This paper introduces a newly developed gait rehabilitation device. The device, called LOPES, combines a freely translatable and 2-D-actuated pelvis segment with a leg exoskeleton containing three actuated rotational joints: two at the hip and one at the knee. The joints are impedance controlled to allow bidirectional mechanical interaction between the robot and the training subject. Evaluation measurements show that the device allows both a "pa- tient-in-charge" and "robot-in-charge" mode, in which the robot is controlled either to follow or to guide a patient, respectively. Electromyography (EMG) measurements (one subject) on eight important leg muscles, show that free walking in the device strongly resembles free treadmill walking; an indication that the device can offer task-specific gait training. The possibilities and limitations to using the device as gait measurement tool are also shown at the moment position measurements are not accurate enough for inverse-dynamical gait analysis.

This article discusses the pros and cons of compliant actuation for rehabilitation robots on the example of LOPES, focusing on the cons. After illustrating the bandwidth limitations, a new result has been derived: if stability in terms of passivity of the haptic device is desired, the renderable stiffness is bounded by the stiffness of the SEA's elastic component. In practical experiments with the VMC, the aforementioned limitations affected the control performance. Desired gait modifications were not tracked exactly, because the subjects were able to deviate from the prescribed pattern even in the stiffest possible configuration. Despite the limitations, the practical experiments also demonstrated the general effectiveness of the realization. Manipulation of selected gait parameters is possible, whereby other parameters are left unaffected. This high selectivity is made possible by the low level of undesired interaction torques, which is achieved by elastic decoupling of motor mass and a lightweight exoskeleton. The discrepancy between theoretical bounds and rendered stiffness indicated that healthy subjects might represent a stabilizing component of the coupled system, which could be different for patients. In light of the theoretical stability analysis and with the focus on patients, the LOPES actuation was slightly modified. The robot was equipped with stiffer springs to obtain sufficient stiffness and to ensure stability without relying on stabilizing effects of the human. For this application, the disadvantages of compliant actuation can thus be tolerated or dealt with, and they are small compared with the advantages. Given that a rehabilitation robot, in the first place, is supposed to imitate therapist action, the limitations of bandwidth and stiffness do not pose severe problems. In contrast, safety and backdrivability are highly relevant, and they can be ensured easier with a compliant actuator. Therefore, we conclude that compliant actuation and a lightweight exoskeleton provide effective means to accomplish the desired AAN behavior of a rehabilitation robot. The next step is to evaluate the robot behavior, control performance, and therapeutic effectiveness in patient studies.

Within the context of impedance controlled exoskeletons, common actuators have important drawbacks. Either the actuators are heavy, have a complex structure or are poor torque sources, due to gearing or heavy nonlinearity. Considering our application, an impedance controlled gait rehabilitation robot for treadmill-training, we designed an actuation system that might avoid these drawbacks. It combines a lightweight joint and a simple structure with adequate torque source quality. It consists of a servomotor, a flexible Bowden cable transmission, and a force feedback loop based on a series elastic element. A basic model was developed that is shown to describe the basic dynamics of the actuator well enough for design purpose.Further measurements show that performance is sufficient for use in a gait rehabilitation robot. The demanded force tracking bandwidths were met: 11 Hz bandwidth for the full force range (demanded 4 Hz) and 20 Hz bandwidth for smaller force range (demanded 12 Hz). The mechanical output impedance of the actuator could be reduced to hardly perceptible level. Maxima of about 0.7 Nm peaks for 4 Hz imposed motions appeared, corresponding to less than 2.5% of the maximal force output. These peaks were caused by the stick friction in the Bowden cables.Spring stiffness variation showed that both a too stiff and a too compliant spring can worsen performance. A stiff spring reduces the maximum allowable controller gain. The relatively low control gain then causes a larger effect of stick in the force output, resulting in a less smooth output in general. Low spring stiffness, on the other side, decreases the performance of the system, because saturation will occur sooner.

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.

To provide an overview of protocols assessing the effect of occupational exoskeletons on users and to formulate recommendations towards a literature-based assessment framework to benchmark the effect of occupational exoskeletons on the user. PubMed (MEDLINE), Web of Science database and Scopus were searched (March 2, 2021). Studies were included if they investigated the effect of one or more occupational exoskeletons on the user. In total, 139 eligible studies were identified, encompassing 33, 25 and 18 unique back, shoulder and other exoskeletons, respectively. Device validation was most frequently conducted using controlled tasks while collecting muscle activity and biomechanical data. As the exoskeleton concept matures, tasks became more applied and the experimental design more representative. With that change towards realistic testing environments came a trade-off with experimental control, and user experience data became more valuable. This evidence mapping systematic review reveals that the assessment of occupational exoskeletons is a dynamic process, and provides literature-based assessment recommendations. The homogeneity and repeatability of future exoskeleton assessment experiments will increase following these recommendations. The current review recognises the value of variability in evaluation protocols in order to obtain an overall overview of the effect of exoskeletons on the users, but the presented framework strives to facilitate benchmarking the effect of occupational exoskeletons on the users across this variety of assessment protocols.

“Assist as needed” control algorithms promote activity of patients during robotic gait training. Implementing these requires a free walking mode of a device, as unassisted motions should not be hindered. The goal of this study was to assess the normality of walking in the free walking mode of the LOPES gait trainer, an 8 degrees-of-freedom lightweight impedance controlled exoskeleton. Kinematics, gait parameters and muscle activity of walking in a free walking mode in the device were compared with those of walking freely on a treadmill. Average values and variability of the spatio-temporal gait variables showed no or small (relative to cycle-to-cycle variability) changes and the kinematics showed a significant and relevant decrease in knee angle range only. Muscles involved in push off showed a small decrease, whereas muscles involved in acceleration and deceleration of the swing leg showed an increase of their activity. Timing of the activity was mainly unaffected. Most of the observed differences could be ascribed to the inertia of the exoskeleton. Overall, walking with the LOPES resembled free walking, although this required several adaptations in muscle activity. These adaptations are such that we expect that Assist as Needed training can be implemented in LOPES.