State of the Art: Bipedal Robots for Lower Limb Rehabilitation

Effects of soft robotic exosuit on ambulation ability in stroke patients: a systematic review

BACKGROUND

Robot-assisted gait training is incorporated into guidelines for stroke rehabilitation. It is a promising tool combined with conventional therapy for low ambulatory patients. The heavy weight and bulky appearance of a robotic exoskeleton limits its practicality. On the other hand, soft robotic exosuit (SRE) based on its light weight and inconspicuous property, is better tolerated by patients in daily life. The aim of this study is to review the efficacy of the SRE with regard to walking ability and biomechanical properties in stroke patients.

METHODS

Electronic searches were carried out in PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database. Clinical trials that investigated the effectiveness of SREs on ambulation ability in patients with post-stroke hemiparesis were eligible. Qualitative data synthesis was subsequently performed.

RESULTS

Nine studies were identified as relevant, involving a total of 83 patients. For the assessment of SRE efficacy, outcome measures were walking ability and biomechanical properties. In terms of both immediate effect and training effect, SREs improved the walking speed, walking distance, peak ankle dorsiflexion angle during swing phase, peak paretic propulsion, stride length and compensated gait in stroke patients.

CONCLUSIONS

SRE improved the ambulation ability of stroke patients in terms of walking ability and biomechanical properties. The small number of studies limits the generalizability of interpretation. More controlled studies with better quality are required to reach a more solid conclusion on this issue.

Gait-Oriented Post-Stroke Rehabilitation Tasks Online Trajectory Generation for 1-DOF Hip Lower-Limb Exoskeleton

In the field of gait rehabilitation lower limb exoskeletons have received a lot of interest. An increasing number of them are revised to be adapted for post-stroke rehabilitation. These exoskeletons mostly work in complement of conventional physiotherapy in the subacute phase to practice gait training. For this gait training the reference trajectory generation is one of the main issues. This is why it usually consists in reproducing some averaged healthy patient's gait pattern. This paper's purpose is to display the online trajectory generation (OTG) algorithm developed to provide reference trajectories applied to gait-oriented tasks designed based on conventional physiotherapy. This OTG algorithm is made to reproduce trajectories similar to the ones a therapist would follow during the same tasks. In addition, experiments are presented in this paper to compare the trajectories generated with the OTG algorithm for two rehabilitation tasks with the trajectories followed by a therapist in the same conditions. During these experiments the OTG is implemented in a runtime system with a 500µs cycle time on a bench able to emulate late and early patients' interaction. These experiments results assess that the OTG can work at a 500µs cycle time to reproduce a similar trajectory as the one followed by the therapist during the two rehabilitation tasks implemented.

Parametric Design and Prototyping of a Low-Power Planar Biped Robot

This study proposes a design approach and the development of a low-power planar biped robot named YU-Bibot. The kinematic structure of the robot consists of six independently driven axes, and it weighs approximately 20 kg. Based on biomimetics, the robot dimensions were selected as the average anthropomorphic dimensions of the human lower extremities. The optimization of the mechanical design and actuator selection of the robot was based on the results of parametric simulations. The natural human walking gait was mimicked as a walking pattern in these simulations. As a result of the optimization, a low power-to-weight ratio of 30 W/kg was obtained. The drive system of the robot joints consists of servo-controlled brushless DC motors with reduction gears and additional bevel gears at the knee and ankle joints. The robot features spring-supported knee and ankle joints that counteract the robot's weight and compensate for the backlash present in these joints. The robot is constrained to move only in the sagittal plane by using a lateral support structure. The robot's feet are equipped with low-cost, force-sensitive resistor (FSR)-type sensors for monitoring ground contact and zero-moment point (ZMP) criterion. The experimental results indicate that the proposed robot mechanism can follow the posture commands accurately and demonstrate locomotion at moderate stability. The proposed parametric natural gait simulation-based design approach and the resulting biped robot design with a low power/weight ratio are the main contributions of this study.

Patent Review of Lower Limb Rehabilitation Robotic Systems by Sensors and Actuation Systems Used

Robotic systems for lower limb rehabilitation are essential for improving patients' physical conditions in lower limb rehabilitation and assisting patients with various locomotor dysfunctions. These robotic systems mainly integrate sensors, actuation, and control systems and combine features from bionics, robotics, control, medicine, and other interdisciplinary fields. Several lower limb robotic systems have been proposed in the patent literature; some are commercially available. This review is an in-depth study of the patents related to robotic rehabilitation systems for lower limbs from the point of view of the sensors and actuation systems used. The patents awarded and published between 2013 and 2023 were investigated, and the temporal distribution of these patents is presented. Our results were obtained by examining the analyzed information from the three public patent databases. The patents were selected so that there were no duplicates after several filters were used in this review. For each patent database, the patents were analyzed according to the category of sensors and the number of sensors used. Additionally, for the main categories of sensors, an analysis was conducted depending on the type of sensors used. Afterwards, the actuation solutions for robotic rehabilitation systems for upper limbs described in the patents were analyzed, highlighting the main trends in their use. The results are presented with a schematic approach so that any user can easily find patents that use a specific type of sensor or a particular type of actuation system, and the sensors or actuation systems recommended to be used in some instances are highlighted.

The Impact of COVID on Lower-Limb Exoskeleton Robotic System Patents—A Review

In recent decades, the field of physical rehabilitation, with the help of robotic systems that aid the population of any age with locomotor difficulties, has been evolving rapidly. Several robotic exoskeleton systems of the lower limbs have been proposed in the patent literature and some are even commercially available. Given the above, we are asking ourselves at the end of the COVID-19 pandemic: how much has this pandemic affected both the publication of patents and the application of new ones? How has new patents’ publication volume or application in robotic exoskeleton systems changed? We hypothesize that this pandemic has caused a reduction in the volume of new applications and possibly publications. We compare pandemic analysis and the last decade’s analysis to answer these questions. In this study, we used a set of statistical tests to see if there were any statistically significant changes. Our results show that the pandemic had at least one effect on applying for new patents based on the information analyzed from the three databases examined.

Real-Time Footprint Planning and Model Predictive Control Based Method for Stable Biped Walking

In order to walk in a physical environment, the biped will encounter various external disturbances, and walking under persistent conditions is still challenging. This paper tries to improve the push recovery performance based on capture point (CP) and model predictive control. The trajectory of zero moment point (ZMP) and center of mass are solved and predicted in a limited time horizon. Online footprint generator is combined with MPC walking pattern generation, which can keep biped stable in the next few steps, and projection of ZMP is used to calculate the next footprint and reach the target CP in an incremental way. Verification of the proposed stable biped walking method is conducted by simulation and experiments.

Discussion on the Stiffness of the Drive Chain in the Legs of Biped Robots

Biped robots’ locomotion is realized by driving the joint motion via a drive chain. Therefore, the stiffness of the drive chain is an important factor that affects the drive performance and can influence the locomotion behavior of the biped robot. This work focused on the influence of the stiffness of the leg’s drive chain using a mass-spring model based on the biped robot AIRO built in Zhejiang Lab. Methods for determination of the parameters in the proposed model were presented, including the use of ANSYS Workbench to determine the stiffness parameters and the determination of the inertia parameters by dynamic modelling of the biped robot. Simulation results show that special attention should be paid to the stiffness of the drive train of the leg when designing a biped robot to ensure the walking capability of the robot. Using the model proposed in this work, relations between the executed accuracy of the joint trajectories and the stiffness can be analyzed; after that, the stiffness parameters can be optimized. In addition, simulation results also showed that attention should be paid to manufacturing tolerances to ensure the symmetry of the legs of the bipedal robot in order to reduce the vibration of the robot body. Experiments were conducted on AIRO for validating the proposed model and the simulation analysis.

A Survey on Design and Control of Lower Extremity Exoskeletons for Bipedal Walking

Exoskeleton robots are electrically, pneumatically, or hydraulically actuated devices that externally support the bones and cartilage of the human body while trying to mimic the human movement capabilities and augment muscle power. The lower extremity exoskeleton device may support specific human joints such as hip, knee, and ankle, or provide support to carry and balance the weight of the full upper body. Their assistive functionality for physically-abled and disabled humans is demanded in medical, industrial, military, safety applications, and other related fields. The vision of humans walking with an exoskeleton without external support is the prospect of the robotics and artificial intelligence working groups. This paper presents a survey on the design and control of lower extremity exoskeletons for bipedal walking. First, a historical view on the development of walking exoskeletons is presented and various lower body exoskeleton designs are categorized in different application areas. Then, these designs are studied from design, modeling, and control viewpoints. Finally, a discussion on future research directions is provided.

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

Human Lower Limb Joint Biomechanics in Daily Life Activities: A Literature Based Requirement Analysis for Anthropomorphic Robot Design

Daily human activity is characterized by a broad variety of movement tasks. This work summarizes the sagittal hip, knee, and ankle joint biomechanics for a broad range of daily movements, based on previously published literature, to identify requirements for robotic design. Maximum joint power, moment, angular velocity, and angular acceleration, as well as the movement-related range of motion and the mean absolute power were extracted, compared, and analyzed for essential and sportive movement tasks. We found that the full human range of motion is required to mimic human like performance and versatility. In general, sportive movements were found to exhibit the highest joint requirements in angular velocity, angular acceleration, moment, power, and mean absolute power. However, at the hip, essential movements, such as recovery, had comparable or even higher requirements. Further, we found that the moment and power demands were generally higher in stance, while the angular velocity and angular acceleration were mostly higher or equal in swing compared to stance for locomotion tasks. The extracted requirements provide a novel comprehensive overview that can help with the dimensioning of actuators enabling tailored assistance or rehabilitation for wearable lower limb robots, and to achieve essential, sportive or augmented performances that exceed natural human capabilities with humanoid robots.

Virtual Sensors for Advanced Controllers in Rehabilitation Robotics

In order to properly control rehabilitation robotic devices, the measurement of interaction force and motion between patient and robot is an essential part. Usually, however, this is a complex task that requires the use of accurate sensors which increase the cost and the complexity of the robotic device. In this work, we address the development of virtual sensors that can be used as an alternative of actual force and motion sensors for the Universal Haptic Pantograph (UHP) rehabilitation robot for upper limbs training. These virtual sensors estimate the force and motion at the contact point where the patient interacts with the robot using the mathematical model of the robotic device and measurement through low cost position sensors. To demonstrate the performance of the proposed virtual sensors, they have been implemented in an advanced position/force controller of the UHP rehabilitation robot and experimentally evaluated. The experimental results reveal that the controller based on the virtual sensors has similar performance to the one using direct measurement (less than 0.005 m and 1.5 N difference in mean error). Hence, the developed virtual sensors to estimate interaction force and motion can be adopted to replace actual precise but normally high-priced sensors which are fundamental components for advanced control of rehabilitation robotic devices.