A systematic review of study results reported for the evaluation of robotic rollators from the perspective of users

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: To evaluate the effectiveness and perception of robotic rollators (RRs) from the perspective of users. Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results. Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive. Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.Implications for Rehabilitation RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention. The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences. The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies. RRs seem generally to be perceived as positive by the users. There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices. Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs

Evaluation studies of robotic rollators by the user perspective: A systematic review

Background: Robotic rollators enhance the basic functions of established devices by technically advanced physical, cognitive, or sensory support to increase autonomy in persons with severe impairment. In the evaluation of such Ambient Assisted Living solutions, both the technical and user perspectives are important to prove usability, effectiveness, and safety, and to ensure adequate device application.Objective: The aim of this systematic review is to summarize the methodology of studies evaluating robotic rollators with focus on the user perspective and to give recommendations for future evaluation studies.Methods: A systematic literature search up to December 31, 2014 was conducted based on the Cochrane Review methodology using the electronic databases PubMed and IEEE Xplore. Articles were selected according to the following inclusion criteria: Evaluation studies of robotic rollators documenting human-robot interaction, no case reports, published in English language.Results: Twenty-eight studies were identified that met the predefined inclusion criteria. Large heterogeneity in the definitions of the target user group, study populations, study designs, and assessment methods was found across the included studies. No generic methodology to evaluate robotic rollators could be identified. We found major methodological shortcomings related to insufficient sample descriptions and sample sizes, and lack of appropriate, standardized and validated assessment methods. Long-term use in habitual environment was also not evaluated.Conclusions: Apart from the heterogeneity, methodological deficits in most of the identified studies became apparent. Recommendations for future evaluation studies include: clear definition of target user group, adequate selection of subjects, inclusion of other assistive mobility devices for comparison, evaluation of the habitual use of advanced prototypes, adequate assessment strategy with established, standardized and validated methods, and statistical analysis of study results. Assessment strategies may additionally focus on specific functionalities of the robotic rollators allowing an individually tailored assessment of innovative features to document their added value

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

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

Design and Evaluation of Pediatric Gait Rehabilitation Robots

Gait therapy methodologies were studied and analyzed for their potential for pediatric patients. Using data from heel, metatarsal, and toe trajectories, a nominal gait trajectory was determined using Fourier transforms for each foot point. These average trajectories were used as a basis of evaluating each gait therapy mechanism. An existing gait therapy device (called ICARE) previously designed by researchers, including engineers at the University of Nebraska-Lincoln, was redesigned to accommodate pediatric patients. Unlike many existing designs, the pediatric ICARE did not over- or under-constrain the patient’s leg, allowing for repeated, comfortable, easily-adjusted gait motions. This design was assessed under clinical testing and deemed to be acceptable. A gait rehabilitation device was designed to interface with both pediatric and adult patients and more closely replicate the gait-like metatarsal trajectory compared to an elliptical machine. To accomplish this task, the nominal gait path was adjusted to accommodate for rotation about the toe, which generated a new trajectory that was tangent to itself at the midpoint of the stride. Using knowledge of the bio-mechanics of the foot, the gait path was analyzed for its applicability to the general population. Several trajectory-replication methods were evaluated, and the crank-slider mechanism was chosen for its superior performance and ability to mimic the gait path adequately. Adjustments were made to the gait path to further optimize its realization through the crank-slider mechanism. Two prototypes were constructed according to the slider-crank mechanism to replicate the gait path identified. The first prototype, while more accurately tracing the gait path, showed difficulty in power transmission and excessive cam forces. This prototype was ultimately rejected. The second prototype was significantly more robust. However, it lacked several key aspects of the original design that were important to matching the design goals. Ultimately, the second prototype was recommended for further work in gait-replication research. Advisor: Carl A. Nelso

Design of actuation system and minimization of sensor configuration for gait event detection for Gen 3.0 Portable Powered Ankle-Foot Orthosis (PPAFO)

Powered ankle-foot orthoses (AFOs), which are capable of providing assistive torque at the ankle joint, have significant potential as both assistance and rehabilitation devices. Technology advancements have led to great progression in the development of powered AFOs. Our group had developed the Portable Powered Ankle-Foot Orthosis (PPAFO) that was capable of providing bidirectional assistive torque at the ankle joint. Two generations of the PPAFO were previously developed. Both designs used two different off-the-shelf rotary actuators. This thesis consists of two studies focusing on the development of a new compact higher torque actuation system and the identification of a minimum sensor configuration for gait event detection for a powered AFO. Study 1 presents the design and evaluation of a new actuation system for the PPAFO (Generation 3.0). The actuation system utilized two dual-action linear actuators and a customized gear train. Compared with the previous designs, it generated higher torque and power while providing a thinner lateral profile. The new design had a total weight of (680g) and was capable of generating 32 Nm torque and 110 W power. While running under the same torque and power level as the previous designs, the new design offered better longevity (42.9% and 81.4% increases in normalized run time for test bench emulation and treadmill walking). Although the overall weight of the new actuation system had a 20% increase compared with previous design, it could generate 166.7% more torque and 120% more power, which will enable us to test the system at various torque and power settings. Study 2 investigated the minimum sensor configuration for detecting gait events. Knowledge of the expected orientation and behavior of a limb as related to specific events during the gait cycle (or state timing as a function of the percentage of the gait cycle, % GC) is essential to allow appropriate control of a powered AFO. A total of five sensors were selected (two force sensitive sensors, one ankle angle sensor, and two inertial measurement units (IMU)). The performances of selected sensor configurations were quantified and compared through state-based and event-based approaches in terms of gait state estimation and gait event detection timing, respectively. Gait data were collected from five healthy subjects while walking on a treadmill wearing the Gen 3.0 PPAFO. Results indicated that, while single IMU configurations (located on the shank or foot) both outperformed all other configurations (mean state estimation error: < 2% GC; mean event detection timing error: < 23 ms), the shank IMU was able to detect more gait events than the foot IMU. Since more detectable events could improve the system's robustness (i.e., adjusting to variable speeds) by updating estimation more frequently, a single shank IMU configuration was recommended for powered AFO applications

Designing LMPA-Based Smart Materials for Soft Robotics Applications

This doctoral research, Designing LMPA (Low Melting Point Alloy) Based Smart Materials for Soft Robotics Applications, includes the following topics: (1) Introduction; (2) Robust Bicontinuous Metal-Elastomer Foam Composites with Highly Tunable Mechanical Stiffness; (3) Actively Morphing Drone Wing Design Enabled by Smart Materials for Green Unmanned Aerial Vehicles; (4) Dynamically Tunable Friction via Subsurface Stiffness Modulation; (5) LMPA Wool Sponge Based Smart Materials with Tunable Electrical Conductivity and Tunable Mechanical Stiffness for Soft Robotics; and (6) Contributions and Future Work.Soft robots are developed to interact safely with environments. Smart composites with tunable properties have found use in many soft robotics applications including robotic manipulators, locomotors, and haptics. The purpose of this work is to develop new smart materials with tunable properties (most importantly, mechanical stiffness) upon external stimuli, and integrate these novel smart materials in relevant soft robots. Stiffness tunable composites developed in previous studies have many drawbacks. For example, there is not enough stiffness change, or they are not robust enough. Here, we explore soft robotic mechanisms integrating stiffness tunable materials and innovate smart materials as needed to develop better versions of such soft robotic mechanisms. First, we develop a bicontinuous metal-elastomer foam composites with highly tunable mechanical stiffness. Second, we design and fabricate an actively morphing drone wing enabled by this smart composite, which is used as smart joints in the drone wing. Third, we explore composite pad-like structures with dynamically tunable friction achieved via subsurface stiffness modulation (SSM). We demonstrate that when these composite structures are properly integrated into soft crawling robots, the differences in friction of the two ends of these robots through SSM can be used to generate translational locomotion for untethered crawling robots. Also, we further develop a new class of smart composite based on LMPA wool sponge with tunable electrical conductivity and tunable stiffness for soft robotics applications. The implications of these studies on novel smart materials design are also discussed

Studies on gait control using a portable pneumatically powered ankle-foot orthosis (PPAFO) during human walking

A powered ankle-foot orthosis (AFO) can be very useful for people with neuromuscular injury. Control of powered AFOs will be more efficient to provide assistance to individuals with lower limb muscle impairments if we can identify different gait events during walking. A walking or gait cycle can be divided into multiple phases and sub-phases by proper gait event detection, and these phases/sub-phases are associated with one of the three main functional tasks during the gait cycle: loading response, forward propulsion, and limb advancement. The gait cycle of one limb can also be characterized by examining the limb’s behavior over one stride, which can be quantified as 0% to 100% of a gait cycle (GC). One easy approach to identify gait events is by checking whether sensor signals go above/below a predetermined threshold. By estimation of a walker’s instantaneous state, as represented by a specific percentage of the gait cycle (from states 0 to 100, which correlate with 0% to 100% GC), we can efficiently detect the various gait events more accurately. Our Human Dynamics and Controls Laboratory previously developed the portable pneumatically powered ankle-foot orthosis (PPAFO), which was capable of providing torque in both plantarflexion and dorsiflexion directions at the ankle. There were three types of sensor attached with the PPAFO (two force sensitive resistors and an angle sensor). In this dissertation, three aspects of effective control strategies for the PPAFO have been proposed. In the first study, two improved and reliable state estimators (Modified Fractional Time (MFT) and Artificial Neural Network (ANN)) were proposed for identifying when the limb with the PPAFO was at a certain percentage of the gait cycle. A correct estimation of percentage of gait cycle will assist with detecting specific gait events more accurately. The performance of new estimators was compared to a previously developed Fractional Time state estimation technique. To control a powered AFO using these estimators, however, detection of proper actuation timing is necessary. In the second study, a supervised learning algorithm to classify the appropriate start timing for plantarflexor actuation was proposed. Proper actuation timing has only been addressed in the literature in terms of functional efficiency or metabolic cost during walking. In this study, we will explore identifying the plantarflexor actuation timing in terms of biomechanics outcomes of human walking using a machine learning based algorithm. The third study investigated the recognition of different gait modes encountered during walking. The actuation scheme plays a significant role in walking on level ground, stair descent or stair ascent modes. The wrong actuation scheme for a given mode can cause falls or trips. A gait mode recognition technique was developed for detecting these different modes by attaching an inertial measurement unit and using a classifier based on artificial neural networks. This new algorithm improves upon the current one step delay limitation found as a drawback of a previously developed technique. Overall, this dissertation focused on addressing some important issues related to control of powered AFO that ultimately will help to assist people wearing the device in daily life situations during walking. The proposed approaches and algorithms introduced in this dissertation showed very promising results that proved that these methods can successfully improve the control system of powered AFOs

Biological and biomimetic machine learning for automatic classification of human gait

Machine learning (ML) research has benefited from a deep understanding of biological mechanisms that have evolved to perform comparable tasks. Recent successes of ML models, superseding human performance in human perception based tasks has garnered interest in improving them further. However, the approach to improving ML models tends to be unstructured, particularly for the models that aim to mimic biology. This thesis proposes and applies a bidirectional learning paradigm to streamline the process of improving ML models’ performance in classification of a task, which humans are already adept at. The approach is validated taking human gait classification as the exemplar task. This paradigm possesses the additional benefit of investigating underlying mechanisms in human perception (HP) using the ML models. Assessment of several biomimetic (BM) and non-biomimetic (NBM) machine learning models on an intrinsic feature of gait, namely the gender of the walker, establishes a functional overlap in the perception of gait between HP and BM, selecting the Long-Short-Term-Memory (LSTM) architecture as the BM of choice for this study, when compared with other models such as support vector machines, decision trees and multi-layer perceptron models. Psychophysics and computational experiments are conducted to understand the overlap between human and machine models. The BM and HP derived from psychophysics experiments, share qualitatively similar profiles of gender classification accuracy across varying stimulus exposure durations. They also share the preference for motion-based cues over structural cues (BM=H>NBM). Further evaluation reveals a human-like expression of the inversion effect, a well-studied cognitive bias in HP that reduces the gender classification accuracy to 37% (p<0.05, chance at 50%) when exposed to inverted stimulus. Its expression in the BM supports the argument for learned rather than hard-wired mechanisms in HP. Particularly given the emergence of the effect in every BM, after training multiple randomly initialised BM models without prior anthropomorphic expectations of gait. The above aspects of HP, namely the preference for motion cues over structural cues and the lack of prior anthropomorphic expectations, were selected to improve BM performance. Representing gait explicitly as motion-based cues of a non-anthropomorphic, gender-neutral skeleton not only mitigates the inversion effect in BM, but also improves significantly the classification accuracy. In the case of gender classification of upright stimuli, mean accuracy improved by 6%, from 76% to 82% (F1,18 = 16, p<0.05). For inverted stimuli, mean accuracy improved by 45%, from 37% to 82% (F1,18 = 20, p<0.05). The model was further tested on a more challenging, extrinsic feature task; the classification of the emotional state of a walker. Emotions were visually induced in subjects through exposure to emotive or neutral images from the International Affective Picture System (IAPS) database. The classification accuracy of the BM was significantly above chance at 43% accuracy (p<0.05, chance at 33.3%). However, application of the proposed paradigm in further binary emotive state classification experiments, improved mean accuracy further by 23%, from 43% to 65% (F1,18 = 7.4, p<0.05) for the positive vs. neutral task. Results validate the proposed paradigm of concurrent bidirectional investigation of HP and BM for the classification of human gait, suggesting future applications for automating perceptual tasks for which the human brain and body has evolved