Gastrocnemius Myoelectric Control of a Robotic Hip Exoskeleton Can Reduce the User's Lower-Limb Muscle Activities at Push Off

Evaluation of controllers for augmentative hip exoskeletons and their effects on metabolic cost of walking: explicit versus implicit synchronization

Background: Efficient gait assistance by augmentative exoskeletons depends on reliable control strategies. While numerous control methods and their effects on the metabolic cost of walking have been explored in the literature, the use of different exoskeletons and dissimilar protocols limit direct comparisons. In this article, we present and compare two controllers for hip exoskeletons with different synchronization paradigms. Methods: The implicit-synchronization-based approach, termed the Simple Reflex Controller (SRC), determines the assistance as a function of the relative loading of the feet, resulting in an emerging torque profile continuously assisting extension during stance and flexion during swing. On the other hand, the Hip-Phase-based Torque profile controller (HPT) uses explicit synchronization and estimates the gait cycle percentage based on the hip angle, applying a predefined torque profile consisting of two shorter bursts of assistance during stance and swing. We tested the controllers with 23 naïve healthy participants walking on a treadmill at 4 km ⋅ h-1, without any substantial familiarization. Results: Both controllers significantly reduced the metabolic rate compared to walking with the exoskeleton in passive mode, by 18.0% (SRC, p < 0.001) and 11.6% (HPT, p < 0.001). However, only the SRC led to a significant reduction compared to walking without the exoskeleton (8.8%, p = 0.004). The SRC also provided more mechanical power and led to bigger changes in the hip joint kinematics and walking cadence. Our analysis of mechanical powers based on a whole-body analysis suggested a reduce in ankle push-off under this controller. There was a strong correlation (Pearson's r = 0.778, p < 0.001) between the metabolic savings achieved by each participant with the two controllers. Conclusion: The extended assistance duration provided by the implicitly synchronized SRC enabled greater metabolic reductions compared to the more targeted assistance of the explicitly synchronized HPT. Despite the different assistance profiles and metabolic outcomes, the correlation between the metabolic reductions with the two controllers suggests a difference in individual responsiveness to assistance, prompting more investigations to explore the person-specific factors affecting assistance receptivity.

Biosignal-integrated robotic systems with emerging trends in visual interfaces: A systematic review

Human-machine interfaces (HMI) are currently a trendy and rapidly expanding area of research. Interestingly, the human user does not readily observe the interface between humans and machines. Instead, interactions between the machine and electrical signals from the user's body are obscured by complex control algorithms. The result is effectively a one-way street, wherein data is only transmitted from human to machine. Thus, a gap remains in the literature: how can information be effectively conveyed to the user to enable mutual understanding between humans and machines? Here, this paper reviews recent advancements in biosignal-integrated wearable robotics, with a particular emphasis on "visualization"-the presentation of relevant data, statistics, and visual feedback to the user. This review article covers various signals of interest, such as electroencephalograms and electromyograms, and explores novel sensor architectures and key materials. Recent developments in wearable robotics are examined from control and mechanical design perspectives. Additionally, we discuss current visualization methods and outline the field's future direction. While much of the HMI field focuses on biomedical and healthcare applications, such as rehabilitation of spinal cord injury and stroke patients, this paper also covers less common applications in manufacturing, defense, and other domains.

Tapping Into Skeletal Muscle Biomechanics for Design and Control of Lower Limb Exoskeletons: A Narrative Review

Lower limb exoskeletons and exosuits ("exos") are traditionally designed with a strong focus on mechatronics and actuation, whereas the "human side" is often disregarded or minimally modeled. Muscle biomechanics principles and skeletal muscle response to robot-delivered loads should be incorporated in design/control of exos. In this narrative review, we summarize the advances in literature with respect to the fusion of muscle biomechanics and lower limb exoskeletons. We report methods to measure muscle biomechanics directly and indirectly and summarize the studies that have incorporated muscle measures for improved design and control of intuitive lower limb exos. Finally, we delve into articles that have studied how the human-exo interaction influences muscle biomechanics during locomotion. To support neurorehabilitation and facilitate everyday use of wearable assistive technologies, we believe that future studies should investigate and predict how exoskeleton assistance strategies would structurally remodel skeletal muscle over time. Real-time mapping of the neuromechanical origin and generation of muscle force resulting in joint torques should be combined with musculoskeletal models to address time-varying parameters such as adaptation to exos and fatigue. Development of smarter predictive controllers that steer rather than assist biological components could result in a synchronized human-machine system that optimizes the biological and electromechanical performance of the combined system.

An integrated evaluation approach of wearable lower limb exoskeletons for human performance augmentation

Wearable robots have been growing exponentially during the past years and it is crucial to quantify the performance effectiveness and to convert them into practical benchmarks. Although there exist some common metrics such as metabolic cost, many other characteristics still needs to be presented and demonstrated. In this study, we developed an integrated evaluation (IE) approach of wearable exoskeletons of lower limb focusing on human performance augmentation. We proposed a novel classification of trial tasks closely related to exoskeleton functions, which were divided into three categories, namely, basic trial at the preliminary phase, semi-reality trial at the intermediate phase, and reality trial at the advanced phase. In the present study, the IE approach has been exercised with a subject who wore an active power-assisted knee (APAK) exoskeleton with three types of trial tasks, including walking on a treadmill at a certain angle, walking up and down on three-step stairs, and ascending in 11-storey stairs. Three wearable conditions were carried out in each trial task, i.e. with unpowered exoskeleton, with powered exoskeleton, and without the exoskeleton. Nine performance indicators (PIs) for evaluating performance effectiveness were adopted basing on three aspects of goal-level, task-based kinematics, and human-robot interactions. Results indicated that compared with other conditions, the powered APAK exoskeleton make generally lesser heart rate (HR), Metabolic equivalent (METs), biceps femoris (BF) and rectus femoris (RF) muscles activation of the subject at the preliminary phase and intermediate phase, however, with minimal performance augmentation at advanced phase, suggesting that the APAK exoskeleton is not suitable for marketing and should be further improved. In the future, continuous iterative optimization for the IE approach may help the robot community to attain a comprehensive benchmarking methodology for robot-assisted locomotion more efficiently.

Current developments of robotic hip exoskeleton toward sensing, decision, and actuation: A review

The aging population is now a global challenge, and impaired walking ability is a common feature in the elderly. In addition, some occupations such as military and relief workers require extra physical help to perform tasks efficiently. Robotic hip exoskeletons can support ambulatory functions in the elderly and augment human performance in healthy people during normal walking and loaded walking by providing assistive torque. In this review, the current development of robotic hip exoskeletons is presented. In addition, the framework of actuation joints and the high-level control strategy (including the sensors and data collection, the way to recognize gait phase, the algorithms to generate the assist torque) are described. The exoskeleton prototypes proposed by researchers in recent years are organized to benefit the related fields realizing the limitations of the available robotic hip exoskeletons, therefore, this work tends to be an influential factor with a better understanding of the development and state-of-the-art technology.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

BACKGROUND

Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors.

METHODS

Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability.

RESULTS

For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO.

CONCLUSIONS

This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Performance Evaluation of Lower Limb Exoskeletons: A Systematic Review

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

Exoskeleton Active Walking Assistance Control Framework Based on Frequency Adaptive Dynamics Movement Primitives

This paper introduces a novel exoskeleton active walking assistance control framework based on frequency adaptive dynamics movement primitives (FADMPs). The FADMPs proposed in this paper is an online learning and prediction algorithm which is able to online estimate the fundamental frequency of human joint trajectory, learn the shape of joint trajectory and predict the future joint trajectory during walking. The proposed active walking assistance control framework based on FADMPs is a model-based controller which relies on the human joint torque estimation. The assistance torque provided by exoskeleton is estimated by human lower limb inverse dynamics model which is sensitive to the noise in the joint motion trajectory. To estimate a smooth joint torque profile, the joint motion trajectory must be filtered first by a lowpass filter. However, lowpass filter will introduce an inevitable phase delay in the filtered trajectory. Both simulations and experiments in this paper show that the phase delay has a significant effect on the performance of exoskeleton active assistance. The active assistant control framework based on FADMPs aims at improving the performance of active assistance control by compensating the phase delay. Both simulations and experiments on active walking assistance control show that the performance of active assistance control can be further improved when the phase delay in the filtered trajectory is compensated by FADMPs.

The exoskeleton expansion: improving walking and running economy

Since the early 2000s, researchers have been trying to develop lower-limb exoskeletons that augment human mobility by reducing the metabolic cost of walking and running versus without a device. In 2013, researchers finally broke this 'metabolic cost barrier'. We analyzed the literature through December 2019, and identified 23 studies that demonstrate exoskeleton designs that improved human walking and running economy beyond capable without a device. Here, we reviewed these studies and highlighted key innovations and techniques that enabled these devices to surpass the metabolic cost barrier and steadily improve user walking and running economy from 2013 to nearly 2020. These studies include, physiologically-informed targeting of lower-limb joints; use of off-board actuators to rapidly prototype exoskeleton controllers; mechatronic designs of both active and passive systems; and a renewed focus on human-exoskeleton interface design. Lastly, we highlight emerging trends that we anticipate will further augment wearable-device performance and pose the next grand challenges facing exoskeleton technology for augmenting human mobility.

State-of-the-art research in robotic hip exoskeletons: A general review

Ageing population is now a global challenge, where physical deterioration is the common feature in elderly people. In addition, the diseases, such as spinal cord injury, stroke, and injury, could cause a partial or total loss of the ability of human locomotion. Thus, assistance is necessary for them to perform safe activities of daily living. Robotic hip exoskeletons are able to support ambulatory functions in elderly people and provide rehabilitation for the patients with gait impairments. They can also augment human performance during normal walking, loaded walking, and manual handling of heavy-duty tasks by providing assistive force/torque. In this article, a systematic review of robotic hip exoskeletons is presented, where biomechanics of the human hip joint, pathological gait pattern, and common approaches to the design of robotic hip exoskeletons are described. Finally, limitations of the available robotic hip exoskeletons and their possible future directions are discussed, which could serve a useful reference for the engineers and researchers to develop robotic hip exoskeletons with practical and plausible applications in geriatric orthopaedics.

The translational potential of this article

The past decade has witnessed a remarkable progress in research and development of robotic hip exoskeletons. Our aim is to summarize recent developments of robotic hip exoskeletons for the engineers, clinician scientists and rehabilitation personnel to develop efficient robotic hip exoskeletons for practical and plausible applications.

Perspectives and Challenges in Robotic Neurorehabilitation

The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.