Wearable accelerometers for measuring and monitoring the motor behaviour of infants with brain damage during CareToy-Revised training.

BACKGROUND: Nowadays, wearable sensors are widely used to quantify physical and motor activity during daily life, and they also represent innovative solutions for healthcare. In the clinical framework, the assessment of motor behaviour is entrusted to clinical scales, but they are dependent on operator experience. Thanks to their intrinsic objectivity, sensor data are extremely useful to provide support to clinicians. Moreover, wearable sensors are user-friendly and compliant to be used in an ecological environment (i.e., at home). This paper aims to propose an innovative approach useful to predict clinical assessment scores of infants' motor activity. MATERIALS AND METHODS: Starting from data acquired by accelerometers placed on infants' wrists and trunk during playtime, we exploit the method of functional data analysis to implement new models combining quantitative data and clinical scales. In particular, acceleration data, transformed into activity indexes and combined with baseline clinical data, represent the input dataset for functional linear models. CONCLUSIONS: Despite the small number of data samples available, results show correlation between clinical outcome and quantitative predictors, indicating that functional linear models could be able to predict the clinical evaluation. Future works will focus on a more refined and robust application of the proposed method, based on the acquisition of more data for validating the presented models. TRIAL REGISTRATION NUMBER: ClincalTrials.gov; NCT03211533. Registered: July, 7th 2017. ClincalTrials.gov; NCT03234959. Registered: August, 1st 2017.

Soft Robotic Manipulator for Improving Dexterity in Minimally Invasive Surgery.

BACKGROUND: Combining the strengths of surgical robotics and minimally invasive surgery (MIS) holds the potential to revolutionize surgical interventions. The MIS advantages for the patients are obvious, but the use of instrumentation suitable for MIS often translates in limiting the surgeon capabilities (eg, reduction of dexterity and maneuverability and demanding navigation around organs). To overcome these shortcomings, the application of soft robotics technologies and approaches can be beneficial. The use of devices based on soft materials is already demonstrating several advantages in all the exploitation areas where dexterity and safe interaction are needed. In this article, the authors demonstrate that soft robotics can be synergistically used with traditional rigid tools to improve the robotic system capabilities and without affecting the usability of the robotic platform. MATERIALS AND METHODS: A bioinspired soft manipulator equipped with a miniaturized camera has been integrated with the Endoscopic Camera Manipulator arm of the da Vinci Research Kit both from hardware and software viewpoints. Usability of the integrated system has been evaluated with nonexpert users through a standard protocol to highlight difficulties in controlling the soft manipulator. RESULTS AND CONCLUSION: This is the first time that an endoscopic tool based on soft materials has been integrated into a surgical robot. The soft endoscopic camera can be easily operated through the da Vinci Research Kit master console, thus increasing the workspace and the dexterity, and without limiting intuitive and friendly use.

Total mesorectal excision using a soft and flexible robotic arm: a feasibility study in cadaver models.

BACKGROUND: Sponsored by the European Commission, the FP7 STIFF-FLOP project aimed at developing a STIFFness controllable Flexible and Learn-able manipulator for surgical operations, in order to overcome the current limitations of rigid-link robotic technology. Herein, we describe the first cadaveric series of total mesorectal excision (TME) using a soft and flexible robotic arm for optic vision in a cadaver model. METHODS: TME assisted by the STIFF-FLOP robotic optics was successfully performed in two embalmed male human cadavers. The soft and flexible optic prototype consisted of two modules, each measuring 60 mm in length and 14.3 mm in maximum outer diameter. The robot was attached to a rigid shaft connected to an anthropomorphic manipulator robot arm with six degrees of freedom. The controller device was equipped with two joysticks. The cadavers (BMI 25 and 28 kg/m2) were prepared according to the Thiel embalming method. The procedure was performed using three standard laparoscopic instruments for traction and dissection, with the aid of a 30° rigid optics in the rear for documentation. RESULTS: Following mobilization of the left colonic flexure and division of the inferior mesenteric vessels, TME was completed down to the pelvic floor. The STIFF-FLOP robotic optic arm seemed to acquire superior angles of vision of the surgical field in the pelvis, resulting in an intact mesorectum in both cases. Completion times of the procedures were 165 and 145 min, respectively. No intraoperative complications occurred. No technical failures were registered. CONCLUSIONS: The STIFF-FLOP soft and flexible robotic optic arm proved effective in assisting a laparoscopic TME in human cadavers, with a superior field of vision compared to the standard laparoscopic vision, especially low in the pelvis. The introduction of soft and flexible robotic devices may aid in overcoming the technical challenges of difficult laparoscopic procedures based on standard rigid instruments.

Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery.

BACKGROUND: This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. MATERIAL AND METHODS: Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. RESULTS: BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. CONCLUSION: BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.

Soft Robotics: A Route to Equality, Diversity, and Inclusivity in Robotics.

Robotics is entering our daily lives. The discipline is increasingly crucial in fields such as agriculture, medicine, and rescue operations, impacting our food, health, and planet. At the same time, it is becoming evident that robotic research must embrace and reflect the diversity of human society to address these broad challenges effectively. In recent years, gender inclusivity has received increasing attention, but it still remains a distant goal. In addition, awareness is rising around other dimensions of diversity, including nationality, religion, and politics. Unfortunately, despite the efforts, empirical evidence shows that the field has still a long way to go before achieving a sufficient level of equality, diversity, and inclusion across these spectra. This study focuses on the soft robotics community-a growing and relatively recent subfield-and it outlines the present state of equality and diversity panorama in this discipline. The article argues that its high interdisciplinary and accessibility make it a particularly welcoming branch of robotics. We discuss the elements that make this subdiscipline an example for the broader robotic field. At the same time, we recognize that the field should still improve in several ways and become more inclusive and diverse. We propose concrete actions that we believe will contribute to achieving this goal, and provide metrics to monitor its evolution.

Artificial intelligence for the recognition of benign lesions of vocal folds from audio recordings.

Objective: The diagnosis of benign lesions of the vocal fold (BLVF) is still challenging. The analysis of the acoustic signals through the implementation of machine learning models can be a viable solution aimed at offering support for clinical diagnosis. Materials and methods: In this study, a support vector machine was trained and cross-validated (10-fold cross-validation) using 138 features extracted from the acoustic signals of 418 patients with polyps, nodules, oedema, and cysts. The model's performance was presented as accuracy and average F1-score. The results were also analysed in male (M) and female (F) subgroups. Results: The validation accuracy was 55%, 80%, and 54% on the overall cohort, and in M and F, respectively. Better performances were observed in the detection of cysts and nodules (58% and 62%, respectively) vs polyps and oedema (47% and 53%, respectively). The results on each lesion and the different patterns of the model on M and F are in line with clinical observations, obtaining better results on F and detection of sensitive polyps in M. Conclusions: This study showed moderately accurate detection of four types of BLVF using acoustic signals. The analysis of the diagnostic results on gender subgroups highlights different behaviours of the diagnostic model.

Development of an Innovative Soft Piezoresistive Biomaterial Based on the Interconnection of Elastomeric PDMS Networks and Electrically-Conductive PEDOT:PSS Sponges.

A deeply interconnected flexible transducer of polydimethylsiloxane (PDMS) and poly(3,4-ethylenedioxythiophene):polystyrenesulfonate (PEDOT:PSS) was obtained as a material for the application of soft robotics. Firstly, transducers were developed by crosslinking PEDOT:PSS with 3-glycidyloxypropryl-trimethoxysilane (GPTMS) (1, 2 and 3% v/v) and using freeze-drying to obtain porous sponges. The PEDOT:PSS sponges were morphologically characterized, showing porosities mainly between 200 and 600 µm2; such surface area dimensions tend to decrease with increasing degrees of crosslinking. A stability test confirmed a good endurance for up to 28 days for the higher concentrations of the crosslinker tested. Consecutively, the sponges were electromechanically characterized, showing a repeatable and linear resistance variation by the pressure triggers within the limits of their working range (∆RR0 max = 80% for 1-2% v/v of GPTMS). The sponges containing 1% v/v of GPTMS were intertwined with a silicon elastomer to increase their elasticity and water stability. The flexible transducer obtained with this method exhibited moderately lower sensibility and repeatability than the PEDOT:PSS sponges, but the piezoresistive response remained stable under mechanical compression. Furthermore, the transducer displayed a linear behavior when stressed within the limits of its working range. Therefore, it is still valid for pressure sensing and contact detection applications. Lastly, the flexible transducer was submitted to preliminary biological tests that indicate a potential for safe, in vivo sensing applications.

Evaluation of the Electroglottographic Signal Variability in Organic and Functional Dysphonia.

OBJECTIVES: To confirm the data reported in our previous studies on the analysis of the variability of the electroglottographic signal in the pathological voice; to evaluate possible differences in variability between organic and functional pathologies; to identify any distinctive/typical EGG patterns for these pathologies. METHODS: One hundred twenty-five subjects were enrolled (36 euphonic and 89 pathological: 24 functional dysphonia, 21 bilateral vocal nodules, 23 unilateral polyps and 21 unilateral cysts). All subjects were studied with videolaryngostroboscopy, spectrographic analysis of voice and electroglottography (EGG). The EGG signal variability was then investigated using amplitude-speed combined analysis, by means of a proprietary software algorithm. Amplitude and Speed variation were expressed as a new parameter, the Variability Index (VI), calculated both for the whole EGG signal recorded (VI-tot) and in each phase of the glottic cycle (VI-Q, absolute value; VI-Q%, percentage value). RESULTS: In the comparison of VI values between pathological and normal groups, VI-tot and VI-Q2% (which corresponds to the final phase of vocal fold contact) were significantly greater in pathological subjects (P= 0.002). The comparison of VI values among subgroups of the various pathologies showed a difference for VI-tot (P< 0.0001) and VI-Q2% (P= 0.001); this difference was more marked in the cysts than in the functional dysphonia. The cut-off values of VI-tot and VI-Q2% were 0.191 and 18.17%, respectively (sensitivity and specificity 65.2% and 66.7% for VI-tot and 84.3% and 77.8% for VI-Q2%). CONCLUSIONS: The variability of the EGG signal investigated through the combined analysis of the amplitude and the speed of vibration using a proprietary algorithm software has proved useful not only to distinguish the normal voice from the pathological voice, but also to characterize which phases are more altered in the various voice pathologies studied, both functional and organic. Furthermore, the analysis of the VI parameter allowed to propose cut-off values characterized by a good sensitivity and specificity to discriminate dysphonia from the euphonic voice. Larger groups of patients will be needed to confirm these results.

Embodied Intelligence in Soft Robotics Through Hardware Multifunctionality.

The soft robotics community is currently wondering what the future of soft robotics is. Therefore, it is very important to identify the directions in which the community should focus its efforts to consolidate its impact. The identification of convincing applications is a priority, especially to demonstrate that some achievements already represent an attractive alternative to current technological approaches in specific scenarios. However, most of the added value of soft robotics has been only theoretically grasped. Embodied Intelligence, being of these theoretical principles, represents an interesting approach to fully exploit soft robotic's potential, but a pragmatic application of this theory still remains difficult and very limited. A different design approach could be beneficial, i.e., the integration of a certain degree of continuous adaptability in the hardware functionalities of the robot, namely, a "flexible" design enabled by hardware components able to fulfill multiple functionalities. In this paper this concept of flexible design is introduced along with its main technological and theoretical basic elements. The potential of the approach is demonstrated through a biological comparison and the feasibility is supported by practical examples with state-of-the-art technologies.

Fiber Jamming Transition as a Stiffening Mechanism for Soft Robotics.

Robots made of soft materials are demonstrating to be well suited in applications where dexterity and intrinsic safety are necessary. However, one of the most challenging goals of soft robotics remains the ability to change the stiffness of body parts to guarantee stability and to produce significant forces. Among soft actuation technologies reported in literature, the jamming phenomenon is now achieving resounding interest. The jamming transition was observed and studied both with granular and laminar material; however, there is a third possibility that is not gaining the attention that probably would deserve: the fiber jamming. The aim of this study was an attempt to analyze the main parameters influencing the fiber jamming transition as promising stiffening solution for soft robotics. A preliminary analysis to choose the most suitable filling material and the external membrane that compose the system was performed and three possible configurations were designed. The prototypes thus assembled were experimentally investigated by using two different setups: one for conducting comparative bending tests on the systems and another for assessing the mechanical properties of single filling fibers. The results of the tests are used to feature the correlation between the arrangement and the material properties of the fibers and the stiffening capability of the fiber jamming systems. The investigation has shown performances comparable with those obtained with granular and layer jamming, demonstrating that fiber jamming is a good candidate for integration in soft robotic devices.

Toward a Variable Stiffness Surgical Manipulator Based on Fiber Jamming Transition.

Soft robots have proved to represent a new frontier for the development of intelligent machines able to show new capabilities that can complement those currently performed by robots based on rigid materials. One of the main application areas where this shift is promising an impact is minimally invasive surgery. In previous works, the STFF-FLOP soft manipulator has been introduced as a new concept of using soft materials to develop endoscopic tools. In this paper, we present a novel kind of stiffening system based on fiber jamming transition that can be embedded in the manipulator to widen its applicability by increasing its stability and with the possibility to produce and transmit higher forces. The STIFF-FLOP original module has been re-designed in two new versions to incorporate the variable stiffness mechanism. The two designs have been evaluated in terms of dexterity and variable stiffness capability and, despite a general optimization rule did not clearly emerge, the study confirmed that fiber jamming transition can be considered an effective technological approach for obtaining variable stiffness in slender soft structures.

Highly dexterous 2-module soft robot for intra-organ navigation in minimally invasive surgery.

BACKGROUND: For some surgical interventions, like the Total Mesorectal Excision (TME), traditional laparoscopes lack the flexibility to safely maneuver and reach difficult surgical targets. This paper answers this need through designing, fabricating and modelling a highly dexterous 2-module soft robot for minimally invasive surgery (MIS). METHODS: A soft robotic approach is proposed that uses flexible fluidic actuators (FFAs) allowing highly dexterous and inherently safe navigation. Dexterity is provided by an optimized design of fluid chambers within the robot modules. Safe physical interaction is ensured by fabricating the entire structure by soft and compliant elastomers, resulting in a squeezable 2-module robot. An inner free lumen/chamber along the central axis serves as a guide of flexible endoscopic tools. A constant curvature based inverse kinematics model is also proposed, providing insight into the robot capabilities. RESULTS: Experimental tests in a surgical scenario using a cadaver model are reported, demonstrating the robot advantages over standard systems in a realistic MIS environment. CONCLUSION: Simulations and experiments show the efficacy of the proposed soft robot.

A soft multi-module manipulator with variable stiffness for minimally invasive surgery.

This work presents a soft manipulator for minimally invasive surgery inspired by the biological capabilities of the octopus arm. The multi-module arm is composed of three identical units, which are able to move thanks to embedded fluidic actuators that allow omnidirectional bending and elongation, typical movements of the octopus. The use of soft materials makes the arm safe, adaptable and compliant with tissues. In addition, a granular jamming-based stiffening mechanism is integrated in each module with the aim of tuning the stiffness of the manipulator and controlling the interactions with biological structures. A miniaturized camera and a pneumatic gripper have been purposely designed and integrated on the tip of the manipulator making it usable in real working conditions. This work reports the design and the fabrication process of the manipulator, the theoretical and experimental evaluation of the stiffness and the analysis of the motion workspace. Finally, pick and place tests with the fully integrated system are shown.

Conduction Electrohydrodynamics with Mobile Electrodes: A Novel Actuation System for Untethered Robots.

Electrohydrodynamics (EHD) refers to the direct conversion of electrical energy into mechanical energy of a fluid. Through the use of mobile electrodes, this principle is exploited in a novel fashion for designing and testing a millimeter-scale untethered robot, which is powered harvesting the energy from an external electric field. The robot is designed as an inverted sail-boat, with the thrust generated on the sail submerged in the liquid. The diffusion constant of the robot is experimentally computed, proving that its movement is not driven by thermal fluctuations, and then its kinematic and dynamic responses are characterized for different applied voltages. The results show the feasibility of using EHD with mobile electrodes for powering untethered robots and provide new evidences for the further development of this actuation system for both mobile robots and compliant actuators in soft robotics.

Learning Closed Loop Kinematic Controllers for Continuum Manipulators in Unstructured Environments.

This article introduces a machine-learning-based approach for closed loop kinematic control of continuum manipulators in the task space. For this purpose, we propose a unique formulation for learning the inverse kinematics of a continuum manipulator while integrating end-effector feedback. We demonstrate that this model-free approach for kinematic control is very well suited for nonlinear stochastic continuum robots. The article addresses problems that are vital for practical realization of machine-learning techniques. The primary objective is to solve the redundancy problem while making the algorithm scalable, fast, and tolerant to stochasticity, requiring minimal sensor elements and involving few open parameters for tuning. In addition, we demonstrate that the proposed controller can exhibit adaptive behavior in the presence of external forces and in an unstructured environment with the help of the morphological properties of the manipulator. Experimental validation of the proposed controller is done on a six-degree-of-freedom tendon-driven manipulator for pose control of the end effector in three-dimensional space with and without external forces. The experimental results exhibit accurate, reliable, and adaptive behavior of the proposed system, which appears suitable for the field of continuum service robots.

Pleasant to the Touch: By Emulating Nature, Scientists Hope to Find Innovative New Uses for Soft Robotics in Health-Care Technology.

Open your Internet browser and search for videos showing the most advanced humanoid robots. Look at how they move and walk. Observe their motion and their interaction with the environment (the ground, users, target objects). Now, search for a video of your favorite sports player. Despite the undoubtedly great achievements of modern robotics, it will become quite evident that a lot of work still remains.

Soft robotics: Technologies and systems pushing the boundaries of robot abilities.

The proliferation of soft robotics research worldwide has brought substantial achievements in terms of principles, models, technologies, techniques, and prototypes of soft robots. Such achievements are reviewed here in terms of the abilities that they provide robots that were not possible before. An analysis of the evolution of this field shows how, after a few pioneering works in the years 2009 to 2012, breakthrough results were obtained by taking seminal technological and scientific challenges related to soft robotics from actuation and sensing to modeling and control. Further progress in soft robotics research has produced achievements that are important in terms of robot abilities-that is, from the viewpoint of what robots can do today thanks to the soft robotics approach. Abilities such as squeezing, stretching, climbing, growing, and morphing would not be possible with an approach based only on rigid links. The challenge ahead for soft robotics is to further develop the abilities for robots to grow, evolve, self-heal, develop, and biodegrade, which are the ways that robots can adapt their morphology to the environment.

Large deformation of self-oscillating polymer gel.

A self-oscillating gel is a system that generates an autonomous volume oscillation. This oscillation is powered by the chemical energy of the Belousov-Zhabotinsky (BZ) reaction, which demonstrates metal ion redox oscillation. A self-oscillating gel is composed of Poly-N-isopropylacrylamide (PNIPAAm) with a metal ion. In this study, we found that the displacement of the volume oscillation in a self-oscillating gel could be controlled by its being subjected to a prestraining process. We also revealed the driving mechanism of the self-oscillating gel from the point of view of thermodynamics. We observed that the polymer-solvent interaction parameter χ is altered by the redox changes to the metal ion incorporated in the self-oscillating gel. The prestraining process leads to changes in χ and changes in enthalpy and entropy when the self-oscillating gel is in a reduced and oxidized state. We found that nonprestrained gel samples oscillate in a poor solution (χ>0.5) and prestrained gel samples oscillate in a good solution (χ<0.5).

Design and Fabrication of an Elastomeric Unit for Soft Modular Robots in Minimally Invasive Surgery.

In recent years, soft robotics technologies have aroused increasing interest in the medical field due to their intrinsically safe interaction in unstructured environments. At the same time, new procedures and techniques have been developed to reduce the invasiveness of surgical operations. Minimally Invasive Surgery (MIS) has been successfully employed for abdominal interventions, however standard MIS procedures are mainly based on rigid or semi-rigid tools that limit the dexterity of the clinician. This paper presents a soft and high dexterous manipulator for MIS. The manipulator was inspired by the biological capabilities of the octopus arm, and is designed with a modular approach. Each module presents the same functional characteristics, thus achieving high dexterity and versatility when more modules are integrated. The paper details the design, fabrication process and the materials necessary for the development of a single unit, which is fabricated by casting silicone inside specific molds. The result consists in an elastomeric cylinder including three flexible pneumatic actuators that enable elongation and omni-directional bending of the unit. An external braided sheath improves the motion of the module. In the center of each module a granular jamming-based mechanism varies the stiffness of the structure during the tasks. Tests demonstrate that the module is able to bend up to 120° and to elongate up to 66% of the initial length. The module generates a maximum force of 47 N, and its stiffness can increase up to 36%.

Cryo-scanning electron microscopy investigation of the Octopus Vulgaris arm structures for the design of an octopus-like arm artefact.

Octopus vulgaris is a cephalopod of the Octopodidae family. It has four pairs of arms and two rows of suckers which perform many functions, including bending and elongation. For this reason the octopus was chosen as model to develop a new generation of soft-body robots. In order to explain some of the fine structures of the octopus arm in relation to its specific ability, we examined the external and internal structures of O. vulgaris arms in a frozen-hydrated state using cryo-scanning electron microscopy. The arms showed skin with a very complex design that is useful to elongation, and a pore pattern distribution on their surface which is functional to cutaneous oxygen uptake. The analysis of freeze-fractured frozen-hydrated arm samples allowed us to describe the developmental differences in the relative proportion of the areas of axial nerve cord, intrinsic and extrinsic musculature, in relation to the growth of the arms and of the increase in functional capability. In the suckers, we analyzed the shedding mechanisms in the outer part of the infundibulum and described the outer and inner characteristics of the denticles, showing in detail their pore system, which is fundamental for their ability to explore the environment. These results are discussed by considering their possible application in the design of new octopus-like artefacts, which will be able to take advantage of some of these ultrastructure characteristics and achieve advanced bioinspired functionalities.