Miranda DL, Hsu W-H, Petersen K, Fitzgibbons S, Niemi J, Lesniewski-Laas N, Walsh CJ. Sensory Enhancing Insoles Modify Gait during Inclined Treadmill Walking with Load. Medicine & Science in Sports & Exercise [Internet]. 2016;48 (5) :860-868. Publisher's VersionAbstract

Introduction: Inclined walking while carrying a loaded backpack induces fatigue, which may destabilize gait and lead to injury. Stochastic resonance (SR) technology has been used to stabilize spatiotemporal gait characteristics of elderly individuals but has not been tested on healthy recreational athletes. Herein, we determined if sustained vigorous walking on an inclined surface while carrying a load destabilizes gait and if SR has a further effect.

Methods: Participants were fitted with a backpack weighing 30% of their body weight and asked to walk at a constant self-selected pace while their feet were tracked using an optical motion capture system. Their shoes were fitted with SR insoles that were set at 90% of the participant’s sensory threshold. The treadmill incline was increased every 5 min until volitional exhaustion after which the treadmill was returned to a level grade. SR stimulation was turned ON and OFF in a pairwise random fashion throughout the protocol. Spatiotemporal gait characteristics were calculated when SR was ON and OFF for the BASELINE period, the MAX perceived exertion period, and the POST period.

Results: Vigorous activity increases variability in the rhythmic stepping (stride time and stride length) and balance control (double support time and stride width) mechanisms of gait. Overall, SR increased stride width variability by 9% before, during, and after a fatiguing exercise.

Conclusion: The increased stride time and stride length variability may compromise the stability of gait during and after vigorous walking. However, participants may compensate by increasing double support time and stride width variability to maintain their stability under these adverse conditions. Furthermore, applying SR resulted in an additional increase of stride width variability and may potentially improve balance before, during, and after adverse walking conditions.

Cezar CA, Roche ET, Vandenburgh HH, Duda GN, Walsh CJ, Mooney DJ. Biologic-free mechanically induced muscle regeneration. Proceedings of the National Academy of Sciences (PNAS) [Internet]. 2016;113 (6) :1534-1539. Publisher's VersionAbstract

Severe skeletal muscle injuries are common and can lead to extensive fibrosis, scarring, and loss of function. Clinically, no therapeutic intervention exists that allows for a full functional restoration. As a result, both drug and cellular therapies are being widely investigated for treatment of muscle injury. Because muscle is known to respond to mechanical loading, we investigated instead whether a material system capable of massage-like compressions could promote regeneration. Magnetic actuation of biphasic ferrogel scaffolds implanted at the site of muscle injury resulted in uniform cyclic compressions that led to reduced fibrous capsule formation around the implant, as well as reduced fibrosis and inflammation in the injured muscle. In contrast, no significant effect of ferrogel actuation on muscle vascularization or perfusion was found. Strikingly, ferrogel-driven mechanical compressions led to enhanced muscle regeneration and a ∼threefold increase in maximum contractile force of the treated muscle at 2 wk compared with no-treatment controls. Although this study focuses on the repair of severely injured skeletal muscle, magnetically stimulated bioagent-free ferrogels may find broad utility in the field of regenerative medicine.

Lee S, Panizzolo F, Miyatake T, Rossi DM, Siviy C, Walsh CJ. Lower limb biomechanical analysis of unanticipated step on a bump, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Bae J, Awad LN, O'Donnell K, Hendron KL, Allen S, De Rossi SMM, Holt KG, Ellis TD, Walsh CJ. Assisting paretic ankle motion with a soft exosuit can reduce whole-body compensatory gait patterns and improve walking efficiency for patients after stroke, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Quinlivan B, Lee S, Malcolm P, Rossi DM, Grimmer M, Siviy C, Walsh CJ. Multi-articular soft exosuit continually reduces the metabolic cost of unloaded walking with increased assistance magnitude, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Siviy C, Rossi DM, Malcolm P, Quinlivan B, Lee S, Grimmer M, Walsh CJ. Optimization of soft exosuit peak force with ramp and step sweep protocol, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Malcolm P, Lee S, Crea S, Siviy C, Saucedo F, Galiana IB, Panizzolo F, Holt KG, Walsh CJ. Study of the contribution of negative work assistance at the ankle with a multi-articular soft exosuit during loaded walking, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Yandell MB, Popov D, Quinlivan B, Walsh CJ, Zelik KE. Systematic evaluation of human-exosuit physical interfaces, in Dynamic Walking. Holly, Michigan, USA ; 2016.
Ding Y, Galiana I, Asbeck AT, De Rossi SMM, Bae J, Teles Dos Santos TR, De Araujo VL, Lee S, Holt KG, Walsh CJ. Biomechanical and Physiological Evaluation of Multi-joint Assistance with Soft Exosuits. IEEE Transactions on Neural Systems and Rehabilitation Engineering [Internet]. 2016;PP (99) :1. Publisher's VersionAbstract

To understand the effects of soft exosuits on human loaded walking, we developed a reconfigurable multi-joint actuation platform that can provide synchronized forces to the ankle and hip joints. Two different assistive strategies were evaluated on eight subjects walking on a treadmill at a speed of 1.25 m/s with a 23.8 kg backpack: 1) hip extension assistance and 2) multi-joint assistance (hip extension, ankle plantarflexion and hip flexion). Results show that the exosuit introduces minimum changes to kinematics and reduces biological joint moments. A reduction trend in muscular activity was observed for both conditions. On average, the exosuit reduced the metabolic cost of walking by 0.21 ± 0.04 W/kg and 0.67 ± 0.09 W/kg for hip extension assistance and multi-joint assistance respectively, which is equivalent to an average metabolic reduction of 4.6% and 14.6% demonstrating that soft exosuits can effectively improve human walking efficiency during load carriage without affecting natural walking gait. Moreover, it indicates that actuating multiple joints with soft exosuits provides a significant benefit to muscular activity and metabolic cost compared to actuating single joint.

Awad LN, Bae J, De Rossi SMM, O'Donnell K, Hendron KL, Holt KG, Ellis T, Walsh CJ. Soft Wearable Robots Can Reduce the Energy Cost of Poststroke Walking: A Proof-of-Concept Study, in Combined Sessions Meeting of the American Physical Therapy Association. Anaheim, CA ; 2016.
Lee S, Crea S, Malcolm P, Galiana IB, Asbeck AT, Walsh CJ. Controlling Negative and Positive Power at the Ankle with a Soft Exosuit, in IEEE International Conference on Robotics and Automation (ICRA). Stockholm, Sweden ; 2016. PDF
Gafford JB, Russo S, Ranzani T, Wood RJ, Walsh CJ. Snap-On Robotic Wrist Module for Enhanced Dexterity in Endoscopy, in IEEE International Conference on Robotics and Automation (ICRA). Stockholm, Sweden ; 2016. PDF
Russo S, Ranzani T, Gafford JB, Walsh CJ, Wood RJ. Soft pop-up mechanisms for micro surgical tools: design and characterization of compliant millimeter-scale articulated structures, in IEEE International Conference on Robotics and Automation (ICRA). Stockholm, Sweden ; 2016. PDF
Ding Y, Galiana I, Siviy C, Panizzolo FA, Walsh CJ. IMU-based Iterative Control for Hip Extension Assistance with a Soft Exosuit, in IEEE International Conference on Robotics and Automation (ICRA). Stockholm, Sweden ; 2016.Abstract

In this paper we describe an IMU-based iterative controller for hip extension assistance where the onset timing of assistance is based on an estimate of the maximum hip flexion angle. The controller was implemented on a mono-articular soft exosuit coupled to a lab-based multi-joint actuation platform that enables rapid reconfiguration of different sensors and control strategy implementation. The controller design is motivated by a model of the suit-human interface and utilizes an iterative control methodology that includes gait detection and step-by-step actuator position profile generation to control the onset timing, peak timing, and peak magnitude of the delivered force. This controller was evaluated on eight subjects walking on a treadmill at a speed of 1.5 m/s while carrying a load of 23 kg. Results showed that assistance could be delivered reliably across subjects. Specifically, for a given profile, the average delivered force started concurrently with the timing of the maximum hip flexion angle and reached its peak timing 22.7 ± 0.63% later in the gait cycle (desired 23%) with a peak magnitude of 198.2 ± 1.6 N (desired 200 N), equivalent to an average peak torque of 30.5 ± 4.7 Nm. This control approach was used to assess the metabolic effect of four different assistive profiles. Metabolic reductions ranging from 5.7% to 8.5% were found when comparing the powered conditions with the unpowered condition. This work enables studies to assess the biomechanical and physiological responses to different assistive profiles to determine the optimal hip extension assistance during walking.

Panizzolo FA, Galiana IB, Asbeck AT, Siviy C, Schmidt K, Holt KG, Walsh CJ. A biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking. Journal of NeuroEngineering and Rehabilitation [Internet]. 2016;13 (1) :1-14. Publisher's VersionAbstract

Carrying load alters normal walking, imposes additional stress to the musculoskeletal system, and results in an increase in energy consumption and a consequent earlier onset of fatigue. This phenomenon is largely due to increased work requirements in lower extremity joints, in turn requiring higher muscle activation. The aim of this work was to assess the biomechanical and physiological effects of a multi-joint soft exosuit that applies assistive torques to the biological hip and ankle joints during loaded walking.

Awad LN, Bae J, O'Donnell K, De Rossi SMM, Hendron KL, Holt KG, Ellis TD, Walsh CJ. A soft exosuit for assisting poststroke walking, in 9th World Congress of Neurorehabilitation. Philadelphia, PA, USA ; 2016.
Self-Assembling, Low-Cost, and Modular mm-Scale Force Sensor
Gafford JB, Wood RJ, Walsh CJ. Self-Assembling, Low-Cost, and Modular mm-Scale Force Sensor. IEEE Sensors Journal [Internet]. 2016;16 (1) :69-76. [Cover Article]. Publisher's VersionAbstract

The innovation in surgical robotics has seen a shift toward flexible systems that can access remote locations inside the body. However, a general reliance on the conventional fabrication techniques ultimately limits the complexity and the sophistication of the distal implementations of such systems, and poses a barrier to further innovation and widespread adoption. In this paper, we present a novel, self-assembling force sensor manufactured using a composite lamination fabrication process, wherein linkages pre-machined in the laminate provide the required degrees-of-freedom and fold patterns to facilitate self-assembly. Using the purely 2-D fabrication techniques, the energy contained within a planar elastic biasing element directly integrated into the laminate is released post-fabrication, allowing the sensor to self-assemble into its final 3-D shape. The sensors are batch-fabricated, further driving down the production costs. The transduction mechanism relies on the principle of light intensity modulation, which allows the sensor to detect axial forces with millinewton-level resolution. The geometry of the sensor was selected based on the size constraints inherent in minimally invasive surgery, as well as with a specific focus on optimizing the sensor's linearity. The sensor is unique from the fiber-based force sensors in that the emitter and the detector are encapsulated within the sensor itself. The bare sensor operates over a force range of 0-200 mN, with a sensitivity of 5 V/N and a resolution of 0.8 mN. The experimental results show that the sensor's stiffness can be tuned using a thicker material for the spring layer and/or encapsulation/integration with soft materials. The empirical validation shows that the sensor has the sensitivity and the resolution necessary to discern the biologically relevant forces in a simulated cannulation task.

A Light-Reflecting Balloon Catheter for Atraumatic Tissue Defect Repair
Roche ET, Fabozzo A, Lee Y, Polygerinos P, Friehs I, Schuster L, Whyte W, Casar Berazaluce AM, Bueno A, Lang N, et al. A Light-Reflecting Balloon Catheter for Atraumatic Tissue Defect Repair. Science Translational Medicine [Internet]. 2015;7 (306) :306ra149. Publisher's VersionAbstract

Closing small defects in the body typically requires stitching of tissues during surgery. Toward a minimally invasive approach, Roche et al. engineered a balloon catheter with a reflective surface coating that could be used to adhere biodegradable patches to tissues. The device unfolds the patch and its adhesive, delivers ultraviolet (UV) light, and then applies pressure to stabilize the adhesive as the light cures the polymer. The authors demonstrated catheter-mediated application of the photocurable polymer patch in vivo in rat tissue, with minimal inflammation and complete animal survival, as well as in a challenging septal defect in the beating hearts of pigs. The device was also used to seal porcine stomach ulcers and abdominal hernias ex vivo, suggesting versatility of this approach in repairing defects more easily and atraumatically than sutures.A congenital or iatrogenic tissue defect often requires closure by open surgery or metallic components that can erode tissue. Biodegradable, hydrophobic light-activated adhesives represent an attractive alternative to sutures, but lack a specifically designed minimally invasive delivery tool, which limits their clinical translation. We developed a multifunctional, catheter-based technology with no implantable rigid components that functions by unfolding an adhesive-loaded elastic patch and deploying a double-balloon design to stabilize and apply pressure to the patch against the tissue defect site. The device uses a fiber-optic system and reflective metallic coating to uniformly disperse ultraviolet light for adhesive activation. Using this device, we demonstrate closure on the distal side of a defect in porcine abdominal wall, stomach, and heart tissue ex vivo. The catheter was further evaluated as a potential tool for tissue closure in vivo in rat heart and abdomen and as a perventricular tool for closure of a challenging cardiac septal defect in a large animal (porcine) model. Patches attached to the heart and abdominal wall with the device showed similar inflammatory response as sutures, with 100% small animal survival, indicating safety. In the large animal model, a ventricular septal defect in a beating heart was reduced to <1.6 mm. This new therapeutic platform has utility in a range of clinical scenarios that warrant minimally invasive and atraumatic repair of hard-to-reach defects.

Asbeck AT, Schmidt K, Walsh CJ. Soft Exosuit for Hip Assistance. Robotics and Autonomous Systems (RAS) Special Issue on Wearable Robotics [Internet]. 2015;73 :102-110. Publisher's VersionAbstract

Exoskeletons comprised of rigid load-bearing structures have been developed for many years, but a new paradigm is to create “exosuits” that apply tensile forces to the body using textiles and utilize the body’s skeletal structure to support compressive forces. Exosuits are intended to augment the musculature by providing small to moderate levels of assistance at appropriate times in the walking cycle. They have a number of substantial benefits: with their fabric construction, exosuits eliminate problems of needing to align a rigid frame precisely with the biological joints and their inertia can be extremely low. In this paper, we present a fully portable hip-assistance exosuit that uses a backpack frame to attach to the torso, onto which is mounted a spooled-webbing actuator that connects to the back of the users thigh. The actuators, powered by a geared brushless motor connected to a spool via a timing belt, wind up seat-belt webbing onto the spool so that a large travel is possible with a simple, compact mechanism. Designed to be worn over the clothing, the webbing creates a large moment arm around the hip that provides torques in the sagittal plane of up to 30% of the nominal biological torques for level-ground walking. Due to its soft design, the system does not restrict the motion of the hip in the ab- and adduction directions or rotation about the leg axis. Here we present the design of the system along with some initial measurements of the system in use during walking on level ground at 1.25 m/s, where it creates a force of up to 150 N on the thigh, equivalent to a torque of 20.5 Nm to assist hip extension.

Polygerinos P, Wang Z, Galloway KC, Wood RJ, Walsh CJ. Soft Robotic Glove for Combined Assistance and at-Home Rehabilitation. Robotics and Autonomous Systems (RAS) Special Issue on Wearable Robotics [Internet]. 2015;73 :135-143. Publisher's VersionAbstract

This paper presents a portable, assistive, soft robotic glove designed to augment hand rehabilitation for individuals with functional grasp pathologies. The robotic glove utilizes soft actuators consisting of molded elastomeric chambers with fiber reinforcements that induce specific bending, twisting and extending trajectories under fluid pressurization. These soft actuators were mechanically programmed to match and support the range of motion of individual fingers. They demonstrated the ability to generate significant force when pressurized and exhibited low impedance when un-actuated. To operate the soft robotic glove, a control hardware system was designed and included fluidic pressure sensors in line with the hydraulic actuators and a closed-loop controller to regulate the pressure. Demonstrations with the complete system were performed to evaluate the ability of the soft robotic glove to carry out gross and precise functional grasping. Compared to existing devices, the soft robotic glove has the potential to increase user freedom and independence through its portable waist belt pack and open palm design.