Exoskeleton home and community use in people with complete spinal cord injury

Heuristic Evaluations of Back-Support, Shoulder-Support, Handgrip-Strength Support, and Sit-Stand-Support Exoskeletons Using Universal Design Principles

Occupational ApplicationsOur study evaluated four occupational exoskeletons using universal design principles, and we found that the exoskeleton design needs improvement to achieve equitable use by diverse worker sets (including disabled, older, and women workers). Assembling exoskeletons for use, donning and doffing wearable devices, and disassembling them can all be difficult because of the strength, dexterity, reach, and balance requirements of users. Workers with disabilities are likely to require additional support from another person to assemble or use these devices. Exoskeleton design can be improved to provide feedback on user actions, error prevention, and recovery. Factors such as assembly and storage space demands, training needs, additional personnel to assist users, and personalization costs could pose substantial barriers in industrial adoption.

Comparison of usability and user-friendliness of three FeNO analyzers in a general population cohort of the LEAD study

Exhaled nitric oxide (FeNO) is a marker for airway inflammation measured by hand-held or stationary analyzers, but their usability was not previously assessed. NIOX VERO (CN), NObreath (BN), Vivatmo pro (BV), and CLD88 analyzer (reference, EC) were compared in a prospective study of the general population LEAD (Lung, hEart, sociAl, boDy) cohort, including the System Usability Scale and tests for equivalence at a clinically relevant range of ≤ 70 ppb with linear models and Bland-Altman plots. In 486 participants (62.4 ± 14.2 years old, 48.1% female), all hand-held analyzers had a good usability score, with BN scoring best. BV required the fewest attempts and time to measurement success, followed by BN. The FeNO results were clinically equivalent between devices (difference to EC 0.7-7.5 ppb) with increasing variability at higher FeNO values. The analyzers had an agreement of ≥ 95% at the threshold of ≥ 40 ppb. CN showed the lowest difference to EC, followed by BV. All portable analyzers showed good usability with an above-average usability score. The best usability score was observed with the BN device, while the BV device had the shortest measuring time and the fewest additional attempts. The lowest difference to the stationary EC analyzers was observed with the CN device.

Outdoor experiences and outdoor-based activities and interventions for individuals with spinal cord injury: a systematic scoping review

STUDY DESIGN

Systematic scoping review.

OBJECTIVES

The aim was to identify and synthesize empirical studies exploring outdoor experiences, activities, and interventions in people with spinal cord injury (SCI).

METHODS

Systematic searches were performed in 7 bibliometric databases. Unique records were independently screened by 2 authors. Peer-reviewed studies on outdoor experiences, activities, or interventions in adults with SCI were included. This was supplemented by Google Scholar searches and citation tracking. Data from included studies were extracted and analysed in a narrative synthesis.

RESULTS

A total of 89 studies were included. Study findings were catalogued into 9 categories and grouped into 3 themes. Theme 1 covered findings related to the experiences and outcomes of outdoor recreational activities and nature exposure. Theme 2 covered findings on facilitators and barriers related to outdoor recreational activities and nature exposure. Theme 3 covered findings related to outdoor testing of equipment and tools.

CONCLUSION

People with SCI mainly report positive experiences from engaging with the natural environment and pursuing outdoor activities, but also experienced a range of barriers that need to be considered in both research and clinical practice. Future studies need to explore the effects of outdoor-based rehabilitation, also employing high-quality methods.

Acceptability of Overground Wearable Powered Exoskeletons for People with Spinal Cord Injury: A Multicenter Qualitative Study

Background: Exoskeletons are used in rehabilitation centers for people with spinal cord injuries (SCI) due to the potential benefits they offer for locomotor rehabilitation. The acceptability of exoskeletons is crucial to promote rehabilitation and to ensure a successful implementation of this technology. The objective was to explore the acceptability of overground wearable powered exoskeleton used in rehabilitation among people with SCI. Methods: Fourteen individuals with SCI (9 men, mean [SD] age 47 years [14.8], a majority with traumatic and thoracic lesion (T6-T12)) who had utilized an exoskeleton in Canada or in France during their rehabilitation participated in a semi-structured interview. A thematic analysis using the theoretical framework of acceptability was carried out. Results: Participants were motivated to use an exoskeleton during their rehabilitation. They reported several perceived benefits to its use, including better walking pattern, increased endurance, and greater muscle mass. They also experienced mild pain, notable concentration demands, and fatigue. Most participants reported that using exoskeletons in their rehabilitation process was appropriate and relevant to them. Conclusions: Exoskeletons are generally well accepted by participants in this study. Adjustments in their use, such as conducting training sessions in obstacle-free environment and technological improvements to address the device's restrictive characteristics, heaviness, and massiveness are however still needed.

Implementation and Tuning of Momentum-Based Controller for Standing Balance in a Lower-limb Exoskeleton with Paraplegic User

Lower limb exoskeletons (LLEs) are wearable devices that can restore the movement autonomy of paraplegic users. LLEs can restore the users' ability to stand upright and walk. However, most of the commercially available and clinically used LLEs rely on the user maintaining balance through the use of crutches. Recent improvements in the design and control of LLEs and other legged robots allow for autonomous balance control. In this work, we implement and evaluate a momentum-based standing balance controller in the Symbitron LLE, consisting of eight active (torque-controlled) and two passive joints. We first investigate how gain tuning of the center of mass tracking control law, part of a multi-objective optimal controller, affects balancing performance. We apply pushes on different device locations while in parallel-stance, compare the response for different gains, and derive heuristic guidelines for controller tuning given the control architecture, high-level goals, and hardware limitations. Next, we show how this controller successfully prescribes joint torques to the LLE to maintain balance with a paraplegic user. The LLE can autonomously balance the user and reject mediolateral and anteroposterior pushes in the order of 60 N at hip height (and 40 N at shoulder height) while standing in parallel-stance, staggered-stance with both feet at the same height, and staggered-stance with a height difference of 0.05 m between the feet. This work presents a viable control strategy for torque-controlled light-weight under-actuated LLEs to keep the balance of paraplegic users during stance, which is a necessary starting point towards autonomous balance control during gait.

Validating Questionnaires for Lower Limb Rehabilitation Systems and Devices: A Scoping Review

This article aims to make a scoping review of Validating Questionnaires used in the field of lower limb (LL) rehabilitation in which systems, devices or exergames are used. Its main objective is to provide a more comprehensive understanding of the results obtained in the validation of questionnaires, as well as to identify specific criteria for evaluating systems, devices or exergames in the area of LL rehabilitation, through the analysis of validating instruments and their application in different associated contexts. The article details the methodology employed, a PRISMA ScR method review which included database research and an evaluation of the selected studies. Inclusion and exclusion criteria were applied to select all relevant studies, resulting in 81 studies after initial review based on titles and abstracts. Subsequently, the criteria were again applied to read the full text, resulting in 58 final studies. The document distinguishes between standardized and non-standardized validating questionnaires, emphasizing that standardized validating questionnaires have undergone rigorous statistical processes to ensure their validity, reliability and consistency. The information compiled in the tables provides a solid basis for identifying and evaluating validation questionnaires in the above-mentioned context. This resource constitutes an accurate and reliable reference for selecting the most appropriate instruments for future research and comparisons with similar work. This article is a valuable resource for those interested in the validation of questionnaires used in the field of lower limb rehabilitation systems/devices/exergames.

Usability and Safety of the ATLAS 2030 Robotic Gait Device in Children with Cerebral Palsy and Spinal Muscular Atrophy

PURPOSE

the purpose of this study was to evaluate the safety and usability of the ATLAS 2030 in children with Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA).

MATERIALS AND METHODS

the sample consisted of six children, three with CP and three with SMA, who received eight sessions of robot-assisted gait therapy. Safety was measured by the presence of adverse events. Usability was measured by spatiotemporal parameters, the Six-Minute Walking Test (6MWT), and the time needed for donning and doffing, as well as satisfaction questionnaires administered to therapists and patients.

RESULTS

no serious adverse events were reported. The average cadence and number of steps per session increased throughout sessions, as well as the distance covered in the 6MWT, both in participants with CP and SMA. The mean donning time at the end of the study was 4.6 ± 1.3 min, and only one therapist was necessary to carry out all of the sessions. Satisfaction was considered high by both children and therapists.

CONCLUSIONS

the ATLAS 2030 was shown to be safe for children with CP and SMA. The usability of the device was good, since a progression in the spatiotemporal parameters was observed throughout the sessions, and patient and therapist satisfaction were high.

Novel neuromuscular controllers with simplified muscle model and enhanced reflex modulation: A comparative study in hip exoskeletons

Neuromuscular controllers (NMCs) offer a promising approach to adaptive and task-invariant control of exoskeletons for walking assistance, leveraging the bioinspired models based on the peripheral nervous system. This article expands on our previous development of a novel structure for NMCs with modifications to the virtual muscle model and reflex modulation strategy. The modifications consist firstly of simplifications to the Hill-type virtual muscle model, resulting in a more straightforward formulation and reduced number of parameters; and second, using a finer division of gait subphases in the reflex modulation state machine, allowing for a higher degree of control over the shape of the assistive profile. Based on the proposed general structure, we present two controller variants for hip exoskeletons, with four- and five-state reflex modulations (NMC-4 and NMC-5). We used an iterative data-driven approach with two tuning stages (i.e., muscle parameters and reflex gains) to determine the controller parameters. Biological joint torque profiles and optimal torque profiles for metabolic cost reduction were used as references for the final tuning outcome. Experimental testing under various walking conditions demonstrated the capability of both variants for adapting to the locomotion task with minimal parameter adjustments, mostly in terms of timing. Furthermore, NMC-5 exhibited better alignment with biological and optimised torque profiles in terms of timing characteristics and relative magnitudes, resulting in less negative mechanical work. These findings firstly validate the adequacy of the simplified muscle model for assistive controllers, and demonstrate the utility of a more nuanced reflex modulation in improving the assistance quality.

User experience of lower extremity exoskeletons and its improvement methodologies: A narrative review

In this review, user experience (UX) of recent lower limb exoskeletons (LLEs) and its improvement methodologies are investigated. First, statistics based on standardised and custom UX evaluations are presented. It is indicated that, LLE users have positive UX, especially in the aspects of safety, dimension and effectiveness. Further, overall, UX levels of ankle and hip-knee exoskeletons are higher than those of other exoskeleton types; unilateral LLEs have higher mean UX levels than that of the bilateral ones. Then, design practices for improving UX are studied; the focused points are burden reduction and improvement of device fit. The former is achieved through lightweight design and approaches that reduce device's moment of inertia (MOI) at mechanical joints. Works on the latter refer to the endeavours to enhance static and dynamic fit; they mainly rely on the optimisations of human-robot interface (HRS) and endeavours to rectify misalignment of axes of mechanical and anatomic joints, respectively. The following section is control approaches to enhance wearing comfort level; it is mainly focused on adaptive, interaction and compensation-based controls. Finally, existing problems and future directions are stated and prospected respectively.

Feasibility of Using Autonomous Ankle Exoskeletons to Augment Community Walking in Cerebral Palsy

Objective: This pilot study investigated the feasibility and efficacy of using autonomous ankle exoskeletons in community settings among individuals with cerebral palsy (CP). Five participants completed two structured community walking protocols: a week-long ankle exoskeleton acclimation and training intervention, and a dose-matched Sham intervention of unassisted walking. Results: Results demonstrated significant improvements in acclimatized walking performance with the ankle exoskeleton, including increased speed and stride length. Participants also reported increased enjoyment and perceived benefits of using the exoskeleton. While ankle exoskeleton training did not lead to significant improvements in unassisted walking, this study demonstrates the feasibility of using ankle exoskeletons in the real world by people with CP. Conclusions: This study highlights the potential of wearable exoskeletons to augment community walking performance in CP, laying a foundation for further exploration in real-world environments.

Effect of a soft exosuit on daily life gait performance in people with incomplete spinal cord injury: study protocol for a randomized controlled trial

BACKGROUND

People with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated.

OBJECTIVE

The primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated.

METHODS

This is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L).

DISCUSSION

This is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05605912. Registered on November 2, 2022.

Exoskeletal-Assisted Walking in Veterans With Paralysis: A Randomized Clinical Trial

Importance

Robotic exoskeletons leverage technology that assists people with spinal cord injury (SCI) to walk. The efficacy of home and community exoskeletal use has not been studied in a randomized clinical trial (RCT).

Objective

To examine whether use of a wheelchair plus an exoskeleton compared with use of only a wheelchair led to clinically meaningful net improvements in patient-reported outcomes for mental and physical health.

Design, Setting, and Participants

This RCT of veterans with SCI was conducted at 15 Veterans Affairs medical centers in the US from September 6, 2016, to September 27, 2021. Data analysis was performed from March 10, 2022, to June 20, 2024.

Interventions

Participants were randomized (1:1) to standard of care (SOC) wheelchair use or SOC plus at-will use of a US Food and Drug Administration (FDA)-cleared exoskeletal-assisted walking (EAW) device for 4 months in the home and community.

Main Outcomes and Measures

Two primary outcomes were studied: 4.0-point or greater improvement in the mental component summary score on the Veterans RAND 36-Item Health Survey (MCS/VR-36) and 10% improvement in the total T score of the Spinal Cord Injury-Quality of Life (SCI-QOL) physical and medical health domain and reported as the proportion who achieved clinically meaningful changes. The primary outcomes were measured at baseline, post randomization after advanced EAW training sessions, and at 2 months and 4 months (primary end point) in the intervention period. Device usage, reasons for not using, and adverse events were collected.

Results

A total of 161 veterans with SCI were randomized to the EAW (n = 78) or SOC (n = 83) group; 151 (94%) were male, the median age was 47 (IQR, 35-56) years, and median time since SCI was 7.3 (IQR, 0.5 to 46.5) years. The difference in proportion of successes between the EAW and SOC groups on the MCS/VR-36 (12 of 78 [15.4%] vs 14 of 83 [16.9%]; relative risk, 0.91; 95% CI, 0.45-1.85) and SCI-QOL physical and medical health domain (10 of 78 [12.8%] vs 11 of 83 [13.3%]; relative risk, 0.97; 95% CI, 0.44-2.15) was not statistically different. Device use was lower than expected (mean [SD] distance, 1.53 [0.02] miles per month), primarily due to the FDA-mandated companion being unavailable 43.9% of the time (177 of 403 instances). Two EAW-related foot fractures and 9 unrelated fractures (mostly during wheelchair transfers) were reported.

Conclusions and Relevance

In this RCT of veterans with SCI, the lack of improved outcomes with EAW device use may have been related to the relatively low device usage. Solutions for companion requirements and user-friendly technological adaptations should be considered for improved personal use of these devices.

Trial Registration

ClinicalTrials.gov Identifier: NCT02658656.

Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists

Background

Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices.

Objective

The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use.

Methods

Six older adults (aged 72-88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis.

Results

Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors.

Conclusions

A light wearable robot-the Myosuit-was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need.

Barriers and facilitators to exoskeleton use in persons with spinal cord injury: a systematic review

PURPOSE

Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices.

METHODS

A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators.

RESULTS

Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers.

CONCLUSION

This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI.

Experimental Evaluation of Machine Learning Models for Gait Segmentation

Accurate estimation of the gait phase is extremely important in exoskeleton control, as various stages in the gait cycle require different control objectives. This study involved the evaluation of seven machine learning models utilizing inertial measurement unit and joint angle data from eight healthy subjects wearing the Ekso Indego exoskeleton for the purpose of gait segmentation. During the experiments, subjects walked on a level instrumented treadmill with gravity compensation assistance for three trials and underwent a fourth trial simulating impairment. A six-state model of gait was employed, where bilateral heel strike, toe off, and tibia vertical determined state transitions. True state transitions were determined using optical motion capture and ground reaction force data. Of the evaluated models, the Support Vector Machine achieved the highest performance, with an average accuracy of 94.5% and 94.1% for normal walking and impaired walking, respectively. Future research should focus on assessing the model's real-time performance among exoskeleton users before considering its application as the basis for an exoskeleton controller.

Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters

BACKGROUND

Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established.

OBJECTIVE

This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure.

RESULTS

Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions).

CONCLUSION

This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.

Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury - a case report & literature review

INTRODUCTION

Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.

CASE

We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.

CONCLUSION

PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.

The most used questionnaires for evaluating the usability of robots and smart wearables: A scoping review

Background

As the field of robotics and smart wearables continues to advance rapidly, the evaluation of their usability becomes paramount. Researchers may encounter difficulty in finding a suitable questionnaire for evaluating the usability of robotics and smart wearables. Therefore, the aim of this study is to identify the most commonly utilized questionnaires for assessing the usability of robots and smart wearables.

Methods

A comprehensive search of databases, including PubMed, Web of Science, and Scopus, was conducted for this scoping review. Two authors performed the selection of articles and data extraction using a 10-field data extraction form. In cases of disagreements, a third author was consulted to reach a consensus. The inclusions were English-language original research articles that utilized validated questionnaires to assess the usability of healthcare robots and smart wearables. The exclusions comprised review articles, non-English publications, studies not focused on usability, those assessing clinical outcomes, articles lacking questionnaire details, and those using non-validated or researcher-made questionnaires. Descriptive statistics methods (frequency and percentage), were employed to analyze the data.

Results

A total of 314 articles were obtained, and after eliminating irrelevant and duplicate articles, a final selection of 50 articles was included in this review. A total of 17 questionnaires were identified to evaluate the usability of robots and smart wearables, with 10 questionnaires specifically for wearables and 7 questionnaires for robots. The System Usability Scale (50%) and Post-Study System Usability Questionnaire (19.44%) were the predominant questionnaires utilized to assess the usability of smart wearables. Moreover, the most commonly used questionnaires for evaluating the usability of robots were the System Usability Scale (56.66%), User Experience Questionnaire (16.66%), and Quebec User Evaluation of Satisfaction with Assistive Technology (10%).

Conclusion

Commonly employed questionnaires serve as valuable tools in assessing the usability of robots and smart wearables, aiding in the refinement and optimization of these technologies for enhanced user experiences. By incorporating user feedback and insights, designers can strive towards creating more intuitive and effective robotic and wearable solutions.

STELO: A New Modular Robotic Gait Device for Acquired Brain Injury-Exploring Its Usability

In recent years, the prevalence of acquired brain injury (ABI) has been on the rise, leading to impaired gait functionality in affected individuals. Traditional gait exoskeletons are typically rigid and bilateral and lack adaptability. To address this, the STELO, a pioneering modular gait-assistive device, was developed. This device can be externally configured with joint modules to cater to the diverse impairments of each patient, aiming to enhance adaptability and efficiency. This study aims to assess the safety and usability of the initial functional modular prototype, STELO, in a sample of 14 ABI-diagnosed participants. Adverse events, device adjustment assistance and time, and gait performance were evaluated during three sessions of device use. The results revealed that STELO was safe, with no serious adverse events reported. The need for assistance and time required for device adjustment decreased progressively over the sessions. Although there was no significant improvement in walking speed observed after three sessions of using STELO, participants and therapists reported satisfactory levels of comfort and usability in questionnaires. Overall, this study demonstrates that the STELO modular device offers a safe and adaptable solution for individuals with ABI, with positive user and therapist feedback.

Disturbance rejection model predictive control of lower limb rehabilitation exoskeleton

Nowadays, exoskeleton is broadly used in the rehabilitation training of many postoperative patients. However, the uncertainty and disturbances caused by different patients and system itself may lead to incompletely rehabilitation training as planned, or even unsafety. This paper addresses the control problem of a lower limb exoskeleton, in the spirit of the recent progress on model predictive control (MPC) and extended state observer (ESO). More precisely, our approach is based on the strategy that designing an ESO to estimate the total disturbance of the dynamics model and compensating it in the design of the MPC process. To accomplish this, we introduce the virtual control quantity to decouple the dynamics model of the system and summarize the human disturbances, unmeasured states and system non-linearity as the total disturbance of the model. By doing so, the uncertainty can be estimated by our designed ESO. Based on the moving horizontal optimization and feedback mechanism of MPC, the output prediction of the system can be more accurate since the uncertainty are effectively compensated. The virtual experiment results demonstrate that proposed controller significantly improves the control accuracy on lower limb rehabilitation exoskeleton with disturbances (improved by over 34[Formula: see text]), comparing with conventional MPC and fuzzy PID. As a result, our achievements will make contributions to better rehabilitation training for patients using rehabilitation exoskeletons.

Momentum-Based Balance Control of a Lower-Limb Exoskeleton During Stance

In this work, we present the implementation of a momentum-based balance controller in a lower-limb exoskeleton that can successfully reject perturbations and self-balance without any external aid. This controller is able to withstand pushes in the order of 30 N in forward and sideways directions with little sway. Additionally, with this controller, the system can perform balanced weight-shifting motions without the need for an explicit joint reference trajectory. There is potential, with fine parameter tuning, for a more robust balance performance that can reject stronger pushes during the presented tasks. Backward pushes were not rejected due to practical limitations (the mass of the device is concentrated in the back) rather than due to the control method itself. This controller is a preliminary result that brings paraplegic patients closer to crutch-free balance in a lower-limb exoskeleton.

Metabolic cost of walking with electromechanical ankle exoskeletons under proportional myoelectric control on a treadmill and outdoors

Lower limb robotic exoskeletons are often studied in the context of steady state treadmill walking in a laboratory environment. However, the end goal for exoskeletons is to be used in real world, complex environments. To reach the point that exoskeletons are openly adopted into our everyday lives, we need to understand how the human and robot interact outside of a laboratory. Metabolic cost is often viewed as a gold standard metric for measuring exoskeleton performance but is rarely used to evaluate performance at non steady state walking outside of a laboratory. In this study, we tested the effects of robotic ankle exoskeletons under proportional myoelectric control on the cost of transport of walking both inside on a treadmill and outside overground. We hypothesized that walking with the exoskeletons would lead to a lower cost of transport compared to walking without them both on a treadmill and outside. We saw no significant increases or decreases in cost of transport or exoskeleton mechanics when walking with the exoskeletons compared to walking without them both on a treadmill and outside. We saw a strong negative correlation between walking speed and cost of transport when walking with and without the exoskeletons. In the future, research should consider how performing more difficult tasks, such as incline and loaded walking, affects the cost of transport while walking with and without robotic ankle exoskeletons. The value of this study to the literature is that it emphasizes the importance of both hardware dynamics and controller design towards reducing metabolic cost of transport with robotic ankle exoskeletons. When comparing our results to other studies using the same hardware with different controllers or very similar controllers with different hardware, there are a wide range of outcomes as to metabolic benefit.

Changes in Distance between a Wearable Robotic Exoskeleton User and Four-Wheeled Walker during Gait in Level and Slope Conditions: Implications for Fall Prevention Systems

When walking with wearable robotic exoskeletons (WRE) in people with spinal cord injury, the distance between the user and the walker is one of the most important perspectives for ensuring safety. The purpose of this study was to clarify the distance between WRE users and four-wheeled walkers (4WW) while walking on level and sloping surfaces. To eliminate the effects of variation in neurological conditions, 12 healthy subjects participated. All participants ambulated using the WRE and the 4WW on level and sloping surfaces. The outcomes were the mean distances between the WRE users and the 4WWs in the level and slope conditions. To examine the influence of uphill and downhill slopes on distance, comparisons were conducted between the uphill or downhill conditions and the respective transitional periods. In the uphill condition, the mean distances were significantly greater than that in the level condition. Conversely, the mean distance moving downhill was significantly shorter than that in the level condition. Changes in the distance between the WRE user and the 4WW might increase the risk of falling forward on an uphill slope and backward on a downhill slope. This study's results will assist in developing a new feedback system to prevent falls.

Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review

BACKGROUND

People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons.

METHODS

A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons.

RESULTS

Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists.

CONCLUSION

Users' satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users' point of view are ease of adjustment, size and weight, and ease of use.

Usability of an exosuit in domestic and community environments

BACKGROUND

Exosuits have been shown to reduce metabolic cost of walking and to increase gait performance when used in clinical environment. Currently, these devices are transitioning to private use to facilitate independent training at home and in the community. However, their acceptance in unsupervised settings remains unclear. Therefore, the aim of this study was to investigate end-user perspectives and the adoption of an exosuit in domestic and community settings.

METHODS

We conducted a mixed-method study to investigate the usability and user experience of an exosuit, the Myosuit. We leveraged on a cohort of seven expert users, who had the device available at home for at least 28 days. Each participant completed two standardized questionnaires (SUS and QUEST) and one personalized, custom questionnaire. Furthermore, a semi-structured interview with each participant was recorded, verbatim transcribed and analyzed using descriptive thematic analysis. Data collected from device sensors quantified the frequency of use.

RESULTS

A mean SUS score of 75.4 out of 100 was reported. Five participants scored above the threshold for above-average usability. Participants also expressed high satisfaction with most of the technical features in the QUEST with an average score of 4.1 (3.86-4.71) out of 5. Participants used the Myosuit mainly for walking outside and exercising at home. However, the frequency of use did not meet the recommendations for physical activity established by the World Health Organization. Five participants used the Myosuit approximately once per week. The two other participants integrated the device in their daily life and used the Myosuit to a greater extent (approx. five times per week). Major factors that prevented an extensive use of the technology were: (i) difficulties in donning that led to (ii) lack of independence and (iii) lack of motivation in exercising.

CONCLUSIONS

Although usable for various activities and well perceived, the adoption of the exosuit in domestic and community settings is yet limited. Use outside the clinic poses further challenges that should be considered when developing new wearable robots. Primarily, design should meet the users' claim for independence and increased adjustability of the device.

Three-Dimensional Printing Component Used in Rehabilitation Exoskeleton

This work aims to develop a light symmetrical structure that can be realized through rapid prototyping techniques. The structure must meet some restrictions imposed by possible practical applications. It must withstand a moderate load, be able to adapt to a specific external shape, be relatively light, allow the execution of some changes according to user requirements, allow execution with the help of owned equipment, and allow relatively fast production (its structure and form). The major application for which the structure is designed is that of an exoskeleton for medical rehabilitation, realized by the authors. The creation of such an exoskeleton is followed by a series of research regarding different aspects of acceptability, reliability, ease of use, and the shortcomings that such a structure can cause. In this study, the authors focused on the mechanical part of the exoskeleton realization, which would fulfill some imposed kinematic and constructive conditions.

Inhibition of IL1R1 or CASP4 attenuates spinal cord injury through ameliorating NLRP3 inflammasome-induced pyroptosis

Spinal cord injury (SCI) is a devastating trauma characterized by serious neuroinflammation and permanent neurological dysfunction. However, the molecular mechanism of SCI remains unclear, and few effective medical therapies are available at present. In this study, multiple bioinformatics methods were used to screen out novel targets for SCI, and the mechanism of these candidates during the progression of neuroinflammation as well as the therapeutic effects were both verified in a rat model of traumatic SCI. As a result, CASP4, IGSF6 and IL1R1 were identified as the potential diagnostic and therapeutic targets for SCI by computational analysis, which were enriched in NF-κB and IL6-JAK-STATA3 signaling pathways. In the injured spinal cord, these three signatures were up-regulated and closely correlated with NLRP3 inflammasome formation and gasdermin D (GSDMD) -induced pyroptosis. Intrathecal injection of inhibitors of IL1R1 or CASP4 improved the functional recovery of SCI rats and decreased the expression of these targets and inflammasome component proteins, such as NLRP3 and GSDMD. This treatment also inhibited the pp65 activation into the nucleus and apoptosis progression. In conclusion, our findings of the three targets shed new light on the pathogenesis of SCI, and the use of immunosuppressive agents targeting these proteins exerted anti-inflammatory effects against spinal cord inflammation by inhibiting NF-kB and NLRP3 inflammasome activation, thus blocking GSDMD -induced pyroptosis and immune activation.

The effect of limited sensory information on exoskeleton performance in people with complete spinal cord injury

Despite the absence of somatosensory information from the lower extremities, people with complete spinal cord injury (SCI) can maintain postural stability in an exoskeleton. This is partly because humans are able to reweigh the relative dependence on each of the senses. However, when the sensory environment is changed, people with complete SCI are limited in their ability to reweigh their sensory organization towards more dependence on somatosensory information. The aim of this study was to investigate the effect of limited visual and/or auditory information on exoskeleton performance in people with complete SCI. Three experienced exoskeleton users performed twelve walking trials in the ReWalk exoskeleton. In each trial, the presence or absence of visual and/or auditory information was varied. Exoskeleton performance was operationalized as the walking distance covered and the amount of crutch loading. In one participant, the distance covered decreased when visual information was limited. The other two participants did not show substantial differences in distance covered between sensory conditions. Two participants decreased crutch loading when visual information was restricted, and one participant decreased crutch loading when auditory information was limited. The current study suggests a limited influence of the presence or absence of visual and auditory information on the distance covered in people with complete SCI walking in an exoskeleton. Interestingly, crutch loading seemed to decrease rather than increase when visual or auditory information was limited.

TWIICE One powered exoskeleton: effect of design improvements on usability in daily life as measured by the performance in the CYBATHLON race

Background

Spinal cord injury leading to paraplegia affects the mobility and physiological well-being of one in a thousand people. Powered exoskeletons can temporarily restore the ability to walk. Their relevance in daily life is still limited because of low performance beyond ground that is even. CYBATHLON is an international competition promoting improvements in assistive technology. In this article, we present the latest design and results of testing of TWIICE One version 2018, one of the competing devices in the 2020 race.

Methods

A person with a motor-complete spinal cord injury at thoracic level T10 participated as race pilot. Training ahead of the race took place over one week at a rate of 2 h per day. The time to perform each of the seven tasks of the competition was recorded together with the number of repetitions. Performance is compared over the training period and against the 2016 race results.

Results

Progression was observed in all tasks and accounted for by both user training and technology improvements. Final competition rank was second out of seven participating teams, with a record time of 4′40". This represents an average improvement of 40% with respect to comparable obstacles of the 2016 race, explaining the two ranks of improvement since then.

Conclusion

These results help understand which features had a positive impact on the real-life performance of the device. Understanding how design affects performance is key information to create devices that really improve the life of people living with paraplegia.

Rehabilitation Program for Gait Training Using UAN.GO, a Powered Exoskeleton: A Case Report

Background: Spinal cord injury is characterized by the interruption of neural pathways of the spinal cord, with alteration of sensory, motor, and autonomic functions. Robotic-assisted gait training offers many possibilities, including the capability to reach a physiological gait pattern. Methods: A training protocol with UAN.GO^®, an active lower limb exoskeleton, was developed. A participant having D10 complete SCI was recruited for this study. The training protocol was composed by 13 sessions, lasting 1.5 h each. The effectiveness of the protocol was evaluated through the mobility performance during the 6 MWT, the level of exertion perceived administrating Borg RPE at the end of each 6 MWT. Furthermore, time and effort required by the participant to earn a higher level of skills were considered. Results: A significant improvement was registered in the six MWT (t₀ = 45.64 m t₁ = 84.87 m). Data referring to the mean level of exertion remained stable. The patient successfully achieved a higher level of independence and functional mobility with the exoskeleton. Discussion: The findings from this preliminary study suggest that UAN.GO can be a valid tool for walking rehabilitation of spinal cord injury patients, allowing the achievement of greater mobility performances.

Usability and perceived usefulness of patient-centered medication reconciliation using a personalized health record: a multicenter cross-sectional study

BACKGROUND

Adoption of a personal health record (PHR) depends on its usability and perceived usefulness. Therefore, we aimed to assess the usability and perceived usefulness of an online PHR used for medication reconciliation and to assess the association between patient-, clinical-, hospital-, and ICT-related factors and the usability and perceived usefulness at both the in- and outpatient clinics.

METHODS

A multicenter cross-sectional study was conducted with patients with either an outpatient visit (rheumatology ward) or planned admission in the hospital (cardiology, neurology, internal medicine or pulmonary wards). All patients received an invitation to update their medication list in the PHR 2 weeks prior to their appointment. One month after the hospital visit, PHR-users were asked to rate usability (using the System Usability Scale (SUS)) and perceived usefulness on a 5-point Likert scale. The usability and perceived usefulness were classified according to the adjective rating scale of Bangor et al. The usability was furthermore dichotomized in the categories: low (SUS between 0 and 51) and good (SUS 51-100) usability. Associations between patient-, clinical-, hospital-, and ICT-related factors and the usability and perceived usefulness were analysed.

RESULTS

255 of the 743 invited PHR-users completed the questionnaire. 78% inpatients and 83% outpatients indicated that usability of the PHR was good. There were no significant association between patient-, clinical-, hospital-, and ICT-related factors and the usability of the PHR. The majority of the patients (57% inpatients and 67% outpatients) classified perceived usefulness of the PHR as good, excellent, or best imaginable. Outpatients who also used the PHR for other drug related purposes reported a higher perceived usefulness (adjusted odds ratio 20.0; 95% confidence interval 2.36-170). Besides that, there was no significant association between patient-, clinical-, hospital-, and ICT-related factors and the perceived usefulness of the PHR.

CONCLUSIONS

The majority of the patients indicated that the PHR for medication reconciliation was useful and easy to use, but there is still room for improvement. To improve the intervention, further research should explore patients' barriers and facilitators of using a PHR for medication reconciliation.

Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury-A Scoping Review

In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.

Exoskeletons for Mobility after Spinal Cord Injury: A Personalized Embodied Approach

Endowed with inherent flexibility, wearable robotic technologies are powerful devices that are known to extend bodily functionality to assist people with spinal cord injuries (SCIs). However, rather than considering the specific psychological and other physiological needs of their users, these devices are specifically designed to compensate for motor impairment. This could partially explain why they still cannot be adopted as an everyday solution, as only a small number of patients use lower-limb exoskeletons. It remains uncertain how these devices can be appropriately embedded in mental representations of the body. From this perspective, we aimed to highlight the homeostatic role of autonomic and interoceptive signals and their possible integration in a personalized experience of exoskeleton overground walking. To ensure personalized user-centered robotic technologies, optimal robotic devices should be designed and adjusted according to the patient's condition. We discuss how embodied approaches could emerge as a means of overcoming the hesitancy toward wearable robots.

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

Wearable robotic exoskeletons (WREs) have been developed from orthoses as assistive devices for gait reconstruction in patients with spinal cord injury. They can solve some problems encountered with orthoses, such as difficulty in independent walking and standing up and high energy consumption during walking. The Wearable Power-Assist Locomotor (WPAL), a WRE, was developed based on a knee–ankle–foot orthosis with a single medial hip joint. The WPAL has been updated seven times during the period from the beginning of its development, in 2005, to 2020. The latest version, launched as a commercialized model in 2016, is available for medical facilities. In this retrospective study, which included updated results from previous reports, all data were extracted from development research records from July 2007 to December 2020. The records were as follows: patient characteristics [the number of participants, injury level, and the American Spinal Injury Association Impairment Scale (AIS) score], the total number of WPAL trials when aggregating the cases with all the versions or only the latest version of the WPAL, and maximum walking performance (functional ambulation category [FAC], distance, and time of continuous walking). Thirty-one patients participated in the development research. The levels of spinal cord injury were cervical (C5–C8), upper thoracic (T3–T6), lower thoracic (T7–T12), and lumbar (L1) in 10, 5, 15, and 1 of the patients, respectively. The numbers of patients with AIS scores of A, B, C, and D were 20, 7, 4, and 0, respectively. The total number of WPAL trials was 1,785, of which 1,009 were used the latest version of the WPAL. Twenty of the patients achieved an FAC score of 4 after an average of 9 (median 8, range 2–22) WPAL trials. The continuous walking distance and time improved with the WPAL were compared to the orthosis. We confirmed that the WPAL improves walking independence in people with a wide range of spinal cord injuries, such as cervical spinal cord injuries. Further refinement of the WPAL will enable its long-term use at home.

The improvement of the lower limb exoskeletons on the gait of patients with spinal cord injury: A protocol for systematic review and meta-analysis

BACKGROUND

Spinal Cord Injury is a severely disabling disease. In the process of Spinal Cord Injury rehabilitation treatment, improving patients' walking ability, improving their self-care ability, and enhancing patients' self-esteem is an important aspect of their return to society, which can also reduce the cost of patients, so the rehabilitation of lower limbs is very important. The lower limb exoskeleton robot is a bionic robot designed according to the principles of robotics, mechanism, bionics, control theory, communication technology, and information processing technology, which can be worn on the lower limb of the human body and complete specific tasks under the user's control. The purpose of this study was to evaluate the effect of the lower limb exoskeleton on the improvement of gait function in patients with spinal cord injury.

METHODS

The following electronic databases will be searched from inception to January 2022: PubMed, the Cochrane Library, Embase, Scopus, EBSCO, Web of Science, China National Knowledge Infrastructure, WanFang Data, Weipu Electronics. In addition, reference lists of the included studies were manually searched to identify additional relevant studies. Randomized controlled trials were collected to examine the effect of lower limb exoskeletons on lower limb functional recovery in spinal cord injury patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of lower limb exoskeletons on the upper limb function of spinal cord injury patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.

RESULTS

The results will provide evidence for judging whether lower limb exoskeletons are effective and safe in improving lower limb function in patients with spinal cord injury.

CONCLUSION

Our study will provide reliable evidence for the effect of lower limb exoskeletons on the improvement of lower limb function in spinal cord injury patients.

INPLASY REGISTRATION NUMBER

INPLASY202180095.

Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study

After spinal cord injury (SCI) physical activity levels decrease drastically, leading to numerous secondary health complications. Exoskeleton-assisted walking (EAW) may be one way to improve physical activity for adults with SCI and potentially alleviate secondary health complications. The effects of EAW may be limited, however, since exoskeletons induce passive movement for users who cannot volitionally contribute to walking. Trans-spinal stimulation (TSS) has shown the potential to enable those with even the most severe SCI to actively contribute to movements during EAW. To explore the effects of EAW training on improving secondary health complications in persons with SCI, participants with chronic (n = 8) were enrolled in an EAW program 2-3 times per week for 12 weeks. Anthropometrics (seated and supine waist and abdominal circumferences (WC and AC), body composition assessment (dual exposure x-ray absorptiometry-derived body fat percent, lean mass and total mass for the total body, legs, and trunk), and peak oxygen consumption (VO2 during a 6-minute walk test [6MWT]) were assessed before and after 12 weeks of EAW training. A subset of participants (n = 3) completed EAW training with concurrent TSS, and neuromuscular activity of locomotor muscles was assessed during a 10-m walk test (10MWT) with and without TSS following 12 weeks of EAW training. Upon completion of 12 weeks of training, reductions from baseline (BL) were found in seated WC (-2.2%, P = 0.036), seated AC (-2.9%, P = 0.05), and supine AC (-3.9%, P = 0.017). Percent fat was also reduced from BL for the total body (-1.4%, P = 0.018), leg (-1.3%, P = 0.018), and trunk (-2%, P = 0.036) regions. No effects were found for peak VO2. The addition of TSS for three individuals yielded individualized responses but generally increased knee extensor activity during EAW. Two of three participants who received TSS were also able to initiate more steps without additional assistance from the exoskeleton during a 10MWT. In summary, 12 weeks of EAW training significantly attenuated markers of obesity relevant to cardiometabolic health in eight men with chronic SCI. Changes in VO2 and neuromuscular activity with vs. without TSS were highly individualized and yielded no overall group effects.

Industrial Upper-Limb Exoskeleton Characterization: Paving the Way to New Standards for Benchmarking

Exoskeletons have been introduced in industrial environments to prevent overload or repetitive stress injuries in workers. However, due to the lack of public detailed information about most of the commercial exoskeletons, it is necessary to further assess their load capacity and evolution over time, as their performance may change with use. We present the design and construction of a controlled device to measure the torque of industrial exoskeletons, along with the results of static and dynamic testing of an exoskeleton model. A step motor in the test bench moves the exoskeleton arm in a pre-defined path at a prescribed speed. The force measured with a beam load cell located at the interface between the exoskeleton arm and the test bench is used to derive the torque. The proposed test bench can be easily modified to allow different exoskeleton models to be tested under the same conditions.

An analysis of usability evaluation practices and contexts of use in wearable robotics

BACKGROUND

User-centered design approaches have gained attention over the past decade, aiming to tackle the technology acceptance issues of wearable robotic devices to assist, support or augment human capabilities. While there is a consensus that usability is key to user-centered design, dedicated usability evaluation studies are scarce and clear evaluation guidelines are missing. However, the careful consideration and integration of user needs appears to be essential to successfully develop an effective, efficient, and satisfactory human-robot interaction. It is primarily the responsibility of the developer, to ensure that this users involvement takes place throughout the design process.

METHODS

Through an online survey for developers of wearable robotics, we wanted to understand how the design and evaluation in actual daily practice compares to what is reported in literature. With a total of 31 questions, we analyzed the most common wearable robotic device applications and their technology maturity, and how these influence usability evaluation practices.

RESULTS

A total of 158 responses from a heterogeneous population were collected and analyzed. The dataset representing contexts of use for augmentation (16.5%), assistance (38.0%), therapy (39.8%), as well as few other specific applications (5.7%), allowed for an insightful analysis of the influence of technology maturity on user involvement and usability evaluation. We identified functionality, ease of use, and performance as the most evaluated usability attributes and could specify which measures are used to assess them. Also, we could underline the frequent use of qualitative measures alongside the expected high prevalence of performance-metrics. In conclusion of the analysis, we derived evaluation recommendations to foster user-centered design and usability evaluation.

CONCLUSION

This analysis might serve as state-of-the-art comparison and recommendation for usability studies in wearable robotics. We believe that by motivating for more balanced, comparable and user-oriented evaluation practices, we may support the wearable robotics field in tackling the technology acceptance limitations.

Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.