Design and functional evaluation of a quasi-passive compliant stance control knee-ankle-foot orthosis

Advances in active knee brace technology: A review of gait analysis, actuation, and control applications

This article discusses the significance of knee joint mechanics and the consequences of knee dysfunctions on an individual's quality of life. The utilization of active knee braces, which incorporate concepts of mechatronics systems, is investigated here as a potential treatment option. The complexity of the construction of the knee joint, which has six degrees of motion and is more prone to injury since it bears weight, is emphasized in this article. By wearing braces and using other support devices, one's knee can increase stability and mobility. In addition, the paper discusses various technologies that can be used to measure the knee adduction moment and supply spatial information on gait. Actuators for active knee braces must be compact, lightweight, and capable of producing a significant amount of torque; as a result, electric, hydraulic, and pneumatic actuators are the most common types. Creating control mechanisms, such as position control techniques and force/torque control approaches, is essential to knee exoskeleton research and development. These methods might make knee joint rehabilitation and assistive technology safer and more effective.

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.

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.

Human Musculoskeletal and Energetic Adaptations to Unilateral Robotic Knee Gait Assistance

OBJECTIVE

This paper aims to analyse the human musculoskeletal and energetic adaptation mechanisms when physically interacting with a unilateral knee orthosis during treadmill walking.

METHODS

Test subjects participated in two walking trials, whereby the orthosis was controlled to deliver five predefined torque profiles of different duration (as % of a gait cycle). The adaptations to assistive torques of different duration were analysed in terms of gait parameters, metabolic effort, and muscle activity.

RESULTS

Orthotic assistances kinematic effects remain local to the assisted leg and joint, unlike the muscles spanning the knee joint, which engage in a balancing-out action to retain stability. Duration of assistive torque significantly affects only the timing of the knee joints peak flexion angle in the stance phase, while the observed joint kinematics and muscle activity demonstrate different recovery times upon changing robotic support (washout effects).

CONCLUSION

Human body adaptations to external robotic knee joint assistance during walking take place on multiple levels and to a different extent in a joint effort to keep the gait stable.

SIGNIFICANCE

This paper provides important insights into the human bodys multiple adaptation mechanisms in the presence of external robotic assistance.

Proposal of Motion Judgment Algorithm Based on Joint Angle of Variable Elastic Assist Suit with High Back Drivability

In recent years, the burden per worker has increased due to a decrease in the working population. Wearable assist suits have been developed as one of the methods for solving the problem. To extend the assist suit to practical situations, it is necessary to provide a motion judgment interface for judging the motion of a wearer. Therefore, in our study, a motion judgment algorithm is proposed for assist suits, based on variable viscoelasticity. The proposed algorithm judges sitting, standing-up, stance, sitting-down, and gait using only the joint angle information of the suit and verification is performed using human joint angles obtained by motion capture. Thus, the motion judgment rate is 90% or more for sitting, standing-up, stance, and sitting-down, and 80% or more for gait, confirming the usefulness of motion judgment. Additionally, based on these results, further verification is performed on an actual machine. As a result, in a series of motions starting from the sitting to the standing-up, the stance, and the gait, the motion judgement is successful five times from the sitting to the standing-up, the stance, and once in gait. In a series of motions from sitting to standing-up, the stance, and sitting-down, the motion judgment is successful five times during sitting; five times during sitting, stance, and sitting-down; and three times during standing-up. In this way, it is confirmed that the proposed method can judge the motion only by angle information, although there is a problem in a success rate depending on the motion.

Microprocessor Controlled Knee Ankle Foot Orthosis (KAFO) vs Stance Control vs Locked KAFO: A Randomized Controlled Trial

OBJECTIVE

To evaluate the potential of a microprocessor swing and stance controlled knee-ankle-foot orthosis (MPO) to improve balance, functional mobility, and quality of life in individuals with lower-extremity impairments as compared to a stance-control-orthosis (SCO) and conventional knee-ankle-foot orthosis (KAFO) over a use-period of a month.

DESIGN

Randomized crossover study.

SETTING

Ambulatory research laboratory and home and community for community-dwelling adults.

PARTICIPANTS

Persons (N=18) who actively used a unilateral KAFO or SCO for impairments due to neurologic or neuromuscular disease, orthopedic disease, or trauma.

INTERVENTION

Participants were trained to acclimate and use SCO and MPO.

MAIN OUTCOME MEASURES

The 6-minute walk test (6MWT), 10-m walk test, Berg Balance Scale (BBS), functional gait assessment (FGA), hill assessment index, stair assessment index (SAI), Five Times Sit to Stand Test, crosswalk test, Modified Falls Efficacy Scale, Orthotic and Prosthetic User's Survey (OPUS), and World Health Organization Quality of Life (WHQOL)-BREF Scale.

RESULTS

Significant changes were observed in participants' self-selected gait speed (P=.023), BBS (P=.01), FGA (P=.002), and SAI (P<.001) between baseline and post-MPO assessment. Similar significant differences were seen when comparing post-MPO with post-SCO data. During the 6MWT, persons using the MPO walked significantly longer (P=.013) than when using their baseline device. Participants reported higher quality of life scores in the OPUS (P=.02) and physical health domain of the WHOQOL-BREF (P=.037) after using the MPO. Participants reported fewer falls when wearing the MPO (5) versus an SCO (38) or locked KAFO (15).

CONCLUSIONS

The MPO may contribute to improved quality of life and health status of persons with lower-extremity impairments by providing the ability to have better walking speed, endurance, and functional balance.

Design and Validation of a Partial-Assist Knee Orthosis with Compact, Backdrivable Actuation

This paper presents the mechatronic design and initial validation of a partial-assist knee orthosis for individuals with musculoskeletal disorders, e.g., knee osteoarthritis and lower back pain. This orthosis utilizes a quasi-direct drive actuator with a low-ratio transmission (7:1) to greatly reduce the reflected inertia for high backdrivability. To provide meaningful assistance, a custom Brushless DC (BLDC) motor is designed with encapsulated windings to improve the motor's thermal environment and thus its continuous torque output. The 2.69 kg orthosis is constructed from all custom-made components with a high package factor for lighter weight and a more compact size. The combination of compactness, backdrivability, and torque output enables the orthosis to provide partial assistance without obstructing the natural movement of the user. Several benchtop tests verify the actuator's capabilities, and a human subject experiment demonstrates reduced quadriceps muscle activation when assisted during a repetitive lifting and lowering task.

Efficacy of a knee orthosis that uses an elastic element

In this study, we evaluate the support effect of a knee orthosis that uses the elasticity element from the perspective of human motor control. The speeds during level-ground walking and the angles during slope walking were varied during the experiments. It was observed that the support effect was remarkable at 4 km/h during the level-ground walking. In particular, at 12° during slope walking, the strength of the stretching muscle decreased for the knee joint in the stance phase and the hip joint in the swing phase. The results show that this orthosis exhibits a different effect from the conventional type adjustment to damping in the swing phase.

Design and Validation of a Torque Dense, Highly Backdrivable Powered Knee-Ankle Orthosis

This paper presents the mechatronic design and experimental validation of a novel powered knee-ankle orthosis for testing torque-driven rehabilitation control strategies. The modular actuator of the orthosis is designed with a torque dense motor and a custom low-ratio transmission (24:1) to provide mechanical transparency to the user, allowing them to actively contribute to their joint kinematics during gait training. The 4.88 kg orthosis utilizes frameless components and light materials, such as aluminum alloy and carbon fiber, to reduce its mass. A human subject experiment demonstrates accurate torque control with high output torque during stance and low backdrive torque during swing at fast walking speeds. This work shows that backdrivability, precise torque control, high torque output, and light weight can be achieved in a powered orthosis without the high cost and complexity of variable transmissions, clutches, and/or series elastic components.

A wearable exoskeleton suit for motion assistance to paralysed patients

Background/Objective

The number of patients paralysed due to stroke, spinal cord injury, or other related diseases is increasing. In order to improve the physical and mental health of these patients, robotic devices that can help them to regain the mobility to stand and walk are highly desirable. The aim of this study is to develop a wearable exoskeleton suit to help paralysed patients regain the ability to stand up/sit down (STS) and walk.

Methods

A lower extremity exoskeleton named CUHK-EXO was developed with considerations of ergonomics, user-friendly interface, safety, and comfort. The mechanical structure, human-machine interface, reference trajectories of the exoskeleton hip and knee joints, and control architecture of CUHK-EXO were designed. Clinical trials with a paralysed patient were performed to validate the effectiveness of the whole system design.

Results

With the assistance provided by CUHK-EXO, the paralysed patient was able to STS and walk. As designed, the actual joint angles of the exoskeleton well followed the designed reference trajectories, and assistive torques generated from the exoskeleton actuators were able to support the patient’s STS and walking motions.

Conclusion

The whole system design of CUHK-EXO is effective and can be optimised for clinical application. The exoskeleton can provide proper assistance in enabling paralysed patients to STS and walk.

Evaluation of a variable resistance orthotic knee joint

Knee-ankle-foot orthoses (KAFOs) are full leg braces for individuals with knee extensor weakness, designed to support the person during weight bearing activities by preventing knee flexion. KAFOs typically result in an unnatural gait pattern and are primarily used for level ground walking. A novel variable resistance orthotic knee joint, the Ottawalk-Variable Speed (OWVS), was designed to address these limitations. This paper presents a pilot test to evaluate the OWVS functional performance during walking and stair descent. A carbon-fiber KAFO was adjusted for an able-bodied participant by a certified orthotist, with a standard orthotic single axis knee joint on the medial side and the OWVS on the lateral side. The participant performed level ground walking (stance-control, open, closed) and stair descent tests. The operator was able to manually switch between closed mode in terminal swing to open mode in terminal stance for stance-control walking. Knee angle kinematics were similar between open and stance control modes. For stair descent, resistance settings supported the participant as they lowered their body to the next step, but with smaller range of motion compared to the open setting. The Ottawalk-Variable Speed design successfully controls knee flexion during stance and stair descent, with one lateral control joint. Mode switching was fast and appropriate. This microprocessor controlled SCKAFO has a low profile that fits beneath clothing and the variable resistance design will allow people to negotiate different terrain types.

Unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton

This article presents the design and experimental testing of a unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton. The proposed actuator is designed for mimicking the high-efficiency passive behavior of biological knee and providing actively assistance in locomotion. The adjustable passive compliance of exoskeletal knee is achieved through a variable ratio lever mechanism with linear elastic element. A compact customized electrohydraulic system is also designed to accommodate application demands. Preliminary experimental results show the prototype has good performances in terms of stiffness regulation and joint torque control. The actuator is also implemented in an exoskeleton knee joint, resulting in anticipant human-like passive compliance behavior.

Therapeutic Experience on Stance Control Knee-Ankle-Foot Orthosis With Electromagnetically Controlled Knee Joint System in Poliomyelitis

A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern.

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.

State of the art review of knee-ankle-foot orthoses

Knee-ankle-foot orthoses (KAFOs) are used to assist in ambulation. The purpose of this paper is to review existing KAFO designs which can be grouped into passive KAFOs, stance control (SC) KAFOs, and dynamic KAFOs. The conventional passive KAFOs do not provide any active control for knee motions. SCKAFOs lock the knee joint during the stance phase and allow free rotations during the swing phase. Some SCKAFOs switch between the stance and swing phases using body posture, while others use some kind of a control system to perform this switch. Finally, dynamic KAFOs control the knee joint during both stance and swing phases. Four dynamic systems are identified in the literature that use pneumatics, linear springs, hydraulics, and torsional rods made of superelastic alloys to control the knee joint during the gait cycle. However, only the two systems that use linear springs and torsional rods can reproduce the normal knee stiffness pattern which has two distinct characteristics: a soft stiffness during the swing phase and a hard stiffness during the stance phase. This review indicates that there is a need to conduct research regarding new KAFO designs that duplicate normal knee function during the whole gait cycle.

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.