In the last decade, several exoskeletons for shoulder rehabilitation have been presented in the literature. Most of these devices focus on the shoulder complex and limit the normal mobility of the rest of the body, forcing the patient into a fixed standing or sitting position. Nevertheless, this severely limits the range of activities that can potentially be simulated during the rehabilitation, preventing the execution of occupational therapy which involves the execution of tasks based on activities of daily living (ADLs). These tasks involve different muscular groups and whole-body movements, such as, e.g., picking up objects from the ground. To enable whole-body functional rehabilitation, the challenge is to shift the paradigm of robotic rehabilitation towards machines that can enable wide workspaces and high mobility. In this perspective, here we present Float: an upper-limb exoskeleton designed to promote and accelerate the motor and functional recovery of the shoulder joint complex following post-traumatic or post-surgical injuries. Indeed, Float allows the patient to move freely in a very large workspace. The key component that enables this is a passive polyarticulated arm which supports the total exoskeleton weight and allows the patient to move freely in space, empowering rehabilitation through a deeper interaction with the surrounding environment. A characterization of the reachable workspace of both the exoskeleton and the polyarticulated passive arm is presented. These results support the conclusion that a patient wearing Float can perform a wide variety of ADLs without bearing its weight.

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A Gravity-Compensated Upper-Limb Exoskeleton for Functional Rehabilitation of the Shoulder Complex

Challenges and solutions for application and wider adoption of wearable robots

For decades, powered exoskeletons have been considered for possible employment in rehabilitation and personal use. Yet, these devices are still far from addressing the needs of users. Here, we introduce TWIN, a novel modular lower limb exoskeleton for personal use of spinal-cord injury (SCI) subjects. This system was designed according to a set of user requirements (lightweight and autonomous portability, quick and autonomous donning and setup, stability when standing/walking, cost effectiveness, long battery life, comfort, safety) which emerged during participatory investigations that organically involved patients, engineers, designers, physiatrists, and physical therapists from two major rehabilitation centers in Italy. As a result of this user-centered process, TWIN's design is based on a variety of small mechatronic modules which are meant to be easily assembled and donned on or off by the user in full autonomy. This paper presents the development of TWIN, an exoskeleton for personal use of SCI users, and the application of user-centered design methods that are typically adopted in medical device industry, for its development. We can state that this approach revealed to be extremely effective and insightful to direct and continuously adapt design goals and activities toward the addressment of user needs, which led to the development of an exoskeleton with modular mechatronics and novel lateral quick release systems. Additionally, this work includes the preliminary assessment of this exoskeleton, which involved healthy volunteers and a complete SCI patient. Tests validated the mechatronics of TWIN and emphasized its high potential in terms of system usability for its intended use. These tests followed procedures defined in existing standards in usability engineering and were part of the formative evaluation of TWIN as a premise to the summative evaluation of its usability as medical device.

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User-Centered Design and Development of the Modular TWIN Lower Limb Exoskeleton.

Lower-limb exoskeletons have been created for different healthcare needs, but no research has been done on developing a proper protocol for users to get accustomed to moving with one. The user manuals provided also do not include such instructions. A pre-test was conducted with the TWIN (IIT), which is a lower-limb exoskeleton made for persons with spinal cord injury. In the pre-test, two healthy, able-bodied graduate students indicated a need for a protocol that can better prepare able-bodied, first-time users to move with an exoskeleton. TWIN was used in this preliminary study and nine users were divided to receive a tutorial or no tutorial before walking with the exoskeleton. Due to COVID-19 regulations, the study could only be performed with healthy, young-to-middle-aged lab members that do not require walking support. The proposed protocol was evaluated with the System Usability Scale, NASA Raw Task Load Index, and two custom surveys. The members who received the tutorial found it easy to follow and helpful, but the tutorial seemed to come at a price of higher perceived mental and physical demands, which could stem from the longer testing duration and the need to constantly recall and apply the things learned from the tutorial. All results presented are preliminary, and it is recommended to include biomechanical analysis and conduct the experiment with more participants in the future. Nonetheless, this proof-of-concept study lays groundwork for future related studies and the protocol will be adjusted, applied, and validated to patients and geriatric users.

Preliminary Study on a Novel Protocol for Improving Familiarity with a Lower-Limb Robotic Exoskeleton in Able-Bodied, First-Time Users

AbstractA positive aging requires placing human changes due to healthy or pathological senescence at the center of gerontechnology design. A set of key solutions for accomplishing this goal is offered by neurotechnologies. These systems can monitor and interpret data related to the central and peripheral nervous systems for understanding the individual conditions, enabling the control and the adaptation of assistive and rehabilitative devices, influencing the nervous system itself and empowering mental processes. Focusing on non-invasive approaches (closer to real-world applications), this chapter describes how adopting these solutions can improve the daily life of seniors and help the translational study of the aging brain in real settings through approaches like the one of neuroergonomics. This manuscript also highlights the potential of neuro-gerontechnologies within emerging frameworks that could enable digital biomarker-based assessment and personalization features. In particular, pervasive solutions of Internet of Things and Minds (IoTM) can make everyday devices truly human-centered (and, in this case, senior-centered). Indeed, a network of systems interpreting a person’s will and needs defines a step-change to properly serve human beings according to their fragilities.KeywordsNeurotechnologyGerontechnologyHuman-Centered DesignPersonalizationInternet of ThingsDigital Health 

Neuro-Gerontechnologies: Applications and Opportunities

Since the uprising of new biomedical orthotic devices, exoskeletons have been put in the spotlight for their possible use in rehabilitation. Even if these products might share some commonalities among them in terms of overall structure, degrees of freedom and possible actions, they quite often differ in their approach on how to generate a feasible, stable and comfortable gait trajectory pattern. This paper introduces three proposed trajectories that were generated by using a basis function interpolation method and by working closely with two major rehabilitation centers in Italy. The whole procedure has been focused on the concepts of a configurable walk for patients that suffer from spinal cord injuries. We tested the solutions on a group of healthy volunteers and on a spinal-cord injury patient with the use of the new TWIN exoskeleton developed at the Rehab Technologies Lab at the Italian Institute of Technology.

Stefano Maludrottu

Papers

Gait patterns generation based on basis functions interpolation for the TWIN lower-limb exoskeleton *

User-Centered Design and Development of the Modular TWIN Lower Limb Exoskeleton.