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

Design and Evaluation of the LOPES Exoskeleton Robot for Interactive Gait Rehabilitation

This paper introduces a newly developed gait rehabilitation device. The device, called LOPES, combines a freely translatable and 2-D-actuated pelvis segment with a leg exoskeleton containing three actuated rotational joints: two at the hip and one at the knee. The joints are impedance controlled to allow bidirectional mechanical interaction between the robot and the training subject. Evaluation measurements show that the device allows both a "pa- tient-in-charge" and "robot-in-charge" mode, in which the robot is controlled either to follow or to guide a patient, respectively. Electromyography (EMG) measurements (one subject) on eight important leg muscles, show that free walking in the device strongly resembles free treadmill walking; an indication that the device can offer task-specific gait training. The possibilities and limitations to using the device as gait measurement tool are also shown at the moment position measurements are not accurate enough for inverse-dynamical gait analysis

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

Empowering and assisting natural human mobility: The simbiosis walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staf