Wearable Robotics Challenges and Trends Proceedings of The 2nd International Symposium On Wearable Robotics

Biosystems & Biorobotics
JosGonzlez-Vargas
JaimeIbez
JoseL.Contreras-Vidal
HermanvanderKooij
JosLuisPons Editors
Wearable Robotics:
Challenges and
Trends
Proceedings of the 2nd International
Symposium on Wearable Robotics,
WeRob2016, October 1821, 2016,
Segovia, Spain

Volume 16
Series editor
Eugenio Guglielmelli, Laboratory of Biomedical Robotics, Universit Campus
Bio-Medico, Rome, Italy
e-mail: e.guglielmelli@unicampus.it
Editorial Board
Dino Accoto, Campus Bio-Medico University of Rome, Rome, Italy
Sunil Agrawal, University of Delaware, Newark, DE, USA
Fabio Babiloni, Sapienza University of Rome, Rome, Italy
Jose M. Carmena, University of California, Berkeley, CA, USA
Maria Chiara Carrozza, Scuola Superiore SantAnna, Pisa, Italy
Paolo Dario, Scuola Superiore SantAnna, Pisa, Italy
Arturo Forner-Cordero, University of Sao Paolo, So Paulo, Brazil
Masakatsu G. Fujie, Waseda University, Tokyo, Japan
Nicolas Garcia, Miguel Hernndez University of Elche, Elche, Spain
Neville Hogan, Massachusetts Institute of Technology, Cambridge, MA, USA
Hermano Igo Krebs, Massachusetts Institute of Technology, Cambridge, MA, USA
Dirk Lefeber, Universiteit Brussel, Brussels, Belgium
Rui Loureiro, Middlesex University, London, UK
Marko Munih, University of Ljubljana, Ljubljana, Slovenia
Paolo M. Rossini, University Cattolica del Sacro Cuore, Rome, Italy
Atsuo Takanishi, Waseda University, Tokyo, Japan
Russell H. Taylor, The Johns Hopkins University, Baltimore, MA, USA
David A. Weitz, Harvard University, Cambridge, MA, USA
Loredana Zollo, Campus Bio-Medico University of Rome, Rome, Italy
Aims & Scope

Biosystems & Biorobotics publishes the latest research developments in three main areas: 1)
understanding biological systems from a bioengineering point of view, i.e. the study of biosystems
by exploiting engineering methods and tools to unveil their functioning principles and unrivalled
performance; 2) design and development of biologically inspired machines and systems to be used
for different purposes and in a variety of application contexts. The series welcomes contributions
on novel design approaches, methods and tools as well as case studies on specic bioinspired
systems; 3) design and developments of nano-, micro-, macrodevices and systems for biomedical
applications, i.e. technologies that can improve modern healthcare and welfare by enabling novel
solutions for prevention, diagnosis, surgery, prosthetics, rehabilitation and independent living.
On one side, the series focuses on recent methods and technologies which allow multiscale,
multi-physics, high-resolution analysis and modeling of biological systems. A special emphasis on
this side is given to the use of mechatronic and robotic systems as a tool for basic research in
biology. On the other side, the series authoritatively reports on current theoretical and experimental
challenges and developments related to the biomechatronic design of novel biorobotic machines.
A special emphasis on this side is given to human-machine interaction and interfacing, and also to
the ethical and social implications of this emerging research area, as key challenges for the
acceptability and sustainability of biorobotics technology.
The main target of the series are engineers interested in biology and medicine, and specically
bioengineers and bioroboticists. Volume published in the series comprise monographs, edited
volumes, lecture notes, as well as selected conference proceedings and PhD theses. The series also
publishes books purposely devoted to support education in bioengineering, biomedical engineering, biomechatronics and biorobotics at graduate and post-graduate levels.
About the Cover

The cover of the book series Biosystems & Biorobotics features a robotic hand prosthesis. This
looks like a natural hand and is ready to be implanted on a human amputee to help them recover
their physical capabilities. This picture was chosen to represent a variety of concepts and
disciplines: from the understanding of biological systems to biomechatronics, bioinspiration and
biomimetics; and from the concept of human-robot and human-machine interaction to the use of
robots and, more generally, of engineering techniques for biological research and in healthcare.
The picture also points to the social impact of bioengineering research and to its potential for
improving human health and the quality of life of all individuals, including those with special
needs. The picture was taken during the LIFEHAND experimental trials run at Universit Campus
Bio-Medico of Rome (Italy) in 2008. The LIFEHAND project tested the ability of an amputee
patient to control the Cyberhand, a robotic prosthesis developed at Scuola Superiore SantAnna in
Pisa (Italy), using the tf-LIFE electrodes developed at the Fraunhofer Institute for Biomedical
Engineering (IBMT, Germany), which were implanted in the patients arm. The implanted tf-LIFE
electrodes were shown to enable bidirectional communication (from brain to hand and vice versa)
between the brain and the Cyberhand. As a result, the patient was able to control complex
movements of the prosthesis, while receiving sensory feedback in the form of direct
neurostimulation. For more information please visit http://www.biorobotics.it or contact the
Series Editor.
More information about this series at http://www.springer.com/series/10421
Jos Gonzlez-Vargas Jaime Ibez

Jose L. Contreras-Vidal Herman van der Kooij
Jos Luis Pons
Editors
Wearable Robotics:
Challenges and Trends
Proceedings of the 2nd International
Symposium on Wearable Robotics,
WeRob2016, October 1821, 2016,
Segovia, Spain
123
Editors
Jos Gonzlez-Vargas
Spanish National Research Council
Cajal Institute
Madrid
Spain
Herman van der Kooij

University of Twente
Enschede
The Netherlands
Jos Luis Pons
Cajal Institute
Madrid
Spain
Jaime Ibez
Cajal Institute
Madrid
Spain
Jose L. Contreras-Vidal
Cullen College of Engineering
University of Houston
Houston, TX
USA
ISSN 2195-3562
ISBN 978-3-319-46531-9
DOI 10.1007/978-3-319-46532-6
ISSN 2195-3570
(electronic)
ISBN 978-3-319-46532-6
(eBook)
Library of Congress Control Number: 2016951712

Springer International Publishing AG 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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The publisher, the authors and the editors are safe to assume that the advice and information in this
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for any errors or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Contents
Part I Clinical Focus on Rehabilitation and Assistive WRs

Clinical Evaluation of a Socket-Ready Naturally Controlled
Multichannel Upper Limb Prosthetic System . . . . . . . . . . . . . . . . . . . . . .
Ivan Vujaklija, Sebastian Amsuess, Aidan D. Roche, Dario Farina
and Oskar C. Aszmann
Evaluation of a Robotic Exoskeleton for Gait Training in Acute
Stroke: A Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ghaith J. Androwis and Karen J. Nolan
Wearable Exoskeleton Assisted Rehabilitation in Multiple Sclerosis:
Feasibility and Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shuo-Hsiu Chang, Marcie Kern, Taimoor Afzal, Shih-Chiao Tseng,
John Lincoln and Gerard Francisco
Exoskeletons for Rehabilitation and Personal Mobility:
Creating Clinical Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
P. T. Arun Jayaraman and William Z. Rymer
Lower Limb Wearable Systems for Mobility and Rehabilitation
Challenges: Clinical Focus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Federica Tamburella, Marcella Masciullo, Iolanda Pisotta,
Nevio Luigi Tagliamonte and Marco Molinari
15
21
25
Part II Emerging Technologies in WRs

Impedance Control of Series Elastic Actuators
Using Acceleration Feedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Andrea Calanca, Riccardo Muradore and Paolo Fiorini
33
vi
Contents
Kinetic Energy Recovery in Human Joints: The Flywheel-Innitely

Variable Transmission Actuator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Roberta Al, Francesco Bottiglione and Giacomo Mantriota
A Compliant Lightweight and Adaptable Active Ankle Foot Orthosis
for Robotic Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Marta Moltedo, Tomislav Bacek, Kevin Langlois, Karen Junius,
Bram Vanderborght and Dirk Lefeber
A Novel Shoulder Mechanism with a Double Parallelogram Linkage
for Upper-Body Exoskeletons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Simon Christensen and Shaoping Bai
A Soft Robotic Extra-Finger and Arm Support to Recover Grasp
Capabilities in Chronic Stroke Patients . . . . . . . . . . . . . . . . . . . . . . . . . . .
Irfan Hussain, Gionata Salvietti, Giovanni Spagnoletti, David Cioncoloni,
Simone Rossi and Domenico Prattichizzo
A Quasi-Passive Knee Exoskeleton to Assist During Descent . . . . . . . . .
Emily Rogers, Panagiotis Polygerinos, Stephen Allen,
Fausto A. Panizzolo, Conor J. Walsh and Dnal P. Holland
Wearable Sensory Apparatus for Multi-segment System Orientation
Estimation with Long-Term Drift and Magnetic Disturbance
Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sebastjan lajpah, Roman Kamnik and Marko Munih
A Portable Active Pelvis Orthosis for Ambulatory
Movement Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Andrea Parri, Tingfang Yan, Francesco Giovacchini, Mario Cortese,
Marco Muscolo, Matteo Fantozzi, Raffaele Molino Lova
and Nicola Vitiello
39
45
51
57
63
69
75
Part III Soft Wearable Robotics

XoSoft - A Vision for a Soft Modular Lower Limb Exoskeleton . . . . . . .
Jesus Ortiz, Eduardo Rocon, Valerie Power, Adam de Eyto,
Leonard OSullivan, Markus Wirz, Christoph Bauer, Samuel Schlein,
Konrad S. Stadler, Barbara Mazzolai, Wouter B. Teeuw, Chris Baten,
Corien Nikamp, Jaap Buurke, Freygardur Thorsteinsson
and Jeanette Mller
On the Efcacy of Isolating Shoulder and Elbow Movements
with a Soft, Portable, and Wearable Robotic Device . . . . . . . . . . . . . . . .
Zahra Kadivar, Christopher E. Beck, Roger N. Rovekamp,
Marcia K. OMalley and Charles A. Joyce
83
89
Contents
vii
Design Improvement of a Polymer-Based Tendon-Driven Wearable

Robotic Hand (Exo-Glove Poly) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Haemin Lee, Brian Byunghyun Kang, Hyunki In and Kyu-Jin Cho
95
Affective Touch and Low Power Articial Muscles for Rehabilitative

and Assistive Wearable Soft Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Jonathan Rossiter, Espen Knoop and Yuichi Nakamura
Evaluation of Force Tracking Controller with Soft Exosuit
for Hip Extension Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Hao Su, Ye Ding, Ignacio Galiana, Jozeen Speeckaert, Nikos Karavas,
Philippe Malcolm, Christopher Siviy and Conor J. Walsh
Part IV Neural Interfacing of WRs
Endogenous Control of Powered Lower-Limb Exoskeleton . . . . . . . . . . . 115
Kyuhwa Lee, Dong Liu, Laetitia Perroud, Ricardo Chavarriaga
and Jos del R. Milln
Natural User-Controlled Ambulation of Lower Extremity
Exoskeletons for Individuals with Spinal Cord Injury . . . . . . . . . . . . . . . 121
Kiran Karunakaran, Ghaith Androwis and Richard Foulds
Real-Time Modeling for Lower Limb Exoskeletons . . . . . . . . . . . . . . . . . 127
Guillaume Durandau, Massimo Sartori, Magdo Bortole, Juan C. Moreno,
Jos L. Pons and Dario Farina
Towards Everyday Shared Control of Lower Limb Exoskeletons . . . . . . 133
Tom Carlson
Part V Biomechanics and Neurophysiological studies with WRs
Joint-Level Responses to Counteract Perturbations Scale
with Perturbation Magnitude and Direction . . . . . . . . . . . . . . . . . . . . . . . 139
Mark Vlutters, Edwin H. F. van Asseldonk and Herman van der Kooij
Metabolic Energy Consumption in a Box-Lifting Task:
A Parametric Study on the Assistive Torque . . . . . . . . . . . . . . . . . . . . . . 143
Mohammad S. Shourijeh, Moonki Jung and Michael Damsgaard
Analysis of the Movement Variability in Dance Activities
Using Wearable Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Miguel Xochicale, Chris Baber and Mourad Oussalah
viii
Contents
Part VI New developments in Wearable Rehabilitation Robotics

Real Time Computation of Centroidal Momentum for the Use as a
Stability Index Applicable to Human Walking with Exoskeleton . . . . . . 157
Je Hyung Jung, Lidwine Van Opheusden, Pierre Barralon
and Jan F. Veneman
A Versatile Neuromuscular Exoskeleton Controller for Gait
Assistance: A Preliminary Study on Spinal Cord Injury Patients . . . . . . 163
Amy R. Wu, Florin Dzeladini, Tycho J. H. Brug, Federica Tamburella,
Nevio L. Tagliamonte, Edwin van Asseldonk, Herman van der Kooij
and Auke J. Ijspeert
Introducing a Modular, Personalized Exoskeleton for Ankle
and Knee Support of Individuals with a Spinal Cord Injury . . . . . . . . . 169
Cory Meijneke, Shiqian Wang, Victor Sluiter and Herman van der Kooij
Towards Exoskeletons with Balance Capacities . . . . . . . . . . . . . . . . . . . . 175
Herman van der Kooij, Edwin H. F. van Asseldonk and Mark Vlutters
EMG-Based Detection of Users Intentions for Human-Machine
Shared Control of an Assistive Upper-Limb Exoskeleton . . . . . . . . . . . . 181
A. Accogli, L. Grazi, S. Crea, A. Panarese, J. Carpaneto, N. Vitiello
and S. Micera
Part VII Legal Framework, standardization and ethical issues in WRs
Safety Standardization of Wearable RobotsThe Need
for Testing Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Jan F. Veneman
The Potential and Acceptance of Exoskeletons in Industry . . . . . . . . . . . 195
Michiel P. de Looze, Frank Krause and Leonard W. OSullivan
Wearable Robots: A Legal Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Andrea Bertolini
A Verication Method for Testing Abrasion in the Use of Restraint
Type Personal Care Robots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Yoji Yamada, Mao Xuewei, Kengo Yoshida, Yasuhiro Akiyama
and Shogo Okamoto
Part VIII Benchmarking in WRs and related communities
Kinematic Comparison of Gait Rehabilitation with Exoskeleton
and End-Effector Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Byung-Woo Ko and Won-Kyung Song
Contents
ix
Evaluating the Gait of Lower Limb Prosthesis Users . . . . . . . . . . . . . . . . 219

Stephanie L. Carey, Kyle B. Reed, Amanda Martori, Tyagi Ramakrishnan
and Rajiv Dubey
Some Considerations on Benchmarking of Wearable Robots
for Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Jan F. Veneman
Benchmarking Data for Human Walking in Different Scenarios. . . . . . . 231
Katja Mombaur, Debora Clever and Alexander Schubert
Clinical Gait Assessment in Relation to Benchmarking
Robot Locomotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
J. H. Buurke, J. F. Veneman and D. Torricelli
Part IX Symbiotic Control of WRs
Attention Level Measurement During Exoskeleton Rehabilitation
Through a BMI System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
lvaro Costa, Guillermo Asn-Prieto, Jos Gonzlez-Vargas,
Eduardo Iez, Juan C. Moreno, Antonio J. Del-Ama,
ngel Gil-Agudo and Jos M. Azorn
Detection of Subjects Intention to Trigger Transitions Between Sit,
Stand and Walk with a Lower Limb Exoskeleton . . . . . . . . . . . . . . . . . . 249
Fernando Trincado-Alonso, Antonio J. del Ama-Espinosa,
Guillermo Asn-Prieto, Elisa Piuela-Martn, Soraya Prez-Nombela,
ngel Gil-Agudo, Jos Luis Pons and Juan C. Moreno
The New Generation of Compliant Actuators for Use in Controllable
Bio-Inspired Wearable Robots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
T. Bacek, M. Moltedo, J. Gonzalez-Vargas, G. Asin Prieto,
M. C. Sanchez-Villamaan, J. C. Moreno and D. Lefeber
An EMG-informed Model to Evaluate Assistance of the Biomot
Compliant Ankle Actuator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Elena Ceseracciu, Luca Tagliapietra, Juan C. Moreno, Guillermo Asin,
Antonio J. del-Ama, Soraya Prez, Elisa Piuela, ngel Gil
and Monica Reggiani
Tacit Adaptability of a Mechanically Adjustable Compliance and
Controllable Equilibrium Position Actuator, a Preliminary Study . . . . . 267
Guillermo Asn-Prieto, Shingo Shimoda, Jos Gonzlez,
M. Carmen Snchez-Villaman, Jos L. Pons and Juan C. Moreno
Contents
Part X Emerging Applications Domains of WRs, Emerging

Technologies in WRs
Design and Kinematic Analysis of the Hanyang Exoskeleton Assistive
Robot (HEXAR) for Human Synchronized Motion . . . . . . . . . . . . . . . . . 275
Wansoo Kim, Hojun Kim, Donghwan Lim, Hyungi Moon
and Changsoo Han
Design and Experimental Evaluation of a Low-Cost Robotic Orthosis
for Gait Assistance in Subjects with Spinal Cord Injury . . . . . . . . . . . . . 281
Josep M. Font-Llagunes, Daniel Clos, Urbano Lugrs, F. Javier Alonso
and Javier Cuadrado
A Powered Low-Back Exoskeleton for Industrial Handling:
Considerations on Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Stefano Toxiri, Jess Ortiz, Jawad Masood, Jorge Fernndez,
Luis A. Mateos and Darwin G. Caldwell
Efcient Lower Limb Exoskeleton for Human Motion Assistance . . . . . 293
Nazim Mir-Nasiri
Active Safety Functions for Industrial Lower Body Exoskeletons:
Concept and Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Jawad Masood, Luis A. Mateos, Jess Ortiz, Stefano Toxiri,
Leonard OSullivan and Darwin Caldwell
SOLEUS: Ankle Foot Orthosis for Space Countermeasure
with Immersive Virtual Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Pierre Letier, Guillaume Fau, Uwe Mittag, Jochen Zange, Joern Rittweger,
Moonki Jung, Jo McIntyre and Arnaud Runge
SPEXOR: Spinal Exoskeletal Robot for Low Back Pain Prevention
and Vocational Reintegration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Jan Babi, Katja Mombaur, Dirk Lefeber, Jaap van Dien,
Bernhard Graimann, Michael Russold, Nejc arabon and Han Houdijk
Part XI Posters
HeSA, Hip Exoskeleton for Superior Assistance . . . . . . . . . . . . . . . . . . . . 319
Thomas G. Sugar, Eduardo Fernandez, Darren Kinney,
Kevin W. Hollander and Sangram Redkar
SPEXOR: Towards a Passive Spinal Exoskeleton . . . . . . . . . . . . . . . . . . 325
L. De Rijcke, M. Nf, C. Rodriguez-Guerrero, B. Graimann, H. Houdijk,
J. van Dien, K. Mombaur, M. Russold, N. Sarabon, J. Babi
and D. Lefeber
Contents
xi
Autonomous Soft Exosuit for Hip Extension Assistance. . . . . . . . . . . . . . 331

Nikos Karavas, Jinsoo Kim, Ignacio Galiana, Ye Ding, Adam Couture,
Diana Wagner, Asa Eckert-Erdheim and Conor Walsh
Comparison of Ankle Moment Inspired and Ankle Positive Power
Inspired Controllers for a Multi-Articular Soft Exosuit
for Walking Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Martin Grimmer, Brendan T. Quinlivan, Sangjun Lee, Philippe Malcolm,
Denise M. Rossi, Christopher Siviy and Conor J. Walsh
Biomechanical Analysis and Inertial Sensing of Ankle Joint While
Stepping on an Unanticipated Bump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Taira Miyatake, Sangjun Lee, Ignacio Galiana, Denise M. Rossi,
Christopher Siviy, Fausto A. Panizzolo and Conor J. Walsh
A Novel Approach to Increase Upper Extremity Active Range
of Motion for Individuals with Duchenne Muscular Dystrophy
Using Admittance Control: A Preliminary Study . . . . . . . . . . . . . . . . . . . 349
Madeline C. Corrigan and Richard A. Foulds
Modulation of Knee Range of Motion and Time to Rest in Cerebral
Palsy Using Two Forms of Mechanical Stimulation . . . . . . . . . . . . . . . . . 355
Peter A. Michael, Ghaith J. Androwis and Richard A. Foulds
Training Response to Longitudinal Powered Exoskeleton Training
for SCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
A. Ramanujam, A. Spungen, P. Asselin, E. Garbarini, J. Augustine,
S. Canton, P. Barrance and G. F. Forrest
Adaptive Classication of Arbitrary Activities Through Hidden
Markov Modeling with Automated Optimal Initialization . . . . . . . . . . . . 367
Chris T. M. Baten, Thijs Tromper and Leonie Zeune
Design and Motion Analysis of a Wearable and Portable
Hand Exoskeleton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Matteo Bianchi, Francesco Fanelli, Roberto Conti, Lapo Governi,
Enrico Meli, Alessandro Ridol, Andrea Rindi, Federica Vannetti
and Benedetto Allotta
Nitiglove: Nitinol-Driven Robotic Glove Used to Assist Therapy
for Hand Mobility Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
C. Jimnez, R. Mora, J. Prez and K. Quirs
3D Printed Arm Exoskeleton for Teleoperation
and Manipulation Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Pierre Letier, Gonzalo Rodriguez, Guillaume Fau, Shashank Govindaraj,
Torsten Siedel, Jeremi Gancet and Michel Ilzkovitz
xii
Contents
Musculoskeletal Simulation of SOLEUS Ankle Exoskeleton

for Countermeasure Exercise in Space . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Moonki Jung, Guillaume Fau, Pierre Letier, Uwe Mittag, Jochen Zange,
Jrn Rittweger and Arnaud Runge
Human Gait Feature Detection Using Inertial Sensors Wavelets . . . . . . . 397
S. Glowinski, A. Blazejewski and T. Krzyzynski
On the Importance of a Motor Model for the Optimization
of SEA-driven Prosthetic Ankles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Tom Verstraten, Glenn Mathijssen, Joost Geeroms, Louis Flynn,
Assessment of a 7-DOF Hand Exoskeleton for Neurorehabilitation . . . . 409
Kevin Abbruzzese and Richard Foulds
Improving the Standing Balance of People with Spinal Cord Injury
Through the Use of a Powered Ankle-Foot Orthosis . . . . . . . . . . . . . . . . 415
Amber Emmens, Iolanda Pisotta, Marcella Masciullo,
Edwin van Asseldonk and Herman van der Kooij
Transparent Mode for Lower Limb Exoskeleton . . . . . . . . . . . . . . . . . . . 421
R. Mendoza-Crespo, R. Soto and J. L. Pons
Human-Robot Mutual Force Borrowing and Seamless
Leader-Follower Role Switching by Learning and Coordination
of Interactive Impedance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Ker-Jiun Wang, Mingui Sun and Zhi-Hong Mao
Upper Limb Exoskeleton Control for Isotropic Sensitivity
of Human Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Rok Goljat, Tadej Petri and Jan Babi
AUTONOMYO: Design Challenges of Lower Limb Assistive Device
for Elderly People, Multiple Sclerosis and Neuromuscular Diseases . . . . 439
A. Ortlieb, M. Bouri and H. Bleuler
Passive Lower Back Moment Support in a Wearable Lifting Aid:
Counterweight Versus Springs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Ralph J. L. Macke, Arvid Q. L. Keemink and Arno H. A. Stienen
Part I
Clinical Focus on Rehabilitation

and Assistive WRs
Clinical Evaluation of a Socket-Ready

Naturally Controlled Multichannel Upper
Limb Prosthetic System
Ivan Vujaklija, Sebastian Amsuess, Aidan D. Roche, Dario Farina
and Oskar C. Aszmann
Abstract Research conducted over the last decades indicates a necessity of having
larger number of EMG sensors in order to extract sufcient information needed for
natural control of upper limb prosthetics. Various studies have addressed this issue,
though clinical transition and evaluation of such systems on a larger pool of patients
is still missing. We propose a specically designed system which allows users to
perform clinically relevant tests in an unobstructed way while handling dexterous
prosthesis. Eight electrodes were embedded into customized sockets along with the
controllers driving an algorithm recently tested in laboratory conditions that allows
simultaneous manipulation of four out of seven prosthetic functions. The fully
self-contained system was evaluated on seven amputees conducting the
Southampton Hand Assessment Procedure. The scores achieved were compared to
those obtained using their own commercial devices. The study shows the necessary
steps to validate novel control algorithms in a clinically meaningful context.
This work was supported by the Christian Doppler Research Foundation of the Austrian Federal
Ministry of Science, Research and Economy and by the European Research Council Advanced
Grant DEMOVE (contract #267888).
I. Vujaklija (&) D. Farina
Institute of Neurorehabilitation Systems, University Medical Center Gttingen,
Gttingen, Germany
e-mail: ivan.vujaklija@bccn.uni-goettingen.de
D. Farina
e-mail: dario.farina@bccn.uni-goettingen.de
S. Amsuess
Ottobock Healthcare Products GmbH, Vienna, Austria
e-mail: sebastian.amsuess@ottobock.com
A.D. Roche O.C. Aszmann
Christian Doppler Laboratory for Restoration of Extremity Function,
Medical University of Vienna, Vienna, Austria
e-mail: aidan.roche@meduniwien.ac.at
O.C. Aszmann
e-mail: oskar.aszmann@meduniwien.ac.at
J. Gonzlez-Vargas et al. (eds.), Wearable Robotics: Challenges and Trends,
Biosystems & Biorobotics 16, DOI 10.1007/978-3-319-46532-6_1
I. Vujaklija et al.
1 Introduction
Various research conducted in the last decades indicated a necessity for introducing
additional EMG sensors in order to provide upper limb prosthetic users with more
versatile and natural control [1, 2]. Namely, the currently available solutions are
almost strictly depending on just a few electrodes and a cumbersome control
paradigm [3, 4]. On the other hand, more advanced systems have seemed to fail in
reaching the clinical testing stage. Reasons for this are numerous, but they mostly
boil down to the issue of robustness.
Transferring myoelectric solutions into systems that can be tested in an
acceptable manner through different clinical scenarios requires production of
sockets which are capable of hosting the majority of the hardware. Even once the
transfer is made, the system is facing challenges such as extensive sweat production, electrode misplacement, uneven loading of the socket and stump volume
changes [5].
Here, we present a socket-ready implementation of a previously laboratory tested
system for simultaneous and proportional control of the dexterous prosthetic hand
[6]. The outcomes of a clinical evaluation are presented and discussed along with
the challenges that were encountered during the testing and tting process.
2 Methods
2.1
Subjects
Total of seven transradial amputees (6 male, 1 female, aged 35.14 10.11) agreed
to participate in the study after reading and signing consent forms approved by local
ethics board of Medical University of Vienna (Ethics Commission number:
1044/2015). All participants are active myoelectric users, though have no previous
experience with advanced control systems.
2.2
Hardware and Control Algorithm
All seven subjects were tted with custom sockets by a certied prosthetist. Each
socket was able to host eight Otto Bock raw signal electrodes 13E200 = 50AC,
through a predened gap positioned over the most muscular circumference of the
forearm. Individual electrodes were placed into the 3D printed casings which
enabled their quick equidistant placement using a single rubber band. Tip of the
thermoplast based liner provided the support for lamination rings needed for
prosthetic attachment and was enclosed in cellacast, the berglass free plaster.
Clinical Evaluation of a Socket-Ready Naturally Controlled Multichannel
The prosthesis that was used throughout the experiment was Ottobock
Michelangelo hand with wrist flexor and rotation units. If the length of the stump
prevented battery pack and the Axonbus system to be tucked into the socket, these
components were simply attached on the outside of the shaft.
Communication with the computer which was running the control algorithm was
done via Bluetooth. In this way full flexibility and control over the implemented
algorithm which allowed proportional activation of the wrist flexor and rotation
units (linear regression) combined with sequential, proportional hand function
(linear discriminant analysis classier) [6] was available without compromising
comfort of the user during testing.
2.3
Clinical Testing
In order to make a clinically relevant evaluation of patient performance using the

implemented system Southampton Hand Assessment Procedure (SHAP) [7] was
conducted. This test includes a variety of tasks ranging from more abstract ones to
those replicating the activities of daily living. The overall end score can range from
0 representing no useful hand function at all, to 100 which is equivalent to a fully
functional able bodied hand. Subjects were given two opportunities in performing
each task and the execution time out was set to 100 s.
2.4
Experiment Protocol
Each subject was invited to come three times. During the rst visit prosthetists
conducted all the necessary measurements for building up the socket, and participants were once again briefed on what is expected from them throughout the
experiment. In the second session the new socket was tested and modications were
made if needed. Additionally, subjects were asked to perform the SHAP test using
their own myoelectric device in order to acquire the baseline score. In the nal
session, the training data needed for the control of the prosthetic device was collected in a standard myoelectric pattern recognition based manner, as in previously
conducted study [8]. After a short brake the participant was invited to test the
device and get familiar and comfortable with its capabilities and a nal SHAP test
was conducted.
6
Table 1 SHAP scores
I. Vujaklija et al.
Subject ID
Baseline session
Advanced session
S1
S2
S3
S4
S5
S6
S7
77
65
72
62
59
46
53
56
50
36
47
39
35
32
3 Results
All subjects were successfully tted with the prosthesis and were able to follow the
experiment. No participant reported any problems with the tting during the third,
advanced session. The only notable complaints were regarding the overall weight of
the system and its poor weight distribution in cases of users with longer stumps.
The results of SHAP testing are presented in Table 1.
Baseline score across all subjects was 62.00 10.65 and in the nal session
patients achieved the average score of 42.14 8.93. Closest score using the
advanced prosthesis to the baseline one was achieved by subject S6 with 11 points
difference, while the greatest discrepancy was observed in S3, 36 points.
Average SHAP score difference between the two systems was 19.86 8.05.
4 Conclusions and Discussion

In this study we have implemented an eight channels based advanced control
system, which is able of delivering simultaneous and proportional control over 3.5
degrees of freedom, into a custom tted wearable socket. The purpose was to
conduct a clinically viable evaluation of the solution in order to identify its potential
for real world applications.
Based on the feedback received from the participants the terminal load of the
prosthetic tting was regarded problematic and a more balanced weight distribution
should be aimed at, especially in patients with longer stumps. The fact that all
participants managed to conduct the entire experiment using the proposed system,
even though somewhat lower scores were achieved, indicates the potential of this
approach of becoming a candidate for a proper clinical study. Though, it also points
out a necessity for conducting a longitudinal evaluation which would eliminate the
effects of learning and accommodation of the patient to an entirely new system and
control paradigm. In addition, inclusion of motion analysis could indicate possible
changes in compensatory movements [9].
Clinical Evaluation of a Socket-Ready Naturally Controlled Multichannel
Acknowledgments The authors would like to extend their gratitude to Mr. Hans Opel and his
team of prosthetists at Otto Bock Healthcare Products GmbH for manufacturing and tting all the
patients with custom made sockets.
References
1. Hudgins, B., Parker, P., Scott, R.N.: A new strategy for multifunction myoelectric control. IEEE
Trans. Biomed. Eng. 40(1), 8294 (1993)
2. Jiang, N., Vujaklija, I., Rehbaum, H., Graimann, B., Farina, D.: Is accurate mapping of EMG
signals on kinematics needed for precise online myoelectric control? IEEE Trans. Neural Syst.
Rehabil. Eng. 22(3), 549558 (2014)
3. Scott, R.N., Parker, P.A.: Myoelectric prostheses: state of the art. J. Med. Eng. Technol. 12(4),
143151 (1988)
4. Oskoei, M.A., Hu, H.: Myoelectric control systems-a survey. Biomed. Signal Process. Control
2(4), 275294 (2007)
5. Hargrove, L., Englehart, K., Hudgins, B.: A training strategy to reduce classication
degradation due to electrode displacements in pattern recognition based myoelectric control.
Biomed. Signal Process. Control 3(2), 175180 (2008)
6. Amsuess, S., Vujaklija, I., Gobel, P., Roche, A., Graimann, B., Aszmann, O., Farina, D.:
Context-dependent upper limb prosthesis control for natural and robust use. IEEE Trans. Neural
Syst. Rehabil. Eng., 1 (2015)
7. Light, C.M., Chappell, P.H., Kyberd, P.J.: Establishing a standardized clinical assessment tool
of pathologic and prosthetic hand function: normative data, reliability, and validity. Arch. Phys.
Med. Rehabil. 83(6), 776783 (2002)
8. Roche, A.D., Vujaklija, I., Amsuess, S., Sturma, A., Gbel, P., Farina, D., Aszmann, O.C.:
Structured rehabilitation training for improved multifunctional prosthetic control : a case study.
J. Vis. Exp. (2015)
9. Montagnani, F., Controzzi, M., Cipriani, C.: Exploiting arm posture synergies in activities of
daily living to control the wrist rotation in upper limb prostheses: a feasibility study. In:
Proceedings of Annual International Conference of the IEEE Engineering in Medicine and
Biology Society, EMBS, vol. 2015, pp. 24622465, November 2015
Evaluation of a Robotic Exoskeleton

for Gait Training in Acute Stroke:
A Case Study
Ghaith J. Androwis and Karen J. Nolan
Abstract The application of robotic exoskeletons in gait therapy during stroke

rehabilitation has grown rapidly over the past decade. The purpose of this investigation is to determine the impact of a robotic exoskeleton (RE) on temporal spatial
gait parameters as compared to traditional standard of care gait training in a single
inpatient after acute stroke. Outcome measures included temporal spatial gait
parameters while walking with and without an RE during a single gait training
session two weeks post stroke. During gait training in the RE, walking speed, and
stride length increased while step width decreased on the affected and unaffected
side. Total double support time decreased, and single support and swing time
increased on the affected and unaffected limb during gait training in the RE. Gait
training in the RE had a positive effect on the patients overall gait which included
improved temporal spatial parameters and gait speed. Positive changes in temporal
spatial parameters were evident on the affected and unaffected limb. Preliminary
rehabilitative improvements with the RE device may include a gait training environment that is more symmetrical and may improve weight transfer and overall gait
speed. Further research with a larger sample with various level of impairment
utilizing an RE for gait training is needed to determine the potential utility of REs as
an alternative to traditional gait training.
G.J. Androwis K.J. Nolan (&)

Kessler Foundation Human Performance and Engineering Research,
West Orange, NJ, USA
e-mail: knolan@kesslerfoundation.org
K.J. Nolan
Department of Physical Medicine and Rehabilitation,
Rutgers New Jersey Medical School, Newark, NJ, USA
G.J. Androwis K.J. Nolan
Children Specialized Hospital, 150 New Providence Road,
Mountainside, NJ, USA
G.J. Androwis
Department of Biomedical Engineering, New Jersey Institute of Technology,
Newark, NJ, USA
10
G.J. Androwis and K.J. Nolan
1 Introduction
Stroke is considered one of the leading causes of long-term disability in the United
States and every year more than 795,000 individuals are affected by stroke [1].
Individuals post stroke experience mobility limitations including gait impairments
and a decrease in functional ambulation [1]. One of the primary goals in stroke
rehabilitation is to regain walking function, which can directly impact community
participation and quality of life. [2].
Early stage recovery, during the acute phase of rehabilitation, is dependent on
the treatment effectiveness and the time frame at which treatments are introduced to
patients [3]. The effectiveness of stroke rehabilitation may be based on the role of
neuroplasticity and the ability to relearn lost function [3, 4]. The integration of
state-of-the-art robotic technologies, such as robotic exoskeletons (RE), for gait
rehabilitation of individuals with neuromuscular disabilities is essential during
acute stroke rehabilitation, when plasticity level is high, to maximize functional
benets and long term outcomes.
The utility of RE devices has been rapidly expanding over the past decade [5].
The demand for utilization of RE for robotic therapy has also been growing side by
side with the development of new and more advanced RE devices [6, 7].
Wearable RE for gait training are driven by high torque motors anatomically
aligned at the hip and knee joints. The RE combines the power needed during gait
therapy for ambulation with human input (through motion sensors and
force/loading sensors) to determine RE performance and the way that the wearer
interacts with the device [8, 9]. The purpose of this investigation is to determine the
impact of a robotic exoskeleton (RE) on temporal spatial gait parameters as compared to traditional standard of care gait training in a single inpatient after acute
stroke.
2 Materials and Methods

2.1
Participants
One female participant with acute stroke and left unilateral hemiparesis (Age 30;
Height 1.63 m; Weight 87.75 kg) was recruited for RE gait training in conjunction
with standard of care therapy in an inpatient rehabilitation hospital. Data was
collected during a single gait training session while participants ambulated with and
without the RE over level surfaces with the assistance of a physical therapist.
Participant inclusion requirements: medical clearance, upright standing tolerance
( 15 min), intact skin, and physically t into the device. All procedures performed
in this investigation were approved by the Human Subjects Review Board and
informed consent was obtained prior to study participation.
Evaluation of a Robotic Exoskeleton for Gait Training in Acute Stroke
11
Fig. 1 Participant using the

RE device, Ekso-GT, for gait
rehabilitation therapy
2.2
Robotic Exoskeleton (RE) Device
Robotic gait therapy was administered via a commercially available robotic device
(Ekso-GT, Ekso Bionics, Inc. Richmond, CA, USA), Fig. 1. Patients lower
extremities were driven in a predened repetitive trajectory to facilitate over ground
walking. The RE used in this investigation includes two motorized joints (hip and
knee) and passively adjustable stiffness (sagittal plane) at the ankle joint. The RE
was operated in combination with a single point straight cane.
2.3
Experimental Procedure and Data Analysis
Temporal Spatial parameters were measured using gait analysis, all kinematic data
was collected at 60 Hz using a 12 camera 3-D motion analysis system (Motion
Analysis Corporation, Santa Rosa, CA, USA). The participant was directed to
ambulate at self-selected speed over level ground with and without the RE with the
assistance of a physical therapist. All data was exported to Matlab (MATLAB
R2015B, MathWorks Inc., Natick, MA, USA) for custom analysis. Kinematic data
were ltered using a Butterworth lter (zero-lag, 4th order; cut-off frequencies of
6 Hz). Kinematic data were normalized to 100 % of a gait cycle (GC) dened as
foot strike to the ipsilateral foot strike; each GC was then sectioned into four
phases: Initial double support (IDS), single support (SS), terminal double support
(TDS) and swing (SW). Timing of temporal and spatial parameters were then
calculated based on the phasic segmentation of GC.
12
G.J. Androwis and K.J. Nolan
3 Results
Temporal spatial outcome variables are summarized in Table 1. During gait training
in the RE, walking speed increased by 0.05 m/s, and stride length increased
bilaterally, while step width decreased on the affected and unaffected side, Table 1.
Step length was still variable between affected and unaffected side but was more
symmetrical during gait training in the RE. During gait training in the RE, total
double support time (IDS + TDS seconds) decreased, and single support and swing
time increased on the affected and unaffected limb, Fig. 2. Total stance time
(IDS + SS + TDS) remained relatively unchanged in the RE.
Table 1 Temporal spatial parameters of participants affected and unaffected side with and
without the RE
Average
Affected with
RE
Affected
without RE
Unaffected
with RE
Unaffected
without RE
Step length
(mm)
Step width
(mm)
Stride length
(mm)
Gait speed
(m/s)
391.41
158.37
277.06
326.43
162.98
205.05
165.42
200.53
660.63
480.14
660.49
460.24
0.29
0.26
0.30
0.25
Fig. 2 Timing of affected and unaffected limbs with and without RE
Evaluation of a Robotic Exoskeleton for Gait Training in Acute Stroke
13
4 Discussion
The objective of the RE is to provide a therapeutic environment with high step
dosing, while providing quality gait retraining. The presented temporal spatial data
begins to quantify the temporal spatial differences between gait training in an RE
and physical therapist guided gait retraining. In this investigation gait training in the
RE had a positive effect on the patients overall gait which included improved
temporal spatial parameters and gait speed. Positive changes in temporal spatial
parameters were evident on the affected and unaffected limb. Preliminary rehabilitative improvements with the RE device may include a gait training environment
that is more symmetrical and may improve weight transfer and overall gait speed.
Improvements in gait quality when utilizing the RE were not limited to the affected
side. There was a decreased dependency of the unaffected limb during gait training
in the RE. Reduced stride width was demonstrated with the RE, which may have an
additional rehabilitative affect by reducing the lateral acceleration and deceleration
and allowing for a more energy efcient gait pattern (narrower step).
Further research with a larger sample with various level of impairment utilizing
an RE for gait training is needed to determine the potential utility of REs as an
alternative to traditional gait training.
References
1. United States Department of Health and Human Services, Underlying Cause of Death 1999
2010 on CDC WONDER Online Database, released 2012, ed.
2. Patterson, S.L., Rodgers, M.M., Macko, R.F., Forrester, L.W.: Effect of treadmill exercise
training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary
report. J. Rehabil. Res. Dev. 45, 221 (2008)
3. Jongbloed, L.: Prediction of function after stroke: a critical review. Stroke 17, 765776 (1986)
4. Levin, M.F., Kleim, J.A., Wolf, S.L.: What do motor recovery and compensation mean in
patients following stroke? Neurorehabilitation Neural Repair (2008)
5. Chen, B., Ma, H., Qin, L.-Y., Gao, F., Chan, K.-M., Law, S.-W., et al.: Recent developments
and challenges of lower extremity exoskeletons. J. Orthop. Transl. 5, 2637 (2016)
6. Agrawal, A., Banala, S.K., Agrawal, S.K., Binder-Macleod, S.A.: Design of a two
degree-of-freedom ankle-foot orthosis for robotic rehabilitation. In: 9th International
Conference on Rehabilitation Robotics, ICORR 2005, pp. 4144 (2005)
7. Zoss, A.B., Kazerooni, H., Chu, A.: Biomechanical design of the Berkeley lower extremity
exoskeleton (BLEEX). IEEE/ASME Trans. Mechatron. 11, 128138 (2006)
8. Guizzo, E., Deyle, T.: Robotics trends for 2012. IEEE Robot. Autom. Mag. 19, 119123 (2012)
9. Tsukahara, A., Kawanishi, R., Hasegawa, Y., Sankai, Y.: Sit-to-stand and stand-to-sit transfer
support for complete paraplegic patients with robot suit HAL. Adv. Robot. 24, 16151638
(2010)
Wearable Exoskeleton Assisted

Rehabilitation in Multiple Sclerosis:
Feasibility and Experience
Shuo-Hsiu Chang, Marcie Kern, Taimoor Afzal, Shih-Chiao Tseng,
John Lincoln and Gerard Francisco
Abstract Impaired ability to walk independently is a signicant consequence of

multiple sclerosis (MS) resulting in substantial limitation in mobility and performance of daily activities, thus restricting full participation and home and community re-integration. Gait training/restoration in MS is necessary but often limited
due to the progress and severity of the disease and limitations of traditional
strengthening exercises Much attention has been emphasized in developing pharmaceutical treatment to stop or delay the progress of the disease, but not in
developing rehabilitation strategies to improve quality of life and facilitate community re-integration for this population. Recently, wearable lower extremity
robotic exoskeletons have been developed to restore ambulation in paralyzed or
weak individuals with spinal cord injuries. Utilizing exoskeleton in MS rehabilitation may provident difference users experience and improve rehabilitation outcomes. The purpose of this paper is to provide preliminary results and early
experience in our MS exoskeleton assisted rehabilitation program.
The study is partly supported by National Multiple Sclerosis Society (PI: Chang), TIRR
Foundation, Memorial Hermann Foundation, and the University of Texas Health Science Center
at Houston (UTHealth) Physical Medicine and Rehabilitation Departmental Funds.
S.-H. Chang M. Kern T. Afzal G. Francisco
NeuroRecovery Research Center at TIRR Memorial Hermann,
Houston, TX, USA
S.-H. Chang (&) T. Afzal G. Francisco
Department of Physical Medicine and Rehabilitation,
UTHealth, Houston, TX, USA
e-mail: shuo-hsiu.chang@uth.tmc.edu
S.-C. Tseng
School of Physical Therapy, Texas Womans University Houston,
Houston, TX, USA
J. Lincoln
Department of Neurology, UTHealth, Houston, TX, USA
15
16
S.-H. Chang et al.
1 Introduction
Multiple Sclerosis is an autoimmune disease of the central nervous system resulting
in progressive deterioration of health in young adults particularly aged 2040.
Signicant gait impairment occurs as a result of motor weakness, spasticity, ataxia
and sensory disturbance [1]. Many MS patients acquire a disturbing gait pattern and
the capacity to walk signicantly diminishes over time with one-third patients could
not retain walking 20 years after diagnosis. Traditionally, persons with MS undergo
various forms of rehabilitation including standard exercises as a therapeutic intervention [2] and treadmill training [3] for maintain and improving the overall health,
however, the outcomes are inconclusive.
Wearable exoskeletons have been developed as assistive walking device for
paralyzed or weak individuals suffered from SCI and stroke. It has become
acceptable that wearable exoskeleton may provide opportunity for gait training
following task specic training principle. In this study, we explore the feasibility of
wearable exoskeleton assisted rehabilitation in MS.

2.1
Subjects
Four subjects with MS participated wearable exoskeleton assisted training during

walking (5 session per week for 3 weeks). Subject characteristics are listed in Table 1.
Subjects were recruited if they have diagnosed MS with Kurtzke Expanded Disability
Status Scale (EDSS) score between 67.5. Subjects with severe and untreated
spasticity, joint contracture, unhealed pelvic and limb fracture were excluded.
2.2
Exoskeleton Assisted Training
After screening for eligibility, subject will receive a total of 15 sessions of

exoskeleton assisted training. The exoskeleton, Ekso (Richmond, CA) was used
Table 1 Subject
characteristics
ID
Gender
Age
1
Female
32
2
Female
45
3
Female
70
4
Male
52
RRMS: Relapsing-Remitting MS
SPMS: Secondary Progressive MS
PPMS: Primary Progressive MS
Type
EDSS
RRMS
SPMS
RRMS
PPMS
6
7
6.5
7.5
Wearable Exoskeleton Assisted Rehabilitation in Multiple Sclerosis: Feasibility and Experience17
Fig. 1 Exoskeleton assisted training and assessment sessions. One subject walked with
exoskeleton with body weight support system (Vector Gait and Safety System, Bioness, left).
Metabolic and EMG data collection during exoskeleton assisted walking (center and right)
for this study (Fig. 1, left). During exoskeleton assisted walking, exoskeleton can
adjust the level/amount of assistance provide to initiate and complete each step. At
the beginning of the training, the exoskeleton was tted according to the subjects
pelvic width and thigh and shank length per manufactures setting During training,
the subject was trained to walk with Ekso and walker in various tasks: standing
balance, slow and fast walking, turning, and sit-to-stand and vice versa. Subjects
perceived exertion was assessed by self-report using the Borg scale of perceived
exertion during each training session.
2.3
Outcome Measures
Outcome measures were performed prior to training (pre-training: without

exoskeleton) and right after training (post-training: with and without exoskeleton).
Functional assessments included six minute walk test (6MWT) and 25 Feet Walk
Test (25FWT, 7.62 m) at self-selected speed. The metabolic costs and muscle
activation prole during 6MWT and 25FWT were assessed by measuring maximum rate of oxygen consumption (VO2 max, Cosmed k4b2) and EMG (Motion Lab
Systems, Baton Rouge, LA), respectively (Fig. 1, center and right). EMG signals
were measured and recorded from the right Rectus Femoris, Vastus Medialis, Bicep
Femoris, Semitendinosus, Tibialis Anterior, Soleus and Gastrocnemius muscles.
18
2.4
S.-H. Chang et al.
Data Analysis
Values of VO2 max during 6MWT and 25FWT were calculated by averaging the
breath-by-breath data. Mean EMG amplitude of each muscle was calculated in one
gait cycle (heel contact and next heel contact of the right foot).
3 Results
The results were presented in Tables 2 and 3. Subjects walked with exoskeleton
during 6MWT has less net oxygen consumption (comparison between walking with
and without exoskeleton at post) regardless the total distance. Improved walking
distance in 6MWT and walking speed (less time in 25FWT) after training (comparison walking without exoskeleton between pre and post) were also observed
(except subject 3).
Table 2 6MWT
ID
Net VO2max (ml/kg/min)
Pre
W/O
Post
W/O
Mean EMG
(v.)
Post
W/O
W
151.2
129.9
92.0
89.8
5.2
8.3
6.0
5.8
5.3
4.0
5.0
8.6
3.9
3.2
4.3
6.4
16.8
10.2
36.1
59.9
Distance (m)
Pre
W/O
Post
W/O
1
221.3
243.2
2
71.0
75.0
3
99.5
93.9
4
53.0
85.1
W/O: without exoskeleton
W: with exoskeleton
14.0
7.9
28.6
49.0
Table 3 25FWT
ID
Time (s)
Pre
W/O
Net VO2max (ml/kg/min)

Post
W/O
1
11.4
8.1
2
45.2
36.3
3
26.0
31.9
4
68.3
25.9
W/O: without exoskeleton
W: with exoskeleton
Pre
W/O
Post
W/O
Mean EMG
(v.)
Post
W/O
W
16.1
22.3
32.9
30.4
2.6
3.9
1.9
4.4
1.2
1.1
2.2
3.7
0.8
1.9
2.4
1.8
16.0
8.0
28.4
25.9
16.0
8.0
28.4
25.9
Wearable Exoskeleton Assisted Rehabilitation in Multiple Sclerosis: Feasibility and Experience19
4 Discussion
The preliminary results suggest that wearable exoskeleton assisted training is safe
and feasible for persons with MS.
Safety during wearable exoskeleton assisted training should be emphasized.
According to our knowledge, there is no fall prevention strategy developed during
exoskeleton assisted walking. We successfully used body weight support system
(Fig. 1) for balance and fall prevention during training, in addition to physical
assistance from a second staff member for one subject (subject 4) who could not use
assistive devices for balance.
Our training protocol was designed to train subjects to utilize exoskeleton as
assistive device. Therefore, the observed improvement in walking distance and
speed were unexpected and could be resulted from increased amount of physical
activity. Based on training principles, training protocol that aims to improve
walking function should be designed to reach maximal therapeutic effects.
Moreover, the success of the training protocol relies the experience of the trainer
(therapist) and control software capability.
Furthermore, walking with wearable exoskeleton requires learning. The capability of motor control and learning plays critical role in efcient and effective
exoskeleton assisted rehabilitation. Therefore, the training protocol should consider
the variance among different patient populations, as MS patients suffer fatigue
easily and may have impaired skill acquisition and retention capability.
5 Conclusion
Wearable exoskeleton assisted training is safe and feasible for persons with MS for
gait training and mobility. Individualized training protocols that emphasize either
gait training or mobility training should apply. Rening current technologies to
design more user friendly device and flexible software control for this population
should be considered.
Acknowledgment We want to thank participants for their time and efforts.
References
1. Shakespeare, D.T., Boggild, M., Young, C.: Anti-spasticity agents for multiple sclerosis.
Cochrane Database Syst. Rev. 4, CD001332 (2003)
2. Briken, S., et al.: Effects of exercise on tness and cognition in progressive MS: a randomized,
controlled pilot trial. Mult. Scler. 20, 382390 (2014)
3. van den Berg, M., et al.: Treadmill training for individuals with multiple sclerosis: a pilot
randomized trial. J. Neurol. Neurosurg. Psychiatry 77, 531533 (2006)
Exoskeletons for Rehabilitation

and Personal Mobility: Creating
Clinical Evidence
P.T. Arun Jayaraman and William Z. Rymer
Abstract Exoskeletons are devices which have recently gained substantial attention in the eld of rehabilitation, especially for use in individuals with neurological
disorders (ND). In individuals with ND, mobility limitations and subsequent
reduced activity levels contribute to signicant reductions in quality of life.
Wearable robots or exoskeletons hold much promise to fulll this unmet need of
over-ground mobility and unimpaired gait. However, variable research evidence
and clinical efcacy are deterring the impact of these eloquent devices from being
introduced into everyday rehabilitation practice. This research summary will
highlight some research studies conducted at the Rehabilitation Institute of Chicago
(RIC) with various exoskeletons, focusing on their clinical efcacy and personal
mobility outcomes.
1 Introduction
Each year in the United States, over a million people are affected by strokes, spinal
cord injuries and brain injuries [1, 2]. With advances in medical care, most individuals with these neurological injuries or disorders survive their initial injuries and
have long-life spans. However, many of these individuals are still affected by the
inability to stand and walk, which not only affects their everyday mobility and
Research is supported NIDLRR RERC grants no. 90RE5010-01-01 & 90RE5014-02-00.

P.T. Arun Jayaraman (&) W.Z. Rymer (&)
Departments of Physical Medicine and Rehabilitation,
Northwestern University, Chicago, IL, USA
e-mail: a-jayaraman@northwestern.edu
W.Z. Rymer
e-mail: w-zymer@northwestern.edu
P.T. Arun Jayaraman W.Z. Rymer
Research Program, The Rehabilitation Institute of Chicago, Chicago, IL, USA
21
22
P.T. Arun Jayaraman and W.Z. Rymer
independence, but also has signicant effects on secondary health consequences

including, pressure ulcers, spasticity/muscle spasms, muscle atrophy, bone loss, and
impaired functioning of their respiratory, digestive, renal, and cardiovascular system. Traditional therapy is successful in improving mobility to a subset of the
impaired population, but is still limited in its ability to impact the recovering
individual across the continuum of care. Current, insurance reimbursements policies
and patient-care models in the United States at least, limit the numbers of therapy
sessions a participant can get for his/her condition and thus are left to fend for
themselves quite early in their recovery process. Wearable robotic systems or
exoskeletons have the potential to provide high-intensity and dosage of gait or
walking training across the continuum of care, from acute rehabilitation, to outpatient clinics, to achieving personal mobility in the home and the community.
Early studies on exoskeletons have been shown them to be safe and efcacious to
achieve over-ground walking in individuals with different neurological disorders
struggling with varying levels of walking disability [35]. Even though hundreds of
exoskeletons currently exist in the research labs, hospitals, and homes, no rigorous
studies have been performed in many clinical populations looking at their therapeutic benet compared to traditional care or quantifying their impact at home and
in the community. This research summary will highlight some of the research
studies being conducted at the RIC using various exoskeletons, focusing on their
clinical efcacy and personal mobility outcomes.
2 Material and Methods

2.1
Patient Populations
The populations we tested in our clinical studies at RIC include, individuals with
motor complete and incomplete spinal cord injury, individuals following a stroke,
individuals with MS, and children with cerebral palsy. Most study participants
suffered chronic neurological impairments and had also received RICs traditional
physical rehabilitation care.
2.2
Exoskeletons
The exoskeletons can be split to full lower body exoskeletons or modular single
joint exoskeletons. The devices which will discussed in this research summary
include, powered lower body exoskeletons (powered hips, knees, and passive
ankles): Ekso (Ekso Bionics), ReWalk (ReWalk Robotics), Indego (Parker
Hannin); modular robots: SMA-powered hips (Honda), Keeogo-powered knees
(B-Temia).
Exoskeletons for Rehabilitation and Personal Mobility
2.3
23
Clinical Studies
The studies discussed in this research summary will include different levels of
evidence ranging from case studies to randomized controlled trials. We will discuss
the clinical utility of exoskeletons compared to gold standard physical therapy in
individuals with spinal cord injury and stroke. We will also look at the impact of
wearable exoskeletons as personal mobility devices and their impact on home and
community mobility. We will discuss on how to plan clinical research on
exoskeletons including, identifying appropriate patient populations, plans timing
and dosing strategies, choosing appropriate clinical outcome measures and discuss
future implications on modifying existing controller and hardware limitations and
safety concerns including falls.
3 Results
Large multi-site safety and efcacy clinical trials indicate that exoskeletons are safe
for individuals from C7-L5 spinal cord level injuries to use for mobility without any
major adverse events. However, most exoskeleton walking speeds currently
available are still much slower than average non-injured humans community
walking speeds. Currently, exoskeletons require more than thirty sessions of
training for performing advance skills sets such stairs and ramp climbing.
Additionally, regular use of exoskeletons in the community has the potential to
reduce long term secondary health complications associated with spinal cord injury,
thus making a good health-care economics case for reimbursement. On the therapeutic benets side, full lower body exoskeletons with variable assistance mode are
better in improving mobility outcomes in severe stroke participants compared to
traditional therapeutic strategies, while modular single joint exoskeletons are able to
provide the similar therapeutic benets as traditional care in mild-to-moderate
stroke participants, thus suggesting the scenario that these devices if taken home
can provide the benets of a physical therapy through the continuum care from
hospital to the home. Rigid robots still not inclusive of the full physical and cognitive range of individuals with disabilities.
4 Discussion
Wearable exoskeletons have come a long way in the last ve years following
commercialization. They show great promise in moving the eld of physical
rehabilitation forward by providing the potential for over-ground mobility to a
wide- range of NDs. However, limitations of the controller and hardware of current
generation exoskeletons results in them being used in a small subsets of the NDs to
24
P.T. Arun Jayaraman and W.Z. Rymer
achieve meaningful therapeutic and mobility benets. Furthermore, no safety or fall

preventions/recovery strategies currently exist in these devices making them one
event from major clinical and legal catastrophes. With over forty exoskeletons
about to be commercialized over the next ve years, these devices are going to
become a staple of human performance augmentation in both in non-disabled and
disabled populations.
5 Conclusion
Wearable exoskeletons when used appropriately can provide superior therapeutic
benets in certain sub-sets of individuals with certain NDs and can also act as
eloquent personal mobility devices for large subset of individuals with NDs.
References
1. Post, M.W., et al.: Life satisfaction of persons with spinal cord injury compared to a population
group. Scand. J. Rehabil. Med. 30, 2330 (1998)
2. Stretton, C.M., et al.: Interventions to improve real-world walking after strong: a systematic
review and meta-analysis. Clin. Rehabil.,7 April 2016
3. Hartigan, C., et al.: Mobility outcomes following ve training sessions with a powered
exoskeleton. Top Spinal Cord Inj. Rehabil. 21(2), 9399 (2015). Spring
4. Spungen, A.M., et al.: Assessment of in-hospital walking velocity and level of assistance in
powered exoskeleton in person with a spinal cord injury. Top Spinal Cord Inj. Rehabil. 21(2),
100109 (2015). Spring
5. Jayaraman, A., et al.: Effects of wearable exoskeleton stride management assist on
spatiotemporal gait characteristics in individuals after stroke: a randomized control trial.
J. Neural Eng. Rehabil. 12, 69 (2015)
Lower Limb Wearable Systems

for Mobility and Rehabilitation
Challenges: Clinical Focus
Federica Tamburella, Marcella Masciullo, Iolanda Pisotta,
Nevio Luigi Tagliamonte and Marco Molinari
Abstract Lower limb exoskeletons (EXOs) may be devised as an ambulation

device, as a rehabilitation tool or may be aimed at allowing both objectives.
Regarding rehabilitation, it is worth noticing that EXOs also provide a perfect
environment for precise assessing of rehabilitation protocols and effects. Different is
the case of EXO for mobility, in this area the old wheelchair is still largely winning
the challenge. In all functional areas: velocity, safety, portability, acceptance as well
as autonomy in the ADL none of today EXOs can compete with the performances
of an average wheelchair. EXO usage requires learning, and brain changes associated with tool usage introduce the human in the loop concept, a key aspect of
clinical relevance for EXO usage. At present, interesting data on the biological
mechanisms and rehabilitation relevance of embodiment are providing hints for
guiding rehabilitation. These challenges will be presented from a clinical rehabilitation perspective and expectations and critics discussed.
1 Introduction
The idea of using technology systems to replace the function of limbs lost by
trauma or diseases is not a prerogative of the modern era: archaeological data have
shown that already in ancient Greece and Roman time several hip replacements
have been built [1]. Over the past twenty years, the idea of human machine
interactions has evolved into one of the fastest-growing areas of neuroscience
research [2]. Nowadays, this technology, is well out of science ction [3], studies,
on the possibility of creating EXOs, come from the early 60s.
Due to recent developments in robotic technologies, powered EXOs have
emerged as both practical devices for assisting individuals with lower limb paralysis
F. Tamburella (&) M. Masciullo I. Pisotta N.L. Tagliamonte M. Molinari
NeuroRobot Lab and Neurological and Spinal Cord Injury Rehabilitation
Department A IRCCS, S. Lucia Foundation,
Via Ardeatina 306, 00179 Rome, Italy
e-mail: f.tamburella@hsantalucia.it
25
26
F. Tamburella et al.
or weakened limbs and as devices to assist and support the work of physical
therapists. We can broadly distinguish two main categories: machines that are
aimed at rehabilitation, usually used in combination with treadmills and some form
of external body weight support, and mobile EXOs, aimed at providing locomotion
for people unable to recover legs functionality. Mobile EXOs do not use external
body weight support system and usually rely on some external support (crutches,
rollator) for balance. As regarding target patient population stroke and trauma
patient either with spinal or brain lesion represent the vast majority of the potential
users for robotic rehabilitation devices. Unfortunately, while EXO technology
continues to advance and psychological as well as physiological benets of legged
mobility are likely, the benets across multiple physiological systems remain largely unproven.
2 Gait Rehabilitation
Within the category of rehabilitation robots, Gait Trainer and the Lokomat, are the
most popular and diffused body weight support devices to assist task-oriented,
intensive practice of walking, even if based on two different approaches: Lokomat
is an EXO actively moving thigh and shank by motors and passively the foot by a
spring; Gait Trainer (GT) is and end-effector device [4]. Both devices are used and
commercially proposed in several neurological conditions with different functional
walking status. In spite of this commercial success, available data on their efcacy
are not striking [5]. Effectiveness studies fail to demonstrate the superiority of
robotic vs traditional therapy. Many hypotheses have been advanced none of them
being conclusive and very few tested. Correctly, selecting patient for the right
robotic/EXO is for user a possible approach [6]. A correct approach would be
somehow the reverse. To pinpoint the rehabilitation needs of the subject and
develop an EXO capable of matching them. Beside the general rules and techniques
applied in the so called traditional rehabilitation at the base of a successful
treatment there is the professional ability of the physiotherapist of modulating the
intervention according to the ever-changing needs of the patient. None of the
available robotic/EXO devices is at present capable of adapting to the specic
conditions of a given subject. Examples of more adaptable and therapy oriented
EXOs can be found in the Lopes prototype by Twente university [6], in the BioMot
project leaded by CSIC and in the upgrading for the Lokomat proposed in the EU
founded BETTER project. BETTER approach combined multiple levels of neural
information with the resulting motion data focusing on top-down approaches to
develop innovative gait protocols for EXO [7].
Lower Limb Wearable Systems for Mobility and Rehabilitation Challenges
27
3 Gait Substitution
In many cases the rehabilitative intervention is directed to the development of
autonomy in daily life using the wheelchair, which, nowadays, is the main tool to
regain mobility and independence, even if sometimes independence might be hinted
by barriers, both physical and psychological [8]. Besides the complexity of the
interrelationships between patient and orthosis, aiming at restoring the complete
loop including incoming movement related sensory information [1]. Commercial
EXOs produced by Ekso Bionics of Richmond, California, Rex Bionics, based in
Auckland, New Zealand, and ReWalk EXO Argo Medical Technologies in Israel
have already reached the market. On the other hand different labs have developed
functioning prototypes. Indego, by Parker Hannin, (USA) is not currently
available for sale, present a modular design is small and light, with no backpack
components.
The main limitation of current wearable EXOs developed is that they do not
provide stability to the user, as a consequence patients have to rely on external
stabilizers such as crutches. Furthermore, existing wearable EXOs are not designed
to exploit the remaining, highly patient specic, physiological functions and
capacities. Nevertheless the use of EXOs among persons with gait impairments is
still extremely limited and almost exclusive conned to supervised environments.
Available EXOs allow very little interactions with the user. In general stepping is
produced in a stereotyped way through a binary command either from a hand
controlled tool or by weight shifting, as for the EXO created within the framework
of the European project the MINDWALKER. To allow a broader diffusion, EXOs
have to overcome many of the present limitations. Bulkiness, autonomy, velocity,
adaptability to all terrains, balance, portability are among the critical aspects that
must be answered in the near future, even if development of human machine
interaction modules capable of collecting biological signal to drive EXO movement
is the real challenge. A balance shared control module will represent an extremely
important step for the development of gait shared control modules. These are the
main goals of the recently founded EU project Symbitron (http://www.symbitron.
eu/). It proposed a patient- instead of a technology-driven methodology in which
the design and control of the wearable EXO and the interface between the EXO and
patient are customized to the unique features (not only impairments but also
remaining capacities) of each individual patient.
4 Clinical Aspects for Gait Rehabilitation

It is generally agreed that locomotor training using robot-assisted therapies depends
on patient engagement, reward and the desire of the patient to conquer the disability. Thus, wearable robots that engage the patient with gait intent detection can
help motivate the patient, provide short-term reward via immediate feedback of
28
F. Tamburella et al.
movement, and empower the patient with direct control of his/her own health and
quality of life [9]. Towards this extent, gait intention detection systems for EXO
control, such as by monitoring shifts in the center of mass (e.g. tilting the trunk or
the pelvis as for the MINDWALKER EXO), may improve the efcacy of rehabilitation by encouraging the user to actively participate rather than relying solely
on the assistance provided by the EXO [10]. EXO should be selected according to
patients features and residual capabilities. Furthermore, due to the continuative use
of the EXO it is possible for patient to partially improve some residual activities and
to modify brain activities. EXO usage requires learning, and learning is always
associated with brain changes at least at synaptic level. Although use of EXOs is
focused on ambulation and lower limb motor improvement, there may be secondary
benets across multiple physiological systems, such as improved bowel/bladder
function, decreased chronic pain, reduced spasticity, and increased bone marrow
density [10].
5 Conclusions
For a better acceptance in clinical rehabilitation framework, EXOs have to improve
their capacity to adapt to rehabilitation needs allowing interactions with rehab
professionals enabling customable evaluation and training sessions. To develop
close loop real time control mechanisms based on biological signals capable of
adapting EXO performances to the ever-changing needs of patients appears at
present the right line for future developments in this eld.
Acknowledgment This work was supported by EU FP7 Program under contract #611626
(SYMBITRON) and Italian Ministry of Health grant.
References
1. Hernigou, P.: Ambroise pare IV: the early history of articial limbs (from robotic to
prostheses). Int. Orthop. 37(6), 11951197 (2013)
2. Shih, J.J., Krusienski, D.J., Wolpaw, J.R.: Brain-computer interfaces in medicine. Mayo Clin.
Proc. 87(3), 268279 (2012)
3. Daly, J.J., Wolpaw, J.R.: Brain-computer interfaces in neurological rehabilitation. Lancet
Neurol. 7(11), 10321043 (2008)
4. Pohl, M., Werner, C., Holzgraefe, M., Kroczek, G., Mehrholz, J., Wingendorf, I., Hoolig, G.,
Koch, R., Hesse, S.: Repetitive locomotor training and physiotherapy improve walking and
basic activities of daily living after stroke: a single-blind, randomized multicentre trial
(DEutsche GAngtrainerStudie, DEGAS). Clin. Rehabil. 21(1), 1727 (2007)
5. Chang, W.H., Kim, Y.H.: Robot-assisted therapy in stroke rehabilitation. J. Stroke 15(3),
174181 (2013)
Lower Limb Wearable Systems for Mobility and Rehabilitation Challenges
29
6. Morone, G., Iosa, M., Bragoni, M., De Angelis, D., Venturiero, V., Coiro, P., Riso, R., Pratesi, L.,
Paolucci, S.: Who may have durable benet from robotic gait training? A 2-year follow-up
randomized controlled trial in patients with subacute stroke. Stroke 43(4), 11401142 (2012)
7. Belda-Lois, J.M., Mena-del Horno, S., Bermejo-Bosch, I., Moreno, J.C., Pons, J.L., Farina, D.,
Iosa, M., Molinari, M., Tamburella, F., Ramos, A.: Rehabilitation of gait after stroke: a review
towards a top-down approach. J. Neuroeng. Rehabil. 8, 66 (2011)
8. Simpson, L.A., Eng, J.J., Hsieh, J.T.C., Wolfe and the Spinal Cord Injury Rehabilitation
Evidence (SCIRE) Research Team, D.: The health and life priorities of individuals with spinal
cord injury: a systematic review. J. Neurotrauma 29(8), 15481555 (2012)
9. Contreras-Vidal, J.L., Bhagat N, A., Brantley, J., Cruz-Garza, J.G., He, Y., Manley, Q.,
Nakagome, S., Nathan, K., Tan, S.H., Zhu, F., Pons, J.L.: Powered EXOs for bipedal
locomotion after spinal cord injury. J. Neural Eng. 13(3), 031001 (2016)
10. Zeilig, G., Weingarden, H., Zwecker, M., Dudkiewicz, I., Bloch, A., Esquenazi, A.: Safety and
tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord
injury: a pilot study. J. Spinal Cord Med. 35, 96101 (2012)
Part II
Emerging Technologies in WRs
Impedance Control of Series Elastic

Actuators Using Acceleration Feedback
Andrea Calanca, Riccardo Muradore and Paolo Fiorini
1 Introduction
More and more robots are designed to help or substitute humans both in daily activities and dangerous scenarios. These robots should be able to cope with humans and
with other robots and to move in houses, factories, hospitals and uncertain outdoor terrains. To accomplish these targets robots must be able to move safely in unstructured
or uncertain environments and to display relatively high forces with high dynamical precision. Currently a widespread solution is that of using impedance controlled
elastic joint robots [7]. While impedance control allows to safely deal with unknown
kinematic and dynamic environmental constraints [4], series elastic joints allows
impedance controllers to be implemented on high force and high power density
motors. This is because accurate impedance control is often implemented relying
on a explicit inner force loop [2] and series compliance can dramatically improve
explicit force control robustness [1, 8].
The physical interaction with humans and surrounding environments is historically considered an hard challenge in robotics. Solutions are often based on passivitybased (PB) control which is an established control paradigm to provide a high level
of stability robustness [3]. In particular in the passive interaction framework passivity
of the robot impedance is a sufficient condition to ensure a stable interaction with
any passive environment [12], and the human has historically been considered as
passive [5].
Several passivity-based force and impedance controllers has been introduced for
SEAs. In the seminal works of Pratt and Williamson a passive force controller
was introduced, based on positive load acceleration feedback [8]. An interesting
aspect of this algorithm is that it not only shows robust stability (passivity) but also
robust performance, thanks to the acceleration feedback [1]. It happened that most
of subsequent research focused on robust stability while not accounting for robust
performance. Vallery et. al. investigated the passivity of SEA control considering
a velocity controlled motor. They considered an impedance control schema and
A. Calanca (B) R. Muradore P. Fiorini
University of Verona, Strada Le Grazie 15, Verona, Italy
e-mail: andrea.calanca@univr.it
33
34
A. Calanca et al.
found that SEA cannot display a higher pure stiffness than the spring stiffness if
passivity is desired. Interestingly this result has been confirmed also with different
control architecture. In [9] the impedance is controlled by shaping the admittance
at the motor level, aiming at reducing the force control effort for high impedance
rendering. Despite not reported in the literature it can be proved that this algorithm
leads to the same passivity result i.e. it cannot passively render a stiffness higher than
the physical spring stiffness. A similar outcome emerged for the passive impedance
control of the the DLR lightweight arm where a parallel force-position architecture
has been adopted. Authors implicitly showed that the passivity constraint doesnt
allow to overcame the physical transmission stiffness. Further related results state
that the physical stiffness limit is even hard to reach. In [10] it is shown that only by
using high force control gains the physical stiffness can be approached while in [6]
it has been shown that in the case of non collocated force sensor the stiffness limit
can be significantly lower than the physical spring stiffness. Also in [11] it has been
shown that an impedance controlled SEA cannot passively display a virtual Vogit
model dynamics, i.e. the dynamics of a spring in parallel to a damper. In conclusion
given the current state of the art there exists no passive algorithm that allows to
overcame the physical spring stiffness. Moreover existing passive algorithms cannot
display any virtual damping in parallel to the virtual spring.
In this paper we present the first passive algorithm that can overcame such stiffness
and damping limitations. The idea is inspired by the seminal work of Pratt and
Williamson [8] where they used the above mentioned load acceleration feedback to
control the SEA output force. Such acceleration feedback allows the motor to have
the same acceleration of the environment thus compensating for load motion and
leading to robust performance, i.e. predictable error dynamics. Quite surprising such
a performance robustness was not highlighted neither in the original work nor in
subsequent publications which focused more on the robust stability issue rather than
on robust performance. In fact the effect of the acceleration feedback is to cancel out
the load dynamics and we will formally show that leveraging on such load dynamics
cancellation we can passively render any passive impedance.
Fig. 1 A model of SEA
interacting with an
environment
Human
m
Jm

Fig. 2 Impedance control of
a SEA. It uses an inner force
control loop and an outer
position loop to shape the
impedance
qr
sI(s)
35
1
Js2
C(s)
ua
e
E
q
2 Impedance Control of Series Elastic Actuators

SEAs are usually modeled using the following equations
s = k( q)
Jm = m s
(1)
(2)
where, considering the scenario in Fig. 1, s is the spring force (or torque in the case
of a rotary joint), is the motor position, q is the environment position and m is the
motor input force (or torque). The actuator parameters are k and Jm which represent
the spring stiffness and the motor inertia respectively. Let us highlight that m is
the actuator input while s is actuator output i.e. the force (or torque) exerted on
the environment. An impedance control architecture applied to a SEA is shown in
Fig. 2, where u a = 0. The force controller F(s) uses the spring deflection feedback
and is fed by an outer loop that measures the load position and computes the force
reference needed to obtain the desired impedance. As example if we desire a first
order impedance, the outer controller should be implemented as
s I (s) = dd s + kd
(3)
where dd and kd are desired damping and stiffness.
3 Impedance Control Using Acceleration Feedback

In this section we analyze the impedance shaping of a SEA considering the control
structure in Fig. 2 where C(s) is a generic stable linear controller, I (s) implements a
desired passive impedance and u a is an auxiliary control output or motor input. This
impedance relation can be computed using standard block algebra as
s =
C(s)I (s) + J s 2 u a
q.
C(s) + kJ s 2 + 1
If we initially neglect u a it turns out that the desired impedance relation is approximately satisfied only if C(s) J s 2 and C(s) kJ s 2 + 1. If this is not the case the
actual impedance can be quite far from the desired impedance I (s) an the impedance
36
A. Calanca et al.
error is influenced by the environment motion. Interestingly, if we consider the following expression for u a
u a (t) =
J
s (t) + s (t) + J q(t)
which includes a positive acceleration feedback, the actual impedance results exactly
equal to the desired impedance:
s = I (s)q.
This means accurate and passive rendering of any passive impedance.
4 Conclusions
The proposed acceleration-based law suggests that embedding the load/environment
acceleration in the control law can help to design accurate impedance controllers.
Unfortunately the acceleration signal is usually a noisy measure or an approximate
estimation. Moreover acceleration overestimation can lead to feedback inversion
and instability [8]. For these reasons an acceleration measure or estimation needs
to be handled carefully. Also common acceleration processing, such as filtering and
amplification, may alter control passivity. In our preliminary experimental results we
achieved stable rendering of 3k, where k is the physical spring stiffness. In our future
work we will analyze the passivity of existing impedance controllers and compare
them to the acceleration-based approach.
References
1. Calanca, A., Fiorini, P.: On the role of compliance in force control. In: Menegatti, E., Michael,
N., Berns, K., Yamaguchi, H. (eds.) International Conference on Intelligent Autonomous Systems IAS-13, Padova, Italy. Springer International Publishing (2014)
2. Calanca, A., Muradore, R., Fiorini, P.: A review of algorithms for compliant control of stiff
and fixed compliance robots. IEEE Trans. Mechatron. 21(2), 613624 (2016)
3. Colgate, E., Hogan, N.: An analysis of contact instability in terms of passive physical equivalents. In: IEEE International Conference on Robotics and Automation, vol. 1, pp. 404409
(1989)
4. Hogan, N.: Impedance control: an approach to manipulation: Part I, II, III. J. Dyn. Syst. Meas.
Contr. 107, 124 (1985)
5. Hogan, N.: Controlling impedance at the man/machine interface. In: International Conference
on Robotics and Automation, Scottsdale, AZ, pp. 16261631. IEEE Computer Society Press
(1989)
6. Oblak, J., Matja, Z.: On stability and passivity of haptic devices characterized by a series elastic
actuation and considerable end-point mass. In: IEEE International Conference on Rehabilitation
Robotics, vol. 1, pp. 15. ETH Zurich Science City (2011)
37
7. Paine, N., Mehling, J.S., Holley, J., Radford, N.A., Johnson, G., Fok, C.-L., Sentis, L.: Actuator
control for the NASA-JSC Valkyrie humanoid robot: a decoupled dynamics approach for torque
control of series elastic robots. J. Field Robot. 32, 378396 (2015)
8. Pratt, G.A., Williamson, M.M..: Series elastic actuators. In: International Conference on Intelligent Robots and Systems, vol. 1, pp. 399406. IEEE (1995)
9. Pratt, G.A., Willisson, P., Bolton, C., Hofman, A.: Late motor processing in low-impedance
robots: impedance control of series-elastic actuators. In: American Control Conference, pp.
32453251 (2004)
10. Tagliamonte, N.L., Accoto, D.: Passivity constraints for the impedance control of series elastic
actuators. J. Syst. Control Eng. 228(3), 138153 (2013)
11. Tagliamonte, N.L., Sergi, F., Accoto, D., Carpino, G., Guglielmelli, E.: Double actuation architectures for rendering variable impedance incompliant robots: a review. Mechatronics 22(8),
11871203 (2012)
12. Van Der Schaft, A.J.: L2-Gain and Passivity Techniques in Nonlinear Control. Lecture Notes
in Control and Information Sciences, vol. 218. Springer (1996)
Kinetic Energy Recovery in Human

Joints: The Flywheel-Innitely Variable
Transmission Actuator
Roberta Al, Francesco Bottiglione and Giacomo Mantriota
Abstract In this extended abstract we present a novel architecture of an

electric-mechanical actuator suitable for application to systems with periodic
motion and here presented as an alternative to traditional actuators employed in
wearable robots for lower limbs: the Flywheel - Innitely Variable Transmission
(F-IVT).
1 Introduction
Wearable robots for lower limbs aspire to become portable devices that will help
disabled people in every day life [1]. Unfortunately, a lot of work is still to be done
in order to achieve this goal and to fulll the related requirements of portability and
reliability.
Most of the wearable robots presently under development are electrically powered
and their less portable components are the actuators and the batteries. The characteristics of lower limbs movements in terms of velocities and forces/torques are not
the best ones for electric drives. Indeed, the motor size must be selected in function of
the peak torque and power requested that are much larger than the average torque and
power, thus leading also to a loss of efciency. This leads to oversize and to overweight the batteries and the actuators with respect to their actual usage. Here we
present a novel architecture named F-IVT (Flywheel-Innitely Variable
Transmission) actuator that in principle permits to exploit the characteristics of the
R. Al F. Bottiglione (&) G. Mantriota

Department of Mechanics Mathematics and Management,
Politecnico Di Bari, Bari, Italy
e-mail: francesco.bottiglione@poliba.it
R. Al
e-mail: roberta.alo@poliba.it
G. Mantriota
e-mail: giacomo.mantriota@poliba.it
39
40
R. Al et al.
lower limb movement optimizing the operating conditions of the electric motor and
overcoming the aforementioned problems [2, 3].
2 The F-IVT Actuator: Working Principle

and Performance Calculation
2.1
Working Principle of F-IVT
The idea at the basis of the F-IVT actuator comes from the evidence that, in
walking, the lower limbs joints (the knee in particular) sometimes need power for
propulsion, sometimes need to be braked, in a periodic fashion. For this reason the
average power per gait is much smaller than the peak power (positive or negative)
requested, being even negative in the case of the knee joint in normal walking: in
principle it is possible to harvest energy from the knee reducing the metabolic cost
associated with braking the joint [4].
Unfortunately, the back drivability of commonly adopted mechanical drives is
hard to achieve and the electric energy recovery has been shown to be inefcient
[6]. Moreover, the electric machine should be sized in function of the peak value of
the torque and power requested in a gait.
The working principle of the F-IVT is the following: a mechanical energy
accumulator (the flywheel) is placed between the actuator and the transmission and
coupled directly with the motor. The motor angular velocity is close to its optimal
value and it is almost constant thanks to the flywheel. The transmission must adapt
the velocity of the flywheel to the changeable angular velocity requested by the
knee. In order to do so, it should be characterized by a small and variable speed
ratio. In practical applications, it would be made of two devices in series: a xed
ratio drive and a continuously variable transmission. In particular, the transmission
will be of innitely variable transmission type (IVT) in order to permit also the
change of the rotation wise of the output shaft. The xed ratio drive is a harmonic
drive (HD) or a ball screw (BS), depending on the attachment to the joint/leg. In the
former case, the F-IVT is of rotating type, in the latter case it is of linear type
(Fig. 1). For one given walking regime and in ideal conditions, (negligible
mechanical power losses and flywheel with innitely large inertia), the variable
power request of the knee would be ltered by the flywheel, and the motor should
only feed the system with the average power needed to walk, applying also an
almost constant torque to the flywheel, thus working on a xed operating point at
optimal electric efciency. Thus, since average power and torque are much smaller
than their peak values the motor can be greatly undersized.
Kinetic Energy Recovery in Human Joints
41
Fig. 1 Schematic picture of the F-IVT architectures
2.2
Performance Calculation
The actual performance of F-IVT actuator is different from the ideal because of the
nite size of the flywheel and the power loss in the transmission. In order to estimate
the potential benets in terms of size, weight and energy efciency of the F-IVT with
respect to existing actuators for similar applications, these aspects must be taken into
account. We followed a back-dynamic approach starting from the torque and angular
velocity requirements of the knee joint, available in the literature [5, 6]. We used
kinematics and efciency models of mechanical components (constant ratio drive,
innitely variable transmissions, motor) [2, 3] to develop a simulation tool for the
calculation of the energy required per gait by the actuator. The IVT is characterized by
a variable efciency with respect to speed ratio, torque and power flow direction, and
thus accurate models of IVT efciency are adopted [7]. Also the harmonic drive is
modeled in detail for similar reasons. The selection of the motor, the flywheel inertia,
the IVT, the xed ratio drive sizes, and of the location of the attachment points to the
leg (for linear F-IVT) has been done by minimizing the energy required per gait
(objective function) with some additional constraints mostly related to the strength of
the mechanical devices as declared by manufacturers. After the selection of the
components has been done, the simulation tool is used to calculate the achievable
performance of the actuator. Following the outlined approach, we also calculated the
performance of a traditional direct drive actuator (DD) for comparison purposes.
42
R. Al et al.
3 Results and Discussion

Figure 2 shows the instant values of electric power needed to achieve the
torque/velocity request of a gait cycle (biological walking at 1.1 m/s) with rotating
F-IVT, linear F-IVT and a Direct Drive (DD) actuators, optimized for this working
condition. It can be noted that both flywheel based actuators permit the motor to
deliver constant power whereas a direct drive actuator follows point-by-point the
power requested by the joint. In our calculations we consider that negative power is
dissipated (electric non-regenerative braking) as it (almost) always happens in these
applications. Moreover, it can be noted that the power consumption of linear F-IVT
is less than the one achieved by the rotating F-IVT. The reason is that the efciency
of the HD is by far less then the efciency of the Ball Screw (BS), and the HD is
hardly back drivable, thus limiting the possibility to recover energy in the braking
phases. In Table 1 it is shown that linear F-IVT in principle permits the gait cycle to
be completed without any energy consumption (as mentioned in the introduction)
Fig. 2 Instant values of electric power in normal walking at 1.1 m/s powered by rotating
F-IVT, linear F-IVT and Direct Drive (DD) actuators
Table 1 Simulation results: knee joint

v [m/s]
slope []
1.1
0
[-]
30
E [J/kg]
PP [W/kg]
PT [Nm/kg]
E [J/kg]
PP [W/kg]
PT [Nm/kg]
Rotating F-IVT
Linear F-IVT
Direct Drive
0.24
0.32
3.4 104
3.02
2.43
2.2 103
0
0
6.9 106
1.25
0.93
7.3 104
0.74
5.69
7.2 103
2.10
5.03
1.9 103
Kinetic Energy Recovery in Human Joints
43
whereas the rotating F-IVT can not. Data shown in Table 1 also suggest that the
motor size of flywheel-based drives is by far smaller than the Direct Drive (the peak
of torque is at least one order of magnitude smaller than for the Direct Drive
actuator) even in case of stairs ascend, where the energy requirements of the
actuators increases so as to make the DD more convenient than the rotating F-IVT.
4 Conclusion
We presented the architecture of the F-IVT actuators and some model based estimations of the achievable performance in wearable robots for lower limbs. It has
been shown that the linear F-IVT actuator may lead to improvements of actuators
portability because of the reduced energy consumption with respect to traditional
devices. In terms of weight and size, the F-IVT actuators permits to undersize the
motor, but they also need an additional micro-IVT transmission that is still under
development. Feasibility of efcient micro-IVT transmissions will be actually
crucial to determine whether the F-IVT has a future in bio-robotics.
References
1. Pons, J.L.: Wearable Robots: Biomechatronic Exoskeletons. John Wiley & Sons Ltd,
Chichester (2008)
2. Al, R., Bottiglione, F., Mantriota, G.: An innovative design of articial knee joint actuator with
energy recovery capabilities. ASME J. Mech. Robot. 8(1), 011009 (2016)
3. Al, R., Bottiglione, F., Mantriota, G.: Articial knee joints actuators with energy recovery
capabilities: a comparison of performance. J. Robot. 2016 (2016)
4. Donelan, J.M., Li, Q., Naing, V., Hoffer, J.A., Weber, D.J., Kuo, A.D.: Biomechanical energy
harvesting: generating electricity during walking with minimal user effort. Science 319(5864),
807810 (2008)
5. Grimmer, M., Eslamy, M., Seyfarth, A.: Energetic and peak power advantages of series elastic
actuators in an actuated prosthetic leg for walking and running. Actuators 3(1), 119 (2014)
6. Riener, R., Rabuffetti, M., Frigo, C.: Stair ascent and descent at different inclinations. Gait &
Posture 15(1), 3244 (2012)
7. Bottiglione, F., Mantriota, G.: Reversibility of power-split transmissions. ASME J. Mech. Des.
133(8), 084503 (2011)
A Compliant Lightweight and Adaptable

Active Ankle Foot Orthosis for Robotic
Rehabilitation
Marta Moltedo, Tomislav Bacek, Kevin Langlois, Karen Junius,
Abstract This paper presents the design of a compliant, lightweight and adaptable
active ankle foot orthosis (AAFO) and preliminary test of its ankle actuator. The
ankle actuator is designed to keep its weight as low as possible. The adaptability
of the AAFO allows adjusting the device to different patients, without the need of
customized versions.
1 Introduction
During the push-off phase of walking, the ankle joint alone generates nearly all the
positive work of the stance leg. In this phase it provides support to the body, ensures
forward progression and initiates the swing of the leg. However, the capability of the
muscles acting at the ankle joint can be negative altered by several neuromuscular
This work is supported by the European Commissions 7th Framework Program as part of the
project BioMot (Grant Agreement number IFP7-ICT-2013-10-611695), by the Flemish agency
for Innovation by Science and Technology as part of the project MIRAD (IWT-SBO 120057)
and by the FWO grant (no. G026214N).
M. Moltedo (B) T. Bacek K. Langlois K. Junius B. Vanderborght D. Lefeber
Department of Mechanical Engineering, Robotics & Multibody Mechanics Research Group,
Vrije Universiteit Brussel, 1040 Brussel, Belgium
e-mail: marta.moltedo@vub.ac.be
T. Bacek
e-mail: tomislav.bacek@vub.ac.be
K. Langlois
e-mail: kevin.langlois@vub.ac.be
K. Junius
e-mail: karen.junius@vub.ac.be
B. Vanderborght
e-mail: bram.vanderborght@vub.ac.be
D. Lefeber
e-mail: dirk.lefeber@vub.ac.be
45
46
M. Moltedo et al.
disorders. Affected patients present impaired walking patterns, often represented by

lack of propulsion, foot drop and toe drag [1]. In these cases, the use of AAFOs as
rehabilitation devices can greatly enhance the recovery of patients motor capabilities. To be suitable for rehabilitation purposes, an AAFO has to be safe for the user,
wearable (meaning lightweight, compact and autonomous) and robust to provide the
necessary torque to the user. In addition, modularity and adaptability to different subjects are preferable characteristics, to avoid the need of building customized versions
of the same prototype. Several AAFOs to assist the human ankle joint during walking
have been built [2], but none of them satisfies all the aforementioned characteristics. In this paper, the design of a compliant, lightweight and adaptable AAFO and
the results of a preliminary characterization test of its ankle actuator are presented.
A more detailed description of the design of the AAFO can be found in [3]. The
results of the characterization tests performed on the presented actuator will be used
as feedback to design a second prototype providing a higher level of assistance.
2 Mechanical Design of the AAFO

2.1 Ankle Actuator
The AAFO presented in this paper is shown in Fig. 1. The ankle actuator implemented
in the AAFO can provide a peak torque of 25 Nm and it is based on the so-called
spindle-driven MACCEPA. The MACCEPA is a torque-controlled, variable stiffness
actuator that basically works as a torsion spring and allows independent control of
its equilibrium position and joint stiffness. The working principle of the MACCEPA
and the design of its spindle-driven version to actuate a joint of an exoskeleton can
be found respectively in [4, 5].
As said before, wearability is one of the desired characteristics for an AAFO. For
this reason, the design of the presented actuator is made to be as lightweight and
compact as possible. A reduction of size and weight of the actuator is obtained by
inserting the MACCEPA spring into the lever arm. This realization allows reducing
the dimensions of the foot link (Fig. 1). A further reduction of weight is achieved
by removing unnecessary material for the structural integrity from the actuators
components. This process was based on the analysis of the distribution of the stresses
and deformations obtained using a Finite Element Method (FEM) analysis. Thanks
to this approach, the total weight of the ankle actuator (including electronics and
excluding batteries) is only 1.1 kg.
A Compliant Lightweight and Adaptable Active Ankle Foot Orthosis ...
47
Fig. 1 The presented AAFO is lightweight (the total weight of the AAFO structure and the ankle
actuator is 1.7 kg, including electronics and excluding batteries), adaptable to different patients and
modular (it can be used as the ankle joint of an exoskeleton). The ankle actuator is a compliant
actuator based on the MACCEPA [4] providing a peak torque of 25 Nm
2.2 Connections to the User

Adaptability of the AAFO to different subjects is achieved by means of the design
of the connections between the ankle actuator and the user. The foot of the user
is attached to two carbon fibers plates, respectively placed below the heel and the
toes of the foot. Each of them is connected to the ankle actuator by means of an
aluminum link (heel link and toe link), whose relative position can be changed in
the sagittal plane. Another advantage of having movable connecting links is the
possibility of aligning the robots and users ankle joint axes. This alignment is
important to minimize unwanted residual forces on the user when the actuator is
active. To allow the biological rotation of the foot around the toe joint while walking,
the toe plate is connected to the toe link by means of a revolute joint. The shank of
the user is attached by means of two cuffs to a carbon fibers shank frame, which is
attached to the shank link of the actuator through a hinged joint. The combination
of a carbon fiber frame and a hinge joint, allows the shank frame to bend in the
frontal plane, to follow the curved shape of the users leg, while the actuator is kept
perpendicular to the ground. The vertical positions of the shank frame and of the
two cuffs can be varied with respect to the ankle joint axis, to adapt the AAFO to
different shank lengths.
48
M. Moltedo et al.
The shank frame and foot plates are made more rigid in the sagittal plane and
more compliant in the frontal plane. In this way, in the sagittal plane, their necessary
stiffness to transfer the actuator torque is not compromised, but they are still able
to bend to follow the movement of the user in the frontal and transversal planes,
allowing a more comfortable walking pattern.
3 Ankle Actuator Characterization

A static characterization test of the actuator was performed. In this test, both links
of the actuator were rigidly fixed to the experimental setup. The actuator was fixed
to the setup only at its internal side, meaning the side that is attached to the users
leg, to simulate the connection to the AAFO frame. The fixed link of the actuator
(Fig. 1) was directly fixed to the experimental setup. The output link (Fig. 1) was
connected to the setup via a force sensor, used to measure the output torque provided
by the actuator. During the experiment, the lever arm was controlled by means of a
PI controller which used the motor velocity signal as control signal. The input to the
controller was an error signal computed as the difference between the desired and
actual torque. The actual torque was computed multiplying the measured force in
the load cell and the length of the output link. The desired output torque was defined
to be a sinusoidal curve having 25 Nm as amplitude.
Fig. 2 Desired predefined output torque (in red) and actual output torque (in blue) obtained during
the static characterization experiment, in which both links of the actuator were rigidly fixed to the
experimental setup
A Compliant Lightweight and Adaptable Active Ankle Foot Orthosis ...
49
Figure 2 shows the predefined reference signal (in red) and the actual torque
obtained during the experiment (in blue). As it can be seen, the actuator successfully
followed the reference trajectory. Small errors at the lowest amplitude, small oscillations and a constant delay in the actuator trajectory come from the gains of the PI
controller, which were not set to be optimal for the given scenario.
4 Conclusion
This paper presented the design of a compliant, lightweight and adaptable AAFO.
The design of the connections between the ankle actuator and the foot and shank of
the user is made to be adaptable to different subjects. The results of a preliminary
characterization test of the ankle actuator showed that the ankle actuator is able to
provide 25 Nm as peak torque. Starting from the design of the presented actuator, a
second prototype will be designed and built. In the second prototype, the conceptual
design and working principle of the actuator will remain the same, but the actuator
will be upscaled to provide 50 Nm as peak torque, while maintaining the weight and
size of the AAFO as low as possible.
Acknowledgments The authors would like to thank MOBILAB @ Thomas More for the development of the carbon fiber foot plates.
References
1. Park, Y.-L., Chen, B.-R., Young, D., Stirling, L., Wood, R.J., Goldfield, E., Nagpal, R.: Bioinspired active soft orthotic device for ankle foot pathologies. In: IEEE/RSJ International Conference on Intelligent Robots and Systems, San Francisco, CA, USA, pp. 44884495 (2011)
2. Duerinck, S., Swinnen, E., Beyl, P., Hagman, F., Jonkers, I., Vaes, P., Van Roy, P.: The added
value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal
cord injury: a systematic review. J. Rehabil. Med. 44(4), 299309 (2012)
3. Moltedo, M., Bacek, T., Junius, K., Vanderborght, B., Lefeber, D.: Mechanical design of a
lightweight compliant and adaptable active ankle foot orthosis. In: 6th IEEE RAS & EMBS
International Conference on Biomedical Robotics and Biomechatronics (BioRob 2016) (submitted for publication)
4. Van Ham, R., Vanderborght, B., Van Damme, M., Verrelst, B., Lefeber, D.: MACCEPA, the
mechanically adjustable compliance and controllable equilibrium position actuator: design and
implementation in a biped robot. Rob. Auton. Syst. 55(10), 761768 (2007)
5. Bacek, T., Unal, R., Moltedo, M., Junius, K., Cuypers, H., Vanderborght, B., Lefeber, D.: Conceptual design of a novel variable stiffness actuator for use in lower limb exoskeletons. In: IEEE
International Conference on Rehabilitation Robotics, Singapore, pp. 583588 (2015)
A Novel Shoulder Mechanism with a Double

Parallelogram Linkage for Upper-Body
Exoskeletons
Simon Christensen and Shaoping Bai
Abstract The design of an innovative spherical mechanism with three degrees of

freedom for a shoulder joint exoskeleton is presented in this paper. The spherical
mechanism is designed with a double parallelogram linkage, which connects two
revolute joints to implement the motion as a spherical joint, while maintaining the
remote center of rotation. The design has several new features compared to the
current state-of-the-art: (1) a relative large range of motion free of singularity, (2) high
overall stiffness, (3) lightweight and (4) compact, which make it suitable for assistive
exoskeletons.
1 Introduction
Traditional designs of shoulder exoskeletons use an serial linkage system with 3revolute (3R) joints [1, 2] to generate the spherical motion of the human shoulder
joint. A problem with a serial structure is its workspace limit. The user of the exoskeleton can only raise the upper arm a small angle in the frontal plane before the shoulder
mechanism collides with his/hers shoulder, neck or head. To avoid this problem, some
alternative designs have been proposed. The designs in [1, 2] minimized the effect
of these problems by designing their exoskeletons so that the singular configurations
and collision problem of the 3R mechanism occur at postures that are less likely for
the user to reach. In another approach, reported in [3], one of the links in the 3R
mechanism is replaced with a circular guide to further avoid collision with the user.
In this paper a novel spherical mechanism using double parallelogram linkages (DPM in short) is presented. The mechanism is featured with a compact
The work reported here is supported by the EU AAL Programme and Innovation Fund Denmark
S. Christensen (B) S. Bai
Department of Mechanical and Manufacturing Engineering, Aalborg University,
9220 Aalborg, Denmark
e-mail: sic@m-tech.aau.dk
S. Bai
e-mail: shb@m-tech.aau.dk
51
52
S. Christensen and S. Bai
structure, lightweight yet rigid design, and a large range of motion free of singularity.
The proposed mechanism is to be used as a novel glenohumeral joint mechanism for
an upper-body exoskeleton.
2 Conceptual Design of Novel Shoulder Mechanism

for an Upper-Body Exoskeleton
The proposed design consists of two revolute joints that are connected together via
four links, as shown in Fig. 1. The four links form a double parallelogram mechanism
(DPM), which under the given configuration form a remote center of motion mechanism [4]. The revolute joints produce extension/flexion and abduction/adduction
respectively, while the DPM produces the internal/external rotation. The working
principle is similar to the 3R mechanisms, meaning it can rotate about three independent axes that all coincide in one point, namely, the Remote Center (RC) (see Fig. 1).
The proposed design is constructed as a hybrid mechanism. The benefit of the
proposed design is that the chance of collision with the user is minimized compared
to the classical 3R mechanism having two links in series. Moreover, the structure is
more compact, lighter and less complicated compared to the 3R mechanism using a
circular guide.
The design parameters of the DPM are displayed in Fig. 2, which include four
link lengths and two offset angles. The links L 1 and L 2 are the lengths of the first
parallelogram and L 3 and L 4 are the lengths of the second parallelogram. For the
proposed design, the offset angles are introduced mainly to account for the footprint
of the actuators, where 2 accounts for the actuator at 1 and 1 for the actuator
at 3 . The range of motion of the DPM, i.e. 2 , is limited by the footprint of the two
revolute joints and the collision with the human shoulder. Axis of joint 1 is aligned
with L1 , while axis of joint 3 is aligned with L2 .
Fig. 1 Design concept of

the double parallelogram
mechanism
Link 2
Link 1
Joint A
Joint B
Joint C
Joint F
Joint D
Link 3
Link 4
Joint G
Joint E
Actuator 2
Actuator 1
Axis 2
Axis 1
Motor Mount 1
Remote
Center
Axis 3
Motor Mount 2

Table 1 Denavit-Hartenberg
parameters of the proposed
mechanism
i1
53
Link, i
ai1
di
1
2
0
0
L 3 sin 2 90
0
0
L2
L3
L 2 sin 1 90
1
90 +
1 2
180
1
2 + 2
90 +
2 2
3
3 Kinematic Analysis of the Mechanism

The kinematics of the proposed mechanism is formulated based on DenavitHartenbergs convention. Cartesian coordinate frames are attached to each link of a
manipulator, as shown in Fig. 2. The corresponding DH parameters can be obtained
as listed in Table 1. Using these parameters the rotation matrix is obtained as:
c1 c2 c3 s1 s3 c3 s1 c1 c2 s3 c1 s2
R = c1 s3 + c2 c3 s1 c1 c3 c2 s1 s3 s1 s2
c3 s2
s2 s3
c2
(1)
where 1 , 2 and 3 are the joint angles. Also, c and s stands for cos and sin
respectively.
Fig. 2 Coordinate frames

attached to the links of the
shoulder mechanism
L3
G
x3
C
y3
G'
L4
z3
D
y4 E y5 x5
E'
z4 x4 z5
3
L2
L1
A
1
A'
x2
y2
z2
B x0,x1
z0,z1
B' y0,y1
1
2
2
RC
54
The inverse kinematics problem is solved for the three joint angles:
2 = arccos(r33 )
1 = arctan 2 (r23 /s2 , r13 /s2 )
3 = arctan 2 (r32 /s2 , r31 /s2 )
where ri, j stands for the (i,j)th element of the matrix R. It should be noted that there
are two possible solutions for 2 , but given the allowable range of motion only the
solution between 0 and 180 is used.
The velocity and singularity analysis of the DPM can be performed by deriving
the Jacobian for the angular velocities:
= J 1 e
(2)
T

where = 1 2 3 is a vector with the joint angular velocities, J is the Jacobian
T

and e = x y z is the end-effector angular velocities. The Jacobian is found
as:
0 s1 c1 s2
J = 0 c1 s1 s2
(3)
1
0
c2
A common measure of the evaluating the performance of a mechanism is the
manipulability index , which is defined as:
(J) =

JJT = |s2 |
(4)
From Eq. (4) it is clear that the kinematic performance of the DPM only depends
on the angle of the double parallelogram. The manipulability index over the range
of motion of the parallelogram is shown in Fig. 3, where it is seen that the DPM is
at a singular configuration in the case that the joint axes constitute a common plane
(2 = 0, ). Due to the two offset angles, the proposed design has a minimum angle
of 2,min = 1 + 2 . Thus, the singular configuration of 2 = 0, is not obtainable.
According to [2], a range of motion for shoulder internal/external rotation of 135 is
sufficient for most of our activities of daily living. Hence, the mechanism is free of
singularities and covers the required range of motion if the maximum angle satisfies
the following condition 2,max = 2,min + 135 < 180 .
4 Application of the Novel Spherical Shoulder Mechanism

The application of the novel shoulder mechanism in an exoskeleton design is illustrated in Fig. 4. The exoskeleton is intended as a part of a portable exoskeleton for
elderly to assist them in their daily activities. For the proposed exoskeleton design,

Fig. 3 The manipulability
index of the DPM within its
operation range
55
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0
20
40
60
80
100 120 140 160 180
Fig. 4 The novel spherical

shoulder mechanism utilized
in an upper-body exoskeleton
the two revolute joints are actuated by a Flat DC motor (EC60 from maxon motors)
and a Harmonic Drive Gear (CSD-25-2A from Harmonic Drive) each, while the
DPM is left passive. As seen from the figure, the novel shoulder mechanism has a
compact design without compromising the range of motion.
5 Conclusion
In this paper, a novel spherical mechanism using a double parallelogram linkage and
two revolute joints for upper-body exoskeletons has been presented. The design has
several new features compared to the current state-of-the-art, such as a relative large
range of motion free of singularity, high overall stiffness, lightweight and compact.
As a result, the design is well suited for portable exoskeletons. A prototype of the
novel design is being developed for design validation and experiments.
References
1. Naidu, D., Stopforth, R., Bright, G., Davrajh, S.: A 7 DOF exoskeleton arm: shoulder, elbow,
wrist and hand mechanism for assistance to upper limb disabled individuals. In: IEEE AFRICON
Conference, pp. 1315, Sept. 2011
56
2. Perry, J.C., Rosen, J., Burns, S.: Upper-limb powered exoskeleton design. IEEE/ASME Trans.
Mechatron. 12(4), 408417 (2007)
3. Jung, Y., Bae, J.: Kinematic analysis of a 5 DOF upper-limb exoskeleton with a tilted and vertically translating shoulder joint. In: 2013 IEEE/ASME International Conference on Advanced
Intelligent Mechatronics (AIM), pp. 16431648, July 2013
4. Bai, G., Li, D., Wei, S., Liao, Q.: Kinematics and synthesis of a type of mechanisms with multiple
remote centers of motion. J. Mech. Eng. Sci. 228(18), 34303440 (2014)
A Soft Robotic Extra-Finger and Arm

Support to Recover Grasp Capabilities
in Chronic Stroke Patients
Irfan Hussain, Gionata Salvietti, Giovanni Spagnoletti, David Cioncoloni,
Simone Rossi and Domenico Prattichizzo
Abstract In this paper, we present the combination of the Soft-SixthFinger, a wearable robotic extra-finger designed to be used by chronic stroke patients to compensate
for the missing hand function, with a robotic arm that is used as an assistive device to
support the patient arm. The extra-finger is a tendon-driven modular structure worn at
the paretic forearm. The robotic extra-finger is used jointly with the paretic hand/arm
to grasp an object similarly to the two parts of a robotic gripper. The flexion/extension
of the robotic finger is controlled by the patient using an Electromyography (EMG)
interface embedded in a cap. The robotic arm is controlled to partially compensate
for the weight of the paretic arm, while not interfering with the user arm motion.
The system has been designed as a tool that can be used by chronic stroke patients to
compensate for grasping in many Activities of Daily Living (ADL). We performed
a pilot test to demonstrate that the proposed system can significantly improve the
performance and the autonomy in ADL.
This work was supported in part by the EU Horizon 2020, project no. 688857 SOFTPRO.
I. Hussain G. Salvietti (B) G. Spagnoletti D. Prattichizzo
Dipartimento di Ingegneria dellInformazione, Universit degli Studi di Siena, Via Roma 56,
53100 Siena, Italy
e-mail: salviettigio@dii.unisi.it
I. Hussain
e-mail: hussain@dii.unisi.it
G. Salvietti D. Prattichizzo
Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30,
16163 Genoa, Italy
e-mail: prattichizzo@dii.unisi.it
D. Cioncoloni S. Rossi
Dipartimento di Scienze Neurologiche e Neurosensoriali,
Azienda Ospedaliera Universitaria Senese, Siena, Italy
e-mail: cioncodavi@libero.it
S. Rossi
e-mail: rossisimo@unisi.it
57
58
I. Hussain et al.
1 Introduction
Long-term disabilities of the upper limb affects millions of stroke survivors [1]. More
than 80 % of individuals who experience severe hemiparesis after stroke cannot completely recover hand and arm functionality [2]. The majority of robotic devices have
been developed to provide intensive, repetitive and task-specific rehabilitation procedure to patients with mild to severe motor impairments after neurologic injury [3, 4].
However, at the moment, robot-assisted therapy did not significantly improve motor
function in patients with long-term upper-limb deficits after stroke, as compared
with usual care or intensive therapy [3]. Thus, together with the current efforts in
improving rehabilitation technologies, we believe that there is a need of active tools
able to recover basic hand and arm functions in chronic stroke patients with a paretic
upper limb.
In this work, we present a possible solution to recover hand grasp capability based
on the combination of an extra-robotic finger, called the Soft-SixthFinger [5], and a
robotic arm. The aim of the Soft-SixthFinger is not to assist the paretic hand motion
of the patient, but rather to add just what is needed to grasp: an extra thumb [6].
The robotic extra-finger is worn on the user forearm and can accomplish a given
task in cooperation with the paretic limb, see Fig. 1. The robotic extra-finger has
been designed to guarantee high wearability and portability, with kinematics and
actuation inspired by recent works on underactuated compliant robotic hands [7]. In
particular, the robotic extra-finger is passively compliant due to its flexible joints.
Only one motor is used to control the device flexion/extension with a tendon-driven
actuation.
The patient can control the motion of the robotic extra-finger through an EMG
based interface [8]. Such interface can recognize, through the acquisition of the
EMG signal read at the frontalis muscle of the patient, when the patient voluntary
Robotic arm
support
EMG interface
Soft-SixthFinger
Fig. 1 The experimental setup. The Soft-SixthFinger works with the paretic limb to compensate
for hand grasp functionality. The patient can control the device thanks to a wearable EMG interface
embedded in a cap. The weight of the arm is partially supported by the robotic arm.
A Soft Robotic Extra-Finger and Arm Support to Recover Grasp Capabilities ...
59
Fig. 2 Tasks executed using the Soft-SixthFinger and the robotic arm support. a Blocks and boxes
test. b Pouring water on a glass. c Drinking from a small bottle
moves his or her eyebrows upwards. Frontalis muscle contractions generate events
that switches the states of a Finite State Machine (FSM) which regulates the finger
flexion/extension. The whole system is embedded in a cap. Electrodes can be easily
placed on the patients forehead just wearing the interface.
To test the proposed devices for grasp compensation, we set up a pilot experiment
where a subject was asked to perform three different tasks without using the hand:
blocks and box test, pouring water from a bottle and drinking from a small bottle,
see Fig. 2.
2 The Soft-SixthFinger and Robotic Arm System

The Soft-SixthFinger has been designed to be wearable, robust and capable to adapt
to different object shapes. The flexible finger has a modular flexible structure attached
to a support base that can be worn at the forearm. Each module has a 3D printed ABS
polymeric part that acts as a rigid link and a 3D printed thermoplastic polyurethane
part that realizes the flexible joint. The CAD of the module as well as details of the
extra-finger parts are reported in Fig. 3. The modules are connected by sliding the
thermoplastic polyurethane part in the ABS part, see Fig. 3. The Soft-SixthFinger
has one servomotor that account for the motion of the whole finger through a tendon.
Due to flexible parts in the modules, the device can passively adapt to objects with
different shapes. The support base of the finger is realized in ABS. It contains the
actuator and an elastic band that allows the user to wear the device on the forearm. The
structure of the support base is symmetrical, feature that enables the robotic finger
to be worn on both the left or right arm of the patients without any modification in
the device. The extra-finger flexion and extension are commanded through the EMG
interface described in [5].
The robotic arm used was a Kinova Mico. This arm has a payload of 1.9 kg a
workspace of around 900 mm and six degrees of freedom.
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I. Hussain et al.
Fig. 3 The Soft-SixthFinger exploded view and part details
3 Pilot Study
As a pilot study, we tested the system in three different tasks: (a) blocks and boxes,
(b) pouring water from a bottle to a glass and (c) drinking from a small bottle. The
subject was able to grasp the different objects using the Soft-SixthFinger. The robotic
arm was used to partially support the weight of the arm. The simulated paretic limb
of the subject was linked to the robotic arm using the two-finger gripper available
with the Kinova Mico arm. The robotic arm was controlled in gravity compensation
so to assist the arm motion without interfering the subject motion.
4 Conclusion
In this extended abstract, we presented our preliminary setup where the SoftSixthFinger is combined with a robotic support for the paretic arm. In our previous
works on active tools for manipulation compensation, we focused mostly on the
grasping part developing a robotic supernumerary finger that can adapt to different
object shapes. However, we noticed that most of the patients testing our devices were
still not able to fulfill basic ADL due to the poor mobility of the arm. The system
proposed in this work is a first step toward the realization of an assisting platform
for chronic stroke patients.
We are currently testing the devices with patients also using passive assistive
device for the arm support.
A Soft Robotic Extra-Finger and Arm Support to Recover Grasp Capabilities ...
61
References
1. Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Blaha, M.J., Dai, S., Ford,
E.S., Fox, C.S., Franco, S., et al.: Heart disease and stroke statistics-2014 update: a report from
the american heart association. Circulation 129(3), e28 (2014)
2. Nakayama, H., Jorgensen, H.S., Raaschou, H.O., Olsen, T.S.: Compensation in recovery of
upper extremity function after stroke: the Copenhagen Stroke Study. Arch. Phys. Med. Rehabil.
75(8), 852857 (1994)
3. Lo, A.C., Guarino, P.D., Richards, L.G., Haselkorn, J.K., Wittenberg, G.F., Federman, D.G.,
Ringer, R.J., Wagner, T.H., Krebs, H.I., Volpe, B.T., et al.: Robot-assisted therapy for long-term
upper-limb impairment after stroke. N. Engl. J. Med. 362(19), 17721783 (2010)
4. Kwakkel, G., Kollen, B.J., Krebs, H.I.: Effects of robot-assisted therapy on upper limb recovery
after stroke: a systematic review. Neurorehabil. Neural Repair (2007)
5. Hussan, I., Salvietti, G., Spagnoletti, G., Prattichizzo, D.: The Soft-SixthFinger: a wearable
EMG controlled robotic extra-finger for grasp compensation in chronic stroke patients. IEEE
Robot. Autom. Lett. (2016)
6. Prattichizzo, D., Malvezzi, M., Hussain, I., Salvietti, G.: The sixth-finger: a modular extra-finger
to enhance human hand capabilities. In: Proc. IEEE Int. Symp. in Robot and Human Interactive
Communication, Edinburgh, United Kingdom (2014)
7. Odhner, L.U., Jentoft, L.P., Claffee, M.R., Corson, N., Tenzer, Y., Ma, R.R., Buehler, M., Kohout,
R., Howe, R.D., Dollar, A.M.: A compliant, underactuated hand for robust manipulation. Int. J.
Robot. Res. 33(5), 736752 (2014)
8. Salvietti, G., Hussain, I., Cioncoloni, D., Taddei, S., Rossi, S., Prattichizzo, D.: Compensating
hand function in chronic stroke patients through the robotic sixth finger. Trans. Neural Syst.
Rehabil. Eng. (2016)
A Quasi-Passive Knee Exoskeleton

to Assist During Descent
Emily Rogers, Panagiotis Polygerinos, Stephen Allen,
Fausto A. Panizzolo, Conor J. Walsh and Dnal P. Holland
Abstract A pneumatic exoskeleton intended to decrease the muscle activity of the

knee extensors during walking on a negative slope is presented. The device consists
of an air spring that can be engaged and disengaged via a solenoid valve. When
engaged, the air spring resists knee flexion. A preliminary evaluation of the device
was conducted with a single healthy subject. During testing, the EMG activity of
the rectus femoris decreased by 15 %, while the EMG activity of the vastus
medialis increased by 8 %.
1 Introduction
This paper presents the design and preliminary evaluation of a quasi-passive knee
exoskeleton to assist during walking on negative inclines. During the stance phase
of descent, when the knee is in flexion while supporting the weight of the body, the
knee extensor muscles contract eccentrically to counteract large moments around
the knee [1]. In other words, the knee effectively acts as a torque dampening
mechanism during downhill walking. These large extensor forces can lead to
muscle fatigue and high stresses on the knee joint in the short term and increased
risk of degenerative joint diseases in the long term [2]. Quasi-passive exoskeletons
This work was supported by the Harvard John A. Paulson School of Engineering and Applied
Sciences, the Harvard Biodesign Lab, and the Wyss Institute for Biologically Inspired
Engineering.
E. Rogers S. Allen F.A. Panizzolo C.J. Walsh
Harvard John A. Paulson School of Engineering and Applied Sciences and the Wyss Institute
for Biologically Inspired Engineering, Harvard University, Cambridge, USA
P. Polygerinos
Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, USA
D.P. Holland (&)
School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
e-mail: donal.holland@ucd.ie
63
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E. Rogers et al.
have previously been evaluated for assisting the knee during level walking [3],
load-carrying [4] and running [5]. To the best of our knowledge, this paper presents
one of the rst evaluations focused on quasi-passive knee assistance during descent.

The prototype presented here (Fig. 1) consists of three modules: two air springs that
provide resistive torques at either knee, a fabric interface to attach the device to the
body, and an integrated sensing and control system to detect the users gait and
control the device accordingly. When heel strike is detected, the corresponding air
spring is sealed and acts to resist flexion. When opposite heel strike is detected, the
air spring is disengaged so that it does not resist flexion or extension during the late
stance and swing phases.
The air spring is the most critical component of the exoskeleton. By resisting
compression when sealed on one end, the air spring generates a resistive torque
about the knee to assist the extensor muscles during downhill walking. A motion
capture study was performed to dene the test subjects knee kinematics during
descent. The resulting data were combined with a simple model to calculate the air
spring dimensions and attachment points required to produce the necessary knee
extension moment. A low-friction glass cylinder with a graphite piston was used to
create the air spring (Stock Piston and Cylinder Sets #2KS444-CP, Airpot Corp,
Norwalk, CT). A protective PVC cylinder was added around the glass cylinder,
custom end caps were designed and 3D printed, and a steel rod was connected to an
alignment coupler, to ensure straight travel of the rod and piston within the cylinder
and reduce undesired kinematic constraints on the user.
Two valves at the proximal end of the air spring allow for control of air flow.
The rst valve is a one-way check valve, that allows air to enter the air spring
during extension (swing phase), while preventing air from escaping during flexion.
A high-flow check valve with a low cracking pressure (0.062 PSI) was used,
allowing air to enter the air spring with minimal extension force from the knee
(High flow check valve, #91030, Qosina, Edgewood, NY). This reduces the amount
of resistance to the user during the swing phase. Flow through the second valve is
controlled by a solenoid. This control valve is closed during stance to provide a
resistive torque, and open during swing so as not to interfere with the natural gait.
The sensing system consists of a foot switch in each shoe connected to a
microcontroller, which regulates a solenoid valve that engages the air spring. When
heel strike is detected by one of the foot switches, the signal is passed to the
microcontroller and the valve is controlled appropriately.
A preliminary evaluation of the prototypes performance was carried out.
A single healthy female subject walked on an instrumented treadmill (Bertec,
Columbus, OH, USA; 2160 Hz) at a speed of 1.0 m/s and a slope of 5. Surface
electromyogram (sEMG) readings were taken from two knee extensors (rectus
femoris, RF, and vastus medialis, VM) using a wired system (Delsys, Natick, MA,
A Quasi-Passive Knee Exoskeleton to Assist During Descent
65
Fig. 1 Left: (a) control system, (b) air spring, (c) fabric interface. Right: during early stance
phase, a solenoid valve seals the air chamber and restricts flexion. When opposite heel strike is
detected, the valve opens and the knee can flex freely.
USA; 2160 Hz). These muscles were chosen as they are the only muscles whose
activity increases during descent [6]. Control data were recorded from the subject
walking on an inclined treadmill while not wearing the exoskeleton, and experimental data consisted of the subject walking on the same incline while wearing the
device. Ground reaction forces were measured to enable gait segmentation. The
resulting data were used to estimate the change in muscle activation while wearing
the exoskeleton prototype.
The EMG and GRF data were analyzed in Visual 3D (C-Motion, Rockville, MD,
USA). The EMG data were band-pass ltered (4th order Butterworth, cut-off
20450 Hz), rectied and low-pass ltered (4th order Butterworth, cut-off 6 Hz) to
obtain an EMG linear envelope. The last 10 strides of each 1 min trial were segmented using an automatic gait event detection algorithm based on GRF data
(Visual 3D, C-Motion, Rockville, MD, USA) and averaged over the gait cycle.

Figure 2 shows muscle activity during the entire gait cycle for the vastus medialis
and rectus femoris, averaged over 10 strides. A 15 % decrease in EMG activity is
seen for the RF, while an 8 % increase is seen for the VM. Thus, the device had the
desired effect upon the RF but caused an undesirable increase for the VM. While an
increase in extensor activity during the swing phase is to be expected, due to the
mass added to the leg and the friction of the air spring, the increase in VM activity
during the stance phase is surprising. The differences may be due to kinematic
constraints at the knee that affect each muscle differently, or to effects of the device
66
E. Rogers et al.
Fig. 2 Left: EMG electrode placement during testing. Centre: EMG activity throughout the gait
cycle, averaged over 10 strides. Right: The area under the curves in the EMG plots, giving an
estimate of total EMG activity over the gait cycle.
on the hip; the RF is a biarticular muscle that crosses both hip and knee, while the
VM crosses only the knee joint.
4 Conclusions
This preliminary design has shown promising results for decreasing RF activity
during descent using a quasi-passive knee exoskeleton. Further research is required
in order to better understand the effect of the exoskeleton on muscle activity and
joint kinetics. Future work will include testing with additional subjects and using
inverse dynamics to estimate the devices effect on knee moment during descent.
References
1. Riener, R., Rabuffetti, M., Frigo, C.: Stair ascent and descent at different inclinations. Gait
Posture 15(1), 3244 (2002)
2. Kuster, M., Wood, G.A., Sakurai, S., Blatter, G.: Stress on the femoropatellar joint in downhill
walking: a biomechanical study. Z Unfallchir Versicherungsmed 86, 178183 (1993)
3. Shamaei, K., et al.: Biomechanical effects of stiffness in parallel with the knee joint during
walking. IEEE Trans. Biomed. Eng. 62(10), 23892401 (2015)
A Quasi-Passive Knee Exoskeleton to Assist During Descent
67
4. Walsh, C.J., Endo, K., Herr, H.: A quasi-passive leg exoskeleton for load-carrying
augmentation. Int. J. Humanoid Rob. 4(3), 487506 (2007)
5. Elliott, G., Marecki, A., Herr, H.: Design of a clutchspring knee exoskeleton for running.
J. Med. Devices 8(3) (2014)
6. Franz, J.R., Kram, R.: The effects of grade and speed on leg muscle activations during walking.
Gait Posture 35(1), 143147 (2012)
Wearable Sensory Apparatus

for Multi-segment System Orientation
Estimation with Long-Term Drift
and Magnetic Disturbance Compensation
Sebastjan lajpah, Roman Kamnik and Marko Munih
Abstract Orientation assessment based on wearable sensors is becoming crucial for

providing feedback information in wearable robotics and sport monitoring. Gravitational acceleration and Earths magnetic field are commonly used as a reference
vectors for orientation estimation. This paper presents a novel sensory fusion algorithm for assessing the orientations of human body segments in long-term human
walking, and enhance performance in environment with magnetic disturbance. The
proposed system was experimentally validated. The results show accurate joint angle
measurements (error median below 5 ) with no expressed drift over time. The incorporated compensation of magnetic disturbances proved assessment with absolute
median errors bellow 2.5 .
1 Introduction
Wearable sensors are becoming essential in wearable robotics and sport applications.
MEMS accelerometer, gyroscope, and magnetometer outputs fused within a Kalman
filter are commonly used for assessment of kinematic parameters.
Two reference vectors are used for orientation assessment: vector of gravitational acceleration for inclination and vector of Earths magnetic field for heading
estimation. However, IMU accelerometer measures only difference between gravitational and dynamical acceleration. Henceforth, the assessment can be limited to
This study was supported by the Slovenia Research Agency, and by EU FP7 project CYBERLEGs under grant FP7-ICT-2011-7-287894.
S. lajpah (B) R. Kamnik M. Munih
Laboratory of Robotics, Department of Measurements and Robotics,
Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
e-mail: sebastjan.slajpah@fe.uni-lj.si
R. Kamnik
e-mail: roman.kamnik@fe.uni-lj.si
M. Munih
e-mail: marko.munih@fe.uni-lj.si
69
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S. lajpah et al.
quasi-static motion [1, 2], or separated into slow motion relaying on gravity vector
and fast dynamic motion relying on angular velocity integration [3, 4], what usually
results in long-term drift. Magnetic disturbances were dealt with a normalisation
of magnetic field vector in horizontal plane [3]. With this, magnetic disturbances
influence only the estimated heading component of the orientation. Roetenberg et
al. [5] used complementary Kalman filter where the standard deviation of modeled
magnetic disturbance is increased relatively with the change of the total magnetic
flux and magnetic dip angle.
In this work we present a novel algorithm for orientation estimation with improved
long-term stability based on kinematic model, and with enhanced robustness based
on an advanced magnetic disturbance compensation approach.
2 Methods
2.1 Wearable Sensors
Wearable sensory system comprises seven inertial and magnetic measurement units
(IMUs) placed on segments of lower extremities and trunk as depicted in Fig. 1a. An
IMU sensor (size 30 mm 20 mm 5 mm) consists of three-axis gyroscope (measuring range 500 s1 ), accelerometer (measurement range 4G; G 9.81 m/s2 ),
and a magnetometer (measurement range 0.13 mT) [2]. Besides, two ParotecSystem pressure measurement shoe insoles are used for measuring reaction forces
under the feet. The measuring system is operating with sampling frequency of 100 Hz.
Fig. 1 a Placement of the sensors; b rightleft sequence of orientation calculations; c leftright

sequence of orientation calculations
Wearable Sensory Apparatus for Multi-segment System Orientation Estimation
71
2.2 Kinematic Relations

The proposed sensory fusion for orientation estimation proposed in this paper is
built upon an extended Kalman filter (EKF) algorithm [6]. The concept is based on a
kinematic relation which states that on a rigid body the acceleration of any point can
be determined if the angular velocity, angular acceleration and linear acceleration
of other point on the body is known. The relation between measured acceleration
from the IMU aS, j and the linear acceleration of the center point of joint connecting
segment j with the previous one aC, j can be described as

aS, j = aC, j + S, j S, j r j + S, j r j gS, j ,
(1)
where S, j and S, j denotes the measured angular velocity and angular acceleration,
respectively. Vector r j is a position vector connecting aC, j and aS, j measurement
points and gS, j gravitational acceleration.
2.3 Magnetic Model

The global magnetic field BG,0 is used for orientation estimates at the following time
steps. When the magnetic disturbance B D,k is introduced at the time step k, the orientational quaternion qk describes the relation between the measured magnetic field
B I,k and the combination of Earths magnetic field BG,0 and magnetic disturbance:
T
T

0, BTI,k = qk 0, BTG,0 + BTD,k qk .
(2)
We model the magnetic disturbance B D,k as

B D,k = B D,k1 + B D,k t,
(3)
where B D,k1 represents magnetic disturbance at previous time step k 1 and t a

length of a time step. The product B D,k t describes the propagation of the magnetic
disturbance and is defined as a difference between the global magnetic field assessed
at previous time step and global magnetic field calculated from current measured
magnetic field and change of orientation between two steps.
2.4 Model-Based Extended Kalman Filter

Described models are implemented into EKF architecture for calculation of the orientation estimate by constantly fusing data from the gyroscope, accelerometer, and
magnetometer [7]. For assessing the kinematic parameters in human walking a seven
72
S. lajpah et al.
segment model of human body was utilized. The foot that is in contact with the floor
is considered to be the first segment in the kinematic chain. For the estimation of the
individual segments orientation a recursive algorithm composed of seven EKFs is
implemented. The direction of the calculation is determined with respect to the foot
which is currently in the stance phase (see Fig. 1).
3 Results
An experimental validation of human walking was accomplished in order to test
the accuracy and long-term reliability of developed algorithm. Five subject were
asked to walk continuously for 15 min on a polygon simulating every day activities: level ground walking, stair negotiation, and turning. Joint angles were assessed
via wearable apparatus and compared to angles measured with reference optoelectronic measuring system Optotrak Certus. Absolute errors between the reference and
assessed joint angles for ankles, knees, and hips during 1st, 5th, 10th, 15th min and
during the whole trial for all trails are presented in Fig. 2a.
For validation of magnetic disturbance compensation we used a 3 DOF pendulum
equipped with IMU. The pendulum was manually swung in the vicinity of a big
metal box. Assessed orientation was compared to the one obtained with reference
measuring system. Results, describing the absolute angle errors around x, y, and z
axes, are depicted in Fig. 2b.
Fig. 2 a Absolute error between assessed and reference joint angles for ankles, knees, and hips
during different time slots accomplished during walking on a polygon; b absolute error for angles
around x, y, and z axes ( X , Y , Z ) assessed with EKF without magnetic compensation (EKF-NC)
and EKF with compensation (EKF-C)
Wearable Sensory Apparatus for Multi-segment System Orientation Estimation
73
4 Discussion and Conclusion

The presented paper introduces the novel sensory system and algorithms for longterm orientation assessment with included magnetic disturbance compensation.
Experimental testing demonstrate that the wearable sensory apparatus is appropriate
for measuring kinematic parameters in long-term, uninterrupted human motion of
different dynamics.
The median achieved errors are 3.0 , 2.7 , 2.4 , 3.3 , 2.6 , and 3.1 for the left and
the right ankle, knee, and hip joint angles, respectively. From results, no tendency
for increasing of median error with time can be observed.
The EKF with incorporated compensation of magnetic disturbances is capable of
orientation estimation with moderate error even when the Earths magnetic field is
disturbed. Compensation of magnetic disturbances yields significantly smaller error
(RMS < 2.5 ) than non-compensated (up to 220 ).
Results prove that the proposed wearable sensory apparatus can be used for acquisition of human motion kinematic parameters or to provide feedback within the
control of wearable robots in everyday life situations regardless of the duration of
movements or surrounding environment.
References
1. Luinge, H.J., Veltink, P.H.: Measuring orientation of human body segments using miniature
gyroscopes and accelerometers. Med. Biol. Eng. Comput. 43(2), 273282 (2005)
2. Beravs, T., Podobnik, J., Munih, M.: Three-axial accelerometer calibration using Kalman filter
covariance matrix for online estimation of optimal sensor orientation. IEEE Trans. Instrum.
Meas. 61(9), 25012511 (2012)
3. Madgwick, S.O., Harrison, A.J., Vaidyanathan, R.: Estimation of IMU and MARG orientation
using a gradient descent algorithm. In: 2011 IEEE International Conference on Re-habilitation
Robotics (ICORR), p. 17. IEEE (2011)
4. ODonovan, K.J., Kamnik, R., OKeeffe, D.T., Lyons, G.M.: An inertial and magnetic sensor
based technique for joint angle measurement. J. Biomech. 40(12), 26042611 (2007)
5. Roetenberg, D., Luinge, H.J., Baten, C.T., Veltink, P.H.: Compensation of magnetic disturbances
improves inertial and magnetic sensing of human body segment orientation. IEEE Trans. Neural
Syst. Rehabil. Eng. 13(3), 395405 (2005)
6. Welch, G., Bishop, G.: An introduction to the Kalman filter. Department of Computer Science,
University of North Carolina, Chapel Hill, NC (2006)
7. lajpah, S., Kamnik, R., Munih, M.: Kinematics based sensory fusion for wearable motion
assessment in human walking. Comput. Methods Programs Biomed. 116(2), 131144 (2014)
A Portable Active Pelvis Orthosis

for Ambulatory Movement Assistance
Andrea Parri, Tingfang Yan, Francesco Giovacchini, Mario Cortese,
Marco Muscolo, Matteo Fantozzi, Raffaele Molino Lova
and Nicola Vitiello
Abstract Aging of population and increased incidence of gait impairments are

dominant trends undermining social welfare and healthcare system. Lower-limb
wearable robots proved to be a viable solution for recovering mobility of people
affected by gait disorders. This work presents the design of the mechatronic
architecture of a fully self-contained active pelvis orthosis (APO) for assisting hip
flexion/extension movements during daily living activities. The APO could act
compliantly with the human biomechanics thanks to series-elastic actuation and to a
novel kinematics chain endowed with passive degrees of freedom. The portability
and autonomy of the control system have opened the horizon to explore different
assistive tasks in out-of-lab scenarios.
A. Parri (&) T. Yan F. Giovacchini M. Cortese

M. Muscolo M. Fantozzi N. Vitiello
The BioRobotics Institute, Scuola Superiore SantAnna di Pisa,
Pontedera, Pisa, Italy
e-mail: an.parri@sssup.it
T. Yan
e-mail: t.yan@sssup.it
F. Giovacchini
e-mail: f.giovacchini@sssup.it
M. Cortese
e-mail: m.cortese@sssup.it
M. Muscolo
e-mail: m.muscolo@sssup.it
M. Fantozzi
e-mail: m.fantozzi@sssup.it
N. Vitiello
e-mail: n.vitiello@sssup.it
R.M. Lova N. Vitiello
Fondazione Don Carlo Gnocchi, Florence, Italy
e-mail: rmolino@dongnocchi.it
75
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A. Parri et al.
1 Introduction
Lower limb mobility is essential for the daily-life activities. Ambulatory disabilities
could bring barriers to the daily life activities both physically and psychologically
[1] undermining the industrialized society global welfare. Within this framework,
researchers have never stopped exploring approaches to assist the locomotion or
restore lost ambulatory functionalities by conceiving different assistive devices. In
the recent decades, wearable robots, including assistive exoskeletons and rehabilitation orthoses [2, 3], are gaining considerable interests for coping with lower-limb
disabilities for restoring walking capabilities or used as treadmill-based gait-training
platforms in rehabilitation. In the state of the art, there are also exoskeletons conceived for assisting elderly or persons with mild gait impairments in daily living
acitivities. For instance, the HONDA Stride Management Assist (Honda, Tokyo,
Japan), an hip exoskeleton from Samsung (Samsung, South Korea) [4] and the
Hyundai Wearable Robots for walking assistance (Hyundai Motor Company, South
Korea) are portable light-weight devices specialized in assisting hip movements in
the sagittal plane.
Grounded on the experience matured in [5] we developed a portable version of
an Active Pelvis Orthosis (APO) for assisting hip joints flexion-extension during
locomotion-related activities. APO is endowed with batteries allowing sufcient
power autonomy, still preserving low encumbrances and weights. The robot is
designed to comply with the users biomechanics in order to prevent from rigid,
uncomfortable interactions. In this framework, the so-called well-established Series
Elastic Actuator (SEA) architecture [6] is exploited. Furthermore, a novel chain of
passive degrees of freedom (DoFs) was designed for preserving the free motion of
the limb around hip rotational axes different from the actuated one. A scene of
assisted walking in ecological environment is given in Fig. 1.

This section presents the mechatronic architecture of the APO. The main subsystems, i.e. mechanics, actuation units and control, are described in the following
subsections.
2.1
Mechanics
The mechanical structure of the APO is constituted of three main parts: the pelvis
frame, the transmission system and the thigh linkages. The pelvis frame structure is
constituted of a main carbon bre plate connecting the exoskeleton to the pelvis cuff
and then to the user. Two carbon-bre plates (one for each leg) can slide on it by
A Portable Active Pelvis Orthosis for Ambulatory Movement Assistance
77
Fig. 1 APO worn by a user

in an out-of-lab scenario.
means of two linear guides. The linear guides allow an easy wearing of the actuation
units of the exoskeleton. Two carbon-bre lateral extensible arms are connected to
the central element of the device through a novel chain of passive DoFs [7] that
allowed to place the actuation units on the rear part of the device, i.e. on the back of
the person for maintaining a more natural swing of the arms in the sagittal plane.
As a result both axes of passive adduction abduction and active flexion extension
are collocated with the anatomical joint axes. Furthermore, each lateral arm is
endowed with passive regulation mechanisms to match the anthropometries and
guarantee the alignment of robotic and human joint axes. A curved carbon bre link
was designed for connecting the APO to the thighs through orthotic shells.
2.2
Actuation Units
The APO is endowed with two SEA-based actuation units, one for each side of hip
flexion-extension joint, located on the rear part of the lateral arms, Each SEA has a
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A. Parri et al.
single axis conguration constituted by a 70 W DC motor (EC60, Maxon Motor,

Sachseln, Switzerland) coupled with a 100:1 Harmonic Drive (CPL-14A-100-2A,
Harmonic Drive, Limburg, Germany). The Harmonic Drive is connected to the
torsional spring whose deformation is directly measured by an absolute 17-bit
Rotary Electric Encoder(DS-37Netzer Precision Motion Sensors Ltd., Misgav,
Israel). The torque is transmitted to the hip joint through a pulley wrapped with
steel cable. A 17-bit absolute Rotary Electric Encoder (DS-25Netzer Precision
Motion Sensors Ltd, Misgav, Israel) placed on the hip axis measures the actual hip
angle. Each actuation unit weights slightly higher than 1 kg.
2.3
Control
The control system runs on a real-time controller, a sbRIO-9632 (National

Instruments, Austin, Texas, US), endowed with a FPGA processor. The high-level
layer runs at 100 Hz. The low-level layer runs on the FPGA at 1 kHz. Both the
experimenter and the user can turn off the apparatus by means of an emergency
button. APO is powered by a 33-V LiPo battery pack ensuring an autonomy lasting
about 2 h. Including electronics and battery, APO entirely weights 8 kg. Low-level
closed-loop torque controllers are independent for each actuation unit and rely on a
2-pole-2-zero compensator designed to achieve the minimum joint output impedance and a relatively high closed-loop bandwidth.
3 System Validation and Results

This section presents the experimental activity performed to assess the controller
performance in terms of output mechanical impedance; results are then reported.
The output joint mechanical impedance has been preliminarily validated through a
characterization session carried out to assess the transparency of the APO to the
intentional movement of the user. The test was carried out with the operator
manually displacing the link with a 20 amplitude motion with a variable frequency
in the range [0.53.2] Hz being the commanded torque set to 0 Nm.
The transfer function from the joint angle displacement to actuator output torque
is an estimate of the output impedance of torque control of APO, i.e. a measurement
of the resistive action exerted by the robot responding to an external applied
movement (Fig. 2 shows the Amplitude Bode plot of the transfer function). The
interaction torque amplitude increases with the motion frequency as it can be seen
that the joint output impedance increases across the spectrum, from about
1 Nm/rad, for a 0.5 Hz motion, up to about 5 Nm/rad at 3.0 Hz.
A Portable Active Pelvis Orthosis for Ambulatory Movement Assistance
79
Fig. 2 Amplitude Bode diagram of the transfer function from angular displacement to interaction
torque.

In this work, we presented a novel robotic platform designed to assist the
locomotion-related activities of daily living of people with mild lower-limb
impairments. Compared with its rst laboratory prototype version [5], the APO is
totally portable, being control electronics and batteries integrated in a self-contained
mechatronic structure. A novel kinematic chain and minimum output actuator
impedance played a signicant role in improving ergonomy and usability of the
system. Portability and adaptive control policies based on smart cognitive
human-robot interfaces guaranteed an effective assistance in activities of daily
living [8]. Future works will focus on a mechatronics optimization steered toward a
light-weight and compact APO with intuitive and reliable human-robot interfaces.
References
1. Ferrucci, L., Giallauria, F., Guralnik, J.M.: Epidemiology of aging. Radiol. Clin. North Am.
46(4), 643652 (2008)
2. Yan, T., Cempini, M., Oddo, C.M., Vitiello, N.: Review of assistive strategies in powered
lower-limb orthoses and exoskeletons. Robot. Auton. Syst. 64, 120136 (2014)
3. Tucker, M.R., Olivier, J., Pagel, A., Bleuler, H., Bouri, M., Lambercy, O.: Control strategies for
active lower extremity prosthetics and orthotics: a review control strategies for active lower
extremity prosthetics and orthotics: a review. J. NeuroEng. Rehabil. 12 (1) (2015)
4. Jang, J., Kim, K., Lee, J., Lim, B., Shim, Y.: Online gait task recognition algorithm for hip
exoskeleton. In: IEEE/RSJ International Conference on Intelligent Robots and Systems,
pp. 53275332, Hamburg (2015)
5. Giovacchini, F., Vannetti, F., Fantozzi, M., Cempini, M., Cortese, M., Parri, A., Yan, T.,
Lefeber, D., Vitiello, N.: A light-weight active orthosis for hip movement assistance. Robot.
Auton. Syst. September 2014
6. Pratt, G.A., Williamson, M.M.: Series elastic actuators. In: Proceedings 1995 IEEE/RSJ
International Conference on Intelligent Robots and Systems. Human Robot Interaction and
Cooperative Robots, vol. 1, pp. 399406 (1995)
80
A. Parri et al.
7. Vitiello, N., Giovacchini, F., Cempini, M., Fantozzi, M., Mois, M., Muscolo, M., Cortese, M.:
Sistema di attuazione per ortesi di anca. Application No. FI2015A000025 (Italian Patent),
Application Date: 9 February 2015. Pending for acceptance
8. Garate, V.R., Parri, A., Yan, T., Munih, M., Lova, R.M., Vitiello, N., Ronsse, R.: Walking
assistance using articial primitives. IEEE Robot. Autom. Mag. 23(1), 8395 (2016)
Part III
Soft Wearable Robotics
XoSoft - A Vision for a Soft Modular

Lower Limb Exoskeleton
Jesus Ortiz, Eduardo Rocon, Valerie Power, Adam de Eyto,
Leonard OSullivan, Markus Wirz, Christoph Bauer,
Samuel Schlein, Konrad S. Stadler, Barbara Mazzolai,
Wouter B. Teeuw, Chris Baten, Corien Nikamp, Jaap Buurke,
Freygardur Thorsteinsson and Jeanette Mller
Abstract XoSoft is an EU project that proposes the development of a modular soft
lower-limb exoskeleton to assist people with mobility impairments. It aims to be
user friendly and comfortable to wear, with a signicant impact on the persons
mobility and health, on their independence and quality of life. Being a modular
system, it comprises of ankle, knee and hip elements, which can be used individually or combined and used unilaterally or bilaterally.
XoSoft follows a user centered design strategy achieved by involving primary,
secondary and tertiary end users as participatory stakeholders in the design and
J. Ortiz (&)
Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego, 30, 16163
Genoa, Italy
e-mail: jesus.ortiz@iit.it
E. Rocon
Neural and Cognitive Engineering Group, Spanish National Research Council, Madrid, Spain
e-mail: e.rocon@csic.es
V. Power A. de Eyto L. OSullivan
Design Factors Group, University of Limerick, Limerick, Ireland
e-mail: valerie.power@ul.ie
A. de Eyto
e-mail: adam.deeyto@ul.ie
L. OSullivan
e-mail: leonard.osullivan@ul.ie
M. Wirz C. Bauer
Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Winterthur,
Switzerland
e-mail: markus.wirz@zhaw.ch
C. Bauer
e-mail: christoph.bauer@zhaw.ch
S. Schlein
Geriatrics Center Erlangen, Erlangen, Germany
e-mail: samuel.schuelein@waldkrankenhaus.de
83
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J. Ortiz et al.
development process. Preliminary ndings of the interviews with the different users
groups are presented in this paper.
Advanced textiles and smart materials are being developed to create sensing,
variable stiffness joints and flexible tactile sensors. Control will be through
biomimetics to identify the users motion and intention and to determine and
provide the appropriate level of assistance. Connected health connectivity and
analysis will enable the wearer and their clinicians/therapist to review activity
information. The concept will be tested extensively in the lab, and subject to trials
in clinical settings and home environments.
1 Introduction
Many elderly and patient groups experience varying degrees of mobility impairment. Assistive devices play a pivotal role in their lives and impact on their ability
to live independently and perform basic tasks of daily living. But many assistive
aids do not encourage or support activation of legs, e.g. powered wheel chairs. The
proportion of the worlds elderly population is expected to increase signicantly by
2050 [1]. Age-related decline in voluntary muscle strength results in important
K.S. Stadler
Institute of Mechatronic Systems, Zurich University of Applied Sciences, Winterthur,
Switzerland
e-mail: stdl@zhaw.ch
B. Mazzolai
Center for Micro-BioRobotics of IIT@SSSA, Istituto Italiano di Tecnologia (IIT), Viale
Rinaldo Piaggio 34, Pontedera, 56025 Pisa, Italy
e-mail: barbara.mazzolai@iit.it
W.B. Teeuw
Saxions Research Group Ambient Intelligence, Enschede, Netherlands
e-mail: w.b.teeuw@saxion.nl
C. Baten C. Nikamp J. Buurke
Roessingh Research and Development, Enschede, Netherlands
e-mail: c.baten@rrd.nl
C. Nikamp
e-mail: c.nikamp@rrd.nl
J. Buurke
e-mail: j.buurke@rrd.nl
F. Thorsteinsson
ssur, Reykjavik, Iceland
e-mail: fthorsteinsson@ossur.com
J. Mller
Accelopment A.G., Zrich, Switzerland
e-mail: jmueller@accelopment.com
XoSoft - A Vision for a Soft Modular Lower Limb Exoskeleton
85
changes to body composition and function [2]. Remaining active and mobile during
ageing is crucial to overall health and cognitive function [3]. Mobility assistance is
also required by patients, such as stroke sufferers or patients with incomplete Spinal
Cord Injuries (SCI). Globally circa 16 million people per year experience a stroke
for the rst time, of which 5 million experience varying degrees of mobility difculty, which signicantly impacts their ability to perform tasks of daily living [4].
Accidents are the most common cause of SCI lesions; of which about the 51 % are
incomplete, i.e. the person is partially disabled [5]. Beside SCI caused by accidents,
there are an in-creasing number of cases due to non-traumatic causes.
A characteristic of the latter group is that patients are older and that the amount of
incomplete SCI is even higher. Patients with an incomplete SCI do not suffer
complete loss of sensory-motor function in the lower limbs but they may still
require assistance to walk.
XoSoft is an EU project that is currently developing a soft lower-limb
exoskeleton to assist people with mobility restrictions due a partial loss of sensory
or motor function. Typically, the existing exoskeletons have a rigid structure that is
heavy weight, bulky and is a risk for lesions due to excessive pressure to the skin.
In contrast, XoSoft will have a flexible and adaptable structure. Its design will be
lightweight due to the basic structure and the fact that assistance requires low power
consumption (e.g. batteries). XoSoft is not intended to substitute complete loss of
function like already existing exoskeletons, but rather assist the user in a tailored
manner. XoSoft is a user centered design lower limb exoskeleton using smart soft
robotics, biomimetic controlled actuation and connected health data feedback and
interface.
2 User Centered Design

A core feature of XoSoft is that it follows a User Centered Design (UCD) approach
[6]. UCD employs design ethnography and participatory stakeholder involvement
as key drivers for the technology development to ensure user needs are at the
forefront XoSofts development. This approach also uses an iterative product
design methodology which re-evaluates and improves the user appropriateness of
the system at each stage. Three versions of XoSoft are identiable based on the
module and subsystem developed, and persons tested on:
1. Alpha version: This version is being designed using existing technologies and
its main purpose is to use it as a test bed for the technologies and a mechanism
to ensure the design process remains user centered.
2. Beta version: Based on the alpha prototype, we will replace and incorporate
new technologies to the system. The different Beta versions of the system will
be tested during laboratory setups. The last Beta version will include the full
sensing and actuation system but with limited autonomous functionality. This
version will be used in the clinical validation.
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J. Ortiz et al.
3. Gamma version: The nal version of the Product Service System (PSS) will be
fully autonomous as a person would use it (i.e. run on batteries and have an
on-board computer) and it will be ready for the home trials.
3 User Groups
In this section we provide some preliminary results of the analysis of the XoSoft
stakeholders and their needs, including demographics of the primary users (PU),
identication of the secondary users (SU) and the commercial analysis of the
tertiary users (TU).
We selected two distinct PU groups: neurological populations, specically
people with stroke and incomplete SCI, and older adults with mobility impairments.
Apart from the assistive capabilities of the system, the PUs put special emphasis in
the wearability and usability of the system, and in particular in the ability of using
the system in their daily life, allowing then to use it under their normal clothes, and
not impeding daily activities.
SUs are dened as persons or organisations directly in contact with a PU.
Professional SUs include healthcare professionals from multidisciplinary backgrounds, such as physicians, nurses, physiotherapists, occupational therapists, speech
and language therapists, and public health nurses, as well as professional care
assistants, home help service providers and other support staff. Non-professional SUs
may include spouses, family members, friends, neighbours, and community and/or
voluntary organisations. The main focus of the SU is centered in the functionality of
the system and the positive immediate outcomes for the patients, rather than in
aesthetics as the PUs.
TUs are dened as bodies that have interests that are in some way affecting the
potential for the device in question. They are often related to the framework that is
in place on the regulatory side and/or to nancial provisions for the devices that are
supplied to patients or other users.
4 System Description
XoSoft exoskeleton comprises an ankle-foot-knee module which can be worn on
one or on both sides and a hip module. All modules will be designed to be highly
customizable and to be operated separately or in combination. XoSoft is meant to
be easy to wear, comfortable, serviceable and compatible with the daily life of the
users. These aspects will ensure a high acceptability by the users, being used not
only in clinical environments but also at home and everyday life.
XoSoft uses non-traditional sensing and actuation systems based on smart
materials and soft structures. Variable stiffness joints based on Electro-Rheological
XoSoft - A Vision for a Soft Modular Lower Limb Exoskeleton
87
Fluids (ERF) are being developed. Different solutions are being analyzed to develop
flexible sensors to measure bending, stretching, force and pressure. In later stages,
we will develop units fusing sensing and actuation capabilities based on the above
technologies.
The system control uses a biomimetic approach, which requires the measurement and identication of the movement of the user. The system aims to inertial
motion sensors to measure and identify gait patterns and other variables, such as
kinematics, intention of turning, transitions, and instabilities. This information, used
in conjunction with the biomimetic approach, determines the appropriate assistance
and strategies.
The activity of the user will be monitored by providing connected online and
offline feedback to the clinicians and users. The information will be segmented for
easy analysis and understanding. The clinician or therapist can also adjust settings
of the device remotely, for example to tune the device to provide more or less
assistance.
The system should be suitable for use in home environments. Therefore, it must
operate autonomously for long periods of time with low energy requirements (lower
battery size and weight, less heat dissipation, etc.). To reach this objective we will
optimize the power requirements for sensors, actuators and computing units
(ultra-low power processors). For the most demanding actuation units we will use
soft mechanical solutions for energy accumulation.
5 Conclusions
In this paper, we have presented the main characteristics of the soft exoskeleton,
which will be developed in the XoSoft project, putting special emphasis in the user
centered design process as well as preliminary ndings from the analysis of the
different user groups.
Acknowledgment This work has received funding from the European Unions Horizon 2020
framework programme for research and innovation under grant agreement No 688175.
References
1. World Health Organization, Facts about ageing (2014). http://www.who.int/ageing/about/
facts/en/
2. Arnold, P., Bautman, I.: The influence of strength training on muscle activation in elderly
persons, Exp. Gerontol. 58, 5868 (2014)
3. Volkers, M., et al.: Lower limb muscle strength: why sedentary life should never start. Arch.
Gerontol. Geriatr. 54, 399414 (2012)
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4. Strong, K., Mathers, C., Bonita, R.: Preventing stroke: saving lives around the world. Lancet
Neurol. 6(2), 182187 (2007)
5. National Spinal Cord Injury Statistical Center, Annual Statistical Report Complete Public
Version, University of Alabama, Birmingham (2014)
6. Sanders, E.B.N.: From user-centered to participatory design approaches. Design and the Social
Sciences: Making Connections, pp. 18 (2002)
On the Efcacy of Isolating Shoulder

and Elbow Movements with a Soft,
Portable, and Wearable Robotic Device
Zahra Kadivar, Christopher E. Beck, Roger N. Rovekamp,
Marcia K. OMalley and Charles A. Joyce
Abstract Treatment intensity has a profound effect on motor recovery following

neurological injury. The use of robotics has potential to automate these
labor-intensive therapy procedures that are typically performed by physical therapists. Further, the use of wearable robotics offers an aspect of portability that may
allow for rehabilitation outside the clinic. The authors have developed a soft,
portable, lightweight upper extremity wearable robotic device to provide motor
rehabilitation of patients with affected upper limbs due to traumatic brain injury
(TBI). A key feature of the device demonstrated in this paper is the isolation of
shoulder and elbow movements necessary for effective rehabilitation interventions.
Herein is presented a feasibility study with one subject and demonstration of the
devices ability to provide safe, comfortable, and controlled upper extremity
movements. Moreover, it is shown that by decoupling shoulder and elbow motions,
desired isolated joint actuation can be achieved.
This work was funded by the DARPA Warrior Web program (BAA-13-43) and NASA Grant
NNX14AK51G.
Z. Kadivar M.K. OMalley
Rice University, Houston, USA
e-mail: zkadivar@gmail.com
M.K. OMalley
e-mail: omalleym@rice.edu
C.E. Beck (&) R.N. Rovekamp C.A. Joyce
NASA JSC Wearable Robotics Laboratory, Houston, USA
e-mail: christopher.e.beck@nasa.gov
R.N. Rovekamp
e-mail: roger.n.rovekamp@nasa.gov
C.A. Joyce
e-mail: charles.a.joyce@nasa.gov
89
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Z. Kadivar et al.
1 Introduction
Current rehabilitation research indicates that task-specic [1] and intensive [2]
practice could signicantly improve motor recovery and induce neuroplasticity after
brain injury. The greater effectiveness of intensive task-specic practice relative to
standard therapy techniques suggests that repetitive motor practice is a crucial
rehabilitation component, and provides a key opportunity for the introduction of
robotics in rehabilitation. Achieving voluntary isolated movements after neurological injuries such as TBI and stroke is a common therapy goal. Synergistic movement
patterns that occur after neurological injuries have the potential to interfere with
activities of daily living (ADLs) and limit functional independence of the individual.
A common rehabilitation approach to address unwanted synergies includes manual
xation of undesired movements and facilitation of desired movements.
The trend of applying robotics to address these rehabilitation challenges continues to grow. Existing robotic devices [35] that provide the capability to assist
the affected proximal upper extremities for rehabilitative purposes, however, are
ground-based. Soft, portable, wearable robotic devices offer additional potential
advantages, including allowing more task-oriented therapy (i.e. performing functional tasks as opposed to merely prescribed motions that are somewhat decoupled
from practical ADLs), and bringing therapy to new venues including the home.
The authors developed a soft upper extremity wearable robotic device at the
NASA JSC Wearable Robotics Laboratory for the purpose of providing effective
upper extremity motor rehabilitation related to TBI, a condition that has left
approximately 5.3 million Americans with a long-term disability [6]. In this paper, a
feasibility study with a single subject is presented to demonstrate successful isolation
of upper extremity movements with a soft wearable robotic device. Given the portable nature of the device, performance of these rehabilitative movements can occur
in the modied settings and task-specic situations alluded to above, potentially
offering a richer approach to the rehabilitation of upper extremity function.

2.1
Device Description
The novel soft, portable, wearable robotic device (see Fig. 1) actively controls the
right shoulder and elbow, both positioning the limb in specic orientations and
commanding the limb through desired motions. The device uses a minimal amount
of rigid components and custom force-controllable tendon actuators developed at
NASA JSC. While the system currently only actuates the right arm, it was designed
to easily incorporate a left arm in the future.
Careful design consideration was given to ease donning and dofng of the
device, both to minimize valuable patient and physical therapist time and to
91
Fig. 1 An artists depiction of the soft upper extremity wearable robotic device developed at
NASA JSC for motor rehabilitation related to TBI.
maximize patient comfort, especially in the presence of muscle tone. Moreover,

comfort of the patient throughout the session was a priority in the design, resulting
in a physical human-robot interface that effectively distributes loads around the
torso, minimizing pressure points and interface migration.
The device offers multiple control modes. In active assist mode, shoulder
abduction and flexion, and elbow flexion, may be commanded either simultaneously
via coordinated control or individually while holding position/orientation of the
other joints. In passive assist mode, the user may freely move his or her limb while
the system provides minimal torque to the shoulder and elbow degrees of freedom.
2.2
Subject Description
Evaluation of the device was conducted with a single subject, male, age 29, with
moderate TBI, 1.5 years post-injury. Due to right hemiparesis the subject was unable
to achieve full ranges of shoulder abduction and flexion against gravity. However, the
subject was able to achieve full elbow flexion against gravity and minimal resistance.
Compensatory movements were present during active shoulder and elbow movements leading to synergistic patterns (e.g. shoulder abduction and internal rotation
during elbow flexion). Increased tone was present in the muscles controlling elbow
flexion, nger flexion, and shoulder internal rotation of the affected limb.
2.3
Exercise Description
Due to the subjects inability to isolate movements, a commanded isolated active

elbow flexion/extension trajectory was chosen while holding a commanded position/
orientation of the shoulder. This allowed for the evaluation of the utility of the device
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Z. Kadivar et al.
in supporting movement isolation. In the rst trial, the subject was asked to follow a
commanded elbow joint angle trajectory between 30 and 90 at a constant velocity of
*13/s. The subject was instructed to only move the elbow joint. During this trial,
minimum shoulder and elbow joint torque was applied via the actuators such that the
subject was responsible for performing the motion with no assistance from the device.
In the second trial, the subject was asked to perform the same movement while the
device maintained the shoulder in an abducted position. The subject was provided
with real-time visual feedback of the desired and actual elbow angles during all trials.
3 Results
The testing session lasted approximately one hour, without any adverse events or
reports of discomfort from the subject. The actuated range of motion (intentionally
constrained to avoid exceeding the patients passive range of motion) was
demonstrated for shoulder abduction, flexion, and elbow flexion. In active assist
mode, the device properly positioned the limb at the commanded orientations.
The subject used compensatory shoulder abduction to achieve desired elbow
range of motion (as seen in Fig. 2). With robot-assisted xation of the shoulder, a
similar range of elbow movement was achieved. However, compensation from
shoulder abduction was greatly reduced. Fixation of the shoulder not only allowed
Fig. 2 Compensatory shoulder abduction is evident during elbow movement when shoulder is
free (Trial 1; blue line). Shoulder xation (Trial 2; black line) allows isolation of elbow and
shoulder movements. (Color gure online)
93
for the ability to move the elbow joint in isolation, but it also improved smoothness
of the movement, as joint velocity error decreased from the rst trial, during which
the shoulder was free.
4 Conclusion
The results demonstrate the feasibility of isolating upper extremity movements with
a soft, portable, wearable robotic device. The current study indicates the possibility
of using the developed wearable robotic device for improving motor control and
coordination of the upper extremity after traumatic brain injury. Although rehabilitation was not directly addressed, unique control features and the portability,
wearability, and comfort of the device highlight its potential for upper limb rehabilitation. In light of this, such a device could pave the way to more task-based forms
of therapy and provide a medium for increased dosage. Additional potential applications of the device are already under investigation, including assist-as-needed
control of the upper extremity and assistance with ADLs. The desire to provide both
benecial rehabilitation and practical ADL assistance with the same hardware is well
aligned with the capabilities of a soft, portable, wearable robotic device.
References
1. Hubbard, I.J., Parsons, M.W., Neilson, C., Carey, L.M.: Task-specic training: evidence for and
translation to clinical practice. Occup. Ther. Int. 16(34), 175189 (2009)
2. Sunderland, A., Tuke, A.: Neuroplasticity, learning and recovery after stroke: a critical
evaluation of constraint-induced therapy. Neuropsychol. Rehabil. 15(2), 8196 (2005)
3. Mihelj, M., Kiefer, G., Perndl, C., Mller, R., Riener, R.: ARMin Exoskeleton for arm therapy
in stroke patients. In: IEEE International Conference on Rehabilitation Robotics, Noordwijk,
The Netherlands, pp. 6874 (2007)
4. Krebs, H.I., Hogan, N., Aisen, M.L., Volpe, B.T.: Robot-aided neurorehabilitation. IEEE Trans.
Rehabil. Eng. 6(1), 7587 (1998)
5. Burgar, C.G., Lum, P.S., Shor, P.C., Van der Loos, H.F.M.: Development of robots for
rehabilitation therapy: the Palo Alto VA/Stanford experience. J. Rehabil. Res. Dev. 37(6),
663673 (2000)
6. Injury Prevention & Control: Traumatic Brain Injury & Concussion. (n.d.). Center for Disease
Control and Prevention. http://www.cdc.gov/traumaticbraininjury/severe.html. Accessed 1 Apr
2016
Design Improvement of a Polymer-Based

Tendon-Driven Wearable Robotic Hand
(Exo-Glove Poly)
Haemin Lee, Brian Byunghyun Kang, Hyunki In and Kyu-Jin Cho
Abstract This paper presents the design improvement of a polymer-based

tendon-driven wearable robotic hand, Exo-Glove Poly. The wearability and adaptiveness are the key points to design the Exo-Glove Poly in considering the cases of
practical use. Thus, magnets are embedded into the wearable part for easy donning
and dofng. Also, the tendon length adjustment mechanism is designed to adapt
different hand sizes by changing length of the tendons. Through these improvements, it is increased the change to practical use of the Exo-Glove Poly.
1 Introduction
Recently, the number of patients suffering from the limited hand function is consistently increasing. Spinal cord injury (SCI) and stroke are the major reasons of the
hand paralysis. Because the patients hand cannot be operated naturally, the patients
need a physical assist by carers to perform activities of daily living (ADLs) such as
washing, grooming, and feeding. Also, it is almost impossible for them to open a
door knob or open a bottle by themselves. Therefore, hand disability deteriorates
their quality of life due to not being able to live independently.
To improve their quality of life by making them possible to perform ADLs
without any help, many hand assistive devices have been developed. Assistive
devices transfer external forces to the hand to generate proper movements of paralyzed hand.
This study was supported by a grant (NRCTR-EX16001) of the Translational Research Center
for Rehabilitation Robots, Korea National Rehabilitation Center, Ministry of Health & Welfare,
Korea.
H. Lee B.B. Kang H. In K.-J. Cho (&)
Biorobotics Lab of Seoul National University, Seoul, Korea
e-mail: kjcho@snu.ac.kr
H. Lee
e-mail: haemin1991@naver.com
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H. Lee et al.
Fig. 1 Improved version of the Exo-Glove Poly
Conventional hand assistive devices are categorized into two groups, which are a
rigid exoskeleton [14] and a soft exoskeleton [59]. Rigid exoskeletons usually
applies forces to the nger in normal direction to the nger, which means easy force
transmission and easy control. However, size of the structure is bulky due to the
mechanisms to align exoskeleton joints to human nger joints. To overcome the
size issue of rigid exoskeleton, soft exoskeletons made of soft materials have been
proposed. Due to the softness and compliance of materials, wearing part of soft
exoskeleton became compact and easily adaptable to the users hand without
concerning joint alignment between robot and human.
In a previous design, we developed a polymer based tendon-driven wearable
robot hand, Exo-Glove Poly, to assist people with hand disability [10]. Since
Exo-Glove Poly uses polymer as its base material of wearable part, it can be easily
adapt to the users hand. Thus, the wearable part is more compact than rigid
exoskeletons wearable part. Furthermore, by using a tendon-driven actuation
method and minimized actuator units, portability has also been achieved. Thanks to
these features, the Exo-Glove Ploy is the one of the most suitable assistive devices,
which can assist people with hand disability. However, still several problems, such
as wearability and adaptiveness, remain to be solved considering the cases of
practical use. The Exo-Glove Poly cannot be easily worn to patients hand. Also, in
Design Improvement of a Polymer-Based Tendon-Driven...
97
order to maximize the performance of the Exo-Glove Poly among different users,
not only the wearable part but also the length of the actuating tendons need to be
adjusted (Fig. 1).
In this paper, we present the design improvement to increase wearability and
adaptiveness of Exo-Glove Poly. Magnets are embedded into the wearable part for
easy donning and dofng. And its fabrication process was developed. Also, the
tendon length adjustment mechanism is designed to adapt different hand sizes by
changing length of the tendons.
2 Design Improvement
2.1
Magnet Embedment
In a previous design, the wearable part of the Exo-Glove Poly has palmar band
which connects the palmar part and dorsal part of the wearable part in one piece.
Because the palmar band permanently connects both palmar and dorsal part, it is
hard for users to inset their all digits into the glove. It is very difcult to wear that
glove in this way, because the people with hand disability cannot maintain their
hand posture. To make the wearing process easy, magnetically attachable palmar
band are designed, using a pair of small magnets. One magnet is imbedded at the
dorsal part and the other is imbedded at the palmar band.
Fig. 2 Magnet is embedded at the palmar band and dorsal part to increase wearability of the
Exo-Glove Poly
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The magnets are located at the proper depth from the surface of parts. Important
point in magnet embedding design is to maximize contraction force between the
magnets while polymer layers surrounding magnets are not thin enough to be torn
(Fig. 2).
2.2
Tendon Length Adjustment Mechanism
In order to decrease the weight of the Exo-Glove Poly, it is important to minimize

the number of actuators. As the same reason, the Exo-Glove Poly uses only one
actuator to drive nger flexion and extension antagonistically. In the antagonistic
actuation, the length of flexion tendon and extension tendon should be carefully
designed. If lengths of tendons are too short, range of motion of nger will be
limited. On the other hand, if the lengths of tendons are too long, mechanical
backlash will be increased. Therefore, required tendon length varies with the hand
size, especially the length of nger.
As one of the solution to this current problem, the tendon length adjustment
mechanism has been developed, as shown sin Fig. 3. This mechanism is designed
to wind and to unwind for single tendon. Using a pair of this mechanism, each
length of both tendons can be adjusted to desired length independently.
Fig. 3 Tendon length adjustment mechanism
Design Improvement of a Polymer-Based Tendon-Driven...
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3 Conclusion
In this paper, magnet imbedding technique and tendon length adjustment mechanism are presented to increase wearability and adaptiveness of the Exo-Glove Poly.
Using a pair of magnets, it is possible for user to wear the glove easily. Also, since
the lengths of tendons can be adjusted by the adjustment mechanism, the
Exo-Glove Poly can be adapted to different hand size. Through these improvements, it is increased the change to practical use of the Exo-Glove Poly.
References
1. Fontana, M., Dettori, A., Salsedo, F., Bergamasco, M.: Mechanical design of a novel hand
exoskeleton for accurate force displaying. In: IEEE International Conference on Robotics and
Automation (ICRA), pp. 17041709 (2009)
2. Chiri, A., Vitiello, N., Giovacchini, F., Roccella, S., Vecchi, F., Carrozza, M.C.: Mechatronic
design and characterization of the index nger module of a hand exoskeleton for post-stroke
rehabilitation. IEEE/ASME Trans. Mechatron. 17(5), 884894 (2012)
3. Hasegawa, Y., Mikami, Y., Watanabe, K., Firouzimehr, Z., Sankai, Y.: Wearable handling
support system for paralyzed patient. In: IEEE/RSJ International Conference in Intelligent
Robots and Systems (IROS), pp. 741746 (2008)
4. Wege, A., Hommel, G.: Development and control of a hand exoskeleton for rehabilitation of
hand injuries. In: IEEE/RSJ International Conference in Intelligent Robots and Systems
(IROS), pp. 30463051 (2005)
5. Polygerinos, P., Galloway, K.C., Savage, E., Herman, M., ODonnell, K., Walsh, C.J.: Soft
robotic glove for hand rehabilitation and task specic training. In: International Conference on
Robotics and Automation (ICRA) (2015)
6. Yap, H.K., Lim, J.H., Nasrallah, F., Goh, J.C.H., Yeow, R.C.H.: A soft exoskeleton for hand
assistive and rehabilitation application using pneumatic actuators with variable stiffness. In:
International Conference on Robotics and Automation (ICRA) (2015)
7. Lee, S., Landers, K., Park, H.S.: Development of a Biomimetic Hand Exotendon Device
(BiomHED) for restoration of functional hand movement post-stroke. IEEE Trans. Neural
Syst. Rehabil. Eng. 22(4), 886898 (2014)
8. Idrogenet srl. (2014), Gloreha. http://www.gloreha.com/
9. In, H., Kang, B.B., Sin, M., Cho, K.J.: Exo-Glvoe: soft wearable robot for the hand using soft
tendon routing system. IEEE Robot. Autom. Mag. 22(1), 97105 (2015)
10. Kang, B.B., Lee, H., In, H., Jeong, U., Chung, J., Cho, K.J.: Development of a polymer-based
tendon-driven wearable robotic hand. In: IEEE International Conference on Robotics and
Automation (ICRA) (2016)
Affective Touch and Low Power Articial

Muscles for Rehabilitative and Assistive
Wearable Soft Robotics
Jonathan Rossiter, Espen Knoop and Yuichi Nakamura
Abstract The goal in wearable rehabilitation is to restore the lost functionality of

the body by rebuilding the sensory-motor link. This may be achieved through a
replication, in an articial or robotic system, of the physiotherapy methods
employed by human experts. These methods are typically focused on physical
manipulation. We suggest that a lower reliance on manipulation, combined with
affective touch stimulation, has the potential to provide effective rehabilitation in
lower power and lighter wearable devices. Here we consider affective touch driven
by soft actuation and how this may be combined with low power articial muscle
actuators for physical rehabilitation.
1 Introduction
People who have suffered from injury, disease and stroke often have reduced
mobility. In order to maintain their independence, quality of life and mental health
these people require rehabilitation and assistance. Rehabilitation is a short term
program which aims to restore as much physical capability as possible. After
rehabilitation has reached a plateau the patient may transition to a long term assisted
lifestyle. Wearable robotics may be helpful in providing enhanced and automatic
rehabilitation and assistance. Conventional rigid robotics, such as exoskeletons,
have set the bar for wearable physical rehab and assist devices [1, 2].
J. RossiterSupported by EPSRC grants EP/M026388/1 and EP/M020460/1.

E. KnoopSupported by the Dyson Foundation.
J. Rossiter (&) E. Knoop
Department of Engineering Mathematics, University of Bristol, Bristol, UK
e-mail: Jonathan.Rossiter@bristol.ac.uk
Y. Nakamura
Faculty of Engineering, Academic Center for Computing and Media Studies,
Graduate School of Electrical Engineering, Kyoto University, Kyoto, Japan
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Unfortunately the limitations of rigid robots and their underlying reliance on geared
motors and rigid metals and plastics reduces the adaptability and comfort of these
devices and elevates their cost and complexity. More recently soft robotic devices
have come to the fore as an alternative to rigid robots [3,4]. Advantages to wearable
soft robotics include inherent compliance (and associated increased safety),
adaptability, lower cost and higher user acceptability. Although most approaches to
soft robotic assist and rehab devices target the same high power range as their rigid
robotic counterparts, there is great potential for lower power devices. A patient with
movement decit may not require a high power assist device that will restore 100 %
of their prior mobility. Rather a restoration of only a few percent may be sufcient
to make a step change in their capabilities and quality of life.
In addition, the acceptability of the wearable device (be it orthotic or prosthetic) is a
major stumbling block to adoption and use [5]. Acceptability includes subjective
assessment of comfort, functionality and aesthetics. We suggest that affective touch,
combined with low power soft articial muscle actuators can provide natural, comfortable and low-cognitive-load soft wearable assistive and rehabilitative devices.
2 Affective Touch
The affective sense of touch is concerned with natural sensations which cover the
spectrum from pleasant to unpleasant [6]. For example, smoothness and softness are
often linked to pleasantness, whereas stiffness, roughness and coarseness are linked
to unpleasantness. Affective haptics seeks to overcome the limitation of simple
mechanical tactile stimulators by targeting the richer conceptual and emotional
channel of communication that is encompassed by the affective sense of touch. This
is in contrast to conventional electromechanical tactile stimulation, such as vibrations, which are convenient to generate with simple technologies, but which are not
related to the natural sensations encountered in evolutionary history. The disconnect
between conventional stimulation and human cognitive processes suggests that
Fig. 1 Affective tactile

stimulation (left) provides a
natural context and channel
for rehabilitation, in contrast
with non-affective unnatural
stimulation (right) such as
vibration. Physical
rehabilitation in red, muscles
in orange
Affective
touch
Non-affective
touch
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rehabilitation using the natural feelings afforded by affective tough may be more
effective. Figure 1 illustrates how the low cognitive impedance of affective touch,
in contrast to non-affective touch, can be combined with physical assistance to
reinforce a rehabilitation activity such as bending the leg.
2.1
Affective Tactile Stimulation
Affective touch can be communicated via a range of affective tactile stimulators,

providing the foundation technologies for inclusion in wearable rehabilitation and
assistance devices. These include the Tickler, a wearable soft robotic tactile stimulator that stokes or tickles the skin [7] (Fig. 2a). The Tickler is fabricated from a
3d printed compliant frame with integrated 3d printed rigid bars which hinge at
their mid points within a soft membrane (Objet260 Connex, Stratasys Ltd.) The
bars are actuated by shape memory alloy laments at the ends away from the skin,
causing the bars to pivot about their hinges and the ends in contact with the skin to
move laterally. The relative lateral motion of the bar ends across the skin stimulates
sensations described by test subjects variously as a subtle tickling sensation, like
a massage, comfortable, feels good.
A smaller scale affective stimulator is achieved by replacing the bars of the
Tickler with rounded pins. We can also reduce the size of the stimulation elements
to achieve a higher resolution or lower prole (Fig. 3) [8]. To actuate the pin array
stimulators we use a dielectric elastomer (DE) electroactive polymer actuator.
This DE membrane is stretched across the base of the pins, and electrodes are
applied to the regions between the pins. When these regions are electrically stimulated (electric eld *1 MV/m) they expand, causing lateral motion at the tips of
the pins in contact with the skin.
Larger laterotactile stimulation can be achieved using more conventional servo
motors to push apart, or bring together, two patches attached to the skin (Fig. 2b, c).
These skin stretchers interact with the skin only and do not directly drive
movement in the limbs. They impart a larger sensory stimulation and a higher
degree of urgency than the smaller scale stimulators, providing an enhanced link
between stretcher movement and limb movement.
3 Articial Muscle Rehabilitation

Electroactive polymer (EAP) articial muscles, such as the DE actuators used above
in the laterotactile stimulators, have power densities of the same order as biological
muscle. This suggests their use in soft wearable assist devices. Unfortunately fabrication challenges, mismatches in natural frequencies, and reliability issues mean
that high power electroactive polymer assist devices are not currently achievable.
A better application of EAPs is as lower power assist devices, for example to
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J. Rossiter et al.
a.
b.
c.
Fig. 2 Affective touch stimulators: (a) The Tickler laterotactile stimulator, (b), (c) large skin
stretchers using servos.
regulate or boost level walking, or to assist with standing stability in those who
would benet from a small level of assistance. The inclusion of the above presented
affective tactile stimulators in these low power devices is expected to improve the
acceptance, comfort and cognitive compatibility of these devices.
Reducing the power output of the wearable rehabilitation device also means that
it can be made smaller, lighter and with lower cost. These will improve user
adoption if the wearable device can be worn discreetly and comfortably under
conventional clothing. With the integration of affective touch, and its emphasis on
natural tactile communication, the device will be minimally disruptive cognitively,
with consequent benets in rehabilitation and long-term assistance.
105
Fig. 3 Electroactive polymer driven laterotactile stimulators: (a) two different tactile arrays,
(b) sensitivity and discrimination experiments.
4 Conclusions
We have presented affective touch as an important and overlooked channel of
communication for integration in wearable soft robotic rehabilitation and assist
devices. By integrating articial muscle-driven affective touch, through natural
laterotactile stimulation such as stoking and tickling, with low power EAP actuators
we propose a new form of wearable device. These are expected to be comfortable,
discrete and have wider acceptance and adoption in target patients undergoing
neuro and physical rehabilitation or in need of long term assistance.
References
1. Delph II, M.A., Fischer, S.A., Gauthier, P.W., Martinez Luna, C.H., Clancy, E.A., Fischer, G.
S.: A soft robotic exomusculature glove with integrated sEMG sensing for hand rehabilitation.
In: Proceedings of the 13th International Conference on Rehabilitation Robotics (ICORR),
Seattle, WA (2013)
2. Kawamoto, H., Kamibayashi, K., Nakata, Y., Yamawaki, K., Ariyasu, R., Sankai, Y., Sakane,
M., Eguchi, K., Ochiai, N.: Pilot study of locomotion improvement using hybrid assistive limb
in chronic stroke patients. BMC Neurol. 13, 141 (2013)
3. Polygerinos, P., Wang, Z., Galloway, K.C., Wood, R.J., Walsh, C.J.: Soft robotic glove for
combined assistance and at-home rehabilitation. Robot. Auton. Syst. 73, 135143 (2015)
4. Oguntosin, V., Harwin, W.S., Kawamura, S., Nasuto, S., Hayashi, Y.: Development of a
wearable assistive soft robotic device for elbow rehabilitation. In: Proceedings of the 2015
ICORR 11th International Conference on Rehabilitation Robotics, Singapore (2015)
5. Roffman, C.E., Buchanan, J., Allison, G.T.: Predictors of non-use of prostheses by people with
lower limb amputation after discharge from rehabilitation: development and validation of
clinical prediction rules. J. Physiotherapy 60(4), 224231 (2014)
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6. Essick, G.K., McGlone, F., Dancer, C., Fabricant, D., Ragin, Y., Phillips, N., Jones, T., Guest, S.:
Quantitative assessment of pleasant touch. Neurosci. Biobehav. Rev. 34(2), 192203 (2010)
7. Knoop, E., Rossiter, J.: The tickler: a compliant wearable tactile display for stroking and
tickling. In: Proceedings of the CHI (2015)
8. Knoop, E., Rossiter, J.: A compliant soft-actuator laterotactile display. Smart Mater. Struct. 24,
045034 (2015)
Evaluation of Force Tracking Controller

with Soft Exosuit for Hip Extension
Assistance
Hao Su, Ye Ding, Ignacio Galiana, Jozeen Speeckaert,
Nikos Karavas, Philippe Malcolm, Christopher Siviy
and Conor J. Walsh
Abstract This abstract describes the design and experimental evaluation of a force
tracking controller for hip extension assistance utilizing a soft exosuit connected to
a tethered off-board actuation system. The new controller aims to improve the force
prole tracking capability and demonstrate its advantages over our previously
reported work. The controller was evaluated by one healthy participant walking on
a treadmill at 1.35 m/s. Results showed that the system can deliver a predened
force prole robustly with a 200 N peak force. The measured peak force value
using force controller was 198.7 2.9 N, and the root-mean-squared (RMS) error
was 3.4 N (1.7 % of desired peak force). These results indicate that the force
control reduces peak force variability and improves force prole tracking capability.
1 Introduction
In recent years we have seen exciting results demonstrating that exoskeleton
devices can reduce energy cost during walking [14]. We have been developing
soft wearable robots we call exosuits that are intended to provide a more conformal
and compliant means to interface to the human body. An exosuit uses textiles and
apparel, resulting in minimal resistance to natural human motion and does not add
signicant inertia to the lower extremities. In prior work, we have implemented a
force-based position control (referred as position controller hereafter) [46] to
indirectly regulate force to reach the desired peak values. This approach has proved
H. Su (&) Y. Ding I. Galiana J. Speeckaert N. Karavas
P. Malcolm C. Siviy C.J. Walsh
John A. Paulson School of Engineering and Applied Sciences,
Harvard University, Cambridge, USA
e-mail: haosu@seas.harvard.edu
C.J. Walsh
e-mail: walsh@seas.harvard.edu
H. Su Y. Ding I. Galiana J. Speeckaert N. Karavas P. Malcolm C. Siviy C.J. Walsh
Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
107
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H. Su et al.
successful to date in our ankle and hip actuation systems where a desired force can
be achieved by having the actuator follow a prescribed position prole. The force
magnitude is then regulated by monitoring the force level on a step by step basis.
However, from other work on wearable robotic systems, the advantage of direct
force control is apparent, as it can potentially minimize the peak force variability
and precisely track desired force proles at a joint [7]. This can enable precise
torque delivery to understand optimal assistive device design [8]. Further, force
control is potentially more robust to variations in gait kinematics as it keeps minimizing force error regardless of joint position.
To accurately regulate force delivery in exoskeletons, force control methods like
iterative learning-based force control [7] have been studied in rigid devices.
However soft exosuits impose particular challenges for force tracking because
stiffness of the human-exosuit interface is nonlinear, and the system presents
varying system characteristics both from human (e.g. gait variability) and the
electromechanical system (e.g. suit stiffness changes and Bowden cable efciency).
To address this, we developed a force tracking controller for hip extension assistance and evaluated its efcacy during treadmill walking.
2 Material and Methods

The hip extension soft exosuit system is composed of a mono-articular hip exosuit
and a recongurable multi-joint actuation platform previously described [6] and the
setup is shown in Fig. 1. The textile components of the hip exosuit include a waist
belt, two thigh braces and two elastic straps on the lateral side of each leg to prevent
migration of the thigh brace [6].
2.1
Sensing and Actuation
Sensors of this soft exosuit system included an Inertial Measurement Unit

(IMU) and one load cell per leg. The thigh angle was measured with an IMU
Fig. 1 Hip extension soft
exosuit system. IMU
measures thigh angles. Two
sets of Bowden cables are
connected between the
multi-joint actuation platform
and the exosuit to provide hip
extension assistance during
walking. The assistive force is
transmitted from the
multi-joint actuation platform
to the wearer
109
Fig. 2 Electromechanical
sensing and control system.
The timing of the motor force
and position control prole is
generated in real-time based
on sensor input from thigh
mounted IMU and load cell
(VN-100, VectorNav Technologies, USA) as shown in Fig. 1. The controller

detects maximum hip flexion and the stride time is estimated as the time between
two consecutive maximum hip flexion events [6]. The data acquisition card
(PCI-6259, NI, USA) acquires the digital IMU and analog load cell signals. Then
the controller processes the signal and sends a reference voltage to the Copley
motor controller (ACP-090-36 Accelnet, USA) for the Maxon EC-4 pole brushless
motor Fig. 2.
2.2
Force Tracking Controller Description
The objective of the force tracking controller is to minimize peak force variability
and enable force prole tracking. This is motivated by the desire for precise and
robust force manipulation to understand the relation between force delivery and
human walking metabolics.
The force controller has both position and force control loops to deliver sinusoidal force prole with 200 N peak. The bio-inspired force prole is a scaled
version of the biological hip moment, designed to provide a joint torque equivalent
to approximately 30 % of the biological hip extension moment.
3 Results
The force tracking controller was evaluated by one healthy participant walking on a
treadmill at 1.35 m/s. The objective is to evaluate if the controller delivers reliable
and accurate force prole to the participant on a step-by-step basis.
In a continuous walking session, the participant walked for 2 min using the
position controller, and then walked for 2 min using the force controller. The
measured force in the last 30 strides was used for analysis. The peak force using
position controller was 196.3 11.2 N, and the root-mean-squared (RMS) error
was 9.5 N (4.8 % of desired peak force) as depicted in Fig. 3(a). The peak force
using force controller was 198.7 2.9 N, and the RMS error was 3.4 N (1.70 % of
desired peak force) as depicted in Fig. 3(b). It is apparent that the force controller
demonstrated better force tracking performance especially in the 10-20 % gait cycle
region comparing Fig. 3(a) and (b).
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H. Su et al.
(a)
(b)
Fig. 3 Force tracking results using the position controller a and the force controller b. The results
were from a healthy participant at 1.35 m/s steady state walking for 30 strides
4 Conclusion
We presented a force tracking controller for hip extension assistance. The experimental results demonstrate the effectiveness at steady-state walking in terms of
reduced peak force variability and enhanced prole tracking capability. Further
evaluation will include force prole tracking results for different subjects with gait
change.
Acknowledgments This material is based upon the work supported by the Defense Advanced
Research Projects Agency (DARPA), Warrior Web Program (W911NF-14-C-0051). This work
was also partially funded by the Wyss Institute for Biologically Inspired Engineering and the
John A. Paulson School of Engineering and Applied Sciences at Harvard University.
References
1. Malcolm, P., Derave, W., Galle, S., De Clercq, D.: A simple exoskeleton that assists
plantarflexion can reduce the metabolic cost of human walking. PLoS ONE 8(2), e56137
(2013)
2. Mooney, L.M., Rouse, E.J., Herr, H.M.: Autonomous exoskeleton reduces metabolic cost of
human walking during load carriage. J. Neuroeng. Rehabil. 11, 80 (2014)
3. Collins, S.H., Wiggin, M.B., Sawicki, G.S.: Reducing the energy cost of human walking using
an unpowered exoskeleton. Nature 522, 212215 (2015)
4. Panizzolo, F., Galiana, I., Asbeck, A., Siviy, C., Schmidt, K., Holt, K., Walsh, C.: A
biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking.
J. NeuroEng. Rehabi. 13(1), 1 (2016). In press
5. Ding, Y., Galiana, I., Asbeck, A., Santos, T., Araujo, V., Lee, S., Holt, K., Walsh, C.:
Biomechanical and physiological evaluation of multi-joint assistance with soft exosuits. IEEE
Trans. Neural Syst. Rehabil. Eng. 99, 1 (2016)
6. Ding, Y., Galiana, I., Malcolm, P., Walsh, C.: IMU-based iterative control for hip extension
assistance with a soft exosuit. In: IEEE International Conference on Robotics and Automation
(ICRA) (2016)
111
7. Zhang, J., Cheah, C.C., Collins, S.H.: Experimental comparison of torque control methods on
an ankle exoskeleton during human walking. In: IEEE International Conference on Robotics
and Automation (ICRA 2015), Seattle, WA, pp. 55845589 (2015)
8. Jackson, R.W., Collins, S.H.: An experimental comparison of the relative benets of work and
torque assistance in ankle exoskeletons. J. Appl. Physiol. 119, 541557 (2015)
Part IV
Neural Interfacing of WRs
Endogenous Control of Powered

Lower-Limb Exoskeleton
Kyuhwa Lee, Dong Liu, Laetitia Perroud, Ricardo Chavarriaga
and Jos del R. Milln
Abstract We present an online decoding method for controlling a powered

lower-limb exoskeleton using endogenously generated electroencephalogram
(EEG) signals of human users. By performing a series of binary classications,
users control the exoskeleton in three directions: walk front, turn left and turn right.
During the rst classication phase, the users intention to either walk front or
change direction is detected. If the users intention to change direction is detected, a
subsequent classication for turning left or right is performed. Five subjects were
able to successfully complete the 3-way navigation task while mounted in the
exoskeleton. We report the improved accuracy of our cascaded protocol over a
baseline method.
This work was supported by the Swiss National Centers of Competence in Research (NCCR)
Robotics project.
K. Lee (&) D. Liu L. Perroud R. Chavarriaga J.d.R. Milln
Brain-Machine Interface Lab, School of Engineering, Center for Neuroprosthetics, cole
Polytechnique Fdrale de Lausanne, Lausanne, Switzerland
e-mail: kyu.lee@epfl.ch
D. Liu
e-mail: dong.liu@epfl.ch
L. Perroud
e-mail: lae.perroud@gmail.com
R. Chavarriaga
e-mail: ricardo.chavarriaga@epfl.ch
J.d.R. Milln
e-mail: jose.millan@epfl.ch
115
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K. Lee et al.
1 Introduction
Recent developments in assistive devices enabled people with disability to benet
from more dexterous functionalities than wheelchairs [1, 2]. Among them,
upper-limb and lower-limb exoskeletons have been given attention as the potential
technology to assist paraplegic or tetraplegic population. Brain-machine interfaces
(BMI) have shown the possibility of controlling exoskeletons and neuroprosthetic
devices using non-invasive EEG (e.g. [35]). A BMI system can be controlled
using either exogenous (evoked) or endogenous (spontaneous) signals. In exogenous BMI, evoked signals appear when a person senses external stimuli such as
visual or auditory cues (e.g. [3]). The advantage of this approach includes minimal
training time. In endogenous BMI, control signals are generated directly by the user
without any external stimulation. It is useful for users who have sensory impairments while providing intuitive means of interactions (e.g. [6]).
With the advances in materials, actuators, sensors and computer size, many
wearable exoskeletons have become real-life products. Some examples of
lower-limb exoskeletons include Rex [7], ReWalk [8], ALEX [9], H2 [10] and
Indego [11]. We use Rex as our testing platform since it is currently the only
available robotic platform that can move independently without the support of the
user. It can perform basic movements such as walking front, back and sides, turning
left and right, sitting down and standing up. In this preliminary study, we test with 5
healthy subjects to assess the feasibility of applying to end users who have difculty
in manual control.
2 Method
2.1
Hardware Setup
We use an active electrode system (g.GAMMAsys) with Ag/AgCl wet electrodes.

g.Tec USBAmp was used to sample the signals in 512 Hz from 16 electrodes
placed on the following positions on the scalp: Fz, FCz, Cz, CPz, FC1-4, C1-4,
CP1-4. Reference electrode was placed on the right ear lobe and ground electrode
was placed on AFz. While in the Rex, subjects follow the visual cue shown on a
wearable see-through screen, Google Glass.
2.2
Protocol
During the training stage, 10 trials of each of the following two tasks are performed
for 5 s each, one after the other. (a) Move: Imagine moving both hands, (b) Relax:
Relax both hands. In both Move and Relax tasks, the subjects are instructed not to
Endogenous Control of Powered Lower-Limb Exoskeleton
117
move any body part including eyes. Subjects are given a rest period of 10 s between
trials to freely move their body.
In our protocol, we use a series of cascaded binary classications to perform a
multiclass classication. Our cascaded protocol is dened as following: (1) Cue
(1 s), (2) Imagery (1-5 s): classication between walk and turn, (3) Feedback (1 s).
If turn intention is detected, the following steps are performed. (4) Imagery (1-5 s):
classication between left and right turn, (5) Feedback (1 s). During the imagery
period, a bar increases in one of two directions until it reaches either end, where
class labels are assigned to both ends. Imagery period ends if the bar reaches a
threshold or 5 s has passed, in which case the dominant direction is chosen. We
compare our protocol with another commonly used 3-way classication protocol, as
used in [13], as a baseline. In this baseline protocol, instead of performing cascaded
classication, if the bar is intentionally kept from reaching either side of the ends
until timeout occurs, the robot executes the third command.
2.3
Experiment Scenario
In our work, we run both protocols in the setup as shown in Fig. 1. Due to the slow
speed of the Rex (48 s per action), we design scenarios such that each trial lasts
between 4 and 8 min which requires 2030 motor commands to nish. There are
two obstacles placed on each side. Although it may seem trivial, it requires 16
consecutive correct decisions to reach the goal in the optimal path. After running a
few practice runs until the user feels comfortable, each subject performs one trial
each for both protocols. We test our protocol and the baseline protocol with 5
healthy subjects (1 female/4 males, mean age 29.2 6.2). The same classication
method explained in Sect. 2.4 is used in both protocols. All subjects had previous
experiences with standard motor imagery (left hand vs right hand movement or
hand vs feet movement) but none of them had any experience with the imagery we
used in this experiment (both hands vs relax).
Fig. 1 (a) A user controlling
Rex. (b) Experiment scenario.
The user starts in S position
and tries to reach G
position.
(a)
(b)
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2.4
K. Lee et al.
Signal Processing and Decoding
The EEG signals are ltered using common average reference (CAR) with 50 Hz
notch lter and transformed into power spectral density (PSD) features in the beta
band (1419 Hz) of a 0.5-s sliding window. We use multitaper PSD, which is
effective in reducing the estimation bias by averaging over multiple independent
estimates from a given sample [12]. The PSD computed for all channels are concatenated to form a feature vector and is used to train a Random Forests classier
(1000 trees, 100 depth limit), which also internally performs feature ranking while
training. During the testing phase, the likelihoods are computed in 15 Hz by the
classier and are accumulated over time, represented as the nal decision score. The
real-time visual feedback is given to the user through a wearable see-through
screen. The computed likelihoods Pc t (c {Move, Relax}) at current sampling
time t are accumulated over time with a scoring function Sc t:
Sc t aSc t 1 1 aPc t; Sc 0 0:5
where 0 a\1 is a damping factor to smooth out the noisy output of the classier,
obtained heuristically. We set a 0:8. Now we dene our decision function Dt
as:
Dt Dt 1 SMove t SRelax t; D0 0
A decision is made and delivered to the robot if jDtj L or t ttimeout , where L

is a bar length threshold. The sign of D(t) determines the class label, which is
assigned in the beginning of the experiment.
3 Results
Table 1 shows the number of errors and total decisions made to fulll the task. The
average completion time was 285 s with the cascaded protocol and 341 s with the
baseline protocol, which reflects the lower error rates of the proposed method. It
should be noted that we do not know the ground truth label of each decision the
user made as each motor command is voluntarily chosen by the user. So instead we
estimate a BMI classication error indirectly by counting how many times the
chosen action led the robot to move farther from the goal, i.e. assuming the user was
always trying to deliver an optimal command. Occasionally, the user gets confused
on what motor command to deliver because of the loss of attention or due to the
error on path planning. Therefore, estimated errors may be interpreted as an upper
bound on the classication error.
Endogenous Control of Powered Lower-Limb Exoskeleton

Table 1 Error estimates. At
least 16 correct decisions need
to be made to successfully
reach the goal position.
ID
119
Proposed
Baseline
Errors
Decisions
Rate
S1
19
0.11
Errors
2
Decisions
21
0.10
Rate
S2
16
0.00
21
0.14
S3
20
0.15
21
0.19
S4
16
0.00
21
0.29
S5
18
0.06
20
0.15
Total
89
0.07
18
104
0.17
4 Discussion
We have shown a working method for controlling a powered lower-limb
exoskeleton using only EEG signals. This work will be extended with more challenging scenarios and larger number of subjects to further validate the feasibility of
brain-controlled locomotion.
References
1. Bogue, R.: Robotic exoskeletons: a review of recent progress. Ind. Robot Int. J. 42(1), 510
(2015)
2. Milln, J.D.R., et al.: Combining braincomputer interfaces and assistive technologies:
state-of-the-art and challenges. Front. Neurosci. 4, 161 (2010)
3. Kwak, N.S., Mller, K.R., Lee, S.W.: A lower limb exoskeleton control system based on
steady state visual evoked potentials. J. Neural Eng. 12(5), 056009 (2015)
4. Mller-Putz, G.R., Scherer, R., Pfurtscheller, G., Rupp, R.: EEG-based neuroprosthesis
control: a step towards clinical practice. Neurosci. Lett. 382(1), 169174 (2005)
5. Contreras-Vidal, J.L., Grossman, R.G.: NeuroRex: a clinical neural interface roadmap for
EEG-based brain machine interfaces to a lower body robotic exoskeleton. In: EMBC, 2013,
pp. 15791582 (2013)
6. Pfurtscheller, G., Neuper, C.: Motor imagery and direct brain-computer communication. Proc.
IEEE 89(7), 11231134 (2001)
7. http://www.rexbionics.com
8. http://www.argomedtec.com
9. Banala, S.K., Kim, S.H., Agrawal, S.K., Scholz, J.P.: Robot assisted gait training with active
leg exoskeleton (ALEX). IEEE TNSRE 17(1), 28 (2009)
10. Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J.C., Francisco, G.E., Pons, J.L.,
Contreras-Vidal, J.L.: The H2 robotic exoskeleton for gait rehabilitation after stroke: early
ndings from a clinical study. J. NeuroEng. Rehab. 12(1), 1 (2015)
11. Quintero, H.A., Farris, R.J., Goldfarb, M.: Control and implementation of a powered lower
limb orthosis to aid walking in paraplegic individuals. In: ICORR, 2011, pp. 16 (2011)
12. Percival, D.B., Walden, A.T.: Spectral Analysis for Physical Applications. Cambridge
University Press, Cambridge (1993)
13. Carlson, T., Millan, J.D.R.: Brain-controlled wheelchairs: a robotic architecture. IEEE Robot.
Autom. Mag. 20, 6573 (2013)
Natural User-Controlled Ambulation

of Lower Extremity Exoskeletons
for Individuals with Spinal Cord Injury
Kiran Karunakaran, Ghaith Androwis and Richard Foulds
Abstract Natural-quality, independent ambulation is a prerequisite for community

use of lower extremity exoskeletons by individuals with disabilities. In general,
current exoskeletons generate pre-programmed gait, where the user cannot exercise
volitional control necessary to navigate over uneven surfaces and avoid obstacles.
This project introduces an intuitive control strategy that allows the user to determine
and sense the exoskeleton movement in real time using trajectories produced by the
hands. The concept allows neurally dened ambulation control to be expressed
through alternative biological articulators. This novel approach uses admittance
control to compute each exoskeletons foot position from Cartesian forces exerted
by the users hand on a trekking pole that is connected to foot through a multi-axis
load cell. The algorithm has been evaluated by nave, non-disabled users who
walked a 10 degree of freedom, scale biped robot on a treadmill. The results show
that the algorithm produced robot-generated gait kinematics that are similar to
human gait kinematics. A human-scale exoskeleton has been developed to allow
further exploration of this control method.
Research funded by the Gustavus and Louisa Pfeiffer Research Foundation and the NJIT/Kessler
Rehabilitation Engineering Research Center on Wearable Robots for Independent Living
(NIDILRR-HSS grant 90RE5021).
K. Karunakaran G. Androwis R. Foulds (&)
New Jersey Institute of Technology, Newark, USA
e-mail: foulds@njit.edu
K. Karunakaran
e-mail: kkk7@njit.edu
G. Androwis
e-mail: ghaith.j.androwis@njit.edu
G. Androwis
Kessler Research Foundation, West Orange, USA
121
122
K. Karunakaran et al.
1 Introduction
Individuals with paraplegia due to spinal cord injury (SCI) have impaired motor
control and sensory feedback which can signicantly reduce their ability to walk.
The preference of many of these people for upright ambulation [1, 2] over
wheelchair use has driven the development and commercialization of advanced
rehabilitation exoskeletons. [3] However, for the new technology to effectively
augment or even replace wheelchair use, the performance of the user/exoskeleton in
community living must approach that of unimpaired ambulation. [4] Thus, the
exoskeleton must operate in a way that reflects the users needs in the real world. In
this paper, we present a novel form of human/robot cooperation that offers the
potential to allow users exceptional control over their exoskeleton-assisted walking.
We suggest that rather than to detect neurally-coded biological walking intentions
via a brain-computer interface(BCI), or endow an exoskeleton with autonomous
gait control that can respond to environmental conditions, the users natural
ambulation can be expressed and sensed through intact articulators and used to
control the exoskeletons movement patterns.
Currently reported user/exoskeleton control strategies have attempted to detect
neural signals that represent the users gait intentions. This work includes the use of
cortically implanted and surface electrodes, as well as hybrid EEG/EMG signal
processing. [58] To date, the decoding of detailed lower extremity motor control
signals has been elusive, with most BCI approaches generating very coarse notions
of intention, or on/off triggers of actions that are carried out by the computer
controlled exoskeleton.
Alternatives to BCI control include the use of sensors to detect ambulation cues
from the tilt of the users torso, arms and crutches, or the movement of the users
center of pressure or center of mass. These signals are used to trigger different
phases of exoskeleton gait. [9, 10] Neither the BCI nor the sensor-based strategies
produce gait that resembles unimpaired human walking, and are not yet adequate
for daily use in the real world.
2 Surrogate Articulation of Gait

Our work explores the use of an individuals neurally-planned gait intention, but
unlike BCI methods, allows those intentions to be biologically processed to produce
natural, walking-like movements of surrogate articulators. We have shown that such
movements can be faithfully produced by users ngers and hands. [11, 12] It is not
known if these controlled movements are linked to ambulation motor areas in the
brain, or if there is connectivity between lower and upper extremity cortical control
that typically facilitates coordinated movement. Regardless, users have demonstrated fast learning of hand-walking that appears quite intuitive.
Natural User-Controlled Ambulation of Lower Extremity Exoskeletons

Fig. 1 scale robot
equipped with trekking poles
and 3 axis force sensors that is
controlled by the walking-like
motions of the users hands
123
2 DOF hip
Trekking pole
1 DOF knee
2 DOF ankle
3 axis force sensor
3 Methods
3.1
Experimental Apparatus
A 1/2 scale biped robot prototype supported by a frame was built to test the hand
control mechanism. Each robot leg has 2 links, from hip to knee, and from knee to
ankle complying with the 50 % scaled anthropometrics of the human leg.
Dynamixel MX series smart servos provide two degrees of freedom (DOF) at the
hip, one at the knee and two at the ankle. A foot was designed with provisions to
mount force sensors to detect ground contact, and also to attach a 3 DOF force
sensor adjacent to the foot of each leg. A trekking pole (carbon ber rod) is
mounted on the 3DOF force sensor and extends upward to the height of the robots
waist (Fig. 1).
3.2
Admittance Control of Hand-Walking
The user grasps the trekking poles on the ipsilateral side and makes walking-like
motions to produce the kinematics similar to the foot. The rigid poles transmit the
users applied forces in the direction intended to the 3 DOF force sensor on the
ipsilateral foot (Fig. 2). An admittance control algorithm converts these forces into
Cartesian position of the exoskeleton foot. The Cartesian forces in x and y are
sampled at 100 Hz and converted to predicted Cartesian positions and velocities for
each 10 ms sample in sagittal plane. This is accomplished by our admittance loop
that implements the equation of motion in (1) for all directions using CVode
(Ordinary Differential Equation Solver) developed at Eindhoven University [13].
The Cartesian foot position values are converted to the corresponding joint angles
and angular velocities of the knee and hip using custom developed inverse kinematics. All angles and velocities as inputs are fed to the corresponding Dynamixel
motors to generate the required torque as the output to perform the intended
124
K. Karunakaran et al.
Fig. 2 scale robot walked on a treadmill by non-disabled subjects using their hands to
produce foot movement of the robot. The biped was supported by a frame. Subjects easily
accommodated unexpected treadmill speed changes, and mock obstacles. Performance was not
degraded when subjects experienced a cognitive load
movement. The process also allows the users hands to feel the movement and
ground impact of the exoskeletons feet, providing essential feedback.
0
00
X t
F t B X t

M
M
Where F (N) is the applied force vector in x and y, M (kg) is the desired mass to
be felt by the user (this is the admittance coefcient), B (Ns/m) is the desired
0
00
damping to be felt by the user, and X (m/s) and X (m/s2) are the velocity and
acceleration of the robot respectively.
4 Results
The results show that the complete gait cycle produced by the control algorithm
resembles the normal gait trajectory as shown in Fig. 3. The frame duration of
10 ms that allows an admittance loop at 100 Hz is shown to be sufcient for human
operators to feel smooth, nearly passive movements of a robot. Subjects successfully walked the robot on a treadmill with little to no learning period. They produced consistent ankle trajectories in the presence of unexpected changes in
x and y Position of Biped Foot
y position (cm)
y position (cm)
6
4
2
0
-20
-18
-16
-14
-12
-10
-8
x position (cm)
-6
-4
-2
25
x and y Position of Human Foot
20
15
10
5
-35 -30 -25 -20 -15
-10
-5
x position (cm)
10
15
Fig. 3 Comparison of the sagittal plane ankle trajectories of the robot foot (left) and human foot
(right) when walking on the treadmill. The shapes are quite similar, with a vertical/horizontal
excursion ratio of approximately .275 in each case. Direction of walking is to the right
Natural User-Controlled Ambulation of Lower Extremity Exoskeletons
125
treadmill speed, the presence of obstacles, and while performing an unrelated

cognitive task (counting backwards). Our future work involves incorporating balance of the exoskeleton to the current control mechanism.
References
1. Ditunno, P.L., Patrick, M., Stineman, M., Ditunno, J.F.: Who wants to walk? Preferences for
recovery after SCI: a longitudinal and cross section study. Spinal Cord 467, 500506 (2008)
2. Esquenazi, A., et al.: The ReWalk powered exoskeleton to restore ambulatory function to
individuals with thoracic-level motor-complete spinal cord injury. Am. J. Phys. Med. Rehabil.
(2012)
3. Strickland, E.: Good-bye, wheelchair. IEEE Spectr. 49(1), 3032 (2012)
4. Kilgore, K.L., et al.: Neuroprosthesis consumers forum: consumer priorities for research
directions. J. Rehabil. Res. Dev. 38(6), 655660 (2001)
5. Chron, G., Duvinage, M., De Saedeleer, C., Castermans, T., Bengoetxea, A., Petieau, M.,
Sylos Labini, F.: From spinal central pattern generators to cortical network: integrated BCI for
walking rehabilitation. Neural Plasticity (2012)
6. Ruiz, A.F., Forner-Cordero, A., Rocon, E., Pons, J.L.: Exoskeletons for rehabilitation and
motor control. In: The First IEEE/RAS-EMBS International Conference on Biomedical
Robotics and Biomechatronics, BioRob 2006, pp. 601606. IEEE, February 2006
7. Frolov, A.A., Biryukova, E.V., Bobrov, P.D., Mokienko, O.A., Platonov, A.K.,
Pryanichnikov, V.E., Chernikova, L.A.: Principles of neurorehabilitation based on the
brain-computer interface and biologically adequate control of the exoskeleton. Hum. Physiol.
39(2), 196208 (2013)
8. Jose, L., Kilicarslan, A.: Non-invasive brain-machine interfaces to powered exoskeletons for
restoration of walking
9. Strausser, K.A., Kazerooni, H.: The development and testing of a human machine interface
for a mobile medical exoskeleton. In: 2011 IEEE/RSJ International Conference on Intelligent
Robots and Systems (2011)
10. Quintero, H.A., Farris, R.J., Goldfarb, M.: A method for the autonomous control of lower
limb exo-skeletons for persons with paraplegia. J. Med. Devices 6(4) (2012)
11. Birmingham, C., Noesner, M., Foulds, R.: Haptic controlled functional electrical stimulation
of the lower extremities. In: 2003 IEEE 29th Annual Proceedings of Bioengineering
Conference, pp. 287288. IEEE, March 2003
12. Karunakaran, K., Abbruzzese, K., Xu, H., Ehrenberg, N., Foulds, R.: Haptic proprioception in
a virtual locomotor task. In: 2014 36th Annual International Conference of the IEEE
Engineering in Medicine and Biology Society (EMBC), pp. 35943597, August 2014
13. Van Riel, N.: Speeding up simulations of ODE models in Matlab using CVode and MEX
les. Eindhoven University of Technology (2012)
Real-Time Modeling for Lower Limb

Exoskeletons
Guillaume Durandau, Massimo Sartori, Magdo Bortole,
Juan C. Moreno, Jos L. Pons and Dario Farina
Abstract Real-time electromyography (EMG) driven musculoskeletal (NMS) modeling estimates internal body biomechanical parameters and motor intentions. This
is central for understanding the dynamics of user-exoskeleton interaction and for
developing closed-loop user-exoskeleton interfaces that are intuitive and effective
in promoting neuroplasticity. This abstract, presents methods and results behind the
interfacing between a six degree of freedom lower limb exoskeleton (H2 exoskeleton, Technaid S.L., Spain) and a real-time EMG-driven NMS model of the human
lower extremity.
1 Introduction
In the past decade the development of exoskeleton technology flourished. Current
solutions feature state of the art hardware mechatronics. However, the available
human-machine interfaces (HMI) permit little user control. These are mostly based on
position controllers using pre-recorded movement data or zero impedance controllers
that minimize user-exoskeleton interaction forces. Examples based on position controllers include the Lokomat (Hocoma, Switzerland), ReWalk (ReWalk, Israel), or
Ekso (Ekso Bionics, USA). Whereas, the H2 (Technaid S.L., Spain) is an example of
zero-impedance controller. Position controllers disregard the users motion intention
thus preventing active user participation. In this context, the user would passively
train with limited engagement and presumably limited induction of neuroplasticity.
Zero-impedance controllers provide support only if the user is capable of producing
This work was supported by the ERC Advanced Grant DEMOVE [267888].
G. Durandau (B) M. Sartori D. Farina
Institute of Neurorehabilitation Systems, Universittmedizin Gttingen, Gttingen, Germany
e-mail: guillaume.durandau@bccn.uni-goettingen.de
M. Bortole J.C. Moreno J.L. Pons
Cajal Institute, CSIC, Madrid, Spain
J.L. Pons
Tecnolgico de Monterrey, Monterrey, Mexico
127
128
G. Durandau et al.
detectable forces and movements [1]. In this context, severely impaired individuals are excluded as target patients. Therefore, there is the need for a new class of
HMIs that can access internal biomechanical variables in vivo in the intact patient.
In this abstract, we show the use of real-time EMG-driven musculoskeletal (NMS)
modeling to gain access to a repertoire of internal biomechanical variables including
muscle-tendon length, moment arms, force as well as the resulting net joint torque in
multiple degrees of freedom (DOFs) in the human lower extremity. We show how this
can be achieved using a fully-embedded solution based on low-power, wearable and
portable systems, i.e. Raspberry PI 2 (Raspberry Pi Foundation, UK) and six-DOF
H2 exoskeleton.
2 Method
2.1 Real-Time EMG-Driven NMS Modeling
The real-time modeling framework extends from the offline Calibrated EMGinformed Neuromusculoskeletal Modeling (CEINMS) toolbox [2] and from the Multidimensional Cubic B-Spline (MCBS) software [3]. Our proposed framework combines CEINMS and MCBS in a stand-alone forward dynamics approach (Fig. 1).
It determines musculoskeletal forces as a function of measured EMGs and joint
angles [4]. Joint angles inform MCBS for the real-time computation of muscle-tendon
length (Lmt) and moment arms (Rmt). This uses the OpenSim [5] application programming interface for the offline computation of the LMT nominal values needed
for generating B-Spline coefficients. Experimental EMG and predicted Lmt and Rmt
inform the CEINMS module for the real-time computation of muscle-tendon forces
and joint torques. Model internal parameters that vary non-linearly across individuals
anthropometrics are estimated using an offline calibration procedure. This adjusts
internal parameters to minimize the difference between predicted and experimental
joint torques across a range of calibration movement trials.
2.2 Interface with the H2 Lower-Limb Exoskeleton

The H2 is a lower limb exoskeleton with six DOFs including left/right hip flexionextension, knee flexion-extension, and ankle plantar-dorsi flexion. Each joint can be
controlled both in position and torque. The H2 sensor information is transmitted on
a CAN (Controller Area Network) bus and includes: joint position, motor torque
and interaction torque. Each joint is actuated by an electric motor and an harmonic
drive that can provide a continuous net torque up to 35 Nm or a peak torque of 180
Nm for short time periods [6]. The H2 was first interfaced with the RP2 via CAN.
We implemented a graphical user interface (GUI) running on a separate desktop
Real-Time Modeling for Lower Limb Exoskeletons
129
Fig. 1 Diagram of the

interface and interaction
between the EMG driven
NMS model and the H2
lower-limb exoskeleton
PC connected to the RP2 using an UDP connection (WIFI or LAN) for real-time
data monitoring. This GUI plots several real-time variables including: processed
EMGs, torques computed by the EMG-driven NMS model and H2 sensor and control information (Fig. 1). This approach (Fig. 1) enables operating the EMG-driven
NMS model as part of an open-loop or a closed-loop formulation. The open-loop
formulation extract real-time biomechanical variables during natural locomotion or
during locomotion wearing the H2. In this application, EMG-driven model based
estimates are not used to close the loop with the H2 for control purposes. The GUI
displays real-time body parameters and how they are altered as a result of humanmachine interaction. The closed-loop formulation uses model-based computed joint
torque to control the exoskeleton (Fig. 1).
2.3 Experimental Protocol and Tests

EMGs are recorded (2048 Hz) using a 256-channel EMG amplifier (OTBioelettronica, Italy) from 9 muscle groups: rectus femoris, vastus medialis and lateralis, lateral
and medial hamstrings, gastrocnemious medialis and lateralis, soleus and tibialis
anterior. Reference joint angles and torques are recorded using the H2 exoskeleton
built-in sensors (i.e. sampled at 100 Hz). Furthermore, the developed software is interfaced in real-time with a seven-camera motion capture system (Qualysis, Sweden)
at 256 Hz and two in-ground force plates (Bertec, USA) at 2048 Hz. In this study,
we used the motion capture system and the force plate to compute joint torques and
angles via real-time inverse dynamics and kinematics. We initially used these data
130
G. Durandau et al.
Fig. 2 Real-time torque

from inverse dynamic (ID)
and from CEINMS of the
ankle joint from 4 squat trials
for the EMG-driven model calibration. After calibration, we validate the EMG driven
model in real-time on a new set of trials not used for calibration. In Fig. 2, we can
see the result of the pilot test for the squat trial. Model-based prediction error was
quantified as the root mean squared error (RMS) between experimental and predicted
joint moments during a set of validation trials that were not used for calibration. RMS
about the ankle and knee DOFs ranged between 13.8 and 12.55 Nm over a maximal
amplitude of 79.33 and 92 Nm. This was measured from one subject who performed
a squat/calf rise trials. The average Processing time was 3.938e+01 54.15 % ms
for the NMS model, 4.136e01 43.6 % ms for the cubic B-spline computation
and 4.830e+01 27.8 % ms for the total delay.
3 Conclusion
Future work will focus on the real-time model-based control of the H2 exoskeleton
system. This will exclusively use H2 sensory data for model calibration and real-time
operation. Different control schemes will be tested including those in the torque and
impedance domains. Our proposed model-based control scheme will allow development of efficient and user specific neurorehabilitation schemes. Moreover, it will
enable quantifying the progress of the patient during therapy helping the physician
to decide to change the rehabilitation strategies and can also help to asses in the long
term the effectiveness of the therapy. Finally, the model can easily be improved for
computing new body parameters in real-time like joint load, stiffness [7], muscle
energy consumption and muscle primitives [8].
References
1. Hidler, J., Nichols, D., Pelliccio, M., Brady, K., Campbell, D.D., Kahn, J.H., Hornby, T.G.:
Multicenter randomized clinical trial evaluating the effectiveness of the lokomat in subacute
stroke. Neurorehabil. Neural Repair 23(1), 513 (2009)
Real-Time Modeling for Lower Limb Exoskeletons
131
2. Pizzolato, C., Lloyd, D.G., Sartori, M., Ceseracciu, E., Besier, T.F., Fregly, B.J., Reggiani,
M.: Ceinms: a toolbox to investigate the influence of different neural control solutions on the
prediction of muscle excitation and joint moments during dynamic motor tasks. J. Biomech.
48(14), 39293936 (2015)
3. Sartori, M., Reggiani, M., van den Bogert, A.J., Lloyd, D.G.: Estimation of musculotendon
kinematics in large musculoskeletal models using multidimensional b-splines. J. Biomech. 45(3),
595601 (2012)
4. Sartori, M., Reggiani, M., Farina, D., Lloyd, D.G.: Emg-driven forward-dynamic estimation of
muscle force and joint moment about multiple degrees of freedom in the human lower extremity.
PloS One 7, 12 (2011)
5. Delp, S.L., Anderson, F.C., Arnold, A.S., Loan, P., Habib, A., John, C.T., Guendelman, E.,
Thelen, D.G.: Opensim: open-source software to create and analyze dynamic simulations of
movement. IEEE Trans. Biomed. Eng. 54(11), 19401950 (2007)
6. Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J.C., Francisco, G.E., Pons, J.L., ContrerasVidal, J.L.: The h2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a
clinical study. J. Neuroeng. Rehabil. 12(1), 54 (2015)
7. Sartori, M., Maculan, M., Pizzolato, C., Reggiani, M., Farina, D.: Modeling and simulating the
neuromuscular mechanisms regulating ankle and knee joint stiffness during human locomotion.
J. Neurophysiol. 114(4), 25092527 (2015)
8. Sartori, M., Gizzi, L., Lloyd, D.G., Farina, D.: A musculoskeletal model of human locomotion
driven by a low dimensional set of impulsive excitation primitives. Frontiers Comput. Neurosci.
7 (2013)
Towards Everyday Shared Control

of Lower Limb Exoskeletons
Tom Carlson
Abstract We take a multi-faceted whole-system approach towards designing and

implementing a neural interface for lower limb exoskeletons. This paper highlights
some of the initial steps we have taken, from the development of shared control
techniques to the characterization of the exoskeleton itself and the identication of
brain signals that could be used in such an interface.
1 Introduction
Wearable lower limb exoskeletons are designed to help people with paralysis walk,
offering them more independence than conventional wheelchairs. Several such
exoskeletons are now commercially available, but most require the user to balance
themselves with crutches or some other external support. The Rex (robotic
exoskeleton by Rex Bionics, NZ) offers full stability support so people who also
have upper limb impairments can use it. However, the joystick interface and pre-set
motions make it challenging to operate effectively in conned and cluttered environments. Several research groups are striving to achieve a more natural control of
such exoskeletons by designing neural interfaces [1].
We believe that despite recent advances, current neural decoding resolutions and
accuracies are not yet sufcient for everyday control of these exoskeletons outside
laboratory environments. Therefore, the Aspire Create team takes a multi-faceted
whole-system approach towards designing and implementing a shared control
system that will work in tandem with the neural interface.
T. Carlson (&)
Aspire Create, Royal National Orthopaedic Hospital,
University College London, London HA7 4LP, UK
e-mail: t.carlson@ucl.ac.uk
133
134
T. Carlson
Fig. 1 (a) Gait analysis of

the Rex using the Motek
Medical Grail. (b) Measuring
the physical
human-exoskeleton
interaction forces.
(c) Simultaneously measuring
interaction forces and
muscular activity.
2 Shared Control
We are extrapolating our extensive experience in brain-controlled smart wheelchairs, such that the control authority will be shared between the user and the
device [2]. The exoskeleton will therefore be able to: perceive its surroundings; use
this information to interpret the user intent in this context; and then provide the user
with an appropriate level of assistance in completing their desired task.
3 Lower Limb Exoskeletons

Our rst steps towards implementing such a system, have been to characterize: the
exoskeleton motion; the physical human-robot interactions; and the users brain
activity (Fig. 1).
We rst performed a gait analysis of the Rex using the Motek Medical Grail
system at the Royal National Orthopaedic Hospital, Stanmore, UK. Not only did
this allow us to compare the gait with a typical human gait and identify specic
differences, such as the dorsi-/plantarflexion [3], but it also enabled us to build a
kinematic model that will be used by the shared controller.
Next, we analyzed the proles of the interaction forces between the lower limbs
and the exoskeleton cuffs, which we found to differ signicantly for each motion
primitive [4]. This real-time information could be exploited both for safety and in
the feedback control loop.
Our most recent preliminary electroencephalography (EEG) results show signicant differences in the mu band power over the motor cortex, when able-bodied
participants wanted to change their state (e.g. stand up, take a step, turn in place
etc.) [5].
Towards Everyday Shared Control of Lower Limb Exoskeletons
135
4 Discussion and Future Work

Combining the results discussed here, we will implement a shared control system,
such that the exoskeleton will be able to interpret the users intent (from EEG)
given the context of the situationand then generate appropriate sequences of
movements to achieve the desired task safely.
Acknowledgments The author would like to thank G. Barbareschi, C. Holloway, R. Loureiro,
JdR. Milln, DZ. Morgado Ramirez, A. Rathore, E. Sanchez, R. Richards, M. Thornton,
M. Wilcox and A. Zervudachi for their contributions to this ongoing project and Rex Bionics for
providing the exoskeleton for our experiments.
References
1. Kilicarslan, A., Prasad, S., Grossman, R.G., Contreras-Vidal, J.L.: High accuracy decoding of
user intentions using EEG to control a lower-body exoskeleton. In: Proceedings of the
Conference of IEEE Engineering in Medicine and Biology Society (EMBC), pp. 56065609
(2013)
2. Carlson, T., Milln, J.D.R.: Brain-controlled wheelchairs: a robotic architecture. IEEE Rob.
Autom. Mag. 20, 6573 (2013)
3. Barbareschi, G., Richards, R., Thornton, M., Carlson, T., Holloway, C.: Statically vs
dynamically balanced gait: analysis of a robotic exoskeleton compared with a human. In:
Proceedings of the Conference of IEEE Engineering in Medicine and Biology Society
(EMBC), pp. 67286731 (2015)
4. Rathore, A., Wilcox, M., Ramirez, D.Z.M, Loureiro, R., Carlson, T.: Quantifying the
human-robot interaction forces between a lower limb exoskeleton and healthy users. In:
Proceedings of the Conference of IEEE Engineering in Medicine and Biology Society (EMBC)
(2016)
5. Zervudachi, A., Sanchez, E., Carlson, T.: Preliminary EEG characterisation of intention to stand
and walk for exoskeleton applications. In: Proceedings of the Conference of NeuroRehabilitation
(ICNR) (2016)
Part V
Biomechanics and Neurophysiological

Studies with WRs
Joint-Level Responses to Counteract

Perturbations Scale with Perturbation
Magnitude and Direction
Mark Vlutters, Edwin H.F. van Asseldonk and Herman van der Kooij
Abstract To realize a lower extremity exoskeleton that can provide balance

assistance in a natural way, an understanding of human balance control is a
necessity. In this study, we investigated how the angle, torque and power of the
ankle, knee and hip joints changed in response to balance perturbations during
walking. Nine healthy young adults walked on an instrumented treadmill and
received pelvis perturbations of various magnitudes and directions at the instance of
toe-off right. An open source musculoskeletal modeling package (OpenSim) was
used to perform inverse kinematics and inverse dynamics. Subjects modulated the
ankle torque in the (left) stance foot with the magnitude and direction of the
perturbation. Also in gait phases following foot placement, subjects addressed ankle
torques to mitigate the remaining effects of the perturbation. The results presented
here support the use of ankle actuation in lower extremity orthoses for natural and
cooperative balance control.
1 Introduction
Most current exoskeletons are unable to stay upright without assistance and guidance of its user. Paraplegic users, for example, often require crutches to prevent
falling. To have an exoskeleton assist its user in maintaining balance instead,
This work was supported by the BALANCE (Balance Augmentation in Locomotion, through
Anticipative, Natural and Cooperative control of Exoskeletons) project, partially funded under
grant 601003 of the Seventh Framework Program (FP7) of the European Commission
(Information and Communication Technologies, ICT-2011.2.1).
M. Vlutters (&)
Biomechanical Engineering Group, University of Twente, Enschede, Netherlands
e-mail: m.vlutters@utwente.nl
E.H.F. van Asseldonk H. van der Kooij
University of Twente, Enschede, Netherlands
e-mail: {e.h.f.vanAsseldonk,h.vanderkooij}@utwente.nl
139
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M. Vlutters et al.
preferably in a natural and human-like manner, an understanding of human balance

control is of major importance.
Investigating balance responses following perturbations can give insight in the
human balance controller. When and how are the different lower extremity joints
controlled to maintain upright posture? Furthermore, insight into joint angles, torques, and power during perturbation recovery can provide guidelines for
exoskeleton hardware specications.
In this study, pelvis perturbations were used to elicit balance recovery responses
in walking human subjects. We investigated how joint-level responses alter with
perturbation magnitude and direction, and provides insight in the ranges of motion,
torque, and power of the ankle, knee, and hip joints during the recovery.

2.1
Experimental Setup and Protocol
Nine healthy young adults walked on a custom dual-belt instrumented treadmill

(MotekForce Link, Culemborg, Netherlands), while keeping arms crossed over the
abdomen. Walking speeds were 2.25 km/h and 4.50 km/h, scaled to the subjects
leg length. For each speed, subjects rst walked a 2 min unperturbed baseline trial.
In subsequent trials, perturbations were applied to the pelvis using one of two
motors (Moog, Nieuw-Vennep, Netherlands), connected with a lever arm to a
pelvic brace (Distrac, Hoegaarden, Belgium), worn by the subject. The motors were
located at the side and the rear of the treadmill. Perturbations were applied at
randomly selected instances of toe-off right (TOR), and consisted of 150 ms block
pulses of a force magnitude equal to 4, 8, 12 and 16 % of the subjects body weight.
Perturbation directions were forward (positive), backward (negative), outward
(positive, away from stance leg) and inward (negative, toward stance leg). Each
perturbation type was repeated 8 times, leading to 256 perturbations per subject.
Kinematic data of various landmarks on the lower extremities, pelvis, trunk and
head [1] were collected at 100 Hz using a motion capture system (Phoenix
Technologies Inc, Vancouver, Canada). Ground reaction forces, subject-motor
interaction forces, and EMG data were collected at 1000 Hz. More details about the
experimental setup can be found in [2].
2.2
Data Processing
Data were processed using Matlab (R2014b, Mathworks, Natick, US) and OpenSim
3.3 [3]. Joint angles and velocities were calculated using inverse kinematics (IK),
joint torques using inverse dynamics (ID), and joint power by multiplying the joint
velocities and torques. The model used for the IK and ID calculations in OpenSim
Joint-Level Responses to Counteract Perturbations Scale
141
was the default gait2354 model, scaled to subject specic dimensions using the
kinematic landmarks from each subjects static measurement. In the ID, the collected ground reaction forces as well as the subject-motor interaction forces were
specied as external force.
All data were cut in sequences from (1) perturbation onset (at TOR) to perturbation end, (2) perturbation end to the subsequent heel strike right (HSR), (3) HSR
to subsequent toe-off left (TOL), (4) TOL to subsequent heel strike left (HSL),
(5) HSL to subsequent TOR. For each subject, all sequences were resampled to 50
samples and averaged over the repetitions. The repetition averages of each subject
were used to obtain averages and standard deviations over subjects.
3 Results
Here, results are only shown for the plantar- and dorsiflexion ankle torque and ankle
power, in response to anteroposterior (AP) perturbations for the 2.25 km/h walking
speed (Fig. 1). Subjects scaled their left ankle torque with perturbation magnitude
and direction during the left single support phase, directly following the perturbation. During this phase subjects extracted energy following forward perturbations, and injected energy following the larger backward perturbations, as can be
observed from the power.
Using the right ankle, subjects delivered an increased plantarflexion torque directly
following HSR in response to the larger forward perturbations, resulting in increased
energy extraction (negative power). In the second double support phase following the
perturbation (HSL-TOR), subjects generated more positive power following backward perturbations as compared to forward perturbations. Surprisingly, the perturbation effects are more pronounced in the right ankle during this second double
Fig. 1 Ankle plantar- and dorsiflexion torques (A) and power (B) in response to anteroposterior
pelvis perturbations during 2.25 km/h walking. Top row: left ankle, bottom row: right ankle.
Colors indicate the different perturbation magnitudes. Shaded gray area indicates the baseline
standard deviation. Standard deviations of the perturbation data are not shown to prevent image
cluttering. Data were made dimensionless using subject weight (m*g) and height (l).
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M. Vlutters et al.
support phase, than in the power delivered by the left ankle during the rst double
support phase (HSR-TOL) after the perturbation.
4 Discussion
Joint angles, torques, and power were obtained using IK and ID. The ankle torques
and power show that an ankle strategy is actively addressed in the recovery from
pelvis perturbations during walking. One might expect a decreased plantarflexion
torque during the push-off directly following forward perturbations (Pert.end-HSR),
but an increase was observed instead. An explanation could be that subjects attempt
to keep their center of mass at approximately the same height to prevent having to
strongly redirect the body vertically [4], or prevent forward body rotation as in [5].
Both require leg extension through plantarflexion. The strong decrease in left ankle
plantarflexion torque directly following the perturbation (Pert.end-HSR) allows
subjects to quickly regain forward velocity and return to the desired gait cycle.
Consequently, no strong ankle torque deviations are observed in the subsequent gait
phases following backward perturbations. The larger variability between conditions
in right peak ankle power (HSR-TOL) compared to left peak ankle power
(HSL-TOR) might be related to the subject repositioning on the treadmill, which
likely does not occur until the second step (HSL).
5 Conclusions
The presented results can give insight in human balance control on a joint level. Future
work consists of nding controllers that can generate such joint-level responses.
References
1. Dumas, R., Chze, L., Verriest, J.P.: Adjustments to McConville et al. and Young et al. body
segment inertial parameters. J. Biomech. 40, 543553 (2007)
2. Vlutters, M., van Asseldonk, E.H.F., van der Kooij, H.: Center of mass velocity based
predictions in balance recovery following pelvis perturbations during human walking.
J. Exp. Biol. 209 (2016, to be published)
3. Delp, S.L., et al.: OpenSim: open-source software to create and analyze dynamic simulations of
movement. IEEE Trans. Biomed. Eng. 54, 19401950 (2007)
4. Donelan, J.M., Kram, R., Kuo, A.D.: Mechanical work for step-to-step transitions is a major
determinant of the metabolic cost of human walking. J. Exp. Biol. 205, 37173727 (2002)
5. Pijnappels, M., Bobbert, M.F., van Dien, J.H.: How early reactions in the support limb
contribute to balance recovery after tripping. J. Biomech. 38, 627634 (2005)
Metabolic Energy Consumption

in a Box-Lifting Task: A Parametric Study
on the Assistive Torque
Mohammad S. Shourijeh, Moonki Jung and Michael Damsgaard
Abstract This study showcases effect of adding assistive torques to the hip, knee,
and ankle joints in the sagittal plane on the total human body metabolic energy
expenditure using the AnyBody musculoskeletal modeling system. To this goal, a
box-lifting task was targeted and metabolic energy was computed for several cases
including when each of the three joints was assisted at a time. Simulation results
showed that the hip joint assistance affects the total metabolic energy consumption
more than the knee and ankle joints.
1 Introduction
Metabolic energy consumption has been shown to be a serious criterion in human
movements. Simulation studies have used this measure to provide information on
optimality level of human motion [1]. Rate of VO2 consumption, which is deemed
to be equivalent to overall rate of metabolic energy consumption, have been simulated in musculoskeletal dynamic simulations by means of simple [2] to complex
[3] mathematical models.
Additionally, metabolic energy has been used and speculated to be important
in efcacy of exoskeletons. How an assistive device contributes to both the
local joint-level and total human body has been a design objective for the
This work has received funding from the European Unions Horizon 2020 research and
innovation programme under grant agreement No. 680754 (The MovAiD project, www.movaid.
eu).
M.S. Shourijeh (&) M. Jung M. Damsgaard
AnyBody Technology, Aalborg, Denmark
e-mail: mss@anybodytech.com
M. Jung
e-mail: mj@anybodytech.com
M. Damsgaard
e-mail: md@anybodytech.com
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M.S. Shourijeh et al.
neuro-rehabilitation engineers. Experimental measurement of VO2 consumption

have been used for assessing performance of human body with and without wearing
assistive devices. However, VO2 rate only reflects the total metabolic energy rate
and is neither informative about effects at the local muscles or joints nor the
contribution of the local elements to the total metabolic energy consumption.
Therefore in design of assistive devices, if the question is to evaluate efciency of
the device at the joint level or in some applications, essentially which joint must be
assisted most, computer simulations have the potential to play an important role.
The goals of this study were (1) to exemplify use of musculoskeletal modeling
for assistive wearables in a box-lifting task and (2) to determine which joint is the
most crucial to be assisted within the desired movement.
2 Methods
AnyBody modeling software [4] has been used to simulate the box-lifting task.
Metabolic energy rate model was a modied model of [3]. Ground reaction forces
were predicted by the reaction force prediction tool in AnyBody to keep the model
dynamic equilibrium; for more details, please see [5].
2.1
Musculoskeletal Model (MSM)
The full human body model in the AnyBody Managed Model Repository (AMMR
v1.6.3) was used for this study; see Fig. 1. The model includes 63 segments, and
834 muscles. The model was 75.6 kg and 1.80 m. Three-element Hill-type muscle
model was chosen for the muscles, which consists of a contractile element (CE), a
parallel elastic element (PE), and a serial elastic element (SE) [6].
Fig. 1 The musculoskeletal

model in AnyBody applied
for the box-lifting task.
Ground reaction forces and
moments are predicted by
AnyBody
Metabolic Energy Consumption in a Box-Lifting Task
2.2
145
Box-Lifting Movement
The vertical kinematics of the box was prescribed by an assumed 6th order polynomial with zero velocity and acceleration for the initial and nal points. Following
that, the kinematics of the model was predicted using the center of mass driver in
AnyBody while keeping the center of pressure within the model feet region in order
to maintain model balance.
2.3
Metabolic Energy
The model for the muscle metabolic power E_ was dened as

_
E_ H_ W
which models the decrease in the muscle internal energy. In Eq. (1), H_ is the heat
rate generated by the muscle dened as the sum of basal, activation, maintenance,
and shortening/lengthening heat rates. W_ is the external work done by the muscle
and dened as
W_ fce lce ; vce ; avce
where lce and vce are length and velocity of the contractile element (CE) in the
muscle model, respectively; fce is the CE force function and a is muscle activation.
The total body metabolic energy Etot was dened as
Etot
N Z
X
i1
tf
E_ i dt
t0
where t0 and tf are initial and nal movement time, which were set to 0 and 3 s,
respectively; i refers to muscle index, and N is the total number of muscles in the
model.
2.4
Assistive Torque
The assistive torque was modeled as a rotational actuator, torque of which is

proportional to the joint angle as
146
Tassist Kh
where K (Nm/rad) is the pseudo-stiffness of the assistive device that can be negative, zero (no assist), or positive. In a parametric study, K was changed between
[500, 500] Nm/rad for each joint at a time that seemed to be a reasonably large
range for this study.
2.5
Box Interaction with the MSM
A cube (0.4 0.4 0.4 m3) with a mass of 5 kg, with Ixx = Iyy = Izz = 0.768
Kgm2 was assumed for the box. The interaction between the hands and the two
sides of the box was modeled as two weld joints. Box bottom was also assumed to
move from 0.1 to 0.6 m of the floor.
3 Results
Figure 2 depicts the total metabolic power for the four cases in this study: unassisted, and optimally-assisted at hip (K = +50), knee (K = +50), and ankle
(K = 100) joints. The total metabolic energy for these cases were 30.3, 25.6, 29.2,
and 29.7 kJ, respectively.
Total Metabolic Power (kW)
15.0
13.0
11.0
Unassisted
Hip +50
Knee +50
Ankle -100
9.0
7.0
5.0
0.0 0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0
Time (s)
Fig. 2 Simulated total metabolic power of the box-lifting task for unassisted (black), optimally
hip-assisted (green), knee-assisted (blue), and ankle-assisted (red) scenarios
Metabolic Energy Consumption in a Box-Lifting Task
147
4 Discussion
All the three optimal assisted cases led to less metabolic energy required to perform
the task. Out of the three joints, hip joint was found to be most influential on the
design criterion (i.e. over 15.5 % less metabolic energy). It must be noted that the
hip flexion is negative in the model; therefore, a positive pseudo-stiffness for the hip
joint will lead to a positive hip extensor torque, which is desired for assistance in
the lifting phase. The optimal joint to assist can be dependent on the style of lifting
(stooped versus squat). It must be pointed out that in the simulations of this study,
the model used the hip more than the knee for the lifting task. The absolute angle
variations for the hip and the knee joints were 1.58 and 0.524 rad, respectively,
which showed that the lifting was more like a stooped style. It is speculated that if a
human subject chooses to perform a squat style lifting, knee will be the optimal
joint for assistance.
The less is the metabolic energy required from the human, the more comfortable
will be the human to perform the task; however, the required assisted torque from
the external device might be constrained by the motor size, material properties, etc.,
which might lead to less assistive torque generation capability. Therefore, computer
modeling of the assistive devices must be done with consideration of design and
fabrication limitations in order to reach a realistic optimal design.
5 Conclusions and Future Work

Effect of adding external assistive torques to the hip, knee, and ankle joints was
studied using the AnyBody software. Total metabolic energy over the period of the
box-lifting motion was computed and utilized as the design variable. As metabolic
energy measure has been broadly used in studies for design optimization of the
exoskeletons, musculoskeletal modeling environments such as AnyBody that can
provide such information in detail at the joint and muscle levels can signicantly
contribute.
Model kinematics was assumed to be the same between the four cases. However,
as the lifting styles might be subjectively different, studying how a range of lifting
styles from stooped to squat affects the metabolic energy consumption could be a
future research study.
148
References
1. Shourijeh, M.S., McPhee, J.: Forward dynamic optimization of human gait simulations: a
global parameterization approach. J. Comput. Nonlinear Dyn. 9, 031018 (2014)
2. Voigt, M., Bojsen-Mller, F., Simonsen, E.B., Dyhre-Poulsen, P.: The influence of tendon
Youngs modulus, dimensions and instantaneous moment arms on the efciency of human
movement. J. Biomech. 28, 281291 (1995)
3. Umberger, B.R., Gerritsen, K.G., Martin, P.E.: A model of human muscle energy expenditure.
Comput. Methods Biomech. Biomed. Eng. 6, 99111 (2003)
4. Damsgaard, M., Rasmussen, J., Christensen, S.T., Surma, E., De Zee, M.: Analysis of
musculoskeletal systems in the AnyBody modeling system. Simul. Model. Pract. Theory 14,
11001111 (2006)
5. Fluit, R., Andersen, M.S., Kolk, S., Verdonschot, N., Koopman, H.F.J.M.: Prediction of
ground reaction forces and moments during various activities of daily living. J. Biomech. 47,
23212329 (2014)
6. Zajac, F.E.: Muscle and tendon: properties, models, scaling, and application to biomechanics
and motor control. Crit. Rev. Biomed. Eng. 17, 359411 (1988)
Analysis of the Movement

Variability in Dance Activities
Using Wearable Sensors
Miguel Xochicale, Chris Baber and Mourad Oussalah
Abstract Variability is an inherent feature of human movement, but little research

has been done in order to measure such a characteristic using inertial sensors
attached to persons body (wearable sensors). Therefore the aim of this preliminary
study is to investigate the assessment of human movement variability for dance
activities. We asked thirteen participants to repeatedly dance two salsa steps (simple
and complex) for 20 s. We then used a technique from nonlinear dynamics
(time-delay embedding) to obtain the reconstructed state space for visual assessment of the variability of dancers. Such reconstructed state space is graphically
linked with their level of skillfulness of the participants.
1 Introduction
Variability is an inherent feature that occurs not only within individual but also
between individual systems of movement. Newell and Corcos stated that the
movement variability (MV) increases or decreases as a function of practice which is
linked with the diminution or increment of skill [1]. In sport biomechanics, for
instance, Preatoni et al. stated two important facts about the MV: (i) MV should not
be treated as a noise that needs to be removed and (ii) conventional approaches can
M. Xochicale is supported by the National Council of Science and TechnologyCONACyT
Mexico. The support is gratefully acknowledged.
M. Xochicale (&) C. Baber
School of Electronic Electrical and System Engineering,
University of Birmingham, Birmingham, UK
e-mail: map479@bham.ac.uk
C. Baber
e-mail: c.baber@bham.ac.uk
M. Oussalah
Center for Ubiquitous Computing, University of Oulu, Oulu, Finland
e-mail: moussala@ee.oulu.
149
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M. Xochicale et al.
only quantify the overall variability. Hence, Preatoni et al. examined non-linear
methodologies (entropy measures, dynamical systems theory approaches, and
principal component analysis) that are able to deal with and measure variability.
This research concluded that the choice of analysis to be used for a particular
movement is dependent on the movement in question [2]. Despite the previous
efforts of researchers in biomechanics and sport science in measuring the MV, little
research has been done with wearable sensors to both quantify the MV and link the
MV with the skill assessment of users. For instance, Velloso et al. [3] automatically
assessed the quality of weight-lifting activity. Further examples of skill assessment
using wearable sensors were investigated on music violin players [4] or medical
students doing surgical activities [5].
Little work has been done regarding the use of nonlinear tools using wearable
sensors. For instance, Liao et al. used the Empirical Mode Decomposition for
activity recognition using accelerometer data [6]. The works of Sama et al. [7] and
Frank et al. [8] used the time-delay embedding technique for gait recognition using
inertial sensors. We therefore believe that the use of nonlinear tools will provide
better measurements and expand the understanding of the variability and skill
assessment of activities using wearable sensors. For the current work, we are
interested in the question of how the time-delay embedding and PCA techniques
can provide insights into the variability and dexterity of dancers. To this end, we
consider the performance of a set of steps from Salsa dance and visually compare
the variability across dancers.
2 Methods
2.1
Time-Delay Embedding
The aim of the time-delay embedding is to reconstruct a D-dimensional manifold

M of an unknown dynamical system st from a time series xt. The time-delay
reconstruction, time delayed copies of the available time series xt, is dene as:
xt xt; xt s; xt 2s; . . .; xt m 1s where m is the embedding
dimension and s is the embedding time-delay. We follow a modied version of the
False Nearest Neighbors and the mutual information algorithms to respectively
determine the embedded values of m and s [9].
2.2
Framework for the Experiment
The raw data is collected from triaxial accelerometer, gyroscope and magnetometer
sensors. For instance, the time series, ax , with a length of N samples is used to
obtain the time-delay embedded matrix, Efax g, with m rows and N m 1s
151
columns. Then, the PCA is applied to obtain, via eigenvalues k1 ; . . .; km of

eigenvectors t1 ; . . .; tm , the principal components PC1 ; . . .; PCm of the
time-delay embedded phase space which also provide the percentage of variance
(POV) per component.
2.3
Participants
Thirteen participants with different years of experience in dancing were invited to

dance basic salsa steps: eleven novice dancers (4 female, 7 male), one intermediate
(male) dancer (4 years of experience) and one (male) expert dancer (14 years of
experience). The design of the experiment was approved by the University of
Birmingham ethics approval process. All participants provided informed consent
prior to participation.
2.4
Experiment Design
Each participant was shown a series of video clips (recorded by the expert dancer)
demonstrating basic salsa steps. Each video clip showed one step repeated several
times for 20 s. For the analysis in this work, we reported two Salsa step patterns:
step 1 which is mambo and step 2 which is side crossover. Participants watched the
video clip and were then asked to copy the steps in time to music. The video was
played during the data collection (so that participants did not have to rely on their
memory of the steps). Data were collected from the IMUs and recorded. The
analysis reported will focus on data from particular axis of the magnetometer (mz
for step 1 and my for step 2) taken from the sensor mounted on the left ankle.
2.5
Data Collection
Data from triaxial accelerometer, gyroscope and magnetometer sensors were collected at a sampling rate of 50 Hz using a Razor 9DOF IMU with Bluetooth
(BlueSMiRF Silver). The IMUs were attached to custom-made bracelets worn by
participants.
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M. Xochicale et al.
3 Results
Figure 1 illustrates the 2-D reconstructed state space for the novice, intermediate
and expert dancers. For the time-delay embedding algorithm, we used m = 10 and
s = 6 [9]. The reconstructed state spaces visually helped us to distinguish different
levels of dexterity. It is immediately noticeable that the shape of the state spaces for
each level (novice, intermediate, expert) appears visually similar across step 1. As
the participants are meant to be performing the same action, this similarity is to be
expected. The state spaces also show a tighter and less varied pattern for the expert
than for the other dexterity levels. This suggests that the expert is producing more
repeatable and more consistent actions than the other dexterity levels. While this is
to be expected, the reconstructed state spaces provide interesting illustrations of this
phenomenon. For step 2, which is a more complicated sequence of movements, one
Fig. 1 2-D reconstructed state spaces and percentage of variance using bar plots from the PCA for
both participants experience and steps
153
can see a marked contrast across dexterity levels. Again, the expert is showing a
consistent and repeatable action. The intermediate participant is showing a consistent action but this is different to that of the expert, and the novice is showing a
pattern which appears disjointed and noisy. Indeed, for the novice dancer, the state
space reconstruction of step 2 seems to have more in common with their state space
for step 1 than it does with the other dancers performing step 2. On the other hand,
for step 2 the percentage of variance values (bar charts) present a decreasing tendency for the components as the expertise level increased. However, for step 1 we
can only say that the rst two components have the highest values across the
remained components and no evident tendency is shown as the expertise of the
participants goes from novice to expert.
4 Conclusion and Future Work

Although the time-delay embedding is subject to the embedded parameters (m and
s), the technique is useful to visually present the differences among levels of
skillfulness. We believe that movement variability (MV) is an ongoing trend
towards extending the understanding of human movement with potentially
promising applications in the eld of human-robot interaction. From this, there are
three areas that we are going to investigate: (i) collect data from a wider range of
individuals (gender and age) and from additional sensors, (ii) undertake a wider
review of nonlinear techniques that can be used for the assessment of MV using
wearable sensors, and (iii) explore the use of Hidden Markov Models and Deep
Neural Networks for automatic recognition of the variability.
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1. Newell, K.M., Corcos, D.M. (eds.): Variability and Motor Control, 1st edn. Human Kinetics
Publishers Inc., United States of America (1993)
2. Preatoni, E., Hamill, J., Harrison, A.J., Hayes, K., Emmerik, R.E.A.V., Wilson, C., Rodado, R.:
Movement variability and skills monitoring in sports. Sports Biomech. 12(2), 6292 (2013)
3. Velloso, E., Bulling, A., Gellersen, H., Ugulino, W., Fuks, H.: Qualitative activity recognition
of weight lifting exercises. Proceeding AH 13 Proceedings of the 4th Augmented Human
International Conference, pp. 116123 (2013)
4. Van Der Linden, J., Schoonderwaldt, E., Bird, J., Johnson, R.: MusicJacketcombining
motion capture and vibrotactile feedback to teach violin bowing. IEEE Trans. Instrum. Meas.
60, 104113 (2011)
5. Khan, A., Mellor, S., Berlin, E., Thompson, R., McNaney, R., Olivier, P., Plotz, T.: Beyond
activity recognition: skill assessment from accelerometer data. UBICOMP (2015)
6. Liao, M., Guo, Y., Qin, Y., Wang, Y.: The application of EMD in activity recognition based on
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7. Sama, A., Ruiz, F.J., Nuria, A., Perez-Lopez, C., Catala, A., Cabestany, J.: Gait identication by
means of box approximation geometry of reconstructed attractors in latent space. Neurocomputing
121, 7788 (2013)
8. Frank, J., Mannor, S., Precup, D.: Activity and gait recognition with time-delay embeddings.
AAAI Conference on Articial Intelligence, pp. 15811586 (2010)
9. Cao, L.: Practical method for determining the minimum embedding dimension of a scalar time
series. Physica D 110, 4350 (1997)
Part VI
New Developments in Wearable

Rehabilitation Robotics
Real Time Computation of Centroidal

Momentum for the Use as a Stability Index
Applicable to Human Walking
with Exoskeleton
Je Hyung Jung, Lidwine Van Opheusden, Pierre Barralon
and Jan F. Veneman
Abstract This abstract presents the real time computation of Centroidal
Momentum (CM) in human walking while addressing its applicability as a stability
index to human walking with exoskeleton. To this end, a real time full body motion
capture suit solution was employed and it was tested both in steady over ground
walking and in walking with tripping events. Results show that observation of CM
is able to detect abnormal state of human gait in real time thanks to its inherent
physical meaning.
1 Introduction
Over the last decade, a variety of studies on both upper and lower limbs exoskeletons
have been presented and shown that the exoskeletons can not only enhance human
power in industrial or military applications but also reduce societal burden for the care
of ageing population by enabling independent daily living [1]. Specically, large
attention on lower limb exoskeletons has been paid as they show huge potential to
augment and recover walking capability for elderly and physically impaired people.
This work has been supported by the partially EU funded project BALANCE, FP7-ICT2011.2.1 grant no. 601003.
J.H. Jung (&) P. Barralon J.F. Veneman
Health Division, TECNALIA, Mikeletegi Pasealekua 1-3,
20009 Donostia-San Sebastian, Spain
e-mail: jehyung.jung@tecnalia.com
P. Barralon
e-mail: pierre.barralon@tecnalia.com
J.F. Veneman
e-mail: jan.veneman@tecnalia.com
L. Van Opheusden
University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
e-mail: l.m.e.vanopheusden@student.utwente.nl
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For practical and reliable use of lower limb exoskeletons interacting with a
human user, however, still several issues remains and have to be resolved. One of
them is how to monitor the stability of a human walking wearing an exoskeleton
and detect abnormal states of the walking when the user meets unpredicted disturbances such as a slippery terrain or when stumbling on uneven pavement.
Recently, to deal with this topic, Centroidal Momentum (CM), referring to linear
and angular momenta at Centre of Mass (CoM), has been introduced and analysed
[2] in the context of the EU FP7 project BALANCE (http://balance-fp7.eu/).
Preliminary analysis results of CM performed in off-line fashion with data sets
recorded in human walking, especially treadmill walking with lateral pelvic perturbations, revealed that monitoring CM is able to distinguish perturbed walking
from unperturbed one, thus allowing detection of perturbations during walking [3].
While the off-line analysis showed applicability of the CM as a stability index, it is
required to examine the behaviour and performance of CM computation under a
real time implementation for the nal application where CM is used as a trigger to
initiate the balance control (e.g. foot placement adaptation) of an exoskeleton. This
abstract deals with this subject and as a rst step, presents the real time computation
of CM during human natural and perturbed over ground walking (without
exoskeleton). The trials were carried out with one subject wearing a full-body
motion capture suit from Xsens Company.
CM is described shortly in Sect. 2 and a platform employed for its real time
computation together with pilot test results appear in Sect. 3. Section 4 contains
conclusions as well as future tasks.
2 Centroidal Momentum
Centroidal Momentum (CM) can be expressed with a vector whose components are
calculated by
~
H

n
X

i
$i i
i
~
~
rCM mi ~
vCM I x
rCM ~
vCM ~
i1
~
L M~
vCM
~ is the angular momentum at CoM, ~

where H
L the linear momentum at CoM, n the
i
!
i
number of body segments, ~
rCM , v CM and mi are, respectively, the position and
$i
~i
velocity of the CoM of each segment, and the mass of i-th segment and I and x
are the i-th segments inertia tensor and angular velocity, respectively, and ~
vCM and
M are, respectively, the linear CoM velocity and the total weight of the body [4]. In
order to minimize data variance between different subjects, the angular and linear
~ by NH M j~
momenta are normalized by dividing H
L by NL M j~
vCM jD and ~
vCM j,
where D is the CoM height of the body.
Real Time Computation of Centroidal Momentum
159
3 Real Time Computation of CM

3.1
Demonstration Platform
To demonstrate the real time computation of CM, we used the real time motion data
acquisition platform from Xsens. Its name is Xsens MVN (Fig. 1) and consists of a
full body suit with 17 Inertial Measurement Units (IMUs), two portable WIFI
transmitters and motion visualization software (MVN Studio). Using the IMUs
signal and anthropometric data, the kinematic data of 23 body segments are measured and transmitted to MVN Studio through WIFI communication. The data from
the suit are refreshed at 120 Hz. In MVN Studio, a human-like 3D avatar imitates,
in real time, body movement captured by MVN suit. In addition, MVN Studio
provides online streaming of captured motion data, position and orientation of 23
body segments, to Matlab application through UDP (User Datagram Protocol).
Hence, the code for real time computation of CM was implemented in Matlab
and executed. Real time plotting is also realized to visualize behavior of all elements of CM. Since CM requires the linear and angular velocities, they were
numerically calculated in the Matlab codes. Under this implementation, computational time of CM was roughly 3.5 ms, which is considered fast enough to use it in
real time, while the visualization for the feedback takes 300 ms in average.
3.2
Demonstration During Natural Overground Walking
The implemented system was investigated in natural over ground walking.

Computed CM in real time well corresponds to that obtained in off-line analysis,
particularly, showing that angular momentum follows a small periodical pattern
around zero during straight walking [4].
3.3
Demonstration During Walking with Tripping Events
In the second test, the subject wearing the suit was asked to fake a tripping situation
while walking. Computed CM in real time was visualized as depicted in Fig. 2.
Fig. 1 Overview of the
platform used for the real time
computation of CM with
Xsens solution
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From the gure, it can be seen that particular elements of CM, which are angular
momentum in Y direction and linear momentum in X direction, show simultaneously large peaks at tripping instances, which means large deviation from the
pattern produced in natural walking. From the biomechanical point of view, the
variations result from fast rotation of the trunk around the medio-lateral axis
together with fast translation in the walking direction, which usually happen when
tripping. From this observation, it can be anticipated that real time monitoring of
certain elements of CM enables to estimate a type of motion currently occurring,
thus detect abnormal states during walking. In addition, it is observed that at turning
instances, the angular momentum in vertical direction and linear momentum in
medio-lateral direction, show large peaks simultaneously, as can be expected from
the biomechanical interpretation.
Fig. 2 Computed normalized

Centroidal Momentum in real
time during walking with
tripping events. X, Y, and
Z denote anterio-posterio,
medio-lateral, and vertical
direction respectively.
indicates tripping event
instance while indicates
turning instance
(a) Calculated normalized angular momentum at CoM
(b) Calculated normalized linear momentum at CoM
Real Time Computation of Centroidal Momentum
161
4 Conclusion
In this paper, we presented the real time computation of Centroidal Momentum and
investigated its use as a stability index during human walking. The results show that
CM is computed fast enough for real time use in commercially available body
motion capture suit while being able to monitor an actual state of balance during
walking thanks to its inherent physical meaning. Next step will be the integration of
the CM approach into an exoskeleton and investigate adoptability of the CM as the
stability index for human walking with the exoskeleton, which might be affected by
interaction between human and exoskeleton. IMU, as is well known, is sensitive to
electromagnetic (EM) elds so the leg kinematic information of the exoskeleton
directly measured with angle sensors will be incorporated together with IMUs
signals in order to improve the robustness of the approach.
Acknowledgments Authors thank Henk Luinge from Xsens for providing their platform for the
study.
References
1. Dollar, A.M., Herr, H.: Lower-extremity exoskeleteon and active orthoses: challenges and
state-of-the-art. IEEE Trans. Robot. 24(1), 144158 (2008)
2. Jung, J.H., Gutirrez, I., Veneman, J.: The use of centroidal momentum analysis for dening a
stability index for walking with an exoskeleton. In: TAR 2015: Technically Assisted
Rehabilitation Conference, Berlin, Germany (2015)
3. Jung, J.H., Veneman , J.: Centroidal momentum analysis for dening a stability index for
human-exoskeleton interactive walking: perturbation detection in human gait. Assistance and
Service Robotics in a Human Environment Workshop in conjunction with 2015 IROS,
September 28 2015Oct. 2, 2015, Hamburg, Germany
4. Herr and, H., Popovic, M.: Angular momentum in human walking. J. Exp. Biol. 211(4), 467
481 (2008)
A Versatile Neuromuscular Exoskeleton

Controller for Gait Assistance: A Preliminary
Study on Spinal Cord Injury Patients
Amy R. Wu, Florin Dzeladini, Tycho J. H. Brug, Federica Tamburella,
Nevio L. Tagliamonte, Edwin van Asseldonk, Herman van der Kooij and
Auke J. Ijspeert
Abstract We investigated the capabilities of a reflex-based neuromuscular controller with a knee and hip gait trainer worn by a subject with a complete spinal cord
injury. With controller assistance, this subject was able to reach a walking speed of
1.0 m/s. Measured joint torques agreed reasonably well with those of healthy subjects.
The controller was also robust, recovering from manual swing foot perturbations.
These preliminary results are promising for future implementation of neuromuscular
controllers on wearable prototypes for real-world walking conditions.
1 Introduction
Robust and reliable controllers of gait assistive devices for patients with neurological disorders must balance healthy-like walking function with promotion of motor
recovery. We take a biologically-inspired approach with a controller based on a neuromuscular model developed by Geyer [2]. This neuromuscular controller (NMC)
generates walking by activating simulated muscle reflex loops based on gait state,
combining muscle-tendon dynamics to produce lower-limb joint torques. While the
full controller can reproduce torques at the ankle, knee, and hip, its modular structure
permits use for any combination of these joints. No pre-defined movement pattern is
needed, and few sensors are required. Ground contact detection is needed to switch
between stance and swing reflexes, and joint angles are used to calculate simulated
A.R. Wu (B) F. Dzeladini A.J. Ijspeert
BioRobotics Laboratory of the cole Polytechnique Fdrale de Lausanne, Lausanne, Switzerland
e-mail: amy.wu@epfl.ch
F. Tamburella N.L. Tagliamonte
Laboratory of Robotic Neurorehabilitation in the Neurological and Spinal Cord Injury
Rehabilitation Department A of Fondazione Santa Lucia, Rome, Italy
T.J.H. Brug E. van Asseldonk H. van der Kooij
Department of Biomechanical Engineering of the University of Twente, Holland, The Netherlands
H. van der Kooij
The Netherlands and the Department of Biomechanical Engineering
of the Delft University of Technology, Delft, The Netherlands
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muscle state. This flexibility enables active recruitment of the patients own neuromuscular system, an important component of motor function recovery [3]. In simulation, this controller is also robust against perturbations [1] and can adapt to non-steady
state behaviors [5].
We performed a preliminary evaluation of this controller on a lower-limb exoskeleton worn by a subject with a complete spinal cord injury (SCI). We hypothesize that
the controller dynamics will enable the subject to walk at different walking speeds
and recover from small perturbations.

We implemented the neuromuscular controller on LOPES, a knee and hip gait trainer
from University of Twente [4]. Only the knee and hip control modules were used in
the sagittal plane; the device had no ankle actuation. With knee and hip angles and
stance detection as inputs, the controller commanded knee and hip torques to the
exoskeleton.
To illustrate the controllers effect on gait, we present results from one SCI subject.
This subject (male, 24 years of age, mass 63 kg, height 1.8 m) has a complete lesion
(AIS A) at T7 (traumatic, 60 months from time of lesion). During the experiment,
the subject was body weight supported (38 % of body weight BW) and used the
handrails (33 % of BW). We compared the subjects NMC-assisted gait with that
of one healthy subject (HC for Healthy with NMC), and two healthy subjects
during shod walking, termed N for Normal. As a preliminary study on controller
robustness, we also applied manual perturbations, push and pull, to the right swing
foot. The manual push in the forward direction produced a longer stride, and the
manual pull in the posterior direction impeded the swing foot and created a shorter
stride.
We recorded knee and hip torques provided by the controller at three different
speeds (0.7, 0.9, and 1.0 m/s). The mean of these torques was compared with Normal data, the average joint torques calculated from inverse dynamics of two healthy
subjects walking at 1.0 m/s. The perturbation trial was performed at 0.6 m/s. All subjects provided written informed consent prior to the study, according to Institutional
Review Board procedures.
3 Results
The SCI subject in this study was able to walk in LOPES with NMC assistance from
0.7 m/s up to 1.0 m/s. This subjects gait was mostly symmetric, as left and right
step duration and step length were similar. Therefore we only include results from
the right leg. The magnitudes of measured joint angles and torques of this subject
increased with greater walking speed (Fig. 1), as observed in previous studies [6].
A Versatile Neuromuscular Exoskeleton Controller for Gait Assistance
KNEE
Angle (deg)
30
HIP
Ext
Ext
Flx
Flx
0
-30
0.7 m/s
0.9 m/s
1.0 m/s
1.0 m/s (HC)
1.0 m/s (N)
-60
Toe-off
-90
50
Torque (N-m)
Fig. 1 Knee and hip angles

and controller torques at
three speeds (solid lines),
compared with Healthy with
NMC (HC, dotted lines) and
Normal (N, dashed lines).
Joint angle and joint torque
magnitudes increased with
speed. Hip and knee torques
deviated from Normal during
early and late stance. Gait
cycle is defined as two
consecutive right heel-strikes
165
Ext
Ext
0
Flx
Flx
-50
-100
50
100 0
Gait Cycle (% of stride)
50
100
We found some differences between NMC-provided torques and Normal torques

(Fig. 1). For example, near 50 % of gait, the controller provided more hip flexion
torque but lacked knee flexion torque. Despite these torque differences, the joint
angle trajectories did not seem greatly affected.
The controller was also able to maintain gait despite perturbations to the swing
leg. The push perturbation, which induced a longer stride (1.21 m vs. 1.07 m preperturbation), created larger hip extension and knee flexion torques during swing
(Fig. 2). To compensate, the post-perturbation stride had less knee extension during
stance and less knee flexion and more hip flexion during swing, with the overall
effect of producing a shorter stride (0.98 m). The pull perturbation had a similar but
Hip Torque (N-m)
50
PUSH PERTURBATION
PULL PERTURBATION
Toe-off
Ext
Ext
Flx
Flx
-50
Pre-pert.
Perturbed
Post-pert.
-100
40
Knee Torque (N-m)
Fig. 2 Hip and knee torques

during two types of swing
leg perturbations. The push
perturbation created higher
hip extension and knee
flexion torques, while the
pull produced the opposite.
The controller compensated
for both in the next stride.
Gait cycle is defined as two
consecutive right heel-strikes
30
20
10
Ext
Ext
0
Flx
Flx
-10
0
50
100 0
50
100
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A.R. Wu et al.
opposite effect. The short stride length from the impeded foot (0.96 m) was followed
by a longer stride (1.27 m). The pull induced more hip flexion and less knee flexion
torques. The compensatory behavior was a larger knee extension torque during stance
and greater hip extension and knee flexion torques near the end of swing.
4 Discussion
We demonstrated the capabilities of the neuromuscular controller on a lower-limb
exoskeleton with one SCI subject. Our preliminary results showed that the controller
enabled the subject to walk at various speeds, including near healthy (1.0 m/s),
and recover from swing foot perturbations. This was accomplished solely with joint
angles and ground contact as controller inputs. While the SCI subjects joint angles
were similar to Normal, the controller torques deviated near late stance. Because
NMC results from the healthy subject (see Fig. 1, dotted line) also exhibited similar
behavior, we believe these deviations were due to the lack of ankle actuation and
unmodeled virtual muscles at the ankle joint.
We could not compare controller torques against the devices transparent mode
(i.e. compensation of passive dynamics) because the subject could not volitionally
initiate and sustain gait. We also had tested the controller with six SCI subjects but
felt the results were not directly comparable. Each subject had unique neurological
symptoms, and controller settings were tuned for their specific walking ability.
Several factors could affect controller behavior, such as body weight support,
handrail usage, and the absence of ankle actuation. The controller was also not
scaled or optimized to the subjects anthropometry and walking speed. Nonetheless the controller exemplified enough versatility to generate gait patterns tuned to
the subjects dynamics. Further work is needed to provide online subject-specific
assistance (i.e. tuning individual virtual muscles or particular joints). Such assistance could start with offline tailoring based on subjects anthropometry and clinical
assessments, but then be further tuned by evaluation of subject effort, gait symmetry,
and similarity to healthy gait, with the overall goal of promoting positive subject
feedback.
5 Conclusion
We performed a preliminary evaluation of a biologically-inspired, neuromuscular
controller on a lower-limb exoskeleton worn by a subject with paraplegia. This subject
was able to walk at multiple speeds and recover from swing foot perturbations. These
auspicious results have important implications towards the design of controllers for
wearable devices, which must be amenable to various environmental conditions and
promote intuitive and unobtrusive human-machine interaction.
A Versatile Neuromuscular Exoskeleton Controller for Gait Assistance
167
Acknowledgments This work is supported by EU research program FP7-ICT-2013-10 (SYMBITRON, grant #611626, coordinated by University of Twente).
The authors thank Gijs van Oort of the University of Twente for help in conducting this study.
References
1. Dzeladini, F., van den Kieboom, J., Ijspeert, A.J.: The contribution of a central pattern generator
in a reflex-based neuromuscular model. Front Hum. Neurosci. 8(371), (2014)
2. Geyer, H., Herr, H.: A muscle-reflex model that encodes principles of legged mechanics produces
human walking dynamics and muscle activities. IEEE Trans. Neural Syst. Rehabil. Eng. 18(3),
263273 (2010)
3. Israel, J.F., Campbell, D.D., Kahn, J.H., Hornby, T.G.: Metabolic costs and muscle activity
patterns during robotic-and therapist-assisted treadmill walking in individuals with incomplete
spinal cord injury. Phys. Ther. 86(11), 14661478 (2006)
4. Meuleman, J., van Asseldonk, E., van Oort, G., Rietman, H., van der Kooij, H.: LOPES II-design
and evaluation of an admittance controlled gait training robot with shadow-leg approach. IEEE
Trans. Neural Syst. Rehabil. Eng. 24(3), 352363 (2016)
5. Song, S., Geyer, H.: A neural circuitry that emphasizes spinal feedback generates diverse behaviours of human locomotion. J Physiol. 593(16), 34933511 (2015)
6. Zelik, K.E., Kuo, A.D.: Human walking isnt all hard work: evidence of soft tissue contributions
to energy dissipation and return. J. Exp. Biol. 213(Pt 24), 42574264 (2010)
Introducing a Modular, Personalized

Exoskeleton for Ankle and Knee Support
of Individuals with a Spinal Cord Injury
Cory Meijneke, Shiqian Wang, Victor Sluiter
and Herman van der Kooij
Abstract In the Symbitron Project, one of the main objectives is to develop a safe,
bio-inspired, and personalized wearable exoskeleton that enables individuals with a
spinal cord injury (SCI) to walk without additional assistance, by complementing
their remaining motor function. The rst target group of ve subjects, have enough
hip control to keep themselves upright, but need support around the ankle and/or
knee joint. This paper gives an overview of the design features of the newly
developed exoskeleton and shares some details about the design process.
1 Introduction
Many exoskeletons have been developed for Spinal Cord Injured (SCI) subjects
[14]. These exoskeletons are mostly designed to support for full lower limb
paralysis and require the use of crutches.
The exoskeletons to be developed in the Symbitron project aim to support SCI
subjects with various levels of impairments. To achieve this, two groups of ve
subjects have been selected: (1) subjects who have impaired motor function at the
ankle and/or knee, but sufcient function at the hip, and (2) subjects with fully
impaired lower limbs. The rst Symbitron Wearable Exoskeleton (WE1) is
The work presented here was supported by the EU within the SYMBITRON project
(FP7-ICT-2013-10 contract #611626).
C. Meijneke (&) S. Wang H. van der Kooij
Department of Biomechanical Engineering, Faculty of Mechanical,
Maritime and Materials Engineering, Delft University of Technology,
Mekelweg 2, 2628 CD Delft, The Netherlands
e-mail: c.meijneke@tudelft.nl
V. Sluiter
Biomechanical Engineering Laboratory, Institute for Biomedical Technology
and Technical Medicine (MIRA), University of Twente, Drienerlolaan 5,
7500 AE Enschede, The Netherlands
169
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C. Meijneke et al.
developed for the rst group of subjects (group I), thus provides knee and ankle
support. Because of the modular design of the joints, the ankle and knee modules
can also be (re)used as a basis for the second exoskeleton (WE2) suited for group II
subjects. Furthermore, the remaining motor function of the group I subjects varies
as well, hence for some, the ankle module can give sufcient support, while for
others, both the ankle and knee are needed.
Commercially available exoskeletons are developed for a large population and
are tted on different users using adjustment mechanisms and custom padding. The
Symbitron exoskeletons are personalized i.e. the anatomical features of the subject
are accommodated for in the design phase.
Special attention is given to the ease of doing on and off the device. Based on
experiences with the Mindwalker [5] and Achilles [6] exoskeleton, it is key to
reducing setup time and improving comfort during experiments.
The following sections discuss the mechanical and electrical design features and
list some preliminary specications of the exoskeleton.
Fig. 1 Rendered 3D model

of side and front view of WE1
where (1) denotes the
personalized tube and strap to
the wearer, (2) knee actuation
unit, (3) quick connection
mechanism between the ankle
and knee modules, (4) ankle
actuation unit,
(5) personalized tube to the
wearer with integrated linkage
mechanism to the ankle,
(6) personal footplates
compatible with sensorized
insoles [7]
171
2 Mechanical Design
An overview of the design features of WE1 is shown in Fig. 1. The design consists
of a knee and ankle module, each with one actuated degree of freedom, respectively
flexion/extension and plantar/dorsal flexion. Additionally, the ankle
inversion/eversion is free, but has option to be locked. The two modules are connected by hooking them in to each other and locked using a toggling latch.
The size and shape of the exoskeleton segments and shells are adapted to body
size, shape and anatomical axis (e.g. distance between ankle and knee joint center)
of the subjects. Instead of introducing adjustment mechanisms, thus adding mass
and complexity, some of the exoskeleton components are designed specically to t
each subject in the test-groups.
An overview of the main features of the actuation unit are shown in Fig. 2. Most
components inside the actuator are generic for each actuated joint. The included
series elastic element and high resolution sensors enable accurate torque control.
The gear ratio and mechanical attachments can be adapted to t each joint.
Fig. 2 Rendered 3D model
of Symbitron Actuation Unit
where (1) power and
EtherCAT communication
connectors, (2) Powerful
control electronics with
integrated IMU, (3) flexible
connection to base
components, (4) flat high
performance electric motor,
(5) compact harmonic drive,
(6) output flange with
integrated end-stops
172
Table 1 Preliminary
specications
C. Meijneke et al.
Description
Peak output torque
Peak output speed
Average motor Power
Actuation unit mass
WE1 mass per leg
Torque resolution
Value
Knee
70
120
750
1.5
5
0.012
Unit
Ankle
100
60
Nm
rpm
W
kg
kg
Nm
3 Electronic Design
The modular design of each actuated joint puts special demands on the electronics.
The actuation unit has custom-made EtherCAT slave electronics, which combines a
motor controller, inertial measurement unit and various interfaces for additional
sensors. The slave has three external connections, i.e., power supply and in/out
EtherCAT communication ports. In this way, the actuation units form a distributed
sensor and actuator network that allows flexible congurations and enables
real-time control of the exoskeleton from a main computer at the trunk of the pilot.
4 Specications
At time of writing of this article, manufacturing of the device is not nished and
basic functional test have been one with a test joint. The specication in Table 1 are
preliminary.
5 Conclusion
This paper showed and overview of a newly developed exoskeleton for knee and
ankle support of SCI subjects. In an effort to get the best t between the exoskeleton
and subject in a simple and lightweight manner, multiple component sets tailored to
t all subjects in the test-group are made.
The modular design of the exoskeleton enables a flexible conguration and easy
doing on and off the device. Thanks to the modular actuation unit, future extension
of the exoskeleton to the hip and trunk is also made relatively simple.
Acknowledgments Great effort has been put into the design and manufacturing of the
exoskeleton by Wouter Gregoor and Tom Phillips from the Electrical and Mechanical Support
Division at Delft University of Technology. Thanks to effort and patience of the subjects and staff
of Fondazione Santa Lucia, we obtained detail data and scans for out design. The exoskeleton
footplates where provided by ssur.
173
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5.
Indego website. http://www.indego.com/indego/en/home (2016). Accessed 15 Apr 2016

Rex Bionics website. http://www.rexbionics.com/ (2016). Accessed 15 Apr 2016
EksoBionics website. http://www.eksobionics.com/ (2016). Accessed 15 Apr 2016
ReWalk Robotics website. http://rewalk.com/ (2016). Accessed 15 Apr 2016
Wang, S., Wang, L., Meijneke, C., van Asseldonk, E., Hoellinger, T., Cheron, G., Ivanenko,
Y., La Scaleia, V., Sylos-Labini, F., Molinari, M., Tamburella, F., Pisotta, I., Thorsteinsson, F.,
Ilzkovitz, M., Gancent, J., Nevatia, Y., Hauffe, R., Zanow, F., van der Kooij, H.: Design and
control of the MINDWALKER exoskeleton. IEEE Trans. Neural Syst. Rehabil. Eng. 4320(c)
(2014)
6. van Dijk, W., Meijneke, C., van der Kooij, H.: Evaluation of the Achilles Ankle exoskeleton.
IEEE Trans. Neural Syst. Rehabil. Eng. 4320(c), 11 (2016)
7. Crea, S., Donati, M., De Rossi, S.M.M., Oddo, C.M., Vitiello, N.: A wireless flexible
sensorized insole for gait analysis. Sensors (Basel) 14(1), 10731093 (2014)
Towards Exoskeletons with Balance

Capacities
Herman van der Kooij, Edwin H.F. van Asseldonk and Mark Vlutters
Abstract Current exoskeletons replay pre-programmed trajectories at the actuated

joints. Towards the employment of exoskeletons with more flexible and adaptive
behavior, we investigate human balance control during gait. We study human
balance control by applying brief force pulses at the pelvis in different directions,
with different amplitude, and applied at different phases of the gait phase. The
observed changes were dependent on the phase at which the perturbation was
applied and the walking velocity. From the results we concluded that foot placement was the dominant strategy in the frontal plane, center of pressure
(CoP) modulation in the double support phase was utilized in the sagittal plane, and
the duration of the swing and double support phase changed. Without the ability to
control the CoP through an ankle torque, humans also used a foot placement
strategy in the sagittal plane. The center of pressure with respect to the center of
mass at the end of the double support phase was linearly related to velocity of the
center of mass at the end of the preceding swing phase, which is in agreement with
extrapolated center of mass or capture point based stepping strategies previously
applied in simple models.
This work was supported by the BALANCE (Balance Augmentation in Locomotion, through
Anticipative, Natural and Cooperative control of Exoskeletons) project, partially funded under grant
601003 of the Seventh Framework Program (FP7) of the European Commission (Information and
Communication Technologies, ICT-2011.2.1) and the SYMBITRON project (FP7-ICT-2013-10
contract #611626).
H. van der Kooij (&)
Biomechanical Engineering Group, University of Twente, Enschede, Netherlands
e-mail: h.vanderkooij@utwente.nl
E.H.F. van Asseldonk M. Vlutters
e-mail: e.h.f.vanAsseldonk@utwente.nl
M. Vlutters
e-mail: m.vlutters@utwente.nl
175
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H. van der Kooij et al.
1 Introduction
Most current exoskeletons are unable to stay upright without assistance and guidance of its user. Paraplegic users, for example, require crutches to prevent falling. In
the EU Balance and Symbitron projects we aim to support balance control by
wearable exoskeletons. Since human balance control during walking is still poorly
understood we performed a series of experiments to analyze balance recovery
during gait in attempt to predict human balance control strategies.

2.1
Experimental Setup and Protocol
Nine healthy young adults walked on a custom dual-belt instrumented treadmill

(MotekForce Link, Culemborg, Netherlands), while keeping arms crossed over the
abdomen. Walking speeds were 2.25 and 4.50 km/h, scaled to the subjects leg
length. For each speed, subjects rst walked a 2 min unperturbed baseline trial. In
subsequent trials, perturbations were applied to the pelvis using one of two motors
(Moog, Nieuw-Vennep, Netherlands), connected with a lever arm to a pelvic brace
(Distrac, Hoegaarden, Belgium), worn by the subject. The motors were located at
the side and the rear of the treadmill. Our experimental setup is shown in Fig. 1.
Fig. 1 Experimental setup
Towards Exoskeletons with Balance Capacities
177
Fig. 2 Pin-foot boots worn

by subjects in one of the
experiments to study the
effect of foot placement in the
sagittal plane, to prevent
modulation of the cop by
changes in ankle torque
Perturbations were applied at randomly selected instances just after toe-off right
(TOR), and consisted of 150 ms block pulses of a force magnitude equal to 4, 8, 12
and 16 % of the subjects body weight.
Perturbation directions were forward (positive), backward (negative), outward
(positive, away from stance leg) and inward (negative, toward stance leg). Each
perturbation type was repeated 8 times, leading to 256 perturbations per subject.
Kinematic data of various landmarks on the lower extremities, pelvis, trunk and
head [1] were collected at 100 Hz using a motion capture system (Phoenix
Technologies Inc, Vancouver, Canada). Ground reaction forces, subject-motor
interaction forces, and EMG data were collected at 1000 Hz. More details about the
experimental setup can be found in [2]. To exclude the ankle strategy (i.e. modulation of the center of pressure (CoP) by applying an ankle moment), we did a
variation of this experiment in which subjects were wearing a pin foot (Fig. 2)
while only the backward and forward perturbations were applied at the slow
walking speed.
3 Results
At heel strike (HS) after the perturbation, recovery from mediolateral (ML) perturbations involved ML foot placement adjustments proportional to the ML CoM
velocity. In contrast, for anterior posterior perturbations (AP) no signicant AP foot
placement adjustment occurred at HS (Fig. 3 left). However, in both directions the
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H. van der Kooij et al.
Fig. 3 Typical example of one subject. The foot placement of the right leg (i.e. the AP distance of
the right foot with respect to the CoM) at heel strike right (HSR) plotted against the AP CoM
velocity at HSR
CoM velocity at HS related linearly to the CoP location at the subsequent toe-off (not
shown). This relation was affected by the walking speed and was, for the slow speed
(not shown), in line with a CoM velocity based control strategy previously applied by
others in a linear inverted pendulum model [3]. Finally, changes in gait phase
durations (not shown) suggest that the timing of actions could play an important role
during the perturbation recovery. Results of this experiment not shown here can be
found in [2]. When subject were wearing the pin-foot boots, recovery from AP
perturbations also involved AP foot placement, which were proportional to the AP
CoM velocity at HS (Fig. 3 right).
4 Discussion
These experimental results have implications for the control and design of wearable
exoskeletons that aim to support human balance control. In AP directions XCoM at
HS can be used to predict the desired CoP location at the end of double support
phase. For ML directions xCoM can be used to predict the desired foot placement
relative to the CoM. For human-like ML stabilization wearable exoskeletons need
actuated hip ab/adduction, and for AP stabilization they require torque controlled
ankle actuation.
5 Conclusions
The CoP is a main variable humans use to maintain balance during gait. In the ML
direction CoP is controlled by foot placement and in the AP direction by ankle
torque and foot placement. When ankle torque cannot be used to change the CoP in
Towards Exoskeletons with Balance Capacities
179
the AP direction, humans switch to the foot placement adjustment strategy in the
sagittal plane. The CoP at the end of the double support phase is linearly related to
the CoM velocity at the end of the preceding swing phase. Timing of foot placement
is an important variable for balance control, which is more difcult to predict.
References
1. Dumas, R., Chze, L., Verriest, J.P., et al.: Adjustments to McConville et al. and Young et al.
body segment inertial parameters. J. Biomech. 40, 543553 (2007)
2. Vlutters, M., van Asseldonk, E.H.F., van der Kooij, H.: Center of mass velocity based
J. Exp. Biol. 20 (2016). doi:10.1242/jeb.129338
3. Hof, L., van Bockel, R.M., Schoppen, T., Postema, K.: Control of lateral balance in walking.
Experimental ndings in normal subjects and above-knee amputees. Gait Posture 25(2), 250
258 (2007)
EMG-Based Detection of Users Intentions

for Human-Machine Shared Control
of an Assistive Upper-Limb Exoskeleton
A. Accogli, L. Grazi, S. Crea, A. Panarese, J. Carpaneto, N. Vitiello
and S. Micera
Abstract To assist people with disabilities, exoskeletons must be provided with

human-machine interfaces (HMI) capable to identify the users intentions and
enable cooperative interaction. Electromyographic (EMG) signals could be suitable
for this purpose, but their usability and effectiveness for shared control schemes in
assistive devices is currently unclear. Here we developed advanced machine
learning (ML) algorithms for detecting the users motion intention and decoding the
intended movement direction, and discuss their applicability to the control of an
upper-limb exoskeleton used as an assistive device for people with severe arm
disabilities.
1 Introduction
Exoskeletons can operate in cooperation with humans and assist them to perform
multiple activities of daily living. One of the goals of the control systems for such
devices is to enable the robot to identify the users intentions and capabilities by
means of a suitable HMI. Shared control schemes can thus be implemented, i.e. the
robot can take over or leave the user to control specic aspects of the motion, and
adjust the level of assistance/cooperation when needed [1]. In the recent years,
EMG signals have been increasingly used for the control of robots [2], still their
This work was supported by the AIDE Project GA 645322, funded by the EU H2020
Framework Programme for Research and Innovation, and by the RONDA Project, funded by
Regione Toscana PAR FAS 2007-2013.
A. Accogli L. Grazi S. Crea A. Panarese (&) J. Carpaneto N. Vitiello S. Micera
Biorobotics Institute, Scuola Superiore SantAnna, Pisa, Italy
e-mail: a.panarese@sssup.it
S. Micera
Center for Neuroprosthetics and Institute of Bioengineering,
Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
181
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A. Accogli et al.
usability to implement shared control schemes for assistive exoskeletons is currently under study.
Here we aimed to develop fast and accurate EMG-based algorithms for detecting
users motion intention and decoding movement direction, and to envisage shared
control schemes for assisting people with severe arm disabilities wearing an
upper-limb exoskeleton.

2.1
Exoskeleton
In this work we used NESM [3], an upper-limb robotic exoskeleton with four active
degrees of freedom allowing for shoulder adduction/abduction, flexion/extension,
intra/extra rotation, and for elbow flexion/extension. The controller of the robot
implements both a joint position and a joint torque control modes. The rst guides
each motor to follow a reference trajectory in the joint space, whereas the second
applies torque to the actuation units to either be transparent or assist the users
movement.
2.2
Setup of the Study
A graphical user interface (GUI) was implemented in Labview (National

Instruments, Austin, TX, US) with three LEDs (W, C, and E) placed on different
positions on a computer screen (15 cm apart, at left, center, and right, respectively;
Fig. 1). The subject (healthy, male, 35 years old) was instructed to (i) keep a resting
position as long as all the LEDs were off, (ii) move the arm towards the LED which
switched on, (iii) stop when the target was reached and keep the position, and
(iv) move back to the resting position as soon as the LED switched off. Each of
n = 9 sessions consisted of 27 reaching trials. The targets were presented in random
order. The LED switched on every 10 s, and remained on for the following 5 s.
During each trial, the exoskeleton was in transparent mode.
Fig. 1 Snapshots of the
experimental setup
183
EMG signals from seven muscles of the right shoulder (Trapezius, Anterior and
Posterior Deltoid), arm (Biceps and Triceps Brachii) and forearm (Flexor and
Extensor Carpi Ulnaris) were recorded at 1.5 kHz with a TeleMyo 2400R (Noraxon
Inc., AZ, US), and low-pass ltered at 500 Hz.
2.3
Motion Intention Detection
A Gaussian Mixture Model (GMM) method was used to model the rest and
movement phases of the muscular activity during the task. The algorithm rst
estimated the model on an initial (training) time window; then, the parameters were
sequentially evaluated for each new time sample, and an optimal threshold between
rest and movement was calculated, minimizing the classication error [4]. The
detector evaluated the outputs of multiple GMM algorithms working in parallel on
the features MMAV1, SSI, VAR e LOG [5]. We compared the performances of
three types of detector based on: (i) single EMG signals, (ii) multiple EMG signals
(different detectors working in parallel on single EMG signals, with a majority
voting procedure for the nal decision), (iii) a compound EMG signal,
sEMG tn
X#EMGs
i1
jEMGi tn EMGi tn Dtj
which takes into account the instantaneous variations of all the EMG signals at the
same time. Three parameters were used to evaluate the performances:
sensitivity
TP
TP FN
precision
TP
TP FP
latency htd t0 itrials
where TP, FN and FP are the number of true positive, false negative and false
positive respectively; td is the detected onset time and t0 is the reference onset time,
estimated as the time instant corresponding to the 10 % of the peak values assumed
by kinematic variables when the LED was on.
2.4
Classication of Movement Direction
Classication problems were solved using Support Vector Machines (SVM),

written in MATLAB (Mathworks, Natick, MA, US). Muscle activity recorded in a
time window of 300 ms, starting from the movement onset, was used to extract
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A. Accogli et al.
features to be used as inputs to the classier, whereas the movement directions (W,
C, and E) were used as outputs. A second version of the classier received the
position signals of the four active joints (in the same window used for EMGs,
[t0 ; t0 300 ms) as additional inputs. 70 % of the available data was used for
training, whereas the remaining 30 % for testing. The mean accuracy across 10
realizations of random sub-sampling validation was evaluated.
3 Results
The detector based on the compound EMG signal was capable to detect movement
onset much earlier than the other two, even *40 ms before the reference onset
time, t0 (Fig. 2a). The three detector types showed to be equally sensitive and
precise. The median performances across all muscles were considered for detectors
using single EMG signals. Correct classication of movement direction was 61 %,
on average, when features of the EMG signals alone were used as inputs.
Performance increased to 89 % (Fig. 2b) by adding kinematic information.
Fig. 2 A Performances of
movement onset detectors.
B Confusion matrices of
classication performance for
movement direction with
EMG features alone (left) and
with additional kinematic
inputs (right)
185
4 Discussion
GMM is a fast and accurate method for detection of EMG onset [4]. Still, its
computational requirements must be minimized for real-time applications. By using
the compound EMG signal instead of multiple EMGs processed in parallel, we have
shown that it is possible to maintain (or even improve) performance while reducing
computational load. SVM classication of movement direction has been studied
previously in people with arm disabilities but proved to be inaccurate [6]. Here, we
demonstrated that decoding performance can be drastically improved by adding
kinematic information from the exoskeleton as input to the classier. This is
expected to strengthen performance even in users with arm disabilities. Future work
will be devoted to study the real-time application of the presented algorithms in
people with severe arm disabilities. The NESM allows for a bump-less switch
between control modes and it is possible to envisage a shared control scheme where
the user commands movement start and intended direction (with the device in
transparent mode) whereas the exoskeleton executes (switching to position control)
or assists the movement thereafter, depending on the users residual capabilities.
5 Conclusions
Fast and accurate detection of motion intention and classication of movement
direction are pivotal to implement useful control schemes for upper-limb assistive
devices. HMI based on EMG and advanced ML algorithms represent a suitable
solution for this purpose.
References
1. Yu, H., et al.: An adaptive shared control system for an intelligent mobility aid for the elderly.
Auton. Robots 15, 5366 (2003)
2. Singh, R.M., Chatterji, S.: Trends and challenges in EMG based control scheme of exoskeleton
robots-a review. Int. J. Sci. Eng. Res. 3, 19 (2012)
3. Crea, S., et al.: A novel shoulder-elbow exoskeleton with series elastic actuators, unpublished
4. Liu, J., et al.: Robust muscle activity onset detection using an unsupervised electromyogram
learning framework. PloS ONE 10(6) (2015)
5. Phinyomark, A., et al.: A novel feature extraction for robust EMG pattern recognition.
J. Comput. 1(1), 7180 (2009)
6. Cesqui, B., et al.: EMG-based pattern recognition approach in post stroke robot-aided
rehabilitation: a feasibility study. J. NeuroEng. Rehabil. 10, 75 (2013)
Part VII
Legal Framework, Standardization

and Ethical Issues in WRs
Safety Standardization of Wearable

RobotsThe Need for Testing Methods
Jan F. Veneman
Abstract Wearable Robots, i.e. exoskeletons, are currently entering the market.
The specic procedure to allow devices on the market, concerning their product
safety depends on the application domain they are sold for (medicalindustrial
personal care). Safety Standards, such as produced by ISO and IEC are important
tools to demonstrate safety for specic devices, but at this moment there are only
very few specic standards available and no specic testing methods in place for
Wearable Robots. Standardized testing methods that do not require human subject
testing can make the road to the market easier and better affordable. Such test
methods need to be based on validated experimental data, and may require the
development and denition of specic targeted test benches or equipment.
1 Introduction
At this moment, Wearable Robots (WRs), such as exoskeletons for rehabilitation
and worker support, start nding their way into the market, while the regulatory
situation around their use is not very well established. The current market introduction can be seen as experimental, which may have unclear and unpredictable
effects on the future of companies marketing this type of robots.
The currently available WR products can in general be considered as a rst
generation of devices that only provide basic functionality, operate at low power
and apply straightforward control. The WR devices that currently emerge in academic and other research environments, the next generation, goes much further in
This work has been partially supported by the EU funded project BALANCE,
FP7-ICT-2011.2.1 grant no. 601003.
J.F. Veneman (&)
Health Division, TECNALIA Research and Innovation,
Mikeletegi Pasealekua, 1, 20009 Donostia-San Sebastian, Spain
189
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J.F. Veneman
Fig. 1 The regulatory environment of Wearable Robots is, as any, characterized by regulation
that prescribes how to realize and assure acceptable (safe) products while occurrences of damage
due to products already in use, where no prior regulation was in place, is set through litigation.
This resembles communicating vessels: if no specic regulation is in place, product safety will be
dened through litigation around liability issues [1]
versatility, power capacity and functionality, and hence in potential safety threats to
the user and the environment.
The realization of product safety for a technology like WR is based on one side
on regulation, which applies before a device is put on the market, and which allows
or forbids specic products; and on the other side on litigation, which takes place
after a specic case of damage has occurred and the liability has to be settled (see
also Fig. 1).
2 Regulation of Wearable Robots

The ex-ante regulation is a framework of rules that prescribes certain aspects of
the technology, for example product safety. In Europe the general guidelines are set
in the Council Directive of 14 June 1993 concerning medical devices (MDD
Medical Device Directive) [2], and Directive 2006/42/EC of the European
Parliament and the Council of 17 May 2006 on machinery, and amending Directive
95/16/EC (MDMachinery Directive) [3]. The regulations directed by the MDD
and the MD indicate the requirements that producers need to respect in order to
obtain an EC marking allowing the commercialization of their product. These
regulations typically demand the manufacturer to demonstrate product safety, and
this is typically performed by applying (on itself voluntary) international standards,
as they provide secured methods for implementing certain features in technology,
for example procedures on how to implement, analyze and demonstrate safety of
new devices before they enter the market.
For example product safety for medical devices that belong to the class of
Medical Electrical Equipment or Medical Electrical Systems is in principle dened
in the IEC 60601-1 Edition 3.1 [4]. In fact, the 60601 is a large family of
standards which includes specic standards for certain aspects or certain types of
Safety Standardization of Wearable Robots
191
medical devices. Wearable Robots that are to be sold would typically choose to
comply with this standard in order to demonstrate their safety. This standard is
based on a risk assessment and risk management approach, and basically demands
from the manufacturer to identify the main risks of use of their specic device. In
this context it provides general points of attention on different aspects and different
potential hazards (electrical, mechanical) as well as indicates specic mitigation
measures.
Concerning regular industrial robots the ISO 10218-1 [5] for robots and ISO
10218-2 [6] for robot systems and integration set similar safety standards, complemented by ISO/TS 15066 [7] concerning collaborative robot safety.
Although these standards all contain elements that apply also for Wearable
Robots, they are not specic and sometimes not adequate for Wearable Robots. In
order to address these and other gaps in the standardization, Working Groups under
ISO and IEC flag are addressing such new developments.
Under the recently established ISO TC299 Robots and Robotic Devices, several
working groups are active in standardization topics relevant to Wearable Robots.
For Medical Devices these groups collaborate with IEC TC62 (sub A for general
and sub D for particular aspects). Between ISO and IEC the ACART (Advisory
Committee on Applications of Robot Technology) has been established to coordinate the future approach to robotics on a higher level. Concretely the currently
active groups of interest to Wearable Robots are:
ISO/TC 299/WG 2 Personal care robot safety
ISO/TC 299/WG 3 Industrial safety
ISO/TC 299/JWG 5 Joint ISO/TC 299IEC/SC 62AIEC/SC 62D: Medical
robot safety;
With subgroups: JWG 35: Surgical Robot Safety and JWG 36: Rehabilitation
Robot Safety
ISO/TC 299/WG 6 Modularity for service robots
A rst concrete recent output of this work relevant to Wearable Robots, is the
publication of ISO 13482 [8]: Robots and robotic devicesSafety requirements for
personal care robots, that covers wearable robotics like exoskeletons under the term
restraint-type physical assistant robots.
Beside of this worldwide work, currently, as far as known, only Japan is working
on their own standards, as the Japanese market is ahead on certain applications. For
example JIS B 8446-2 Part 2: Low powered wearable type physical assistant robot
is highly relevant to Wearable Robots.
An important landmark in the Wearable Robot regulations is the recent publication of the US Food and Drug Administration (FDA, main regulator of medical
devices in USA) on exoskeleton classication [9], where the FDA sets out to
classify exoskeletons as class II (special controls), describing how to demonstrate
safety of such devices and which special controls are in place. This actual clearance
procedure for the US marker requires extensive subject testing to demonstrate
safety, and the permitted product use is limited. At this moment, to have
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J.F. Veneman
exoskeleton type devices cleared by FDA or CE marking, usually requires extensive subject trials, as manufacturers cannot demonstrate their products safety by
complying with specic standards.
3 Need for Testing Procedures

Although, for medical devices, patient trials may always be needed for novel
devices to demonstrate their effectivity, Wearable Robots that t prior established
categories, or in industrial or personal care domains, could largely benet from
standards that prescribe specic testing procedures that allow benchmarking product safety. Testing methods are for example available for orthoses and prostheses
in ISO 22523 [10]: External limb prostheses and external orthoses - Requirements
and test methods. This standard includes specic test methods and requirements
for example for strength of orthoses. However, this standard as is, does not address
any specic properties that relate to robotic, or active orthoses and prosthesis,
which fall under the denition of Wearable Robots.
As an example: for Wearable Robots one may want to determine interactive
force and displacement/velocity generated at the contact surfaces between the
wearable robot and the human skin to ensure that the physical stress or strain to the
user will remain at safe levels during normal operation. Which levels are safe
should be based on validated experimental data, gathered from test subjects. Such a
hypothetical test might further require the design of a specic dummy that copies all
essential characteristics of a human limb, as well as being equipped with sensor to
measure for example the pressure distribution. Preferably one would have an active
dummy that can generate realistic movement so that the reaction forces to normal
human movements can be determined in the dummy.
4 Conclusion
This abstract summarizes the current state of regulation regarding product safety as
applies for Wearable Robots, as well as the ongoing work in safety standardization
in ISO and IEC context. In the last section the interest of establishing specic
testing procedures and equipment that would facilitate safety benchmarking of
Wearable Robots is indicated, and rst illustrative examples are sketched. We
believe that denition of such benchmarks and development of specic testing
equipment could greatly facilitate further market introduction of safe Wearable
Robots.
Safety Standardization of Wearable Robots
193
References
1. Bertolini, A., Palmerini, E.: Regulating robotics: a challenge for Europe. Upcoming Issues of
EU Law, 94129 (2014)
2. Medical Device Directive; Ofcial Journal of the European Communities, L 169, 12 July
1993
3. Machinery Directive; Ofcial Journal of the European Communities, L 157, 9 June 2006
4. IEC 60601-1:2005; Medical electrical equipmentPart 1: general requirements for basic
safety and essential performance
5. ISO 10218-1:2011; Robots and robotic devicessafety requirements for industrial robots
Part 1: Robots
6. ISO 10218-2:2011; Robots and robotic devicessafety requirements for industrial robots
Part 2: robot systems and integration
7. ISO/TS 15066:2016; Robots and robotic devicescollaborative robots
8. ISO 13482:2014; Robots and robotic devicessafety requirements for personal care robots
9. FDA publication on Medical Devices; Physical Medicine Devices; Classication of the
powered exoskeleton (2015). https://federalregister.gov/a/2015-03692; 80 FR 9600; pp.
96009603
10. ISO 22523:2006; External limb prostheses and external orthosesrequirements and test
methods
The Potential and Acceptance

of Exoskeletons in Industry
Michiel P. de Looze, Frank Krause and Leonard W. OSullivan
Abstract Worldwide, a signicant interest in wearable robots or exoskeletons does

exist, also from an industrial background. This paper provides an overview of
assistive exoskeletons that have specically been developed for industrial purposes.
It discusses their potential in increasing performance and flexibility on one hand
and in reducing the mechanical loads on workers involved in manual work on the
other. From this it is concluded that exoskeletons have the potential to increase
performance under specic conditions and to reduce physical loads signicantly.
However, several technical issues hinder mainstay practical use of exoskeletons in
industry until now. One main issue concerns the human-machine interaction which
stands in the way of acceptance. This issue and its linkage to ethics and standardization will be discussed during the conference.
1 Introduction
Despite the on-going trend in automation in industry, many workers are still
exposed to physical workloads due to material handling (over 30 % of the work
population in the EU), repetitive movements (63 %), and awkward body postures
(46 %) [1]. To reduce the health risk involved, one approach might be the use
exoskeletons.
M.P. de Looze (&) F. Krause

TNO, Leiden, The Netherlands
e-mail: michiel.delooze@tno.nl
F. Krause
e-mail: frank.krause@tno.nl
M.P. de Looze
VU University, Amsterdam, The Netherlands
L.W. OSullivan
University of Limerick, Limerick, Ireland
e-mail: leonard.osullivan@ul.ie
195
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M.P. de Looze et al.
An exoskeleton can be dened as a wearable, external mechanical structure that

enhances the power of a person. The main application area of exoskeletons has been
for medical/rehabilitation purposes where the devices are aimed to support physically weak, injured, or disabled people [2].
In this paper, we determined the potential of exoskeletons to be useful in industry
settings from the perspectives of industrial performance and workers health, and
address the shortcomings as it comes to acceptance. To that purpose, we performed a
stakeholder analysis and a literature review. The issue of acceptance in relation to
ethics and standardization will be discussed during the conference on the basis of
eld tests in the automotive industry with the so-called RoboMate exoskeleton.
2 Methods
2.1
Stakeholder Analysis
Eight experts in the eld of manufacturing industry who could elaborate on the
business and social needs and the value of human work in production environments
were approached and consulted by interview. They were interviewed about the
main general trends in manufacturing industry, about the current and future
developments in the value of human work within these trends, and about the needs
in relation to any type of exoskeleton to be potentially used on the manufacturing
shop floors from the business perspective.
2.2
Literature Review
A literature review was performed by an electronic literature search using the

Scopus search engine. We focused on exoskeletons developed for use in occupational elds to support shop floor workers perform physically demanding activities.
Papers considering other applications, e.g. rehabilitation, medical, tele-operations,
military, and virtual reality, were excluded. We included all types of exoskeletons,
i.e. passive and active, anthropomorphic or not, and lower body, upper body and
full-body exoskeletons. Single-joint exoskeletons covering the hand and wrist only,
were excluded.
2.3
Acceptance
The issue of acceptance will be discussed based on the outcome of the eld tests
with the RoboMate exoskeleton, which has been developed recently and will be
tested in the automotive industry during summer time in 2016.
The Potential and Acceptance of Exoskeletons in Industry
197
3 Results
3.1
Stakeholder-Analysis Results
The following trends in manual work, of relevance for the potential use of
exoskeletons in manufacturing, were stressed by the stake-holders.
Due to mechanization and automation, manual work on the shop floor decreases,
while more people are involved in the pre-production planning, programming,
engineering
Due to increased needs for flexibility, more human workers are required on the
shop floor, particularly in highly-automated environments
Due to the ageing of the work force, technology-based support is required to
keep older workers productive and safe
Due to the shortage on the labour market, one should increase the attractiveness
of factory work for new employees.
Due to prevalence of injury (back, shoulder, arms), technology-based support is
required to reduce the physical loads on workers.
Main business and social needs of relevance for the application of exoskeletons
put forward in the interviews:
Need
Need
Need
Need
Need
to
to
to
to
to
increase the flexibility of production

increase the flexibility of workers
increase the productivity of manual work
increase the quality of manual work
reduce the physical load and the risks of injury.
The stakeholders indicate that an exoskeleton could be most useful in the following situations:
Flexible production cannot be achieved through automation because of frequent
changes of activities, product types and order sizes,
Weights of parts are just too large to be safely handled by a person while task
execution is not on a specic location (thus, local cranes are not an option),
Preventions of manual handling injuries is required.
Finally, it was stressed that the main benet of the application of an exoskeleton
above any type of robot system (classical robots, full-automation systems or
humanoid robots), would be that, specically in dynamic environments, one will
fully prot from the humans creativity and flexibility, while he is the one in charge,
and there is thus no need for robot programming or teaching of robots.
198
3.2
M.P. de Looze et al.
Literature Review Results
The search resulted in 40 papers in which an exoskeleton with an industrial purpose

was described. In these papers a total of 26 different industrial exoskeletons were
described These were broken down as 20 upper body, 4 full body, and 2 lower body
exoskeletons, with 19 being active (among others [38]) and 7 passive (among
others [913]).
These exoskeletons were most frequently aimed to give support in stooped
working postures, static holding of a load, and dynamic lifting (and lowering) of a
weight. Some studies also mentioned carrying as an activity to be supported.
Finally, some job specic activities were mentioned, i.e. patient lifting and transfer
(for three different exoskeletons), construction work, agricultural and overhead
carpentry work.
For 13 out of the 26 industrial exoskeletons, some evaluations of the physical
load reductions were performed.
Generally, positive effects, either tested statistically or not, have been reported
for the physiological (EMG) and biomechanical parameters, both for the passive
and the active exoskeletons. For the passive exoskeletons, 10 to 40 % reductions in
back muscle activity during dynamic lifting and static holding have been reported.
For the active exoskeletons, muscle activity reductions up to 80 % have been
reported.
4 Discussion and Conclusions

Exoskeletons may be specically useful where workers have to handle weights
which are above health threshold limits, where materials handling takes place at
various spots (worker needs to be mobile), and where the production tasks are too
difcult to fully automate.
Exoskeletons have the potential to considerably reduce the underlying factors
associated with work-related musculoskeletal injury.
At this point however, several issues hinder acceptance in industry. One main
issues, the human-machine interaction, will be discussed in detail on the basis of the
outcome of eldlab testing of the RoboMate exoskeleton, as well as its implications
for standardization.
Acknowledgments This research was supported by the European shared cost project Robo-Mate,
funded under the Seventh Framework Program [grant number FP7-2013-NMP-ICT-FOF].
The Potential and Acceptance of Exoskeletons in Industry
199
References
1. Eurofound, 2012. Fifth European Working Conditions Survey, Publications Ofce of the
European Union, 978-92-897-1062-6. Publications Ofce of the European Union,
Luxembourg (2012)
2. Viteckova, S., Kutilek, P., Jirina, M.: Wearable lower limb robotics: a review. Biocybern.
Biomed. Eng. 33(2), 96105 (2013)
3. Kobayashi, H., Aida, T., Hashimoto, T.: Muscle suit development and factory application. Int.
J. Autom. Technol. 3(6), 709715 (2009)
4. Muramatsu, Y., Kobayashi, H., Sato, Y., Jiaou, H., Hashimoto, T., Kobayashi, H.:
Quantitative performance analysis of exoskeleton augmenting devices-muscle suit-for manual
worker. Int. J. Autom. Technol. 5(4), 559567 (2011)
5. Kim, W.S., Lee, H.D., Lim, D.H., Han, C.S.: Development of a lower extremity exoskeleton
system for walking assistance while load carrying. In: Proceedings of the Sixteenth
International Conference on Climbing and Walking Robots, Sydney, Australia, pp. 3542,
1417 July 2013
6. Kawabata, T., Satoh, H., Sankai, Y.: Working posture control of robot suit HAL for reducing
structural stress. In: 2009 IEEE International Conference on Robotics and Biomimetics
(ROBIO), pp. 20132018. IEEE (2009)
7. Yu, W., Rosen, J.: A novel linear PID controller for an upper limb exoskeleton. In: 2010 49th
IEEE Conference on Decision and Control (CDC), pp. 35483553. IEEE (2010)
8. Kadota, K., Akai, M., Kawashima, K., Kagawa, T.: Development of power-assist robot arm
using pneumatic rubbermuscles with a balloon sensor. In: The 18th IEEE International
Symposium on Robot and Human Interactive Communication, 2009. RO-MAN 2009,
pp. 546551. IEEE (2009)
9. Abdoli-Eramaki, M., Stevenson, J.M.: The effect of on-body lift assistive device on the
lumbar 3D dynamic moments and EMG during asymmetric freestyle lifting. Clin. Biomech.
23, 372380 (2008)
10. Barret, A.L., Fathallah F.A.: Evaluation of four weight transfer devices for reducing loads on
the lower back during agricultural stoop labor. Paper number 018056 of the ASAE Meeting,
Sacramento, USA (2001)
11. Godwin, A.A., Stevenson, J.M., Agnew, M.J., Twiddy, A.L., Abdoli-E, M., Lotz, C.A.:
Testing the efcacy of an ergonomic lifting aid at diminishing muscular fatigue in women
over a prolonged period of lifting. Int. J. Ind. Ergon. 3, 121126 (2009)
12. Lotz, C.A., Agnew, M.J., Godwin, A.A., Stevenson, J.M.: The effect of an on-body personal
lift assist device (PLAD) on fatigue during a repetitive lifting task. J. Electromyogr. Kinesiol.
19(2), 331340 (2009)
13. Sadler, E.M., Graham, R.B., Stevenson, J.M.: The personal lift-assist device and lifting
technique: a principal component analysis. Ergonomics 54(4), 392402 (2011)
Wearable Robots: A Legal Analysis

Andrea Bertolini
Abstract The paper provides a complete overview of the legal issues involving
wearable robots, in particular ranging from their denition and applicable regulation
at the European level, civil liability issues of producers and users as well as a brief
approach to issues of human enhancement.
1 Introduction
Wearable robots are sophisticated devices intended to substantially improve the
quality of life of users, by helping them recover lost functions or acquire new ones.
However, their novelty also triggers a series of legal concerns that are not easily
addressed through existing regulation. The rst necessary effort is thus that of
describing the legal framework within which design needs to occur, so as to possibly minimize costsex ante and ex post costs associated with legal rulesas well
as understand the ethical implications of human enhancement and how the legal
system might react to that, by enabling or limiting these technologies.
The analysis addresses the legal denition of wearable robots, liability rules and
insurance law issues, and human enhancement.
Scientic Independence of young Researchers (SIR) project RELIABLE contributed to the

nancing of this research.
A. Bertolini (&)
Private Law Scuola Superiore SantAnna (SSSA), Pisa, Italy
e-mail: a.bertolini@sssup.it
201
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A. Bertolini
2 Legal Denitions
Wearable robots are products1 intended to be implanted or worn by the human user
to substantially improve the quality of life of people with disabilities and other users
intending to recover lost functions or acquire new ones.2
The wide variety of devices which fall under this denition can however be
framed in quite different ways in a legal perspective, in particular with respect to
European directives regulating safety standards.
A wearable robot qualies as a medical device for the purposes of the Medical
Device Directive3 (in particular so long as an exoskeleton is concerned) or as an Active
Implantable Medical Device4 (should prostheses requiring some sort of medical procedure to be installed onto the human body be included within the broad denition).
All these regulations address safety standards the devices need to conform to in
order to receive the EC marking enabling their distribution on the European market.
It is however clear that those directives were not specically tailored for wearable
robots and it could be disputedboth from a technological and legal perspective
whether those rules are indeed adequate. For instance, it could be claimed that adequate technological standards for safety purposes should directly address the control
mechanism and its degree of invasiveness, providing detailed benchmarks for each.
At the same time, it shall be stressed that while the CE marking is strictly
necessary to enable the distribution of the device it does not sufce to exclude
liability once the product is used and eventually involved in an accident.
3 Liability and Insurance

Being a product, a wearable robotno matter what specic kindfalls under the
application of the European Defective Product Directive.5
Pursuant to this regulation, the producermeaning the legal person manufacturer of a nished product, the producer of any raw material or of a component part
and any person who presents himself as producer by trademark or nameis
objectively responsible of all damages deriving from the use of his device (art. 2).
Therefore, should any accident occur when the user wears the device the producer
might be called into compensate damages suffered. Given the wide variety of
1
Bertolini [1].
Bertolini [2].
3
Council Directive of 14 June 1993 concerning medical devices (henceforth MDD), OJ L 169,
12.07.1993, pp. 143.
4
Council Directive of 20 June 1990 on the approximation of the laws of the Member States relating
to active implantable medical devices (90/385/EEC) (henceforth AIMDD), OJ L 189, 20.7.1990,
p. 17.
5
Council Directive 85/374/EEC of 25 July 1985 on the approximation of the laws, regulations and
administrative provisions of the Member States concerning liability for defective products
(henceforth DPD).
2
Wearable Robots: A Legal Analysis
203
situations where a wearable robot could be used, it is hard to anticipate the kind of
damages the producer might be bound to repay. Indeed, a wearable robot is intended
to follow the user in all day activities, whose range is limitless. The same technological failure however, could lead to extremely different consequences, according to
the action performed in that moment. Damages could be trivial if the action is simple
and does not involve others, but could also amount to something severe if the activity
underwent entails the collaboration with other persons or the use of a device
eventually even a vehicle. For instance, a misleading interpretation of the biological
signal utilized to control the robot by the human-machine interface, might lead to
different accidents, such as the falling of the wearer or a crash.
This dramatically increases ex ante uncertainty and causes the insuring of the
devices to be problematic.
Moreover, insurance companies calculate premiums by taking into account the
likelihood of the occurrence of a harmful event and the expected economic loss they
would face in that case. Lack of sufcient statistical data about the frequency of
malfunctioning, the amount of damages normally caused, and the application of
existing normsgiven the absence of precedents and pertinent case-lawmight
impede that operation. This will cause a delay in the offering of adequate insurance
products for wearable-robot manufacturers, exposing them to greater legal risks,
ultimately disincentivizing the marketing of such devices.
4 Human Enhancement
Wearable robots represent a relevant technology for the purpose of improving the
overall living conditions of many individuals, in particular and foremost persons
with disabilities.
Favouring their development on the side of national and European legislators
might also be deemed a legal obligation as emerging from art. 4, let. g of the United
Nations Convention on the Rights of People with Disabilities (UNCRPD).
However, at the same time those technologies could be used for pure
enhancement purposes.6 Enhancement7 is not per se illicit, however it needs to be
framed under existing constitutional and supranational principles. These include the
notion of human dignity (art. 1 EUCFR)8 and of equality (art. 20 EUCFR)9 but also
principles of self determination.
How these balance out is to be ascertained in the single case at hand, nonetheless
the possibility that regulations restrain the possibility to resort to enhancement
through wearable robots needs be considered.
Lucivero and Vedder [5].

Coenen et al. [3].
8
Feldman [4].
9
Swindells [6].
7
204
A. Bertolini
Most certainly if the robot is not permanently attached to the human body and its
use would not entail a permanent corporal alteration, then self determination of the
user would possibly prevail. Otherwise relevant constitutional concerns might emerge
and subsequently limitations implemented either though ad hoc regulation or case law.
5 Final Considerations
Wearable robots are products highly regulated at the European level. Applicable
norms refer to their safety requirements, upon which their testing needs to take place
and which regulate their certication for purposes of resale on the European market.
Such norms however, do not exclude the possibility of the producer to be held
liable when damages occur as a consequence of the use of the device. These are
regulated by the DPD which poses a relevant burden on the manufacturer and
researcher. This circumstance, together with the existing limited statistical data
available about possible technical failures of the devices causes the seizing of
adequate insurance covering to be problematic, ultimately delaying innovation.
This stifling effect of liability rules can be analysed in detail and directly depends
upon the intrinsic technological and functional characteristics of wearable robots,
intended to follow the wearer in most of his daily activities, thence used in multiple,
and ex ante non-restrained, scenarios.
Finally, because wearable robots might be used as human enhancement devices,
their use might be subject to specic limitations due to relevant constitutional
principles, which govern bioethics.
In particular, a use for non-merely rehabilitative purposes might be seen as
problematic, and require attentive analysis, in particular taking into account whether
the use of the device demands a medical procedure with permanent or reversible
consequences.
References
1. Bertolini, A.: Robotic Prostheses. Guidelines on Regulating Robotics. E. Palmerini (2014)
2. Bertolini, A.: Robotic prostheses as products enhancing the rights of people with disabilities.
reconsidering the structure of liability rules. Law Comput. Technol. 29(23), 116136 (2015)
3. Coenen, C., Schuijff, M., Smits, M., Klaassen, P., Hennen, L., Rader, M., Wolbring, G.:
Human Enhancement. Science and Technology Options Assessment on Human Enhancement
(2009). https://www.itas.kit.edu/downloads/etag_coua09a.pdf
4. Feldman, D.: Human Dignity as a Legal ValuePart I. Public Law, 682 (1999)
5. Lucivero, F., Vedder, A. (eds.): Beyond Therapy vs. Enhancement? Multidisciplinary Analyses
of a Heated Debate. Pisa University Press (2013)
6. Swindells, F.: Economic inequality and human enhancement technology. Hum. Mente J. Polit.
Stud. (26), 213 (2014)
A Verication Method for Testing

Abrasion in the Use of Restraint Type
Personal Care Robots
Yoji Yamada, Mao Xuewei, Kengo Yoshida, Yasuhiro Akiyama
and Shogo Okamoto
Abstract Physical stress hazards are identied as a part of the safety requirements
for personal care robots as described in ISO 13482. We conducted a safety verication study to clarify an inherently safe condition region in the shear stresstime
relationship: The higher the shear stress is, the smaller number of times is needed
for blister generation. For validating the veried safety data, we also built a testbed
where a manipulator is used to optimally control the position and force of a cuff in
contact with a piece of porcine skin for the purpose of reproducing the contact
conditions as close as possible to those obtained when a human wears a robot.
1 Introduction
Based upon strong demands from industry, various safety test methods have been
developed in Japan in the framework of a nation-wide R&D project for putting
personal care robots (PCRs, hereafter) into practical use. The abstract paper reports
a part of the project activities the outcome of which includes a compilation and
proposal of a V&V (Verication and Validation) document to be standardized in
compliance with the safety standard ISO 13482 for PCRs. We investigated to
identify 62 items in ISO 13482 that require new tests for one or more of the three
types of PCRs. Based upon the investigation, 34 test methods are developed and
described in a standard form of V&V test methods. In the test methods, the authors
research group develops the test of physical hazard characteristics for restraint type
physical assistant robots (PARs, hereafter).
Physical stress hazards are identied from the statement in 5.9.2 of ISO 13482
stating that a PCR shall be designed to minimize or reduce physical stress or strain
Y. Yamada (&) M. Xuewei Y. Akiyama S. Okamoto
Safety Intelligence Group, Department of Mechanical Science and Engineering,
Nagoya University, Nagoya, Japan
e-mail: yamada-yoji@mech.nagoya-u.ac.jp
K. Yoshida
Kansai Electric Power Co. Inc., Osaka, Japan
205
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Y. Yamada et al.
to its user due to continuous use. We concluded through discussions with a Japanese
company manufacturing PARs that the risk of generating skin wounds becomes also
not negligible in such a use of restraint type PAR as to wear their cuff parts each of
which directly contacts human skin without any clothing in between a cuff surface
and the skin of the wearer. Later, it was also reported that friction blisters were
observed to be generated considerably easily in the use of the PAR by a wearer
suffering liver cirrhosis. The following sections describe the test method in detail.
2 Verication Test Method for Abrasion Risk

We develop a blister generation method for establishing a safety verication system
focusing on skin friction trauma [1]. Porcine skin as experimental subject was
excised from the anterior part of a pigs shank shortly after its death, and delivered
to our lab within sixteen hours under 4 degree centigrade. Before the experiments,
each of the skin surface was shaved by a scissor, cleaned by alcohol, and the
excessive fat underneath was also cut off. In our study, the representative direction
(shear direction) of force component is selected for emulating the skin surface
rubbing phenomena.
For conducting a horizontal reciprocating rubbing action, a rheometer (DHR: TA
Instrument Co.) is used to exert oscillating rotational rubbing on the porcine skin
with high calibration accuracy. A piece of the porcine skin was extended and rmly
clamped between the plate with a sheet of sandpaper (40#) attached and a xation
frame. After a certain period of rubbing under oscillating shear force, the structure
of the porcine skin was examined by serial sectioning at intervals of 10 lm and the
micro-section is analyzed by haematoxylin and eosin (H&E), and the stained sections were observed with a microscope sequentially. The sections of both original
porcine skin without any rubbing and the microscopic appearance of porcine skin
after the rst rubbing experiment are shown in Fig. 1a, b.
It can be seen from the gures that the main epidermal structure of porcine skin,
including the stratum corneum, stratum granulosum, stratum spinosum, and epidermal basal layer, keeps intact before rubbing test.
To conrm the availability of the verication data by use of porcine skin, the
characteristics of blister generation should match those obtained in the previous
blister generation test using human skins as subjects, which was conducted by
P. F. D. Naylor in mid 1950s [2]. After some discussion on the similarity of
mechanical properties for both the human and the porcine skin, we combined the
verication data obtained through the use of both kinds of skins. In our experimental model, we set shear stress as a unit of the interactive force between the
porcine skin and the rubbing head. We calculated to draw a regression curve from
the inherently safe time points after statistical analysis including outlier one,
regarded it as a pattern of inherently safe threshold, and combined it with the human
subjects blister generation conditions as shown in Fig. 2.
A Verication Method for Testing Abrasion
207
(a). Appearance of the structure of an original porcine skin surface

(intact stratum spinosum indicated by arrow)
(b). Intra-epidermal clefts (indicated by arrow) after 1200s of

rubbing under shear stress value 3.2104 Pa
Fig. 1 a Appearance of the structure of an original porcine skin surface (intact stratum spinosum
indicated by arrow). b Intra-epidermal clefts (indicated by arrow) after 1200s of rubbing under
shear stress value 3.2 104 Pa
Fig. 2 Combination of
porcine skins and human
subjects blister generation
conditions
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Y. Yamada et al.
3 Validation of the Veried Data

We conducted an experiment validating a cuff attachment in the use of a PAR after
conrming the feasibility of using porcine skin for a safety verication test. We
focused on a human subjects stand-up and sit-down motion which is considered
to exhibit the largest level of relative displacement between the cuff and the skin
surface of the subject. The interaction force between the robots cuff and the users
thigh skin can be exerted repeatedly by the experimental apparatus consisting primarily of a manipulator and dummy skin built for the validation experiments.
Figure 3 shows the overview of the experimental apparatus where we adopted an
adaptive controller called IFT (Iterative Feedback Tuning) to reproduce on the
dummy skin the cuff motion represented by both relative displacement generated and
interactive force exerted respectively at a contact point between human skin and the
cuff of a PAR [3]. Figure 4 illustrates the block diagram of the manipulator controller and Fig. 5 depicts the force reproduction in the cuff sliding direction. Three
pieces of porcine skin were tested during the series of experiments, where every test
lasted for 1800s. The smallest contact area between urethane and porcine skin was
about 12 104 m2 and the largest shear stress applied on the porcine skin was
calculated approximately as 2.3 104 Pa to verify the safe operation condition.
Fig. 3 Overview of the experimental apparatus
Fig. 4 Control system of the manipulator
A Verication Method for Testing Abrasion
209
Fig. 5 Controlled force

exerted at a contact point on
the cuff in the sliding
direction
4 Conclusion
In the paper, the authors mainly deal with his recent research and development of a
safety verication test method: We have conducted a novel study to discuss a safe
condition of not generating blisters at mechanical contact between human skin and
a cuff of a restrain type personal care robot. Such wounds as blisters are estimated to
have a high risk because the probability of occurrence is high while the severity is
low. An increase in the number of porcine skin samples for applying them to the
dummy skincuff system is a part of ongoing work for biomedical verication
with higher accuracy.
Acknowledgments This work was supported by NEDO (New Energy and Industry Organization),
Japan.
References
1. Mao, X.W., et al.: Development of a novel test method for skin safety verication of physical
assistant robots. In: Proceedings of the IEEE International Conference on Rehabilitation
Robotics (ICORR15), pp. 319324, Singapore, Aug 2015
2. Naylor, P.F.D.: The skin surface and friction. Br. J. Dermatol. 67(7), 2398 (1955)
3. Yoshida, K. et al.: Development of a safety validation test equipment for severity estimation of
wounds caused by physical assistant robot. In: Proceedings of the RSJ/SICE/JSME 20th
Robotics Symposia, Karuizawa, Nagano, Japan, pp. 483488, March 2015 (in Japanese)
Part VIII
Benchmarking in WRs and Related

Communities
Kinematic Comparison of Gait

Rehabilitation with Exoskeleton
and End-Effector Devices
Byung-Woo Ko and Won-Kyung Song
Abstract Recently, various gait rehabilitation robots have been used as therapy in
clinical elds for stroke, spinal cord injuries, and several neurological disorders. We
investigated the kinematic differences with joint trajectories of two types of gait
rehabilitation robots, i.e., exoskeleton and end-effector devices. Furthermore, we
compared the end-effector devices stair climbing and descending motions to actual
motions. The exoskeleton device shows larger hip and knee angle than the
end-effector device during gait. However, exoskeleton ankle joint was restricted in
dorsiflexed position. The end-effector devices stair climbing motion was similar to
actual stair motion, although there was a delayed and lower maximum flexion.
Compared with the actual motion, the stair descending motion had a lower maximum flexion angle for both hip and knee joints in the end-effector device. In
addition, the end-effector devices ankle trajectory was aligned with the dorsiflexion
angle, while descending to the bottom stair.
1 Introduction
Gait rehabilitation is a tough task for patients and therapists. Particularly, therapists
need to take physical efforts for patients with severe conditions who have difculty
in walking independently. Nowadays, several gait rehabilitation systems are launched in the market for reducing these physical efforts and enlarging the time and
This work was supported by the R&D Program of MOTIE/KEIT [10045164, Development of an
overground gait rehabilitation robot technology with a success rate over 90 % in gait intention
detection based on biosignal interface for various gait rehabilitation of stroke patients].
B.-W. Ko W.-K. Song (&)
Research Institute, National Rehabilitation Center,
Samgaksan-Ro 58, Gangbuk-gu, Seoul 10122, South Korea
e-mail: wksong@nrc.go.kr
B.-W. Ko
e-mail: powch@korea.kr
213
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B.-W. Ko and W.-K. Song
number of gait rehabilitation interventions. These systems consist of a balance

support module including body weight support, a robot module, and other modules
such as virtual reality module for improving motivations.
Gait rehabilitation robots could be mainly divided into two types: exoskeleton
and end-effector robotic devices [1]. The exoskeleton-type device has an external
structural mechanism with joints and links in correspondence with a human body.
However, the end-effector-based device has footplates that are mounted on the
robot [2]. The end-effector-based robot does not need to be accurately aligned with
the joints. The exoskeleton-based robot operates via smaller end-effector forces [3].
Robot-assisted gait training provides versatile control, but the expensive robot
devices lead to efciency debates in comparison with other conventional training
techniques [2]. Some studies show signicantly higher rates of independent
walking during end-effector-based training compared with exoskeleton-based
training [4]. The end-effector-based robot presents new features including climbing up and down the stairs [5].
The purpose of this study was kinematic comparison of gait trajectory of body
joints, i.e., hip, knee, and ankle joints, provided by gait rehabilitation robots:
exoskeleton-based and end-effector-based robots. In addition, we analyzed the up
and down stair climbing motions for the end-effector-based robot. The analyzed
data could be used to optimize intervention as well as for designing overground
wearable robotic devices.

2.1
Robot Systems: Exoskeleton and End-Effector Devices
In this study, we used two types of gait rehabilitation robots as shown in Fig. 1.
One is Lokomat robotic gait orthosis (Hocoma AG) system that consists of a
treadmill, a dynamic unloading system, and two light-weight robotic actuators that
attach to the subjects legs. The hip and knee joints are actuated by small DC
motors and linear ball screw assemblies [6]. These motors do not require a high
torque.
Fig. 1 Gait rehabilitation

robot systems (left Lokomat,
right G-EO system)
215
The other is G-EO System Evolution (RehaTechnology). This device allows

securing the subjects with a harness while they stand on the footplates of the
machine. The footplates have three degrees of freedom each, allowing control of the
length and height of the steps and footplate angles [7].
2.2
Procedure and Instrumentation
One healthy male subject with no known neurological injuries or gait disorders
participated in this study. All experimental procedures and risks were fully
explained prior to his participation.
The subject walked at a comfortable pace (2.2 km/h) using the Lokomat, and a
physical therapist who has used the Lokomat for over three years adjusted the step
length of the Lokomat until the subject felt comfortable with the gait pattern. As
with standard clinical practice, the Lokomat was operated in the position control
mode with 100 % guidance force. A foot lifter was used in this study for blocking
the foot drop during gait.
The G-EO system could adjust the ankle dorsiflexion angle at initial contact and
the plantar flexion at toe off. Thus, we adjusted the gait speed, step length, and
ankle angle of the G-EO until the subject felt comfortable with the gait pattern.
The hip, knee, and ankle range of motion in sagittal plane data during gait, stair
climbing, and descending were captured using a flexible goniometer (SG Series;
Biometrics Ltd) connected to a wireless transceiver (Delsys Trigno).
The stair climbing and descending motions were performed on real stairs that
consists of total 12 stairs, which had a step height of 17 cm. We used foot-switches
under each heel for detecting the gait cycle and start points of stair climbing and
descending motions. The start points of stair climbing and descending motions were
set to the timing of heel rise to perform each motion, respectively. To comparison of
gait motion with robot devices, we added Winters gait data [8].

3.1
Comparison of Gait Motion Trajectory
Generally, Lokomat shows greater hip joint trajectory than G-EO during gait. In late
stance phase, G-EO kept the hip flexed and showed the lower hip flexion in swing
phase compared with Lokomat. The knee joint trajectory of G-EO was kept flexed
throughout gait. At initial contact, G-EO shows greater knee flexion and smaller
swing phase than Lokomat. The Lokomat ankle trajectory was small and limited
compared with G-EO because a foot lifter is applied to the ankle of the Lokomat. The
foot lifter consists of a loop that is fastened around the ball of the foot to prevent the
216
B.-W. Ko and W.-K. Song
Fig. 2 Hip, knee, and ankle trajectories during gait. The vertical line represents toe-off. Normal
data means Winters [8] gait data
patients foot drop in the treadmill while walking. Therefore, the Lokomat ankle
trajectory was limited to perform only the plantar flexion (Fig. 2).
3.2
Comparison of Stair Climbing and Descending Motion
G-EOs stair climbing motion shows similar trajectories to the real stair climbing
motion. However, the G-EO indicated a delayed and lower hip flexion compared
with the real stair motion. These trends of delayed and lower maximum flexion are
displayed similarly for the knee joint. The ankle trajectory of the G-EO shows
larger plantar flexion when the foot is lifted until it is laid on the stair while
climbing each stair.
The stair descending trajectory of the G-EO presents lower maximum hip flexion
compared to the real stair descending motion. These trends were also observed for a
knee joint. The ankle joint trajectory showed maximum plantar flexion while
descending the bottom stair, but the G-EO showed increased dorsiflexed ankle
trajectory during the stair descending motion (Fig. 3).
The two types of wearable robotic devices can have similar concepts of general
stationary gait rehabilitation robots, such as Lokomat and G-EO. A wearable
robotic device has an external mechanism, like ReWalk [9] and Robin-H [10], that
corresponds with the human joints. Additionally, a wearable device has foot and
ankle posture control with respect to the body trunk. The robot gait training is
repeat the training in the context of the best obtained by limiting the degree of
freedom conned to the articial within the hardware and software framework of
the patients. For the patients who can endure end-effector driven movements with
Fig. 3 Hip, knee, and ankle

trajectories during stair
climbing and descending
(Normal actual stair climbing
and descending motions)
217
trunk control, weight bearing and shifting, the end-effector devices allow dexterous
ankle movements for the subjects with some motivation of self-determined hip and
knee movements. An exoskeleton device effectively blocks foot drop using a foot
lifter in the case of severe patients. In view of gait adaptation, exoskeleton device is
much better than with end-effector device. However, an end-effector-based device is
more effective to encourage a users motivation.
4 Conclusion
In this study, we conrm the kinematic difference characteristics of the training
motion of two types of gait rehabilitation robotic devices. Even though the analysis
results are restricted to two devices, the results represent distinguished points for
joint kinematics, such as ankle and other joints. For developing overground
wearable robotic devices, the kinematic analysis results could be applicable. Further
studies are required to evaluate not only the kinematics but also the kinetics of gait
rehabilitation robots.
References
1. Daz, I., Gil, J.J., Snchez, E.: Lower-limb robotic rehabilitation: literature review and
challenges. J. Robot., 111 (2011)
2. Sale, P., Franceschini, M., Waldner, A., Hesse, S.: Use of the robot assisted gait therapy in
rehabilitation of patients with stroke and spinal cord injury. Eur. J. Phys. Rehabil. Med., 111
121 (2012)
3. Veneman, J.F., Kruidhof, R., Hekman, E.E.G.: Design and evaluation of the LOPES
exoskeleton robot for interactive gait rehabilitation. IEEE Trans. Neural Syst. Rehabil. Eng.,
379386 (2007)
4. Mehrholz, J., Pohl, M.: Electromechanical-assisted gait training after stroke: a systematic
review comparing end-effector and exoskeleton devices. J. Rehabil. Med., 193199 (2012)
5. Hesse, S., Waldner, A., Tomelleri, C.: Innovative gait robot for the repetitive practice of floor
walking and stair climbing up and down in stroke patients. J. Rehabil. Med. (2010)
6. Hidler, J., Wisman, W., Neckel, N.: Kinematic trajectories while walking within the Lokomat
robotic gait-orthosis. Clin. Biomech., 12511259 (2008)
7. Hesse, S., Waldner, A., Tomelleri, C.: Innovative gait robot for the repetitive practice of floor
walking and stair climbing up and down in stroke patients. J. Neuroeng. Rehabil. 7 (30)
(2010)
8. Winter, D.A.: The Biomechanics and Motor Control of Human Movement, 3rd edn. Wiley,
New York (1990)
9. Esquenazi, A., Talaty, M., Packel, A.: The ReWalk powered exoskeleton to restore
ambulatory function to individuals with thoracic-level motor-complete spinal cord injury.
Am. J. Phys. Med. Rehabil., 911921 (2012)
10. Heo, W.H., Kim, E., Park, H., Jung, J.-Y.: A gait phase classier using a recurrent neural
network. J. Inst. Control Robot. Syst., 518523 (2015)
Evaluating the Gait of Lower Limb

Prosthesis Users
Stephanie L. Carey, Kyle B. Reed, Amanda Martori,
Tyagi Ramakrishnan and Rajiv Dubey
Abstract Outcome assessments are vital in facilitating periodic, episodic and

ongoing evaluation of persons with limb loss. There are many outcome measures
used to quantify prosthetic t, alignment, comfort, functionality and usability of
lower limb prostheses. However, many measures are subjective, difcult to
implement in a clinical setting and lack psychometric evaluation. This study used
an immersive Computer Assisted Rehabilitation Environment (CAREN) virtual
reality system with an instrumented spilt-belt treadmill and real time motion capture
system as a research tool to evaluate and compare the gait of lower limb prosthesis
users and non-amputees as a preliminary study to determine the effectiveness and
appropriate use of outcome measures. The use of the CAREN system providing
more real world scenarios such as ramps, inclines and unexpected inclines helped
evaluate the hill assessment index (HAI) and the combined gait asymmetry metric
(CGAM).
S.L. Carey (&) K.B. Reed T. Ramakrishnan R. Dubey

Department of Mechanical Engineering,
University of South Florida, Tampa, USA
e-mail: scarey3@usf.edu
K.B. Reed
e-mail: kylereed@usf.edu
T. Ramakrishnan
e-mail: tyagi@mail.usf.edu
R. Dubey
e-mail: dubey@usf.edu
A. Martori
Department of Chemical and Biomedical Engineering,
University of South Florida, Tampa, USA
e-mail: martori@mail.usf.edu
219
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S.L. Carey et al.
1 Introduction
Lower limb amputations are prevalent in the U.S., often due to complications from
vascular issues caused by diseases such as diabetes as well as trauma from war
related injuries or motor vehicle accidents [1]. In the United States, there are more
than 2 million people who have lost a limb and that number is expected to double
by 2050 [1]. On average the healthcare costs are $500,000 per person over a 5-year
period following limb loss, and additional prosthesis costs over the 5-year period
can reach $450,000, with additional rehabilitative costs [1]. Prostheses are often
rejected or underused due to problems with control, function, training, comfort or
t. The prevalence and expenses involved in lower limb amputations necessitate
specic and effective tools and outcome measures for prosthesis prescription,
evaluation and rehabilitation. Outcome assessments are vital in facilitating periodic,
episodic and ongoing evaluation of persons with limb loss. Third party reimbursors
are demanding justication and evidence for payment of services. There is a need
for valid and reliable outcome assessments to quantitatively measure prosthetic t
and patient performance.
The Hill Assessment Index is a 12 level ordinal scale developed to address
different characteristics of hill ascent and descent but is a high subjective measure
[2]. Learning how a prosthetic leg functions on inclines and declines may assist
with prosthetic design and training. Measuring asymmetry of prosthetic gait is also
of great importance to prosthesis designers, users and therapists. Most amputees
have many asymmetric biomechanical parameters including spatial, temporal,
kinetic and kinematic. This is because of the inherent asymmetric change in force
and motion capabilities in their limbs. However, kinematic and dynamic symmetry
is not possible in an asymmetric system [3], and symmetry may not even be
necessary for a gait to be considered normal and unimpaired [4]. Since individuals
with amputations are inherently asymmetric, aiming for a gait pattern close to that
of a symmetric person may not the ideal approach. To understand how multiple
parameters interact, we use the Combined Gait Asymmetry Metric (CGAM) to
represent the level of asymmetry using ve gait parameters [5].
2 Methods
2.1
The CAREN System
The CAREN system (Fig. 1) consists of D-Flow control software, a 180 projection
screen and projectors, a 6-degree of freedom platform with a built-in instrumented
dual-belt treadmill, and 10 Vicon motion capture cameras. Reflective markers were
positioned according to the Vicon Plug-in-Gait lower limb model and motion
capture data were processed in Vicon Nexus. An YXZ cardan sequence with two
Evaluating the Gait of Lower Limb Prosthesis Users
221
Fig. 1 Bilateral transtibial amputee walking on the CAREN system
proximal segments was used to calculate joint angles. In order to compare hip,
knee, and ankle flexion of all participants, gait trials were normalized to percent of
the gait cycle
2.2
Data Collection and Analysis
A testing protocol (IRB # Pro00018519) was approved by the University of South

Floridas Institutional Review Board to collect data with the CAREN while
non-amputees and amputees walk on a treadmill at a self-selected speed at various
elevations and with unexpected gait perturbations.
Two preliminary studies using the CAREN system to evaluate and compare the
gait of lower limb prosthesis users were completed. Five non-amputees, four
females and one male with a mean age 26 yr 10 participated and one bilateral
transtibial amputee (TTA), a 50 year old diabetic male, 15 (leg 1) and 13 years
(leg 2) post-amputation participated in the rst study. Gait trials included walking
on level ground, 5 incline and decline, and a 3 cross slope for able-bodied and
2 cross slope for the bilateral amputee. The methods for non-amputees in [6]
were similar for the amputee.
A second preliminary study was conducted with one non-amputee participant
and one 37 year old female with a right unilateral transfemoral amputation tted
with two different socket designs: the IRC and VAS brimless. In order to understand how multiple parameters interact, the Combined Gait Asymmetry Metric
(CGAM) was used to represent the level of asymmetry using ve gait parameters.
In addition to typical walking, the ve randomized scenarios were foot slip, tread
deceleration, missing step (4 pitch), height change (5 roll), and unstable ground.
The perturbations utilized the split belt treadmill and were performed at three
speeds of 0.5, 0.9, and 1.3 m/s. The perturbations were randomized to prevent
anticipation by the subject.
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3 Results
For the rst study, average hip, knee (Fig. 2), and ankle flexion were calculated
illustrating a comparison between elevations, as well as a comparison between
non-amputee and amputee gait. The bilateral TTA demonstrated signicantly
reduced flexion compared to the non-amputees across all joints and phases of the
gait cycle. The greatest difference occurred in knee flexion where the non-amputee
maximum across all elevations was approximately 60 and the amputee maximum
was approximately 40. Hip extension was also about 10 less across all elevations
for the TTA and hip hiking was evident during the swing phase. Lastly, there was a
reduction in both ankle dorsi and plantar flexion for the TTA. This was to be
expected as the amputee did not use a multi-axial prosthetic foot.
For the second study, the gait biomechanics with spatial, temporal, kinematic,
and kinetic parameters are used to calculate the CGAM. Both prosthetic gaits
showed a higher magnitude compared to the able-body gait, as expected.
The CGAM was calculated for all perturbations at each speed and are presented for
walking at all three speeds. These speeds are shown for comparison to our earlier
experiment on able-bodied subjects at the same speeds. Figure 3 depicts the CGAM
magnitudes with the respective sockets and speeds.
Fig. 2 Average knee kinematics at various elevations: level (black), uphill (red), downhill (blue),
and cross slope (green) walking in non-amputees (solid) and bilateral transtibial amputee (dashed)
Evaluating the Gait of Lower Limb Prosthesis Users
223
Fig. 3 Combined Gait Asymmetry Metric magnitudes for a Able- Body subjects, b Gait with
VAS-Brimless Socket, and c Gait with IRC Socket
4 Discussion
Providing objective data on how lower limb prosthetic function at various inclines
and side slopes will aid in benchmarking to improve prosthetic design and training.
These data showed the differences in hip, knee, and ankle kinematics at various
elevations with the CAREN, as well as a comparison between normative and
bilateral transtibial amputee gait. This information can improve upon subjective
outcome measures such as the HAI.
CGAM is a quantiable single number representing gait quality that could serve
as a clinical measure of biomechanical parameters of gait rather than a qualitative
and subjective perspective. In this presented comparison between sockets and
able-bodied individuals, it was demonstrated that there are differences in asymmetry
and reducing the CGAM magnitude will result in an improved gait pattern.
5 Conclusion
This work demonstrated that the CAREN can be used to measure the functional
status of an amputee. Future studies with more subjects will examine outcome
measures that can be used to track ability, test different devices, and demonstrate the
patients need for specic types of prostheses. The effects of various prosthetic
components and rehabilitation interventions can also be evaluated.
References
1. Sheehan, T.P., Gondo, G.C.: Impact of limb loss in the United States. Phys. Med. Rehabil.
Clin. N Am. 25(1), 928 (2014)
2. Hafner, B.J., et al.: Evaluation of function, performance and preference as transfemoral
amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch.
Phys. Med. Rehabil. 88, 207217 (2007)
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3. Muratagic, H., Handzic, I., Reed, K.B.: Passive kinematic synchronization of dissimilar and
uncoupled rotating systems. Nonlinear Dyn. Syst. Theory 15(4), 383399 (2015)
4. Handzic, I., Reed, K.B.: Perception of gait patterns that deviate from normal and symmetric
biped locomotion. Front. Psychol. 6 (2015)
5. Ramakrishnan, T., Muratagic, H.,Reed, K.B.: Combined gait asymmetry metric. In: 38th IEEE
Engineering in Medicine & Biology Conference (EMBC) (2016)
6. Martori, A., Carey, S.: Proceedings of the Biomedical Engineering Society Annual Meeting
(2015)
Some Considerations on Benchmarking

of Wearable Robots for Mobility
Jan F. Veneman
Abstract Wearable Robots for Mobility (WR-Mob), i.e. exoskeletons, are currently
entering the market. This makes the topic of how to dene and measure their
performance more relevant and urgent. This abstract provides some considerations
that could be taken into account when designing quantitative benchmark metrics that
aim to quantify the performance of WR-Mob, focusing on measurement of reduction
of metabolic cost and of improvement of balance. The considerations on metrics and
their normalization are rst steps to well-dened benchmark tests. Proper benchmarks contribute to solid comparison among devices that can be performed in
different labs, and thus support a faster progress beyond the state of the art.
1 Introduction
As Wearable Robots for Mobility (WR-Mob), such as exoskeletons for rehabilitation and worker support, are nding their way into the market, it becomes
increasingly important to measure their performance. Not only to be able to clearly
describe the performance that can be expected from products, but also to compare
results obtained in different research labs, to quantify the state of the art performance or to set targets for innovation, or to track intermediate development stages,
for example when developing an application according to the Technology
Readiness Levels (TRLs) [1].
Performance benchmarking of WR-Mob can be either meant to quantify how
much benet using a specic WR-Mob yields relative to not using it, or to quantify
the relative performance of one WR-Mob compared to another. As potential uses
This work has been partially supported by the EU funded project BALANCE,
FP7-ICT-2011.2.1 grant no. 601003.
J.F. Veneman (&)
Health Division, TECNALIA Research and Innovation,
Mikeletegi Pasealekua 1, 20009 Donostia-San Sebastian, Spain
225
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J.F. Veneman
and sought benets of WR-Mob are very diverse, the benchmarks need to be
diverse and relate to the intended use and goal related to the specic WR-Mob
application. Exoskeletons are promoted to reduce load on workers in manufacturing
or other industrial tasks, to support mobility of impaired or frail people, or to
provide safe rehabilitation training, or tele-operation of robots, or to improve range
of operation of load-carrying soldiers. Each of such scenarios might need their own
specic performance benchmarks, but some benchmarks may be more general and
relevant among different applications.
General performance topics could for example be the influence of a WR-Mob on
the metabolic cost of walking, or the influence of a WR-Mob on the ability to
maintain balance. As an example, this abstract shortly reviews approaches to
benchmark metabolic cost of walking and balance performance in WR-Mob.
2 Metabolic Cost of Walking

One of the holy grails of WR-Mob design is to reduce the effort of walking, usually
interpreted as maximally reducing the metabolic cost of walking. This is often
measured through measuring the oxygen consumption and carbon dioxide production through pulmonary gas exchange measurements over a certain distance
walked, usually on a treadmill. However, even if well performed, such measurements are not without problems; outcomes depend on walking speed, loads carried,
total weight and physical condition of the walking subjects, implying that conditions need to be normalized. Care has to be taken that no switch from aerobic to
anaerobic metabolic regime or vice versa occurs during an experiment or among
comparison conditions.
WR-Mob unavoidably add weight to the walking person; a proper WR-Mob is
fully self-contained, that is, all necessary components are worn on-body e.g.
power supply, controller, and actuators, with no tether to external systems. As a
WR-Mob may contain stored energy, for example in a battery, the weight depends
on how much energy is contained, and hence is related to the radius of action, as
well as on the efciency of the energy storage in the sense of amount of stored
energy over storage mass. Also this should be normalized; or radius of action
should always concurrently be reported.
To reduce the effect of some individual differences, such as level of tness,
spirometry values can be converted to Power (P[Watt]) through experimentally
determined relations, such as by Brockway et al. [2], after which the metabolic rate
of standing can be subtracted from the gross metabolic rate of walking [3].
Additionally this value can be normalized to body mass. The full objective metric
E
P
here is the dimensionless specic Cost of Transport, dened as: CoT mgd
mgv
,
which allows comparison of values of efciency of transport across different
velocities and masses. Basically the CoT of the task (e.g. walking) in the natural
situation should be compared with the CoT with the assistive WR-Mob, in the same
227
external conditions (e.g. with different transported mass between conditions due to
the added WR-Mob, as the formula includes transported mass). Nevertheless, as an
in-between condition the situation that includes only the added mass of the device
but not its power support (unpowered operation or using a mock-up) could be
obtained in order to distinguish increase and effective reduction.
It should be taken into account that, as walking exploits passive structural
properties, the optimal walking speed depends mechanically on the mass and its
distribution over the body. This implies poor comparison if devices largely alter
such parameters among conditions. This could be dealt with through measuring at
self-selected walking speed, supposing that a human automatically selects an
energy efcient mode of walking, although this is difcult to ascertain.
Sawicki and Ferris [4] presented the Exoskeleton Performance Index (EPI),
DNet Metabolic Powerg
muscle
dened as: EPI Average exoskeleton positive mech:
power, with gmuscle the muscular efciency; that for example asymptotically approaches 0.25 for the ankle [5, 6].
This metric reaches a value 1 when the exoskeleton fully replaces the work of the
underlying biological muscles normally performing the positive mechanical work
for the supported joint(s). Obviously, when using this metric, comparisons should
be performed with the same added weight among conditions.
Finally, it should be noted that training with a device may improve its effectiveness for the trained subject.
3 Balance Performance
With the potential use of exoskeletons to improve the ability to deal with perturbations, such as is the target of the EC FP7 BALANCE (www.balance-fp7.eu)
research project, also balance performance needs to be benchmarked.
As known from studying the human, several subsystems compose the ability to
avoid falls, and this composition is different between standing and walking.
Subsystems also contribute differently depending on whether there is opportunity to
anticipate the specic threats to balance or not. Therefore, the performance
benchmark for balance should be designed for the specic purpose of the device
and the comparison. Considering the ability to react to unpredictable perturbations,
a benchmark requires means to provide random, well-quantied, repeatable perturbations, for example the pelvic pusher device developed within the
BALANCE project by the University of Twente, which can provide perturbations
designed with a specic force-over-time prole [7].
Reactions to perturbations can probably best be benchmarked by basic metrics
such as maximum perturbation that can be dealt with (as impulse: force integrated
over time) in standing or in walking, comparing the conditions using the WM-Mob
with supportive control and human only. Like in the metabolic cost benchmarks,
wearing the WM-Mob without supportive control, but with added weight (device
228
J.F. Veneman
powered off, or operated in transparent mode; or using a mock up), can be

considered as intermediate condition of comparison.
To compare maximum perturbation that can be dealt with among conditions
that are substantially different, requires adequate normalization of the perturbation
impulse. Important for normalization are: the size of the Base of Support, the height
of Center of Mass (or approximated by leg length or body length). In walking,
especially concerning the duration of the perturbation, also the speed of walking,
and for timing additionally the moment in the gait cycle should be considered.
These parameters should be used to design a perturbation that can be considered
equivalent among conditions. Gait relevant values are normalized by: m = body
mass (total biped, including WR-Mob - hence may change importantly through a
WR-Mob), l = lower-limb length (hip-joint to floor) and g = gravitational constant.
Proper normalization factors can be found in [8], leading to a normalization of
perturbation impulse with: This also implies for the perturbation angular impulse:
J
^
Jang ang
3 1 . Additionally, care has to be taken that the size of the Base of Support,
ml2 g 2
dened as distance from centered CoG to the edge of the Base of Support in the
direction of the perturbation (dBoS,P) should be similar among conditions or lengths
q
2
may be more correctly normalized to
l2 dBoS;P
, instead of to l being the
lower-limb length.
4 Conclusion
This abstract provides some considerations that could be taken into account when
designing quantitative benchmark metrics that aim to quantify the performance of
Wearable Robots for Mobility, focusing on measurement of reduction of metabolic
cost and of improvement of balance. The considerations are rst steps to well dened
benchmark test through which such performance can be objectively benchmarked
and properly compared among devices and performed in different labs.
References
1. Torricelli, D., Gonzalez-Vargas, J., Veneman, J.F., Mombaur, K., Tsagarakis, N., del Ama,
A.J., Gil-Agudo, A., Moreno, J.C., Pons, J.L.: Benchmarking bipedal locomotion: a unied
scheme for humanoids, wearable robots, and humans. IEEE Robot. Autom. Mag. 22(3), 103
115 (2015)
2. Brockway, J.M.: Derivation of formulae used to calculate energy expenditure in man. Hum.
Nutr.: Clin. Nutr. 41C, 463471 (1987)
3. Mooney, L.M., Rouse, E.J., Herr, H.M.: Autonomous exoskeleton reduces metabolic cost of
human walking. J. Neuroeng. Rehabil. 11(1), 151 (2014). http://dx.doi.org/, doi: 10.1186/17430003-11-151
4. Sawicki, S., Ferris, D.P.: Mechanics and energetics of level walking with powered ankle
exoskeletons. J. Exp. Biol. 211(Pt. 9), 14021413 (2008)
229
5. Margaria, R.: Positive and negative work performances and their efciencies in human
locomotion. Int. Z Angew. Physiol. Einschl. Arbeitsphysiol. 25, 339351 (1968)
6. Margaria, R.: Biomechanics and Energetics Of Muscular Exercise. Clarendon Press, Oxford
(1976)
7. Vlutters, M., Van Asseldonk, E.H.F., Van der Kooij, H.: Center of mass velocity-based
J. Exp. Biol. 219(10), 15141523 (2016)
8. Hof, A.L.: Scaling gait data to body size. Gait Posture 4, 222223 (1996)
Benchmarking Data for Human Walking

in Different Scenarios
Katja Mombaur, Debora Clever and Alexander Schubert
Abstract Benchmarking bipedal locomotion is an important topic not only for wearable robotics, but also for human movement analysis and humanoid robotics. In this
paper we discuss how data from the KoroiBot walking database can be used to establish benchmarking data for human walking in different situations based on direct
extraction and on model-based analysis. The goal is to identify human reference
values for important quantities defining walking motions which can then serve for
evaluating walking motions in the different areas of applications.
1 Introduction
Developing efficient measures for benchmarking bipedal locomotion is important
for different areas of research, including humanoid robotics, human motion studies in biomechanics or medical application, exoskeletons etc. Among other things,
benchmarking allows to compare different robot platforms, technologies or control
algorithms, define walking standards, measure progress of human walking during
therapy, define training goals etc. The importance of benchmarking has also been
acknowledged by the EU and play an important role in several European projects,
such as H2R, KoroiBot, WalkMan, Balance and BioMot. The interest in benchmarking of bipedal locomotion has also lead to the formation of the benchmarking
initiative [1]. [2] is an attempt to formulate a unified benchmarking scheme based on
the views of the five mentioned European projects as well as the results of an online
survey performed via the benchmarking list. In [3] we have described the benchmarking approach in the KoroiBot project which does not have the goal to compare
robots or technology but instead focuses on key performance indicators to measure
The research leading to these results has received funding from the European Union Seventh
Framework Program FP7 under grant agreement n 611909 (KoroiBot).
K. Mombaur (B) D. Clever A. Schubert
Robotics & Biomechanics Research Group, Interdisciplinary Center for Scientific Computing,
Heidelberg University, Heidelberg, Germany
e-mail: katja.mombaur@iwr.uni-heidelberg.de
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K. Mombaur et al.
progress of individual robot performance in the project. We distinguish technical indicators, computational indicators and high-level indicators such as human-likeness.
Especially the first group which is of general interest and has also been extensively
discussed in [2]. Technical indicators include general walking indicators such as
walking speed, energy consumption and efficiency, or robustness, but also evaluate
the particular walking scenario, such as stair height, slope angle etc.
If such technical indicators are to be used for robots or other technical systems
and their performance is to be compared to human performance, extensive reference
values of human performance will be urgently needed. In this talk, we discuss how
some of these values can be extracted from human motion capture databases.
2 The Koroibot Project and the Koroibot Motion Capture

Database
The research presented here has been performed in the context of the KoroiBot project
[4] which addresses the issue that todays humanoids still lack the ability to walk in a
human-like fashion. This is however crucial for many of the tasks they are supposed
to perform, namely support humans in households or in the working environment, or
to replace them in places that are too dangerous or too far away, such as disaster sites
or space missions. Human gaits are at the same time efficient, robust and versatile
but gaits of humanoids or bipedal robots are at best good in one of these areas.
This problem is not only linked to the present hardware, but also to a large extent
to the control principles and the software used. The idea of KoroiBot is to address
this issue by developing novel techniques for the generation and control of motions
and applying them to different robot platforms. The KoroiBot methodology is based
on a thorough experimental study of human walking in different situations and the
development of mathematical models as well as optimization and learning methods.
One general idea is to perform the transfer from human to humanoid motions not by a
direct mapping of motions which would not be feasible due to the serious constraints
of humanoid robots - but via the models and corresponding optimization principles
for motion generation and control.
Fig. 1 The KoroiBot walking parcours with different walking scenarios for which also motion
recordings have been performed: level ground, rough and soft terrain, beams, easaws, step stones
and stairs up and down
Benchmarking Data for Human Walking in Different Scenarios
233
In this context, extensive experimental studies of human walking motions have

been performed. This includes many unconstrained and constrained walking scenarios that are important for the KoroiBot project, such as walking on level ground,
slopes, stairs up and down, beams, step stones, sea-saws, soft mattresses etc. (see
sketch in Fig. 1). Data sets include motion capture data from optical systems in all
cases, as well as additional force or pressure distribution data in the feet for some
of the sets. Recordings have been performed by KoroiBot partners University of
Tuebingen, Weizmann, KIT and LAAS-CNRS. The data is publicly available in the
KoroiBot database which comprises by now more than 5000 data sets and is still
growing (see [5, 6] for the technical implementation of the database.
3 Human Walking Reference Data

In the talk, we will present evaluations of many data sets of the KoroiBot database.
Some characteristics can be directly extracted from marker information or force /
pressure measurements in the database, others have to be derived via some simple
mathematical models. Among others, we are investigating the different properties:
Walking speed: The average walking speed of human subjects is extracted for
different scenarios and as a function of the level of difficulty of the particular
scenario (e.g. increased slope angles or stair heights). We look at absolute walking
speed and relative speed normalized by the subjects leg length.
Step width: Here the interest is to evaluate to what extent increased difficulty of
the scenario leads to an increased step width.
Walking speed variance in difficult terrain: The goal is to evaluate if in difficult
scenarios, such as very rough terrain or step stones, subjects tend to maintain their
average walking velocity or if they highly adjust it to the requirements of the
specific terrain.
Joint trajectories: Different analysis of the individual joint trajectories of humans
in different situations are performed. This also includes a study of intersegmental
coordination, i.e. the relationship between absolute thigh, shank and foot angles.
Properties related to simple stability criteria, such as the capture point and the
center of pressure.
Developments of different types of energy over the course of the motion.
Closness to periodicity for constrained and unconstrained motions.
4 Conclusion & Outlook

Together with numbers extracted from other data sources in a similar way, the numbers presented in this talk can later serve as reference data to benchmark how close
the performance of humanoid robots or other technical systems such as exoskeletons
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K. Mombaur et al.
gets to typical human-like behavior, or how much a patient in therapy still has to train
in order to be back at his normal walking capabilities. We also work on analyzing
advanced stability properties of recorded human data which however requires sophisticated multi-body system models and optimal control techniques and is subject of
another talk submitted to ICNR. For analyzing human-likeness of motions of systems
with different kinematic and dynamic properties we have developed an online survey
with a similarity rating tool [7] that allows to compare captured motions and different
types of modified motions. The outcome of the survey will then be used to further
refine the definition of the high level benchmarking criterion human-likeness.
References
1. Benchmarking initiative: www.benchmarkinglocomotion.org, 20132016
2. Torricelli, D., Gonzales-Vargas, J., Veneman, J., Mombaur, K., Tsagarakis, N., del-Ama, A.J.,
Gil-Agudo, A., Moreno, J.C., Pons, J.L.: Benchmarking bipedal locomotion in humanoids,
wearable robots and humans: a unified scheme. IEEE Robot. Autom. Mag. 103115, (September
2015)
3. Schubert, A., Clever, D., Mombaur, K.: Key performance indicators for humanoid walking
motions defined in the KoroiBot project. In: International Workshop on Wearable Robotics
(WeRob 2014) (2014)
4. The Koroibot project: www.koroibot.eu, 20132016
5. KoroiBot Motion Capture Database: https://koroibot-motion-database.humanoids.kit.edu/,
20142016
6. Mandery, C., Terlemez, O., Do, M., Vahrenkamp, N., Asfour, T.: The KIT whole-body human
motion database. In: IEEE International Conference on Advanced Robotics (ICAR 2015),
329336 (2015)
7. Walking similarity, online survey: https://orb.iwr.uni-heidelberg.de/ratingapp/similarity/ (2016)
Clinical Gait Assessment in Relation

to Benchmarking Robot Locomotion
J.H. Buurke, J.F. Veneman and D. Torricelli
Abstract The objective of this paper is to identify clinical assessments that are
potentially useful for benchmarking of bipedal locomotion. Results: Several clinical
measures for static conditions and clinical measures for motion are suggested.
Conclusions: Potentially useful clinical measures are identied. New metrics
coming from new ambulant measurement techniques may be a good alternative for
the qualitative clinical measures.
1 Introduction
In a recent paper on benchmarking bipedal locomotion, Torricelli et al. state that there
is a growing awareness of the importance of benchmarking in the eld of robotics [1].
The objective of the paper of Torricelli et al. was to dene the basis of a benchmarking
scheme for the assessment of bipedal locomotion that could be applied and shared
across different research communities. For that purpose, a web-based survey was
carried out rst. Secondly, a common nomenclature was dened based on the work of
Gentile [2] and Fleishman [3]. A common nomenclature is crucial, since the target
J.H. Buurke (&)

Rehabilitation Technology Research Group, Roessingh Research and Development,
Enschede, The Netherlands
e-mail: j.buurke@rrd.nl
J.H. Buurke
Biomedical Signals and Systems, MIRA-Institute for Biomedical Technology
and Technical Medicine, University of Twente, Enschede, The Netherlands
J.F. Veneman
Health Division, Tecnalia Research & Innovation San Sebastin, Madrid, Spain
D. Torricelli
Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC),
Madrid, Spain
e-mail: diego.torricelli@csic.es
235
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J.H. Buurke et al.
group is multidisciplinary and different terms and denitions are often used by various
disciplines working in the eld of robotics. Subsequently, motor skills were classied,
based on Fleishman, listing a subset of signicant motor skills related to lower-limb
motion and identifying related benchmarks.
However, most of these benchmarks describe the biomechanical property of the
ability. This paper aims to identify clinical assessments useful for benchmarking of
bipedal locomotion. Therefore, the proposed common nomenclature will rst be
compared to denitions used in clinical practice. Subsequently, potentially useful
clinical assessments for benchmarking will be selected, based on their suitability for
application in clinical practice.
1.1
Taxonomies Related to International Classication

of Functioning
In the proposed scheme for benchmarking of bipedal locomotion, three terms were
selected to dene a common nomenclature (Fig. 1), based on the work of Magill
[4]. These terms are: (a) Skill, dened as a task or activity with a specic goal
(i.e. walking); (b) Ability, dened as the independent functional blocks needed to
achieve a skill; (c) Performance, dened as the level of achievement of the goal.
In healthcare measures are generally dened according to the International
Classication of Functioning (ICF) [5]. The ICF is a multipurpose classication
designed to serve various disciplines and different sectors and to establish a common language for describing health and health-related states in order to improve
communication between different users, such as healthcare workers, researchers,
policymakers and the public, including people with disabilities.
In the ICF three components are dened (Fig. 2): (a) Body functions; these are
the physiological functions of body systems (including psychological functions),
(b) Activity; this is the execution of a task or action by an individual,
(c) Participation; this is the involvement in a life situation. Furthermore the actual
behavior of an individual is influenced by (a) Environmental factors, which make
Fig. 1 The basic components

of our benchmarking
taxonomy: motor skills, motor
abilities, and motor
performance as suggested by
Torricelli et al.
237
Fig. 2 Interactions and

components of ICF
up the physical, social and attitudinal environment in which people live and conduct
their lives, and (b) Personal factors, which are the particular background of an
individuals life and living, and comprise features of the individual that are not part
of a health condition or health states (i.e., habits, lifestyle).
Although the nomenclature and denitions differ between the two taxonomies
they also seem to have a lot in common. For facilitating the discussion on
benchmarking of bipedal locomotion, the taxonomy as proposed by Torricelli et al.
is used in this paper.
1.2
Clinical Assessments for Bipedal Locomotion
In clinical practice, and especially in the eld of rehabilitation medicine, clinical

scales are used for decision making and/or evaluation of patients. These scales are
used to describe the abilities (i.e., muscle force, sensation, etc.) and skills (i.e.,
walking, climbing stairs, etc.). Scales used in clinical practice should by reliable,
reproducible and valid. A potential problem for benchmarking is that a lot of these
scales are specic for a particular diagnosis, meaning that they are only validated
for a specic patient group. A crucial prerequisite of clinical scales for benchmarking is that they are suitable for different patient groups (and healthy elderly).
Another essential factor, which may be even more important, is the minimal
important difference (MID). This MID is dened as the smallest change in a
treatment outcome that a patient would identify as important. Last but not least,
measurements should be validated in different languages.
In general, existing clinical measures dont distinguish between body posture or
body transport (as is suggested in the paper of Torricelli). Measures either focus at
static conditions (i.e., static balance), with or without (internal) perturbations, or at
conditions where the body is in motion (i.e., walking, climbing stairs). Therefore,
the current paper identies clinical scales based on their corroboration with
abovementioned factors concerning practical applicability, that can be used for
benchmarking of motor skills related to lower-limb motion.
238
J.H. Buurke et al.
2 Method
Outcome measures were identied from a random selection of various databases,
such as:
http://www.meetinstrumentenzorg.nl/
http://www.rehabmeasures.org/rehabweb/allmeasures.aspx?PageView=Shared
http://geriatrictoolkit.missouri.edu/
3 Results
Suggested measures for static conditions: Berg Balance Scale (BBS), Timed
Balance test (TBT), Reach test (RT). Suggested measures for motion: 10 m walk
test (10 MWT), 6 min walk test (6 MWT), Functional Ambulation Category
(FAC), Rivermead Mobility Index (RMI), Timed up and Go (TUG), L-Test (LT),
Eight walk test (8 WT), Dynamic gait index (DGI), Functional Gait assessment
(FGA), Stairs Test (ST), Falls efcacy Scale (FES).
4 Discussion
This paper describes the selection of potentially useful clinical measures for
benchmarking of bipedal locomotion.
A possible disadvantage of these scales is that they are based on observation and
that outcomes are often dened on a general level. New quantitative and reliable
metrics might offer a solution for this problem. In the INTERACTION (training and
monitoring of daily-life physical INTERACTION with the environment after
stroke) project (EC FP7 Strep FP7-ICT-2011-7-287351), an unobtrusive and
modular system for monitoring of daily life activities of stroke subjects and physical
interactions of upper and lower extremity motor function with their environment
was developed and validated. First results showed that the data measured by this
system, which consists of inertial motion units (IMUs) and force sensors, correlate
very nicely with clinical scales like the BBS, TUG and 10 MWT. Moreover, it
provides additional quantitative information that is essential for discrimination
between normal and abnormal (compensatory) movements while performing these
tests [6].
Furthermore, measurements using this system can be conducted both in a controlled (movement lab) and uncontrolled (at home) environment [7].
239
5 Conclusion
Potentially useful clinical measures to benchmark bipedal locomotion were identied using the framework described by Torricelli et al. Important factors guiding
the selection of clinical measures are generalizability over different patient groups,
validity and reproducibility of the results, in combination with the minimal
important difference. New metrics coming from new developments in the area of
ambulant measurement techniques may be a good alternative for the existing
clinical measures.
References
1. Torricelli, D., Gonzlez-Vargas, J., Veneman, J.F., Mombaur, K., Tsagarakis, N., del-Ama, A.
J., Gil-Agudo, A., Moreno, J.C., Pons, J.L.: Benchmarking bipedal locomotion. IEEE Robot.
Autom. Mag. Sept. 2015. DOI:10.1109/MRA.2015.2448278
2. Gentile, M.: Skill acquisition: action, movement, and neuromotor processes. In: Carr, J.H.,
Shepherd, R.B., Gordon, J. (eds.) Movement science: foundations for physical therapy in
rehabilitation, pp. 93154. Aspen Publishers Inc., Rockville, MD (1987)
3. Fleishman, E.A., Quaintance, M.K.: Taxonomies of human performance. Academic Press,
Orlando, FL (1984)
4. Magill, R.A.: Motor learning and control: concepts and applications. McGraw-Hill, New York
(2007)
5. International Classication of Functioning, Disability And Health: ICF. WHO Library
Cataloguing-in-Publication Data. World Health Organization 2001. ISBN:92 4 154542 9.
http://psychiatr.ru/download/1313?view=name=CF_18.pdf
6. van Meulen, F.B., Weenk, D., Buurke, J.H., van Beijnum, B.F., Veltink, P.H.: Ambulatory
assessment of walking balance after stroke using instrumented shoes. J. NeuroEng. Rehabil. 13,
48 (2016). DOI:10.1186/s12984-016-0146-5
7. van Meulen, F.B., Klaassen, B., Held, J., Reenalda, J., Buurke, J.H., van Beijnum, B.-J.F.,
Luft, A., Veltink, P.H.: Objective evaluation of the quality of movement in daily life after
stroke. Front. Bioeng. Biotechnol. 3, 210 (2016). doi:10.3389/fbioe.2015.00210
Part IX
Symbiotic Control of WRs
Attention Level Measurement During

Exoskeleton Rehabilitation Through
a BMI System
lvaro Costa, Guillermo Asn-Prieto, Jos Gonzlez-Vargas, Eduardo Iez,
Juan C. Moreno, Antonio J. Del-Ama, ngel Gil-Agudo and Jos M. Azorn
Abstract Brain-Machine Interfaces based on wearable robots control have been

proposed in the research field for rehabilitation purposes. The combination of both
systems allow the performance of more natural movements and a higher level of
involvement of patients on their therapy. Studies focused on this topic should face
several issues related to the integration of these systems. The current work is meant
to test the accuracy of a real time Brain-Machine Interface based on the detection of
gait attention during lower limb exoskeletal rehabilitation. Four users performed the
experiment wearing an ankle exoskeleton. The system provides a coefficient between
0 and 1 depending on the level of attention experienced by the subject. These results
show good similitude between real and decoded attention level.
1 Introduction
Several studies suggest that rehabilitation results could be improved by taking advantage of the human ability to generate physical changes in the brain structure [1]. This
brain plasticity could be enhanced during rehabilitation by increasing the involvement
of patients on their therapy. BMIs have been proposed in the literature to introduce
This research has been funded by the Commission of the European Union under the BioMot
project - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (Grant Agreement
number IFP7-ICT- 2013-10-611695).
. Costa (B) E. Iez J.M. Azorn
Brain-Machine Interface Systems Lab, Miguel Hernndez University,
Av. de la Universidad S/N, 03202 Elche, Spain
e-mail: acosta@umh.es
G. Asn-Prieto J. Gonzlez-Vargas J.C. Moreno
Human Locomotion Laboratory, Neural Rehabilitation Group, Cajal Institute,
Spanish National Research Council, Avda. Doctor Arce 37, 28002 Madrid, Spain
A.J. Del-Ama . Gil-Agudo
Biomechanics and Technical Aids Units, Physical Medicine and Rehabilitation Department,
National Hospital for Spinal Cord Injury, SESCAM, Finca de la Peraleda S/N,
45071 Toledo, Spain
243
244
. Costa et al.
this involvement in the rehabilitation process [2]. These systems are focussed on the
decoding of the brain response of people in different situations. This information
could be used to fit the rehabilitation to the mental state of the user.
Current study works on the integration of a BMI to detect the attention level
during gait while wearing an ankle exoskeleton. The online BMI presented is based
in offline studies previously performed [3]. During systems integration involving the
use of BMIs based on electroencephalograpic measurements, the artifact robustness
of the system should be evaluated. On the current work, 3 attention levels are going
to be measured to provide an attention coefficient. The main goal of this work is to
test how accurate is the proposed BMI system during exoskeleton walking. In this
case, the BMI system does not provide information to the exoskeleton although this
will be the next step of this research. The BMI system is based on the detection of
a high gamma band desyncronization produced during a dual task paradigm related
to the attention paid to the gait. This selective attention mechanism has been widely
applied in other works based on dual tasks paradigms [4, 5].

2.1 Ankle Exoskeleton
An ankle exoskeleton is attached to the dominant foot of the participants during
this experiment. This exoskeleton is being developed in the framework of the BioMot Project (Smart Wearable Robots with Bioinspired Sensory-Motor Skills). This
exoskeleton is designed to be a biomimetic mechanical structure with compliant
characteristics that allows a natural interface between the patient and the robot.
2.2 EEG Acquisition

The cortical signals are recorded using 21 active channels located on the scalp through
an elastic cap (actiCap, Brain Products, GmbH, Germany). Electrodes are placed
on the motor and premotor cortex with the following distribution according to the
10/10 International System: FZ, FC3, FC1, FCZ, FC2, FC4, C3, C1, CZ, C2, C4,
CP3, CP1, CPZ, CP2, CP4, P3, P1, PZ, P2 and P4 with a reference in the right
earlobe and AF4 electrode as ground. Electrical signals are amplified by a wireless
commercial amplifier (actiCHamp, Brain Products, GmbH, Germany) and digitalized
at 500 Hz. A hardware bandpass filter between 0.5 and 100 Hz is applied to remove
unnecessary signal bandwidth and also a 50 Hz Notch filter is used to remove power
line interference.
Attention Level Measurement During Exoskeleton
245
2.3 EEG Real Time Processing and Feature Extraction

The real time acquisition loop records 0.5 s of EEG data on each iteration. Signal
is divided in 1 s epochs with a 0.5 s of overlap between them. Each epoch goes
to a processing stage. With a previous 30 s offline register, the Segment Maximum
Average (SAM) is computed for each channel and used to standardize the data [6]. The
power spectral density of the standardized segments is computed using the Maximum
Entropy Method (MEM) [7] with a spectral resolution of 1 Hz. An average value of
gamma band (from 30 to 45 Hz and from 55 to 90 Hz to avoid the frequencies affected
by the 50 Hz Notch filter) is extracted from each channel. Finally these 21 features
are concatenated in a single vector and sent to a classification stage. This processing
is repeated for each incoming epoch.
2.4 EEG Classification

Features vectors are classified using a Linear Discriminant Analysis (LDA) classifier
that fits a multivariate normal density to each group, with a pooled estimate of
covariance. The classifier take a decisions every 0.5 s. Each decoded attention level
is associated to a coefficient value: 0 for low attention level, 0.5 for standard attention
level and 1 for high attention level. After each classification, the value is added to
the end of a 10 position buffer (5 s). The final classification is obtained by averaging
the values from this buffer. Although the use of this averaged value introduce a
small delay in the classification (less than 5 s), it helps reducing the influence of
misclassified segments and it is not critical as the attention during rehabilitation do
not experience huge variation in a short period of time.
2.5 Experimental Protocol

The users were instrumented with the EEG equipment and the ankle exoskeleton
was adjusted to the specific size of each participant. On each run of the experiment
the user was asked to perform three tasks during straight walking. During the first
task the participant was asked to perform some mathematical operations shown on a
tablet carried by an experimenter (low gait attention level). On the second task, the
participant was asked to walk without any distractions (standard gait attention level).
On the third task the participant was asked to follow some marks placed on the floor
with an unsteady gait step (high gait attention level). Each task lasts for 30 s. Each
experimental session is composed of eight runs. Four healthy participants performed
the experiment, all of them were right handed men with ages between 25 and 37
(31.2 5.3). Runs 1, 2, 3 and 4 of each participants are used to create a classification
model and classification results are computed for runs 5, 6, 7 and 8.
246
. Costa et al.
Fig. 1 Averaged value of the attention coefficient provided by the classifier (in blue) during runs
5, 6, 7 and 8 and real attentional task performed by each participant (in red)

On Fig. 1 the averaged coefficient obtained for each subject during runs 5, 6, 7 and
8 are shown. The attention coefficient provided by the classifier (in red) is compared
to the real attention level (in blue) to appreciate how accurate is the real time system
during exoskeleton rehabilitation.
The attention coefficient provided by the system presents appreciable changes
related to the attention level experienced by the participant. On this regard, high
attention level is easily distinguished from low and standard attention level. However,
between low and standard levels there are lower differences but, the use of the average
of the 5 s buffer allows to fix a personalized threshold in the attention coefficient
depending on the user to approximate the coefficient provided to the real attention
level.
4 Conclusions
A real time BMI to decode the attention level during gait has been designed. The
system has been validated with four healthy users during the simulation of a lower
limb rehabilitation strategy assisted by and ankle exoskeleton that supports dominant
leg motion during walking. The exoskeleton provides the assistance to perform a
natural gait step. The real time BMI system provides the attention level that the
subject experiences during rehabilitation. In future works, this system will be used
to modified the exoskeleton assistance.
Acknowledgments The authors would like to thank Marta Moltedo, Tomislav Bacek and Dirk
Lefeber for their support in the work on the MACCEPA actuator used in these experiments. We also
thank Maria del Carmen Snchez , Guillermo Asn-Prieto, Jos Gonzlez and Juan Camilo Moreno
for the mechanical design and fitting of the ankle exoskeleton.
Attention Level Measurement During Exoskeleton
247
References
1. Johnston, M.V.: Plasticity in the developing brain: implications for rehabilitation. Dev. Disabil.
Res. Rev. 15, 94101 (2009)
2. Ramos-Murguialday, A., Broetz, D., Rea, M., Ler, L., Yilmaz, ., Brasil, F.L., Liberati, G.,
Curado, M.R., Garcia-Cossio, E., Vyziotis, A., et al.: Brain-machine interface in chronic stroke
rehabilitation: a controlled study. Ann. Neurol. 74, 100108 (2013)
3. Costa, A., Iez, E., beda, A., Planelles, D., Hortal, E., Azorn, J.M.: Frequency and number of
neighbors study for attention level classification using eeg signals. In: International Workshop
on Wearable Robotics (WeRob 2014) (2014)
4. Zhang, D., Maye, A., Gao, X., Hong, B., Engel, A.K., Gao, S.: An independent brain-computer
interface using covert non-spatial visual selective attention. J. Neural Eng. 7, 016010 (2010)
5. Kim, D.W., Hwang, H.J., Lim, J.H., Lee, Y.H., Jung, K.Y., Im, C.H.: Classification of selective attention to auditory stimuli: toward vision-free brain-computer interfacing. J. Neurosci.
Methods 197, 180185 (2011)
6. Costa, A., Salazar-Varas, R., beda, A., Azorn, J.M.: Characterization of artifacts produced by
gel displacement on non-invasive brain-machine interfaces during ambulation. Front. Neurosci.
10, 60 (2016)
7. Marple Jr, S.L.: Digital Spectral Analysis with Applications, vol. 1. Prentice-Hall, Inc.,
Englewood Cliffs, NJ, 512 p. (1987)
Detection of Subjects Intention to Trigger

Transitions Between Sit, Stand and Walk
with a Lower Limb Exoskeleton
Fernando Trincado-Alonso, Antonio J. del Ama-Espinosa,
Guillermo Asn-Prieto, Elisa Piuela-Martn, Soraya Prez-Nombela,
ngel Gil-Agudo, Jos Luis Pons and Juan C. Moreno
Abstract In this study we explore a way of controlling a lower limb exoskeleton
based on the detection of the user intention by recording and classifying information from force sensors placed on both knees and hips. The classier is based on
Linear Discriminant Analysis and has been tested offline in 5 healthy subjects,
obtaining an average accuracy of 91.11 % for the sit-to-stand transition, 72.5 % for
the stand-to-walk transition and 70 % for the stand-to-sit transition.
This work is supported by The Biomot Project, funded by the Commission of the European
Union under Grant Agreement number IFP7-ICT-2013-10-611695.
F. Trincado-Alonso (&) A.J. del Ama-Espinosa E. Piuela-Martn S. Prez-Nombela
. Gil-Agudo
Biomechanics and Technical Aids Department,
National Hospital for Spinal Cord Injury, Toledo, Spain
e-mail: fernandotrin@gmail.com
A.J. del Ama-Espinosa
e-mail: ajdela@sescam.jccm.es
E. Piuela-Martn
e-mail: elisapinuela@gmail.com
S. Prez-Nombela
e-mail: sperezn@sescam.jccm.es
. Gil-Agudo
e-mail: amgila@sescam.jccm.es
G. Asn-Prieto J.L. Pons J.C. Moreno
Neural Rehabilitation Group,
Spanish National Research Council (CSIC), Madrid, Spain
e-mail: guillermo.asin.prieto@csic.es
J.L. Pons
e-mail: jose.pons@csic.es
J.C. Moreno
e-mail: jc.moreno@csic.es
249
250
F. Trincado-Alonso et al.
1 Introduction
Lower limb exoskeletons are robotic devices whose aim is to assist people with gait
decits during walking. During the last years, several studies have shown the feasibility of these systems in patients with spinal cord injury [1]. However, the
effectiveness of such devices in terms of functional outcome remains unclear [2].
One of the challenges of the current systems is to improve the interaction between
the robotic device and the human who is wearing it. Some of the state-of-the-art
exoskeletons are controlled by a switch button, which is an easy way to control any
system, but may not be useful when considering two aspects. Firstly, many of the
potential users of lower limb exoskeletons require additional technical aids to walk,
such as crutches or walkers. This hinders the use of a button at the same time that the
user is walking. The second reason lies on the rehabilitative aim of the exoskeletons.
Since the main objective of these systems is to provide a tool that facilitates training
of gait, in order to maximize the benets of such training, it should be as similar as
possible to the normal gait. Ideally, the operation of the exoskeleton should be
transparent to the user. With this objective, in this study we explore a way of
controlling a lower limb exoskeleton based on the detection of the users intention by
recording and classifying information from force sensors placed on both knees and
hips. To this end, a classier based on Linear Discriminant Analysis (LDA) was
developed and tested offline in recording from 5 healthy subjects.

2.1
Material
The exoskeleton used to assist gait was the H2, a 6 degrees-of-freedom wearable
lower-limb orthosis with anthropomorphic conguration [3]. It was equipped with
three active joints for each leg: hip, knee and ankle, each of which powered by a DC
motor coupled with a harmonic drive gear. Interaction torques are computed on
each joint from the information that comes from the strain gauges placed on the
exoskeleton. Additionally, 6 potentiometers (one on each joint) are used to calculate
the angular position of the joints. In order to detect the intention of movement, a
button was located on one of the crutches, in such a way that does not affect the
position of the subject when performing the tasks. The experimenter triggered the
exoskeletons transitions by using a mobile phone application that communicates
via Bluetooth with the controller [3]. Data from the sensors are sampled at a 100 Hz
rate, and synchronized with the signals of the 2 trigger signals: the one from the
button and the other one from the mobile application, controlled by the subject and
by the experimenter, respectively. Predened trajectories, obtained from healthy
subjects, were used as the desired gait pattern for the sit-to-stand, walking and
stand-to-sit movements.
Detection of Subjects Intention to Trigger Transitions
2.2
251
Protocol
After wearing the exoskeleton, ve healthy male subjects (average age 30 6.4
years) were instructed to perform the following sequence of transitions with the aid
of two crutches, beginning seated on a chair: stand up, start to walk, stop and sit
down again. Subjects were asked to push the button right at the moment that they
attempt to perform such a transition; namely, try to stand up when they are seated,
try to start to walk when they are standing and try to sit down when they have
nished to walk. 1 s after the subjects pushed the button to show their intention to
move, the experimenter triggered the desired transition of the exoskeleton by
pressing the corresponding button of the mobile application. Each subject repeated
the aforementioned sequence of transitions 4 times.
2.3
Classier
From the experiment described in the previous section, we obtained, for each of the
3 transitions (sit-to-stand, stand-to-walk and stand-to-sit), 4 windows of one-second
of length with sensors data of the subjects intention to trigger such transitions. Note
that walk-to-stand transition is out of the scope of this study because the
exoskeleton was congured to perform a predened number of steps and then to
stop, therefore the stopping is not controlled by the subject.
A classier was developed with the objective of distinguishing between rest
period (when the subject stays in the same position) and transition period (when the
subject wants to perform a transition). Three features were selected to this end: right
knee torque, left knee torque and right hip torque. Rest period was considered
between 2 and 1 s (where 0 is considered the beginning of the movement
attempt). Transition period was considered between 0 and 1 s. Features for both
periods were calculated as the difference of the absolute values of the average of the
torque in the corresponding 1 s window and in the immediately prior window,
according to the following formulas:
Ftransition
Frest
1s
0s
1 X
1 X
jTtj
jTtj
100 t0s
100 t1s
1s
2s
1 X
1 X
jTtj
jTtj
100 t2s
100 t3s
Note that T is the torque and 1 s represents 100 samples.

A different LDA classier was trained and tested for each transition. The classier for each subject (S1, for example) was always trained with data of the other 4
252
Table 1 Accuracy of
classication for 5 healthy
subjects
F. Trincado-Alonso et al.
Transition
Accuracy (%)
Sit to stand
Stand to walk
Stand to sit
91.11 %
72.5 %
70 %
subjects (S2, S3, S4 and S5) and tested with his own data (S1). Then, using a 4th
order cross-validation method, the average accuracy was computed for each
transition.
3 Results
The classier has been tested offline in 5 healthy subjects, obtaining an average
accuracy of 91.11 % for the sit-to-stand transition, 72.5 % for the stand-to-walk
transition and 70 % for the stand-to-sit transition (Table 1). Interestingly, the
classier for each subject has been trained only with data of the other 4 subjects.
4 Discussion
Improving the interaction between the subject and the exoskeleton is essential for
the success of these devices in rehabilitation. Users should control these systems in
a natural way, as similar as possible to the normal gait. A correct detection and
interpretation of the users intention of movement is crucial to this end. A previous
work correctly detected and classied (90 % of accuracy) different phases of gait
and stand with an exoskeleton, using information from inertial sensors [4]. Another
study used joint position, velocity and ground reaction forces to the same end,
discriminating between 5 states: sit, stand, walking, sit-to-stand and stand-to-sit,
obtaining an accuracy over 90 % in all cases [5]. The main contribution of our work
with respect to the previous ones is that we developed a classier for each subject
using information from other subjects, whereas in the aforementioned studies a
classier was tailored to a single subject. The use of a common classier for every
subject allows minimizing the preparation time, which is a crucial matter in a
rehabilitation procedure. Moreover, the correct detection of the subjects intention
enables a more natural way of controlling lower limb exoskeletons, which could
facilitates the effectiveness for rehabilitative purposes. Besides, our work shows that
3 features could be sufcient to obtain a classier with an acceptable accuracy and,
at the same time, with a low computational load, which is important to get fast
decision times. In the same direction, each classier was trained to discriminate
between rest and movement intention for each transition, but not between the 3
different movement intentions (sit to stand, walk and stand to sit). In the future
online validation, the classier will be complemented with a state machine, to apply
Detection of Subjects Intention to Trigger Transitions
253
for each transition the corresponding classier, thus minimizing the computational
load. Further analyses will be needed to validate the application to patients, which is
the nal goal of this development, since the interaction torques could be different
than the ones of the healthy subjects.
5 Conclusions
This work shows that it is possible to determine a common pattern of subjects
intention of moving an exoskeleton, although further analysis will be required to
validate online these preliminary results.
References
1. Del-Ama, A.J., Gil-Agudo, A., Pons, J.L., Moreno, J.C.: Hybrid gait training with an
overground robot for people with incomplete spinal cord injury: a pilot study. Front. Hum.
Neurosci. 8, 298 (2014)
2. Federici, S., Meloni, F., Bracalenti, M., De Filippis, M.L.: The effectiveness of powered, active
lower limb exoskeletons in neurorehabilitation: a systematic review. NeuroRehabilitation 37,
321340 (2015)
3. Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J.C., Francisco, G.E., Pons, J.L.,
ndings from a clinical study. J. Neuroeng. Rehabil. 12(1), 54 (2015)
4. Wang, M., Wu, X., Liu, D., Wang, C., Zhang, T., Wang, P.: A human motion prediction
algorithm for non-binding lower extremity exoskeleton. In: IEEE International Conference on
Information and Automation, pp. 369374 (2015)
5. Shen, B., Li, J., Bai, F., Chew, C.: Motion intent recognition for control of a lower extremity
assistive device ( LEAD), pp. 926931 (2013)
The New Generation of Compliant Actuators

for Use in Controllable Bio-Inspired
Wearable Robots
T. Bacek, M. Moltedo, J. Gonzalez-Vargas, G. Asin Prieto,
M.C. Sanchez-Villamaan, J.C. Moreno and D. Lefeber
Abstract In this paper, a conceptual design of the two iterations of compliant actuators used within BioMot project, as well as the control strategy used to operate these
actuators, is presented. The result of the presented approach are 2 exoskeleton gait
prototypes that will be used for incomplete spinal cord injury (iSCI) patients gait
rehabilitation.
1 Introduction
Human locomotion is a product of a complex interplay between the neural and the
musculoskeletal systems. One of the outcomes of this interplay is the flexibility of
the real-time human adaptability when confronted with both task and environmental
constraints. However, despite their indisputable benefits, wearable robots (WRs) are
T. Bacek (B) M. Moltedo D. Lefeber
Department of Mechanical Engineering,
R&MM Research Group, Vrije Universiteit Brussel (VUB), 1050 Brussel, Belgium
e-mail: tomislav.bacek@vub.ac.be
M. Moltedo
e-mail: marta.moltedo@vub.ac.be
D. Lefeber
e-mail: dirk.lefeber@vub.ac.be
J. Gonzalez-Vargas G.A. Prieto M.C. Sanchez-Villamaan J.C. Moreno
Bioengineering Group, Consejo Superior de Investigaciones Cientficas (CSIC),
28500 Madrid, Spain
e-mail: je.gonzalez@csic.es
G.A. Prieto
M.C. Sanchez-Villamaan
e-mail: mcarmen.sanchez@csic.es
J.C. Moreno
e-mail: jc.moreno@csic.es
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presenting constraints for human wearers due to the lack of a proper human-robot
(HR) interface and robots versatility.
The main goal of the BioMot project [1] is to explore and to exploit dynamic
sensory-motor interplays to achieve seamless interaction and safe locomotion adjusted
to the users intentions and capabilities. A milestone in the process of moving
WRs into an unconstrained daily life environment is to develop and incorporate an
adjustable compliance that adapts the human body to the desired dynamic motions.
Compliance, important in human locomotion [2], has several advantages over stiff
actuation. These include energy efficiency, shock tolerance, ability to explore natural
dynamics and safety. Despite the benefits of the pneumatic muscles and Series Elastic
Actuators, it was by introducing the Variable Impedance Actuators (VIAs) that the
embodiment of the characteristics found in biological systems became possible in
the new generation mechatronic systems.
Within the BioMot project, MACCEPA [3] is used due to its simplicity, compactness and favourable output characteristic. Apart from this series elasticity principle,
parallel elasticity principle is also exploited in the BioMot actuator design, leading to a further energy savings while not compromising versatility, flexibility and
adaptability of the exoskeleton device.
However, passive compliance itself is not sufficient to ensure safe actuation and
it should be complemented by the appropriate low and high level control strategies.
Hence, this paper presents conceptual design of the two iterations of VIAs used
within BioMot project and the actuators accompanying low-level control strategies.
2 Compliant Actuation in WRs for Gait

A. Series elasticity
MACCEPA is a torque-controlled, variable stiffness actuator that works as a torsion spring that allows independent control of equilibrium position and joint stiffness. It has been recently used to build a modular compliant actuator successfully
employed for powering all the joints of a sit-to-stance exoskeleton [4]. In order to
improve the performance of these actuators, which suffered several drawbacks, first
BioMot exoskeleton prototype introduced a highly efficient spindle-driven MACCEPA, leading to a better distribution of the actuators inertia and a more compact
design.
The conceptual design of the actuators in all the joints of the first BioMot exoskeleton is the same (see Fig. 1), but due to different kinematic/kinetic requirements, their
realization is different. The knee actuator exploits knee gait kinematics/kinetics by
employing a spring working in parallel to the joint (see next section). The shape of
the actuators is guided by an anthropomorphic design approach, leading to a revolute
joint-actuators providing a torque in the sagittal plane. All the actuators can provide
the same peak torque equal to 25Nm. This value comes from a capability gap analysis
conducted within the BioMot project (the capability gap is the difference between
the torque provided by a healthy subject and the one provided by an impaired one).
The New Generation of Compliant Actuators for Use in Controllable Bio-Inspired
257
Although MACCEPA can change spring pre-compression online by using a second motor, only the equilibrium position motor is implemented in the BioMot actuators due to a wearability requirement. The pre-compression can be changed manually
by means of a screw and a clamped Kevlar strap.
The second BioMot exoskeleton is a multidimensional upgrade of the first version.
Being built for assisting gait, the first exoskeletons actuators have a limited ROM for
e.g. sit-to-stand, which is thus increased in the second prototype. By putting the spring
inside the lever arm, an important novelty, the actuators are made smaller and more
compact, leading to an improved wearability and human-robot synergy [5]. Further
decrease in weight is obtained by performing a Finite Element Method analysis to
remove the unnecessary material while preserving actuators structural integrity.
Being more compact, the new actuators are flipped at the ankle and the knee
joint (e.g. Link1, Fig. 1, is now aligned with the thigh and Link2 with the shank; the
opposite is true in the first actuator iteration), leading to a bigger variability in the
exoskeleton size. The second iteration of the actuators is also able to provide 50Nm
peak at all the joints, which is achieved by a stronger actuator structure, higher gear
ratio and a Dyneema rope. Spring pre-compression is now easily changeable by
means of a worm gear and a simple key.
B. Parallel elasticity
During gait, kinematics and kinetics of the knee joint is such that two clearly different
gait phases can be observed: stiff weight-acceptance phase and compliant swing
phase [6]. In order to mimic this behaviour more accurately, and to exploit passive
energy storing and releasing of the former phase, the spring is added in parallel to
the knee joint (Fig. 1) and its existing series elasticity actuation (MACCEPA). This
spring, which is a part of an energy efficient quasi-passive on/off mechanism, will
be controlled using a feedback position control based on a current gait phase.
Fig. 1 Schematic design of the spindle-driven MACCEPA of the first (red spring only) and the
second (blue spring only) BioMot exoskeleton. The main difference is in the placement of the
MACCEPA spring. The spring in parallel (in green) is implemented only in the knee actuator.
Torque of the actuator depends on its geometry, spring pre-compression and torque angle . Detailed
description of the MACCEPA parameters can be found in [6]
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3 Control Strategy
The control strategy proposed for the BioMot exoskeleton aims at exploiting the
energy storage and compliance properties of the MACCEPA. For example, at the
ankle joint the state machine (SM) depicted in Fig. 2 is being used, which aims
at increasing the power during the push-off phase of the gait, while keeping to a
minimum the HR interaction during the rest of the gait. Hence, the way the motor
is actuated changes between three states separated by the specific events of the gait.
The first state (swing phase) maintains the interaction torque between the patient and
the actuator as close as possible to zero using a zero-impedance control strategy.
The second state (dorsiflexion) is triggered by the heel-strike event. In this state,
the energy is stored into the spring by a natural forward shank motion. If the patients
forward movement is not sufficient to generate enough of force to compress the spring
(i.e. store the energy), a zero-impedance control as described earlier is used.
The third state (push-off) is triggered by an event that marks the start of the
heel rise. The vertical ground reaction force profile during walking exhibits two
noticeable peaks. The local minimum between these two peaks corresponds to the
heel rise event [7]. At this point, the control changes to a feedforward strategy that
introduces extra energy to the push-off movement. The main advantage of using this
strategy with the MACCEPA is the simultaneous contribution of the energy stored
in the dorsiflexion and motor activation, thus improving the efficiency of the energy
transfer. Once the toe-off is detected (i.e. the swing phase starts), the state machine
goes back to the zero-impedance control.
Fig. 2 SM and control strategies proposed for the BioMot ankle actuator. S1:The minimized interaction torque is approximated by measuring the torque angle , which is used as a feedback in a
PID-based controller; S2:A PID-based position control keeps the lever arm position fixed, thus storing the energy into the spring. Fixed position depends on the patients capabilities; S3:The energy
from the motor is a result of a fixed step of a current to the motor. Motor current also depends on
the patients needs
The New Generation of Compliant Actuators for Use in Controllable Bio-Inspired
259
4 Conclusion
Two design approaches of the BioMot exoskeleton that takes advantages of the
MACCEPA concept have been shown. Furthermore, the control used at the ankle
joint is presented as an example of the control strategies that are being used for this
exoskeleton. Tests with able subjects, as well as iSCI patients are currently being
carried out to test the mechanical design and the control strategies.
Acknowledgments This work is supported by the ECs 7th Framework Program as part of the
project BioMot (Grant Agreement number IFP7-ICT-2013-10-611695).
References
1. BioMot Project: Smart Wearable Robots with Bioinspired Sensory-Motor Skills. http://www.
biomotproject.eu
2. Alexander, R.: Three uses of springs in legged locomotion. Int. J. Robot. Res. (Special Issue on
Legged Locomotion) 9(2), 5361 (1990)
3. Van Ham, R., et al.: MACCEPA, the mechanically adjustable compliance and controllable equilibrium position actuator: design and implementation in a biped robot. Robot. Auton. Syst.
55(10), 761768 (2007)
4. Junius, K., et al.: Mechatronic design of a sit-to-stance exoskeleton. In: 5th IEEE RAS & EMBS
International Conference on Biomedical Robotics and Biomechatronics, Sao Paulo, Brazil, pp.
945950 (2014)
5. Moltedo, M., et al.: Mechanical design of a lightweight compliant and adaptable active ankle foot
orthosis. In: 6th IEEE International Conference on Biomedical Robotics and Biomechatronics
2016, submitted for publication
6. Bacek, T., et.al.: Conceptual design of a novel variable stiffness actuator for use in lower limb
exoskeletons. In: IEEE International Conference on Rehabilitation Robotics, Singapore, pp.
583588 (2015)
7. Perry, J., Burnfield, J.M.: Gait analysis: normal and pathological function. J. Sports Sci. Med.
9(2), 353 (2010)
An EMG-informed Model to Evaluate

Assistance of the Biomot Compliant
Ankle Actuator
Elena Ceseracciu, Luca Tagliapietra, Juan C. Moreno, Guillermo Asin,
Antonio J. del-Ama, Soraya Prez, Elisa Piuela, ngel Gil and
Monica Reggiani
Abstract A main concern that rises when developing active orthoses is how to
actively engage the users and monitor how they are affected by the devices. Through
EMG-informed neuromusculoskeletal modeling, it is possible to estimate users muscle contributions to joint moments generation. We present preliminary results about
the application of such models to a subject wearing the BioMot ankle actuator.
1 Introduction
The successful development of novel wearable robotic devices for physical assistance
of human locomotion requires that they be treated not as independent devices, but
as actors in an ecosystem [1], where the environment and especially the user play
crucial roles. One of the solutions adopted in the BioMot project is to sense users
intention and estimate their contribution to motion generation through the use of
electromyography(EMG)-informed models. In the present work, the applicability of
these models and related technology to the BioMot Ankle Actuator device has been
investigated on a healthy subject during treadmill walking.
E. Ceseracciu L. Tagliapietra M. Reggiani (B)

Department of Management and Engineering, University of Padua, Vicenza, Italy
e-mail: monica.reggiani@gmail.com
E. Ceseracciu
e-mail: elena.ceseracciu@gmail.com
J.C. Moreno G. Asin
Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
A.J. del-Ama S. Prez E. Piuela . Gil
Biomechanics and Technical Aids Department, National Hospital for Paraplegics, Toledo, Spain
261
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A. Biomot Ankle Actuator
The BioMot Ankle Actuator (BAA) is an orthotic ankle device comprising a Mechanically Adjustable Compliance and Controllable Equilibrium Position Actuator (MACCEPA) [2]. To reduce cumbersomeness, the compliance of this actuator can only be
changed manually, thus avoiding the need for a second motor on the unit. A flat
MACCEPA design is used to better distribute the actuators inertia. Parameters and
components were determined from simulation studies, targeting a user muscle weakness of 30 %; peak torque that the actuator can provide is 25 Nm. This actuator is
compliant, modular, thus able to be used as a part of an exoskeleton or just as active
ankle-foot orthosis, and bidirectional, therefore able to assist the patients during
every phase of the gait cycle.
For the present study, the actuator was controlled in transparent mode: the controller aims at compensating the presence of the device, without interfering with
the user motion nor providing additional assistance to the user. Only the left ankle
actuator was actually controlled, but the subject also wore the left knee actuator, to
provide a measurement for the knee angle that is needed to determine the state of
biarticular muscles, and the right side actuators, to maintain a symmetric gait (Fig. 1).
B. CEINMS
Neuromusculoskeletal (NMS) models reproduce the process with which muscles
transform neural commands into movement, and can be used to estimate the forces
generated inside the human body. Through the use of surface electromyography,
we can indeed estimate the neural commands that are used as inputs for the NMS
models: the linear envelope is computed from EMG data, then normalized to maximum voluntary contraction (MVC) value for each muscle. A non linear filter is then
employed to model the muscle twitch response, obtaining activation signals that are
input to Hill-type muscle models. These consist of an active force generating component (the muscle fibers) in series with a passive one (the tendon). Parameters for
Fig. 1 User wearing the

BioMot actuators and
Cometa EMG sensors
An EMG-informed Model to Evaluate Assistance
263
the non linear filter and for the Hill-type models (most relevant are optimal fiber
length, tendon slack length, maximum isometric force) are initially estimated from
literature or measured from medical images, and then calibrated to ensure that resulting joint moments are consistent with the ones experimentally determined by means
of inverse dynamics analysis of reference motions. The NMS models we employ
are implemented through the Calibrated EMG-Informed NMS Modelling Toolbox
(CEINMS) [3], available at https://simtk.org/home/ceinms.
C. Experimental session
One male healthy subject (age 30, height 174 cm, weight 65 kg) was recruited for this
study, upon giving his informed consent. Active Codamotion (Charnwood Dynamics
Ltd., UK) markers were placed on the subject by a physiotherapist (PT), according to
Codamotions Bilateral Segmental Gait Analysis protocol. The PT also instrumented
the subjects leg with Cometa Wave Wireless EMG (2000 Hz; Cometa srl, Italy) electrodes, on the following muscles: tibialis anterior, medial and lateral gastrocnemius,
soleus, peroneus longus. Two force platforms (Kistler AG, Switzerland), placed in
the gait laboratory walkway, were used to collect ground reaction force data. A static
acquisition of the subject in a standing posture was first recorded. The subject then
performed at least 5 walking trials at self selected speed, hitting a force platform
with the instrumented leg. MVC trials were performed, to determine normalization
values for all subsequent EMG data processing.
A generic musculoskeletal model was scaled to match the subject anthropometry measured with the static acquisition. The scaled model was used to run OpenSim analyses (inverse kinematics, inverse dynamics, muscle analysis) on the walking trials. Joint moments estimated through inverse dynamics were used as target
for CEINMS model calibration. Muscle kinematics information (muscle-tendon
lengths and moment arms) instead constituted the inputs for CEINMS, together with
processed EMG data. A calibrated NMS model of the subject was thus obtained,
which was used to estimate muscle forces and joint moments generated by the user
while walking with the BAA. For the latter condition, the user performed continuous
walking on a treadmill, at slow speed for safety reasons. As for CEINMS inputs,
EMG data were acquired with the Cometa system and processed online, while joint
angles measured by the BAA encoders were assumed to be consistent with the user
joint angles. All systems and software were synchronized and connected within a
ROS framework as in [4].
3 Results
Subjects ankle moment estimated by CEINMS during the walking trial with the
BAA is shown in Fig. 2, together with ankle torque data recorded by the BAA.
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Fig. 2 Ankle moments exerted by the BAA (blue line) and by the user, as estimated by CEINMS
(red line) during a walking session on a treadmill. Dorsiflexor moment is positive, plantaflexor is
negative. Vertical lines show gait events for some of the steps (heel strike: solid lines, toe off: dashed
lines), delimiting stance (ST) and swing (SW) phases
4 Discussion
A quantitative assessment of BAA influence on user ankle moments was not possible
in the current study because of the difference in walking speed, which affects the
walking pattern of the user. For example, lower plantarflexor and dorsiflexor peaks
when the subject wears the BAA might be attributed to the reduced speed. Nonetheless, the effect of the actuator controller can be clearly seen during the swing phase,
where the dorsiflexor moment counteracts gravity, while user plantarflexor moment
occurs during stance phase. While not conclusive, these data will be used as yardstick
to evaluate the performance of the BAA when providing different assistance levels.
5 Conclusions
An EMG-informed NMS model was successfully created and employed to monitor
the state and the involvement of a healthy user wearing the BioMot Ankle Actuator.
This model will be employed to assess the influence of different control parameters
on the performance of the BAA, and possibly to integrate information on the state
of the user within a novel control strategy.
Acknowledgments This research has been supported by EU-F7 grant BioMot (project no. 611695).
An EMG-informed Model to Evaluate Assistance
265
References
1. Tucker, M.R., et al.: Control strategies for active lower extremity prosthetics and orthotics: a
review. J. NeuroEngineering Rehabil. 12(1) (2015)
2. Van Ham, R., Vanderborght, B., Van Damme, M., Verrelst, B., Lefeber, D.: MACCEPA, the
mechanically adjustable compliance and controllable equilibrium position actuator: design and
implementation in a biped robot. Robot. Auton. Syst. 55(10), 8761 (2007)
3. Pizzolato, C., et al.: CEINMS: a toolbox to investigate the influence of different neural control
solutions on the prediction of muscle excitation and joint moments during dynamic motor tasks.
J. Biomech. 48(14), 39293936 (2015)
4. Ceseracciu, E. et al.: A flexible architecture to enhance wearable robots: integration of EMGinformed models. In: International Conference on Intelligent Robots and Systems (IROS 2015)
Tacit Adaptability of a Mechanically

Adjustable Compliance and Controllable
Equilibrium Position Actuator,
a Preliminary Study
Guillermo Asn-Prieto, Shingo Shimoda, Jos Gonzlez,
M. Carmen Snchez-Villaman, Jos L. Pons and Juan C. Moreno
Abstract Current powered exoskeleton (exo) control algorithms for locomotion
assistance and rehabilitation are based on assistive, resistive and error augmentation paradigms. Within the assistive controllers family, assist-as-needed consists in
applying a corrective force proportional to the error (actual limb position versus reference pattern). Our final goal is to implement a fully adaptable control mechanism
to allow a full lower limb exo to dynamically adapt the gait pattern to each patient.
We propose to use a modified version of tacit learning algorithm in combination
with a variable stiffness actuator to explore the improvement of the adaptability in
comparison to stiff actuators. The preliminary results show that using this concept
on a compliant actuator it is possible to modulate a fixed trajectory to adapt to the
position limits that are induced by users movement capabilities.
1 Introduction
Current powered exoskeleton (exo) control algorithms for locomotion assistance and
rehabilitation are based on assistive, resistive and error augmentation paradigms.
Within the assistive controllers family, assist-as-needed (AAN) consists in applying
a corrective force proportional to the error from the actual position of the limb with
respect to a reference pattern (eg. the physiological gait) [1]. This corrective force can
be modulated to stimulate the active participation of the user to generate movement.
In the literature, AAN has been applied to the control of stiff actuation exos, which
gives certain ability to adapt to the patients movement capacity [2, 3]. Recently, AAN
has been proposed as a control strategy for exos with compliant actuators, such as in
the LOPES exo [4]. However, the adaptability of AAN depends on a manually fixed
value that specifies the magnitude of the corrective force. Therefore, it is difficult
G. Asn-Prieto (B) J. Gonzlez M. Snchez-Villaman C. Pons J. Moreno
Neural Rehabilitation Group, Spanish National Research Council, Madrid, Spain
S. Shimoda
Intelligent Behaviour Control Unit, RIKEN Brain Science Institute, Wako, Japan
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for the exo controller to automatically adapt to the changing characteristics of each
patients gait capability.
In the framework of the European Project BioMot, our goal is to obtain a behavioural flexibility that enhances the patients skill acquisition process. In previous
work we have successfully used the tacit learning (TL) algorithm to improve the
adaptability of a stiff actuated exo [5]. However, due to the rigidity of the exo, this
adaptation was limited. Therefore, in this study, we modified the TL algorithm to
use it with a variable stiffness actuator (VSA). We called this modification of the
algorithm tacit adaptability (TA) since it allows an automatic adaptation of the exo
control in real time. We implemented and tested the control strategy with the knee
joint of an exo, using a position controller, with the aim of demonstrating that the
approach could be moved to a real rehabilitative scenario. Thus, the exo would exert
a fixed gait pattern that could be automatically adapted.

A. Variable Stiffness Actuator
The actuator we used is based on the intrinsically compliant MACCEPA (mechanically adjustable compliance and controllable equilibrium position actuator) concept [8]. It is based on a compliant torque-controlled rotational actuator with
adjustable compliance.
The motor is connected rigidly to the lever arm (LA), which is connected to the
fixed link (FL) with a spring, as shown in Fig. 1. LA and FL move with respect to
the output link (OL). We have used the actuator of the knee, so in a real scenario OL
should be attached to the upper leg, while FL should be attached to the shank. In this
way, if the motor is set to a specific position, the user is still able to rotate the knee
by compressing the spring. This allows to approximate the interaction force between
the user and the actuator by measuring the resulting length of the spring ( angle).
Fig. 1 Model and real MACCEPA actuator. Lever arm is rigidly moved by the motor, while fixed
link should be attached to the limb of the user. A spring (K) attaches LA to FL. The spring compression is proportional to the interaction force
Tacit Adaptability of a Mechanically Adjustable Compliance and Controllable
269
Fig. 2 PID control scheme

integrating a TA and a
reference-tracking PID
controller. represents the
deflection between LA and
FL
B. Tacit adaptability control

TA algorithm is shown in (Fig. 2). This control strategy automatically adapts a reference trajectory to the users movement capabilities. In this way, the output of a
position PID controller is modulated by a integral gain we call TA constant (TAc).
Therefore, if the user is not able of realizing the trajectory, the output of the control
adapts proportionally to the interaction torque between the exo and the user. This
adaptation is important, since it will automatically reduce the force applied to the
user. The response time of the adaptation can be modulated by changing TAc.
C. Experimental setup
The system was powered with a 24 volts/300 watts power supply. A magnetic encoder
measures , what allows us to infer the interaction between the user and actuator
through the spring compression. An absolute optical encoder measures the angle on
the users joint. The data is acquired in a PC with a PCI CAN card, running Simulink.
We recorded 60 seconds per condition sampled at 200 Hz.
We fixed the links of the actuator to a rigid structure, and allow the motor to move
LA by compressing the spring. The goal with this setup was to explore the adaptability
of the controller to predefined reference trajectories. We propose a condition to
simulate the situation in which a user is not able to generate any limb movement.
In our setup, the actuator was limited to the horizontal plane to avoid the effects of
gravity. In this scenario, the mechanical compliance, given by the spring constant (K),
absorbs some of the force that the motor applies to the users limb. Since the limb
cannot move as it is fixed in one position, TA adjusts the reference trajectory, to further
reduce the applied force. TA controller was set to follow a 60 degrees sinusoidal
trajectory (range of motion of the knee actuator) at a frequency of 0.2 Hz. The range
for is determined by the spring stiffness. The actuator was fixed at three different
joint angles (15, 30 and 45 degrees). We collected the LA and the controller output
for 5 different TAc (0, 5, 10, 15 and 20).
3 Results
Figure 3 shows the evolution of with different values of TAc. When TAc = 0 the
behaviour is a pure PID control, thus no adaptation on LA position trend can be seen.
When the TAc takes values greater than zero, TA acts, and the sinusoidal signal is
modulated in a way that the neutral position of LA is aligned with the position of FL.
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Fig. 3 Comparison of angle amplitude for TAc values of 0, 10 and 20 during the experiment.
angle amplitude is represented with a slim line; the thick line shows the trend, calculated as the
centered moving average (3000 points window over the 12000 points signal)
4 Conclusion
The preliminary results show that using the TA concept on a compliant actuator it
is possible to modulate a fixed trajectory reference to adapt to the position limits
that are induced by users movement capabilities. We tested the control strategy in a
setting that simulates the extreme case where the user is not capable of realizing any
movement. When no TA is used, we observed that the control output results in a stiffer
behaviour of the actuator. On the other hand, a high TAc results in a more compliant
behaviour of the actuator. Thus, the adaptation is given by the compliance of the exo
as well as by TA. These results point out at the possibility to automatically adapt a
fixed reference trajectory to the movement capabilities of the user by modulating the
TAc.
5 Futute Work
We plan to extend this study to consider other input variables to the TA block, and
emulating non-extreme conditions, e.g. a study in dynamic conditions with partial
torque contribution. A study involving healthy subjects wearing the full exo and
applying this TA approach is to be designed, also exploring the approach for gait
cadence adaptability. Compare these results with other AAN-based controllers that
use trajectory references, e.g. virtual tunnel with the H2 [6] or hybrid (FES and exo)
actuation with Kinesis [7].
Acknowledgments This study has been funded by grant from the European Commission, within
the Seventh Framework Programme (IFP7-ICT-2013-10-611695: BioMot - Smart Wearable Robots
with Bioinspired Sensory-Motor Skills).
Tacit Adaptability of a Mechanically Adjustable Compliance and Controllable
271
References
1. Riener, R., Nef, T., Colombo, G.: Robot-aided neurorehabilitation of the upper extremities.
Medical and Biological Engineering and Computing, vol. 43(1), pp. 210. Springer (2015)
2. del Ama, A.J., Moreno, J.C., Gil-Agudo, ., Pons, J.L.: Hybrid FES-robot cooperative control of
ambulatory gait rehabilitation exoskeleton for spinal cord injured users. In: Converging Clinical
and Engineering Research on Neurorehabilitation, pp. 155159. Springer (2013)
3. Moreno, J.C., Collantes, I., Asn-Prieto, G., Pons, J.L.: Design of better robotic tools adapted to
stroke rehabilitation practice. World Cong. Med. Phys. Biomed. Eng. (2012)
4. Lagoda, C., Schou, A.C., Stienen, A.H.A., Hekman, E.E.G., and van der Kooij, H.: Herman:
Design of an electric series elastic actuated joint for robotic gait rehabilitation training. In: 2010
3rd IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob), pp. 2126 (2010)
5. Shimoda, S., Costa, ., Asn-Prieto, G., Okajima, S., Iez, E., Hasegawa, Y., Azorn, J.M.,
Pons, J.L., Moreno, J.C.: Joint stiffness tuning of exoskeleton robot H2 by tacit learning. In:
Symbiotic Interaction, pp. 138144. Springer
6. Bortole, M.: Design and control of a robotic exoskeleton form gait rehabilitation. Ph.D. thesis,
Carlos III University, Madrid, Spain (2013)
7. Del-Ama, A.J., Gil-Agudo, ., Pons, J.L., Moreno, J.C.: Hybrid gait training with an overground
robot for people with incomplete spinal cord injury: a pilot study. Front. Hum. Neurosci. 8,
298298 (2013)
8. Bacek, T., Unal, R., Moltedo, M., Junius, K., Cuypers, H., Vanderborght, B., Lefeber, D.: Conceptual design of a novel variable stiffness actuator for use in lower limb exoskeletons. In: IEEE
International Conference on Rehabilitation Robotics (ICORR), vol. 2015, pp. 583588 (2015)
Part X
Emerging Applications Domains of WRs,

Emerging Technologies in WRs
Design and Kinematic Analysis of the

Hanyang Exoskeleton Assistive Robot
(HEXAR) for Human Synchronized Motion
Wansoo Kim, Hojun Kim, Donghwan Lim, Hyungi Moon and Changsoo Han
Abstract The Hanyang Exoskeleton Assistive Robot (HEXAR)-CR50, which performs human synchronized gait motions to augment human power during load carrying, was designed and analyzed in this study. The HEXAR-CR50 was developed
for industrial and military purposes to carry a payload of 2030 kg while walking on
level ground and climbing stairs. For the design of the exoskeleton robot with considered the joint functions and motion, we conducted a gait analysis that was based
on biomechanics. The parameters for the design were based on the results of the gait
analysis. The designed exoskeleton consisted of one leg with seven degrees of freedom (DOF). The simulations were conducted to verify the kinematic synchronized
motion using LifeMODTM .
1 Introduction
Researchers have studied the lower extremity exoskeleton systems with the purpose of augmenting the physical capability of wearers to walk long distances or
to carry heavy objects easily. Depending on the design structure of the alignment to the rotation axis of the robot joint and the rotation axis of the human
joint, an exoskeleton may be classified as anthropomorphic, quasi-anthropomorphic,
or non-anthropomorphic [1]. For example, exoskeleton systems were developed
for power augmentation has been designed quasi-anthropomorphically to carry
heavy loads [2, 3]. The Massachusetts Institute of Technology (MIT) designed an
W. Kim
Human-Robot Interfaces and Physical Interaction (HRI2), Istituto Italiano di Tecnologia (IIT),
Genoa, Italy
e-mail: wan-soo.kim@iit.it
H. Kim D. Lim H. Moon
Mechanical Engineering, Hanyang University, Seoul, South Korea
C. Han (B)
Department of Robot Engineering, Hanyang University ERICA, Ansan, South Korea
e-mail: cshan@hanyang.ac.kr
275
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anthropomorphic exoskeleton system with spring and variable dampers [4]. However,
walking assist device (WAD) has been designed non-anthropomorphically [5].
The purpose of this study was to design the Hanyang Exoskeleton Assistive Robot
(HEXAR)-CR50, a lower extremity exoskeleton that is used for power augmentation,
and to provide HEXAR-CR50 with human-synchronized gait motion. Therefore, the
degree of freedom (DOF) and joint types that allow for human motions and joint functions had to be considered. Simulations were conducted to verify the effectiveness
of the design for synchronized motion with a human using LifeMODTM .
2 System Requirements
This study focused on the load carrier, which performs the anti-weight function of
the load while walking on level ground. The functions of exoskeleton structure in the
stance phase is only required to support the load bearing along the gravitational axis,
which is perpendicular to the ground. For the purpose of the exoskeleton design, the
peak values were analyzed for the angle, torque, and power during human motion,
which represented the hip, knee, and ankle joints in the sagittal plane, because the vast
majority of the gait is done in the sagittal plane [6]. The peak values can be used to
select the following three elements in the design phase: (1) the range of motion (ROM)
were considered through the peak value of the joint angle; (2) the joint peak moment
were considered in selecting the actuator specifications; and (3) the joint actuating
methods were selected through the analysis of the peak power of the joint. The
exoskeletons power of the joints must be generated using the active joints. However, it
is difficult to implement all the DOF in anthropomorphic exoskeleton robots due to the
space limitations caused by structural characteristics. Thus, a quasi-anthropomorphic
architecture was selected for efficiency and for synchronized motion to achieve the
load carrying goal. Our previous study provided more details about the design concept
of the HEXAR-CR50 [7].
3 Mechanical Design of HEXAR-CR50

The HEXAR-CR50 has seven DOF per leg: three for the hip motions, one for the
knee motions, and three for the ankle motions (Fig. 1). The active mechanism is
applied to the hip and knee joints for extension/flexion movements; the ankle and
other side-joint modules use a quasi-passive mechanism.
The active mechanism uses a flat brush-less direct current motor (BLDC) motor,
which can produce extension/flexion motions in the sagittal plane, with a Harmonic Drive. The specifications of the electrical BLDC motors and the harmonic
gear that were selected using biomechanical data. We used a 207 W BLDC motor
(Kollmorgen ) with a 100:1 gear ratio (Harmonic Drive LLC). The quasi-passive
mechanism that can generates a force by applying spring elements; it is applied to the
Design and Kinematic Analysis of the Hanyang Exoskeleton Assistive Robot
277
Fig. 1 The active,

quasi-passive, and passive
joint arrangement of the
HEXAR-CR50 showing the
ROM.
dorsi-plantarflexion motion of the ankle joint to compensate for the torque generated
in the stance phase and to generate a propulsion force in the toe-off phase. Consequently, the spring constant was determined to be 69.6 N/mm, which resulted from
the conversion of the results of the gait analysis to the weight of the exoskeleton [7].
4 Kinematic Simulation with Walking Motions

Simulations were conducted to verify the efficiency of the HEXAR-CR50 design in
terms of joint arrangement, ROM, and shape. Two assumptions were considered in
order to analyze the coordinated motions between the human and the exoskeleton
in the simulations. The first assumption was that the contact locations between the
human and exoskeleton were the torso, thigh, and foot. The second assumption was
that the exoskeleton motions were synchronized completely with the human motions
through the wearer. Utilizing LifeMOD software, we also constructed simulation
environments to check the human and exoskeleton motions. To verify the ROM and
the arrangement of exoskeleton joints attached to the human, the normal gait cycle
by the human and the exoskeleton were compared in a 3D spaces. Because, normal
gait cycles are represented well in our target motion. Based on the torso link, the
human and exoskeleton trajectories of each joints were represented in the frontal,
transversal, and sagittal planes to compare their motion ranges. Similar trajectories
indicated that the designed exoskeleton could be imitated the human motions well.
In the sagittal plane, since the hip and knee joints of the exoskeleton had the same
axis as the human joints, no significant difference was shown during the operation.
However, in the case of the ankle joint, the dorsi/plantarflexion joint was designed to
be close to the ground to represent the ROM, as shown in Fig. 2a. Figure 2b shows the
motions in the frontal plane. As the figure shows, the joint trajectories of the human
and the exoskeleton were expressed as offsets because the exoskeleton was attached
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Fig. 2 The trajectories were

generated by the all the
joints, which as human and
exoskeleton, that moved
according to the training
through LifeMOD
(a)
(b)
(c)
externally, although it was verified that the motion patterns were similar. Figure 2c
shows in the transversal plane, in which the motions in the trajectories were expressed
with offsets. In particular, the results shown in this Fig. 2c verified that the motions in
the internal/external rotation mechanism of the hip joint represented human motions
very well. According to the simulation results, also implemented human motion well.
5 Conclusion
Through this study, a lower-extremity exoskeleton called HEXAR-CR50 was
designed for power augmentation during load carrying. The design specifications
of the exoskeleton were based on the results from biomechanical considerations and
gait analysis. Based on the these specifications, we have selected the ROM, joint
types, and arrangement of the exoskeleton for design procedure. In the design, each
leg had seven-DOF and was configured with a combination of active, passive and
quasi-passive joints. The designed exoskeleton was verified the design efficiency with
respect to the ROM, DOF and structure layout, through the LifeMOD simulations.
Design and Kinematic Analysis of the Hanyang Exoskeleton Assistive Robot
279
Acknowledgments This work was supported by the National Research Foundation of Korea (NRF)
grant funded by the Korea government(MSIP) (No.NRF-2015R1A2A2A01002887)
References
1. Lee, H., Kim, W., Han, J., Han, C.: The technical trend of the exoskeleton robot system for
human power assistance. Int. J. Precis. Eng. Manuf. 13(8), 14911497 (2012)
2. Kazerooni, H., Steger, R.: The Berkeley lower extremity exoskeleton. J. Dyn. Syst. Meas. Control
128(1), 14 (2006)
3. Bogue, R.: Exoskeletons and robotic prosthetics: a review of recent developments. Ind. Robot.
Int. J. 36(5), 421427 (2009)
4. Walsh, C.J., Endo, K., Herr, H.: A quasi-passive leg exoskeleton for load-carrying augmentation.
Int. J. Humanoid Robot. 4(3), 487506 (2007)
5. Ikeuchi, Y., Ashihara, J., Hiki, Y., Kudoh, H., Noda, T.: Walking assist device with bodyweight
support system. In: IEEE/RSJ International Conference on Intelligent Robots and Systems, IROS
2009, pp. 40734079. IEEE (2009)
6. Palmer, M.L.: Sagittal plane characterization of normal human ankle function across a range of
walking gait speeds. Masters thesis, Massachusetts Institute of Technology (2002)
7. Kim, W., Lee, H., Kim, D., Han, J., Han, C.L.: Mechanical design of the Hanyang Exoskeleton
Assistive Robot (HEXAR). In: International Conference on Control, Automation, and Systems
(ICCAS 2014), pp. 479484 (2014)
Design and Experimental Evaluation

of a Low-Cost Robotic Orthosis
for Gait Assistance in Subjects
with Spinal Cord Injury
Josep M. Font-Llagunes, Daniel Clos, Urbano Lugrs,
F. Javier Alonso and Javier Cuadrado
Abstract Robotic gait training after spinal cord injury (SCI) is of high priority to
maximize independence and improve the living conditions of these patients.
Current rehabilitation robots are expensive and heavy, and are generally found only
in the clinic. To overcome these issues, we present the design of a low-cost,
low-weight robotic orthosis for subjects with SCI. The paper also presents a preliminary experimental evaluation of the assistive device on a subject with SCI.
Results show that gait velocity, stride length and cadence of walking increased
(24.11, 7.41 and 15.56 %, respectively) when wearing active orthoses compared to
the case with standard passive orthoses.
1 Introduction
SPINAL cord injury (SCI) is prevalent in society. Worldwide each year more than
250.000 individuals suffer SCI [1]. Walking impairment after injury leads to a
decreased quality of life and other serious health conditions, and carries substantial
health care costs. Locomotor rehabilitation is reported as a high priority issue for
subjects with SCI independent of severity, time after injury, and age [2].
This work has been supported by the Spanish Ministry of Economy and Competitiveness under
the project DPI2015-65959-C3-2-R, co-funded by the European Union through ERDF funds.
J.M. Font-Llagunes (&) D. Clos
Department of Mechanical Engineering and Biomedical Engineering Research Centre
of the Technical University of Catalonia, Barcelona, Spain
e-mail: josep.m.font@upc.edu
U. Lugrs J. Cuadrado
Laboratory of Mechanical Engineering of the University of La Corua, Barcelona, Spain
F.J. Alonso
Department of Mechanical Energetics and Materials Engineering
of the University of Extremadura, Barcelona, Spain
281
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Current gait rehabilitation robots are machines that support the patients weight
and train the walking motion over a treadmill or feet supports; or lower limb
exoskeletons that assist over-ground walking. These robots are generally heavy and
expensive, and are only found in the clinic because skilled personnel have to
manually t the robot to the patient and operate it. Moreover, they are adapted to
the patient before the treatment, increasing time and health care costs; and, in
general, they impose a motion pattern rather than complementing patients
capabilities.
With the aim of overcoming these limitations, this work presents the design,
control and experimental evaluation of a low-cost, low-weight and simple robotic
orthosis for gait assistance in subjects with SCI. The prototype is intended for
patients that can control hip flexion/extension to a certain extent, but lack control of
knee and ankle muscles. The design is based on the current passive knee-ankle-foot
orthoses that these patients use after rehabilitation. The latter include a knee locking
system, which is essential to bear the patients weight during stance due to the lack
of quadriceps force; and a compliant system that applies a dorsiflexion torque at the
ankle to avoid drop-foot gait (klenzak joint).
The robotic orthosis presented here improves the passive devices by adding a
motor at the knee, that can move or lock the joint, and an inertial measurement unit
(IMU) at the shank to detect gait events. The aim of this work is two-fold: rst, we
present the design of the robotic orthosis; and second, we perform a preliminary
experimental evaluation on a subject with SCI. In this case study, the kinematics of
walking with passive orthoses is compared with that obtained with the robotic
device.
2 Robotic Orthosis Design

The proposed lower limb orthosis has two degrees of freedom. The knee joint is
powered by an electrical motor in series with a Harmonic Drive gearbox. The ankle
is passively actuated by a mechanism that applies the mentioned dorsiflexion torque
(klenzak joint). A preliminary design of the orthosis was reported in [3].
The current device weights 2.7 kg per leg, along with a 1.7 kg backpack containing a BeagleBone Black board, the motor drivers and the battery. The bilateral
thigh and shank uprights are articulated at the knee, using a standard hinge joint at
the medial side and the motor-gearbox set at the lateral side. A footplate with a shoe
is hinged to the shank uprights by the compliant klenzak joint, which allows an
ankle range of motion between 0 and 20 (dorsiflexion). The orthosis structure is
specically tailored to the patient to avoid adapting the same design to the wide
range of morphologies found among subjects with SCI. Figure 1a shows the right
robotic orthosis with the elements described later.
Design and Experimental Evaluation of a Low-Cost Robotic
283
Fig. 1 Robotic orthosis design: a general view showing the knee actuation system and the IMU;
b CAD design of the actuation system
2.1
Knee Actuation System
The design and selection of the orthosis actuation system were based on kinematic
and kinetic data of the knee joint during normal gait at a normal speed [4]. The most
signicant criteria for the actuation system selection were specic power (power to
weight ratio), system dimensions, and portability of the power supply system. Based
on these considerations, a 70 W brushless DC motor (Maxon Motor, Sachseln,
Switzerland) was selected, which has a nominal voltage of 24 V and a nominal
torque of 128 mNm. A Harmonic Drive gearbox (Harmonic Drive, LimburgLahn, Germany) is coupled to the motor to increase torque and reduce velocity,
which offers a large gear ratio with a reduced space (Fig. 1b). The selected gear ratio
of 160:1 allows a continuous net torque at the knee of 20.5 Nm and peak torques of
60 Nm according to the driver current limit.
2.2
Sensors and Control
All the sensors are placed on the orthosis mechanical structure in order to avoid
issues related to safety, comfort, reliability and donning/dofng process. The sensors used are one IMU and one angular encoder per orthosis. The low-cost 9-DOF
IMU (SparkFun Electronics, Niwot, USA) is attached to the shank upright; and
incorporates a triple-axis gyro, a triple-axis accelerometer and a triple-axis magnetometer. The orientation and acceleration measurements are sent to the
BeagleBone board through a serial interface. The angular encoder is coupled to the
knee motor.
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The control algorithm uses both IMUs measurements to detect the

stance-to-swing transition within the gait cycle. During stance, the knee is fully
extended and the motor acts as a brake. When the stance-to-swing transition is
detected, based on vertical acceleration and pitch angle of both shanks, the knee
motor launches a xed flexion-extension cycle using a PID position controller with
feedforward. This cycle is personalized to the subject in terms of duration, shape
and maximum flexion angle.
3 Experimental Evaluation
The subject was an adult female 41 years old, mass 65 kg and height 1.52 m; with
SCI at T11. In the rst experiment, she walked with her usual pair of passive
knee-ankle-foot orthoses with the help of two parallel bars. Then, the subject carried
out 6 one-hour training sessions wearing the active orthoses and did some specic
exercises at home to facilitate adaptation. After this period, a second experiment
walking with the active orthoses, also with the help of parallel bars, was performed
(Fig. 2a).
In order to compare the walking kinematics in the two experiments, 4 consecutive gait cycles were captured each time by 6 optical infrared cameras (Natural
Point, Corvallis, USA) that measured the position of 37 optical markers. Then, a
computational 3D skeletal model with 18 anatomical segments and 57 degrees of
freedom was used to determine the kinematic characteristics of the subjects gait
(Fig. 2b).
Table 1 shows kinematic descriptors for one gait cycle during the rst experiment and another gait cycle during the second experiment. Gait velocity, stride
length and cadence of walking increased (24.11, 7.41 and 15.56 %, respectively)
Fig. 2 Gait of spinal cord injured subject assisted by active orthoses and parallel bars: a acquired
motion; b computational model
Design and Experimental Evaluation of a Low-Cost Robotic

Table 1 Kinematic data with
passive and active orthoses
Gait velocity (m/s)
Stride length (m)
Cadence
(step/min)
COM lat. displ.
(cm)
285
Ex.1:
passive
Ex.2:
active
%
change
0.17
0.53
38.46
0.21
0.57
44.44
+24.11
+7.41
+15.56
7.89
6.37
19.31
when wearing active orthoses compared to the case with passive orthoses.
Furthermore, the lateral displacement of the subjects centre of mass
(COM) decreased in 19.31 % when the subject walked with active orthoses.
4 Conclusion
This paper presents the design and control of a patient-tailored low-cost
knee-ankle-foot robotic orthosis for subjects with SCI. This orthosis is equipped
with a compact knee actuation system and an IMU at the shank to detect gait events.
Preliminary experimental evaluation of this assistive device on a subject with SCI
shows that the subject walked faster, and in a more natural and stable way when
wearing the designed active orthoses. While the experiments provided promising
results, more tests with a larger sample of subjects are needed in order to conrm
the improvements when walking with the designed orthosis.
References
1. Bickenbach, J., Bodine, C., Brown, D., Burns, A., Campbell, R., Cardenas, D., et al.:
International Perspectives on Spinal Cord Injury. World Health Organization (WHO), Geneva
(2013)
2. Ditunno, P.L., Patrick, M., Stineman, M., Ditunno, J.F.: Who wants to walk? Preferences for
recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord 46(7), 500506
(2008)
3. Font-Llagunes, J.M., Lugrs, U., Romero, F., Clos, D., Alonso, F.J., Cuadrado, J.: Design of a
patient-tailored active knee-ankle-foot orthosis to assist the gait of spinal cord injured subjects.
In: Proceedings of the International Workshop on Wearable Robotics, Baiona, Spain, 2014,
paper 54
4. Bovi, G., Rabuffetti, M., Mazzoleni, P., Ferrarin, M.: A multiple-task gait analysis approach:
kinematic, kinetic and EMG reference data for healthy young and adult subjects. Gait Posture
33(1), 613 (2011)
A Powered Low-Back Exoskeleton

for Industrial Handling: Considerations
on Controls
Stefano Toxiri, Jess Ortiz, Jawad Masood, Jorge Fernndez,
Luis A. Mateos and Darwin G. Caldwell
Abstract A powered low-back exoskeleton is being developed to support manual

material handling in industry. Controlling this device poses several challenges. At
the low-level, the actuation units need to be capable of large torque outputs as well
as transparent interaction. At the high-level, the exoskeleton needs to modulate its
assistance based on information acquired from the environment and the wearer,
so as to maximise its beneficial effect. These challenges have great relevance to
industrial applications, where complexity, cost and invasiveness are key to successful
deployment. In describing the current progress in the development of the exoskeleton,
an attempt is made to highlight and discuss these challenges and possible technical
solutions.
1 Introduction
In industrial manufacturing processes, manual material handling is one of the most
frequent operations. There has been increasing interest in researching the use of
wearable assistive devices to reduce the risk of resulting musculoskeletal disorders.
S. Toxiri (B) J. Ortiz J. Masood J. Fernndez L.A. Mateos D.G. Caldwell
Advanced Robotics Department, Istituto Italiano di Tecnologia,
Via Morego, 30, 16163 Genoa, Italy
e-mail: stefano.toxiri@iit.it
J. Ortiz
J. Masood
e-mail: jawad.masood@iit.it
J. Fernndez
e-mail: jorge.fernandez@iit.it
L.A. Mateos
e-mail: luis.mateos@iit.it
D.G. Caldwell
e-mail: darwin.caldwell@iit.it
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The review presented in [1] summarises existing industry-oriented devices and points
at evidence of reduced resulting physical loads on wearers. In [2], we further supported the proposition that the spinal loads are reduced.
Building upon previous experience, we report here the progress towards the development of a wearable powered low-back exoskeleton aimed at reducing spinal loads
during manual material handling (as part of the Robo-Mate consortium [3]). The
present manuscript offers a brief description of the current prototype. The focus is
on the controls of wearable robots, and the description is complemented with general
considerations relevant to the issues we encountered while developing our prototype.
In the following sections, we discuss two aspects separately: the low-level control of
the actuators and the high-level assistive strategy.
2 Low-Back Exoskeleton
As anticipated, the goal is to reduce the spinal loads during manual material handling.
Biomechanically, the compression on the lumbar spine is considered as a key risk
factor for musculoskeletal injuries. In this respect, we envisioned a wearable device
that would reduce the lumbar compression by reducing the need for muscular activity
in the spine [2]. Requirements were extracted using a simple biomechanical model
combined with human motion data. In order to provide substantial assistance, we
therefore aim at applying torques on the upper body of around 100 Nm on the
sagittal plane.
As shown in Fig. 1, our prototype exoskeleton spans the lower back and upper
legs and its weight rests mainly on the waist. The actuator torques are transferred to
the wearer as assistive forces applied onto thighs and torso. The two actuation units
Fig. 1 User wearing the prototype. Different postures of a typical handling task are shown
A Powered Low-Back Exoskeleton for Industrial Handling
289
are approximately aligned with the hip on both sides. A set of passive joints is aimed
at allowing unhindered movements outside the sagittal plane.
3 Low-Level: Actuator Control

A highly desirable feature of powered joints in wearable robots is transparent physical
interaction. It can be explained as the device not hindering the wearers movement
unless required, and finds important applications in motor rehabilitation as well as
power augmentation.
Some important considerations concerning the implementation of said transparent interaction are necessary. Reduction gears are often employed when relatively
high torques are required, allowing the use of small and lightweight motors. However, this comes at a cost: achievable speeds are reduced, and output friction and
inertia are greatly amplified. The result is a sacrificed control bandwidth, which may
significantly limit performances when dealing with dynamic tasks. Force/torque sensors only partially mitigate the above restrictions, as they increase weight, cost and
complexity [4]. Hence the motivation to research sensorless solutions, such as those
proposed in [5] and [6]. In this respect, we are currently working towards a formal comparison of sensor-based versus sensorless methods to control our prototype
actuation units.
With reference to the restrictions introduced above, our prototype actuation units
present limiting dynamic properties. Each unit includes a flat brushless DC motor
(Maxon EC90) and a 160:1 HarmonicDrive. The motors are current-controlled via a
commercial control board (Maxon ESCON). Unsurprisingly, the units exhibit very
large output friction and inertia, which made for poor performances in transparent
interaction in current-control mode. This led to the inclusion of a joint torque sensor,
that allows far more accurate control of the torque output. As a result, the exoskeleton
is capable of providing over 120 Nm total continuous torque with maximum speeds
limited to around 2 rad/s, which still barely keeps up with the human movements during handling tasks. On the one hand, we are considering alternative motor/reduction
combinations to allow for higher speeds and therefore more dynamic tasks. On the
other hand, we are looking into leaving out the joint torque-sensor while retaining
comparable torque control performance.
4 High-Level: Assistive Strategy

At the high level, a strategy is needed for the modulation of the assistance with the
aim of maximising the beneficial effect on the wearer. Extensive reviews on assistive strategies can be found in [79]. In general, one can think of indirect and direct
control as the two cases in which the assistance is modulated using information
from either the environment (e.g. ground reaction force) or the wearer (e.g. surface
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electromyography, sEMG), respectively. As considered in [7], acquiring direct volitional information from the wearer is especially important when noncyclic tasks are to
be supported, as opposed to cyclic ones such as walking. The study in [10] presents
a hybrid scheme that uses sEMG to assist the knee during sit-to-stand. However,
direct volitional information requires relatively invasive acquisition techniques that
may not be compatible with industrial settings, which probably explains the poor
diffusion of EMG-based methods outside research laboratories.
Our prototype embeds an inertial unit to measure the orientation of the upper
torso. This indirect information is used to calculate a torque reference such that the
effect of gravity acting on the wearers upper body is counteracted by the exoskeleton. Yet, no information on the weight of the external load being handled is available. We are therefore exploring the use of instrumented foot insoles to estimate
the change in ground reaction forces as the user picks up and releases objects of
different weights [11]. The weight of the external object will also be estimated via
instrumented gloves, currently being developed by ZHAW, a Robo-Mate consortium
partner [3].
5 Conclusions
This contribution highlights and discusses important technical challenges related
with controlling a wearable powered low-back exoskeleton. These challenges have
great impact to translating robotics research into industrial applications, where complexity, cost and invasiveness are key to successful deployment.
Acknowledgments The authors are grateful to the whole Robo-Mate project consortium, particularly to the team in ZHAW and their contribution to the controls.
The research leading to these results has received funding from the European Unions Seventh
Framework Programme for research, technological development and demonstration under grant
agreement n 608979, and from the People Programme (Marie Curie Actions) of the European
Unions Seventh Framework Programme FP7/2007-2013/ for research, technological development
and demonstration under REA grant agreement n 608022.
References
1. de Looze, M.P., Bosch, T., Krause, F., Stadler, K.S., OSullivan, L.W.: Exoskeletons for industrial application and their potential effects on physical work load. Ergonomics 111
2. Toxiri, S., Ortiz, J., Masood, J., Fernndez, J., Mateos, L.A., Caldwell, D.G.: A wearable
device for reducing spinal loads during lifting tasks: biomechanics and design concepts. In:
2015 IEEE International Conference on Robotics and Biomimetics (ROBIO), pp. 22952300.
IEEE (2015)
3. http://www.robo-mate.eu
4. Zanotto, D., Lenzi, T., Stegall, P., Agrawal, S.K.: Improving transparency of powered exoskeletons using force/torque sensors on the supporting cuffs. In: 2013 IEEE International Conference
on Rehabilitation Robotics (ICORR), pp. 16. IEEE (2013)
A Powered Low-Back Exoskeleton for Industrial Handling
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5. Nef, T., Lum, P.: Improving backdrivability in geared rehabilitation robots. Med. Biol. Eng.
Comput. 47(4), 441447 (2009)
6. Ugurlu, B., Nishimura, M., Hyodo, K., Kawanishi, M., Narikiyo, T.: A framework for sensorless
torque estimation and control in wearable exoskeletons. In: 2012 12th IEEE International
Workshop on Advanced Motion Control (AMC), pp. 17. IEEE (2012)
7. Tucker, M.R., Olivier, J., Pagel, A., Bleuler, H., Bouri, M., Lambercy, O., del R Milln, J.,
Riener, R., Vallery, H., Gassert, R.: Control strategies for active lower extremity prosthetics
and orthotics: a review. J. Neuroeng. Rehabil. 12(1), 1 (2015)
8. Yan, T., Cempini, M., Oddo, C.M., Vitiello, N.: Review of assistive strategies in powered
lower-limb orthoses and exoskeletons. Robot. Auton. Syst., 64, 120136 (2015)
9. Lobo-Prat, J., Kooren, P.N., Stienen, A.H., Herder, J.L., Koopman, B.F., Veltink, P.H.: Noninvasive control interfaces for intention detection in active movement-assistive devices. J. Neuroeng. Rehabil., 11(1), 1 (2015)
10. Karavas, N., Ajoudani, A., Tsagarakis, N., Saglia, J., Bicchi, A., Caldwell, D.: Tele-impedance
based assistive control for a compliant knee exoskeleton. Robot. Auton. Syst. 73, 7890 (2015)
11. Mateos, L.A., Ortiz, J., Toxiri, S., Fernndez, J., Masood, J., Caldwell, D.G.: Exoshoe: a
sensory system to measure foot pressure in industrial exoskeleton. In: 2016 IEEE International
Conference on Biomedical Robotics and Mechatronics (BioRob) (accepted for)
Efcient Lower Limb Exoskeleton

for Human Motion Assistance
Nazim Mir-Nasiri
Abstract The main advantage of the fully autonomous system is its ability to
decouple the weight/mass carrying function of the system from its forward motion
function. It makes exoskeleton more efcient by reducing its power consumption,
weight and size of the propulsion motors as well as by extending the run time of the
batteries. A human machine interface has been achieved by means of flexible
sensors to monitor subject shank and ankle movements and subjects foot pressure.
When subject stands on one leg and swings the other one the body weight is fully
supported by standing leg exoskeleton structure where the knee joint motion is fully
blocked. The join motors are small in size and consume less electrical energy from
batteries because they do not support subjects weight during the walk.
1 Introduction
During the last decade, researchers have focused on the development of lower limb
exoskeletons that are now applied to several elds, including power augmentation
for the military [1], medical assistance [2], and rehabilitation [3, 4]. In such devices
human provides control signals while the exoskeleton actuators provide required
power for performing the task. On lower extremity exoskeletons, most previous
researchers paid their attention in developing walking aid systems for gait disorder
persons or aged people [5]. One of those systems is HAL (Hybrid Assistive Leg)
developed by Yoshiyuki Sankai of University of Tsukuba was aimed at assisting
human leg muscles during walking [6]. The system was based on electromyography
(EMG) sensing of human muscles as the primary drive signals. The development
resulted in several versions of HAL with the latest HAL-5 in 2009 [7]. The
exoskeleton was motor powered on the hip and knee joints, leaving other joints
free. The Berkeley Lower Extremity Exoskeleton (BLEEX) [8] was aimed at
enhancing human strength and endurance for payload transport. The exoskeleton
N. Mir-Nasiri (&)
Nazarbayev University, Astana, Kazakhstan
e-mail: nazim.mir-nasiri@nu.edu.kz
293
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N. Mir-Nasiri
incorporates hydraulic actuation on all three sagittal joints and two coronal joints on
the hip with all others joints free. The ECUST Leg Exoskeleton Robot (ELEBOT)
designed at East China University of Science and Technology (ECUST) shares the
similar design goal as BLEEX but with a simplied system [9]. While the above
exoskeleton designs require substantial power for operation on low efciency, an
exoskeleton design at Massachusetts Institute of Technology (MIT) [10] attempted
to lower the power requirement for load carrying. The exoskeleton has only series
elastic actuation at hip sagittal joints, variable damper at the knee joints and spring
at ankle sagittal joints. Various problems remain to be solved, the most important
remains being the creation of a power and cost efcient system that will allow an
exoskeleton to operate for extended periods. Such lighter and cheaper devices are
currently important engineering research area in medicine and military [11].
2 Mechanical Design and Components

Figure 1 shows the conceptual sketch of the proposed exoskeleton structure in
Solid Works. In the gures seat 1 is there to rest subjects body and support its
weight. Each exoskeleton leg has four degrees of freedom: two at the hip 2, one at
the knee 3 and one at the ankle 4 to allow legs forward and lateral motions.
Cushioned seat 1 in between subject crotch is connected to two parallel rigid pipes
5 at the back the object. A back panel 6 mounted onto the rigid pipes serves as a
platform for control and power supply mounting. At hip level, the two parallel rigid
pipes extend out to the two hip coronal joints. The link then continues to both sides
of the hip 2 where sagittal and transverse joints are located, subsequently to the
knee joints 3 and through the ankle joints 4 to the ground. Both exoskeleton legs are
attached to subject legs using flexible cuffs 7. Single degree four-bar linkage
mechanism 8 with rotary joints at the hip level provides hip-centered lateral rotation
of the exoskeleton leg around vertical axis. The remaining three single-degree
Fig. 1 Concept of the exoskeleton structure
Efcient Lower Limb Exoskeleton for Human Motion Assistance
295
Fig. 2 Schematic diagrams

of the exoskeleton
parallel axes rotary joints at the hip 2, knee 3 and ankle 4 provide freedom of
flexion at the joints. Pneumatic cylinders 9 are used to block the motion at the knee
joints 3 when necessary to support the weight.
Figure 2 shows schematic diagrams of the exoskeleton. In these Fig. 1 are
adjustable telescopic members of the exoskeleton; 2 are dummy pneumatic cylinders that are able to inhibit the motion at the knee joints; 3 and 4 are the sensors to
detect motion of subject thigh and shank; 5 are springs to support feet 6 of the
exoskeleton; 7 and 8 are flexible belts to fasten exoskeleton to the subject thigh and
shank. In the gures M1 and M2 are motors driving the hip and knee joints of each
leg; C1 and C2 are solenoid valves of the pneumatic cylinders 2 that are able to
inhibit motions at the knee joints; S1 and S2 are flexible strips 3 and 4 with bonded
strain gages that are able to sense the tiny motions of subject limbs; F1 and F2 are
foot pressure sensors to sense the amount of pressure applied by the ground on the
exoskeleton sole 6 during the walk. The pressure at the exoskeleton sole is generated due to the transmission of the weight forces via mechanical structure to the
ground while the subject is resting on the seat.
3 Exoskeleton Operation
The operation of all actuators, i.e. motors M1, M2 and cylinders solenoid valves C1
and C2 depends on the amount of pressure felt by the feet pressure sensors F1 and
F2 (Fig. 2). The pressure on the feet depends on actual posture of the subject and
can be classied in three distinct cases. In case 1 the subject is stands on one leg and
reading from the corresponding leg foot sensors will be at its maximum value Pb
whereas for other leg that will be zero. In case 2 the subject stands still on both legs
then the total subject body weight is almost equally shared by both legs and the
pressure reading will be Pb/2. In case 3 the subject is in the stage of transiting its
weight from one leg to another. As a result pressure reading will go to zero for one
leg and increase to maximum for another one. The operation of the cylinders that
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can inhibit the knee joint motion and the motors based on the following rules of
operation that depends on the actual knee angle and foot pressure reading Pb:
Motors M1 and M2 of each leg are actuated only and only if min [AND]
the pressure reading from sensors at the foot P Pmin in order to pick up the
leg from the ground and take a step
Cylinders solenoid valves C1 and C2 are actuated only and only if < min. It
means the cylinders are actuated when the knee has reached the minimum
allowed value to bend. The value of the minimum bending angle min depends
on usual walk style of the subject
The control strategy for the motors M1 and M2 is aimed to make sure that the
exoskeleton structure will follow the subjects leg physical motion without hindering it. The set of sensors S1 and S2 (flexible strips with bonded strain gages) are
attached to links of the exoskeleton (Fig. 2). When the subject limbs commence the
motion the limbs will touch and bend the strips. The sensors will detect in real time
the intention of the subject to move limbs and send the signals to PID controller.
The close-loop controller will react immediately by activating hip and knee motors
M1 and M2 in order to move the links of the exoskeleton away from the object
limbs and thus to restore the original shape of the strips.
4 Conclusion
The paper describes the methodology of mechanical design and effective control of
a new exoskeleton system to enhance walk capabilities of people. It also can be
used for rehabilitation of people with light leg injuries. The core idea is to use
exoskeleton to decouple weight carrying capabilities of the legs from its body
advancing capabilities. This has been done by special logic and management of
exoskeleton actuators. This exoskeleton is power efcient because electrical motors
are smaller in size and did not participate in supporting the weight like in all other
existing exoskeleton designs.
References
1. Zoss, A.B., Kazerooni, H., Chu, A.: Biomechanical design of the Berkeley lower extremity
exoskeleton (BLEEX). IEEE/ASME Trans. Mechatron. 11(2), 128138 (2006)
2. Suzuki, K., Mito, G., Kawamoto, H., Hasegawa, Y., Sankai, Y.: Intention-based walking
support for paraplegia patients with robot suit HAL. Adv. Robot. 21, 14411469 (2007)
3. Jamwal, P.K., Sheng, Q.X., Shahid, H., John, G.P.: An adaptive wearable parallel robot for
the treatment of ankle injuries. IEEE/ASME Trans. Mechatron. 19(1), 6475 (2014)
4. Iqbal, J., Baizid, K.: Stroke rehabilitation using exoskeleton-based robotic exercisers Mini
Review. Biomed. Res. 26(1), 197201 (2015)
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5. Banala, S., Agrawal, S., Scholz, J.: Robot assisted gait training with active leg exoskeleton
(ALEX). IEEE Trans. Neural Syst. Rehabil. Eng. 17, 28 (2009)
6. Kawamoto, H., Sankai, Y.: Power assists method based on phase sequence and muscle force
condition for HAL. J. Adv. Robot. 19(7), 717734 (2005)
7. Kawabata, T., Satoh, H., Sankai, Y.: Working posture control of robot suit HAL for reducing
structural stress. In: Proceedings of IEEE International Conference on Robotics and
Biomimetics (ROBIO), pp. 20132018 (2009)
8. Ghan, J., Kazerooni, H.: System identication for the Berkeley lower extremity exoskeleton
(BLEEX). In: Proceedings 2006 IEEE International Conference on Robotics and Automation
(ICRA), pp. 34773484 (2006)
9. Heng, C., Jun, Z., Chunming, X., Hong, Z., Xiao, C., Yu, W.: Design and control of a
hydraulic-actuated leg exoskeleton for load-carrying augmentation. In: Proceedings 2006
IEEE International Conference on Robotics and Automation (ICRA), Part I, LNAI 6424,
pp. 590599 (2010)
10. Walsh, C.J., Paluska, D.: Development of a lightweight, underactuated exoskeleton for
load-carrying augmentation. In: Proceedings of IEEE International Conference on Robotics
and Automation (ICRA), pp. 34853491 (2006)
11. Leslie, M.: The next generation of exoskeletons. Mag. IEEE Eng. Med. Biol. Soc. 3(4), 5661
(2012)
Active Safety Functions for Industrial Lower

Body Exoskeletons: Concept and Assessment
Jawad Masood, Luis A. Mateos, Jess Ortiz, Stefano Toxiri,
Leonard OSullivan and Darwin Caldwell
Abstract Exoskeleton technology can assist human effort performing manual handling tasks in industrial environments. Safety is vital both for the commercial and
legal acceptance of industrial exoskeletons. We consider such systems as safety critical as they directly involve humans. Active safety functions can enhance the safety of
exoskeletons and prevent accidents and injuries. We present the conceptual and evaluation criteria for Fall Detection, Active Balancing, Active Detachment, Collision
Detection and Automatic Motor Braking. This evaluation highlights the safety critical
scenarios which can be helpful in future hazard and risk assessment of exoskeletons,
and also for safety certification evaluation.
1 Introduction
Exoskeleton technology is a vibrant area of research due to its potential in force
augmentation both for medical and industrial applications. For industrial handling
applications, current EU research includes the Robo-Mate and Spexor projects. But
to date, there has been limited commercial success of this type of technology in the
J. Masood (B) L.A. Mateos J. Ortiz S. Toxiri D. Caldwell
Istituto Italiano di Tecnologia, Via Morego, 30, 16163 Genoa, Italy
e-mail: jawad.masood@iit.it
L.A. Mateos
e-mail: luis.mateos@iit.it
J. Ortiz
S. Toxiri
e-mail: stefano.toxiri@iit.it
D. Caldwell
e-mail: darwin.caldwell@iit.it
L. OSullivan
University of Limerick, Limerick, Ireland
e-mail: Leonard.OSullivan@ul.ie
299
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industry. Most industrial exoskeletons on the market to date have focused on passive
devices e.g. Fortis. The current Robo-Mate exoskeleton forms the first step towards
a real world, active, industrial handling exoskeleton.
Robo-Mate is a wearable exoskeleton which is designed to work closely with the
user. The system dynamics synchronize with the user natural biomechanics through
information flow from sensors. The intended system objective is to provide assistance
to the user during lowering, lifting and carrying tasks. This close interaction makes
Robo-Mate a safety critical system which can lead the user to Musculo Skeletal
Disorders (MSDs) [1].
The aim of Robo-Mate is not only to provide intended functionality of assistance
but to enhance the safety of the worker. This ambitious objective has focused our
interests on devising intelligent safety functions. We conceptualize four active safety
function based on available hardware, software, and safety risk scenarios. The Risk
Scenarios are evaluated through the Hazard Analysis and Risk Assessment (HARA)
of the Robo-Mate system. These functions are Active Balancing, Fall Detection,
Collision Detection and Automatic Motor Braking. But are these safety functions
safe enough or do they introduce additional hazards and risks to the user and system?
These interesting research questions are yet to be answered.
HARA is a technique used in established standards to measure the performance of
safety-critical systems. For example, in the automotive industry ISO-26262 provides
the guidelines for HARA. Relevant standards for Industrial Exoskeleton Technologies are evolving quickly. The primary standard is ISO 13482-2014 on personal care
robot safety. That standard mentions the use of dummies which infers instrumented
manikins as used in automotive crash research and safety certification. Yet there is a
paucity of instrumented manikins for low-velocity contact testing. There is no mentioning of software models in this standard. This paper is an important opportunity to
provide safety information to support exoskeleton design and also certification used
in an industrial context. In addition, these concepts can be beneficial for the development of other standards on the safety of industrial robots such as ISO 10218/1-2011
and ISO 10218/2-2011.
The evaluation process and safety functions presented in this paper can contribute
towards developing simulation methods and procedures that can help in exoskeleton
safety verification at early design stages.
2 Active Safety Functional Concepts

A. Active Balancing
(1) Scenario: The safety critical scenario can be defined as the situation when the
user is handling a load with varying center of gravity (e.g. fluid in a basin) or when
due to some unforeseen condition the system is under the uneven distribution of
load.
Active Safety Functions for Industrial Lower Body Exoskeletons

Table 1 Available posture states for Active Safety Functions
State
Weight
Inclination
(force sensor)
(IMU)
301
Edge
(Force sensor + IMU)
90
Lift up
Initial body weight

(base weight)
Increase
135 90
Lift down
Decrease
90 135
Walk
Walk while carrying
Initial body weight

Initial body weight +
Lifted weight
90 95
90 95
Force sensor Rising,

IMU Falling
Force sensor Falling,
IMU Rising
Stand
(2) Risk: The scenario can risk the health and safety of the user. The uneven distribution of load can lead to dangerous posture and instability of the full system.
(3) Definition: The exoskeleton detects the non-homogeneous distribution of external load and adapts the control algorithm accordingly. The information received
from foot force sensors, Inertial Measurement Unit (IMU) and hand force sensors
can be fused to detect the system unbalancing Table 1. The foot force sensors can
detect the weight distribution on each foot before and after user handles the load.
The hand force sensors can validate the presence of a load in the hand. The information is fused in the centrally embedded computer. During assistance mode,
this information can help to update the torque control algorithm. In this way, the
system can generate different torque profiles for left and the right actuator such
that the center of the system can remain in sagittal plane. This information can
be validated and controlled by IMU.
B. Fall Detection
user falls while wearing Robo-Mate.
(2) Risk: The scenario can risk the health and safety of the user. The uneven distribution of load can lead to dangerous posture and instability of the full system.
(3) Definition: The exoskeleton detects the user falling. The information received
from the IMU in the form of vertical acceleration can be used to detect the fall.
The foot force sensors can detect the weight distribution on each foot before
and after detection of the fall. The hand force sensors can validate the presence
of a load in the hand. The information can be fused in the centrally embedded
computer. This function will bring the Robo-Mate into fall mode. This safety
function can be enabled during all operational modes.
C. Collision Detection
user handling the load collides with an obstacle in its workspace.
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(2) Risk: The scenario can risk the health and safety of the user. The collision can
lead to dangerous posture and instability of the full system.
(3) Definition: The exoskeleton detects the collision by using sensor-less obstacle
detection using hybrid torque-motion control strategy. The collision detection
information is computed in the central embedded computer. A collision detection
warning is generated in the Human Machine Interface (HMI). The user is asked
to return to a safe configuration. If the collision warning is repeated three times
in critical time (t), then the system enters into halt mode.
D. Automatic Motor Braking
user tries to move outside the system safe range of motion.
(2) Risk: The scenario can risk the health and safety of the user. Moving outside the
safe range of motion can lead to dangerous posture and instability of the full
system.
(3) Definition: The exoskeleton function can monitor the movement of the user.
A warning is generated as the user moves close to the limits of safe range of
motion. If the user moves beyond this range, the actuators provide an opposite
torque (i.e. Automatic Motor BrakingAMB) to constraint the users motion
beyond the safe range of motion. As the system returns back to the safe range,
the actuator returns to the previous mode.
3 Hazard Analysis and Risk Assessment

HARA of active safety functions is an important task during design and development
of safety critical systems such as exoskeletons. The International Standard Organization (ISO) describes the systematic procedure for this task. For example, the
ISO-26262 is the automotive functional safety standard which divides this task into
three main sub-tasks. These sub-tasks are Severity of Failure, Controllability during
Failure and Probability of Failure. The assessment of these sub-tasks is performed
by dividing them into several levels and computing the mutual score. In practice,
these assessments are based on intuitive knowledge of the production manager and
engineers. This approach is error prone and raises questions on all safety assessment
process. There are several tools used in practice [2]. They can calculate the Safety
Integrity Levels (SIL) by considering severity, controllability, and probability of failure without explicitly supporting design decisions and analysis. We suggest to use
the rigorous simulations to assess these risk [24] because it can help in quickly
verifying the safety concepts at earlier design stages of exoskeleton.
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4 Conclusions
We present the concepts and assessment for four active safety functions for industrial
exoskeletons. The safety scenarios are defined and risks are identified. The evaluation
and assessment of these safety functions can be performed by using rigorous simulations because of their capability to express explicit design decision and analysis. We
propose to use the SIL to evaluate the functional performance similar to ISO 26262,
which is based on severity, controllability, exposure and probability to failure. The
presented work can be beneficial in developing the HARA for upcoming standards
for industrial exoskeletons.
Acknowledgments The authors acknowledge the contributions of the Robo-Mate consortium.
The research funding is supported by the European Unions Seventh Framework Programme for
research, technological development and demonstration under grant agreement no. 608979.
References
1. Van der Vorm, J., OSullivan, L., Nugent, R., de Looze, M.: Considerations for developing safety
standards for industrial exoskeletons (2015)
2. Duracz, A., Bartha, F.A., Aljarbouh, A., Masood, J., Philippsen, R., Eriksson, H., Duracz, J., Xu,
F., Zeng, Y., Taha, W., Grante, C.: Using rigorous simulation to support hazard analysis and risk
assessment (HARA) in the ISO 26262 functional safety standard. In: ACM Transactions on
Embedded Computing Systems (TECS) (2016)
3. Duracz, A., Eriksson, H., Bartha, F.A., Xu, F., Zeng, Y., Taha, W.: Using rigorous simulation to
support ISO 26262 hazard analysis and risk assessment. In: IEEE 12th International Conference
on Embedded Software and Systems (ICESS) (2015)
4. Masood, J., Philippsen, R., Duracz, J., Taha, W., Eriksson, H., Grante, C.: Domain analysis
for standardised functional safety: a case study on design-time verification of automatic emergency breaking. In: The International Federation of Automotive Engineering Societie Congress,
FISITA (2014)
SOLEUS: Ankle Foot Orthosis for Space

Countermeasure with Immersive Virtual
Reality
Pierre Letier, Guillaume Fau, Uwe Mittag, Jochen Zange,
Joern Rittweger, Moonki Jung, Jo McIntyre and Arnaud Runge
Abstract This paper presents the SOLEUS project, which aims to design innovative countermeasure for astronauts in space, based on the development of an
active foot orthosis and immersive virtual reality technologies. The paper introduces
the problematics of space countermeasure and describes the expected benets of the
proposed technology. It provides details on the system architecture, components
and the simulation tool that has been used to support the design process. Finally, the
scientic evaluation strategy for the validation of the system is introduced.
1 Introduction
During spaceflight, the human body is subject to physiological adaptation to the
microgravity environment. Although some effects, like vestibular disorders, lead to
temporary discomfort for some days, other reactions such as bone mineral loss or
muscle atrophy affect the physical condition of astronauts in proportion to the time
spent in space. These are major concerns for long-duration missions such as those
P. Letier (&) G. Fau
Space Applications Services, Zaventem, Belgium
e-mail: pierre.letier@spaceapplications.com
U. Mittag J. Zange J. Rittweger
Institute of Aerospace Medicine, German Aerospace Center DLR,
Cologne, Germany
J. Rittweger
Department of Paediatrics and Adolescent Medicine,
University of Cologne, Cologne, Germany
M. Jung
Anybody Technology A/S, Aalborg, Denmark
J. McIntyre
Tecnalia, Derio, Spain
A. Runge
TEC-MMG, European Space Agency, Noordwijk, The Netherlands
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on-board the ISS (several months) and for future planetary exploration missions to
the Moon and Mars (several years).
Increasing time exposure of astronauts to microgravity for new missions requires
a more thorough understanding of issues met by astronauts in microgravity. Current
countermeasures are not effective enough, as they only partially mitigate deconditioning effects. The development of new or signicantly enhanced countermeasures is of paramount importance. The on-going ESA project SOLEUS aims to
develop a new approach of integrated countermeasure device in the shape of a
lower-leg boot-exoskeleton associated with 3D head mounted display. It focuses
primarily on the neuromotor and mechanical stimulation of the lower leg body
segments that are the most heavily affected body parts while astronauts are exposed
to microgravity. This approach is supported by immersive Virtual Reality
(VR) technologies aiming at providing additional stimulation and information to the
user, in order to increase the countermeasure efciency. This paper presents the
status of the project, describing the expected benets of the device and the system
design, supported by the use of musculo-skeletal simulation tools.
2 SOLEUS Project Expected Benets

The SOLEUS project is mainly characterized by the association of active ankle
orthosis for each leg and an immersive virtual reality display. Compared to existing
approaches for space countermeasure currently used on-board the ISS, the following benets are expected:
Activation of the muscle-tendon unit (MTU) of the lower legs as a whole, with a
focus on the spring-damper behavior and stiffness characteristics of the MTU
[1], that is not well addressed by the current use of the treadmill or body press
[2]. Optimization of energy storage in the MTU has a direct impact on the
longitudinal bone force loading during specic motion (jumping, running).
The use of the VR to create scenarios addressing not only the pure muscle
atrophy but also the full functional task including the neurologic transmissions
[3]. The system can be used to stimulate different neurological pathways (e.g.
balance, locomotor, reflex, patterns generators) to increase the number of motor
units activated (MU, association of a neuron and muscle ber). That can also
include tricks and cheats to increase the effect or compensate for the absence of
other solicitations (e.g. feel of the gravity vector).
Increased motivation by using the VR for displaying challenging and recreative
adapted scenarios. Experiments have suggested that outcomes are better when
practice is task oriented, repetitive and adapted to the user [4].
307
Fig. 1 SOLEUS system architecture overview
3 SOLEUS System Architecture

Figure 1 represents the SOLEUS system architecture overview that is mainly
composed of the exoskeletons and VR sub-systems.
3.1
Exoskeletons Subsystem
The Exoskeleton subsystem is responsible to measure the motion and interaction

forces of the user and implements active feedback based on the scenarios exercises.
It is composed of two portable lower-leg exoskeletons enabling active control of the
ankle joint in the flexion/extension and pronation/supination motions. Each
exoskeleton features a mechanical structure, comfortable mechanical xations to
the user, two brushless DC actuators, absolute position and force sensors, and
Synapticon boards for low-level control, power amplication, sensors conditioning
and communication purposes. The boards are interconnected by a power bus and
EtherCAT data bus to the Exoskeleton Controller that is running Orocos for
high-level real-time mechatronics control [5]. Each orthosis can provide up to
130 Nm of equivalent torque around the ankle thanks to the use of an offset
slider-crack mechanism.
3.2
Virtual Reality Subsystem
The Virtual Reality subsystem is responsible to simulate physics of the exercises

scenarios and to create the 3D world environment in which the user will be
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Fig. 2 Muscular-skeletal simulation of a human ankle wearing the SOLEUS orthosis under load
scenario, output of the muscular response under activation of the SOLEUS orthosis
immersed. It is composed of a computing unit running Unity3D [6] and the eVRS
framework that allows standard physicians to create and manage easily 3D medical
scenarios, and to interface many different hardware components to be used during
the experiments. The system allows connecting a 3D head mounted display (Oculus
Rift) to render the 3D world computed by Unity and to track users head motion.
Both subsystems are connected through ROS to exchange measured and control
data. The system can also be interfaced with medical instrumentation (e.g. EMG
sensors) to measure muscle activity during operations (for medical evaluation).
The SOLEUS system is currently under integration for further tests to be carried
out during a Scientic Evaluation campaign (Sect. 5).
4 Musculo-Skeletal Simulations
The design process has been supported by the AnyBody Technology inverse
dynamics software [7]. Based on a realistic model of the lower-leg human
muscular-skeletal system and a model of the mechatronics design, we demonstrated
the ability of the SOLEUS orthosis to generate the proper muscular response from
typical users scenarios (Fig. 2). The simulation has also been used to derive the
mechanical loads for nite element analyses and mechanical design optimizations.
5 Scientic Evaluation
Once integrated, SOLEUS will be tested during a short scientic evaluation with
the purpose, to validate the main functions of the system, focusing on the good
synchronization between the mechatronics and virtual reality. We will in addition
perform preliminary countermeasure tests through different scenarios to assess the
expected benets while analyzing risks of using such technology (e.g. risks of
309
fracture). Beside standard activities like isometric, isotonic and isokinetic stimulations, more advanced scenarios with full 3D immersion of the subject will be
tested such as body jumping and balancing. The goal is to obtain evidences of
the activation of the spring-damper behavior of the MTU, as well as increased EMG
amplitude signal by the use of the VR rendering.
6 Conclusion
This paper presented the SOLEUS system as a wearable technology for the
emerging applications of countermeasure for astronauts in space. This technology
has also potential for other applications such as rehabilitation and healthcare.
Acknowledgments This study if funded by ESA in the framework of a Technology Research
program (contract No. 4000112181/14/NL/RA) entitled Integrated Countermeasures with
Biofeedback and Actuators.
References
1. Farris, D., Robertson, B., Sawicki, G.: Elastic ankle exoskeletons reduce soleus muscle force
but not work in human hopping. J. Appl. Physiol. 115, 579585 (2013)
2. Alkner, B.A., Tesch, P.A.: Efcacy of a gravity-independent resistance exercise device as a
countermeasure to muscle atrophy during 29-day bed rest. Acta Physiol. Scand. 181, 345357
(2004)
3. Chopard, A., Hillock, S., Jasmin, B.J.: Molecular events and signalling pathways involved in
skeletal muscle disuse-induced atrophy and the impact of countermeasures. J. Cell Mol. Med.
13, 30323050 (2009)
4. Levin, M., et al.: Virtual reality environments to enhance upper limb functional recovery in
patients with hemiparesis. In: Advanced Technologies in Rehabilitation (2009)
5. Orocos: http://www.orocos.org/
6. Unity3D: https://unity3d.com/
musculoskeletal systems in the AnyBody Modeling System. Simul. Model. Pract. Theory 14,
11001111 (2006)
SPEXOR: Spinal Exoskeletal Robot

for Low Back Pain Prevention
and Vocational Reintegration
Jan Babic, Katja Mombaur, Dirk Lefeber, Jaap van Dien,
Bernhard Graimann, Michael Russold, Nejc arabon and Han Houdijk
Abstract Most assistive robotic devices are exoskeletons which assist or augment
the motion of the limbs and neglect the role of the spinal column in transferring load
from the upper body and arms to the legs. In the SPEXOR project we will fill this
gap and design a novel spinal exoskeleton to prevent low-back pain in able bodied
workers and to support workers with low-back pain in vocational rehabilitation.
J. Babic (B)
Department of Automation, Biocybernetics and Robotics, Joef Stefan Institute,
Ljubljana, Slovenia
e-mail: jan.babic@ijs.si
K. Mombaur
Department of Optimization in Robotics & Biomechanics, Heidelberg University,
Heidelberg, Germany
D. Lefeber
Robotics & Multibody Mechanics Research Group, Department of Mechanical Engineering,
Vrije Universiteit Brussel, Ixelles, Belgium
J. van Dien
MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
B. Graimann
Department of Translations Research and Knowledge Management,
Otto Bock Healthcare GmbH, Duderstadt, Germany
M. Russold
Department of Translational Research, Otto Bock Healthcare Products GmbH, Wien, Austria
N. arabon
Department of Health Study, University of Primorska and with S2P Science To Practice d.o.o,
Koper, Slovenia
H. Houdijk
Human Movement Sciences Amsterdam and with Heliomare Research and Development,
Amsterdam, The Netherlands
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1 Context
Low-back pain (LBP) is a growing issue in our modern society. From all the diseases studied in the Global Burden of Disease Study from 2010 (Institute for Health
Metrics and Evaluation), LBP was ranked number one concerning the years lived
with disability in Europe [1]. Regarding the overall burden, LBP was ranked third in
Central and Eastern Europe and first in Western Europe [1]. Depending on sex and
region, the European point prevalence of LBP was up to 15.6 %. Prevalence and burden were found to increase with age and are even expected to further increase within
the next years due to the current demographic developments [2]. From several studies reviewing the costs related to LBP in European countries, it has been calculated
that the lowest cost per capita in Europe can be found in Belgium with e116 and
e209 in Sweden [3]. Most of the costs of LBP are related to reduced work capacity,
sick-leaves, early retirement and legal claims. To reduce those costs and the burden
on the workers, work place interventions such as education, exercise and braces, are
becoming widely accepted. However, most of these measures ease the consequences
of LBP but dont eliminate their causes. It has been shown that a strong correlation
between physically demanding jobs and prevalence of LBP exists [4]. Movements
which cause LBP in these jobs are: handling heavy loads, repeated lifting and turning,
and working time spent in a flexed position. The SPEXOR project targets to design
a spinal exoskeleton which assists these movements to prevent LBP for able-bodied
workers and to support workers with LBP who are in vocational reintegration. Most
of the existing assistive robotic devices are exoskeletons which augment the motion
of the humans limbs. However, they mostly neglect the role of the spine in transferring the load from the upper body and limbs to the lower limbs, which will be the
main contribution of the SPEXOR project.
2 Objectives
In the SPEXOR project, see Fig. 1, a spinal exoskeleton for working in sustained
awkward postures and those involved in manual handling of heavy loads, will be
designed. The exoskeleton will have several modes:
The assistive mode will prevent excessive or sustained non-neutral spine postures.
It will also limit the mechanical load on the spinal column.
The monitoring mode will monitor spinal movements and spinal loading and
provide feedback to the user.
In the training mode, the device will provide active neuromuscular trunk conditioning. In this mode the exoskeleton will act as an advanced fitness or rehabilitation
device to strengthen the wearers muscles and prevent spine disorders.
Finally in the diagnostic mode the exoskeleton will provide an objective assessment of neuromuscular trunk functions. This mode will serve as a diagnostic tool to
forecast possible physiological issues concerning the spine of the wearer.
313
Fig. 1 A conceptual image of the SPEXOR exoskeleton [5]
The contribution of the authors of this paper will mainly be situated in the design
and development of a flexible exoskeleton mechanism for spinal support. This mechanism has to be efficient as well as unobtrusive for the wearer. In this first design
the emphasis will be on the requirements for LBP prevention and the use of passive
viscoelastic elements for gravity compensation. The design will be made in a way to
passively transfer external loads acting on the upper body and arms to the wearers
legs. In the second phase of the project the authors are responsible for the design
and development of compliant actuators for this exoskeleton. The actuation will be
designed to exhibit an adaptive compliant behavior. This will allow a comfortable
interaction with the user and provide different levels of mechanical effort, depending
on the need of torque augmentation, rehabilitation or training activities.
3 Going Beyond the State of the Art

Several power augmenting and/or assistive exoskeletons have already been developed. From a technical point of view they can be split in two categories: active
and passive devices. Although active devices are more powerful, they are also
heavier as they require actuators and a power source. Examples of such active
exoskeletons are the power assist suit for day-care from the Kanagawa Institute
of Technology, JP [6], the lightweight active power assist device HAL from the
Tsukuba University, JP [7], exoskeletons for the augmentation of soldiers combat
abilities of the Defense Advanced Research Project Agency, USA, and the Lower
extremity exoskeleton BLEEX, CA [8]. Recently an FP7 project named RoboMate
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has started. The RoboMate project is also targeting the issue of workspace injuries
but, in contrast with the SPEXOR project, a full body exoskeleton is developed.
Passive devices are mainly used to reduce the burden of the user rather than to
amplify the wearers forces [9]. Some examples of such devices are the Smart Suite
lite, a compact lightweight robotic suit which utilizes the elastomeric force of elastic
materials to assist the wearer [9] and a passive device for enhancing limb movement
for people with neuromuscular disabilities [10].
A crucial element in the development of active exoskeletons are the actuators. For
the safety of the wearer a compliant behavior is desired [11]. Compliant actuators
possess a physical elastic element capable of storing and releasing energy. Those
actuators have an equilibrium position, which is the position where they do not
exert any force/torque. Deviations from this position are allowed. This allows a safer
human-robot interaction, shock absorption, and can lead to a greater energy efficiency
than with stiff actuators [12].
Although a lot of effort has already been spent on developing exoskeletons, only
a few targeted the spine or lower back. The few which did, focused mostly on the
assistance of the trunk flexion/extension [6].
To our knowledge, there is no exoskeleton which has been built yet that would
provide assistance for functional trunk movements; an exoskeleton that doesnt only
take power assistance into account but also the spine motions that could result in
neuromuscular injuries and subsequently in LBP. This will be done in the SPEXOR
project. The exoskeleton will be effective as assistive exoskeleton for laborers which
have to work in awkward postures and repeatedly lift loads, as training device and
as diagnostic tool. A wide range of possibilities for exercise and measurement protocols will be provided by SPEXOR. The combination of the different modes of the
SPEXOR exoskeleton will provide a powerful preventive tool against the most frequent musculoskeletal disorder of today, LBP. This will make the spinal exoskeleton
developed in SPEXOR a top-end device that goes well beyond the state-of-the-art.
Acknowledgments Members of SPEXOR consortium: J. Babic (coordinator), T. Petric, R.
Goljat: Joef Stefan Institute, Slovenia; K. Mombaur (PI), M. Sreenivasa, M. Millard, P. Manns:
Heidelberg University, Germany; D. Lefeber (PI), C. Rodriguez-Guerrero, L. De Rijcke, M. Nf:
Vrije Universiteit Brussel, Belgium; J. van Dien (PI), I. Kingma, G. Faber, S. Bruin, A. Koopman:
VU University Amsterdam, The Netherlands; B. Graimann (PI), M. Tttemann, A. Kurzweg, J.
Bornmann, H. Glindemann: Otto Bock Healthcare GmbH, Germany; M. Russold (PI), D. Pieringer:
Otto Bock Healthcare Products GmbH, Austria; N. arabon (PI), A. Panjan, K. Kastelic, M. Savic:
S2P Science to practice d.o.o., Slovenia; H. Houdijk (PI), C. van Bennekom (PI), J. Nachtegaal, S.
Baltrusch: Heliomare, The Netherlands.
Funding: This project has received funding from the European Unions Horizon 2020 research and
innovation programme under grant agreement No 687662 - SPEXOR.
Project webpage: http://www.spexor.eu.
315
References
1. Buchbinder, R., Blyth, F.M., March, L.M., Brooks, P., Woolf, D.A., Hoy, D.G.: Placing the
global burden of low back pain in context. Best Pract. Res.: Clin. Rheumatol. 27, 575589
(2013)
2. Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Williams, G., Smith, E., Vos,
T., Barendregt, J.: The global burden of low back pain: estimates from the Global Burden of
Disease 2010 study. Ann. Rheum. Dis. (2014)
3. Lambeek, L.C., van Tulder, M.W., Swinkels, I.C.S., Koppes, L.L.J., Anema, J.R., van Mechelen,
W.: The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine
36(13), 10501058 (2011)
4. Waddell, G., Burton, A.K.: Occupational health guidelines for the management of low back
pain at work: evidence review. Occup. Med. 51, 124135 (2001)
5. Spinal Exoskeletal Robot for Low Back Pain Prevention and Vocational Reintegration. http://
www.spexor.eu
6. Yamamoto, K., Ishii, M., Noborisaka, H., Hyodo, K.: Stand alone wearable power assisting
suit-sensing and control systems. In: International Workshop on Robot and Human Interactive
Communication, pp. 661666 (2004)
7. Kawamoto, H., Sankai, Y.: Power assist method based on phase sequence and muscle force
condition for HAL. Adv. Robot. 19, 717734 (2005)
8. Kazerooni, H.: Hybrid control of the berkeley lower extremity exoskeleton (BLEEX). Int. J.
Robot. Res. 25(56), 561573 (2006)
9. Imamura, Y., Tanaka, T., Suzuki, Y., Takizawa, K., Yamanaka, M.: Motion-based design of elastic belts for passive assistive device using musculoskeletal model. In: International Conference
on Robotics and Biomimetics, pp. 13431348 (2011)
10. Rahman, T., Sample, W., Jayakumar, S., King, M.M., Wee, J.Y., Seliktar, R., Alexander, M.,
Scavina, M., Clark, A.: Passive exoskeletons for assisting limb movement. J. Rehabil. Res.
Dev. 43(5), 583 (2006)
11. Vallery, H., Veneman, J., van Asseldonk, E., Ekkelenkamp, R., Buss, M., van Der Kooij, H.:
Compliant actuation of rehabilitation robots. IEEE Robot. Autom. Mag. 15(3), 6069 (2008)
12. Vanderborght, B., Albu-Schaeffer, A., Bicchi, A., Burdet, E., Caldwell, D., Carloni, R., Wolf,
S.: Variable impedance actuators: moving the robots of tomorrow. In: International Conference
on Intelligent Robots and Systems, pp. 54545455 (2012)
Part XI
Posters
HeSA, Hip Exoskeleton for Superior

Assistance
Thomas G. Sugar, Eduardo Fernandez, Darren Kinney,
Kevin W. Hollander and Sangram Redkar
Abstract A hip exoskeleton was designed that can assist hip flexion and extension.
The device incorporates a motor, ball-screw, and spring in a lightweight package.
The total weight including the battery is 2.95 kg. The system uses 20 W of power
per leg. The system is controlled based on the phase angle of each leg and the
torque is applied in synchrony with the users steps. The device assists walking,
running, and does not interfere when going up and down stairs.
1 Introduction
Wearable robotic systems are being developed to assist at the hips, knees and ankles
[110]. These systems must be lightweight, energy efcient, and must conform to
the human. For systems to assist gait, they must not interfere with the human
motion.
We have developed a hip exoskeleton, HeSA (Hip Exoskeleton for Superior
Assistance). It was initially designed to assist soldiers walking on patrol, wearing a
tactical vest that holds body armor. This tactical vest can weigh approximately
18 kg, see Fig. 1. The system was also integrated into a standard back brace to be
used in a manufacturing environment, see Fig. 1. The design, control and testing of
the system will be described.
T.G. Sugar (&)

Technology at SpringActive, Inc., Research and Technology,
Wearable Robotics Association, Arizona State University, Tempe, USA
e-mail: Thomas.sugar@asu.edu
E. Fernandez S. Redkar
Arizona State University, Tempe, USA
D. Kinney
SpringActive, Inc, Tempe, USA
K.W. Hollander
Product Development at SpringActive, Inc, Tempe, USA
319
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Fig. 1 The hip exoskeleton in the left gure is integrated into a tactical vest that holds body
armor. In the right gure, the HeSA device is integrated into a workers back brace. It can be used
in a manufacturing environment
2 Design
The HeSA device provides bi-directional torque support to each hip. The device is
capable of supporting both walking and running gaits.
Peak torque for hip flexion and extension
Average electrical power when walking at 1.34 m/s per motor
Total device weight without battery
Battery weight, 24 W 72 W h
Motor/ball screw/spring actuator
15 Nm
20 W
2.27 kg
0.68 kg
The hip actuator can disengage from the thigh attachment to allow for extended
range of motion. The extended free motion allows the user to flex the hip to ascend
stairs and get easily in and out of cars.
The actuator is attached to the waist using a clamp structure. The clamp can be
adjusted up and down using pins and it slides back on forth on the pins to align the
motor joint with the hip joint. The structure also has a pin joint to allow hip abduction.
3 Control
The system is controlled based on the phase angle of each hip. The phase angle can
be calculated by knowing the angular position and velocity of the hip. Because each
hip movement is unique, the phase angle is calculated independently for each leg.
HeSA, Hip Exoskeleton for Superior Assistance
321
The system uses a phase oscillator to assist hip flexion and extension. The
controller has been developed and described in [11, 12]. A force/torque applied
based on the sine of the phase angle has been shown to assist and maintain a
limit-cycle. A force/torque applied based on the cosine of the phase angle has been
shown to adjust the frequency of the oscillation.
For the upper leg, the inertia of the thigh is modeled as I, the damping by b, and
the stiffness of the thigh by k. A hip sensor is used to measure the angular motion of
the thigh modeled by h_ and h.
I h bh_ kh c sin; d cos;
ch_
dx2 h2
I h bh_ kh p p
h_ 2 x2 h2
h_ 2 x2 h2
If c is positive, the system oscillates back and forth. The energy is always
bounded. If c is negative, the energy is dissipated and the system state returns to
zero. With a larger, positive value for c, more assistance is provided.
If d is positive, the frequency of the oscillations are decreased, and if d is
negative, the frequency increases. In our work x was xed to a value of 2 * pi * 3.
4 Testing
The device was worn and tested. Preliminary data is shown in Figs. 2 and 3. The
robot angle measures the internal angle of the thigh strap and is shown in Fig. 2.
This angle approximates the hip angle because there are some small angular
movements of the device as the actuator attachment is xed to a flexible waist band
or tactical vest. For example, there are small oscillations as the device changes
direction or when the load is applied.
The applied, assistive, torque is shown in Fig. 3. It is calculated by determining
the spring deflection in the mechanism. The ball screw carriage or nut pushes on a
spring which in turn pushes on the lever arm connected to the thigh attachment. The
position of the lever arm attached to the thigh is calculated from the robot angle.
The motor position is adjusted based on the sine of the phase angle.
After weight acceptance of the leg, the motor applies positive 9 Nm torques to
extend the hip and assist in the stance phase. As the thigh is flexed during the swing
phase, 8 Nm torques are applied to lift the leg against gravity. The value of c is
adjusted determining the peak torques.
In Fig. 4, the user can climb over obstacles and run.
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Fig. 2 Robot angle is measured with 30 of flexion and 20 of extension
Fig. 3 The angle of the robot is converted to mm of movement. The position of the ball screw is
labeled nut pos. The torque applied is given in Nm
Fig. 4 Walking over ground and running
5 Conclusion
We have designed a lightweight hip exoskeleton that can apply 15 Nm of assistive
torque in concert with the user. The user can walk, run, and climb over objects.
Further developments will include the ability to assist stair climbing and sit-to-stand
tasks.
HeSA, Hip Exoskeleton for Superior Assistance
323
Acknowledgments A patent application has been led on the phase oscillator and mechanisms.
This work is partially supported by the DARPA grant W911NF-15-1-0162. Any opinions, ndings, and conclusions or recommendations expressed in this material are those of the authors and
do not necessarily reflect the views of the funding agency
References
1. Asbeck, A.T., De Rossi, S.M., Holt, K.G., Walsh, C.J.: A biologically inspired soft exosuit
for walking assistance. Int. J. Robot. Res. 0278364914562476 (2015)
2. Asbeck, A.T., Schmidt, K., Walsh, C.J.: Soft exosuit for hip assistance. Robot. Auton. Syst.
(2014)
3. Bharadwaj, K., Sugar, T.G., Koeneman, J.B., Koeneman, E.J.: Design of a robotic gait trainer
using spring over muscle actuators for ankle stroke rehabilitation. ASME J. Biomech. Eng.
127, 10091013 (2005)
4. Blaya, J.A., Herr, H.: Adaptive control of a variable-impedance ankle-foot orthosis to assist
drop-foot gait. IEEE Trans. Neural Syst. Rehabil. Eng. 12 (2004)
5. Esposito, E.R., Blanck, R.V., Harper, N.G., Hsu, J.R., Wilken, J.M.: How does ankle-foot
orthosis stiffness affect gait in patients with lower limb salvage? Clin. Orthop. Relat. Res. 472,
30263035 (2014)
6. Giovacchini, F., Vannetti, F., Fantozzi, M., Cempini, M., Cortese, M., Parri, A., Yan, T.,
Lefeber, D., Vitiello, N.: A light-weight active orthosis for hip movement assistance. Robot.
Auton. Syst. 73, 123134 (2015)
7. Meijneke, C., van Dijk, W., van der Kooij, H.: Achilles: an autonomous lightweight ankle
exoskeleton to provide push-off power. Presented at the 5th IEEE RAS & EMBS International
Conference on Biomedical Robotics and Biomechatronics (2014)
8. Shamaei, K., Cenciarini, M., Adams, A.A., Gregorczyk, K.N., Schiffman, J.M., Dollar, A.M.:
Effects of exoskeletal stiffness in parallel with the knee on the motion of the human body
center of mass during walking. In: 2015 IEEE International Conference on Robotics and
Automation (ICRA), pp. 55575564 (2015)
9. Hollander, K.W., Cahill, N., Holgate, R., Churchwell, R., Clouse, P., Kinney, D., Boehler, A.:
A passive and active joint torque augmentation robot (JTAR) for hip gait assistance. In:
ASME 2014 International Design Engineering Technical Conferences and Computers and
Information in Engineering Conference, pp. V05AT08A079V05AT08A079 (2014)
10. Hollander, K.W., Cahill, N., Holgate, R., Churchwell, R., Clouse, P., Kinney, D., Boehler, A.,
Ward, J.: A joint torque augmentation robot (JTAR) for ankle gait assistance. In: ASME 2014
International Design Engineering Technical Conferences and Computers and Information in
Engineering Conference (2014)
11. Kerestes, J., Sugar, T.G., Holgate, M.: Adding and subtracting energy to body motion: phase
oscillator. In: ASME 2014 International Design Engineering Technical Conferences and
Computers and Information in Engineering Conference, pp. V05AT08A004V05AT08A004
(2014)
12. Sugar, T.G., Bates, A., Holgate, M., Kerestes, J., Mignolet, M., New, P., Ramachandran, R.
K., Redkar, S., Wheeler, C.: Limit cycles to enhance human performance based on phase
oscillators. J. Mech. Robot. 7, 011001 (2015)
SPEXOR: Towards a Passive Spinal

Exoskeleton
L. De Rijcke, M. Nf, C. Rodriguez-Guerrero, B. Graimann, H. Houdijk,
J. van Dien, K. Mombaur, M. Russold, N. Sarabon, J. Babic and D. Lefeber
Abstract Most assistive robotic devices are exoskeletons which assist or augment
the motion of the limbs and neglect the role of the spinal column in transferring load
from the upper body and arms to the legs. In this part of the SPEXOR project we
will fill this gap and design a novel, passive spinal exoskeleton to prevent low-back
pain in able bodied workers and to support workers with low-back pain in vocational
rehabilitation.
L. De Rijcke (B) M. Nf C. Rodriguez-Guerrero D. Lefeber

Robotics & Multibody Mechanics Research Group, Department of Mechanical Engineering,
Vrije Universiteit Brussel, Ixelles, Belgium
e-mail: lderijck@vub.ac.be
http://mech.vub.ac.be/robotics
B. Graimann
Department of Translations Research and Knowledge Management,
Otto Bock Healthcare GmbH, Duderstadt, Germany
J. van Dien
Neuromusculoskeletal Mechanics Research Program, MOVE Research Institute Amsterdam,
Amsterdam, The Netherlands
H. Houdijk
Faculty of Human Movement Sciences, VU University Amsterdam and
with Heliomare Research and Development, Amsterdam, The Netherlands
K. Mombaur
Department of Optimization in Robotics & Biomechanics, Heidelberg University,
Heidelberg, Germany
M. Russold
Department of Translational Research, Otto Bock Healthcare Products GmbH, Wien, Austria
N. Sarabon
Department of Health Study, University of Primorska and
with S2P Science To Practice d.o.o, Koper, Slovenia
J. Babic
Department of Automation, Biocybernetics and Robotics, Joef Stefan Intitute,
Ljubljana, Slovenia
325
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L. De Rijcke et al.
1 Introduction
Low-back pain (LBP) is a growing issue in our modern society. From all the diseases studied in the Global Burden of Disease Study from 2010 (Institute for Health
Metrics and Evaluation), LBP was ranked number one concerning the years lived
with disability in Europe [1]. Regarding the overall burden, LBP was ranked third in
Central and Eastern Europe and first in Western Europe [1]. In addition of lowering
the life quality of the patient, LPB also causes an economical burden for the society.
From several studies reviewing the costs related to LBP in European countries, it has
been calculated that the lowest cost per capita in Europe can be found in Belgium
with e116 and goes up to e209 in Sweden [2]. Most of these costs are related to
reduced work capacity, sick-leaves, early retirement and legal claims. To reduce this,
preventive measures such as education and training, adjustment of work stations,
re-organization of the work process, the use of mechanical aids like cranes or balancers and the use of braces, are becoming widely accepted [3]. However, this may
not always be possible when the load is changing constantly (like e.g. for movers)
or the workplace makes these measures infeasible (e.g. with confined spaces).
It has been shown that a strong correlation between physically demanding jobs
and prevalence of LBP exists [4]. Movements which cause LBP in these jobs are:
handling heavy loads, repeated trunk flexion and rotation, and working time spent
in a flexed position. The SPEXOR project targets to design a spinal exoskeleton,
illustrated in Fig. 1, which assist these movements to prevent LBP for able-bodied
workers and to support workers with LBP who are in vocational reintegration. In
the first part of the project, a passive, spinal orthotic module which assist the wearer
with the lumbar flexion/extension will be developed.
Fig. 1 A conceptual image of the SPEXOR exoskeleton [5]
SPEXOR: Towards a Passive Spinal Exoskeleton
327
2 SOTA of Passive Exoskeletons

Passive devices are mainly used to reduce the burden of the user rather than to amplify
the wearers forces [6]. In the last years several passive spinal exoskeletons have been
developed. The first one, to our knowledge, was the Personal Lift Augmentation
Device (PLAD) [7], designed to prevent lower-back pain of workers. The PLAD
device is an exoskeleton which is based on the concept of stored elastic energy.
When the wearer bends, elastic elements are compressed and energy is stored. When
the wearer goes back to an upright position, the elastic elements release the energy
and the exoskeleton gives assistance to the wearer [7]. This device exchanges forces
with the wearer at the spine, shoulders, pelvis and feet. For this device significant
reductions of the back muscle activity have been reported during lifting and static
bending [3].
The Bending Non-Demand Return (BNDR) [8] is a similar device. It also stores
energy when the wearer is bending forward and releases the energy when the wearer
goes upright. Its frame covers the trunk and pelvis of the wearer. It exchanges forces
with the wearer at the upper legs and the chest. An important difference with the
PLAD is that the BNDR reduces the torso flexion range while the PLAD doesnt
interfere with the body kinematics during flexion.
The Smart Suit Lite (SSL) was developed to reduce the muscle load in the lumbar
region during nursing care [9]. This passive power assist device uses elastic belts. The
belts exercise an assistive torque on the lumbar joint and on the hip joint, when the
wearer changes posture. An additional elastic belt is placed around the torso in order
to stabilize it, similar to the working of a corset. It has been proven that by increasing
the pressure surrounding the pelvis, the corset increases the lumbar support or the
intra-abdominal pressure, which in turn reduces the intradiscal pressure and stabilizes
posture [9].
The passive LAEVO exoskeleton [3] was designed to assist nurses for the lifting
of patients. The device is connected with the wearer at the chest, the lower back and
the upper legs. The exoskeleton is intended to transfer load from the lower back to
the chest and to the legs by making use of circular tubes. Those tubes are situated at
both sides of the body and have spring-like characteristics. For this device significant
reduces of the back and leg muscles have been observed during the bending motion.
Also the endurance was ameliorated. However the patients reported discomfort in
the chest region.
3 Going Beyond
Previous devices are all assisting the trunk flexion/extension. Interesting with the SSL
is that it also stabilizes the posture by using a corset-like belt. The implementation of
the range of motion reduction of the trunk flexion in the BNDR is important as it has
been proven that movement in this boundary region is a risk factor for back pain [10].
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However, these devices dont account for rotation and/or lateral bending. The passive
exoskeleton developed in the SPEXOR project will assist the trunk flexion/extension,
have an adjustable trunk flexion range of motion limit, and implement adjustable
rotation and lateral bending angle limits. The passive exoskeleton will interact with
the wearer without interfering with walking and stair climbing, respectively. The
interfaces between the wearer and the exoskeleton will be designed in a way to not
cause discomfort to the wearer. Attention will be paid to apply normal forces from
the exoskeleton to the wearer (avoiding shear forces). It will be designed in a way to
be comfortable as well for men as for women.
The main force acting on the trunk while bending is the gravitational force acting
on the upper body. This force is characterized by a sinusoidal function. In order to
achieve a proportional compensation a spring will be combined with a cam-profile,
similar to [11].
4 Conclusion
Although several passive devices have been developed to prevent lower-back pain,
many aspects and functionalities have still to be improved. The criteria pointed out
for the passive exoskeleton developed within the SPEXOR project will make the
exoskeleton effective as assistive device for laborers which have to work in awkward
postures and repeatedly lift loads, as training device and as diagnostic tool.
Acknowledgments This work is funded by the European Commission under Grant agreement Nr.
687662. http://www.spexor.eu.
References
1. Buchbinder, R., Blyth, F.M., March, L.M., Brooks, P., Woolf, D.A., Hoy, D.G.: Placing the
global burden of low back pain in context. Best Pract. Res.: Clin. Rheumatol. 27, 575589
(2013)
2. Lambeek, L.C., van Tulder, M.W., Swinkels, I.C.S., Koppes, L.L.J., Anema, J.R., van Mechelen,
W.: The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine
36(13), 10501058 (2011)
3. Bosch, T., van Eck, J., Knitel, K., de Looze, M.: The effects of a passive exoskeleton on muscle
activity, discomfort and endurance time in forward bending work. Appl. Ergon. 54, 212217
(2016)
4. Waddell, G., Burton, A.K.: Occupational health guidelines for the management of low back
pain at work: evidence review. Occup. Med. 51, 124135 (2001)
5. Spinal Exoskeletal Robot for Low Back Pain Prevention and Vocational Reintegration. http://
www.spexor.eu
6. Imamura, Y., Tanaka, T., Suzuki, Y., Takizawa, K., Yamanaka, M.: Motion-based design of elastic belts for passive assistive device using musculoskeletal model. In: International Conference
on Robotics and Biomimetics, pp. 13431348 (2011)
SPEXOR: Towards a Passive Spinal Exoskeleton
329
7. Sadler, E.M., Graham, R.B., Stevenson, J.M.: The personal lift-assist device and lifting technique: a principal component analysis. Theoret. Issues Ergon. Sci. 0139, 116 (2011)
8. Ulrey, B.L., Fathallah, F.A.: Subject-specific, whole-body models of the stooped posture with
a personal weight transfer device. J. Electromyogr. Kinesiol. 23(1), 206215 (2013)
9. Imamura, Y., Tanaka, T., Suzuki, Y., Takizawa, K., Yamanaka, M.: Analysis of trunk stabilization effect by passive power-assist device. J. Robot. Mechatron. 26(6), 791798 (2014)
10. Hoogendoorn, W.E., van Poppel, M.N.M., Bongers, P.M., Koes, B.W., Bouter, L.M.: Systematic
review of psychosocial factors at work and private life as risk factors for back pain. Spine 25(16),
21142125 (2000)
11. Koser, K.: A cam mechanism for gravity-balancing. Mech. Res. Commun. 36(4), 523530
(2009). doi:10.1016/j.mechrescom.2008.12.005
Autonomous Soft Exosuit for Hip

Extension Assistance
Nikos Karavas, Jinsoo Kim, Ignacio Galiana, Ye Ding,
Adam Couture, Diana Wagner, Asa Eckert-Erdheim
and Conor Walsh
Abstract In this abstract, we describe a mono-articular soft exosuit to assist with

hip extension during overground walking. The system is comprised of a mobile
Bowden-cable-driven electrical actuation unit, soft textiles, and a load cell and an
inertia measurement unit per leg. The exosuit applies forces with a peak of 300 N
enabled by an IMU-based iterative control algorithm. This iterative controller
detects the onset timing of the hip extension assistance based on an estimation of
the maximum hip flexion angle. The timing and magnitude of the applied peak
force is modulated by generating step-by-step actuator position proles based on
the previously measured assistive force. Results from a human subject during
overground walking at self-selected speed indicate the robustness of the system to
apply effectively forces with a high consistency in terms of magnitude and timing of
the peak force prole.
1 Introduction
Plethora of conventional rigid exoskeletons have been developed over the past
decades to assist with human locomotion [1]. These devices can support the
wearers body weight and apply a substantial portion of the required biological
torques [2]. However, such rigidly structured devices can restrict the users
movements and apply undesired forces resulting in discomfort. In addition to
This material is based upon work supported by the Defense Advanced Research Projects Agency
(DARPA), Warrior Web Program (Contract No. W911NF-14-C-0051). This work was also
partially funded by the Wyss Institute for Biologically Inspired Engineering and the John A.
Paulson School of Engineering and Applied Sciences at Harvard University.
N. Karavas J. Kim I. Galiana Y. Ding A. Couture
D. Wagner A. Eckert-Erdheim C. Walsh (&)
John A. Paulson School of Engineering and Applied Science and the Wyss Institute
for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA
331
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N. Karavas et al.
kinematic restrictions and joint misalignments rigid exoskeletons often have high
inertias which can impede the user especially when control tracking deciencies
occur [3]. To overcome these limitations, we have recently proposed exosuits which
are composed of soft materials such as textiles and elastomers to provide a compliant means to interface with the human [46]. Exosuits apply tensile forces to the
body through load paths well dened by the textile architecture. As exosuits
incorporate soft components they have extremely low inertia and eliminate the
challenges associated to joint misalignments.
Several research groups have investigated the benets of powering the hip joint
using a wearable robot. In particular, in [7] it is proposed that providing external
power to the hip joint could yield a greater reduction in metabolic cost, than
providing the same amount of power at the ankle joint. Moreover, in [8] authors
reported a reduced metabolic cost of *18 % compared to walking with
exoskeleton unpowered when providing an assistive torque corresponding to 100 %
of the average torque of the human hip joint.
To this end, we present an autonomous exosuit system to assist hip extension
during overground walking especially outdoors. The system is capable of consistently delivering mechanical power to the user across subjects, varied walking
speeds and step lengths. In addition, it is intuitive and does not hinder other motion
tasks (uphill/downhill walking, stair climbing/descending and walking over
obstacles). It is also worth to mention that the robustness of each subsystem
(i.e. actuation in terms of thermo-mechanical fatigue, suit in terms of component
drifting, and controller in terms of tracking performance) has been successfully
evaluated by several subjects testing during 3 miles hiking on rough terrains.
2 System Description
2.1
Actuation and Suit
The Bowden-cable-driven actuation unit is a two degree-of-freedom (DoF) system

that actuates each leg independently and it is designed so that it can be simply
mounted on top of a MOLLE II Large Rucksack as shown in Fig. 1. Each DoF
consists of a Maxon EC 4-pole, 200 W motor that is connected to a gearbox of ratio
51:1 and drives an 8 cm diameter pulley. A motor controller unit (by Elmo Motion
Control Inc.) controls each motor and is integrated into a custom electronic board.
In addition, an Amtel microprocessor communicates with the Elmo motor controller
through the CANOpen communication protocol and provides with the required
position commands. A removable battery unit containing two 6-cell Li-Po batteries
(5200 mAh) is placed on the bottom of the rucksack and provides the device with
an autonomy over approximately 6 miles. The overall system weight is 4.9 kg
(actuation, 3.1 kg, suit, 0.4 kg, and battery, 1.4 kg).
Autonomous Soft Exosuit for Hip Extension Assistance
333
Fig. 1 A subject wearing the

autonomous soft exosuit
(left). Load path to actuate hip
extension and components of
the suit (right)
The exosuit consists of a spandex base layer, a waist belt that wraps around the
subjects pelvis, two thigh brace pieces and two IMU elastic bands (for IMU
placement). The waist belt and the thigh brace provide with the two required anchor
points. In particular, the Bowden cable sheath connects to the back of the waist belt
and the inner cable connects to the back of the thigh brace. Therefore, when the
motor retracts the cable a hip extension torque is created and when the motor feeds
out cable the suit is slack.
2.2
IMU-Based Iterative Controller
The main goal of the mobile soft exosuit is to deliver consistent and robust hip
extension force in sync with subjects gait dynamics. Based on our examination of
the relationship between metabolic energy reduction and net work rate provided by
actuators in previous study [5], the force prole was chosen to mimic the biological
joint torque, with the assumption that this will allow the muscle activation to
decrease proportionally and consequently reduce the metabolic energy.
From an analysis of the hip biomechanics it can be found that the onset of the hip
positive power concurs with the maximum hip flexion angle, and the hip extensor
muscles start to activate slightly earlier to this [4, 6]. Therefore, we select to detect
the maximum hip flexion using an IMU sensor mounted on the thigh of each leg.
A force-based position control is then used to create the hip extension torque with
onset, peak and offset timings similar to the one of the biological hip joint torque
[5]. To ensure a consistent and robust delivered force given the variability in hip
kinematics, kinetics, and suit positioning, the controller adjusts the pretension level
and the maximum amplitude of the motor position command based on the force
prole of the previous gait step.
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N. Karavas et al.
Fig. 2 Hip extension force (load cell) and thigh angle (IMU) based on the percentage of gait cycle
(right leg)
3 Results
To evaluate the performance of our proposed system and IMU-based controller, we
conducted an overground walking experiment. A healthy subject (male, age 30,
height 179 cm, weight 76 kg) wore the system and walked with the freedom to vary
his walking speed as preferred. Our objective is to deliver constant and robust hip
extension forces of 300 N to the user (which corresponds to a hip torque of
approximately 45 Nm and a 60 % of the nominal biological torque) regardless of
his gait pattern. Thus, the performance of the assistive force has been evaluated
using the following metrics on a step by step basis: the magnitude and timing of the
peak force and the offset timing of the force waveform. Figure 2 depicts the average
and standard deviation of the measured forces and thigh angles for a trial of 10 min
of walking, segmented based on the percentage of the gait cycle. Note that, the
percentage of the gait cycle has been calculated based on the average onset timing
(i.e. maximum hip flexion) and 0 % gait cycle corresponds to the heel strike. The
average of the peak force was 294 11 N, which results in an error of *3 %. In
addition, the average of the peak and offset timing of the force prole were
16.4 0.8 % and 28.2 0.8 % gait cycle, respectively. These results demonstrate
the ability of the system to accurately control the peak force and the peak force
timing to the desired values.
4 Conclusion
We presented an autonomous soft exosuit for hip extension assistance. The system
is able to deliver constantly and repetitively mechanical power to the user with an
error in the magnitude of the peak force of *3 % regardless of the kinematic and
kinetic variations occurring during gait. In a previous study with an off-board
actuation platform which applied similar force proles with a peak of 200 N, we
Autonomous Soft Exosuit for Hip Extension Assistance
335
found that metabolic energy is reduced by an average between 5.7 and 8.5 %
compared to the unpowered condition [6]. Thus, we expect that a greater reduction
in metabolic energy will be achieved with a hip assistance of 300 N. Future work
will include investigation of the proposed systems benet in energy expenditure
among different subjects.
References
1. Guizzo, E., Goldstein, H.: The rise of the body bots. Spectrum, IEEE 42(10), 5056 (2005)
2. Farris, R.J., Quintero, H.A., Goldfarb, M.: Preliminary evaluation of a powered lower limb
orthosis to aid walking in paraplegic individuals. IEEE Trans. Neural Syst. Rehabil. Eng. 19(6),
652659 (2011)
3. Browning, R.C., Modica, J.R., Kram, R., Goswami, A.: The effects of adding mass to the legs
on the energetics and biomechanics of walking. Med. Sci. Sport Exerc. 39, (2007)
4. Asbeck, A.T., Schmidt, K., Galiana, I., Wagner, D., Walsh, C.: Multi-joint soft exosuit for gait
assistance. In: IEEE International Conference on Robotics and Automation (ICRA), May 2015
5. Ding, Y., Galiana, I., Siviy, C., Panizzolo, F.A., Walsh, C.: IMU-based iterative control for hip
extension assistance with a soft exosuit. In: IEEE International Conference on Robotics and
Automation (ICRA), May 2016 (to be published)
6. Ding, Y., Panizzolo, F.A., Siviy, C., Malcolm, P., Galiana, I., Holt, K.G., Walsh, C.: Effect of
timing of hip extension assistance during loaded walking with a soft exosuit. J. Neuroeng.
Rehabil. (in review)
7. Sawicki, G.S., Lewis, C.L., Ferris, D.P.: It pays to have a spring in your step. Exerc. Sport Sci.
Rev. 37, 130138 (2009)
8. Ronsse, R., Koopman, B., Vitiello, N., Lenzi, T., De Rossi, S.M.M., van den Kieboom, J., van
Asseldonk, E., Carrozza, M.C., van der Kooij, H., Ijspeert, A.J.: Oscillator-based walking
assistance: a model-free approach. IEEE Int. Conf. Rehabil. Robot. (2011)
Comparison of Ankle Moment Inspired

and Ankle Positive Power Inspired
Controllers for a Multi-Articular Soft
Exosuit for Walking Assistance
Martin Grimmer, Brendan T. Quinlivan, Sangjun Lee,
Philippe Malcolm, Denise M. Rossi, Christopher Siviy
and Conor J. Walsh
Abstract Mobility can be limited due to age or impairments. Wearable robotics

provide the chance to increase mobility and thus independence. A powered soft
exosuit was designed that assist with both ankle plantarflexion and hip flexion
through a multi-articular suit architecture. So far, the best method to reduce metabolic cost of human walking with external forces is unknown. Two basic control
strategies are compared in this study: an ankle moment inspired controller (AMIC)
and an ankle positive power inspired controller (APIC). Both controllers provided a
similar amount of average positive exosuit power and reduced the net metabolic cost
of walking by 15 %. These results suggest that average positive power could be
more important than assistive moment during single stance for reducing metabolic
cost. Further analysis must show if one of the approaches has advantages for wearers
comfort, changes in walking kinetics and kinematics, balance related biomechanics,
or electrical energy consumption.
The material is based upon the work supported by the Defense Advanced Research Projects
Agency, Warrior Web Program (Contract No. W911NF-14-C-0051). This work was also funded
by the Robert Bosch Stiftung (Grant No. 32.5.G412.0003.0), the National Science Foundation
(Grant No. DGE1144152, CNS-1446464), the So Paulo Research Foundation (FAPESP; Grant
No. 2015/02116-1) and the Samsung Scholarship This work was partially funded by the Wyss
Institute for Biologically Inspired Engineering and the John A. Paulson School of Engineering
and Applied Sciences at Harvard University.
Martin Grimmer, Sangjun Lee and Brendan T. Quinlivan: Authors contributed equally to this
work.
M. Grimmer (&)
Technische Universitaet Darmstadt, Darmstadt, Germany
B.T. Quinlivan S. Lee (&) P. Malcolm C. Siviy C.J. Walsh (&)
School of Engineering and Applied Sciences and the Wyss Institute for Biologically Inspired
Engineering, Harvard University, Cambridge, MA, USA
D.M. Rossi
University of Sao Paulo, Ribeiro Preto Medical School, Ribeiro Preto, SP, Brazil
337
338
M. Grimmer et al.
1 Introduction
Mobility determines human independence and thus quality of life. It can be affected
due to age and/or disease. Next to exercise, wearable robotics can provide solutions
for mobility improvements. Several prototypes to assist human movement have
been developed and have shown promising results [15]. However, to date the best
conguration and assistance prole is still unknown. The majority of the rst
studies with exoskeletons intended for metabolic rate reduction prioritized reducing
biological positive joint power over joint moment. It might be possible that assistance proles that follow the biological moment also effectively reduce metabolic
rate because it is known that biological muscles can still consume energy even
when they do not produce positive joint power [6, 7]. To address this topic, we
conducted a study comparing an ankle moment inspired controller (AMIC) and an
ankle positive power inspired controller (APIC) using a multi-articular exosuit [5].
2 Methods
The soft exosuit used in this study has a single actuator per leg which assists with
ankle plantarflexion and hip flexion through the multi-articular load path specied
by the textile architecture (Fig. 1) [4]. An offboard actuation system was used to
generate assistive forces, and Bowden cables were used to transmit the forces to the
soft exosuit local to the subjects ankle. On each leg, two gyroscopes and a load cell
were attached to measure data from the suit and the wearer.
Seven healthy male adults participated in this study (26.71 4.75 y;
68.43 9.46 kg; 1.74 0.06 m; mean SD). While participants walked on a
treadmill at 1.50 m s1, two different control strategies were investigated, each with
with the offboard actuation
system and the multi-articular
soft exosuit that assists with
both ankle plantarflexion and
hip flexion
339
Fig. 2 Example position

trajectories of the AMIC and
APIC. a and b The AMIC
performs a force-based
position control using a
position trajectory inspired by
a robotic-tendon model [8]
that takes into account the
suit-human series stiffness
and natural ankle
kinematics/kinetics in attempt
to produce a biologically
relevant ankle moment. c and
d The APIC controller
performs power-based
position control using the
ankle speed zero-crossing to
ensure that assistance
delivered by the exosuit
coincides with the positive
biological ankle power
their own powered-off condition for relative metabolic comparison. Metabolic rates,
lower-limb kinematics, and ground reaction forces were measured (Fig. 1).
Ankle moment inspired controller: As shown in Fig. 2a, b, using an approach
similar to [8], the AMIC used the suit-human series stiffness of the exosuit [5] and
averaged ankle kinematics and kinetics data to identify a position trajectory that
would produce biologically relevant assistive ankle moments during push-off. The
system performed a force-based position control on a step-by-step basis to reach a
maximum peak force of 5.52 N kg1.
Ankle positive power inspired controller: As shown in Fig. 2c, d and previously
described in [4], the APIC delivered assistance predominantly during the positive
ankle power phase. Ankle speed zero-crossing, which corresponds to the positive
power onset, was estimated using the gyroscopes and used to trigger actuation. The
system performed a power-based position control on a step-by-step basis to deliver
8 W of positive exosuit power assistance in parallel to the positive biological ankle
power [4]. By applying 8 W of positive power we were able to approximately
match the average positive exosuit power from the AMIC.
3 Results
The AMIC and APIC were able to deliver desired power and moment to the ankle
joint and reduce the net metabolic cost of walking by 0.72 0.21 W kg1
(14.78 3.63 %) and 0.74 0.30 W kg1 (15.36 5.53 %), respectively. The
average peak applied forces were 5.60 0.50 and 4.99 1.36 N kg1 (Fig. 3a).
340
M. Grimmer et al.
Fig. 3 a Average exosuit force and b average exosuit power for the AMIC and APIC
The average positive exosuit power was 0.133 0.028 and 0.124 0.023 W kg1
for the AMIC and APIC respectively (Fig. 3b). The average negative exosuit power
was 0.026 0.017 and 0.007 0.002 W kg1. Using the AMIC, peak ankle
dorsiflexion during stance was signicantly reduced. For both controllers, ankle
peak plantarflexion angle increased and occurs earlier in the gait cycle.
4 Discussion & Conclusion

APIC produces similar metabolic benet as AMIC with much lower moment
assistance during single stance and similar average positive exosuit power during
push-off. This seems to suggest that positive power is more helpful. However, we
cannot make strong claims about the specic influence of peak positive power since
we did not test the effect of this parameter in isolation from other changes in the
actuation prole. Nevertheless, the nding that positive exosuit power could be
more important than assistive moment during single stance for reducing metabolic
cost aligns well with previous ndings [9].
In summary, in this work we showed that the metabolic cost of walking can be
reduced using two different controllers, an ankle moment inspired controller and an
ankle positive power inspired controller. Further analysis of the data must show if
one of the approaches has advantages for wearers comfort, changes in walking
kinetics/kinematics, balance related biomechanics or electrical energy consumption.
These parameters might give further insight to the benets of each approach.
Acknowledgments Sponsor and nancial support acknowledgments are placed in the unnumbered footnote on the rst page.
341
References
(2013)
2. Collins, S.H., Wiggin, M.B., Sawicki, G.S.: Reducing the energy cost of human walking using
an unpowered exoskeleton. Nature 522, 212215 (2015)
3. Mooney, L.M., Herr, H.M.: Biomechanical walking mechanisms underlying the metabolic
reduction caused by an autonomous exoskeleton. J. NeuroEng. Rehabil. 13(1), 415 (2016)
4. Lee, S., Crea, S., Malcolm, P., Galiana, I., Asbeck, A., Walsh, C.: Controlling negative and
positive power at the ankle with a soft exosuit. In: IEEE International Conference on Robotics
and Automation (ICRA), Stockholm, 2016 (accepted)
5. Asbeck, A.T., De Rossi, S.M.M., Holt, K.G., Walsh, C.J.: A Biologically inspired soft exosuit
for walking assistance. Int. J. Robot. Res. 34(6), 744762 (2013)
6. Ma, S., Zahalak, G.I.: A distribution-moment model of energetics in skeletal muscle.
J. Biomech. 24(1), 2135 (1991)
7. Ryschon, T.W., Fowler, M.D., Wysong, R.E., Anthony, A.R., Balaban, R.S.: Efciency of
human skeletal muscle in vivo: comparison of isometric, concentric, and eccentric muscle
action. J. Appl. Physiol. 83(3), 867874 (1997)
8. Hollander, K.W., Ilg, R., Sugar, T.G., Herring, D.: An efcient robotic tendon for gait
assistance. J. Biomech. Eng. 128(5), 788791 (2006)
9. Jackson, R.W., Collins, S.H.: An experimental comparison of the relative benets of work and
torque assistance in ankle exoskeletons. J. Appl. Physiol. 119(5), 541557 (2015)
Biomechanical Analysis and Inertial

Sensing of Ankle Joint While Stepping
on an Unanticipated Bump
Taira Miyatake, Sangjun Lee, Ignacio Galiana, Denise M. Rossi,
Christopher Siviy, Fausto A. Panizzolo and Conor J. Walsh
Abstract Walking on uneven terrain with a wearable assistive robot requires the
controller to adapt to rapid changes in humans biomechanics. To do so, the
changes due to terrain should be measured using wearable sensors. We investigated
human ankle joint mechanics when stepping on different small, unanticipated
bumps with either the forefoot or the rearfoot. It was shown that kinematics and
kinetics change signicantly depending on how humans step on a bump, and that
changes in kinematics could be measured by IMUs. This result could be used to
inform the design of adaptive controllers for wearable robots that provide optimal
assistance to the ankle joint when walking on uneven terrain.
1 Introduction
Lower extremity wearable robots have been developed to help able-bodied individuals to walk or carry loads, and several recent studies have shown reductions in
energy expenditure in lab-based tests [13]. For practical use outside of lab, it is
The material is based upon the work supported by the Defense Advanced Research Projects
Agency, Warrior Web Program (Contract No. W911NF-14-C-0051). This study was also funded
by Funai Overseas Scholarship (T.M.), Samsung Scholarship (S. L.), and So Paulo Research
Foundation (FAPESP; Grant No. 2015/02116-1) (D. M. R.). This work was partially funded by
the Wyss Institute for Biologically Inspired Engineering and the John A. Paulson School of
Engineering and Applied Sciences at Harvard University.
T. Miyatake S. Lee I. Galiana C. Siviy F.A. Panizzolo C.J. Walsh (&)
John A. Paulson SEAS, Cambridge, USA
T. Miyatake S. Lee I. Galiana C. Siviy F.A. Panizzolo C.J. Walsh
Wyss Institute at Harvard University, Boston, MA, USA
D.M. Rossi
Ribeiro Preto Medical School,
University of So Paulo, Ribeiro Preto, SP, Brazil
343
344
T. Miyatake et al.
crucial that these devices quickly adapt to variable terrain. Previous studies have
shown that humans adapt their kinematics and kinetics to irregular surfaces such as
wooden blocks [4] or ballast [5]. If designed purely for walking on flat surfaces,
assistance from wearable devices may become less optimal or even obstructive to
natural motion. However, it is still unclear how humans change their kinematics and
kinetics when stepping on irregular surfaces, and how wearable sensors can measure the changes.
In line with this, the aim of our study was (i) to investigate ankle joint kinematics
and kinetics while performing a step on an irregular surface and (ii) to check if the
kinematic variations can be sufciently captured by inertial measurement units
(IMUs) mounted on the body. IMUs have been used for gait analysis in the
detection of gait events (e.g. heel-strike and toe-off) [6, 7] and joint angle measurement [8], but most studies have been conducted only on treadmills or flat
ground, and the feasibility of IMU sensing to capture the kinematic changes on
irregular surface has not been thoroughly studied. To address this topic, an
experimental study was conducted in which subjects walked on simplied irregular
surfaces, in this case a small bump, and ankle joint mechanics as well as the
measurements from body-mounted IMUs were investigated.
2 Methods
Nine healthy male adults (age 29.1 4.8 y; mass 76.8 10.2 kg; height
176.3 4.7 cm; mean SD) participated in this study. Participants were asked to
walk on a straight flat walkway during ve different conditions: four conditions
involving bumps of two different heights (Fig. 1) and one condition without bumps
(FLAT). In the conditions with bumps, participants stepped on bumps of different
sizes with their right rearfoot (High-RF, Low-RF) or with their right forefoot (HighFF, Low-FF). Participants were asked to look straight in order not to know the
exact bump location before stepping on it.
IMU (VN-100, VectorNav) consisting of gyroscopes, accelerometers, and
magnetometers (all 3-axes) were placed at the dorsum of the foot and the front of
the shank (Fig. 1). Angular velocity and orientation (Euler angles calculated by
IMUs onboard extended Kalman Filter) were collected at a frequency of 200 Hz.
Ankle joint angle was calculated by subtracting the sagittal angles of the two IMUs.
Ground-truth lower limb kinematics was collected by an optical motion capture
system (Vicon; 120 Hz), and ground reaction forces on the stride of interest were
collected with a force plate (OR-6, AMTI; 1000 Hz) to calculate reference joint
torques using inverse dynamics. Positive work was calculated as the time integral of
positive power. Muscle activation on eight lower limb muscles (biceps femoris,
Biomechanical Analysis and Inertial Sensing of Ankle Joint
345
Fig. 1 a Placement of IMU

on foot and shank.
b Experimental setup,
dimension of bumps used for
experiment (right top) and
foot positions on each
condition
rectus femoris, vastus medialis and lateralis, tibialis anterior, soleus, gastrocnemius
lateral and medial) was also collected by surface electromyography (Telemyo,
Noraxon; 1500 Hz).
3 Results
The ankle angle during stance phase varied greatly over the ve experimental conditions (Fig. 2a). Ankle torque plantarflexion onset was found to happen signicantly
later in the gait cycle for High-RF (31.0 3.6 %) and Low-RF (27.0 3.5 %) and
earlier for High-FF (9.3 2.6 %) and Low-FF (13.2 2.1 %), compared to FLAT
(19.7 2.3 %; all p < 0.01 by paired t-test) (Fig. 2b). Similarly, onset of positive
joint power was found to happen later for High-RF (57.4 2.0 %) and Low-RF
(56.1 2.0 %) and earlier for High-FF (49.4 3.7 %) compared to FLAT
(52.2 1.9 %; all p < 0.01) (Fig. 2c). Ankle positive work was lower in both HighRF (0.17 0.03 J kg1) and Low-RF (0.20 0.04 J kg1) compared with FLAT
(0.26 0.03 J kg1; both p < 0.002). Mean muscle activation of lateral gastrocnemius and soleus was higher in High-FF compared with FLAT (52 and 29 %
respectively, both p < 0.01) (Fig. 2d).
IMU-based joint angles showed average root mean square error of 3.2 (HighRF: 3.1, Low-RF: 3.2, FLAT: 2.8, Low-FF: 3.3, High-FF: 3.5) compared to
ground-truth (dashed lines in Fig. 2a).
346
T. Miyatake et al.
Fig. 2 Averaged ankle joint kinematics and kinetics over the ve experimental conditions: a Joint
angle. Ground-truth measured by optical system (solid) and IMU-based (dashed). b Joint torque.
c Joint power. Joint torque and joint power are normalized to the subjects body weight.
d Normalized muscle activation of lateral gastrocnemius, a plantarflexor muscle

The present ndings suggest that humans adapt differently when stepping on an
unanticipated bump, depending on which part of the foot contacts the bump. There
were clear changes in the kinematics and kinetics across the different conditions as
measured using motion capture and a force plate. It can be noted that the joint
torque prole varied signicantly over the ve experimental conditions, as it is one
of the most important measures for designing and controlling wearable devices
assisting locomotion. In addition, it was shown that body-mounted IMUs have a
Biomechanical Analysis and Inertial Sensing of Ankle Joint
347
potential to capture the changes in kinematics on uneven terrain. These results

suggest the possibility of real-time wearable assistive devices that can adapt to
irregular terrain by means of body-mounted IMU sensors. Future work will include
applying these ndings to the soft exosuits [2, 3], making it highly adaptable to
various ground conditions.
Acknowledgments The authors would like to thank Philippe Malcolm and Jozeen Speeckaert
for their contribution to this work.
References
(2013)
2. Panizzolo, F.A., Galiana, I., Asbeck, A., Siviy, C., Schmidt, K., Holt, K.G., Walsh, C.J.: A
biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking.
J. Neuroeng. Rehabil. (In press)
3. Asbeck, A.T., De Rossi, S.M.M., Holt, K.G., Walsh, C.J.: A Biologically inspired soft exosuit
for walking assistance. Int. J. Robot. Res. 34(6), 744762 (2013)
4. Voloshina, A.S., Kuo, A.D., Daley, M.A., Ferris, D.P.: Biomechanics and energetics of
walking on uneven terrain. J. Exp. Biol. 216(21), 39633970 (2013)
5. Wade, C., Redfern, M.S., Andres, R.O., Breloff, S.P.: Joint kinetics and muscle activity while
walking on ballast. Hum. Factors 52(5), 560573 (2010)
6. Rueterbories, J., Spaich, E.G., Larsen, B., Andersen, O.K.: Methods for gait event detection
and analysis in ambulatory systems. Med. Eng. Phys. 32(6), 545552 (2010)
7. Mariani, B., Rouhani, H., Crevoisier, X., Aminian, K.: Quantitative estimation of foot-flat and
stance phase of gait using foot-worn inertial sensors. Gait Posture 37(2), 229234 (2013)
8. Seel, T., Raisch, J., Schauer, T.: IMU-Based Joint Angle Measurement for Gait Analysis.
Sensors 14(4), 68916909 (2014)
A Novel Approach to Increase Upper

Extremity Active Range of Motion
for Individuals with Duchenne Muscular
Dystrophy Using Admittance Control:
A Preliminary Study
Madeline C. Corrigan and Richard A. Foulds
Abstract Progressive muscle weakness characteristic of Duchenne muscular dystrophy (DMD) results in loss of upper extremity active range of motion (AROM)
despite residual muscle strength that is insufcient to overcome gravity. Admittance
control is well suited for use by individuals with DMD as it allows for the utilization
of residual muscle strength to intuitively control the motion of a powerful robot
without requiring strength to overcome gravity and the friction and inertia of the
robot. This study examined the feasibility of using the HapticMASTER, an admittance control motorized arm support, to increase the upper extremity AROM of
individuals with DMD to a greater degree than that provided by the Armon Edero, a
commercially available passive arm support. The results demonstrate that the
HapticMASTER robot signicantly increased the reachable surface area scores
compared to the Armon Edero passive arm support (paired-samples t-test, t(5) =
3.984, p = 0.010, Cohens d = 1.6).
1 Introduction
Duchenne muscular dystrophy (DMD), a neuromuscular disease with a prevalence
of 1 in 3500 male births, results in progressive muscle weakness causing loss of
independence and imposing the demands of costly and intrusive assistive support
This research is funded by NJIT/Kessler Foundation Rehabilitation Engineering Research

Center on Wearable Robots for Independent Living (NIDILRR-HHS 90RE5021) and Gustavus
and Louise Pfeiffer Research Foundation.
M.C. Corrigan (&) R.A. Foulds
New Jersey Institute of Technology, Newark, NJ, USA
e-mail: mc378@njit.edu
R.A. Foulds
349
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M.C. Corrigan and R.A. Foulds
and personal care for daily living tasks [1]. Upper extremity function begins to
decline while ambulation is still possible and gradually progresses with time in a
proximal to distal gradient, playing a prominent role in loss of independence [2].
Importantly, upper extremity functional limitations exist despite residual muscle
strength because remaining muscle strength is not sufcient to lift the arms against
gravity and therefore cannot be utilized by the individual [3].
Presently, there exist a number of commercially available assistive devices aimed
at augmenting upper extremity functional decit. These devices are not widely used
by individuals with DMD and have been largely unsuccessful in delivering the
independence they seek to provide. Passive orthoses, the most common of these
commercially available assistive devices, increase AROM by reducing friction and
balancing the users arm against gravity using a spring or rubber bands. Limitations
of passive arm supports include imperfect gravity compensation and the requirement
of sufcient muscle strength to overcome inertia, which render these devices ineffective for those in the later stages of functional loss [4].
Admittance control is an inherently safe and intuitive robotic control paradigm
that maps the users applied force to the motion of a robot. The use of admittance
control provides a means to balance the arm against gravity more precisely and to
minimize friction and inertia, thereby decreasing the overall force required by the
user to generate a movement compared to that required by a passive arm support
[5]. The objective of this study is to investigate the degree of upper extremity
AROM associated with use of an admittance control motorized arm support
compared to that associated with the use of a passive arm support by individuals
with DMD.

The upper extremity AROM of 6 individuals with DMD was evaluated while
unsupported, while supported by the Armon Edero passive arm support, and while
supported by the HapticMASTER admittance control robot. Figure 1 shows the
Armon Edero arm support and the HapticMASTER robot. The maximum workspace
of both arm supports is about 0.08 m3, with the HapticMASTER having a slightly
smaller workspace compared to the Armon Edero. Inclusion criteria required individuals to be nonambulatory with limited upper extremity function (a Brooke scale
score of 4 or greater). The reachable workspace protocol was administered for each
of the arm support conditions and the reachable surface area scores were used as the
primary outcome measure to evaluate AROM [6]. This study was approved by
NJITs Institutional Review Board.
Fig. 1 a The Armon Edero passive arm support and b the HapticMASTER robot
Fig. 2 The reachable surface

area (RSA) scores for
a unsupported movements,
b Armon Edero supported
movements, and
c HapticMASTER supported
movements for one subject
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M.C. Corrigan and R.A. Foulds
3 Results
Figure 2 shows an example of the reachable workspace evaluation output for one
subject for unsupported movements, Armon Edero supported movements, and
HapticMASTER supported movements. Figure 3 shows the mean reachable surface
area scores for all 6 subjects for Armon Edero and HapticMASTER supported
movements. The HapticMASTER robot signicantly increased the reachable surface area scores compared to the Armon Edero passive arm support (paired-samples
t-test, t(5) = 3.984, p = 0.010, Cohens d = 1.6). An a priori power analysis,
conducted using G*Power 3.1 software, suggested that a sample size of n = 6
would be sufcient to obtain a minimum of 95 % power (a = 0.05, paired-samples
t-test) to detect an effect, given an effect size of Cohens d = 1.6. Five out of 6
subjects showed increased vertical range of motion for HapticMASTER supported
movements compared to Armon Edero supported movements. All subjects reported
that less exertion was required to generate the reachable workspace evaluation
movements while supported by the HapticMASTER robot compared to the Armon
Edero passive arm support.
Fig. 3 Mean reachable surface area scores for Armon Edero and for HapticMASTER supported
movements. Error bars show SEM
353

The results of this study support the hypothesis that an admittance control arm
support will provide individuals with DMD greater AROM than that provided by a
passive arm support. Ongoing work involves the development of a wheelchairmountable admittance control arm support that aims to increase independence in
activities of daily living for individuals with DMD.
Acknowledgments The authors would like to acknowledge the developers of the reachable
workspace evaluation software (G. Kurillo and J. Han, et al.).
References
1. Jung, I.Y., Chae, J.H., Park, S.K., Kim, J.H., Kim, J.Y., Kim, S.J., Bang, M.S.: The correlation
analysis of functional factors and age with duchenne muscular dystrophy. Ann. Rehabil. Med.
36, 2232 (2012)
2. Bartels, B., Pangelila, R.F., Bergen, M.P., Cobben, N.A.M., Stam, H.J., Roebroeck, M.E.:
Upper limb function in adults with duchenne muscular dystrophy. J. Rehabil. Med. 43, 770
775 (2011)
3. Mazzone, E.S., Vasco, G., Palermo, C., Bianco, F., Galluccio, C., Ricotti, V., Castronovo, A.
D., DiMAuro, M.S., Pane, M., Mayhew, A., Mercuri, E.: A critical review of functional
assessment tools for upper limbs in Duchenne muscular dystrophy. Dev. Med. Child Neurol.
I 54, 879885 (2012)
4. Rahman, R., Sample, W., Seliktar, R., Alexander, M., Scavina, M.: A body-powered functional
upper limb orthosis. J. Rehabil. Res. Dev. 37(6) (2000)
5. Corrigan, M., Foulds, R.: Admittance control of the intelligent assistive robotic manipulator for
individuals with duchenne muscular dystrophy: a proof-of-concept design. J. Rehabil. Rob. 3,
15 (2015)
6. Han, J.J., Kurillo, G., Abresch, R.T., Nicorici, A., Bajcsy, R.: Validity, reliability, and
sensitivity of a 3D vision sensor-based upper extremity reachable workspace evaluation in
neuromuscular diseases. PLOS Currents Muscular Dystrophy (2013)
Modulation of Knee Range of Motion

and Time to Rest in Cerebral Palsy Using
Two Forms of Mechanical Stimulation
Peter A. Michael, Ghaith J. Androwis and Richard A. Foulds
Abstract Spasticity and dystonia are challenging motor impairments that may
interfere with the use of exoskeleton-based therapy. We suggest that two
mechanical stimulation techniques that target and remediate these manifestations in
cerebral palsy, will allow exoskeletons become a much more feasible rehabilitation
technique. This will improve function and, importantly, safety. Our previous studies
have shown the positive outcomes of vestibular stimulation, and published literature
proposes the possible advantages of whole body vibration. Our current approach
utilizes both techniques to dene a rehabilitation method specic to the subjects
diagnosis of spasticity and dystonia. Our recent pilot data shows great potential in
temporarily eliminating/reducing both spasticity and dystonia in a subject with
CP. Results suggest a reduction in tone and possible improvements to mobility after
a single session of stimulation. Therefore, this paper serves to propose the use of
this approach to enable and enhance the benets of robotic therapy.
This work is supported by the NJIT/Kessler Rehabilitation Engineering Research Center on

Wearable Robots for Independent Living, (NIDILRR-HSS grant 90RE5921).
P.A. Michael (&) G.J. Androwis R.A. Foulds
New Jersey Institute of Technology, Newark, NJ, USA
e-mail: peter.a.michael@njit.edu
G.J. Androwis
e-mail: ghaith.j.androwis@njit.edu
R.A. Foulds
G.J. Androwis
Kessler Foundation, West Orange, NJ, USA
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P.A. Michael et al.
1 Introduction
The recent increase in exoskeleton use and development encourages the exploration
of methods to enable access by users who otherwise would not have be able to take
advantage of this technology. Robot-assisted rehabilitation for individuals who
exhibit high muscle tone is extremely problematic for the device and potentially
dangerous for the user. Studies often exclude subjects with spasticity to avoid
complication [13]. By reducing the excessive tone, not only will the therapy
function as intended, but the user is less likely to sustain injury or experience
fatigue [1]. Neurological disabilities such as cerebral palsy (CP) are usually
accompanied by loss of motor function, spasticity, and/or dystonia [4, 5].
Cerebral palsy poses a challenge in that subjects not only have excessive tone
due to spasticity, but may also exhibit dystonia in the form of unwanted
co-contraction of muscles. Many individuals with CP actually have a combination
of spasticity and dystonia [4], but the distinction is often clinically blurred between
the two classications. Spasticity is dened as a hypersensitivity to joint movement
above a certain velocity threshold. Dystonia on the other hand is sudden and
uncontrollable co-contraction of muscles that usually leads to excessively stiff joints
and bad posture [6].
Previous work from our laboratory shows that vestibular stimulation of the
otolith organs is able to signicantly reduce muscle tone in individuals who are
purely spastic [7]. This effect lasts for 20 min, during which robotic therapy may be
particularly effective. However, we discovered that if any dystonia were present,
our stimulation had a much less dramatic effect since motor function was dominated
by the dystonia [8], which caused joints to appear locked.
Dystonia can be triggered by a startle or sudden movement. Some of our dystonic
subjects have actually exhibited more dystonic symptoms after receiving vestibular
stimulation [8]. Figure 1 utilizes the Pendulum Knee Drop (PKD) to demonstrate the
leg trajectory of a spastic/dystonic subject before and after vestibular intervention.
Fig. 1 Representative shank
trajectory of a dystonic
subject before and after
vestibular stimulation. In
dystonia, the limb appears to
hang at a non-zero angle,
and slowly relax to a vertical
(0 rad) position. The
relaxation (time to rest) takes
longer after vestibular
stimulation
Modulation of Knee Range of Motion and Time
357
It is important to note the amount of time it takes for the leg to relax and return to
zero (vertical).
Our current recent case study suggests that a different form of stimulation may
temporarily overcome dystonic co-contraction. Several studies have used whole
body vibration to reducing muscle tone, referred to as spasticity [5, 9]. However,
our review of the data led us to believe that subjects in these studies also exhibit a
high degree of dystonia. We have conducted a single subject trial to explore the use
of whole body vibration followed by vestibular stimulation to remediate bit dystonia and spasticity [10].

2.1
Whole Body Vibration (WBV)
Whole body vibration consists of applying high frequency low amplitude vertical
oscillations to the feet of a standing subject. The DKN XG10 vibrating platform
was used at a frequency of 35 Hz. The subjects was instructed to assume a shallow
squat position to target the legs and dampen the vibrations to the torso and head.
The subject received 1 min stimulation bursts with seated rest in between; total
stimulation time was 5 min.
2.2
Vestibular Stimulation (VS)
The vestibular stimulation apparatus used in this study was developed and tested
extensively in our lab [7]. It is an IRB-approved chair that is translated vertically by
four pneumatic actuators. Valve timing is programed in MATLAB and is used to
vary the speed and amplitude of movement. Our previous work has optimized the
parameters to be 7.5 cm excursion at 2 Hz. This phase of stimulation lasts for
15 min.
2.3
Assessment Technique
Quantitative measurements are based on the PKD test which is administered in

three sets throughout the stimulation session; baseline, post WBV and post VS. An
Ascension Technologies TrakSTAR was used to collect position data of the subjects shank. Data were recorded with a sampling rate of 100 Hz.
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P.A. Michael et al.
Fig. 2 Unltered PKD trajectory for testing phase: (i) baseline, (ii) post whole body vibration and
(iii) post vestibular stimulation
Table 1 Knee range of motion and time to rest of the shank
(A)
(B)
Range of motion (% of lift angle)

Time to rest (s)
Pre
Post WBV
Post VS
74.32
5.90
86.50
3.62
101.82
3.25
3 Results
See Figure 2 and Table 1.
4 Discussion
The above data are promising in remediating tone in preparation for robotic therapy.
The baseline data is clearly dominated by the subjects dystonia, which is nearly
eliminated by the application of whole body vibration, revealing the underlying
spasticity. Following subsequent vestibular stimulation, the spasticity is also reduced
as indicated by improvement in range of motion, decreased hyper-reflexia and
reduced joint stiffness. The points marked A signify the range of motion of the
initial swing. A larger swing is indicative of reduced tone. The locations marked B
are the time for the shank to come to rest in the vertical position. These results
highlight the benets of the combination of stimulation techniques, as well as
suggest their benecial use prior to robotic therapy. By increasing the compliance of
the body, the individual is less likely to sustain injuries from interacting with a robot.
Modulation of Knee Range of Motion and Time
359
5 Conclusion
Utilizing our ability to customize a stimulation routine based on the subjects CP
classication (i.e. spastic, dystonic or spastic/dystonic) gives us a unique advantage
in modulating their tone and co-contraction. The noted retention is arguably the
most crucial outcome, whereby the subject is now more likely a candidate to
operate and benet from an exoskeleton. A larger study will be conducted to verify
these outcomes.
References
1. Evans, N., et al.: Acute cardiorespiratory and metabolic responses during exoskeleton-assisted
walking overground among persons with chronic spinal cord injury. Top. Spinal Cord Inj.
Rehabil. 21(2), 122132 (2015)
2. Frisoli, A., et al.: Positive effects of robotic exoskeleton training of upper limb reaching
movements after stroke. J. NeuroEng. Rehabil. 9(1), 1 (2012)
3. Louie, D., et al.: Gait speed using powered robotic exoskeletons after spinal cord injury: a
systematic review and correlational study. J. NeuroEng. Rehabil. 12(1), 1 (2015)
4. ODwyer, N., Ada, L.: Reflex hyperexcitability and muscle contraction in relation to spastic
hypertonia. Curr. Opin. Neurol. 9(6), 451455 (1996)
5. Ahlborg, L., et al.: Whole-body vibration training compared with resistance training: effect on
spasticity, muscle strength and motor performance in adults with cerebral palsy. J. Rehabil.
Med. Off. J. Eur. Board Phys. Rehabil. Med. 38(5), 302308 (2006)
6. Sanger, T., et al.: Classication and denition of disorders causing hypertonia in childhood.
Pediatrics 111(1), e89e97 (2003)
7. Androwis, G., et al.: Alterations of neuromuscular signals as a result of vestibular stimulation.
In: 6th International IEEE/EMBS Conference on Neural Engineering (NER), pp. 12381241.
IEEE (2013)
8. Androwis, G., et al.: Spasticity and dystonia differentiated via the equilibrium point
hypothesis. In: 40th Annual Northeast Bioengineering Conference. IEEE (2014)
9. van Nes, I., et al.: Short-term effects of whole-body vibration on postural control in unilateral
chronic stroke patients: preliminary evidence. Am. J. Phys. Med. Rehabil. 83, 867873 (2004)
10. Michael, P., et al.: Non-invasive mechanical stimulation for reduction of dystonia and
spasticity in cerebral palsy: a case study. In: EMBC. IEEE (2016)
Training Response to Longitudinal

Powered Exoskeleton Training for SCI
A. Ramanujam, A. Spungen, P. Asselin, E. Garbarini, J. Augustine,
S. Canton, P. Barrance and G.F. Forrest
Abstract The goal of this research is to assess how powered exoskeleton-training

for 5 h per week over 20 weeks can change gait parameters to increase walking
speed for chronic SCI. Gait parameters include Center of Mass (CoM) excursions,
walking velocity, initial double stance time (IDS), single stance time (SS), terminal
double stance time (TDS), swing time (SW), and spatial parameters such as step
length, step width and stride length. Exoskeleton training had a signicant effect on
walking velocity due to specic temporal spatial gait parameters (IDS, TDS, Step
and Stride Length) and increased stability (CoM).
1 Introduction
Spinal cord injury (SCI) can be characterized by the degree of loss of motor and
sensory function an individual sustains that limits or restricts their walking ability
overground. Powered exoskeletons are robotic devices that are intended for rehabilitation, mobility and walking overground in those with SCI who have limited or
no ability to walk. The powered exoskeleton is also envisioned as a device that will
potentially improve mobility and independence in the home and community.
Currently, there are publications emerging that reflect training adaption in walking
velocity as an indicator of improved mobility within the device [1, 2]. However, the
underlying motor control strategies for gains in walking speed have not been presented for either spinal cord populations or ablebodied (AB) controls. Understanding
acute and chronic training adaptions for gains in mobility (such as walking velocity)
using different devices is critical to development of powered robotic exoskeletons,
rehabilitation, motor control and neuromuscular control adaption. The objective of
A. Ramanujam E. Garbarini J. Augustine S. Canton P. Barrance G.F. Forrest (&)
Kessler Foundation, West Orange, NJ, USA
e-mail: gforrest@kesslerfoundation.org
A. Spungen P. Asselin
National Center of Excellence for the Medical Consequences of SCI,
James J. Peters VAMC, Bronx, NY 10468, USA
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A. Ramanujam et al.
this paper is to explore how individuals with motor incomplete SCI who train for
100 h adapt in the device to increase walking velocity. A secondary analysis
explores how increased voluntary control can affect walking velocity in ablebodied
controls.

2.1
Experimental Test Conditions
Five participants with SCI and two AB controls were recruited for the study
(Table 1), of which 3 SCI and 2 AB trained using EksoGT (Ekso Bionics,
Richmond, CA) and 2 SCI participants trained using ReWalk (ReWalk Robotics,
Inc., Marlborough, MA). All participants in the EksoGT were tested using the
Max Assist condition. For each group a standardized training paradigm was
implemented. The participants were tested pre- and post-training under set walking
conditions with their respective exoskeleton. The AB control participants were
asked to ambulate under 5 experimental conditions in the same session with and
without the Ekso. For conditions one, two, and three, the AB group walked
overground without the Ekso: at a SLOW, SELF-SELECTED, and FAST pace.
For conditions four and ve, the AB control group ambulated with the Ekso with
minimal or no volitional control (EXO-WOVC) and with increased active volitional
control of the lower limbs (EXO-WVC). All trials captured 68 steps while walking
along a 10-m walkway and were repeated 24 times as needed within a one hour
session. For all individuals, walking with the exoskeleton occurred with close
supervision (no physical contact) by a skilled physical therapist. All procedures
performed were approved by the Institutional Review Board with prior informed
consent of participants.
Table 1 Demographics
Group/participant
Age
(yrs)
SCI group
RW1
29
RW2
31
EK1
54
EK2
42
EK3
52
AB group
AB1
26
AB2
26
*TPI time post injury; LOI level of
TPI*
(mths)
21.2
36.7
112.8
13.9
32.2
injury
LOI*/
AIS
T7/C
T4/C
C6/C
T12/C
C2/C
Training
(hours)
100
80
60
100
100
10
10
Testing conditions
ReWalk
EksoGT
Max Assist
With & without
EksoGT
Training Response to Longitudinal Powered Exoskeleton
2.2
363
Data Collection and Analysis
Kinematic data were collected at 60 Hz using a Motion Analysis Corporation (Santa

Rosa, CA) motion capture system. Reflective markers were placed on anatomical
landmarks on the whole body according to the Helen-Hayes marker sets using
adhesive Velcro tape. Kinematic data were ltered (2nd order low pass Butterworth
lter, cut-off frequency of 6 Hz) and normalized to percent gait cycle (foot-strike to
foot-strike). Temporal measures analyzed included time (in secs and %) during Initial
Double Stance (IDS), Single Stance (SS), Terminal Double Stance (TDS), and Swing
(SW). Spatial measures comprised of Step Length (StepL), Step Width (StepW), and
Stride Length (StrideL). Kinematic variables included Anterior-Posterior CoM (normalized to %StepL), Medial-Lateral CoM (normalized to %Base of Support) and
walking velocity. Primary statistical analyses included a one-way ANCOVA with
device as the covariate to evaluate training responses for velocity, temporal, and spatial
variables.
3 Results
3.1
Demographics
Participant demographics are presented in Table 1. The maximum training time for
all SCI participants was 100 h with mean number of steps = 170,000 (79,708).
3.2
Spatial Temporal Parameters
Temporal parameters showed a signicant decrease in IDS and TDS (p < 0.05)
post-training, Fig. 1a. Spatial parameters showed a signicant increase in StepL and
StrideL (p < 0.05), Fig. 1b. After training, there was also a signicant increase in
walking velocity (p < 0.05), Fig. 2a. For percent of gait cycle, there was a signicant greater percent swing time for ReWalk. The ReWalk post-training SW
is similar to AB control in EXO-WVC, Fig. 2b.
3.3
Correlation of Temporal-Spatial Measures to Velocity
Correlation data showed a strong signicant positive correlation between walking

velocity and StepL (q = 0.9010, p < 0.001) and StrideL (q = 0.9027, p < 0.001)
and a strong negative correlation between walking velocity and IDS (q = 0.9644,
p < 0.001) and TDS (q = 0.9604, p < 0.001).
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A. Ramanujam et al.
Fig. 1 a Temporal (in seconds) and b spatial measures (in meters) with EksoGT and ReWalk
Fig. 2 a (left). Walking velocity and b (right). Temporal distribution as % Gait cycle with
EksoGT and ReWalk
3.4
CoM
Post-training in the EksoGT, the MLCoM excursion increased for all SCI subjects
and was more centered towards midline of 50 % (particularly EK3, Fig. 3). For AB
controls the MLCoM excursion decreased with volitional control (EXO-WVC) in the
EksoGT and with increasing speed.
3.5
Able Bodied with EksoGT
For AB controls the walking velocity for EXO-WVC was signicantly greater than
EXO-WOVC (p < 0.05). Temporal parameters (IDS, TDS) signicantly decreased
while spatial parameters for StrideL and StepL increased.
Training Response to Longitudinal Powered Exoskeleton
365
Fig. 3 Medial-lateral (X-axis) versus anterior-posterior (AP) (Y-axis) normalized CoM excursions with respect to left leg
4 Discussion
After 100 h of training, walking velocity for both devices positively correlated with
StrideL/StepL and negatively correlated with IDS/TDS. Greater MLCoM excursion
(in EksoGT) combined with reduced IDS/TDS time post-training provides evidence of a more efcient weight transfer strategy onto the stance leg thereby initiating swing on the opposite leg. The increase in velocity for SCI can be attributed
to the changes in these characteristics as well as the improved dynamic stability
(measured by the MLCoM). For ReWalk the signicant increase in %SW combined with increase in StepL contributed towards greater walking velocity. Notably,
after training there was a signicant increase in walking velocity for EksoGT,
even though absolute walking velocity was greater for ReWalk. For AB controls
in EXO-WVC, there was a decrease in IDS/TDS and a signicant increase in
StepL/StrideL that resulted in increased walking velocity. The increase in active
voluntary control also reflected an increase in muscle activation of the lower limbs
as reported elsewhere [3].
5 Conclusion
This study provides a potential rationale for the increase in robotic exoskeleton
velocity for SCI who have completed longitudinal training and AB controls who
train using an increase in active voluntary control.
Acknowledgments CSCR13IRG013 New Jersey Commission on Spinal Cord Research.
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References
1. Esquenazi, A.: The ReWalk powered exoskeleton to restore ambulatory function to individuals
with thoracic-level motor-complete spinal cord injury. Am. J. Phys. Med. Rehabil. 91(11),
911921 (2013)
2. Kressler, J.: Understanding therapeutic benets of overground bionic ambulation: exploratory
case series in persons with chronic, complete spinal cord injury. Arch. Phys. Med. Rehabil.
95(10), 1878 (2014)
3. Ramanujam, A., Cirnigliaro, C., Pilkar, R., Forrest, G.F.: Muscle activation during robotic
powered exoskeleton assisted walking: case series. Front. Neurosci. (submitted for publication)
Adaptive Classication of Arbitrary

Activities Through Hidden Markov
Modeling with Automated
Optimal Initialization
Chris T.M. Baten, Thijs Tromper and Leonie Zeune
Abstract An adaptive method for classication of arbitrary activities is presented

that assesses continuously the activity in which a subject is engaged, thus providing
contextual information facilitating the interpretation of any continuous data gathered from an (unsupervised) applied wearable robotics device and its bearer.
Specically the effect of a novel adaptive and fully automated initialization method
using Potts energy functionals is discussed. Exemplary data suggests that this
method very likely improves overall performance equally or better than more traditional methods. This includes state of the art methods based on segmental
k-means initialization that do require substantial recurrent manual intervention.
1 Introduction
To interpret all detailed kinematic, kinetic and muscle activation and system control
data gathered from a wearable robotic device and its wearer in a real life unsupervised application, contextual information is very valuable. Specically there is a
need for continuous contextual information on the activity in which the subject is
engaged.
The ideal method for contextual data assessment recognizes any activity in
which a person is engaged in from data that is already gathered by the wearable
robotic device.
As there are many activities in which a subject could be engaged and given the
many specic ways in which a given activity can be performed by a subject, a
method that can adapt to the situation is required.
C.T.M. Baten (&) T. Tromper

Ambulatory Analysis of 3D Human Movement Group of Roessingh Research
and Development (RRD), Enschede, Netherlands
e-mail: C.Baten@RRD.nl
L. Zeune
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C.T.M. Baten et al.
One such an adaptive method is presented earlier by authors and is built around
Hidden Markov Modeling, This method is capable of adapting to the activity
classication challenge at hand by learning to recognize a given set of activities
from a given set of relevant data channels performed in a specic way [3]. This
paper discusses how to improve application of this method by optimizing the
initialization of the used HMMs with a newly developed adaptive method.
2 Methods
A. Data preparation
From 3 IMMUs (Xsens Mtw) placed on pelvis, lumbar back section and
sternum only 3D linear acceleration and 3D angular velocity data were used. To
make data more independent from the occasion, subject and sensor placement,
all sensor data was transformed to body segment through a body segment
calibration procedure [1].
Transformation of the data to a more mutually independent vector base was
done by applying Principal Component Analysis (PCA).
B. HMM initialization
3 different types of HMM initialization were tested. Flat start (or no) initialization, an initialization using k-means clustering and an initialization
through a custom algorithm developed using Potts energy functionals:
1. Flat start initialization (standard approach)
All activities are represented by 8 states representing segments of equal
duration
Each state has a normal data distribution with the same overall mean and
variance for the whole activity as initial mean and variance
2. Segmental K-means initialization
Each activity has a manually chosen number of states representing
segments of equal duration
Each state has an estimate for initial mean and average determined
through a K-means clustering procedure [2].
3. Potts Initialization
For each activity the number of states and the duration of each state was
estimated by a variation on Potts algorithm and each state was then given
the mean and variance of the data in the interval of each state
The classical Potts problem to be solved to nd the optimal number and duration
of states is formulated as:
Adaptive Classication of Arbitrary Activities Through Hidden Markov Modeling
369
Pc ckrtk0 kt f k22 ! min:

c2R
where f(t) = u(t) + noise(t) is the measured signal where u(t) is the state function.
Here a successful optimization run delivers u(t) and the number of jump discontinuities in it: the initial number of states. Gamma controls the sensitivity of this
process in adding extra states.
The Hidden Markov Models for activity k = (A, B, p) were optimized in a
training sequence with a the Baum-Welch algorithm [3], i.e. solving:
ki arg maxki PActivityi jki
Here A is a transition probability matrix, B the signal probability distribution
matrix and p the initial state distribution.
3 Results
Figure 1 shows the HMM training results for the 3 methods of initialization applied
to an articial signal. It is clear that flat initialization performs badly and the other 2
perform quite good, where the Potts has a more correct segment start, end and
duration estimate.
In another example Fig. 2 shows in the left graph the original set of the trunk
acceleration z-channel instances for one activity and their average (Black). In the
right graph the mean and the resulting state function u(t) with estimated state
segment durations, means and variances. Note the different durations of the state
segments.
Finally Fig. 3 shows in the top row classication results for a set of typical
activities for an order picker for applying the full method with all three initialization
methods. Clearly the K-means method performed better than the flat initialization
method. The Potts method failed badly. It turned out that this was caused by the
Fig. 1 Results after HMM training for three methods of initialization applied on an articial one
dimensional signal with 4 states with duration average 25 and variance of 1 and amplitude average
(6, 4, 6, 4), with variance (1, 1, 1, 1). Left Flat, middle K-means and right Potts initialization
370
C.T.M. Baten et al.
Fig. 2 Results of Potts method of initialization applied on actual thorax z channel acceleration
signal of a squat lift activity. Left Original signal, right depiction of states with duration, amplitude
mean and variance as estimated by the Potts initialization method. (arbitrary units on both axes)
Fig. 3 Results when applying to set of activities. Top classication results for all three
initialization methods, bottom classication table with predicted versus original activities
segmental k-means initialization
HMM software not being adapted for the new nuance in initialization, introduced
by the Potts method, of state segments possibly having different initial lengths. At
the time of writing this abstract it is not clear how the Potts method will perform
when this software bug is corrected.

Although statistically more powerful analysis results are not yet available, the
exemplary data presented in this paper strongly suggests that optimizing the HMM
initialization with the k-means method improves the systems classication capabilities. As the Potts method performed n better than the k-means method in estimating initial state parameters it is expected that this method will perform similar or
better in classication, specically in situations of states with different segment
durations.
Adaptive Classication of Arbitrary Activities Through Hidden Markov Modeling
371
If this indeed proves true the fully automated Potts method is strongly preferred
over the k-means method that requires manual human intervention for each activity
to be trained every time it is applied.
References
1. Baten, C.T.M., Luinge, H.J., Moerkerk, Hv: Estimating body segment orientation applying
inertial sensing. Neural Syst. Rehabil. Eng. 15(3), 469471 (2000)
2. Juang, B.-H., Rabiner, L.R.: The segmental K-means algorithm for estimating parameters of
hidden Markov models. IEEE Trans. Acoust. Speech Signal Process. 38.9, 16391641 (1990)
3. Wassink, R.G.V., Baten, C.T.M., Veltink, P.H.: Classifying human lifting activities
automatically by applying hidden markov modeling technology. J. Biomech. 40, S428 (2007)
Design and Motion Analysis of a Wearable

and Portable Hand Exoskeleton
Matteo Bianchi, Francesco Fanelli, Roberto Conti, Lapo Governi, Enrico Meli,
Alessandro Ridolfi, Andrea Rindi, Federica Vannetti and Benedetto Allotta
Abstract The design of an aid for the hand function based on exoskeleton technologies for patients who have lost or injured hand skills, e.g. because of neuromuscular
or aging diseases, is one of the most influential challenge in modern robotics to
assure them an independent and healthy life. This research activity is focused on
the design and development of a low-cost Hand Exoskeleton System (HES) for supporting patients affected by hand opening disabilities during the Activities of Daily
Living (ADLs). In addition, the device, able to exert suitable forces on the hand,
can be used during the rehabilitative sessions to implement specific tasks useful to
restore the dexterity of the users hand. The validating and testing phase, conducted
in collaboration with the Don Carlo Gnocchi Foundation, showed satisfying results
both in terms of portability and wearability which are fundamental requirements for
assistance during the Activities of Daily Living (ADLs) and for rehabilitation of
people with hand impairments.
1 Introduction
Nowadays, the first cause of adult disability in Europe is the Cerebral Vascular Accident (CVA) [1]. Up to 80 % of post-stroke patients suffer from hemiparesis of the
upper arm. Moreover, the number of patients with a disability in the upper part of
the body is rising together with the number of elderly [2], who will constitute, in a
A special thanks goes to the Don Carlo Gnocchi Foundation, where the validation phase of the
research activity has been carried out and the testing phase is currently ongoing.
M. Bianchi (B) F. Fanelli L. Governi E. Meli A. Ridolfi A. Rindi B. Allotta
Department of Industrial Engineering, University of Florence, 50139 Florence, Italy
e-mail: matteo.bianchi@unifi.it
R. Conti
IUVO S.r.l. Company, Pontedera, Italy
F. Vannetti
Don Carlo Gnocchi Foundation, Florence, Italy
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Fig. 1 The low-cost hand

exoskeleton developed by
the MDM Lab
few years, more than the 30 % of the total population. Post stroke survivors, genetic
disease patients and elderly with hand disease need timely and persistent rehabilitative training to regain previously dexterity and an assistance during the Activities
of Daily Living (ADLs). An effective and specific solution for the aforementioned
patients may be provided by the use of robotic devices. In fact, robotic systems allow
to provide prolonged and higher-intensity rehabilitation treatments, with a reduction
of costs and burden for the therapists [3]. Since such devices [4] are designed to be
used during rehabilitative sessions, their portability requirement is not mandatory, as
they are employed in hospitals, rehabilitation centers or at home in a specific location
dedicated to their utilization [5, 6]. In case the hand functions may not be totally
restored even after an intense rehabilitation process, hand exoskeletons can be used
to support the user in ADLs assisting the hand performance by amplifying the hand
gripping force [7] or automating the motion [8]. In this case, the wearability of the
device is essential as it must be worn for a long time during the day. Basing on strict
requirements of wearability, portability, cheapness and modularity, the researchers
of the Mechatronics and Dynamic Modeling Laboratory (MDM Lab) of the Department of Industrial Engineering of the University of Florence (DIEF) have developed
and tested an assistive and rehabilitative device for hand disabilities [9] (Fig. 1).
This robotic orthosis is designed to be a low-cost and portable hand exoskeleton for
patients assistance and for rehabilitative use. If compared to the current state of the
art [10, 11], the proposed novel mechanism results easily adaptable to different hand
sizes by modifying only a few geometrical parameters. In addition, the device is
specific for the hand anatomy of the user and is able to closely follow the trajectories
of all the long fingers.
2 Design Phase
The design of the mechanism and the choice of the actuation system have been performed in parallel with the development of the 3D multibody model of the exoskeleton (which includes the hand model): this model-based approach allows the authors
to optimize the wearability of the system.
Design and Motion Analysis of a Wearable and Portable Hand Exoskeleton
375
Fig. 2 Exoskeleton mechanism parts
Fig. 3 Closed-loop angular control of the device
A. Mechanical Part
Starting from the 3D multibody model, a novel exoskeleton kinematic chain, based on
a 1 Degree Of Freedom (DOF) mechanism (Fig. 2), has been designed to reproduce
the desired trajectories of the fingers. The hand exoskeleton mechanism has then been
optimized to reduce both the lateral and the height encumbrances and, finally, all the
parts have been built and assembled. The device is mainly realized in Acrylonitrile
Butadiene Styrene (ABS) and all the structural components have been built by means
the 3D printer of the MDM Lab.
B. Electronics
The electronics consists of four independent servomotors (one for each finger, placed
on the back of the hand), a control unit and a battery pack. The characteristics of
the servomotor, in terms of torque, size and weight, have been chosen according
to the results of numerical simulations. Using a 15-bit magnetic encoder placed
on the joint A of the Fig. 2, the value of the angle 2 , which identifies the single
DOF of the mechanism, can be measured. Using this angular information, a closedloop angular control of the mechanism is realized by means of an Arduino singleboard microcontroller (see Fig. 3 for the control loops architecture). The opening and
closing gestures are commanded using buttons.
3 Results
This phase of the research activity consists in the evaluation of the transparency
of the HES (the capability of the device in reproducing the real trajectories of the
hand phalanges) for a particular test case (a patient suffering from Spinal Muscular
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Fig. 4 Comparison between

the finger (blue) and
exoskeleton (green)
trajectories
Atrophy) and it has been executed using a Motion Capture (MoCap) system. The
motion analysis was carried out by means of the optoelectronic system made up
of 3 cameras. The system (BTS SMART-Suite Motion Capture System by BTS
Bioengineering S.p.A., Milano, Italy) is able to automatically record 3D trajectories
of passive markers Fig. 4 reports the comparison between the trajectories of the
contact point between the hand and the end effector of the device for the index finger.
In particular, the blue line is the trajectory of the index finger acquired through the
MoCap system, while the green one is the trajectory of the mechanism end effector
(also this trajectory is acquired by means the SMART-DX system) when the device
is not worn by the user. The kinematic behavior of the device is very close to the
natural one; in this case, the maximum error is 0.57 mm (red line in Fig. 4).
4 Conclusion
In this work the development and the testing phase of a portable HES for assisting
people with hand opening disabilities have been presented. The comparison between
the real phalanx and the mechanism trajectories provides very satisfying results in
terms of trajectory agreement, highlighting the transparency of the mechanism with
respect to the users general movements. At the time of writing, several exoskeleton
devices are involved in the testing phase on patients at the Don Carlo Gnocchi Foundation Rehabilitation Center, Florence, Italy. These exoskeletons present a reduced
weight, less than 500 g, and they proved to be very comfortable for the users.
References
1. Truelsen, T., Piechowski-Jzwiak, B., Bonita, R., Bogousslavsky, J., Boysen, G.: Stroke incidence and prevalence in Europe: a review of available data. Eur. J. Neurol. 13, 581598 (2006)
2. United Nation Department of Economic and Social Affairs Population Division, World population ageing 2013, United Nations publication, 2013, ST/SEA/SER.A/348
Design and Motion Analysis of a Wearable and Portable Hand Exoskeleton
377
3. Rosenstein, L., Ridgel, A.L., Thota, A., Samame, B., Alberts, J.L.: Effects of combined robotic
therapy and repetitive-task practice on upper-extremity function in a patient with chronic stroke.
Am. J. Occup. Ther. Official Publ. Am. Occup. Ther. Assoc. 1(62), 2835 (2008)
4. Idrogenet srl.: Gloreha(R) (2014). http://www.gloreha.com/
5. Schabowsky, C., Godfrey, S., Holley, R., Lum, P.: Development and pilot testing of HEXORR:
Hand EXOskeleton Rehabilitation Robot. J. NeuroEng. Rehabil. 7(1), 3652 (2010)
6. Takahashi, C.D., Der-Yeghiaian, L., Le, V., Motiwala, R.R., Cramer, S.C.: Robot-based hand
motor therapy after stroke. Brain 131(2), 425437 (2008)
7. Toya, K., Miyagawa, T., Kubota, Y.: Power-assist glove operated by predicting the grasping
mode. J. Syst. Design Dyn. 5(1), 94108 (2011)
8. Lucas, L., DiCicco, M., Matsuoka, Y.: An EMGcontrolled hand exoskeleton for natural pinching. J. Robot. Mechatron. 16(5), 482488 (2004)
9. Conti, R., Meli, E., Ridolfi, A.: A novel kinematic architecture for portable hand exoskeletons.
Mechatronics 35, 192207 (2016)
10. Maciejasz, P., et al.: A survey on robotic devices for upper limb rehabilitation. J. NeuroEng.
Rehabil. 11(1) (2014)
11. Heo, P.: Current hand exoskeleton technologies for rehabilitation and assistive engineering.
Int. J. Precis. Eng. Manuf. 13(5), 807824 (2012)
Nitiglove: Nitinol-Driven Robotic Glove

Used to Assist Therapy for Hand Mobility
Recovery
C. Jimnez, R. Mora, J. Prez and K. Quirs
Abstract Physical therapy is an important resource for the recovery process of

several medical conditions. Hand mobility impairment, for example, affects a patients
life quality, making it a need to develop aid devices that improve the results of
hand therapy, quickening the recovery process. The engineering design process of
a wearable and portable rehabilitation glove, was based on the use of muscle wires
or Nitinol and specially designed flex sensors. The automated control of this device
is performed based on Pulse Width Modulation (PWM), its working cycle, and the
feedback provided by the flex sensors, which allow the controlled movement of the
different joints in each finger through the use of an interactive graphical user interface,
simplifying the phases of measuring the bending angles of each joint before and after
each session.
1 Introduction
Different medical conditions such as carpal tunnel syndrome, arthritis and neurological disorders compromise the ability and strength to properly control hand movement [2]. In these cases physical therapy becomes an important resource in achieving
recovery. The device aids specifically in repetitive joint movement which helps the
recovery process.
Hand therapy includes repeating a sequence of movements to allow the muscles to
develop the strength and coordination to perform simple tasks. Patients that suffered
C. Jimnez (B) R. Mora J. Prez K. Quirs
Instituto Tecnolgico de Costa Rica, Cartago, Costa Rica
e-mail: c.andre1607@gmail.com
R. Mora
e-mail: raquel.mora.mls@gmail.com
J. Prez
e-mail: jdaniel1609@gmail.com
K. Quirs
e-mail: karolq07@gmail.com
379
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a stroke, for example, need to be treated in accordance to both condition severity and
stage of recovery (in this case, specifically flaccidity or spasticity). One of the main
treatments involves repeatedly opening ones hand completely and then making a
fist [3].
Given the exercises included in a hand therapy session, a wearable, portable and
low-cost rehabilitation glove was designed using shape memory wires to execute
the programmed movement. Specially designed flex sensors work alongside a user
interface (UI), allowing the patient and therapist to monitor the session and visualize the movement of each phalange. The following sections will detail the design,
operational principle and specifications of this device.
2 Engineering Design Process

2.1 Muscle Wires
Nitinol is a shape memory alloy composed from nickel and titanium, that has the
distinction of being able to react to environmental stimuli (such as electrical current
and heat), allowing the development of more advanced and inexpensive actuators
with a significant reduction in mechanical complexity and size [4].
To achieve the desired movement the material was preformed by a heat treatment
that forces it to transition from martensitic to austenitic crystalline structure. Setting
the materials shape before this treatment allows it to regain said form on the application of stimuli, therefore, once the materials temperature rises it will reshape to a
desired configuration [1].
The main objective of the preforming process is to obtain wires bent on 90 or
"L" shaped. This simulates a joint while completely bent, as shown in Fig. 1.
The preformed wire was then sewn to a glove on the joints both lateral and palmar
sides to handle the contraction (as shown in Fig. 2) while straight ones were set in
the palmar side only, to handle the finger stretching.
The proposed design contemplates the independent movement of each joint,
allowing the glove to perform independent contractions. This enables the user to
Fig. 1 Hand model showing 90 bent on joints
381
Fig. 2 Hand prototype

showing 90 bent on joints
plan different exercises to work on. In order to generate the required force to move
the joints, three 0.015 in. caliber muscle wires are used on the contraction, while two
are used to stretch a single finger.
Finally, each joint movement is controlled by applying Pulse Width Modulation
(PWM) signals to a wire array using a microcontroller and a basic circuit with a power
MOSFET. The waves frequency as well as its duty cycle are calibrated in values of
25 Hz and 50 % respectively, supplied with 6 V and 1.5 A peak power per wire. Wire
arrays handle a single joint movement. This means that bending a joint at 90 is
done by a set, while another one handles the stretching, though not simultaneously.
This means that the average power consumption for the whole system equals the
specifications required for the biggest wire set.
2.2 Flex Sensors

Custom sensors were built with a pressure-sensitive conductive sheet, named Velostat
or Linqstat, which is a versatile component that is used to create different kinds of
flex and pressure sensors. The final prototype was built with three 2 0.5 cm Velostat
rectangles, and two copper tape layers. Each one has an electrical resistance range
of [1.5, 30] k approximately. This range is converted into bending angles through
the reading of the analog pins of an Arduino. To be able to do this conversion and
obtain appropriate angle values its necessary to perform a basic calibration with the
sensors secured to each intended joint. These sensors are sewn opposite to the wire
array used to stretch joints, as shown on Fig. 3.
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Fig. 3 Flex sensors sewn

onto the glove in order to
measure joint approximate
position
2.3 Results
This design process achieves complete control over joints. Changes in frequency
showed changes in the wires behavior while contracting, but due to the requirement
of the users comfort, frequency was adjusted to the given value of 25 Hz. Heating the
wire is needed for it to change its shape, so through an average temperature at a 50 %
duty cycle PWM, the wire exerted enough force to both contract and expand the joint
used to experiment. Given that three sensors per finger are required, except for the
thumbs, which requires two, its advisable to use the same dimensions for all the used
sensors, obtaining a value within a specific range and reducing measurement errors.
Fixing the sensors directly to the glove increased their precision and stability.
Tables 1 and 2 show joint angles obtained before and after applying the controlled
signal to stretching and bending wire arrays respectively. Data shows effectiveness
on stretching and bending motions in a single joint. Variation on results goes up to
4
4 % error on position
4 along 90 movements, meaning it represents a 4/90 90
obtained. Given the systems specifications this error can be dismissed.
The wire contracts on stimuli due to the materials properties. This contraction,
however was observed to be 1 mm on both the 46 and 26 mm wires. The relative
Table 1 Experimental angles
achieved by the stretching
wire set
Initial angle ( )
Final angle ( )
90
90
90
9
9
7
Table 2 Experimental angles

achieved by the bending wire
set
Initial angle ( )
Final angles ( )
0
0
0
94
92
90
383
contraction is irrelevant given its dimension and the fact it doesnt affect the gloves
functionality.
3 Conclusion
Functionality was achieved because of the adaptability and integrated work of the
nitinol and the flex sensors, making the glove wearable and portable, helping therapies
be more practical. The modification and programming of routines, makes the device
adaptable for the treatment of different conditions, and helps acquire data for research
and feedback of the patients progress. The results also show the repetitiveness of the
wire performance in both cases, stretch and bend, which supports the reliability of the
design device. Futures work involves the combination between the different actuators
in order to achieve mid bending angles.
Acknowledgments The authors gratefully acknowledge the intellectual contributions of Licda.
Alejandra Gonzlez C., Msc. Marta E. Vlchez M., and Ing. Jorge Bolaos, for this projects research
and development.
References
1. Gao, F., Deng, H., Zhang, Y.: Hybrid actuator combining shape memory alloy with dc motor
for prosthetic fingers. Sensors and Actuators A: Physical, vol. 223, pp. 4048 (2015). ISSN:
0924-4247, http://dx.doi.org/10.1016/j.sna.2014.11.025
2. Gloreha: Hand Rehabilitation device. http://www.gloreha.com/index.php/en/home-eng
3. Craig, D., Lucy Der-Yeghiaian, Vu Le, Rehan R. Motiwala, Steven, C.: Robot-based hand motor
therapy after stroke. Brain 131(2), 425437 (2008). doi:10.1093/brain/awm311
4. Jani J.M., Leary, M., Subic, A., Gibson, M.A.: A review of shape memory alloy research,
applications and opportunities. Materials & Design, vol. 56, pp. 10781113 (2014). ISSN: 02613069, http://dx.doi.org/10.1016/j.matdes.2013.11.084
3D Printed Arm Exoskeleton

for Teleoperation and Manipulation
Applications
Pierre Letier, Gonzalo Rodriguez, Guillaume Fau,
Shashank Govindaraj, Torsten Siedel, Jeremi Gancet
and Michel Ilzkovitz
Abstract This paper presents the recent activities of Space Applications Services
for the development of force feedback arm exoskeletons based on 3D printing
technologies. The paper describes the design of the exoskeleton system and illustrates its application through two different projects of slave robotic arm teleoperation, ICARUS and DEXROV, where the concept is used.
1 Introduction
Since several years, Space Applications Services develops exoskeletons technology
to enhance advanced space and ground robotics arm teleoperation applications. The
conventional approach and interfaces for e.g. tele-operating a robotic manipulator
can be ineffective for operators. Arm exoskeletons are intuitive interfaces allowing
to overcome such limitations, capturing human arm movements and translating
them to robot motion commands in a convenient and effective manner. Assets
include a large workspace and force feedback to the operator during manipulation
tasks, resulting in highly intuitive operations. This is especially important for
activities requiring human skills and expertise, in e.g. hostile, non-reachable or
de/un/structured environment.
The rst exoskeleton arm system we have been working on was a demonstrator
for robotic teleoperation in space [1, 2]. This paper presents our experience with the
next generation of exoskeleton we have been developing afterward, in the context
of the EC funded projects ICARUS (and more recently DexROV). As a key
characteristics, this 2nd generation is almost fully built relying on 3D printing rapid
prototyping techniques, instead of regular aluminum structural components. 3D
printing allows completely re-considering the approach to the mechanical design as
it offers a lot more freedom than more conventional approaches. This technique has
been used to reduce the complexity of the overall mechanical design (e.g. number
P. Letier (&) G. Rodriguez G. Fau S. Govindaraj T. Siedel J. Gancet M. Ilzkovitz
Robotics Group, Space Applications Services, Zaventem, Belgium
385
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of components, optimized components regarding efforts and functionality), and to

reduce the weight and the cost of manufacturing.
In the following section, this paper describes the mechatronic design of the
exoskeleton. As an application case, the EC FP7 ICARUS project is further introduced, as well as the EC H2020 DexROV project where similar approach is being
applied in a large extent.
2 Exoskeleton Design
2.1
Mechanical Design
The developed exoskeleton arm has an anthropometric kinematic conguration that

follows the structure of the human arm, with seven degrees of freedom, from the
shoulder to the wrist. The upper arm rotation is ensured by an open rail guiding
system that allows to enter easily within the exoskeleton and reduces collisions with
users body (in contrast to the previous generation implementing a full circular
guide). Apart from the rail support, all the structural mechanical components are
built from Alumide (mix powder of plastic and aluminum) and 3D printed with a
Selective Laser Sintering process (SLA). This approach offers an excellent trade-off
between mechanical design freedom, weight and stiffness (required for haptic
interfaces). Moreover, this material can be easily reworked with conventional
techniques, ensuring good integration with COTS elements as bearings (Fig. 1).
Fig. 1 3D printed
exoskeleton
387
The exoskeleton has ve adjustment links - between the back, the arm and the
hand, that can be easily adapted, without tooling, to the size of the operator.
Polypropylene orthopedic orthoses ensure a good, safe and comfortable xation and
force transmission between the exoskeleton and the operator.
2.2
Mechatronics
Each joint of the exoskeleton is actuated by the coupling of a geared brushless DC

motor with a capstan reducer (cable based reducer frequently used for haptic
interface due to its limited friction and absence of backlash). The specicity of this
design is the implementation of multiple cables on the most powerful joint to
improve to robustness and reliability of this technology. Each joint is also equipped
with position sensors and local joint electronics (Synapticon boards) that perform
electrical interfaces with the sensors and the motors, control locally the joint (in
position or torque) and communicate with the other joint and the main controller
through EtherCAT communication bus. The main controller is responsible for the
global management of the system and is based on the OROCOS framework with
the implementation of an EtherCAT Master interface.
3 Application 1: ICARUS
ICARUS is an EC FP7 funded project aiming developing and demonstrating mobile
robotic capabilities (aerial, ground and see) in support to Search and Rescue
(SAR) operations. In the context of Urban Search and Rescue (USAR) scenarios,
the exoskeleton has been interfaced with 2 different types of robotic arms: a
lightweight 6 dof electrical manipulator mounted on a 50 kg tracks UGV, and large
5 dof hydraulic manipulator mounted on a 4 tons tracks UGV. Relying on the
developed exoskeleton system, we could experiment complex manipulation operations such as clearing debris, opening doors, inspection, deploying rst aid kit and
assisting robot motion in uneven terrain. Windowing position control (to scale the
position control of the robotic arm) and force-feedback based on position-position
algorithms (no force sensors or estimations on the slave robots) have been implemented and tested. During eld trials, the effectiveness of the exoskeleton has been
analyzed and the intuitiveness of the system proven (Fig. 2).
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Fig. 2 Excavator control

with exoskeleton during
ICARUS eld trial
4 Application 2: DEXROV
DexROV is an ongoing EC Horizon 2020 funded project addressing the development of under-sea robotic intervention capabilities, with a focus on (1) far distance
teleoperationinvolving variable communication latencies to mitigate, and
(2) dexterous manipulation capabilities beneting from context specic human
skills and know-how. DexROV intends to develop cost-effective technologies and
methods that will enable subsea operations with fewer off-shore personnel while
increasing the range, flexibility and complexity of operations that are possible.
In DexROV, a double exoskeleton arms system will be developed and interfaced
with a virtual reality environment (rendering models built from data perceived
undersea). The operator will have the possibility to demonstrate the dexterous
manipulation actions to be done. These will be translated into primitives and passed
to the ROV controller (offshore side), so that to execute corresponding manipulation actions.
In this project, the former exoskeleton concept will be enhanced with a second
arm and with exoskeleton hands to match all degrees of freedom available with 2
purposely developed dexterous manipulators to be mounted on the ROV. The
exoskeleton system will feature a modular gravity compensation system to reduce
the constraints on the actuation chain. Novel mechanical design technics based on
shell structure are under investigation in complement to the previous 3D printing
based approach, for improved performance and robustness (Fig. 3).
389
Fig. 3 DexROV operation

concept
Acknowledgments ICARUS is founded from the European Communitys Seventh Framework

Programme (FP7/2007-2013) under grant agreement n285417 -project ICARUS (Integrated
Components for Assisted Rescue and Unmanned Search operations). DexROV contributes in the
Blue Growth long term European strategy to support sustainable growth in the marine and
maritime sectors. DexROV is funded through the EC Horizon 2020 programme (Grant #635491).
References
1. Letier, P., Motard, E., Verschueren, J.-P.: EXOSTATION: haptic exoskeleton based control
station. In: 2010 IEEE International Conference on Robotics and Automation (ICRA), 1840
1845 (2010). doi:10.1109/ROBOT.2010.5509423
2. Letier, P., Preumont, A.: Portable haptic arm exoskeleton. In: Sobh, T., Xiong, X. (eds.)
Prototyping of Robotic Systems: Applications of Design and Implementation, pp. 122145.
Information Science Reference, IGI Global (2012). Chapter 5
Musculoskeletal Simulation of SOLEUS

Ankle Exoskeleton for Countermeasure
Exercise in Space
Moonki Jung, Guillaume Fau, Pierre Letier, Uwe Mittag,
Jochen Zange, Jrn Rittweger and Arnaud Runge
Abstract SOLEUS system aims at providing efcient countermeasure exercises

focused on the lower legs. The nal product is foreseen to be based on an orthotics
structure allowing exercising the ankle joint and muscle groups, even in microgravity. In order to test the pedal-pulling scenario for the operation of the system,
multibody dynamics based musculoskeletal simulation has been performed. The
result of the simulation shows the prole of the ankle plantar flexion torque by
muscles with the given exoskeletons actuator force and motion conditions. Also
the muscle activation patterns could be retrieved.
M. Jung (&)
AnyBody Technology, Aalborg, Denmark
e-mail: mj@anybodytech.com
G. Fau P. Letier
Space Applications Services, Zaventem, Belgium
e-mail: gfa@spaceapplications.com
P. Letier
U. Mittag J. Zange J. Rittweger
German Aerospace Center (DLR), Kln, Germany
e-mail: Uwe.Mittag@dlr.de
J. Zange
e-mail: Jochen.Zange@dlr.de
J. Rittweger
e-mail: Joern.Rittweger@dlr.de
A. Runge
European Space Agency, Paris, France
e-mail: Arnaud.Runge@esa.int
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1 Introduction
Current exercise devices on-board the ISS include e.g. a treadmill device (Treadmill
with vibration isolation system, TVIS), and a device allowing a training analogue
for weight lifting with barbells (Advanced Resistive Exercise Device, ARED).
Astronauts use only about 45 min of their recreation time for exercise and the loads
used for running or resistive strength training (on IRED, the precursor of ARED)
were lower than the virtual body weight related to current body mass. These circumstances may explain the partial efciency of exercise countermeasures in space.
But neither in a treadmill where the trainee performs the typical locomotion
activities like walking or running, nor in the resistance devices the lower leg enters
the energy storing spring like mode. This can be only effectively achieved by a
jumping or hopping-like motion.
SOLEUS system aims at providing efcient countermeasure exercises focused
on the lower legs by allowing customized and targeted training of the body parts
mainly afflicted by bone and muscle degradation.
In order to test the pedal-pulling scenario as a possible exercise protocol of the
system, inverse dynamics based musculoskeletal simulation has been performed so
that the prole of ankle plantar flexion torque by muscles could be calculated with
given exoskeletons actuator force and motion conditions. Also the relevant muscle
activations could be simulated as well so that the systems performance can be
estimated.
2 Methods
AnyBody Modeling System [1] has been used in order to perform the inverse
dynamics analysis on the human-exoskeleton combined model.
2.1
Musculoskeletal Human Model
The lower body musculoskeletal model including head, thorax, pelvis and leg
segments from AnyBody Managed Model Repository (AMMR v1.6) was used for
this study [2]. This human model is scaled by its default setting so that the height is
1.8 m and the mass is 75.6 kg. There are 22 degrees of freedom in this lower body
model. Muscles only exist in the lower body segments whereas there are some joint
torque actuators in the upper body joints.

Table 1 Simulatoin
parameters
2.2
393
Parameters
Values
Dorsiflexion max angle (deg.)

Plantarflexion max angle (deg.)
Plantarflexion speed (deg./sec.)
Medial actuator force (N)
Lateral actuator force (N)
20
40
60
400
400
Denition of Pedal-Pulling Motion
User of this system is supposed to only move his ankle joint except anything else.
During 1 s of the simulation period, then ankle plantar flexion angle will change
from 20 in dorsiflexion to 40 in plantarflexion. So the speed of ankle plantarflexion angle is 60 per second.
2.3
Conditions of the Linear Actuators
There are two linear actuators (medial and lateral) which are involved in both
dorsiflexion/plantarflexion and pronation/supination degrees of freedom. For the
simplicity of simulations, both medial and lateral linear actuators have the same
force prole of constant linear force as -400 N. Negative force means that there will
be a pulling force inside the linear actuator instead of a pushing force (Table 1).
In terms of the kinematics of these actuators, these two actuators are aimed to be
driven in order to always have the same length each other. So the ankle
pronation/supination motion of the human model will be determined by the kinematics of these two actuators.
2.4
Interactions Between Human and SOLEUS System
There are several contact points dened between SOLEUS and human segments
such as thigh, shank and foot in order to predict the interactions between these
segments [3]. Also the existence of tension forces in the straps is assumed. And the
shank part of SOLUES system is assumed to be fully connected to the ground by
using 6 reactional forces and moments. Finally, pelvis is also fully xed to the
virtual chair by using 6 reactional forces and moments (Fig. 1).
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Fig. 1 Interactions between human, SOLEUS and environment
2.5
Inverse Dynamics of Musculoskeletal System
The system of equilibrium equations in inverse dynamics for a musculoskeletal

system can be organized on the following form [1]:
Cf r
where f is a vector of muscle and joint forces, r is a vector of representing the

external forces and inertia forces, and C is the matrix of equation coefcients.
In general, there is a known issue for muscle redundancy due to the fact that
there are more muscles and the degrees of the freedom of the entire system. So the
equilibrium equation has more unknowns than the number of its equations and
therefore there are innitely many solutions.
So this muscle recruitment can be solved by using optimization and the problem
can be formulated in the following way:
Minimize : Gf M
X fi 3
Ni
And there are some constraints regarding the directions of the muscles force
because muscles are unilateral element that can only generate the pulling force [1]:
M
fi
0;
i 1; . . .nM
3 Results
Inverse dynamics analysis of human-SOLEUS combined model could generate
various human-related biomechanical values such as muscle activations and joint
torques by muscles. Individual muscle forces and activations could be determined
395
Fig. 2 Muscle activations while using SOLEUS system
Fig. 3 Ankle plantarflexion torque generated by muscles
by muscle recruitment optimization under the condition that those muscle forces
should generate the necessary amount of human joint torques. And especially the
ankle plantar flexion torque by muscles should overcome the torque that is generated by two linear actuators (Figs. 2, 3).
4 Conclusion
A musculoskeletal simulation model that includes both human and exoskeleton
could be developed in order to perform the inverse dynamics analysis so that
various musculoskeletal values such as muscle activations and joint torques could
be calculated. Also the interaction forces between human and exoskeleton are
available from the same simulation process. All of these simulations values can be
utilized in order to estimate the performance of a new exoskeleton system which is
supposed to provide a certain amount of countermeasure exercise effect on its users.
396
M. Jung et al.
Acknowledgments This study is funded by ESA in the framework of a Technology Research

Program (contract no. 4000112181/14/NL/RA) entitled Integrated Countermeasures with
Biofeedback and Actuators.
References
musculoskeletal systems in the AnyBody Modeling System. Simul. Model. Pract. Theory 14,
11001111 (2006)
2. AnyBody Technology A/S. http://www.anybodytech.com/
3. Jung, Y., Jung, M., Lee, K., Koo, S.: Ground reaction force estimation using an insole-type
pressure mat and joint kinematics during walking. J. Biomech. 47(11), 26932699 (2014)
Human Gait Feature Detection Using

Inertial Sensors Wavelets
S. Glowinski, A. Blazejewski and T. Krzyzynski
Abstract The human gait analysis by using wavelets transform of signal obtained
from six inertial ProMove mini sensors is proposed in this work. The angular
velocity data measured by the gyro sensors is used to estimate the translational
acceleration in the gait analysis. As a result, the flexionextension, the adduction
abduction joint angles of the hips, flexionextension of the knees and dorsi and
plantar flexion of the ankle are calculated. After measurements we propose to use
one of wavelet transform (wavelet type) in order to analyze the signals, indicate a
characteristic feature and compare them.
1 Introduction
This paper is a proposal of a new analysis and experimental tools application in a
scope of human gait. Gait analysis is a clinical tool for obtaining quantitative
information of the gait of a person to diagnose walking disabilities [1, 2]. Common
methods of gait analysis include cameras application to track the position of body
by using reflective markers. An alternative is to use acceleration and angular
velocity data, which are measured from inertial sensors attached to the body.
Miniature inertial sensors are steadily gaining interest because of their limited
power consumption, low cost and good user compliance, when they are embedded
in wearable sensor systems or portable devices [3]. Currently several applications in
human motion analysis may benet from miniature inertial sensors [4]. Human
body motions are captured, measured and next inertial data from sensors are
transmitted to computer. Then data have to be processed because this method does
S. Glowinski (&) A. Blazejewski T. Krzyzynski
Koszalin University of Technology, Koszalin, Poland
e-mail: sebastian.glowinski@tu.koszalin.pl
A. Blazejewski
e-mail: andrzej.blazejewski@tu.koszalin.pl
T. Krzyzynski
e-mail: tomasz.krzyzynski@tu.koszalin.pl
397
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S. Glowinski et al.
not directly measure position. But a major challenge is to translate these data into
meaningful information.
2 Wireless Sensing System

The sensing system is composed of six body wireless inertial sensor nodes based on
ProMove mini platform [5]. The measurement range of the sensor is 10 degreesof-freedom: 2G to 16G (accelerometer), 250 to 2000/s (gyroscope with resolution 0.007/s) and 4912 lT magnetic eld intensity (compass). The maximum
sampling rate is 1000 Hz, and the measured data are transferred wirelessly by using
Inertia Gateway as a central hub. The sampling rate of all measured signals equals
200 Hz, because it is expected a signicant meaning of low frequencies the signals
components. The Inertia Studio software enables real-time visualization of sensor
data, as well as over-the-air reconguration of the sensors and wireless parameters.
All data retrieved by the Inertia Studio software is logged for post-analysis. As
shown in the Fig. 1, the ProMove mini sensors are placed on the part of body along
the right and left leg on the thigh, shank and foot. In global coordinate system
(green color) the x-axis is the walking direction, y-axis lateral direction and z-axis
opposite direction of gravity.
For each sensor the orientation relative to Earth reference frame is calculated in
terms of roll, pitch and yaw angles. By combining the orientation of each node, we
obtain the joint motions of the three segments of the lower limbs. In our experiments the kinematic parameters of interest are the knee and ankle joint angles. By
using four quaternion parameters q0, q1, q2, q3 obtained from survey, we calculate
the Euler angles h of each node as follows:
h arcsin2q0 q2 q3 q1
Fig. 1 The human model and

coordinate systems. The x, y,
z coordinates represent the
global coordinate system, the
xs, ys, zs represents the sensor
coordinate system
Human Gait Feature Detection Using Inertial Sensors and Wavelets
399
Fig. 2 Knee angles during

gait
where it means rotation about y-axis. In the Fig. 2, the knee flexion angle of left and
right leg in sagittal plane, averaged over whole gait period, is shown. The angles are
calculated by divided data into separated steps. Each step is interpolated, because of
different number of samples. The mean angle of the right and left knee is transformed to the cycle. For example, in this case it is noted a slight difference between
angles in loading response and swing (approx. 3). In the left leg in stance phase,
there is noticed the characteristic change in flexion angle in 1315 % of cycle,
whereas in the right leg this phenomenon does not occur.
3 Wavelet Analysis
The sensors transfer an acceleration signals, among others. The sum of the components is taken into consideration as analysed signal, which describes the movement of the part of a leg. The signal includes acceleration of gravity.
We propose to use algorithm combining discrete Fourier transform (DFT) and
continuous wavelet transform (CWT). It applies DFT of the signal in rst step and
next the same transform of the analyzing wavelet at the appropriate angular frequencies in order to obtain directly comparable scales. In the next step the algorithm
takes the product of the signal DFT and the wavelet DFT over all scales found.
Eventually, it inverts the DFT to obtain the CWT coefcients. This procedure easy
allows to convert wavelets scales to frequencies, precisely to so-called
pseudo-frequencies. These pseudo-frequencies represent, not the exact frequencies, but some frequency ranges. The Morlet wavelet is the analyzing wavelet in the
using algorithm [6, 7]. The conducted analysis shows some particular features of
the human gait, which are not possible to observed in raw signal. Look out for
important symptoms of human gait may be difcult as well. The example of
analysis of 4 steps gait, for one sensor placed on human foots (right and left leg), is
shown in Fig. 3. The Fig. 3a, b show the analyzed signal (red curve) and the signal
after reconstruction (blue curve) by using inverse wavelet transform for specic,
chosen range of scales. Both signals should be the same for whole range of scales,
which indicates that the wavelet transform does not cause any loss of information.
400
S. Glowinski et al.
Fig. 3 The analyzed (red) and reconstructed (blue) signals after inverse wavelets transform (aright, b-left foot). Continuous wavelet transform of the analyzed signals obtained by using Morlet
wavelet of parameter 4, where c, d is modulus of wavelet coefcients vs. scales and e, f versus
pseudo-frequency
In the Fig. 3c, d there are absolute scales values of wavelet coefcients shown for
each leg. This kind of analysis may deliver details about components of a gait
characterized by constant frequencies, having variation similar to harmonic functions. The area approx. above 4.59 scales values, along whole time axis, indicates
constant pace of human gait. The character and variation of this pace, conrm the
harmonic changes. The other area is in the range of higher frequencies (Fig. 3c, d),
at scale level approx. 1.09. It is related to steps periods. In these gures the areas on
appropriate scales level (approx. 0.59) show, when the human foot, at rst moment
a heel and next a mid-foot, take a contact with a floor and next it is lifted above.
Below, in the highest frequency range, there is another region that shows moments,
when a body weight is removed from the mid-foot on toes. These parts of signals
are more clearly seen after to pseudo-frequency domain recalculation, which is
shown in Fig. 3e, f.
Comparing the both set of wavelets coefcients values, it is possible to observe
the symmetry or asymmetry of a gait and other signicant features.
4 Conclusion
The many more analyses are possible using wavelets. In the paper we propose the
methodology, which helps to recognize specic feature of human gait that can be
useful in health diagnostic or sport individual training programs creation. The
Human Gait Feature Detection Using Inertial Sensors and Wavelets
401
advantage afforded by wavelets is the ability to perform local analysis. Because

wavelets are localized in time and scale, wavelet coefcients are able to localize
characteristic changes or differences in analysed signals [8]. By shifting parameters
of wavelets, they can be applied as a focus directed to interesting signal area
described by time and scale related to frequencies.
References
1. Glowinski, S., Krzyzynski, T., Pecolt, S., Maciejewski, I.: Design of motion trajectory of an
arm exoskeleton. Arch. Appl. Mech. 85, 7587 (2015)
2. Glowinski, S., Krzyzynski, T.: An Inverse Kinematic Algorithm for Human leg. J. Theor.
Appl. Mech. 54(1), 5361 (2016)
3. Chen, X.: Human Motion Analysis with Wearable Inertial Sensors. University of Tennessee,
Knoxville, Doctoral Dissertation (2013)
4. Zhu, R., Zhou, Z.A.: A real-time articulated human motion tracking using tri-axis
inertial/magnetic sensors package. IEEE Trans. Neural Syst. Rehabil. Eng. 12, 295302 (2004)
5. ProMove wireless inertial sensing platform. http://www.inertia-technology.com/promove-mini
6. Mallat, S.: A Wavelet Tour of Signal Processing. Academic Press, San Diego, CA (1998)
7. Torrence, C., Compo, G.P.: A practical guide to wavelet analysis. Bull. Am. Meteorol. Soc. 79,
6178 (1998)
8. Daubechies, I.: Ten Lectures on Wavelets. Society for Industrial and Applied Mathematics
(SIAM), Philadelphia (1992)
On the Importance of a Motor Model for the

Optimization of SEA-driven Prosthetic
Ankles
Tom Verstraten, Glenn Mathijssen, Joost Geeroms, Louis Flynn,
Abstract Several examples in literature demonstrate the potential impact of motor

inertia on the electrical energy consumption of actuators. Nevertheless, optimizations of actuated prosthetics are often based on the mechanical energy consumption,
disregarding the potential effects of motor inertia. In this short abstract, we simulate the electrical energy consumption of a powered prosthetic ankle actuated by a
Series Elastic Actuator. Its compliant element is optimized for mechanical energy
consumption, a typical strategy in state-of-the-art prosthetics. Our results confirm
the importance of motor inertia. Due to the resulting changes in the operating points
of the motor, the average motor efficiency is lowered by 17 %.
1 Introduction
In a previous study on a pendulum, we concluded that motor inertia plays an important
role in the electrical energy consumption of a stiff actuator [1]. In such actuators,
the operating point corresponding to minimal mechanical energy consumption does
not coincide with the operating point of minimal electrical energy consumption. The
difference between both can be explained by the power needed to accelerate the
motors inertia, leading to an electrical power profile which is dinstinctly different
from the mechanical power profile.
In compliant actuators, motor inertia also has an impact on the dynamics of the
actuator. While a Series Elastic Actuator (SEA) with zero motor inertia would have
a single resonance frequency, a nonzero motor inertia introduces a second resonance
frequency and an antiresonance frequency [2, 3]. It is the latter which is of importance for the minimization of electrical peak power and energy consumption [4].
The first and second author are Ph.D fellows of the Research Foundation Flanders (FWO). The
third author is funded by a Ph.D grant of the Agency for Innovation by Science and Technology
Flanders (IWT).
T. Verstraten (B) G. Mathijssen J. Geeroms L. Flynn B. Vanderborght D. Lefeber
Robotics and Multibody Mechanics Research Group, Vrije Universiteit Brussel, Ixelles, Belgium
e-mail: Tom.Verstraten@vub.ac.be
403
404
T. Verstraten et al.
Nevertheless, most papers on the optimization of SEAs for prosthetics have focused
on mechanical output energy or peak power, not including the motor inertia, motor
and gearbox efficiency into their models [57]. In this extended abstract, we briefly
discuss the consequences of such a simplified approach for the power and energetics
of actuated prosthetic ankles.

In our analysis, we will study a prosthetic ankle actuated by a SEA. We consider
a conceptual SEA consisting of a torsional spring and a 200 W Maxon RE50 DC
motor with a gearbox (gear ratio n = 319, efficiency tr = 68 %). The spring stiffness
is will be the output of an optimization with the goal of minimizing the absolute
mechanical energy consumption

E mech =
|Pmech |dt
(1)
This is the approach followed in most papers. Pmech is calculated from the torque
(Tm ) and speed (m ) at the motor shaft,
Pmech = Tm m
(2)
Tm and m can be calculated from the desired output torque and position T and ,
which are obtained from gait data [8]:
Tm = C T /n
m = n (T /ks + )
(3)
(4)
where ks is the stiffness of the series spring and C is the gearbox efficiency function

C=
1/tr (Pmech > 0)

(Pmech < 0)
tr
(5)
The electrical power consumption Pelec is then calculated as the product of motor
current (I ) and voltage (U ). These are obtained by applying the motor model

I = k1t Jm m + Tm + m m
U = L I + R I + kb m
(6)
which requires knowledge of the motor parameters listed in Table 1. A more detailed
discussion of this model can be found in [1].

Table 1 Motor parameters
for 200W RE50 Maxon motor
405
Symbol Name
Value
kt
kb
m
R
L
Jm
38.5 mNm/A
248 rpm/V
1.46e-5 Nms/rad
0.103
0.0717 mH
536 gcm2
Torque constant
Speed constant
Friction coefficient
Terminal resistance
Terminal inductance
Motor inertia

In this section, we will present a motor efficiency map constructed from Eq. (6). It
represents the motor efficiency as a function of the motor speed m and the dynamic
motor torque Tm + Jm m . This is the torque which is relevant for the energy consumption of the motor, since it is this torque which needs to be delivered by the
motor windings. By plotting the operating points of the motor on such an efficiency
map, one can obtain a fairly good idea of how efficiently the motor is used for a
specific motion. As such, efficiency maps can be a useful tool for tuning the imposed
motion or the actuator design in order to obtain a minimal energy consumption of the
actuator [1]. In the case of an SEA-driven ankle prosthesis, the motion profile of the
motor is determined by the choice of spring stiffness ks through (4). As mentioned
earlier, stiffness is found by minimizing (1), yielding ks = 375 Nm/rad. This is only
slightly different from the value of ks = 368 Nm/rad found by Grimmer et al. [5],
who applied this exact method for their optimization.
Fig. 1 Efficiency map for
the 200 W Maxon RE50
motor, which includes the
Joule losses R I 2 and the
friction losses m m2 . The
green trajectory corresponds
to the operating points (m ,
Tm ), the blue trajectory to
(m , Tm + Jm m ). For
reference, the trajectory of a
stiff actuator (motor inertia
included) is shown in black.
The white lines denote the
maximum permissible motor
torque
406
T. Verstraten et al.
Table 2 Effect of motor inertia Jm on the energy consumption of the Series Elastic Actuator
Actuator
SEA (Jm = 0) SEA (Jm = 536 gcm2 ) Stiff (Jm = 536 gcm2 )
E mech (J)
21.4
E elec (J)
27.7
Average motor eff (%) 77.1
21.4
35.8
59.7
21.4
46.4
46.1
To illustrate the importance of motor inertia, two sets of operating points for the
prosthetic ankle motor are plotted on the motors efficiency map (Fig. 1). The first
set (green) is based on the motor shaft torque Tm , which can actually be measured by
a torque transducer. The second set (blue) is based on the motor torque with motor
inertia included, Tm + Jm m . While the optimization is based on mechanical power,
thus on Tm , it is the latter set of operating points which influences the instantaneous
motor efficiency. However, we can see that both sets of operating points follow
completely different trajectories. The operating points (m , Tm ) are confined within
the recommended operating region of the motor. They do not exceed the maximum
motor speed (9500 rpm) or maximum motor torque (700 mNm), as required for
a good design. Looking at (m , Tm + Jm m ), however, we find that the operating
points exceed this recommended region by far, yielding peak torques of up to 1.28
Nm. Furthermore, commanding high torques at relatively low speeds leads to poor
efficiencies [1]. This is exactly the region in which the SEA is operating. We can
therefore expect the actual efficiency of the motor to be a lot lower than the catalog
efficiency, with potentially detrimental consequences for the overall efficiency of
the actuator. This is confirmed by the calculated energy consumption, presented in
Table 2. With a massless rotor, the calculated electrical energy consumption would
be 27.7J. With motor inertia, the energy consumption rises to 35.8 J. Still, the SEA
clearly outperforms a stiff actuator, which would consume no less than 46.4 J.
Note that, in a cyclic motion, inertias do not contribute directly to energy consumption. However, like springs, their ability to store energy affects the systems
power flows. This can have a positive or negative influence on the losses in other
components. As seen in Table 2, the motor inertia causes a decrease in average motor
efficiency of approximately 17 %. This demonstrates that the SEAs trajectory (m ,
Tm + Jm m ) indeed passes through regions of lower motor efficiency.
4 Conclusion
In this short abstract, we have shown that motor inertia may contribute significantly
to the total torque experienced by the motor. As such, it has a considerable impact
on the energy consumption of the actuator. This could also lead to differences in
the optimized spring stiffness, which is very relevant for compliant designs. Future
research will therefore focus on quantifying the impact of the motor model on the
optimization of compliant actuators for wearable robotics.
407
References
1. Verstraten, T., Mathijssen, G., Furnmont, R., Vanderborght, B., Lefeber, D.: Modeling and
design of geared DC motors for energy efficiency: comparison between theory and experiments.
Mechatronics 30, 198213 (2015)
2. Sensinger, J.W., Burkart, L.E., Pratt, G.A., et al.: Effect of compliance location in series elastic
actuators. Robotica 16 (2013)
3. Beckerle, P., Wojtusch, J., Rinderknecht, S., von Stryk, O.: Analysis of system dynamic influences in robotic actuators with variable stiffness. Smart Struct. Syst. 13(4), 711730 (2014)
4. Verstraten, T., Beckerle, P., Furnmont, R., Mathijssen, G., Vanderborght, B., Lefeber, D.: Series
and parallel elastic actuation: impact of natural dynamics on power and energy consumption.
Mech. Mach. Theory 102, 232246 (2016)
5. Grimmer, M., Eslamy, M., Seyfarth, A.: Energetic and peak power advantages of series elastic
actuators in an actuated prosthetic leg for walking and running. Actuators 3(1), 1 (2014)
6. Paluska, D., Herr, H.: The effect of series elasticity on actuator power and work output: implications for robotic and prosthetic joint design. Robot. Auton. Syst. 54(8), 667673 (2006)
7. Flynn, L., Geeroms, J., Jimenez-Fabian, R., Vanderborght, B., Vitiello, N., Lefeber, D.: Ankleknee prosthesis with active ankle and energy transfer: development of the CYBERLEGs alphaprosthesis. Robot. Auton. Syst. 73, 415 (2015)
8. Winter D.A.: Biomechanics and Motor Control of Human Movement. 4th edn. Wiley (2009)
Assessment of a 7-DOF Hand Exoskeleton

for Neurorehabilitation
Kevin Abbruzzese and Richard Foulds
Abstract Stroke is the leading cause of disability in the United States with
approximately 800,000 cases per year. This cerebral vascular accident results in
neurological impairments that reduce limb function and limit the daily independence of the individual. Robotic rehabilitation may present an exercise intervention
that can improve training and induce motor plasticity in individuals with stroke.
A motorized hand exoskeleton that operates under admittance control provides
support for wrist flexion/extension, abduction/adduction, pronation/supination, and
nger pinch has been integrated with a pre-existing 3-Degree of Freedom
(DOF) haptic robot (Haptic Master, FCS Moog) to determine the efcacy of
increased DOF during proximal and distal training for neurorehabilitation.
1 Introduction
Stroke is the leading cause of disability in the United States with approximately
800,000 cases per year [1]. Despite current technology and interventions, 3066 %
of hemiplegic stroke patients remain without arm function after 6 months recovery;
while only 520 % demonstrate complete functional recovery of the paretic arm [2].
Neurological impairments affecting the Upper Extremities (UE) signicantly limit
the independence of the affected subjects. Strong evidence suggests that therapeutic
interventions that introduce task specic training in the presence of motor practice
can enhance recovery [24]. However, optimal therapeutic interventions that promote recovery of arm and hand function remain unclear due to discrepancies in
This research is funded by Rehabilitation Engineering Research Center on Wearable Robots for
Independent Living (NIDILRR-HSS 90RE5021).
K. Abbruzzese (&) R. Foulds
NJIT, Newark, NJ, USA
e-mail: kma26@njit.edu
R. Foulds
409
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K. Abbruzzese and R. Foulds
current rehabilitation. Robotic rehabilitation may present a complete exercise therapy that can enhance training and standardize clinical practice.
Most robotic systems are designed for elbow and shoulder rehabilitation.
However, there is a necessity to develop upper extremity devices that focus on hand
rehabilitation. We propose that to improve neuroplasticity and establish appropriate
cortical representations, robot mediated therapy should provide a robust approach to
incorporate coordination of arm and hand movements. An active 4-DOF hand
exoskeleton will be integrated with a pre-existing 3-DOF haptic robot (Haptic
Master, FCS Moog) to determine the efcacy of proximal and distal training in UE
rehabilitation. The functional system will allow the user to move their arm in space,
while obtaining robotic assistance for wrist movements such as flexion/extension,
abduction/adduction, and supination/pronation. Pinch assistance will rely on an
active gripper with rotation about the metacarpal joints (MCP) joint of the index
nger and rotation of the thumb MCP to provide flexion/extension of each digit.
The NJIT HandsOn (7-DOF) will support distal hand movements and proximal arm
movements in 3-D space in a Virtual Environment (VE). The system operates under
admittance control and will allow patients with residual muscle function to perform
the desired movements during training. The training system provides a consistent
environment to facilitate repetitive practice with haptic assistance.
Upper extremity movements are biologically encoded for simultaneous control
of arm and hand movement. The motor control response utilizes all DOF to perform
sequential movement during a task. Training with more DOF should provide a more
natural response and greater coordination. UE arm movements for rehabilitation
should reflect the encoded movement and offer training with both gross and ne
motor control.
2 Design Components
2.1
Admittance Control Paradigm
Admittance control (AC) allows the user to input a force, translating the force into
motion. Under AC, the user senses only the inertia of the small virtual mass which
can be very small compared to the inertia and load capabilities of the actual robot
actuators. This makes it useful for individuals with signicant muscle weakness to
employ their residual motor control to effectively drive a powerful robot [5]. The
positive features associated with an AC system for UE rehabilitation include: force
amplication, back-drivability, and intuitive volitional control (Fig. 1). Users
unable to modulate force must rely on preprogrammed movements.
Newtons Second Law can be expanded to include variable system damping where:
F(x) = Force (N), M = Mass (kg), B = damping (Ns/m), x_ (t) = velocity (m/s),
x(t) = acceleration (m/s2 ). This second order differential equation (Eq. 1) serves as
the basis for the admittance control algorithm.
Assessment of a 7-DOF Hand Exoskeleton for Neurorehabilitation
411
Fig. 1 Schematic
representation of admittance
control paradigm
2.2
Fx B x_

M
M
Wrist End Effector
A 3-DOF wrist exoskeleton has been designed to mimic the range of motion of the
wrist and serve as a distal attachment for the Haptic Master. The device incorporates 3-Dynamixel Motors (Robotis) to provide roll, pitch, and yaw (Fig. 2 Top).
The motors are coupled to 3-D printed constructs to support the wrist. The system
provides assistance for flexion/extension, abduction/adduction, and pronation/
supination. It should be noted that intended movements are assisted regardless of
strength limitations.
2.3
Modular Gripper
A modular gripper can be added to the active exoskeleton to provide the ability to
manipulate objects in space and provide haptic sensation within the VE. A single
degree of freedom gripper allows rotation of the MCP of the thumb and index
Fig. 2 NJIT HandsOn

components: 3-DOF distal
end effector with Haptic
Master (top). Modular
Gripper (left) with VE (right)
412
K. Abbruzzese and R. Foulds
nger. The MCP rotation is generated at the index joint using a Dynamixel MX-28
motor and is coupled to the thumb MCP to provide rotation (Fig. 2). This movement provides tip pinch which is critical to hand function for daily life. Impaired
pinch skill signicantly affects dexterity function for stroke survivors, leading to
higher dependency of daily activities and poor quality of life [6]. It is important that
the patient is able to see the hand on the mechanism, especially the thumb to
facilitate grasp pre-shaping, maintain grasp and release [3]. The integrated
exoskeleton grants the user an increase in range of motion and the ability to
manipulate and interact with objects.
2.4
Virtual Environment
Exercise environments can be rendered virtually in order to create a systematic

therapy where the intensity of practice as well as the rewarding feedback can be
consistently monitored and manipulated to aid in motor learning tasks. Subjects
who train in VE show accelerated learning rates as compared to control subjects [7].
Virtual environments possess the ability to provide a more appealing and motivating environment for therapy, offering realistic scenarios with challenging tasks
that can better prepare the patient for daily activities. Unity3D is a cross platform
3-D engine that can be used to develop powerful games and applications for
therapeutic interventions. A VE was created using Unity3D to develop an interface
for the hand exoskeleton. The trajectories of the wrist and nger are mapped to the
virtual representation of the hand, Fig. 2.
3 Methods
Healthy subjects with no visual or motor impairments that are right hand dominate
will be recruited to participate in the study. Subjects will be seated with their left
forearm in an arm orthosis attached to the Haptic Master. The left hand will be
placed in the wrist exoskeleton mounted to the end effector of the Haptic Master.
Subjects will be randomly assigned into 4 groups: Haptic Master control group
(HM), Haptic Master with Gripper (HMG), Haptic Master with Wrist (HMW), and
Haptic Master with Gripper and Wrist (HMGW). Subjects will be instructed to
perform the Pick and Place Task and pick up a virtual cube of varied thickness
(0.45, 0.35, and 0.25 in) and place it on the specied target as many times as
possible during the 120 s trial. Each subject will participate in 6 training sessions,
where each session will consist of 8 trials each. Subjects will perform two sessions
per cube size for 8 trials each.
Assessment of a 7-DOF Hand Exoskeleton for Neurorehabilitation
413
4 Conclusion
The purpose of this study is to establish the effectiveness of the NJIT HandsOn
(7-DOF active system) and the ability to augment learning with haptic feedback in a
virtual environment. This research observes the effect of an admittance controlled
end effector that provides increased DOF at the wrist and hand. The wrist
exoskeleton and modular gripper are able to provide haptic feedback to augment
reaching and grasping mechanics in a VE. The virtual Pick and Place Task will
assess the efcacy of increased DOF at the hand during training. Increased DOF
should provide more biologically appropriate excursions and yield greater success
compared to movements without the appropriate DOF. Feasibility for stroke or
populations with neurological impairment affecting motor control will be assessed
based upon the outcome measures of this study.
References
1. Mozzafarian, D., Benjamin, E.J., Go, A.S., et al.: Heart disease and stroke statistics2015
update: a report from the American Heart Association. Circulation 131(4), e29322 (2015)
2. Kwakkel, G., Kollen, B.J., Krebs, H.I.: Effects of robot-assisted therapy on upper limb
recovery after stroke: a systematic review. Neurorehabil. Neural Repair 22(2), 111121 (2008)
3. Loureiro, R., Harwin, W., Nagai, K., Johnson, M.: Advances in upper limb stroke
rehabilitation: a technology push. Med. Biol. Eng. Comput. 49(10), 11031118
4. Maciejasz, P., Eschweiler, J., Gerlach-Hahn, K., Jansen-Troy, A., Leonhardt, S.: A survey on
robotic devices for upper limb rehabilitation. J. Neuroeng. Rehabil. 11, 3 (2014). doi:10.1186/
1743-0003-11-3
5. Hu, X.: A novel continuous intention-driven rehabilitation robot and its training effectiveness.
Biomech. Med.
6. Faria-Fortini, I., et al.: Upper extremity function in stroke subjects: relationships between the
international classication of functioning, disability, and health domains. J. Hand Ther. 24(3),
257264 (2011)
7. Todorov, E., Shadmehr, R., Bizzi, E.: Augmented feedback presented in a virtual environment
accelerates learning of a difcult motor task. J. Mot. Behav. 29(2), 147158 (1997)
Improving the Standing Balance of People

with Spinal Cord Injury Through
the Use of a Powered Ankle-Foot Orthosis
Amber Emmens, Iolanda Pisotta, Marcella Masciullo, Edwin van Asseldonk
and Herman van der Kooij
Abstract In this study, our goal was to improve the standing balance of people with
a Spinal Cord Injury (SCI) by using a powered Ankle-Foot orthosis acting in the
sagittal plane. We tested four different controllers on two SCI subjects that have a
lesion at a low level. In the experiments the subjects repeatedly had to recover from
pelvis perturbations, while receiving ankle assistive torques from the orthosis. We
found that the controllers that use centroidal dynamics as input parameters were
able to provide proper support to the subjects after a perturbation had been applied,
even though they worked against the subjects after they had recovered from the
perturbation. These preliminary results show the potential of balancing controllers
that operate in Center of Mass-space.
1 Introduction
For people with a spinal cord injury (SCI) who lack ankle motor control, maintaining
balance during standing can be difficult, if not impossible. When properly controlled,
exoskeletons could help to improve the standing balance of these paraplegics. For
people that have an injury at a low level, but who still have hip function, an ankle-foot
orthosis (AFO) may already provide sufficient support.
SYMBITRON is supported by EU research program FP7-ICT-2013-10 (contract #611626).
SYMBITRON is coordinated by University of Twente.
A. Emmens (B) E. van Asseldonk H. van der Kooij
Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
e-mail: a.r.emmens@utwente.nl
I. Pisotta
Laboratory of Robotic Neurorehabilitation,
Neurological and Spinal Cord Injury Rehabilitation Department A,
Fondazione Santa Lucia, Rome, Italy
M. Masciullo
Laboratory of Spinal Rehabilitation, Neurological and Spinal Cord Injury Rehabilitation
Department A, Fondazione Santa Lucia, Rome, Italy
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Our goal is to improve the standing balance of people with a SCI by using a
powered AFO. In this case study, we test standing balance in the sagittal plane using
various balance controllers, that operate in Center of Mass (CoM) space or joint space.
We have implemented these controllers on the Achilles AFO [1] and compared their
balancing performance.

Two subjects that have a SCI participated in the balance experiments. Their characteristics are shown in Table 1.
The experimental setup consisted of the Achilles exoskeleton; a robotic pusher
able to provide systematic perturbations on the trunk [2]; three inertial measurement
units (IMUs) placed at the lower leg, the upper leg and the back of the subject; force
plates; and a safety harness. Figure 1 shows an overview of the setup.
Ethical approval for the experimental protocol was given by the ethical board of
Fondazione Santa Lucia, Italy. In the experiments, subjects had to maintain their
standing balance, without stepping, while receiving pushes on the pelvis from the
pusher. Each subject tested the following controllers:
a Zero-Impedance controller (ZI) (tested twice)
a fixed ankle stiffness (Pankle)
Table 1 Test pilot
characteristics
Subject Sex
code
Mass
(kg)
Height
(m)
Lesion
level
ASIA
S02
S03
71
80
1.65
1.78
C7
L3
D
D
M
M
Improving the Standing Balance of People with Spinal Cord Injury ...
417
a PD-controller on the CoM (PDCoM) that controls the CoM to a reference

location.
a Momentum-based Controller (MBC) that tries to find joint torques such that a
certain desired centroidal momentum is obtained [3, 4]. By optimization, torques
are found that satisfy constraints on the center of pressure (CoP), joint angle limits
and limit torques.
In each trial, one of the controllers was tested and three different perturbation sizes
were applied by the pusher: 0.02Mg (N), 0.08Mg (N) and 0.14Mg (N), where
M is the mass of the subject and g the gravitational constant. Each perturbation
was repeated seven times in one trial, or less when subjects got tired before all
perturbations were applied.
Using the force plates, the torque generated by the subject was estimated and
compared to the torque delivered by the Achilles, to evaluate the supportive effect
of the Achilles. Furthermore we estimated the CoM based on the IMU data to check
when the subjects had restored from a perturbation, that is, when the CoM returned
to a steady state.
3 Results
Figure 2 shows that in the PDCoM trial, and to lesser extent in the MBC trial, an
assistive torque is applied by the Achilles after the onset of a perturbation. The torque
induced by the subject in the PDCoM trial is then reduced compared to the ZI case,
while the total ankle torque is similar to that in the ZI trial. This means that the
subject could supply less ankle torque to maintain balance, because the Achilles was
helping. Figure 2a also shows that the Pankle controller only gives a small support
torque shortly after a perturbation is applied and the subject needs to provide most
of the balancing torque himself. The time it takes for CoM to return to a steady-state
value after a perturbation is similar for all three controllers in Fig. 2a, indicating
that the balancing performance is also similar. Strikingly, Fig. 2b shows that before
the perturbation is applied and after the subject has recovered from a perturbation
(stationary state), the torques delivered by the Achilles and the subject have opposite
sign, which means that they work against each other.
4 Discussion
We found that the PDCoM and MBC could provide a support torque to the subjects, so subjects did not have to apply all the ankle torques necessary for balancing
themselves. Although we could not make a clear distinction between the balancing
performances of the different controllers, this is a promising results, because these
controllers could be beneficial for e.g. people with a SCI that are not able to supply
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Fig. 2 Left: torque delivered by Achilles vs. the torque delivered by the subject and right: corresponding CoM trajectories. Each line in the figure represents a response to the largest perturbation
size. The perturbation time is indicated with the grey box. a Responses of subject S02 in case of the
ZI, Pankle and PDCoM trial. Not enough data was available of the large perturbation responses in
the MBC trial. b Responses of subject S03 in case of the MBC trial
all the balancing torques themselves. Ideally, the Achilles complements the torque
provided by the subject, but we found that the Achilles in some cases works against
the subject. This occurs because the PDCoM and MBC try to bring back the CoM to
a certain desired location (measured in a static pose). When this location is different
Improving the Standing Balance of People with Spinal Cord Injury ...
419
from the instantaneous desired CoM location of the subject, as is the case in Fig. 2b
shown by the difference between the stationary CoM value and zero, he needs to
counteract the Achilles torque. It may not be obvious to subjects that changing their
CoM location can reduce the opposing torque. In that sense, it would be better to let
subjects practice with the controllers first. It is the first time that these controllers are
implemented on an AFO and we expect that the problem of the undesired counteraction can easily be solved in next iterations by not defining a desired CoM location,
but a desired range within which the CoM must return and by resetting this range
when a new steady-state value is measured.
5 Conclusions
We implemented various controllers on the Achilles AFO to improve the standing
balance of subjects with a SCI. We found that the controllers working in CoM-space
were able to provide support torques to help subjects balancing. This could particularly be useful for paraplegics that can generate little ankle torques themselves.
In future work we will improve the balance controllers, based on a centroidal dynamics analysis of standing balance in healthy subjects and extend the controllers to an
exoskeleton with more actuated degrees of freedom.
References
1. Meijneke, C., van Dijk, W., van der Kooij, H.: Achilles: an autonomous lightweight ankle
exoskeleton to provide push-off power. Biomed. Robot. Biomech. 918923, Aug. 2014
2. Vlutters, M., Van Asseldonk, E.H.F., Van der Kooij, H.: Center of mass velocity based predictions
in balance recovery following pelvis perturbations during human walking. J. Exp. Biol. (to be
published)
3. Herzog, A., Righetti, L., Grimminger, F., Pastor, P., Schaal, S.: Momentum-based balance control
for torque controlled humanoids. http://arxiv.org/abs/1305.2042v1 (2013)
4. Lee, S.H., Goswami, A.: A momentum-based balance controller for humanoid robots on nonlevel and non-stationary ground. Auton. Robot. 33, 399414 (2012)
Transparent Mode for Lower

Limb Exoskeleton
R. Mendoza-Crespo, R. Soto and J.L. Pons
Abstract In this paper a method to reduce the mechanical impedance of the joints
of a lower limb exoskeleton is presented. When user is in charge of the motion the
exoskeleton mimic its movements. Gravity, Friction and Interaction Force compensators are designed in order to reduce the force necessary to move the exoskeleton
joints. Gravity compensation is used to mitigate the effect of the exoskeletons weight.
This weight adds a force component when the orientation of the limb is different to
the gravity vector. The added Friction compensation effect reduces the frictional
phenomena of the joints gearboxes. The Interaction Force is calculated from the
measured strain of the segments of the exoskeleton. User intention is also detected
using the Interaction Force. The gain block adjusts the weights of the friction and
interaction compensators depending on the joint velocity. First in this work the context is shown. Followed by the experimental set-up, several compensators and its
effects and the control algorithm.
1 Introduction
There are several control systems for robotic exoskeletons [1, 2]. Impedance control
is one of the most used approach to control robotic systems that interact with humans
[35]. Other works take into account user intention. Measuring EMG signals the
exoskeleton is able to assist walking. This system calculates virtual torques from
EMG signals [6]. There are other patient-cooperative approaches. The system detects
R. Mendoza-Crespo (B) R. Soto

Biomechatronics Group, Tecnolgico de Monterrey, Monterrey, NL, Mexico
e-mail: rafaelmendoza@ingenieros.com
R. Soto
e-mail: rsoto@itesm.mx
J.L. Pons
Bioengineering Group, Spanish National Research Council, Madrid, Spain
e-mail: jose.pons@csic.es
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users intention and voluntary efforts and calculates the correspondent commands to
the actuators instead of repeating predefined sequences or other rigid strategies [7].
In most impedance control methods there is the fundamental difficulty of finding
the appropriate impedance parameters. This is because the physical interaction forces
generated by the user to move the exoskeleton changes from one to another. Even it
changes with the same user between days [8]. Other implementations use the minimal
force interaction approach to make the exoskeleton more transparent to the user [9].
This means that the main goal of the system is to reduce the sensation of forcing the
exoskeleton to move the way the user wants to.
Making the exoskeleton system is an interesting problem to solve. The dynamics
of the system should be canceled in order to have a transparent behavior. Because of
the high reduction ratio of the gear boxes it could be difficult to reduce the inertia of
the assembly.
2 Experimental Set-Up
The H2 robotic exoskeleton has six actuated joints, 3 degrees of freedom per leg in
sagittal plane. Flexion and extension movements are taken into account for Hip and
Knee joints, and dorsi and plantarflexion for the Ankle joint. The exoskeleton has
2 braces per segment to attach it to the user legs. Each joint has its own low level
control and power electronics. The joints have a brushless motor and a harmonic
drive to generate each movement. Each segment that couples a joint to the next has
a pair of strain gauges to measure the link deformation. Using these, the interaction
forces are estimated [10].
3 Gravity Compensation
This compensation is explained here as the joints commands necessary to compensate
the gravity effect on the exoskeleton. Using direct kinematics with all 6 joint angles
known. We are able to calculate the magnitude of the compensation. If velocities and
accelerations are zero it can be expressed as following.
Ti = G (i )
(1)
In (1), T is the magnitude of the torque. G is a function that depends on the angular
position of the joints . i represent the iterator index of each joint.
Tgc H i p = g [(m H l H + m K l K + m A l A ) s H ]
+ g [(m K l K + m A l A ) s H K + m A l A s H K A ]
(2)
Transparent Mode for Lower Limb Exoskeleton
423
Tgc K nee = g [(m K l K + m A l A ) s H K + m A l A s H K A ]
(3)
Tgc Ankle = gm A l A s H K A
(4)
From (2) to (4), T gc is the compensation torque for Hip, Knee and Ankle. g is
the gravitational acceleration. m H , m K , m A are the mass of the Hip, Knee and Ankle
segments respectively. l is the length of the center mass. And s H , s H K , s H K A are sin
function of Hip joint angle, Hip plus Knee angles and the 3 joint angles. The same
calculations are made for both legs.
4 Friction Compensation
If two surfaces are in contact, friction forces may arise when one or both surfaces are
moved. This is a consequence of the irregularities at micro scale. The effects of the
friction depends on many factors, like temperature, properties of the material that
the surface is made of, presence of lubrication and many others [11].
Friction could be modeled in many different ways. It could be taken into account
the static and dynamic effects. The most basic friction model is the so-called Coulomb
Friction Model. It greatly simplifies the frictional phenomena. But it does not include
dynamic effects. Anyway it is part of more complex models even dynamic ones. It
is modeled as a constant force that opposites to motion. Another term that can be
added to the model is the Viscous Friction. It models the friction force as a force that
is directly proportional displacement velocity.
FFC = sign (v) (FCoulomb + FV iscous |v|)
(5)
where FFC is the resultant magnitude of Coulomb and Viscous friction models.
FCoulomb Force of coulomb friction. FV iscous Viscous friction force and v is the
relative velocity of the surfaces involved.
5 Interaction Force
Each exoskeleton joint by itself present mechanical impedance. That is resistance to
movement, but it depends on the speed at which the joint is moved. The interaction
force is defined as the reaction force between the users limb and the exoskeleton
braces. It is produced when the user is trying to move its legs with the exoskeleton
attached. The magnitude of this force does not produce painful movements but it
could be uncomfortable. In consequence the user can not move (walk, sit down,
stand up, or climb stairs) freely.
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Fig. 1 Gravity TGC , friction TFC and interaction force TI F compensation. External forces are
modeled as the torque generated by the user Tuser
The proposed control algorithm minimizes the interaction force between the users
legs and the robotic exoskeleton straps. This mode is called Transparent Mode. It
means that the user perceive the exoskeleton like only carrying a lightweight device
attached to its legs. Except for the braces that has to be adjusted to the users legs.
6 Control System
The proposed control system integrates three terms: Gravity, Friction and Interaction Force compensation in order to reduce the dynamics of the exoskeleton. In
consequence the sensation of wearing the exoskeleton is reduced.
The gain block adjusts the weights of the friction and interaction compensators
depending on the joint velocity. When the joint velocity is zero the ratio between
gains is 9:1. With the Torque controller gain set higher. This is because strain gauges
array are more sensitive to small movements. In addition even if the joint is not
moving at all, it is still possible to calculate the interaction force. When the velocity
is different to zero the ratio will be 1:1 for both signals. This means that the friction
compensation has bigger gain if the joint is moving. When a change of direction of
movement is detected, the ratio changes again. The torque controller gain is 3 times
higher than the friction compensation gain. This way the effect of inertia of the motor
and the joint segment is reduced. The gains where fine tuned heuristically.
7 Conclusion
The compensation strategy has been able to reduce the feeling of the mechanical
impedance of the exoskeleton joints. Friction and Interaction force compensation can
work alone by itself. But the added effects reflects better behaviors and sensation
Transparent Mode for Lower Limb Exoskeleton
425
when wearing the exoskeleton to the user. The Gain adjust block gave us the opportunity to fine tune the behaviour of the joints depending on the velocity and direction.
Using the transparent mode we were able to capture the walking pattern of healthy
subjects wearing the lower limb exoskeleton.
References
1. Kazerooni, H., Racine, J.L., et al.: On the control of the Berkeley lower extremity exoskeleton
(BLEEX). In: IEEE Int. Conf. on Robotics and Automation, Barcelona, Spain, pp. 43534360
(2005)
2. Mendoza-Crespo, R., Gordillo, J.L., Soto, R.: Wearable human lower limb prototype exoskeleton: an operative approach. In: 11th IEEE International Conference on Control and Automation
ICCA, Taichung, Taiwan (2014)
3. Lee, S., Sankai, Y.: Virtual impedance adjustment in unconstrained motion for an exoskeletal
robot assisting the lower limb. Adv. Robot. 19(7), 773795 (2005)
4. Aguirre-Ollinger, G., Colgate, J.E., et al.: Active-impedance control of a lower-limb assistive
exoskeleton. In: IEEE 10th International Conference on Rehabilitation Robotics, Noordwijk,
pp. 188195 (2007)
5. Unluhisarcikli, O., Pietrusinski, M., et al.: Design and control of a robotic lower extremity
exoskeleton for gait rehabilitation. In: IEEE/RSJ Int. Conf. on Intel. Rob. and Sys., San Fran.,
USA, pp. 2530, Sept. 2011
6. Lee, S., Sankai, Y.: Power assist control for walking aid with HAL- 3 based on EMG and
impedance adjustment around knee joint. In: IEEE Int. Conf. on Intel. Rob. and Sys., Switz.,
vol. 2, pp. 14991504 (2002)
7. Riener, R., Lunenburger, L., et al.: Patient-cooperative strategies for robot-aided treadmill
training: first experimental result. IEEE Trans. Neural Syst. Rehabil. Eng. 13(3), 380394
(2005)
8. Tran, H.-T., Cheng, H., Duong, M.-K., Zheng, H.: Fuzzy-based impedance regulation for control of the coupled human-exoskeleton system. In: Proceedings of the 2014 IEEE International
Conference on Robotics and Biomimetics, Bali, Indonesia (2014)
9. Claros, M.J., Soto, R., Gordillo, J.L., Pons, J.L., Contreras-Vidal, J.L.: Robotic assistance of
human motion using active-backdrivability on a geared electromagnetic motor. Int. J. Adv.
Robot. Syst. (2016)
10. Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J., Francisco, G., Pons, J.L.,
findings from a clinical study. J. NeuroEng. Rehabil. (2015)
11. Bona, B., Indri, M.: Friction compensation in robotics: an overview. In: IEEE Conference on
Decision and Control, and the European Control Conference, Seville, Spain, December 1215,
2005
Human-Robot Mutual Force Borrowing

and Seamless Leader-Follower Role
Switching by Learning and Coordination
of Interactive Impedance
Ker-Jiun Wang, Mingui Sun and Zhi-Hong Mao
Abstract This research developed a bilateral human-robot mutual adaptive

impedance control strategy. The developed interactive impedance coordination
methods can let human and robot arbitrarily switch the role between leader and
follower seamlessly. Also, through iteratively increasing the impedance in the
intended moving direction, human and robot can mutually borrow the force from
each other to facilitate the task execution.
1 Introduction
In recent years, with the growing number of stroke, neurologically-disordered
patients, as well as the more and more aging population, scientists are constantly
looking for the development of wearable exoskeletons to compensate and improve
the human capabilities. In a foreseeable future, human-robot symbiosis on
exoskeleton devices will be a common scenario in our society.
In designing and controlling the exoskeletons, some critical issues need to be
considered. First of all, since the exoskeleton is tightly coupled with the human
body, a seamless physical Human-Robot Interaction (pHRI) strategy, which lets
human and robot jointly perform motor skills and dynamically react to the world,
has to be properly designed. The controller should be a two-way bilateral structure,
where both human and robot controllers are in parallel with the system plant,
treating each others feedback gains as part of their own control plants. Human and
robot are constantly learning and adaptively stabilizing the system until reaching a
mutually agreed control protocol [1]. Secondly, the controller should be able to
negotiate both human and robot intentions in order to decide a consensus assistive
modality. In such a way, human and robot can arbitrarily switch the role between
leader (active role) and follower (passive role) in necessary circumstances. When
either human or robot is weak (or has erroneous motions), the other one can actively
K.-J. Wang (&) M. Sun Z.-H. Mao
Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
e-mail: kew88@pitt.edu
427
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K.-J. Wang et al.
take the lead to guide the overall movements. This strategy is extremely useful
when the patients receive active training in the rehabilitation procedures. Finally, to
make the controller work, one grand challenge is the human-robot mutual understanding. A biomimic human-like interaction skill should be established into the
exoskeleton. As a consequence, human can easily understand exoskeletons
behavior and interprets its intention.
Here, we propose a biomimic human-robot symbiosis framework to address the
above issues. We have developed a human-robot co-adaptive optimal controller to
realize the bilateral cooperation behavior [1]. This method can nd out the cooperative impedance both of the human and the robot. Another important contribution
of this paper is that we developed a human-robot mutual impedance coordination
strategy from observing the behaviors of human and human playing Chinese Tai
Chi Chuan [2], an ancient martial art with abundant physical interactive tactics. It
exemplies how to use minimum efforts to steer the opponents limbs by exploiting
the intrinsic biomechanical properties while the limb is moving. Under the impedance coordination strategies of Chinese Tai Chi Chuan, human and robot can
arbitrarily switch the roles between leader and follower seamlessly. In addition,
through iteratively increasing the impedance in the intended moving direction,
human and robot can mutually borrow the force from each other to facilitate the
task execution.
2 Human-Robot Mutual Force Borrowing and Seamless

Leader-Follower Role Switching
Human impedance characteristics when interacting with the environment have been
investigated intensively for a long time [3, 4]. Different human impedance in static
or dynamic environment has been measured or tested [5] to understand how human
control their movement to stabilize the interaction. Until recently, many researchers
start to teach the robot human-like impedance in order to make the interaction more
effective [6, 7]. However, these approaches still lack the fundamental knowledge of
how and when human generates different impedance coordination strategies to react
to different interaction situations. Here, in this research, we observe the behavior of
human-human playing Chinese Tai Chi Chuan and generalize the rules of impedance coordination strategies.
In Fig. 1, we have illustrated the human arm endpoint impedance prole. One
interesting nding is that the human stiffness ellipse is proximately aligned with the
direction of arms movement, meaning that the human has large impedance in the
direction of motion, but has low impedance in the lateral direction perpendicular to
that motion. This nding is exactly how human utilizes his interactive impedance
when playing Chinese Tai Chi Chuan. The players are constantly borrowing force
from each other in their common intended direction, and change the interactive
429
Fig. 1 Illustraion of human arm endpoint impedance in different motion directions and under
different external disturbances. a Stiffness ellipse prole when subject moves in X-Axis direction
[5]. b Stiffness ellipse when subject maintain a constant force against perturbations with different
magnitudes in different directions [5]. c Stiffness geometry interprets a correlation with the direction
of motion. The major principle axis (i.e., maximum stiffness) direction of the ellipse is roughly
aligned with motion direction. d Stiffness ellipse prole when moving in Y-Axis direction [5]
behavior in the lateral direction by tweaking the traits of human impedance

characteristics.
On the intended motion trajectory, human will use his arm stiffness ellipse to
stabilize each transient goal at every time instance. The attractive force generated
from the stiffness ellipse of the next transient goal will drive his arm moving
forward. The force borrowing strategy is achieved by generating additional
attractive force by his opponent in the next-to-the-next transient goal according to
the prediction of his opponent. Human and robot can iteratively execute this
technique to realize the mutual force borrowing strategy.
In the mean while, when human and robot have different intended motion trajectories with each other, the Leader-Follower role switching condition can be
triggered by generating an attractive force in the direction of minor principle axis of
the estimated stiffness ellipses of human or robot, where it has the lowest stiffness to
resist the motion. To be noticed here, since the Leader-Follower role switching also
involves cognitive level interaction. The switching condition we provided here is
simply for the stable physical interaction. After the motion direction has been
changed, the human or robot could still decide whether they will keep the same role
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K.-J. Wang et al.
Fig. 2 Human-robot impedance interaction strategy to achieve force borrowing and

Leader-Follower role switching. Base on the predicted human trajectory and the estimated human
stiffness ellipses, robot can decide how to interact with human according to its own synthesized
stiffness ellipses, and vice versa for human to interact with robot. Leader-Follower role switching
condition is valid only when one is moving in another ones weakest point (i.e., minor principle
axis of the ellipse)
or not. The constant role switching at this Leader-Follower role switching condition
will provide a seamless interaction behavior. The overall strategy can be found in
Fig. 2.
3 Co-Adaptive Optimal Control Framework

To realize our impedance interaction strategy, we build up a human-robot
co-adaptive optimal controller [1]. Human and robot are modeled as two adaptive
optimal controllers in parallel with the system plant, i.e., coupled human-robot
dynamics. The objective of the two controllers is to negotiate their intentions and
cooperatively stabilize the system to achieve a common goal. At here, in order to
reduce the online co-adaptation time required for iteratively adjusting the feedback
gains of both human and robot, we build up a virtual physical human-robot
interaction model inside the robot brain (see Fig. 3). This virtual model can virtually interact with each other and directly predict the future coordinated consensus

^h; K
^ r . These matrices
behavior, interpreted as cooperative stiffness matrices, K
can be used to cooperate with the real entity, or generate the desired impedance
431
Fig. 3 Human-robot co-adaptive optimal control framework with build-in virtual pHRI model.
We assume that robot has all the necessary sensors to collect data. Through the data collections of
fur ; uh ; xg, we can use the illustrated method to learn the virtual plant dynamics x_ ^f ur ; uh ; x,

^ ;R
^ . The
the prediction of human intention ^
vih , and the human optimal control cost values Q
h h
^ h; R
^ h , we
cost values are estimated using inverse optimal control method [8]. After we obtain Q
can reconstruct the virtual human optimal controller to interact with the virtual plant as well as the
robot optimal controller. The virtual interaction will eventually reach to a stable consensus
behavior that we can calculate by solving iterative Linear Quadratic Regulator (iLQR). The
consensus cooperative behavior is calculated as feedback gain or interpreted as cooperative

^r .
^h; K
stiffness matrices K
interaction behavior discussed in Sect. 2. How to learn this virtual interaction model
can be nd in Fig. 3. Here, we use Extended Kalman Filter (EKF) to predict the
human intended trajectory.
References
1. Wang, K.J., Sun, M., Xia, R., Mao, Z.H.: Human-robot symbiosis framework on exoskeleton
devices. In: 2016 IEEE International Conference on Industrial Technology (ICIT), Taipei,
pp. 15001506 (2016)
2. Cheng, M.C.: Master Chengs new method of Tai Chi Chuan self-cultivation (translated by
Mark Hennessy). North Atlantic Books, Berkeley, CA (1999)
3. Hogan, N.: Impedance control: an approach to manipulation: Part i, ii, iii. J. Dyn. Syst. Meas.
Control 107(1), 124 (1985)
4. Burdet, E., Osu, R., Franklin, D.W., Milner, T.E., Kawato, M.: The central nervous system
stabilizes unstable dynamics by learning optimal impedance. Nature 414(6862), 446449
(2001)
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5. Tee, K.P., Burdet, E., Chew, C.M., Milner, T.E.: A model of force and impedance in human
arm movements. Biol. Cybern. 90(5), 368375 (2004)
6. Rozo, L., Calinon, S., Caldwell, D., Jimenez, P., Torras, C.: Learning collaborative
impedance-based robot behaviors. In: AAAI Conference on Articial Intelligence,
North America, June 2013
7. Howard, M., Mitrovic, D., Vijayakumar, S.: Transferring impedance control strategies between
heterogeneous systems via apprenticeship learning. In: Proc. 2010 IEEE-RAS International
Conference on Humanoid Robots (2010)
8. Anderson, B.D.: The inverse problem of optimal control. DTIC Document, Fort Belvoir, VA,
USA, Tech. Rep. 6560-3 (1966)
Upper Limb Exoskeleton Control

for Isotropic Sensitivity of Human Arm
Rok Goljat, Tadej Petric and Jan Babic
Abstract Most of todays assistive devices are controlled to provide uniform assistance irrespectively from the configuration of the human arm and the direction of the
movement. We propose an innovative control method for arm exoskeletons that takes
into account both of these parameters and compensates the anisotropic property of
the force manipulability measure, intrinsic to the biomechanics of the human arm. To
test our controller we designed a set of reaching tasks where the subjects had to carry
two different loads to targets at five different locations and of two different sizes.
Reaching times and trajectories were analysed for the evaluation of the controller.
Through the analysis of the average reaching times we found that our method successfully enhances the motion while the analysis of the average maximal deviation
from the ideal trajectories showed that our method does not induce any additional
dynamic behaviour to the user.
1 Introduction
Robotic wearable devices such as exoskeletons are being developed to either augment the abilities of healthy individuals or to improve the condition of those with
impaired physical abilities [1, 2]. A common approach to control such devices is to
measure interaction dynamics and use the inverse dynamics models to either directly
amplify the forces produced by the human muscles or to generate task dependent
The work presented in this paper was supported by the European Unions Horizon 2020 research
and innovation programme under grant agreement No. 687662SPEXOR.
R. Goljat (B) T. Petric J. Babic
Automation, Biocybernetics and Robotics Department, Jozef Stefan Institute, Ljubljana, Slovenia
e-mail: rok.goljat@ijs.si
T. Petric
e-mail: tadej.petric@ijs.si
J. Babic
e-mail: jan.babic@ijs.si
433
434
R. Goljat et al.
trajectories [3]. Although this approach efficiently augments human motion, it does
not take into account the mechanical characteristics such as the highly anisotropic
manipulability of the human arm. The aim of this paper is to propose a feed-forward
control approach that augments the motion of the human arm by transforming the
anisotropy of the arm manipulability [4, 5] in such a way that the axes become equal.
Instead of amplifying the forces exerted by the human hand equally in all directions,
our control approach produces forces in such a way that the manipulability ellipsoid
becomes a circle.

For the design of our control approach we considered two biomechanical parameters
of the human arm: the manipulability measure which is based purely on the arm
kinematics, and the mobility measure which takes into account both the kinematics
and the dynamics of the arm.
2.1 Manipulability
The manipulability measure takes the uncertainty of joint angles and transforms it
to the uncertainty in end-point position. By assuming that the joint sensors are noisy
with variance 2 and independent from each other then the covariance of uncertainty
is transformed from joint space to covariance of uncertainty at the end-point:
Cov(x) = JCov(q)JT = 2 M.
(1)
Here, x and q are the end-point and joint uncertainties and J is the Jacobian of
the current arm configuration. In (1), the matrix
M = JJT
(2)
represents the manipulability matrix [6] that shapes the independent joint noise into
Cartesian end-point noise.
2.2 Mobility
The mobility measure is based on the instantaneous response of the arm to dynamic
perturbations [7]. If the inertial matrix H of the arm is known, we can then define
the mobility measure as
(3)
W = JH1 JT ,
Upper Limb Exoskeleton Control for Isotropic Sensitivity of Human Arm
435
where W represents the end-point mobility matrix [8]. Because mobility also includes
the inertia of the arm, it can be considered as a more precise measure of arm sensitivity.
2.3 Control Method

The eigenvectors of mobility and manipulability matrices represent directional sensitivity of the arm [7]. Specifically, it is the easiest to control the end-effector position
and sense perturbations along the axis of the minor eigenvector and the hardest in
the direction of the major eigenvector. If we invert the sensitivity matrices, than they
relate to the joint torque and end-effector force. In this case, the major eigenvector
points in the direction where it is the easiest to exert the end-effector force and the
minor eigenvector points in the direction where it is the hardest to exert the endeffector force. To counteract these anisotropic properties we propose a novel control
method for arm exoskeletons that transforms the anisotropic sensitivity of the arm to
the isotropic sensitivity. Using singular value decomposition, the sensitivity matrices
can be represented as ellipses with the major and minor axes representing the major
and minor eigenvectors.
To augment the user exerted force and obtain isotropic sensitivity, the assistive
force Fa needs to equal the user exerted force Fu amplified by the ratio between
ellipse major axis Maxis and the projection of the user force Faxis on the ellipse (4).

Fa =

||Maxis ||
1 Fu
||Faxis ||
(4)
3 Experiments and Results

We implemented the proposed controller in a simulation environment and compared
its performance for both mobility and manipulability measures. For the manipulability measure, the controller was also experimentally evaluated on 5 subjects.
Figure 1 shows the forces generated by the controller if the user exerted 1 N forces
in three different positions of the arm. Due to the thin shape of the ellipse on the
edges of the workspace, larger assistive forces were exerted there than in the central
region of the workspace. For the safety reasons, the maximum assistive force was
limited to 9 N.
Subjects performed unassisted and assisted load carrying motions to five different
targets of two sizes (20 mm, 5 mm). The motions were performed on a transverse
plane at the shoulder height. The experiment consisted of three consecutive sessions.
In the first session, the subjects were unassisted and had to move a 3 kg object
(baseline session). In the second session, the subjects were also unassisted but had
to move a heavier object weighting 30 kg (heavy session). In the final session the
436
R. Goljat et al.
Arm position
0.5
-0.5
0
-9
9
Fy [N]
1.5
y [m]
Controller
Fy [N]
y [m]
1.5
0.5
-0.5
0
-9
9
Fy [N]
1.5
y [m]
Fig. 1 Plots in the left

column show the inverted
manipulability (blue) and
mobility (red) ellipsoids for
tree different positions of the
arm inside the workspace
(black). The dotted lines
show the normalized
ellipsoids. Plots in the right
column show the assistive
forces of the proposed
controller for the
corresponding configurations
in the left column. The
arrows represent the assistive
forces for the manipulability
measure (blue) and the
mobility measure (red)
0.5
-0.5
-1
0
-9
-9
Fx [N]
x [m]
subjects had to move the 30 kg object but were assisted by the proposed controller
(assisted session).
Table 1 shows the average reaching times and average maximum deviations of
motions performed by subjects during the three sessions and for both target sizes.
When the subjects were asked to move a heavy load, their average reaching times
were larger than during the baseline session. When they were asked to move a heavy
load while being assisted by the controller, their average reaching times were close to
the times during the baseline session. Decreasing the target size increased the overall
time of the movements but did not have any notable effect on the motion trajectory.
Table 1 Experimental results

Trial (target size)
Baseline (large)
Heavy (large)
Assisted (large)
Baseline (small)
Heavy (small)
Assisted (small)
Average time (s)
Average deviation (m)
0.51
0.76
0.58
0.98
1.26
1.05
0.024
0.028
0.018
0.030
0.028
0.025
Upper Limb Exoskeleton Control for Isotropic Sensitivity of Human Arm
437
4 Conclusions
We developed and evaluated a novel controller to augment the motion of the human
arm based on its manipulability and mobility measures. By simulations and an experimental study we demonstrated that the proposed control method successfully augments human capabilities without introducing any additional disturbances to the
human motion. In the future we plan to carry out an extensive experimental study
involving both manipulability and mobility measures and further expand the sensitivity model to generalize it for more complex tasks.
References
1. Dollar, A.M., Herr, H.: Lower extremity exoskeletons and active orthoses: challenges and stateof-the-art. IEEE Trans. Robot. 24, 144158 (2008)
2. Peternel, L., Noda, T., Petric, T., Ude, A., Morimoto, J., Babic, J.: Adaptive control of exoskeleton
robots for periodic assistive behaviours based on EMG feedback minimisation. PLoS ONE 11(2),
02 (2016)
3. Peternel, L., Petric, T., Oztop, E., Babic, J.: Teaching robots to cooperate with humans in dynamic
manipulation tasks based on multi-modal human-in-the-loop approach. Auton Rob 36(1), 123
136 (2013)
4. Cos, I., Belanger, N., Cisek, P.: The influence of predicted arm biomechanics on decision making.
J. Neurophysiol. 105(6), 30223033, Jun 2011
5. Yamashita, M.: Robotic rehabilitation system for human upper limbs using guide control and
manipulability ellipsoid prediction. Procedia Technol. 15, 559565 (2014)
6. Yoshikawa, T.: Foundations of robotics: analysis and control. MIT Press, Cambridge, MA (1990)
7. Sabes, P.N., Jordan, M.I.: Obstacle avoidance and a perturbation sensitivity model for motor
planning. J. Neurosci.: Off. J. Soc. Neurosci. 17(18), 71197128, Sept. 1997
8. Hogan, N.: Impedance control: an approach to manipulation: part ii implementation. J. Dyn.
Syst. Meas. Control 107(1), 816 (1985)
AUTONOMYO: Design Challenges

of Lower Limb Assistive Device
for Elderly People, Multiple Sclerosis
and Neuromuscular Diseases
A. Ortlieb, M. Bouri and H. Bleuler
Abstract Lower limb wearable robotics also known as exoskeleton or power suit
is a booming eld of research. Potential medical applications cover a large range of
gait disorders from rehabilitation to assistance in daily mobility. Surprisingly, or
not, paraplegia seems to be the rst target of all commercialized exoskeleton. In this
paper we will try to understand this choice and look at other disorders leading to the
inability to walk. Neuromuscular, autoimmune or neurological diseases such as
muscular dystrophy, multiple sclerosis or stroke, can lead to similar gait disorders
and are mostly incurable today. SCI (Spinal Cord Injury) symptoms are quite
dissimilar from theirs and reveal specic design challenges. Existing devices
architecture and human-robot interaction are presented and discussed in terms of
adaptation toward non-SCI disorders.
1 Introduction
Trends in lower limb assistive devices currently target mostly SCI (Spinal Cord
Injury) patients. Over the four commercialized products (Ekso from Eksobionics,
ReWalk from ReWalk robotics, REX from REX bionics and HAL from
Cyberdyne) targeted users are unanimously SCI patients [14]. However, based on
This study is co-nanced by ASRIMM (Association Suisse Romande Intervenant contre les
Maladies neuro-Musculaires) and FSRMM (Fondation Suisse de Recherche sur les Maladies
Musculaires).
A. Ortlieb (&) M. Bouri H. Bleuler
Laboratory of Robotic Systems, Ecole Polytechnique Fdrale de Lausanne,
Lausanne, Switzerland
e-mail: amalric.ortlieb@epfl.ch
M. Bouri
e-mail: mohamed.bouri@epfl.ch
H. Bleuler
e-mail: hannes.bleuler@epfl.ch
439
440
A. Ortlieb et al.
the National Health Interview Survey from 2012, about 7 % of the adult US
population (17 million people) reported not to be able to walk a quarter of a mile
(*400 m) or with major difculties [5]. The same year, the number of SCI patients
was estimated to be about 270,000 [6], which represents 1.59 % of the population
under the walking autonomy of 400 m. The two questions that come out from this
observation are: why does the industry of medical exoskeleton target mostly SCI
patients while the market seems 60 times bigger and what are the other disorders
that lead to a poor walking autonomy?
2 Walking Impairments
Various effects can severely affect the walking ability. First, Blackwell et al. [5]
reports that the percentage of people with walking disability largely increases with
age, where the median is about 64 years old. The elderly population has thus the
larger representation in gait impairments. Ma et al. [7] reported that in rehabilitation
perspectives there exist 8 dominant cause of disability in the US: back pain,
osteoarthritis, rheumatoid arthritis, stroke, traumatic brain injury, amputation,
multiple sclerosis and SCI. In terms of prevalence (in the US) [7], osteoarthritis is
the main cause of disability for 8.6 million adults (2012), rheumatoid arthritis
affected 1.3 million adults in 2005, stroke 6.8 million people (2013), traumatic brain
injury 3.32 million (2005), lower limb amputation 1.6 million (2005), multiple
Fig. 1 Illustration of the

different systems of the body
involved in the walking
ability process
441
sclerosis 400,000 (2009) and SCI *270,000 (2012). From this non-exhaustive list,
neuromuscular diseases (NMD) such as muscular dystrophy are not mentioned.
Based on the incidence in Northern Ireland [8] extrapolated to the US adult population in 2012, the number of NMD patients is estimated to be about 80,000.
The nature of the disability is essential for the design of the assistance. Figure 1
below maps the different origins of the walking impairment in the human body.
3 Trends of Existing Medical Devices

As described in the introduction, actual medical exoskeletons focus mainly on SCI
patients with applications as for personal use at home or for rehabilitation in clinics.
These devices basically propose two designs and different but comparable strategies
of interaction.
3.1
Human-Robot Interaction
Current strategies in medical exoskeletons are mostly called mobilization strategies.

What underlies this term is that the motion trajectories made by the device follow a
given pattern independently from the user will. However, the user can smartly
decide on the activity and the timing of the motion based on different approaches
such as a hand controlled joystick, the trunk motion or the position of the center of
mass (CoM). The current trend in human-robot interaction follows a high level
control where the interactions between the users legs and the exoskeleton are
unidirectional.
3.2
Design Architecture
Two architectures are currently observed among existing devices: a quasi-full

actuation architecture with more than ve actuated degrees of freedom (DOFs) on
each side of the device and the minimal actuation architecture with two actuators
each side. The minimal actuation architecture locks all DOFs at the ankle joint,
while the hip and knee flexion/extension are motorized. For the quasi-full actuation
architecture, only the internal/external rotations can be non-actuated. As a consequence, the minimal architecture cannot be self-stabilizing and the user needs an
external support (crutches or a rollator) to maintain balance. If the quasi-full
architecture allows balance control and free hands, it is heavier, bulkier and slower
up to a factor 10.
442
A. Ortlieb et al.
Another aspect of current devices is the poor back drivability of the

actuation-transmission design which is however coherent with the unidirectional
interaction presented above.
4 Challenges Toward Assistive Devices

As described in section II, SCI represents a small part of walking impairments.
However frail elderly people, multiple sclerosis and neuromuscular diseases share
several similarities: A need for (assisted) daily activity to prevent the deterioration
of the walking ability, residual but localized and variable strength in the lower
limbs, weak upper limb muscles and a high risk of falls due to low balance control.
To address these disorders, a new type of exoskeleton needs to be developed in
accordance with the following criteria.
4.1
Human-Robot Interaction
In opposition with SCI patients, targeted populations need a strong bidirectional

interaction between the users legs and the device. This interaction will strongly
depend on the residual control and strength at each joint of the user. The interaction
should be at a lower control level to allow the real time synchronization between the
user will and the exoskeleton motion. At the same time, the device should be able to
evaluate and predict the risk of falls and react over the user in case of emergency.
4.2
Design Architecture
The rst element is that to be able to have a bidirectional interaction, the actuation
and transmission system requires a high transparency or back drivability. The other
aspect is that the device should be very flexible to be able to adapt each joint power
to the impairment of the user in order to keep a lightweight and allow a high degree
of back drivability. Finally, the exoskeletons architecture should be complete
enough to augment the balance of the user in the frontal and lateral directions while
keeping the number of actuators as low as possible to reduce the weight of the
device.
The proposed design in the frame of the AUTONOMYO project comprises high
torque, efcient and low inertia motors combined with planetary gearboxes with an
efciency about 80 %. Each motor-gearbox chain is standard so that it can easily be
changed to better suits the users need for each joint. All actuators and batteries
which represents about 70 % of the mass of the device are placed, thanks to cable
443
transmission, about the pelvis which makes the robotic lower limbs very lightweight and allows high dynamics.
5 Conclusion
While commercialized medical exoskeletons currently target SCI patients, a wide
range of other walking impairments could benet from different and more adapted
assistive exoskeletons. The solution proposed allows an important level of back
drivability while affording high dynamics and torque. The possibility to easily adapt
the hardware to different joints requirements largely increases the scope of user.
References
1. Ekso Bionics - An exoskeleton bionic suit or a wearable robot that helps people walk again
(Online). http://intl.eksobionics.com/. Accessed 30 Mar 2016
2. ReWalk 6.0 Home: ReWalk More Than Walking (Online). http://rewalk.com/. Accessed 30
Mar 2016
3. REX Bionics - Step into the Future: Rex Bionics (Online). http://www.rexbionics.com/.
Accessed 30 Mar 2016
4. CYBERDYNE (Online). http://www.cyberdyne.jp/. Accessed 30 Mar 2016
5. Blackwell, D., Lucas, J., Clarke, T.: Summary health statistics for U.S. adults: National Health
Interview Survey, 2012. National Center for Health Statistics (2014)
6. 2012 NSCISC Annual Statistical Report Complete Public Version: National Spinal Cord Injury
Statistical Center (2012)
7. Ma, V.Y., Chan, L., Carruthers, K.J.: Incidence, prevalence, costs, and impact on disability of
common conditions requiring rehabilitation in the United States: stroke, spinal cord injury,
traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and
back pain. Arch. Phys. Med. Rehabil. 95(5), 986995.e1, May 2014
8. Hughes, M.I., Hicks, E.M., Nevin, N.C., Patterson, V.H.: The prevalence of inherited
neuromuscular disease in Northern Ireland. Neuromuscul. Disord. 6(1), 6973 (1996)
Passive Lower Back Moment Support

in a Wearable Lifting Aid: Counterweight
Versus Springs
Ralph J.L. Macke, Arvid Q.L. Keemink and Arno H.A. Stienen
Abstract Passive wearable lifting aids support workers by applying gravity force
compensation at the arms. In this study we investigated the feasibility of a compensatory lower back moment, generated by a practically constant spring force (38.5
Nm), extending the lower back by pushing on the upper leg. This design is proposed
as a light-weight solution to generate lower back moments. The method is compared
to using counterweights at a different distances. We recorded EMG activity of the
erector spinae longissimus (ES) muscle, the perceived workload (NASA TLX) and
the preference of 12 subjects. Results showed no significant difference in ES peak
EMG activity during the task, and no significant difference between perceived workload between conditions, as we expected. However, 10 out of 12 subjects indicated
preferring the spring mechanism over both counterweights. The main reason of preference was the reduction of weight and inertia of the system. Therefore, the proposed
constant spring force mechanism is a feasible alternative to counterweights.
1 Introduction
Heavy lifting is a strong contributor to low back injuries, in part due to the spinal
loading [4]. Part of this load stems from trunk muscles with a short moment arm that
need to provide high forces to stabilize the spine.
The authors would like to thank Hankamp Rehab for providing the SaeboMAS and the SaeboMAS Mini passive lifting devices.
This research is supported by the Dutch Technology Foundation STW, which is part of the
Netherlands Organisation for Scientific Research (NWO), and which is partly funded by the
Ministry of Economic Affairs. Project Number: 12162.
R.J.L. Macke A.Q.L. Keemink (B) A.H.A. Stienen
Department of Biomechanical Engineering of the University of Twente, Enschede, Netherlands
e-mail: a.q.l.keemink@utwente.nl
A.H.A. Stienen
Department of Physical Therapy and Human Movement Sciences, Northwestern University,
Chicago, USA
445
446
R.J.L. Macke et al.
Passive wearble lifting devices to reduce this burden on its user can therefore
be very valuable for the health of the user. The passive FORTIS (Lockheed Martin
Corporation, Bethesda, MD, USA) uses a counterweight to balance the moment
induced by the supported load carried by the user. Devices that use a spring mechanism only provide a supportive force when the user is flexing their trunk (much
like a torsion spring) such as the Personal Lift Assist Device (Queens University,
Kingston, ON, Canada) [1, 3] or the Laevo (Laevo B.V., Delft, Netherlands). This is
a major difference compared to using a counterweight, which continuously provides
compensation, but also makes the device heavier.
In this study we investigated if springs are a feasible alternative to counterweights,
when providing an almost constant moment compensation, which different from torsion spring behavior. We measured electromyography (EMG) activity on the lower
back, specifically the erector spinae longissimus (ES), during a lifting and lowering
task. This study also investigated subject preference for the various moment compensation methods using a questionnaire and the NASA Task Load Index (TLX).

A balanced repeated measures design was used where subjects performed a symmetric lifting task in three varying conditions. Subjects were asked to lift an 11.2 kg
load while being assisted in gravity compensation force for 50 % by a passive lifting assistive device (SaeboMAS Mini, Saebo, Charlotte-NC, USA). During lifting,
subjects were supported and the lower back with a counter moment of 38.5 Nm.
In this experiment three different moment compensation conditions were compared: a constant spring force mechanism, a light counterweight of 6 kg at a distance
of 0.54 m, and a heavy counterweight of 12 kg at a distance of 0.27 m. The lifting
aids are shown schematically in Fig. 1 and the real setup is shown in Fig. 2.
Subjects were instructed to lift once per minute the load from a table onto a
plateau and after 30 s lower the load back onto the table, for a total of 10 repetitions
per condition. The table had a height of 79.5 cm and the plateau had a height of 120.7
cm; both measured from the ground.
Twelve healthy subjects (11 male, 1 female) were recruited from the university
population. Average subject characteristics were 23.3 1.8 years of age and 185 7
cm in length. Subjects were aware of the goal of the study and blinding was not
possible. We met institutional requirements and informed consent was obtained from
all subjects.
EMG of the ES was measured using the Delsys Trigno wireless EMG system
(Delsys Inc., Boston, MA). Electrodes were placed 3 cm lateral from the spinous
process of the L3 [2]. An online tool was used to fill in the NASA-TLX. Subjects
were asked after the experiment which compensation method they preferred, and why.
From the EMG data, peak muscle activity was investigated, because this would
relate to peak spinal compression. The envelope of the EMG signal was calculated
by phase-lag free (Matlab filter filtfilt) high-pass filtering (10 Hz 4th order
Passive Lower Back Moment Support in a Wearable
447
Fig. 1 Schematic view of the assistive device with only relevant forces to show the contribution
to moments around and forces in the lower back. A load Fload is held at distance dload . A gravity
compensator (its weight and reaction force omitted for clarity, see Fig. 2) assists with force Fgc .
The human generates a residual lifting force Fhand at the hand and an extension moment Mlb at
the lower back. The moment in shoulder is omitted for clarity. a The spring mechanism provides
an almost constant force at the leg-interface Fsp,nor mal , over distance d, assisting the extension
moment, irrespective of the angle made with the rest of the suit. b The counterweight generates a
gravity force Fcw , at a distance d, assisting the extension moment. The downward force experienced
at the hip is higher than in (a) due to the counterweright Fcw
Fig. 2 The gravity
compensation device on the
upper back assists in lifting
50 % of the weight. a The
spring mechanism pushes on
the upper legs to generate an
assistive moment in the
lower back. b a heavy
counterweight of 12 kg
delivers an assistive moment
in the lower back
(a) Spring Mechanism
(b) Counterweight
Butterworth), full wave rectification and phase-free low-pass filtering (3 Hz 2nd

order Butterworth). Peak muscle activity for the left ES was calculated per lift or
lowering as the highest peak of the EMG envelope. Due to the lack of space, the right
ES data is omitted. EMG data was normalized to a % maximum voluntary isometric
contraction (MVIC), which was determined before the experiment. From the 10 task
repetitions, the compound mean peak activity was determined. This measure, as well
as the overall workload score from the NASA-TLX, were compared in a repeated
measures ANOVA.
448
R.J.L. Macke et al.
Fig. 3 Peak activity for the left erector spinae longissimus during lifts (a) and lowers (b) and
the overall score for the NASA Task Load Index (TLX) (c). The mean is indicated by the red
circle, the median by the red line. No statistical difference was found between the different moment
compensation methods for either lifts, lowers, or the workload. CW: Counterweight
3 Results
Repeated measures ANOVA showed that the peak EMG activity was not significantly affected by the type of moment compensation provided. For the left
ES during the lifts F(2, 22) = 2.78, p > 0.05. For the left ES during the lowers
F(2, 22) = 1.21, p > 0.05.
The results show that the overall TLX score was not significantly affected by the
type of moment compensation provided, V = 0.17, F(2, 10) = 1.01, p > 0.05.
On the question which of the three methods was most preferred, 10 out of 12
subjects answered the springs mechanism. One subject prefered the heavy, and one
prefered the light counterweigt. The main motivation for preferring the spring mechanism was its low weight, compared to the counterweights and its reduced inertia
during (especially rotational) movements.
4 Discussion
Results show no obvious differences between the mean peak EMG activity for the
type of moment compensation provided; this holds for both the lifts and the lowers.
Mean peak EMG activity is somewhat lower for the lowers than for the lifts. This
is likely due to subjects first pulling the load towards themselves before lifting the
load from the plateau and placing it down on the table. The workload, quantified
by the NASA TLX, also shows very little difference between the different moment
compensation methods.
There was no significant difference found for the workload. This does not correlate
to the subjective preference of the subjects, since 10 out of 12 subjects indicated
Passive Lower Back Moment Support in a Wearable
449
to prefer the spring mechanism over either of the counterweights. This, and the
fact that no statistically significant difference in peak EMG was found, shows that
a constant spring force mechanism is a feasible and prefered alternative to heavy
counter-weights.
References
1. Abdoli, E.M., Agnew, M.J., Stevenson, J.M.: An on-body personal lift augmentation device
(PLAD) reduces EMG amplitude of erector spinae during lifting tasks. Clin. Biomech. 21(5),
456465 (2006)
2. van Dien, J.H., de Looze, M.P., Hermans, V.: Effects of dynamic office chairs on trunk kinematics,
trunk extensor EMG and spinal shrinkage. Ergonomics 44(7), 739750 (2001)
3. Sadler, E.M., Graham, R.B., Stevenson, J.M.: The personal lift-assist device and lifting technique: a principal component analysis. Ergonomics 54(4), 392402 (2011)
4. Waters, T.R., Dick, R.B., Krieg, E.F.: Trends in work-related musculoskeletal disorders: A
comparison of risk factors for symptoms using quality of work life data from the 2002 and 2006
general social survey. J. Occup. Environ. Med. 53(9), 10131024 (2011)

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Biosystems & Biorobotics

Biosystems & Biorobotics

Aims & Scope

About the Cover

More information about this series at http://www.springer.com/series/10421

Jos Gonzlez-Vargas Jaime Ibez

Herman van der Kooij

Library of Congress Control Number: 2016951712

Part I Clinical Focus on Rehabilitation and Assistive WRs

Part II Emerging Technologies in WRs

Kinetic Energy Recovery in Human Joints: The Flywheel-Innitely

Part III Soft Wearable Robotics

Design Improvement of a Polymer-Based Tendon-Driven Wearable

Affective Touch and Low Power Articial Muscles for Rehabilitative

Part VI New developments in Wearable Rehabilitation Robotics

Evaluating the Gait of Lower Limb Prosthesis Users . . . . . . . . . . . . . . . . 219

Part X Emerging Applications Domains of WRs, Emerging

Autonomous Soft Exosuit for Hip Extension Assistance. . . . . . . . . . . . . . 331

Musculoskeletal Simulation of SOLEUS Ankle Exoskeleton

Clinical Focus on Rehabilitation

Clinical Evaluation of a Socket-Ready

Hardware and Control Algorithm

Clinical Evaluation of a Socket-Ready Naturally Controlled Multichannel

In order to make a clinically relevant evaluation of patient performance using the

4 Conclusions and Discussion

Clinical Evaluation of a Socket-Ready Naturally Controlled Multichannel

Evaluation of a Robotic Exoskeleton

Abstract The application of robotic exoskeletons in gait therapy during stroke

G.J. Androwis K.J. Nolan (&)

G.J. Androwis and K.J. Nolan

2 Materials and Methods

Evaluation of a Robotic Exoskeleton for Gait Training in Acute Stroke

Fig. 1 Participant using the

Robotic Exoskeleton (RE) Device

Experimental Procedure and Data Analysis

G.J. Androwis and K.J. Nolan

Fig. 2 Timing of affected and unaffected limbs with and without RE

Evaluation of a Robotic Exoskeleton for Gait Training in Acute Stroke

Wearable Exoskeleton Assisted

Abstract Impaired ability to walk independently is a signicant consequence of

S.-H. Chang et al.

2 Materials and Methods

Four subjects with MS participated wearable exoskeleton assisted training during

Exoskeleton Assisted Training

After screening for eligibility, subject will receive a total of 15 sessions of

Wearable Exoskeleton Assisted Rehabilitation in Multiple Sclerosis: Feasibility and Experience17

Outcome measures were performed prior to training (pre-training: without

S.-H. Chang et al.

Net VO2max (ml/kg/min)

Net VO2max (ml/kg/min)

Wearable Exoskeleton Assisted Rehabilitation in Multiple Sclerosis: Feasibility and Experience19

Exoskeletons for Rehabilitation

Research is supported NIDLRR RERC grants no. 90RE5010-01-01 & 90RE5014-02-00.

P.T. Arun Jayaraman and W.Z. Rymer

independence, but also has signicant effects on secondary health consequences

2 Material and Methods

Exoskeletons for Rehabilitation and Personal Mobility

P.T. Arun Jayaraman and W.Z. Rymer

achieve meaningful therapeutic and mobility benets. Furthermore, no safety or fall

Lower Limb Wearable Systems

Abstract Lower limb exoskeletons (EXOs) may be devised as an ambulation

Lower Limb Wearable Systems for Mobility and Rehabilitation Challenges

4 Clinical Aspects for Gait Rehabilitation