Evaluation of Physical Interaction during Walker-Assisted Gait with the AGoRA Walker: Strategies Based on Virtual Mechanical Stiffness

Smart walkers are commonly used as potential gait assistance devices, to provide physical and cognitive assistance within rehabilitation and clinical scenarios. To understand such rehabilitation processes, several biomechanical studies have been conducted to assess human gait with passive and active walkers. Several sessions were conducted with 11 healthy volunteers to assess three interaction strategies based on passive, low and high mechanical stiffness values on the AGoRA Smart Walker. The trials were carried out in a motion analysis laboratory. Kinematic data were also collected from the smart walker sensory interface. The interaction force between users and the device was recorded. The force required under passive and low stiffness modes was 56.66% and 67.48% smaller than the high stiffness mode, respectively. An increase of 17.03% for the hip range of motion, as well as the highest trunk’s inclination, were obtained under the resistive mode, suggesting a compensating motion to exert a higher impulse force on the device. Kinematic and physical interaction data suggested that the high stiffness mode significantly affected the users’ gait pattern. Results suggested that users compensated their kinematics, tilting their trunk and lower limbs to exert higher impulse forces on the device

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

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011–2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities

A Service Robot for Navigation Assistance and Physical Rehabilitation of Seniors

The population of the advanced countries is ageing, with the direct consequence that an increasing number of people will have to live with sensitive, cognitive and physical disabilities. People with impaired physical ability are not confident to move alone, especially in crowded environment and for long journeys, highly reducing the quality of their life. We propose a new generation of robotic walking assistants whose mechanical and electronic components are conceived to optimize the collaboration between the robot and its users. We will apply these general ideas to investigate the interaction between older adults and a robotic walker, named FriWalk, exploiting it either as a navigational or as a rehabilitation aid. For the use of the FriWalk as a navigation assistance, the system guides the user securing high levels of safety, a perfect compliance with the social rules and non-intrusive interaction between human and machine. To this purpose, we developed several guidance systems ranging from completely passive strategies to active solutions exploiting either the rear or the front motors mounted on the robot. The common strategy at the basis of all the algorithms is that the responsibility of the locomotion belongs always to the user, both to increase the mobility of elder users and to enhance their perception of control over the robot. This way the robot intervenes only whenever it is strictly necessary not to mitigate the user safety. Moreover, the robotic walker has been endowed with a tablet and graphical user interface (GUI) which provides the user with the visual indications about the path to follow. Since the FriWalk was developed to suit the needs of users with different deficits, we conducted extensive human-robot interaction (HRI) experiments with elders, complemented with direct interviews of the participants. As concerns the use of the FriWalk as a rehabilitation aid, force sensing to estimate the torques applied by the user and change the user perceived inertia can be exploited by doctors to let the user feel the device heavier or lighter. Moreover, thanks to a new generation of sensors, the device can be exploited in a clinical context to track the performance of the users' rehabilitation exercises, in order to assist nurses and doctors during the hospitalization of older adults

Wearable and BAN Sensors for Physical Rehabilitation and eHealth Architectures

The demographic shift of the population towards an increase in the number of elderly citizens, together with the sedentary lifestyle we are adopting, is reflected in the increasingly debilitated physical health of the population. The resulting physical impairments require rehabilitation therapies which may be assisted by the use of wearable sensors or body area network sensors (BANs). The use of novel technology for medical therapies can also contribute to reducing the costs in healthcare systems and decrease patient overflow in medical centers. Sensors are the primary enablers of any wearable medical device, with a central role in eHealth architectures. The accuracy of the acquired data depends on the sensors; hence, when considering wearable and BAN sensing integration, they must be proven to be accurate and reliable solutions. This book is a collection of works focusing on the current state-of-the-art of BANs and wearable sensing devices for physical rehabilitation of impaired or debilitated citizens. The manuscripts that compose this book report on the advances in the research related to different sensing technologies (optical or electronic) and body area network sensors (BANs), their design and implementation, advanced signal processing techniques, and the application of these technologies in areas such as physical rehabilitation, robotics, medical diagnostics, and therapy

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

Haptic interface based on tactile sensors for assistive devices

Tesis leída el 14 de febrero de 2018.Los países desarrollados deben hacer frente al creciente envejecimiento de su población. Un proceso de envejecimiento adecuado requiere capacidad funcional en las actividades del día a día. Así, las tecnologías de asistencia deben lidiar con uno de los principales problemas asociados con la edad: el deterioro de la movilidad. Los bastones y los andadores son prescritos para personas con movilidad reducida, pero aún con capacidad de andar. Sin embargo, hay un considerable número de personas en la tercera edad que necesitan otro tipo de ayuda. En este sentido, las sillas de ruedas eléctricas suponen un medio para el aumento de la participación y de la actividad de sus usuarios. Normalmente, estas sillas se conducen mediante un joystick alojado al final de uno de los reposabrazos. No obstante, este dispositivo no es adecuado para todo tipo de usuarios. Algunos de ellos lo encuentran difícil de usar y, para otros, su manejo no es posible y necesitan de la asistencia de otra persona (aquellos que padecen ciertas enfermedades del sistema nervioso, lesiones en la médula espinal, discapacidad mental, etc.). De esta manera, hay casos en que se requiere la ayuda de un cuidador que desplace la silla. Empujar una silla de ruedas de forma habitual produce distintos tipos de lesiones, por lo que es interesante que los asistentes o cuidadores también se beneficien de las ventajas de las sillas de ruedas eléctricas. En este caso, la solución más común consiste en otro joystick situado en la parte trasera de la silla. Como se ha apuntado anteriormente, este no es un dispositivo cómodo e intuitivo para muchos usuarios. Con respecto a la investigación, con frecuencia los dispositivos de asistencia propuestos basan su interfaz con el asistente en sensores de fuerza. Estos componentes son caros y suponen por tanto una barrera de cara a que el dispositivo llegue al mercado

State of the art of audio- and video based solutions for AAL

Working Group 3. Audio- and Video-based AAL ApplicationsIt is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living (AAL) technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters (e.g., heart rate, respiratory rate). Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals (e.g., speech recordings). Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary 4 debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely (i) lifelogging and self-monitoring, (ii) remote monitoring of vital signs, (iii) emotional state recognition, (iv) food intake monitoring, activity and behaviour recognition, (v) activity and personal assistance, (vi) gesture recognition, (vii) fall detection and prevention, (viii) mobility assessment and frailty recognition, and (ix) cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed.publishedVersio

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

Adaptive control for wearable robots in human-centered rehabilitation tasks

Robotic rehabilitation therapies have been improving by providing the needed assistance to the patient, in a human-centered environment, and also helping the therapist to choose the necessary procedure. This thesis presents an adaptive "Assistance-as-needed" strategy which adheres to the specific needs of the patient and with the inputs from the therapist, whenever needed. The exertion of assistive and responsive behavior of the lower limb wearable robot is dedicated for the rehabilitation of incomplete spinal cord injury (SCI) patients. The main objective is to propose and evaluate an adaptive control model on a wearable robot, assisting the user and adhering to their needs, with no or less combination of external devices. The adaptation must be more interactive to understand the user needs and their volitional orders. Similarly, by using the existing muscular strength, in incomplete SCI patients, as a motivation to pursue the movement and assist them, only when needed. The adaptive behavior of the wearable robot is proposed by monitoring the interaction and movement of the user. This adaptation is achieved by modulating the stiffness of the exoskeleton in function of joint parameters, such as positions and interaction torques. These joint parameters are measured from the user independently and then used to update the new stiffness value. The adaptive algorithm performs with no need of external sensors, making it simple in terms of usage. In terms of rehabilitation, it is also desirable to be compatible with combination of assistive devices such as muscle stimulation, neural activity (BMI) and body balance (Wii), to deliver a user friendly and effective therapy. Combination of two control approaches has been employed, to improve the efficiency of the adaptive control model and was evaluated using a wearable lower limb exoskeleton device, H1. The control approaches, Hierarchical and Task based approach have been used to assist the patient as needed and simultaneously motivate the patient to pursue the therapy. Hierarchical approach facilitates combination of multiple devices to deliver an effective therapy by categorizing the control architecture in two layers, Low level and High level control. Task-based approaches engage in each task individually and allow the possibility to combine them at any point of time. It is also necessary to provide an interaction based approach to ensure the complete involvement of the user and for an effective therapy. By means of this dissertation, a task based adaptive control is proposed, in function of human-orthosis interaction, which is applied on a hierarchical control scheme. This control scheme is employed in a wearable robot, with the intention to be applied or accommodated to different pathologies, with its adaptive capabilities. The adaptive control model for gait assistance provides a comprehensive solution through a single implementation: Adaptation inside a gait cycle, continuous support through gait training and in real time. The performance of this control model has been evaluated with healthy subjects, as a preliminary study, and with paraplegic patients. Results of the healthy subjects showed a significant change in the pattern of the interaction torques, elucidating a change in the effort and adaptation to the user movement. In case of patients, the adaptation showed a significant improvement in the joint performance (flexion/extension range) and change in interaction torques. The change in interaction torques (positive to negative) reflects the active participation of the patient, which also explained the adaptive performance. The patients also reported that the movement of the exoskeleton is flexible and the walking patterns were similar to their own distinct patterns. The presented work is performed as part of the project HYPER, funded by Ministerio de Ciencia y Innovación, Spain. (CSD2009 - 00067 CONSOLIDER INGENIOLas terapias de rehabilitación robóticas han sido mejoradas gracias a la inclusión de la asistencia bajo demanda, adaptada a las variaciones de las necesidades del paciente, así como a la inclusión de la ayuda al terapeuta en la elección del procedimiento necesario. Esta tesis presenta una estrategia adaptativa de asistencia bajo demanda, la cual se ajusta a las necesidades específicas del paciente junto a las aportaciones del terapeuta siempre que sea necesario. El esfuerzo del comportamiento asistencial y receptivo del robot personal portátil para extremidades inferiores está dedicado a la rehabilitación de pacientes con lesión de la médula espinal (LME) incompleta. El objetivo principal es proponer y evaluar un modelo de control adaptativo en un robot portátil, ayudando al usuario y cumpliendo con sus necesidades, en ausencia o con reducción de dispositivos externos. La adaptación debe ser más interactiva para entender las necesidades del usuario y sus intenciones u órdenes volitivas. De modo similar, usando la fuerza muscular existente (en pacientes con LME incompleta) como motivación para lograr el movimiento y asistirles solo cuando sea necesario. El comportamiento adaptativo del robot portátil se propone mediante la monitorización de la interacción y movimiento del usuario. Esta adaptación conjunta se consigue modulando la rigidez en función de los parámetros de la articulación, tales como posiciones y pares de torsión. Dichos parámetros se miden del usuario de forma independiente y posteriormente se usan para actualizar el nuevo valor de la rigidez. El desempeño del algoritmo adaptativo no requiere de sensores externos, lo que favorece la simplicidad de su uso. Para una adecuada rehabilitación, efectiva y accesible para el usuario, es necesaria la compatibilidad con diversos mecanismos de asistencia tales como estimulación muscular, actividad neuronal y equilibrio corporal. Para mejorar la eficiencia del modelo de control adaptativo se ha empleado una combinación de dos enfoques de control, y para su evaluación se ha utilizado un exoesqueleto robótico H1. Los enfoques de control Jerárquico y de Tarea se han utilizado para ayudar al usuario según sea necesario, y al mismo tiempo motivarle para continuar el tratamiento. Enfoque jerárquico facilita la combinación de múltiples dispositivos para ofrecer un tratamiento eficaz mediante la categorización de la arquitectura de control en dos niveles : el control de bajo nivel y de alto nivel. Los enfoques basados en tareas involucran a la persona en cada tarea individual, y ofrecen la posibilidad de combinarlas en cualquier momento. También es necesario proporcionar un enfoque basado en la interacción con el usuario, para asegurar su participación y lograr así una terapia eficaz. Mediante esta tesis, proponemos un control adaptativo basado en tareas y en función de la interacción persona-ortesis, que se aplica en un esquema de control jerárquico. Este esquema de control se emplea en un robot portátil, con la intención de ser aplicado o acomodado a diferentes patologías, con sus capacidades de adaptación. El modelo de control adaptativo propuesto proporciona una solución integral a través de una única aplicación: adaptación dentro de la marcha y apoyo continúo a través de ejercicios de movilidad en tiempo real. El rendimiento del modelo se ha evaluado en sujetos sanos según un estudio preliminar, y posteriormente también en pacientes parapléjicos. Los resultados en sujetos sanos mostraron un cambio significativo en el patrón de los pares de interacción, elucidando un cambio en la energía y la adaptación al movimiento del usuario. En el caso de los pacientes, la adaptación mostró una mejora significativa en la actuación conjunta (rango de flexión / extensión) y el cambio en pares de interacción. El cambio activo en pares de interacción (positivo a negativo) refleja la participación activa del paciente, lo que también explica el comportamiento adaptativo