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Proportional myoelectric controller (PMC) has been one of the most common assistance strategies for robotic exoskeletons due to its ability to modulate assistance level directly based on the user's muscle activation. However, existing PMC strategies (static or user-adaptive) scale torque linearly with muscle activation level and fail to address complex and non-linear mapping between muscle activation and joint torque. Furthermore, previously presented adaptive PMC strategies do not allow for environmental changes (such as changes in ground slopes) and modulate the system's assistance level over many steps. In this work, we designed a novel user- and environment-adaptive PMC for a knee exoskeleton that modulates the peak assistance level based on the slope level during locomotion. We recruited nine able-bodied adults to test and compare the effects of three different PMC strategies (static, user-adaptive, and user- and environment-adaptive) on the user's metabolic cost and the knee extensor muscle activation level during load-carriage walking (6.8 kg) in three inclination settings (0°, 4.5°, and 8.5°). The results showed that only the user- and environment-adaptive PMC was effective in significantly reducing user's metabolic cost (5.8% reduction) and the knee extensor muscle activation (19% reduction) during 8.5° incline walking compared to the unpowered condition while other PMCs did not have as large of an effect. This control framework highlights the viability of implementing an assistance paradigm that can dynamically adjust to the user's biological demand, allowing for a more personalized assistance paradigm. 

Tibiofemoral compression forces present during locomotion can result in high stress and risk damage to the knee. Powered assistance using a knee exoskeleton may reduce the knee load by reducing the work required by the muscles. However, the exact effect of assistance on the tibiofemoral force is unknown. The goal of this study was to investigate the effect of knee extension assistance during the early stance phase on the tibiofemoral force. Nine able-bodied adults walked on an inclined treadmill with a bilateral knee exoskeleton with assistance and with no assistance. Using an EMG-informed neuromusculoskeletal model, muscle forces were estimated, then utilized to estimate the tibiofemoral contact force. Results showed a 28% reduction in the knee moment, which resulted in approximately a 15% decrease in knee extensor muscle activation and a 20% reduction in subsequent muscle force, leading to a significant 10% reduction in peak and 9% reduction in average tibiofemoral contact force during the early stance phase (p < 0.05). The results indicate the tibiofemoral force is highly dependent on the knee kinetics and quadricep muscle activation due to their influence on knee extensor muscle forces, the primary contributor to the knee load.