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.
This paper presents further developments, characterization and initial evaluation of a recently developed assistive soft robotic glove for individuals with hand pathologies. The glove technology utilizes a combination of elastomeric and inextensible materials to create soft actuators that conform to the user's hand and can generate sufficient hand closing force to assist with activities of daily living. User intent (i.e. desire to close or open hand) is detected by monitoring gross muscle activation signals with surface electromyography electrodes mounted on the user's forearm. In particular, we present an open-loop sEMG logic that distinguishes muscle contractions and feeds the information to a low-level fluidic pressure controller that regulates pressure in pre-selected groups of the glove's actuators. Experiments are conducted to determine the level of assistance provided by the glove by monitoring muscle effort and mapping the pressure distribution during a simple grasping task when the glove is worn. Lastly, quantitative and qualitative results are presented using the sEMG-controlled glove on a healthy participant and on a patient with muscular dystrophy.
Recently, there has been a growing interest in moving away from traditional rigid exoskeletons towards soft exosuits that can provide a variety of advantages including a reduction in both the weight carried by the wearer and the inertia experienced as the wearer flexes and extends their joints. These advantages are achieved by using structured functional textiles in combination with a flexible actuation scheme that enables assistive torques to be applied to the biological joints. Understanding the human-suit interface in these systems is important, as one of the key challenges with this approach is applying force to the human body in a manner that is safe, comfortable, and effective. This paper outlines a methodology for characterizing the structured functional textile of soft exosuits and then uses that methodology to evaluate several factors that lead to different suit-human series stiffnesses and pressure distributions over the body. These factors include the size of the force distribution area and the composition of the structured functional textile. Following the test results, design guidelines are suggested to maximize the safety, comfort, and efficiency of the exosuit.
A direct cardiac compression (DCC) device is a non-blood contacting sleeve placed around the failing heart to actively assist blood pumping function. For design optimization of a DCC device, it is necessary to monitor the surface pressure exerted on the heart surface at multiple points during active assist, and to correlate this with device performance and cardiac output. In this paper, we present the design, fabrication and characterization of a soft, elastic, conformable pressure sensing sleeve that is placed at the heart/device interface to monitor device performance without affecting device function. This sleeve enables identification of optimal pre-tensioning, positioning and user-controlled parameters of the DCC device. Individual sensors (8×8×3 mm) were fabricated using a surface mount device (SMD) barometer on a custom double-sided flexible printed circuit board and casting the assembly in urethane rubber. A typical sensor has a dynamic range of 2.5 kPa to 50 kPa with a sensitivity of 11.3 counts per kPa. An array of up to 24 sensors was integrated into a flexible, stretchable circuit embedded in a thin (500 micron) silicone sheet using a multi-step layering fabrication process. Continuous magnet wires were wrapped around an alignment fixture, soldered to individual sensors in place and the entire circuit was transfer printed on to a silicone sheet. This assembly allows stretch corresponding to the fractional shortening of the heart muscles (up to 50%). The sleeve successfully measured static and dynamic pressures with a mechanical tensile tester and did not affect DCC device performance. Preliminary results demonstrated that the sleeve is robust enough to withstand >10000 cycles, compression forces from the DCC device and can achieve sensing range and repeatability suitable for procedural pressure monitoring for a DCC device. In addition to allowing performance measurements for iterating DCC device designs, the sensing sleeve can enable increased understanding of the response of the cardiovascular system to compressive assistance.
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.
Exosuits represent a new approach for applying assistive forces to an individual, using soft textiles to interface to the wearer and transmit forces through specified load paths. In this paper we present a body-worn, multi-joint soft exosuit that assists both ankle plantar flexion and hip flexion through a multiarticular load path, and hip extension through a separate load path, at walking speeds up to 1.79m/s (4.0mph). The exosuit applies forces of 300N in the multiarticular load path and 150N in hip extension, which correspond to torques of 21% and 19% of the nominal biological moments at the ankle and hip during unloaded walking. The multi-joint soft exosuit uses a new actuation approach that exploits joint synergies, with one motor actuating the multiarticular load paths on both legs and one motor actuating the hip extension load paths on both legs, in order to reduce the total system weight. Control is accomplished by an algorithm that uses only a gyroscope at the heel and a load cell monitoring the suit tension, and is shown to adapt within a single step to changes in cadence. Additionally, the control algorithm can create slack in the suit during non-level-ground walking motions such as stepping over obstacles so that the system can be transparent to the wearer when required. The resulting system consumes 137W, and has a mass of 6.5kg including batteries.
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.
This paper presents advancements in the design of a portable, soft robotic glove for individuals with functional grasp pathologies. The robotic glove leverages soft material actuator technology to safely distribute forces along the length of the finger and provide active flexion and passive extension. These actuators consist of molded elastomeric bladders with anisotropic fiber reinforcements that produce specific bending, twisting, and extending trajectories upon fluid pressurization. In particular, we present a method for customizing a soft actuator to a wearer's biomechanics and demonstrate in a motion capture system that the ranges of motion (ROM) of the two are nearly equivalent. The active ROM of the glove is further evaluated using the Kapandji test. Lastly, in a case study, we present preliminary results of a patient with very weak hand strength performing a timed Box-and-Block test with and without the soft robotic glove.