Opportunities and Challenges in the Development of Exoskeletons for Locomotor Assistance

Overview

Journal Nat Biomed Eng

Publisher Springer Nature

Specialty Biomedical Engineering

Date 2022 Dec 22

PMID 36550303

Authors

Christopher Siviy

Lauren M Baker

Brendan T Quinlivan

Franchino Porciuncula

Krithika Swaminathan

Louis N Awad

Conor J Walsh

Affiliations

Soon will be listed here.

Abstract

Exoskeletons can augment the performance of unimpaired users and restore movement in individuals with gait impairments. Knowledge of how users interact with wearable devices and of the physiology of locomotion have informed the design of rigid and soft exoskeletons that can specifically target a single joint or a single activity. In this Review, we highlight the main advances of the past two decades in exoskeleton technology and in the development of lower-extremity exoskeletons for locomotor assistance, discuss research needs for such wearable robots and the clinical requirements for exoskeleton-assisted gait rehabilitation, and outline the main clinical challenges and opportunities for exoskeleton technology.

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References

Sen-Gupta E, Wright D, Caccese J, Wright Jr J, Jortberg E, Bhatkar V . A Pivotal Study to Validate the Performance of a Novel Wearable Sensor and System for Biometric Monitoring in Clinical and Remote Environments. Digit Biomark. 2020; 3(1):1-13. PMC: 7015390. DOI: 10.1159/000493642. View

Winstein C, Stein J, Arena R, Bates B, Cherney L, Cramer S . Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016; 47(6):e98-e169. DOI: 10.1161/STR.0000000000000098. View

Zhang J, Fiers P, Witte K, Jackson R, Poggensee K, Atkeson C . Human-in-the-loop optimization of exoskeleton assistance during walking. Science. 2017; 356(6344):1280-1284. DOI: 10.1126/science.aal5054. View

Quinlivan B, Lee S, Malcolm P, Rossi D, Grimmer M, Siviy C . Assistance magnitude versus metabolic cost reductions for a tethered multiarticular soft exosuit. Sci Robot. 2020; 2(2). DOI: 10.1126/scirobotics.aah4416. View

Stein J, Bishop L, Stein D, Wong C . Gait training with a robotic leg brace after stroke: a randomized controlled pilot study. Am J Phys Med Rehabil. 2014; 93(11):987-94. DOI: 10.1097/PHM.0000000000000119. View

Panizzolo F, Bolgiani C, Di Liddo L, Annese E, Marcolin G . Reducing the energy cost of walking in older adults using a passive hip flexion device. J Neuroeng Rehabil. 2019; 16(1):117. PMC: 6794907. DOI: 10.1186/s12984-019-0599-4. View

Lee S, Kim J, Baker L, Long A, Karavas N, Menard N . Autonomous multi-joint soft exosuit with augmentation-power-based control parameter tuning reduces energy cost of loaded walking. J Neuroeng Rehabil. 2018; 15(1):66. PMC: 6044002. DOI: 10.1186/s12984-018-0410-y. View

Dobkin B, Duncan P . Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate?. Neurorehabil Neural Repair. 2012; 26(4):308-17. PMC: 4099044. DOI: 10.1177/1545968312439687. View

Grimmer M, Quinlivan B, Lee S, Malcolm P, Rossi D, Siviy C . Comparison of the human-exosuit interaction using ankle moment and ankle positive power inspired walking assistance. J Biomech. 2018; 83:76-84. PMC: 6375290. DOI: 10.1016/j.jbiomech.2018.11.023. View

10.

Lee S, Lee H, Chang W, Choi B, Lee J, Kim J . Gait performance and foot pressure distribution during wearable robot-assisted gait in elderly adults. J Neuroeng Rehabil. 2017; 14(1):123. PMC: 5706419. DOI: 10.1186/s12984-017-0333-z. View

11.

Haufe F, Kober A, Schmidt K, Sancho-Puchades A, Duarte J, Wolf P . User-driven walking assistance: first experimental results using the MyoSuit. IEEE Int Conf Rehabil Robot. 2019; 2019:944-949. DOI: 10.1109/ICORR.2019.8779375. View

12.

Mooney L, Herr H . Biomechanical walking mechanisms underlying the metabolic reduction caused by an autonomous exoskeleton. J Neuroeng Rehabil. 2016; 13:4. PMC: 4730720. DOI: 10.1186/s12984-016-0111-3. View

13.

Ferris D, Gordon K, Sawicki G, Peethambaran A . An improved powered ankle-foot orthosis using proportional myoelectric control. Gait Posture. 2005; 23(4):425-8. DOI: 10.1016/j.gaitpost.2005.05.004. View

14.

Ray T, Choi J, Bandodkar A, Krishnan S, Gutruf P, Tian L . Bio-Integrated Wearable Systems: A Comprehensive Review. Chem Rev. 2019; 119(8):5461-5533. DOI: 10.1021/acs.chemrev.8b00573. View

15.

Esquenazi A, Talaty M, Packel A, Saulino M . The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. 2012; 91(11):911-21. DOI: 10.1097/PHM.0b013e318269d9a3. View

16.

Medrano R, Thomas G, Rouse E . Can humans perceive the metabolic benefit provided by augmentative exoskeletons?. J Neuroeng Rehabil. 2022; 19(1):26. PMC: 8881941. DOI: 10.1186/s12984-022-01002-w. View

17.

Farris D, Hicks J, Delp S, Sawicki G . Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping. J Exp Biol. 2014; 217(Pt 22):4018-28. PMC: 4229366. DOI: 10.1242/jeb.107656. View

18.

Reisman D, Wityk R, Silver K, Bastian A . Locomotor adaptation on a split-belt treadmill can improve walking symmetry post-stroke. Brain. 2007; 130(Pt 7):1861-72. PMC: 2977955. DOI: 10.1093/brain/awm035. View

19.

Ding Y, Panizzolo F, Siviy C, Malcolm P, Galiana I, Holt K . Effect of timing of hip extension assistance during loaded walking with a soft exosuit. J Neuroeng Rehabil. 2016; 13(1):87. PMC: 5048481. DOI: 10.1186/s12984-016-0196-8. View

20.

Seel T, Raisch J, Schauer T . IMU-based joint angle measurement for gait analysis. Sensors (Basel). 2014; 14(4):6891-909. PMC: 4029684. DOI: 10.3390/s140406891. View