Development and Biomechanical Analysis toward a Mechanically Passive Wearable Shoulder Exoskeleton

Shoulder disability is a prevalent health issue associated with various orthopedic and neurological conditions, like rotator cuff tear and peripheral nerve injury. Many individuals with shoulder disability experience mild to moderate impairment and struggle with elevating the shoulder or holding the arm against gravity. To address this clinical need, I have focused my research on developing wearable passive exoskeletons that provide continuous at-home movement assistance. Through a combination of experiments and computational tools, I aim to optimize the design of these exoskeletons. In pursuit of this goal, I have designed, fabricated, and preliminarily evaluated a wearable, passive, cam-driven shoulder exoskeleton prototype. Notably, the exoskeleton features a modular spring-cam-wheel module, allowing customizable assistive force to compensate for different proportions of the shoulder elevation moment due to gravity. The results of my research demonstrated that this exoskeleton, providing modest one-fourth gravity moment compensation at the shoulder, can effectively reduce muscle activity, including deltoid and rotator cuff muscles. One crucial aspect of passive shoulder exoskeleton design is determining the optimal anti-gravity assistance level. I have addressed this challenge using computational tools and found that an assistance level within the range of 20-30% of the maximum gravity torque at the shoulder joint yields superior performance for specific shoulder functional tasks. When facing a new task dynamic, such as wearing a passive shoulder exoskeleton, the human neuro-musculoskeletal system adapts and modulates limb impedance at the end-limb (i.e., hand) to enhance task stability. I have presented development and validation of a realistic neuromusculoskeletal model of the upper limb that can predict stiffness modulation and motor adaptation in response to newly introduced environments and force fields. Future studies will explore the model\u27s applicability in predicting stiffness modulation for 3D movements in novel environments, such as passive assistive devices\u27 force fields

Development of a Wearable Mechatronic Elbow Brace for Postoperative Motion Rehabilitation

This thesis describes the development of a wearable mechatronic brace for upper limb rehabilitation that can be used at any stage of motion training after surgical reconstruction of brachial plexus nerves. The results of the mechanical design and the work completed towards finding the best torque transmission system are presented herein. As part of this mechatronic system, a customized control system was designed, tested and modified. The control strategy was improved by replacing a PID controller with a cascade controller. Although the experiments have shown that the proposed device can be successfully used for muscle training, further assessment of the device, with the help of data from the patients with brachial plexus injury (BPI), is required to improve the control strategy. Unique features of this device include the combination of adjustability and modularity, as well as the passive adjustment required to compensate for the carrying angle

Otimização muscle-in-the-loop em tempo real para reabilitação física com um exosqueleto ativo: uma mudança de paradigma

Assisting human locomotion with a wearable robotic orthosis is still quite challenging, largely due to the complexity of the neuromusculoskeletal system, the time-varying dynamics that accompany motor adaptation, and the uniqueness of every individual’s response to the assistance given by the robot. To this day, these devices have not met their well-known promise yet, mostly due to the fact that they are not perfectly suitable for the rehabilitation of neuropathologic patients. One of the main challenges hampering this goal still relies on the interface and co-dependency between the human and the machine. Nowadays, most commercial exoskeletons replay pre-defined gait patterns, whereas research exoskeletons are switching to controllers based on optimized torque profiles. In most cases, the dynamics of the human musculoskeletal system are still ignored and do not take into account the optimal conditions for inducing a positive modulation of neuromuscular activity. This is because both rehabilitation strategies are still emphasized on the macro level of the whole joint instead of focusing on the muscles’ dynamics and activity, which are the actual anatomical elements that may need to be rehabilitated. Strategies to keep the human in the loop of the exoskeleton’s control laws in real-time may help to overcome these challenges. The main purpose of the present dissertation is to make a paradigm shift in the approach on how the assistance that is given to a subject by an exoskeleton is modelled and controlled during physical rehabilitation. Therefore, in the scope of the present work, it was intended to design, concede, implement, and validate a real-time muscle-in-the-loop optimization model to find the best assistive support ratio that would induce optimal rehabilitation conditions to a specific group of impaired muscles while having a minimum impact on the other healthy muscles. The developed optimization model was implemented in the form of a plugin and was integrated on a neuromechanical model-based interface for driving a bilateral ankle exoskeleton. Experimental pilot tests evaluated the feasibility and effectiveness of the model. Results of the most significant pilots achieved EMG reductions up to 61 ± 3 % in Soleus and 41 ± 10 % in Gastrocnemius Lateralis. Moreover, results also demonstrated the efficiency of the optimization’s specific reduction on rehabilitation by looking into the muscular fatigue after each experiment. Finally, two parallel preliminary studies emerged from the pilots, which looked at muscle adaptation, after a new assistive condition had been applied, over time and at the effect of the lateral positioning of the exoskeleton’s actuators on the leg muscles.Auxiliar a locomoção humana com uma ortose robótica ainda é bastante desafiante, em grande parte devido à complexidade do sistema neuromusculoesquelético, à dinâmica variável no tempo que acompanha a adaptação motora e à singularidade da resposta de cada indivíduo à assistência dada pelo robô. Até hoje, está por cumprir a promessa inicial destes dispositivos, principalmente devido ao facto de não serem perfeitamente adequados para a reabilitação de pacientes neuropatológicos. Um dos principais desafios que dificultam esse objetivo foca-se ainda na interface e na co-dependência entre o ser humano e a máquina. Hoje em dia, a maioria dos exoesqueletos comerciais reproduz padrões de marcha predefinidos, enquanto que os exoesqueletos em investigação estão só agora a mudar para controladores com base em perfis de binário otimizados. Na maioria dos casos, a dinâmica do sistema musculoesquelético humano ainda é ignorada e não tem em consideração as condições ideais para induzir uma modulação positiva da atividade neuromuscular. Isso ocorre porque ambas as estratégias de reabilitação ainda são enfatizadas no nível macro de toda a articulação, em vez de se concentrar na dinâmica e atividade dos músculos, que são os elementos anatómicos que realmente precisam de ser reabilitados. Estratégias para manter o ser humano em loop nos comandos que controlam o exoesqueleto em tempo real podem ajudar a superar estes desafios. O principal objetivo desta dissertação é fazer uma mudança de paradigma na abordagem em como a assistência que é dada a um sujeito por um exosqueleto é modelada e controlada durante a reabilitação física. Portanto, no contexto do presente trabalho, pretendeu-se projetar, conceder, implementar e validar um modelo de otimização muscle-in-the-loop em tempo real para encontrar a melhor relação de suporte capaz de induzir as condições ideais de reabilitação para um grupo específico de músculos fragilizados, tendo um impacto mínimo nos outros músculos saudáveis. O modelo de otimização desenvolvido foi implementado na forma de um plugin e foi integrado numa interface baseada num modelo neuromecânico para o controlo de um exoesqueleto bilateral de tornozelo. Testes experimentais piloto avaliaram a viabilidade e a eficácia do modelo. Os resultados dos testes mais significativos demonstraram reduções de EMG de até 61 ± 3 % no Soleus e 41 ± 10 % no Gastrocnemius Lateral. Adicionalmente, os resultados demonstraram também a eficiência em reabilitação da redução específica no EMG devido à otimização tendo em conta a fadiga muscular após cada teste. Finalmente, dois estudos preliminares paralelos emergiram dos testes piloto, que analisaram a adaptação muscular após uma nova condição assistiva ter sido definida ao longo do tempo e o efeito do posicionamento lateral dos atuadores do exoesqueleto nos músculos da perna.Mestrado em Engenharia Biomédic

Comparative study of actuation systems for portable upper limb exoskeletons.

During the last two decades, a large variety of upper limb exoskeletons have been developed. Out of these, majority are platform based systems which might be the reason for not being widely adopted for post-stroke rehabilitation. Despite the potential benefits of platform-based exoskeletons as being rugged and reliable, stroke patients prefer to have a portable and user-friendly device that they can take home. However, the types of actuator as well as the actuation mechanism used in the exoskeleton are the inhibiting factors why portable exoskeletons are mostly non-existent for patient use. This paper presents a quantitative analysis of the actuation systems available for developing portable upper arm exoskeletons with their specifications. Finally, it has been concluded from this research that there are not many stand-alone arm exoskeletons which can provide all forms of rehabilitation, therefore, a generic solution has been proposed as the rehabilitation strategy to get best out of the portable arm exoskeletons

Elbow exoskeleton mechanism for multistage poststroke rehabilitation.

More than three million people are suffering from stroke in England. The process of post-stroke rehabilitation consists of a series of biomechanical exercises- controlled joint movement in acute phase; external assistance in the mid phase; and variable levels of resistance in the last phase. Post-stroke rehabilitation performed by physiotherapist has many limitations including cost, time, repeatability and intensity of exercises. Although a large variety of arm exoskeletons have been developed in the last two decades to substitute the conventional exercises provided by physiotherapist, most of these systems have limitations with structural configuration, sensory data acquisition and control architecture. It is still difficult to facilitate multistage post-stroke rehabilitation to patients sited around hospital bed without expert intervention. To support this, a framework for elbow exoskeleton has been developed that is portable and has the potential to offer all three types of exercises (external force, assistive and resistive) in a single structure. The design enhances torque to weight ratio compared to joint based actuation systems. The structural lengths of the exoskeleton are determined based on the mean anthropometric parameters of healthy users and the lengths of upperarm and forearm are determined to fit a wide range of users. The operation of the exoskeleton is divided into three regions where each type of exercise can be served in a specific way depending on the requirements of users. Electric motor provides power in the first region of operation whereas spring based assistive force is used in the second region and spring based resistive force is applied in the third region. This design concept provides an engineering solution of integrating three phases of post-stroke exercises in a single device. With this strategy, the energy source is only used in the first region to power the motor whereas the other two modes of exercise can work on the stored energy of springs. All these operations are controlled by a single motor and the maximum torque of the motor required is only 5 Nm. However, due to mechanical advantage, the exoskeleton can provide the joint torque up to 10 Nm. To remove the dependency on biosensor, the exoskeleton has been designed with a hardware-based mechanism that can provide assistive and resistive force. All exoskeleton components are integrated into a microcontroller-based circuit for measuring three joint parameters (angle, velocity and torque) and for controlling exercises. A user-friendly, multi-purpose graphical interface has been developed for participants to control the mode of exercise and it can be managed manually or in automatic mode. To validate the conceptual design, a prototype of the exoskeleton has been developed and it has been tested with healthy subjects. The generated assistive torque can be varied up to 0.037 Nm whereas resistive torque can be varied up to 0.057 Nm. The mass of the exoskeleton is approximately 1.8 kg. Two comparative studies have been performed to assess the measurement accuracy of the exoskeleton. In the first study, data collected from two healthy participants after using the exoskeleton and Kinect sensor by keeping Kinect sensor as reference. The mean measurement errors in joint angle are within 5.18 % for participant 1 and 1.66% for participant 2; the errors in torque measurement are within 8.48% and 7.93% respectively. In the next study, the repeatability of joint measurement by exoskeleton is analysed. The exoskeleton has been used by three healthy users in two rotation cycles. It shows a strong correction (correlation coefficient: 0.99) between two consecutive joint angle measurements and standard deviation is calculated to determine the error margin which comes under acceptable range (maximum: 8.897). The research embodied in this thesis presents a design framework of a portable exoskeleton model for providing three modes of exercises, which could provide a potential solution for all stages of post- stroke rehabilitation

Advances of Italian Machine Design

This 2028 Special Issue presents recent developments and achievements in the field of Mechanism and Machine Science coming from the Italian community with international collaborations and ranging from theoretical contributions to experimental and practical applications. It contains selected contributions that were accepted for presentation at the Second International Conference of IFToMM Italy, IFIT2018, that has been held in Cassino on 29 and 30 November 2018. This IFIT conference is the second event of a series that was established in 2016 by IFToMM Italy in Vicenza. IFIT was established to bring together researchers, industry professionals and students, from the Italian and the international community in an intimate, collegial and stimulating environment