Design and evaluation of a quasi-passive knee exoskeleton for investigation of motor adaptation in lower extremity joints

Combining enhanced spectral resolution of EMG and a deep learning approach for knee pathology diagnosis

Knee osteoarthritis (OA) is a prevalent, debilitating joint condition primarily affecting the elderly. This investigation aims to develop an electromyography (EMG)-based method for diagnosing knee pathologies. EMG signals of the muscles surrounding the knee joint were examined and recorded. The principal components of the proposed method were preprocessing, high-order spectral analysis (HOSA), and diagnosis/recognition through deep learning. EMG signals from individuals with normal and OA knees while walking were extracted from a publicly available database. This examination focused on the quadriceps femoris, the medial gastrocnemius, the rectus femoris, the semitendinosus, and the vastus medialis. Filtration and rectification were utilized beforehand to eradicate noise and smooth EMG signals. Signals' higher-order spectra were analyzed with HOSA to obtain information about nonlinear interactions and phase coupling. Initially, the bicoherence representation of EMG signals was devised. The resulting images were fed into a deep-learning system for identification and analysis. A deep learning algorithm using adapted ResNet101 CNN model examined the images to determine whether the EMG signals were conventional or indicative of knee osteoarthritis. The validated test results demonstrated high accuracy and robust metrics, indicating that the proposed method is effective. The medial gastrocnemius (MG) muscle was able to distinguish Knee osteoarthritis (KOA) patients from normal with 96.3±1.7% accuracy and 0.994±0.008 AUC. MG has the highest prediction accuracy of KOA and can be used as the muscle of interest in future analysis. Despite the proposed method's superiority, some limitations still require special consideration and will be addressed in future research.

Genomic Determinants of Knee Joint Biomechanics: An Exploration into the Molecular Basis of Locomotor Function, a Narrative Review

In recent years, the nexus between genetics and biomechanics has garnered significant attention, elucidating the role of genomic determinants in shaping the biomechanical attributes of human joints, specifically the knee. This review seeks to provide a comprehensive exploration of the molecular basis underlying knee joint locomotor function. Leveraging advancements in genomic sequencing, we identified specific genetic markers and polymorphisms tied to key biomechanical features of the knee, such as ligament elasticity, meniscal resilience, and cartilage health. Particular attention was devoted to collagen genes like COL1A1 and COL5A1 and their influence on ligamentous strength and injury susceptibility. We further investigated the genetic underpinnings of knee osteoarthritis onset and progression, as well as the potential for personalized rehabilitation strategies tailored to an individual's genetic profile. We reviewed the impact of genetic factors on knee biomechanics and highlighted the importance of personalized orthopedic interventions. The results hold significant implications for injury prevention, treatment optimization, and the future of regenerative medicine, targeting not only knee joint health but joint health in general.

Quasi-passive lower limbs exosuit: an in-depth assessment of fatigue, kinematic and muscular patterns while comparing assistive strategies on an expert subject's gait analysis

Wearable robots are becoming a valuable solution that helps injured, and elderly people regain mobility and improve clinical outcomes by speeding up the rehabilitation process. The XoSoft exosuit identified several benefits, including improvement of assistance, usability, and acceptance with a soft, modular, bio-mimetic, and quasi-passive exoskeleton. This study compares two assistive configurations: (i) a bilateral hip flexion (HA, hips-assistance) and (ii) a bilateral hip flexion combined with ankle plantarflexion (HAA, hips-ankles-assistance) with the main goal of evaluating compensatory actions and synergetic effects generated by the human- exoskeleton interaction. A complete description of this complex interaction scenario with this actuated exosuit is evaluated during a treadmill walking task, using several indices to quantify the human-robot interaction in terms of muscular activation and fatigue, metabolic expenditure, and kinematic motion patterns. Evidence shows that the HAA biomimetic controller is synergetic with the musculature and performs better concerning the other control strategy. The experimentation demonstrated a metabolic expenditure reduction of 8% of Metabolic Equivalent of Task (MET), effective assistance of the muscular activation of 12.5%, a decrease of the muscular fatigue of 0.6% of the mean frequency, and a significant reduction of the compensatory actions, as discussed in this work. Compensatory effects are present in both assistive configurations, but the HAA modality provides a 47% reduction of compensatory effects when considering muscle activation.

Estimation of Knee Assistive Moment in a Gait Cycle Using Knee Angle and Knee Angular Velocity through Machine Learning and Artificial Stiffness Control Strategy (MLASCS)

Nowadays, many people around the world cannot walk perfectly because of their knee problems. A knee-assistive device is one option to support walking for those with low or not enough knee muscle forces. Many research studies have created knee devices with control systems implementing different techniques and sensors. This study proposes an alternative version of the knee device control system without using too many actuators and sensors. It applies the machine learning and artificial stiffness control strategy (MLASCS) that uses one actuator combined with an encoder for estimating the amount of assistive support in a walking gait from the recorded gait data. The study recorded several gait data and analyzed knee moments, and then trained a k-nearest neighbor model using the knee angle and the angular velocity to classify a state in a gait cycle. This control strategy also implements instantaneous artificial stiffness (IAS), a control system that requires only knee angle in each state to determine the amount of supporting moment. After validating the model via simulation, the accuracy of the machine learning model is around 99.9% with the speed of 165 observers/s, and the walking effort is reduced by up to 60% in a single gait cycle.

Effects of stance control via hidden Markov model-based gait phase detection on healthy users of an active hip-knee exoskeleton

Introduction: In the past years, robotic lower-limb exoskeletons have become a powerful tool to help clinicians improve the rehabilitation process of patients who have suffered from neurological disorders, such as stroke, by applying intensive and repetitive training. However, active subject participation is considered to be an important feature to promote neuroplasticity during gait training. To this end, the present study presents the performance assessment of the AGoRA exoskeleton, a stance-controlled wearable device designed to assist overground walking by unilaterally actuating the knee and hip joints. Methods: The exoskeleton's control approach relies on an admittance controller, that varies the system impedance according to the gait phase detected through an adaptive method based on a hidden Markov model. This strategy seeks to comply with the assistance-as-needed rationale, i.e., an assistive device should only intervene when the patient is in need by applying Human-Robot interaction (HRI). As a proof of concept of such a control strategy, a pilot study comparing three experimental conditions (i.e., unassisted, transparent mode, and stance control mode) was carried out to evaluate the exoskeleton's short-term effects on the overground gait pattern of healthy subjects. Gait spatiotemporal parameters and lower-limb kinematics were captured using a 3D-motion analysis system Vicon during the walking trials. Results and Discussion: By having found only significant differences between the actuated conditions and the unassisted condition in terms of gait velocity (ρ = 0.048) and knee flexion (ρ ≤ 0.001), the performance of the AGoRA exoskeleton seems to be comparable to those identified in previous studies found in the literature. This outcome also suggests that future efforts should focus on the improvement of the fastening system in pursuit of kinematic compatibility and enhanced compliance.

Effects of simulated reduced gravity and walking speed on ankle, knee, and hip quasi-stiffness in overground walking

Quasi-stiffness characterizes the dynamics of a joint in specific sections of stance-phase and is used in the design of wearable devices to assist walking. We sought to investigate the effect of simulated reduced gravity and walking speed on quasi-stiffness of the hip, knee, and ankle in overground walking. 12 participants walked at 0.4, 0.8, 1.2, and 1.6 m/s in 1, 0.76, 0.54, and 0.31 gravity. We defined 11 delimiting points in stance phase (4 each for the ankle and hip, 3 for the knee) and calculated the quasi-stiffness for 4 phases for both the hip and ankle, and 2 phases for the knee. The R² value quantified the suitability of the quasi-stiffness models. We found gravity level had a significant effect on 6 phases of quasi-stiffness, while speed significantly affected the quasi-stiffness in 5 phases. We concluded that the intrinsic muscle-tendon unit stiffness was the biggest determinant of quasi-stiffness. Speed had a significant effect on the R² of all phases of quasi-stiffness. Slow walking (0.4 m/s) was the least accurately modelled walking speed. Our findings showed adaptions in gait strategy when relative power and strength of the joints were increased in low gravity, which has implications for prosthesis and exoskeleton design.

Cooperativity Model for Improving the Walking-Assistance Efficiency of the Exoskeleton

(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.

A Wearable Lower Limb Exoskeleton: Reducing the Energy Cost of Human Movement

Human body enhancement is an interesting branch of robotics. It focuses on wearable robots in order to improve the performance of human body, reduce energy consumption and delay fatigue, as well as increase body speed. Robot-assisted equipment, such as wearable exoskeletons, are wearable robot systems that integrate human intelligence and robot power. After careful design and adaptation, the human body has energy-saving sports, but it is an arduous task for the exoskeleton to achieve considerable reduction in metabolic rate. Therefore, it is necessary to understand the biomechanics of human sports, the body, and its weaknesses. In this study, a lower limb exoskeleton was classified according to the power source, and the working principle, design idea, wearing mode, material and performance of different types of lower limb exoskeletons were compared and analyzed. The study shows that the unpowered exoskeleton robot has inherent advantages in endurance, mass, volume, and cost, which is a new development direction of robot exoskeletons. This paper not only summarizes the existing research but also points out its shortcomings through the comparative analysis of different lower limb wearable exoskeletons. Furthermore, improvement measures suitable for practical application have been provided.

Coordination Between Partial Robotic Exoskeletons and Human Gait: A Comprehensive Review on Control Strategies

Lower-limb robotic exoskeletons have become powerful tools to assist or rehabilitate the gait of subjects with impaired walking, even when they are designed to act only partially over the locomotor system, as in the case of unilateral or single-joint exoskeletons. These partial exoskeletons require a proper method to synchronize their assistive actions and ensure correct inter-joint coordination with the user’s gait. This review analyzes the state of the art of control strategies to coordinate the assistance provided by these partial devices with the actual gait of the wearers. We have analyzed and classified the different approaches independently of the hardware implementation, describing their basis and principles. We have also reviewed the experimental validations of these devices for impaired and unimpaired walking subjects to provide the reader with a clear view of their technology readiness level. Eventually, the current state of the art and necessary future steps in the field are summarized and discussed.

Design and investigation of the effectiveness of a metatarsophalangeal assistive device on the muscle activities of the lower extremity

The metatarsophalangeal (MTP) joint is not considered in most current walking assistive devices even though it plays an important role during walking. The purpose of this study was to develop a new MTP assistive device and investigate its effectiveness on the muscle activities of the lower extremities during walking while wearing the device. The MTP assistive device is designed to support MTP flexion by transmitting force through a cable that runs parallel with the plantar fascia. Eight participants were instructed to walk at a constant speed on a treadmill while wearing the device. The muscle activities of their lower extremities and MTP joint kinematics were obtained during walking under both actuated and non-actuated conditions. Paired t-tests were performed to compare the differences in each dependent variable between the two conditions. The muscle activity of the MTP flexor was significantly reduced during walking under actuated conditions (p = 0.013), whereas no differences were found in the muscle activities of other muscles or in the MTP joint angle between actuated and non-actuated conditions (p > 0.05 for all comparisons). In conclusion, the cable-driven MTP assistive device is able to properly assist the MTP flexor without interfering with the action of other muscles in the lower extremities; as such, this MTP assistive device, when integrated into existing exoskeleton designs, has the potential to offer improved walking assistance by reducing the amount of muscle activity needed from the MTP flexor.

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.

Sensors and Actuation Technologies in Exoskeletons: A Review

Exoskeletons are robots that closely interact with humans and that are increasingly used for different purposes, such as rehabilitation, assistance in the activities of daily living (ADLs), performance augmentation or as haptic devices. In the last few decades, the research activity on these robots has grown exponentially, and sensors and actuation technologies are two fundamental research themes for their development. In this review, an in-depth study of the works related to exoskeletons and specifically to these two main aspects is carried out. A preliminary phase investigates the temporal distribution of scientific publications to capture the interest in studying and developing novel ideas, methods or solutions for exoskeleton design, actuation and sensors. The distribution of the works is also analyzed with respect to the device purpose, body part to which the device is dedicated, operation mode and design methods. Subsequently, actuation and sensing solutions for the exoskeletons described by the studies in literature are analyzed in detail, highlighting the main trends in their development and spread. The results are presented with a schematic approach, and cross analyses among taxonomies are also proposed to emphasize emerging peculiarities.

Evaluating the Effectiveness of Soft Tissue Therapy in the Treatment of Disorders and Postoperative Conditions of the Knee Joint-A Systematic Review

The term "soft tissue therapy" (STT) refers to mechanical methods of treatment involving passive kneading, pressing and stretching of pathologically tense tissues in supporting the process of recovery after surgery or trauma to the musculoskeletal system. The objective of this study was to review current scientific reports evaluating the effectiveness of the use of STT in patients with diseases or after surgical procedures of the knee joint. A systematic search of the popular scientific databases PubMed, Scopus and Embase was performed from inception to 15 October 2021. Eight articles met eligibility criteria and were included in the review. Six papers were related to disorders of the knee joint, while the remaining two studies were related to dysfunctions associated with the conditions after surgical intervention. The findings presented confirmed the effectiveness of STT in orthopaedic patients who showed an increase in lower limb functional parameters. The research has shown that the use of various methods of STT has a significant impact on increasing muscle activity and flexibility as well as increasing the range of motion in the knee joint. The physiotherapeutic methods used had a significant impact on reducing pain and increasing physical function and quality of life. The techniques used reduced the time to descend stairs in patients with knee osteoarthritis. This review summarises the effectiveness of STT as an important form of treatment for orthopaedic patients with various knee joint dysfunctions.

Design Principles for Compact, Backdrivable Actuation in Partial-Assist Powered Knee Orthoses

This paper presents the design and validation of a backdrivable powered knee orthosis for partial assistance of lower-limb musculature, which aims to facilitate daily activities in individuals with musculoskeletal disorders. The actuator design is guided by design principles that prioritize backdrivability, output torque, and compactness. First, we show that increasing the motor diameter while reducing the gear ratio for a fixed output torque ultimately reduces the reflected inertia (and thus backdrive torque). We also identify a tradeoff with actuator torque density that can be addressed by improving the motor's thermal environment, motivating our design of a custom Brushless DC motor with encapsulated windings. Finally, by designing a 7:1 planetary gearset directly into the stator, the actuator has a high package factor that reduces size and weight. Benchtop tests verify that the custom actuator can produce at least 23.9 Nm peak torque and 12.78 Nm continuous torque, yet has less than 2.68 Nm backdrive torque during walking conditions. Able-bodied human subjects experiments (N=3) demonstrate reduced quadriceps activation with bilateral orthosis assistance during lifting-lowering, sit-to-stand, and stair climbing. The minimal transmission also produces negligible acoustic noise.

A portable exotendon assisting hip and knee joints reduces muscular burden during walking

Assistive devices are used to reduce human effort during locomotion with increasing success. More assistance strategies are worth exploring, so we aimed to design a lightweight biarticular device with well-chosen parameters to reduce muscle effort. Based on the experience of previous success, we designed an exotendon to assist in swing leg deceleration. Then we conducted experiments to test the performance of the exotendon with different spring stiffness during walking. With the assistance of the exotendon, peak activation of semitendinosus decreased, with the largest reduction of 12.3% achieved with the highest spring stiffness (p = 0.004). The peak activations of other measured muscles were not significantly different (p = 0.15-0.92). The biological hip extension and knee flexion moments likewise significantly decreased with the spring stiffness (p < 0.01). The joint angle was altered during the assisted phases with decreased hip flexion and knee extension. Meanwhile, the step frequency and the step length were also altered, while the step width remained unaffected. Gait variability changed only in the frontal plane, exhibiting lower step width variability. We conclude that passive devices assisting hip extension and knee flexion can significantly reduce the burden on the hamstring muscles, while the kinematics is easily altered.

Knee Exoskeletons Design Approaches to Boost Strength Capability: A Review

There are different devices to increase the strength capacity of people with walking problems. These devices can be classified into exoskeletons, orthotics, and braces. This review aims to identify the state of the art in the design of these medical devices, based on an analysis of patents and literature. However, there are some difficulties in processing the records due to the lack of filters and standardization in the names, generating discrepancies between the search engines, among others. Concerning the patents, 74 patents were analyzed using search engines such as Google Patents, Derwent, The Lens, Patentscope, and Espacenet over the past ten years. A bibliometric analysis was performed using 63 scientific reports from Web of Science and The Lens in the same period for scientific communications. The results show a trend to use the mechanical design of exoskeletons based on articulated rigid structures and elements that provide force to move the structure. These are generally two types: (a) elastic elements and (b) electromechanical elements. The United States accounts for 32% of the technological patents reviewed. The results suggest that the use of exoskeletons or orthoses customized to the users’ needs will continue to increase over the years due to the worldwide growth in disability, particularly related to mobility difficulties and technologies related to the combined use of springs and actuators.

Review of control strategies for lower-limb exoskeletons to assist gait

Background

Many lower-limb exoskeletons have been developed to assist gait, exhibiting a large range of control methods. The goal of this paper is to review and classify these control strategies, that determine how these devices interact with the user.

Methods

In addition to covering the recent publications on the control of lower-limb exoskeletons for gait assistance, an effort has been made to review the controllers independently of the hardware and implementation aspects. The common 3-level structure (high, middle, and low levels) is first used to separate the continuous behavior (mid-level) from the implementation of position/torque control (low-level) and the detection of the terrain or user’s intention (high-level). Within these levels, different approaches (functional units) have been identified and combined to describe each considered controller.

Results

291 references have been considered and sorted by the proposed classification. The methods identified in the high-level are manual user input, brain interfaces, or automatic mode detection based on the terrain or user’s movements. In the mid-level, the synchronization is most often based on manual triggers by the user, discrete events (followed by state machines or time-based progression), or continuous estimations using state variables. The desired action is determined based on position/torque profiles, model-based calculations, or other custom functions of the sensory signals. In the low-level, position or torque controllers are used to carry out the desired actions. In addition to a more detailed description of these methods, the variants of implementation within each one are also compared and discussed in the paper.

Conclusions

By listing and comparing the features of the reviewed controllers, this work can help in understanding the numerous techniques found in the literature. The main identified trends are the use of pre-defined trajectories for full-mobilization and event-triggered (or adaptive-frequency-oscillator-synchronized) torque profiles for partial assistance. More recently, advanced methods to adapt the position/torque profiles online and automatically detect terrains or locomotion modes have become more common, but these are largely still limited to laboratory settings. An analysis of the possible underlying reasons of the identified trends is also carried out and opportunities for further studies are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00906-3.

Performance Evaluation of Lower Limb Exoskeletons: A Systematic Review

Benchmarks have long been used to verify and compare the readiness level of different technologies in many application domains. In the field of wearable robots, the lack of a recognized benchmarking methodology is one important impediment that may hamper the efficient translation of research prototypes into actual products. At the same time, an exponentially growing number of research studies are addressing the problem of quantifying the performance of robotic exoskeletons, resulting in a rich and highly heterogeneous picture of methods, variables and protocols. This review aims to organize this information, and identify the most promising performance indicators that can be converted into practical benchmarks. We focus our analysis on lower limb functions, including a wide spectrum of motor skills and performance indicators. We found that, in general, the evaluation of lower limb exoskeletons is still largely focused on straight walking, with poor coverage of most of the basic motor skills that make up the activities of daily life. Our analysis also reveals a clear bias towards generic kinematics and kinetic indicators, in spite of the metrics of human-robot interaction. Based on these results, we identify and discuss a number of promising research directions that may help the community to attain a comprehensive benchmarking methodology for robot-assisted locomotion more efficiently.

Active Motion Control of a Knee Exoskeleton Driven by Antagonistic Pneumatic Muscle Actuators

The pneumatic muscle actuator (PMA) has been widely applied in the researches of rehabilitation robotic devices for its high power to weight ratio and intrinsic compliance in the past decade. However, the high nonlinearity and hysteresis behavior of PMA limit its practical application. Hence, the control strategy plays an important role in improving the performance of PMA for the effectiveness of rehabilitation devices. In this paper, a PMA-based knee exoskeleton based on ergonomics is proposed. Based on the designed knee exoskeleton, a novel proxy-based sliding mode control (PSMC) is introduced to obtain the accurate trajectory tracking. Compared with conventional control approaches, this new PSMC can obtain better performance for the designed PMA-based exoskeleton. Experimental results indicate good tracking performance of this controller, which provides a good foundation for the further development of assist-as-needed training strategies in gait rehabilitation.

Design and Preliminary Assessment of a Passive Elastic Leg Exoskeleton for Resistive Gait Rehabilitation

OBJECTIVE

This article aimed to develop a unique exoskeleton to provide different types of elastic resistances (i.e., resisting flexion, extension, or bidirectionally) to the leg muscles during walking.

METHODS

We created a completely passive leg exoskeleton, consisting of counteracting springs, pulleys, and clutches, to provide different types of elastic resistance to the knee. We first used a benchtop setting to calibrate the springs and validate the resistive capabilities of the device. We then tested the device's ability to alter gait mechanics, muscle activation, and kinematic aftereffects when walking on a treadmill under the three resistance types.

RESULTS

Benchtop testing indicated that the device provided a nearly linear torque profile and could be accurately configured to alter the angle where the spring system was undeformed (i.e., the resting position). Treadmill testing indicated the device could specifically target knee flexors, extensors, or both, and increase eccentric loading at the joint. Additionally, these resistance types elicited different kinematic aftereffects that could be used to target user-specific spatiotemporal gait deficits.

CONCLUSION

These results indicate that the elastic device can provide various types of targeted resistance training during walking.

SIGNIFICANCE

The proposed elastic device can provide a diverse set of resistance types that could potentially address user-specific muscle weaknesses and gait deficits through functional resistance training.

Identification of muscle morphology with noncontact capacitive sensing: Preliminary study

Human-machine interface with muscle signals serves as an important role in the field of wearable robotics. To compensate for the limitations of the existing surface Electromyography (sEMG) based technologies, we previously proposed a noncontact capacitive sensing approach that could record the limb shape changes. The sensing approach frees the human skin from contacting to the metal electrodes, thus enabling the measurement of muscle signals by dressing the sensing front-ends outside of the clothes. We validated the capacitive sensing in human motion intent recognition tasks with the wearable robots and produced comparable results to existing studies. However, the biological significance of the capacitance signals is still unrevealed, which is an indispensable issue for robot intuitive control. In this study, we address the problems of identifying the relationships between the muscle morphological parameters and the capacitance signals. We constructed a measurement system that recorded the noncon-tact capacitive sensing signals and the muscle ultrasound (US) images simultaneously. With the designed device, five subjects were employed and the US images from the gastrocnemius muscle (GM) and the tibialis anterior (TA) muscle during level walking were sampled. We fitted the calculated muscle morphological parameters (the pinnation angles and the muscle fascicle length) and the capacitance signals of the same gait phases. The results demonstrated that at least one-channel capacitance signal strongly correlated to the muscle morphological parameters (R² > 0.5, quadratic regression). The average R²s of the most correlated channels were up to 0.86 for pinnation angles and 0.83 for the muscle fascicle length changes. The interesting findings in this preliminary study suggest the biological physical significance of the capacitance signals during human locomotion. Future efforts are worth being paid in this new research direction for more promising results.

Gait Phase Recognition Using Deep Convolutional Neural Network with Inertial Measurement Units

Gait phase recognition is of great importance in the development of assistance-as-needed robotic devices, such as exoskeletons. In order for a powered exoskeleton with phase-based control to determine and provide proper assistance to the wearer during gait, the user’s current gait phase must first be identified accurately. Gait phase recognition can potentially be achieved through input from wearable sensors. Deep convolutional neural networks (DCNN) is a machine learning approach that is widely used in image recognition. User kinematics, measured from inertial measurement unit (IMU) output, can be considered as an ‘image’ since it exhibits some local ‘spatial’ pattern when the sensor data is arranged in sequence. We propose a specialized DCNN to distinguish five phases in a gait cycle, based on IMU data and classified with foot switch information. The DCNN showed approximately 97% accuracy during an offline evaluation of gait phase recognition. Accuracy was highest in the swing phase and lowest in terminal stance.

A hinge-free, non-restrictive, lightweight tethered exosuit for knee extension assistance during walking

In individuals with motor impairments such as those post-stroke or with cerebral palsy, the function of the knee extensors may be affected during walking, resulting in decreased mobility. We have designed a lightweight, hinge-free wearable robot combining soft textile exosuit components with integrated rigid components, which assists knee extension when needed but is otherwise highly transparent to the wearer. The exosuit can apply a wide range of assistance profiles using a flexible multi-point reference trajectory generator. Additionally, we implemented a controller safety limit to address the risk of hyperextension stemming from the hinge-free design. The exosuit was evaluated on six healthy participants walking uphill and downhill on a treadmill at a 10° slope with a set of joint power-inspired assistance profiles. A comparison of sagittal plane joint angles between no exosuit and exosuit unpowered conditions validated the device transparency. With positive power assistance, we observed reduction in average positive knee biological power during uphill walking (left: 17.5 ± 3.21%, p = 0.005; right: 23.2 ± 3.54%, p = 0.008). These initial findings show promise for the assistive capability of the device and its potential to improve the quality of gait and increase mobility in clinical populations.

Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can Affect It: A Systematic Review

The knee joint, as the main lower limb motor joint, is the most vulnerable and susceptible joint. The knee injuries considerably impact the normal living ability and mental health of patients. Understanding the biomechanics of a normal and diseased knee joint is in urgent need for designing knee assistive devices and optimizing a rehabilitation exercise program. In this paper, we systematically searched electronic databases (from 2000 to November 2019) including ScienceDirect, Web of Science, PubMed, Google Scholar, and IEEE/IET Electronic Library for potentially relevant articles. After duplicates were removed and inclusion criteria applied to the titles, abstracts, and full text, 138 articles remained for review. The selected articles were divided into two groups to be analyzed. Firstly, the real movement of a normal knee joint and the normal knee biomechanics of four kinds of daily motions in the sagittal and coronal planes, which include normal walking, running, stair climbing, and sit-to-stand, were discussed and analyzed. Secondly, an overview of the current knowledge on the movement biomechanical effects of common knee musculoskeletal disorders and knee neurological disorders were provided. Finally, a discussion of the existing problems in the current studies and some recommendation for future research were presented. In general, this review reveals that there is no clear assessment about the biomechanics of normal and diseased knee joints at the current state of the art. The biomechanics properties could be significantly affected by knee musculoskeletal or neurological disorders. Deeper understanding of the biomechanics of the normal and diseased knee joint will still be an urgent need in the future.

Gait Guidance Control for Damping of Unnatural Motion in a Powered Pediatric Lower-Limb Orthosis

The nominal gait of each individual is unique and varies with the walking speed of the person. This poses a difficult problem for powered rehabilitative orthoses since control strategies often require a reference trajectory and give little control to the patient. This paper describes a simple control approach which applies torque resistive to joint movement that is unnatural for healthy individuals in the hip and knee joints during the swing phase of gait. The controller uses a configuration-dependent orthonormal basis to represent vectors in terms of components which are tangent and normal to healthy gait patterns for a continuum of gait speeds. The controller damps motion in the normal direction, thereby resisting movement which is unnatural for healthy individuals. With this control law, subjects are not restricted to a particular reference trajectory and have a large degree of volition over spatiotemporal gait parameters (e.g., stride length, swing time, and cadence). Experiments are conducted to check the feasibility of the control law in a provisional powered pediatric lower-limb orthosis. The gait guidance controller is used in conjunction with a human controller representing an individual with gait impairment. The main results compare gait shape quality when the gait guidance controller is enabled versus disabled, and show how the gait guidance controller is able to reshape gait to more closely resemble that of a healthy individual for various cadences.

Passive Knee Assistance Affects Whole-Body Biomechanics During Sit-to-Stand

The sit-to-stand (STS) motion is an activity of daily living which requires significant torque generation and coordinated movement at multiple joints. It is therefore important to consider the whole-body biomechanics when designing an assistive device for STS. In this study, a passive elastic orthotic was developed which provides bilateral knee extension assistance. Initial human experiments were conducted with two subjects under two foot-placement conditions. The human and device kinematics and dynamics were modelled, allowing for the assessment of the biomechanical effects of the device. The assistance resulted in a decrease in the human knee torque as well as changes in whole-body biomechanics, notably an increase in the linear momentum of the upper body and a decrease in the anterior excursion of the center of mass. These results indicate that single-joint assistance at the knee has the potential to both facilitate successful STS and positively alter whole-body biomechanics.

Empowering lower limbs exoskeletons: state-of-the-art

Given the advanced breakthroughs in the field of supportive robotic technologies, interest in the integration of the human body and a robot into a single system has rapidly increased. The aim of this work is to provide an overview of empowering lower limbs exoskeletons. Along with lower exoskeleton limbs, their unique design concepts, operator–exoskeleton interactions and control strategies are described. Although many problems have been solved in recent development, many challenges remain. Especially in the context of infantry soldiers, fire fighters and rescuers, the challenges of empowering exoskeletons are discussed, and improvements are outlined and described. This study is not only a summary of the current state, but also points to weaknesses of empowering lower limbs exoskeletons and outlines possible improvements.

A 3D-Printed, Adjustable-Stiffness Knee Brace with Embedded Magnetic Angle Sensor

In this work, we detail the design and verification of a novel, 3D-printed, flexible knee brace with an embedded magnetic angle sensor for monitoring joint kinematics. The brace's torsional stiffness can be selectively modified by applying elastic bands of varying thickness. Through benchtop tests and finite element analysis simulations, we characterize the mechanical behavior of the knee brace and determine estimates of torsional stiffness across a range of band thicknesses. To demonstrate the ability to modulate knee joint loading in a real-world scenario, we report results of a pilot study in which able-bodied subjects wear the device during treadmill walking and seated flexion-extension tasks.

Towards human-knee orthosis interaction based on adaptive impedance control through stiffness adjustment

Rehabilitation interventions involving powered, wearable lower limb orthoses that can provide high-challenging locomotor tasks for repetitive training sessions, mainly when assist-as-needed strategies, such as adaptive impedance control, are designed. In this study, the adaptive behavior was ensured by software control of the robotic stiffness involved in the human-knee orthosis interaction in function of the gait cycle and speed. To estimate the stiffness, we analyzed the interaction torque-angle characteristics with experimental data. The speed-stiffness dependency was more evident when high stiffness values are demanded by the user's effort. Experimental evidence from five healthy subjects highlight that the adaptive control strategy provides a more comfortable, natural motion, and kinematic freedom as compared to the trajectory tracking control, allowing the user to contribute to the gait training. Future insights cover the implementation of gravitational compensation and real-time estimation and control of all inner dynamic properties of the impedance control law.

Gait Phase Estimation Based on Noncontact Capacitive Sensing and Adaptive Oscillators

This paper presents a novel strategy aiming to acquire an accurate and walking-speed-adaptive estimation of the gait phase through noncontact capacitive sensing and adaptive oscillators (AOs). The capacitive sensing system is designed with two sensing cuffs that can measure the leg muscle shape changes during walking. The system can be dressed above the clothes and free human skin from contacting to electrodes. In order to track the capacitance signals, the gait phase estimator is designed based on the AO dynamic system due to its ability of synchronizing with quasi-periodic signals. After the implementation of the whole system, we first evaluated the offline estimation performance by experiments with 12 healthy subjects walking on a treadmill with changing speeds. The strategy achieved an accurate and consistent gait phase estimation with only one channel of capacitance signal. The average root-mean-square errors in one stride were 0.19 rad (3.0% of one gait cycle) for constant walking speeds and 0.31 rad (4.9% of one gait cycle) for speed transitions even after the subjects rewore the sensing cuffs. We then validated our strategy in a real-time gait phase estimation task with three subjects walking with changing speeds. Our study indicates that the strategy based on capacitive sensing and AOs is a promising alternative for the control of exoskeleton/orthosis.

Effect of timing of hip extension assistance during loaded walking with a soft exosuit

Background

Recent advances in wearable robotic devices have demonstrated the ability to reduce the metabolic cost of walking by assisting the ankle joint. To achieve greater gains in the future it will be important to determine optimal actuation parameters and explore the effect of assisting other joints. The aim of the present work is to investigate how the timing of hip extension assistance affects the positive mechanical power delivered by an exosuit and its effect on biological joint power and metabolic cost during loaded walking. In this study, we evaluated 4 different hip assistive profiles with different actuation timings: early-start-early-peak (ESEP), early-start-late-peak (ESLP), late-start-early-peak (LSEP), late-start-late-peak (LSLP).

Methods

Eight healthy participants walked on a treadmill at a constant speed of 1.5 m · s^-1 while carrying a 23 kg backpack load. We tested five different conditions: four with the assistive profiles described above and one unpowered condition where no assistance was provided. We evaluated participants’ lower limb kinetics, kinematics, metabolic cost and muscle activation.

Results

The variation of timing in the hip extension assistance resulted in a different amount of mechanical power delivered to the wearer across conditions; with the ESLP condition providing a significantly higher amount of positive mechanical power (0.219 ± 0.006 W · kg^-1) with respect to the other powered conditions. Biological joint power was significantly reduced at the hip (ESEP and ESLP) and at the knee (ESEP, ESLP and LSEP) with respect to the unpowered condition. Further, all assistive profiles significantly reduced the metabolic cost of walking compared to the unpowered condition by 5.7 ± 1.5 %, 8.5 ± 0.9 %, 6.3 ± 1.4 % and 7.1 ± 1.9 % (mean ± SE for ESEP, ESLP, LSEP, LSLP, respectively).

Conclusions

The highest positive mechanical power delivered by the soft exosuit was reported in the ESLP condition, which showed also a significant reduction in both biological hip and knee joint power. Further, the ESLP condition had the highest average metabolic reduction among the powered conditions. Future work on autonomous hip exoskeletons may incorporate these considerations when designing effective control strategies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-016-0196-8) contains supplementary material, which is available to authorized users.

Gait-Event-Based Synchronization Method for Gait Rehabilitation Robots via a Bioinspired Adaptive Oscillator

In the field of gait rehabilitation robotics, achieving human-robot synchronization is very important. In this paper, a novel human-robot synchronization method using gait event information is proposed. This method includes two steps. First, seven gait events in one gait cycle are detected in real time with a hidden Markov model; second, an adaptive oscillator is utilized to estimate the stride percentage of human gait using any one of the gait events. Synchronous reference trajectories for the robot are then generated with the estimated stride percentage. This method is based on a bioinspired adaptive oscillator, which is a mathematical tool, first proposed to explain the phenomenon of synchronous flashing among fireflies. The proposed synchronization method is implemented in a portable knee-ankle-foot robot and tested in 15 healthy subjects. This method has the advantages of simple structure, flexible selection of gait events, and fast adaptation. Gait event is the only information needed, and hence the performance of synchronization holds when an abnormal gait pattern is involved. The results of the experiments reveal that our approach is efficient in achieving human-robot synchronization and feasible for rehabilitation robotics application.

A springy pendulum could describe the swing leg kinetics of human walking

The dynamics of human walking during various walking conditions could be qualitatively captured by the springy legged dynamics, which have been used as a theoretical framework for bipedal robotics applications. However, the spring-loaded inverted pendulum model describes the motion of the center of mass (CoM), which combines the torso, swing and stance legs together and does not explicitly inform us as to whether the inter-limb dynamics share the springy legged dynamics characteristics of the CoM. In this study, we examined whether the swing leg dynamics could also be represented by springy mechanics and whether the swing leg stiffness shows a dependence on gait speed, as has been observed in CoM mechanics during walking. The swing leg was modeled as a spring-loaded pendulum hinged at the hip joint, which is under forward motion. The model parameters of the loaded mass were adopted from body parameters and anthropometric tables, whereas the free model parameters for the rest length of the spring and its stiffness were estimated to best match the data for the swing leg joint forces. The joint forces of the swing leg were well represented by the springy pendulum model at various walking speeds with a regression coefficient of R(2)>0.8. The swing leg stiffness increased with walking speed and was correlated with the swing frequency, which is consistent with previous observations from CoM dynamics described using the compliant leg. These results suggest that the swing leg also shares the springy dynamics, and the compliant walking model could be extended to better present swing leg dynamics.

Estimating the Mechanical Behavior of the Knee Joint During Crouch Gait: Implications for Real-Time Motor Control of Robotic Knee Orthoses

Individuals with cerebral palsy frequently exhibit crouch gait, a pathological walking pattern characterized by excessive knee flexion. Knowledge of the knee joint moment during crouch gait is necessary for the design and control of assistive devices used for treatment. Our goal was to 1) develop statistical models to estimate knee joint moment extrema and dynamic stiffness during crouch gait, and 2) use the models to estimate the instantaneous joint moment during weight-acceptance. We retrospectively computed knee moments from 10 children with crouch gait and used stepwise linear regression to develop statistical models describing the knee moment features. The models explained at least 90% of the response value variability: peak moment in early (99%) and late (90%) stance, and dynamic stiffness of weight-acceptance flexion (94%) and extension (98%). We estimated knee extensor moment profiles from the predicted dynamic stiffness and instantaneous knee angle. This approach captured the timing and shape of the computed moment (root-mean-squared error: 2.64 Nm); including the predicted early-stance peak moment as a correction factor improved model performance (root-mean-squared error: 1.37 Nm). Our strategy provides a practical, accurate method to estimate the knee moment during crouch gait, and could be used for real-time, adaptive control of robotic orthoses.

A Review on Compliant Joint Mechanisms for Lower Limb Exoskeletons

Lower limb exoskeletons are experiencing a rapid development that may suggest a prompt introduction to the market. These devices have an inherent close interaction with the human body; therefore, it is necessary to ensure user’s safety and comfort. The first exoskeletal designs used to represent the human joints as simple revolute joints. This approximation introduces an axial misalignment issue, which generates uncontrollable internal forces. A mathematical description of the said misalignments is provided to better understand the concept and its consequences. This review will only focus on mechanisms aiming to comply with its user.

Biomechanical Effects of Stiffness in Parallel With the Knee Joint During Walking

The human knee behaves similarly to a linear torsional spring during the stance phase of walking with a stiffness referred to as the knee quasi-stiffness. The spring-like behavior of the knee joint led us to hypothesize that we might partially replace the knee joint contribution during stance by utilizing an external spring acting in parallel with the knee joint. We investigated the validity of this hypothesis using a pair of experimental robotic knee exoskeletons that provided an external stiffness in parallel with the knee joints in the stance phase. We conducted a series of experiments involving walking with the exoskeletons with four levels of stiffness, including 0%, 33%, 66%, and 100% of the estimated human knee quasi-stiffness, and a pair of joint-less replicas. The results indicated that the ankle and hip joints tend to retain relatively invariant moment and angle patterns under the effects of the exoskeleton mass, articulation, and stiffness. The results also showed that the knee joint responds in a way such that the moment and quasi-stiffness of the knee complex (knee joint and exoskeleton) remains mostly invariant. A careful analysis of the knee moment profile indicated that the knee moment could fully adapt to the assistive moment; whereas, the knee quasi-stiffness fully adapts to values of the assistive stiffness only up to ∼80%. Above this value, we found biarticular consequences emerge at the hip joint.

Preliminary investigation of effects of a quasi-passive knee exoskeleton on gait energetics

In this paper, we explain that the human knee behavior in the weight acceptance phase of gait (first ~40% of gait cycle) resembles that of a linear torsional spring. This led us to study the effects of the assistance provided by a pair of quasi-passive knee exoskeletons, which implement springs in parallel with the knee joints in the weight acceptance phase. Using the exoskeletons in a series of experiments on seven participants, we found that the exoskeleton mildly but non-significantly reduces the metabolic power of walking. We also found that the metabolic power of walking is significantly correlated with both the positive rate of moment generation and positive mechanical power of the lower extremity joints. This suggests that augmenting exoskeletons can aim to reduce both the muscle force and work generation to reduce the metabolic cost of walking.

Control strategies for active lower extremity prosthetics and orthotics: a review

: Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user.This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user's sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies.As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os--not as independent devices, but as actors within an ecosystem--is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers.Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use.The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user's neuromusculoskeletal system and are practical for use in locomotive ADL.