Experimental Evaluation of Energy Efficiency for a Soft Wearable Robotic Suit

A State-of-the-Art of Exoskeletons in Line with the WHO's Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle-foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.

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.

Reaction moments matter when designing lower-extremity robots for tripping recovery

Balance recovery after tripping often requires an active adaptation of foot placement. Thus far, few attempts have been made to actively assist forward foot placement for balance recovery employing wearable devices. This study aims to explore the possibilities of active forward foot placement through two paradigms of actuation: assistive moments exerted with the reaction moments either internal or external to the human body, namely 'joint' moments and 'free' moments, respectively. Both paradigms can be applied to manipulate the motion of segments of the body (e.g., the shank or thigh), but joint actuators also exert opposing reaction moments on neighbouring body segments, altering posture and potentially inhibiting tripping recovery. We therefore hypothesised that a free moment paradigm is more effective in assisting balance recovery following tripping. The simulation software SCONE was used to simulate gait and tripping over various ground-fixed obstacles during the early swing phase. To aid forward foot placement, joint moments and free moments were applied either on the thigh to augment hip flexion or on the shank to augment knee extension. Two realizations of joint moments on the hip were simulated, with the reaction moment applied to either the pelvis or the contralateral thigh. The simulation results show that assisting hip flexion with either actuation paradigm on the thigh can result in full recovery of gait with a margin of stability and leg kinematics closely matching the unperturbed case. However, when assisting knee extension with moments on the shank, free moment effectively assist balance but joint moments with the reaction moment on the thigh do not. For joint moments assisting hip flexion, placement of the reaction moment on the contralateral thigh was more effective in achieving the desired limb dynamics than placing the reaction on the pelvis. Poor choice of placement of reaction moments may therefore have detrimental consequences for balance recovery, and removing them entirely (i.e., free moment) could be a more effective and reliable alternative. These results challenge conventional assumptions and may inform the design and development of a new generation of minimalistic wearable devices to promote balance during gait.

Soft Wearable Robots: Development Status and Technical Challenges

In recent years, more and more research has begun to focus on the flexible and lightweight design of wearable robots. During this process, many novel concepts and achievements have been continuously made and shown to the public, while new problems have emerged at the same time, which need to be solved. In this paper, we give an overview of the development status of soft wearable robots for human movement assistance. On the basis of a clear definition, we perform a system classification according to the target assisted joint and attempt to describe the overall prototype design level in related fields. Additionally, it is necessary to sort out the latest research progress of key technologies such as structure, actuation, control and evaluation, thereby analyzing the design ideas and basic characteristics of them. Finally, we discuss the possible application fields, and propose the main challenges of this valuable research direction.

Ergonomics Design and Assistance Strategy of A-Suit

Concerning the biomechanics and energy consumption of the lower limbs, a soft exoskeleton for the powered plantar flexion of the ankle, named A-Suit, was developed to improve walking endurance in the lower limbs and reduce metabolic consumption. The method of ergonomics design was used based on the biological structures of the lower limbs. A profile of auxiliary forces was constructed according to the biological force of the Achilles tendon, and an iterative learning control was applied to shadow this auxiliary profile by iteratively modifying the traction displacements of drive units. During the evaluation of the performance experiments, four subjects wore the A-Suit and walked on a treadmill at different speeds and over different inclines. Average heart rate was taken as the evaluation index of metabolic consumption. When subjects walked at a moderate speed of 1.25 m/s, the average heart rate Hav under the Power-ON condition was 7.25 ± 1.32% (mean ± SEM) and 14.40 ± 2.63% less than the condition of No-suit and Power-OFF. Meanwhile, the additional mass of A-Suit led to a maximum Hav increase of 7.83 ± 1.44%. The overall reduction in Hav with Power-ON over the different inclines was 6.93 ± 1.84% and 13.4 ± 1.93% compared with that of the No-Suit and Power-OFF condition. This analysis offers interesting insights into the viability of using this technology for human augmentation and assistance for medical and other purposes.

Noninvasive Human-Computer Interface Methods and Applications for Robotic Control: Past, Current, and Future

The purpose of this study is to explore the noninvasive human-computer interaction methods that have been widely used in various fields, especially in the field of robot control. To have a deep understanding of the development of the methods, this paper employs “Mapping Knowledge Domains” (MKDs) to find research hotspots in the area to show the future potential development. Through the literature review, this paper found that there was a paradigm shift in the research of noninvasive BCI technologies for robotic control, which has occurred from early 2010 since the rapid development of machine learning, deep learning, and sensory technologies. This study further provides a trend analysis that the combination of data-driven methods with optimized algorithms and human-sensory-driven methods will be the key areas for the future noninvasive method development in robotic control. Based on the above findings, the paper provides a potential developing way of noninvasive HCI methods for related areas including health care, robotic system, and media.

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.

Flexible lower limb exoskeleton systems: A review

BACKGROUND

As an emerging exoskeleton robot technology, flexible lower limb exoskeleton (FLLE) integrates flexible drive and wearable mechanism, effectively solving many problems of traditional rigid lower limb exoskeleton (RLLE) such as higher quality, poorer compliance and relatively poor portability, and has become one of the important development directions in the field of active rehabilitation.

OBJECTIVE

This review focused on the development and innovation process in the field of FLLE in the past decade.

METHOD

Related literature published from 2010 to 2021 were searched in EI, IEEE Xplore, PubMed and Web of Science databases. Seventy target research articles were further screened and sorted through inclusion and exclusion criteria.

RESULTS

FLLE is classified according to different driving modes, and the advantages and disadvantages of passive flexible lower limb exoskeletons and active flexible lower limb exoskeletons are comprehensively summarized.

CONCLUSION

At present, FLLE's research is mainly based on cable drive, bionic pneumatic muscles followed and matured, and new exoskeleton designs based on smart material innovations also trend to diversify. In the future, the development direction of FLLE will be lightweight and drive compliance, and the multi-mode sensory feedback control theory, motion intention recognition theory and human-machine interaction theory will be combined to reduce the metabolic energy consumption of walking.

A Portable Waist-Loaded Soft Exosuit for Hip Flexion Assistance with Running

The soft exosuit is an emerging robotics, which has been proven to considerably reduce the metabolic consumption of human walking and running. However, compared to walking, relatively few soft exosuits have been studied for running. Many soft exosuits used for running are worn on the back and with a heavy weight load, which may cause instability while running and potentially increase metabolic consumption. Therefore, reducing the weight of the whole soft exosuit system as much as possible and keeping the soft exosuit close to the center of gravity, may improve running stability and further reduce metabolic consumption. In this paper, a portable waist-loaded soft exosuit, the weight of which is almost entirely concentrated at the waist, is shown to assist hip flexion during running, and justifies choosing to assist hip flexion while running. As indicated by the experiments of motion flexibility, wearing the waist-loaded soft exosuit can assist in performing many common and complex motions. The metabolic consumption experiments proved that the portable waist-loaded soft exosuit reduces the metabolic consumption rate of wearers when jogging on the treadmill at 6 km per hour by 7.79% compared with locomotion without the exosuit. Additionally, at the running speed of 8 km per hour, using the waist-loaded soft exosuit can reduce metabolic consumption rate by 4.74%. Similarly, at the running speed of 10 km per hour, it also can be reduced by 6.12%. It is demonstrated that assisting hip flexion for running is also a reasonable method, and wearing the waist-loaded soft exosuit can keep human motion flexibility and reduce metabolic consumption.

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.

MotorSkins-a bio-inspired design approach towards an interactive soft-robotic exosuit

The work presents a bio-inspired design approach to a soft-robotic solution for assisting the knee-bending in users with reduced mobility in lower limbs. Exosuits and fluid-driven actuators are fabric-based devices that are gaining increasing relevance as alternatives assistive technologies that can provide simpler, more flexible solutions in comparison with the rigid exoskeletons. These devices, however, commonly require an external energy supply or a pressurized-fluid reservoir, which considerably constrain the autonomy of such solutions. In this work, we introduce an event-based energy cycle (EBEC) design concept, that can harvest, store, and release the required energy for assisting the knee-bending, in a synchronised interaction with the user and the environment, thus eliminating any need for external energy or control input. Ice-plant hydro-actuation system served as the source of inspiration to address the specific requirements of such interactive exosuit through a fluid-driven material system. Based on the EBEC design concepts and the abstracted bio-inspired principles, a series of (material and process driven) design experimentations helped to address the challenges of realising various functionalities of the harvest, storage, actuation and control instances within a closed hydraulic circuit. Sealing and defining various areas of water-tight seam made out of thermoplastic elastomers provided the base material system to program various chambers, channels, flow-check valves etc of such EBEC system. The resulting fluid-driven EBEC-skin served as a proof of concept for such active exosuit, that brings these functionalities into an integrated 'sense-acting' material system, realising an auto-synchronised energy and information cycles. The proposed design concept can serve as a model for development of similar fluid-driven EBEC soft-machines for further applications. On the more general scheme, the work presents an interdisciplinary design-science approach to bio-inspiration and showcases how biological material solutions can be looked at from a design/designer perspective to bridge the bottom-up and top-down approach to bio-inspiration.

A Time Division Multiplexing Inspired Lightweight Soft Exoskeleton for Hip and Ankle Joint Assistance

Exoskeleton robots are frequently applied to augment or assist the user's natural motion. Generally, each assisted joint corresponds to at least one specific motor to ensure the independence of movement between joints. This means that as there are more joints to be assisted, more motors are required, resulting in increasing robot weight, decreasing motor utilization, and weakening exoskeleton robot assistance efficiency. To solve this problem, the design and control of a lightweight soft exoskeleton that assists hip-plantar flexion of both legs in different phases during a gait cycle with only one motor is presented in this paper. Inspired by time-division multiplexing and the symmetry of walking motion, an actuation scheme that uses different time-periods of the same motor to transfer different forces to different joints is formulated. An automatic winding device is designed to dynamically change the loading path of the assistive force at different phases of the gait cycle. The system is designed to assist hip flexion and plantar flexion of both legs with only one motor, since there is no overlap between the hip flexion movement and the toe-offs movement of the separate legs during walking. The weight of the whole system is only 2.24 kg. PD iterative control is accomplished by an algorithm that utilizes IMUs attached on the thigh recognizing the maximum hip extension angle to characterize toe-offs indirectly, and two load cells to monitor the cable tension. In the study of six subjects, muscle fatigue of the rectus femoris, vastus lateralis, gastrocnemius and soleus decreased by an average of 14.69%, 6.66%, 17.71%, and 8.15%, respectively, compared to scenarios without an exoskeleton.

A Soft Robotic Intervention for Gait Enhancement in Older Adults

Falls continue to be a major safety and health concern for older adults. Researchers reported that increased gait variability was associated with increased fall risks. In the present study, we proposed a novel wearable soft robotic intervention and examined its effects on improving gait variability in older adults. The robotic system used customized pneumatic artificial muscles (PAMs) to provide assistive torque for ankle dorsiflexion during walking. Twelve older adults with low fall risks and twelve with medium-high fall risks participated in an experiment. The participants were asked to walk on a treadmill under no soft robotic intervention, inactive soft robotic intervention, and active soft robotic intervention, and their gait variability during treadmill walking was measured. The results showed that the proposed soft robotic intervention could reduce step length variability for elderly people with medium-high fall risks. These findings provide supporting evidence that the proposed soft robotic intervention could potentially serve as an effective solution to fall prevention for older adults.

A Novel Lightweight Wearable Soft Exosuit for Reducing the Metabolic Rate and Muscle Fatigue

Wearable robotic devices have been proved to considerably reduce the energy expenditure of human walking. It is not only suitable for healthy people, but also for some patients who require rehabilitation exercises. However, in many cases, the weight of soft exosuits are relatively large, which makes it difficult for the assistant effect of the system to offset the metabolic consumption caused by the extra weight, and the heavy weight will make people uncomfortable. Therefore, reducing the weight of the whole system as much as possible and keeping the soft exosuit output power unchanged, may improve the comfort of users and further reduce the metabolic consumption. In this paper, we show that a novel lightweight soft exosuit which is currently the lightest among all known powered exoskeletons, which assists hip flexion. Indicated from the result of experiment, the novel lightweight soft exosuit reduces the metabolic consumption rate of wearers when walking on the treadmill at 5 km per hour by 11.52% compared with locomotion without the exosuit. Additionally, it can reduce more metabolic consumption than the hip extension assisted (HEA) and hip flexion assisted (HFA) soft exosuit which our team designed previously, which has a large weight. The muscle fatigue experiments show that using the lightweight soft exosuit can also reduce muscle fatigue by about 10.7%, 40.5% and 5.9% for rectus femoris, vastus lateralis and gastrocnemius respectively compared with locomotion without the exosuit. It is demonstrated that decreasing the weight of soft exosuit while maintaining the output almost unchanged can further reduce metabolic consumption and muscle fatigue, and appropriately improve the users’ comfort.

Quasi-Passive Resistive Exosuit for Space Activities: Proof of Concept

The limits of space travel are continuously evolving, and this creates increasingly extreme challenges for the crew’s health that must be addressed by the scientific community. Long-term exposure to micro-gravity, during orbital flights, contributes to muscle strength degradation and increases bone density loss. In recent years, several exercise devices have been developed to counteract the negative health effects of zero-gravity on astronauts. However, the relatively large size of these devices, the need for a dedicated space and the exercise time-frame for each astronaut, does not make these devices the best choice for future long range exploration missions. This paper presents a quasi-passive exosuit to provide muscle training using a small, portable, proprioceptive device. The exosuit promotes continuous exercise, by resisting the user’s motion, during routine all-day activity. This study assesses the effectiveness of the resistive exosuit by evaluating its effects on muscular endurance during a terrestrial walking task. The experimental assessment on biceps femoris and vastus lateralis, shows a mean increase in muscular activation of about 97.8% during five repetitions of 3 min walking task at 3 km/h. The power frequency analysis shows an increase in muscular fatigue with a reduction of EMG median frequency of about 15.4% for the studied muscles.

Systematic framework for performance evaluation of exoskeleton actuators

Wearable devices, such as exoskeletons, are becoming increasingly common and are being used mainly for improving motility and daily life autonomy, rehabilitation purposes, and as industrial aids. There are many variables that must be optimized to create an efficient, smoothly operating device. The selection of a suitable actuator is one of these variables, and the actuators are usually sized after studying the kinematic and dynamic characteristics of the target task, combining information from motion tracking, inverse dynamics, and force plates. While this may be a good method for approximate sizing of actuators, a more detailed approach is necessary to fully understand actuator performance, control algorithms or sensing strategies, and their impact on weight, dynamic performance, energy consumption, complexity, and cost. This work describes a learning-based evaluation method to provide this more detailed analysis of an actuation system for our XoTrunk exoskeleton. The study includes: (a) a real-world experimental setup to gather kinematics and dynamics data; (b) simulation of the actuation system focusing on motor performance and control strategy; (c) experimental validation of the simulation; and (d) testing in real scenarios. This study creates a systematic framework to analyze actuator performance and control algorithms to improve operation in the real scenario by replicating the kinematics and dynamics of the human-robot interaction. Implementation of this approach shows substantial improvement in the task-related performance when applied on a back-support exoskeleton during a walking task.

Iterative Learning Control for a Soft Exoskeleton with Hip and Knee Joint Assistance

Walking on different terrains leads to different biomechanics, which motivates the development of exoskeletons for assisting on walking according to the type of a terrain. The design of a lightweight soft exoskeleton that simultaneously assists multiple joints in the lower limb is presented in this paper. It is used to assist both hip and knee joints in a single system, the assistance force is directly applied to the hip joint flexion and the knee joint extension, while indirectly to the hip extension also. Based on the biological torque of human walking at three different slopes, a novel strategy is developed to improve the performance of assistance. A parameter optimal iterative learning control (POILC) method is introduced to reduce the error generated due to the difference between the wearing position and the biological features of the different wearers. In order to obtain the metabolic rate, three subjects walked on a treadmill, for 10 min on each terrain, at a speed of 4 km/h under both conditions of wearing and not wearing the soft exoskeleton. Results showed that the metabolic rate was decreased with the increasing slope of the terrain. The reductions in the net metabolic rate in the experiments on the downhill, flat ground, and uphill were, respectively, 9.86%, 12.48%, and 22.08% compared to the condition of not wearing the soft exoskeleton, where their corresponding absolute values were 0.28 W/kg, 0.72 W/kg, and 1.60 W/kg.

Pneumatic Quasi-Passive Actuation for Soft Assistive Lower Limbs Exoskeleton

There is a growing international interest in developing soft wearable robotic devices to improve mobility and daily life autonomy as well as for rehabilitation purposes. Usability, comfort and acceptance of such devices will affect their uptakes in mainstream daily life. The XoSoft EU project developed a modular soft lower-limb exoskeleton to assist people with low mobility impairments. This paper presents the bio-inspired design of a soft, modular exoskeleton for lower limb assistance based on pneumatic quasi-passive actuation. The design of a modular reconfigurable prototype and its performance are presented. This actuation centers on an active mechanical element to modulate the assistance generated by a traditional passive component, in this case an elastic belt. This study assesses the feasibility of this type of assistive device by evaluating the energetic outcomes on a healthy subject during a walking task. Human-exoskeleton interaction in relation to task-based biological power assistance and kinematics variations of the gait are evaluated. The resultant assistance, in terms of overall power ratio (Λ) between the exoskeleton and the assisted joint, was 26.6% for hip actuation, 9.3% for the knee and 12.6% for the ankle. The released maximum power supplied on each articulation, was 113.6% for the hip, 93.2% for the knee, and 150.8% for the ankle.

A real-time walking pattern recognition method for soft knee power assist wear

Real-time recognition of walking-related activities is an important function that lower extremity assistive devices should possess. This article presents a real-time walking pattern recognition method for soft knee power assist wear. The recognition method employs the rotation angles of thighs and shanks as well as the knee joint angles collected by the inertial measurement units as input signals and adopts the rule-based classification algorithm to achieve the real-time recognition of three most common walking patterns, that is, level-ground walking, stair ascent, and stair descent. To evaluate the recognition performance, 18 subjects are recruited in the experiments. During the experiments, subjects wear the knee power assist wear and carry out a series of walking activities in an out-of-lab scenario. The results show that the average recognition accuracy of three walking patterns reaches 98.2%, and the average recognition delay of all transitions is slightly less than one step.

Biarticular muscles in light of template models, experiments and robotics: a review

Leg morphology is an important outcome of evolution. A remarkable morphological leg feature is the existence of biarticular muscles that span adjacent joints. Diverse studies from different fields of research suggest a less coherent understanding of the muscles' functionality in cyclic, sagittal plane locomotion. We structured this review of biarticular muscle function by reflecting biomechanical template models, human experiments and robotic system designs. Within these approaches, we surveyed the contribution of biarticular muscles to the locomotor subfunctions (stance, balance and swing). While mono- and biarticular muscles do not show physiological differences, the reviewed studies provide evidence for complementary and locomotor subfunction-specific contributions of mono- and biarticular muscles. In stance, biarticular muscles coordinate joint movements, improve economy (e.g. by transferring energy) and secure the zig-zag configuration of the leg against joint overextension. These commonly known functions are extended by an explicit role of biarticular muscles in controlling the angular momentum for balance and swing. Human-like leg arrangement and intrinsic (compliant) properties of biarticular structures improve the controllability and energy efficiency of legged robots and assistive devices. Future interdisciplinary research on biarticular muscles should address their role for sensing and control as well as non-cyclic and/or non-sagittal motions, and non-static moment arms.

What Do Older Adults and Clinicians Think About Traditional Mobility Aids and Exoskeleton Technology?

Mobility impairments can prevent older adults from performing their daily activities, which highly impacts quality of life. Powered exoskeletons, which are wearable robotic devices, can assist older adults by providing additional support to compensate for age-related decline in muscle strength. To date, little is known about the opinions and needs of older adults regarding exoskeletons, as current research primarily focuses on the technical development of exoskeleton devices and on groups with more severe mobility impairments such as people with spinal cord injuries. Therefore, the aim of this article is to inform the design of exoskeletons for older adults from a person-centered perspective. Interviews were conducted with seven older adults and six clinicians. Results indicated that exoskeletons can be a valuable addition to existing mobility devices to support older adults during walking and other actions necessary to perform their daily activities. Although reactions towards the concept of exoskeleton technology were positive, older adults did not currently perceive the need for an exoskeleton device. Exoskeletons for older adults should be easy to use; preferably, users should be able to put the device on and take it off independently. Moreover, the appearance of the exoskeleton should be as inconspicuous as possible, as most older adults do not like to advertise their need for assistive devices. At this point in time, the willingness to use exoskeleton technology will depend on personal needs and preferences.

Long-Term Effects of a Soft Robotic Suit on Gait Characteristics in Healthy Elderly Persons

As a walking assistive device for elderly persons, one of the major aims should be to improve and rehabilitate gait characteristics after long-term repeated use of the device. However, most of the existing research on walking assistive devices only emphasize their immediate effects, and there is limited research indicating the long-term effects. To address this gap, this paper experimentally validates the effects of our soft wearable robotic suit on gait characteristics of elderly persons after repeated use of the device for six weeks. Experimental results on four elderly subjects (age = 74.8 ± 5.0 year) show that, after six weeks of gait rehabilitation training by the robotic suit, the gait characteristics of the subjects were improved, leading to an increased walk ratio with an average of 9.8% compared with the initial state. The results of this research will benefit the potential use of the robotic suit in gait training and rehabilitation for elderly persons and also will be useful to the establishment of practical guidelines that maximize the training and rehabilitation effectiveness of the robotic suit.

Design and Evaluation of a Soft Assistive Lower Limb Exoskeleton

Wearable devices are fast evolving to address mobility and autonomy needs of elderly people who would benefit from physical assistance. Recent developments in soft robotics provide important opportunities to develop soft exoskeletons (also called exosuits) to enable both physical assistance and improved usability and acceptance for users. The XoSoft EU project has developed a modular soft lower limb exoskeleton to assist people with low mobility impairments. In this paper, we present the design of a soft modular lower limb exoskeleton to improve person’s mobility, contributing to independence and enhancing quality of life. The novelty of this work is the integration of quasi-passive elements in a soft exoskeleton. The exoskeleton provides mechanical assistance for subjects with low mobility impairments reducing energy requirements between 10% and 20%. Investigation of different control strategies based on gait segmentation and actuation elements is presented. A first hip–knee unilateral prototype is described, developed, and its performance assessed on a post-stroke patient for straight walking. The study presents an analysis of the human–exoskeleton energy patterns by way of the task-based biological power generation. The resultant assistance, in terms of power, was 10.9% ± 2.2% for hip actuation and 9.3% ± 3.5% for knee actuation. The control strategy improved the gait and postural patterns by increasing joint angles and foot clearance at specific phases of the walking cycle.

A wearable hip-assist robot reduces the cardiopulmonary metabolic energy expenditure during stair ascent in elderly adults: a pilot cross-sectional study

Background

Stair ascent is one of the most important and challenging activities of daily living to maintain mobility and independence in elderly adults. Recently, various types of wearable walking assist robots have been developed to improve gait function and metabolic efficiency for elderly adults. Several studies have shown that walking assist robots can improve cardiopulmonary metabolic efficiency during level walking in elderly. However, there is limited evidence demonstrating the effect of walking assist robots on cardiopulmonary metabolic efficiency during stair walking in elderly adults. Therefore, the aim of this study was to investigate the assistance effect of a newly developed wearable hip assist robot on cardiopulmonary metabolic efficiency during stair ascent in elderly adults.

Methods

Fifteen healthy elderly adults participated. The Gait Enhancing Mechatronic System (GEMS), developed by Samsung Electronics Co., Ltd., Korea, was used in the present study. The metabolic energy expenditure was measured using a K4b² while participants performed randomly assigned two conditions consecutively: free ascending stairs without the GEMS or robot-assisted ascending stair with the GEMS.

Results

There were significant differences in the oxygen consumption per unit mass (ml/min/kg), metabolic power per unit mass (W/kg) and metabolic equivalents (METs) values between the GEMS and NoGEMS conditions. A statistically significant difference was found between the two conditions in net oxygen consumption and net metabolic power, with a reduction of 8.59% and 10.16% respectively in GEMS condition (p < 0.05). The gross oxygen consumption while climbing stairs under the GEMS and NoGEMS conditions was equivalent to 6.38 METs and 6.85 METs, respectively.

Conclusion

This study demonstrated that the GEMS was helpful for reducing cardiopulmonary metabolic energy expenditure during stair climbing in elderly adults. The use of the GEMS allows elderly adults to climb stairs with less metabolic energy, therefore, they may experience more endurance in stair climbing while using the GEMS.

Trial registration

NCT03389165, Registered 26 December 2017 - retrospectively registered

Influence of a Soft Robotic Suit on Metabolic Cost in Long-Distance Level and Inclined Walking

Metabolic cost during walking is positively linked to exercise intensity. For a walking assistive device, one of the major aims should be the maximization of wearers' metabolic benefits for different walking situations. Toward this goal, this paper experimentally evaluates the influence of an authors' soft robotic suit, which has been developed to assist hip flexion for energy-efficient walking of elderly persons in daily life activities, on metabolic cost reduction in the long-distance level and inclined walking. Experiment results show that, for a 79-year-old healthy male subject, the robotic suit significantly reduced metabolic cost in the condition of the robotic suit worn and powered on compared with the condition of worn but powered off.

A Soft Wearable Robotic Suit for Ankle and Hip Assistance: a Preliminary Study

As a walking assistive device, one of major goals should be reduce wearer's metabolic cost as much as possible. Toward this goal, this paper presents the preliminary study on a new soft wearable robotic suit for ankle and hip assistance for daily life activities. The presented robotic suit is lightweight, and it almost does not restrict the lower limb motion range. In addition, its structure is simple, and thus wearers can easily take the device on and off by themselves. Experimental results on two young subjects show that the robotic suit reduced metabolic cost with averaged reductions of 10.2 % and 6.8 %, respectively, by not drastically disrupting the normal walking biomechanics of the subjects.

The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers

Muscle weakness-which can result from neurological injuries, genetic disorders, or typical aging-can affect a person's mobility and quality of life. For many people with muscle weakness, assistive devices provide the means to regain mobility and independence. These devices range from well-established technology, such as wheelchairs, to newer technologies, such as exoskeletons and exosuits. For assistive devices to be used in everyday life, they must provide assistance across activities of daily living (ADLs) in an unobtrusive manner. This article introduces the Myosuit, a soft, wearable device designed to provide continuous assistance at the hip and knee joint when working with and against gravity in ADLs. This robotic device combines active and passive elements with a closed-loop force controller designed to behave like an external muscle (exomuscle) and deliver gravity compensation to the user. At 4.1 kg (4.6 kg with batteries), the Myosuit is one of the lightest untethered devices capable of delivering gravity support to the user's knee and hip joints. This article presents the design and control principles of the Myosuit. It describes the textile interface, tendon actuators, and a bi-articular, synergy-based approach for continuous assistance. The assistive controller, based on bi-articular force assistance, was tested with a single subject who performed sitting transfers, one of the most gravity-intensive ADLs. The results show that the control concept can successfully identify changes in the posture and assist hip and knee extension with up to 26% of the natural knee moment and up to 35% of the knee power. We conclude that the Myosuit's novel approach to assistance using a bi-articular architecture, in combination with the posture-based force controller, can effectively assist its users in gravity-intensive ADLs, such as sitting transfers.