Towards compliant and wearable robotic orthoses: A review of current and emerging actuator technologies

Robotic orthoses, or exoskeletons, have the potential to provide effective rehabilitation while overcoming the availability and cost constraints of therapists. However, current orthosis actuation systems use components designed for industrial applications, not specifically for interacting with humans. This can limit orthoses' capabilities and, if their users’ needs are not adequately considered, contribute to their abandonment. Here, a user centered review is presented on: requirements for orthosis actuators; the electric, hydraulic, and pneumatic actuators currently used in orthoses and their advantages and limitations; the potential of new actuator technologies, including smart materials, to actuate orthoses; and the future of orthosis actuator research

The smart Peano fluidic muscle: A low profile flexible orthosis actuator that feels pain

Robotic orthoses have the potential to provide effective rehabilitation while overcoming the availability and cost constraints of therapists. These orthoses must be characterized by the naturally safe, reliable, and controlled motion of a human therapist's muscles. Such characteristics are only possible in the natural kingdom through the pain sensing realized by the interaction of an intelligent nervous system and muscles' embedded sensing organs. McKibben fluidic muscles or pneumatic muscle actuators (PMAs) are a popular orthosis actuator because of their inherent compliance, high force, and muscle-like load-displacement characteristics. However, the circular cross-section of PMA increases their profile. PMA are also notoriously unreliable and difficult to control, lacking the intelligent pain sensing systems of their biological muscle counterparts. Here the Peano fluidic muscle, a new low profile yet high-force soft actuator is introduced. This muscle is smart, featuring bioinspired embedded pressure and soft capacitive strain sensors. Given this pressure and strain feedback, experimental validation shows that a lumped parameter model based on the muscle geometry and material parameters can be used to predict its force for quasistatic motion with an average error of 10 - 15N. Combining this with a force threshold pain sensing algorithm sets a precedent for flexible orthosis actuation that uses embedded sensors to prevent damage to the actuator and its environment

Modeling the Peano fluidic muscle and the effects of its material properties on its static and dynamic behavior

The promise of wearable assistive robotics cannot be realized without the development of actuators that mimic the behavior and form of biological muscles. Planar fluidic muscles known as Peano muscles or pouch motors have the potential to provide the high force and compliance of McKibben pneumatic artificial muscles with the low threshold pressure of pleated pneumatic artificial muscles. Yet they do so in a soft and slim form that can be discreetly distributed over the human body. This work is an investigation into the empirical modeling of the Peano muscle, the effect of its material on its performance, and its capabilities and limitations. We discovered that the Peano muscle could provide responsive and discreet actuation of soft and rigid bodies requiring strains between 15% and 30%. Ideally, they are made of non-viscoelastic materials with high tensile and low bending stiffnesses. While Sarosi et al's empirical model accurately captures its static behavior with an root mean square error of 10.2 N, their dynamic model overestimates oscillation frequency and damping. We propose that the Peano muscle be modeled by a parallel ideal contractile unit and viscoelastic element, both in series with another viscoelastic element

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research