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.
Burgeoning transendoscopic procedures, such as endoscopic submucosal dissection (ESD), provide a promising means of treating early-stage gastric neoplasia in a minimally-invasive way. However, the remote locations of these lesions, coupled with their origination in the submucosal layers of the gastrointestinal tract, often lead to extreme technical, cognitive and ergonomic challenges which combat the widespread applicability and adoption of these techniques. Among these challenges is achieving the in vivo dexterity required to retract and dissect tissue. By leveraging workspace and force data obtained through clinical studies, we developed a modular, disposable, distally-mounted actuator (an 'active endcap') that can augment an endoscopist's distal dexterity in ways that are not achievable with the endoscope's built-in degrees-of-freedom. The device consists of a flexible articulating 'exoskeleton' manufactured via printed-circuit MEMS (PCMEMS) which engages and deflects electrosurgical tools that are passed through the endoscopic working channel. Embedded proprioceptive sensing is implemented on-board using distributed LED/phototransistor pairs and the principle of light intensity modulation (LIM). The distal degree-of-freedom is actuated using shape memory alloy (SMA) technology, and the actuation transmission system is fully contained within a 1-inch-long end cap that can be mounted on the distal end of the endoscope, thereby obviating the need for a mechanical connection to a proximal source. Proof-of-concept tests demonstrate that the actuator adds over 50 degrees of distal articulation to existing tools and can generate 450 mN of lateral force which has been clinically determined to be sufficient for performing circumferential incisions in ESD.
This paper introduces a manufacturing technique which enables the integration of soft materials and soft fluidic micro-actuators in the Pop-up book MEMS paradigm. Such a technique represents a promising approach to the design and fabrication of low cost and scalable articulated mechanisms provided with sensing capabilities and on-board actuation with potential applications in the field of minimally invasive surgery. Design and integration of soft components in the rigid-flex laminates is described along with the resulting soft pop-up mechanisms realized at different scales. Prototype characterization is presented, demonstrating forces and dexterity in a range suitable for surgical applications, as well as the possibility to integrate sensing capabilities. Based on these results, a multi-articulated robotic arm is fabricated and mounted on top of an endoscope model to provide a proof of concept of simple robotic mechanisms that could be useful in a surgical scenario.
In this paper we describe an IMU-based iterative controller for hip extension assistance where the onset timing of assistance is based on an estimate of the maximum hip flexion angle. The controller was implemented on a mono-articular soft exosuit coupled to a lab-based multi-joint actuation platform that enables rapid reconfiguration of different sensors and control strategy implementation. The controller design is motivated by a model of the suit-human interface and utilizes an iterative control methodology that includes gait detection and step-by-step actuator position profile generation to control the onset timing, peak timing, and peak magnitude of the delivered force. This controller was evaluated on eight subjects walking on a treadmill at a speed of 1.5 m/s while carrying a load of 23 kg. Results showed that assistance could be delivered reliably across subjects. Specifically, for a given profile, the average delivered force started concurrently with the timing of the maximum hip flexion angle and reached its peak timing 22.7 ± 0.63% later in the gait cycle (desired 23%) with a peak magnitude of 198.2 ± 1.6 N (desired 200 N), equivalent to an average peak torque of 30.5 ± 4.7 Nm. This control approach was used to assess the metabolic effect of four different assistive profiles. Metabolic reductions ranging from 5.7% to 8.5% were found when comparing the powered conditions with the unpowered condition. This work enables studies to assess the biomechanical and physiological responses to different assistive profiles to determine the optimal hip extension assistance during walking.
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.
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.