Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer's paretic limb to facilitate an immediate 5.33 ± 0.91°increase in the paretic ankle's swing phase dorsiflexion and 11 ± 3% increase in the paretic limb's generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.

We present the design and evaluation of a multi-articular soft exosuit that is portable, fully autonomous, and provides assistive torques to the wearer at the ankle and hip during walking. Traditional rigid exoskeletons can be challenging to perfectly align with a wearer's biological joints and can have large inertias, which can lead to the wearer altering their natural motion patterns. Exosuits, in comparison, use textiles to create tensile forces over the body in parallel with the muscles, enabling them to be light and not restrict the wearer's kinematics. We describe the biologically inspired design and function of our exosuit, including a simplified model of the suit's architecture and its interaction with the body. A key feature of the exosuit is that it can generate forces passively due to the body's motion, similar to the body's ligaments and tendons. These passively generated forces can be supplemented by actively contracting Bowden cables using geared electric motors, to create peak forces in the suit of up to 200 N. We define the suit-human series stiffness as an important parameter in the design of the exosuit and measure it on several subjects, and we perform human subjects testing to determine the biomechanical and physiological effects of the suit. Results from a five-subject study showed a minimal effect on gait kinematics and an average best-case metabolic reduction of 6.4%, comparing suit worn unpowered versus powered, during loaded walking with 34.6 kg of carried mass including the exosuit and actuators (2.0 kg on both legs, 10.1 kg total).

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BackgroundCarrying load alters normal walking, imposes additional stress to the musculoskeletal system, and results in an increase in energy consumption and a consequent earlier onset of fatigue. This phenomenon is largely due to increased work requirements in lower extremity joints, in turn requiring higher muscle activation. The aim of this work was to assess the biomechanical and physiological effects of a multi-joint soft exosuit that applies assistive torques to the biological hip and ankle joints during loaded walking.MethodsThe exosuit was evaluated under three conditions: powered (EXO_ON), unpowered (EXO_OFF) and unpowered removing the equivalent mass of the device (EXO_OFF_EMR). Seven participants walked on an instrumented split-belt treadmill and carried a load equivalent to 30 % their body mass. We assessed their metabolic cost of walking, kinetics, kinematics, and lower limb muscle activation using a portable gas analysis system, motion capture system, and surface electromyography.ResultsOur results showed that the exosuit could deliver controlled forces to a wearer. Net metabolic power in the EXO_ON condition (7.5 ± 0.6 W kg−1) was 7.3 ± 5.0 % and 14.2 ± 6.1 % lower than in the EXO_OFF_EMR condition (7.9 ± 0.8 W kg−1; p = 0.027) and in the EXO_OFF condition (8.5 ± 0.9 W kg−1; p = 0.005), respectively. The exosuit also reduced the total joint positive biological work (sum of hip, knee and ankle) when comparing the EXO_ON condition (1.06 ± 0.16 J kg−1) with respect to the EXO_OFF condition (1.28 ± 0.26 J kg−1; p = 0.020) and to the EXO_OFF_EMR condition (1.22 ± 0.21 J kg−1; p = 0.007).ConclusionsThe results of the present work demonstrate for the first time that a soft wearable robot can improve walking economy. These findings pave the way for future assistive devices that may enhance or restore gait in other applications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0150-9) contains supplementary material, which is available to authorized users.

Abstract-In this paper we present a soft lower-extremity robotic exosuit intended to augment normal muscle function in healthy individuals. Compared to previous exoskeletons, the device is ultra-lightweight, resulting in low mechanical impedance and inertia. The exosuit has custom McKibben style pneumatic actuators that can assist the hip, knee and ankle. The actuators attach to the exosuit through a network of soft, inextensible webbing triangulated to attachment points utilizing a novel approach we call the virtual anchor technique. This approach is designed to transfer forces to locations on the body that can best accept load. Pneumatic actuation was chosen for this initial prototype because the McKibben actuators are soft and can be easily driven by an off-board compressor. The exosuit itself (human interface and actuators) had a mass of 3500 g and with peripherals (excluding air supply) is 7144 g. In order to examine the exosuit's performance, a pilot study with one subject was performed which investigated the effect of the ankle plantar-flexion timing on the wearer's hip, knee and ankle joint kinematics and metabolic power when walking. Wearing the suit in a passive unpowered mode had little effect on hip, knee and ankle joint kinematics as compared to baseline walking when not wearing the suit. Engaging the actuators at the ankles at 30% of the gait cycle for 250 ms altered joint kinematics the least and also minimized metabolic power. The subject's average metabolic power was 386.7 W, almost identical to the average power when wearing no suit (381.8 W), and substantially less than walking with the unpowered suit (430.6 W). This preliminary work demonstrates that the exosuit can comfortably transmit joint torques to the user while not restricting mobility and that with further optimization, has the potential to reduce the wearer's metabolic cost during walking.