Advances on mechanical designs for assistive ankle-foot orthoses

Assistive ankle-foot orthoses (AFOs) are powerful solutions to assist or rehabilitate gait on humans. Existing assistive AFO technologies include passive, quasi-passive, and active principles to provide assistance to the users, and their mechanical configuration and control depend on the eventual support they aim for within the gait pattern. In this research we analyze the state-of-the-art of assistive AFOs and classify the different approaches into clusters, describing their basis and working principles. Additionally, we reviewed the purpose and experimental validation of the devices, providing the reader with a better view of the technology readiness level. Finally, the reviewed designs, limitations, and future steps in the field are summarized and discussed.Comment: Figures appear at the end. Article submitted to Frontiers in Bioengineering and Biotechnology (currently under review

Design of an Elastic Actuation System for a Gait-Assistive Active Orthosis for Incomplete Spinal Cord Injured Subjects

A spinal cord injury severely reduces the quality of life of affected people. Following the injury, limitations of the ability to move may occur due to the disruption of the motor and sensory functions of the nervous system depending on the severity of the lesion. An active stance-control knee-ankle-foot orthosis was developed and tested in earlier works to aid incomplete SCI subjects by increasing their mobility and independence. This thesis aims at the incorporation of elastic actuation into the active orthosis to utilise advantages of the compliant system regarding efficiency and human-robot interaction as well as the reproduction of the phyisological compliance of the human joints. Therefore, a model-based procedure is adapted to the design of an elastic actuation system for a gait-assisitve active orthosis. A determination of the optimal structure and parameters is undertaken via optimisation of models representing compliant actuators with increasing level of detail. The minimisation of the energy calculated from the positive amount of power or from the absolute power of the actuator generating one human-like gait cycle yields an optimal series stiffness, which is similar to the physiological stiffness of the human knee during the stance phase. Including efficiency factors for components, especially the consideration of the electric model of an electric motor yields additional information. A human-like gait cycle contains high torque and low velocities in the stance phase and lower torque combined with high velocities during the swing. Hence, the efficiency of an electric motor with a gear unit is only high in one of the phases. This yields a conceptual design of a series elastic actuator with locking of the actuator position during the stance phase. The locked position combined with the series compliance allows a reproduction of the characteristics of the human gait cycle during the stance phase. Unlocking the actuator position for the swing phase enables the selection of an optimal gear ratio to maximise the recuperable energy. To evaluate the developed concept, a laboratory specimen based on an electric motor, a harmonic drive gearbox, a torsional series spring and an electromagnetic brake is designed and appropriate components are selected. A control strategy, based on impedance control, is investigated and extended with a finite state machine to activate the locking mechanism. The control scheme and the laboratory specimen are implemented at a test bench, modelling the foot and shank as a pendulum articulated at the knee. An identification of parameters yields high and nonlinear friction as a problem of the system, which reduces the energy efficiency of the system and requires appropriate compensation. A comparison between direct and elastic actuation shows similar results for both systems at the test bench, showing that the increased complexity due to the second degree of freedom and the elastic behaviour of the actuator is treated properly. The final proof of concept requires the implementation at the active orthosis to emulate uncertainties and variations occurring during the human gait

Development of Walk Assistive Orthoses for Elderly

The proportion of elderly people is rapidly growing and the resources to help them will soon be insufficient. An important difficulty faced by the seniors is locomotion. Among the conditions that may be responsible for gait impairment, the reduced muscular force is one of the most frequent in elderly. This thesis focuses on the design and the evaluation of new solutions for assisting people with reduced vigor. Robotic orthoses are then used to support critical movements required for walking. Over the last two decades, the use of actuated orthotic devices for helping people suffering from gait disorders has been made possible. Recently, autonomous devices have even enabled spinal cord injured patients to walk again by mobilizing their paralyzed limbs. Addressing a completely different population, similar devices have been developed to augment healthy users' capabilities, for instance when heavy loads need to be carried. In this case, the wearer is in charge of the movements and the device simply follows the imposed trajectories. Extra load can then be carried by the exoskeleton without being felt by the user. The walk assistive devices developed as part of this thesis being intended for the elderly, they are at the intersection between these two classes of robotic orthosis. Indeed, most of the seniors who have difficulties to walk are able to move and therefore the mobilization devices are not adapted to them. Even though they need assistance, they surely do not want to have their movements imposed by a robotic device. The performance augmentation exoskeletons cannot help them either, as they simply follow the movements and only reject the external perturbations. A device that follows their movements and that adds the right amount of force when needed is therefore required. In order to achieve the demanding characteristics associated with assistive devices, new actuation solutions based on conventional electric motors are proposed. The combination of specifications in terms of overall weight, required assistance torque, dynamics capabilities or transparency when no support is provided is undeniably challenging. Various mechanisms are therefore presented to address these requirements. Two prototypes based on the proposed solutions are presented. The first one is based on a ball-screw transmission combined with linkages which provides a transmission ratio that is adapted to multiple walk related activities. The second one uses a transmission with clutches and an inversion mechanism which notably limits the losses due to the inertia of the actuation and greatly improves the natural transparency. In order to limit the obstructiveness of the assistive device, we propose to use partial devices that support specific movements. Two studies about the influence of such partial devices on gait are therefore presented. The first one focuses on identifying the potential sources of gait disturbance that orthotic device can induce. The second examines the effects of an assistive controller implemented on one of the developed prototypes. These studies demonstrate that even though the passive influence of a hip assistive orthosis on kinematic patterns is limited, the metabolic cost is increased. A moderate assistance cannot compensate for this undesirable effect but a link between the hip assistance and the ankle trajectory could be established. This is of major importance as the elderly tend to compensate for their weak ankle muscles with their hips

Design of a wearable active ankle-foot orthosis for both sides

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Biomateriais, Reabilitação e Biomecânica)Portugal is the west European country with the highest rate of stroke-related mortality, being that, of those who suffer cerebrovascular accidents, 40% feature an impairment which can manifest itself through motor sequelae, namely drop foot. An ankle-foot orthosis is often recommended to passively accommodate these motor problems; however, active/powered exoskeletons are also a suitable solution for post-stroke patients. Due to the high complexity of the human ankle joint, one of the problems regarding these active devices is the misalignment occurring between the rehabilitation device and the human joint, which is a cause of parasitic forces, discomfort, and pain. The present master dissertation proposes the development of an adjustable wearable active ankle-foot orthosis that is able to tackle this misalignment issue concerning commercially available lower limb orthotic devices. This work is integrated on the SmartOs – Smart, Stand-alone Active Orthotic System – project that proposes an innovative robotic technology (a wearable mobile lab) oriented to gait rehabilitation. The conceptual design of a standard version of the SmartOs wearable active orthosis was initiated with the analysis of another ankle-foot orthosis – Exo-H2 (Technaid) – from which the necessary design changes were implemented, aiming at the improvement of the established device. In order to achieve a conceptual solution, both the practical knowledge of the Orthos XXI design team and several design methods were used to ensure the accomplishment of the defined requirements. The detailed design process of the standard SmartOs wearable active orthosis prototype is disclosed. With the purpose of validating the design, the critical components were simulated with the resources available in SolidWorks®, and the necessary CAD model’s adaptations were implemented to guarantee a reliable and safe design. The presented design is currently set for further production in Orthos XXI, followed by the mandatory mechanical tests.Portugal é o país da Europa ocidental com maior taxa de mortalidade por acidente vascular cerebral (AVC), sendo que, dos que sofrem acidentes vasculares cerebrais, 40% apresentam uma deficiência que pode manifestar-se por sequelas motoras, nomeadamente o pé pendente. Uma ortótese do tornozelo é recomendada frequentemente para acomodar passivamente esses problemas motores; no entanto, exoesqueletos ativos são também uma solução adequada para pacientes pós-AVC. Devido à alta complexidade da articulação do tornozelo humano, um dos problemas associados a esses dispositivos ativos é o desalinhamento que ocorre entre o dispositivo de reabilitação e a articulação humana, que é uma causa de forças parasitas, desconforto e dor. A presente dissertação de mestrado propõe o desenvolvimento de uma ortótese ativa do tornozelo ajustável e vestível, que seja capaz de resolver esse problema de desalinhamento relativo aos dispositivos ortóticos de membros inferiores disponíveis comercialmente. Este trabalho está integrado no projeto SmartOs - Smart, Stand-alone Active Orthotic System - projeto que propõe uma tecnologia robótica inovadora (wearable mobile lab) direcionada para a reabilitação da marcha. O projeto conceptual de uma versão padrão da ortótese ativa vestível do projeto SmartOs foi iniciado com a análise de outra ortótese do tornozelo – Exo-H2 (Technaid) - a partir da qual foram implementadas as alterações de projeto necessárias, visando o aprimoramento do dispositivo estabelecido. Para se chegar a uma solução conceptual, tanto o conhecimento prático da equipa de projeto da Orthos XXI como os diversos métodos de projeto foram utilizados para garantir o cumprimento dos requisitos definidos. O processo do desenho detalhado da versão padrão da ortótese ativa SmartOs será também divulgado. Com o objetivo de validar o projeto, os componentes críticos foram simulados com os recursos disponíveis no SolidWorks® e as adaptações necessárias do modelo CAD foram implementadas para garantir um projeto fidedigno e seguro. O projeto apresentado está atualmente em preparação para produção na empresa Orthos XXI, depois do qual se seguem os ensaios mecânicos obrigatórios

A Novel Design of a Cable-driven Active Leg Exoskeleton (C-ALEX) and Gait Training with Human Subjects

Exoskeletons for gait training commonly use a rigid-linked "skeleton" which makes them heavy and bulky. Cable-driven exoskeletons eliminate the rigid-linked skeleton structure, therefore creating a lighter and more transparent design. Current cable-driven leg exoskeletons are limited to gait assistance use. This thesis presented the Cable-driven Active Leg Exoskeleton (C-ALEX) designed for gait retraining and rehabilitation. Benefited from the cable-driven design, C-ALEX has minimal weight and inertia (4.7 kg) and allows all the degrees-of-freedom (DoF) of the leg of the user. C-ALEX uses an assist-as-needed (AAN) controller to train the user to walk in a new gait pattern. A preliminary design of C-ALEX was first presented, and an experiment was done with this preliminary design to study the effectiveness of the AAN controller. The result on six healthy subjects showed that the subjects were able to follow a new gait pattern significantly more accurately with the help of the AAN controller. After this experiment, C-ALEX was redesigned to improve its functionality. The improved design of C-ALEX is lighter, has more DoFs and larger range-of-motion. The controller of the improved design improved the continuity of the generated cable tensions and added the function to estimate the phase of the gait of the user in real-time. With the improved design of C-ALEX, an experiment was performed to study the effect of the weight and inertia of an exoskeleton on the gait of the user. C-ALEX was used to simulate exoskeletons with different levels of weight and inertia by adding extra mass and change the weight compensation level. The result on ten subjects showed that adding extra mass increased step length and reduced knee flexion. Compensating the weight of the mass partially restored the knee flexion but not the step length, implying that the inertia of the mass is responsible for the change. This study showed the distinctive effect of weight and inertia on gait and demonstrated the benefit of a lightweight exoskeleton. C-ALEX was designed for gait training and rehabilitation, and its training effectiveness was studied in nine healthy subjects and a stroke patient. The healthy subjects trained with C-ALEX to walk in a new gait pattern with 30% increase in step height for 40 min. After the training, the subjects were able to closely repeat the trained gait pattern without C-ALEX, and the step height of the subjects increased significantly. A stroke patient also tested C-ALEX for 40 minutes and showed short-term improvements in step length, step height, and knee flexion after training. The result showed the effectiveness of C-ALEX in gait training and its potential to be used in stroke rehabilitation

The design, validation, and performance evaluation of an untethered ankle exoskeleton

Individuals with neuromuscular impairment from conditions like cerebral palsy face reduced quality of life due to diminishing mobility and independence. Lower-limb exoskeletons, particularly ankle exoskeletons, have potential to aid mobility in impaired populations and augment performance in unimpaired populations and have been extensively researched for the past decade. Few untethered ankle exoskeletons exist due to the difficulty of providing enough mechanical power to offset the weight of the exoskeleton on top of improving human biomechanics and metabolic efficiency. Short battery life is also an obstacle to widespread adoption of untethered ankle exoskeletons in the clinic and at home. In this work, we assess the efficacy of our prototype devices during over-ground walking, design new exoskeleton controllers, develop a new ankle exoskeleton device from the ground up, and evaluate the potential for parallel elasticity to improve the performance of our refined exoskeleton platform. In the first study, we observed that our ankle exoskeleton prototype improved metabolic economy, increased walking speed, and lowered plantarflexor muscle activity in a small cohort of individuals with cerebral palsy during over-ground walking – a significant obstacle to the adoption of exoskeletons in free-living settings. In the second study, we presented a framework for developing adaptive, torque sensor-less open-loop controllers that were competitive with our standard closed-loop controllers in mechanical terms while reducing motor energy consumption and noise. The shortcomings of our prototypes in the first and second chapters inspired a third study to develop new lightweight and modular ankle exoskeleton design with a significantly higher torque and power output and joint-level sensing that improved metabolic economy in both unimpaired and impaired cohorts – our device is the second ever to improve metabolic economy in unimpaired adults. We also presented the first-ever lower-limb exoskeleton usability study. In the final study, we use our new hardware platform to design, validate, and demonstrate that a simple parallel elastic element can significantly improve the performance and battery life of our device. Together, these studies establish our untethered ankle exoskeletons as effective and versatile tools for rehabilitation and human augmentation and support the continued research of exoskeletons in clinical and at-home settings