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.
Carrying load alters normal walking, imposes additional stress to the musculoskeletal system, and results in an increase in energy consumption and a consequent earlier onset of fatigue. This phenomenon is largely due to increased work requirements in lower extremity joints, in turn requiring higher muscle activation. The aim of this work was to assess the biomechanical and physiological effects of a multi-joint soft exosuit that applies assistive torques to the biological hip and ankle joints during loaded walking.
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.
The Soft Robotics Toolkit (SRT) is an open-access website containing detailed information about the design, fabrication, and characterization of soft-robotic components and systems (Figure 1). Soft robotics is a growing field of research concerned with the development of electromechanical technology composed of compliant materials or structures. The SRT website hosts design files, multimedia fabrication instructions, and software tutorials submitted by an international community of soft-robotics researchers and designers. In this article, we describe the development of the SRT and some challenges in developing widely disseminated robotic-hardware resources. Our attempts to overcome these challenges in the development of the toolkit are discussed by focusing on strategies that have been used to engage participants ranging from K-12 grade students to robotics research groups. A series of design competitions encouraged people to use and contribute to the toolkit. New fabrication methods requiring only low-cost and accessible materials were developed to lower the entry barriers to soft robotics and instructional materials and outreach activities were used to engage new audiences. We hope that our experiences in developing and scaling the toolkit may serve as guidance for other open robotic-hardware projects.
There is much interest in form-fitting, low-modulus, implantable devices or soft robots that can mimic or assist in complex biological functions such as the contraction of heart muscle. We present a soft robotic sleeve that is implanted around the heart and actively compresses and twists to act as a cardiac ventricular assist device. The sleeve does not contact blood, obviating the need for anticoagulation therapy or blood thinners, and reduces complications with current ventricular assist devices, such as clotting and infection. Our approach used a biologically inspired design to orient individual contracting elements or actuators in a layered helical and circumferential fashion, mimicking the orientation of the outer two muscle layers of the mammalian heart. The resulting implantable soft robot mimicked the form and function of the native heart, with a stiffness value of the same order of magnitude as that of the heart tissue. We demonstrated feasibility of this soft sleeve device for supporting heart function in a porcine model of acute heart failure. The soft robotic sleeve can be customized to patient-specific needs and may have the potential to act as a bridge to transplant for patients with heart failure.
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.
Previous soft robotic ventricular assist devices have generally targeted biventricular heart failure and have not engaged the interventricular septum that plays a critical role in blood ejection from the ventricle. We propose implantable soft robotic devices to augment cardiac function in isolated left or right heart failure by applying rhythmic loading to either ventricle. Our devices anchor to the interventricular septum and apply forces to the free wall of the ventricle to cause approximation of the septum and free wall in systole and assist with recoil in diastole. Physiological sensing of the native hemodynamics enables organ-in-the-loop control of these robotic implants for fully autonomous augmentation of heart function. The devices are implanted on the beating heart under echocardiography guidance. We demonstrate the concept on both the right and the left ventricles through in vivo studies in a porcine model. Different heart failure models were used to demonstrate device function across a spectrum of hemodynamic conditions associated with right and left heart failure. These acute in vivo studies demonstrate recovery of blood flow and pressure from the baseline heart failure conditions. Significant reductions in diastolic ventricle pressure were also observed, demonstrating improved filling of the ventricles during diastole, which enables sustainable cardiac output.
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.
Severe skeletal muscle injuries are common and can lead to extensive fibrosis, scarring, and loss of function. Clinically, no therapeutic intervention exists that allows for a full functional restoration. As a result, both drug and cellular therapies are being widely investigated for treatment of muscle injury. Because muscle is known to respond to mechanical loading, we investigated instead whether a material system capable of massage-like compressions could promote regeneration. Magnetic actuation of biphasic ferrogel scaffolds implanted at the site of muscle injury resulted in uniform cyclic compressions that led to reduced fibrous capsule formation around the implant, as well as reduced fibrosis and inflammation in the injured muscle. In contrast, no significant effect of ferrogel actuation on muscle vascularization or perfusion was found. Strikingly, ferrogel-driven mechanical compressions led to enhanced muscle regeneration and a ∼threefold increase in maximum contractile force of the treated muscle at 2 wk compared with no-treatment controls. Although this study focuses on the repair of severely injured skeletal muscle, magnetically stimulated bioagent-free ferrogels may find broad utility in the field of regenerative medicine.
Wearable robotic devices have been shown to substantially reduce the energy expenditure of human walking. However, response variance between participants for fixed control strategies can be high, leading to the hypothesis that individualized controllers could further improve walking economy. Recent studies on human-in-the-loop (HIL) control optimization have elucidated several practical challenges, such as long experimental protocols and low signal-to-noise ratios. Here, we used Bayesian optimization—an algorithm well suited to optimizing noisy performance signals with very limited data—to identify the peak and offset timing of hip extension assistance that minimizes the energy expenditure of walking with a textile-based wearable device. Optimal peak and offset timing were found over an average of 21.4 ± 1.0 min and reduced metabolic cost by 17.4 ± 3.2% compared with walking without the device (mean ± SEM), which represents an improvement of more than 60% on metabolic reduction compared with state-of-the-art devices that only assist hip extension. In addition, our results provide evidence for participant-specific metabolic distributions with respect to peak and offset timing and metabolic landscapes, lending support to the hypothesis that individualized control strategies can offer substantial benefits over fixed control strategies. These results also suggest that this method could have practical impact on improving the performance of wearable robotic devices.
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).
The increasing capabilities of exoskeletons and powered prosthetics for walking assistance have paved the way for more sophisticated and individualized control strategies. In response to this opportunity, recent work on human-in-the-loop optimization has considered the problem of automatically tuning control parameters based on realtime physiological measurements. However, the common use of metabolic cost as a performance metric creates significant experimental challenges due to its long measurement times and low signal-to-noise ratio. We evaluate the use of Bayesian optimization—a family of sample-efficient, noise-tolerant, and global optimization methods—for quickly identifying near-optimal control parameters. To manage experimental complexity and provide comparisons against related work, we consider the task of minimizing metabolic cost by optimizing walking step frequencies in unaided human subjects. Compared to an existing approach based on gradient descent, Bayesian optimization identified a near-optimal step frequency with a faster time to convergence (12 minutes, p < 0.01), smaller inter-subject variability in convergence time (± 2 minutes, p < 0.01), and lower overall energy expenditure (p < 0.01).