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Lower limb exoskeletons and exosuits ("exos") are traditionally designed with a strong focus on mechatronics and actuation, whereas the "human side" is often disregarded or minimally modeled. Muscle biomechanics principles and skeletal muscle response to robot-delivered loads should be incorporated in design/control of exos. In this narrative review, we summarize the advances in literature with respect to the fusion of muscle biomechanics and lower limb exoskeletons. We report methods to measure muscle biomechanics directly and indirectly and summarize the studies that have incorporated muscle measures for improved design and control of intuitive lower limb exos. Finally, we delve into articles that have studied how the human–exo interaction influences muscle biomechanics during locomotion. To support neurorehabilitation and facilitate everyday use of wearable assistive technologies, we believe that future studies should investigate and predict how exoskeleton assistance strategies would structurally remodel skeletal muscle over time. Real-time mapping of the neuromechanical origin and generation of muscle force resulting in joint torques should be combined with musculoskeletal models to address time-varying parameters such as adaptation to exos and fatigue. Development of smarter predictive controllers that steer rather than assist biological components could result in a synchronized human–machine system that optimizes the biological and electromechanical performance of the combined system. [ABSTRACT FROM AUTHOR]

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

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

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

Fuzzy ranking plays a vital role in decision-making problems and various fuzzy applications. There are plenty of ranking methods that are used to rank fuzzy numbers. However, they fail to give satisfactory results in certain situations due to the complexity of the problem. In this present study, an attempt has been made to introduce four types of ranking methods in the field of intuitionistic dense fuzzy (IDF) depending on centroid and graded mean ranking. Also, arithmetic operations based on λ 1 , λ 2 -cuts, fuzzy numbers, and extension principles are defined for IDF environment. A model is framed to rank MCDM problems, which are aggregated using a weighted aggregation operator and ordered using the proposed and extended ranking methods. To illustrate the proposed MCDM model under the field of IDF, the problem of robot selection is taken for war fighter robots and exoskeleton robots to help and replace humans in war and help assistive walking patients with spinal cord injuries. The result reveals that the Ripsaw and Rewalk emerge as preferable options for substituting humans in the contexts of war fighters and exoskeleton robots, respectively. To analyze the effectiveness of the ranking results, comparative and sensitivity analyses are examined. Thus, the results provide a satisfactory output. [ABSTRACT FROM AUTHOR]

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

Exoskeleton robots are a promising solution to reduce musculoskeletal disorders (MSDs) in different work environments, but a specific usability scale for evaluating them is lacking. This study aimed to develop and verify a preliminary Exoskeleton Usability Questionnaire (EUQ) for the lower limb exoskeletons by creating a draft survey questionnaire from existing questions in prior studies. An experiment was conducted with 20 participants who performed a specific task while wearing three lower limb robots and provided subjective feedback using the developed questionnaire. Data were analysed using exploratory and confirmatory factor analysis (CFA), resulting in a usability evaluation questionnaire for exoskeleton robots clustered into four main factors: mobility, adjustability, handling and safety. This study's findings are expected to be useful in evaluating the usability of the lower limb exoskeletons in both general production sites and agricultural work, which can aid in reducing the prevalence of lower limb MSDs. Practitioner Summary: This study developed a preliminary subjective usability evaluation questionnaire for exoskeleton robots. The questionnaire is clustered into four main factors: mobility, adjustability, handling and safety. These findings provide a valuable tool for assessing exoskeleton usability, potentially reducing musculoskeletal disorders (MSDs) in various work environments. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task. PRACTITIONER SUMMARY: To examine the potential adoption of a back-support exosuit system in the surgical environment, this study used an 18-minute posture maintenance task that reflected trunk flexion postures observed during a vascular surgery procedure and suggests that the exosuit system can effectively reduce low back muscle fatigue during a vascular surgical procedure. [ABSTRACT FROM AUTHOR]

Work-related musculoskeletal disorders (WMSDs) are a major health concern in the construction industry. Occupational exoskeletons (EXOs) are a promising ergonomic intervention to help reduce WMSD risk. Their adoption, however, has been low in construction. To understand the contributing factors to EXO use-intention and assist in future decision-making, we built decision trees to predict responses to each of three EXO use-intention questions (Try, Voluntary Use, and Behavioural Intention), using online survey responses. Variable selection and hyperparameter tuning were used respectively to reduce the number of potential predictors and improve prediction performance. The importance of variables in each final tree was calculated to understand which variables had a greater influence. The final trees had moderate prediction performance. The root node of each tree included EXOs becoming standard equipment, fatigue reduction, or performance increase. Important variables were found to be quite specific to different decision trees. Practical implications of the findings are discussed. Practitioner summary: This study used decision trees to identify key factors influencing the use-intention of occupational exoskeletons (EXOs) in construction, using online survey data. Key factors identified included EXOs becoming standard equipment, fatigue reduction, and performance improvement. Final trees provide intuitive visual representations of the decision-making process for workers to use EXOs. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Approved in 2014 by the Food and Drug Administration (FDA) for use with a trained companion, personal powered exoskeletons (PPE) for individuals with spinal cord injury (SCI) provide an opportunity for the appropriate candidate to ambulate in their home and community. As an adjunct to wheeled mobility, PPE use allows those individuals who desire to ambulate the opportunity to experience the potential physiological and psychosocial benefits of assisted walking outside of a rehabilitation setting. There exists, however, a knowledge gap for clinicians regarding appropriate candidate selection for use, as well as who might benefit from ambulating with a PPE. The purpose of this paper is to provide guidance for clinicians working with individuals living with SCI by outlining an expert consensus for a PPE decision-making algorithm, as well as a discussion of potential physiological and psychosocial benefits from PPE use based on early evidence in publication. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods: This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) prepost intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion: This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. [ABSTRACT FROM AUTHOR]

Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training. [ABSTRACT FROM AUTHOR]

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

Electrically driven soft pumps act as ideal “hearts” for flexible fluidic systems in soft robots and wearable devices. Dielectric elastomers (DEs) are promising for soft pump fabrication owing to their features of fast response, large strain, high energy density, and low power consumption. However, conventional dielectric elastomer actuators (DEAs) using single DE material usually exhibit poor pumping performance due to electromechanical instability or insulating problems. Herein, a multilayer structured heterogeneous dielectric elastomer actuator (H‐DEA) is fabricated based on thin films of processable, high‐performance dielectric elastomer (PHDE) and silicones, and is integrated onto silicone pump body to build a fully soft pump. The pump achieves a flow rate of 3.25 mL min−1 and a blocked pressure of 2.75 kPa with a mass of less than 1 g and a power consumption of 0.21 W. It maintains pumping functions when being bent or stretched and after twisted. It works for viscous liquids and is demonstrated to drive a soft robotic fluidic circuit. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effects of overground robot exoskeleton gait training on gait outcomes, balance, and motor function in patients with stroke. Methods: Following the PRISMA guidelines, literature searches were performed in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Ovid-LWW, and RISS databases. A total of 504 articles were identified, of which 19 were included for analysis after application of the inclusion and exclusion criteria. The included literature was qualitatively evaluated using the PEDro scale, while the Egger's regression, funnel plot, and trim-and-fill methods were applied to assess and adjust for publication bias. Results: The averaged PEDro score was 6.21 points, indicating a high level of methodological quality. In the analysis based on dependent variables, higher effect sizes were observed in the following ascending order: gait speed (g = 0.26), motor function (g = 0.21), gait ability (g = 0.18), Timed Up and Go Test (g = −0.15), gait endurance (g = 0.11), and Berg Balance Scale (g = 0.05). Subgroup analyses further revealed significant differences in Asian populations (g = 0.26), sessions lasting longer than 30 min (g = 0.37), training frequency of three times per week or less (g = 0.38), and training duration of four weeks or less (g = 0.25). Overall, the results of this study indicate that overground robot exoskeleton gait training is effective at improving gait speed in patients with stroke, particularly when the sessions exceed 30 min, are conducted three times or less per week, and last for four weeks or less. Conclusion: our results suggest that training is an effective intervention for patients with stroke, provided that appropriate goal-setting and intensity and overground robot exoskeleton gait are applied. [ABSTRACT FROM AUTHOR]

The behavior of pedestrians in a non-constrained environment is difficult to predict. In wearable robotics, this poses a challenge, since devices like lower-limb exoskeletons and active orthoses need to support different walking activities, including level walking and climbing stairs. While a fixed movement trajectory can be easily supported, switches between these activities are difficult to predict. Moreover, the demand for these devices is expected to rise in the years ahead. In this work, we propose a cloud software system for use in wearable robotics, based on geographical mapping techniques and Human Activity Recognition (HAR). The system aims to give context to the surrounding pedestrians by providing hindsight information. The system was partially implemented and tested. The results indicate a viable concept with great extensibility prospects. [ABSTRACT FROM AUTHOR]

Physical therapy is often essential for complete recovery after injury. However, a significant population of patients fail to adhere to prescribed exercise regimens. Lack of motivation and inconsistent in-person visits to physical therapy are major contributing factors to suboptimal exercise adherence, slowing the recovery process. With the advancement of virtual reality (VR), researchers have developed remote virtual rehabilitation systems with sensors such as inertial measurement units. A functional garment with an integrated wearable sensor can also be used for real-time sensory feedback in VR-based therapeutic exercise and offers affordable remote rehabilitation to patients. Sensors integrated into wearable garments offer the potential for a quantitative range of motion measurements during VR rehabilitation. In this research, we developed and validated a carbon nanocomposite-coated knit fabric-based sensor worn on a compression sleeve that can be integrated with upper-extremity virtual rehabilitation systems. The sensor was created by coating a commercially available weft knitted fabric consisting of polyester, nylon, and elastane fibers. A thin carbon nanotube composite coating applied to the fibers makes the fabric electrically conductive and functions as a piezoresistive sensor. The nanocomposite sensor, which is soft to the touch and breathable, demonstrated high sensitivity to stretching deformations, with an average gauge factor of ~35 in the warp direction of the fabric sensor. Multiple tests are performed with a Kinarm end point robot to validate the sensor for repeatable response with a change in elbow joint angle. A task was also created in a VR environment and replicated by the Kinarm. The wearable sensor can measure the change in elbow angle with more than 90% accuracy while performing these tasks, and the sensor shows a proportional resistance change with varying joint angles while performing different exercises. The potential use of wearable sensors in at-home virtual therapy/exercise was demonstrated using a Meta Quest 2 VR system with a virtual exercise program to show the potential for at-home measurements. [ABSTRACT FROM AUTHOR]

The purpose of this study is to simulate the different walking adaptation strategies and their impact on muscle activities while changing the anchor point position of an exosuit in hip extension assistance motion. In particular, muscle activation and metabolic power consumption are assessed at varying levels of assistive force actuation that alters the position of anchor points. OpenSim software was used to perform simulations of 10 elderly subjects at comfortable gait speed while varying the anchor point positions of the thigh. Compared to unassisted gait, the extension assistance at placements below 40% (proximal) requires an increase in metabolic cost to maintain gait characteristics. At 40%, energy consumption corresponds to unassisted gait. From 50% proximal to distal positions, a reduction in metabolic cost is observed, with a minimum at 80%. The variation of the metabolic cost at different positions of the anchor point is reflected in the muscular activities, with an increase when the cable is placed below 40% of the total length of the thigh and a decrease from this position onwards. The activation level and metabolic cost exerted by the hip flexors and extensors muscles may be optimized during the exosuit actuation. The dynamics of the muscles spanning joints not actuated by the exosuit are not influenced by the actuation. The results and analysis provide information to optimize actuation profiles in the design of exosuits to assist gait for older adults and, thus, promote active aging and improving rehabilitation routines. [ABSTRACT FROM AUTHOR]

A four‐degree‐of‐freedom upper limb exoskeleton rehabilitation robot system with a gravity compensation device is constructed. The objective is to address the rehabilitation training needs of patients with upper limb motor dysfunction. A BP neural network adaptive control method based on particle swarm optimization is proposed. First, the degrees of freedom of the human body are analyzed, and a Lagrange method is employed to construct a dynamic model. Second, a particle swarm optimization back propagation neural network adaptive control algorithm based on particle swarm optimization is presented. Subsequently, the range of motion of the upper limbs is analyzed with reference to muscle anatomy and a three‐dimensional motion capture system. And the robot structure design is analyzed in detail. Finally, simulation experiments were conducted, and the results demonstrated that the proposed method exhibited high effectiveness and accuracy. [ABSTRACT FROM AUTHOR]

In this study, we introduce a two-dimensional (2D) human skeletal model coupled with knee, spine, and shoulder exoskeletons. The primary purpose of this model is to predict the optimal lifting motion and provide torque support from the exoskeleton through the utilization of inverse dynamics optimization. The kinematics and dynamics of the human model are expressed using the Denavit–Hartenberg (DH) representation. The lifting optimization formulation integrates the electromechanical dynamics of the DC motors in the exoskeletons of the knee, spine, and shoulder. The design variables for this study include human joint angle profiles and exoskeleton motor current profiles. The optimization objective is to minimize the squared normalized human joint torques, subject to physical and task-specific lifting constraints. We solve this optimization problem using the gradient-based optimizer SNOPT. Our results include a comparison of predicted human joint angle profiles, joint torque profiles, and ground reaction force (GRF) profiles between lifting tasks with and without exoskeleton assistance. We also explore various combinations of exoskeletons for the knee, spine, and shoulder. By resolving the lifting optimization problems, we designed the optimal torques for the exoskeletons located at the knee, spine, and shoulder. It was found that the support from the exoskeletons substantially lowers the torque levels in human joints. Additionally, we conducted experiments only on the knee exoskeleton. Experimental data indicated that using the knee exoskeleton decreases the muscle activation peaks by 35.00%, 10.03%, 22.12%, 30.14%, 16.77%, and 25.71% for muscles of the erector spinae, latissimus dorsi, vastus medialis, vastus lateralis, rectus femoris, and biceps femoris, respectively. [ABSTRACT FROM AUTHOR]

Balanomorph (acorn) barnacles are found throughout the world's coastal oceans, and their success is dependent on a hard, mineralized, outer shell. Although macro-scale morphology of barnacle shells has been studied extensively, relatively little is known about shell properties at the micron-scale and if such properties vary among species. We assessed shell structure, mechanics, and composition in seven species of balanomorph barnacles from five genera. Three species, Amphibalanus amphitrite, Amphibalanus improvisus, and Austrominius modestus, were laboratory-reared, enabling direct comparison of shell properties of barnacles grown under the same conditions for the same duration. Four other species, Semibalanus balanoides, Amphibalanus eburneus, Chthamalus stellatus, and Tetraclita rubescens, were field-collected. At the macro- and meso-scales, shell properties varied markedly among species, with differences in the number of shell plates, the presence of canals within the plates, mineralization of the base, and shell plate thickness. At the micron-scale, however, structure was remarkably similar among species. Plates of all species were constructed of irregular micron-scale crystallites, with a broad range of crystallite dimensions observed within the same shell. Similarly, micromechanical properties did not vary among species, regardless of testing orientation. Calcium carbonate was identified as calcite in all species assessed with no other mineral phases present, and calcium content did not vary among species. Hence, despite variation in the overall macro- and meso-scale morphology of barnacles, all appear to be built using the same, evolutionarily conserved, mineralization pathway. [ABSTRACT FROM AUTHOR]

To enhance the safety of direct physical interaction between humans and lower-limb exoskeletons, the actuator of the lower-limb exoskeleton should possess compliance, force controllability, and back-drivability. In this paper, a novel compact compliant force control actuator with worm gear and gear rack as transmission modes is designed to provide flexible power to the lower-limb exoskeleton. The worm gear is utilized to amplify the torque generated by the motor in the compact compliant actuator, while the gear rack is established to improve the bearing capacity. Yet, the friction is occurred between the worm gear, rack and other mechanical configurations which may lead to non-negligible force control error of the compliant actuator. A noise-tolerant zeroing neural network controller is proposed to suppress noises. Additionally, theoretical proofs are provided for the convergence performance of the noise-tolerant zeroing neural network controller, as well as the suppression of constant noise, linear disturbances, and bounded random noise. The proposed noise-tolerant zeroing neural network controller is validated on the compliant actuator through numerical simulations, experimental results, and comparison experiments, demonstrating its effectiveness in suppressing various noise and improving the convergence, stability, and robustness of the compliant actuator system. Additionally, the controller is further verified through walking experiments conducted on a knee robot. [ABSTRACT FROM AUTHOR]

This paper presents an innovative adaptive fractional-order (FO) terminal sliding mode (TSM) controller designed for a 5-degree-of-freedom (5-DOF) upper-limb exoskeleton robot. The primary focus is on addressing the challenges posed by nonlinearities and uncertainties in parameter values. The proposed approach integrates several key elements, including a novel fractional-order non-singular terminal sliding mode (FONSTSM) surface, an exponential reaching law, and the utilization of the extreme learning machine (ELM). This comprehensive strategy guarantees not only finite-time convergence but also robust stability, effectively alleviating the well-known chattering phenomenon. Furthermore, it successfully overcomes the singularity issues typically observed in conventional TSM controllers. The incorporation of the ELM with rectified linear unit (ReLU) activation function enhances robustness by facilitating the estimation of parameters related to the exponential control law. Numerical simulations provide compelling evidence of improved tracking, increased robustness against uncertainties, achievement of finite-time convergence, and notable reductions in control signal oscillations and singularity problems. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) mapping is important to achieve early warning for construction safety and support the long-term safety maintenance of tunnels. However, generating 3D point cloud maps of excavation tunnels that tend to be deficient in features, have rough lining structures, and suffer from dynamic construction interference, can be a challenging task. In this paper, we propose a novel legged robot-aided 3D tunnel mapping method to address the influence of point clouds in the mapping phase. First, a method of kinematic model construction that integrates information from both the robot's motors and the inertial measurement unit (IMU) is proposed to correct the motion distortion of point clouds. Then, a residual compensation model for unreliable regions (abbreviated as the URC model) is proposed to eliminate the inherent alignment errors in the 3D structures. The structural regions of a tunnel are divided into different reliabilities using the K-means method, and an inherent alignment metric is compensated based on region residual estimation. The compensated alignment metric is then incorporated into a rotation-guided anomaly consistency detection (RAD) model. An isolation forest-based anomaly consistency indicator is designed to remove anomalous light detection and ranging (LiDAR) points and reduce sensor noise caused by ultralong distances. To verify the proposed method, we conduct numerous experiments in three tunnels, namely, a drilling and blasting tunnel, a TBM tunnel, and an underground pedestrian tunnel. According to the experimental results, the proposed method achieves 0.84 ‰, 0.40 ‰, and 0.31 ‰ closure errors (CEs) for the three tunnels, respectively, and the absolute map error (AME) and relative map error (RME) are approximately 1.45 cm and 0.57 %, respectively. The trajectory estimation and mapping errors of our method are smaller than those of existing methods, such as FAST-LIO2, Faster-LIO and LiLi-OM. In addition, ablation tests are conducted to further reveal the roles of the different models used in our method for legged robot-aided 3D mapping in tunnels. [ABSTRACT FROM AUTHOR]

This paper presents a wrist exoskeleton called the KIST Upper-Limb EXoskeleton (KULEX)-wrist for activities of daily living assistance of the elderly and the disabled. A novel linkage-based structure of the rotational mechanism with three degrees-of-freedom is proposed. The proposed wrist mechanism is composed of two prismatic-universal-spherical serial chains and one revolute-revolute-revolute spherical chain. Besides, a combination of a planar slider-crank and spherical four-bar linkages was employed as a drive mechanism for power transmission. Kinematic analysis was conducted to understand its working principle. Then, the dimensions of all the linkages were synthesized to meet the structural design suitable for the wearable exoskeleton and the transmission quality. In addition, motion twists and wrenches were geometrically derived. Finally, a prototype of the KULEX-wrist was designed, and then its performance of mechanical stiffness, motion capability, and power assistance was verified. [ABSTRACT FROM AUTHOR]

Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices. A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators. Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers. This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI. Optimize the use of this technology to adapt as much as possible to individual needs. Offer an in-depth understanding of the challenges that can arise when adopting exoskeletons. Highlight the critical issues with the device, that prevent me from using it outside of clinical contexts. Offer useful information to therapists to select the most suitable patients for the use of the exoskeleton and to customize rehabilitation programs more effectively. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Harbin Institute of Technology. Social Sciences Edition / Haerbin Gongye Daxue Xuebao. Shehui Kexue Ban is the property of Harbin Institute of Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article studies the passive tracking problem of a wearable exoskeleton for lower limb rehabilitation therapy in the face of unmodeled dynamics, interactive friction, disturbance, prescribed performance constraints, and actuator faults. Adaptive neural networks and a smooth performance function are incorporated to establish a novel fault-tolerant tracking scheme, which can not only compensate for the nonlinear uncertainties and disturbance, but also handle the actuator fault with guaranteed tracking performance. A state feedback controller is presented by using the full state information and an output feedback controller is developed when the angular velocity is unavailable. The differential explosion issue of the backstepping technique is resolved by constructing a first-order filter and the unmeasurable velocity is estimated by a nonlinear observer. Semiglobal uniform boundedness stabilities of the exoskeleton system are proved via the Lyapunov direct method. The tracking performances of the designed control approaches are tested by comparative simulations. [ABSTRACT FROM AUTHOR]

Work-related musculoskeletal disorders (WMSDs) are a common occupational health problem in industries, and they can lead to decreased productivity and a reduced quality of life for workers. Exoskeletons, as an emerging technology, have the potential to solve this challenge by assisting arm movements and reducing muscle effort during load lifting tasks. In this paper, a passive exoskeleton based on a variable stiffness mechanism (VSM) torque generator is proposed and evaluated. This exoskeleton can provide adjustable torque curves and accommodate three degrees of freedom (DOFs) while remaining compact and lightweight. The workspace analysis shows that the workspace of this exoskeleton is sufficient for most industrial manual handling tasks. The experimental results demonstrate that the exoskeleton effectively reduces muscle effort during overhead reaching and load-lifting tasks, highlighting its effectiveness for repetitive tasks in industrial settings. [ABSTRACT FROM AUTHOR]

Manipulation involves both fine tactile feedback, with dynamic transients perceived by fingerpad mechanoreceptors, and kinaesthetic force feedback, involving the whole hand musculoskeletal structure. In teleoperation experiments, these fundamental aspects are usually divided between different setups at the operator side: those making use of lightweight gloves and optical tracking systems, oriented toward tactile-only feedback, and those implementing exoskeletons or grounded manipulators as haptic devices delivering kinaesthetic force feedback. At the level of hand interfaces, exoskeletons providing kinaesthetic force feedback undergo a trade-off between maximum rendered forces and bandpass of the embedded actuators, making these systems unable to properly render tactile feedback. To overcome these limitations, here, we investigate a full upper limb exoskeleton, covering all the upper limb body segments from shoulder to finger phalanxes, coupled with linear voice coil actuators at the fingertips. These are developed to render wide-bandwidth tactile feedback together with the kinaesthetic force feedback provided by the hand exoskeleton. We investigate the system in a pick-and-place teleoperation task, under two different feedback conditions (visual-only and visuo-haptic). The performance based on measured interaction forces and the number of correct trials are evaluated and compared. The study demonstrates the overall feasibility and effectiveness of a complex full upper limb exoskeleton (seven limb-actuated DoFs plus five hand DoFs) capable of combined kinaesthetic and tactile haptic feedback. Quantitative results show significant performance improvements when haptic feedback is provided, in particular for the mean and peak exerted forces, and for the correct rate of the pick-and-place task. [ABSTRACT FROM AUTHOR]

With the increasing development of intelligent robots and wearable electronics, the demand for high-performance flexible energy storage devices is drastically increasing. In this study, flexible symmetric microsupercapacitors (MSCs) that could operate in a wide working voltage window were developed by combining laser-direct-writing graphene (LG) electrodes with a phosphoric acid-nonionic surfactant liquid crystal (PA-NI LC) gel electrolyte. To increase the flexibility and enhance the conformal ability of the MSC devices to anisotropic surfaces, after the interdigitated LG formed on the polyimide (PI) film surface, the devices were further transferred onto a flexible, stretchable and transparent polydimethylsiloxane (PDMS) substrate; this substrate displayed favorable flexibility and mechanical characteristics in the bending test. Furthermore, the electrochemical performances of the symmetric MSCs with various electrode widths (300, 400, 500 and 600 μm) were evaluated. The findings revealed that symmetric MSC devices could operate in a large voltage range (0–1.5 V); additionally, the device with a 300 μm electrode width (MSC-300) exhibited the largest areal capacitance of 2.3 mF cm−2 at 0.07 mA cm−2 and an areal (volumetric) energy density of 0.72 μWh cm−2 (0.36 mWh cm−3) at 55.07 μW cm−2 (27.54 mW cm−3), along with favorable mechanical and cycling stability. After charging for ~20 s, two MSC-300 devices connected in series could supply energy to a calculator to operate for ~130 s, showing its practical application potential as an energy storage device. Moreover, the device displayed favorable reversibility, stability and durability. After 12 months of aging in air at room temperature, its electrochemical performance was not altered, and after charging-discharging measurements for 5000 cycles at 0.07 mA cm−2, ~93.6% of the areal capacitance was still retained; these results demonstrated its practical long-term application potential as an energy storage device. [ABSTRACT FROM AUTHOR]

Featured Application: The machine learning model predicts Minimum Foot Clearance heights to prevent tripping falls. Integrated into exoskeletons or other assistive devices, it offers real-time interventions for vulnerable populations, enhancing safety with quick and accurate foot clearance adjustments. Tripping is the largest cause of falls, and low swing foot ground clearance during the mid-swing phase, particularly at the critical gait event known as Minimum Foot Clearance (MFC), is the major risk factor for tripping-related falls. Intervention strategies to increase MFC height can be effective if applied in real-time based on feed-forward prediction. The current study investigated the capability of machine learning models to classify the MFC into various categories using toe-off kinematics data. Specifically, three MFC sub-categories (less than 1.5 cm, between 1.5 and 2.0 cm, and higher than 2.0 cm) were predicted to apply machine learning approaches. A total of 18,490 swing phase gait cycles' data were extracted from six healthy young adults, each walking for 5 min at a constant speed of 4 km/h on a motorized treadmill. K-Nearest Neighbor (KNN), Random Forest, and XGBoost were utilized for prediction based on the data from toe-off for five consecutive frames (0.025 s duration). Foot kinematics data were obtained from an inertial measurement unit attached to the mid-foot, recording tri-axial linear accelerations and angular velocities of the local coordinate. KNN, Random Forest, and XGBoost achieved 84%, 86%, and 75% accuracy, respectively, in classifying MFC into the three sub-categories with run times of 0.39 s, 13.98 s, and 170.98 s, respectively. The KNN-based model was found to be more effective if incorporated into an active exoskeleton as the intelligent system to control MFC based on the preceding gait event, i.e., toe-off, due to its quicker computation time. The machine learning-based prediction model shows promise for the prediction of critical MFC data, indicating higher tripping risk. [ABSTRACT FROM AUTHOR]

The motor features of people with cerebellar ataxia suggest that locomotion is substantially impaired due to incoordination of the head, trunk, and limbs. The purpose of this study was to investigate how well a wearable soft passive exoskeleton worked for motor coordination in these patients. We used an optoelectronic system to examine the gait of nine ataxic people in three different conditions: without an exoskeleton and with two variants of the exoskeleton, one less and the other more flexible. We investigated kinematics using trunk ranges of motion, the displacement of the center of mass in the medio-lateral direction, and the parameters of mechanical energy consumption and recovery. Furthermore, we investigated the lower limb and trunk muscle coactivation. The results revealed a reduction of the medio-lateral sway of the center of mass, a more efficient behavior of the body in the antero-posterior direction, an energy expenditure optimization, a reduction of muscle coactivation and a better coordination between muscle activations. As a result, the findings laid the groundwork for the device to be used in the rehabilitation of individuals with cerebellar ataxia. [ABSTRACT FROM AUTHOR]

In this paper, serial elastic actuators (SEAs) in conjunction with an accelerometer are proposed as force sensors to detect the intention of movement, and the SEA is proposed as a gentle actuator of a patient's upper-limb exoskeleton. A smooth trajectory is proposed to provide comfortable performance. There is an offset trajectory between the link and the motor, which increases safety by preventing sudden movements, and the offset is equivalent to the torsional elastic spring constant. The proposed control law is based on a backstepping approach tested in real-time experiments with robust results in a 2-DoF upper-limb rehabilitation exoskeleton. The experimental results showed a sensitivity of 100% and a positive predictive value of 97.5% for movement intention detection. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the efficacy and user's impression of an arm-support exoskeleton in complex and realistic ceiling construction tasks. 11 construction workers performed 9 tasks. We determined objective and subjective efficacy of the exoskeleton by measuring shoulder muscle activity and perceived exertion. User's impression was assessed by questionnaires on expected support, perceived support, perceived hindrance and future intention to use the exoskeleton. Wearing the exoskeleton yielded persistent reductions in shoulder muscle activity of up to 58% and decreased perceived exertion. Participants reported limited perceived hindrance by the exoskeleton, as also indicated by no increase in antagonistic muscle activity. The findings demonstrate the high potential of an arm-support exoskeleton for unloading the shoulder muscles when used in the dynamic and versatile working environment of a ceiling construction worker, which is in line with the consistent intention of the workers to use the exoskeleton in the future. Practitioner Summary: The majority of research focuses on the effect of using an arm-support exoskeleton during isolated postures and prescribed movements. We investigated the efficacy of an exoskeleton during a complex and realistic work, namely ceiling construction. Shoulder muscle activity was lower in almost all tasks when wearing the exoskeleton. [ABSTRACT FROM AUTHOR]

Trial design: This study is a pilot randomized clinical trial aimed to investigate the effect of using Hip Exoskeleton Assistive (HEXA) robot compared to conventional physiotherapy on the quality of walking, disability, and quality of life of stroke patients with hemiplegia. Methods: In this study, 24 patients were randomly assigned to the intervention group (robotic physiotherapy with HEXA robot), or control group (conventional physiotherapy). In each session, both groups received 30 min of conventional physiotherapy including electrotherapy and conventional exercises, and then the intervention group did gait training for 30 min with the HEXA robot and the control group for 30 min without the HEXA robot. The treatment program was 12 sessions, 3 times a week. Before the 1st and after the 12th sessions, both groups were evaluated for walking quality, disability, and quality of life. Results: The results showed that the main effect of time was significant (P < 0.05) in all outcomes and patients in both groups achieved significant improvement in all outcomes after the intervention. The main effect of the group was also significant in the outcomes of 6MWT (P < 0.05) and TUG (P < 0.05), and the intervention group patients experienced more distance and speed in these two tests. This study was approved by the ethics committee of Mashhad University of Medical Sciences (IR.MUMS.FHMPM.REC.1400.079 dated 28th Jan 2022). The trial was registered with the clinical trials site of www.IRCT.ir (IRCT20210730052024N1) on January 28th 2022. Conclusion: It seems that the HEXA robot can effectively improve walking capacity and speed. [ABSTRACT FROM AUTHOR]

Introduction: Children with cerebral palsy (CP) exhibit a variety of sensory impairments that can interfere with motor performance, but how these impairments persist into adulthood needs further investigation. The objective of this study was to describe the sensory impairments in adults having CP and how they relate to motor impairments. Methods: Nineteen adults having CP performed a set of robotic and clinical assessments. These assessments were targeting different sensory functions and motor functions (bilateral and unilateral tasks). Frequency of each type of impairments was determined by comparing individual results to normative data. Association between the sensory and motor impairments was assessed with Spearman correlation coefficient. Results: Impairment in stereognosis was the most frequent, affecting 57.9% of participants. Although less frequently impaired (26.3%), tactile discrimination was associated with all the motor tasks (unilateral and bilateral, either robotic or clinical). Performance in robotic motor assessments was more frequently associated with sensory impairments than with clinical assessments. Finally, sensory impairments were not more closely associated with bilateral tasks than with unilateral tasks. Discussion: Somatosensory and visuo-perceptual impairments are frequent among adults with CP, with 84.2% showing impairments in at least one sensory function. These sensory impairments show a moderate association with motor impairments. [ABSTRACT FROM AUTHOR]