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Ramella G, Grazi L, Giovacchini F, Trigili E, Vitiello N, Crea S. Evaluation of antigravitational support levels provided by a passive upper-limb occupational exoskeleton in repetitive arm movements. APPLIED ERGONOMICS 2024; 117:104226. [PMID: 38219374 DOI: 10.1016/j.apergo.2024.104226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/24/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Upper-limb occupational exoskeletons to support the workers' upper arms are typically designed to provide antigravitational support. Although typical work activities require workers to perform static and dynamic actions, the majority of the studies in literature investigated the effects of upper-limb occupational exoskeletons in static and quasi-static activities, while only a few works focused on dynamic tasks. This article presents a systematic evaluation of the effects of different levels of antigravitational support (from about 60% to 100% of the arm gravitational load) provided by a passive upper-limb occupational exoskeleton on muscles' activity during repetitive arm movements. The effect of the exoskeleton on muscle activity was evaluated by the comparison of muscle activations with and without the exoskeleton. The average muscle activation was computed considering shoulder full flexion-extension cycles, and sub-movements, namely the arm-lifting (i.e., flexion) and arm-lowering (i.e., extension) movements. Results showed a quasi-linear correlation between antigravitational support and muscle activity reductions, both when considering the full flexion-extension cycle and in the arm-lifting movement (reductions were up to 64 and 61% compared to not wearing the exoskeleton, respectively). When considering the arm-lowering movement, providing antigravitational support close to or higher than 100% of the arm gravitational load led to increased muscle activations of the extensors (up to 127%), suggesting that such an amount of antigravitational support may be not effective for a complete biomechanical load reduction on the shoulder district in dynamic tasks.
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Affiliation(s)
- Giulia Ramella
- Biorobotics Laboratory, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Lorenzo Grazi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | | | - Emilio Trigili
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy; IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56025 Pontedera, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy; IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
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Hussain M, Kong YK, Park SS, Shim HH, Park J. Exoskeleton Usability Questionnaire: a preliminary evaluation questionnaire for the lower limb industrial exoskeletons. ERGONOMICS 2023:1-10. [PMID: 38111360 DOI: 10.1080/00140139.2023.2289856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
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.
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Affiliation(s)
- Muhammad Hussain
- Department of Computer Science, University of York, York, UK
- Department of Industrial and Management Engineering, Incheon National University (INU), Incheon, Republic of Korea
| | - Yong-Ku Kong
- Department of Industrial Engineering, Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Sang-Soo Park
- Department of Industrial Engineering, Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Hyun-Ho Shim
- Department of Industrial Engineering, Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Jaehyun Park
- Department of Industrial and Management Engineering, Incheon National University (INU), Incheon, Republic of Korea
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Li YY, Gan J. Effect of wearable chair on gait, balance, and discomfort of new users during level walking with anterior loads. JOURNAL OF SAFETY RESEARCH 2023; 87:27-37. [PMID: 38081701 DOI: 10.1016/j.jsr.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/22/2023] [Accepted: 08/25/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Walking with anterior loads is common in industrial scenarios, but as exoskeletons are increasingly used in work environments to alleviate musculoskeletal disorders (MSDs), this new "human-robot" system composed of the human body and exoskeleton may be associated with new risks and harm that warrant further investigation. Therefore, this study will discuss the effect of a wearable chair on the gait, balance, and discomfort of new users with different weights of anterior loads during level walking. METHOD Twenty-two healthy subjects (sex balanced) participated in the experiment. Each exposure comprised one of two exoskeleton states (with/without) and four load conditions: No carried load, carrying an empty box (0.3 kg), 5%Body Weight (BW), and 10%BW. The order of exoskeleton states and load conditions was randomly assigned. Using an eight-camera motion capture system to record the entire movement. And the subjective discomfort and perceived balance after each exposure were recorded on an 11-point numeric rating scale, respectively. Using SPSS 26.0 software (IBM Inc., Chicago) to conduct statistical analyses. RESULTS Level walking with a wearable chair in different load conditions significantly affected gait parameters (like cadence) and gait balance. The perceived balance decreased with the exoskeleton, consistent with objective results. For subjective discomfort, wearing the exoskeleton significantly impacted global discomfort. Also, it increased the local discomfort of the shoulders, waist, thighs, shanks, and feet/ankles. CONCLUSIONS For new users, the risk of losing balance or falling may be increased when wearing an exoskeleton for non-target task behaviors (level walking/anterior load), and caution is recommended when the anterior load exceeds 5% BW. PRACTICAL APPLICATION The proposed strategy for assessing human gait, balance, and discomfort in wearable chairs may be applied during the iterative design of the product. These controls will help develop training programs and implementation guidelines for this exoskeleton type.
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Affiliation(s)
- Ying-Yi Li
- School of Mechanical Engineering, Sichuan University, Chengdu, China.
| | - Jing Gan
- School of Mechanical Engineering, Sichuan University, Chengdu, China.
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Chen YN, Wu YN, Yang BS. The neuromuscular control for lower limb exoskeleton- a 50-year perspective. J Biomech 2023; 158:111738. [PMID: 37562276 DOI: 10.1016/j.jbiomech.2023.111738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Historically, impaired lower limb function has resulted in heavy health burden and large economic loss in society. Although experts from various fields have put large amounts of effort into overcoming this challenge, there is still not a single standard treatment that can completely restore the lost limb function. During the past half century, with the advancing understanding of human biomechanics and engineering technologies, exoskeletons have achieved certain degrees of success in assisting and rehabilitating patients with loss of limb function, and therefore has been spotlighted in both the medical and engineering fields. In this article, we review the development milestones of lower limb exoskeletons as well as the neuromuscular interactions between the device and wearer throughout the past 50 years. Fifty years ago, the lower-limb exoskeletons just started to be devised. We review several prototypes and present their designs in terms of structure, sensor and control systems. Subsequently, we introduce the development milestones of modern lower limb exoskeletons and discuss the pros and cons of these differentiated devices. In addition, we summarize current important neuromuscular control systems and sensors; and discuss current evidence demonstrating how the exoskeletons may affect neuromuscular control of wearers. In conclusion, based on our review, we point out the possible future direction of combining multiple current technologies to build lower limb exoskeletons that can serve multiple aims.
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Affiliation(s)
- Yu-Ning Chen
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, MA, USA; The New England Robotics Validation and Experimentation Center, University of Massachusetts Lowell, MA, USA
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Mechanical and Mechatronics Systems Research Laboratories, Industrial Technology Research Institute, Taiwan; Taiwanese Society of Biomechanics, Taiwan.
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Li-Baboud YS, Virts A, Bostelman R, Yoon S, Rahman A, Rhode L, Ahmed N, Shah M. Evaluation Methods and Measurement Challenges for Industrial Exoskeletons. SENSORS (BASEL, SWITZERLAND) 2023; 23:5604. [PMID: 37420770 DOI: 10.3390/s23125604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 07/09/2023]
Abstract
In recent years, exoskeleton test methods for industrial exoskeletons have evolved to include simulated laboratory and field environments. Physiological, kinematic, and kinetic metrics, as well as subjective surveys, are used to evaluate exoskeleton usability. In particular, exoskeleton fit and usability can also impact the safety of exoskeletons and their effectiveness at reducing musculoskeletal injuries. This paper surveys the state of the art in measurement methods applied to exoskeleton evaluation. A notional classification of the metrics based on exoskeleton fit, task efficiency, comfort, mobility, and balance is proposed. In addition, the paper describes the test and measurement methods used in supporting the development of exoskeleton and exosuit evaluation methods to assess their fit, usability, and effectiveness in industrial tasks such as peg in hole, load align, and applied force. Finally, the paper includes a discussion of how the metrics can be applied towards a systematic evaluation of industrial exoskeletons, current measurement challenges, and future research directions.
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Affiliation(s)
- Ya-Shian Li-Baboud
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Ann Virts
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Roger Bostelman
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
- Smart HLPR LLC, Troutman, NC 28166, USA
| | - Soocheol Yoon
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
- Institute for Soft Matter, Georgetown University, Washington, DC 20057, USA
| | - Amaan Rahman
- Department of Electrical Engineering, Albert Nerken School of Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY 10003, USA
| | - Lucia Rhode
- Department of Electrical Engineering, Albert Nerken School of Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY 10003, USA
| | - Nishat Ahmed
- Department of Electrical Engineering, Albert Nerken School of Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY 10003, USA
| | - Mili Shah
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
- Department of Mathematics, Albert Nerken School of Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY 10003, USA
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Kuber PM, Alemi MM, Rashedi E. A Systematic Review on Lower-Limb Industrial Exoskeletons: Evaluation Methods, Evidence, and Future Directions. Ann Biomed Eng 2023:10.1007/s10439-023-03242-w. [PMID: 37248409 DOI: 10.1007/s10439-023-03242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
Industrial tasks that involve frequent sitting/standing transitions and squatting activities can benefit from lower-limb industrial exoskeletons; however, their use is not as widespread as their upper-body counterparts. In this review, we examined 23 articles that evaluated the effects of using Wearable Chair (WC) and Squat-assist (SA) exoskeletons. Evaluations mainly included assessment of muscular demands in the thigh, shank, and upper/lower back regions. Both types of devices were found to lessen muscular demands in the lower body by 30-90%. WCs also reduced low-back demands (~ 37%) and plantar pressure (54-80%) but caused discomfort/unsafe feeling in participants. To generalize outcomes, we suggest standardizing approaches used for evaluating the devices. Along with addressing low adoption through design upgrades (e.g., ground and body supports/attachments), we recommend that researchers thoroughly evaluate temporal effects on muscle fatigue, metabolic rate, and stability of wearers. Although lower-limb exoskeletons were found to be beneficial, discrepancies in experimental protocols (posture/task/measures) were discovered. We also suggest simulating more realistic conditions, such as walking/sitting interchangeability for WCs and lifting loads for SA devices. The presented outcomes could help improve the design/evaluation approaches, and implementation of lower limb wearable devices across industries.
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Affiliation(s)
- Pranav Madhav Kuber
- Biomechanics and Ergonomics Lab, Industrial and Systems Engineering Department, Rochester Institute of Technology, 1 Lomb Memorial Dr, Rochester, NY, 14623, USA
| | - Mohammad Mehdi Alemi
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
- Training Services, MathWorks, Natick, MA, USA
| | - Ehsan Rashedi
- Biomechanics and Ergonomics Lab, Industrial and Systems Engineering Department, Rochester Institute of Technology, 1 Lomb Memorial Dr, Rochester, NY, 14623, USA.
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Brambilla C, Lavit Nicora M, Storm F, Reni G, Malosio M, Scano A. Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review. Bioengineering (Basel) 2023; 10:bioengineering10040445. [PMID: 37106632 PMCID: PMC10135542 DOI: 10.3390/bioengineering10040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.
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Affiliation(s)
- Cristina Brambilla
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Matteo Lavit Nicora
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
- Industrial Engineering Department, University of Bologna, 40126 Bologna, Italy
| | - Fabio Storm
- Bioengineering Laboratory, Scientific Institute, IRCCS “Eugenio Medea”, 23842 Bosisio Parini, Italy
| | - Gianluigi Reni
- Informatics Department, Autonomous Province of Bolzano, 39100 Bolzano, Italy
| | - Matteo Malosio
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
| | - Alessandro Scano
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy
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Dooley S, Kim S, Nussbaum MA, Madigan ML. A passive leg-support exoskeleton adversely affects reactive balance after simulated slips and trips on a treadmill. J Biomech 2023; 151:111533. [PMID: 36905730 DOI: 10.1016/j.jbiomech.2023.111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
Occupational exoskeletons have become more prevalent as an ergonomic control to reduce the physical demands of workers. While beneficial effects have been reported, there is relatively little evidence regarding potential adverse effects of exoskeletons on fall risk. The purpose of this study was to investigate the effects of a leg-support exoskeleton on reactive balance after simulated slips and trips. Six participants (three females) used a passive, leg-support exoskeleton that provided chair-like support in three experimental conditions (no exoskeleton, low-seat setting, high-seat setting). In each of these conditions, participants were exposed to 28 treadmill perturbations from an upright standing posture simulating a backward slip (0.4-1.6 m/s) or a forward trip (0.75-2.25 m/s). The exoskeleton increased the probability of a failed recovery, and adversely affected reactive balance kinematics, after simulated slips and trips. After simulated slips, the exoskeleton decreased initial step length 0.039 m, decreased mean step speed 0.12 m/s, anteriorly displaced touchdown position of the initial recovery step by 0.045 m, and decreased PSIS height at initial step touchdown by 1.7 % sof its standing height. After simulated trips, the exoskeleton increased trunk angle at step 2.4 degrees, and decreased initial step length 0.033 m. These effects appeared to result from the exoskeleton inhibiting regular stepping motion due to its posterior placement on the lower limbs, added mass, and mechanical constraints on participant movement. Our results suggest care may be needed among leg-support exoskeleton users when at risk of slips or trips and motivate potential exoskeleton design modifications to reduce fall risk.
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Affiliation(s)
- Stephen Dooley
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, United States
| | - Sunwook Kim
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, United States
| | - Maury A Nussbaum
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, United States
| | - Michael L Madigan
- Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, United States.
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Feasibility and Application of the B.E.A.T. Testbed for Assessing the Effects of Lower Limb Exoskeletons on Human Balance. ROBOTICS 2022. [DOI: 10.3390/robotics11060151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Assessing the performance of exoskeletons in assisting human balance is important for their design process. This study proposes a novel testbed, the B.E.A.T (Balance Evaluation Automated Testbed) to address this aim. We applied the B.E.A.T to evaluate how the presence of a lower limb exoskeleton influenced human balance. The B.E.A.T. consists of a robotic platform, standardized protocols, and performance indicators. Fifteen healthy subjects were enrolled and subjected to repeatable step-type ground perturbations in different directions using the multi-axis robotic platform. Each participant performed three trials, both with and without the exoskeleton (EXO and No-EXO conditions). Nine performance indicators, divided into kinematic and body stability indicators, were computed. The reliability of performance indicators was assessed by computing the Inter Class Correlation (ICC). The indicators showed good (0.60 ≤ ICC < 0.75) to excellent (ICC ≥ 0.75) reliability. The comparison between the EXO and No-EXO conditions revealed a significant increase in the joint range of motion and the center of pressure displacement while wearing the exoskeleton. The main differences between the EXO and No-EXO conditions were found in the range of motion of the knee joints, with an increment up to 17° in the sagittal plane.
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Dong Y, Jiang P, Jin X, Jiang N, Huang W, Peng Y, Shen Y, He L, Forsman M, Yang L. Association between long-term static postures exposure and musculoskeletal disorders among university employees: A viewpoint of inflammatory pathways. Front Public Health 2022; 10:1055374. [PMID: 36530652 PMCID: PMC9752851 DOI: 10.3389/fpubh.2022.1055374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Musculoskeletal disorders (MSDs) are critical occupational and social problems. With the improvement of production mechanization and automation, and the widespread application of computers, more occupations are exposed to static postures and load. This study explored the role of inflammation in the association between static postures exposure and MSDs. Methods This study adopted a prospective nested case-control design in which 66 lower back MSDs cases and 66 healthy controls were selected from a cohort study of university employees. The personal information, postural load, musculoskeletal symptoms, pressure pain thresholds (PPTs), and inflammatory cytokines were collected. Logistic and linear regressions were used to investigate the association among postural load, inflammatory cytokines, and lower back MSDs. Mediation analysis was used to calculate the mediation effect. Results The results of logistic and linear regressions showed that postural load and inflammatory cytokines were positively associated with lower back MSDs (P < 0.05), and postural load was positively associated with inflammatory cytokines (P < 0.05). Further, mediation analysis showed that the mediation effect of postural load on the lower back MSDs through TNF-α was 0.073 (95%CI: 0.025-0.128), and the mediation effect of posture load on the lower back MSDs through IL-6 was 0.098 (95%CI: 0.041-0.179), respectively. Conclusion Static postures were associated with the occurrence of MSDs through inflammatory cytokines, and low-level inflammation may be a critical early event in the generation of MSDs. This study may help bridge the gap of potential mechanisms linking static postures to increased risks of MSDs, and provide new evidence for targeted protection against the global increasing MSDs.
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Affiliation(s)
- Yidan Dong
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Ping Jiang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Xu Jin
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Nanyu Jiang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Wenchu Huang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Yu Peng
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Yuhong Shen
- Institute of Quartermaster Engineering & Technology, Beijing, China
| | - Lihua He
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China,*Correspondence: Lihua He
| | - Mikael Forsman
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology, and Health, Royal Institute of Technology, Huddinge, Sweden,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Liyun Yang
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology, and Health, Royal Institute of Technology, Huddinge, Sweden,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Cooperativity Model for Improving the Walking-Assistance Efficiency of the Exoskeleton. MICROMACHINES 2022; 13:mi13071154. [PMID: 35888970 PMCID: PMC9323024 DOI: 10.3390/mi13071154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: To enhance the walking-assistance efficiencies of exoskeletons, this paper proposed the biomechanical-based cooperativity model based on a passive exoskeleton prototype to fill the technical gap in exoskeleton design regarding the torque transmission law between humans and exoskeletons. (2) Methods: The cooperativity model was used to solve the key system parameters based on the minimum average dispersion degree, in which the average dispersion degree algorithm based on the joint angle was designed and applied. (3) Results: The influence of the cooperativity model on the exoskeleton was indicated by comparing the walking-assistance efficiencies of the exoskeletons with the same structure but with different elastic parameters of the energy storage components, in which the exoskeleton based on the cooperativity design exhibited the highest walking-assistance performance. The walking-assistance efficiency of the exoskeleton with the optimal parameter combinations was also tested by comparing the respiratory metabolisms with and without the exoskeleton, in which the exoskeleton provided the average walking-assistance efficiency of 14.45% for more than 80% of the subjects. (4) Conclusions: The effects of the cooperativity model on exoskeletons were proven, but the accuracy and efficiency of the model still have room for improvement, especially the accuracy of the offset principle.
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Steinhilber B, Seibt R, Rieger MA, Luger T. Postural Control When Using an Industrial Lower Limb Exoskeleton: Impact of Reaching for a Working Tool and External Perturbation. HUMAN FACTORS 2022; 64:635-648. [PMID: 32988243 PMCID: PMC9136386 DOI: 10.1177/0018720820957466] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 08/14/2020] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate postural control related to a lower limb exoskeleton (Chairless Chair) when (a) reaching for a working tool, and (b) an external perturbation occurs. BACKGROUND Lower limb exoskeletons aiming to reduce physical load associated with prolonged standing may impair workers' postural control and increase the risk of falling. METHOD Forty-five males were reaching for an object (3-kg dumbbell) at the lateral end of their reaching area without the exoskeleton in upright standing (STAND) and with the exoskeleton at a high (EXOHIGH.SEAT) and low sitting position (EXOLOW.SEAT). The task was performed with the object placed in three different angles (120°, 150°, and 180°) in the transversal plane. The minimum absolute static postural stability (SSABS.MIN) as the shortest distance (mm) of the center of pressure to the base of support border was measured (zero indicates risk of falling). Additionally, eight subjects were standing without the exoskeleton or sitting on it (EXOHIGH.SEAT and EXOLOW.SEAT) while being pulled backward. The tilting moment when subjects lost their balance was assessed. RESULTS SSABS.MIN was lower when using the exoskeleton (p < .05) but still about 17 mm. The location of the object to be reached had no influence. Tilting moments of less than 30 nm were sufficient to let people fall backward when sitting on the exoskeleton (50 nm for STAND). CONCLUSION Impairments in postural control by the exoskeleton may not be relevant when reaching laterally for objects up to 3 kg. When an external perturbation occurs, the risk of falling may be much higher; irrespective of factors like uneven or slippery flooring. APPLICATION The risk of falling using the exoskeleton seems to be low when reaching laterally for an object of up to 3 kg. In situations where, for example, a collision with coworkers is likely, this exoskeleton is not recommended.
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Assessment of a Passive Lumbar Exoskeleton in Material Manual Handling Tasks under Laboratory Conditions. SENSORS 2022; 22:s22114060. [PMID: 35684682 PMCID: PMC9185583 DOI: 10.3390/s22114060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 12/10/2022]
Abstract
Manual material handling tasks in industry cause work-related musculoskeletal disorders. Exoskeletons are being introduced to reduce the risk of musculoskeletal injuries. This study investigated the effect of using a passive lumbar exoskeleton in terms of moderate ergonomic risk. Eight participants were monitored by electromyogram (EMG) and motion capture (MoCap) while performing tasks with and without the lumbar exoskeleton. The results showed a significant reduction in the root mean square (VRMS) for all muscles tracked: erector spinae (8%), semitendinosus (14%), gluteus (5%), and quadriceps (10.2%). The classic fatigue parameters showed a significant reduction in the case of the semitendinosus: 1.7% zero-crossing rate, 0.9% mean frequency, and 1.12% median frequency. In addition, the logarithm of the normalized Dimitrov’s index showed reductions of 11.5, 8, and 14% in erector spinae, semitendinosus, and gluteus, respectively. The calculation of range of motion in the relevant joints demonstrated significant differences, but in almost all cases, the differences were smaller than 10%. The findings of the study indicate that the passive exoskeleton reduces muscle activity and introduces some changes of strategies for motion. Thus, EMG and MoCap appear to be appropriate measurements for designing an exoskeleton assessment procedure.
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14
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Borooghani D, Hadi A, Alipour K, Tarvirdizadeh B. Falling Analysis and Examination of Different Novel Strategies for Preserving the Postural Stability of a User Wearing ASR-EXO during Stair Climbing. J INTELL ROBOT SYST 2022. [DOI: 10.1007/s10846-022-01629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Golabchi A, Chao A, Tavakoli M. A Systematic Review of Industrial Exoskeletons for Injury Prevention: Efficacy Evaluation Metrics, Target Tasks, and Supported Body Postures. SENSORS 2022; 22:s22072714. [PMID: 35408328 PMCID: PMC9002381 DOI: 10.3390/s22072714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023]
Abstract
Industrial workplaces expose workers to a high risk of injuries such as Work-related Musculoskeletal Disorders (WMSDs). Exoskeletons are wearable robotic technologies that can be used to reduce the loads exerted on the body's joints and reduce the occurrence of WMSDs. However, current studies show that the deployment of industrial exoskeletons is still limited, and widespread adoption depends on different factors, including efficacy evaluation metrics, target tasks, and supported body postures. Given that exoskeletons are not yet adopted to their full potential, we propose a review based on these three evaluation dimensions that guides researchers and practitioners in properly evaluating and selecting exoskeletons and using them effectively in workplaces. Specifically, evaluating an exoskeleton needs to incorporate: (1) efficacy evaluation metrics based on both subjective (e.g., user perception) and objective (e.g., physiological measurements from sensors) measures, (2) target tasks (e.g., manual material handling and the use of tools), and (3) the body postures adopted (e.g., squatting and stooping). This framework is meant to guide the implementation and assessment of exoskeletons and provide recommendations addressing potential challenges in the adoption of industrial exoskeletons. The ultimate goal is to use the framework to enhance the acceptance and adoption of exoskeletons and to minimize future WMSDs in industrial workplaces.
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Affiliation(s)
- Ali Golabchi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada;
| | - Andrew Chao
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada;
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada;
- Correspondence:
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Ergonomic Assessment of Physical Load in Slovak Industry Using Wearable Technologies. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The physical tasks of workers are demanding, particularly when performed long-term in unsuitable working position, with high frequency, heavy load, after injury, with developing damage of health or reduced performance due to advanced age. Work-related musculoskeletal disorders (WMSDs) result from overuse or develop over time. Work activities, which are frequent and repetitive, or activities with awkward postures, cause disorders that may be painful during work or at rest. There is a new technology in the market, occupational exoskeletons, which have the prerequisites for minimizing the negative consequences of workload on WMSDs. We provided pilot quantitative measurements of the ergonomic risk at one selected workplace in a Slovak automotive company with four different workers to prove our methodology using wearable wireless multi-sensor systems Captiv and Actigraph. At first, the test was performed in standard conditions without an exoskeleton. The unacceptable physical load was identified in considerable evaluated body areas—neck, hip, and shoulder. Next, the passive chair exoskeleton Chairless Chair 2.0 was used in trials as an ergonomic measure. Our intention was to determine whether an exoskeleton would be an effective tool for optimizing the workload in selected workplaces and whether the proposed unique quantitative measurement system would give reliable and quick results.
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17
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Elprama SA, Vanderborght B, Jacobs A. An industrial exoskeleton user acceptance framework based on a literature review of empirical studies. APPLIED ERGONOMICS 2022; 100:103615. [PMID: 34847372 DOI: 10.1016/j.apergo.2021.103615] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Studying the acceptance of exoskeletons in industry has gained increased attention. Exoskeletons (wearable support devices) are envisioned to alleviate heavy work. Examining what factors influence the use of exoskeletons is important, because influencing these factors could positively contribute to the adoption of industrial exoskeletons. The factors identified in this paper have been systematically derived from empirical research with (potential future) end users, most of whom have tried on an exoskeleton. Our framework with factors influencing the acceptance of industrial exoskeletons can be used during the (ideally iterative) design, (re)development and evaluation phase of new or existing exoskeletons. This could improve the quality of exoskeletons since this allows designers to already consider acceptance factors early in the design process instead of finding out what is important late in the design process during (field) testing. In turn, this might accelerate the adoption of exoskeletons. Also, our framework can be used to study the ongoing introduction of exoskeletons at work since it also addresses policy decisions companies interested in implementing exoskeletons should consider.
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Affiliation(s)
- Shirley A Elprama
- imec-SMIT-Vrije Universiteit Brussel - BruBotics, Pleinlaan 9, 1050 Brussels, Belgium.
| | - Bram Vanderborght
- Vrije Universiteit Brussel - imec - BruBotics, Pleinlaan 2, 1050 Brussels, Belgium.
| | - An Jacobs
- imec-SMIT-Vrije Universiteit Brussel - BruBotics, Pleinlaan 9, 1050 Brussels, Belgium.
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Santoso G, Sugiharto S, Mughni A, Ammarullah MI, Bayuseno AP, Jamari J. Chairless Chairs for Orthopedic Surgery Purpose – A Literature Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Musculoskeletal disorders are often found in various types of work, including surgeons. Standing working position is immobile and rigid when performing surgical operations. The equipment used is less ergonomic which is the main parameter. The surgeon profession belongs to the category of the high-risk profession and has the potential to experience musculoskeletal disorders. Surgeons who suffer musculoskeletal disorders sense disease start from mild-to-severe due to the muscles receiving static loads frequently in the long-term. The emergence of musculoskeletal disorders can be caused by working environment conditions and standing position while working, causing injury to joints, vertebral discs, nerves, cartilage, tendons, and muscles. This paper describes in extensive the potential for reducing musculoskeletal problems with the use of a chairless chair for surgeons in carrying out operations. Musculoskeletal problems in surgery and the use of chairless chairs have been further explored to close the existing research gap.
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19
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Tu Y, Zhu A, Song J, Zhang X, Cao G. Design and Experimental Evaluation of a Lower-Limb Exoskeleton for Assisting Workers With Motorized Tuning of Squat Heights. IEEE Trans Neural Syst Rehabil Eng 2022; 30:184-193. [PMID: 35030082 DOI: 10.1109/tnsre.2022.3143361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents the E-LEG, a novel semi-passive lower-limb exoskeleton for worker squatting assistance, with motorized tuning of the assistive squatting height. Compared with other passive industrial exoskeletons for the lower-limbs, the E-LEG presents novel design features namely inertial sensor for measuring the tilt angle of thigh and the novel electromagnetic switch for adjusting squat height. These features could enhance the effectiveness of the system. In addition to the introduction to exoskeleton design, this paper also reports the systematic experimental evaluation of human subjects. With the assistance of different conditions, the variability of muscular activity was evaluated in long-term static squatting task. The set of metrics to evaluate the effect of the device included leg muscle activity, plantar pressure fluctuation, plantar pressure center fluctuation and gait angles. Results show that the exoskeleton can reduce the muscular activity of the user during squatting, and it will have little affect the normal gait of the user during walking. In this study, we found that the E-LEG exoskeleton has potential effectiveness in reducing the muscular strain on long-term continuous squatting activities.
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De Bock S, Ghillebert J, Govaerts R, Tassignon B, Rodriguez-Guerrero C, Crea S, Veneman J, Geeroms J, Meeusen R, De Pauw K. Benchmarking occupational exoskeletons: An evidence mapping systematic review. APPLIED ERGONOMICS 2022; 98:103582. [PMID: 34600307 DOI: 10.1016/j.apergo.2021.103582] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To provide an overview of protocols assessing the effect of occupational exoskeletons on users and to formulate recommendations towards a literature-based assessment framework to benchmark the effect of occupational exoskeletons on the user. METHODS PubMed (MEDLINE), Web of Science database and Scopus were searched (March 2, 2021). Studies were included if they investigated the effect of one or more occupational exoskeletons on the user. RESULTS In total, 139 eligible studies were identified, encompassing 33, 25 and 18 unique back, shoulder and other exoskeletons, respectively. Device validation was most frequently conducted using controlled tasks while collecting muscle activity and biomechanical data. As the exoskeleton concept matures, tasks became more applied and the experimental design more representative. With that change towards realistic testing environments came a trade-off with experimental control, and user experience data became more valuable. DISCUSSION This evidence mapping systematic review reveals that the assessment of occupational exoskeletons is a dynamic process, and provides literature-based assessment recommendations. The homogeneity and repeatability of future exoskeleton assessment experiments will increase following these recommendations. The current review recognises the value of variability in evaluation protocols in order to obtain an overall overview of the effect of exoskeletons on the users, but the presented framework strives to facilitate benchmarking the effect of occupational exoskeletons on the users across this variety of assessment protocols.
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Affiliation(s)
- Sander De Bock
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
| | - Jo Ghillebert
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Renée Govaerts
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Carlos Rodriguez-Guerrero
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, 1050, Brussels, Belgium; COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium
| | - Simona Crea
- COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium; The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Jan Veneman
- COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium; Hocoma AG, Volketswil, Switzerland
| | - Joost Geeroms
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, 1050, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Strategic Research Program 'Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Strategic Research Program 'Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, 1050, Brussels, Belgium
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Babič J, Laffranchi M, Tessari F, Verstraten T, Novak D, Šarabon N, Ugurlu B, Peternel L, Torricelli D, Veneman JF. Challenges and solutions for application and wider adoption of wearable robots. WEARABLE TECHNOLOGIES 2021; 2:e14. [PMID: 38486636 PMCID: PMC10936284 DOI: 10.1017/wtc.2021.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/25/2021] [Accepted: 09/18/2021] [Indexed: 03/17/2024]
Abstract
The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human-robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots.
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Affiliation(s)
- Jan Babič
- Laboratory for Neuromechanics and Biorobotics, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Federico Tessari
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Tom Verstraten
- Robotics & Multibody Mechanics Research Group, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
| | - Domen Novak
- University of Wyoming, Laramie, Wyoming, USA
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Barkan Ugurlu
- Biomechatronics Laboratory, Faculty of Engineering, Ozyegin University, Istanbul, Turkey
| | - Luka Peternel
- Delft Haptics Lab, Department of Cognitive Robotics, Delft University of Technology, Delft, The Netherlands
| | - Diego Torricelli
- Cajal Institute, Spanish National Research Council, Madrid, Spain
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Bär M, Steinhilber B, Rieger MA, Luger T. The influence of using exoskeletons during occupational tasks on acute physical stress and strain compared to no exoskeleton - A systematic review and meta-analysis. APPLIED ERGONOMICS 2021; 94:103385. [PMID: 33676059 DOI: 10.1016/j.apergo.2021.103385] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis determined the effects of using an exoskeleton during occupational tasks on physical stress and strain compared to not using an exoskeleton. METHODS Systematic electronic database searches were performed and the review was prepared according to the PRISMA guidelines. Treatment effects on the predefined outcomes were calculated using standardized mean differences for continuous outcomes in several meta-analyses using Review Manager 5.3. Registration: PROSPERO (CRD42020168701). RESULTS 63 articles were included in qualitative syntheses and 52 in quantitative, but most of them did not extensively evaluate musculoskeletal stress and strain and the risk of bias was rated high for all included studies. Statistically significant effects of using back, upper-limb, or lower-limb exoskeletons have been observed in the supported body areas (e.g. reduced muscle activity, joint moments and perceived strain). Studies which did not exclusively focus on the supported body area also showed statistically significant effects in the non-supported areas (e.g. changed muscle activity and perceived strain) and in physiological outcomes (e.g. reduced energy expenditure). CONCLUSIONS Using an exoskeleton during occupational tasks seems to reduce user's acute physical stress and strain in the exoskeleton's target area. However, impact on workers' health is still unknown, primarily because of missing long-term evaluations under real working conditions. Furthermore, this systematic review highlights a lack of studies (1) following high quality methodological criteria, (2) evaluating various inter-related stress and strain parameters instead of only focusing on one specific, and (3) evaluating non-target body areas instead of only the directly supported body area.
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Affiliation(s)
- Mona Bär
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
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Kong YK, Park CW, Cho MU, Kim SY, Kim MJ, Hyun DJ, Bae K, Choi JK, Ko SM, Choi KH. Guidelines for Working Heights of the Lower-Limb Exoskeleton (CEX) Based on Ergonomic Evaluations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105199. [PMID: 34068352 PMCID: PMC8153283 DOI: 10.3390/ijerph18105199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the muscle activities and subjective discomfort according to the heights of tasks and the lower-limb exoskeleton CEX (Chairless EXoskeleton), which is a chair-type passive exoskeleton. Twenty healthy subjects (thirteen males and seven females) participated in this experiment. The independent variables were wearing of the exoskeleton (w/ CEX, w/o CEX), working height (6 levels: 40, 60, 80, 100, 120, and 140 cm), and muscle type (8 levels: upper trapezius (UT), erector spinae (ES), middle deltoid (MD), triceps brachii (TB), biceps brachii (BB), biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA)). The dependent variables were EMG activity (% MVC) and subjective discomfort rating. When wearing the CEX, the UT, ES, RF, and TA showed lower muscle activities at low working heights (40-80 cm) than not wearing the CEX, whereas those muscles showed higher muscle activities at high working heights (100-140 cm). Use of the CEX had a positive effect on subjective discomfort rating at lower working heights. Generally, lower discomfort was reported at working heights below 100 cm when using the CEX. At working heights of 100-140 cm, the muscle activity when wearing the CEX tended to be greater than when not wearing it. Thus, considering the results of this study, the use of the lower-limb exoskeleton (CEX) at a working height of 40-100 cm might reduce the muscle activity and discomfort of whole body and decrease the risk of related disorders.
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Affiliation(s)
- Yong-Ku Kong
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
| | - Chae-Won Park
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
| | - Min-Uk Cho
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
| | - Seoung-Yeon Kim
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
| | - Min-Jung Kim
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
| | - Dong Jin Hyun
- Robotics Lab in the R&D Division, Hyundai Motor Company, Uiwang 16082, Korea; (D.J.H.); (K.B.); (J.K.C.); (S.M.K.)
| | - Kihyeon Bae
- Robotics Lab in the R&D Division, Hyundai Motor Company, Uiwang 16082, Korea; (D.J.H.); (K.B.); (J.K.C.); (S.M.K.)
| | - Jong Kyu Choi
- Robotics Lab in the R&D Division, Hyundai Motor Company, Uiwang 16082, Korea; (D.J.H.); (K.B.); (J.K.C.); (S.M.K.)
| | - Sang Min Ko
- Robotics Lab in the R&D Division, Hyundai Motor Company, Uiwang 16082, Korea; (D.J.H.); (K.B.); (J.K.C.); (S.M.K.)
| | - Kyeong-Hee Choi
- Department of Industrial Engineering, Sungkyunkwan University, Suwon 16419, Korea; (Y.-K.K.); (C.-W.P.); (M.-U.C.); (S.-Y.K.); (M.-J.K.)
- Correspondence: ; Tel.: +82-31-290-7629
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Kozinc Ž, Babič J, Šarabon N. Human pressure tolerance and effects of different padding materials with implications for development of exoskeletons and similar devices. APPLIED ERGONOMICS 2021; 93:103379. [PMID: 33556885 DOI: 10.1016/j.apergo.2021.103379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
In this study, we assessed pressure tolerance in 16 healthy participants at the thigh, chest, and pelvic area, using different surfaces (1 cm2, 20 cm2 and different components, used in exoskeleton design), and the effects of different padding materials. Our results showed substantial variability in pressure tolerance among the participants, as well as lower pressure tolerance in females. Regarding the force applied with the exoskeleton components, male participants had higher discomfort threshold (230.3 ± 44.9 N compared to females (116.1 ± 24.6 N) in the chest area. For the applications with 20 cm2 surface, the males also showed higher pain threshold at the thigh (89.3 ± 41.8 N vs. 34.6 ± 27.2 N) and the pelvis (97.6 ± 37.0 N vs. 56.1 ± 29.5 N). All padding materials increased pressure tolerance for 10-38% (p < 0.001), but little differences between materials were observed.
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Affiliation(s)
- Žiga Kozinc
- Department of Health Studies, Andrej Marušič Institute, Universiry of Primorska, 6000, Koper, Slovenia; Faculty of Health Sciences Universiry of Primorska, 6310, Izola, Slovenia
| | - Jan Babič
- Laboratory of Neuromechanics and Biorobotics, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Nejc Šarabon
- Department of Health Studies, Andrej Marušič Institute, Universiry of Primorska, 6000, Koper, Slovenia; Innorenew CoE, Livade 2, 6310, Izola, Slovenia; S2P Ltd, Tehnološki Park 19, 1000, Ljubljana, Slovenia.
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Yan Z, Han B, Du Z, Huang T, Bai O, Peng A. Development and testing of a wearable passive lower-limb support exoskeleton to support industrial workers. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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EMG Characterization and Processing in Production Engineering. MATERIALS 2020; 13:ma13245815. [PMID: 33419283 PMCID: PMC7766856 DOI: 10.3390/ma13245815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023]
Abstract
Electromyography (EMG) signals are biomedical signals that measure electrical currents generated during muscle contraction. These signals are strongly influenced by physiological and anatomical characteristics of the muscles and represent the neuromuscular activities of the human body. The evolution of EMG analysis and acquisition techniques makes this technology more reliable for production engineering applications, overcoming some of its inherent issues. Taking as an example, the fatigue monitoring of workers as well as enriched human–machine interaction (HMI) systems used in collaborative tasks are now possible with this technology. The main objective of this research is to evaluate the current implementation of EMG technology within production engineering, its weaknesses, opportunities, and synergies with other technologies, with the aim of developing more natural and efficient HMI systems that could improve the safety and productivity within production environments.
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Ramanujam A, Momeni K, Ravi M, Augustine J, Garbarini E, Barrance P, Spungen AM, Asselin P, Knezevic S, Forrest GF. Dynamic Margins of Stability During Robot-Assisted Walking in Able-Bodied Individuals: A Preliminary Study. Front Robot AI 2020; 7:574365. [PMID: 33501335 PMCID: PMC7805966 DOI: 10.3389/frobt.2020.574365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Gait analysis studies during robot-assisted walking have been predominantly focused on lower limb biomechanics. During robot-assisted walking, the users' interaction with the robot and their adaptations translate into altered gait mechanics. Hence, robust and objective metrics for quantifying walking performance during robot-assisted gait are especially relevant as it relates to dynamic stability. In this study, we assessed bi-planar dynamic stability margins for healthy adults during robot-assisted walking using EksoGT™, ReWalk™, and Indego® compared to independent overground walking at slow, self-selected, and fast speeds. Further, we examined the use of forearm crutches and its influence on dynamic gait stability margins. Methods: Kinematic data were collected at 60 Hz under several walking conditions with and without the robotic exoskeleton for six healthy controls. Outcome measures included (i) whole-body center of mass (CoM) and extrapolated CoM (XCoM), (ii) base of support (BoS), (iii) margin of stability (MoS) with respect to both feet and bilateral crutches. Results: Stability outcomes during exoskeleton-assisted walking at self-selected, comfortable walking speeds were significantly (p < 0.05) different compared to overground walking at self-selected speeds. Unlike overground walking, the control mechanisms for stability using these exoskeletons were not related to walking speed. MoSs were lower during the single support phase of gait, especially in the medial-lateral direction for all devices. MoSs relative to feet were significantly (p < 0.05) lower than those relative to crutches. The spatial location of crutches during exoskeleton-assisted walking pushed the whole-body CoM, during single support, beyond the lateral boundary of the lead foot, increasing the risk for falls if crutch slippage were to occur. Conclusion: Careful consideration of crutch placement is critical to ensuring that the margins of stability are always within the limits of the BoS to control stability and decrease fall risk.
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Affiliation(s)
- Arvind Ramanujam
- Kessler Foundation, West Orange, NJ, United States
- Koneksa Health, New York, NY, United States
| | - Kamyar Momeni
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
| | | | | | | | - Peter Barrance
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
| | - Ann M. Spungen
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Pierre Asselin
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Steven Knezevic
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, United States
- Rutgers, New Jersey Medical School, Newark, NJ, United States
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Steinhilber B, Luger T, Schwenkreis P, Middeldorf S, Bork H, Mann B, von Glinski A, Schildhauer TA, Weiler S, Schmauder M, Heinrich K, Winter G, Schnalke G, Frener P, Schick R, Wischniewski S, Jäger M. The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints. IISE Trans Occup Ergon Hum Factors 2020; 8:132-144. [PMID: 33140996 DOI: 10.1080/24725838.2020.1844344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Peter Schwenkreis
- Neurological University Hospital, BG University Hospital Bergmannsheil GmbH, Bochum, Germany
| | - Stefan Middeldorf
- Centre for Orthopaedics, Schön Clinic Bad Staffelstein, Bad Staffelstein, Germany
| | - Hartmut Bork
- St. Josef-Stift Sendenhorst Hospital for Orthopaedic Surgery and Rheumatology, Sendenhorst, Germany
| | - Bernhard Mann
- Institute for Sociology, University of Koblenz-Landau, Koblenz-Metternich, Germany
| | - Alexander von Glinski
- Surgical University Hospital and Polyclinic, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thomas A Schildhauer
- Surgical University Hospital and Polyclinic, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Martin Schmauder
- Institute of Material Handling and Industrial Engineering, Technical University Dresden, Dresden, Germany
| | - Kai Heinrich
- Institute for Occupational Safety and Health of the German Social Accident Insurance, Sankt Augustin, Germany
| | - Gabriele Winter
- (BG) German Social Accident Insurance Institution for Commercial Transport, Postal Logistics and Telecommunication, Darmstadt, Germany
| | - Gerhard Schnalke
- Outpatient Rehabilitation Center Braunschweig, Braunschweig, Germany
| | - Peter Frener
- (BG) German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, Düsseldorf, Germany
| | - Ralf Schick
- (BG) German Social Accident Insurance Institution for the Trade and Logistics Industry, Mannheim, Germany
| | | | - Matthias Jäger
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany
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