environment is analysed by comparing the experimental group using the portable upper-limb rehabilitation robot with the control group using conventional therapy. The result shows that portable robots prove to be effective (FMA: SMD = 0.696, 95% = 0.099 to .293, p < 0.05). Discussion: Both robot-assisted and conventional rehabilitation effects are comparable. In some studies, PRR performs better than conventional rehabilitation, but conventional treatments are still irreplaceable. Smaller size with better portability has its advantages, and portable upper-limb rehabilitation robots are feasible in clinical rehabilitation. Conclusion: Although portable upper-limb rehabilitation robots are clinically beneficial, few studies have focused on portability. Further research should focus on modular design so that rehabilitation robots can be decomposed, which benefits remote rehabilitation and household applications. [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]

Upper limb exoskeleton rehabilitation devices can improve the quality of rehabilitation and relieve the pressure of rehabilitation medical treatment, which is a research hotspot in the field of medical robots. Aiming at the problems such as large volume, high cost, low comfort, and difficulty in promotion of traditional exoskeleton rehabilitation devices, and considering the lightweight, discontinuous, high flexibility, and high biomimetic characteristics of tensegrity structure, we designed an upper limb bionic exoskeleton rehabilitation device based on tensegrity structure. First, this article uses mapping methods to establish a mapping model for upper limb exoskeletons based on the tensegrity structure and designs the overall structure of upper limb exoskeletons based on the mapping model. Second, a bionic elbow joint device based on gear and rack was designed, and the stability of the bionic elbow joint was proved using the positive definite matrix method. This device can simulate the micro displacement between bones of the human elbow joint, improve the axial matching ability between the upper limbs and the rehabilitation device, and enhance the comfort of rehabilitation. Third, an impedance control scheme based on back propagation (BP) neural network was designed to address the low control accuracy of flexible structures and patient spasms. Finally, we designed the impedance control scheme of the PSO–BP neural network based on a fuzzy rehabilitation state evaluator. The experimental results show that the exoskeleton rehabilitation device has good flexion motion stability and assist ability and has significant advantages in volume and mobility. The control strategy proposed in this paper has high control precision and adaptive ability and has potential application value in the field of medical rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The current lower limb robotic exoskeleton training (LRET) for treating and managing stroke patients remains a huge challenge. Comprehensive ICF analysis and informative treatment options are needed. This review aims to analyze LRET' s efficacy for stroke patients, based on ICF, and explore the impact of intervention intensities, devices, and stroke phases. Methods: We searched Web of Science, PubMed, and The Cochrane Library for RCTs on LRET for stroke patients. Two authors reviewed studies, extracted data, and assessed quality and bias. Standardized protocols were used. PEDro and ROB2 were employed for quality assessment. All analyses were done with RevMan 5.4. Results: Thirty-four randomized controlled trials (1,166 participants) were included. For function, LRET significantly improved motor control (MD = 1.15, 95%CI = 0.29-2.01, p = 0.009, FMA-LE), and gait parameters (MD = 0.09, 95%CI = 0.03-0.16, p = 0.004, Instrumented Gait Velocity; MD = 0.06, 95%CI = 0.02-0.09, p = 0.002, Step length; MD = 4.48, 95%CI = 0.32-8.65, p = 0.04, Cadence) compared with conventional rehabilitation. For activity, LRET significantly improved walking independence (MD = 0.25, 95%CI = 0.02-0.48, p = 0.03, FAC), Gait Velocity (MD = 0.07, 95%CI = 0.03-0.11, p = 0.001) and balance (MD = 2.34, 95%CI = 0.21-4.47, p = 0.03, BBS). For participation, social participation (MD = 0.12, 95%CI = 0.03-0.21, p = 0.01, EQ-5D) was superior to conventional rehabilitation. Based on subgroup analyses, LRET improved motor control (MD = 1.37, 95%CI = 0.47-2.27, p = 0.003, FMA-LE), gait parameters (MD = 0.08, 95%CI = 0.02-0.14, p = 0.006, Step length), Gait Velocity (MD = 0.11, 95%CI = 0.03-0.19, p = 0.005) and activities of daily living (MD = 2.77, 95%CI = 1.37-4.16, p = 0.0001, BI) for the subacute patients, while no significant improvement for the chronic patients. For exoskeleton devices, treadmill-based exoskeletons showed significant superiority for balance (MD = 4.81, 95%CI = 3.10-6.52, p < 0.00001, BBS) and activities of daily living (MD = 2.67, 95%CI = 1.25-4.09, p = 0.00002, BI), while Over-ground exoskeletons was more effective for gait parameters (MD = 0.05, 95%CI = 0.02-0.08, p = 0.0009, Step length; MD = 6.60, 95%CI = 2.06-11.15, p = 0.004, Cadence) and walking independence (MD = 0.29, 95%CI = 0.14-0.44, p = 0.0002, FAC). Depending on the training regimen, better results may be achieved with daily training intensities of 45-60 min and weekly training intensities of 3 h or more. Conclusion: These findings offer insights for healthcare professionals to make effective LRET choices based on stroke patient needs though uncertainties remain. Particularly, the assessment of ICF participation levels and the design of time-intensive training deserve further study. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, Unique Identifier: CRD42024501750. [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]

Brain-computer interfaces (BCIs) have emerged as transformative tools for translating users' neural signals into commands for external devices. The urgent need for innovative treatments to enhance upper limb motor function in stroke survivors is underscored by the limitations of traditional rehabilitation methods. The development of communication and control technology for individuals with severe neuromuscular diseases, particularly stroke patients, is centered on utilizing electroencephalographic (EEG) signals to accurately decode users' intentions and operate external devices. Two healthy subjects and a stroke patient were enrolled to acquire EEG signals using the EMOTIV EPOC+ sensor. The experimental procedure involved recording five actions for both motor imagery and facial expression signals to control the 3D-printed upper limb exoskeleton. EEGLAB and BCILAB software were used for preprocessing and classification. The results showed successful EEG-based control of the exoskeleton, representing a significant advancement in assistive technology for individuals with motor impairments. The support vector machine (SVM) classifier achieved higher accuracy in both offline and online modes for both motor imaginary and facial expression tasks. The conclusion highlights the appropriateness of using EEGLAB for offline EEG data analysis and BCILAB for both offline and online analysis and classification. The integration of servo motors in the exoskeleton, allowing movements in five Degrees of Freedom (DOF), positions it as an effective rehabilitation solution for individuals with upper limb impairments. [ABSTRACT FROM AUTHOR]