Rationale, Implementation and Evaluation of Assistive Strategies for an Active Back-Support Exoskeleton

Bilateral Back Extensor Exosuit for multidimensional assistance and prevention of spinal injuries

Lumbar spine injuries resulting from heavy or repetitive lifting remain a prevalent concern in workplaces. Back-support devices have been developed to mitigate these injuries by aiding workers during lifting tasks. However, existing devices often fall short in providing multidimensional force assistance for asymmetric lifting, an essential feature for practical workplace use. In addition, validation of device safety across the entire human spine has been lacking. This paper introduces the Bilateral Back Extensor Exosuit (BBEX), a robotic back-support device designed to address both functionality and safety concerns. The design of the BBEX draws inspiration from the anatomical characteristics of the human spine and back extensor muscles. Using a multi-degree-of-freedom architecture and serially connected linear actuators, the device's components are strategically arranged to closely mimic the biomechanics of the human spine and back extensor muscles. To establish the efficacy and safety of the BBEX, a series of experiments with human participants was conducted. Eleven healthy male participants engaged in symmetric and asymmetric lifting tasks while wearing the BBEX. The results confirm the ability of the BBEX to provide effective multidimensional force assistance. Moreover, comprehensive safety validation was achieved through analyses of muscle fatigue in the upper and the lower erector spinae muscles, as well as mechanical loading on spinal joints during both lifting scenarios. By seamlessly integrating functionality inspired by human biomechanics with a focus on safety, this study offers a promising solution to address the persistent challenge of preventing lumbar spine injuries in demanding work environments.

Dynamic and Static Assistive Strategies for a Tailored Occupational Back-Support Exoskeleton: Assessment on Real Tasks Carried Out by Railway Workers

This study on occupational back-support exoskeletons performs a laboratory evaluation of realistic tasks with expert workers from the railway sector. Workers performed both a static task and a dynamic task, each involving manual material handling (MMH) and manipulating loads of 20 kg, in three conditions: without an exoskeleton, with a commercially available passive exoskeleton (Laevo v2.56), and with the StreamEXO, an active back-support exoskeleton developed by our institute. Two control strategies were defined, one for dynamic tasks and one for static tasks, with the latter determining the upper body's gravity compensation through the Model-based Gravity Compensation (MB-Grav) approach. This work presents a comparative assessment of the performance of active back support exoskeletons versus passive exoskeletons when trialled in relevant and realistic tasks. After a lab characterization of the MB-Grav strategy, the experimental assessment compared two back-support exoskeletons, one active and one passive. The results showed that while both devices were able to reduce back muscle activation, the benefits of the active device were triple those of the passive system regarding back muscle activation (26% and 33% against 9% and 11%, respectively), while the passive exoskeleton hindered trunk mobility more than the active mechanism.

Control strategies for trunk exoskeletons based on motion intent recognition: A review

BACKGROUND

Wearable trunk exoskeletons hold immense potential in fields such as healthcare and industry. Previous research has indicated that intention recognition control plays a crucial role in users' daily use of exoskeletons.

OBJECTIVE

This review aims to discuss the characteristics of intention recognition control schemes for intelligent trunk exoskeletons under different control objectives over the past decade.

METHODS

Considering the relatively late development of active trunk exoskeletons, we selected papers published in the last decade (2013 to 2023) from the Web of Science, PubMed, and IEEE Xplore databases. In total, 50 articles were selected and examined based on four control objectives.

RESULTS

In general, we found that researchers focus on trunk exoskeleton devices designed for assistance and motor augmentation, which rely more on body movement signals as a source for intention recognition.

CONCLUSION

Based on these results, we identify and discuss several promising research directions that may help to attain a widely accepted control methods, thereby advancing further development of trunk exoskeleton technology.

A Neuromechanical Model-Based Strategy to Estimate the Operator's Payload in Industrial Lifting Tasks

One of the main technological barriers hindering the development of active industrial exoskeleton is today represented by the lack of suitable payload estimation algorithms characterized by high accuracy and low calibration time. The knowledge of the payload enables exoskeletons to dynamically provide the required assistance to the user. This work proposes a payload estimation methodology based on personalized Electromyography-driven musculoskeletal models (pEMS) combined with a payload estimation method we called "delta torque" that allows the decoupling of payload dynamical properties from human dynamical properties. The contribution of this work lies in the conceptualization of such methodology and its validation considering human operators during industrial lifting tasks. With respect to existing solutions often based on machine learning, our methodology requires smaller training datasets and can better generalize across different payloads and tasks. The proposed payload estimation methodology has been validated on lifting tasks with 0kg, 5kg, 10kg and 15kg, resulting in an average MAE of about 1.4 Kg. Even if 5kg and 10Kg lifting tasks were out of the training set, the MAE related to these tasks are 1.6 kg and 1.1 kg, respectively, demonstrating the generalizing property of the proposed methodology. To the best of the authors' knowledge, this is the first time that an EMG-driven model-based approach is proposed for human payload estimation.

Trends in Robotics Research in Occupational Safety and Health: A Scientometric Analysis and Review

Robots have been deployed in workplaces to assist, work alongside, or collaborate with human workers on various tasks, which introduces new occupational safety and health hazards and requires research efforts to address these issues. This study investigated the research trends for robotic applications in occupational safety and health. The scientometric method was applied to quantitatively analyze the relationships between robotics applications in the literature. The keywords "robot", "occupational safety and health", and their variants were used to find relevant articles. A total of 137 relevant articles published during 2012-2022 were collected from the Scopus database for this analysis. Keyword co-occurrence, cluster, bibliographic coupling, and co-citation analyses were conducted using VOSviewer to determine the major research topics, keywords, co-authorship, and key publications. Robot safety, exoskeletons and work-related musculoskeletal disorders, human-robot collaboration, and monitoring were four popular research topics in the field. Finally, research gaps and future research directions were identified based on the analysis results, including additional efforts regarding warehousing, agriculture, mining, and construction robots research; personal protective equipment; and multi-robot collaboration. The major contributions of the study include identifying the current trends in the application of robotics in the occupational safety and health discipline and providing pathways for future research in this discipline.

Efficacy of passive upper-limb exoskeletons in reducing musculoskeletal load associated with overhead tasks

Overhead work can pose substantial musculoskeletal stress in many industrial settings. This study aimed to evaluate the efficacy of passive upper-limb exoskeletons in reducing muscular activity and subjective discomfort ratings. In a repeated-measures laboratory experiment, 20 healthy male participants performed 10-min drilling tasks with and without two passive upper-limb exoskeletons (VEX and Airframe). During the tasks, muscle activity in eight muscles (upper limb - upper trapezius, middle deltoid, biceps brachii, triceps brachii; low back - erector spinae; lower limb - rectus femoris, biceps femoris, tibialis anterior) was collected using electromyography as a physical exertion measure. Subjective discomfort rating in six body parts was measured using the Borg's CR-10 scale. The results showed that muscle activity (especially in the upper-limb muscles) was significantly decreased by 29.3-58.1% with both exoskeletons compared to no exoskeleton condition. The subjective discomfort ratings showed limited differences between the conditions. These findings indicate that passive upper-limb exoskeletons may have potential as an effective intervention to reduce muscular loading and physical exertion during overhead work.

Active exoskeleton reduces erector spinae muscle activity during lifting

Musculoskeletal disorders (MSD) are a widespread problem, often regarding the lumbar region. Exoskeletons designed to support the lower back could be used in physically demanding professions with the intention of reducing the strain on the musculoskeletal system, e.g., by lowering task-related muscle activation. The present study aims to investigate the effect of an active exoskeleton on back muscle activity when lifting weights. Within the framework of the study, 14 subjects were asked to lift a 15 kg box with and without an active exoskeleton which allows the adjustment of different levels of support, while the activity of their M. erector spinae (MES) was measured using surface electromyography. Additionally, the subjects were asked about their overall rating of perceived exertion (RPE) during lifting under various conditions. Using the exoskeleton with the maximum level of support, the muscle activity was significantly lower than without exoskeleton. A significant correlation was found between the exoskeleton's support level and the reduction of MES activity. The higher the support level, the lower the observed muscle activity. Furthermore, when lifting with the maximum level of support, RPE was found to be significantly lower than without exoskeleton too. A reduction in the MES activity indicates actual support for the movement task and might indicate lower compression forces in the lumbar region. It is concluded that the active exoskeleton supports people noticeably when lifting heavy weights. Exoskeletons seem to be a powerful tool for reducing load during physically demanding jobs and thus, their use might be helpful in lowering the risk of MSD.

IMU-based human activity recognition and payload classification for low-back exoskeletons

Nowadays, work-related musculoskeletal disorders have a drastic impact on a large part of the world population. In particular, low-back pain counts as the leading cause of absence from work in the industrial sector. Robotic exoskeletons have great potential to improve industrial workers' health and life quality. Nonetheless, current solutions are often limited by sub-optimal control systems. Due to the dynamic environment in which they are used, failure to adapt to the wearer and the task may be limiting exoskeleton adoption in occupational scenarios. In this scope, we present a deep-learning-based approach exploiting inertial sensors to provide industrial exoskeletons with human activity recognition and adaptive payload compensation. Inertial measurement units are easily wearable or embeddable in any industrial exoskeleton. We exploited Long-Short Term Memory networks both to perform human activity recognition and to classify the weight of lifted objects up to 15 kg. We found a median F1 score of [Formula: see text] (activity recognition) and [Formula: see text] (payload estimation) with subject-specific models trained and tested on 12 (6M-6F) young healthy volunteers. We also succeeded in evaluating the applicability of this approach with an in-lab real-time test in a simulated target scenario. These high-level algorithms may be useful to fully exploit the potential of powered exoskeletons to achieve symbiotic human-robot interaction.

A systematic literature review of evidence for the use of assistive exoskeletons in defence and security use cases

Advances in assistive exoskeleton technology, and a boom in related scientific literature, prompted a need to review the potential use of exoskeletons in defence and security. A systematic review examined the evidence for successful augmentation of human performance in activities deemed most relevant to military tasks. Categories of activities were determined a priori through literature scoping and Human Factors workshops with military stakeholders. Workshops identified promising opportunities and risks for integration of exoskeletons into military use cases. The review revealed promising evidence for exoskeletons' capacity to assist with load carriage, manual lifting, and working with tools. However, the review also revealed significant gaps in exoskeleton capabilities and likely performance levels required in the use case scenarios. Consequently, it was recommended that a future roadmap for introducing exoskeletons to military environments requires development of performance criteria for exoskeletons that can be used to implement a human-centred approach to research and development.

Design and evaluation of a parallel mechanism for wearable lumbar support exoskeleton

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are a serious problem, and manual material handling (MMH) tasks remain common in most industries. Thus, a lightweight and active exoskeleton is needed.

OBJECTIVE

A facile, convenient, multifunctional, wearable lumbar support exoskeleton (WLSE) was proposed to relieve the muscular tension and fatigue especially in the way of WMSDs.

METHOD

Based on the screw theory and virtual power principle, the parallel structure was used as the scheme choice for selecting suitable actuators and joints. The exoskeleton, which was characterized by high adaptability and complied with human motion, included branch unit, mechanism branch units, control units and sensors. Furthermore, using surface electromyography (sEMG) signal evaluation, an experiment which contains several tests was designed to evaluate whether WLSE had effect on supporting and reliving muscular fatigue while lifting-up different weight of objects under wearing without traction (T1) and wearing with traction (T2).

RESULTS

Data collected were analyzed statistically by the two-way ANOVA. It showed that the RMS of sEMG was obviously reduced while carrying the heavy objects with WLSE under T2, and the MF values always performed the decreasing trend in T2/T1.

CONCLUSION

This paper proposed a facile, convenient, multifunctional WLSE. From the results, it was concluded that the WLSE was significantly effective in reliving the muscle tension and muscle fatigue while lifting to prevent and treat WMSDs.

sEMG-Triggered Fast Assistance Strategy for a Pneumatic Back Support Exoskeleton

To prevent lower back pain (LBP) in the industrial workplace, various powered back support exoskeletons (BSEs) have been developed. However, conventional kinematics-triggered assistance (KA) strategies induce latency, degrading assistance efficiency. Therefore, we proposed and experimentally evaluated a surface electromyography (sEMG)-triggered assistance (EA) strategy. Nine healthy subjects participated in the lifting experiments: 1) external loads test, 2) extra latency test, and 3) repetitive lifting test. In the external loads test, subject performed lifting with four different external loads (0 kg, 7.5 kg, 15 kg, and 22.5 kg). The assistance was triggered earlier by EA compared to KA from 114 ms to 202 ms, 163 ms to 269 ms for squat and stoop lifting respectively, as external loads increased from 0 kg to 22.5 kg. In the extra latency test, the effects of extra latency (manual switch, 0 ms, 100 ms and 200 ms) in EA on muscle activities were investigated. Muscle activities were minimized in the fast assistance (0 ms and 100 ms) condition and increased with extra latency. In the repetitive lifting test, the EA strategy significantly reduced L1 muscle fatigue by 70.4% in stoop lifting, compared to KA strategy. Based on the experimental results, we concluded that fast assistance triggered by sEMG improved assistance efficiency in BSE and was particularly beneficial in heavy external loads situations. The proposed assistive strategy can be used to prevent LBP by reducing back muscle fatigue and is easily applicable to various industrial exoskeleton applications.

Design of a Compact Energy Storage with Rotary Series Elastic Actuator for Lumbar Support Exoskeleton

Lumbar support exoskeletons with active and passive actuators are currently the cutting-edge technology for preventing back injuries in workers while lifting heavy objects. However, many challenges still exist in both types of exoskeletons, including rigid actuators, risks of human–robot interaction, high battery consumption, bulky design, and limited assistance. In this paper, the design of a compact, lightweight energy storage device combined with a rotary series elastic actuator (ES-RSEA) is proposed for use in a lumbar support exoskeleton to increase the level of assistance and exploit the human bioenergy during the two stages of the lifting task. The energy storage device takes the responsibility to store and release passive mechanical energy while RSEA provides excellent compliance and prevents injury from the human body’s undesired movement. The experimental tests on the spiral spring show excellent linear characteristics (above 99%) with an actual spring stiffness of 9.96 Nm/rad. The results demonstrate that ES-RSEA can provide maximum torque assistance in the ascent phase with 66.6 Nm while generating nearly 21 Nm of spring torque during descent without turning on the DC motor. Ultimately, the proposed design can maximize the energy storage of human energy, exploit the biomechanics of lifting tasks, and reduce the burden on human effort to perform lifting tasks.

Flexible Control Strategy for Upper-Limb Rehabilitation Exoskeleton Based on Virtual Spring Damper Hypothesis

The focus of this work is to design a control strategy with the dynamic characteristics of spring damping to realize the virtual flexibility and softness of a rigid-joint exoskeleton without installing real, physical elastic devices. The basic idea of a “virtual softening control strategy” for a single rigid joint is that a virtual spring damper (VSD) is installed between the motor and the output shaft. By designing the control signal of the motor, the torque output of the joint actuator is softened so that the output has the characteristics of elasticity and variable stiffness. The transfer velocity profile of human limbs reaching from one posture to another always presents as bell-shaped. According to this characteristic, we constructed a trajectory planning method for a point-to-point position-tracking controller based on a normal distribution function, and it was successfully applied to the control of 5-DoF upper-limb rehabilitation exoskeleton. A multi-joint cooperative flexible controller based on the virtual spring damper hypothesis (VSDH) was successfully applied to solve the constrained control problem of the exoskeletons and the self-motion problem caused by redundant degrees of freedom (DoFs). The stability of the closed-loop controlled system is theoretically proven by use of the scalar energy function gradient method and the Riemann metric convergence analysis method.

Exoskeleton Application to Military Manual Handling Tasks

OBJECTIVE

The aim of this review was to determine how exoskeletons could assist Australian Defence Force personnel with manual handling tasks.

BACKGROUND

Musculoskeletal injuries due to manual handling are physically damaging to personnel and financially costly to the Australian Defence Force. Exoskeletons may minimize injury risk by supporting, augmenting, and/or amplifying the user's physical abilities. Exoskeletons are therefore of interest in determining how they could support the unique needs of military manual handling personnel.

METHOD

Industrial and military exoskeleton studies from 1990 to 2019 were identified in the literature. This included 67 unique exoskeletons, for which Information about their current state of development was tabulated.

RESULTS

Exoskeleton support of manual handling tasks is largely through squat/deadlift (lower limb) systems (64%), with the proposed use case for these being load carrying (42%) and 78% of exoskeletons being active. Human-exoskeleton analysis was the most prevalent form of evaluation (68%) with reported reductions in back muscle activation of 15%-54%.

CONCLUSION

The high frequency of citations of exoskeletons targeting load carrying reflects the need for devices that can support manual handling workers. Exoskeleton evaluation procedures varied across studies making comparisons difficult. The unique considerations for military applications, such as heavy external loads and load asymmetry, suggest that a significant adaptation to current technology or customized military-specific devices would be required for the introduction of exoskeletons into a military setting.

APPLICATION

Exoskeletons in the literature and their potential to be adapted for application to military manual handling tasks are presented.

Exoskeletons for workers: A case series study in an enclosures production line

This case-series study aims to investigate the effects of a passive shoulder support exoskeleton on experienced workers during their regular work shifts in an enclosures production site. Experimental activities included three sessions, two of which were conducted in-field (namely, at two workstations of the painting line, where panels were mounted and dismounted from the line; each session involved three participants), and one session was carried out in a realistic simulated environment (namely, the workstations were recreated in a laboratory; this session involved four participants). The effect of the exoskeleton was evaluated through electromyographic activity and perceived effort. After in-field sessions, device usability and user acceptance were also assessed. Data were reported individually for each participant. Results showed that the use of the exoskeleton reduced the total shoulder muscular activity compared to normal working conditions, in all subjects and experimental sessions. Similarly, the use of the exoskeleton resulted in reductions of the perceived effort in the shoulder, arm, and lower back. Overall, participants indicated high usability and acceptance of the device. This case series invites larger validation studies, also in diverse operational contexts.

Methodologies for evaluating exoskeletons with industrial applications

Industrial exoskeletons are globally developed, explored, and increasingly implemented in industrial workplaces. Multiple technical, physical, and psychological aspects should be assessed prior to their daily application in various occupational environments. The methodology for evaluating these aspects is not standardised and differs in terms of focussed research objectives, used types of analyses, applied testing procedures, and use cases. The aim of this paper is to provide a matrix comparing the prevalence of different types of analyses combined with their respective research objective(s). A systematic review in the database 'Web of Science' identified 74 studies, mainly in laboratory settings, with a focus on short-term effects as well as with male-dominated samples being low representative for industrial workforces. The conducted evaluation methodologies are further discussed and compared in terms of testing procedure, sample, and research objectives. Finally, relevant aspects for prospectively evaluating industrial exoskeletons in a more harmonised and comprehensive way are suggested. Practitioner summary: Industrial exoskeletons are still inconsistently and insufficiently evaluated in scientific studies, which might hamper the comparability of systems, threaten the human health, and block an iterative system optimisation. Thus, a comprehensive evaluation methodology is needed with harmonised and multicriteria types of analyses.

Systematic Review of Back-Support Exoskeletons and Soft Robotic Suits

Lower back pain and musculoskeletal injuries are serious concerns for workers subjected to physical workload and manual material handling tasks. Spine assistive exoskeletons are being developed to support the spine and distribute the spine load. This article presents a detailed up-to-date review on the back support exoskeletons by discussing their type (Active/Passive), structure (Rigid/Soft), power transmission methods, weight, maximum assistive force, battery technologies, tasks (lifting, bending, stooping work), kinematic compatibility and other important features. This article also assesses the back support exoskeletons in terms of their ability to reduce the physical load on the spine. By reviewing functional and structural characteristics, the goal is to increase communication and realization among ergonomics practitioners, developers, customers, and factory workers. The search resulted in reviewing 34 exoskeletons of which 16 were passive and 18 were active. In conclusion, back support exoskeletons have immense potential to significantly reduce the factors regarding work-related musculoskeletal injuries. However, various technical challenges and a lack of established safety standards limit the wide adaptation of exoskeletons in industry.

Simultaneously varying back stiffness and trunk compression in a passive trunk exoskeleton during different activities: A pilot study

Passive trunk exoskeletons support the human body with mechanical elements like springs and trunk compression, allowing them to guide motion and relieve the load on the spine. However, to provide appropriate support, elements of the exoskeleton (e.g., degree of compression) should be intelligently adapted to the current task. As it is not currently clear how adjusting different exoskeleton elements affects the wearer, this study preliminarily examines the effects of simultaneously adjusting both exoskeletal spinal column stiffness and trunk compression in a passive trunk exoskeleton. Six participants performed four dynamic tasks (walking, sit-to-stand, lifting a 20-lb box, lifting a 40-lb box) and experienced unexpected perturbations both without the exoskeleton and in six exoskeleton configurations corresponding to two compression levels and three stiffness levels. While results are preliminary due to the small sample size and relatively small increases in stiffness, they indicate that both compression and stiffness may affect kinematics and electromyography, that the effects may differ between activities, and that there may be interaction effects between stiffness and compression. As the next step, we will conduct a larger study with the same protocol more participants and larger stiffness increases to systematically evaluate the effects of different exoskeleton characteristics on the wearer.Clinical Relevance- Trunk exoskeletons can support wearers during a variety of different tasks, but their configuration may need to be intelligently adjusted to provide appropriate support. This pilot study provides information about the effects of exoskeleton back stiffness and trunk compression on the wearer, which can be used as a basis for more effective device design and usage.

Toward Real-Time Detection of Object Lifting Using Wearable Inertial Measurement Units

Back injuries and other occupational injuries are common in workers who engage in long, arduous physical labor. The risk of these injuries could be reduced using assistive devices that automatically detect an object lifting motion and support the user while they perform the lift; however, such devices must be able to detect the lifting motion as it occurs. We thus developed a system to detect the start and end of a lift (performed as a stoop or squat) in real time based on pelvic angle and the distance between the user's hands and the user's center of mass. The measurements were input to an algorithm that first searches for hand-center distance peaks in a sliding window, then checks the pelvic displacement angle to verify lift occurrence. The approach was tested with 5 participants, who performed a total of 100 lifts of four different types. The times of actual lifts were determined by manual video annotation. The median time error (absolute difference between detected and actual occurrence time) for lifts that were not false negatives was 0.11 s; a lift was considered a false negative if it was not detected within two seconds of it actually occurring. Furthermore, 95% of lifts that were detected occurred within 0.28 s of actual occurrence. This shows that it is possible to reliably detect lifts in real time based on the pelvic displacement angle and the distance between the user's hands and their center of mass.

Comparing the risk of low-back injury using model-based optimization: Improved technique versus exoskeleton assistance

Although wearable robotic systems are designed to reduce the risk of low-back injury, it is unclear how effective assistance is, compared to improvements in lifting technique. We use a two-factor block study design to simulate how effective exoskeleton assistance and technical improvements are at reducing the risk of low-back injury when compared to a typical adult lifting a box. The effects of assistance are examined by simulating two different models: a model of just the human participant, and a model of the human participant wearing the SPEXOR exoskeleton. The effects of lifting technique are investigated by formulating two different types of optimal control problems: a least-squares problem which tracks the human participant's lifting technique, and a minimization problem where the model is free to use a different movement. Different lifting techniques are considered using three different cost functions related to risk factors for low-back injury: cumulative low-back load (CLBL), peak low-back load (PLBL), and a combination of both CLBL and PLBL (HYB). The results of our simulations indicate that an exoskeleton alone can make modest reductions in both CLBL and PLBL. In contrast, technical improvements alone are effective at reducing CLBL, but not PLBL. The largest reductions in both CLBL and PLBL occur when both an exoskeleton and technical improvements are used. While all three of the lifting technique cost functions reduce both CLBL and PLBL, the HYB cost function offers the most balanced reduction in both CLBL and PLBL.

Versatile and non-versatile occupational back-support exoskeletons: A comparison in laboratory and field studies

Assistive strategies for occupational back-support exoskeletons have focused, mostly, on lifting tasks. However, in occupational scenarios, it is important to account not only for lifting but also for other activities. This can be done exploiting human activity recognition algorithms that can identify which task the user is performing and trigger the appropriate assistive strategy. We refer to this ability as exoskeleton versatility. To evaluate versatility, we propose to focus both on the ability of the device to reduce muscle activation (efficacy) and on its interaction with the user (dynamic fit). To this end, we performed an experimental study involving healthy subjects replicating the working activities of a manufacturing plant. To compare versatile and non-versatile exoskeletons, our device, XoTrunk, was controlled with two different strategies. Correspondingly, we collected muscle activity, kinematic variables and users' subjective feedbacks. Also, we evaluated the task recognition performance of the device. The results show that XoTrunk is capable of reducing muscle activation by up to in lifting and in carrying. However, the non-versatile control strategy hindered the users' natural gait (e.g., reduction of hip flexion), which could potentially lower the exoskeleton acceptance. Detecting carrying activities and adapting the control strategy, resulted in a more natural gait (e.g., increase of hip flexion). The classifier analyzed in this work, showed promising performance (online accuracy > 91%). Finally, we conducted 9 hours of field testing, involving four users. Initial subjective feedbacks on the exoskeleton versatility, are presented at the end of this work.

Occupational exoskeletons: A roadmap toward large-scale adoption. Methodology and challenges of bringing exoskeletons to workplaces

The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.

Effects of industrial back-support exoskeletons on body loading and user experience: an updated systematic review

This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at addressing the recent findings regarding objective (e.g. body loading, user performance) and subjective evaluations (e.g. user satisfaction), potential side effects, and methodological aspects of usability testing. Thirteen studies of active and twenty of passive exoskeletons were identified. The exoskeletons were tested during lifting and bending tasks, predominantly in laboratory settings and among healthy young men. In general, decreases in participants' back-muscle activity, peak L5/S1 moments and spinal compression forces were reported. User endurance during lifting and static bending improved, but performance declined during tasks that required increased agility. The overall user satisfaction was moderate. Some side effects were observed, including increased abdominal/lower-limb muscle activity and changes in joint angles. A need was identified for further field studies, involving industrial workers, and reflecting actual work situations. Practitioner summary: Due to increased research activity in the field, a systematic review was performed of recent studies on industrial back-support exoskeletons, addressing objective and subjective evaluations, side effects, and methodological aspects of usability testing. The results indicate the efficiency of exoskeletons in back-load reduction and a need for further studies in real work situations. Abbrevaitions: BB: biceps brachii; BF: biceps femoris; CoM: centre of mass; DA: deltoideus anterior; EMG: electromyography; ES: erector spinae; ES-C: erector spinae-cervical; ESI: erector spinae iliocostalis; ESI-L: erector spinae iliocostalis-lumborum; ESL: erector spinae longissimus; ES-L: erector spinae-lumbar; ESL-L: erector spinae longissimus-lumborum; ESL-T: erector spinae longissimus-thoracis; ES-T: erector spinae-thoracic; GM: glutaeus maximus; LBP: low back pain; LD: latissimus dorsi; LPD: local perceived discomfort scale; LPP: local perceived pressure scale; MS: multifidus spinae; MSD: musculoskeletal disorder; M-SFS: modified spinal function sort; NMV: no mean value provided; OA: obliquus abdominis (internus and externus); OEA: obliquus externus abdominis; OIA : obliquus internus abdominis; RA: rectus abdominis; RF: rectus femoris; RoM: range of motion; SUS: system usability scale; T: trapezius (pars Ascendens and Descendens); TA: trapezius pars ascendens; TC: mid-cervical trapezius; TD: trapezius pars descendens; VAS: visual analog scale; VL: vastus lateralis; VM: vastus medialis.

Equivalent Weight: Connecting Exoskeleton Effectiveness with Ergonomic Risk during Manual Material Handling

Occupational exoskeletons are becoming a concrete solution to mitigate work-related musculoskeletal disorders associated with manual material handling activities. The rationale behind this study is to search for common ground for exoskeleton evaluators to engage in dialogue with corporate Health & Safety professionals while integrating exoskeletons with their workers. This study suggests an innovative interpretation of the effect of a lower-back assistive exoskeleton and related performances that are built on the benefit delivered through reduced activation of the erector spinae musculature. We introduce the concept of "equivalent weight" as the weight perceived by the wearer, and use this to explore the apparent reduced effort needed when assisted by the exoskeleton. Therefore, thanks to this assistance, the muscles experience a lower load. The results of the experimental testing on 12 subjects suggest a beneficial effect for the back that corresponds to an apparent reduction of the lifted weight by a factor of 37.5% (the perceived weight of the handled objects is reduced by over a third). Finally, this analytical method introduces an innovative approach to quantify the ergonomic benefit introduced by the exoskeletons' assistance. This aims to assess the ergonomic risk to support the adoption of exoskeletons in the workplace.

Evaluation of an acceleration-based assistive strategy to control a back-support exoskeleton for manual material handling

To reduce the incidence of occupational musculoskeletal disorders, back-support exoskeletons are being introduced to assist manual material handling activities. Using a device of this type, this study investigates the effects of a new control strategy that uses the angular acceleration of the user's trunk to assist during lifting tasks. To validate this new strategy, its effectiveness was experimentally evaluated relative to the condition without the exoskeleton as well as against existing strategies for comparison. Using the exoskeleton during lifting tasks reduced the peak compression force on the L5S1 disc by up to 16%, with all the control strategies. Substantial differences between the control strategies in the reductions of compression force, lumbar moment and back muscle activation were not observed. However, the new control strategy reduced the movement speed less with respect to the existing strategies. Thanks to improved timing in the assistance in relation to the typical dynamics of the target task, the hindrance to typical movements appeared reduced, thereby promoting intuitiveness and comfort.

Design and preliminary evaluation of a flexible exoskeleton to assist with lifting

We present a passive (unpowered) exoskeleton that assists the back during lifting. Our exoskeleton uses carbon fiber beams as the sole means to store energy and return it to the wearer. To motivate the design, we present general requirements for the design of a lifting exoskeleton, including calculating the required torque to support the torso for people of different weights and heights. We compare a number of methods of energy storage for exoskeletons in terms of mass, volume, hysteresis, and cycle life. We then discuss the design of our exoskeleton, and show how the torso assembly leads to balanced forces. We characterize the energy storage in the exoskeleton and the torque it provides during testing with human subjects. Ten participants performed freestyle, stoop, and squat lifts. Custom image processing software was used to extract the curvature of the carbon fiber beams in the exoskeleton to determine the stored energy. During freestyle lifting, it stores an average of 59.3 J and provides a peak torque of 71.7 Nm.

Applicability of an Active Back-Support Exoskeleton to Carrying Activities

Occupational back-support exoskeletons are becoming a more and more common solution to mitigate work-related lower-back pain associated with lifting activities. In addition to lifting, there are many other tasks performed by workers, such as carrying, pushing, and pulling, that might benefit from the use of an exoskeleton. In this work, the impact that carrying has on lower-back loading compared to lifting and the need to select different assistive strategies based on the performed task are presented. This latter need is studied by using a control strategy that commands for constant torques. The results of the experimental campaign conducted on 9 subjects suggest that such a control strategy is beneficial for the back muscles (up to 12% reduction in overall lumbar activity), but constrains the legs (around 10% reduction in hip and knee ranges of motion). Task recognition and the design of specific controllers can be exploited by active and, partially, passive exoskeletons to enhance their versatility, i.e., the ability to adapt to different requirements.

The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints

OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.

Exoskeleton kinematic design robustness: An assessment method to account for human variability

Exoskeletons are wearable devices intended to physically assist one or multiple human joints in executing certain activities. From a mechanical point of view, they are kinematic structures arranged in parallel to the biological joints. In order to allow the users to move while assisted, it is crucial to avoid mobility restrictions introduced by the exoskeleton's kinematics. Passive degrees of freedom and other self-alignment mechanisms are a common option to avoid any restrictions. However, the literature lacks a systematic method to account for large inter- and intra-subject variability in designing and assessing kinematic chains. To this end, we introduce a model-based method to assess the kinematics of exoskeletons by representing restrictions in mobility as disturbances and undesired forces at the anchor points. The method makes use of robotic kinematic tools and generates useful insights to support the design process. Though an application on a back-support exoskeleton designed for lifting tasks is illustrated, the method can describe any type of rigid exoskeleton. A qualitative pilot trial is conducted to assess the kinematic model that proved to predict kinematic configurations associated to rising undesired forces recorded at the anchor points, that give rise to mobility restrictions and discomfort on the users.

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.

Load Position and Weight Classification during Carrying Gait Using Wearable Inertial and Electromyographic Sensors

Lifting and carrying heavy objects is a major aspect of physically intensive jobs. Wearable sensors have previously been used to classify different ways of picking up an object, but have seen only limited use for automatic classification of load position and weight while a person is walking and carrying an object. In this proof-of-concept study, we thus used wearable inertial and electromyographic sensors for offline classification of different load positions (frontal vs. unilateral vs. bilateral side loads) and weights during gait. Ten participants performed 19 different carrying trials each while wearing the sensors, and data from these trials were used to train and evaluate classification algorithms based on supervised machine learning. The algorithms differentiated between frontal and other loads (side/none) with an accuracy of 100%, between frontal vs. unilateral side load vs. bilateral side load with an accuracy of 96.1%, and between different load asymmetry levels with accuracies of 75-79%. While the study is limited by a lack of electromyographic sensors on the arms and a limited number of load positions/weights, it shows that wearable sensors can differentiate between different load positions and weights during gait with high accuracy. In the future, such approaches could be used to control assistive devices or for long-term worker monitoring in physically demanding occupations.

Actuation Selection for Assistive Exoskeletons: Matching Capabilities to Task Requirements

Selecting actuators for assistive exoskeletons involves decisions in which designers usually face contrasting requirements. While certain choices may depend on the application context or design philosophy, it is generally desirable to avoid oversizing actuators in order to obtain more lightweight and transparent systems, ultimately promoting the adoption of a given device. In many cases, the torque and power requirements can be relaxed by exploiting the contribution of an elastic element acting in mechanical parallel. This contribution considers one such case and introduces a methodology for the evaluation of different actuator choices resulting from the combination of different motors, reduction gears, and parallel stiffness profiles, helping to match actuator capabilities to the task requirements. Such methodology is based on a graphical tool showing how different design choices affect the actuator as a whole. To illustrate the approach, a back-support exoskeleton for lifting tasks is considered as a case study.

Kinematic and kinetic functional requirements for industrial exoskeletons for lifting tasks and overhead lifting

The aim of this study was to sample human kinematics and kinetics during simulated tasks to aid the design of industrial exoskeletons. Twelve participants performed two dynamic tasks; a simulated lifting task and an overhead lifting task. Based on the current data, to completely assist a worker with lifting loads up to 15 kg, hip actuators would need to supply up to 111 Nm of extensor torque at speeds up to 139°/s of extension velocity and 26°/s of flexion velocity. The actuators should allow the hip to extend to 11° and flex to 95°, and supply a power of 212 W. To completely assist workers lifting a 3 kg load overhead, actuators assisting shoulder flexion would need to supply up to 20 Nm of flexor torque at speeds up to 21°/s of extension velocity and 116°/s of flexion velocity. The actuators should also allow 67° of shoulder flexion and supply a power of 27 W. Practitioner summary: There is increasing interest in developing exoskeletons for industrial applications. This study details relevant kinetic and kinematic exposures for common production tasks, which can be used to inform functional requirements of industrial exoskeletons.AbbreviationsWMSD(s)work-related musculoskeletal disordersMMHmanual materials handlingDOFdegrees of freedomBLEEXBerkeley lower extremity exoskeletonLED(s)light emitting diodeRelrelativeHighlightsThis study sampled joint kinematic and kinetic activity to inform design of industrial exoskeletons.The study presents sample values to two types of common industrial tasks across the major joints as are often assisted.We also indicate considerations on which joints should be considered to be actively assisted.

A Pilot Study of Varying Thoracic and Abdominal Compression in a Reconfigurable Trunk Exoskeleton During Different Activities

OBJECTIVE

Trunk exoskeletons are a new technology with great promise for human rehabilitation, assistance and augmentation. However, it is unclear how different exoskeleton features affect the wearer's body during different activities. This study thus examined how varying a trunk exoskeleton's thoracic and abdominal compression affects trunk kinematics and muscle demand during several activities.

METHODS

We developed a trunk exoskeleton that allows thoracic and abdominal compression to be changed quickly and independently. To evaluate the effect of varying compression, 12 participants took part in a two-session study. In the first session, they performed three activities (walking, sit-to-stand, lifting a box). In the second session, they experienced unexpected perturbations while sitting. This was done both without the exoskeleton and in four exoskeleton configurations with different thoracic and abdominal compression levels. Trunk flexion angle, low back extension moment and the electromyogram of the erector spinae and rectus abdominis were measured in both sessions.

RESULTS

Different exoskeleton compression levels resulted in significantly different peak trunk flexion angles and peak electromyograms of the erector spinae. However, the effects of compression differed significantly between activities.

CONCLUSION

Our results indicate that a trunk exoskeleton's thoracic and abdominal compression affect the wearer's kinematics and muscle demand; furthermore, a single compression configuration is not appropriate for all activities.

SIGNIFICANCE

The study suggests that future trunk exoskeletons should either be able to vary their compression levels to suit different activities or should have the compression designed for a specific activity in order to be beneficial to the wearer.

Gaussian Mixture Models for Control of Quasi-Passive Spinal Exoskeletons

Research and development of active and passive exoskeletons for preventing work related injuries has steadily increased in the last decade. Recently, new types of quasi-passive designs have been emerging. These exoskeletons use passive viscoelastic elements, such as springs and dampers, to provide support to the user, while using small actuators only to change the level of support or to disengage the passive elements. Control of such devices is still largely unexplored, especially the algorithms that predict the movement of the user, to take maximum advantage of the passive viscoelastic elements. To address this issue, we developed a new control scheme consisting of Gaussian mixture models (GMM) in combination with a state machine controller to identify and classify the movement of the user as early as possible and thus provide a timely control output for the quasi-passive spinal exoskeleton. In a leave-one-out cross-validation procedure, the overall accuracy for providing support to the user was 86.72±0.86% (mean ± s.d.) with a sensitivity and specificity of 97.46±2.09% and 83.15±0.85% respectively. The results of this study indicate that our approach is a promising tool for the control of quasi-passive spinal exoskeletons.

Characterizing Human Box-Lifting Behavior Using Wearable Inertial Motion Sensors

Although several studies have used wearable sensors to analyze human lifting, this has generally only been done in a limited manner. In this proof-of-concept study, we investigate multiple aspects of offline lift characterization using wearable inertial measurement sensors: detecting the start and end of the lift and classifying the vertical movement of the object, the posture used, the weight of the object, and the asymmetry involved. In addition, the lift duration, horizontal distance from the lifter to the object, the vertical displacement of the object, and the asymmetric angle are computed as lift parameters. Twenty-four healthy participants performed two repetitions of 30 different main lifts each while wearing a commercial inertial measurement system. The data from these trials were used to develop, train, and evaluate the lift characterization algorithms presented. The lift detection algorithm had a start time error of 0.10 s ± 0.21 s and an end time error of 0.36 s ± 0.27 s across all 1489 lift trials with no missed lifts. For posture, asymmetry, vertical movement, and weight, our classifiers achieved accuracies of 96.8%, 98.3%, 97.3%, and 64.2%, respectively, for automatically detected lifts. The vertical height and displacement estimates were, on average, within 25 cm of the reference values. The horizontal distances measured for some lifts were quite different than expected (up to 14.5 cm), but were very consistent. Estimated asymmetry angles were similarly precise. In the future, these proof-of-concept offline algorithms can be expanded and improved to work in real-time. This would enable their use in applications such as real-time health monitoring and feedback for assistive devices.

Selecting the appropriate input variables in a regression approach to estimate actively generated muscle moments around L5/S1 for exoskeleton control

Back support exoskeletons are designed to prevent work-related low-back pain by reducing mechanical loading. For actuated exoskeletons, support based on moments actively produced by the trunk muscles appears a viable approach. The moment can be estimated by a biomechanical model. However, one of the main challenges here is the feasibility of recording the required input variables (kinematics, EMG data, ground reaction forces) to run the model. The aim of this study was to evaluate how accurate different selections of input variables can estimate actively generated moments around L5/S1. Different multivariate regression analyses were performed using a dataset consisting of spinal load, body kinematics and trunk muscle activation levels during different lifting conditions with and without an exoskeleton. The accuracy of the resulting models depended on the number and type of input variables and the regression model order. The current study suggests that third-order polynomial regression of EMG signals of one or two bilateral back muscle pairs together with exoskeleton trunk and hip angle suffices to accurately estimate the actively generated muscle moment around L5/S1, and thereby design a proper control system for back support exoskeletons.

Biomechanical analysis of common solid waste collection throwing techniques using OpenSim and an EMG-assisted solver

The solid waste collection industry is one of the most common occupations resulting in low back pain (LBP). Lumbar peak joint reaction forces and peak and integrated moments are strong correlates of LBP. To investigate these risks, this study compared three common waste collection throwing techniques of varying lumbar symmetry: the symmetric (SYM) technique, the asymmetric fixed stance (AFS) technique, and the asymmetric with pivot (AWP) technique. Lumbar moments and joint reaction loads were computed for throwing garbage bags of 3, 7, and 11 kg to quantify the effects that technique and object weight have on LBP risk. LBP risk factors were computed using a full-body musculoskeletal model in OpenSim. Muscle activations were estimated using two methods: the EMG-assisted method, which included electromyography data in the solution, and the conventional static optimization method, which did not. The EMG-assisted method more accurately reproduced measured muscle activation, resulting in significantly larger peak compressive and shear forces (p < 0.05) of magnitudes indicative of LBP risk. Risk factors associated with the SYM technique were either larger or not statistically different compared to the asymmetric techniques for the 3 kg condition; however, the opposite result occurred for the 7 and 11 kg conditions (p < 0.05). These results suggest using rapid, asymmetric techniques when handling lightweight objects and slower, symmetric techniques for heavier objects to reduce LBP risk during waste collection throwing techniques. Results indicating increased risk between asymmetric techniques were mostly inconclusive. As expected, increasing bag mass generally increased LBP risk factors, regardless of technique (p < 0.05).

Mechanical Sensing for Lower Limb Soft Exoskeletons: Recent Progress and Challenges

Soft exoskeletons hold promise for facilitating monitoring and assistance in case of light impairment and for prolonging independent living. In contrast to rigid material-based exoskeletons, they strongly demand for new approaches of soft sensing and actuation solutions. This chapter overviews soft exoskeletons in contrast to rigid exoskeletons and focuses on the recent advancements on the movement monitoring in lower limb soft exoskeletons. Compliant materials and soft tactile sensing approaches can be utilized to build smart sensorized garments for joint angle measurements (needed for both control and monitoring). However, currently there are still several open challenges derived from the needed close interaction between the human body and the soft exoskeleton itself, especially related to how sensing function and robustness are strongly affected by wearability, which will need to be overcome in the near future.

Assessment of an On-board Classifier for Activity Recognition on an Active Back-Support Exoskeleton

Despite the growing interest, the adoption of industrial exoskeletons may still be held back by technical limitations. To enhance versatility and promote adoption, one aspect of interest could be represented by the potential of active and quasi-passive devices to automatically distinguish different activities and adjust their assistive profiles accordingly. This contribution focuses on an active back-support exoskeleton and extends previous work proposing the use of a Support Vector Machine to classify walking, bending and standing. Thanks to the introduction of a new feature-forearm muscle activity-this study shows that it is possible to perform reliable online classification. As a consequence, the authors introduce a new hierarchically-structured controller for the exoskeleton under analysis.

Changes in Muscle Activity in Response to Assistive Force during Isometric Elbow Flexion

This study investigated the muscle activity and force variability in response to perturbation of assistive force during isometric elbow flexion. Sixteen healthy right-handed young men (age: 22.0 ± 1.1 years; height: 171.9 ± 4.8 cm; weight 68.4 ± 11.2 kg) were recruited and the muscle activity of biceps brachii and triceps brachii were assessed using surface electromyography. Workload force and assistive force applied on isometric elbow flexion significantly affected the changes in both biceps and triceps muscle activities. A higher assistive force was shown to result in reduced biceps muscle activity compared to the unassisted period. In contrast, the efficiency of the assistive force acting on the biceps decreased as the assistive force increased. In general, the force variability of the biceps muscle remained approximately the same at lower workload force conditions than that at higher workload force conditions. In conclusion, higher assistive force may not yield a higher performance efficiency in human-assistive force interaction.