How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Design Principles for FES Concept Development

© Cranfield University 2013. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright owner.A variety of pathologies can cause injury to the spinal cord and hinder movement. A range of equipment is available to help spinal injury sufferers move their affected limbs. One method of rehabilitation is functional electrical stimulation (FES). FES is a technique where small electrical currents are applied to the surface of the user’s legs to stimulate the muscles. Studies have demonstrated the benefits of using this method and it has also been incorporated into a number of devices. The aim of the project was to produce a number of designs for a new device that uses FES technology. The project was completed in conjunction with an industrial partner. A review of the literature and consultation with industrial experts suggested a number of ways current devices could be improved. These included encouraging the user to lean forwards while walking and powering the device using a more ergonomic method. A group of designers were used to produce designs that allowed the user to walk with a more natural gait and avoided cumbersome power packs. The most effective of these designs were combined to form one design that solved both problems. A 3-dimensional model of this design was simulated using computer-aided design software. Groups of engineers, scientists and consumers were also invited to provide input on how a new device should function. Each of these groups provided a design that reflected their specific needs, depending on their experience with similar technology. Low level prototypes were produced of these designs. A group of designers were also used to design concepts for a functional electrical stimulation device based on an introduction given by industry experts. Each of the designs was presented to experienced professionals to obtain feedback. A set of guidelines were also produced during the project that instructed how to create the designs

Accessibility Design and Operational Considerations in the Development of Urban Aerial Mobility Vehicles and Networks

Urban aerial mobility vehicles and networks have recently gained considerable interest in the aviation community. These small, short-range vehicles with all-electric or hybrid-electric propulsion systems, tailored to metropolitan aerial transportation needs, promise to radically change passenger mobility and cargo distribution in cities. Accessibility issues have not been a major consideration in UAM vehicle and network discussions to date. This paper seeks to help change that

Nutzerorientierte Evaluation zweier altersgerechter Assistenzroboter zur Unterstützung von Alltagsaktivitäten („Ambient Assisted Living-Roboter“) bei älteren Menschen mit funktionellen Einschränkungen: MOBOT-Rollator und I-SUPPORT-Duschroboter

Ziel der vorliegenden Arbeit ist die nutzerorientierte Evaluation zweier Prototypen für altersgerechte Assistenzroboter zur Unterstützung von Alltagsaktivitäten („Ambient Assisted Living“ [AAL]-Roboter) bei älteren Menschen mit funktionellen Einschränkungen. Bei den Prototypen handelt es sich dabei um (1) einen robotergestützten Rollator zur Unterstützung der Mobilität (MOBOT) und (2) einen Assistenzroboter zur Unterstützung von Duschaktivitäten (I-SUPPORT). Manuskript I dokumentiert eine systematische Literaturanalyse des methodischen Vorgehens bisheriger Studien zur Evaluation robotergestützter Rollatoren aus der Nutzerperspektive. Die meisten Studien zeigen erhebliche methodische Mängel, wie unzureichende Stichprobengrößen/-beschreibungen; Teilnehmer nicht repräsentativ für die Nutzergruppe der robotergestützten Rollatoren; keine geeigneten, standardisierten und validierten Assessmentmethoden und/oder keine Inferenzstatistik. Ein generisches methodisches Vorgehen für die Evaluation robotergestützter Rollatoren konnte nicht identifiziert werden. Für die Konzeption und Durchführung zukünftiger Studien zur Evaluation robotergestützter Rollatoren, aber auch anderer AAL-Systeme werden in Manuskript I abschließend Handlungsempfehlungen formuliert. Manuskript II analysiert die Untersuchungsergebnisse der in Manuskript I identifizierten Studien. Es zeigen sich sehr heterogene Ergebnisse hinsichtlich des Mehrwerts der innovativen Assistenzfunktionen von robotergestützten Rollatoren. Im Allgemeinen werden sie jedoch als positiv von den Nutzern wahrgenommen. Die große Heterogenität und methodischen Mängel der Studien schränken die Interpretierbarkeit ihre Untersuchungsergebnisse stark ein. Insgesamt verdeutlicht Manuskript II, dass die Evidenz zur Effektivität und positiven Wahrnehmung robotergestützter Rollatoren aus der Nutzerperspektive noch unzureichend ist. Basierend auf den Erkenntnissen und Handlungsempfehlungen der systematischen Literaturanalysen aus Manuskript I und II wurden die nutzerorientierten Evaluationsstudien des MOBOT-Rollators konzipiert und durchgeführt (Manuskript III-VI). Manuskript III überprüft die Effektivität des in den MOBOT-Rollator integrierten Navigationssystems bei potentiellen Nutzern (= ältere Personen mit Gangstörungen bzw. Rollator als Gehhilfe im Alltag). Es liefert erstmals einen statistischen Nachweis dafür, dass eine solche Assistenzfunktion effektiv ist, um die Navigationsleistung der Nutzer (z. B. geringer Stoppzeit, kürzere Wegstrecke) – insbesondere derjenigen mit kognitiven Einschränkungen – in einem realitätsnahen Anwendungsszenario zu verbessern. Manuskript IV untersucht die konkurrente Validität des MOBOT-integrierten Ganganalysesystems bei potentiellen Nutzern. Im Vergleich zu einem etablierten Referenzstandard (GAITRite®-System) zeigt es eine hohe konkurrente Validität für die Erfassung zeitlicher, nicht jedoch raumbezogener Gangparameter. Diese können zwar ebenfalls mit hoher Konsistenz gemessen werden, aber lediglich mit einer begrenzten absoluten Genauigkeit. Manuskript V umfasst die nutzerorientierte Evaluation der im MOBOT-Rollator integrierten Assistenzfunktion zur Hindernisvermeidung und belegt erstmals die Effektivität einer solchen Funktionen bei potentiellen Nutzern. Unter Verwendung des für den MOBOT-Rollator neu entwickelten technischen Ansatzes für die Hindernisvermeidung zeigten die Teilnehmer signifikante Verbesserungen bei der Bewältigung eines Hindernisparcours (weniger Kollisionen und geringere Annäherungsgeschwindigkeit an die Hindernisse). Manuskript VI dokumentiert die Effektivität und Zufriedenheit mit der Aufstehhilfe des MOBOT-Rollators von potentiellen Nutzern. Es wird gezeigt, dass die Erfolgsrate für den Sitzen-Stehen-Transfer älterer Personen mit motorischen Einschränkungen durch die Aufstehhilfe signifikant verbessert werden kann. Die Ergebnisse belegen zudem eine hohe Nutzerzufriedenheit mit dieser Assistenzfunktion, insbesondere bei Personen mit höherem Body-Mass-Index. Manuskript VII untersucht die Mensch-Roboter-Interaktion zwischen dem I-SUPPORT-Duschroboter und seiner potentiellen Nutzer (= ältere Personen mit Problemen bei Baden/Duschen) und überprüft deren Effektivität sowie Zufriedenheit mit drei unterschiedlich autonomen Betriebsmodi. Die Studienergebnisse dokumentieren, dass sich mit zunehmender Kontrolle des Nutzers (= abnehmende Autonomie des Duschroboters) nicht nur die Effektivität für das Abduschen eines definierten Körperbereichs verringert, sondern auch die Nutzerzufriedenheit sinkt. Manuskript VIII umfasst die Evaluation eines spezifischen Nutzertrainings auf die gestenbasierte Mensch-Roboter-Interaktion mit dem I-SUPPORT-Duschroboter. Es wird gezeigt, dass ein solches Training die Ausführung der Gesten potentieller Nutzer und sowie die Gestenerkennungsrate des Duschroboters signifikant verbessern, was insgesamt auf eine optimierte Mensch-Roboter-Interaktion in Folge des Trainings schließen lässt. Teilnehmer mit der schlechtesten Ausgangsleistung in der Ausführung der Gesten und mit der größten Angst vor Technologien profitierten am meisten vom Nutzertraining. Insgesamt belegen die Studienergebnisse zur nutzerorientierten Evaluation des MOBOT-Rollators die Effektivität und Gültigkeit seiner innovativen Teilfunktionen. Sie weisen auf ein hohes Potential der Assistenzfunktionen (Navigationssystem, Hindernisvermeidung, Aufstehhilfe) zur Verbesserung der Mobilität älterer Menschen mit motorischen Einschränkungen hin. Vor dem Hintergrund der methodischen Mängel und unzureichenden evidenzbasierten Datenlage hierzu, liefert diese Dissertationsschrift erstmals statistische Belege für den Mehrwert solcher Teilfunktionen bei potentiellen Nutzern und leistet somit einen wichtigen Beitrag zur Schließung der bisherigen Forschungslücke hinsichtlich des nutzerorientierten Wirksamkeits- und Gültigkeitsnachweises robotergestützter Rollatoren und ihrer innovativen Teilfunktionen. Die Ergebnisse der Studien des I-SUPPORT-Duschroboters liefern wichtige Erkenntnisse hinsichtlich der Mensch-Roboter-Interaktion im höheren Alter. Sie zeigen, dass bei älteren Nutzern für eine effektive Interaktion Betriebsmodi mit einem hohen Maß an Autonomie des Duschroboters notwendig sind. Trotz ihrer eingeschränkten Kontrolle über den Roboter, waren die Nutzer mit dem autonomsten Betriebsmodus sogar am zufriedensten. Darüber hinaus unterstreichen die Ergebnisse hinsichtlich der gestenbasierten Interaktion mit dem I-SUPPORT-Duschroboter, dass zukünftige Entwicklungen von altersgerechten Assistenzrobotern mit gestenbasierter Interaktion nicht nur die Verbesserungen technischer Aspekte, sondern auch die Sicherstellung und Verbesserungen der Qualität der Nutzergesten für die Mensch-Roboter-Interaktion durch geeignete Trainings- oder Schulungsmaßnahmen berücksichtigen sollten. Das vorgestellte Nutzertraining könnte hierfür ein mögliches Modell darstellen

Trunk Rehabilitation Using Cable-Driven Robotic Systems

Upper body control is required to complete many daily tasks. One needs to stabilize the head and trunk over the pelvis, as one shifts the center of mass to interact with the world. While healthy individuals can perform activities that require leaning, reaching, and grasping readily, those with neurological and musculoskeletal disorders present with control deficits. These deficits can lead to difficulty in shifting the body center of mass away from the stable midline, leading to functional limitations and a decline in the quality of activity. Often these patient groups use canes, walkers, and wheelchairs for support, leading to occasional strapping or joint locking of the body for trunk stabilization. Current rehabilitation strategies focus on isolated components of stability. This includes strengthening, isometric exercises, hand-eye coordination tasks, isolated movement, and proprioceptive training. Although all these components are evidence based and directly correlate to better stability, motor learning theories such as those by Nikolai Bernstein, suggest that task and context specific training can lead to better outcomes. In specific, based on our experimentation, we believe functional postural exploration, while encompassing aspects of strengthening, hand-eye coordination, and proprioceptive feedback can provide better results. In this work, we present two novel cable robotic platforms for seated and standing posture training. The Trunk Support Trainer (TruST) is a platform for seated posture rehabilitation that provides controlled external wrench on the human trunk in any direction in real-time. The Stand Trainer is a platform for standing posture rehabilitation that can control the trunk, pelvis, and knees, simultaneously. The system works through the use of novel force-field algorithms that are modular and user-specific. The control uses an assist-as-needed strategy to apply forces on the user during regions of postural instability. The device also allows perturbations for postural reactive training. We have conducted several studies using healthy adult populations and pilot studies on patient groups including cerebral palsy, cerebellar ataxia, and spinal cord injury. We propose new training methods that incorporate motor learning theory and objective interventions for improving posture control. We identify novel methods to characterize posture in form of the “8-point star test”. This is to assess the postural workspace. We also demonstrate novel methods for functional training of posture and balance. Our results show that training with our robotic platforms can change the trunk kinematics. Specifically, healthy adults are able to translate the trunk further and rotate the trunk more anteriorly in the seated position. In the standing position, they can alter their reach strategy to maintain the upper trunk more vertically while reaching. Similarly, Cerebral Palsy patients improve their trunk translations, reaching workspace, and maintain a more vertical posture after training, in the seated position. Our results also showed that an Ataxia patient was able to improve their reaching workspace and trunk translations in the standing position. Finally, our results show that the robotic platforms can successfully reduce trunk and pelvis sway in spinal cord injury patients. The results of the pilot studies suggest that training with our robotic platforms and methods is beneficial in improving trunk control

Development of a standing disruptive concept for the mobility of individuals with motor disability

Dissertação de mestrado integrado em Biomedical EngineeringThe present project intends to explore the idea of creating a new and better kind of mobility device, capable of transporting individuals who suffer of mobility impairments. The developments of the dissertation culminated in an explanatory prototype based of a set of requirements and of withdrawn conclusions of the state of the art of mobility devices. It is proposed a novel concept of vertical transport for the mobility impaired. The present idea allows the user greater agility than most mobility devices, improved self-autonomy and operating while in a vertical stance, reducing health risks which the mobility disabled are prone to, both mental and physical. Firstly, it is presented a literature review of the mobility devices targeted for the mobility impaired developed thus far. The analysis of the development throughout history and of the devices currently presented in the market allowed to understand which necessities of the mobility disabled are yet to be answered. Said knowledge is the foundation of a project intended to further improve the quality of life of whoever has such special needs. To counter the list of requirements and specifications, the complex engineering problem was divided in smaller subfunctions that could be more easily answered to. After presenting several solutions to each subfunction, the ones considered best were selected and developed. For designing the device, several steps were taken. For a broader triage of concepts, it was used sketching. Later, the best notions were recreated on the CAD software SolidWorks, which allowed for virtual testing of the wouldbe prototype. Once a design was deemed worthy, the pieces of the mechanism were 3D printed, creating a physical model of the final goal of the project. Thus, it was created the basis of a mobility device for the individuals who suffer from mobility impairments that can be used in the outdoors, reach running speeds and assists in maintaining a vertical stance, diminishing the risks of developing health problems triggered from prolonged times in a seated position.O presente projeto pretende explorar a ideia de criar um novo e melhor dispositivo de mobilidade, capaz de transportar indivíduos que sofrem de deficiências de mobilidade. A evolução da dissertação culminou num protótipo elucidativo baseado num conjunto de requisitos e conclusões retiradas do estado da arte de dispositivos de mobilidade. Propõe-se um novo conceito de transporte vertical para quem sofre de problemas de mobilidade. A ideia permite ao usuário uma maior agilidade do que a maioria dos dispositivos de mobilidade, auto autonomia aprimorada e ser operável em posição vertical, reduzindo os riscos de saúde a que os deficientes de mobilidade são propensos, tanto a nível mental como físico. Em primeiro lugar, é apresentada a revisão da literatura sobre os dispositivos de mobilidade desenvolvidos até agora para quem sofre de problemas de mobilidade. A análise do desenvolvimento ao longo da história e dos dispositivos atualmente apresentados no mercado permitiu entender quais as necessidades dos deficientes que ainda necessitam de ser respondidas. O referido conhecimento é o fundamento de um projeto destinado a melhorar ainda mais a qualidade de vida de quem tem tais necessidades especiais. Para a lista de requisitos e especificações, o complexo problema de engenharia foi dividido em subfunções menores que poderiam ser mais facilmente respondidas. Depois de apresentar várias soluções para cada subfunção, os considerados melhores foram selecionados e desenvolvidos. Para projetar o dispositivo, foram tomadas várias etapas. Para uma triagem mais ampla de conceitos, foram utilizados esboços. Mais tarde, as melhores noções foram recriadas no software CAD SolidWorks, o que permitiu testes virtuais do potencial protótipo. Uma vez que um design foi considerado digno, as peças do mecanismo foram impressas em 3D, criando um modelo físico do objetivo final do projeto. Assim, foi criada a base de um dispositivo de mobilidade para os indivíduos que sofrem de deficiências de mobilidade que pode ser usado no exterior, alcança velocidades de corrida e ajudam a manter uma posição vertical, diminuindo os riscos de desenvolver problemas de saúde desencadeados por períodos prolongados na posição sentada

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

A biomechanical investigation of seated balance and upright mobility with a robotic exoskeleton in individuals with a spinal cord injury

Spinal cord injury (SCI) is a complex medical condition with multiple sequelae. The level and severity of a lesion will determine the degree of disability and associated co- morbidities, the most obvious of which is paralysis. Other concomitant issues, such as muscle contractures, poor seated posture and fear of falling, can also lead to a reduced quality of life. Although there is currently no cure for SCI, many of the comorbidities can be managed or mitigated through technology and physical rehabilitation practices.The aim of this thesis was to inform spinal cord injury (SCI) mobility rehabilitation, focusing on postural control and upright stepping using robotic assisted gait training (RAGT). A systematic review investigating RAGT use in SCI concluded that although RAGT has the potential to benefit upright locomotion of SCI individuals, it should not replace other therapies but should be incorporated into a multi-modality rehabilitation approach.Seated postural control, upper-body posture and fear-of-falling in SCI individuals were also explored. Stability performance and control demand were compared between high- and low-level injury groups as was fear-of-falling. An individualised limit of stability boundary (LOS) facilitated the differentiation between high- and low-level injuries during static tasks; however, its use during dynamic tasks was limited and potentially influenced by fear-of-falling.Few studies have quantified the user’s motion inside a lower limb robotic exoskeleton (LEXO), and none have reported marker placement repeatability. Standard error of measurement was reported for three-dimensional trunk and pelvic orientations and hip, knee and ankle angles in the sagittal plane during level walking. This revealed the marker set and placement to produce good levels of agreement between visits, with most values falling between the accepted standard of 2-5o. These findings indicated that the marker placement was repeatable and could be used in the subsequent chapters involving motion capture of overground walking.Three-dimensional gait parameters of able-bodied individuals walking with and without a LEXO at two speeds (comfortable (CMBL) and speed-matched (SLOW) to the LEXO) were investigated. Statistical parametric mapping revealed significantly different waveforms at the ANOVA level for all kinematic variables, however minimal differences in sagittal plane lower limb kinematics were identified between LEXO and SLOW gait, suggesting LEXO gait resembled slow walking when speed-matched. Altered kinematics of the pelvis and trunk during LEXO use suggest that overground exoskeletons may provide a training environment benefiting postural control training.Finally, the biomechanical characteristics of able-bodied and SCI users walking in an overground LEXO were investigated. Variables associated with neuroplasticity in SCI (hip extension and lower limb un-loading) were not significantly different between groups, indicating that afferent stimuli to facilitate neuroplastic adaptations in individuals with a SCI can be generated during LEXO gait. Upper-body orientation facilitated stepping and maintained balance, thereby requiring the participant’s active involvement.This thesis has provided evidence that LEXOs can deliver appropriate stimuli for upright stepping and that upper-body engagement can facilitate postural control training, potentially leading to improved seated postural control

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Low obstacles avoidance for lower limb exoskeletons

Gli esoscheletri motorizzati per gli arti inferiori (LLEs) sono robot indossabili che permettono a soggetti con disabilità degli arti inferiori di camminare indipendentemente, e persino migliorare le prestazioni degli arti inferiori nel caso di soggetti sani. Nonostante i recenti sviluppi, l'uso di questa promettente tecnologia è relegato agli ambiti clinici e di ricerca; il suo utilizzo come strumento per camminare in modo indipendente in ambienti non controllati è ancora mancante. Il motivo principale di questa limitazione è dovuto alla mancanza di adattabilità degli LLE ai diversi ambienti che possono essere incontrati durante il cammino: la maggioranza degli LLE sfrutta traiettorie predefinite degli arti inferiori senza valutare l'ambiente circostante. Questo implica che ogni tipo di controllo addizionale è a carico dell'utente, e risulta in un sovraccarico fisico e cognitivo da parte di quest'ultimo. Questa tesi si pone l'obbiettivo di superare le limitazioni sopracitate, proponendo un approccio innovativo per aumentare l'autonomia degli LLE. In particolare, il metodo proposto ha lo scopo di stimare la traiettoria degli arti inferiori ottimale, così da poter superare in modo autonomo gli ostacoli bassi che potrebbero essere incontrati lungo il cammino. Tramite l'uso di una stereo camera unita ad un algoritmo di Computer Vision, l'ambiente viene percepito in modo da identificare il pavimento e gli ostacoli che potrebbero influenzare il cammino con l'obbiettivo di selezionare il punto d'appoggio ottimale per il piede. Successivamente, un algoritmo iterativo per la generazione della traiettoria del piede senza collisioni (CFFTG) permette di ottenere i dati necessari a calcolare la cinematica inversa dell'esoscheletro, ed infine gli angoli ai giunti ottenuti da quest'ultima vengono forniti ai controllori dei motori per effettuare il movimento desiderato. Test sperimentali in simulazione (basati su dati reali) sono stati eseguiti per valutare il comportamento dell'algoritmo di Computer Vision e del CFFTG, mostrando ottimi risultati in diversi scenari. Inoltre, le assunzioni su cui si basa la soluzione proposta permettono la sua compatibilità con la maggioranza degli esoscheletri commerciali e di ricerca attualmente disponibili. Credo che pensare agli esoscheletri come degli agenti semi autonomi, piuttosto che come dei dispositivi controllati unicamente dall'utente, rappresenti non solo un percorso che porterà alla simbiosi tra uomo ed esoscheletro, ma anche all'uso di questa tecnologia nella vita di tutti i giorni.Powered lower limb exoskeletons (LLEs) are innovative wearable robots that allow independent walking in people with severe gait impairments, or even to augment lower limb capabilities of able-bodied users. Despite the recent advancements, the use of this promising technology is still restricted to controlled research/clinical settings; uptake in real-life conditions as a device to promote user independence is still lacking. The main reason behind this limitation can be traced back to the lack adaptability of LLEs to the different walking conditions that may be encountered in real world settings: the majority of LLEs relies on predefined gait trajectories and is generally unaware of the environment in which gait occurs. This means that the control burden is entirely on the user, resulting in an increased physical and cognitive workload. This thesis aims at overcoming the aforementioned limitations by proposing a novel approach to enhance the autonomy of the LLEs. In particular, the proposed method has the purpose of estimating the optimal gait trajectory of the exoskeleton in order to autonomously avoid low obstacles on the ground. By using a depth camera coupled with Computer Vision software module, the environment is sensed to detect the ground plane and obstacles that might interfere with the forward motion, in order to predict the following foothold. Then, an iterative-based collision-free foot trajectory generator (CFFTG) algorithm is proposed to calculate the optimal foot motion and the joints’ angles to be sent to the exoskeleton low-level controllers. Experimental tests have been carried out in simulation to evaluate both the CV module and the CFFTG based on real data, showing successful performance in different scenarios. In addition, the assumptions that have been considered in this work make the proposed approach compatible with the majority of exoskeletons in research and on the market. I believe that re-thinking exoskeletons as semi-autonomous agents will represent not only the cornerstone to promote a more symbiotic human-exoskeleton interaction but may also pave the way for the use of this technology in the everyday life