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1. Design of a Hybrid SMA-Pneumatic based Wearable Upper Limb Exoskeleton

   Alireza Golgouneh, Eric Beaudette ( September 2021 , International Symposium on Wearable Computers Design Exhibition)

   null (Ed.)

   Upper limb mobility impairments affect individuals at all life stages. Exoskeletons can assist in rehabilitation as well as performing Activities of Daily Living (ADL). Most commercial assistive devices still rely on rigid robotics with constrained biomechanical degrees of freedom that may even increase user exertion. Therefore, this paper discusses the iterative design and development of a novel hybrid pneumatic actuation and Shape Memory Alloy (SMA) based wearable soft exoskeleton to assist in shoulder abduction and horizontal flexion/extension movements, with integrated soft strain sensing to track shoulder joint motion. The garment development was done in two stages which involved creating (1) SMA actuators integrated with soft sensing, and (2) integrating pneumatic actuation. The final soft exoskeleton design was developed based on the insights gained from two prior prototypes in terms of wearability, usability, comfort, and functional specifications (i.e., placement and number) of the sensors and actuators. The final exoskeleton is a modular, multilayer garment which uses a hybrid and customizable actuation strategy (SMA and inflatable pneumatic bladder). 

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2. Restoring arm function with a soft robotic wearable for individuals with amyotrophic lateral sclerosis

   https://doi.org/10.1126/scitranslmed.add1504  

   Proietti, Tommaso ; O’Neill, Ciaran ; Gerez, Lucas ; Cole, Tazzy ; Mendelowitz, Sarah ; Nuckols, Kristin ; Hohimer, Cameron ; Lin, David ; Paganoni, Sabrina ; Walsh, Conor ( February 2023 , Science Translational Medicine)

   Despite promising results in the rehabilitation field, it remains unclear whether upper limb robotic wearables, e.g., for people with physical impairments resulting from neurodegenerative disease, can be made portable and suitable for everyday use. We present a lightweight, fully portable, textile-based, soft inflatable wearable robot for shoulder elevation assistance that provides dynamic active support to the upper limbs. The technology is mechanically transparent when unpowered, can quantitatively assess free movement of the user, and adds only 150 grams of weight to each upper limb. In 10 individuals with amyotrophic lateral sclerosis (ALS) with different degrees of neuromuscular impairment, we demonstrated immediate improvement in the active range of motion and compensation for continuing physical deterioration in two individuals with ALS over 6 months. Along with improvements in movement, we show that this robotic wearable can improve functional activity without any training, restoring performance of basic activities of daily living. In addition, a reduction in shoulder muscle activity and perceived muscular exertion, coupled with increased endurance for holding objects, highlight the potential of this device to mitigate the impact of muscular fatigue for patients with ALS. These results represent a further step toward everyday use of assistive, soft, robotic wearables for the upper limbs.

    

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3. Assessments and Evaluation Methods for Upper Limb Exoskeleton - a Literature Survey

   https://doi.org/10.1115/DETC2022-88968  

   Lee, Seunghun ; Xiang, Yujiang ; Xia, Ting ; Yang, James ( August 2022 , ASME 2022 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference)

   Exoskeleton technology has gained great interests in several fields including robotics, medicine, rehabilitation, ergonomics, and military. Especially, upper-limb exoskeletons are developed aiming to increase worker’s physical ability such as stability, force and power production and reduce biomechanical loads, working fatigue, which relieves overexertion risk. Extensive research has been conducted to assess existing and newly proposed exoskeletons, but they still have trade-off and user convenience issues to resolve. Therefore, the primary purpose of this paper is to review classification of the upper-limb exoskeletons and functional assessment, particularly regarding the complex interactions between human and exoskeleton. Secondly the paper is to provide insight in issues associated with the upper-limb exoskeletons. Finally, discussion on future directions for upper limb exoskeleton development and assessment is presented. 

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4. Navigating the FDA Medical Device Regulatory Pathways for Pediatric Lower Limb Exoskeleton Devices

   https://doi.org/10.1109/JSYST.2020.3025111  

   Eguren, David ; Contreras-Vidal, Jose Luis ( October 2020 , IEEE Systems Journal)

   null (Ed.)

   There have been significant advances in the technologies for robot-assisted lower-limb rehabilitation in the last decade. However, the development of similar systems for children has been slow despite the fact that children with conditions such as cerebral palsy (CP), spina bifida (SB) and spinal cord injury (SCI) can benefit greatly from these technologies. Robotic assisted gait therapy (RAGT) has emerged as a way to increase gait training duration and intensity while decreasing the risk of injury to therapists. Robotic walking devices can be coupled with motion sensing, electromyography (EMG), scalp electroencephalography (EEG) or other noninvasive methods of acquiring information about the user’s intent to design Brain-Computer Interfaces (BCI) for neuromuscular rehabilitation and control of powered exoskeletons. For users with SCI, BCIs could provide a method of overground mobility closer to the natural process of the brain controlling the body’s movement during walking than mobility by wheelchair. For adults there are currently four FDA approved lower-limb exoskeletons that could be incorporated into such a BCI system, but there are no similar devices specifically designed for children, who present additional physical, neurological and cognitive developmental challenges. The current state of the art for pediatric RAGT relies on large clinical devices with high costs that limit accessibility. This can reduce the amount of therapy a child receives and slow rehabilitation progress. In many cases, lack of gait training can result in a reduction in the mobility, independence and overall quality of life for children with lower-limb disabilities. Thus, it is imperative to facilitate and accelerate the development of pediatric technologies for gait rehabilitation, including their regulatory path. In this paper an overview of the U.S. Food and Drug Administration (FDA) clearance/approval process is presented. An example device has been used to navigate important questions facing device developers focused on providing lower limb rehabilitation to children in home-based or other settings beyond the clinic. 

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5. FES Cycling and Closed-Loop Feedback Control for Rehabilitative Human–Robot Interaction

   https://doi.org/10.3390/robotics10020061  

   Cousin, Christian ; Duenas, Victor ; Dixon, Warren ( June 2021 , Robotics)

   null (Ed.)

   For individuals with movement impairments due to neurological injuries, rehabilitative therapies such as functional electrical stimulation (FES) and rehabilitation robots hold vast potential to improve their mobility and activities of daily living. Combining FES with rehabilitation robots results in intimately coordinated human–robot interaction. An example of such interaction is FES cycling, where motorized assistance can provide high-intensity and repetitive practice of coordinated limb motion, resulting in physiological and functional benefits. In this paper, the development of multiple FES cycling testbeds and safeguards is described, along with the switched nonlinear dynamics of the cycle–rider system. Closed-loop FES cycling control designs are described for cadence and torque tracking. For each tracking objective, the authors’ past work on robust and adaptive controllers used to compute muscle stimulation and motor current inputs is presented and discussed. Experimental results involving both able-bodied individuals and participants with neurological injuries are provided for each combination of controller and tracking objective. Trade-offs for the control algorithms are discussed based on the requirements for implementation, desired rehabilitation outcomes and resulting rider performance. Lastly, future works and the applicability of the developed methods to additional technologies including teleoperated robotics are outlined. 

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