The personal lift-assist device and lifting technique: a principal component analysis

The effects of exoskeleton use on human response to simulated overhead tasks with vibration

The use of occupational exoskeletons has grown fast in manufacturing industries in recent years. One major scenario of exoskeleton use in manufacturing is to assist overhead, power hand tool operations. This preliminary work aimed to determine the effects of arm-supporting exoskeletons on shoulder muscle activity and human-hand tool coupling in simulated overhead tasks with axially applied vibration. An electromagnetic shaker capable of producing the random vibration spectrum specified in ISO 10819 was hung overhead to deliver vibrations. Two passive, arm-supporting exoskeletons, with one (ExoVest) transferring load to both the shoulder and pelvic region while the second one (ExoStrap) transferring load primarily to the pelvic region, were used in testing. Testing was also done with the shaker placed in front of the body to better understand the posture and exoskeleton engagement effects. The results collected from 6 healthy male subjects demonstrate the dominating effects of the overhead working posture on increased shoulder muscle activities. Vibration led to higher muscle activities in both agonist and antagonist shoulder muscles to a less extent. Exoskeleton use reduced the anterior deltoid and serratus anterior activities by 27% to 43%. However, wearing the ExoStrap increased the upper trapezius activities by 23% to 38% in the overhead posture. Furthermore, an increased human-shaker handle coupling was observed in the OH posture when wearing the ExoVest, indicating a more demanding neuromuscular control.

Quantifying how functional and structural personal factors influence biomechanical exposures in paramedic lifting tasks

It is unknown how structural (sex, stature, body mass) and functional (strength, flexibility) personal factors influence lifting strategy in paramedic work. We explored whether variance in peak low back forces and kinematic coordination patterns could be explained by structural and functional personal factors in paramedic lifting tasks. Seventy-two participants performed backboard and stretcher lifts. Peak low back forces normalised to body mass, as well as kinematic coordination patterns, were calculated as dependent variables. Being female, stronger, shorter, having higher body mass, and/or having greater lower body range of motion (ROM) were all independently associated with lower normalised low back forces across backboard and stretcher lifting. Females and stronger individuals seemed to define a movement objective to consistently minimise compressive forces, while individuals with greater hip ROM consistently minimised anteroposterior shear forces. The efficacy of improving strength and hip ROM to reduce low back forces in paramedic lifting should be investigated.Practitioner summary: Females, stronger individuals, and individuals with greater hip range of motion consistently exhibited lower normalised low back forces in paramedic lifting. Improving strength and hip range of motion via training is a potential proactive ergonomics approach to reduce peak low back forces in paramedic lifting tasks.

Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion

Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.

Differential effects of sex on upper body kinematics and kinetics during fatiguing, Asymmetric lifting

This study quantified sex-specific biomechanical adaptations to fatigue in asymmetric lifting. Twenty-one females and fifteen males performed a prolonged asymmetric lifting protocol while upper body, trunk and pelvis kinematics were collected. Features of movement identified with principal component analysis, and peak joint angular velocities and moments were calculated. Sex-specific kinematic adaptations to fatigue included females adopting a 'stoop-like' lifting strategy to a greater extent than males. Additionally, females exhibited higher vertical elbow positions during load rotation, moved their body toward the destination for load deposit, and did not reduce peak right shoulder flexion velocities, in contrast to male participants. Females also had greater low back and shoulder peak normalized joint moments. When fatigued, females adopted an asymmetric lifting strategy that minimized metabolic demand as supported by smaller decreases in maximum voluntary contractions. However, females' fatigue-related adaptations increased biomechanical exposures associated with injury risk.

The Influence of Contextual and Theoretical Expertise on Generic and Occupation-Specific Lifting Strategy

OBJECTIVE

To determine whether (i) low back loads and/or (ii) kinematic coordination patterns differed across theoretical expert, contextual expert and novice groups when completing both generic and occupation-specific lifts.

BACKGROUND

Experience has been proposed as a factor that could reduce biomechanical exposures in lifting, but the literature reports mixed effects. The inconsistent relationship between experience and exposures may be partially attributable to the broad classification of experience and experimental lifting protocols not replicating the environment where experience was gained.

METHODS

Purposive sampling was used to recruit 72 participants including theoretical experts (formal training on lifting mechanics), contextual experts (paramedics), and novices. Participants performed 10 barbell and crate (generic) lifts, as well as backboard and stretcher (occupation-specific) lifts while whole-body kinematics and ground reaction forces were collected. Peak low back compression and anteroposterior shear loads normalized to body mass, as well as kinematic coordination patterns, were calculated as dependent variables.

RESULTS

No significant differences in low back loads were observed across expertise groups. However, significant differences were seen in kinematic coordination patterns across expertise groups in occupation-specific lifts, but not in generic lifts.

CONCLUSION

Increasing expertise is unlikely to minimize low back loads in lifting. However, contextual expertise did influence lifting kinematics, but only when performing occupationally specific lifts.

APPLICATION

Contextual expertise may help lifters adopt lifting kinematics that enhance the tolerance of their musculoskeletal system to withstand applied loads, but does not seem to reduce the applied low back loads relative to noncontextual expert groups.

Dynamic assessment for low back-support exoskeletons during manual handling tasks

Exoskeletons can protect users' lumbar spine and reduce the risk of low back injury during manual lifting tasks. Although many exoskeletons have been developed, their adoptability is limited by their task- and movement-specific effects on reducing burden. Many studies have evaluated the safety and effectiveness of an exoskeleton using the peak/mean values of biomechanical variables, whereas the performance of the exoskeleton at other time points of the movement has not been investigated in detail. A functional analysis, which presents discrete time-series data as continuous functions, makes it possible to highlight the features of the movement waveform and determine the difference in each variable at each time point. This study investigated an assessment method for exoskeletons based on functional ANOVA, which made it possible to quantify the differences in the biomechanical variables throughout the movement when using an exoskeleton. Additionally, we developed a method based on the interpolation technique to estimate the assistive torque of an exoskeleton. Ten men lifted a 10-kg box under symmetric and asymmetric conditions five times each. Lumbar load was significantly reduced during all phases (flexion, lifting, and laying) under both conditions. Additionally, reductions in kinematic variables were observed, indicating the exoskeleton's impact on motion restrictions. Moreover, the overlap F-ratio curves of the lumbar load and kinematic variables imply that exoskeletons reduce the lumbar load by restricting the kinematic variables. The results suggested that at smaller trunk angles (<25°), an exoskeleton neither significantly reduces the lumbar load nor restricts trunk movement. Our findings will help increasing exoskeleton safety and designing effective products for reducing lumbar injury risks.

Reducing Back Exertion and Improving Confidence of Individuals with Low Back Pain with a Back Exosuit: A Feasibility Study for Use in BACPAC

OBJECTIVE

Low back pain (LBP) is hallmarked by activity limitations, especially for tasks involving bending. Back exosuit technology reduces low back discomfort and improves self-efficacy of individuals with LBP during bending and lifting tasks. However, the biomechanical efficacy of these devices in individuals with LBP is unknown. This study sought to determine biomechanical and perceptual effects of a soft active back exosuit designed to assist individuals with LBP sagittal plane bending. To understand patient-reported usability and use cases for this device.

METHODS

Fifteen individuals with LBP performed two experimental lifting blocks once with and without an exosuit. Trunk biomechanics were measured by muscle activation amplitudes, and whole-body kinematics and kinetics. To evaluate device perception, participants rated task effort, low back discomfort, and their level of concern completing daily activities.

RESULTS

The back exosuit reduced peak back extensor: moments by 9%, and muscle amplitudes by 16% when lifting. There were no changes in abdominal co-activation and small reductions maximum trunk flexion compared to lifting without an exosuit. Participants reported lower task effort, back discomfort, and concern about bending and lifting with an exosuit compared to without.

CONCLUSIONS

This study demonstrates a back exosuit not only imparts perceptual benefits of reduced task effort, discomfort, and increased confidence in individuals with LBP but that it achieves these benefits through measurable biomechanical reductions in back extensor effort. The combined effect of these benefits implies back exosuits might be a potential therapeutic aid to augment physical therapy, exercises, or daily activities.

Trends in Robotics Research in Occupational Safety and Health: A Scientometric Analysis and Review

Robots have been deployed in workplaces to assist, work alongside, or collaborate with human workers on various tasks, which introduces new occupational safety and health hazards and requires research efforts to address these issues. This study investigated the research trends for robotic applications in occupational safety and health. The scientometric method was applied to quantitatively analyze the relationships between robotics applications in the literature. The keywords "robot", "occupational safety and health", and their variants were used to find relevant articles. A total of 137 relevant articles published during 2012-2022 were collected from the Scopus database for this analysis. Keyword co-occurrence, cluster, bibliographic coupling, and co-citation analyses were conducted using VOSviewer to determine the major research topics, keywords, co-authorship, and key publications. Robot safety, exoskeletons and work-related musculoskeletal disorders, human-robot collaboration, and monitoring were four popular research topics in the field. Finally, research gaps and future research directions were identified based on the analysis results, including additional efforts regarding warehousing, agriculture, mining, and construction robots research; personal protective equipment; and multi-robot collaboration. The major contributions of the study include identifying the current trends in the application of robotics in the occupational safety and health discipline and providing pathways for future research in this discipline.

Effects of back-support exoskeletons with different functional mechanisms on trunk muscle activity and kinematics

Musculoskeletal disorders constitute the leading work-related health issue. Mechanical loading of the lower back contributes as a major risk factor and is prevalent in many tasks performed in logistics. The study aimed to compare acute effects of exoskeletons with different functional mechanisms in a logistic task. Twelve young, healthy individuals participated in the study. Five exoskeletons with different functional mechanisms were tested in a logistic task, consisting of lifting, carrying, and lowering a 13 kg box. By using electromyography (EMG), mean muscle activities of four muscles in the trunk were analyzed. Additionally, kinematics by task completion time and range of motion (RoM) of the major joints and segments were investigated. A main effect was found for Musculus erector spinae, Musculus multifidus, and Musculus latissimus dorsi showing differences in muscle activity reductions between exoskeletons. Reduction in ES mean activity compared to baseline was primarily during lifting from ground level. The exoskeletons SoftExo Lift and Cray X also showed ES mean reduction during lowering the box. Prolonged task duration during the lifting phase was found for the exoskeletons BionicBack, SoftExo Lift, and Japet.W. Japet.W showed a trend in reducing hip RoM during that phase. SoftExo Lift caused a reduction in trunk flexion during the lifting phase. A stronger trunk inclination was only found during lifting from the table for the SoftExo Lift and the Cray X. In conclusion, muscle activity reductions by exoskeleton use should not be assessed without taking their designed force paths into account to correctly interpret the effects for long-term injury prevention.

Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton

PURPOSE

Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style.

SCOPE

Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton × lifting style were assessed on outcomes during the complete lifting cycle and its four phases.

RESULTS

For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting.

CONCLUSION

Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.

Detecting subject-specific fatigue-related changes in lifting kinematics using a machine learning approach

Individual responses to fatigue have been observed in lifting kinematics, suggesting a subject-specific approach is necessary for fatigue identification. One-class support vector machines (OCSVM) may provide an objective method to classify fatigue-related kinematic changes during repetitive lifting. Participants completed a repetitive lifting protocol while motion capture recorded lifting motions. Subject-specific kinematics from participants' first 35% of lifts trained OCSVM decision boundaries. The remaining lifts were separated into test sets and classified against the decision boundary to identify the percentage of outlier lifts within each test set. Spearman's correlation assessed if the test sets' percentage of outlier lifts increased concurrently with participants' rating of perceived exertion (RPE). Significant positive associations were found for participants who demonstrated evidence of fatigue, while no significant associations were found for participants who did not demonstrate evidence of fatigue. These results demonstrate the prospective efficacy of an outlier detection tool for fatigue detection during repetitive lifting.Practitioner Summary: An objective subject-specific fatigue detection method is desired for workplace tasks, such as lifting. An outlier detection machine learning approach was identified when lifting movement patterns changed from baseline throughout a repetitive lifting protocol. Participants who demonstrated an increase in outlier movement patterns had a concurrent increase in self-reported fatigue.

Design and evaluation of a parallel mechanism for wearable lumbar support exoskeleton

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are a serious problem, and manual material handling (MMH) tasks remain common in most industries. Thus, a lightweight and active exoskeleton is needed.

OBJECTIVE

A facile, convenient, multifunctional, wearable lumbar support exoskeleton (WLSE) was proposed to relieve the muscular tension and fatigue especially in the way of WMSDs.

METHOD

Based on the screw theory and virtual power principle, the parallel structure was used as the scheme choice for selecting suitable actuators and joints. The exoskeleton, which was characterized by high adaptability and complied with human motion, included branch unit, mechanism branch units, control units and sensors. Furthermore, using surface electromyography (sEMG) signal evaluation, an experiment which contains several tests was designed to evaluate whether WLSE had effect on supporting and reliving muscular fatigue while lifting-up different weight of objects under wearing without traction (T1) and wearing with traction (T2).

RESULTS

Data collected were analyzed statistically by the two-way ANOVA. It showed that the RMS of sEMG was obviously reduced while carrying the heavy objects with WLSE under T2, and the MF values always performed the decreasing trend in T2/T1.

CONCLUSION

This paper proposed a facile, convenient, multifunctional WLSE. From the results, it was concluded that the WLSE was significantly effective in reliving the muscle tension and muscle fatigue while lifting to prevent and treat WMSDs.

Biomechanical assessment of a passive back-support exoskeleton during repetitive lifting and carrying: Muscle activity, kinematics, and physical capacity

INTRODUCTION

Most people have experienced low back pain (LBP) more or less in their lifetime. Heavier load weight could increase the risk of LBP, especially in repetitive lifting and carrying tasks. The risk could also increase with the frequency of lifting. This study aims to investigate the effects of a passive back-support exoskeleton (PBSE) on trunk muscle activation, kinematics, and physical capacity in a repetitive lifting task and a carrying task in consideration of load weights in a laboratory setting.

RESULTS

Results showed that using the PBSE, the activities of the thoracic erector spinae and lumbar erector spinae muscles were reduced significantly by nearly 7% MVC and 3% MVC in the repetitive lifting task and the carrying task, respectively. There was no significant effect of the PBSE on the spine kinematics and physical capacity.

PRACTICAL APPLICATIONS

This study supports the use of the PBSE to reduce trunk muscle activity in repetitive lifting and carrying tasks.

A review of the design of load-carrying exoskeletons

The increasing necessity of load-carrying activities has led to greater human musculoskeletal damage and an increased metabolic cost. With the rise of exoskeleton technology, researchers have begun exploring different approaches to developing wearable robots to augment human load-carrying ability. However, there is a lack of systematic discussion on biomechanics, mechanical designs, and augmentation performance. To achieve this, extensive studies have been reviewed and 108 references are selected mainly from 2013 to 2022 to address the most recent development. Other earlier 20 studies are selected to present the origin of different design principles. In terms of the way to achieve load-carrying augmentation, the exoskeletons reviewed in this paper are sorted by four categories based on the design principles, namely load-suspended backpacks, lower-limb exoskeletons providing joint torques, exoskeletons transferring load to the ground and exoskeletons transferring load between body segments. Specifically, the driving modes of active and passive, the structure of rigid and flexible, the conflict between assistive performance and the mass penalty of the exoskeleton, and the autonomy are discussed in detail in each section to illustrate the advances, challenges, and future trends of exoskeletons designed to carry loads.

The influence of sex and strength capacity on normalized low-back exposure during lifting: Insights from a joint power analysis

OBJECTIVE

Investigate the influence of sex, strength capacity, and relative load mass on low-back exposure and lower extremity joint power generation in backboard lifting.

BACKGROUND

Sex and strength have been shown to influence lifting strategy, but without load mass being scaled to strength it is unknown which factor influences low-back exposures, and whether there are interactions with load mass.

METHODS

Motion capture and force plate data from 28 participants were collected during backboard lifting at load masses scaled to strength capacity. Differences in normalized peak low-back moment, peak knee-to-hip power magnitude ratio and timing were tested as a function of sex, strength, and load mass.

RESULTS

Stronger participants had lower normalized peak low-back moments (average 32% change from low-capacity across all load masses), with no significant sex effect (p = 0.582). As load mass increased, normalized peak low-back moment, peak knee-to-hip power magnitude and synchronicity decreased.

CONCLUSION

Training to both increase strength capacity and hip-joint power generation may be a strategy to reduce low-back exposure in backboard lifting.

Using Artificial Intelligence for Assistance Systems to Bring Motor Learning Principles into Real World Motor Tasks

Humans learn movements naturally, but it takes a lot of time and training to achieve expert performance in motor skills. In this review, we show how modern technologies can support people in learning new motor skills. First, we introduce important concepts in motor control, motor learning and motor skill learning. We also give an overview about the rapid expansion of machine learning algorithms and sensor technologies for human motion analysis. The integration between motor learning principles, machine learning algorithms and recent sensor technologies has the potential to develop AI-guided assistance systems for motor skill training. We give our perspective on this integration of different fields to transition from motor learning research in laboratory settings to real world environments and real world motor tasks and propose a stepwise approach to facilitate this transition.

Methodologies for evaluating exoskeletons with industrial applications

Industrial exoskeletons are globally developed, explored, and increasingly implemented in industrial workplaces. Multiple technical, physical, and psychological aspects should be assessed prior to their daily application in various occupational environments. The methodology for evaluating these aspects is not standardised and differs in terms of focussed research objectives, used types of analyses, applied testing procedures, and use cases. The aim of this paper is to provide a matrix comparing the prevalence of different types of analyses combined with their respective research objective(s). A systematic review in the database 'Web of Science' identified 74 studies, mainly in laboratory settings, with a focus on short-term effects as well as with male-dominated samples being low representative for industrial workforces. The conducted evaluation methodologies are further discussed and compared in terms of testing procedure, sample, and research objectives. Finally, relevant aspects for prospectively evaluating industrial exoskeletons in a more harmonised and comprehensive way are suggested. Practitioner summary: Industrial exoskeletons are still inconsistently and insufficiently evaluated in scientific studies, which might hamper the comparability of systems, threaten the human health, and block an iterative system optimisation. Thus, a comprehensive evaluation methodology is needed with harmonised and multicriteria types of analyses.

An ergonomic assessment tool for evaluating the effect of back exoskeletons on injury risk

Low back disorders (LBDs) are a leading injury in the workplace. Back exoskeletons (exos) are wearable assist devices that complement traditional ergonomic controls and reduce LBD risks by alleviating musculoskeletal overexertion. However, there are currently no ergonomic assessment tools to evaluate risk for workers wearing back exos. Exo-LiFFT, an extension of the Lifting Fatigue Failure Tool, is introduced as a means to unify the etiology of LBDs with the biomechanical function of exos. We present multiple examples demonstrating how Exo-LiFFT can assess or predict the effect of exos on LBD risk without costly, time-consuming electromyography studies. For instance, using simulated and real-world material handling data we show an exo providing a 30 Nm lumbar moment is projected to reduce cumulative back damage by ∼70% and LBD risk by ∼20%. Exo-LiFFT provides a practical, efficient ergonomic assessment tool to assist safety professionals exploring back exos as part of a comprehensive occupational health program.

Benchmarking occupational exoskeletons: An evidence mapping systematic review

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.

Use of a passive lumbar back exoskeleton during a repetitive lifting task: effects on physiologic parameters and intersubject variability

Objectives. This study evaluated the effects of wearing the Laevo v2.56 exoskeleton (Laevo, The Netherlands) on physiological parameters related to working load and metabolic cost (MC) during a lifting task, explored the variability in exoskeleton performance among users and determined whether perceived discomfort negatively correlates with a reduction in MC. Methods. Twenty participants completed a 4-min repetitive lifting task with/without the exoskeleton. Respiratory gases, heart rate, blood lactate and ratings of perceived exertion and experienced discomfort were collected, and MC was calculated. Results. Wearing the exoskeleton significantly reduced MC and oxygen uptake during the lifting task by 4.8 and 3.8%, respectively. Workload reduction occurred in 65% of the participants. Conclusion. The Laevo v2.56 exoskeleton reduced MC and workload in a repetitive lifting task in a subject-dependent manner. Future studies should focus on identifying factors that could cause performance variability such as user-robot interaction forces.

Influence of an on-body lifting aid (HAL® for Care Support) on kinematics during repetitive lifting in healthy men

Work-related lower back pain (LBP) leads to socio-economic burden and demands solutions. The hybrid assistive limb (HAL) for Care Support (Cyberdyne Inc., Ibaraki, Japan) is an active on-body lifting aid to assist joint motion according to the wearer's voluntary motor drive to reduce the lumbar load. A few studies investigated HAL and stated efficacy in terms of enhanced performance and reduced fatigue, yet the question remained if the use of HAL may result in a different execution of movement, for example by influencing the kinematics of the lower extremities. The aim of this study was to determine the influence of HAL on kinematics of the lower limbs and the spinal column during repetitive freestyle symmetrical lifting. Kinematic data was recorded by an inertial measurement unit sensor system in 11 healthy men lifting and lowering a 19.5 kg barbell under three conditions (no HAL, HAL Level 3/5, HAL Level 5/5). Outcome parameters were maximum and minimum angles as well as range of motion (ROM) of thoracic spine, lumbar spine, hip- and knee joint in sagittal plane. We found a significantly decreased ROM of the lumbar spine as well as a significantly reduced maximum and minimum thorax extension when starting lifting and in upright position after lifting, respectively, while using HAL. Influence of HAL on the kinematics of the lower limbs was not significant. Differences between both evaluated HAL conditions were not significant. This study proved limited lumbar spine ROM and reduced thorax extension without alterations of lower limbs kinematics when using HAL. This might potentially decrease the risk of work-related LBP.

Effectiveness of Soft versus Rigid Back-Support Exoskeletons during a Lifting Task

This study investigated the influence of passive back-support exoskeletons (EXO_BK) design, trunk sagittal inclination (TSI), and gender on the effectiveness of an exoskeleton to limit erector spinae muscle (ES) activation during a sagittal lifting/lowering task. Twenty-nine volunteers performed an experimental dynamic task with two exoskeletons (two different designs: soft (SUIT) and rigid (SKEL)), and without equipment (FREE). The ES activity was analyzed for eight parts of TSI, each corresponding to 25% of the range of motion (lifting: P1 to P4; lowering: P5 to P8). The impact of EXO_BK on ES activity depended on the interaction between exoskeleton design and TSI. With SKEL, ES muscle activity significantly increased for P8 (+36.8%) and tended to decrease for P3 (−7.2%, p = 0.06), compared to FREE. SUIT resulted in lower ES muscle activity for P2 (−9.6%), P3 (−8.7%, p = 0.06), and P7 (−11.1%), in comparison with FREE. Gender did not influence the effect of either back-support exoskeletons on ES muscle activity. These results point to the need for particular attention with regard to (1) exoskeleton design (rigid versus soft) and to (2) the range of trunk motion, when selecting an EXO_BK. In practice, the choice of a passive back-support exoskeleton, between rigid and soft design, requires an evaluation of human-exoskeleton interaction in real task conditions. The characterization of trunk kinematics and ranges of motion appears essential to identify the benefits and the negative effects to take into account with each exoskeleton design.

Kinematic effects of a passive lift assistive exoskeleton

The VT-Lowe's exoskeleton was designed to help support the back during repetitive lifting tasks. This study focused on the kinematic differences between lifting with and without the exoskeleton (With-Exo and Without-Exo) over three different lifting styles (Freestyle, Squat, and Stoop) and two different box weights (0% and 20% of bodyweight). Twelve young and healthy males (Age 23.5 +/- 4.42 years; Height 179.33 +/- 6.37 cm; Weight 80.4 +/- 5.59 kg) participated in this study. Variables analyzed include the ankle and knee angles and angle between the Shoulder-Hip-Knee (SHK); the shoulder, elbow, and wrist heights; and the lifting speed and acceleration. The relationships between the torso angle, SHK angle, center of mass of the torso, torso torque, box height, as well as electromyography (EMG) data from a related study were also analyzed. On average, wearing the exoskeleton resulted in a 1.5 degree increase in ankle dorsiflexion, a 2.6 degree decrease in knee flexion, and a decrease of 2.3 degrees in SHK angle. Subjects' shoulder, elbow, and wrist heights were slightly higher while wearing the exoskeleton, and they lifted slightly more slowly while wearing the exoskeleton. Subjects moved more quickly while bending down as compared to standing up, and with the 0% bodyweight box as compared to the 20% bodyweight box. The values for Freestyle lifts generally fell in between Squat and Stoop lift styles or were not significantly different from Squat. EMG data from the leg muscles had relationships with torso torque while the back and stomach muscles showed no significant relationships.

Feature Detection and Biomechanical Analysis to Objectively Identify High Exposure Movement Strategies When Performing the EPIC Lift Capacity test

Purpose The Epic Lift Capacity (ELC) test is used to determine a worker's maximum lifting capacity. In the ELC test, maximum lifting capacity is often determined as the maximum weight lifted without exhibiting a visually appraised "high-risk workstyle." However, the criteria for evaluating lifting mechanics have limited justification. This study applies feature detection and biomechanical analysis to motion capture data obtained while participants performed the ELC test to objectively identify aspects of movement that may help define "high-risk workstyle". Method In this cross-sectional study, 24 participants completed the ELC test. We applied Principal Component Analysis, as a feature detection approach, and biomechanical analysis to motion capture data to objectively identify movement features related to biomechanical exposure on the low back and shoulders. Principal component scores were compared between high and low exposure trials (relative to median exposure) to determine if features of movement differed. Features were interpreted using single component reconstructions of principal components. Results Statistical testing showed that low exposure lifts and lowers maintained the body closer to the load, exhibited squat-like movement (greater knee flexion, wider base of support), and remained closer to neutral posture at the low back (less forward flexion and axial twist) and shoulder (less flexion and abduction). Conclusions Use of feature detection and biomechanical analyses revealed movement features related to biomechanical exposure at the low back and shoulders. The objectively identified criteria could augment the existing scoring criteria for ELC test technique assessment. In the future, such features can inform the design of classifiers to objectively identify "high-risk workstyle" in real-time.

Review of Current Spinal Robotic Orthoses

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

The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints

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.

Understanding individual differences in lifting mechanics: Do some people adopt motor control strategies that minimize biomechanical exposure

The movement strategy an individual uses to complete a lift can influence the resultant biomechanical exposure on their low back. We hypothesize that some lifters may choose a motor control strategy to minimize exposure to the low back, where others may not. Lower magnitudes of exposure to the low back coupled with less variability in lift-to-lift exposure and in features of movement strategy related to biomechanical exposure would support that such lifters consider minimizing exposure in their motor control strategy. We tested this hypothesis by investigating if differences in variability of low back exposure measures, as well as features of movement strategy related to resultant low back exposures differed across lifters. Twenty-eight healthy adults participated in the study where ten repetitions of a lifting task with the load scaled to 75% of participant's one-repetition maximum were completed. In all trials, whole-body kinematics and ground reaction forces were collected. Lifters were grouped as low, moderate or high relative exposure based on low back flexion angles and normalized L4/L5 extensor moments when lifting. Principal component analysis was used to identify independent movement strategy features, and statistical testing determined which features differed between high and low exposure lifts. Variability in low back exposures and movement features associated with relative biomechanical exposure were compared across lifter classifications. Significantly less variability was observed in low back exposures among the low exposure lifter group. Additionally, a trend towards lower variability in movement features associated with relative biomechanical exposure was also observed in low exposure lifters. These findings provide initial support for the hypothesis that some lifters likely define a motor control strategy that considers minimizing biomechanical exposure in addition to completing the lift demands. Future work should explore how state and trait-based factors influence an individual to consider biomechanical exposure within their motor control strategy in lifting.

Assessing the potential for "undesired" effects of passive back-support exoskeleton use during a simulated manual assembly task: Muscle activity, posture, balance, discomfort, and usability

Back-support exoskeletons (BSEs) are wearable systems designed to reduce physical demands on the back, but which could have undesired effects beyond this design intention. Participants (n = 18) used two commercial BSEs to complete a brief (~15-20 s) simulated manual assembly task in varying conditions, with outcome measures that included: working posture, activity levels in "secondary" muscle groups (shoulders and thighs), perceived balance, discomfort, and usability. Using a BSE led to small and inconsistent changes in working postures (e.g., < ~14° change in lumbar flexion), muscular activity in the secondary muscle groups (<±2% of maximum voluntary isometric contractions), or perceived balance. Limitations in movement were reported for both BSEs, however, along with moderate levels of discomfort. Task-specific responses were evident for all outcome measures, though these depended on the specific BSE used and differed between genders in many cases. Future work should focus on interactions between a given user, BSE design, and task conditions.

Biomechanical assessment of two back-support exoskeletons in symmetric and asymmetric repetitive lifting with moderate postural demands

Two passive back-support exoskeleton (BSE) designs were assessed in terms of muscular activity, energy expenditure, joint kinematics, and subjective responses. Eighteen participants (gender-balanced) completed repetitive lifting tasks in nine different conditions, involving symmetric and asymmetric postures and using two BSEs (along with no BSE as a control condition). Wearing both BSEs significantly reduced peak levels of trunk extensor muscle activity (by ~9-20%) and reduced energy expenditure (by ~8-14%). Such reductions, though, were more pronounced in the symmetric conditions and differed between the two BSEs tested. Participants reported lower perceived exertion using either BSE yet raised concerns regarding localized discomfort. Minimal changes in lifting behaviors were evident when using either BSE, and use of both BSEs led to generally positive usability ratings. While these results are promising regarding the occupational use of BSEs, future work is recommended to consider inter-individual differences to accommodate diverse user needs and preferences.

Inclusion of Workers with Disabilities in Production 4.0: Legal Foundations in Europe and Potentials Through Worker Assistance Systems

The inclusion of employees with disabilities in production is an issue that has rarely been addressed by scientists from the manufacturing sector. In this article, we examine to what extent the trend towards Industry 4.0 offers potential for the inclusion of people with disabilities in Production 4.0. First, we examine relevant legal foundations and restrictions in Europe and in more detail in Austria, Italy, and Norway. Next, based on a literature review, we examine which technological aids in the form of worker assistance systems derived from Industry 4.0 can make jobs in the manufacturing sector accessible for people with disabilities. Three types of assistance systems have been examined: sensorial aid systems, physical aid systems, and cognitive aid systems. In a concluding discussion of the results, we finally summarize the implications on management and policies as well as the potential and limitations of identified worker assistance technologies. On the one hand, the study is intended to draw the attention of researchers and industrial companies to new technological possibilities for the inclusion of people with disabilities in production. On the other hand, difficulties and grievances due to the legal foundations are pointed out to stimulate a critical discussion here as well.

Effects of exoskeleton design and precision requirements on physical demands and quality in a simulated overhead drilling task

We compared three passive exoskeleton designs in a mock drilling task under three precision requirements levels, defined by required hole sizes, in terms of physical demands (perceived exertion and muscular activation) and quality. The investigated designs were: 1) an upper-body exoskeleton mainly supporting the shoulder; and both 2) full-body, and 3) upper-body exoskeletons, each with connected supernumerary arms. At a fixed pace, participants (n = 12) repeated "drilling" two same-sized holes for 2 min. A fairly consistent result across exoskeleton designs was that higher precision demands increased some muscle activation levels and deteriorated quality. Designs with supernumerary arms led to the largest reductions in quality and increased physical demands overall, mainly in the low back. The shoulder-focused exoskeleton reduced shoulder demands but appeared to reduce quality with the highest precision requirement. Although future work is needed under more diverse/realistic scenarios, these results might be useful to (re)design occupational exoskeletons.

The effect of a passive trunk exoskeleton on metabolic costs during lifting and walking

The objective of this study was to assess how wearing a passive trunk exoskeleton affects metabolic costs, movement strategy and muscle activation during repetitive lifting and walking. We measured energy expenditure, kinematics and muscle activity in 11 healthy men during 5 min of repetitive lifting and 5 min of walking with and without exoskeleton. Wearing the exoskeleton during lifting, metabolic costs decreased as much as 17%. In conjunction, participants tended to move through a smaller range of motion, reducing mechanical work generation. Walking with the exoskeleton, metabolic costs increased up to 17%. Participants walked somewhat slower with shortened steps while abdominal muscle activity slightly increased when wearing the exoskeleton. Wearing an exoskeleton during lifting decreased metabolic costs and hence may reduce the development of fatigue and low back pain risk. During walking metabolic costs increased, stressing the need for a device that allows disengagement of support depending on activities performed. Practitioner summary: Physiological strain is an important risk factor for low back pain. We observed that an exoskeleton reduced metabolic costs during lifting, but had an opposite effect while walking. Therefore, exoskeletons may be of benefit for lifting by decreasing physiological strain but should allow disengagement of support when switching between tasks. Abbreviations: COM: centre of mass; EMG: electromyography; LBP: low back pain; MVC: maximum voluntary isometric contraction; NIOSH: National Institute for Occupational Safety and Health; PLAD: personal lift augmentation device; PWS: preferred walking speed without exoskeleton; PWSX: preferred walking speed with exoskeleton; ROM: range of motion; RER: respiratory exchange ratio; V ̇O2max: maximum rate of oxygen consumption.

Influences of different exoskeleton designs and tool mass on physical demands and performance in a simulated overhead drilling task

We compared different passive exoskeletal designs in terms of physical demands (maximum acceptable frequency = MAF, perceived discomfort, and muscular loading) and quality in a simulated overhead drilling task, and the moderating influence of tool mass (∼2 and ∼5 kg). Three distinct designs were used: full-body and upper-body exoskeletons with attached mechanical arms; and an upper-body exoskeleton providing primarily shoulder support. Participants (n = 16, gender-balanced) simulated drilling for 15 min to determine their MAF, then maintained this pace for three additional minutes while the remaining outcome measures were obtained. The full-body/upper-body devices led to the lowest/highest MAF for females and the lowest quality. The shoulder support design reduced peak shoulder muscle loading but did not significantly affect either quality or MAF. Differences between exoskeleton designs were largely consistent across the two tool masses. These results may be helpful to (re)design exoskeletons to help reduce injury risk and improve performance.

Biomechanical evaluation of exoskeleton use on loading of the lumbar spine

The objective of this study was to investigate biomechanical loading to the low back as a result of wearing an exoskeletal intervention designed to assist in occupational work. Twelve subjects simulated the use of two powered hand tools with and without the use of a Steadicam vest with an articulation tool support arm in a laboratory environment. Dependent measures of peak and mean muscle forces in ten trunk muscles and peak and mean spinal loads were examined utilizing a dynamic electromyography-assisted spine model. The exoskeletal device increased both peak and mean muscle forces in the torso extensor muscles (p < 0.001). Peak and mean compressive spinal loads were also increased up to 52.5% and 56.8%, respectively, for the exoskeleton condition relative to the control condition (p < 0.001). The results of this study highlight the need to design exoskeletal interventions while anticipating how mechanical loads might be shifted or transferred with their use.

Exoskeletons for industrial application and their potential effects on physical work load

The aim of this review was to provide an overview of assistive exoskeletons that have specifically been developed for industrial purposes and to assess the potential effect of these exoskeletons on reduction of physical loading on the body. The search resulted in 40 papers describing 26 different industrial exoskeletons, of which 19 were active (actuated) and 7 were passive (non-actuated). For 13 exoskeletons, the effect on physical loading has been evaluated, mainly in terms of muscle activity. All passive exoskeletons retrieved were aimed to support the low back. Ten-forty per cent reductions in back muscle activity during dynamic lifting and static holding have been reported. Both lower body, trunk and upper body regions could benefit from active exoskeletons. Muscle activity reductions up to 80% have been reported as an effect of active exoskeletons. Exoskeletons have the potential to considerably reduce the underlying factors associated with work-related musculoskeletal injury. Practitioner Summary: Worldwide, a significant interest in industrial exoskeletons does exist, but a lack of specific safety standards and several technical issues hinder mainstay practical use of exoskeletons in industry. Specific issues include discomfort (for passive and active exoskeletons), weight of device, alignment with human anatomy and kinematics, and detection of human intention to enable smooth movement (for active exoskeletons).

Principal component modeling of isokinetic moment curves for discriminating between the injured and healthy knees of unilateral ACL deficient patients

Bilateral knee strength evaluations of unilateral anterior cruciate ligament (ACL) deficient patients using isokinetic dynamometry are commonly performed in rehabilitation settings. The most frequently-used outcome measure is the peak moment value attained by the knee extensor and flexor muscle groups. However, other strength curve features may also be of clinical interest and utility. The purpose of this investigation was to identify, using Principal Component Analysis (PCA), strength curve features that explain the majority of variation between the injured and uninjured knee, and to assess the capabilities of these features to detect the presence of injury. A mixed gender cohort of 43 unilateral ACL deficient patients performed 6 continuous concentric knee extension and flexion repetitions bilaterally at 60°s(-1) and 180°s(-1) within a 90° range of motion. Moment waveforms were analyzed using PCA, and binary logistic regression was used to develop a discriminatory decision rule. For all directions and speeds, a statistically significant overall reduction in strength was noted for the involved knee in comparison to the uninvolved knee. The discriminatory decision rule yielded a specificity and sensitivity of 60.5% and 60.5%, respectively, corresponding to an accuracy of ∼62%. As such, the curve features extracted using PCA enabled only limited clinical usefulness in discerning between the ACL deficient and contra lateral, healthy knee. Improvement in discrimination capabilities may perhaps be achieved by consideration of different testing speeds and contraction modes, as well as utilization of other data analysis techniques.

Interjoint Coordination and the Personal Lift-Assist Device

It has been suggested that interjoint coordination may serve to reduce joint stress and muscular demand and to maintain balance during dynamic lifting tasks, thus having implications for safe lifting practices. Before recommending the use of an on-body ergonomic aid, the Personal Lift-Assist Device (PLAD), it is important to determine any effects this device may have on interjoint coordination. Principal component analyses were applied to relative phase angle waveforms, defining the hip–knee and lumbar spine–hip coordination of 15 males and 15 females during a repetitive lifting task. When wearing the PLAD, users lifted with more synchronous hip–knee and lumbar spine–hip coordination patterns (P< .01). Furthermore, increases in load caused less synchronized interjoint coordination at both the hip–knee and lumbar spine–hip during the up and down phases of the lift (P< .01) for all conditions. No significant main effects of sex or significant interactions were observed on any of the outcome variables.

Local dynamic stability of the lifting kinematic chain

While a stable trunk and centre of mass (CoM) trajectory are required during lifting, it is unclear how stability is controlled. Thirty healthy participants (15M, 15F) performed repetitive, symmetric lifting at 10 cycles per minute for 3 min with a load-in-hands equivalent to 10% of their maximum back strength. Short- and long-term maximum finite-time Lyapunov exponents (λ(max-s) and λ(max-l)), describing responses to small (local) perturbations, estimated the local dynamic stability of the foot, shank, thigh, pelvis, lower back, and upper back segments. Instability (λ(max-s)) significantly increased when moving up the kinematic chain (p<0.001). Therefore, to maintain trunk equilibrium and accurately regulate CoM trajectory during lifting, stability of the distal (fixed) lower limb segments is prioritized. This is contrary to previous results observed during gait, indicating that trunk control via kinematic chain stability is accomplished differently for walking and lifting.