The impact of interdisciplinarity and user involvement on the design and usability of an assistive upper limb exoskeleton - a case study on the EXOTIC.

This study describes an interdisciplinary approach to develop a 5 degrees of freedom assistive upper limb exoskeleton (ULE) for users with severe to complete functional tetraplegia. Four different application levels were identified for the ULE ranging from basic technical application to interaction with users, interaction with caregivers and interaction with the society, each level posing requirements for the design and functionality of the ULE. These requirements were addressed through an interdisciplinary collaboration involving users, clinicians and researchers within social sciences and humanities, mechanical engineering, control engineering media technology and biomedical engineering. The results showed that the developed ULE, the EXOTIC, had a high level of usability, safety and adoptability. Further, the results showed that several topics are important to explicitly address in relation to the facilitation of interdisciplinary collaboration including, defining a common language, a joint visualization of the end goal and a physical frame for the collaboration, such as a shared laboratory. The study underlined the importance of interdisciplinarity and we believe that future collaboration amongst interdisciplinary researchers and centres, also at an international level, can strongly facilitate the usefulness and adoption of assistive exoskeletons and similar technologies.

User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control.

This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC.

Eyes-Free Tongue Gesture and Tongue Joystick Control of a Five DOF Upper-Limb Exoskeleton for Severely Disabled Individuals.

Spinal cord injury can leave the affected individual severely disabled with a low level of independence and quality of life. Assistive upper-limb exoskeletons are one of the solutions that can enable an individual with tetraplegia (paralysis in both arms and legs) to perform simple activities of daily living by mobilizing the arm. Providing an efficient user interface that can provide full continuous control of such a device-safely and intuitively-with multiple degrees of freedom (DOFs) still remains a challenge. In this study, a control interface for an assistive upper-limb exoskeleton with five DOFs based on an intraoral tongue-computer interface (ITCI) for individuals with tetraplegia was proposed. Furthermore, we evaluated eyes-free use of the ITCI for the first time and compared two tongue-operated control methods, one based on tongue gestures and the other based on dynamic virtual buttons and a joystick-like control. Ten able-bodied participants tongue controlled the exoskeleton for a drinking task with and without visual feedback on a screen in three experimental sessions. As a baseline, the participants performed the drinking task with a standard gamepad. The results showed that it was possible to control the exoskeleton with the tongue even without visual feedback and to perform the drinking task at 65.1% of the speed of the gamepad. In a clinical case study, an individual with tetraplegia further succeeded to fully control the exoskeleton and perform the drinking task only 5.6% slower than the able-bodied group. This study demonstrated the first single-modal control interface that can enable individuals with complete tetraplegia to fully and continuously control a five-DOF upper limb exoskeleton and perform a drinking task after only 2 h of training. The interface was used both with and without visual feedback.