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Iranzo S, Belda-Lois JM, Martinez-de-Juan JL, Prats-Boluda G. Assessment of Muscle Coordination Changes Caused by the Use of an Occupational Passive Lumbar Exoskeleton in Laboratory Conditions. SENSORS (BASEL, SWITZERLAND) 2023; 23:9631. [PMID: 38139478 PMCID: PMC10747114 DOI: 10.3390/s23249631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
The introduction of exoskeletons in industry has focused on improving worker safety. Exoskeletons have the objective of decreasing the risk of injury or fatigue when performing physically demanding tasks. Exoskeletons' effect on the muscles is one of the most common focuses of their assessment. The present study aimed to analyze the muscle interactions generated during load-handling tasks in laboratory conditions with and without a passive lumbar exoskeleton. The electromyographic data of the muscles involved in the task were recorded from twelve participants performing load-handling tasks. The correlation coefficient, coherence coefficient, mutual information, and multivariate sample entropy were calculated to determine if there were significant differences in muscle interactions between the two test conditions. The results showed that muscle coordination was affected by the use of the exoskeleton. In some cases, the exoskeleton prevented changes in muscle coordination throughout the execution of the task, suggesting a more stable strategy. Additionally, according to the directed Granger causality, a trend of increasing bottom-up activation was found throughout the task when the participant was not using the exoskeleton. Among the different variables analyzed for coordination, the most sensitive to changes was the multivariate sample entropy.
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Affiliation(s)
- Sofía Iranzo
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, 46022 Valencia, Spain; (S.I.); (J.-M.B.-L.)
| | - Juan-Manuel Belda-Lois
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, 46022 Valencia, Spain; (S.I.); (J.-M.B.-L.)
| | - Jose Luis Martinez-de-Juan
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, 46022 Valencia, Spain;
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2
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Proud JK, Lai DTH, Mudie KL, Carstairs GL, Billing DC, Garofolini A, Begg RK. Exoskeleton Application to Military Manual Handling Tasks. HUMAN FACTORS 2022; 64:527-554. [PMID: 33203237 DOI: 10.1177/0018720820957467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this review was to determine how exoskeletons could assist Australian Defence Force personnel with manual handling tasks. BACKGROUND Musculoskeletal injuries due to manual handling are physically damaging to personnel and financially costly to the Australian Defence Force. Exoskeletons may minimize injury risk by supporting, augmenting, and/or amplifying the user's physical abilities. Exoskeletons are therefore of interest in determining how they could support the unique needs of military manual handling personnel. METHOD Industrial and military exoskeleton studies from 1990 to 2019 were identified in the literature. This included 67 unique exoskeletons, for which Information about their current state of development was tabulated. RESULTS Exoskeleton support of manual handling tasks is largely through squat/deadlift (lower limb) systems (64%), with the proposed use case for these being load carrying (42%) and 78% of exoskeletons being active. Human-exoskeleton analysis was the most prevalent form of evaluation (68%) with reported reductions in back muscle activation of 15%-54%. CONCLUSION The high frequency of citations of exoskeletons targeting load carrying reflects the need for devices that can support manual handling workers. Exoskeleton evaluation procedures varied across studies making comparisons difficult. The unique considerations for military applications, such as heavy external loads and load asymmetry, suggest that a significant adaptation to current technology or customized military-specific devices would be required for the introduction of exoskeletons into a military setting. APPLICATION Exoskeletons in the literature and their potential to be adapted for application to military manual handling tasks are presented.
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Affiliation(s)
| | | | - Kurt L Mudie
- 2222 Defence Science and Technology (DST), Melbourne, Australia
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De Bock S, Ghillebert J, Govaerts R, Tassignon B, Rodriguez-Guerrero C, Crea S, Veneman J, Geeroms J, Meeusen R, De Pauw K. Benchmarking occupational exoskeletons: An evidence mapping systematic review. APPLIED ERGONOMICS 2022; 98:103582. [PMID: 34600307 DOI: 10.1016/j.apergo.2021.103582] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To provide an overview of protocols assessing the effect of occupational exoskeletons on users and to formulate recommendations towards a literature-based assessment framework to benchmark the effect of occupational exoskeletons on the user. METHODS PubMed (MEDLINE), Web of Science database and Scopus were searched (March 2, 2021). Studies were included if they investigated the effect of one or more occupational exoskeletons on the user. RESULTS In total, 139 eligible studies were identified, encompassing 33, 25 and 18 unique back, shoulder and other exoskeletons, respectively. Device validation was most frequently conducted using controlled tasks while collecting muscle activity and biomechanical data. As the exoskeleton concept matures, tasks became more applied and the experimental design more representative. With that change towards realistic testing environments came a trade-off with experimental control, and user experience data became more valuable. DISCUSSION This evidence mapping systematic review reveals that the assessment of occupational exoskeletons is a dynamic process, and provides literature-based assessment recommendations. The homogeneity and repeatability of future exoskeleton assessment experiments will increase following these recommendations. The current review recognises the value of variability in evaluation protocols in order to obtain an overall overview of the effect of exoskeletons on the users, but the presented framework strives to facilitate benchmarking the effect of occupational exoskeletons on the users across this variety of assessment protocols.
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Affiliation(s)
- Sander De Bock
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
| | - Jo Ghillebert
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Renée Govaerts
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Carlos Rodriguez-Guerrero
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, 1050, Brussels, Belgium; COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium
| | - Simona Crea
- COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium; The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Jan Veneman
- COST (European Cooperation in Science and Technology) Action 16116, Wearable Robots for Augmentation, Assistance or Substitution of Human Motor Functions, Belgium; Hocoma AG, Volketswil, Switzerland
| | - Joost Geeroms
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Department of Mechanical Engineering, Faculty of Applied Sciences, Vrije Universiteit Brussel and Flanders Make, 1050, Brussels, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Strategic Research Program 'Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, 1050, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium; Strategic Research Program 'Exercise and the Brain in Health and Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, 1050, Brussels, Belgium
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Wang W, Jiang N, Teng L, Sui M, Li C, Wang L, Li G. Synergy Analysis of Back Muscle Activities in Patients with Adolescent Idiopathic Scoliosis Based on High-Density Electromyogram. IEEE Trans Biomed Eng 2021; 69:2006-2017. [PMID: 34882541 DOI: 10.1109/tbme.2021.3133583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a common structural spinal deformity and is typically associated with altered muscle properties. However, it is still unclear how muscle activities and the underlying neuromuscular control are changed in the entire scoliotic zone, restricting the corresponding pathology investigation and treatment enhancements. In this study, high-density electromyogram (HD-EMG) was utilized to explore the neuromuscular synergy of back muscle activities. For each of ten AIS patients and ten healthy subjects for comparison, a high-density electrode array was placed on their back from T8 to L4 to record EMG signals when performing five spinal motions (flexion/extension, lateral bending, axial rotation, siting, and standing). From the HD-EMG recordings, muscle synergies were extracted using the non-negative matrix factorization method and the topographical maps of EMG root-mean-square were constructed. For both the AIS and healthy subjects, the experimental results indicated that two muscle synergy groups could explain over 90% of recorded muscle activities for all five motions. During flexion/extension, the patients presented statistically significant higher activations on the convex side in the entire root-mean-square maps and synergy vector maps (p <0.05). During lateral bending and axial rotation, the patients exhibited less activated muscles on the dominant actuating side relative to the contralateral side and their synergy vector maps showed a less homogenous and more diffuse distribution of muscle contraction with statistically different centers of gravity. The findings suggest that a scoliotic spine might adopt an altered modular muscular coordination strategy to actuate different dominant muscles as adapted compensations for the deformation.
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Brinkemper A, von Glinski A, Schildhauer TA. Influence of an on-body lifting aid (HAL® for Care Support) on kinematics during repetitive lifting in healthy men. J Clin Neurosci 2021; 93:23-30. [PMID: 34656253 DOI: 10.1016/j.jocn.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Work-related lower back pain (LBP) leads to socio-economic burden and demands solutions. The hybrid assistive limb (HAL) for Care Support (Cyberdyne Inc., Ibaraki, Japan) is an active on-body lifting aid to assist joint motion according to the wearer's voluntary motor drive to reduce the lumbar load. A few studies investigated HAL and stated efficacy in terms of enhanced performance and reduced fatigue, yet the question remained if the use of HAL may result in a different execution of movement, for example by influencing the kinematics of the lower extremities. The aim of this study was to determine the influence of HAL on kinematics of the lower limbs and the spinal column during repetitive freestyle symmetrical lifting. Kinematic data was recorded by an inertial measurement unit sensor system in 11 healthy men lifting and lowering a 19.5 kg barbell under three conditions (no HAL, HAL Level 3/5, HAL Level 5/5). Outcome parameters were maximum and minimum angles as well as range of motion (ROM) of thoracic spine, lumbar spine, hip- and knee joint in sagittal plane. We found a significantly decreased ROM of the lumbar spine as well as a significantly reduced maximum and minimum thorax extension when starting lifting and in upright position after lifting, respectively, while using HAL. Influence of HAL on the kinematics of the lower limbs was not significant. Differences between both evaluated HAL conditions were not significant. This study proved limited lumbar spine ROM and reduced thorax extension without alterations of lower limbs kinematics when using HAL. This might potentially decrease the risk of work-related LBP.
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Affiliation(s)
- Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Crea S, Beckerle P, De Looze M, De Pauw K, Grazi L, Kermavnar T, Masood J, O’Sullivan LW, Pacifico I, Rodriguez-Guerrero C, Vitiello N, Ristić-Durrant D, Veneman J. Occupational exoskeletons: A roadmap toward large-scale adoption. Methodology and challenges of bringing exoskeletons to workplaces. WEARABLE TECHNOLOGIES 2021; 2:e11. [PMID: 38486625 PMCID: PMC10936259 DOI: 10.1017/wtc.2021.11] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 03/17/2024]
Abstract
The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.
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Affiliation(s)
- Simona Crea
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
- IRCCS Fondazione Don Gnocchi, Florence, Italy
| | - Philipp Beckerle
- Chair of Autonomous Systems and Mechatronics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute for Mechatronic Systems, Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, and Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Grazi
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
| | - Tjaša Kermavnar
- School of Design, and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Jawad Masood
- Processes and Factory of the Future Department, CTAG – Centro Tecnológico de Automoción de Galicia, Pontevedra, Spain
| | - Leonard W. O’Sullivan
- School of Design, and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Ilaria Pacifico
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
| | - Carlos Rodriguez-Guerrero
- Robotics and Multibody Mechanics Research Group, Department of Mechanical Engineering, Vrije Universiteit Brussel and Flanders Make, Brussel, Belgium
| | - Nicola Vitiello
- Scuola Superiore Sant’Anna, The BioRobotics Institute, Pontedera, Italy
- IRCCS Fondazione Don Gnocchi, Florence, Italy
| | | | - Jan Veneman
- Chair of COST Action 16116, Hocoma Medical GmbH, Zürich, Switzerland
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Primitive muscle synergies reflect different modes of coordination in upper limb motions. Med Biol Eng Comput 2021; 59:2153-2163. [PMID: 34482509 DOI: 10.1007/s11517-021-02429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
The motor system relies on the recruitment of motor modules to perform various movements. Muscle synergies are the modules used by the central nervous system to simplify the control of complex motor tasks. In this paper, we aim to explore the primitive synergies to reflect different modes of coordination in upper limb motions. Muscle synergies and corresponding activation coefficients were extracted via non-negative matrix factorization from the electromyography signals of three basic and four complex upper limb motions in sagittal plane and coronal plane. Similarities of muscle synergies and activation coefficients between different tasks and different subjects were compared. Moreover, we used network theory to assess the coordination between multiple muscles and to elucidate the neural implementation of muscle synergies. The results showed that the combination of different sets of primitive muscle synergies can achieve complex motions in different planes. The muscle synergy network topology differed significantly between different tasks. We also demonstrated the potential of this study for the understanding of human motor control mechanism and implications for neurorehabilitation.
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Kermavnar T, de Vries AW, de Looze MP, O'Sullivan LW. Effects of industrial back-support exoskeletons on body loading and user experience: an updated systematic review. ERGONOMICS 2021; 64:685-711. [PMID: 33369518 DOI: 10.1080/00140139.2020.1870162] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
This study is an updated systematic review of papers published in the last 5 years on industrial back-support exoskeletons. The research questions were aimed at addressing the recent findings regarding objective (e.g. body loading, user performance) and subjective evaluations (e.g. user satisfaction), potential side effects, and methodological aspects of usability testing. Thirteen studies of active and twenty of passive exoskeletons were identified. The exoskeletons were tested during lifting and bending tasks, predominantly in laboratory settings and among healthy young men. In general, decreases in participants' back-muscle activity, peak L5/S1 moments and spinal compression forces were reported. User endurance during lifting and static bending improved, but performance declined during tasks that required increased agility. The overall user satisfaction was moderate. Some side effects were observed, including increased abdominal/lower-limb muscle activity and changes in joint angles. A need was identified for further field studies, involving industrial workers, and reflecting actual work situations. Practitioner summary: Due to increased research activity in the field, a systematic review was performed of recent studies on industrial back-support exoskeletons, addressing objective and subjective evaluations, side effects, and methodological aspects of usability testing. The results indicate the efficiency of exoskeletons in back-load reduction and a need for further studies in real work situations. Abbrevaitions: BB: biceps brachii; BF: biceps femoris; CoM: centre of mass; DA: deltoideus anterior; EMG: electromyography; ES: erector spinae; ES-C: erector spinae-cervical; ESI: erector spinae iliocostalis; ESI-L: erector spinae iliocostalis-lumborum; ESL: erector spinae longissimus; ES-L: erector spinae-lumbar; ESL-L: erector spinae longissimus-lumborum; ESL-T: erector spinae longissimus-thoracis; ES-T: erector spinae-thoracic; GM: glutaeus maximus; LBP: low back pain; LD: latissimus dorsi; LPD: local perceived discomfort scale; LPP: local perceived pressure scale; MS: multifidus spinae; MSD: musculoskeletal disorder; M-SFS: modified spinal function sort; NMV: no mean value provided; OA: obliquus abdominis (internus and externus); OEA: obliquus externus abdominis; OIA : obliquus internus abdominis; RA: rectus abdominis; RF: rectus femoris; RoM: range of motion; SUS: system usability scale; T: trapezius (pars Ascendens and Descendens); TA: trapezius pars ascendens; TC: mid-cervical trapezius; TD: trapezius pars descendens; VAS: visual analog scale; VL: vastus lateralis; VM: vastus medialis.
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Affiliation(s)
| | | | | | - Leonard W O'Sullivan
- School of Design, Confirm Smart Manufacturing Centre and Health Research Institute, University of Limerick, Limerick, Ireland
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9
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Poliero T, Lazzaroni M, Toxiri S, Di Natali C, Caldwell DG, Ortiz J. Applicability of an Active Back-Support Exoskeleton to Carrying Activities. Front Robot AI 2020; 7:579963. [PMID: 33501340 PMCID: PMC7805869 DOI: 10.3389/frobt.2020.579963] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Occupational back-support exoskeletons are becoming a more and more common solution to mitigate work-related lower-back pain associated with lifting activities. In addition to lifting, there are many other tasks performed by workers, such as carrying, pushing, and pulling, that might benefit from the use of an exoskeleton. In this work, the impact that carrying has on lower-back loading compared to lifting and the need to select different assistive strategies based on the performed task are presented. This latter need is studied by using a control strategy that commands for constant torques. The results of the experimental campaign conducted on 9 subjects suggest that such a control strategy is beneficial for the back muscles (up to 12% reduction in overall lumbar activity), but constrains the legs (around 10% reduction in hip and knee ranges of motion). Task recognition and the design of specific controllers can be exploited by active and, partially, passive exoskeletons to enhance their versatility, i.e., the ability to adapt to different requirements.
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Affiliation(s)
- Tommaso Poliero
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Informatics Bioengineering Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Maria Lazzaroni
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Stefano Toxiri
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Christian Di Natali
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Darwin G. Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Jesús Ortiz
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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