Physiological and kinematic effects of a soft exosuit on arm movements

Evaluation of a passive wearable arm ExoNET

Wearable ExoNETs offer a novel, wearable solution to support and facilitate upper extremity gravity compensation in healthy, unimpaired individuals. In this study, we investigated the safety and feasibility of gravity compensating ExoNETs on 10 healthy, unimpaired individuals across a series of tasks, including activities of daily living and resistance exercises. The direct muscle activity and kinematic effects of gravity compensation were compared to a sham control and no device control. Mixed effects analysis revealed significant reductions in muscle activity at the biceps, triceps and medial deltoids with effect sizes of -3.6%, -4.5%, and -7.2% rmsMVC, respectively, during gravity support. There were no significant changes in movement kinematics as evidenced by minimal change in coverage metrics at the wrist. These findings reveal the potential for the ExoNET to serve as an alternative to existing bulky and encumbering devices in post-stroke rehabilitation settings and pave the way for future clinical trials.

Soft Robotics to Enhance Upper Limb Endurance in Individuals with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system and can result in various symptoms, including muscle weakness, spasticity, and fatigue, ultimately leading to the deterioration of the musculoskeletal system. However, in recent years, exosuits have emerged as a game-changing solution to assist individuals with MS during their daily activities. These lightweight and affordable wearable robotic devices have gained immense popularity. In our study, we assessed the performance of an elbow exosuit on eight individuals with MS using high-density electromyography to measure biceps muscle activity. The results demonstrated that our prototype significantly reduced muscle effort during both dynamic and isometric tasks while increasing the elbow range of motion. In addition, the exosuit effectively delayed the onset of muscle fatigue, enhancing endurance for people with MS and enabling them to perform heavy duty tasks for a longer period.

Muscle fatigue during assisted violin performance

Muscle fatigue is a primary risk factor in developing musculoskeletal disorders, which affect up to 93% musicians, especially violinists. Devices providing dynamic assistive support (DAS) to the violin-holding arm can lessen fatigue. The objective was to assess DAS effects on electromyography median frequency and joint kinematics during a fatiguing violin-playing task. Fifteen university-level and professional violinists were equipped with electromyography sensors and reflective markers to record upper-body muscle activity and kinematics. They played G scales with and without DAS until exhaustion. Paired t-tests assessed DAS effects on delta (final-initial) electromyography median frequencies and joint kinematics. DAS prevented the median frequency decrease of left supraspinatus, superior trapezius, and right medial deltoid, and increases in trunk rotation, left-wrist abduction, and right arm-elevation plane. DAS effects on kinematics were marginal due to retention of musical performance despite fatigue. However, DAS reduced fatigue of several muscles, which is promising for injury prevention.Practitioner summary: Violinists are greatly affected by musculoskeletal disorders. Effects of a mobility assistive device on muscle fatigue during violin playing was investigated. The assistive technology slowed down the development of fatigue for three neck/shoulder muscles, making assisted musical performance a promising avenue to prevent violinists' injuries.

Three-dimensional printed exoskeletons and orthoses for the upper limb-A systematic review

This systematic review aims to assess and summarize the current landscape in exoskeletons and orthotic solutions developed for upper limb medical assistance, which are partly or fully produced using 3-dimensional printing technologies and contain at least the elbow or the shoulder joints. The initial search was conducted on Web of Science, PubMed, and IEEEXplore, resulting in 92 papers, which were reduced to 72 after removal of duplicates. From the application of the inclusion and exclusion criteria and selection questionnaire, 33 papers were included in the review, being divided according to the analyzed joints. The analysis of the selected papers allowed for the identification of different solutions that vary in terms of their target application, actuation type, 3-dimensional printing techniques, and material selection, among others. The results show that there has been far more research on the elbow joint than on the shoulder joint, which can be explained by the relative complexity of the latter. Moreover, the findings of this study also indicate that there is still a gap between the research conducted on these devices and their practical use in real-world conditions. Based on current trends, it is anticipated that the future of 3-dimensional printed exoskeletons will revolve around the use of flexible and high-performance materials, coupled with actuated devices. These advances have the potential to replace the conventional fabrication methods of exoskeletons with technologies based on additive manufacturing.

Reconfigurable Soft Pneumatic Actuators Using Extensible Fabric-Based Skins

The development of the field of soft robotics has led to the exploration of novel techniques to manufacture soft actuators, which provide distinct advantages for wearable assistive robotics. One subset of these soft pneumatic actuators is conventionally developed from silicone, fabrics, and thermoplastic polyurethane (TPU). Each of these materials in isolation possesses limitations of low-stress capacity, low-design complexity, and high-input pressure requirements, respectively. Combining these materials can overcome some limitations and maintain their desirable properties. In this article, we explore one such composite design scheme using a combination of silicone polymer-based bladder and reconfigurable fabric skin made from an anisotropic extensible fabric. The silicone polymer bladder acts as the hermetic seal, while this skin acts as the constraint. Bending and torsional actuators were designed utilizing the anisotropy of these fabrics. The torsional actuator designs can achieve over 540° of twist, significantly larger than previously reported in the literature, owing to the lower mechanical impedance of the extensible fabrics. Actuators with 360° of bending were also fabricated using this method. In addition, the lack of TPU-backed or inextensible fabrics reduces the actuator's stiffness, leading to lower actuation pressures. Skin-based designs also confer the advantage of modularity, reconfigurability, and the ability to achieve complex motions by tuning the properties of the bladder and the skin. For applications with high-force requirements, such as wearable exoskeletons, we demonstrate the utility of multilayer design schemes. A multilayer bending actuator generated 190 N of force at 100 kPa and was shown to be a candidate for wearable assistive devices. In addition, torsional designs were shown to have utility in practical scenarios such as screwing on a bottle cap and turning knobs. Thus, we present a novel fabric-skin-based design concept that is highly versatile and customizable for various application requirements.

Air Efficient Soft Wearable Robot for High-Torque Elbow Flexion Assistance

Recent developments in soft wearable robots have shown promise for assistive and rehabilitative use-cases. For inflatable approaches, a major challenge in developing portable systems is finding a balance between portability, performance, and usability. In this paper, we present a textile-based robotic sleeve that can provide functional elbow flexion assistance and is compatible with a portable actuation unit (PAU). Flexion is driven by a curved textile actuator with internal pneumatic supports (IPS). We show that the addition of IPS improves torque generation and increases battery-powered actuations by 60%. We demonstrate that the device can provide enough torque throughout the ROM of the elbow joint for daily life assistance. Specifically, the device generates 13.5 Nm of torque at 90°. Experimental testing in five healthy individuals and two individuals with Amyotrophic Lateral Sclerosis (ALS) demonstrates its impact on wearer muscle activity and kinematics. The results with healthy subjects show that the device was able to reduce the bicep muscle activity by an average of 49.1±13.3% during static and dynamic exercises, 43.6±11.1% during simulated ADLs, and provided an assisted ROM of 134°±13°. Both ALS participants reported a reduced rate of perceived exertion during both static and dynamic tasks while wearing the device and had an average ROM of 115°±8°. Future work will explore other applications of the IPS and extend the approach to assisting multiple joints.

The NuroSleeve, a user-centered 3D printed hybrid orthosis for individuals with upper extremity impairment

BACKGROUND

Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis.

METHODS

This study introduces the design, implementation, and clinical evaluation of the NuroSleeve, a user-centered hybrid device that incorporates a lightweight, easy to don and doff 3D-printed motorized UE orthosis and a functional electrical stimulation (FES) component. Our primary goals are to develop a customized hybrid device that individuals with UE neuromuscular impairment can use to perform ADLs and to evaluate the benefits of incorporating the device into occupational therapy sessions. The trial is designed as a prospective, open-label, single-cohort feasibility study of eight-week sessions combined with at-home use of the device and implements an iterative device design process where feedback from participants and therapists informs design improvement cycles.

RESULTS

All participants learned how to independently don, doff, and use the NuroSleeve in ADLs, both in clinical therapy and in their home environments. All participants showed improvements in their Canadian Occupational Performance Measure (COPM), which was the primary clinical trial outcome measure. Furthermore, participants and therapists provided valuable feedback to guide further development.

CONCLUSIONS

Our results from non-clinical testing and clinical evaluation demonstrate that the NuroSleeve has met feasibility and safety goals and effectively improved independent voluntary function during ADLs. The study's encouraging preliminary findings indicate that the NuroSleeve has met its technical and clinical objectives while improving upon the limitations of the existing UE orthoses owing to its personalized and flexible approach to hardware and firmware design.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04798378, https://clinicaltrials.gov/ct2/show/NCT04798378 , date of registration: March 15, 2021.

Elbow-sideWINDER (Elbow-side Wearable INDustrial Ergonomic Robot): design, control, and validation of a novel elbow exoskeleton

Musculoskeletal Disorders associated with the elbow are one of the most common forms of work-related injuries. Exoskeletons have been proposed as an approach to reduce and ideally eliminate these injuries; however, exoskeletons introduce their own problems, especially discomfort due to joint misalignment. The Elbow-sideWINDER with its associated control strategy is a novel elbow exoskeleton to assist elbow flexion/extension during occupational tasks. This study describes the exoskeleton showing how this can minimize discomfort caused by joint misalignment, maximize assistive performance, and provide increased robustness and reliability in real worksites. The proposed medium-level control strategy can provide effective assistive torque using three control units as follows: an arm kinematics estimator, a load estimator, and a friction compensator. The combined hardware/software system of the Elbow-sideWINDER is tested in load-lifting tasks (2 and 7 kg). This experiment focuses on the reduction in the activation level of the biceps brachii and triceps brachii in both arms and the change in the range of motion of the elbow during the task. It is shown that using the Elbow-sideWINDER, the biceps brachii, responsible for the elbow flexion, was significantly less activated (up to 38.8% at 2 kg and 25.7% at 7 kg, on average for both arms). For the triceps brachii, the muscle activation was reduced by up to 37.0% at 2 kg and 35.1% at 7 kg, on average for both arms. When wearing the exoskeleton, the range of motion of the elbow was reduced by up to 13.0° during the task, but it was within a safe range and could be compensated for by other joints such as the waist or knees. There are extremely encouraging results that provide good indicators and important clues for future improvement of the Elbow-sideWINDER and its control strategy.

Sensing and Control Strategies for a Synergy-Based, Cable-Driven Exosuit via a Modular Test Bench

Ageing results in the eventual loss of muscle mass and strength, joint problems, and overall slowing of movements, with a greater risk of suffering falls or other such accidents. The use of gait assistance exoskeletons can help in the active aging of this segment of the population. Given the user specificity of the mechanics and control these devices need, the facility used to test different design parameters is indispensable. This work deals with the modeling and construction of a modular test bench and prototype exosuit to test different mounting and control schemes for a cable-driven exoskeleton or exosuit. The test bench allows the experimental implementation of postural or kinematic synergies to assist multiple joints by using only one actuator and the optimization of the control scheme to better adapt to the characteristics of the specific patient. The design is open to the research community and it is expected to improve the design of cable-driven systems for exosuits.

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.

Neuro-cognitive assessment of intentional control methods for a soft elbow exosuit using error-related potentials

Soft exosuits offer promise to support users in everyday workload tasks by providing assistance. However, acceptance of such systems remains low due to the difficulty of control compared with rigid mechatronic systems. Recently, there has been progress in developing control schemes for soft exosuits that move in line with user intentions. While initial results have demonstrated sufficient device performance, the assessment of user experience via the cognitive response has yet to be evaluated. To address this, we propose a soft pneumatic elbow exosuit designed based on our previous work to provide assistance in line with user expectations utilizing two existing state-of-the-art control methods consisting of a gravity compensation and myoprocessor based on muscle activation. A user experience study was conducted to assess whether the device moves naturally with user expectations and the potential for device acceptance by determining when the exosuit violated user expectations through the neuro-cognitive and motor response. Brain activity from electroencephalography (EEG) data revealed that subjects elicited error-related potentials (ErrPs) in response to unexpected exosuit actions, which were decodable across both control schemes with an average accuracy of 76.63 ± 1.73% across subjects. Additionally, unexpected exosuit actions were further decoded via the motor response from electromyography (EMG) and kinematic data with a grand average accuracy of 68.73 ± 6.83% and 77.52 ± 3.79% respectively. This work demonstrates the validation of existing state-of-the-art control schemes for soft wearable exosuits through the proposed soft pneumatic elbow exosuit. We demonstrate the feasibility of assessing device performance with respect to the cognitive response through decoding when the device violates user expectations in order to help understand and promote device acceptance.

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.

Upper limb soft robotic wearable devices: a systematic review

INTRODUCTION

Soft robotic wearable devices, referred to as exosuits, can be a valid alternative to rigid exoskeletons when it comes to daily upper limb support. Indeed, their inherent flexibility improves comfort, usability, and portability while not constraining the user's natural degrees of freedom. This review is meant to guide the reader in understanding the current approaches across all design and production steps that might be exploited when developing an upper limb robotic exosuit.

METHODS

The literature research regarding such devices was conducted in PubMed, Scopus, and Web of Science. The investigated features are the intended scenario, type of actuation, supported degrees of freedom, low-level control, high-level control with a focus on intention detection, technology readiness level, and type of experiments conducted to evaluate the device.

RESULTS

A total of 105 articles were collected, describing 69 different devices. Devices were grouped according to their actuation type. More than 80% of devices are meant either for rehabilitation, assistance, or both. The most exploited actuation types are pneumatic (52%) and DC motors with cable transmission (29%). Most devices actuate 1 (56%) or 2 (28%) degrees of freedom, and the most targeted joints are the elbow and the shoulder. Intention detection strategies are implemented in 33% of the suits and include the use of switches and buttons, IMUs, stretch and bending sensors, EMG and EEG measurements. Most devices (75%) score a technology readiness level of 4 or 5.

CONCLUSION

Although few devices can be considered ready to reach the market, exosuits show very high potential for the assistance of daily activities. Clinical trials exploiting shared evaluation metrics are needed to assess the effectiveness of upper limb exosuits on target users.

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.

Upper limb exosuit cable routing optimization

Exosuits are emerging as promising in assisting with activities of daily living. In the design phase of an exosuit, it is fundamental to maximize its portability. The goal of this work was to identify the best cable routing configuration for an upper limb cable-driven exosuit to assist elbow flexion. Simulations were run in OpenSim. Different cable configurations were evaluated. The goal was to minimize the overall tension of the cables to reduce the device's power consumption and torque requirements. The optimal configuration was evaluated in simulation for different percentages of assistance to study its effects in terms of muscle activation and joint reaction forces. We then tested three different configurations on a test bench to both evaluate the motor current and their effect on the pronation/supination of the elbow. Simulation results suggested that a double cable configuration might help to lower the motor torque and power consumption. This conclusion was supported by the experimental results, in which the motor current was reduced by 12.5% with respect to the single cable configuration. Simulation results also showed that the optimal configuration lowered muscle activation without greatly affecting joint reactions at the elbow, even though it might cause unwanted pronation/supination, as experimental results confirmed. However, since a double configuration results in greater complexity and reduced efficiency, single-cable solutions still represent a good option.

Design and Implementation of a Rehabilitation Upper-limb Exoskeleton Robot Controlled by Cognitive and Physical Interfaces

This paper presents an upper limb exoskeleton that allows cognitive (through electromyography signals) and physical user interaction (through load cells sensors) for passive and active exercises that can activate neuroplasticity in the rehabilitation process of people who suffer from a neurological injury. For the exoskeleton to be easily accepted by patients who suffer from a neurological injury, we used the ISO9241-210:2010 as a methodology design process. As the first steps of the design process, design requirements were collected from previous usability tests and literature. Then, as a second step, a technological solution is proposed, and as a third step, the system was evaluated through performance and user testing. As part of the technological solution and to allow patient participation during the rehabilitation process, we have proposed a hybrid admittance control whose input is load cell or electromyography signals. The hybrid admittance control is intended for active therapy exercises, is easily implemented, and does not need musculoskeletal modeling to work. Furthermore, electromyography signals classification models and features were evaluated to identify the best settings for the cognitive human-robot interaction.

Development of a Series Elastic Tendon Actuator (SETA) Based on Gait Analysis for a Knee Assistive Exosuit

An exosuit is a wearable robot that assists the muscular strength of a human that wears it by using multiple wires with similar functions to human muscles. This study focuses on the development of a series elastic tendon actuator (SETA) for the actuation of an exosuit. A gait analysis was performed for walking on stairs to deduce the design requirements of SETA, and the necessary performances were then determined based on these requirements. The SETA is designed to assign compliance to rigid wires using linear springs. The deformation in linear springs generated during tension was measured through an encoder to calculate the human robot interaction (HRI) force. By utilizing the HRI force as feedback of an admittance controller, the SETA was capable of providing wire tensions required by an exosuit. The performance of the SETA was verified through series elastic component (SEC) deformation and force control experiments. The SEC deformation increased from 0 to 3.86 mm when the wire tension increased from 0 to 100 N. This force controller demonstrated a slight vibration owing to the mechanical properties of the springs constituting the SEC during the step input; however, the value gradually converged to 100 N. The developed SETA was applied to an exosuit system for supporting knee strength of the elderly when walking on stairs.

Ergonomic Design and Performance Evaluation of H-Suit for Human Walking

A soft exoskeleton for the hip flexion, named H-Suit, is developed to improve the walking endurance of lower limbs, delay muscle fatigue and reduce the activation level of hip flexors. Based on the kinematics and biomechanics of the hip joints, the ergonomic design of the H-Suit system is clearly presented and the prototype was developed. The profile of the auxiliary forces is planned in the auxiliary range where the forces start at the minimum hip angle, reach the maximum (120 N) and end at 90% of each gait cycle. The desired displacements of the traction unit which consist of the natural and elastic displacements of the steel cables are obtained by the experimental method. An assistance strategy is proposed to track the profile of the auxiliary forces by dynamically adjusting the compensation displacement Lc and the hold time Δt. The influences of the variables Lc and Δt on the natural gaits and auxiliary forces have been revealed and analyzed. The real profile of the auxiliary forces can be obtained and is consistent with the theoretical one by the proposed assistance strategy. The H-Suit without the drive unit has little effect on the EMG signal of the lower limbs. In the powered condition, the H-Suit can delay the muscle fatigue of the lower limbs. The average rectified value (ARV) slope decreases and the median frequency (MNF) slope increases significantly. Wearing the H-Suit resulted in a significant reduction of the vastus lateralis effort, averaged over subjects and walking speeds, of 13.3 ± 2.1% (p = 2 × 10−5).

Soft, lightweight wearable robots to support the upper limb in activities of daily living: a feasibility study on chronic stroke patients

Stroke can be a devastating condition that impairs the upper limb and reduces mobility. Wearable robots can aid impaired users by supporting performance of Activities of Daily Living (ADLs). In the past decade, soft devices have become popular due to their inherent malleable and low-weight properties that makes them generally safer and more ergonomic. In this study, we present an improved version of our previously developed gravity-compensating upper limb exosuit and introduce a novel hand exoskeleton. The latter uses 3D-printed structures that are attached to the back of the fingers which prevent undesired hyperextension of joints. We explored the feasibility of using this integrated system in a sample of 10 chronic stroke patients who performed 10 ADLs.We observed a significant reduction of 30.3 ± 3.5% (mean ± standard error), 31.2 ± 3.2% and 14.0 ± 5.1% in the mean muscular activity of the Biceps Brachii (BB), Anterior Deltoid (AD) and Extensor Digitorum Communis muscles, respectively. Additionally, we observed a reduction of 14.0 ± 11.5%, 14.7 ± 6.9% and 12.8 ± 4.4% in the coactivation of the pairs of muscles BB and Triceps Brachii (TB), BB and AD, and TB and Pectoralis Major (PM), respectively, typically associated to pathological muscular synergies, without significant degradation of healthy muscular coactivation. There was also a significant increase of elbow flexion angle (12.1±1.5°). These results further cement the potential of using lightweight wearable devices to assist impaired users.

Human Joint Torque Estimation Based on Mechanomyography for Upper Extremity Exosuit

Human intention recognition belongs to the algorithm basis for exoskeleton robots to generate synergic movements and provide corresponding assistance. In this article, we acquire and analyze the mechanomyography (MMG) to estimate the current joint torque and apply this method to the rehabilitation training research of the upper extremity exosuit. In order to obtain relatively pure biological signals, a MMG processing method based on the Hilbert-Huang Transform (HHT) is proposed to eliminate the mixed noise and motion artifacts. After extracting features and forming the dataset, a random forest regression (RFR) model is designed to build the mapping relationship between MMG and human joint output through offline learning. In addition, an upper extremity exosuit is constructed for multi-joint assistance. Based on the above research, we develop a torque estimation-based control strategy and make it responsible for the intention understanding and motion servo of this customized system. Finally, an actual test verifies the accuracy and reliability of this recognition algorithm, and an efficiency evaluation experiment also proves the feasibility for power assistance.

Benchmarking occupational exoskeletons: An evidence mapping systematic review

OBJECTIVES

To provide an overview of protocols assessing the effect of occupational exoskeletons on users and to formulate recommendations towards a literature-based assessment framework to benchmark the effect of occupational exoskeletons on the user.

METHODS

PubMed (MEDLINE), Web of Science database and Scopus were searched (March 2, 2021). Studies were included if they investigated the effect of one or more occupational exoskeletons on the user.

RESULTS

In total, 139 eligible studies were identified, encompassing 33, 25 and 18 unique back, shoulder and other exoskeletons, respectively. Device validation was most frequently conducted using controlled tasks while collecting muscle activity and biomechanical data. As the exoskeleton concept matures, tasks became more applied and the experimental design more representative. With that change towards realistic testing environments came a trade-off with experimental control, and user experience data became more valuable.

DISCUSSION

This evidence mapping systematic review reveals that the assessment of occupational exoskeletons is a dynamic process, and provides literature-based assessment recommendations. The homogeneity and repeatability of future exoskeleton assessment experiments will increase following these recommendations. The current review recognises the value of variability in evaluation protocols in order to obtain an overall overview of the effect of exoskeletons on the users, but the presented framework strives to facilitate benchmarking the effect of occupational exoskeletons on the users across this variety of assessment protocols.

Challenges and solutions for application and wider adoption of wearable robots

The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human-robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots.

Human-device interface pressure measurement in prosthetic, orthotic and exoskeleton applications: A systematic review

This study aimed to investigate normal and shear load sensor technology that has been characterised and used at the human-device interface in prosthetic, orthotic and exoskeleton applications. In addition to taking a cross-disciplinary view, this study expands on previous reviews by considering recently published papers, clinical translation of sensors, and development of the sensor technology itself. A search of MEDLINE, INSPEC, SCOPUS and Web of Science was performed up to 26 January 2021. A total of 33 studies were assessed for quality and their data extracted. The review found variable quality of published papers, with normal load being most commonly measured, and resistive sensor technology most commonly used. The translation to clinical environments was indicated in most studies, though the study population was not always made up of the target users. Studies could benefit from more direct comparison with clinically relevant load thresholds and by ensuring clinical testing is performed in the most realistic and representative way possible. Additionally, more focus on developing sensors that measure shear loads would enable further insights into conditions at the human-device interface. Finally, all researchers would benefit from better and more widespread anonymous data sharing practices to facilitate further experimentation.

Textiles in soft robots: Current progress and future trends

Soft robotics have substantial benefits of safety, adaptability, and cost efficiency compared to conventional rigid robotics. Textiles have applications in soft robotics either as an auxiliary material to reinforce the conventional soft material or as an active soft material. Textiles of various types and configurations have been fabricated into key components of soft robotics in adaptable formats. Despite significant advancements, the efficiency and characteristics of textile actuators in practical applications remain unsatisfactory. To address these issues, novel structural and material designs as well as new textile technologies have been introduced. Herein, we aim at giving an insight into the current state of the art in textile technology for soft robotic manufacturing. We firstly discuss the fundamental actuation mechanisms for soft robotics. We then provide a critical review on the recently developed functional textiles as reinforcements, sensors, and actuators in soft robotics. Finally, the future trends and current strategies that can be employed in textile-based actuator manufacturing process have been explored to address the critical challenges in soft robotics.

Reaching higher: External scapula assistance can improve upper limb function in humans with irreversible scapula alata

Background

Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided.

Methods

The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis.

Results

With therapist assistance, average arm elevation increased by 17.3° in flexion (p < 0.001, 95% confidence interval of the mean \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$C{I}_{95\%}=\hspace{0.17em}\left[9.8^\circ , 24.9^\circ \right]$$\end{document}CI95%=9.8∘,24.9∘), and by 11.2° in abduction (p < 0.01, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$C{I}_{95\%}=\left[4.7^\circ , 17.7^\circ \right]$$\end{document}CI95%=4.7∘,17.7∘), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$C{I}_{95\%}=\left[0.4^\circ ,11.9^\circ \right]$$\end{document}CI95%=0.4∘,11.9∘) and by 5.8° in abduction (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$C{I}_{95\%}=\left[3.0^\circ ,8.5^\circ \right]$$\end{document}CI95%=3.0∘,8.5∘). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task.

Conclusion

These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios.

Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00926-z.

How Do Violinists Adapt to Dynamic Assistive Support? A Study Focusing on Kinematics, Muscle Activity, and Musical Performance

OBJECTIVE

Assessing violinists' motor and musical performance adaptations to dynamic assistive support (DAS) provided by a passive device, using a force-field adaptation paradigm.

BACKGROUND

Up to 93% of instrumentalists are affected by musculoskeletal injuries and particularly violinists. The repetitive nature of their work may lead to muscle fatigue, an injury risk factor. DAS has been used in occupational settings to minimize muscle activations and limit fatigue accumulation. DAS may however affect motor and musical performance.

METHOD

Fifteen expert violinists were equipped with reflective markers and surface and intramuscular electromyography (EMG) sensors. Movements, muscle activations, and sound were recorded while participants completed three experimental conditions for which they continuously played a 13-s musical excerpt: Control (no DAS), Adaptation (DAS), and Washout (no DAS). DAS was applied at the left elbow (violin-holding side). Conditions were repeated 1 week later. Participants later listened to their own audio recordings playing with and without DAS and blindly assessed their performances. Linear mixed models were used to compare DAS and no-DAS conditions' kinematic, EMG, and musical performance data.

RESULTS

DAS perturbed user kinematics but reduced mean activations of left medial deltoid and superior trapezius. Joint kinematic and muscle activation patterns between DAS and no DAS conditions however remained similar. Musical performance was unchanged with DAS.

CONCLUSION

Though DAS modified violinists' upper-limb configurations, resulting kinematics were not detrimental to musical performance. Reduced muscle activations with DAS could contribute to lessening muscle fatigue.

APPLICATION

Although its effect on muscle fatigue should be further investigated, DAS might be useful in preventing violinists' injuries.

Soft Exoskeletons: Development, Requirements, and Challenges of the Last Decade

In this article, various investigations on soft exoskeletons are presented and their functional and structural characteristics are analyzed. The present work is oriented to the studies of the last decade and covers the upper and lower joints, specifically the shoulder, elbow, wrist, hand, hip, knee, and ankle. Its functionality, applicability, and main characteristics are exposed, such as degrees of freedom, force, actuators, power transmission methods, control systems, and sensors. The purpose of this work is to show the current trend in the development of soft exoskeletons, in addition to specifying the essential characteristics that must be considered in its design and the challenges that its construction implies.

Single limb cable driven wearable robotic device for upper extremity movement support after traumatic brain injury

Introduction

Recently, soft exosuits have been proposed for upper limb movement assistance, most supporting single joint movements. We describe the design of a portable wearable robotic device (WRD), “Armstrong,” able to support three degrees-of-freedom of arm movements, and report on its feasibility for movement support of individuals with hemiparesis after traumatic brain injury (TBI).

Methods

We introduce Armstrong and report on a pilot evaluation with two male individuals post-TBI (T1 and T2) and two healthy individuals. Testing involved elbow flexion/extension with and without robotic-assisted shoulder stabilization; shoulder abduction with and without robotic-assisted elbow stabilization; and assisted shoulder abduction and flexion. Outcome measures included range of motion and root mean square trajectory and velocity errors.

Results

TBI subjects performed active, passive, hybrid and active assistive movements with Armstrong. Subjects showed improvements in movement trajectory and velocity. T1 benefited from hybrid, active, and assistive modes due to upper extremity weakness and muscle tone. T2 benefited from hybrid and assistive modes due to impaired coordination. Healthy subjects performed isolated movements of shoulder and elbow with minimal trajectory and velocity errors.

Conclusions

This study demonstrates the safety and feasibility of Armstrong for upper extremity movement assistance for individuals with TBI, with therapist supervision.

Soft pneumatic elbow exoskeleton reduces the muscle activity, metabolic cost and fatigue during holding and carrying of loads

To minimize fatigue, sustain workloads, and reduce the risk of injuries, the exoskeleton Carry was developed. Carry combines a soft human-machine interface and soft pneumatic actuation to assist the elbow in load holding and carrying. We hypothesize that the assistance of Carry would decrease, muscle activity, net metabolic rate, and fatigue. With Carry providing 7.2 Nm of assistance, we found reductions of up to 50% for the muscle activity, up to 61% for the net metabolic rate, and up to 99% for fatigue in a group study of 12 individuals. Analyses of operation dynamics and autonomous use demonstrate the applicability of Carry to a variety of use cases, presumably with increased benefits for increased assistance torque. The significant benefits of Carry indicate this device could prevent systemic, aerobic, and/or possibly local muscle fatigue that may increase the risk of joint degeneration and pain due to lifting, holding, or carrying.

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human-machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals-namely, family members and professional carers-to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.

An Assistive Soft Wrist Exosuit for Flexion Movements With an Ergonomic Reinforced Glove

Soft exosuits are a promising solution for the assistance and augmentation of human motor abilities in the industrial field, where the use of more symbiotic wearable robots can avoid excessive worker fatigue and improve the quality of the work. One of the challenges in the design of soft exosuits is the choice of the right amount of softness to balance load transfer, ergonomics, and weight. This article presents a cable-driven based soft wrist exosuit for flexion assistance with the use of an ergonomic reinforced glove. The flexible and highly compliant three-dimensional (3D)-printed plastic structure that is sewn on the glove allows an optimal force transfer from the remotely located motor to the wrist articulation and to preserve a high level of comfort for the user during assistance. The device is shown to reduce fatigue and the muscular effort required for holding and lifting loads in healthy subjects for weights up to 3 kg.

An Identification-Based Method Improving the Transparency of a Robotic Upper Limb Exoskeleton

Over the past decade, research on human–robot collaboration has grown exponentially, motivated by appealing applications to improve the daily life of patients/operators. A primary requirement in many applications is to implement highly “transparent” control laws to reduce the robot impact on human movement. This impact may be quantified through relevant motor control indices. In this paper, we show that control laws based on careful identification procedures improve transparency compared to classical closed-loop position control laws. A new performance index based on the ratio between electromyographic activity and limb acceleration is also introduced to assess the quality of human exoskeleton interaction.

Relationship Between Muscular Activity and Assistance Magnitude for a Myoelectric Model Based Controlled Exosuit

The growing field of soft wearable exosuits, is gradually gaining terrain and proposing new complementary solutions in assistive technology, with several advantages in terms of portability, kinematic transparency, ergonomics, and metabolic efficiency. Those are palatable benefits that can be exploited in several applications, ranging from strength and resistance augmentation in industrial scenarios, to assistance or rehabilitation for people with motor impairments. To be effective, however, an exosuit needs to synergistically work with the human and matching specific requirements in terms of both movements kinematics and dynamics: an accurate and timely intention-detection strategy is the paramount aspect which assume a fundamental importance for acceptance and usability of such technology. We previously proposed to tackle this challenge by means of a model-based myoelectric controller, treating the exosuit as an external muscular layer in parallel to the human biomechanics and as such, controlled by the same efferent motor commands of biological muscles. However, previous studies that used classical control methods, demonstrated that the level of device's intervention and effectiveness of task completion are not linearly related: therefore, using a newly implemented EMG-driven controller, we isolated and characterized the relationship between assistance magnitude and muscular benefits, with the goal to find a range of assistance which could make the controller versatile for both dynamic and static tasks. Ten healthy participants performed the experiment resembling functional daily activities living in separate assistance conditions: without the device's active support and with different levels of intervention by the exosuit. Higher assistance levels resulted in larger reductions in the activity of the muscles augmented by the suit actuation and a good performance in motion accuracy, despite involving a decrease of the movement velocities, with respect to the no assistance condition. Moreover, increasing torque magnitude by the exosuit resulted in a significant reduction in the biological torque at the elbow joint and in a progressive effective delay in the onset of muscular fatigue. Thus, contrarily to classical force and proportional myoelectric schemes, the implementation of an opportunely tailored EMG-driven model based controller affords to naturally match user's intention detection and provide an assistance level working symbiotically with the human biomechanics.

Myoelectric untethered robotic glove enhances hand function and performance on daily living tasks after stroke

Introduction

Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently.

Methods

We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance.

Results

The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines.

Conclusions

People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.

An Exoneuromusculoskeleton for Self-Help Upper Limb Rehabilitation After Stroke

This article presents a novel electromyography (EMG)-driven exoneuromusculoskeleton that integrates the neuromuscular electrical stimulation (NMES), soft pneumatic muscle, and exoskeleton techniques, for self-help upper limb training after stroke. The developed system can assist the elbow, wrist, and fingers to perform sequential arm reaching and withdrawing tasks under voluntary effort control through EMG, with a lightweight, compact, and low-power requirement design. The pressure/torque transmission properties of the designed musculoskeletons were quantified, and the assistive capability of the developed system was evaluated on patients with chronic stroke (n = 10). The designed musculoskeletons exerted sufficient mechanical torque to support joint extension for stroke survivors. Compared with the limb performance when no assistance was provided, the limb performance (measured as the range of motion in joint extension) significantly improved when mechanical torque and NMES were provided (p < 0.05). A pilot trial was conducted on patients with chronic stroke (n = 15) to investigate the feasibility of using the developed system in self-help training and the rehabilitation effects of the system. All the participants completed the self-help device-assisted training with minimal professional assistance. After a 20-session training, significant improvements were noted in the voluntary motor function and release of muscle spasticity at the elbow, wrist, and fingers, as indicated by the clinical scores (p < 0.05). The EMG parameters (p < 0.05) indicated that the muscular coordination of the entire upper limb improved significantly after training. The results suggested that the developed system can effectively support self-help upper limb rehabilitation after stroke. ClinicalTrials.gov Register Number NCT03752775.

Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke

BACKGROUND

The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable.

METHODS

Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1-4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove.

RESULTS

The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were 'more or less satisfied' with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands.

CONCLUSIONS

The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.

Soft Elbow Exoskeleton for Upper Limb Assistance Incorporating Dual Motor-Tendon Actuator

Loss of muscle functions, such as the elbow, can affect the quality of life of a person. This research is aimed at developing an affordable two DOF soft elbow exoskeleton incorporating a dual motor-tendon actuator. The soft elbow exoskeleton can be used to assist two DOF motions of the upper limb, especially elbow and wrist movements. The exoskeleton is developed using fabric for the convenience purpose of the user. The dual motor-tendon actuator subsystem employs two DC motors coupled with lead-to-screw converting motion from angular into linear motion. The output is connected to the upper arm hook on the soft exoskeleton elbow. With this mechanism, the proposed actuator system is able to assist two DOF movements for flexion/extension and pronation/supination motion. Proportional-Integral (PI) control is implemented for controlling the motion. The optimized value of Kp and Ki are 200 and 20, respectively. Based on the test results, there is a slight steady-state error between the first and the second DC motor. When the exoskeleton is worn by a user, it gives more steady-state errors because of the load from the arm weight. The test results demonstrate that the proposed soft exoskeleton elbow can be worn easily and comfortably by a user to assist two DOF for elbow and wrist motion. The resulted range of motion (ROM) for elbow flexion–extension can be varied from 90° to 157°, whereas the maximum of ROM that can be achieved for pronation and supination movements are 19° and 18°, respectively.

On the edge between soft and rigid: an assistive shoulder exoskeleton with hyper-redundant kinematics

In this paper, we present a prototype of an innovative portable shoulder exoskeleton for human assistance and augmentation. The device provides torques to flexion/extension movements of the shoulder, compensating for gravitational forces, and is passively compliant along the remaining degrees of freedom letting the shoulder moving along them. The novelty of our system is a flexible link, made of a hyper-redundant passive structure, that avoids joint misalignment by adapting to the complex movements of the humerus head, similarly to a soft component. The flexible link is compliant to rotations around one axis but rigid around the other two axes, allowing transmission of flexion/extension torque but kinematically transparent along the remaining degrees of freedom. The device is light weight and allows to cover around the 82% of the shoulder flexion/extension range of motion. The exoskeleton was tested on a cohort of 5 healthy subjects, monitoring shoulder kinematics, interaction forces and acquiring the electromyography of three major muscles contributing to shoulder flexion. During both static postures and dynamic movements, assistance from the exoskeleton resulted in a significant reduction of muscular effort in the anterior (-32.2% in static, -25.3% in dynamic) and medial deltoid (56.9% in static, -49.6% in dynamic) and an average reduction of the biceps brachii.

Design and Validation of a Modular One-To-Many Actuator for a Soft Wearable Exosuit

The size, weight, and power consumption of soft wearable robots rapidly scale with their number of active degrees of freedom. While various underactuation strategies have been proposed, most of them impose hard constrains on the kinetics and kinematics of the device. Here we propose a paradigm to independently control multiple degrees of freedom using a set of modular components, all tapping power from a single motor. Each module consists of three electromagnetic clutches, controlled to convert a constant unidirectional motion in an arbitrary output trajectory. We detail the design and functioning principle of each module and propose an approach to control the velocity and position of its output. The device is characterized in free space and under loading conditions. Finally, we test the performance of the proposed actuation scheme to drive a soft exosuit for the elbow joint, comparing it with the performance obtained using a traditional DC motor and an unpowered-exosuit condition. The exosuit powered by our novel scheme reduces the biological torque required to move by an average of 46.2%, compared to the unpowered condition, but negatively affects movement smoothness. When compared to a DC motor, using the our paradigm slightly deteriorates performance. Despite the technical limitations of the current design, the method proposed in this paper is a promising way to design more portable wearable robots.