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Manero A, Rivera V, Fu Q, Schwartzman JD, Prock-Gibbs H, Shah N, Gandhi D, White E, Crawford KE, Coathup MJ. Emerging Medical Technologies and Their Use in Bionic Repair and Human Augmentation. Bioengineering (Basel) 2024; 11:695. [PMID: 39061777 PMCID: PMC11274085 DOI: 10.3390/bioengineering11070695] [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: 06/13/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
As both the proportion of older people and the length of life increases globally, a rise in age-related degenerative diseases, disability, and prolonged dependency is projected. However, more sophisticated biomedical materials, as well as an improved understanding of human disease, is forecast to revolutionize the diagnosis and treatment of conditions ranging from osteoarthritis to Alzheimer's disease as well as impact disease prevention. Another, albeit quieter, revolution is also taking place within society: human augmentation. In this context, humans seek to improve themselves, metamorphosing through self-discipline or more recently, through use of emerging medical technologies, with the goal of transcending aging and mortality. In this review, and in the pursuit of improved medical care following aging, disease, disability, or injury, we first highlight cutting-edge and emerging materials-based neuroprosthetic technologies designed to restore limb or organ function. We highlight the potential for these technologies to be utilized to augment human performance beyond the range of natural performance. We discuss and explore the growing social movement of human augmentation and the idea that it is possible and desirable to use emerging technologies to push the boundaries of what it means to be a healthy human into the realm of superhuman performance and intelligence. This potential future capability is contrasted with limitations in the right-to-repair legislation, which may create challenges for patients. Now is the time for continued discussion of the ethical strategies for research, implementation, and long-term device sustainability or repair.
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Affiliation(s)
- Albert Manero
- Limbitless Solutions, University of Central Florida, 12703 Research Parkway, Suite 100, Orlando, FL 32826, USA (V.R.)
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
| | - Viviana Rivera
- Limbitless Solutions, University of Central Florida, 12703 Research Parkway, Suite 100, Orlando, FL 32826, USA (V.R.)
| | - Qiushi Fu
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Jonathan D. Schwartzman
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Hannah Prock-Gibbs
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Neel Shah
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Deep Gandhi
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Evan White
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
| | - Kaitlyn E. Crawford
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Melanie J. Coathup
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA; (Q.F.); (K.E.C.)
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA; (J.D.S.); (H.P.-G.); (N.S.); (D.G.); (E.W.)
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Hybart RL, Ferris DP. Neuromechanical Adaptation to Walking With Electromechanical Ankle Exoskeletons Under Proportional Myoelectric Control. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:119-128. [PMID: 38274783 PMCID: PMC10810305 DOI: 10.1109/ojemb.2023.3288469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To determine if robotic ankle exoskeleton users decrease triceps surae muscle activity when using proportional myoelectric control, we studied healthy young participants walking with commercially available electromechanical ankle exoskeletons (Dephy Exoboot) with a novel controller. The vast majority of robotic lower limb exoskeletons do not have direct neural input from the user which makes adaptation of exoskeleton dynamics based on user intent difficult. Proportional myoelectric control has proven to allow considerable adaptation in muscle activation and gait kinematics in pneumatic, tethered ankle exoskeletons. In this study we quantified the changes in muscle activity and joint biomechanics of twelve participants walking for 30 minutes on a treadmill. RESULTS The exoskeletons provided 29% of the peak total ankle power and 18% of the peak total ankle moment by the end of the practice session. There was a decrease of 12% in soleus, 17% in lateral gastrocnemius and 5% in medial gastrocnemius electromyography (EMG) root mean square (root mean squared) after walking with the exoskeleton for 30 minutes compared to not wearing the exoskeleton, but this difference was not statistically significant. There were no differences in joint biomechanics of the ankle, hip, or knee between the end of training compared to walking without the exoskeletons. CONCLUSIONS Contrary to expectations, triceps surae muscle activity showed only small non-significant decreases in 30 minutes of walking with portable, electromechanical ankle exoskeletons under proportional myoelectric control. The commercially available ankle exoskeletons were likely too weak to produce a statistically meaningful decline in triceps surae recruitment. Future research should include a wider variety of tasks, including measurements of metabolic energy expenditure, and provide a longer period of adaptation to evaluate the ankle exoskeletons.
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Affiliation(s)
- Rachel L. Hybart
- J. Crayton Pruitt Department of Biomedical EngineeringUniversity of FloridaGainesvilleFL32611USA
| | - Daniel P. Ferris
- J. Crayton Pruitt Department of Biomedical EngineeringUniversity of FloridaGainesvilleFL32611USA
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Chen B, Zi B, Qin L, Pan Q. State-of-the-art research in robotic hip exoskeletons: A general review. J Orthop Translat 2019; 20:4-13. [PMID: 31908928 PMCID: PMC6939102 DOI: 10.1016/j.jot.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
Ageing population is now a global challenge, where physical deterioration is the common feature in elderly people. In addition, the diseases, such as spinal cord injury, stroke, and injury, could cause a partial or total loss of the ability of human locomotion. Thus, assistance is necessary for them to perform safe activities of daily living. Robotic hip exoskeletons are able to support ambulatory functions in elderly people and provide rehabilitation for the patients with gait impairments. They can also augment human performance during normal walking, loaded walking, and manual handling of heavy-duty tasks by providing assistive force/torque. In this article, a systematic review of robotic hip exoskeletons is presented, where biomechanics of the human hip joint, pathological gait pattern, and common approaches to the design of robotic hip exoskeletons are described. Finally, limitations of the available robotic hip exoskeletons and their possible future directions are discussed, which could serve a useful reference for the engineers and researchers to develop robotic hip exoskeletons with practical and plausible applications in geriatric orthopaedics. The translational potential of this article The past decade has witnessed a remarkable progress in research and development of robotic hip exoskeletons. Our aim is to summarize recent developments of robotic hip exoskeletons for the engineers, clinician scientists and rehabilitation personnel to develop efficient robotic hip exoskeletons for practical and plausible applications.
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Affiliation(s)
- Bing Chen
- School of Mechanical Engineering, Hefei University of Technology, Hefei, China
- Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bin Zi
- School of Mechanical Engineering, Hefei University of Technology, Hefei, China
- Corresponding author. Hefei University of Technology, Room 301, Gewu Building, Tunxi Road, Hefei, Anhui Province, 230009, China.
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qiaosheng Pan
- School of Instrument Science and Opto-Electronics Engineering, Hefei University of Technology, Hefei, China
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Toxiri S, Koopman AS, Lazzaroni M, Ortiz J, Power V, de Looze MP, O'Sullivan L, Caldwell DG. Rationale, Implementation and Evaluation of Assistive Strategies for an Active Back-Support Exoskeleton. Front Robot AI 2018; 5:53. [PMID: 33500935 PMCID: PMC7805873 DOI: 10.3389/frobt.2018.00053] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023] Open
Abstract
Active exoskeletons are potentially more effective and versatile than passive ones, but designing them poses a number of additional challenges. An important open challenge in the field is associated to the assistive strategy, by which the actuation forces are modulated to the user's needs during the physical activity. This paper addresses this challenge on an active exoskeleton prototype aimed at reducing compressive low-back loads, associated to risk of musculoskeletal injury during manual material handling (i.e., repeatedly lifting objects). An analysis of the biomechanics of the physical task reveals two key factors that determine low-back loads. For each factor, a suitable control strategy for the exoskeleton is implemented. The first strategy is based on user posture and modulates the assistance to support the wearer's own upper body. The second one adapts to the mass of the lifted object and is a practical implementation of electromyographic control. A third strategy is devised as a generalized combination of the first two. With these strategies, the proposed exoskeleton can quickly adjust to different task conditions (which makes it versatile compared to using multiple, task-specific, devices) as well as to individual preference (which promotes user acceptance). Additionally, the presented implementation is potentially applicable to more powerful exoskeletons, capable of generating larger forces. The different strategies are implemented on the exoskeleton and tested on 11 participants in an experiment reproducing the lifting task. The resulting data highlights that the strategies modulate the assistance as intended by design, i.e., they effectively adjust the commanded assistive torque during operation based on user posture and external mass. The experiment also provides evidence of significant reduction in muscular activity at the lumbar spine (around 30%) associated to using the exoskeleton. The reduction is well in line with previous literature and may be associated to lower risk of injury.
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Affiliation(s)
- Stefano Toxiri
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics Bioengineering Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Axel S Koopman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Maria Lazzaroni
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jesús Ortiz
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Valerie Power
- School of Design, University of Limerick, Limerick, Ireland
| | - Michiel P de Looze
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,TNO, Leiden, Netherlands
| | - Leonard O'Sullivan
- School of Design, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Grazi L, Crea S, Parri A, Molino Lova R, Micera S, Vitiello N. Gastrocnemius Myoelectric Control of a Robotic Hip Exoskeleton Can Reduce the User's Lower-Limb Muscle Activities at Push Off. Front Neurosci 2018; 12:71. [PMID: 29491830 PMCID: PMC5817084 DOI: 10.3389/fnins.2018.00071] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/29/2018] [Indexed: 11/27/2022] Open
Abstract
We present a novel assistive control strategy for a robotic hip exoskeleton for assisting hip flexion/extension, based on a proportional Electromyography (EMG) strategy. The novelty of the proposed controller relies on the use of the Gastrocnemius Medialis (GM) EMG signal instead of a hip flexor muscle, to control the hip flexion torque. This strategy has two main advantages: first, avoiding the placement of the EMG electrodes at the human-robot interface can reduce discomfort issues for the user and motion artifacts of the recorded signals; second, using a powerful signal for control, such as the GM, could improve the reliability of the control system. The control strategy has been tested on eight healthy subjects, walking with the robotic hip exoskeleton on the treadmill. We evaluated the controller performance and the effect of the assistance on muscle activities. The tuning of the assistance timing in the controller was subject dependent and varied across subjects. Two muscles could benefit more from the assistive strategy, namely the Rectus Femoris (directly assisted) and the Tibialis Anterior (indirectly assisted). A significant correlation was found between the timing of the delivered assistance (i.e., synchronism with the biological hip torque), and reduction of the hip flexors muscular activity during walking; instead, no significant correlations were found for peak torque and peak power. Results suggest that the timing of the assistance is the most significant parameter influencing the effectiveness of the control strategy. The findings of this work could be important for future studies aimed at developing assistive strategies for walking assistance exoskeletons.
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Affiliation(s)
- Lorenzo Grazi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Parri
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translation Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Don Carlo Gnocchi, Firenze, Italy
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Young AJ, Gannon H, Ferris DP. A Biomechanical Comparison of Proportional Electromyography Control to Biological Torque Control Using a Powered Hip Exoskeleton. Front Bioeng Biotechnol 2017; 5:37. [PMID: 28713810 PMCID: PMC5491916 DOI: 10.3389/fbioe.2017.00037] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite a large increase in robotic exoskeleton research, there are few studies that have examined human performance with different control strategies on the same exoskeleton device. Direct comparison studies are needed to determine how users respond to different types of control. The purpose of this study was to compare user performance using a robotic hip exoskeleton with two different controllers: a controller that targeted a biological hip torque profile and a proportional myoelectric controller. METHODS We tested both control approaches on 10 able-bodied subjects using a pneumatically powered hip exoskeleton. The state machine controller targeted a biological hip torque profile. The myoelectric controller used electromyography (EMG) of lower limb muscles to produce a proportional control signal for the hip exoskeleton. Each subject performed two 30-min exoskeleton walking trials (1.0 m/s) using each controller and a 10-min trial with the exoskeleton unpowered. During each trial, we measured subjects' metabolic cost of walking, lower limb EMG profiles, and joint kinematics and kinetics (torques and powers) using a force treadmill and motion capture. RESULTS Compared to unassisted walking in the exoskeleton, myoelectric control significantly reduced metabolic cost by 13% (p = 0.005) and biological hip torque control reduced metabolic cost by 7% (p = 0.261). Subjects reduced muscle activity relative to the unpowered condition for a greater number of lower limb muscles using myoelectric control compared to the biological hip torque control. More subjects subjectively preferred the myoelectric controller to the biological hip torque control. CONCLUSION Myoelectric control had more advantages (metabolic cost and muscle activity reduction) compared to a controller that targeted a biological torque profile for walking with a robotic hip exoskeleton. However, these results were obtained with a single exoskeleton device with specific control configurations while level walking at a single speed. Further testing on different exoskeleton hardware and with more varied experimental protocols, such as testing over multiple types of terrain, is needed to fully elucidate the potential benefits of myoelectric control for exoskeleton technology.
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Affiliation(s)
- Aaron J Young
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hannah Gannon
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Daniel P Ferris
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
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