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Exosuits for the lower limb have developed rapidly as an affordable, light, and more cost-effective alternative to the bulkier, traditional exoskeletons. The synergy-based approach aims at further emphasizing such advantages, providing even lighter and cheaper solutions, thanks to its reduction in actuators and the subsequent simplification of the actuation unit. In this paper, a design approach based on dynamic synergies is proposed to reduce the number of required actuators, thus decreasing the price and weight of walking-assistance exosuits. Also, in this work, we propose a methodology to calculate motor torque output and cable forces during assisted gait. Mechanical designs for the actuation unit are proposed along with experimental and computer-based testing and simulation. Lastly, actuation units with one and two motors are studied and compared, regarding control, mechanical complexity, and metabolic cost reduction. The results show that dynamic synergies can indeed contribute to the design of these assistive devices, with its own set of advantages and disadvantages when compared to the previously proposed postural synergies: while the latter led to a higher cumulative variance of the first principal component and the transmission system is simpler, control may be more unpredictable and forces upon the system, harder to estimate. With dynamic synergies, more related to muscle synergies, metabolic benefit on users may be more significant. [ABSTRACT FROM AUTHOR]

The purpose of this study is to simulate the different walking adaptation strategies and their impact on muscle activities while changing the anchor point position of an exosuit in hip extension assistance motion. In particular, muscle activation and metabolic power consumption are assessed at varying levels of assistive force actuation that alters the position of anchor points. OpenSim software was used to perform simulations of 10 elderly subjects at comfortable gait speed while varying the anchor point positions of the thigh. Compared to unassisted gait, the extension assistance at placements below 40% (proximal) requires an increase in metabolic cost to maintain gait characteristics. At 40%, energy consumption corresponds to unassisted gait. From 50% proximal to distal positions, a reduction in metabolic cost is observed, with a minimum at 80%. The variation of the metabolic cost at different positions of the anchor point is reflected in the muscular activities, with an increase when the cable is placed below 40% of the total length of the thigh and a decrease from this position onwards. The activation level and metabolic cost exerted by the hip flexors and extensors muscles may be optimized during the exosuit actuation. The dynamics of the muscles spanning joints not actuated by the exosuit are not influenced by the actuation. The results and analysis provide information to optimize actuation profiles in the design of exosuits to assist gait for older adults and, thus, promote active aging and improving rehabilitation routines. [ABSTRACT FROM AUTHOR]

This document is an editorial titled "Rehabilitation robotics: challenges in design, control, and real applications, volume II." It discusses the field of rehabilitation robotics, which combines knowledge from various disciplines to develop devices that aid in rehabilitation. The editorial highlights the shift from rigid, clinical-centric solutions to more adaptable and user-centric approaches, such as soft, lightweight, and fully wearable devices. The document also mentions advancements in design, control, and simulation techniques, as well as the integration of rehabilitation devices into everyday living environments. The editorial concludes by summarizing the six articles included in the second volume of the research topic, which cover various aspects of rehabilitation robotics, including lower limb exoskeletons and reinforcement learning control. The article discusses various aspects of developing rehabilitation robots, emphasizing interdisciplinary collaboration and user involvement in the design process. It also highlights the potential of biomechanical models, simulation techniques, and advanced control strategies in improving rehabilitation outcomes. The article concludes by discussing future directions in rehabilitation device design, including portable devices, biosignal feedback, and personalized interventions. [Extracted from the article]

With ever-rising population comes a corresponding rise in people with mobility issues who have difficulty handling tasks in their daily lives. Such persons could benefit significantly from an active movement assistance device. This paper presents the design of a lower-limb exosuit designed to provide the wearer with useful gait assistance. While exoskeletons have existed for a while, soft exoskeletons or exosuits are relatively new. One challenge in the design of a gait-assistance device is the reduction of device weight. In order to facilitate this, the concept of kinematic synergies is implemented to reduce the number of actuators. In this prototype, the exosuit can actuate the hip, ankle, and knee of both legs using just one single motor, and a transmission system consisting of gears and clutches. The implementation of these synergies and their advantages are detailed in this paper, as well as preliminary tests to assess performance. This was performed by testing the exosuit worn by a subject on a treadmill while taking EMG readings and measuring cable tension produced. Significant reductions by up to 35% in certain muscle activations were observed, demonstrating the validity of this prototype for gait assistance. [ABSTRACT FROM AUTHOR]

Ageing results in the eventual loss of muscle mass and strength, joint problems, and overall slowing of movements, with a greater risk of suffering falls or other such accidents. The use of gait assistance exoskeletons can help in the active aging of this segment of the population. Given the user specificity of the mechanics and control these devices need, the facility used to test different design parameters is indispensable. This work deals with the modeling and construction of a modular test bench and prototype exosuit to test different mounting and control schemes for a cable-driven exoskeleton or exosuit. The test bench allows the experimental implementation of postural or kinematic synergies to assist multiple joints by using only one actuator and the optimization of the control scheme to better adapt to the characteristics of the specific patient. The design is open to the research community and it is expected to improve the design of cable-driven systems for exosuits. [ABSTRACT FROM AUTHOR]

Older adults (aged 55 years and above) have greater difficulty carrying out activities of daily living than younger adults (aged 25–55 years). Although age-related changes in human gait kinetics are well documented in qualitative terms in the scientific literature, these differences may be quantified and analyzed using the analysis of motor control strategies through kinetic synergies. The gaits of two groups of people (older and younger adults), each with ten members, were analyzed on a treadmill at a constant controlled speed and their gait kinetics were recorded. The decomposition of the kinetics into synergies was applied to the joint torques at the hip, knee, and ankle joints. Principal components determined the similarity of the kinetic torques in the three joints analyzed and the effect of the walking speed on the coordination pattern. A total of three principal components were required to describe enough information with minimal loss. The results suggest that the older group showed a change in coordination strategy compared to that of the younger group. The main changes were related to the ankle and hip torques, both showing significant differences (p-value < 0.05 ) between the two groups. The findings suggest that the differences between the gait patterns of the two groups were closely related to a reduction in ankle torque and an increase in hip torque. This change in gait pattern may affect the rehabilitation strategy used when designing general-purpose rehabilitation devices or rehabilitation/training programs for the elderly. [ABSTRACT FROM AUTHOR]

When designing any rehabilitation, sportswear or exoskeleton device the mechanical behaviour of the body segment must be known, specifically the skin, because an excessive tissue strain may lead to ulceration and bedsores. To date, it is not known if the kinematic variability between subjects have an effect on the skin strain field, and therefore, in the design and manufacturing of rehabilitation products, such as orthoses. Several studies have analysed the skin deformation during human motion, nevertheless, the comparison between the skin strain field in different subjects during normal or pathological gait has not been reported yet. This work presents a comparison of skin strain analysis for different gait patterns to study the differences between people and, specifically, if it is possible to standardize the orthotic design between subjects with the same gait disorder. Moreover, the areas with relatively minimum strain during the ankle-foot motion are compared to improve the design of structural parts of rehabilitation devices. In this case, a validated 3D digital image correlation system has been used for this purpose combined with strain ellipse theory. The results demonstrate variations in the skin strain field between subjects with the same pathology and similarities between subjects with normal gait. However, more studies and experiments are necessaries to validate this hypothesis and also to test it between different gait pathologies. [ABSTRACT FROM AUTHOR]

Hybrid orthoses or rehabilitation exoskeletons have proven to be a powerful tool for subjects with gait disabilities due to their combined use of electromechanical actuation to provide motion and support, and functional electrical stimulation (FES) to contract muscle tissue so as to improve the rehabilitation process. In these devices, each degree of freedom is governed by two actuators. The main issue arises in the design of the two actuation profiles for there to be natural or normative gait motion in which the two actuators are transparent to each other. Hybrid exoskeleton control solutions proposed in the literature have been based on tracking the desired kinematics and applying FES to maintain the desired motion rather than to attain the values expected for physiological movement. This work proposes a muscle-model approach involving inverse dynamics optimization for the design of combined actuation in hybrid orthoses. The FES profile calculated in this way has the neurophysiological meaningfulness for the device to be able to fulfill its rehabilitative purpose. A general scheme is proposed for a hybrid hip-knee-ankle-foot orthosis. The actuation profiles, when muscle tissue is fatigued due to FES actuation are analyzed, and an integrated approach is presented for estimating the actuation profiles so as to overcome muscle peak force reduction during stimulation. The objective is to provide a stimulation profile for each muscle individually that is compatible with the desired kinematics and actuation of the orthosis. The hope is that the results may contribute to the design of subject-specific rehabilitation routines with hybrid exoskeletons, improving the exoskeleton's actuation while maintaining its rehabilitative function. [ABSTRACT FROM AUTHOR]

Today there is continuous development of wearable devices in various fields such as sportswear, orthotics and personal gadgets, among others. The design of these devices involves the human body as a support environment. Based on this premise, the development of wearable devices requires an improved understanding of the skin strain field of the body segment during human motion. This paper presents a methodology based on a three dimensional digital image correlation (3D-DIC) system to measure the skin strain field and to estimate anatomical lines with minimum deformation as design criteria for the aforementioned wearable devices. The errors of displacement and strain measurement related to 3-D reconstruction and out-of-plane motion are investigated and the results are acceptable in the case of large deformation. This approach can be an effective tool to improve the design of wearable devices in the clinical orthopaedics and ergonomics fields, where comfort plays a key role in supporting the rehabilitation process. [ABSTRACT FROM AUTHOR]

In this work, the recent advances for rapid prototyping in the orthoprosthetic industry are presented. Specifically, the manufacturing process of orthoprosthetic aids are analysed, as thier use is widely extended in orthopedic surgery. These devices are devoted to either correct posture or movement (orthosis) or to substitute a body segment (prosthesis) while maintaining functionality. The manufacturing process is traditionally mainly hand-crafted: The subject's morphology is taken by means of plaster molds, and the manufacture is performed individually, by adjusting the prototype over the subject. This industry has incorporated computer aided design (CAD), computed aided engineering (CAE) and computed aided manufacturing (CAM) tools; however, the true revolution is the result of the application of rapid prototyping technologies (RPT). Techniques such as fused deposition modelling (FDM), selective laser sintering (SLS), laminated object manufacturing (LOM), and 3D printing (3DP) are some examples of the available methodologies in the manufacturing industry that, step by step, are being included in the rehabilitation engineering market—an engineering field with growth and prospects in the coming years. In this work we analyse different methodologies for additive manufacturing along with the principal methods for collecting 3D body shapes and their application in the manufacturing of functional devices for rehabilitation purposes such as splints, ankle-foot orthoses, or arm prostheses. [ABSTRACT FROM AUTHOR]

Soft exosuits stand out when it comes to the development of walking-assistance devices thanks to both their higher degree of wearability, lower weight, and price compared to the bulkier equivalent rigid exoskeletons. In cable-driven exosuits, the acting force is driven by cables from the actuation system to the anchor points; thus, the user's movement is not restricted by a rigid structure. In this paper, a 3D inverse dynamics model is proposed and integrated with a model for a cable-driven actuation to predict the required motor torque and traction force in cables for a walking-assistance exosuit during gait. Joint torques are to be shared between the user and the exosuit for different design configurations, focusing on both hip and ankle assistance. The model is expected to guide the design of the exosuit regarding aspects such as the location of the anchor points, the cable system design, and the actuation units. An inverse dynamics analysis is performed using gait kinematic data from a public dataset to predict the cable forces and position of the exosuit during gait. The obtained joint reactions and cable forces are compared with those in the literature, and prove the model to be accurate and ready to be implemented in an exosuit control scheme. The results obtained in this study are similar to those found in the literature regarding the walking study itself as well as the forces under which cables operate during gait and the cable position cycle.