Upper limb soft robotic wearable devices: a systematic review

Introduction: Soft robotic wearable devices, referred to as exosuits, can be a valid alternative to rigid exoskeletons when it comes to daily upper limb support. Indeed, their inherent flexibility improves comfort, usability, and portability while not constraining the user’s natural degrees of freedom. This review is meant to guide the reader in understanding the current approaches across all design and production steps that might be exploited when developing an upper limb robotic exosuit. Methods: The literature research regarding such devices was conducted in PubMed, Scopus, and Web of Science. The investigated features are the intended scenario, type of actuation, supported degrees of freedom, low-level control, high-level control with a focus on intention detection, technology readiness level, and type of experiments conducted to evaluate the device. Results: A total of 105 articles were collected, describing 69 different devices. Devices were grouped according to their actuation type. More than 80% of devices are meant either for rehabilitation, assistance, or both. The most exploited actuation types are pneumatic (52%) and DC motors with cable transmission (29%). Most devices actuate 1 (56%) or 2 (28%) degrees of freedom, and the most targeted joints are the elbow and the shoulder. Intention detection strategies are implemented in 33% of the suits and include the use of switches and buttons, IMUs, stretch and bending sensors, EMG and EEG measurements. Most devices (75%) score a technology readiness level of 4 or 5. Conclusion: Although few devices can be considered ready to reach the market, exosuits show very high potential for the assistance of daily activities. Clinical trials exploiting shared evaluation metrics are needed to assess the effectiveness of upper limb exosuits on target users

Elbow exoskeleton mechanism for multistage poststroke rehabilitation.

More than three million people are suffering from stroke in England. The process of post-stroke rehabilitation consists of a series of biomechanical exercises- controlled joint movement in acute phase; external assistance in the mid phase; and variable levels of resistance in the last phase. Post-stroke rehabilitation performed by physiotherapist has many limitations including cost, time, repeatability and intensity of exercises. Although a large variety of arm exoskeletons have been developed in the last two decades to substitute the conventional exercises provided by physiotherapist, most of these systems have limitations with structural configuration, sensory data acquisition and control architecture. It is still difficult to facilitate multistage post-stroke rehabilitation to patients sited around hospital bed without expert intervention. To support this, a framework for elbow exoskeleton has been developed that is portable and has the potential to offer all three types of exercises (external force, assistive and resistive) in a single structure. The design enhances torque to weight ratio compared to joint based actuation systems. The structural lengths of the exoskeleton are determined based on the mean anthropometric parameters of healthy users and the lengths of upperarm and forearm are determined to fit a wide range of users. The operation of the exoskeleton is divided into three regions where each type of exercise can be served in a specific way depending on the requirements of users. Electric motor provides power in the first region of operation whereas spring based assistive force is used in the second region and spring based resistive force is applied in the third region. This design concept provides an engineering solution of integrating three phases of post-stroke exercises in a single device. With this strategy, the energy source is only used in the first region to power the motor whereas the other two modes of exercise can work on the stored energy of springs. All these operations are controlled by a single motor and the maximum torque of the motor required is only 5 Nm. However, due to mechanical advantage, the exoskeleton can provide the joint torque up to 10 Nm. To remove the dependency on biosensor, the exoskeleton has been designed with a hardware-based mechanism that can provide assistive and resistive force. All exoskeleton components are integrated into a microcontroller-based circuit for measuring three joint parameters (angle, velocity and torque) and for controlling exercises. A user-friendly, multi-purpose graphical interface has been developed for participants to control the mode of exercise and it can be managed manually or in automatic mode. To validate the conceptual design, a prototype of the exoskeleton has been developed and it has been tested with healthy subjects. The generated assistive torque can be varied up to 0.037 Nm whereas resistive torque can be varied up to 0.057 Nm. The mass of the exoskeleton is approximately 1.8 kg. Two comparative studies have been performed to assess the measurement accuracy of the exoskeleton. In the first study, data collected from two healthy participants after using the exoskeleton and Kinect sensor by keeping Kinect sensor as reference. The mean measurement errors in joint angle are within 5.18 % for participant 1 and 1.66% for participant 2; the errors in torque measurement are within 8.48% and 7.93% respectively. In the next study, the repeatability of joint measurement by exoskeleton is analysed. The exoskeleton has been used by three healthy users in two rotation cycles. It shows a strong correction (correlation coefficient: 0.99) between two consecutive joint angle measurements and standard deviation is calculated to determine the error margin which comes under acceptable range (maximum: 8.897). The research embodied in this thesis presents a design framework of a portable exoskeleton model for providing three modes of exercises, which could provide a potential solution for all stages of post- stroke rehabilitation

Novel soft bending actuator based power augmentation hand exoskeleton controlled by human intention

This article presents the development of a soft material power augmentation wearable robot using novel bending soft artificial muscles. This soft exoskeleton was developed as a human hand power augmentation system for healthy or partially hand disabled individuals. The proposed prototype serves healthy manual workers by decreasing the muscular effort needed for grasping objects. Furthermore, it is a power augmentation wearable robot for partially hand disabled or post-stroke patients, supporting and augmenting the fingers’ grasping force with minimum muscular effort in most everyday activities. This wearable robot can fit any adult hand size without the need for any mechanical system changes or calibration. Novel bending soft actuators are developed to actuate this power augmentation device. The performance of these actuators has been experimentally assessed. A geometrical kinematic analysis and mathematical output force model have been developed for the novel actuators. The performance of this mathematical model has been proven experimentally with promising results. The control system of this exoskeleton is created by hybridization between cascaded position and force closed loop intelligent controllers. The cascaded position controller is designed for the bending actuators to follow the fingers in their bending movements. The force controller is developed to control the grasping force augmentation. The operation of the control system with the exoskeleton has been experimentally validated. EMG signals were monitored during the experiments to determine that the proposed exoskeleton system decreased the muscular efforts of the wearer

Design, Fabrication, and Control of an Upper Arm Exoskeleton Assistive Robot

Stroke is the primary cause of permanent impairment and neurological damage in the United States and Europe. Annually, about fifteen million individuals worldwide suffer from stroke, which kills about one third of them. For many years, it was believed that major recovery can be achieved only in the first six months after a stroke. More recent research has demonstrated that even many years after a stroke, significant improvement is not out of reach. However, economic pressures, the aging population, and lack of specialists and available human resources can interrupt therapy, which impedes full recovery of patients after being discharged from hospital following initial rehabilitation. Robotic devices, and in particular portable robots that provide rehabilitation therapy at home and in clinics, are a novel way not only to optimize the cost of therapy but also to let more patients benefit from rehabilitation for a longer time. Robots used for such purposes should be smaller, lighter and more affordable than the robots currently used in clinics and hospitals. The common human-machine interaction design criteria such as work envelopes, safety, comfort, adaptability, space limitations, and weight-to-force ratio must still be taken into consideration.;In this work a light, wearable, affordable assistive robot was designed and a controller to assist with an activity of daily life (ADL) was developed. The mechanical design targeted the most vulnerable group of the society to stroke, based on the average size and age of the patients, with adjustability to accommodate a variety of individuals. The novel mechanical design avoids motion singularities and provides a large workspace for various ADLs. Unlike similar exoskeleton robots, the actuators are placed on the patient\u27s torso and the force is transmitted through a Bowden cable mechanism. Since the actuators\u27 mass does not affect the motion of the upper extremities, the robot can be more agile and more powerful. A compact novel actuation method with high power-to-weight ratio called the twisted string actuation method was used. Part of the research involved selection and testing of several string compositions and configurations to compare their suitability and to characterize their performance. Feedback sensor count and type have been carefully considered to keep the cost of the system as low as possible. A master-slave controller was designed and its performance in tracking the targeted ADL trajectory was evaluated for one degree of freedom (DOF). An outline for proposed future research will be presented

Comparative study of actuation systems for portable upper limb exoskeletons.

During the last two decades, a large variety of upper limb exoskeletons have been developed. Out of these, majority are platform based systems which might be the reason for not being widely adopted for post-stroke rehabilitation. Despite the potential benefits of platform-based exoskeletons as being rugged and reliable, stroke patients prefer to have a portable and user-friendly device that they can take home. However, the types of actuator as well as the actuation mechanism used in the exoskeleton are the inhibiting factors why portable exoskeletons are mostly non-existent for patient use. This paper presents a quantitative analysis of the actuation systems available for developing portable upper arm exoskeletons with their specifications. Finally, it has been concluded from this research that there are not many stand-alone arm exoskeletons which can provide all forms of rehabilitation, therefore, a generic solution has been proposed as the rehabilitation strategy to get best out of the portable arm exoskeletons

A novel hardware approach to integrating active and passive rehabilitation in a single exoskeleton

The proposed exoskeleton is based on the elbow joint where patients can have active and passive rehabilitation in a single structure without changing its configuration. The structural formation of the exoskeleton has been designed in such a way that it offers two working regions namely; actuator based active rehabilitation in the first phase and passive rehabilitation in the second phase. The solution for integrating these two phases has been implemented using an innovative passive locking mechanism which uses a spring-based system for transformation. The stiffness of the spring is utilized to switch between active and passive rehabilitation regions. Besides this there are some other advantages this exoskeleton offers such as reduction of the actuation torque as well as ease of control. The paper is divided into three parts: the first part describes the existing designs, the second part gives an overview of the developed mechanism with structural description and the last part provides the solution with technical specification

Development of a 4-DoF Active Upper Limb Orthosis

In this paper, the designs and manufacturing process of a powered upper limb orthosis are presented. The orthosis is an exoskeleton worn on one arm by the user and fixed to the trunk. The orthosis’ architecture, design, and manufacturing process are presented and discussed. Estimations of the ranges of movement related to daily living activities are presented. The preliminary tests to verify the functionality of the design show encouraging results

Wrist rehabilitation exoskeleton robot based on pneumatic soft actuators

The aim of this paper is to describe the design of a soft, wearable splint for wrist joint rehabilitation, based on pneumatic soft actuators. The extensor bending and the contraction types of pneumatic soft actuators have been adopted in this study. These actuators are shown to be appropriate by examining their characteristics. The main contributions of this study are developing a safe, lightweight, soft and small actuator for direct human interaction, designing a novel single portable wearable soft robot capable of performing all wrist rehabilitation movements, and using low-cost materials to create the device. Three modes of rehabilitation exercises in the exoskeleton are involved: Flexion/Extension, Radial/Ulnar deviation, and circular movements