Integrating Exosuit Capabilities into Clothing to Make Back Relief Accessible to Workers Unserved by Existing Exoskeletons: Design and Preliminary Evaluation.

OCCUPATIONAL APPLICATIONSWe developed a method for integrating back-assist exosuit capabilities into regular clothing to make musculoskeletal relief accessible to more workers. We demonstrated proof-of-concept that this uniform-integrated exosuit can be effective and usable. Existing occupational exosuits are standalone accessories worn on top of a user's clothing and are not suitable for all workers. Our newly developed sub-class of exosuit could be beneficial to workers who alternate between bending, lifting, and sitting tasks, or to those in customer- or patient-facing jobs where it is important for wearable technology to be discreet.

Background Occupational exos (comprising both rigid exoskeletons and soft exosuits) are emerging technologies designed to reduce the risk of work-related musculoskeletal disorders. Existing occupational exos are standalone accessories worn on top of a user's clothing.Purpose Our objective was to determine whether back-assist exosuit capabilities could be integrated into regular clothing in an effective and usable manner, which could make musculoskeletal relief accessible to more workers.Methods We redesigned an accessory exosuit so it could integrate into a standard-issue U.S. Army uniform. The uniform-integrated exosuit prototype was low-profile (protruding <30 mm from the body), lightweight (adding 800 grams to the uniform), and could be donned/doffed like normal clothing. We demonstrated the effectiveness and usability of the prototype in lab testing (N = 5) and in a case study (N = 1) with a U.S. Army Soldier.Results In lab testing, the exosuit provided 18-27 Nm of torque about the low back during lifting. Assistance could be engaged or disengaged one-handed in about half a second, and the exosuit did not restrict a user's natural range of motion or cause discomfort. The case study Soldier who performed operationally relevant tasks reported that he was satisfied with the weight, comfort, range of motion, and lifting assistance of the prototype.Conclusions This work demonstrated proof-of-concept that integrating back-assist exosuit capabilities into standard workwear can be effective and usable. We added lifting assistance with little change to the form factor, weight, range of motion, or comfort of the standard uniform. This new sub-class of exosuit could be beneficial to workers who alternate between bending, lifting, and sitting (e.g., driving) tasks, or to those in customer- or patient-facing jobs where it is important for wearable technology to be discreet.

Unilateral transtibial prosthesis users load their intact limb more than their prosthetic limb during sit-to-stand, squatting, and lifting.

BACKGROUND: Lower limb prosthesis users exhibit high rates of joint pain and disease, such as osteoarthritis, in their intact limb. Overloading of their intact limb during daily activities may be a contributing factor. Limb loading biomechanics have been extensively studied during walking, but fewer investigations into limb loading during other functional movements exist. The purpose of this study was to characterize the lower limb loading of transtibial prosthesis users during three common daily tasks: sit-to-stand, squatting, and lifting. METHODS: Eight unilateral transtibial prosthesis users performed sit-to-stand (from three chair heights), squatting, and lifting a 10 kg box. Peak vertical ground reaction forces and peak knee flexion moments were computed for each limb (intact and prosthetic) to characterize limb loading and asymmetry. Ranges of motion of the intact and prosthetic ankles were also quantified. FINDINGS: Users had greater peak ground reaction forces and knee flexion moments in their intact limb for all tasks (p < 0.02). On average, the intact limb had 36-48% greater peak ground reaction forces and 168-343% greater peak knee flexion moments compared to the prosthetic limb. The prosthetic ankle provided <10° of ankle range of motion for all tasks, less than half the range of motion provided by the intact ankle. INTERPRETATION: Prosthesis users overloaded their intact limb during all tasks. This asymmetric loading may lead to an accumulation of damage to the intact limb joints, such as the knee, and may contribute to the development of osteoarthritis. Prosthetic design and rehabilitation interventions that promote more symmetric loading should be investigated for these tasks.

Data-Driven Dynamic Motion Planning for Practical FES-Controlled Reaching Motions in Spinal Cord Injury.

Functional electrical stimulation (FES) is a promising technology for restoring reaching motions to individuals with upper-limb paralysis caused by a spinal cord injury (SCI). However, the limited muscle capabilities of an individual with SCI have made achieving FES-driven reaching difficult. We developed a novel trajectory optimization method that used experimentally measured muscle capability data to find feasible reaching trajectories. In a simulation based on a real-life individual with SCI, we compared our method to attempting to follow naive direct-to-target paths. We tested our trajectory planner with three control structures that are commonly used in applied FES: feedback, feedforward-feedback, and model predictive control. Overall, trajectory optimization improved the ability to reach targets and improved the accuracy for the feedforward-feedback and model predictive controllers ( ). The trajectory optimization method should be practically implemented to improve the FES-driven reaching performance.

Combining an Artificial Gastrocnemius and Powered Ankle Prosthesis: Effects on Transtibial Prosthesis User Gait.

Walking is more difficult for transtibial prosthesis users, partly due to a lack of calf muscle function. Powered ankle prostheses can partially restore calf muscle function, specifically push-off power from the soleus. But one limitation of a powered ankle is that emulating the soleus does not restore the multi-articular function of the gastrocnemius. This missing function may explain elevated hip and knee muscle demands observed in individuals walking on powered ankles. These elevated demands can make walking more fatiguing and impact mobility. Adding an Artificial Gastrocnemius to a powered ankle might improve gait for prosthesis users by reducing the prosthesis-side hip and knee demands. This work investigates if an Artificial Gastrocnemius reduced prosthesis-side hip or knee demands for individuals walking with a powered ankle providing high levels of push-off. We performed two case series studies that examined the effects that a passive elastic Artificial Gastrocnemius has on joint moment-impulses when prosthesis users walked with a powered ankle. We found that hip moment-impulse was reduced during stance when walking with an Artificial Gastrocnemius for six of seven participants. The Artificial Gastrocnemius effects on knee kinetics were variable and subject-specific, but in general, it did not reduce the knee flexor or extensor demands. The Artificial Gastrocnemius should be further explored to determine if reduced hip demands improve mobility or the user's quality of life by increasing the distance they can walk, increasing walking economy, or leading to increased physical activity or community engagement.

Predicting functional force production capabilities of upper extremity functional electrical stimulation neuroprostheses: a proof of concept study.

OBJECTIVE: This study's goal was to demonstrate person-specific predictions of the force production capabilities of a paralyzed arm when actuated with a functional electrical stimulation (FES) neuroprosthesis. These predictions allow us to determine, for each hand position in a person's workspace, if FES activated muscles can produce enough force to hold the arm against gravity and other passive forces, the amount of force the arm can potentially exert on external objects, and in which directions FES can move the arm. APPROACH: We computed force production predictions for a person with high tetraplegia and an FES neuroprosthesis used to activate muscles in her shoulder and arm. We developed Gaussian process regression models of the force produced at the end of the forearm when stimulating individual muscles at different wrist positions in the person's workspace. For any given wrist position, we predicted all possible forces a person can produce by any combination of individual muscles. Based on the force predictions, we determined if FES could produce force sufficient to overcome passive forces to hold a wrist position, the maximum force FES could produce in all directions, and the set of directions in which FES could move the arm. To estimate the error in our predictions, we then compared our force predictions based on single-muscle models to the actual forces produced when stimulating combinations of the person's muscles. MAIN RESULTS: Our models classified the person's ability to hold static arm positions correctly for 83% (Session #1) and 69% (Session #2) for 39 wrist positions over two sessions. We predicted this person's ability to produce force at the end of her arm with an RMS error of 5.5 N and the percent of directions for which FES could achieve motion with RMS error of 10%. The accuracy of these predictions is similar to that found in the literature for FES systems with fewer degrees of freedom and fewer muscles. SIGNIFICANCE: These person and device-specific predictions of functional capabilities of the arm allow neuroprosthesis developers to set achievable functional objectives for the systems they develop. These predictions can potentially serve as a screening tool for clinicians to use in planning neuroprosthetic interventions, greatly reducing the risk and uncertainty in such interventions.

Developing a Quasi-Static Controller for a Paralyzed Human Arm: A Simulation Study.

Individuals with paralyzed limbs due to spinal cord injuries lack the ability to perform the reaching motions necessary to every day life. Functional electrical stimulation (FES) is a promising technology for restoring reaching movements to these individuals by reanimating their paralyzed muscles. We have proposed using a quasi-static model-based control strategy to achieve reaching controlled by FES. This method uses a series of static positions to connect the starting wrist position to the goal. As a first step to implementing this controller, we have completed a simulated study using a MATLAB based dynamic model of the arm in order to determine the suitable parameters for the quasi-static controller. The selected distance between static positions in the path was 6 cm, and the amount of time between switching target positions was 1.3 s. The final controller can complete reaches of over 30 cm with a median accuracy of 6.8 cm.

Holding Static Arm Configurations With Functional Electrical Stimulation: A Case Study.

Functional electrical stimulation (FES) is a promising solution for restoring functional motion to individuals with paralysis, but the potential for achieving any desired full-arm reaching motion has not been realized. We present a combined feedforward-feedback controller capable of automatically calculating and applying the necessary muscle stimulations to hold the wrist of an individual with high tetraplegia in a desired static position. We used the controller to hold a complete arm configuration to maintain a series of static wrist positions. The average distance to the target wrist position, or accuracy, was 2.9 cm. The precision is defined as the radius of the 95% confidence ellipsoid for the final positions of a set of trials with the same muscle stimulations and starting position. The average precision was 3.7 cm. The control architecture used in this study to hold static positions has the potential to control arbitrary reaching motions.

Evaluating an open-loop functional electrical stimulation controller for holding the shoulder and elbow configuration of a paralyzed arm.

Functional electrical stimulation (FES) is a promising solution for restoring functional motion to individuals with paralysis, but the potential for achieving full-arm reaching motions with FES for various desired tasks has not been realized. We present an open-loop controller capable of calculating and applying the necessary muscle stimulations to hold the wrist of an individual with high tetraplegia at any desired position. We used the controller to hold the wrist at a series of static positions. The controller was capable of discriminating between different wrist positions. The average distance to the target wrist position, or accuracy, was 7.7 cm. The average radius of the 95% confidence ellipsoid for a set of trials with the same muscle stimulations, or precision, was 6.7 cm. Adding feedback or online model updates will likely improve the accuracy for tasks requiring finer control. The controller is a good first step to controlling full-arm motions with FES.