Evaluation of a passive wearable arm ExoNET

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

B-FMEA-TRIZ model for scheme decision in conceptual product design: A study on upper-limb hemiplegia rehabilitation exoskeleton

Upper-limb rehabilitation devices are essential in restoring and improving the motor function of hemiplegic patients. However, developing a product design that meets the needs of users is challenging. Current design tools and methods suffer from limitations such as a single model, poor synergy between integrated models, and subjective bias in analysing user needs and translating them into product attributes. To address these issues, this study proposes a new structural design decision-making model based on Behaviour Analysis (B), Failure Mode Effect Analysis (FMEA), and Teoriya Resheniya Izobreatatelskikh Zadatch (TRIZ theory). The model was developed and applied to design an upper-limb rehabilitation exoskeleton for hemiplegia. In this paper, an empirical investigation was conducted in several rehabilitation hospitals in Xuzhou City and used user journey mapping to identify potential failure points in the behaviour process. Then, the fault models were ranked according to the Fuzzy Risk Priority Number (FRPN) calculated by FMEA and used TRIZ theory to determine principles for resolving contradictions and generating creative design solutions for the product. By integrating B, FMEA, and TRIZ theory, it eliminated subjective bias in product design, improved the design decision-making process, and provided new methods and ideas for designing assistive rehabilitation devices and similar products. The framework of the proposed approach can be used in other contexts to develop effective and precise product designs that meet the needs of users.

A comparative study of biomechanical assessments in laboratory and field settings for manual material handling tasks using extractor tools and exoskeletons

To enhance physical capabilities of workers who regularly perform physically demanding tasks involving heavy lifting and awkward postures, various tools and occupational exoskeletons can be used. Most of the studies aiming to explore the efficiency of these tools and exoskeletons have been performed in confined and controlled laboratory spaces, which do not represent the real-world work environment. This study aimed to compare the outcome of biomechanical assessment of using a back support exoskeleton and assistive tools (Lever and Jake) in the procedure of a high demanding manual material handling task versus the results found by performing the same task in a laboratory. Ten able-bodied participants and ten able-bodied utility workers performed the same manhole removal task in-lab and in-field, respectively, with the aid of an exoskeleton and Lever and Jake tools. Muscle activity and Rapid Entire Body Assessment (REBA) scores were recorded using surface electromyography and inertial measurement units, respectively and compared between in-lab and in-field trials. The field experiments indicated significant differences (p < 0.05) in normalized muscle activity across most muscles when compared to laboratory data. These results revealed how muscle activity is affected by the controlled lab setting compared to real-world field conditions. However, REBA scores indicate similar ergonomic implications regardless of the utilization of exoskeletons or tools. These findings underscore that real-world field assessments are crucial for evaluating ergonomic risks and effects of occupational exoskeletons and tools to account for environmental factors and workers' skills in ergonomic evaluations of this nature.

The effects of an upper limb exoskeleton on gait performance and stability

Upper limb exoskeletons (ULEs) are emerging as workplace tools to alleviate workload and prevent work-related musculoskeletal disorders during lifting tasks. However, their introduction raises concerns about potential instability and increased fall risk for workers. This study investigates gait performance and stability parameters implications of ULE use. Fifteen participants performed a carrying task with different loads (0, 5, 10, 15 kg), both with and without the use of an ULE. Spatiotemporal gait parameters, Required Coefficient of Friction (RCoF), Minimum Foot Clearance (MFC), and Margin of Stability (MoS) were analysed. The findings indicate that while the ULE does not significantly alter most gait parameters or slip risk, it may negatively impact trip risk. Furthermore, while mediolateral stability remains unaffected, anteroposterior stability is compromised by ULE usage. These insights are critical for ensuring the safe implementation of ULEs in occupational settings.

Model-free finite-time robust control using fractional-order ultra-local model and prescribed performance sliding surface for upper-limb rehabilitation exoskeleton

To address the trajectory tracking issue of upper-limb rehabilitation exoskeleton with uncertainties and external disturbances, this paper proposes a fractional-order ultra-local model-based model-free finite-time robust controller (FO-FTRC) using predefined performance sliding surface. Different from previous model-free control strategies, a novel multi-input multi-output (MIMO) fractional-order ultra-local model which is a virtual model is proposed to approximate the complex uncertain nonlinear exoskeleton dynamics in a short sliding time window. This allows the design of controller to be independent of any exoskeleton model information and reduces the difficulty of controller design. The developed robust model-free control method incorporates a fractional-order quasi-time delay estimator (FO-QTDE), unknown disturbance estimator (UDE) as well as prescribed performance sliding mode control (PPSMC). The FO-QTDE is utilized to estimate the unknown lumped uncertainties which employs short time delayed knowledge only about the control input. However, the low-pass filter is always added for FO-QTDE when disturbances change fast, which leads to unavoidable estimation error. Then, UDE is designed to further eliminate the estimation error of FO-QTDE to enhance control performance. The PPSMC is constructed to converge sliding surface to zero in a finite time. Besides, the sliding surface is always limited in performance boundaries. After that, the overall system stability and convergence analyses are demonstrated by using the Lyapunov theorem. Finally, with the comparison to other methods of α-variable adaptive model free control (α-AMFC), time-delay estimation-based continuous nonsingular fast terminal sliding mode controller (TDE-CNFTSMC), time delay estimation (TDE)-based model-free fractional-order nonsingular fast terminal sliding mode control (MFF-TSM) and fractional-order proportion-differential (PDβ), the co-simulation results on 7-degree-of-freedom (DOF) iReHave upper-limb exoskeleton virtual prototype and experiment results on 2-DOF upper-limb exoskeleton are obtained to illustrate the effectiveness and superiority of the proposed FO-FTRC method.

Innovative Metaheuristic Optimization Approach with a Bi-Triad for Rehabilitation Exoskeletons

The present work proposes a comprehensive metaheuristic methodology for the development of a medical robot for the upper limb rehabilitation, which includes the topological optimization of the device, kinematic models (5 DOF), human-robot interface, control and experimental tests. This methodology applies two cutting-edge triads: (1) the three points of view in engineering design (client, designer and community) and (2) the triad formed by three pillars of Industry 4.0 (autonomous machines and systems, additive manufacturing and simulation of virtual environments). By applying the proposed procedure, a robotic mechanism was obtained with a reduction of more than 40% of its initial weight and a human-robot interface with three modes of operation and a biomechanically viable kinematic model for humans. The digital twin instance and its evaluation through therapeutic routines with and without disturbances was assessed; the average RMSEs obtained were 0.08 rad and 0.11 rad, respectively. The proposed methodology is applicable to any medical robot, providing a versatile and effective solution for optimizing the design and development of healthcare devices. It adopts an innovative and scalable approach to enhance their processes.

Determinants of wearer satisfaction factors for harnesses in upper-limb assistive wearable robots

Wearable robots are increasingly being deployed for use in industrial fields. However, only a few studies have focused on the usability of wearable robots. The present study evaluated the factors affecting the usability of a harness in securing a wearable robot to the body because the harness directly affects the work efficiency, and thus its design and use require careful consideration. A comparative evaluation of the arrangement of the Vest Exoskeleton before and after improvements was conducted, in which participants performed a benchmark assembly task while wearing the robot. Results showed that wearability decreased after the improvements due to the additional straps and buckles used, but the overall wearing satisfaction improved as a result of increased stability. Stability and convenience were the main factors affecting the overall wearing satisfaction, while sub-indicators included wearing comfort and tactile sensation. Therefore, improvements in stability, such as those related to fixation strength and tactile sensation, had a direct positive impact on the overall wearing satisfaction.

Design of a wearable shoulder exoskeleton robot with dual-purpose gravity compensation and a compliant misalignment compensation mechanism

This paper presents the design and validation of a wearable shoulder exoskeleton robot intended to serve as a platform for assistive controllers that can mitigate the risk of musculoskeletal disorders seen in workers. The design features a four-bar mechanism that moves the exoskeleton's center of mass from the upper shoulders to the user's torso, dual-purpose gravity compensation mechanism located inside the four-bar's linkages that supports the full gravitational loading from the exoskeleton with partial user's arm weight compensation, and a novel 6 degree-of-freedom (DoF) compliant misalignment compensation mechanism located between the end effector and the user's arm to allow shoulder translation while maintaining control of the arm's direction. Simulations show the four-bar design lowers the center of mass by  cm and the kinematic chain can follow the motion of common upper arm trajectories. Experimental tests show the gravity compensation mechanism compensates gravitational loading within  Nm over the range of shoulder motion and the misalignment compensation mechanism has the desired 6 DoF stiffness characteristics and range of motion to adjust for shoulder center translation. Finally, a workspace admittance controller was implemented and evaluated showing the system is capable of accurately reproducing simulated impedance behavior with transparent low-impedance human operation.

Influence of an upper limb exoskeleton on muscle activity during various construction and manufacturing tasks

Musculoskeletal disorders (MSDs) significantly impact workers in the manufacturing and construction sectors. One solution that has gained interest to reduce MSDs incidence is the use of exoskeletons. In this study, the influence of an upper limb exoskeleton on muscle activity was investigated experimentally for three commonly performed tasks in the manufacturing and construction sectors. The tasks tested were overhead assembly, bricklaying, and box moving tasks. Eighteen males participated in the tests. The results showed a reduction in shoulder flexor muscle activation during all three tasks (up to -45.46 ± 4.52% for the anterior deltoid), but increased extensor activation (up to 15.47 ± 8.01% for the latissimus dorsi) was observed when the task was not primarily performed above shoulder level. The results revealed the dependence of the upper-body exoskeleton on tasks and arm posture, which should be considered for both in-field applications and designing new exoskeletons for performance enhancement.

The clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation: a meta-analysis and systematic review

PURPOSE

Many recent clinical studies have suggested that the combination of brain-computer interfaces (BCIs) can induce neurological recovery and improvement in motor function. In this review, we performed a systematic review and meta-analysis to evaluate the clinical effects of BCI-robot systems.

METHODS

The articles published from January 2010 to December 2020 have been searched by using the databases (EMBASE, PubMed, CINAHL, EBSCO, Web of Science and manual search). The single-group studies were qualitatively described, and only the controlled-trial studies were included for the meta-analysis. The mean difference (MD) of Fugl-Meyer Assessment (FMA) scores were pooled and the random-effects model method was used to perform the meta-analysis. The PRISMA criteria were followed in current review.

RESULTS

A total of 897 records were identified, eight single-group studies and 11 controlled-trial studies were included in our review. The systematic analysis indicated that the BCI-robot systems had a significant improvement on motor function recovery. The meta-analysis showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects (p > 0.05).

CONCLUSION

The use of BCI-robot systems has significant improvement on the motor function recovery of hemiparetic upper-limb, and there is a sustaining effect. The meta-analysis showed no statistical difference between the experimental group (BCI-robot) and the control group (robot). However, there are a few shortcomings in the experimental design of existing studies, more clinical trials need to be conducted, and the experimental design needs to be more rigorous.Implications for RehabilitationIn this review, we evaluated the clinical effects of brain-computer interface with robot on upper-limb function for post-stroke rehabilitation. After we screened the databases, 19 articles were included in this review. These articles all clinical trial research, they all used non-invasive brain-computer interfaces and upper-limb robot.We conducted the systematic review with nine articles, the result indicated that the BCI-robot system had a significant improvement on motor function recovery. Eleven articles were included for the meta-analysis, the result showed there were no statistic differences between BCI-robot groups and robot groups, neither in the immediate effects nor long-term effects.We thought the result of meta-analysis which showed no statistic difference was probably caused by the heterogenicity of clinical trial designs of these articles.We thought the BCI-robot systems are promising strategies for post-stroke rehabilitation. And we gave several suggestions for further research: (1) The experimental design should be more rigorous, and describe the experimental designs in detail, especially the control group intervention, to make the experiment replicability. (2) New evaluation criteria need to be established, more objective assessment such as biomechanical assessment, fMRI should be utilised as the primary outcome. (3) More clinical studies with larger sample size, novel external devices, and BCI systems need to be conducted to investigate the differences between BCI-robot system and other interventions. (4) Further research could shift the focus to the patients who are in subacute stage, to explore if the early BCI training can make a positive impact on cerebral cortical recovery.

Upper limb modeling and motion extraction based on multi-space-fusion

Modeling and motion extraction of human upper limbs are essential for interpreting the natural behavior of upper limb. Owing to the high degrees of freedom (DOF) and highly dynamic nature, existing upper limb modeling methods have limited applications. This study proposes a generic modeling and motion extraction method, named Primitive-Based triangular body segment method (P-BTBS), which follows the physiology of upper limbs, allows high accuracy of motion angles, and describes upper-limb motions with high accuracy. For utilizing the upper-limb modular motion model, the motion angles and bones can be selected as per the research topics (The generic nature of the study targets). Additionally, P-BTBS is suitable in most scenarios for estimating spatial coordinates (The generic nature of equipment and technology). Experiments in continuous motions with seven DOFs and upper-limb motion description validated the excellent performance and robustness of P-BTBS in extracting motion information and describing upper-limb motions, respectively. P-BTBS provides a new perspective and mathematical tool for human understanding and exploration of upper-limb motions, which theoretically supports upper-limb research.

Model-Based Upper-Limb Gravity Compensation Strategies for Active Dynamic Arm Supports

NeuroMuscular Disorders (NMDs) may induce difficulties to perform daily life activities in autonomy. For people with NMDs affecting the upper-limb mobility, Dynamic Arm Supports (DASs) turn out to be relevant assistive devices. In particular, active DASs benefit from an external power source to support severely impaired people. However, commercially available active devices are controlled with push buttons, which add cognitive load and discomfort. To alleviate this issue, we propose a new force-based assistive control framework. In this preliminary work, we focus on the computation of a feedforward force to compensate upper-limb gravity. Four strategies based on a biomechanical model of the upper limb, tuned using anthropometric measurements, are proposed and evaluated. The first one is based on the potential energy of the upper-limb, the second one makes a compromise between the shoulder and elbow torques, the third one minimizes the sum of the squared user joint torques and the last one uses a probabilistic approach to minimize the expected torque norm in the presence of model uncertainties. These strategies have been evaluated quantitatively through an experiment including nine participants with an active DAS prototype. The activity of six muscles was measured and used to compute the Mean Effort Index (MEI) which represents the global effort required to maintain the pose. A statistical analysis shows that the four strategies significantly lower the MEI (p-value < 0.001).

Robotically Aided Method to Characterise the Soft Tissue Interaction with Wearable Robots

Wearable robots are widely used to enhance, support or assist humans in different tasks. To accomplish this scope, the interaction between the human body and the device should be comfortable, smooth, high-efficient to transfer forces, and safe for the user. Nevertheless, the pressure and shear stress related to these goals have been overlooked or partially analysed. In this sense, it is crucial to understand the soft tissue response through the in-vivo characterisation of multiple areas of the human body. In fact, soft tissue characterisation plays an essential role in calculating the pressure distribution and shear stress. However, current approaches to estimating soft tissue properties are unsuitable for deployment with multiple human body areas. Hence, this work presents a novel methodology to ease the characterisation of soft tissues using a robotic arm and a 3D superficial scanner. First, the robotic arm is validated by comparing the tensile and compression tests to the indentation tests done by the robot, estimating a 10,4% error. The preliminary experimental tests present the hyperelastic model which fit two adjacent zones of the forearm. This analysis can be extended in several ways, such as: calculating the shear stress, the energy losses or deformations caused by the interaction, and investigating the pressure distribution of different types of physical interfaces.

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

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

Home-Based Rehabilitation of the Shoulder Using Auxiliary Systems and Artificial Intelligence: An Overview

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.

Conversion of Upper-Limb Inertial Measurement Unit Data to Joint Angles: A Systematic Review

Inertial measurement units (IMUs) have become the mainstay in human motion evaluation outside of the laboratory; however, quantification of 3-dimensional upper limb motion using IMUs remains challenging. The objective of this systematic review is twofold. Firstly, to evaluate computational methods used to convert IMU data to joint angles in the upper limb, including for the scapulothoracic, humerothoracic, glenohumeral, and elbow joints; and secondly, to quantify the accuracy of these approaches when compared to optoelectronic motion analysis. Fifty-two studies were included. Maximum joint motion measurement accuracy from IMUs was achieved using Euler angle decomposition and Kalman-based filters. This resulted in differences between IMU and optoelectronic motion analysis of 4° across all degrees of freedom of humerothoracic movement. Higher accuracy has been achieved at the elbow joint with functional joint axis calibration tasks and the use of kinematic constraints on gyroscope data, resulting in RMS errors between IMU and optoelectronic motion for flexion-extension as low as 2°. For the glenohumeral joint, 3D joint motion has been described with RMS errors of 6° and higher. In contrast, scapulothoracic joint motion tracking yielded RMS errors in excess of 10° in the protraction-retraction and anterior-posterior tilt direction. The findings of this study demonstrate high-quality 3D humerothoracic and elbow joint motion measurement capability using IMUs and underscore the challenges of skin motion artifacts in scapulothoracic and glenohumeral joint motion analysis. Future studies ought to implement functional joint axis calibrations, and IMU-based scapula locators to address skin motion artifacts at the scapula, and explore the use of artificial neural networks and data-driven approaches to directly convert IMU data to joint angles.

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

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

Simulation-based design optimization of a wrist exoskeleton

Exoskeletons are widely used in the field of rehabilitation robotics. Upper limb exoskeletons (ULEs) can be very useful for patients with diminished ability to control their limbs in aiding activities of daily living (ADLs). The design of ULEs must account for a human's limitations and ability to work with an exoskeleton. It can typically be achieved by the involvement of vulnerable end-users in each design cycle. On the other hand, simulation-based design methods on a model with human-in-the-loop can limit the design cycles, thereby reducing research time and dependency on end users. This study makes it evident by using a case where the design of an exoskeleton wrist can be optimized with the usage of a torsional spring at the joint, that compensates for the required motor torque. Considering the human-in-the-loop system, the multibody modeling results show that the usage of a torsional spring in the joint can be useful in designing a lightweight and compact exoskeleton joint by downsizing the motor.Clinical Relevance- The proposed methodology of designing an upper-limb exoskeleton has a utility in limiting design cycles and making it both convenient and useful to assist users with severe impairment in ADLs.

NeBULA: A Standardized Protocol for the Benchmarking of Robotic-based Upper Limb Neurorehabilitation

The use of robotic technologies in neurorehabilitation is growing, because they allow highly repeatable exercise protocols and patient-tailored therapies. However, there is a lack of objective methods for assessing these technologies, which makes it difficult to determine their value in rehabilitation settings. While there exist many outcome measurements for motor assessment from a clinical standpoint (such as the Fugl-Meyer scale), the evaluation of performance and clinical benefits of technology for rehabilitation still lacks a standardized approach from a technical standpoint.In this work, we describe NeBULA (Neuromechanical Biomarkers for Upper Limb Assessment), a benchmarking platform for evaluating robotic technology for upper limb neurorehabilitation. By utilizing standardized neuromechanical biomarkers, NeBULA aims at providing a groundwork for assessing and comparing neurorehabilitation robots. We describe its implementation and preliminary results assessing a novel upper limb exoskeleton.Clinical Relevance- Standardized evaluation of neurorehabilitation robots can lead to better patient outcomes, optimizing resources by identifying the most effective technology and by boosting their use in clinical practice. This would provide quantitative and objective information to complement clinical motor evaluation - preventing suboptimal treatments and ensuring that patients receive personalized care. It can also facilitate the transfer of technologyto clinics, identifying the most promising ones for further investment and research.

A Systematic Review on Lower-Limb Industrial Exoskeletons: Evaluation Methods, Evidence, and Future Directions

Industrial tasks that involve frequent sitting/standing transitions and squatting activities can benefit from lower-limb industrial exoskeletons; however, their use is not as widespread as their upper-body counterparts. In this review, we examined 23 articles that evaluated the effects of using Wearable Chair (WC) and Squat-assist (SA) exoskeletons. Evaluations mainly included assessment of muscular demands in the thigh, shank, and upper/lower back regions. Both types of devices were found to lessen muscular demands in the lower body by 30-90%. WCs also reduced low-back demands (~ 37%) and plantar pressure (54-80%) but caused discomfort/unsafe feeling in participants. To generalize outcomes, we suggest standardizing approaches used for evaluating the devices. Along with addressing low adoption through design upgrades (e.g., ground and body supports/attachments), we recommend that researchers thoroughly evaluate temporal effects on muscle fatigue, metabolic rate, and stability of wearers. Although lower-limb exoskeletons were found to be beneficial, discrepancies in experimental protocols (posture/task/measures) were discovered. We also suggest simulating more realistic conditions, such as walking/sitting interchangeability for WCs and lifting loads for SA devices. The presented outcomes could help improve the design/evaluation approaches, and implementation of lower limb wearable devices across industries.

Evaluation of a machine-learning-driven active-passive upper-limb exoskeleton robot: Experimental human-in-the-loop study

Evaluating exoskeleton actuation methods and designing an effective controller for these exoskeletons are both challenging and time-consuming tasks. This is largely due to the complicated human-robot interactions, the selection of sensors and actuators, electrical/command connection issues, and communication delays. In this research, a test framework for evaluating a new active-passive shoulder exoskeleton was developed, and a surface electromyography (sEMG)-based human-robot cooperative control method was created to execute the wearer's movement intentions. The hierarchical control used sEMG-based intention estimation, mid-level strength regulation, and low-level actuator control. It was then applied to shoulder joint elevation experiments to verify the exoskeleton controller's effectiveness. The active-passive assistance was compared with fully passive and fully active exoskeleton control using the following criteria: (1) post-test survey, (2) load tolerance duration, and (3) computed human torque, power, and metabolic energy expenditure using sEMG signals and inverse dynamic simulation. The experimental outcomes showed that active-passive exoskeletons required less muscular activation torque (50%) from the user and reduced fatigue duration indicators by a factor of 3, compared to fully passive ones.

A 3D-printed passive exoskeleton for upper limb assistance in children with motor disorders: proof of concept through an electromyography-based assessment

The rehabilitation of children with motor disorders is mainly focused on physical interventions. Numerous studies have demonstrated the benefits of upper function using robotic exoskeletons. However, there is still a gap between research and clinical practice, owing to the cost and complexity of these devices. This study presents a proof of concept of a 3D-printed exoskeleton for the upper limb, following a design that replicates the main characteristics of other effective exoskeletons described in the literature. 3D printing enables rapid prototyping, low cost, and easy adjustment to the patient anthropometry. The 3D-printed exoskeleton, called POWERUP, assists the user’s movement by reducing the effect of gravity, thereby allowing them to perform upper limb exercises. To validate the design, this study performed an electromyography-based assessment of the assistive performance of POWERUP, focusing on the muscular response of both the biceps and triceps during elbow flexion–extension movements in 11 healthy children. The Muscle Activity Distribution (MAD) is the proposed metric for the assessment. The results show that (1) the exoskeleton correctly assists elbow flexion, and (2) the proposed metric easily identifies the exoskeleton configuration: statistically significant differences (p-value = 2.26 ⋅ 10−7 < 0.001) and a large effect size (Cohen’s d = 3.78 > 0.8) in the mean MAD value were identified for both the biceps and triceps when comparing the transparent mode (no assistance provided) with the assistive mode (anti-gravity effect). Therefore, this metric was proposed as a method for assessing the assistive performance of exoskeletons. Further research is required to determine its usefulness for both the evaluation of selective motor control (SMC) and the impact of robot-assisted therapies.

A novel passive shoulder exoskeleton for assisting overhead work

Shoulder exoskeletons (SEs) can assist the shoulder joint of workers during overhead work and are usually passive for good portability. However, current passive SEs face the challenge that their torque generators are often attached to the human arm, which adds a significant amount of weight to the user's arms, resulting in additional energy consumption of the user. In this paper, we present a novel passive SE whose torque generator is attached to the user's back and assists the shoulder joint through Bowden cables. Our approach greatly reduces the weight on the user's arms and can accommodate complex shoulder joint movements with simple and lightweight mechanical structure based on Bowden cables. In addition, to match the nonlinear torque requirements of the shoulder joint, a unique spring-cam mechanism is proposed as the torque generator. To verify the effectiveness of the device, we conducted a usability test based on muscle activations of 10 healthy subjects. When assisting overhead work, the SE significantly reduced the mean and maximum electromyography signals of the shoulder-related muscles by up to 25%. The proposed SE contributes to further research on passive SE design to improve usability, especially in terms of reducing weight on human arms.

Recent Trends on Innovative Robot Designs and Approaches

The use and function of robots are evolving at a fast pace, sparking interest in creative solutions within a quickly expanding potential market in cutting-edge industries with applications including service robotics, surgical and rehabilitative robotics, and assistive robotics [...]

Lower limb exoskeleton robot and its cooperative control: A review, trends, and challenges for future research

Effective control of an exoskeleton robot (ER) using a human-robot interface is crucial for assessing the robot's movements and the force they produce to generate efficient control signals. Interestingly, certain surveys were done to show off cutting-edge exoskeleton robots. The review papers that were previously published have not thoroughly examined the control strategy, which is a crucial component of automating exoskeleton systems. As a result, this review focuses on examining the most recent developments and problems associated with exoskeleton control systems, particularly during the last few years (2017-2022). In addition, the trends and challenges of cooperative control, particularly multi-information fusion, are discussed.

Exoskeletons: A challenge for development

The development of exoskeletons is currently a lengthy process full of challenges. We are proposing a framework to accelerate the process and make the resulting exoskeletons more user-centered. The needed accomplishments in science are described in an effort to lay the foundation for future research projects. Since the early 2000s, exoskeletons have been discussed as an emerging technology in industrial, medical, or military applications. Those systems are designed to support people during manual tasks. At first, those systems lacked broad acceptance. Many models found their niches in ongoing developments and more diverse systems entering the market. There are still applications that are in dire need of such assistance. Due to the lack of experience with body-worn robotics, the development of such systems has been shaped by trial and error. The lack of legacy products results in longer development times. In this paper, a process to generate a framework is presented to display the required research to enable future exoskeleton designers. Owing to their proximity to the user's body, exoskeletons are highly complex systems that need sophisticated subsystems, such as kinematic, control, interaction design, or actuators, to be accepted by users. Due to the wide variety of fields and high user demands, a synchronized multidisciplinary effort is necessary. To achieve this, a process to develop a modular framework for exoskeleton design is proposed. It focuses on user- and use-case-centered solutions for matching kinematics, actuation, and control. To ensure the usefulness of the framework, an evaluation of the incorporated solutions is required.

Modeling of a Non-Rigid Passive Exoskeleton-Mathematical Description and Musculoskeletal Simulations

There is a growing application of passive exoskeletons in the industrial sector with the purpose to reduce the incidence of work-related musculoskeletal disorders (MSDs). Nowadays, while many passive shoulder exoskeletons have been developed to support overhead tasks, they present limitations in supporting tasks such as load lifting and carrying. Further developments are therefore needed to have a wider application of these devices in the industrial sector. This paper presents a modelling procedure of a passive non-rigid exoskeleton for shoulder support that can be used to evaluate the device in its development phase. The modelling began with the definition of the equations to describe the exoskeleton kinematics and dynamics to obtain the support force profile provided by the device over the shoulder flexion angle. A musculoskeletal simulation software was then used to evaluate the effect of the device on the human body. The computed support force profile is in agreement with the purpose of the device, with the maximal support force obtained for a shoulder flexion angle of 85–90°. The maximum support force value had the same magnitude as the one reported by the device user manual (3.5 kg). In particular, for a determined exoskeleton configuration, the maximum support force value computed was 34.3 N, equal to the reported by the manufacturer. The subsequent musculoskeletal simulation showed the ability of the device to reduce the muscular activation of agonist muscles such as the anterior deltoid (−36.01%) compared to the case when the exoskeleton is not used. The musculoskeletal results showed a positive effect of the device on the joint reaction forces at the glenohumeral joint with a reduction up to 41.91%. Overall the methodology and the mathematical model proposed can be used to further develop these devices, making them suitable for a wider range of tasks.

Model-Based Biomechanical Exoskeleton Concept Optimization for a Representative Lifting Task in Logistics

Occupational exoskeletons are a promising solution to prevent work-related musculoskeletal disorders (WMSDs). However, there are no established systems that support heavy lifting to shoulder height. Thus, this work presents a model-based analysis of heavy lifting activities and subsequent exoskeleton concept optimization. Six motion sequences were captured in the laboratory for three subjects and analyzed in multibody simulations with respect to muscle activities (MAs) and joint forces (JFs). The most strenuous sequence was selected and utilized in further simulations of a human model connected to 32 exoskeleton concept variants. Six simulated concepts were compared concerning occurring JFs and MAs as well as interaction loads in the exoskeleton arm interfaces. Symmetric uplifting of a 21 kg box from hip to shoulder height was identified as the most strenuous motion sequence with highly loaded arms, shoulders, and back. Six concept variants reduced mean JFs (spine: >70%, glenohumeral joint: >69%) and MAs (back: >63%, shoulder: >59% in five concepts). Parasitic loads in the arm bracing varied strongly among variants. An exoskeleton design was identified that effectively supports heavy lifting, combining high musculoskeletal relief and low parasitic loads. The applied workflow can help developers in the optimization of exoskeletons.

Dataset with Tactile and Kinesthetic Information from a Human Forearm and Its Application to Deep Learning

There are physical Human-Robot Interaction (pHRI) applications where the robot has to grab the human body, such as rescue or assistive robotics. Being able to precisely estimate the grasping location when grabbing a human limb is crucial to perform a safe manipulation of the human. Computer vision methods provide pre-grasp information with strong constraints imposed by the field environments. Force-based compliant control, after grasping, limits the amount of applied strength. On the other hand, valuable tactile and proprioceptive information can be obtained from the pHRI gripper, which can be used to better know the features of the human and the contact state between the human and the robot. This paper presents a novel dataset of tactile and kinesthetic data obtained from a robot gripper that grabs a human forearm. The dataset is collected with a three-fingered gripper with two underactuated fingers and a fixed finger with a high-resolution tactile sensor. A palpation procedure is performed to record the shape of the forearm and to recognize the bones and muscles in different sections. Moreover, an application for the use of the database is included. In particular, a fusion approach is used to estimate the actual grasped forearm section using both kinesthetic and tactile information on a regression deep-learning neural network. First, tactile and kinesthetic data are trained separately with Long Short-Term Memory (LSTM) neural networks, considering the data are sequential. Then, the outputs are fed to a Fusion neural network to enhance the estimation. The experiments conducted show good results in training both sources separately, with superior performance when the fusion approach is considered.

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

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

A Tenodesis-Induced-Grip exoskeleton robot (TIGER) for assisting upper extremity functions in stroke patients: a randomized control study

PURPOSE

This study was aimed toward developing a lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) and to examine the performance of the TIGER in stroke patients with hemiplegia.

METHODS

This was a single-blinded, randomized control trial with pre-treatment, immediate post-treatment, and 12-week follow-up assessments. Thirty-four stroke patients were recruited and randomized to either an experimental or control group, where each participant in both groups underwent 40 min of training. In addition to a 20-min bout of regular task-specific motor training, each participant in the experimental group received 20 min of TIGER training, and the controls received 20 min of traditional occupational therapy in each treatment session. Primary outcomes based on the Fugl-Meyer Motor Assessment of Upper Extremity (FMA-UE) were recorded.

RESULTS

Thirty-two patients (94.1%) completed the study: 17 and 15 patients in the experimental and control groups, respectively. Significant beneficial effects were found on the total score (ANCOVA, p = 0.006), the wrist score (ANCOVA, p = 0.037), and the hand score (ANCOVA, p = 0.006) for the FMA-UE in the immediate post-treatment assessment of the participants receiving the TIGER training.

CONCLUSION

The TIGER has beneficial effects on remediating upper limb impairments in chronic stroke patients. Clinical trial registration: ClinicalTrials.gov; identifier NCT03713476Implications for rehabilitationBased on use-dependent plasticity concepts, robot training with the more distal segments of the upper extremities has a beneficial effect in patients with chronic stroke.A novel lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) system using a mechanism involving musculotendinous coordination of the wrist and hand was proposed in this study.Between-group differences in changes in the upper limb motor performance were observed in the experimental group as compared to patients in the control group. For patients with chronic stroke, receiving 20 min of TIGER training in conjunction with 20 min of task-specific motor training led to clinically important changes in motor control and functioning of the affected upper limb.

Myoelectric Control Systems for Upper Limb Wearable Robotic Exoskeletons and Exosuits-A Systematic Review

In recent years, myoelectric control systems have emerged for upper limb wearable robotic exoskeletons to provide movement assistance and/or to restore motor functions in people with motor disabilities and to augment human performance in able-bodied individuals. In myoelectric control, electromyographic (EMG) signals from muscles are utilized to implement control strategies in exoskeletons and exosuits, improving adaptability and human-robot interactions during various motion tasks. This paper reviews the state-of-the-art myoelectric control systems designed for upper-limb wearable robotic exoskeletons and exosuits, and highlights the key focus areas for future research directions. Here, different modalities of existing myoelectric control systems were described in detail, and their advantages and disadvantages were summarized. Furthermore, key design aspects (i.e., supported degrees of freedom, portability, and intended application scenario) and the type of experiments conducted to validate the efficacy of the proposed myoelectric controllers were also discussed. Finally, the challenges and limitations of current myoelectric control systems were analyzed, and future research directions were suggested.

Design and Scaling of Exoskeleton Power Units Considering Load Cycles of Humans

Exoskeletons are powerful tools for aiding humans with pathological conditions, in dangerous environments or in manually exhausting tasks. Typically, they are designed for specific maximum scenarios without taking into account the diversity of tasks and the individuality of the user. To address this discrepancy, a framework was developed for personalizing an exoskeleton by scaling the components, especially the electrical machine, based on different simulated human muscle forces. The main idea was to scale a numerical arm model based on body mass and height to predict different movements representing both manual labor and daily activities. The predicted torques necessary to produce these movements were then used to generate a load/performance cycle for the power unit design. Considering these torques, main operation points of this load cycle were defined and a reference power unit was scaled and optimized. Therefore, a scalability model for an electrical machine is introduced. This individual adaptation and scaling of the power unit for different users leads to a better performance and a lighter design.

The effect of a movable headrest in shoulder assist device for overhead work

Recently, many kinds of shoulder-support exoskeletons have been developed and some of them are commercially available. However, to the best of our knowledge, shoulder-support exoskeletons that have neck-support mechanism have not been found. During the overhead work, physical strain is added to not only upper limb and shoulder but also neck of workers since the workers work keeping their face raised. Therefore, in this study, to reduce the physical strain on the neck during the overhead work, a movable headrest that can be attached to the shoulder assist device was developed, which has reclining and slide functions of a head. The main purpose of this article was to evaluate usefulness of the proposed movable headrest. To this end, measurements of electromyogram were carried out under simulating an overhead work activity, and the reduction effect for physical strain of the neck was compared among three types of headrests: (a) slide-type headrest which can slide the head backward and forward, (b) reclining-type headrest which can recline the head, and (c) reclining and slide-type headrest which can recline and slide the head. In addition, usefulness of the shoulder assist device with the proposed headrest was evaluated for a realistic overhead work activity through measurements of muscular stiffness of neck and shoulder. The experimental results showed that the existence of the headrest in the shoulder assist device is effective to reduce the physical strain to the workers, and that (c) reclining and slide-type headrest is the most effective among these three types of headrests.

User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control

This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC.

A wearable textile-based pneumatic energy harvesting system for assistive robotics

Wearable assistive, rehabilitative, and augmentative devices currently require bulky power supplies, often making these tools more of a burden than an asset. This work introduces a soft, low-profile, textile-based pneumatic energy harvesting system that extracts power directly from the foot strike of a user during walking. Energy is harvested with a textile pump integrated into the insole of the user's shoe and stored in a wearable textile bladder to operate pneumatic actuators on demand, with system performance optimized based on a mechano-fluidic model. The system recovered a maximum average power of nearly 3 W with over 20% conversion efficiency-outperforming electromagnetic, piezoelectric, and triboelectric alternatives-and was used to power a wearable arm-lift device that assists shoulder motion and a supernumerary robotic arm, demonstrating its capability as a lightweight, low-cost, and comfortable solution to support adults with upper body functional limitations in activities of daily living.

Analysis of Dynamic Behavior of ParReEx Robot Used in Upper Limb Rehabilitation

This paper presents a dynamic analysis of the ParReEx multibody mechanism, which has been designed for human wrist joint rehabilitation. The starting point of the research is a virtual prototype of the ParReEx multibody mechanism. This model is used to simulate the dynamics of the multibody mechanism using ADAMS in three simulation scenarios: (a) rigid kinematic elements without friction in joints, (b) rigid kinematic elements with friction in joints, and (c) kinematic elements as deformable solids with friction in joints. In all three cases, the robot is used by a virtual patient in the form of a mannequin. Results such as the connecting forces in the kinematic joints and the torques necessary to operate the ParReEx robot modules are obtained by dynamic simulation in MSC.ADAMS. The torques obtained by numerical simulation are compared with those obtained experimentally. Finite element structural optimization (FEA) of the flexion/extension multibody mechanism module is performed. The results demonstrate the operational safety of the ParReEx multibody mechanism, which is structurally capable of supporting the external loads to which it is subjected.

A Systematic Review on Evaluation Strategies for Field Assessment of Upper-Body Industrial Exoskeletons: Current Practices and Future Trends

With rising manual work demands, physical assistance at the workplace is crucial, wherein the use of industrial exoskeletons (i-EXOs) could be advantageous. However, outcomes of numerous laboratory studies may not be directly translated to field environments. To explore this discrepancy, we conducted a systematic review including 31 studies to identify and compare the approaches, techniques, and outcomes within field assessments of shoulder and back support i-EXOs. Findings revealed that the subjective approaches [i.e., discomfort (23), usability (22), acceptance/perspectives (21), risk of injury (8), posture (3), perceived workload (2)] were reported more common (27) compared to objective (15) approaches [muscular demand (14), kinematics (8), metabolic costs (5)]. High variability was also observed in the experimental methodologies, including control over activity, task physics/duration, sample size, and reported metrics/measures. In the current study, the detailed approaches, their subject-related factors, and observed trends have been discussed. In sum, a new guideline, including tools/technologies has been proposed that could be utilized for field evaluation of i-EXOs. Lastly, we discussed some of the common technical challenges experimenters face in evaluating i-EXOs in field environments. Efforts presented in this study seek to improve the generalizability in testing and implementing i-EXOs.

Biomechanical Analysis of Stoop and Free-Style Squat Lifting and Lowering with a Generic Back-Support Exoskeleton Model

Musculoskeletal disorders (MSDs) induced by industrial manual handling tasks are a major issue for workers and companies. As flexible ergonomic solutions, occupational exoskeletons can decrease critically high body stress in situations of awkward postures and motions. Biomechanical models with detailed anthropometrics and motions help us to acquire a comprehension of person- and application-specifics by considering the intended and unintended effects, which is crucial for effective implementation. In the present model-based analysis, a generic back-support exoskeleton model was introduced and applied to the motion data of one male subject performing symmetric and asymmetric dynamic manual handling tasks. Different support modes were implemented with this model, including support profiles typical of passive and active systems and an unconstrained optimal support mode used for reference to compare and quantify their biomechanical effects. The conducted simulations indicate that there is a high potential to decrease the peak compression forces in L4/L5 during the investigated heavy loaded tasks for all motion sequences and exoskeleton support modes (mean reduction of 16.0% without the optimal support mode). In particular, asymmetric motions (mean reduction of 11.9%) can be relieved more than symmetric ones (mean reduction of 8.9%) by the exoskeleton support modes without the optimal assistance. The analysis of metabolic energy consumption indicates a high dependency on lifting techniques for the effectiveness of the exoskeleton support. While the exoskeleton support substantially reduces the metabolic cost for the free-squat motions, a slightly higher energy consumption was found for the symmetric stoop motion technique with the active and optimal support mode.

Fabric muscle with a cooling acceleration structure for upper limb assistance soft exosuits

Soft exosuits used for supporting human muscle strength must be lightweight and wearable. Shape memory alloy (SMA) spring-based fabric muscles (SFM) are light and flexible, making them suitable for soft and shape-conformable exosuits. However, SFMs have a slow actuation speed owing to the slow cooling rate of the SMA spring. This paper proposes a forced air-cooling fan-integrated fabric muscle (FCFM) that improves the cooling rate by arranging a thin-diameter SMA spring bundle with a high surface-area-to-volume ratio inside a breathable fabric with integrated fans. The relaxation time of an FCFM weighing 30 g and containing a 2.6 g SMA spring bundle, which contains 200 thin springs, was reduced by over 70.2% via forced-air cooling using the integrated fans. A 4 kg weight, which is 1530 times the mass of the SMA spring bundle, was hung from the FCFM and was repeatedly actuated in ten-second cycles. An upper limb assistive soft exosuit with FCFMs was fabricated and worn on a mannequin holding a dumbbell, and the arm extension time after flexion was improved by 4.5 times. Additionally, the assistive performance of the exosuits for repetitive tasks in specific scenarios was evaluated, and the strong potential of the proposed FCFM for soft exosuits was verified.

AGREE: an upper-limb robotic platform for personalized rehabilitation, concept and clinical study design

Rehabilitation exoskeletons can supplement therapist-based training allowing post-stroke patients to perform functional, high-dosage, repetitive exercises. The use of robotic devices allows providing intense rehabilitation sessions and permits clinicians to personalize the therapy according to the patient's need. In this work, we propose an upper-limb rehabilitation system developed within the AGREE project. The platform relies on a four degrees-of-freedom arm exoskeleton, capable of assisting state-of-the-art rehabilitation exercises under different training modalities while behaving transparently to user-generated and therapist-applied forces. The system is provided with a LEDs-matrix mat to guide patients during reaching tasks with visual feedback, an EMG reader to evaluate the patient's involvement during the therapy, and several software tools to help clinicians customize the treatment and monitor the patient's progress. A randomized controlled pilot study aimed at evaluating the usability and the effectiveness of the AGREE rehabilitation platform to improve arm impairment after stroke is currently ongoing.

The impact of interdisciplinarity and user involvement on the design and usability of an assistive upper limb exoskeleton - a case study on the EXOTIC

This study describes an interdisciplinary approach to develop a 5 degrees of freedom assistive upper limb exoskeleton (ULE) for users with severe to complete functional tetraplegia. Four different application levels were identified for the ULE ranging from basic technical application to interaction with users, interaction with caregivers and interaction with the society, each level posing requirements for the design and functionality of the ULE. These requirements were addressed through an interdisciplinary collaboration involving users, clinicians and researchers within social sciences and humanities, mechanical engineering, control engineering media technology and biomedical engineering. The results showed that the developed ULE, the EXOTIC, had a high level of usability, safety and adoptability. Further, the results showed that several topics are important to explicitly address in relation to the facilitation of interdisciplinary collaboration including, defining a common language, a joint visualization of the end goal and a physical frame for the collaboration, such as a shared laboratory. The study underlined the importance of interdisciplinarity and we believe that future collaboration amongst interdisciplinary researchers and centres, also at an international level, can strongly facilitate the usefulness and adoption of assistive exoskeletons and similar technologies.

ARMIA: A Sensorized Arm Wearable for Motor Rehabilitation

In this paper, we present ARMIA: a sensorized arm wearable that includes a combination of inertial and sEMG sensors to interact with serious games in telerehabilitation setups. This device reduces the cost of robotic assistance technologies to be affordable for end-users at home and at rehabilitation centers. Hardware and acquisition software specifications are described together with potential applications of ARMIA in real-life rehabilitation scenarios. A detailed comparison with similar medical technologies is provided, with a specific focus on wearable devices and virtual and augmented reality approaches. The potential advantages of the proposed device are also described showing that ARMIA could provide similar, if not better, the effectivity of physical therapy as well as giving the possibility of home-based rehabilitation.

Hand Rehabilitation Devices: A Comprehensive Systematic Review

A cerebrovascular accident, or a stroke, can cause significant neurological damage, inflicting the patient with loss of motor function in their hands. Standard rehabilitation therapy for the hand increases demands on clinics, creating an avenue for powered hand rehabilitation devices. Hand rehabilitation devices (HRDs) are devices designed to provide the hand with passive, active, and active-assisted rehabilitation therapy; however, HRDs do not have any standards in terms of development or design. Although the categorization of an injury’s severity can guide a patient into seeking proper assistance, rehabilitation devices do not have a set standard to provide a solution from the beginning to the end stages of recovery. In this paper, HRDs are defined and compared by their mechanical designs, actuation mechanisms, control systems, and therapeutic strategies. Furthermore, devices with conducted clinical trials are used to determine the future development of HRDs. After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.

Wearable neck assistive device strain evaluation study on surface neck muscles for head/neck movements

BACKGROUND

This article examines a dynamic wearable assistive device for individuals suffering from pain in the neck. As a part of the clinical treatment, static braces/cervical collars are suggested, however, these collars aid the person in maintaining the upright position of the head but restrict the head motion to a single configuration. To address this problem, a dynamic wearable assistive cervical collar is fabricated based on human anatomical head/neck data.

OBJECTIVE

The objective of this study is to observe the strain acting on the neck surface muscles for bending and compression neck movements with and without the neck brace using a strain sensor.

METHODS

To evaluate the perform of this device, experimental trials were conducted on test subjects to find out the angular tilt of the head with the device worn using the cervical range of motion (CROM) device. In addition, a neck surface muscle strain study is also conducted using strain sensors to investigate the strain produced while using the wearable assistive device. The strain on the neck surface muscle is measured using NI-9236 strain DAQ (data acquisition system). In this experimental study, a group of aged individuals with minor neck pain were recruited to study the head/neck movements.

RESULTS

It was found that by using the proposed assistive device, test subjects were able to mimic 65% of human head/neck movements like flexion, extension, lateral bending, and rotation, and the strain generated from the neck surface muscle was minimal.

CONCLUSION

The results show that using the designed assistive device reduced the strain on neck surface muscle, and strain obtained is within the range of 40 × 10-6 to 80 × 10-6, and may aid in recovery of the individuals suffering with neck pain.

Assessment of the Mechanical Support Characteristics of a Light and Wearable Robotic Exoskeleton Prototype Applied to Upper Limb Rehabilitation

Robotic exoskeletons are active devices that assist or counteract the movements of the body limbs in a variety of tasks, including in industrial environments or rehabilitation processes. With the introduction of textile and soft materials in these devices, the effective motion transmission, mechanical support of the limbs, and resistance to physical disturbances are some of the most desirable structural features. This paper proposes an evaluation protocol and assesses the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs. Since this prototype was built from soft materials, it is necessary to evaluate the mechanical behavior in the areas that support the arm. Some of the rehabilitation-supporting movements such as elbow flexion and extension, as well as increased muscle tone (spasticity), are emulated. Measurements are taken using the reference supplied to the system's control stage and then compared with an external high-precision optical tracking system. As a result, it is evidenced that the use of soft materials provides satisfactory outcomes in the motion transfer and support to the limb. In addition, this study lays the groundwork for a future assessment of the prototype in a controlled laboratory environment using human test subjects.