All Publications

2024
L. M. Baker, A. Yawar, D. E. Lieberman, and C. J. Walsh, “Predicting overstriding with wearable IMUs during treadmill and overground running,” Nature Scientific Reports, vol. 14, no. 6347, 2024. Publisher's VersionAbstract
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.
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J. Chung, et al., “Lightweight active back exosuit reduces muscular effort during an hour-long order picking task,” Nature Communications Engineering, vol. 3, no. 35, 2024. Publisher's VersionAbstract
Occupational back exoskeletons and exosuits aim to reduce low back injuries in the workplace. For these technologies to be adopted, it is important that they provide biomechanical benefits to the wearer and do not disrupt job performance. To address this challenge, here we developed a lightweight, soft, active back exosuit that can autonomously control virtual impedance to apply differing assistance during lowering and lifting. In usability tests, participants rated the exosuit as easy to learn and use and reported feeling confident while wearing it. In an experiment involving an hour-long order picking task we demonstrated that the exosuit reduced peak and median muscle activations in the back by 18% and 20%, respectively. Despite the complexity of the movements required, such as walking, bending, and navigating around obstacles while lifting boxes from under a rack, our controller demonstrated impressive robustness with only 14 mistriggers out of 9600 lifts (0.1%). The results of this research suggest that active exosuit technology has the potential to be a highly usable solution to aid warehouse workers in real-world settings.
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J. J. Banks, D. A. Quirk, J. Chung, J. M. Cherin, C. J. Walsh, and D. E. Anderson, “The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts,” Ergonomics, 2024. Publisher's VersionAbstract
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.
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A. N. Collimore, et al., “A Portable, Neurostimulation-Integrated, Force Measurement Platform for the Clinical Assessment of Plantarflexor Central Drive,” Bioengineering, vol. 11, no. 2, 2024. Publisher's VersionAbstract
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.
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R. Hennig, A. Beaudette, H. M. Golecki, and C. J. Walsh, “Educational Soft Underwater Robot with an Electromagnetic Actuation,” Soft Robotics, 2024. Publisher's VersionAbstract
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.
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T. Proietti, et al., “Combining soft robotics and telerehabilitation for improving motor function after stroke,” Wearable Technologies, vol. 5, 2024. Publisher's VersionAbstract
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.
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J. Kim, et al., “Soft robotic apparel to avert freezing of gait in Parkinson’s disease.Nature Medicine, 2024. Publisher's VersionAbstract
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.
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C. Walsh and T. Ellis, “Wearable robot helps man with Parkinson’s disease to walk.Nature Medicine, 2024. Publisher's VersionAbstract
In one person with Parkinson’s disease, freezing of gait was averted through the use of a soft robotic apparel that provided a moderate level of hip-flexion assistance during the swing phase of walking. This approach delivered instantaneous effects and consistently improved walking quality and function across a range of conditions.
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2023
F. Porciuncula, et al., “Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial,” Journal of NeuroEngineering and Rehabilitation, vol. 20, no. 148, 2023. Publisher's VersionAbstract

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.

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J. Kim, et al., “Pre-College Robotics: Best Practices for Adapting Research to Outreach,” in 2023 ASEE Annual Conference & Exposition, ASEE Annual Conference & Exposition., Baltimore, MD, 2023, 2023. Publisher's VersionAbstract

Adapting research for K-12 outreach is critical for inspiring the next generation of engineers. Community-focused STEM fairs and events attract a wide range of students with varying degrees of knowledge and exposure to engineering. The challenge when creating programming for these events is the ability to adapt research for young students with a wide range of engineering backgrounds. Adding to the complexity, engineers are not trained teachers, therefore outreach events can often contain overly complex activities that do not take a student’s dexterity or comprehension skills into consideration. Understanding students’ abilities and interests are critical to developing pre-college curricula that are engaging for a variety of students. In this project, we present findings from an observational study conducted at a community-focused outreach event with over 200 participants. This paper is focused on a soft robot gripper activity consisting of two tendon-actuated fingers and its utility as an outreach tool. In the activity, students must navigate various tests of dexterity and comprehension. Observations from these tests were used to record successes and pain points of the activity design. The data collected during the activity was organized into several categories based on age, dexterity, and spatial awareness. After collecting and analyzing data, we identified areas of improvement for wide dissemination of this soft gripper activity. We also categorized prior activities that lead to a successful gripper build. Overall results showed areas where the soft robotics activity could be improved to be more inclusive of a variety of skill and age levels.

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M. Yip, et al., “Artificial intelligence meets medical robotics,” Science, vol. 381, no. 6654, 2023. Publisher's VersionAbstract
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
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L. H. Sloot, et al., “Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke,” Journal of NeuroEngineering and Rehabilitation, vol. 20, no. 113, 2023. Publisher's VersionAbstract

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.

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C. T. O'Neill, et al., “Tunable, Textile-Based Joint Impedance Module for Soft Robotic Applications,” Soft Robotics, vol. 10, no. 4, 2023. Publisher's VersionAbstract
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.
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D. A. Quirk, et al., “Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion,” Ergonomics, 2023. Publisher's VersionAbstract

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 tradeoff 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.

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K. Swaminathan, et al., “Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke,” Journal of NeuroEngineering and Rehabilitation, vol. 20, no. 85, 2023. Publisher's VersionAbstract

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.

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S. L. MCNAMARA, et al., “Anti-inflammatory therapy enables robot-actuated regeneration of aged muscle ,” Science Robotics, vol. 8, no. 76, 2023. Publisher's VersionAbstract
Robot-actuated mechanical loading (ML)–based therapies (“mechanotherapies”) can promote regeneration after severe skeletal muscle injury, but the effectiveness of such approaches during aging is unknown and may be influenced by age-associated decline in the healing capacity of skeletal muscle. To address this knowledge gap, this work used a noninvasive, load-controlled robotic device to impose highly defined tissue stresses to evaluate the age dependence of ML on muscle repair after injury. The response of injured muscle to robot-actuated cyclic compressive loading was found to be age sensitive, revealing not only a lack of reparative benefit of ML on injured aged muscles but also exacerbation of tissue inflammation. ML alone also disrupted the normal regenerative processes of aged muscle stem cells. However, these negative effects could be reversed by introducing anti-inflammatory therapy alongside ML application, leading to enhanced skeletal muscle regeneration even in aged mice.
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R. W. Nuckols, et al., “Design and evaluation of an independent 4-week, exosuit-assisted, post-stroke community walking program,” Annals of the New York Academy of Sciences, 2023. Publisher's VersionAbstract
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.
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C. M. McCann, C. J. Hohimer, C. T. O’Neill, H. T. Young, K. Bertoldi, and C. J. Walsh, “In-Situ Measurement of Multi-Axis Torques Applied by Wearable Soft Robots for Shoulder Assistance,” IEEE Transactions on Medical Robotics and Bionics, vol. 5, no. 2, pp. 363-374, 2023. Publisher's VersionAbstract
While a number of wearable soft robotic devices have been proposed to assist the shoulder, limited efforts have been made to quantify the amount of torque they apply to the body. Most work to-date has assessed soft actuator performance with simple benchtop experiments that may not be representative of the boundary conditions on the human body. We propose a new methodology to measure torques directly in-situ on the body and then use this technique to make a detailed comparison of two versions of a soft wearable shoulder assistance robot. The impact of a number of factors are considered, such as actuator design, garment anchoring, material hysteresis, arm pose, and inflation pressure. Many of these factors are not present on the benchtop and are found to significantly affect torque production. We compare results obtained on a simple benchtop test fixture with two on-body settings: an idealized mannequin and actual human subjects. The mannequin and human results were similar, but differed significantly from the benchtop, further motivating the need for on-body testing. Moving forward, we believe that the ability to directly quantify device performance in-situ will be critical to develop new design, modeling, and control strategies for wearable robots.
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D. A. Quirk, et al., “Reducing back exertion and improving confidence of individuals with low back pain with a back exosuit: A feasibility study for use in BACPAC,” Pain Medicine, 2023. Publisher's VersionAbstract

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.

Conclusion

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.

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L. Gionfrida, R. W. Nuckols, C. J. Walsh, and R. D. Howe, “Age-Related Reliability of B-Mode Analysis for Tailored Exosuit Assistance,” Sensors, vol. 23, no. 3, 2023. Publisher's VersionAbstract
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 (R 2 = 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.
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