Modular robotic systems that integrate with commercially-available endoscopic equipment have the potential to improve the standard-of-care in therapeutic endoscopy by granting clinicians with capabilities not present in commercial tools, such as precision dexterity and motion sensing. With the desire to integrate both sensing and actuation distally for closed-loop position control in fully-deployable, endoscope-based robotic modules, commercial sensor and actuator options that acquiesce to the strict form-factor requirements are sparse or nonexistent. Herein we describe a proprioceptive angle sensor for potential closed-loop position control applications in distal robotic modules. Fabricated monolithically using printed-circuit MEMS, the sensor employs a kinematic linkage and the principle of light intensity modulation to sense the angle of articulation with a high degree of fidelity. On-board temperature and environmental irradiance measurements, coupled with linear regression techniques, provide robust angle measurements that are insensitive to environmental disturbances. The sensor is capable of measuring +/-45 degrees of articulation with an RMS error of 0.98 degrees. An integrated demonstration shows that the sensor can give real-time proprioceptive feedback when coupled with an actuator module, opening up the possibility of fully-distal closed-loop control.
Passive assistance devices such as canes and braces are often used by people after stroke, but mobility remains limited for some patients. Awad et al. studied the effects of active assistance (delivery of supportive force) during walking in nine patients in the chronic phase of stroke recovery. A soft robotic exosuit worn on the partially paralyzed lower limb reduced interlimb propulsion asymmetry, increased ankle dorsiflexion, and reduced the energy required to walk when powered on during treadmill and overground walking tests. The exosuit could be adjusted to deliver supportive force during the early or late phase of the gait cycle depending on the patient’s needs. Although long-term therapeutic studies are necessary, the immediate improvement in walking performance observed using the powered exosuit makes this a promising approach for neurorehabilitation.
Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite—and perhaps because of—their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance ( 12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.
Objective The aim of the study was to evaluate the effects on common poststroke gait compensations of a soft wearable robot (exosuit) designed to assist the paretic limb during hemiparetic walking.
Design A single-session study of eight individuals in the chronic phase of stroke recovery was conducted. Two testing conditions were compared: walking with the exosuit powered versus walking with the exosuit unpowered. Each condition was 8 minutes in duration.
Results Compared with walking with the exosuit unpowered, walking with the exosuit powered resulted in reductions in hip hiking (27 [6%], P = 0.004) and circumduction (20 [5%], P = 0.004). A relationship between changes in knee flexion and changes in hip hiking was observed (Pearson r = −0.913, P < 0.001). Similarly, multivariate regression revealed that changes in knee flexion (β = −0.912, P = 0.007), but not ankle dorsiflexion (β = −0.194, P = 0.341), independently predicted changes in hip hiking (R2= 0.87, F(2, 4) = 13.48, P = 0.017).
Conclusions Exosuit assistance of the paretic limb during walking produces immediate changes in the kinematic strategy used to advance the paretic limb. Future work is necessary to determine how exosuit-induced reductions in paretic hip hiking and circumduction during gait training could be leveraged to facilitate more normal walking behavior during unassisted walking.
A hybrid manufacturing paradigm is introduced that combines pop-up book microelectromechanical systems (MEMS) manufacturing with soft-lithographic techniques to produce millimeter-scale mechanisms with embedded sensing and user-defined distributed compliance. This method combines accuracy, flexibility in material selection, scalability, and topological complexity with soft, biocompatible materials and microfluidics, paving the way for applications of soft fluid-powered biomedical robotics. This paper proposes two classes of fully soft fluidic microactuators and two integration strategies to demonstrate the hybrid soft pop-up actuators. Fatigue properties, blocked torque, maximum deflection, stiffness, and maximum speed are analyzed and the performance of the hybrid mechanisms is compared to their fully soft counterparts. The manufacturing approach allows integrating capacitive sensing elements in the mechanisms to achieve proprioceptive actuation. Multiple hybrid soft pop-up actuators are combined into a multiarticulated robotic arm that is integrated with current flexible endoscopes to improve distal dexterity and enable tissue retraction in an ex vivo proof of concept experiment.
Background Different groups developed wearable robots for walking assistance, but there is still a need for methods to quickly tune actuation parameters for each robot and population or sometimes even for individual users. Protocols where parameters are held constant for multiple minutes have traditionally been used for evaluating responses to parameter changes such as metabolic rate or walking symmetry. However, these discrete protocols are time-consuming. Recently, protocols have been proposed where a parameter is changed in a continuous way. The aim of the present study was to compare effects of continuously varying assistance magnitude with a soft exosuit against discrete step conditions.
Methods Seven participants walked on a treadmill wearing a soft exosuit that assists plantarflexion and hip flexion. In Continuous-up, peak exosuit ankle moment linearly increased from approximately 0 to 38% of biological moment over 10 min. Continuous-down was the opposite. In Discrete, participants underwent five periods of 5 min with steady peak moment levels distributed over the same range as Continuous-up and Continuous-down. We calculated metabolic rate for the entire Continuous-up and Continuous-down conditions and the last 2 min of each Discrete force level. We compared kinematics, kinetics and metabolic rate between conditions by curve fitting versus peak moment.
Results Reduction in metabolic rate compared to Powered-off was smaller in Continuous-up than in Continuous-down at most peak moment levels, due to physiological dynamics causing metabolic measurements in Continuous-up and Continuous-down to lag behind the values expected during steady-state testing. When evaluating the average slope of metabolic reduction over the entire peak moment range there was no significant difference between Continuous-down and Discrete. Attempting to correct the lag in metabolics by taking the average of Continuous-up and Continuous-down removed all significant differences versus Discrete. For kinematic and kinetic parameters, there were no differences between all conditions.
Conclusions The finding that there were no differences in biomechanical parameters between all conditions suggests that biomechanical parameters can be recorded with the shortest protocol condition (i.e. single Continuous directions). The shorter time and higher resolution data of continuous sweep protocols hold promise for the future study of human interaction with wearable robots.
This paper presents design and batch manufacturing of a highly stretchable textile-silicone capacitive sensor to be used in human articulation detection, soft robotics, and exoskeletons. The proposed sensor is made of conductive knit fabric as electrode and silicone elastomer as dielectric. The batch manufacturing technology enables production of large sensor mat and arbitrary shaping of sensors, which is precisely achieved via laser cutting of the sensor mat. Individual capacitive sensors exhibit high linearity, low hysteresis, and a gauge factor of 1.23. Compliant, low-profile, and robust electrical connections are established by fusing filaments of micro coaxial cable to conductive fabric electrodes of the sensor with thermoplastic film. The capacitive sensors are integrated on a reconstructed glove for monitoring finger motions.
Background Only very recently, studies have shown that it is possible to reduce the metabolic rate of unloaded and loaded walking using robotic ankle exoskeletons. Some studies obtained this result by means of high positive work assistance while others combined negative and positive work assistance. There is no consensus about the isolated contribution of negative work assistance. Therefore, the aim of the present study is to examine the effect of varying negative work assistance at the ankle joint while maintaining a fixed level of positive work assistance with a multi-articular soft exosuit.
Methods We tested eight participants during walking at 1.5 ms−1 with a 23-kg backpack. Participants wore a version of the exosuit that assisted plantarflexion via Bowden cables tethered to an off-board actuation platform. In four active conditions we provided different rates of exosuit bilateral ankle negative work assistance ranging from 0.015 to 0.037 W kg−1 and a fixed rate of positive work assistance of 0.19 W kg−1.
Results All active conditions significantly reduced metabolic rate by 11 to 15% compared to a reference condition, where the participants wore the exosuit but no assistance was provided. We found no significant effect of negative work assistance. However, there was a trend (p = .08) toward greater reduction in metabolic rate with increasing negative work assistance, which could be explained by observed reductions in biological ankle and hip joint power and moment.
Conclusions The non-significant trend of increasing negative work assistance with increasing reductions in metabolic rate motivates the value in further studies on the relative effects of negative and positive work assistance. There may be benefit in varying negative work over a greater range or in isolation from positive work assistance.
Wearable sensing technology is an emerging area and can be utilized for human motion monitoring, physiology monitoring, and human–machine interaction. In this paper, a new manufacturing approach is presented to create highly stretchable and soft capacitance-based strain sensors. This involves a rapid surface modification technique based on direct-write laser rastering to create microstructured surfaces on prestrained elastomeric sheets. Then, to impart conductivity, sputtering technology is utilized to deposit aluminum and silver metal layers on the bottom and top surfaces of the elastomer sheet, creating a soft capacitor. During benchtop characterization of the sensors, this study demonstrates that the fabricated electrodes maintain their electrical conductivity up to the 250% strain, and the sensor shows a linear and repeatable output up to 85% strain. Finally, their potential is demonstrated for monitoring human motion and respiration through their integration into a wearable arm sleeve and a thoracic belt, respectively.
Background Wearable assistive devices have demonstrated the potential to improve mobility outcomes for individuals with disabilities, and to augment healthy human performance; however, these benefits depend on how effectively power is transmitted from the device to the human user. Quantifying and understanding this power transmission is challenging due to complex human-device interface dynamics that occur as biological tissues and physical interface materials deform and displace under load, absorbing and returning power.
Methods Here we introduce a new methodology for quickly estimating interface power dynamics during movement tasks using common motion capture and force measurements, and then apply this method to quantify how a soft robotic ankle exosuit interacts with and transfers power to the human body during walking. We partition exosuit end-effector power (i.e., power output from the device) into power that augments ankle plantarflexion (termed augmentation power) vs. power that goes into deformation and motion of interface materials and underlying soft tissues (termed interface power).
Results We provide empirical evidence of how human-exosuit interfaces absorb and return energy, reshaping exosuit-to-human power flow and resulting in three key consequences: (i) During exosuit loading (as applied forces increased), about 55% of exosuit end-effector power was absorbed into the interfaces. (ii) However, during subsequent exosuit unloading (as applied forces decreased) most of the absorbed interface power was returned viscoelastically. Consequently, the majority (about 75%) of exosuit end-effector work over each stride contributed to augmenting ankle plantarflexion. (iii) Ankle augmentation power (and work) was delayed relative to exosuit end-effector power, due to these interface energy absorption and return dynamics.
Conclusions Our findings elucidate the complexities of human-exosuit interface dynamics during transmission of power from assistive devices to the human body, and provide insight into improving the design and control of wearable robots. We conclude that in order to optimize the performance of wearable assistive devices it is important, throughout design and evaluation phases, to account for human-device interface dynamics that affect power transmission and thus human augmentation benefits.
We introduce an implantable intracardiac soft robotic right ventricular ejection device (RVED) for dynamic approximation of the right ventricular (RV) free wall and the interventricular septum (IVS) in synchrony with the cardiac cycle to augment blood ejection in right heart failure (RHF). The RVED is designed for safe and effective intracardiac operation and consists of an anchoring system deployed across the IVS, an RV free wall anchor, and a pneumatic artificial muscle linear actuator that spans the RV chamber between the two anchors. Using a ventricular simulator and a custom controller, we characterized ventricular volume ejection, linear approximation against different loads and the effect of varying device actuation periods on volume ejection. The RVED was then tested in vivo in adult pigs (n = 5). First, we successfully deployed the device into the beating heart under 3D echocardiography guidance (n = 4). Next, we performed a feasibility study to evaluate the device's ability to augment RV ejection in an experimental model of RHF (n = 1). RVED actuation augmented RV ejection during RHF; while further chronic animal studies will provide details about the efficacy of this support device. These results demonstrate successful design and implementation of the RVED and its deployment into the beating heart. This soft robotic ejection device has potential to serve as a rapidly deployable system for mechanical circulatory assistance in RHF.
When defining requirements for any wearable robot for walking assistance, it is important to maximize the user’s metabolic benefit resulting from the exosuit assistance while limiting the metabolic penalty of carrying the system’s mass. Thus, the aim of this study was to isolate and characterize the relationship between assistance magnitude and the metabolic cost of walking while also examining changes to the wearer’s underlying gait mechanics. The study was performed with a tethered multiarticular soft exosuit during normal walking, where assistance was directly applied at the ankle joint and indirectly at the hip due to a textile architecture. The exosuit controller was designed such that the delivered torque profile at the ankle joint approximated that of the biological torque during normal walking. Seven participants walked on a treadmill at 1.5 meters per second under one unpowered and four powered conditions, where the peak moment applied at the ankle joint was varied from about 10 to 38% of biological ankle moment (equivalent to an applied force of 18.7 to 75.0% of body weight). Results showed that, with increasing exosuit assistance, net metabolic rate continually decreased within the tested range. When maximum assistance was applied, the metabolic rate of walking was reduced by 22.83 ± 3.17% relative to the powered-off condition (mean ± SEM).
Soft actuators are the components responsible for producing motion in soft robots. Although soft actuators have allowed for a variety of innovative applications, there is a need for design tools that can help to efficiently and systematically design actuators for particular functions. Mathematical modeling of soft actuators is an area that is still in its infancy but has the potential to provide quantitative insights into the response of the actuators. These insights can be used to guide actuator design, thus accelerating the design process. Here, we study fluid-powered fiber-reinforced actuators, because these have previously been shown to be capable of producing a wide range of motions. We present a design strategy that takes a kinematic trajectory as its input and uses analytical modeling based on nonlinear elasticity and optimization to identify the optimal design parameters for an actuator that will follow this trajectory upon pressurization. We experimentally verify our modeling approach, and finally we demonstrate how the strategy works, by designing actuators that replicate the motion of the index finger and thumb.
Abstract: Flexible endoscopes are still the gold standard in most natural orifice translumenal endoscopic surgery (NOTES) procedures; however their flexibility (necessary for navigating through the GI tract) limits their capabilities in terms of distal manipulation and stability. We propose a deployable endoscopic add-on aimed at locally counteracting forces applied at the tip of an endoscope. We analyze different designs: a fully soft version and two hybrid soft-folded versions. The hybrid designs exploit either an inextensible structure pressurized by a soft actuator or the stiffness provided by the unfolded “magic cube” origami structure. We focus on the fabrication and experimental characterization of the proposed structures and present some preliminary designs and integration strategies to mount them on top of current flexible endoscopes.
‘Snap-On’ robotic modules that can integrate distally with existing commercially-available endoscopic equipment have the potential to provide new capabilities such as enhanced dexterity, bilateral manipulation and feedback sensing with minimal disruption of the current clinical workflow. However, the desire for fully-distal integration of sensors and actuators and the resulting form factor requirements preclude the use of many off-the-shelf actuators capable of generating the relevant strokes and forces required to interact with tools and tissue. In this work, we investigate the use of millimeter-scale, optimally-packed helical shape memory alloy (SMA) actuators in an antagonistic configuration to provide distal actuation without the need for a continuous mechanical coupling to proximal, off-board actuation packages to realize a truly plug-and-play solution. Using phenomenological modeling, we design and fabricate antagonistic helical SMA pairs and implement them in an at-scale roboendoscopic module to generate strokes and forces necessary for deflecting tools passed through the endoscope working port, thereby providing a controllable robotic ‘wrist’ inside the body to otherwise passive flexible tools. Bandwidth is drastically improved through the integration of targeted fluid cooling. The integrated system can generate maximum lateral forces of 10N and demonstrates an additional 96 degrees of distal angulation, expanding the reachable workspace of tools passed through a standard endoscope.