A Review of In Vitro and In Silico Swallowing Simulators: Design and Applications.

Swallowing is a primary and complex behaviour that transports food and drink from the oral cavity, through the pharynx and oesophagus, into the stomach at an appropriate rate and speed. To understand this sophisticated behaviour, a tremendous amount of research has been carried out by utilising the in vivo approach, which is often challenging to perform, poses a risk to the subjects if interventions are undertaken and are seldom able to control for confounding factors. In contrast, in silico (computational) and in vitro (instrumental) methods offer an alternate insight into the process of the human swallowing system. However, the appropriateness of the design and application of these methods have not been formally evaluated. The purpose of this review is to investigate and evaluate the state of the art of in vitro and in silico swallowing simulators, focusing on the evaluation of their mechanical or computational designs in comparison to the corresponding swallowing mechanisms during various phases of swallowing (oral phase, pharyngeal phase and esophageal phase). Additionally, the potential of the simulators is also discussed in various areas of applications, including the study of swallowing impairments, swallowing medications, food process design and dysphagia management. We also address current limitations and recommendations for the future development of existing simulators.

Biomimetic Closed-Loop Control of a Novel Soft Gastric Simulator Toward Emulating Antral Contraction Waves.

Soft gastric simulators are in vitro biomimetic modules that can reproduce the antral contraction waves (ACWs). Along with providing information concerning stomach contents, stomach simulators enable experts to evaluate the digestion process of foods and drugs. Traditionally, open-loop control approaches were implemented on stomach simulators to produce ACWs. Constructing a closed-loop control system is essential to improve the simulator's ability to imitate ACWs in additional scenarios and avoid constant tuning. Closed-loop control can enhance stomach simulators in accuracy, responding to various food and drug contents, timing, and unknown disturbances. In this article, a new generation of anatomically realistic soft pneumatic gastric simulators is designed and fabricated. The presented simulator represents the antrum, the lower portion of the stomach where ACWs occur. It is equipped with a real-time feedback system to implement diverse closed-loop controllers on demand. All the details of the physical design, fabrication, and assembly process are discussed. Also, the measures taken for the mechatronics design and sensory system are highlighted in this article. Through several implementation algorithms and techniques, three closed-loop controllers, including model-based and model-free schemes are designed and successfully applied on the presented simulator to imitate ACWs. All the experimental outcomes are carefully analyzed and compared against the biological counterparts. It is demonstrated that the presented simulator can serve as a reliable tool and method to scrutinize digestion and promote novel technologies around the human stomach and the digestion process. This research methodology can also be utilized to develop other biomimetic and bioinspired applications.

Finite-Time Contraction Control of a Ring-Shaped Soft Pneumatic Actuator Mimicking Gastric Pathologic Motility Conditions.

Soft gastric simulators are the latest gastric models designed to imitate gastrointestinal (GI) functions in actual physiological conditions. They are used in in vitro tests for examining the drug and food behaviors in the GI tract. As the main motility function of the GI tract, the peristalsis can be altered in some gastric disorders, for example, by being delayed or accelerated. To simulate the stomach motility, a GI simulator must achieve a prescribed healthy or pathological peristalsis. This requires the simulator to be controlled in a closed loop. Unlike conventional controllers that stabilize a controlled plant asymptotically, a finite-time controller regulates state variables to their equilibrium points in a predetermined time interval. This article presents the design and implementation of a finite-time, model-based state feedback controller (based on the differential Riccati equation) on a soft robotic gastric simulator's actuators for the first time. We propose a mass-spring-damper model of a ring-shaped soft pneumatic actuator (RiSPA). RiSPA is a bellows-driven, elastomer-based actuator developed to reproduce motility functions of the lower part of the stomach (pyloric antrum). The proposed model is augmented by a new approach for modeling the soft tissues, where the moments of inertia of the system constituents are considered as time-varying functions. The finite-time controller is successfully applied on the RiSPA in numerical simulation and experimental implementation, and the results were thoroughly analyzed and discussed. Its accuracy and the ability to control in a predetermined time are highlighted in the tracking of peristalsis trajectory and contractive regulations.

SoRSS: A Soft Robot for Bio-Mimicking Stomach Anatomy and Motility.

A human stomach is an organ in the digestive system that breaks down foods by physiological digestion, including mechanical and chemical functions. The mechanical function is controlled by peristaltic waves generated over the stomach body, known as antral contraction waves (ACW). The stomach's physiological digestion is essential to sustain nutrition and health in humans. Replicating the digestion process in a robot provides a test environment as an alternative solution to in vivo testing, which is difficult in practice. Stomach robots made of rigid rods and metal cylinders are unrealistic replicas to contract and expand like biological examples. With soft robotics technology, it is possible to translate biological behavior into an engineering context. Soft robotics introduce potential methods to replicate peristaltic waves and achieve a soft-bodied stomach simulator. This work presents a soft robotic stomach simulator's (SoRSS) concept, design, and experimental validation. A pneumatic bellows actuation for linear elongation and a ring of bellows actuation for circular contraction are proposed first. Multi-ring actuators are then arranged to form an SoRSS that generates ACW and antral contracting pressure (ACP). The SoRSS satisfies the specification of human stomach anatomy and motility and finally undergoes experimental validation using videofluoroscopy with the outcomes presenting the ACW, ACP, and the digestion phases during the actuation process. Those are compared with other medical studies to validate SoRSS functionality.

A Biologically Inspired Ring-Shaped Soft Pneumatic Actuator for Large Deformations.

Biomimicry of the stomach's peristaltic contractions can be challenging in the design, modeling, and control of a soft actuator. The mimicking of organ contractions advances our knowledge of the digestive system and analyzes the biological behavior by testing with a physical robot. This article proposes a ring-shaped soft pneumatic actuator (RiSPA) as a segment of the digestive tract. RiSPA is made of a ring frame with embedded bellow actuators that generate contractive motions. An embedded sensory system measures the contraction using range sensors. The kinematics and dynamics of RiSPA's contraction are modeled and simulated, while a state feedback algorithm is applied to them. The simulation results are validated experimentally by comparing the RiSPA measurements with desired applied signals. The proposed actuator provides controllable symmetrical and asymmetrical contractions analog to the human stomach. The results of RiSPA validate the prediction performance of the simulation and controller with applied sinusoidal signals as a peristaltic wave. RiSPA contractions can be applied to a broad range of applications, such as imitating the esophagus and intestine contractions.

SoGut: A Soft Robotic Gastric Simulator.

The human stomach breaks down and transports food by coordinated radial contractions of the gastric walls. The radial contractions periodically propagate through the stomach and constitute the peristaltic contractions, also called the gastric motility. The force, amplitude, and frequency of peristaltic contractions are relevant to massaging and transporting the food contents in the gastric lumen. However, existing gastric simulators have not faithfully replicated gastric motility. Herein, we report a soft robotic gastric simulator (SoGut) that emulates peristaltic contractions in an anatomically realistic way. SoGut incorporates an array of circular air chambers that generate radial contractions. The design and fabrication of SoGut leverages principles from the soft robotics field, which features compliance and adaptability. We studied the force and amplitude of the contractions when the lumen of SoGut was empty or filled with contents of different viscosity. We examined the contracting force using manometry. SoGut exhibited a similar range of contracting force as the human stomach reported in the literature. Besides, we investigated the amplitude of the contractions through videofluoroscopy where the contraction ratio was derived. The contraction ratio as a function of inflation pressure is found to match the observations of in vivo situations. We demonstrated that SoGut can achieve in vitro peristaltic contractions by coordinating the inflation sequence of multiple air chambers. It exhibited the functions to massage and transport the food contents. SoGut can simulate the physiological motions of the human stomach to advance research of digestion.

Experimental Investigation into the Dynamics of a Radially Contracting Actuator with Embedded Sensing Capability.

Dynamics, control, and sensing are still challenges for pneumatically actuated soft actuators. We consider feasible solutions based on a radially contracting actuator to overcome these challenges. The radially contracting actuator was inspired by the movement of the stomach wall. It was capable of achieving radial contraction by inflating its circular air chamber. A quasi-static model that relates the pressure with the deformed wall of the air chamber was proposed and validated. In this article, we conduct a thorough experimental investigation into the contracting dynamics of the actuator with embedded sensing capability. We analyze the kinematics of the actuator at its rest and pressurization states focusing on the midpoint of the deformed wall. The actuator dynamics is characterized under the square wave pressure input by two variables that are the pressure in the air chamber and the trajectories of the midpoint. To achieve the desired contraction, we construct a feed-forward control based on the quasi-static model. It proves that the actuator is capable of tracking a prescribed triangular wave displacement of the midpoint with small deviations. A custom-made soft sensor is integrated into the actuator, which brings in the embedded sensing capability without affecting the actuator compliance. The resistance changes of the sensor versus the controlled contraction are examined, which are used to indicate the amount of radial contraction. The experimental investigation provides a foundation for the closed-loop control and practical applications of the radially contracting actuator developed.

A Soft Ring-Shaped Actuator for Radial Contracting Deformation: Design and Modeling.

Bioinspired movements such as elongation/shortening and bending are extensively studied in the field of soft robotics. However, radial contracting deformation has been overlooked, another typical deformation in nature, such as the constrictive deformation in the human esophagus and bladder. We present a novel soft ring-shaped actuator that generates radial contraction and examine its quasi-static performance under pressurization. This actuator consists of a soft ring-shaped body and a rigid casing. A single circular air chamber embedded concentrically inside the actuator is created through the lost-wax method. A theoretical model of the quasi-static state of the actuator's contracting deformation was formulated in light of the minimum total potential energy principle. Meanwhile, a finite-element method (FEM) model was constructed to stimulate the radial contraction of the actuator. In addition, experiments were conducted to identify the maximum input pressure and measure the deformations at the specific input pressure. When the actuators were pressurized under 20.0 kPa, axisymmetric contractions were achieved. The theoretical model and FEM models produced the predictions in good agreement with experimental results, with slight mean relative differences regarding peak points, 3.4% and 5.4%, respectively. In addition, pilot tests suggest that the ring-shaped actuator can achieve the key tasks of robotic manipulators, such as gripping and holding.