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Stroke has a considerable incidence in the world population and would cause sequelae in the upper limbs. One way to increase the efficiency in the rehabilitation process of patients with these sequelae is through robot-assisted therapy. The present study developed a portable robotic orthosis called Pinotti Portable Robotic Exoskeleton (PPRE) and validated its functioning in clinical tests. The static and dynamic parts of the device modules are described. Design issues, such as heavyweight and engine positioning, have been optimized. The implementation of control was through a smartphone application that communicates with a microcontroller to perform desired movements. Four individuals with motor impairment of the upper limbs due to stroke performed clinical tests to validate the device. Participants did not mention pain, discomfort, tingling, and paresthesia. The robotic device showed the ability to perform the flexion and extension movements of the fingers and elbow. The PPRE was confirmed to be adequate and functional at different levels of motor impairment assessed. The orthosis presented advantages over the currently existing devices, concerning its biomechanical functioning, portability, comfort, and versatility. Thus, the apparatus has the great innovative potential to become a device for home use, serving as an aid to the therapist and facilitating the rehabilitation of patients after an injury. In a larger sample, future studies are needed to assess the effect of a robotic orthosis on the level of rehabilitation in individuals with upper limb impairment. [ABSTRACT FROM AUTHOR]

Survivors post stroke commonly have upper limb impairments. Patients can drive neural reorganization, brain recovery and return of function with task specific repetitive training (TSRT). Fifteen community independent stroke survivors (25-75 years, >6 months post stroke, Upper Limb Fugl Meyer [ULFM] scores 16-39) participated in this randomized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis (bilateral or unilateral) or a physical therapist. After 6 weeks of training (18 h), across all subjects, there were significant improvements in depression, flexibility, strength, tone, pain and voluntary movement (ULFM) (p < 0.05; effect sizes 0.49-3.53). Each training group significantly improved ULFM scores and range of motion without significant group differences. Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor hand control, activities of daily living or independence. [ABSTRACT FROM AUTHOR]

Powered lower limb orthoses have been commercially available for patients with Spinal Cord Injuries (SCI) or stroke. However, studies have shown that there are adverse effects on kinematics as well as metabolic energy of the users due to the additional mass of the orthoses to the lower limbs. Since additional metabolic energy required to use the powered orthoses is one of the reasons to avoid using them, it is important to reduce the mass and moment of inertia of the exoskeletons for longer use and better outcomes. In this study, a powered-lower-limb orthosis for stroke patients using a cable-differential mechanism, which is called COWALK-Mobile 2, was proposed. The cable-differential mechanism was utilized to transmit the actuating torques from actuators to the hip and knee joints. The cable-differential mechanism enabled the actuators to be located near the hip, which yields reduced inertia of the device, as well as the loads at the joints to be shared by the actuators, which results in smaller required actuator torque. Optimal radii of the pulleys for the cable-differential mechanism were found for efficient load-sharing during walking. Experimental results with a healthy person walking on a level surface have shown that larger joint torques were generated with smaller actuator torques.

Background: Transfemoral amputation is a serious intervention that alters the locomotion pattern, leading to secondary disorders and reduced quality of life. The outcomes of current gait rehabilitation for TFAs seem to be highly dependent on factors such as the duration and intensity of the treatment and the age or etiology of the patient. Although the use of robotic assistance for prosthetic gait rehabilitation has been limited, robotic technologies have demonstrated positive rehabilitative effects for other mobility disorders and may thus offer a promising solution for the restoration of healthy gait in TFAs. This study therefore explored the feasibility of using a bilateral powered hip orthosis (APO) to train the gait of community-ambulating TFAs and the effects on their walking abilities.Methods: Seven participants (46-71 years old with different mobility levels) were included in the study and assigned to one of two groups (namely Symmetry and Speed groups) according to their prosthesis type, mobility level, and prior experience with the exoskeleton. Each participant engaged in a maximum of 12 sessions, divided into one Enrollment session, one Tuning session, two Assessment sessions (conducted before and after the training program), and eight Training sessions, each consisting of 20 minutes of robotically assisted overground walking combined with additional tasks. The two groups were assisted by different torque-phase profiles, aiming at improving symmetry for the Symmetry group and at maximizing the net power transferred by the APO for the Speed group. During the Assessment sessions, participants performed two 6-min walking tests (6mWTs), one with (Exo) and one without (NoExo) the exoskeleton, at either maximal (Symmetry group) or self-selected (Speed group) speed. Spatio-temporal gait parameters were recorded by commercial measurement equipment as well as by the APO sensors, and metabolic efficiency was estimated via the Cost of Transport (CoT). Additionally, kinetic and kinematic data were recorded before and after treatment in the NoExo condition.Results: The one-month training protocol was found to be a feasible strategy to train TFAs, as all participants smoothly completed the clinical protocol with no relevant mechanical failures of the APO. The walking performance of participants improved after the training. During the 6mWT in NoExo, participants in the Symmetry and Speed groups respectively walked 17.4% and 11.7% farther and increased walking speed by 13.7% and 17.9%, with improved temporal and spatial symmetry for the former group and decreased energetic expenditure for the latter. Gait analysis showed that ankle power, step width, and hip kinematics were modified towards healthy reference levels in both groups. In the Exo condition metabolic efficiency was reduced by 3% for the Symmetry group and more than 20% for the Speed group.Conclusions: This study presents the first pilot study to apply a wearable robotic orthosis (APO) to assist TFAs in an overground gait rehabilitation program. The proposed APO-assisted training program was demonstrated as a feasible strategy to train TFAs in a rehabilitation setting. Subjects improved their walking abilities, although further studies are required to evaluate the effectiveness of the APO compared to other gait interventions. Future protocols will include a lighter version of the APO along with optimized assistive strategies. [ABSTRACT FROM AUTHOR]

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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]

In recent technological advancements, designing of exoskeleton have gained attraction from various scientists and researchers across the world. Exoskeletons are assistive devices which are used by the subjects with limb impairments. Various trajectory tracking control schemes have been developed in the past, however there are several challenges like human machine interaction, external disturbances and model uncertainties present that should be handled in the efficient designing of a controller. This paper deals with the development of 2-link lower limb extremity manipulator for rehabilitation purposes in bio-medical engineering. A novel control strategy is proposed to track the desired trajectory for assistive devices using the robust adaptive sliding mode controller coupled with Radial Basis Function (RBF) neural network and fuzzy techniques for function approximation. The simulations are carried out on a musculoskeletal model Gait2354 which can be scaled according to the physical dimensions of the experimental subject developed in OpenSim software. The controller designed is robust in terms of uncertainties and disturbances present in the system and reduces chattering problems. In addition, Minimum Learning Parameter is also incorporated in the system which reduces the number of parameters to only one, thereby reducing the computational cost and enhancing the real time performance of the system. For validation of the proposed model, Matlab Simulink environment is used. The different performance index parameters used in comparative analysis are Integral Absolute Error (IAE), Integral Square Error (ISE), Integral Time Absolute Error (ITAE) and Integral Time Square Error (ITSE). The simulation results show that SMC-RBF network has better performance and tracking rate as compared to other controllers implemented. The results obtained were also compared with the existing method to prove their effectiveness. The simulation results obtained ensures to provide effective and comfortable rehabilitation services for lower limb extremity in the future. [ABSTRACT FROM AUTHOR]

Introduction: Electromechanically-assisted gait training has been introduced in stroke rehabilitation as a means to enable gait training with a large number of reproducible and symmetrical task repetitions, i.e. steps. However, few studies have evaluated its impact on gait pattern functions. This study includes persons with no independent ambulation function at the start of a 4-week neurorehabilitation period in the sub-acute phase after stroke. The primary aim of the study was to evaluate whether the addition of electromechanically-assisted gait training to conventional training resulted in better gait pattern function than conventional training alone. The secondary aim was to identify correlations between overall gait quality and standardized clinical assessments. Participants and methods: Seventeen patients with no independent ambulation function who participated in a Prospective Randomized Open Blinded End-point study in the sub-acute phase after stroke were randomized into two groups; one group (n = 7) to undergo conventional training only (CONV group) and the other group (n = 10) to undergo conventional training with additional electromechanically-assisted gait training (HAL group). All patients were assessed with 3D gait analysis and clinical assessments after the 4-week intervention period. Overall gait quality as per the Gait Profile Score (GPS), as well as kinematic, and kinetic and other spatiotemporal metrics were collected and compared between intervention groups. Correlations between biomechanical and clinical outcomes were evaluated. Results: Both the CONV and HAL groups exhibited similar gait patterns with no significant differences between groups in any kinematic, kinetic parameters or other spatiotemporal metrics. The GPS for the paretic limb had a median (IQR) of 12.9° (7.8°) and 13.4° (4.3°) for the CONV and HAL groups, respectively (p = 0.887). Overall gait quality was correlated with independence in walking, walking speed, movement function and balance. We found no added benefit in gait pattern function from the electromechanically-assisted gait training compared to the conventional training alone. Discussion: This finding raises new questions about how to best design effective and optimal post-stroke rehabilitation programs in patients with moderate to severe gait impairments to achieve both independent walking and optimal gait pattern function, and about which patients should be in focus in further studies on the efficacy of electromechanically-assisted gait training. [ABSTRACT FROM AUTHOR]

This review aims to characterize the current landscape of exoskeletons designed to promote medical care and occupational safety in industrial settings. Extensive exploration of scientific databases spanning industries, health, and medicine informs the classification of exoskeletons according to their distinctive attributes and specific footholds on the human physique. Within the scope of this review, a comprehensive analysis is presented, contextualizing the integration of exoskeletons based on different work activities. The reviewers extracted the most relevant articles published between 2008 and 2023 from IEEE, Proquest, PubMed, Science Direct, Scopus, Web of Science, and other databases. In this review, the PRISMA-ScR checklist was used, and a Cohen's kappa coefficient of 0.642 was applied, implying moderate agreement among the reviewers; 75 primary studies were extracted from a total of 344. The future of exoskeletons in contributing to occupational health and safety will depend on continued collaboration between researchers, designers, healthcare professionals, and industries. With the continued development of technologies and an increasing understanding of how these devices interact with the human body, exoskeletons will likely remain valuable for improving working conditions and safety in various work environments. [ABSTRACT FROM AUTHOR]

Background: Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis. Methods: This study introduces the design, implementation, and clinical evaluation of the NuroSleeve, a user-centered hybrid device that incorporates a lightweight, easy to don and doff 3D-printed motorized UE orthosis and a functional electrical stimulation (FES) component. Our primary goals are to develop a customized hybrid device that individuals with UE neuromuscular impairment can use to perform ADLs and to evaluate the benefits of incorporating the device into occupational therapy sessions. The trial is designed as a prospective, open-label, single-cohort feasibility study of eight-week sessions combined with at-home use of the device and implements an iterative device design process where feedback from participants and therapists informs design improvement cycles. Results: All participants learned how to independently don, doff, and use the NuroSleeve in ADLs, both in clinical therapy and in their home environments. All participants showed improvements in their Canadian Occupational Performance Measure (COPM), which was the primary clinical trial outcome measure. Furthermore, participants and therapists provided valuable feedback to guide further development. Conclusions: Our results from non-clinical testing and clinical evaluation demonstrate that the NuroSleeve has met feasibility and safety goals and effectively improved independent voluntary function during ADLs. The study's encouraging preliminary findings indicate that the NuroSleeve has met its technical and clinical objectives while improving upon the limitations of the existing UE orthoses owing to its personalized and flexible approach to hardware and firmware design. Trial Registration: ClinicalTrials.gov identifier: NCT04798378, https://clinicaltrials.gov/ct2/show/NCT04798378, date of registration: March 15, 2021. [ABSTRACT FROM AUTHOR]

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery. [ABSTRACT FROM AUTHOR]

Although Cable-driven rehabilitation devices (CDRDs) have several advantages over traditional link-driven devices, including their light weight, ease of reconfiguration, and remote actuation, the majority of existing lower-limb CDRDs are limited to rehabilitation in the sagittal plane. In this work, we proposed a novel three degrees of freedom (DOF) lower limb model which accommodates hip abduction/adduction motion in the frontal plane, as well as knee and hip flexion/extension in the sagittal plane. The proposed model was employed to investigate the feasibility of using bi-planar cable routing to track a bi-planar reference healthy trajectory. Various possible routings of four cable configurations were selected and studied with the 3DOF model. The optimal locations of the hip cuffs were determined using optimization. When compared with the five-cable routing configuration, the four-cable routing produced higher joint forces, which motivated the future study of other potential cable routing configurations and their ability to track bi-planar motion. [ABSTRACT FROM AUTHOR]

Medical and rehabilitation exoskeletons are being increasingly considered by therapists when choosing a treatment for individuals affected by lower limb impairments. Although all such exoskeletons seem to provide similar features and performance, there are, in practice, significant differences among them in terms of maximum walking speed, maximum torque, weight, autonomy, interaction with the user, or even the way to use it. In this review, the state of the art of the main commercial exoskeletons is described, while analyzing their properties, advantages, and disadvantages. Three groups are considered: complete exoskeletons, partial exoskeletons and open lines of research. A comparative analysis between them is performed while considering the main scientific and technical aspects to be improved. In conclusion to this analysis, the balance between feasibility and innovation in exoskeletons development is a design challenge. Commercial exoskeletons must fulfil standards whilst ensuring their safety and robustness. However, achieving a new generation of exoskeletons means a need to implement new hardware paradigms, and to enhance control strategies focused on assist-as-needed scheme. Finally, some aspects to improve current designs of the exoskeleton are presented. [ABSTRACT FROM AUTHOR]

Stroke disease leads to a partial or complete disability affecting muscle strength and functional mobility. Early rehabilitation sessions might induce neuroplasticity and restore the affected function or structure of the patients. Robotic rehabilitation minimizes the burden on therapists by providing repetitive and regularly monitored therapies. Commercial exoskeletons have been found to assist hip and knee motion. For instance, unilateral exoskeletons have the potential to become an effective training system for patients with hemiparesis. However, these robotic devices leave the ankle joint unassisted, essential in gait for body propulsion and weight-bearing. This article evaluates the effects of the robotic ankle orthosis T-FLEX during cooperative assistance with the AGoRA unilateral lower-limb exoskeleton (hip and knee actuation). This study involves nine subjects, measuring muscle activity and gait parameters such as stance and swing times. The results showed a reduction in muscle activity in the Biceps Femoris of 50%, Lateral Gastrocnemius of 59% and Tibialis Anterior of 35% when adding T-FLEX to the AGoRA unilateral lower-limb exoskeleton. No differences were found in gait parameters. Nevertheless, stability is preserved when comparing the two legs. Future works should focus on evaluating the devices in ground tests in healthy subjects and pathological patients. [ABSTRACT FROM AUTHOR]

In recent decades, the field of physical rehabilitation, with the help of robotic systems that aid the population of any age with locomotor difficulties, has been evolving rapidly. Several robotic exoskeleton systems of the lower limbs have been proposed in the patent literature and some are even commercially available. Given the above, we are asking ourselves at the end of the COVID-19 pandemic: how much has this pandemic affected both the publication of patents and the application of new ones? How has new patents' publication volume or application in robotic exoskeleton systems changed? We hypothesize that this pandemic has caused a reduction in the volume of new applications and possibly publications. We compare pandemic analysis and the last decade's analysis to answer these questions. In this study, we used a set of statistical tests to see if there were any statistically significant changes. Our results show that the pandemic had at least one effect on applying for new patents based on the information analyzed from the three databases examined. [ABSTRACT FROM AUTHOR]

Featured Application: Precise and accurate lower limb rehabilitation in the form of locomotion assistance and gait training through robust control of robotic exoskeletons. Rehabilitation in the form of locomotion assistance and gait training through robotic exoskeletons requires both precision and accuracy to achieve effective results. The essential challenge is to ensure robust tracking of the reference signal, i.e., of the gait or locomotion. This paper presents the design of model-based (MB) and model-free (MF) robust control strategies to achieve desired performance and robustness in terms of transient behavior and steady-state/tracking error, implementable to the locomotion assistance and gait training by exoskeletons. The dynamic responses of the exoskeleton system were investigated with both the control strategies. The study was carried out with a variety of reference signals and performance was evaluated to identify the best suited approach for rehabilitation exoskeletons. In case of the model-based control, a mathematical model of the system was developed using a bond graph modeling technique and a lead compensated H-infinity reference gain controller was designed to ensure robust tracking performance. In the model-free control strategy, however, the system function is approximated using radial basis function neural networks (RBFNNs) and an adaptive proportional-derivative RBFNN controller was designed to achieve the desired results with minimum tracking error. Both strategies make the system robust and stable. However, the MF control strategy is faster for all reference inputs as compared to the MB control strategy i.e., faster to approach the peak value and settle, and rapidly approaches the zero steady-state/tracking error. The rise time in the case of a sinusoidal input for model-free control is 0.4 s faster than the rise time in model-based control. Similarly, the settling time is 3.9 s faster in the case of model-free control, which is a prominent difference and can provide better rehabilitation results. [ABSTRACT FROM AUTHOR]

In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals’ quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations. [ABSTRACT FROM AUTHOR]

Lower limb exoskeleton which augments the human performance is a wearable human–machine integrated system used to assist people carrying heavy loads. Recently, underactuated lower limb exoskeleton systems with some passive joints become more and more attractive due to the advantages of smaller weight, lower system energy consumption and lower cost. However, because of the less of control inputs, the existed control methods of fully actuated exoskeletons cannot be extended to underactuated systems, which makes the robust controller design of underactuated lower limb exoskeletons becomes more challenged. This article focuses on the high-performance human–machine interaction force control design of underactuated lower limb exoskeletons with passive ankle joint. In order to solve the reduction of control inputs, the holonomic constraint from the wearer is considered, which help transform the dynamics of 3-degree-of-freedom underactuated exoskeleton in joint space into a 2-degree-of-freedom fully actuated system in Cartesian space. A two-level interaction force controller using adaptive robust control algorithm is proposed to effectively address the negative effect of various model uncertainties and external disturbances. In order to facilitate the control parameter selection, a gain tuning method is also presented. Comparative simulations are carried out, which indicate that the proposed two-level interaction force controller achieves smaller interaction force and better robust performance to various modeling errors and disturbances. [ABSTRACT FROM AUTHOR]

Background: Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. Method: Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. Experiment: Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. Result: Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. Conclusion: Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. Clinical trial registration: KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310&ltype=&rtype= [ABSTRACT FROM AUTHOR]

With the widespread development of leg exoskeletons to provide external force-based repetitive training for gait rehabilitation, the prospect of undesired movement adaptation due to applied forces and imposed constraints require adequate investigation. A cable-driven leg exoskeleton, CDLE, presents a lightweight, flexible, and redundantly actuated architecture that enables the possibility of system parameters modulation to alter human–robot interaction while applying the desired forces. In this work, multi-joint stiffness performance of CDLE is formulated to systematically analyze human–CDLE interaction. Further, potential alterations in CDLE architecture are presented to tune human–CDLE interaction that favors the desired human leg movement during a gait rehabilitation paradigm. [ABSTRACT FROM AUTHOR]

Utilizing exoskeleton devices to help elderly or empower workers is a growing field of research in robotics. The structure of an exoskeleton can vary depending on user's physical dimensions, joints or muscles targeted for assistance, and maximum achievable actuator torque. In this research, a Human-Model-In-the-Loop (HMIL) constrained optimization technique is proposed to design the RoboWalk lower-limb exoskeleton. RoboWalk is an under-actuated non-anthropomorphic assistive robot, that besides applying the desired assistive force, exerts an undesirable disturbing force leading to the user's fall. The HMIL method uses the augmented human-robot 2D model to take RoboWalk and human body's joint torques into account during optimization. The superiority of HMIL method is proven by comparing the results with other strategies in the literature. Obtained results reveal elimination of the disturbing forces, 2 N.m. reduction in average human knee-joint torque, and significant decrease in the actuator required torque. [ABSTRACT FROM AUTHOR]

As wearable assistive devices, such as prostheses and exoskeletons, become increasingly sophisticated and effective, the mental workload associated with their use remains high and becomes a major challenge to their ecological use and long-term adoption. Numerous methods of measuring mental workload co-exist, making analysis of this research topic difficult. The aim of this review is to examine how mental workload resulting from the use of wearable assistive devices has been measured, in order to gain insight into the specific possibilities and limitations of this field. Literature searches were conducted in the main scientific databases and 60 articles measuring the mental workload induced by the use of a wearable assistive device were included in this study. Three main families of methods were identified, the most common being 'dual task' and 'subjective assessment' methods, followed by those based on 'physiological measures', which included a wide variety of methods. The variability of the measurements was particularly high, making comparison difficult. There is as yet no evidence that any particular method of measuring mental workload is more appropriate to the field of wearable assistive devices. Each method has intrinsic limitations such as subjectivity, imprecision, robustness or complexity of implementation or interpretation. A promising metric seems to be the measurement of brain activity, as it is the only method that is directly related to mental workload. Finally, regardless of the measurement method chosen, special attention should be paid to the measurement of mental workload in the context of wearable assistive devices. In particular, certain practical considerations, such as ecological situations and environments or the level of expertise of the participants tested, may be essential to ensure the validity of the mental workload assessed. [ABSTRACT FROM AUTHOR]

This study aimed to assess the outcome of acute and chronic participants with spinal cord injury (SCI) after 12 weeks of bodyweight supported treadmill training (BWSTT) with a hybrid assistive limb exoskeleton (HAL). Acute participants were defined as ≤12 months between SCI and training, chronic participants >12 months between SCI and training. We assessed whether HAL-assisted BWSTT is advantageous for acute and chronic participants and if length of time post injury impacts the outcome of HAL-assisted BWSTT. As the primary outcome, we assessed the time needed for the 10 meter walk test (10MWT). Hundred and twenty-one individuals participated in a 12-week HAL-assisted BWSTT five times a week. We regularly conducted a 10MWT, a 6 minute walk test (6MWT), and assessed the walking index for spinal cord injury (WISCI II) and lower extremity motor score (LEMS) to evaluate the gait performance without the exoskeleton. Distance and time were recorded by the treadmill while the participant was walking with the exoskeleton. All participants benefit from the 12-week HAL-assisted BWSTT. A significant difference between acute and chronic participants' outcomes was found in 6MWT, LEMS, and WISCI II, though not in 10MWT. Although chronic participants improved significantly lesser than acute participants, they did improve their outcome significantly compared to the beginning. Hybrid assistive limb-assisted BWSTT in the rehabilitation of patients with SCI is advantageous for both acute and chronic patients. We could not define a time related cut-off threshold following SCI for effectiveness of HAL-assisted BWSTT. [ABSTRACT FROM AUTHOR]

This article analyzes the current state of studies of aspects of the neurophysiological control of parameters of atypical postures in humans associated with the use of external exoskeleton-type devices. The main results of studies in the last five years relate to the formation of scientific concepts of neurophysiological rearrangements of the motor control system on use of robotic devices. The resulting information can be used in sports physiology, motor rehabilitation, development of upper and lower limb exoskeletons, organizing the work of operators, and training to specific movements. [ABSTRACT FROM AUTHOR]

Background: Many lower-limb exoskeletons have been developed to assist gait, exhibiting a large range of control methods. The goal of this paper is to review and classify these control strategies, that determine how these devices interact with the user.Methods: In addition to covering the recent publications on the control of lower-limb exoskeletons for gait assistance, an effort has been made to review the controllers independently of the hardware and implementation aspects. The common 3-level structure (high, middle, and low levels) is first used to separate the continuous behavior (mid-level) from the implementation of position/torque control (low-level) and the detection of the terrain or user's intention (high-level). Within these levels, different approaches (functional units) have been identified and combined to describe each considered controller.Results: 291 references have been considered and sorted by the proposed classification. The methods identified in the high-level are manual user input, brain interfaces, or automatic mode detection based on the terrain or user's movements. In the mid-level, the synchronization is most often based on manual triggers by the user, discrete events (followed by state machines or time-based progression), or continuous estimations using state variables. The desired action is determined based on position/torque profiles, model-based calculations, or other custom functions of the sensory signals. In the low-level, position or torque controllers are used to carry out the desired actions. In addition to a more detailed description of these methods, the variants of implementation within each one are also compared and discussed in the paper.Conclusions: By listing and comparing the features of the reviewed controllers, this work can help in understanding the numerous techniques found in the literature. The main identified trends are the use of pre-defined trajectories for full-mobilization and event-triggered (or adaptive-frequency-oscillator-synchronized) torque profiles for partial assistance. More recently, advanced methods to adapt the position/torque profiles online and automatically detect terrains or locomotion modes have become more common, but these are largely still limited to laboratory settings. An analysis of the possible underlying reasons of the identified trends is also carried out and opportunities for further studies are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Disturbances of balance control are common after stroke, affecting the quality of gait and increasing the risk of falls. Because balance and gait disorders may persist also in the chronic stage, reducing individual independence and participation, they represent primary goals of neurorehabilitation programs. For this purpose, in recent years, numerous technological devices have been developed, among which one of the most widespread is the Lokomat®, an actuated exoskeleton that guide the patient's limbs, simulating a symmetrical bilateral gait. Preliminary evidence suggests that beyond gait parameters, robotic assisted gait training may also improve balance. Therefore, the aim of this systematic review was to summarize evidence about the effectiveness of Lokomat® in improving balance in stroke patients. Methods: Randomized controlled trials published between January 1989 and August 2020, comparing Lokomat® training to conventional therapy for stroke patients, were retrieved from seven electronic databases. Balance, assessed by means of validated clinical scales, was considered as outcome measure. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the studies. The study protocol was registered on PROSPERO (no. CRD42020197531). Results: After the removal of the duplicates, according to the inclusion criteria, 13 studies were selected, involving 445 subacute or chronic stroke patients. Eleven papers contributed to three meta-analyses. Favorable results for recovery of balance in stroke survivors treated with Lokomat® were shown using Timed Up and Go (pooled mean difference = −3.40, 95% CI −4.35 to −2.44; p < 0.00001) and Rivermead Mobility Index as outcome measures (pooled mean difference = 0.40, 95% CI 0.26–0.55; p < 0.00001). Inconclusive results were found when balance was measured by means of the Berg Balance Scale (pooled mean difference = 0.17, 95% CI −0.26 to 0.60; p = 0.44). Conclusions: Overall, most studies have shown beneficial effects of Lokomat® on balance recovery for stroke survivors, at least comparable to conventional physical therapy. However, due to the limited number of studies and their high heterogeneity, further research is needed to draw more solid and definitive conclusions. [ABSTRACT FROM AUTHOR]

Purpose: Exoskeleton robots generally have multi-functions and one such function is doing rehabilitation therapy in upper limb and lower limb in stroke-affected patients. A novel hybrid (serial-parallel) robot manipulator was proposed in this paper for rehabilitation of upper limb and its kinematics are studied systematically. This robot manipulator intends to perform wrist flexion, wrist extension, wrist radial deviation, wrist ulnar deviation, elbow flexion, elbow extension, elbow pronation and elbow supination motions. The contemporary mechanical designs especially the kinematic structure of upper limb exoskeleton robots have a unique feature that is, almost all of them use serial manipulators, and few others used parallel manipulators. The kinematic structure of the proposed robot is that of a hybrid manipulator (two parallel manipulators connected in series) which has 4-degrees-of-freedom. It is composed of an upper 3SPS-type parallel manipulator and 2SPR-type parallel manipulator connected in series. Methods: The Jacobian and Hessian Matrix method was used to derive the manipulator kinematic formula for solving the displacement, velocity and acceleration. Results: A 3D model of the robotic arm was constructed and analyzed by simulation. The positioning workspace of manipulator was constructed and analyzed. Conclusions: The 3SPS-type parallel manipulator has good kinematic characteristics while performing wrist motions. The 2SPR-type parallel manipulator produced singular configuration, while performing the desired rehabilitation elbow motions, it was found to not be suitable for usage in performing rehabilitation therapy in stroke-affected patients. [ABSTRACT FROM AUTHOR]

Upright-legged locomotion is a desirable ability for people with paraplegia. This paper introduces a newly developed lightweight powered exoskeleton (LIPE) for level walking and posture transfer of people with paraplegia using a user-centered design concept, which integrates the requirements of practical use, mechanical structure, and control system. The LIPE was evaluated with two subjects through several experimental tasks including kinematics and dynamics analysis in a local hospital. Results of functional evaluation showed that these subjects received the exoskeleton intervention well and the LIPE could provide appropriate gait assistance to the wearer during level walking, it could also help the wearer achieve the posture transfer from sitting to standing or from standing to sitting independently. Moreover, an endurance test also indicated that LIPE allows wearers to use it continuously for a long time. It is lightweight, cost effective, easy to use, and practical for people with paraplegia in their daily lives. [ABSTRACT FROM AUTHOR]

In this paper, a novel hybrid optimal Adaptive High-Order Super Twisting Sliding Mode (AHOSTWSM) impedance control is proposed for a lower limb exoskeleton robot with 7 active joints, which takes the interaction forces between the robot and the user into account. First, the dynamic model of the robot is extracted using Lagrange approach. Then, an adaptive super twisting sliding mode controller is designed based on Lyapanov theory. Moreover, the interaction forces are obtained in every time-step and applied to the robot as a compensating torque to guard against disturbances. The desired trajectory of the upper limb joint has been extracted so that the stability of the robot is achieved based on Zero Moment Point (ZMP) criterion at any moment. Moreover, to achieve optimal performance (maximum stability, minimum tracking error, reduced interacting forces, and optimal energy consumption), parameters of the proposed controller, the upper limb desired trajectory, and the impedance system are optimized using Harmony Search Algorithm (HSA). Finally, in order to demonstrate the effectiveness of the proposed controller, optimal sliding mode controller (SMC) is designed and performance of the AHOSTWSM is compared with SMC. The simulation results reveal the superiority of the controller in comparison with SMC. [ABSTRACT FROM AUTHOR]

Background: Compared with traditional physical therapy for stroke patients, lower extremity exoskeletons can provide patients with greater endurance and more repeatable and controllable training, which can reduce the therapeutic burden of the therapist. However, most exoskeletons are expensive, heavy or require active power to be operated. Therefore, a lighter, easy to wear, easy to operate, low-cost technology for stroke rehabilitation would be a welcome opportunity for stroke survivors, caregivers and clinicians. One such device is the Kickstart Walk Assist system and the purpose of this study was to determine feasibility of using this unpowered exoskeleton device in a sample of stroke survivors.Methods: Thirty stroke survivors were enrolled in the study and experienced walking with the Kickstart exoskeleton device that provided spring-loaded assistance during gait. After 5 days of wearing the exoskeleton, participants were evaluated in the two states of wearing and not wearing the exoskeleton. Outcome measures included: (a) spatio-temporal gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire.Results: In comparison to not wearing the device, when participants wore the Kickstart walking system, weight bearing asymmetry was reduced. The time spent on the 10-m walk test was also reduced, but there was no difference in the timed-up-and-go test (TUGT). Gait analysis data showed reduction in step time and double support time. Stroke survivors were positive about the Kickstart walking system's ability to improve their balance, speed and gait. In addition, their confidence level and willingness to use the device was also positive.Conclusions: These findings show the feasibility of using the Kickstart walking system for improving walking performance in stroke survivors. Our future goal is to perform a longer duration study with more comprehensive pre- and post-testing in a larger sample of stroke survivors. Trial registration Chinese Clinical Trial Registry, ChiCTR2000032665. Registered 5 May 2020-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=53288. [ABSTRACT FROM AUTHOR]

The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human-robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots. [ABSTRACT FROM AUTHOR]

The surface electromyography (sEMG) signal has been used for volitional control of robotic assistive devices. There are still challenges in improving system performance accuracy and signal processing to remove systematic noise. This study presents procedures and a pilot validation of the EMG-driven speed-control of exoskeleton and integrated treadmill with a goal to provide better interaction between a user and the system. The gait cycle duration (GCD) was extracted from sEMG signals using the autocorrelation algorithm and Bayesian fusion algorithm. GCDs of various walking speeds were then programmed to control the motion speed of exoskeleton robotic system. The performance and efficiency of this sEMG-controlled robotic assistive ambulation system was tested and validated among 6 healthy volunteers. The results demonstrated that the autocorrelation algorithm extracted the GCD from individual muscle contraction. The GCDs of individual muscles had variability between different walking steps under a designated walking speed. Bayesian fusion algorithms processed the GCDs of multiple muscles yielding a final GCD with the least variance. The fused GCD effectively controlled the motion speeds of exoskeleton and treadmill. The higher amplitude of EMG signals with shorter GCD was found during a faster walking speed. The algorithms using fused GCDs and gait stride length yielded trajectory joint motion tracks in a shape of sine curve waveform. The joint angles of the exoskeleton measured by a decoder mounted on the hip turned out to be in sine waveforms. The hip joint motion track of the exoskeleton matched the angles projected by trajectory curve generated by computer algorithms based on the fused GCDs with high agreement. The EMG-driven speed-control provided the human-machine inter-limb coordination mechanisms for an intuitive speed control of the exoskeleton-treadmill system at the user's intents. Potentially the whole system can be used for gait rehabilitation of incomplete spinal cord hemispheric stroke patients as goal-directed and task-oriented training tool. [ABSTRACT FROM AUTHOR]

As passive rehabilitation training with fixed trajectory ignores the active participation of patients, in order to increase the active participation of patients and improve the effect of rehabilitation training, this paper proposes an innovative adaptive sliding mode variable admittance (ASMVA) controller for the Lower Limb Rehabilitation Exoskeleton Robot. The ASMVA controller consists of an outer loop with variable admittance controller and an inner loop with an adaptive sliding mode controller. It estimates the wearer's active muscle strength and movement intention by judging the deviation between the actual and standard interaction force of the wearer's leg and the exoskeleton, thereby adaptively changing admittance controller parameters to alter training intensity. Three healthy volunteers engaged in further experimental studies, including trajectory tracking experiments with no admittance, fixed admittance, and variable admittance adjustment. The experimental results show that the proposed ASMVA control scheme has high control accuracy. Besides, the ASMVA can not only increase training intensity according to the active muscle strength of the patient during positive movement intention (so as to increase active participation of the patient), but also increase the amount of trajectory adjustment during negative movement intention to ensure the safety of the patient. [ABSTRACT FROM AUTHOR]

This paper describes the development of an angle-sensorless exoskeleton with a tap water-driven artificial muscle actuator. The artificial muscle actuator consisted of an elastic rubber tube reinforced by braided fiber. Such actuators are highly flexible, lightweight, and water-resistant, and thus are inherently safe even for operations in direct contact with humans. An estimation system for the displacement of the artificial muscle actuator based on the water flow rates detected by flowmeters was constructed for the water-hydraulic exoskeleton. In addition, estimators of the velocity and acceleration of the actuator based on the estimated displacement and the measured flow rates were derived and incorporated into the estimation system. With this system, our previous wearable upper-limb assistive exoskeleton prototype was converted into an angle-sensorless version with higher safety in wet conditions. Its assistive performance was evaluated through experiments with research participants. Experimental results demonstrated that muscle activity could be reduced, although an assistive control strategy was executed with the variables estimated, excluding force. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to design a lower limb exoskeleton to enhance hemiplegic patient's muscle strength and help the affected side return to normal gait after a long period of training. Design/methodology/approach: A wire rope-driven exoskeleton that combines rigid bracket and flexible driven method was presented to assist the patients with rehabilitative walking training. By using three noncontact cameras, the patient's gait was captured and the target trajectory of the affected side was analyzed. Meanwhile, a controlling strategy of the affected side, which mimics the gait of the healthy side, was developed to help hemiplegic patients with varying degrees of hemiplegic gait obtain personalized walking rehabilitation training. Findings: The results show that the hemiplegic gait of hip excessive abduction and strephenopodia was prevented. After wearing the exoskeleton, the movement trajectories of both sides of the lower limb were approximately identical. Based on the controlling strategy, the exoskeleton can correct the impaired gait and provide assistance for patients during walking. The exoskeleton has great benefits in walking rehabilitation training for hemiplegic patients. Originality/value: This work improves the efficiency of the patient's individualized training in the room. The presented exoskeleton provides great benefits in walking rehabilitation training for hemiplegic patients. [ABSTRACT FROM AUTHOR]

This paper introduces a new concept of a lower limb exoskeleton, KUEX, and its control framework. KUEX is a fully actuated system and is developed for a wearer's walking assistance and sit-to-stand/stand-to-sit assistance. Because of full actuation, it is able to balance by itself and assist the wearer's weight directly. Also, it is worn on the wearer's front side. As the reason, it is easy to wear the robot and is able to reduce wearing time. The control framework for KUEX is composed with a walking pattern generator and various controllers to operate the robot based on the finite state machine. The hardware and the control framework of KUEX were verified through the various experiments. [ABSTRACT FROM AUTHOR]

Wearable exoskeletons have generally been designed to enhance user strength or to reduce user fatigue. Two areas that have often been overlooked are that exoskeletons should increase user safety and have increased durability for use in extreme environments. In this paper, we developed an SMA spring-based shock absorption module for an exoskeleton or a quadruped walking robot, which can provide increased protection to the user during high-impact events in an extreme environment. We analyzed the impact force during the collision between the module and the ground based on impulse and momentum theories. The shock absorber module can be reused by exploiting the inherent shape memory characteristics of the SMA spring after every use. We confirmed that the spring constant of the SMA spring and the maximum allowable length affect the impulse reduction, and the results showed that the latter has a greater influence on impulse reduction. [ABSTRACT FROM AUTHOR]

The amount of research on developing exoskeletons for human gait assistance has been growing in the recent years. However, the control design of exoskeletons for assisting human walking remains unclear. This paper presents a novel bio-inspired reflex-based control for assisting human walking. In this approach, the leg force is used as a feedback signal to adjust hip compliance. The effects of modulating hip compliance on walking gait is investigated through joint kinematics, leg muscle activations and overall metabolic costs for eight healthy young subjects. Reduction in the average metabolic cost and muscle activation are achieved with fixed hip compliance. Compared to the fixed hip compliance, improved assistance as reflected in more consistent reduction in muscle activities and more natural kinematic behaviour are obtained using the leg force feedback. Furthermore, smoother motor torques and less peak power are two additional advantages obtained by compliance modulation. The results show that the proposed control method which is inspired by human posture control can not only facilitate the human gait, but also reduce the exoskeleton power consumption. This demonstrates that the proposed bio-inspired controller allows a synergistic interaction between human and robot. [ABSTRACT FROM AUTHOR]

The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots' capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients' recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease. [ABSTRACT FROM AUTHOR]

Purpose: The assistive knee exoskeleton device is used for supporting the surrounding ligaments, tendons, and muscles of the injured knee joint. Various knee exoskeletons have been discussed; however, their shape synthesis is not reported. This study aims to present the shape synthesis of the assistive knee device. Moreover, four-bar linkage is used for the knee exoskeleton, in this study. Methods: Clinical biomechanical data are adapted from gait database for one gait cycle. Using the clinical gait data, position and static force analyses are performed to obtain a set of orientations and unknown forces. Simultaneously, CAD models are prepared, and the obtained forces are applied to the CAD models of the four-bar linkage knee exoskeleton. Consequently, the threshold is obtained for each component of the knee exoskeleton and the unwanted material below the threshold is removed. Results: A reduction of 45% in the peak actuating force is observed in comparison with the literature. Besides, a total reduction of 21% in the mass of four-bar knee exoskeleton is observed in contrast to the base models when shape synthesis is performed. Conclusions: An assistive knee exoskeleton is developed using the shape synthesis methodology in which four-bar linkage is used. New shapes of thigh and shank attachments are obtained. The developed knee exoskeleton can be used by persons with the injured knee for supporting the ligaments, tendons, and muscles. Besides, control technology can be implemented to make it useful for persons with monoplegia. Assistive knee exoskeleton devices proved to be an important tool for providing support to injured knee joints. Typically single axis joints are observed in the lower limb exoskeletons which can be replaced with linkage mechanisms to obtain the desired range of motion. In this study, four-bar linkages are used for the knee exoskeleton in which cranks and rockers are connected to the lateral and medial sides of the knee joint, for connecting shank and thigh attachments. Shape synthesis is performed on the components of four-bar exoskeleton through the evaluated reaction forces. The components are assembled to form an assistive knee exoskeleton which can be used by any person with injured knee joint. [ABSTRACT FROM AUTHOR]