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

Assistive mobility devices focusing on smart walkers : classification and review

In an aging society it is extremely important to develop devices, which can support and aid the elderly in their daily life. This demands means and tools that extend independent living and promote improved health. Thus, the goal of this article is to review the state of the art in the robotic technology for mobility assistive devices for people with mobility disabilities. The important role that robotics can play in mobility assistive devices is presented, as well as the identification and survey of mobility assistive devices subsystems with a particular focus on the walkers technology. The advances in the walkers’ field have been enormous and have shown a great potential on helping people with mobility disabilities. Thus it is presented a review of the available literature of walkers and are discussed major advances that have been made and limitations to be overcome

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable

Instrumentation and validation of a robotic cane for transportation and fall prevention in patients with affected mobility

Dissertação de mestrado integrado em Engenharia Física, (especialização em Dispositivos, Microssistemas e Nanotecnologias)O ato de andar é conhecido por ser a forma primitiva de locomoção do ser humano, sendo que este traz muitos benefícios que motivam um estilo de vida saudável e ativo. No entanto, há condições de saúde que dificultam a realização da marcha, o que por consequência pode resultar num agravamento da saúde, e adicionalmente, levar a um maior risco de quedas. Nesse sentido, o desenvolvimento de um sistema de deteção e prevenção de quedas, integrado num dispositivo auxiliar de marcha, seria essencial para reduzir estes eventos de quedas e melhorar a qualidade de vida das pessoas. Para ultrapassar estas necessidades e limitações, esta dissertação tem como objetivo validar e instrumentar uma bengala robótica, denominada Anti-fall Robotic Cane (ARCane), concebida para incorporar um sistema de deteção de quedas e um mecanismo de atuação que possibilite a prevenção de quedas, ao mesmo tempo que assiste a marcha. Para esse fim, foi realizada uma revisão do estado da arte em bengalas robóticas para adquirir um conhecimento amplo e aprofundado dos componentes, mecanismos e estratégias utilizadas, bem como os protocolos experimentais, principais resultados, limitações e desafios em dispositivos existentes. Numa primeira fase, foi estipulado o objetivo de: (i) adaptar a missão do produto; (ii) estudar as necessidades do consumidor; e (iii) atualizar as especificações alvo da ARCane, continuação do trabalho de equipa, para obter um produto com design e engenharia compatível com o mercado. Foi depois estabelecida a arquitetura de hardware e discutidos os componentes a ser instrumentados na ARCane. Em seguida foram realizados testes de interoperabilidade a fim de validar o funcionamento singular e coletivo dos componentes. Relativamente ao controlo de movimento, foi desenvolvido um sistema inovador, de baixo custo e intuitivo, capaz de detetar a intenção do movimento e de reconhecer as fases da marcha do utilizador. Esta implementação foi validada com seis voluntários saudáveis que realizaram testes de marcha com a ARCane para testar sua operabilidade num ambiente de contexto real. Obteve-se uma precisão de 97% e de 90% em relação à deteção da intenção de movimento e ao reconhecimento da fase da marcha do utilizador. Por fim, foi projetado um método de deteção de quedas e mecanismo de prevenção de quedas para futura implementação na ARCane. Foi ainda proposta uma melhoria do método de deteção de quedas, de modo a superar as limitações associadas, bem como a proposta de dispositivos de deteção a serem implementados na ARCane para obter um sistema completo de deteção de quedas.The act of walking is known to be the primitive form of the human being, and it brings many benefits that motivate a healthy and active lifestyle. However, there are health conditions that make walking difficult, which, consequently, can result in worse health and, in addition, lead to a greater risk of falls. Thus, the development of a fall detection and prevention system integrated with a walking aid would be essential to reduce these fall events and improve people quality of life. To overcome these needs and limitations, this dissertation aims to validate and instrument a cane-type robot, called Anti-fall Robotic Cane (ARCane), designed to incorporate a fall detection system and an actuation mechanism that allow the prevention of falls, while assisting the gait. Therefore, a State-of-the-Art review concerning robotic canes was carried out to acquire a broad and in-depth knowledge of the used components, mechanisms and strategies, as well as the experimental protocols, main results, limitations and challenges on existing devices. On a first stage, it was set an objective to (i) enhance the product's mission statement; (ii) study the consumer needs; and (iii) update the target specifications of the ARCane, extending teamwork, to obtain a product with a market-compatible design and engineering that meets the needs and desires of the ARCane users. It was then established the hardware architecture of the ARCane and discussed the electronic components that will instrument the control, sensory, actuator and power units, being afterwards subjected to interoperability tests to validate the singular and collective functioning of cane components altogether. Regarding the motion control of robotic canes, an innovative, cost-effective and intuitive motion control system was developed, providing user movement intention recognition, and identification of the user's gait phases. This implementation was validated with six healthy volunteers who carried out gait trials with the ARCane, in order to test its operability in a real context environment. An accuracy of 97% was achieved for user motion intention recognition and 90% for user gait phase recognition, using the proposed motion control system. Finally, it was idealized a fall detection method and fall prevention mechanism for a future implementation in the ARCane, based on methods applied to robotic canes in the literature. It was also proposed an improvement of the fall detection method in order to overcome its associated limitations, as well as detection devices to be implemented into the ARCane to achieve a complete fall detection system

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke

\ua9 2023, BioMed Central Ltd., part of Springer Nature.Background: Soft robotic exosuits can provide partial dorsiflexor and plantarflexor support in parallel with paretic muscles to improve poststroke walking capacity. Previous results indicate that baseline walking ability may impact a user’s ability to leverage the exosuit assistance, while the effects on continuous walking, walking stability, and muscle slacking have not been evaluated. Here we evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. We also compared two speed-based subgroups (threshold: 0.93 m/s) to address poststroke heterogeneity. Methods: We refined a previously developed portable lightweight soft exosuit to support continuous overground walking. We compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, as well as the energy cost of transport, walking stability and plantarflexor muscle slacking. Results: Exosuit assistance was associated with improvements in the targeted gait impairments: 22% increase in ground clearance during swing, 5\ub0 increase in foot-to-floor angle at initial contact, and 22% increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7% (0.04 m/s) increase in walking speed (R 2 = 0.82). This enhancement in gait function was achieved without deterioration in muscle effort, stability or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantarflexor assistance to improve propulsion by 35% to walk 13% faster, while faster individuals did not change either. Conclusions: The immediate restorative benefits of the exosuit presented here underline its promise for rehabilitative gait training in poststroke individuals

System Identification of Bipedal Locomotion in Robots and Humans

The ability to perform a healthy walking gait can be altered in numerous cases due to gait disorder related pathologies. The latter could lead to partial or complete mobility loss, which affects the patients’ quality of life. Wearable exoskeletons and active prosthetics have been considered as a key component to remedy this mobility loss. The control of such devices knows numerous challenges that are yet to be addressed. As opposed to fixed trajectories control, real-time adaptive reference generation control is likely to provide the wearer with more intent control over the powered device. We propose a novel gait pattern generator for the control of such devices, taking advantage of the inter-joint coordination in the human gait. Our proposed method puts the user in the control loop as it maps the motion of healthy limbs to that of the affected one. To design such control strategy, it is critical to understand the dynamics behind bipedal walking. We begin by studying the simple compass gait walker. We examine the well-known Virtual Constraints method of controlling bipedal robots in the image of the compass gait. In addition, we provide both the mechanical and control design of an affordable research platform for bipedal dynamic walking. We then extend the concept of virtual constraints to human locomotion, where we investigate the accuracy of predicting lower limb joints angular position and velocity from the motion of the other limbs. Data from nine healthy subjects performing specific locomotion tasks were collected and are made available online. A successful prediction of the hip, knee, and ankle joints was achieved in different scenarios. It was also found that the motion of the cane alone has sufficient information to help predict good trajectories for the lower limb in stairs ascent. Better estimates were obtained using additional information from arm joints. We also explored the prediction of knee and ankle trajectories from the motion of the hip joints

Instrumentation of a cane to detect and prevent falls

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)The number of falls is growing as the main cause of injuries and deaths in the geriatric community. As a result, the cost of treating the injuries associated with falls is also increasing. Thus, the development of fall-related strategies with the capability of real-time monitoring without user restriction is imperative. Due to their advantages, daily life accessories can be a solution to embed fall-related systems, and canes are no exception. Moreover, gait assessment might be capable of enhancing the capability of cane usage for older cane users. Therefore, reducing, even more, the possibility of possible falls amongst them. Summing up, it is crucial the development of strategies that recognize states of fall, the step before a fall (pre-fall step) and the different cane events continuously throughout a stride. This thesis aims to develop strategies capable of identifying these situations based on a cane system that collects both inertial and force information, the Assistive Smart Cane (ASCane). The strategy regarding the detection of falls consisted of testing the data acquired with the ASCane with three different fixed multi-threshold fall detection algorithms, one dynamic multi-threshold and machine learning methods from the literature. They were tested and modified to account the use of a cane. The best performance resulted in a sensitivity and specificity of 96.90% and 98.98%, respectively. For the detection of the different cane events in controlled and real-life situations, a state-of-the-art finite-state-machine gait event detector was modified to account the use of a cane and benchmarked against a ground truth system. Moreover, a machine learning study was completed involving eight feature selection methods and nine different machine learning classifiers. Results have shown that the accuracy of the classifiers was quite acceptable and presented the best results with 98.32% of overall accuracy for controlled situations and 94.82% in daily-life situations. Regarding pre-fall step detection, the same machine learning approach was accomplished. The models were very accurate (Accuracy = 98.15%) and with the implementation of an online post-processing filter, all the false positive detections were eliminated, and a fall was able to be detected 1.019s before the end of the corresponding pre-fall step and 2.009s before impact.O número de quedas tornou-se uma das principais causas de lesões e mortes na comunidade geriátrica. Como resultado, o custo do tratamento das lesões também aumenta. Portanto, é necessário o desenvolvimento de estratégias relacionadas com quedas e que exibam capacidade de monitorização em tempo real sem colocar restrições ao usuário. Devido às suas vantagens, os acessórios do dia-a-dia podem ser uma solução para incorporar sistemas relacionados com quedas, sendo que as bengalas não são exceção. Além disso, a avaliação da marcha pode ser capaz de aprimorar a capacidade de uso de uma bengala para usuários mais idosos. Desta forma, é crucial o desenvolvimento de estratégias que reconheçam estados de queda, do passo anterior a uma queda e dos diferentes eventos da marcha de uma bengala. Esta dissertação tem como objetivo desenvolver estratégias capazes de identificar as situações anteriormente descritas com base num sistema incorporado numa bengala que coleta informações inerciais e de força, a Assistive Smart Cane (ASCane). A estratégia referente à deteção de quedas consistiu em testar os dados adquiridos através da ASCane com três algoritmos de deteção de quedas (baseados em thresholds fixos), com um algoritmo de thresholds dinâmicos e diferentes classificadores de machine learning encontrados na literatura. Estes métodos foram testados e modificados para dar conta do uso de informação adquirida através de uma bengala. O melhor desempenho alcançado em termos de sensibilidade e especificidade foi de 96,90% e 98,98%, respetivamente. Relativamente à deteção dos diferentes eventos da ASCane em situações controladas e da vida real, um detetor de eventos da marcha foi e comparado com um sistema de ground truth. Além disso, foi também realizado um estudo de machine learning envolvendo oito métodos de seleção de features e nove classificadores diferentes de machine learning. Os resultados mostraram que a precisão dos classificadores foi bastante aceitável e apresentou, como melhores resultados, 98,32% de precisão para situações controladas e 94.82% para situações do dia-a-dia. No que concerne à deteção de passos pré-queda, a mesma abordagem de machine learning foi realizada. Os modelos foram precisos (precisão = 98,15%) e com a implementação de um filtro de pós-processamento, todas as deteções de falsos positivos foram eliminadas e uma queda foi passível de ser detetada 1,019s antes do final do respetivo passo de pré-queda e 2.009s antes do impacto

Haptic induced motor learning and the extension of its benefits to stroke patients

In this research, the Haptic Master robotic arm and virtual environments are used to induce motor learning in subjects with no known musculoskeletal or neurological disorders. It is found in this research that both perception and performance of the subject are increased through the haptic and visual feedback delivered through the Haptic Master. These system benefits may be extended to enhance therapies for patients with loss of motor skills due to neurological disease or brain injury. Force and visual feedback were manipulated within virtual environment scenarios to facilitate learning. In one force feedback condition, the subject is required to maneuver a sphere through a haptic maze or linear channel. In the second feedback condition, the subject\u27s movement was stopped when the sphere came in contact with the haptic walls. To resume movement, the force vector had to be redirected towards the optimal trajectory. To analyze the efficiency of the various scenarios, the area between the optimal and actual trajectories was used as a measure of learning. The results from this research demonstrated that within more complex environments one type of force feedback was more successful in facilitating motor learning. In a simpler environment, two out of three subjects experienced a higher degree of motor learning with the same type of force feedback. Learning is not enhanced with the presence of visual feedback. Also, in nearly all studied cases, the primary limitation to learning is shoulder and attention fatigue brought on by the experimentation

Active Training and Assistance Device for an Individually Adaptable Strength and Coordination Training

Das Altern der Weltbevölkerung, insbesondere in der westlichen Welt, stellt die Menschheit vor eine große Herausforderung. Zu erwarten sind erhebliche Auswirkungen auf den Gesundheitssektor, der im Hinblick auf eine steigende Anzahl von Menschen mit altersbedingtem körperlichem und kognitivem Abbau und dem damit erhöhten Bedürfnis einer individuellen Versorgung vor einer großen Aufgabe steht. Insbesondere im letzten Jahrhundert wurden viele wissenschaftliche Anstrengungen unternommen, um Ursache und Entwicklung altersbedingter Erkrankungen, ihr Voranschreiten und mögliche Behandlungen, zu verstehen. Die derzeitigen Modelle zeigen, dass der entscheidende Faktor für die Entwicklung solcher Krankheiten der Mangel an sensorischen und motorischen Einflüssen ist, diese wiederum sind das Ergebnis verringerter Mobilität und immer weniger neuer Erfahrungen. Eine Vielzahl von Studien zeigt, dass erhöhte körperliche Aktivität einen positiven Effekt auf den Allgemeinzustand von älteren Erwachsenen mit leichten kognitiven Beeinträchtigungen und den Menschen in deren unmittelbarer Umgebung hat. Diese Arbeit zielt darauf ab, älteren Menschen die Möglichkeit zu bieten, eigenständig und sicher ein individuelles körperliches Training zu absolvieren. In den letzten zwei Jahrzehnten hat die Forschung im Bereich der robotischen Bewegungsassistenten, auch Smarte Rollatoren genannt, den Fokus auf die sensorische und kognitive Unterstützung für ältere und eingeschränkte Personen gesetzt. Durch zahlreiche Bemühungen entstand eine Vielzahl von Ansätzen zur Mensch-Rollator-Interaktion, alle mit dem Ziel, Bewegung und Navigation innerhalb der Umgebung zu unterstützen. Aber trotz allem sind Trainingsmöglichkeiten zur motorischen Aktivierung mittels Smarter Rollatoren noch nicht erforscht. Im Gegensatz zu manchen Smarten Rollatoren, die den Fokus auf Rehabilitationsmöglichkeiten für eine bereits fortgeschrittene Krankheit setzen, zielt diese Arbeit darauf ab, kognitive Beeinträchtigungen in einem frühen Stadium soweit wie möglich zu verlangsamen, damit die körperliche und mentale Fitness des Nutzers so lang wie möglich aufrechterhalten bleibt. Um die Idee eines solchen Trainings zu überprüfen, wurde ein Prototyp-Gerät namens RoboTrainer-Prototyp entworfen, eine mobile Roboter-Plattform, die mit einem zusätzlichen Kraft-Momente-Sensor und einem Fahrradlenker als Eingabe-Schnittstelle ausgestattet wurde. Das Training beinhaltet vordefinierte Trainingspfade mit Markierungen am Boden, entlang derer der Nutzer das Gerät navigieren soll. Der Prototyp benutzt eine Admittanzgleichung, um seine Geschwindigkeit anhand der Eingabe des Nutzers zu berechnen. Desweiteren leitet das Gerät gezielte Regelungsaktionen bzw. Verhaltensänderungen des Roboters ein, um das Training herausfordernd zu gestalten. Die Pilotstudie, die mit zehn älteren Erwachsenen mit beginnender Demenz durchgeführt wurde, zeigte eine signifikante Steigerung ihrer Interaktionsfähigkeit mit diesem Gerät. Sie bewies ebenfalls den Nutzen von Regelungsaktionen, um die Komplexität des Trainings ständig neu anzupassen. Obwohl diese Studie die Durchführbarkeit des Trainings zeigte, waren Grundfläche und mechanische Stabilität des RoboTrainer-Prototyps suboptimal. Deswegen fokussiert sich der zweite Teil dieser Arbeit darauf, ein neues Gerät zu entwerfen, um die Nachteile des Prototyps zu beheben. Neben einer erhöhten mechanischen Stabilität, ermöglicht der RoboTrainer v2 eine Anpassung seiner Grundfläche. Dieses spezifische Merkmal der Smarten Rollatoren dient vor allem dazu, die Unterstützungsfläche für den Benutzer anzupassen. Das ermöglicht einerseits ein agiles Training mit gesunden Personen und andererseits Rehabilitations-Szenarien bei Menschen, die körperliche Unterstützung benötigen. Der Regelungsansatz für den RoboTrainer v2 erweitert den Admittanzregler des Prototypen durch drei adaptive Strategien. Die erste ist die Anpassung der Sensitivität an die Eingabe des Nutzers, abhängig von der Stabilität des Nutzer-Rollater-Systems, welche Schwankungen verhindert, die dann passieren können, wenn die Hände des Nutzers versteifen. Die zweite Anpassung beinhaltet eine neuartige nicht-lineare, geschwindigkeits-basierende Änderung der Admittanz-Parameter, um die Wendigkeit des Rollators zu erhöhen. Die dritte Anpassung erfolgt vor dem eigentlichen Training in einem Parametrierungsprozess, wo nutzereigene Interaktionskräfte gemessen werden, um individuelle Reglerkonstanten fein abzustimmen und zu berechnen. Die Regelungsaktionen sind Verhaltensänderungen des Gerätes, die als Bausteine für unterstützende und herausfordernde Trainingseinheiten mit dem RoboTrainer dienen. Sie nutzen das virtuelle Kraft-Feld-Konzept, um die Bewegung des Gerätes in der Trainingsumgebung zu beeinflussen. Die Bewegung des RoboTrainers wird in der Gesamtumgebung durch globale oder, in bestimmten Teilbereichen, durch räumliche Aktionen beeinflusst. Die Regelungsaktionen erhalten die Absicht des Nutzers aufrecht, in dem sie eine unabhängige Admittanzdynamik implementieren, um deren Einfluss auf die Geschwindigkeit des RoboTrainers zu berechnen. Dies ermöglicht die entscheidende Trennung von Reglerzuständen, um während des Trainings passive und sichere Interaktionen mit dem Gerät zu erreichen. Die oben genannten Beiträge wurden getrennt ausgewertet und in zwei Studien mit jeweils 22 bzw. 13 jungen, gesunden Erwachsenen untersucht. Diese Studien ermöglichen einen umfassenden Einblick in die Zusammenhänge zwischen unterschiedlichen Funktionalitäten und deren Einfluss auf die Nutzer. Sie bestätigen den gesamten Ansatz, sowie die gemachten Vermutungen im Hinblick auf die Gestaltung einzelner Teile dieser Arbeit. Die Einzelergebnisse dieser Arbeit resultieren in einem neuartigen Forschungsgerät für physische Mensch-Roboter-Interaktionen während des Trainings mit Erwachsenen. Zukünftige Forschungen mit dem RoboTrainer ebnen den Weg für Smarte Rollatoren als Hilfe für die Gesellschaft im Hinblick auf den bevorstehenden demographischen Wandel