Design, implementation and control of an overground gait and balance trainer with an active pelvis-hip exoskeleton

Human locomotion is crucial for performing activities of daily living and any disability in gait causes a significant decrease in the quality of life. Gait rehabilitation therapy is imperative to improve adverse effects caused by such disabilities. Gait therapies are known to be more effective when they are intense, repetitive, and allow for active involvement of patients. Robotic devices excel in performing repetitive gait rehabilitation therapies as they can eliminate the physical burden of the therapist, enable safe and versatile training with increased intensity, while allowing quantitative measurements of patient progress. Gait therapies need to be applied to specific joints of patients such that the joints work in a coordinated and repetitious sequence to generate a natural gait pattern. Six determinants of gait pattern have been identified that lead to efficient locomotion and any irregularities in these determinants result in pathological gaits. Three of these six basic gait determinants include movements of the pelvic joint; therefore, an effective gait rehabilitation robot is expected to be capable of controlling the movements of the human pelvis. We present the design, implementation, control, and experimental verification of AssistOn-Gait, a robot-assisted trainer, for restoration and improvement of gait and balance of patients with disabilities affecting their lower extremities. In addition to overground gait and balance training, AssistOn-Gait can deliver pelvis-hip exercises aimed to correct compensatory movements arising from abnormal gait patterns, extending the type of therapies that can be administered using lower extremity exoskeletons. AssistOn-Gait features a modular design, consisting of an impedance controlled, self-aligning pelvis-hip exoskeleton, supported by a motion controlled holonomic mobile platform and a series-elastic body weight support system. The pelvis-hip exoskeleton possesses 7 active degrees of freedom to independently control the rotation of the each hip in the sagittal plane along with the pelvic rotation, the pelvic tilt, lateral pelvic displacement, and the pelvic displacements in the sagittal plane. The series elastic body weight support system can provide dynamic unloading to support a percentage of a patient's weight, while also compensating for the inertial forces caused by the vertical movements of the body. The holonomic mobile base can track the movements of patients on flat surfaces, allowing patients to walk naturally, start/stop motion, vary their speed, sidestep to maintain balance, and turn to change their walking direction. Each of these modules can be used independently or in combination with each other, to provide different configurations for overground and treadmill based training with and without dynamic body weight support. The pelvis-hip exoskeleton of AssistOn-Gait is constructed using two passively backdrivable planar parallel mechanisms connected to the patient with a custom harness, to enable both passive movements and independent active impedance control of the pelvis-hip complex. Furthermore, the exoskeleton is self-aligning; it can automatically adjust the center of rotation of its joint axes, enabling an ideal match between patient's hip rotation axes and the device axes in the sagittal plane. This feature not only guarantees ergonomy and comfort throughout the therapy, but also extends the usable range of motion for the hip joint. Moreover, this feature significantly shortens the setup time required to attach the patient to the exoskeleton. The exoskeleton can also be used to implement virtual constraints to ensure coordination and synchronization between various degrees of freedom of the pelvis-hip complex and to assist patients as-needed for natural gait cycles. The overall kinematics of AssistOn-Gait is redundant, as the exoskeleton module spans all the degrees of freedom covered by the mobile platform. Furthermore, the device features dual layer actuation, since the exoskeleton module is designed for force control with good transparency, while the mobile base is designed for motion control to carry the weight of the patient and the exoskeleton. The kinematically redundant dual layer actuation enables the mobile base of the system to be controlled using workspace centering control strategy without the need for any additional sensors, since the patient movements are readily measured by the exoskeleton module. The workspace centering controller ensures that the workspace limits of the exoskeleton module are not reached, decoupling the dynamics of the mobile base from the dynamics of the exoskeleton. Consequently, AssistOn-Gait possesses virtually unlimited workspace, while featuring the same output impedance and force rendering performance as its exoskeleton module. The mobile platform can also be used to generate virtual fixtures to guide patient movements. The ergonomy and useability of AssistOn-Gait have been tested with several human subject experiments. The experimental results verify that AssistOn-Gait can achieve the desired level of ergonomy and passive backdrivability, as the gait patterns with the device in zero impedance mode are shown not to significantly deviate from the natural gait of the subjects. Furthermore, virtual constraints and force-feedback assistance provided by AssistOn-Gait have been shown to be adequate to ensure repeatability of desired corrective gait patterns

Impact of Ear Occlusion on In-Ear Sounds Generated by Intra-oral Behaviors

We conducted a case study with one volunteer and a recording setup to detect sounds induced by the actions: jaw clenching, tooth grinding, reading, eating, and drinking. The setup consisted of two in-ear microphones, where the left ear was semi-occluded with a commercially available earpiece and the right ear was occluded with a mouldable silicon ear piece. Investigations in the time and frequency domains demonstrated that for behaviors such as eating, tooth grinding, and reading, sounds could be recorded with both sensors. For jaw clenching, however, occluding the ear with a mouldable piece was necessary to enable its detection. This can be attributed to the fact that the mouldable ear piece sealed the ear canal and isolated it from the environment, resulting in a detectable change in pressure. In conclusion, our work suggests that detecting behaviors such as eating, grinding, reading with a semi-occluded ear is possible, whereas, behaviors such as clenching require the complete occlusion of the ear if the activity should be easily detectable. Nevertheless, the latter approach may limit real-world applicability because it hinders the hearing capabilities.</p

Towards better assessment and training of kinematics in post-stroke gait therapy

Gait impairment is common following neurological injury such as stroke. Therapists train patients based on restoring healthy motions, or kinematics, but evidence for training proper kinematics is not well-established. Because the dosage of therapy has not been well quantified, it is unclear what aspects of gait therapy are important, but simply that more therapy is likely better. However, cost restrictions prevent such intensive therapy, incentivizing value-based care. Robotic gait trainers that repetitively train a specific kinematic walking motions can potentially ease the burden on therapists and allow greater patient throughput, improving the value of therapy. Still, the cost of these trainers is only affordable to the wealthiest clinics, leaving them unavailable to the vast majority of stroke survivors. The overall goal of my research is twofold: to show the role of kinematics in gait recovery following stroke, and how these kinematics can be trained in an economical manner. My first aim focuses on design of an affordable robotic gait trainer that can adapt to an individual’s healthy gait pattern. Such a device could make robotic gait training more accessible to new markets including resource-limited hospitals and even patients’ homes. My second aim presents development of an online algorithm for producing speed-dependent reference joint trajectories that can be used for general robotic gait training applications. The goals of my third and fourth aims investigate the importance of gait kinematics using a novel longitudinal cohort approach in subacute stroke patients. I quantified the dosage of therapy using a wearable motion capture to find correlates of functional recovery, defined as gait speed. I then questioned whether gait speed was sufficient to define gait recovery, taking an innovative look at how gait quality during this subacute period changes as gait function improves. I expect these aims will justify the importance of kinematics and suggest that wearable sensors can become a valuable tool for monitoring detailed kinematic motion, providing insight for more effective therapy regimens.Mechanical Engineerin

Switched Kinematic and Force Control for Lower-Limb Motorized Exoskeletons and Functional Electrical Stimulation

Millions of people experience movement deficits from neurological conditions (NCs) that impair their walking ability and leg function. Exercise-based rehabilitation procedures have shown the potential to facilitate neurological reorganization and functional recovery. Lower-limb powered exoskeletons and motorized ergometers have been combined with functional electrical stimulation (FES) to provide repetitive movement, partially reduce the burden of therapists, improve range of motion, and induce therapeutic benefits. FES evokes artificial muscles contractions and can improve muscle mass and strength, and bone density in people with NCs. Stationary cycling is recommended for individuals who cannot perform load-bearing activities or have increased risks of falling. Cycling has been demonstrated to impart physiological and cardiovascular benefits. Motorized FES-cycling combines an electric motor and electrical stimulation of lower-limb muscles to facilitate coordinated, long-duration exercise, while mitigating the inherent muscle fatigue due to FES. Lower-limb exoskeletons coupled with FES, also called neuroprostheses or hybrid exoskeletons, can facilitate continuous, repetitive motion to improve gait function and build muscle capacity. The human-robot interaction during rehabilitative cycling and walking yield a mix of discrete effects (i.e., foot impact, input switching to engage lower-limb muscles and electric motors, etc.) and continuous nonlinear, uncertain, time-varying dynamics. Switching control is necessary to allocate the control inputs to lower-limb muscle groups and electric motors involved during assisted cycling and walking. Kinematic tracking has been the primary control objective for devices that combine FES and electric motors. However, there are force interactions between the machine and the human during cycling and walking that motivate the design of torque-based controllers (i.e., exploit torque or force feedback) to shape the leg dynamics through controlling joint kinematics and kinetics. Technical challenges exist to develop closed-loop feedback control strategies that integrate kinematic and force feedback in the presence of switching and discontinuous effects. The motivation in this dissertation is to design, analyze and implement switching controllers for assisted cycling and walking leveraging kinematic and force feedback while guaranteeing the stability of the human-robot closed-loop system. In Chapter 1, the motivation to design closed-loop controllers for motorized FES-cycling and powered exoskeletons is described. A survey of closed-loop kinematic and force feedback control methods is also introduced related to the tracking objectives presented in the subsequent chapters of the dissertation. In Chapter 2, the dynamics models for walking and assisted cycling are described. First, a bipedal walking system model with switched dynamics is introduced to control a powered lower-limb exoskeleton. Then, a stationary FES-cycling model with nonlinear dynamics and switched control inputs is introduced based on published literature. The muscle stimulation pattern is defined based on the kinematic effectiveness of the rider, which depends on the crank angle. The experimental setup for lower-limb exoskeleton and FES-cycling are described. In Chapter 3, a hierarchical control strategy is developed to interface a cable-driven lower-limb exoskeleton. A two-layer control system is developed to adjust cable tensions and apply torque about the knee joint using a pair of electric motors that provide knee flexion and extension. The control design is segregated into a joint-level control loop and a low-level loop using feedback of the angular positions of the electric motors to mitigate cable slacking. A Lyapunov-based stability analysis is developed to ensure exponential tracking for both control objectives. Moreover, an average dwell time analysis computes an upper bound on the number of motor switches to preserve exponential tracking. Preliminary experimental results in an able-bodied individual are depicted. The developed control strategy is extended and applied to the control of both knee and hip joints in Chapter 4 for treadmill walking. In Chapter 4, a cable-driven lower-limb exoskeleton is integrated with FES for treadmill walking at a constant speed. A nonlinear robust controller is used to activate the quadriceps and hamstrings muscle groups via FES to achieve kinematic tracking about the knee joint. Moreover, electric motors adjust the knee joint stiffness throughout the gait cycle using an integral torque feedback controller. A Lyapunov-based stability analysis is developed to ensure exponential tracking of the kinematic and torque closed-loop error systems, while guaranteeing that the control input signals remain bounded. The developed controllers were tested in real-time walking experiments on a treadmill in three able-bodied individuals at two gait speeds. The experimental results demonstrate the feasibility of coupling a cable-driven exoskeleton with FES for treadmill walking using a switching-based control strategy and exploiting both kinematic and force feedback. In Chapter 5, input-output data is exploited using a finite-time algorithm to estimate the target desired torque leveraging an estimate of the active torque produced by muscles via FES. The convergence rate of the finite-time algorithm can be adjusted by tuning selectable parameters. To achieve cadence and torque tracking for FES-cycling, nonlinear robust tracking controllers are designed for muscles and motor. A Lyapunov-based stability analysis is developed to ensure exponential tracking of the closed-loop cadence error system and global uniformly ultimate bounded (GUUB) torque tracking. A discrete-time Lyapunov-based stability analysis leveraging a recent tool for finite-time systems is developed to ensure convergence and guarantee that the finite-time algorithm is Holder continuous. The developed tracking controllers for the muscles and electric motor and finite-time algorithm to compute the desired torque are implemented in real-time during cycling experiments in seven able-bodied individuals. Multiple cycling trials are implemented with different gain parameters of the finite-time torque algorithm to compare tracking performance for all participants. Chapter 6 highlights the contributions of the developed control methods and provides recommendations for future research extensions

Design Feasibility of an Active Ankle-Foot Stabilizer

Walking is the most common form of mobility in humans. For lower limb mobility impairments, a common treatment is to prescribe an ankle-foot orthosis (AFO) or brace, which is a passive device designed to resist undesired ankle-foot motion. Recent advances in actuator technology have led to the development of active AFOs (AAFOs). However, these devices are generally too bulky for everyday use and are limited to applications such as gait training for rehabilitation. The aim of this research was to investigate the feasibility of developing a novel Active Ankle-Foot Stabilizer (AAFS). The design criteria were mainly based on the strengths and limitations of existing AFOs. The sagittal plane functional requirements were determined using simulated gait data for elderly individuals and drop foot patients; however, it is intended that the device would be suitable for a wider range of disabilities including ankle sprains. A model of the foot was introduced to modify the moment of a deficient ankle where young healthy adult kinematics and kinetics were assumed. A moment deficit analysis was performed for different gait periods resulting in an AAFS model with two components: a linear rotational spring to modify the ankle joint rotational stiffness, and a torque source. The frontal plane functional requirements for the AAFS were modeled as a linear rotational spring which responded to particular gait events. A novel Variable Rotational Stiffness Actuator (VSRA) AFO was also investigated. It consisted of an actuated spring medial and lateral to the ankle to control sagittal plane ankle stiffness and a passive leafspring posterior to the ankle to control frontal plane ankle stiffness. Due to high forces and profile limitations, a spring and rotation actuator that satisfied the design criteria could not be developed, resulting in an infeasible design. Considering the high forces and moments required by the AAFS, a pneumatic approach was adopted. A novel Airbeam AFO, which consisted of a shank cuff and a foot plate to which airbeams were attached proximally and distally to the ankle, was examined. The joint rotational stiffness of the ankle would be controlled by the inflation of these individual cylindrical airbeams. To satisfy the functional requirements, the airbeam diameters and pressures were too large to meet the design criteria and were unrealistic for a portable device. Finally, a Pneumatic Sock AFO, which proved to best satisfy the functional requirements within the design criteria, was examined. The design consisted of an inner sock worn on the ankle, surrounded by anterior, posterior, medial, and lateral bladders which inflate against outer fabric shells. Although promising, the Pneumatic Sock AFO requires further investigation in regards to manufacturing and behaviour characterization before a functional prototype can be developed. Mechanical test methods to characterize the behaviour of the Pneumatic Sock AFO in the sagittal and frontal planes were developed including the control components required, the configuration of a test rig, and test procedures.1 yea

serial and parallel robotics: energy saving systems and rehabilitation devices

This thesis focuses on the design and discussion of robotic devices and their applications. Robotics is the branch of technology that deals with the design, construction, operation, and application of robots as well as computer systems for their control, sensory feedback, and information processing [1]. Nowadays, robotics has been an unprecedented increase in applications of industry, military, health, domestic service, exploration, commerce, etc. Different applications require robots with different structures and different functions. Robotics normally includes serial and parallel structures. To have contribution to two kinds of structures, this thesis consisting of two sections is devoted to the design and development of serial and parallel robotic structures, focused on applications in the two different fields: industry and health

Cable-driven robotic interface for lower limb neuromechanics identification.

This paper presents a versatile cable-driven robotic interface to investigate the single-joint joint neuromechanics of the hip, knee and ankle in the sagittal plane. This endpoint-based interface offers highly dynamic interaction and accurate position control (as is typically required for neuromechanics identification), and provides measurements of position, interaction force and EMG of leg muscles. It can be used with the subject upright, corresponding to a natural posture during walking or standing, and does not impose kinematic constraints on a joint, in contrast to existing interfaces. Mechanical evaluations demonstrated that the interface yields a rigidity above 500 N/m with low viscosity. Tests with a rigid dummy leg and linear springs show that it can identify the mechanical impedance of a limb accurately. A smooth perturbation is developed and tested with a human subject, which can be used to estimate the hip neuromechanics

Bioinspired robotic rehabilitation tool for lower limb motor learning after stroke

Mención Internacional en el título de doctorEsta tesis doctoral presenta, tras repasar la marcha humana, las principales patologíıas y condiciones que la afectan, y los distintos enfoques de rehabilitación con la correspondiente implicación neurofisiológica, el camino de investigación que desemboca en la herramienta robótica de rehabilitación y las terapias que se han desarrollado en el marco de los proyectos europeos BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills y HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients, y probado bajo el paraguas del proyecto europeo ASTONISH: Advancing Smart Optical Imaging and Sensing for Health y el proyecto nacional ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This doctoral thesis presents, after reviewing human gait, the main pathologies and conditions that affect it, and the different rehabilitation approaches with the corresponding neurophysiological implications, the research journey that leads to the development of the rehabilitation robotic tool, and the therapies that have been designed, within the framework of the European projects BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills and HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients and tested under the umbrella of the European project ASTONISH: Advancing Smart Optical Imaging and Sensing for Health and the national project ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This work has been carried out at the Neural Rehabilitation Group (NRG), Cajal Institute, Spanish National Research Council (CSIC). The research presented in this thesis has been funded by the Commission of the European Union under the BioMot project - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (Grant Agreement number IFP7-ICT - 611695); under HANK Project - European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients (Grant Agreements number H2020-EU.2. - PRIORITY ’Industrial leadership’ and H2020-EU.3. - PRIORITY ’Societal challenges’ - 699796); also under the ASTONISH Project - Advancing Smart Optical Imaging and Sensing for Health (Grant Agreement number H2020-EU.2.1.1.7. - ECSEL - 692470); with financial support of Spanish Ministry of Economy and Competitiveness (MINECO) under the ASSOCIATE project - A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury (Grant Agreement number 799158449-58449-45-514); and with grant RYC-2014-16613, also by Spanish Ministry of Economy and Competitiveness.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: Fernando Javier Brunetti Fernández.- Secretario: Dorin Sabin Copaci.- Vocal: Antonio Olivier