This review meta-analysis combines and compares the findings of previously published works in the field of soft wearable robots (SWRs) that provide active methods of actuation for assistive and augmentative purposes. A thorough investigation of major contributions in the field of an SWR is made to analyze trends in the field focused on fluidic and cable-driven systems, prevalent and successful approaches, and identify the future direction of SWRs and active actuation strategies. Types of soft actuators used in wearables are outlined, as well as general practices for fabrication methods of soft actuators and considerations for human–robot interface designs of garment-like exosuits. An overview of well-known and emerging upper body (UB)- and lower body (LB)-assistive technologies is categorized by the specific joints and degree of freedom (DoF) assisted and which actuator methodology is provided. Different use cases for SWRs are addressed, as well as implementation strategies and design applications.

The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs’ effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.

Exoskeletons that assist the hip, knee, and ankle joints have begun to improve human mobility, particularly by reducing the metabolic cost of walking. However, direct comparisons of optimal assistance of these joints, or their combinations, have not yet been possible. Assisting multiple joints may be more beneficial than the sum of individual effects, because muscles often span multiple joints, or less effective, because single-joint assistance can indirectly aid other joints. In this study, we used a hip–knee–ankle exoskeleton emulator paired with human-in-the-loop optimization to find single-joint, two-joint, and whole-leg assistance that maximally reduced the metabolic cost of walking. Hip-only and ankle-only assistance reduced the metabolic cost of walking by 26 and 30% relative to walking in the device unassisted, confirming that both joints are good targets for assistance (N = 3). Knee-only assistance reduced the metabolic cost of walking by 13%, demonstrating that effective knee assistance is possible (N = 3). Two-joint assistance reduced the metabolic cost of walking by between 33 and 42%, with the largest improvements coming from hip-ankle assistance (N = 3). Assisting all three joints reduced the metabolic cost of walking by 50%, showing that at least half of the metabolic energy expended during walking can be saved through exoskeleton assistance (N = 4). Changes in kinematics and muscle activity indicate that single-joint assistance indirectly assisted muscles at other joints, such that the improvement from whole-leg assistance was smaller than the sum of its single-joint parts. Exoskeletons can assist the entire limb for maximum effect, but a single well-chosen joint can be more efficient when considering additional factors such as weight and cost.

Wearable electronics are an essential direction for the future development of smart wearables. Among them, the battery life of wearable electronics is a key technology that limits their development. The proposal of self-powered wearable electronics (SWE) provides a promising solution to the problem of long-term stable working of wearable electronics. This review has made a comprehensive summary and analysis of recent advances on SWE from the perspectives of energy, materials, and ergonomics methods. At the same time, some representative research work was introduced in detail. SWE can be divided into energy type SWE and sensor type SWE according to their working types. Both types of SWE are broadly applied in human–machine interaction, motion information monitoring, diagnostics, and therapy systems. Finally, this article summarizes the existing bottlenecks of SWE, and predicts the future development direction of SWE.

The science and technology of wearable robots are steadily advancing, and the use of such robots in our everyday life appears to be within reach. Nevertheless, widespread adoption of wearable robots should not be taken for granted, especially since many recent attempts to bring them to real-life applications resulted in mixed outcomes. The aim of this article is to address the current challenges that are limiting the application and wider adoption of wearable robots that are typically worn over the human body. We categorized the challenges into mechanical layout, actuation, sensing, body interface, control, human–robot interfacing and coadaptation, and benchmarking. For each category, we discuss specific challenges and the rationale for why solving them is important, followed by an overview of relevant recent works. We conclude with an opinion that summarizes possible solutions that could contribute to the wider adoption of wearable robots.

During long-duration spaceflight, astronauts are exposed to various risks including spaceflight-associated neuro-ocular syndrome, which serves as a risk to astronaut vision and a potential physiological barrier to future spaceflight. When considering exploration missions that may expose astronauts to longer periods of microgravity, radiation exposure, and natural aging processes during spaceflight, more severe changes to functional vision may occur. The macula plays a critical role in central vision and disruptions to this key area in the eye may compromise functional vision and mission performance. In this article, we describe the development of a countermeasure technique to digitally suppress monocular central visual distortion with head-mounted display technology. We report early validation studies with this noninvasive countermeasure in individuals with simulated metamorphopsia. When worn by these individuals, this emerging wearable countermeasure technology has demonstrated a suppression of monocular visual distortion. We describe the considerations and further directions of this head-mounted technology for both astronauts and aging individuals on Earth.

Occupational exoskeletons and exosuits have been shown to reduce muscle demands and fatigue for physical tasks relevant to a variety of industries (e.g., logistics, construction, manufacturing, military, healthcare). However, adoption of these devices into the workforce has been slowed by practical factors related to comfort, form-factor, weight, and not interfering with movement or posture. We previously introduced a low-profile, dual-mode exosuit comprised of textile and elastic materials to address these adoption barriers. Here we build upon this prior work by introducing an extension mechanism that increases the moment arm of the exosuit while in engaged mode, then collapses in disengaged mode to retain key benefits related to being lightweight, low-profile, and unobstructive. Here we demonstrate both analytically and empirically how this extensible exosuit concept can (a) reduce device-to-body forces (which can improve comfort for some users and situations), or (b) increase the magnitude of torque assistance about the low back (which may be valuable for heavy-lifting jobs) without increasing shoulder or leg forces relative to the prior form-fitting exosuit. We also introduce a novel mode-switching mechanism, as well as a human-exosuit biomechanical model to elucidate how individual design parameters affect exosuit assistance torque and device-to-body forces. The proof-of-concept prototype, case study, and modeling work provide a foundation for understanding and implementing extensible exosuits for a broad range of applications. We envision promising opportunities to apply this new dual-mode extensible exosuit concept to assist heavy-lifting, to further enhance user comfort, and to address the unique needs of last-mile and other delivery workers.

Exoskeletons are wearable devices intended to physically assist one or multiple human joints in executing certain activities. From a mechanical point of view, they are kinematic structures arranged in parallel to the biological joints. In order to allow the users to move while assisted, it is crucial to avoid mobility restrictions introduced by the exoskeleton’s kinematics. Passive degrees of freedom and other self-alignment mechanisms are a common option to avoid any restrictions. However, the literature lacks a systematic method to account for large inter- and intra-subject variability in designing and assessing kinematic chains. To this end, we introduce a model-based method to assess the kinematics of exoskeletons by representing restrictions in mobility as disturbances and undesired forces at the anchor points. The method makes use of robotic kinematic tools and generates useful insights to support the design process. Though an application on a back-support exoskeleton designed for lifting tasks is illustrated, the method can describe any type of rigid exoskeleton. A qualitative pilot trial is conducted to assess the kinematic model that proved to predict kinematic configurations associated to rising undesired forces recorded at the anchor points, that give rise to mobility restrictions and discomfort on the users.

We present a passive (unpowered) exoskeleton that assists the back during lifting. Our exoskeleton uses carbon fiber beams as the sole means to store energy and return it to the wearer. To motivate the design, we present general requirements for the design of a lifting exoskeleton, including calculating the required torque to support the torso for people of different weights and heights. We compare a number of methods of energy storage for exoskeletons in terms of mass, volume, hysteresis, and cycle life. We then discuss the design of our exoskeleton, and show how the torso assembly leads to balanced forces. We characterize the energy storage in the exoskeleton and the torque it provides during testing with human subjects. Ten participants performed freestyle, stoop, and squat lifts. Custom image processing software was used to extract the curvature of the carbon fiber beams in the exoskeleton to determine the stored energy. During freestyle lifting, it stores an average of 59.3 J and provides a peak torque of 71.7 Nm.

This paper presents a soft, tendon-driven, robotic glove designed to augment grasp capability and provide rehabilitation assistance for postspinal cord injury patients. The basis of the design is an underactuation approach utilizing postural synergies of the hand to support a large variety of grasps with a single actuator. The glove is lightweight, easy to don, and generates sufficient hand closing force to assist with activities of daily living. Device efficiency was examined through a characterization of the power transmission elements, and output force production was observed to be linear in both cylindrical and pinch grasp configurations. We further show that, as a result of the synergy-inspired actuation strategy, the glove only slightly alters the distribution of forces across the fingers, compared to a natural, unassisted grasping pattern. Finally, a preliminary case study was conducted using a participant suffering from an incomplete spinal cord injury (C7). It was found that through the use of the glove, the participant was able to achieve a 50% performance improvement (from four to six blocks) in a standard Box and Block test.

Assistive strategies for occupational back-support exoskeletons have focused, mostly, on lifting tasks. However, in occupational scenarios, it is important to account not only for lifting but also for other activities. This can be done exploiting human activity recognition algorithms that can identify which task the user is performing and trigger the appropriate assistive strategy. We refer to this ability as exoskeleton versatility. To evaluate versatility, we propose to focus both on the ability of the device to reduce muscle activation (efficacy) and on its interaction with the user (dynamic fit). To this end, we performed an experimental study involving $ 10 $ healthy subjects replicating the working activities of a manufacturing plant. To compare versatile and non-versatile exoskeletons, our device, XoTrunk, was controlled with two different strategies. Correspondingly, we collected muscle activity, kinematic variables and users’ subjective feedbacks. Also, we evaluated the task recognition performance of the device. The results show that XoTrunk is capable of reducing muscle activation by up to $ 40\% $ in lifting and $ 30\% $ in carrying. However, the non-versatile control strategy hindered the users’ natural gait (e.g., $ -24\% $ reduction of hip flexion), which could potentially lower the exoskeleton acceptance. Detecting carrying activities and adapting the control strategy, resulted in a more natural gait (e.g., $ +9\% $ increase of hip flexion). The classifier analyzed in this work, showed promising performance (online accuracy > 91%). Finally, we conducted 9 hours of field testing, involving four users. Initial subjective feedbacks on the exoskeleton versatility, are presented at the end of this work.

To reduce the incidence of occupational musculoskeletal disorders, back-support exoskeletons are being introduced to assist manual material handling activities. Using a device of this type, this study investigates the effects of a new control strategy that uses the angular acceleration of the user’s trunk to assist during lifting tasks. To validate this new strategy, its effectiveness was experimentally evaluated relative to the condition without the exoskeleton as well as against existing strategies for comparison. Using the exoskeleton during lifting tasks reduced the peak compression force on the L5S1 disc by up to 16%, with all the control strategies. Substantial differences between the control strategies in the reductions of compression force, lumbar moment and back muscle activation were not observed. However, the new control strategy reduced the movement speed less with respect to the existing strategies. Thanks to improved timing in the assistance in relation to the typical dynamics of the target task, the hindrance to typical movements appeared reduced, thereby promoting intuitiveness and comfort.

Hemiparetic walking after stroke is typically slow, asymmetric, and inefficient, significantly impacting activities of daily living. Extensive research shows that functional, intensive, and task-specific gait training is instrumental for effective gait rehabilitation, characteristics that our group aims to encourage with soft robotic exosuits. However, standard clinical assessments may lack the precision and frequency to detect subtle changes in intervention efficacy during both conventional and exosuit-assisted gait training, potentially impeding targeted therapy regimes. In this paper, we use exosuit-integrated inertial sensors to reconstruct three clinically meaningful gait metrics related to circumduction, foot clearance, and stride length. Our method corrects sensor drift using instantaneous information from both sides of the body. This approach makes our method robust to irregular walking conditions poststroke as well as usable in real-time applications, such as real-time movement monitoring, exosuit assistance control, and biofeedback. We validate our algorithm in eight people poststroke in comparison to lab-based optical motion capture. Mean errors were below 0.2 cm (9.9%) for circumduction, −0.6 cm (−3.5%) for foot clearance, and 3.8 cm (3.6%) for stride length. A single-participant case study shows our technique’s promise in daily-living environments by detecting exosuit-induced changes in gait while walking in a busy outdoor plaza.

Despite the promise of powered lower limb prostheses, existing controllers do not assist many daily activities that require continuous control of prosthetic joints according to human states and environments. The objective of this case study was to investigate the feasibility of direct, continuous electromyographic (dEMG) control of a powered ankle prosthesis, combined with physical therapist-guided training, for improved standing postural control in an individual with transtibial amputation. Specifically, EMG signals of the residual antagonistic muscles (i.e. lateral gastrocnemius and tibialis anterior) were used to proportionally drive pneumatical artificial muscles to move a prosthetic ankle. Clinical-based activities were used in the training and evaluation protocol of the control paradigm. We quantified the EMG signals in the bilateral shank muscles as well as measures of postural control and stability. Compared to the participant’s daily passive prosthesis, the dEMG-controlled ankle, combined with the training, yielded improved clinical balance scores and reduced compensation from intact joints. Cross-correlation coefficient of bilateral center of pressure excursions, a metric for quantifying standing postural control, increased to .83(±.07) when using dEMG ankle control (passive device: .39(±.29)). We observed synchronized activation of homologous muscles, rapid improvement in performance on the first day of the training for load transfer tasks, and further improvement in performance across training days (p = .006). This case study showed the feasibility of this dEMG control paradigm of a powered prosthetic ankle to assist postural control. This study lays the foundation for future study to extend these results through the inclusion of more participants and activities.

Wearable devices, such as exoskeletons, are becoming increasingly common and are being used mainly for improving motility and daily life autonomy, rehabilitation purposes, and as industrial aids. There are many variables that must be optimized to create an efficient, smoothly operating device. The selection of a suitable actuator is one of these variables, and the actuators are usually sized after studying the kinematic and dynamic characteristics of the target task, combining information from motion tracking, inverse dynamics, and force plates. While this may be a good method for approximate sizing of actuators, a more detailed approach is necessary to fully understand actuator performance, control algorithms or sensing strategies, and their impact on weight, dynamic performance, energy consumption, complexity, and cost. This work describes a learning-based evaluation method to provide this more detailed analysis of an actuation system for our XoTrunk exoskeleton. The study includes: (a) a real-world experimental setup to gather kinematics and dynamics data; (b) simulation of the actuation system focusing on motor performance and control strategy; (c) experimental validation of the simulation; and (d) testing in real scenarios. This study creates a systematic framework to analyze actuator performance and control algorithms to improve operation in the real scenario by replicating the kinematics and dynamics of the human–robot interaction. Implementation of this approach shows substantial improvement in the task-related performance when applied on a back-support exoskeleton during a walking task.

The aging population is now a global challenge, and impaired walking ability is a common feature in the elderly. In addition, some occupations such as military and relief workers require extra physical help to perform tasks efficiently. Robotic hip exoskeletons can support ambulatory functions in the elderly and augment human performance in healthy people during normal walking and loaded walking by providing assistive torque. In this review, the current development of robotic hip exoskeletons is presented. In addition, the framework of actuation joints and the high-level control strategy (including the sensors and data collection, the way to recognize gait phase, the algorithms to generate the assist torque) are described. The exoskeleton prototypes proposed by researchers in recent years are organized to benefit the related fields realizing the limitations of the available robotic hip exoskeletons, therefore, this work tends to be an influential factor with a better understanding of the development and state-of-the-art technology.

This article presents a novel neuromechanical force-based control strategy called FMCA (force modulated compliant ankle), to control a powered prosthetic foot. FMCA modulates the torque, based on sensory feedback, similar to neuromuscular control approaches. Instead of using a muscle reflex-based approach, FMCA directly exploits the vertical ground reaction force as sensory feedback to modulate the ankle joint impedance. For evaluation, we first demonstrated how FMCA can predict human-like ankle torque for different walking speeds. Second, we implemented the FMCA in a neuromuscular transtibial amputee walking simulation model to validate if the approach can be used to achieve stable walking and to compare the performance to a neuromuscular reflex-based controller that is already used in a powered ankle. Compared to the neuromuscular model-based approach, the FMCA is a simple solution with a sufficient push-off that can provide stable walking. Third, to assess the ability of the FMCA to generate human-like ankle biomechanics during walking at the preferred speed, we implemented this strategy in a powered prosthetic foot and performed experiments with a non-amputee subject. The results confirm that, for this subject, FMCA can be used to mimic the non-amputee reference ankle torque and the reference ankle angle. The findings of this study support the applicability and advantages of a new bioinspired control approach for assisting amputees. Future experiments should investigate the applicability to other walking speeds and the applicability to the target population.

Musculoskeletal disorders constitute the leading work-related health issue. Mechanical loading of the lower back contributes as a major risk factor and is prevalent in many tasks performed in logistics. The study aimed to compare acute effects of exoskeletons with different functional mechanisms in a logistic task. Twelve young, healthy individuals participated in the study. Five exoskeletons with different functional mechanisms were tested in a logistic task, consisting of lifting, carrying, and lowering a 13 kg box. By using electromyography (EMG), mean muscle activities of four muscles in the trunk were analyzed. Additionally, kinematics by task completion time and range of motion (RoM) of the major joints and segments were investigated. A main effect was found for Musculus erector spinae, Musculus multifidus, and Musculus latissimus dorsi showing differences in muscle activity reductions between exoskeletons. Reduction in ES mean activity compared to baseline was primarily during lifting from ground level. The exoskeletons SoftExo Lift and Cray X also showed ES mean reduction during lowering the box. Prolonged task duration during the lifting phase was found for the exoskeletons BionicBack, SoftExo Lift, and Japet.W. Japet.W showed a trend in reducing hip RoM during that phase. SoftExo Lift caused a reduction in trunk flexion during the lifting phase. A stronger trunk inclination was only found during lifting from the table for the SoftExo Lift and the Cray X. In conclusion, muscle activity reductions by exoskeleton use should not be assessed without taking their designed force paths into account to correctly interpret the effects for long-term injury prevention.