Posts Tagged soft exosuit

[ARTICLE] Physiological and kinematic effects of a soft exosuit on arm movements – Full Text



Soft wearable robots (exosuits), being lightweight, ergonomic and low power-demanding, are attractive for a variety of applications, ranging from strength augmentation in industrial scenarios, to medical assistance for people with motor impairments. Understanding how these devices affect the physiology and mechanics of human movements is fundamental for quantifying their benefits and drawbacks, assessing their suitability for different applications and guiding a continuous design refinement.


We present a novel wearable exosuit for assistance/augmentation of the elbow and introduce a controller that compensates for gravitational forces acting on the limb while allowing the suit to cooperatively move with its wearer. Eight healthy subjects wore the exosuit and performed elbow movements in two conditions: with assistance from the device (powered) and without assistance (unpowered). The test included a dynamic task, to evaluate the impact of the assistance on the kinematics and dynamics of human movement, and an isometric task, to assess its influence on the onset of muscular fatigue.


Powered movements showed a low but significant degradation in accuracy and smoothness when compared to the unpowered ones. The degradation in kinematics was accompanied by an average reduction of 59.20±5.58% (mean ± standard error) of the biological torque and 64.8±7.66% drop in muscular effort when the exosuit assisted its wearer. Furthermore, an analysis of the electromyographic signals of the biceps brachii during the isometric task revealed that the exosuit delays the onset of muscular fatigue.


The study examined the effects of an exosuit on the characteristics of human movements. The suit supports most of the power needed to move and reduces the effort that the subject needs to exert to counteract gravity in a static posture, delaying the onset of muscular fatigue. We interpret the decline in kinematic performance as a technical limitation of the current device. This work suggests that a powered exosuit can be a good candidate for industrial and clinical applications, where task efficiency and hardware transparency are paramount.


In the never-ending quest to push the boundaries of their motor performance, humans have designed a wealth of wearable robotic devices. In one of the earliest recorded attempts to do so, in 1967, Mosher aspired to create a symbiotic unit that would have the “…alacrity of man’s information and control system coupled with the machine’s power and ruggedness” [1]. His design of the Hardiman, although visionary, ran into fundamental technological limitations.

Advances in materials science, electronics and energy storage have since enabled an exponential growth of the field, with state-of-the-art exoskeletons arguably accomplishing Mosher’s vision [2]. Wearable robotic technology has been successful in augmenting human strength during locomotion [3], reducing the metabolic cost of human walking [45], restoring ambulatory capabilities to paraplegic patients [6], assisting in rehabilitating stroke patients [789], harvesting energy from human movements [10] and helping to study fundamental principles underlying human motor control [1112].

These feats were achieved with machines made of rigid links of metal and capable of accurately and precisely delivering high forces to their wearer. While this is undeniably an advantage, it comes at a cost: 1) a significant inertia, which affects both the kinematics of human movement and the power requirements of the device; 2) the need for the joints of the robot to be aligned with the biological joints [13], resulting in increased mechanical complexity and size [14]; 3) a strong cosmetic impact, shown to be linked with psychological health and well-being [15].

The recent introduction of soft materials to transmit forces and torques to the human body [16] has allowed to design wearable robotic devices on the other side of the spectrum: lightweight, low-profile and compliant machines that sacrifice accuracy and magnitude of assistance for the sake of portability and svelteness.

Soft exoskeletons, or exosuits, are clothing-like devices made of fabric or elastomers that wrap around a person’s limb and work in parallel with his/her muscles [1718]. Characteristic of exosuits is that they rely on the structural integrity of the human body to transfer reaction forces between body segments, rather than having their own frame, thus acting more like external muscles than an external skeleton. Their intrinsic compliance removes the need for alignment with the joints and their low-profile allows to wear them underneath everyday clothing.

Exosuits actively transmit power to the human body either using cables, moved by electric motors, or soft pneumatic actuators, embedded in the garment. The latter paradigm was probably among the first to be proposed [19] and has been explored to assist stroke patients during walking [20], to increase shoulder mobility in subjects with neuromuscular conditions [21], to help elbow movements [22] and for rehabilitation purposes to train and aid grasping [232425].

Cable-driven exosuits, instead, include a DC motor that transmits power to the suit using Bowden cables. This flexible transmission allows to locate the actuation stage where its additional weight has the least metabolic impact on its wearer. Using this paradigm to provide assistance to the lower limbs has resulted in unprecedented levels of walking economy in healthy subjects [26] and improved symmetry and efficiency of mobility in stroke patients [27]. Similar principles were used to provide active support to hip and knee extension, reducing activation of the gluteus maximus in sit-to-stand and stand-to-sit transitions [28].

Cable-driven exosuits seem to work particularly well for lower-limbs movements, where small bursts of well-timed assistance can have a big impact on the dynamics and metabolic cost of locomotion [29]. Yet, Park et al. have shown that they have the potential for assisting the upper-limbs in quasi-static movements too: using a tendon-driving mechanism, a textile interface and an elastic component they found a significant reduction in the activity of the deltoid muscle when supporting the weight of the arm [30].

Similar results were reported by Chiaradia et al., where a soft exosuit for the elbow was shown to reduce the activation of the biceps brachii muscle in dynamic movements [31], and by Khanh et al., where the same device was used to improve the range of motion of a patient suffering from bilateral brachial plexus injury [32].

While there is extensive work on the analysis of the effects of wearing a soft exosuit on the kinematics, energetics and muscular activation during walking [33], the authors are unaware of comparable studies on movements of the upper limbs, whose variety of volitional motions is fundamentally different from the rhythmic nature of walking.

Understanding how these devices affect the physiology and mechanics of human movements is fundamental for quantifying their benefits and drawbacks, assessing their suitability for different applications and guiding a continuous data-driven design refinement.

In this study we investigate the kinematic and physiological effects of wearing a cable-driven exosuit to support elbow movements. We hypothesize that the low inertia and soft nature of the exosuit will allow it to work in parallel with the user’s muscles, delaying the onset of fatigue while having little to no impact on movement kinematics.

We propose a variation of the design and controller presented in [3234] and introduce a controller that both detects the wearer’s intention, allowing the suit to quickly shadow the user’s movements, and compensates for gravitational forces acting on the limb, thus reducing the muscular effort required for holding a static posture. We collect kinematic, dynamic and myoelectric signals from subjects wearing the device, finding that the exosuit affects motion smoothness, significantly reduces muscular effort and delays the onset of fatigue. The analysis offers interesting insights on the viability of using this technology for human augmentation/assistance and medical purposes.


Exosuit design

An exosuit is a device consisting of a frame made of soft material that wraps around the human body and transmits forces to its wearer’s skeletal structure. In a cable-driven exosuit, artificial tendons are routed along a targeted joint and attached to anchor points on both of its sides. When the tendons are tensioned they deliver an assistive moment to the joint.


Continue —>  Physiological and kinematic effects of a soft exosuit on arm movements | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] A soft robotic exosuit improves walking in patients after stroke – Full Text

A softer recovery after stroke

Passive assistance devices such as canes and braces are often used by people after stroke, but mobility remains limited for some patients. Awad et al. studied the effects of active assistance (delivery of supportive force) during walking in nine patients in the chronic phase of stroke recovery. A soft robotic exosuit worn on the partially paralyzed lower limb reduced interlimb propulsion asymmetry, increased ankle dorsiflexion, and reduced the energy required to walk when powered on during treadmill and overground walking tests. The exosuit could be adjusted to deliver supportive force during the early or late phase of the gait cycle depending on the patient’s needs. Although long-term therapeutic studies are necessary, the immediate improvement in walking performance observed using the powered exosuit makes this a promising approach for neurorehabilitation.


Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite—and perhaps because of—their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.


Bipedal locomotion is a defining trait of the human lineage, with a key evolutionary advantage being a low energetic cost of transport (1). However, the economy of bipedal gait may be lost because of neurological injury with disabling consequences. Hemiparetic walking (27) is characterized by a slow and highly inefficient gait that is a major contributor to disability after stroke (8, 9), which is a leading cause of disability among Americans (10). Despite rehabilitation, the vast majority of stroke survivors retain neuromotor deficits that prevent walking at speeds suitable for normal, economical, and safe community ambulation (11). Impaired motor coordination (12), muscle weakness and spasticity (13), and reduced ankle dorsiflexion (DF; drop foot) and knee flexion during walking are examples of typical deficits after stroke that limit walking speed and contribute to gait compensations such as hip circumduction and hiking (1418), increase the risk of falls, and reduce fitness reserve and endurance (3, 4, 9, 12, 1921). Even those able to achieve near-normal walking speeds present with gait deficits (22, 23) that hinder community reintegration and limit participation to well below what is observed in even the most sedentary older adults (24, 25), ultimately contributing to reduced health and quality of life (10, 26, 27).

Walking independence is an important short-term goal for survivors of a stroke; however, independence can be achieved via compensatory mechanisms. The persistence of neuromotor deficits after rehabilitation often necessitates the prescription of passive assistive devices such as canes, walkers, and orthoses to enable walking at home and in the community (2830). Unfortunately, commonly prescribed devices compensate for poststroke neuromotor impairments in a manner that prevents normal gait function. For example, ankle-foot orthoses (AFOs) inhibit normal push-off during walking (31) and reduce gait adaptability (32). The stigma associated with the use of these devices is also important to consider, especially for the growing population of young adult survivors of stroke (33, 34). The major personal and societal costs of stroke-induced walking difficulty and the limitations of the existing intervention paradigm motivate the development of rehabilitation interventions and technologies that enable the rapid attainment of more normal walking behavior.

Recent years have seen the development of powered exoskeletal devices designed to enable walking in individuals who are unable to walk (35, 36). Central to this remarkable engineering achievement is a rigid structure that can support its own weight and provide high amounts of assistance; however, these powerful machines may not always be necessary to restore more normal gait function in individuals who retain the ability to walk after neurological injury, such as the majority of those after stroke. To address this opportunity, our team developed a lightweight, soft wearable robot (exosuit) that interfaces to the paretic limb of persons after stroke via garment-like, functional textile anchors. Exosuits produce gait-restorative joint torques by transmitting mechanical power from waist-mounted body-worn (37) or off-board (38, 39) actuators to the wearer through the interaction of the textile anchors and a cable-based transmission.

Several factors, such as the compliance of the exosuit-human system (40), prevent exosuits from providing the assistance necessary to enable nonambulatory individuals to walk again (41); however, for ambulatory individuals, the lightweight and nonrestrictive nature of this technology has the potential to facilitate a more natural interaction with the wearer and minimize disruption of the natural dynamics of walking (42). Our first efforts developing exosuits led to the creation of systems that could comfortably deliver assistive forces to healthy users during walking (39, 40, 4347). Recently, we demonstrated that assistive forces delivered through the exosuit interface produce marked reductions in the energy cost of healthy walking (37, 48). Thus, although exosuits can only augment, not replace, a wearer’s existing gait functions, we posit that they have the potential to work synergistically with the residual abilities of individuals with impaired gait to improve walking function.

The primary objective of this foundational study was to evaluate the potential of using the exosuit technology to restore healthy walking behavior in individuals after stroke. Toward this end, we evaluated the effects on hemiparetic gait of actively assisting the paretic limb during treadmill walking using a tethered, unilateral (worn on only one side of the body) exosuit designed to supplement the wearer’s generation of paretic ankle plantarflexion (PF) during stance phase and DF during swing phase. We posited that this targeted assistance of the paretic ankle’s gait functions would facilitate more symmetrical propulsive force generation by the paretic and nonparetic limbs and reduce the energetic burden associated with poststroke walking, which previous work has shown can be more than 60% more costly (49). Previous work on wearable assistive robots for persons after stroke has suggested that the timing of PF force delivery during walking could be an important contributor to positive outcomes in this heterogeneous population (50). Hence, we also evaluated different onset timings of PF force delivery for each individual, hypothesizing that this timing would need to be individualized to optimize outcomes.

Designed to be unobtrusive to the wearer when not powered, the exosuit’s mass of ~0.9 kg is distributed along the length of the paretic limb similar to a pair of pants. Nonetheless, to understand the net effect of walking with an exosuit powered and assisting the paretic limb, it is necessary to evaluate whether there are effects because of simply wearing the exosuit passively (worn but unpowered). A secondary objective was thus to evaluate the effects of walking with the passive exosuit relative to walking with the exosuit not worn. Moreover, because one of the compelling aspects of soft wearable robots, such as exosuits, is their potential to provide gait assistance and, potentially, rehabilitation benefit during community-based walking activities, in addition to treadmill-based biomechanical investigation into the effects of a tethered exosuit, our final objective was to evaluate the effects of exosuit assistance delivered from a first-generation, body-worn (untethered) exosuit during overground walking. Ultimately, by investigating how individuals with poststroke hemiparesis respond to exosuit-generated active assistance of ankle PF and DF during treadmill and overground walking, this study serves to define the technology’s potential for improving mobility and enabling more effective neurorehabilitation after stroke. […]

Continue —> A soft robotic exosuit improves walking in patients after stroke | Science Translational Medicine


Fig. 1. Overview of a soft wearable robot (exosuit) designed to augment paretic limb function during hemiparetic walking. Exosuits (A) use garment-like functional textile anchors worn around the waist and calf (B) and Bowden cable-based mechanical power transmissions to generate assistive joint torques as a function of the paretic gait cycle (C). Integrated sensors (load cells and gyroscopes) are used to detect gait events and in a cable position–based force controller that modulates force delivery. The contractile elements of the exosuit are the Bowden cables located posterior and anterior to the ankle joint. Exosuit-generated PF and DF forces are designed to restore the paretic limb’s contribution to forward propulsion (GRF) and ground clearance (ankle DF angle during swing phase)—subtasks of walking that are impaired after stroke. Poststroke deficits in these variables are demonstrated through a comparison of paretic (black) and nonparetic (gray) limbs. Means across participants are presented (n = 7).


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