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

Abstract Human–robot walking with prosthetic legs and exoskeletons, especially over complex terrains, such as stairs, remains a significant challenge. Egocentric vision has the unique potential to detect the walking environment prior to physical interactions, which can improve transitions to and from stairs. This motivated us to develop the StairNet initiative to support the development of new deep learning models for visual perception of real-world stair environments. In this study, we present a comprehensive overview of the StairNet initiative and key research to date. First, we summarize the development of our large-scale data set with over 515,000 manually labeled images. We then provide a summary and detailed comparison of the performances achieved with different algorithms (i.e., 2D and 3D CNN, hybrid CNN and LSTM, and ViT networks), training methods (i.e., supervised learning with and without temporal data, and semi-supervised learning with unlabeled images), and deployment methods (i.e., mobile and embedded computing), using the StairNet data set. Finally, we discuss the challenges and future directions. To date, our StairNet models have consistently achieved high classification accuracy (i.e., up to 98.8%) with different designs, offering trade-offs between model accuracy and size. When deployed on mobile devices with GPU and NPU accelerators, our deep learning models achieved inference speeds up to 2.8 ms. In comparison, when deployed on our custom-designed CPU-powered smart glasses, our models yielded slower inference speeds of 1.5 s, presenting a trade-off between human-centered design and performance. Overall, the results of numerous experiments presented herein provide consistent evidence that StairNet can be an effective platform to develop and study new deep learning models for visual perception of human–robot walking environments, with an emphasis on stair recognition. This research aims to support the development of next-generation vision-based control systems for robotic prosthetic legs, exoskeletons, and other mobility assistive technologies.

In this perspective paper, we explore the use of haptic feedback to enhance human-human interaction during musical tasks. We start by providing an overview of the theoretical foundation that underpins our approach, which is rooted in the embodied music cognition framework, and by briefly presenting the concepts of action-perception loop, sensorimotor coupling and entrainment. Thereafter, we focus on the role of haptic information in music playing and we discuss the use of wearable technologies, namely lightweight exoskeletons, for the exchange of haptic information between humans. We present two experimental scenarios in which the effectiveness of this technology for enhancing musical interaction and learning might be validated. Finally, we briefly discuss some of the theoretical and pedagogical implications of the use of technologies for haptic communication in musical contexts, while also addressing the potential barriers to the widespread adoption of exoskeletons in such contexts. [ABSTRACT FROM AUTHOR]

Human–robot walking with prosthetic legs and exoskeletons, especially over complex terrains, such as stairs, remains a significant challenge. Egocentric vision has the unique potential to detect the walking environment prior to physical interactions, which can improve transitions to and from stairs. This motivated us to develop the StairNet initiative to support the development of new deep learning models for visual perception of real-world stair environments. In this study, we present a comprehensive overview of the StairNet initiative and key research to date. First, we summarize the development of our large-scale data set with over 515,000 manually labeled images. We then provide a summary and detailed comparison of the performances achieved with different algorithms (i.e., 2D and 3D CNN, hybrid CNN and LSTM, and ViT networks), training methods (i.e., supervised learning with and without temporal data, and semi-supervised learning with unlabeled images), and deployment methods (i.e., mobile and embedded computing), using the StairNet data set. Finally, we discuss the challenges and future directions. To date, our StairNet models have consistently achieved high classification accuracy (i.e., up to 98.8%) with different designs, offering trade-offs between model accuracy and size. When deployed on mobile devices with GPU and NPU accelerators, our deep learning models achieved inference speeds up to 2.8 ms. In comparison, when deployed on our custom-designed CPU-powered smart glasses, our models yielded slower inference speeds of 1.5 s, presenting a trade-off between human-centered design and performance. Overall, the results of numerous experiments presented herein provide consistent evidence that StairNet can be an effective platform to develop and study new deep learning models for visual perception of human–robot walking environments, with an emphasis on stair recognition. This research aims to support the development of next-generation vision-based control systems for robotic prosthetic legs, exoskeletons, and other mobility assistive technologies. [ABSTRACT FROM AUTHOR]

In this perspective paper, we explore the use of haptic feedback to enhance human-human interaction during musical tasks. We start by providing an overview of the theoretical foundation that underpins our approach, which is rooted in the embodied music cognition framework, and by briefly presenting the concepts of action-perception loop, sensorimotor coupling and entrainment. Thereafter, we focus on the role of haptic information in music playing and we discuss the use of wearable technologies, namely lightweight exoskeletons, for the exchange of haptic information between humans. We present two experimental scenarios in which the effectiveness of this technology for enhancing musical interaction and learning might be validated. Finally, we briefly discuss some of the theoretical and pedagogical implications of the use of technologies for haptic communication in musical contexts, while also addressing the potential barriers to the widespread adoption of exoskeletons in such contexts.

This work introduces a real-time intention decoding algorithm grounded in muscle synergies (Syn-ID). The algorithm detects the electromyographic (EMG) onset and infers the direction of the movement during reaching tasks to control a powered shoulder–elbow exoskeleton. Features related to muscle synergies are used in a Gaussian Mixture Model and probability accumulation-based logic to infer the user’s movement direction. The performance of the algorithm was verified by a feasibility study including eight healthy participants. The experiments comprised a transparent session, during which the exoskeleton did not provide any assistance, and an assistive session in which the Syn-ID strategy was employed. Participants were asked to reach eight targets equally spaced on a circumference of 25 cm radius (adjusted chance level: 18.1%). The results showed an average accuracy of 48.7% after 0.6 s from the EMG onset. Most of the confusion of the estimate was found along directions adjacent to the actual one (type 1 error: 33.4%). Effects of the assistance were observed in a statistically significant reduction in the activation of Posterior Deltoid and Triceps Brachii. The final positions of the movements during the assistive session were on average 1.42 cm far from the expected ones, both when the directions were estimated correctly and when type 1 errors occurred. Therefore, combining accurate estimates with type 1 errors, we computed a modified accuracy of 82.10±6.34%. Results were benchmarked with respect to a purely kinematics-based approach. The Syn-ID showed better performance in the first portion of the movement (0.14 s after EMG onset).

Studies on robotic interventions for gait rehabilitation after stroke require: (i) rigorous performance evidence; (ii) systematic procedures to tune the control parameters; and (iii) combination of control modes. In this study, we investigated how stroke individuals responded to training for two weeks with a knee exoskeleton (ABLE-KS) using both Assistance and Resistance training modes together with auditory feedback to train peak knee flexion angle. During the training, the torque provided by the ABLE-KS and the biofeedback were systematically adapted based on the subject’s performance and perceived exertion level. We carried out a comprehensive experimental analysis that evaluated a wide range of biomechanical metrics, together with usability and users’ perception metrics. We found significant improvements in peak knee flexion (${p} = {0}.{0016}$), minimum knee angle during stance (${p} = {0}.{0053}$), paretic single support time (${p} = {0}.{0087}$) and gait endurance (${p} = {0}.{022}$) when walking without the exoskeleton after the two weeks of training. Participants significantly (${p} < {0}.{00025}$) improved the knee angle during the stance and swing phases when walking with the exoskeleton powered in the high Assistance mode in comparison to the No Exo and the Unpowered conditions. No clinically relevant differences were found between Assistance and Resistance training sessions. Participants improved their performance with the exoskeleton (24-55 %) for the peak knee flexion angle throughout the training sessions. Moreover, participants showed a high level of acceptability of the ABLE-KS (QUEST 2.0 score: 4.5 ± 0.3 out of 5). Our preliminary findings suggest that the proposed training approach can produce similar or larger improvements in post-stroke individuals than other studies with knee exoskeletons that used higher training intensities. [ABSTRACT FROM AUTHOR]

Abstract Background The past few decades have seen rapid advancements in exoskeleton technology, with a considerable shift towards applications involving users with gait pathologies. Commercial devices from ReWalk, Ekso Bionics, and Indego, mainly designed for rehabilitation purposes, have inspired the development of many research platforms aimed at extending capabilities for use as safe and effective personal mobility devices. The 2016 Cybathlon featured an impressive demonstration of exoskeletons designed to enable mobility for individuals with spinal cord injury, however, not a single team completed every task and only two completed the stairs. Major improvements were showcased at the 2020 Cybathlon, with seven of the nine teams completing a similar set of tasks. Team IHMC built upon its silver-medal success from 2016 with an upgraded device, Quix. Methods Quix features several notable improvements including an additional powered degree of freedom for hip ab/adduction to laterally shift the device and reduce user effort while walking, custom-tailored cuffs and soft goods based on 3D body scans to optimize user comfort, and a streamlined testing pipeline for online tuning of gait parameters. Results Team IHMC finished in fourth place behind the teams from EPFL and Angel Robotics. Although we suffered from a considerably slower flat-ground walking speed, our pilot reported marked improvements in overall effort, comfort, and ease-of-use compared to our previous device. Conclusions Clear progress in exoskeleton development has been exhibited since the inaugural Cybathlon, with tasks involving rough terrain, stairs, and ramps now posing little threat to most of the competitors. As a result, the layout of the powered exoskeleton course will likely undergo significant modifications to further push the devices towards suitability for personal everyday use. The current tasks do not address the issue of donning and doffing, nor do they simulate a scenario similar to maneuvering a kitchen to prepare a meal, for example. An additional limitation that may be more difficult to test in a competition setting is the required upper-body effort to manipulate the device in an effective manner.

While several lower-limb exoskeletons have been designed for adult patients, there remains a lack of pediatric-oriented devices. This paper presented a human factor assessment of an adjustable pediatric lower-limb exoskeleton for childhood gait assistance. The hip and knee exoskeleton uses an adjustable frame for compatibility with children 6–11 years old. This assessment evaluates the device's comfort and ease of use through timed donning, doffing, and reconfiguration tasks. The able-bodied study participants donned the device in 6 min and 8 s, doffed it in 2 min and 29 s, and reconfigured it in 8 min and 23 s. The results of the timed trials suggest that the exoskeleton can be easily donned, doffed, and reconfigured to match the anthropometrics of pediatric users. A 6-min unpowered walking experiment was conducted while the child participant wore the exoskeletal device. Inspection of both the device and participant yielded no evidence of damage to either the device or wearer. Participant feedback on the device was positive with a system usability scale rating of 80/100. While minor improvements can be made to the adjustability indicators and padding placement, the results indicate the exoskeleton is suitable for further experimental evaluation through assistive control assessments. [ABSTRACT FROM AUTHOR]

Lower-limb exoskeletons are promising applications of robotic rehabilitation for people with motor impairment. As current studies have tailored the design of gait trajectories for the target users, realizing a high-precision motion control is a critical issue for safe and effective assistance. The walking assistance involves unique characteristic phases that embody different physical constraints and requirements for assistance. Conventional methods often utilized gain-switching control for time-varying adaptation. However, despite their intuitiveness as well as simplicity, the control performance was unsatisfying due to unmodeled responses by human behavior and continuous interaction with the external environment. To tackle these challenges, this study proposes a hybrid control method applied to the disturbance observer that can provide robust robotic rehabilitation. The proposed method adaptively identifies the exoskeletal system as a hybrid nominal model and online exchanges model-based tracking controllers parallelly to the gait phase of a user. Furthermore, a unique filter named allowance filter is introduced to compensate for the plant dynamics, preventing instability of the inverted plant and realizing digital implementation. In this article, a practical user with complete paraplegia participated in the experiments for verification of the proposed methods. [ABSTRACT FROM AUTHOR]

Cerebral palsy is a neurological disorder with a variety of symptoms that can affect muscle coordination and movement. Crouch gait is one such symptom that is defined as excessive knee flexion accompanied by a crouched posture. This paper introduces a passive exoskeleton to support the knee joint during stance of individuals with cerebral palsy that are affected by crouch gait. The exoskeleton utilizes a hydraulic disc brake mechanism that is actuated only by the body weight and gait of the wearer to provide a braking torque at the knee joint. This passive, gait-based control method aims to offer a compact, lightweight, and simple alternative to existing exoskeletons. Preliminary experiments were conducted to verify the mechanics, safety, and braking capabilities of the device with healthy participants. A pilot study with an individual with cerebral palsy was then conducted. The individual with cerebral palsy showed a reduction in hip joint angle when using the device (18.8 ∘ and 21.7 ∘ for left and right sides, respectively). The muscle co-activation index was also reduced from 0.48 to 0.24 on the right side and from 0.17 to 0.017 on the left side. However, changes such as activation timing and device training need to be improved to better support the user. [ABSTRACT FROM AUTHOR]

In this paper, an experimental evaluation of an active upper-limb exoskeleton, where 12 subjects perform an overhead industrial task with and without the exoskeleton, is presented. The experimental laboratory test has been carried out to analyze the advantages of wearing the exoskeleton to carry out repetitive industrial tasks, assessing whether the proposed device reduces metabolic parameters and the muscular strain. The set of metrics to assess the effects of the exoskeleton included biomechanical parameters, such as electromyographic signals, and metabolic parameters, such as heart rate, heart rate variability, respiratory frequency, tidal volume, ventilation and oxygen consumption. The results show that the developed active upper-limb exoskeleton can reduce cardiorespiratory responses and muscular activity. In addition, statistical data analysis shows significant differences in oxygen consumption, heart rate and effort supported by muscles between conditions (when handling a load of 1.7 kg with and without the exoskeleton). It is observed that, wearing the exoskeleton reduces oxygen consumption by more than 24%, the heart rate decreases by 14%, and muscle activity is reduced by almost 37% in triceps and up to 64% in biceps compare to no wearing. Based on these results, the presented active upper-limb exoskeleton could be potentially useful to reduce muscular strain and fatigue in repetitive overhead tasks.

Despite more than thirty-five years of research on wearable technologies to assist the upper-limb and a multitude of promising preliminary results, the goal of restoring pre-impairment quality of life of people with physical disabilities has not been fully reached yet. Whether it is for rehabilitation or for assistance, nowadays robotics is still only used in a few high-tech clinics and hospitals, limiting the access to a small amount of people. This work provides a description of the three major “revolutions” occurred in the field (end-effector robots, rigid exoskeletons, and soft exosuits), reviewing forty-eight systems for the upper-limb (excluding hand-only devices) used in eighty-nine studies enrolling a clinical population before June 2022. The review critically discusses the state of the art, analyzes the different technologies, and compares the clinical outcomes, with the goal of determine new potential directions to follow.

Passive upper limb exoskeletons are often designed to relieve muscle fatigue of manufacturing workers. Existing exoskeletons often provide partial assistance, and their assistive torque is only affected by elastic elements and mechanisms, which, however, are not sufficient because of the changing load of the shoulder joint due to the motion of the elbow and the weight of various tools. To improve the assistive effect without affecting the free movement of the arm, a passive exoskeletal vest has been designed. This exoskeleton has two operating states which can be switched using a unique ratchet bar mechanism. The upper arm can be locked at any vertical position when engaged. The assistive torque is determined by the load. The arm also can move freely without any resistance when separated. Seven subjects participated in the evaluation experiment, who performed static tasks, precision tasks, and dynamic tasks. The experimental data demonstrate that (1) the exoskeleton can effectively reduce the activation level of related muscles at a variety of tasks. (2) The accuracy and stability of the arm during heavy work are not affected. (3) The exoskeleton has a minimal restriction on the range of motion of the arm. (4) the comfort and portability achieved a high score of 8 (1-10) from subjective measures. The experimental results further revealed that the designed exoskeletal vest could effectively relieve the shoulder burden, where it does not impede or restrain the arm’s movements.

Abstract Background User-centered design approaches have gained attention over the past decade, aiming to tackle the technology acceptance issues of wearable robotic devices to assist, support or augment human capabilities. While there is a consensus that usability is key to user-centered design, dedicated usability evaluation studies are scarce and clear evaluation guidelines are missing. However, the careful consideration and integration of user needs appears to be essential to successfully develop an effective, efficient, and satisfactory human-robot interaction. It is primarily the responsibility of the developer, to ensure that this users involvement takes place throughout the design process. Methods Through an online survey for developers of wearable robotics, we wanted to understand how the design and evaluation in actual daily practice compares to what is reported in literature. With a total of 31 questions, we analyzed the most common wearable robotic device applications and their technology maturity, and how these influence usability evaluation practices. Results A total of 158 responses from a heterogeneous population were collected and analyzed. The dataset representing contexts of use for augmentation (16.5%), assistance (38.0%), therapy (39.8%), as well as few other specific applications (5.7%), allowed for an insightful analysis of the influence of technology maturity on user involvement and usability evaluation. We identified functionality, ease of use, and performance as the most evaluated usability attributes and could specify which measures are used to assess them. Also, we could underline the frequent use of qualitative measures alongside the expected high prevalence of performance-metrics. In conclusion of the analysis, we derived evaluation recommendations to foster user-centered design and usability evaluation. Conclusion This analysis might serve as state-of-the-art comparison and recommendation for usability studies in wearable robotics. We believe that by motivating for more balanced, comparable and user-oriented evaluation practices, we may support the wearable robotics field in tackling the technology acceptance limitations.

Objective: This paper assesses the effect of a passive shoulder exoskeleton prototype, Exo4Work, on muscle activity, muscle fatigue and subjective experience during simulated occupational overhead and non-overhead work. Methods: Twenty-two healthy males performed six simulated industrial tasks with and without Exo4Work exoskeleton in a randomized counterbalanced cross-over design. During these tasks electromyography, heart rate, metabolic cost, subjective parameters and performance parameters were acquired. The effect of the exoskeleton and the body side on these parameters was investigated. Results: Anterior deltoid activity and fatigue reduced up to 16% and 41%, respectively, during isometric overhead work, and minimized hindrance of the device during non-overhead tasks. Wearing the exoskeleton increased feelings of frustration and increased discomfort in the areas where the exoskeleton and the body interfaced. The assistive effect of the exoskeleton was less prominent during dynamic tasks. Conclusion: This exoskeleton may reduce muscle activity and delay development of muscle fatigue in an overhead working scenario. For dynamic applications, the exoskeleton’s assistive profile, which mimics the gravitational torque of the arm, is potentially sub-optimal. Significance: This evaluation paper is the first to report reduced muscle fatigue and activity when working with an occupational shoulder exoskeleton providing one third of the gravitational torque of the arm during overhead work. These results stress the potential of occupational shoulder exoskeletons in overhead working situations and may direct towards longitudinal field experiments. Additionally, this experiment may stimulate future work to further investigate the effect of different assistive profiles. [ABSTRACT FROM AUTHOR]

Background: The past few decades have seen rapid advancements in exoskeleton technology, with a considerable shift towards applications involving users with gait pathologies. Commercial devices from ReWalk, Ekso Bionics, and Indego, mainly designed for rehabilitation purposes, have inspired the development of many research platforms aimed at extending capabilities for use as safe and effective personal mobility devices. The 2016 Cybathlon featured an impressive demonstration of exoskeletons designed to enable mobility for individuals with spinal cord injury, however, not a single team completed every task and only two completed the stairs. Major improvements were showcased at the 2020 Cybathlon, with seven of the nine teams completing a similar set of tasks. Team IHMC built upon its silver-medal success from 2016 with an upgraded device, Quix.Methods: Quix features several notable improvements including an additional powered degree of freedom for hip ab/adduction to laterally shift the device and reduce user effort while walking, custom-tailored cuffs and soft goods based on 3D body scans to optimize user comfort, and a streamlined testing pipeline for online tuning of gait parameters.Results: Team IHMC finished in fourth place behind the teams from EPFL and Angel Robotics. Although we suffered from a considerably slower flat-ground walking speed, our pilot reported marked improvements in overall effort, comfort, and ease-of-use compared to our previous device.Conclusions: Clear progress in exoskeleton development has been exhibited since the inaugural Cybathlon, with tasks involving rough terrain, stairs, and ramps now posing little threat to most of the competitors. As a result, the layout of the powered exoskeleton course will likely undergo significant modifications to further push the devices towards suitability for personal everyday use. The current tasks do not address the issue of donning and doffing, nor do they simulate a scenario similar to maneuvering a kitchen to prepare a meal, for example. An additional limitation that may be more difficult to test in a competition setting is the required upper-body effort to manipulate the device in an effective manner. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons with proper assistance can improve the mobility of people with leg impairments. Prior studies have shown that tethered ankle exoskeletons can reduce the metabolic cost during walking and running, but few mobile ankle exoskeletons can achieve similar performance. The additional weight of the actuation system and compromised control performance decrease the assistance efficiency. Here, we developed a mobile exoskeleton that can provide plantarflexion torque assistance at the ankle. The actuation system is switchable between a single- and dual-motor ones to adapt to different users and tasks. The single-motor system can achieve lighter weight and better transparency while the dual-motor one can provide higher assistance. The single-motor exoskeleton system has a 0.95 kg weight worn on the leg with another 1.15 kg power belt mounted on the waist. The dual-motor system can provide up to 100 N $\cdot$ m assistive torque and reduce an average of 32.5% of soleus muscle activity in preliminary tests. A real-time controller was implemented in an integrated embedded system and achieved high torque control performance. The closed-loop bandwidths of the single- and the dual-motor systems were 13.0 and 15.3 Hz, respectively. The average root-mean-squared torque tracking error was 2.6% of peak torque during walking and running. The mobile ankle exoskeleton can assist for 3 h of continuous active walking or running with an integrated 4500 mAh battery, making it promising in investigating assistance strategies off the treadmill. [ABSTRACT FROM AUTHOR]

Scoliosis is an abnormality of the spinal curvature that severely affects the musculoskeletal, respiratory, and nervous systems. Conventionally, it is treated using rigid spinal braces. These braces are static, rigid, and passive in nature, and they (largely) limit the mobility of the spine, resulting in other spinal complexities. Moreover, these braces do not have precise control over how much force is being applied by them. Over-exertion of force may deteriorate the spinal condition. This article presents a novel active soft brace that allows mobility to the spine while applying controlled corrective forces that are regulated by varying the tensions in elastic bands using low-power light weight twisted string actuators (TSAs). This article focuses on the actuator and contact force modeling of the active soft brace (ASB). The actuator modeling is required to translate the twisting of string in terms of contraction of the string's length, whereas the contact force modeling helps in estimating the net resultant force exerted by the band on the body using single point pressure/force sensors. The actuators (TSAs) are modeled as helix geometry and validated using a laser position sensor. The results showed that the model effectively tracked the position (contraction in length) with root mean square error (RMSE) of 1.7386 mm. The contact force is modeled using the belt and pulley contact model and validated by building a custom testbed. The actuator module is able to regulate the pressure in the range 0–6 Kpa, which is comparable to 0–8 Kpa pressure regulated in rigid braces. This makes it possible to verify and demonstrate the working principle of the proposed active soft brace. [ABSTRACT FROM AUTHOR]

Passive upper limb exoskeletons are often designed to relieve muscle fatigue of manufacturing workers. Existing exoskeletons often provide partial assistance, and their assistive torque is only affected by elastic elements and mechanisms, which, however, are not sufficient because of the changing load of the shoulder joint due to the motion of the elbow and the weight of various tools. To improve the assistive effect without affecting the free movement of the arm, a passive exoskeletal vest has been designed. This exoskeleton has two operating states which can be switched using a unique ratchet bar mechanism. The upper arm can be locked at any vertical position when engaged. The assistive torque is determined by the load. The arm also can move freely without any resistance when separated. Seven subjects participated in the evaluation experiment, who performed static tasks, precision tasks, and dynamic tasks. The experimental data demonstrate that the exoskeleton can effectively reduce the activation level of related muscles at a variety of tasks. The accuracy and stability of the arm during heavy work are not affected. The exoskeleton has a minimal restriction on the range of motion of the arm. the comfort and portability achieved a high score of 8 (1-10) from subjective measures. The experimental results further revealed that the designed exoskeletal vest could effectively relieve the shoulder burden, where it does not impede or restrain the arm’s movements. [ABSTRACT FROM AUTHOR]

Over the course of both evolution and development, the human musculoskeletal system has been well shaped for the cushion function of the foot during foot-strike and the impulsive function of the ankle joint during push-off. Nevertheless, an efficient energy interaction between foot structure and ankle joint is still lacking in the human body itself, which may limit the further potential of economical walking. Here we showed the metabolic expenditure of walking can be lessened by an unpowered exoskeleton robot that modulates energy among the foot-ankle complex towards a more effective direction. The unpowered exoskeleton recycles negative mechanical energy of the foot that is normally dissipated in heel-strike, retains the stored energy before mid-stance, and then transfers the energy to the ankle joint to assist the push-off. The modulation process of the exoskeleton consumes no input energy, yet reduces the metabolic cost of walking by $8.19~\pm ~0.96$ % (mean ± s.e.m) for healthy subjects. The electromyography measurements demonstrate the activities of target ankle plantarflexors decreased significantly without added effort for the antagonistic muscle, suggesting the exoskeleton enhanced the subjects’ energy efficiency of the foot-ankle complex in a natural manner. Furthermore, the exoskeleton also provides cushion assistance for walking, which leads to significantly decreased activity of the quadriceps muscle during heel-strike. Rather than strengthening the functions of existing biological structures, developing the complementary energy loop that does not exist in the human body itself also shows its potential for gait assistance. [ABSTRACT FROM AUTHOR]

Stroke can be a devastating condition that impairs the upper limb and reduces mobility. Wearable robots can aid impaired users by supporting performance of Activities of Daily Living (ADLs). In the past decade, soft devices have become popular due to their inherent malleable and low-weight properties that makes them generally safer and more ergonomic. In this study, we present an improved version of our previously developed gravity-compensating upper limb exosuit and introduce a novel hand exoskeleton. The latter uses 3D-printed structures that are attached to the back of the fingers which prevent undesired hyperextension of joints. We explored the feasibility of using this integrated system in a sample of 10 chronic stroke patients who performed 10 ADLs. We observed a significant reduction of 30.3 ± 3.5% (mean ± standard error), 31.2 ± 3.2% and 14.0 ± 5.1% in the mean muscular activity of the Biceps Brachii (BB), Anterior Deltoid (AD) and Extensor Digitorum Communis muscles, respectively. Additionally, we observed a reduction of 14.0 ± 11.5%, 14.7 ± 6.9% and 12.8 ± 4.4% in the coactivation of the pairs of muscles BB and Triceps Brachii (TB), BB and AD, and TB and Pectoralis Major (PM), respectively, typically associated to pathological muscular synergies, without significant degradation of healthy muscular coactivation. There was also a significant increase of elbow flexion angle ($12.1\pm 1.5^\circ $). These results further cement the potential of using lightweight wearable devices to assist impaired users. [ABSTRACT FROM AUTHOR]

Recognition of continuous foot motions is important in robot-assisted lower limb rehabilitation, especially in prosthesis and exoskeleton design. For instance, perceiving foot motion is essential feedback for the robot controller. However, few studies have focused on perceiving multiple-degree of freedom (DOF) foot movements. This paper proposes a novel human-machine interaction (HMI) recognition wearable system for continuous multiple-DOF ankle-foot movements. The proposed system uses solely kinematic signals from inertial measurement units and multiclass support vector machines by creating error-correcting output codes. We conducted a study with multiple participants to validate the performance of the system using two strategies, a general model and a subject-specific model. The experimental results demonstrated satisfactory performance. The subject-specific approach achieved 98.45% ± 1.17% (mean ± SD) overall accuracy within a prediction time of 10.9 ms ± 1.7 ms, and the general approach achieved 85.3% ± 7.89% overall accuracy within a prediction time of 14.1 ms ± 4.5 ms. The results prove that the proposed system can more effectively recognize multiple continuous DOF foot movements than existing strategies. It can be applied to ankle-foot rehabilitation and fills the HMI high-level control demand for multiple-DOF wearable lower-limb robotics. [ABSTRACT FROM AUTHOR]

The rate of development of robotic technologies has been meteoric, as a result of compounded advancements in hardware and software. Amongst these robotic technologies are active exoskeletons and orthoses, used in the assistive and rehabilitative fields. Artificial intelligence techniques are increasingly being utilised in gait analysis and prediction. This review paper systematically explores the current use of intelligent algorithms in gait analysis for robotic control, specifically the control of active lower limb exoskeletons and orthoses. Two databases, IEEE and Scopus, were screened for papers published between 1989 to May 2020. 41 papers met the eligibility criteria and were included in this review. 66.7% of the identified studies used classification models for the classification of gait phases and locomotion modes. Meanwhile, 33.3% implemented regression models for the estimation/prediction of kinematic parameters such as joint angles and trajectories, and kinetic parameters such as moments and torques. Deep learning algorithms have been deployed in ~15% of the machine learning implementations. Other methodological parameters were reviewed, such as the sensor selection and the sample sizes used for training the models.

While several lower-limb exoskeletons have been designed for adult patients, there remains a lack of pediatric-oriented devices. This paper presented a human factor assessment of an adjustable pediatric lower-limb exoskeleton for childhood gait assistance. The hip and knee exoskeleton uses an adjustable frame for compatibility with children 6–11 years old. This assessment evaluates the device’s comfort and ease of use through timed donning, doffing, and reconfiguration tasks. The able-bodied study participants donned the device in 6 min and 8 s, doffed it in 2 min and 29 s, and reconfigured it in 8 min and 23 s. The results of the timed trials suggest that the exoskeleton can be easily donned, doffed, and reconfigured to match the anthropometrics of pediatric users. A 6-min unpowered walking experiment was conducted while the child participant wore the exoskeletal device. Inspection of both the device and participant yielded no evidence of damage to either the device or wearer. Participant feedback on the device was positive with a system usability scale rating of 80/100. While minor improvements can be made to the adjustability indicators and padding placement, the results indicate the exoskeleton is suitable for further experimental evaluation through assistive control assessments.

Background: User-centered design approaches have gained attention over the past decade, aiming to tackle the technology acceptance issues of wearable robotic devices to assist, support or augment human capabilities. While there is a consensus that usability is key to user-centered design, dedicated usability evaluation studies are scarce and clear evaluation guidelines are missing. However, the careful consideration and integration of user needs appears to be essential to successfully develop an effective, efficient, and satisfactory human-robot interaction. It is primarily the responsibility of the developer, to ensure that this users involvement takes place throughout the design process.Methods: Through an online survey for developers of wearable robotics, we wanted to understand how the design and evaluation in actual daily practice compares to what is reported in literature. With a total of 31 questions, we analyzed the most common wearable robotic device applications and their technology maturity, and how these influence usability evaluation practices.Results: A total of 158 responses from a heterogeneous population were collected and analyzed. The dataset representing contexts of use for augmentation (16.5%), assistance (38.0%), therapy (39.8%), as well as few other specific applications (5.7%), allowed for an insightful analysis of the influence of technology maturity on user involvement and usability evaluation. We identified functionality, ease of use, and performance as the most evaluated usability attributes and could specify which measures are used to assess them. Also, we could underline the frequent use of qualitative measures alongside the expected high prevalence of performance-metrics. In conclusion of the analysis, we derived evaluation recommendations to foster user-centered design and usability evaluation.Conclusion: This analysis might serve as state-of-the-art comparison and recommendation for usability studies in wearable robotics. We believe that by motivating for more balanced, comparable and user-oriented evaluation practices, we may support the wearable robotics field in tackling the technology acceptance limitations. [ABSTRACT FROM AUTHOR]

Dynamic control of robotic exoskeletons is paramount to ensuring safe, synergistic assistive action of functional benefit to users. To date, exoskeleton controllers have excelled in rhythmic and quasi-rhythmic tasks, whereas control methods for assisting discrete movements remain limited by their task-specificity. Inspired by neurophysiological dynamic movement primitives (DMPs), we formulated a novel controller that facilitated a variety of lifting movements using a single adaptive DMP (aDMP), for wearable robotic assistance of discrete movements. For a variety of load lifting tasks, we first benchmarked our method's trajectory prediction accuracy against the state-of-the-art DMP using passively recorded exoskeleton sensor data (offline), followed by a functional validation of online aDMP trajectory estimates. Finally, we assessed the functional effects of aDMP-based exoskeletal assistance on joint kinematics and muscular activity during repetitive lifting. The new aDMP method accurately predicted and smoothly synchronized robotic assistance with variable movement trajectories, resulting in reduced muscular activation of the erector spinae muscles (up to 47.6%) while preserving lower-limb joint kinematics and reducing the extension time by 15.5% compared to unassisted conditions. This method holds promise for use in a wide range of wearable robotic applications, including both clinical rehabilitation and user assistance in activities of daily living and/or manual labor. [ABSTRACT FROM AUTHOR]

Upper-limb impairments are all-pervasive in Activities of Daily Living (ADLs). As a consequence, people affected by a loss of arm function must endure severe limitations. To compensate for the lack of a functional arm and hand, we developed a wearable system that combines different assistive technologies including sensing, haptics, orthotics and robotics. The result is a device that helps lifting the forearm by means of a passive exoskeleton and improves the grasping ability of the impaired hand by employing a wearable robotic supernumerary finger. A pilot study involving 3 patients, which was conducted to test the capability of the device to assist in performing ADLs, confirmed its usefulness and serves as a first step in the investigation of novel paradigms for robotic assistance.

Misalignments between powered exoskeleton joints and the user’s anatomical joints are inevitable due to difficulty locating the anatomical joint axis, non-constant location of the anatomical joint axis, and soft-tissue deformations. Self-aligning mechanisms have been proposed to prevent spurious forces and torques on the user’s limb due to misalignments. Several exoskeletons have been developed with self-aligning mechanisms based on theoretical models. However, there is no experimental evidence demonstrating the efficacy of self-aligning mechanisms in lower-limb exoskeletons. Here we show that a lightweight and compact self-aligning mechanism improves the user’s comfort and performance while using a powered knee exoskeleton. Experiments were conducted with 14 able-bodied subjects with the self-aligning mechanism locked and unlocked. Our results demonstrate up to 15.3% increased comfort and 38% improved performance when the self-aligning mechanism was unlocked. Not surprisingly, the spurious forces and torques were reduced by up to 97% when the self-aligning mechanism was unlocked. This study demonstrates the efficacy of self-aligning mechanisms in improving comfort and performance for sit-to-stand and position tracking tasks with a powered knee exoskeleton. [ABSTRACT FROM AUTHOR]

The Exoskeleton represents a promising technology aiming to improve physical and organizational ergonomics in manufacturing reducing the physical fatigue, thus enhancing cognitive ergonomics. The foundations of digital transformation of human-centred workplaces with integrated Exoskeletons have been well researched by the group, coping currently with the challenge of optimizing the ergonomics simulation parameters and embedding the Exoskeleton controller in simulation systems. A methodology of capturing in real-time workers' physiological status wearing active and passive Exoskeletons, data interpretation and aggregation towards developing a hybrid human/Exoskeleton Digital Model represents the current work of the group. The performed experiments developed model and validation in several use cases for assembly and logistics activities are reported. [ABSTRACT FROM AUTHOR]

This article presents the H-PULSE, a novel semi-passive upper-limb exoskeleton for worker assistance, with motorized tuning of the assistive level. The H-PULSE presents novel design features compared to other passive industrial exoskeletons for the upper limbs, namely joint angle sensors for measuring shoulder flexion/extension and a novel active mechanism for regulating the assistance level. These features could enhance the effectiveness of the system. Along with the presentation of the exoskeleton design, this article reports on the system experimental evaluation with human subjects. The H-PULSE was assessed in prolonged static overhead tasks under different conditions of assistive support. The set of metrics to evaluate the effects of the device included shoulder muscular activity, heart rate, and subjective user feedback. Results show that the exoskeleton can reduce the users’ muscular activity and the heart rate. Subjective questionnaires allowed the assessment of perceived exoskeleton effectiveness. In this study, the H-PULSE exoskeleton was found to be potentially effective in reducing the muscular strain while reducing the global fatigue level during prolonged continuous overhead activities. [ABSTRACT FROM AUTHOR]

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This review meta-analysis combines and compares the findings of previously published works in the field of soft wearable robots (SWRs) that provide active methods of actuation for assistive and augmentative purposes. A thorough investigation of major contributions in the field of an SWR is made to analyze trends in the field focused on fluidic and cable-driven systems, prevalent and successful approaches, and identify the future direction of SWRs and active actuation strategies. Types of soft actuators used in wearables are outlined, as well as general practices for fabrication methods of soft actuators and considerations for human–robot interface designs of garment-like exosuits. An overview of well-known and emerging upper body (UB)- and lower body (LB)-assistive technologies is categorized by the specific joints and degree of freedom (DoF) assisted and which actuator methodology is provided. Different use cases for SWRs are addressed, as well as implementation strategies and design applications.

Summary: People with severe neuromuscular trunk impairment cannot maintain or control upright posture of the upper body in sitting while reaching. Passive orthoses are clinically available to provide support and promote the use of upper extremities in this population. However, these orthoses only position the torso passively without any degree of trunk movement. We introduce for the first time a novel active-assistive torso brace called Wheelchair Robot for Active Postural Support (WRAPS). It consists of two rings over the hips and chest connected by a 2RPS-2UPS parallel robotic device. WRAPS can modulate the displacement of the upper ring and/or the forces applied on the torso through the ring in four degrees-of-freedom (DOF), including rotations and translation in the sagittal and frontal planes. In the present study, we evaluate the design of WRAPS and its functions. Moreover, we discuss the potential effectiveness of WRAPS as a therapeutic robotic tool in people with severe trunk control deficits. The performance of WRAPS was evaluated in seated healthy subjects. Kinematics and surface electromyography (sEMG) were collected when the participants performed selective trunk movements. First, the torso range of motion (tROM) was calculated with WRAPS in transparent mode—zero-force control mode—which was compared with free-guided tROM (no WRAPS) with motion capture system. Second, a position control mode was configured to mobilize the torso along the trajectories obtained with the transparent mode. Our results show that the design of WRAPS suited well the subject's anthropometrics while supporting the weight of the torso. Importantly, WRAPS can be programmed to replicate the subject's tROM, without the full activation of torso muscles. This can be critical in individuals with no trunk control. Altogether, these preliminary results indicate the potential applicability of WRAPS to promote active-assistive trunk mobility in people who cannot sit independently because of trunk dysfunction. [ABSTRACT FROM AUTHOR]

Soft hand exoskeletons offer a lightweight, low-profile alternative to rigid rehabilitative robotic systems, enabling their use to restore activities of daily living (ADL) in those with hand paresis due to stroke or other conditions. The hand exoskeleton with embedded synergies (HEXOES) is a soft cable-driven hand exoskeleton capable of independently actuating and sensing 10 degrees of freedom (DoF) of the hand. Control of the 10 DoF exoskeleton is dimensionally reduced using three manually defined synergies in software corresponding to thumb, index, and 3-finger flexion and extension. In this paper, five healthy subjects control HEXOES using a neural network which decodes synergy weights from contralateral electromyography (EMG) activity. The three synergies are manipulated in real time to grasp and lift 15 ADL objects of various sizes and weights. The neural network's training and validation mean squared error, object grasp time, and grasp success rate were measured for five healthy subjects. The final training error of the neural network was 4.8 ± 1.8% averaged across subjects and tasks, with 8.3 ± 3.4% validation error. The time to reach, grasp, and lift an object was 11.15 ± 4.35 s on average, with an average success rate of 66.7% across all objects. The complete system demonstrates real time use of biosignals and machine learning to allow subjects to operate kinematic synergies to grasp objects using a wearable hand exoskeleton. Future work and applications are further discussed, including possible design improvements and enrollment of individuals with stroke. [ABSTRACT FROM AUTHOR]

Lower-limb exoskeletons used to improve free-living mobility for individuals with neuromuscular impairment must be controlled to prescribe assistance that adapts to the diverse locomotor conditions encountered during daily life, including walking at different speeds and across varied terrain. The goal of this paper is to design and establish clinical feasibility of an ankle exoskeleton control strategy that instantly and appropriately adjusts assistance to the changing biomechanical demand during variable walking. To accomplish this goal, we developed a proportional joint-moment control strategy that prescribes assistance as a function of the instantaneous estimate of the ankle joint moment and conducted a laboratory-based feasibility study. Four individuals with neuromotor impairment and one unimpaired individual completed exoskeleton-assisted slow and fast gait transition tasks that involved gait initiation and changing walking speed. We found that the controller was effective in instantaneously prescribing exoskeleton assistance that was proportional to the ankle moment with less than 14% root-mean-square error, on average. We also performed a three-subject pilot investigation to determine the ability of the proportional joint-moment controller to improve walking economy. Evaluated in two individuals with cerebral palsy and one unimpaired individual, metabolic cost of transport improved 17–27% during treadmill and over-ground walking with proportional control compared with wearing the exoskeleton unassisted. These preliminary findings support the continued investigation of proportional joint-moment control for assisting individuals with neuromuscular disabilities during walking in real-world settings. [ABSTRACT FROM AUTHOR]

The high energy cost of walking in individuals with cerebral palsy (CP) contributes significantly to reduced mobility and quality of life. The purpose of this paper was to develop and clinically evaluate an untethered ankle exoskeleton with the ability to reduce the metabolic cost of walking in children and young adults with gait pathology from CP. We designed a battery-powered device consisting of an actuator-and-control module worn above the waist with a Bowden cable transmission used to provide torque to pulleys aligned with the ankle. Special consideration was made to minimize adding mass to the body, particularly distal portions of the lower-extremity. The exoskeleton provided plantar-flexor assistance during the mid-to-late stance phase, controlled using a real-time control algorithm and embedded sensors. We conducted a device feasibility and a pilot clinical evaluation study with five individuals with CP ages five through thirty years old. Participants completed an average of 130 min of exoskeleton-assisted walking practice. We observed a 19±5% improvement in the metabolic cost of transport (p = 0.011) during walking with untethered exoskeleton assistance compared to how participants walked normally. These preliminary findings support the future investigation of powered ankle assistance for improving mobility in this patient population. [ABSTRACT FROM AUTHOR]

Bowden cables are frequently used as remote transmissions on wearable devices because of their light weight, simplicity, and flexibility of design. However, a Bowden cable suffers from inefficiency, nonlinear backlash, and cable tension variation due to the bending of the cable housing and friction losses, leading to deteriorating force control performance, and a wearers comfort level and augmentation effectiveness. In this paper, to enhance wearable device performance and to overcome the above drawbacks, we propose a novel high-performance, cable-drive module with rolling cable transmissions (RoCT) that can efficiently transmit motion and mechanical power from an input to an output via an inner cable/rope. The RoCT is compact, modular, lightweight, extremely stiff, highly backdrivable, and is freely rotatable and translatable during manipulation. It maintains the cable tension regardless of the transmission angle between the input and output. The configuration of the proposed tethered cable-drive module, the working principle of the rolling cable transmission, and its properties, are introduced. Mechanical designs based on the working principle are also provided. Finally, as one of the applications of the proposed module, a tethered ankle exoskeleton system and its experimental results demonstrating the properties of the proposed transmission are presented. [ABSTRACT FROM AUTHOR]

Robotic exoskeletons provide programmable, consistent and controllable active therapeutic assistance to patients with neurological disorders. Here we introduce a prototype and preliminary experimental evaluation of a rehabilitative gait exoskeleton that enables compliant yet effective manipulation of the fragile limbs of rats. To assist the displacements of the lower limbs without impeding natural gait movements, we designed and fabricated soft pneumatic actuators (SPAs). The exoskeleton integrates two customizable SPAs that are attached to a limb. This configuration enables a 1 N force load, a range of motion exceeding 80 mm in the major axis, and speed of actuation reaching two gait cycles/s. Preliminary experiments in rats with spinal cord injury validated the basic features of the exoskeleton. We propose strategies to improve the performance of the robot and discuss the potential of SPAs for the design of other wearable interfaces. [ABSTRACT FROM AUTHOR]