Study on the Applicability of Digital Twins for Home Remote Motor Rehabilitation.

The COVID-19 pandemic created the need for telerehabilitation development, while Industry 4.0 brought the key technology. As motor therapy often requires the physical support of a patient's motion, combining robot-aided workouts with remote control is a promising solution. This may be realised with the use of the device's digital twin, so as to give it an immersive operation. This paper presents an extensive overview of this technology's applications within the fields of industry and health. It is followed by the in-depth analysis of needs in rehabilitation based on questionnaire research and bibliography review. As a result of these sections, the original concept of controlling a rehabilitation exoskeleton via its digital twin in the virtual reality is presented. The idea is assessed in terms of benefits and significant challenges regarding its application in real life. The presented aspects prove that it may be potentially used for manual remote kinesiotherapy, combined with the safety systems predicting potentially harmful situations. The concept is universally applicable to rehabilitation robots.

Exoskeletons and Exosuits Could Benefit from Mode-Switching Body Interfaces That Loosen/Tighten to Improve Thermal Comfort.

Exoskeletons and exosuits (exos) are wearable devices that physically assist movement. User comfort is critically important for societal adoption of exos. Thermal comfort (a person's satisfaction with their thermal environment) represents a key design challenge. Exos must physically attach/interface to the body to apply forces, and these interfaces inevitably trap some heat. It is envisioned that thermal comfort could be improved by designing mode-switching exo interfaces that temporarily loosen around a body segment when assistive forces are not being applied. To inform exo design, a case series study (N = 4) based on single-subject design principles was performed. Our objective was to assess individual responses to skin temperature and thermal comfort during physical activity with a Loose leg-sleeve interface compared with a Form-Fitting one, and immediately after a Form-Fitting sleeve switched to Loose. Skin under the Loose sleeve was 2-3 °C (4-6 °F) cooler after 25 min of physical activity, and two of four participants reported the Loose sleeve improved their thermal comfort. After completion of the physical activity, the Form-Fitting sleeve was loosened, causing a 2-4 °C (3-8 °F) drop in skin temperature underneath for all participants, and two participants to report slightly improved thermal comfort. These findings confirmed that an exo that can quickly loosen its interface when assistance is not required-and re-tighten when it is- has the potential to enhance thermal comfort for some individuals and environments. More broadly, this study demonstrates that mode-switching mechanisms in exos can do more than adjust physical assistance: they can also exploit thermodynamics and facilitate thermoregulation in a way that enhances comfort for exo users.

Evaluation of the HeroWear Apex back-assist exosuit during multiple brief tasks.

Trunk exoskeletons are wearable devices that support humans during physically demanding tasks by reducing biomechanical loads on the back. While most trunk exoskeletons are rigid devices, more lightweight soft exoskeletons (exosuits) have recently been developed. One such exosuit is the HeroWear Apex, which achieved promising results in the developers' own work but has not been independently evaluated. This paper thus presents an evaluation of the Apex with 20 adult participants during multiple brief tasks: standing up from a stool with a symmetric or asymmetric load, lifting a unilateral or bilateral load from the floor to waist level, lifting the same bilateral load with a 90-degree turn to the right, lowering a bilateral load from waist level to floor, and walking while carrying a bilateral load. The tasks were performed in an ABA-style protocol: first with exosuit assistance disengaged, then with it engaged, then disengaged again. Four measurement types were taken: electromyography (of the erector spinae, rectus abdominis, and middle trapezius), trunk kinematics, self-report ratings, and heart rate. The exosuit decreased the erector spinae electromyogram by about 15% during object lifting and lowering tasks; furthermore, participants found the exosuit mildly to moderately helpful. No adverse effects on other muscles or during non-lifting tasks were noted, and a decrease in middle trapezius electromyogram was observed for one task. This confirms that the HeroWear Apex could reduce muscle demand and fatigue. The results may transfer to other exoskeletons with similar design principles, and may inform researchers working with other wearable devices.

Design, Development, and Testing of an Intelligent Wearable Robotic Exoskeleton Prototype for Upper Limb Rehabilitation.

Neuromotor rehabilitation and recovery of upper limb functions are essential to improve the life quality of patients who have suffered injuries or have pathological sequels, where it is desirable to enhance the development of activities of daily living (ADLs). Modern approaches such as robotic-assisted rehabilitation provide decisive factors for effective motor recovery, such as objective assessment of the progress of the patient and the potential for the implementation of personalized training plans. This paper focuses on the design, development, and preliminary testing of a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms that are fully embedded in the device. The proposed exoskeleton is a 1-DoF system that allows flexion-extension at the elbow joint, where the chosen materials render it compact. Different operation modes are supported by a hierarchical control strategy, allowing operation in autonomous mode, remote control mode, or in a leader-follower mode. Laboratory tests validate the proper operation of the integrated technologies, highlighting a low latency and reasonable accuracy. The experimental result shows that the device can be suitable for use in providing support for diagnostic and rehabilitation processes of neuromotor functions, although optimizations and rigorous clinical validation are required beforehand.