Combining soft robotics and telerehabilitation for improving motor function after stroke.

Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients' home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.

Predicting overstriding with wearable IMUs during treadmill and overground running.

Running injuries are prevalent, but their exact mechanisms remain unknown largely due to limited real-world biomechanical analysis. Reducing overstriding, the horizontal distance that the foot lands ahead of the body, may be relevant to reducing injury risk. Here, we leverage the geometric relationship between overstriding and lower extremity sagittal segment angles to demonstrate that wearable inertial measurement units (IMUs) can predict overstriding during treadmill and overground running in the laboratory. Ten recreational runners matched their strides to a metronome to systematically vary overstriding during constant-speed treadmill running and showed similar overstriding variation during comfortable-speed overground running. Linear mixed models were used to analyze repeated measures of overstriding and sagittal segment angles measured with motion capture and IMUs. Sagittal segment angles measured with IMUs explained 95% and 98% of the variance in overstriding during treadmill and overground running, respectively. We also found that sagittal segment angles measured with IMUs correlated with peak braking force and explained 88% and 80% of the variance during treadmill and overground running, respectively. This study highlights the potential for IMUs to provide insights into landing and loading patterns over time in real-world running environments, and motivates future research on feedback to modify form and prevent injury.

A Portable, Neurostimulation-Integrated, Force Measurement Platform for the Clinical Assessment of Plantarflexor Central Drive.

Plantarflexor central drive is a promising biomarker of neuromotor impairment; however, routine clinical assessment is hindered by the unavailability of force measurement systems with integrated neurostimulation capabilities. In this study, we evaluate the accuracy of a portable, neurostimulation-integrated, plantarflexor force measurement system we developed to facilitate the assessment of plantarflexor neuromotor function in clinical settings. Two experiments were conducted with the Central Drive System (CEDRS). To evaluate accuracy, experiment #1 included 16 neurotypical adults and used intra-class correlation (ICC2,1) to test agreement of plantarflexor strength capacity measured with CEDRS versus a stationary dynamometer. To evaluate validity, experiment #2 added 26 individuals with post-stroke hemiparesis and used one-way ANOVAs to test for between-limb differences in CEDRS' measurements of plantarflexor neuromotor function, comparing neurotypical, non-paretic, and paretic limb measurements. The association between paretic plantarflexor neuromotor function and walking function outcomes derived from the six-minute walk test (6MWT) were also evaluated. CEDRS' measurements of plantarflexor neuromotor function showed high agreement with measurements made by the stationary dynamometer (ICC = 0.83, p < 0.001). CEDRS' measurements also showed the expected between-limb differences (p's < 0.001) in maximum voluntary strength (Neurotypical: 76.21 ± 13.84 ft-lbs., Non-paretic: 56.93 ± 17.75 ft-lbs., and Paretic: 31.51 ± 14.08 ft-lbs.), strength capacity (Neurotypical: 76.47 ± 13.59 ft-lbs., Non-paretic: 64.08 ± 14.50 ft-lbs., and Paretic: 44.55 ± 14.23 ft-lbs.), and central drive (Neurotypical: 88.73 ± 1.71%, Non-paretic: 73.66% ± 17.74%, and Paretic: 52.04% ± 20.22%). CEDRS-measured plantarflexor central drive was moderately correlated with 6MWT total distance (r = 0.69, p < 0.001) and distance-induced changes in speed (r = 0.61, p = 0.002). CEDRS is a clinician-operated, portable, neurostimulation-integrated force measurement platform that produces accurate measurements of plantarflexor neuromotor function that are associated with post-stroke walking ability.

The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts.

Back support exosuits aim to reduce tissue demands and thereby risk of injury and pain. However, biomechanical analyses of soft active exosuit designs have been limited. The objective of this study was to evaluate the effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading in participants performing stoop and squat lifts of 6 and 10 kg crates, using participant-specific musculoskeletal models. The exosuit did not change overall trunk motion but affected lumbo-pelvic motion slightly, and reduced peak compressive and shear vertebral loads at some levels, although shear increased slightly at others. This study indicates that soft active exosuits have limited kinematic effects during lifting, and can reduce spinal loading depending on the vertebral level. These results support the hypothesis that a soft exosuit can assist without limiting trunk movement or negatively impacting skeletal loading and have implications for future design and ergonomic intervention efforts.

Back support exosuits have the potential to reduce musculoskeletal workplace injuries. We examined and modelled the impact of a soft active exosuit on spine motion and loading. The exosuit generally reduced vertebral loading and did not inhibit trunk motion. Results of this study support future research to examine the exosuit as an ergonomic intervention.

Soft robotic apparel to avert freezing of gait in Parkinson's disease.

Freezing of gait (FoG) is a profoundly disruptive gait disturbance in Parkinson's disease, causing unintended stops while walking. Therapies for FoG reveal modest and transient effects, resulting in a lack of effective treatments. Here we show proof of concept that FoG can be averted using soft robotic apparel that augments hip flexion. The wearable garment uses cable-driven actuators and sensors, generating assistive moments in concert with biological muscles. In this n-of-1 trial with five repeated measurements spanning 6 months, a 73-year-old male with Parkinson's disease and substantial FoG demonstrated a robust response to robotic apparel. With assistance, FoG was instantaneously eliminated during indoor walking (0% versus 39 ± 16% time spent freezing when unassisted), accompanied by 49 ± 11 m (+55%) farther walking compared to unassisted walking, faster speeds (+0.18 m s-1) and improved gait quality (-25% in gait variability). FoG-targeting effects were repeatable across multiple days, provoking conditions and environment contexts, demonstrating potential for community use. This study demonstrated that FoG was averted using soft robotic apparel in an individual with Parkinson's disease, serving as an impetus for technological advancements in response to this serious yet unmet need.

Educational Soft Underwater Robot with an Electromagnetic Actuation.

As demonstrated by the Soft Robotics Toolkit Platform, compliant robotics pose an exciting educational opportunity. Underwater robotics using soft undulating fins is an expansive research topic with applications such as exploration of underwater life or replicating 3d swarm behavior. To make this research area accessible for education we developed Educational Soft Underwater Robot with Electromagnetic Actuation (ESURMA), a humanoid soft underwater robot. We achieved advances in simplicity, modularity, and performance by implementing electromagnetic actuation into the caudal fin. An electromagnet, including electronics, is placed in a waterproof housing, and permanent magnets are embedded in a soft silicone cast tail. The force from their magnetic interaction results in a bending movement of the tail. The magnetic actuation is simple to implement and requires no mechanical connection between the actuated component and the electrically controlled coil. This enables robust waterproofing and makes the device fully modular. Thanks to the direct and immediate transmission of force, experimental flapping frequencies of 14 Hz were achieved, an order of magnitude higher compared to pneumatically actuated tails. The completely silent actuation of the caudal fin enables a maximum swimming speed of 14.3 cm/s. With its humanoid shape, modular composition, and cost efficiency ESURMA represents an attractive platform for education and demonstrates an alternative method of actuating soft structures.

Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion.

Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.

Air Efficient Soft Wearable Robot for High-Torque Elbow Flexion Assistance.

Recent developments in soft wearable robots have shown promise for assistive and rehabilitative use-cases. For inflatable approaches, a major challenge in developing portable systems is finding a balance between portability, performance, and usability. In this paper, we present a textile-based robotic sleeve that can provide functional elbow flexion assistance and is compatible with a portable actuation unit (PAU). Flexion is driven by a curved textile actuator with internal pneumatic supports (IPS). We show that the addition of IPS improves torque generation and increases battery-powered actuations by 60%. We demonstrate that the device can provide enough torque throughout the ROM of the elbow joint for daily life assistance. Specifically, the device generates 13.5 Nm of torque at 90°. Experimental testing in five healthy individuals and two individuals with Amyotrophic Lateral Sclerosis (ALS) demonstrates its impact on wearer muscle activity and kinematics. The results with healthy subjects show that the device was able to reduce the bicep muscle activity by an average of 49.1±13.3% during static and dynamic exercises, 43.6±11.1% during simulated ADLs, and provided an assisted ROM of 134°±13°. Both ALS participants reported a reduced rate of perceived exertion during both static and dynamic tasks while wearing the device and had an average ROM of 115°±8°. Future work will explore other applications of the IPS and extend the approach to assisting multiple joints.

Individualized Learning-Based Ground Reaction Force Estimation in People Post-Stroke Using Pressure Insoles.

Stroke is a leading cause of gait disability that leads to a loss of independence and overall quality of life. The field of clinical biomechanics aims to study how best to provide rehabilitation given an individual's impairments. However, there remains a disconnect between assessment tools used in biomechanical analysis and in clinics. In particular, 3-dimensional ground reaction forces (3D GRFs) are used to quantify key gait characteristics, but require lab-based equipment, such as force plates. Recent efforts have shown that wearable sensors, such as pressure insoles, can estimate GRFs in real-world environments. However, there is limited understanding of how these methods perform in people post-stroke, where gait is highly heterogeneous. Here, we evaluate three subject-specific machine learning approaches to estimate 3D GRFs with pressure insoles in people post-stroke across varying speeds. We find that a Convolutional Neural Network-based approach achieves the lowest estimation errors of 0.75 ± 0.24, 1.13 ± 0.54, and 4.79 ± 3.04 % bodyweight for the medio-lateral, antero-posterior, and vertical GRF components, respectively. Estimated force components were additionally strongly correlated with the ground truth measurements ( ). Finally, we show high estimation accuracy for three clinically relevant point metrics on the paretic limb. These results suggest the potential for an individualized machine learning approach to translate to real-world clinical applications.

Investigating Changes in Muscle Coordination During Cycling with Soft Wearable Strain Sensors Sensitive to Muscle Deformation.

Continuous monitoring of muscle coordination can provide valuable information regarding an individual's performance during physical activities. For example, changes in muscle coordination can indicate muscle fatigue during exhaustive exercise or can be used to track the rehabilitation progress of patients post-injury. Traditional methods to evaluate coordination often focus solely on measuring muscle activation with electromyography, ignoring timing changes of the resultant force produced by the activated muscle. Setups designed to evaluate force directly to study muscle coordination are often limited by either hyper-constrained settings or cost-prohibitive hardware. In this paper, we employ wearable, ultra-sensitive soft strain sensors that track muscle deformation for estimating changes in muscle coordination during cycling at different cadences and to exhaustion. The results were compared to muscle activation timing measured by electromyography and peak force timing measured by a cycle ergometer. We demonstrate that with an increase in cadence, the soft strain sensor and ergometer timing metrics align more closely than those measured by electromyography. We also demonstrate how muscle coordination is altered with the onset of fatigue during cycling to exhaustion.

Improved Fascicle Length Estimates From Ultrasound Using a U-net-LSTM Framework.

Brightness-mode (B-mode) ultrasound has been used to measure in vivo muscle dynamics for assistive devices. Estimation of fascicle length from B-mode images has now transitioned from time-consuming manual processes to automatic methods, but these methods fail to reach pixel-wise accuracy across extended locomotion. In this work, we aim to address this challenge by combining a U-net architecture with proven segmentation abilities with an LSTM component that takes advantage of temporal information to improve validation accuracy in the prediction of fascicle lengths. Using 64,849 ultrasound frames of the medial gastrocnemius, we semi-manually generated ground-truth for training the proposed U-net-LSTM. Compared with a traditional U-net and a CNNLSTM configuration, the validation accuracy, mean square error (MSE), and mean absolute error (MAE) of the proposed U-net-LSTM show better performance (91.4%, MSE =0.1± 0.03 mm, MAE =0.2± 0.05 mm). The proposed framework could be used for real-time, closed-loop wearable control during real-world locomotion.

Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial.

INTRODUCTION: High-intensity gait training is widely recognized as an effective rehabilitation approach after stroke. Soft robotic exosuits that enhance post-stroke gait mechanics have the potential to improve the rehabilitative outcomes achieved by high-intensity gait training. The objective of this development-of-concept pilot crossover study was to evaluate the outcomes achieved by high-intensity gait training with versus without soft robotic exosuits. METHODS: In this 2-arm pilot crossover study, four individuals post-stroke completed twelve visits of speed-based, high-intensity gait training: six consecutive visits of Robotic Exosuit Augmented Locomotion (REAL) gait training and six consecutive visits without the exosuit (CONTROL). The intervention arms were counterbalanced across study participants and separated by 6 + weeks of washout. Walking function was evaluated before and after each intervention using 6-minute walk test (6MWT) distance and 10-m walk test (10mWT) speed. Moreover, 10mWT speeds were evaluated before each training visit, with the time-course of change in walking speed computed for each intervention arm. For each participant, changes in each outcome were compared to minimal clinically-important difference (MCID) thresholds. Secondary analyses focused on changes in propulsion mechanics and associated biomechanical metrics. RESULTS: Large between-group effects were observed for 6MWT distance (d = 1.41) and 10mWT speed (d = 1.14). REAL gait training resulted in an average pre-post change of 68 ± 27 m (p = 0.015) in 6MWT distance, compared to a pre-post change of 30 ± 16 m (p = 0.035) after CONTROL gait training. Similarly, REAL training resulted in a pre-post change of 0.08 ± 0.03 m/s (p = 0.012) in 10mWT speed, compared to a pre-post change of 0.01 ± 06 m/s (p = 0.76) after CONTROL. For both outcomes, 3 of 4 (75%) study participants surpassed MCIDs after REAL training, whereas 1 of 4 (25%) surpassed MCIDs after CONTROL training. Across the training visits, REAL training resulted in a 1.67 faster rate of improvement in walking speed. Similar patterns of improvement were observed for the secondary gait biomechanical outcomes, with REAL training resulting in significantly improved paretic propulsion for 3 of 4 study participants (p < 0.05) compared to 1 of 4 after CONTROL. CONCLUSION: Soft robotic exosuits have the potential to enhance the rehabilitative outcomes produced by high-intensity gait training after stroke. Findings of this development-of-concept pilot crossover trial motivate continued development and study of the REAL gait training program.

Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke.

BACKGROUND: Soft robotic exosuits can provide partial dorsiflexor and plantarflexor support in parallel with paretic muscles to improve poststroke walking capacity. Previous results indicate that baseline walking ability may impact a user's ability to leverage the exosuit assistance, while the effects on continuous walking, walking stability, and muscle slacking have not been evaluated. Here we evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. We also compared two speed-based subgroups (threshold: 0.93 m/s) to address poststroke heterogeneity. METHODS: We refined a previously developed portable lightweight soft exosuit to support continuous overground walking. We compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, as well as the energy cost of transport, walking stability and plantarflexor muscle slacking. RESULTS: Exosuit assistance was associated with improvements in the targeted gait impairments: 22% increase in ground clearance during swing, 5° increase in foot-to-floor angle at initial contact, and 22% increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7% (0.04 m/s) increase in walking speed (R2 = 0.82). This enhancement in gait function was achieved without deterioration in muscle effort, stability or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantarflexor assistance to improve propulsion by 35% to walk 13% faster, while faster individuals did not change either. CONCLUSIONS: The immediate restorative benefits of the exosuit presented here underline its promise for rehabilitative gait training in poststroke individuals.

Impact of serum sodium concentrations, and effect modifiers on mortality in the Irish Health System.

BACKGROUND: Abnormalities of serum sodium are associated with increased mortality risk in hospitalised patients, but it is unclear whether, and to what extent other factors influence this relationship. We investigated the impact of dysnatraemia on total and cause-specific mortality in the Irish health system while exploring the concurrent impact of age, kidney function and designated clinical work-based settings. METHODS: A retrospective cohort study of 32,666 participants was conducted using data from the National Kidney Disease Surveillance System. Hyponatraemia was defined as < 135 mmol/L and hypernatraemia as > 145 mmol/L with normal range 135-145 mmol/L. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR's) and 95% Confidence Intervals (CIs) while penalised spline models further examined patterns of risk. RESULTS: There were 5,114 deaths (15.7%) over a median follow up of 5.5 years. Dysnatraemia was present in 8.5% of patients overall. In multivariable analysis, both baseline and time-dependent serum sodium concentrations exhibited a U-shaped association with mortality. Hyponatremia was significantly associated with increased risk for cardiovascular [HR 1.38 (1.18-1.61)], malignant [HR: 2.49 (2.23-2.78)] and non-cardiovascular/non-malignant causes of death [1.36 (1.17-1.58)], while hypernatremia was significantly associated with cardiovascular [HR: 2.16 (1.58-2.96)] and non-cardiovascular/ non-malignant deaths respectively [HR: 3.60 (2.87-4.52)]. The sodium-mortality relationship was significantly influenced by age, level of kidney function and the clinical setting at baseline (P < 0.001). For hyponatraemia, relative mortality risks were significantly higher for younger patients (interaction term P < 0.001), for patients with better kidney function, and for patients attending general practice [HR 2.70 (2.15-3.36)] than other clinical settings. For hypernatraemia, age and kidney function remained significant effect modifiers, with patients attending outpatient departments experiencing the greatest risk [HR 9.84 (4.88-18.62)] than patients who attended other clinical locations. Optimal serum sodium thresholds for mortality varied by level of kidney function with a flattening of mortality curve observed for patients with poorer kidney function. CONCLUSION: Serum sodium concentrations outside the standard normal range adversly impact mortality and are associated with specific causes of death. The thresholds at which these risks appear to vary by age, level of kidney function, and are modified in specific clinical settings within the health system.

Artificial intelligence meets medical robotics.

Artificial intelligence (AI) applications in medical robots are bringing a new era to medicine. Advanced medical robots can perform diagnostic and surgical procedures, aid rehabilitation, and provide symbiotic prosthetics to replace limbs. The technology used in these devices, including computer vision, medical image analysis, haptics, navigation, precise manipulation, and machine learning (ML) , could allow autonomous robots to carry out diagnostic imaging, remote surgery, surgical subtasks, or even entire surgical procedures. Moreover, AI in rehabilitation devices and advanced prosthetics can provide individualized support, as well as improved functionality and mobility (see the figure). The combination of extraordinary advances in robotics, medicine, materials science, and computing could bring safer, more efficient, and more widely available patient care in the future. -Gemma K. Alderton.

Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke.

BACKGROUND: Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke. METHODS: We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section. RESULTS: Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg- 1 in peak biological ankle torque and 0.26 ± 0.04 W kg- 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb. CONCLUSIONS: Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.

Design and evaluation of an independent 4-week, exosuit-assisted, post-stroke community walking program.

Chronic impairment in the paretic ankle following stroke often requires that individuals use compensatory patterns such as asymmetric propulsion to achieve effective walking speeds needed for community engagement. Ankle exosuit assistance can provide ankle biomechanical benefit in the lab, but such environments inherently limit the amount of practice available. Community walking studies without exosuits can provide massed practice and benefit walking speed but are limited in their ability to assist proper mechanics. In this study, we combined the positive aspects of community training with those of exosuit assistance. We developed and evaluated a community Robotic Exosuit Augmented Locomotion (cREAL) program. Four participants in the chronic stage of stroke independently used our community ankle exosuit for walking in the community 3-5 days/week for 4 weeks. We performed lab evaluations before and after the 4-week program. Two participants significantly improved their unassisted paretic propulsion by an average of 27% after the program and walked on average 4001 steps/day more in the week following the program. Despite the small number of participants, this study provides preliminary evidence for the potential of exosuits to augment gait training and rehabilitation in the community.

Tunable, Textile-Based Joint Impedance Module for Soft Robotic Applications.

The design of soft actuators is often focused on achieving target trajectories or delivering specific forces and torques, rather than controlling the impedance of the actuator. This article outlines a new soft, tunable pneumatic impedance module based on an antagonistic actuator setup of textile-based pneumatic actuators intended to deliver bidirectional torques about a joint. Through mechanical programming of the actuators (select tuning of geometric parameters), the baseline torque to angle relationship of the module can be tuned. A high bandwidth fluidic controller that can rapidly modulate the pressure at up to 8 Hz in each antagonistic actuator was also developed to enable tunable impedance modulation. This high bandwidth was achieved through the characterization and modeling of the proportional valves used, derivation of a fluidic model, and derivation of control equations. The resulting impedance module was capable of modulating its stiffness from 0 to 100 Nm/rad, at velocities up to 120°/s and emulating asymmetric and nonlinear stiffness profiles, typical in wearable robotic applications.

Age-Related Reliability of B-Mode Analysis for Tailored Exosuit Assistance.

In the field of wearable robotics, assistance needs to be individualized for the user to maximize benefit. Information from muscle fascicles automatically recorded from brightness mode (B-mode) ultrasound has been used to design assistance profiles that are proportional to the estimated muscle force of young individuals. There is also a desire to develop similar strategies for older adults who may have age-altered physiology. This study introduces and validates a ResNet + 2x-LSTM model for extracting fascicle lengths in young and older adults. The labeling was generated in a semimanual manner for young (40,696 frames) and older adults (34,262 frames) depicting B-mode imaging of the medial gastrocnemius. First, the model was trained on young and tested on both young (R2 = 0.85, RMSE = 2.36 ± 1.51 mm, MAPE = 3.6%, aaDF = 0.48 ± 1.1 mm) and older adults (R2 = 0.53, RMSE = 4.7 ± 2.51 mm, MAPE = 5.19%, aaDF = 1.9 ± 1.39 mm). Then, the performances were trained across all ages (R2 = 0.79, RMSE = 3.95 ± 2.51 mm, MAPE = 4.5%, aaDF = 0.67 ± 1.8 mm). Although age-related muscle loss affects the error of the tracking methodology compared to the young population, the absolute percentage error for individual fascicles leads to a small variation of 3-5%, suggesting that the error may be acceptable in the generation of assistive force profiles.

Reducing Back Exertion and Improving Confidence of Individuals with Low Back Pain with a Back Exosuit: A Feasibility Study for Use in BACPAC.

OBJECTIVE: Low back pain (LBP) is hallmarked by activity limitations, especially for tasks involving bending. Back exosuit technology reduces low back discomfort and improves self-efficacy of individuals with LBP during bending and lifting tasks. However, the biomechanical efficacy of these devices in individuals with LBP is unknown. This study sought to determine biomechanical and perceptual effects of a soft active back exosuit designed to assist individuals with LBP sagittal plane bending. To understand patient-reported usability and use cases for this device. METHODS: Fifteen individuals with LBP performed two experimental lifting blocks once with and without an exosuit. Trunk biomechanics were measured by muscle activation amplitudes, and whole-body kinematics and kinetics. To evaluate device perception, participants rated task effort, low back discomfort, and their level of concern completing daily activities. RESULTS: The back exosuit reduced peak back extensor: moments by 9%, and muscle amplitudes by 16% when lifting. There were no changes in abdominal co-activation and small reductions maximum trunk flexion compared to lifting without an exosuit. Participants reported lower task effort, back discomfort, and concern about bending and lifting with an exosuit compared to without. CONCLUSIONS: This study demonstrates a back exosuit not only imparts perceptual benefits of reduced task effort, discomfort, and increased confidence in individuals with LBP but that it achieves these benefits through measurable biomechanical reductions in back extensor effort. The combined effect of these benefits implies back exosuits might be a potential therapeutic aid to augment physical therapy, exercises, or daily activities.