Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles

Sanchez-Villamañan, Maria del Carmen; González-Vargas, José; Torricelli, Diego; Moreno, Juan C.; Pons, José L.

doi:10.1186/s12984-019-0517-9

Cited by 145 publications

(123 citation statements)

References 153 publications

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“…In this context, and based on promising results in the inclusion of robotic devices in therapy [15,16,17], rehabilitation programs are motivating the development of Active Ankle-Foot Orthoses (AAFOs) [18]. Currently, novel control strategies and different actuation principles are applied in robotic orthoses [19,18], which are looking for improving the human-robot interaction, and thus the user gait patterns.…”

Section: Introductionmentioning

confidence: 99%

“…This AAFO is part of a small group of exoskeletons with compliant actuators and soft structures referred to as fully compliant exoskeletons [18]. T-FLEX has a high potential for applications in portable scenarios in contrast to the other devices classified in the same group, which integrate pneumatic actuation and require heavyweight air supplies.…”

Section: Introductionmentioning

confidence: 99%

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Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Gomez-Vargas

Ballén-Moreno

Barria³

et al. 2020

Preprint

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Abstract Background: Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which harm the independence to execute different Activities of Daily Living (ADL). From the fundamental role of the ankle in walking, Active Ankle-Foot Orthoses (AAFOs) have been developed to enhance the users' gait patterns, and hence, their quality of life.Methods: Ten patients who suffered stroke used the actuation system of the T-FLEX orthosis triggered by an inertial sensor on the foot tip. The VICON motion capture system recorded the users' kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. Results: The biomechanical assessment exhibited changes in the range of motion of the lower joints for $70\%$ of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70\% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30\% of the paretic limbs, where one volunteer increased this index in 14\%. The spatiotemporal parameters did not show significant variations between modalities, although users' cadence had a decrease. Lastly, the satisfaction with the device was positive, being the comfort the most users-selected aspect.Conclusions: This article presented the assessment of the T-FLEX actuation system in people who suffered stroke. Biomechanical results showed improvement in the ankle kinematic and variation in the other joints. In general terms, GDI did not exhibit significant changes, and Movement Analysis Profile (MAP) registered the main movements altered by the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients that includes a stage of training.Trial registration: This study was registered as Preliminary Biomechanical and Usability Study of an Active Ankle-Foot Orthosis for Stroke Survivors on 30 January 2020 in Clinical Trials with the identi er No NCT04249349 (available at https://clinicaltrials.gov/ct2/show/NCT04249349).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Gomez-Vargas

Ballén-Moreno

Barria³

et al. 2020

Preprint

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“…Standard soft exoskeletons are characterized for being textile devices actuating on user's joints through Bowden cable-based transmission [69,70]. The soft structure translates into lighter devices which do not restrict the wearer's mobility, leading to improved comfort, reduced metabolic cost and improved ease to don and doff [69,71]. However, the low actuation torques prevent soft exoskeletons from assisting people with severe motor impairments, such as non-ambulatory individuals [22,72].…”

Section: Design and Structurementioning

confidence: 99%

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

Rodríguez-Fernández

Lobo-Prat²,

Font-Llagunes

2020

Preprint

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Abstract Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what are the benefits and risks for exoskeleton users?, and (3) what is the current evidence on clinical efficacy for wearable exoskeletons?. We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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“…Exoskeleton robot is a kind of wearable bionic device, which integrates rehabilitation medicine, robotics and arti cial intelligence [8] . Its application in the eld of rehabilitation medicine is a research hotspot in various countries [9] . Compared with traditional rehabilitation methods, it can not only provide highly controllable, high-intensity and personalized rehabilitation training to relieve clinical staff of huge burden, but also can evaluate the improvement of motor function objectively and accurately [10] .…”

Section: Introductionmentioning

confidence: 99%

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

Wang¹,

Yu²,

Hui-min³

et al. 2020

Preprint

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Background In recent years, the number of people suffering from stroke-induced motor function lost increased considerably. Recovery of motility is essential in improving their quality of life. However, the existing rehabilitation methods cannot fulfill patients’ training requirements. As a new rehabilitation technology, exoskeleton robot provides a new treatment scheme for post-stroke hemiplegic patients. Objective To explore the safety and effectiveness of exoskeleton-assisted gait training for post-stroke hemiplegic patients. Methods A lower extremity hip joint exoskeleton robot was designed by the cooperation team, and 9 post-stroke hemiplegic patients were included for exoskeleton-assisted gait training. The three-dimensional gait parameters, plantar pressure and surface electromyography were used to validate the effectiveness of the exoskeleton robot in post-stroke hemiplegic patients. Results Exoskeleton-assisted ambulation training for post-stroke hemiplegic patients can correct the asymmetry of gait and abnormal phase of gait cycle, increase the toe-ground clearance and the angle of hip joint, reduce the pressure of non-paretic plantar and the impulse of bilateral feet, which help balance the plantar pressure distribution. It can also improve the integral electromyography value of specific muscle, which means that corresponding muscles are stimulated to generate activities. Conclusions The exoskeleton robot designed by our team can correct the hemiplegic gait and foot drop phenomenon of post-stroke patients, protecting them from damage caused by long-term abnormal gait, which contributes to the recovery of lower extremity motor function in hemiplegic patients. The results also provide important information for the design of lower extremity exoskeleton robot. In the future, we should further explore the rehabilitation function of exoskeleton robot in post-stroke hemiplegic patients, as well as the ambulation and rehabilitation function in other lower extremity motor dysfunction patients.

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Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles

Cited by 145 publications

References 153 publications

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

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