User-centred assistive SystEm for arm Functions in neUromuscuLar subjects (USEFUL): a randomized controlled study

Multidisciplinary collaboration on exoskeleton development adopting user-centered design: a systematic integrative review

Purpose: The world population is ageing, along with an increasing possibility of functional limitations that affect independent living. Assistive technologies such as exoskeletons for rehabilitative purposes and daily activities assistance maintaining the independence of people with disabilities, especially older adults who wish to ageing-in-place. The purpose of this systematic integrative review was threefold: to explore the development team compositions and involvement, to understand the recruitment and engagement of stakeholders, and to synthesise reported or anticipated consequences of multidisciplinary collaboration.Methods: Databases searched included PubMed, CINAHL Plus, PsycINFO, Web of Science, Scopus, and IEEE Xplore. A total of 34 studies that reported the development of exoskeleton adopting user-centered design (UCD) method in healthcare or community settings that were published in English from 2000 to July 2022 were included.Results: Three major trends emerged from the analysis of included studies. First, there is a need to redefine multidisciplinary collaboration, from within-discipline collaboration to cross-discipline collaboration. Second, the level of engagement of stakeholders during the exoskeleton development remained low. Third, there was no standardised measurement to quantify knowledge production currently.Conclusion: As suggested by the synthesised results in this review, exoskeleton development has been increasing to improve the functioning of people with disabilities. Exoskeleton development often required expertise from different disciplines and the involvement of stakeholders to increase acceptance, thus we propose the Multidisciplinary Collaboration Appraisal Tool to assess multidisciplinary collaboration using the UCD approach. Future research is required to understand the effectiveness of multidisciplinary collaboration on exoskeleton development using the UCD approach.IMPLICATIONS FOR REHABILITATIONGlobal trend of population ageing causes a higher risk of disability in older adults who require rehabilitation and assistance in daily living.Assistive technologies such as exoskeletons have the potential to contribute to rehabilitation training and daily activity assistance demand closer multidisciplinary collaboration.A Multidisciplinary Collaboration Appraisal Tool using user-centered design approach (MCAT) is proposed to understand the effectiveness as well as limitations and barriers associated with multidisciplinary collaboration in developing exoskeletons.

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.

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).

Comparison of Lower Arm Weight and Passive Elbow Joint Impedance Compensation Strategies in Non-Disabled Participants

People with severe muscle weakness in the upper extremity are in need of an arm support to enhance arm function and improve their quality of life. In addition to weight support, compensation of passive joint impedance (pJimp) seems necessary. Existing devices do not compensate for pJimp yet, and the best way to compensate for it is still unknown. The aim of this study is to 1) identify pJimp of the elbow, and 2) compare four different compensation strategies of weight and combined weight and pJimp in an active elbow support system. The passive elbow joint moments, including gravitational and pJimp contributions, were measured in 12 non-disabled participants. The four compensation strategies (scaled-model, measured, hybrid, and fitted-model) were compared using a position-tracking task in the near vertical plane. All four strategies showed a significant reduction (20-47%) in the anti-gravity elbow flexor activity measured by surface electromyography. The pJimp turned out to contribute to a large extent to the passive elbow joint moments (range took up 60%) in non-disabled participants. This underlines the relevance of compensating for pJimp in arm support systems. The parameters of the scaled-model and hybrid strategy seem to overestimate the gravitational component. Therefore, the measured and fitted-model strategies are expected to be most promising to test in people with severe muscle weakness combined with elevated pJimp.

Upper limb soft robotic wearable devices: a systematic review

INTRODUCTION

Soft robotic wearable devices, referred to as exosuits, can be a valid alternative to rigid exoskeletons when it comes to daily upper limb support. Indeed, their inherent flexibility improves comfort, usability, and portability while not constraining the user's natural degrees of freedom. This review is meant to guide the reader in understanding the current approaches across all design and production steps that might be exploited when developing an upper limb robotic exosuit.

METHODS

The literature research regarding such devices was conducted in PubMed, Scopus, and Web of Science. The investigated features are the intended scenario, type of actuation, supported degrees of freedom, low-level control, high-level control with a focus on intention detection, technology readiness level, and type of experiments conducted to evaluate the device.

RESULTS

A total of 105 articles were collected, describing 69 different devices. Devices were grouped according to their actuation type. More than 80% of devices are meant either for rehabilitation, assistance, or both. The most exploited actuation types are pneumatic (52%) and DC motors with cable transmission (29%). Most devices actuate 1 (56%) or 2 (28%) degrees of freedom, and the most targeted joints are the elbow and the shoulder. Intention detection strategies are implemented in 33% of the suits and include the use of switches and buttons, IMUs, stretch and bending sensors, EMG and EEG measurements. Most devices (75%) score a technology readiness level of 4 or 5.

CONCLUSION

Although few devices can be considered ready to reach the market, exosuits show very high potential for the assistance of daily activities. Clinical trials exploiting shared evaluation metrics are needed to assess the effectiveness of upper limb exosuits on target users.

Upper limb exosuit cable routing optimization

Exosuits are emerging as promising in assisting with activities of daily living. In the design phase of an exosuit, it is fundamental to maximize its portability. The goal of this work was to identify the best cable routing configuration for an upper limb cable-driven exosuit to assist elbow flexion. Simulations were run in OpenSim. Different cable configurations were evaluated. The goal was to minimize the overall tension of the cables to reduce the device's power consumption and torque requirements. The optimal configuration was evaluated in simulation for different percentages of assistance to study its effects in terms of muscle activation and joint reaction forces. We then tested three different configurations on a test bench to both evaluate the motor current and their effect on the pronation/supination of the elbow. Simulation results suggested that a double cable configuration might help to lower the motor torque and power consumption. This conclusion was supported by the experimental results, in which the motor current was reduced by 12.5% with respect to the single cable configuration. Simulation results also showed that the optimal configuration lowered muscle activation without greatly affecting joint reactions at the elbow, even though it might cause unwanted pronation/supination, as experimental results confirmed. However, since a double configuration results in greater complexity and reduced efficiency, single-cable solutions still represent a good option.

Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.