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.
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.
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.
In this work we investigate the influence of fiber angle on the deformation of fiber-reinforced soft fluidic actuators and examine the manner in which these actuators extend axially, expand radially and twist about their axis as a function of input pressure. We study the quantitative relationship between fiber angle and actuator deformation by performing finite element simulations for actuators with a range of different fiber angles, and we verify the simulation results by experimentally characterizing the actuators. By combining actuator segments in series, we can achieve combinations of motions tailored to specific tasks. We demonstrate this by using the results of simulations of separate actuators to design a segmented wormlike soft robot capable of propelling itself through a tube and performing an orientation-specific peg insertion task at the end of the tube. Understanding the relationship between fiber angle and pressurization response of these soft fluidic actuators enables rapid exploration of the design space, opening the door to the iteration of exciting soft robot concepts such as flexible and compliant endoscopes, pipe inspection devices, and assembly line robots.
This paper details the design, analysis, fabrication, and validation of a deployable, atraumatic grasper intended for retraction and manipulation tasks in manual and robotic minimally invasive surgical (MIS) procedures. Fabricated using a combination of shape deposition manufacturing (SDM) and 3D printing, the device (which acts as a deployable end-effector for robotic platforms) has the potential to reduce the risk of intraoperative hemorrhage by providing a soft, compliant interface between delicate tissue structures and the metal laparoscopic forceps and graspers that are currently used to manipulate and retract these structures on an ad hoc basis. This paper introduces a general analytical framework for designing SDM fingers where the desire is to predict the shape and the transmission ratio, and this framework was used to design a multijointed grasper that relies on geometric trapping to manipulate tissue, rather than friction or pinching, to provide a safe, stable, adaptive, and conformable means for manipulation. Passive structural compliance, coupled with active grip force monitoring enabled by embedded pressure sensors, helps to reduce the cognitive load on the surgeon. Initial manipulation tasks in a simulated environment have demonstrated that the device can be deployed though a 15 mm trocar and develop a stable grasp using Intuitive Surgical's daVinci robotic platform to deftly manipulate a tissue analog.
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.
We report a new method for fabricating textile integrable capacitive soft strain sensors based on multicore–shell fiber printing. The fiber sensors consist of four concentric, alternating layers of conductor and dielectric, respectively. These wearable sensors provide accurate and hysteresis-free strain measurements under both static and dynamic conditions.
We present the design and evaluation of a multi-articular soft exosuit that is portable, fully autonomous, and provides assistive torques to the wearer at the ankle and hip during walking. Traditional rigid exoskeletons can be challenging to perfectly align with a wearer’s biological joints and can have large inertias, which can lead to the wearer altering their natural motion patterns. Exosuits, in comparison, use textiles to create tensile forces over the body in parallel with the muscles, enabling them to be light and not restrict the wearer’s kinematics. We describe the biologically inspired design and function of our exosuit, including a simplified model of the suit’s architecture and its interaction with the body. A key feature of the exosuit is that it can generate forces passively due to the body’s motion, similar to the body’s ligaments and tendons. These passively generated forces can be supplemented by actively contracting Bowden cables using geared electric motors, to create peak forces in the suit of up to 200 N. We define the suit–human series stiffness as an important parameter in the design of the exosuit and measure it on several subjects, and we perform human subjects testing to determine the biomechanical and physiological effects of the suit. Results from a five-subject study showed a minimal effect on gait kinematics and an average best-case metabolic reduction of 6.4%, comparing suit worn unpowered versus powered, during loaded walking with 34.6 kg of carried mass including the exosuit and actuators (2.0 kg on both legs, 10.1 kg total).
The spectrum of ischaemic cardiomyopathy, encompassing acute myocardial infarction to congestive heart failure is a significant clinical issue in the modern era. This group of diseases is an enormous source of morbidity and mortality and underlies significant healthcare costs worldwide. Cardiac regenerative therapy, whereby pro-regenerative cells, drugs or growth factors are administered to damaged and ischaemic myocardium has demonstrated significant potential, especially preclinically. While some of these strategies have demonstrated a measure of success in clinical trials, tangible clinical translation has been slow. To date, the majority of clinical studies and a significant number of preclinical studies have utilised relatively simple delivery methods for regenerative therapeutics, such as simple systemic administration or local injection in saline carrier vehicles. Here, we review cardiac regenerative strategies with a particular focus on advanced delivery concepts as a potential means to enhance treatment efficacy and tolerability and ultimately, clinical translation. These include (i) delivery of therapeutic agents in biomaterial carriers, (ii) nanoparticulate encapsulation, (iii) multimodal therapeutic strategies and (iv) localised, minimally invasive delivery via percutaneous transcatheter systems.
Soft fluidic actuators consisting of elastomeric matrices with embedded flexible materials are of particular interest to the robotics community because they are affordable and can be easily customized to a given application. However, the significant potential of such actuators is currently limited as their design has typically been based on intuition. In this paper, the principle of operation of these actuators is comprehensively analyzed and described through experimentally validated quasi-static analytical and finite-element method models for bending in free space and force generation when in contact with an object. This study provides a set of systematic design rules to help the robotics community create soft actuators by understanding how these vary their outputs as a function of input pressure for a number of geometrical parameters. Additionally, the proposed analytical model is implemented in a controller demonstrating its ability to convert pressure information to bending angle in real time. Such an understanding of soft multimaterial actuators will allow future design concepts to be rapidly iterated and their performance predicted, thus enabling new and innovative applications that produce more complex motions to be explored.
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.
Exosuits show much promise as a method for augmenting the body with lightweight, portable, and compliant wearable systems. We envision that such systems can be further refined so that they can be sufficiently low profile to fit under a wearer's existing clothing. Our focus is on creating an assistive device that provides a fraction of the nominal biological torques and does not provide external load transfer. In early work, we showed that the system can substantially maintain normal biomechanics and positively affect a wearer's metabolic rate. Many basic fundamental research and development challenges remain in actuator development, textile innovation, soft sensor development, human-machine interface (control), biomechanics, and physiology, which provides fertile ground for academic research in many disciplines. While we have focused on gait assistance thus far, numerous other applications are possible, including rehabilitation, upper body support, and assistance for other motions. We look forward to a future where wearable robots provide benefits for people across many areas of our society.
Soft sensors comprising a flexible matrix with embedded circuit elements can undergo large deformations while maintaining adequate performance. These devices have attracted considerable interest for their ability to be integrated with the human body and have enabled the design of skin-like health monitoring devices, sensing suits, and soft active orthotics. Numerical tools are needed to facilitate the development and optimization of these systems. In this letter, we introduce a 3D finite element-based numerical tool to simultaneously characterize the mechanical and electrical response of fluid-embedded soft sensors of arbitrary shape, subjected to any loading. First, we quantitatively verified the numerical approach by comparing simulation and experimental results of a dog-bone shaped sensor subjected to uniaxial stretch and local compression. Then, we demonstrate the power of the numerical tool by examining a number of different loading conditions. We expect this work will open the door for further design of complex and optimal soft sensors.
Cell delivery to the infarcted heart has emerged as a promising therapy, but is limited by very low acute retention and engraftment of cells. The objective of this study was to compare a panel of biomaterials to evaluate if acute retention can be improved with a biomaterial carrier. Cells were quantified post-implantation in a rat myocardial infarct model in five groups (n = 7–8); saline injection (current clinical standard), two injectable hydrogels (alginate, chitosan/β-glycerophosphate (chitosan/ß-GP)) and two epicardial patches (alginate, collagen). Human mesenchymal stem cells (hMSCs) were delivered to the infarct border zone with each biomaterial. At 24 h, retained cells were quantified by fluorescence. All biomaterials produced superior fluorescence to saline control, with approximately 8- and 14-fold increases with alginate and chitosan/β-GP injectables, and 47 and 59-fold increases achieved with collagen and alginate patches, respectively. Immunohistochemical analysis qualitatively confirmed these findings. All four biomaterials retained 50–60% of cells that were present immediately following transplantation, compared to 10% for the saline control. In conclusion, all four biomaterials were demonstrated to more efficiently deliver and retain cells when compared to a saline control. Biomaterial-based delivery approaches show promise for future development of efficient in vivo delivery techniques.
Accurately targeting multi-adjacent points (MAPs) during image-guided percutaneous procedures is challenging due to needle deflection and misalignment. The associated errors can result in inadequate treatment of cancer in the case of prostate brachytherapy, or inaccurate diagnosis during biopsy, while repeated insertions increase procedure time, radiation dose, and complications. To address these challenges, we present an image-guided robotic system capable of MAP targeting of irregularly shaped volumes after a single insertion of a percutaneous instrument. The design of the compact CT-compatible drive mechanism is based on a nested screw and screw-spline combination that actuates a straight outer cannula and a curved inner stylet that can be repeatedly straightened when retracted inside the cannula. The stylet translation and cannula rotation/translation enable a 3-D workspace to be reached with the stylet's tip. A closed-form inverse kinematics and image-to-robot registration are implemented in an image-guided system including a point-and-click user interface. The complete system is successfully evaluated with a phantom under a Siemens Definition Flash CT scanner. We demonstrate that the system is capable of MAP targeting for a 2-D shape of the letter “H” and a 3-D helical pattern with an average targeting error of 2.41 mm. These results highlight the benefit and efficacy of the proposed robotic system in seed placement during image-guided brachytherapy.
This article describes the development of the Soft Robotics Toolkit, a set of open access resources to support the design, fabrication, modeling, characterization, and control of soft robotic devices. The ultimate aim of the toolkit is to support researchers in building upon each other's work, and thereby advance the field of soft robotics. An additional aim is to support educators and encourage students to pursue careers in engineering and science by making the resources as accessible as possible. The toolkit was developed and refined through a series of pilot studies and user tests. Specifically, the resources were used by students in a project-based medical device design course; volunteers from a variety of backgrounds tested the toolkit and provided feedback, and soft robotics researchers used the collection of resources and contributed to its development. Throughout all user studies, qualitative data were collected and used to guide improvements to the toolkit. This process of testing and refinement has resulted in a website containing design documentation describing general hardware control platforms and specific soft robotic component designs. The online documentation includes downloadable computer-aided design (CAD) files, detailed multimedia protocols for the fabrication of soft devices, tutorials and scripts for modeling and analyzing soft actuators and sensors, and source code for controlling soft devices. Successive iterations of qualitative data gathering and redesign have confirmed that the toolkit documentation is sufficiently detailed to be useful for researchers from a wide range of backgrounds. To date, the focus of the toolkit has primarily been fluid-actuated robotic systems, but the plan is to expand it to support a wider range of soft robotic-enabling technologies. The toolkit is intended as a community resource, and all researchers working in this field are invited to guide its future development by providing feedback and contributing new content.
Wearable robots based on soft materials will augment mobility and performance of the host without restricting natural kinematics. Such wearable robots will need soft sensors to monitor the movement of the wearer and robot outside the lab. Until now wearable soft sensors have not demonstrated significant mechanical robustness nor been systematically characterized for human motion studies of walking and running. Here, we present the design and systematic characterization of a soft sensing suit for monitoring hip, knee, and ankle sagittal plane joint angles. We used hyper-elastic strain sensors based on microchannels of liquid metal embedded within elastomer, but refined their design with the use of discretized stiffness gradients to improve mechanical durability. We found that these robust sensors could stretch up to 396% of their original lengths, would restrict the wearer by less than 0.17% of any given joint’s torque, had gauge factor sensitivities of greater than 2.2, and exhibited less than 2% change in electromechanical specifications through 1500 cycles of loading–unloading. We also evaluated the accuracy and variability of the soft sensing suit by comparing it with joint angle data obtained through optical motion capture. The sensing suit had root mean square (RMS) errors of less than 5° for a walking speed of 0.89 m/s and reached a maximum RMS error of 15° for a running speed of 2.7 m/s. Despite the deviation of absolute measure, the relative repeatability of the sensing suit’s joint angle measurements were statistically equivalent to that of optical motion capture at all speeds. We anticipate that wearable soft sensing will also have applications beyond wearable robotics, such as in medical diagnostics and in human–computer interaction.
A class of soft actuated materials that can achieve lifelike motion is presented. By embedding pneumatic actuators in a soft material inspired by a biological muscle fibril architecture, and developing a simple finite element simulation of the same, tunable biomimetic motion can be achieved with fully soft structures, exemplified here by an active left ventricle simulator.
Finger therapy exercises, which include table-top, proximal-interphalangeal blocking, straight-fist, distal-interphalangeal blocking, hook-fist and fist exercises, are important for maintaining hand mobility and preventing development of tendon adhesions in post-operative hand-injury patients. Continuous passive motion devices act as an adjunct to the therapist in performing therapy exercises on patients, however current devices are unable to recreate these exercises well. The current study aimed to design and evaluate a finger exercise device that reproduces the therapy exercises, by adopting a cable-actuated flexion and spring-return extension mechanism. The device comprises of phalanx interface attachments, connected by palmar-side cables to spooling actuators and linked by dorsal-side extension springs to provide passive return. Two designs were tested, whereby the springs had similar (Design 1) or different stiffnesses (Design 2). The device was donned onto a model hand and actuated into the desired therapy postures. Our findings indicated that Design 1 is able to recreate table-top, straight-fist and fist exercises, while Design 2 is capable of further replicating distal-interphalangeal blocking, proximal-interphalangeal blocking and hook-fist exercises. Considering that these therapy exercises have not yet been well-replicated in current devices, developing a new device that reproduces the exercises will be beneficial for post-operative rehabilitation of patients.