Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles.
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ABSTRACT:
SUBMITTER: Sanchez-Villamanan MDC
PROVIDER: S-EPMC6506961 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The development of assistive lower-limb exoskeletons can be time-consuming. Testing prototype medical devices on vulnerable populations such as children also has safety concerns. Mechanical phantoms replicating the lower-limb kinematics provide an alternative for the fast validation and iteration of exoskeletons. However, most phantoms treat the limbs as rigid bodies and fail to capture soft tissue deformation at the human/exoskeleton interface. Human soft tissue can absorb and dissipate energy when compressed, leading to a mismatch between simulated and human exoskeleton testing outcomes. We have developed a methodology for quickly testing and validating the performance of knee exoskeletons using a mechanical phantom capable of emulating knee kinematics soft-tissue deformation of the lower-limb. Our phantom consisted of 3D-printed bones surrounded by ballistic gel. A motorized hexapod moved the knee to follow a walking trajectory. A custom inverse dynamics model estimated the knee assistance moment from marker and load cell data. We applied this methodology to quantify the effects of soft-tissue deformation on exoskeleton assistance by loading the phantom knee with a torsional spring exoskeleton interfacing and bypassing the ballistic gel. We found that including soft-tissue deformation led to a lower knee assistance moment and stiffness. Some but not all of this difference could be explained by the deflection of the exoskeleton relative to the knee angle, suggesting energy absorption within soft tissue. The direct measurements of exoskeleton assistance provide insight into increasing the assistive moment transmission efficacy. The phantom provided a relatively accurate framework for knee exoskeleton testing, aiding future exoskeleton design.
| S-EPMC10311455 | biostudies-literature
Project description:BackgroundMany lower-limb exoskeletons have been developed to assist gait, exhibiting a large range of control methods. The goal of this paper is to review and classify these control strategies, that determine how these devices interact with the user.MethodsIn addition to covering the recent publications on the control of lower-limb exoskeletons for gait assistance, an effort has been made to review the controllers independently of the hardware and implementation aspects. The common 3-level structure (high, middle, and low levels) is first used to separate the continuous behavior (mid-level) from the implementation of position/torque control (low-level) and the detection of the terrain or user's intention (high-level). Within these levels, different approaches (functional units) have been identified and combined to describe each considered controller.Results291 references have been considered and sorted by the proposed classification. The methods identified in the high-level are manual user input, brain interfaces, or automatic mode detection based on the terrain or user's movements. In the mid-level, the synchronization is most often based on manual triggers by the user, discrete events (followed by state machines or time-based progression), or continuous estimations using state variables. The desired action is determined based on position/torque profiles, model-based calculations, or other custom functions of the sensory signals. In the low-level, position or torque controllers are used to carry out the desired actions. In addition to a more detailed description of these methods, the variants of implementation within each one are also compared and discussed in the paper.ConclusionsBy listing and comparing the features of the reviewed controllers, this work can help in understanding the numerous techniques found in the literature. The main identified trends are the use of pre-defined trajectories for full-mobilization and event-triggered (or adaptive-frequency-oscillator-synchronized) torque profiles for partial assistance. More recently, advanced methods to adapt the position/torque profiles online and automatically detect terrains or locomotion modes have become more common, but these are largely still limited to laboratory settings. An analysis of the possible underlying reasons of the identified trends is also carried out and opportunities for further studies are discussed.
| S-EPMC8314580 | biostudies-literature
Project description:Gait disability is a major health care problem worldwide. Powered exoskeletons have recently emerged as devices that can enable users with gait disabilities to ambulate in an upright posture, and potentially bring other clinical benefits. In 2014, the US Food and Drug Administration approved marketing of the ReWalk™ Personal Exoskeleton as a class II medical device with special controls. Since then, Indego™ and Ekso™ have also received regulatory approval. With similar trends worldwide, this industry is likely to grow rapidly. On the other hand, the regulatory science of powered exoskeletons is still developing. The type and extent of probable risks of these devices are yet to be understood, and industry standards are yet to be developed. To address this gap, Manufacturer and User Facility Device Experience, Clinicaltrials.gov, and PubMed databases were searched for reports of adverse events and inclusion and exclusion criteria involving the use of lower limb powered exoskeletons. Current inclusion and exclusion criteria, which can determine probable risks, were found to be diverse. Reported adverse events and identified risks of current devices are also wide-ranging. In light of these findings, current regulations, standards, and regulatory procedures for medical device applications in the USA, Europe, and Japan were also compared. There is a need to raise awareness of probable risks associated with the use of powered exoskeletons and to develop adequate countermeasures, standards, and regulations for these human-machine systems. With appropriate risk mitigation strategies, adequate standards, comprehensive reporting of adverse events, and regulatory oversight, powered exoskeletons may one day allow individuals with gait disabilities to safely and independently ambulate.
| S-EPMC5431736 | biostudies-literature
Project description: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.
| S-EPMC7852187 | biostudies-literature
Project description:PurposeThis study designs and provides a pilot evaluation of a novel surrogate lower limb (SLL) that provides anatomically realistic three-dimensional (3D) foot motion, based on a literature consensus of passive lower limb motion. This SLL is intended to replace single axis surrogates currently used in mechanical testing of ankle-foot orthoses (AFO).Material and methodsThe SLL design is inspired by the Rizzoli foot model, with shank, hindfoot, midfoot, forefoot, and toe sections. Ball and socket joints were used between hindfoot-midfoot (HM)-forefoot sections. Forefoot-toes used a hinge joint. Three-dimensional printed nylon, thermoplastic polyurethane (TPU) and polylactic acid (PLA), as well as casted silicone rubber were used to re-create foot components. After fabrication, motion capture was performed to measure rotation using fiducial markers. The SLL was then loaded under both static and cyclic loads representing a 100 kg person walking for 500,000 cycles.ResultsMost joints were within 5° of target angles. The SLL survived static loads representing 1.5 times body weight for both static and cyclical loading.ConclusionsThis SLL moved as designed and survived testing loads, warranting further investigation towards enabling essential mechanical testing for AFO currently on the market, and helping to guide device prescription.
| S-EPMC9693806 | biostudies-literature
Project description:A common issue with many commercial rehabilitative exoskeletons and orthoses are that they can be prohibitively expensive for an average individual to afford without additional financial support. Due to this a user may have limited to the usage of such devices within set rehabilitation sessions as opposed to a continual usage. The purpose of this review is therefore to find which actuator implementations would be most suitable for a simplistic, low-cost powered orthoses capable of assisting those with pathologic gait disorders by collating literature from Web of Science, Scopus, and Grey Literature. In this systematic review paper 127 papers were selected from these databases via the PRISMA guidelines, with the financial costs of 25 actuators discovered with 11 distinct actuator groups identified. The review paper will consider a variety of actuator implementations used in existing lower-limb exoskeletons that are specifically designed for the purpose of rehabilitating or aiding those with conditions inhibiting natural movement abilities, such as electric motors, hydraulics, pneumatics, cable-driven actuators, and compliant actuators. Key attributes such as technical simplicity, financial cost, power efficiency, size limitations, accuracy, and reliability are compared for all actuator groups. Statistical findings show that rotary electric motors (which are the most common actuator type within collated literature) and compliant actuators (such as elastic and springs) would be the most suitable actuators for a low-cost implementation. From these results, a possible actuator design will be proposed making use of both rotary electric motors and compliant actuators.Supplementary informationThe online version contains supplementary material available at 10.1007/s10846-022-01695-0.
| S-EPMC9379875 | biostudies-literature
Project description:Lower-limb wearable robotic devices can improve clinical gait and reduce energetic demand in healthy populations. To help enable real-world use, we sought to examine how assistance should be applied in variable gait conditions and suggest an approach derived from knowledge of human locomotion mechanics to establish a 'roadmap' for wearable robot design. We characterized the changes in joint mechanics during walking and running across a range of incline/decline grades and then provide an analysis that informs the development of lower-limb exoskeletons capable of operating across a range of mechanical demands. We hypothesized that the distribution of limb-joint positive mechanical power would shift to the hip for incline walking and running and that the distribution of limb-joint negative mechanical power would shift to the knee for decline walking and running. Eight subjects (6M,2F) completed five walking (1.25 m s-1) trials at -8.53°, -5.71°, 0°, 5.71°, and 8.53° grade and five running (2.25 m s-1) trials at -5.71°, -2.86°, 0°, 2.86°, and 5.71° grade on a treadmill. We calculated time-varying joint moment and power output for the ankle, knee, and hip. For each gait, we examined how individual limb-joints contributed to total limb positive, negative and net power across grades. For both walking and running, changes in grade caused a redistribution of joint mechanical power generation and absorption. From level to incline walking, the ankle's contribution to limb positive power decreased from 44% on the level to 28% at 8.53° uphill grade (p < 0.0001) while the hip's contribution increased from 27% to 52% (p < 0.0001). In running, regardless of the surface gradient, the ankle was consistently the dominant source of lower-limb positive mechanical power (47-55%). In the context of our results, we outline three distinct use-modes that could be emphasized in future lower-limb exoskeleton designs 1) Energy injection: adding positive work into the gait cycle, 2) Energy extraction: removing negative work from the gait cycle, and 3) Energy transfer: extracting energy in one gait phase and then injecting it in another phase (i.e., regenerative braking).
| S-EPMC7454943 | biostudies-literature
Project description:Assist-as-needed (AAN) algorithms for the control of lower extremity rehabilitation robots can promote active participation of patients during training while adapting to their individual performances and impairments. The implementation of such controllers requires the adaptation of a control parameter (often the robot impedance) based on a performance (or error) metric. The choice of how an adaptive impedance controller is formulated implies different challenges and possibilities for controlling the patient's leg movement. In this paper, we analyze the characteristics and limitations of controllers defined in two commonly used formulations: joint and end-point space, exploring especially the implementation of an AAN algorithm. We propose then, as a proof-of-concept, an AAN impedance controller that combines the strengths of working in both spaces: a hybrid joint/end-point impedance controller. This approach gives the possibility to adapt the end-point stiffness in magnitude and direction in order to provide a support that targets the kinematic deviations of the end-point with the appropriate force vector. This controller was implemented on a two-link rehabilitation robot for gait training-the Lokomat®Pro V5 (Hocoma AG, Switzerland) and tested on 5 able-bodied subjects and 1 subject with Spinal Cord Injury. Our experiments show that the hybrid controller is a feasible approach for exoskeleton devices and that it could exploit the benefits of the end-point controller in shaping a desired end-point stiffness and those of the joint controller to promote the correct angular changes in the trajectories of the joints. The adaptation algorithm is able to adapt the end-point stiffness based on the subject's performance in different gait phases, i.e., the robot can render a higher stiffness selectively in the direction and gait phases where the subjects perform with larger kinematic errors. The proposed approach can potentially be generalized to other robotic applications for rehabilitation or assistive purposes.
| S-EPMC7805861 | biostudies-literature
Project description:Exoskeletons and other wearable robotic devices have a wide range of potential applications, including assisting patients with walking pathologies, acting as tools for rehabilitation, and enhancing the capabilities of healthy humans. However, applying these devices effectively in a real-world setting can be challenging, as the optimal design features and control commands for an exoskeleton are highly dependent on the current user, task and environment. Consequently, robust metrics and methods for quantifying exoskeleton performance are required. This work presents an analysis of walking data collected for healthy subjects walking with an active pelvis exoskeleton over three assistance scenarios and five walking contexts. Spatial and temporal, kinematic, kinetic and other novel dynamic gait metrics were compared to identify which metrics exhibit desirable invariance properties, and so are good candidates for use as a stability metric over varying walking conditions. Additionally, using a model-based approach, the average metabolic power consumption was calculated for a subset of muscles crossing the hip, knee and ankle joints, and used to analyse how the energy-reducing properties of an exoskeleton are affected by changes in walking context. The results demonstrated that medio-lateral centre of pressure displacement and medio-lateral margin of stability exhibit strong invariance to changes in walking conditions. This suggests that these dynamic gait metrics are optimised in human gait and are potentially suitable metrics for optimising in an exoskeleton control paradigm. The effectiveness of the exoskeleton at reducing human energy expenditure was observed to increase when walking on an incline, where muscles aiding in hip flexion were assisted, but decrease when walking at a slow speed. These results underline the need for adaptive control algorithms for exoskeletons if they are to be used in varied environments.
| S-EPMC7904313 | biostudies-literature
Project description:BackgroundIn the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes.MethodsFour databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy.Results(1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke.ConclusionsDespite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
| S-EPMC9938998 | biostudies-literature