Figure 1 - available from: Scientific Reports
This content is subject to copyright. Terms and conditions apply.
Average MCoT at T0, TF and TU for the APO and the control groups. Stars mark statistically significant differences.
Source publication
Robotic exoskeletons are regarded as promising technologies for neurological gait rehabilitation but have been investigated comparatively little as training aides to facilitate active aging in the elderly. This study investigated the feasibility of an exoskeletal Active Pelvis Orthosis (APO) for cardiopulmonary gait training in the elderly. Ten hea...
Context in source publication
Context 1
... efficiency. Figure 1 displays the MCoT for each group at each of three time points: baseline (T0), post-training (TF -end of week 4), and at one-month follow-up (TU). No significant differences were found between the average MCoT of the APO group (0.162 ± 0.038 ml/kg/m) and the control group (0.145 ± 0.038 ml/ kg/m) at baseline (p = 0.33). ...
Similar publications
Mobility impairments can prevent older adults from performing their daily activities, which highly impacts quality of life. Powered exoskeletons, which are wearable robotic devices, can assist older adults by providing additional support to compensate for age-related decline in muscle strength. To date, little is known about the opinions and needs...
Citations
... On the other hand, powered exoskeletons are designed to provide active assistance in movement for healthy individuals and those with motor impairments [7][8][9][10]. Their applications encompass tasks such as aiding individuals in carrying heavy objects over long distances [11], facilitating long-term rehabilitation, supporting the mobility of injured or elderly individuals [12], etc. Despite their immense application potential, the design, control, and performance evaluation of wearable exoskeletons present significant challenges due to several reasons. ...
The modeling and simulation of coupled neuromusculoskeletal-exoskeletal systems play a crucial role in human biomechanical analysis, as well as in the design and control of exoskeletons. This study incorporates the integration of exoskeleton models into a reflex-based gait model, emphasizing human-exoskeleton interaction. Specifically, we introduce an optimization-based dynamic simulation framework that integrates a neuromusculoskeletal feedback loop, multibody dynamics, human-exoskeleton interaction, and foot-ground contact. The framework advances in human-exoskeleton interaction and muscle reflex model refinement. Without relying on experimental measurements or empirical data, our framework employs a stepwise optimization process to determine muscle reflex parameters, taking into account multidimensional criteria. This allows the framework to generate a full range of kinematic and biomechanical signals, including muscle activations, muscle forces, joint torques, etc., which are typically challenging to measure experimentally. To evaluate the validity of the framework, we compare the simulated results with experimental data obtained from a healthy subject wearing an exoskeleton while walking at different speeds (0.9, 1.0, and 1.1 m/s) and terrains (flat and uphill). The results demonstrate that our framework can capture the qualitative differences in muscle activity associated with different functions, as well as the evolutionary patterns of muscle activity and kinematic signals with respect to varying walking conditions, with the Pearson correlation coefficient R > 0.7. Simulations of the human walking with the exoskeleton in both passive mode and assisting mode at a peak torque of 20 N⋅m are further conducted to investigate the effect of exoskeleton assistance on human biomechanics. The simulation framework we propose has the potential to facilitate gait analysis and performance evaluation of coupled human-exoskeleton systems, as well as enable efficient and cost-effective testing of novel exoskeleton designs and control strategies.
... Assistive devices have emerged as a promising solution to preserve, regain and enhance gait performance. In the design of such a device (e.g., neuromuscular electrical stimulation [4], [5], robotic exoskeleton [6], [7] or powered prostheses [8]), prediction of motion intention is a fundamental task to achieve intuitive control. Moreover, motion intention prediction during gait can have implications for medical diagnosis [9], providing insights into disease progression, prevention and rehabilitation. ...
The prediction of gait motion intention is essential for achieving intuitive control of assistive devices and diagnosing gait disorders. To reduce the cost associated with using multimodal signals and signal processing, we proposed a novel method that integrates machine learning with musculoskeletal modelling techniques for the prediction of time-series joint angles, using only kinematic signals. Additionally, we hypothesised that a stacked long short-term memory (LSTM) neural network architecture can perform the task without relying on any ahead-of-motion features typically provided by electromyography signals. Optical cameras and inertial measurement unit (IMU) sensors were used to track level gait kinematics. Joint angles were modelled using the musculoskeletal model. The optimal LSTM architecture in fulfilling the prediction task was determined. Joint angle predictions were performed for joints on the sagittal plane, benefiting from joint angle modelling using signals from optical cameras and IMU sensors. Our proposed method predicted the upcoming joint angles in the prediction time of 10 ms, with an averaged root mean square error of 5.3° and a coefficient of determination of 0.81. Moreover, in support of our hypothesis, the recurrent stacked LSTM network demonstrated its ability to predict intended motion accurately and efficiently in gait, outperforming two other neural network architectures: a feedforward MLP and a hybrid LSTM-MLP. The method paves the way for the development of a cost-effective, single-modal control system for assistive devices in gait rehabilitation.
... The primary reason behind this is thought to be due to the lack of patient participation [23][24][25]. In order to resolve this issue, more recently, various wearable robots have been incorporated into the exercise regimen [26][27][28][29]. While hard exoskeletons were initially developed to assist patients with total loss of lower extremity function, they are now being utilized for more general RAGT purposes [30,31]. 2 of 10 Due to added inertia and the wearability and comfort issues of hard exoskeletons, soft-type exoskeletons comprising textiles and Bowden cables have also been developed to boost users' mobility [32][33][34][35][36]. ...
It is vital for rehabilitating patients to perform as many task-related exercises as possible. These patients often need either force or trajectory assistance in order to perform gait. While this can be provided in the form of traditional gait rehabilitation or currently emerging robot-assisted gait training, there is a need for an affordable means to assist gait training. In this study, we present a passive gait assistance device that is composed of a spring-bar system attached to an elastic cord and a specialized shoe. The shoe has two straps attached such that both plantar and dorsiflexion torque can be applied to the user depending on the angle of the pulling force. The merit of the devices is that it is an affordable means to provide the user with gait assistance while allowing some freedom of one’s foot movement. We show that, with 20 community-dwelling seniors, our system successfully produces plantar flexion and dorsiflexion torque according to the gait cycle. Furthermore, electromyography analysis suggests that plantar flexor demand during the late stance phase and dorsiflexor demand during the swing phase are significantly reduced.
... To date, gait training using wearable assistive robots has mainly been performed for patients that have suffered a stroke, a spinal cord injury, or an intractable neurological disease, (4)(5)(6) whereas more recent studies have been focused on the provision of walking support for elderly people and patients with locomotive syndrome. (7)(8)(9)(10) Exoskeletal robots for the elderly and locomotive syndrome patients assist their hip flexion and extension by providing assistive torque generated from DC motors attached to the hip joint parts via rigid exoskeletal frames. Therefore, the total weights of these systems are lower than those of previously developed exoskeleton robots. ...
... Further, metabolic cost reductions of 4-7% were found when assisting elderly individuals with a hip , Martini et al., 2019 or an ankle [Galle et al., 2017] exoskeleton. For a single subject with an incomplete spinal cord injury, a walking speed increase of 30% and a metabolic cost decrease of 9% [Xiloyannis et al., 2020] were demonstrated when using the Myosuit [Schmidt et al., 2017] on a sloped mountain path. ...
Exoskeletons are a potential solution to assist individuals with mobility needs. In this review we provide an overview
of the major exoskeleton-related developments at the Technical University of Darmstadt. In addition to two upper
limb exoskeletons that assist with load holding and carrying as well as drilling, we discuss exoskeleton developments
that assist the lower limb during walking. Some of these developments were performed in collaboration
with other national and international universities. To achieve the high-level target of mobility assistance, research
focused on hardware and control developments and an understanding of human motor control. Most developed
exoskeletons have used active designs that included motors for actuation. Stiff and soft (exosuits) materials have
been used for the user-machine interface and a variety of concepts and sensors have been used for exoskeleton
control. These developments have guided the exploration of solutions aimed at advancing the exoskeleton state of
the art. This work has also led to several students being qualified in the interdisciplinary field of human-machine
interaction.
... 1) Experimental setup: The participant was equipped with a 7.0 kg load made of fitness soft dumbbells on his left ankle, and wore an Active Pelvis Orthosis (APO). This is an exoskeleton conceived for assisting both hips in the sagittal plane and experimented on different user profiles such as healthy subjects [20], elderly people [21] and transfemoral amputees [22]. The first APO prototypes were developed within the CYBERLEGs research project [23], then the technology was licensed to IUVO S.r.l., a spin-off company of the same institution. ...
... Globally, several robot-assisted gait devices have been developed, and the research into rehabilitation robotics has increased. Pre-clinical studies with robotic hip exoskeletons have demonstrated improvements in gait and physical function, muscle effort, and cardiopulmonary metabolic efficiency in elderly individuals and individuals with stroke 16,[24][25][26][27]31,32,60 . A study using an exoskeletal Active Pelvis Orthosis (APO) 16 investigated its feasibility for cardiopulmonary gait training in the elderly and showed a decrease in Metabolic Cost of Transport (− 26.6 ± 16.1%) during treadmill walking after a 4-week APO-assisted training program, similar to our results. ...
... Pre-clinical studies with robotic hip exoskeletons have demonstrated improvements in gait and physical function, muscle effort, and cardiopulmonary metabolic efficiency in elderly individuals and individuals with stroke 16,[24][25][26][27]31,32,60 . A study using an exoskeletal Active Pelvis Orthosis (APO) 16 investigated its feasibility for cardiopulmonary gait training in the elderly and showed a decrease in Metabolic Cost of Transport (− 26.6 ± 16.1%) during treadmill walking after a 4-week APO-assisted training program, similar to our results. Our prior study with stroke subjects using an earlier version of the EX1 24 demonstrated improvement in spatiotemporal gait parameters and muscle efforts and decrease in net cardiopulmonary metabolic energy cost (− 14.71%) after the training intervention. ...
Wearable assistive robotics has emerged as a promising technology to supplement or replace motor functions and to retrain people recovering from an injury or living with reduced mobility. We developed delayed output feedback control for a wearable hip-assistive robot, the EX1, to provide gait assistance. Our purpose in this study was to investigate the effects of long-term exercise with EX1 on gait, physical function, and cardiopulmonary metabolic energy efficiency in elderly people. This study used parallel experimental (exercise with EX1) and control groups (exercise without EX1). A total of 60 community-dwelling elderly persons participated in 18 exercise intervention sessions during 6 weeks, and all participants were assessed at 5 time points: before exercise, after 9 exercise sessions, after 18 sessions, and 1 month and 3 months after the last session. The spatiotemporal gait parameters, kinematics, kinetics, and muscle strength of the trunk and lower extremities improved more after exercise with EX1 than in that without EX1. Furthermore, the effort of muscles over the trunk and lower extremities throughout the total gait cycle (100%) significantly decreased after exercise with EX1. The net metabolic energy costs during walking significantly improved, and functional assessment scores improved more in the experimental group than in the control group. Our findings provide evidence supporting the application of EX1 in physical activity and gait exercise is effective to improve age-related declines in gait, physical function, and cardiopulmonary metabolic efficiency among older adults.
... The torque curve will be transformed in each stage, which provides references for driving the exoskeleton. An active pelvis orthosis that uses hip kinematics such as maximum hip flexion/extension is developed to accurately estimate the gait phase based on predefined profiles [19]. ...
Lower limb exoskeleton has been proven to be effective in gait training and locomotion assistance. Specifically, control strategies of exoskeletons play the most important role in safe and effective interaction between the user, the exoskeleton, and the environment. In this paper, an analysis on the control strategies of hip exoskeletons and exosuits is performed. The controls are divided into three levels: high, medium, and low. The definition of high-level control as well as the corresponding control methods are listed and the principle of each is explained. Then, the mid-level control section is divided between detection and action layer and each control that belongs to one of the two categories is analyzed. The definition of low-level control and its control methods are then explained. At last, according to the results of various studies, the advantages and potential disadvantages of each method are put forward. The purpose of this paper is to provide reference and guidance for future researchers who hope to develop new controls or improve existing control strategies for hip exoskeletons and exosuits.
... Furthermore, gait exercise with a wearable hip exoskeleton improves cardiopulmonary function. In a previous study, gait training with an assisted-exoskeleton robot required less oxygen consumption than a home exercise program of self-paced overground walking without a robot at the same speed in the elderly [18]. ...
Demand for wearable devices and supportive technology is growing as these devices have the potential to enhance physical function and quality of life in users. The purpose of this study was to investigate usability and satisfaction after performing functional and gait exercise with a wearable hip exoskeleton in community-living adults. A total of 225 adults residing in the local community participated in this study. All participants performed 40 min of exercise once with a wearable hip exoskeleton in various environments. The EX1, which functions as a wearable hip exoskeleton, was used. Physical function was assessed before and after exercise with the EX1. After completing exercise with the EX1, the usability and satisfaction questionnaires were evaluated. Gait speed, timed up and go test (TUG), and four square step test (FSST) showed statistically significant improvements after exercise with the EX1 in both groups (p < 0.05). In the 6 min walking test (6MWT), a significant increase was observed in the middle-aged group (p < 0.05). In the short physical performance battery (SPPB), there was a significant improvement in the old-aged group (p < 0.05). On the other hand, positive results in usability and satisfaction were noticed in both groups. These results demonstrate that a single session of exercise with the EX1 was effective in improving physical performance of both middle- and old-aged adults, with positive feedback from most of the participants.
... The motorized hip exoskeleton's interface design optimization and its effect on metabolic cost has been studied, recently [48]. Studying the Active Pelvis Orthosis (APO) on elderly, oxygen (4.24 ± 2.57%) and metabolic (−26.6 ± 16.1%) consumption reduced post-training notably more than control group [49]. On patients with lower limb amputation, motorized hip exoskeleton could reduce 15.6 % of metabolic cost [50]. ...
Background: Gait disorders and as a consequence, robotic rehabilitation techniques are becoming increasingly prevalent as the population ages. In the area of rehabilitation robotics, using lightweight single hip joint exoskeletons are of significance. Considering no prior systematic review article on clinical outcomes, we aim to systematically review powered hip exoskeletons in terms of gait parameters and metabolic expenditure effects.
Methods: Three databases of PubMed, Scopus, and Web of science were searched for clinical articles comparing outcomes of gait rehabilitation using hip motorized exoskeleton with conventional methods, on patients with gait disorder or healthy individuals. Of total number of 37 reviewed articles, 14 trials were quantitatively analyzed. Analyses performed in terms of gait spatiotemporal parameters like speed (self-speed and maximum speed), step length, stride length, cadence, and oxygen consumption.
Results: Improved clinical outcomes of gait spatiotemporal parameters with hip joint exoskeletons are what our review's findings show. In terms of gait values, meta-analysis indicates that rehabilitation with single hip joint exoskeleton enhanced parameters of max speed (P = 0.018) and stride length (P = 0.01). Subgroup analysis showed that cadence improved among healthy elderly people (P = 0.050). For the remaining investigated gait parameters, no statistically significant difference was observed. Regarding metabolic parameters, oxygen consumption was lower in individuals treated with hip exoskeleton (P = 0.007).
Conclusion: Although the analysis demonstrated improvement with just specific gait measures utilizing powered hip exoskeletons, the lack of improvement in all parameters is likely caused by the high patient condition heterogeneity among the evaluated articles. We also noted in patients who rehabilitated with the hip exoskeleton, the oxygen cost was lower. More randomized controlled trials are needed to verify both the short- and long-term clinical outcomes, including patient-reported measures.
Level of evidence: Level I (systematic review and meta-analysis)
