This thesis concerns the design, construction, control, and testing of soft robotic actuators to be used in a soft robotic exoskeleton; the Boa Exoskeleton could be used for joint rehabilitation including: wrist, elbow and possibly shoulder or any joint that requires a soft body actuator to aid with bending movement. We detail the design, modeling and fabrication of two types of actuators: Fiber-reinforced Actuator and PneuNet Actuator. Fiber-Reinforced actuator was chosen for the exoskeleton due to its higher force. The Fiber-Reinforced actuator molds were 3D printed, four models were made. Two materials were used to fabricate the models: Dragon Skin 30A and Sort-A-Clear 40A. Two number of windings: (n=40) and (n=25), actuators wrapped with carbon fiber. An air tank was used to supply pressure. The actuators were studied at different pressures. Pressure-force relation was studied, and a close to linear relationship was found. Boa Exoskeleton was made for wrist. Electromyography (EMG) was used; Four EMG receptors were put around the arm. EMG was utilized to actuate the Boa Exoskeleton and record the muscle movement. Five tests were done on six human subjects to validate the Boa Exoskeleton. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

The rationale behind this research originates from the lack of public health care in South Africa. There is an escalation in the number of stroke victims which is a consequence of the increase in hypertension in this urbanising society. This increase results in a growing need for physiotherapists and occupational therapists in this country which is further hindered by the division between urban and rural areas. The exoskeleton device has been formulated to encapsulate methodologies that enable the anthropomorphic integration between a biological and mechatronic limb. The physiotherapeutic mechanism was designed to be portable and adjustable, without limiting the spherical motion and workspace of the human arm. The exoskeleton was portable in the sense that it could be transported geographically and is a complete device allowing for motion in the shoulder, elbow, wrist and hand joints. The avoidance of singularities in the workspace required the implementation of non-orthogonal joints which produces extensive forward kinematics. Traditional geometric or analytical derivations of the inverse kinematics are complicated by the nonorthogonal layout. This hindrance was resolved iteratively via the Damped Least Squares method. The electronic and computer system allowed for professional personnel, such as an occupational therapist or a physiotherapist, to either change an individual joint or a combination of joints angles. A ramp PI controller was established to provide a smooth response in order to simulate the passive therapy motion. / Thesis (M.Sc.Eng)-University of KwaZulu-Natal, Durban, 2011.

Exoskeletons for rehabilitation commonly focus on gait training, despite the variety of human movements and functional assistance needed. Cable-driven exoskeletons have an advantage in addressing a variety of movements by being non-restrictive in their design. Additionally, these devices do not require complex mechanical joints to apply forces on the user or hinder the user's mobility. This accommodation of movement makes these cable-driven architectures more suitable for everyday movement. However, these flexible cable-driven exoskeletons often actuate a reduced number of actuated degrees-of-freedom to simplify their mechanical complexity. There is a need to design flexible and low-profile cable-driven exoskeletons to accommodate the movement of the user and be more flexible in their ability to actuate them. This thesis presents cable-driven exoskeleton designs that are used during walking and or squatting. These exoskeletons can be reconfigured to apply forces that are appropriate for these functional tasks. The three designs presented in this thesis are non-restrictive cable-driven designs that add minimal weight to the user. The first design shown is the cable-driven active leg exoskeleton previously developed by the Robotics and Rehabilitation Laboratory (C-ALEX, 10kg). The second and third designs are novel cable-driven architectures: (i) the modular C-ALEX (mC-ALEX, 3kg) and (ii) the soft C-ALEX (SC-ALEX, <1kg). A preliminary evaluation of the latter two devices was performed, and the results of these studies are presented to better understand the limitations and abilities of each design. The functionalities added to the latter two designs include the ability to reconfigure the robot's cable routing and attachment geometry, allowing the devices to apply torques through cables in the non-sagittal plane. These features will enable the robot to assist in tasks other than gait while still using the original C-ALEX design methods. Another feature added to the exoskeleton controller is to allow visual feedback through an Augmented Reality headset (the HoloLens) to incorporate visual feedback during tasks better. This feature is currently missing from the rehabilitation field using exoskeletons. The effects of using the C-ALEX with post-stroke participants were carried out to ascertain the efficacy of using a cable-driven system for gait adaptations in persons with gait impairments and compare their effectiveness against rigid-linked exoskeletons. The C-ALEX was assessed to induce a change in the walking patterns of ten post-stroke participants using a single-session training protocol. The ability of C-ALEX to accurately provide forces and torques in the desired directions was also evaluated to compare its design performance to traditional rigid-link designs. Participants were able to reach 91% ± 12% of their target step length and 89% ± 13 % of their target step height. The achieved step parameters differed significantly from participant baselines (p <0.05). To quantify the performance, the forces in each cable's out-of-the-plane movements were evaluated relative to the in-plane desired cable tension magnitudes. This corresponded to an error of under 2Nm in the desired controlled joint torques. This error magnitude is low compared to the system command torques and typical adult biological torques during walking (2-4%). These results point to the utility of using non-restrictive cable-driven architectures in gait retraining, in which future focus can be on rehabilitating gait pathologies seen in stroke survivors. Visual and force feedback are common elements in rehabilitation robotics, but visual feedback is difficult to provide in over-ground mobile exoskeleton systems. A preliminary study was carried out to assess the effects of providing force-only, force and visual, or visual-only feedback to three independent groups, each containing 8 participants. The groups showed an increase in normalized step height, (force and visual: 1.10 ± .13, force-only: 1.03 ± .23 visual-only: 1.61 ± .52) and decreased normalized trajectory tracking error (force and visual: 42.8% ± 23.4%, force: 47.6% ± 18.4% , visual-only: 114.2% ± 60.0%). Visual normalized step height differed significantly from force and visual and force-only normalized step height (p<0.005). Lap-wise normalized tracking error differed significantly ($p < 0.005$) within participants. The mC-ALEX and the HoloLens were used to test the effectiveness of robot force feedback compared to visual feedback with a squat task. The squat task aimed to have the user reach targets of 25%, 75%, and 125% of baseline squats depths through each feedback modality. The kinematic and foot loading effects were considered to establish the differences in user behavior when receiving both types of feedback. The results show that visual feedback has lower errors from targets with similar lower variability in user performance. The force feedback changed joint flexion profiles without changing foot loading biomechanics. When looking at the sessions in sequence, both feedback modalities reduced depth error magnitudes further along with the sessions time-wise. This is the first study where augmented in-field-of-view visual feedback and robotic feedback are used with the aim of changing the kinematics of a squatting task. Overall, this thesis contributes to expanding the capabilities of cable-driven exoskeletons in lower limb rehabilitative tasks. Three designs are evaluated to understand their on-user performance, with the latter two devices being novel designs. The devices are used in protocols that include visual feedback to ascertain their effects on movement adaptation through the two feedback modalities.

Physical therapy is a field with ever increasing demands as the population ages, resulting in a larger number of individuals living with impairments. Therapy is both physically intensive and time intensive for physical therapists, and can require more than one therapist per patient. The use of technology can reduce both these physical and time demands if appropriately applied, while improving repeatability and providing quantitative evaluation of performance. Through these abilities, it may also improve the quality of life for patients. The work presented here explores how the mechanical and controller design of exoskeletons can be used to improve adaptations to new gait patterns in healthy individuals. Armed with this knowledge, new treatment methods can be adapted, applied, and validated for impaired populations with the intention of recovering a more natural gait pattern. First, the ALEX II device is presented. It is a unilateral device, designed to aid in gait training for stroke survivors. The previous version, ALEX I, had several limitations in terms of pelvic freedom, leg range of motion, and the support of the gravitational load. ALEX II was designed to address these issues. Next, a study is presented, using healthy young adults (N=30), in which ALEX II was used to explore how the amount of freedom allowed at the pelvis during gait training affects the level of adaptation subjects are able to achieve. This was evaluated for five separate configurations which resemble existing exoskeletons. It was found that intermediate levels of pelvic freedom degrade the amount of adaptation and that pelvic translation contributes more to this effect than hip abduction/adduction. The next work concerns the design of ALEX III, a bilateral device with twelve active degrees-of-freedom. ALEX III was created to increase the ability to explore the functionality required for gait training, which is why it is capable of controlling 4 degrees-of-freedom at each leg, and 4 degrees-of-freedom at the pelvis. This is followed by the the design of a new type of haptic feedback which utilizes a variable, viscous damping field, which increases the damping coeffiecent as the subject moves away from a specified path. This feedback type was tested in a set of experiments in healthy young adults. The first study (N=32) compared four different settings for the new feedback, finding that while all groups demonstrated adaptations in gait, the lowest rate of change of the damping field exhibited less adaptation. The final study (N=36) compared this haptic feedback to two previously used haptic feedback types. The previously used feedback strategies used a force that pushed the leg either towards or away from the desired path. All three of these strategies were found to produce similar levels of adaptation, however the damping field used much less external force. These findings may change the way exoskeletons for gait training are designed and increase their accessibility. While all the findings need to be validated in impaired populations they can still inform the design of future exoskeletons. The first finding, that providing an intermediate amount of freedom to the pelvis can interfere with gait training, suggests that future devices should have very high amounts of freedom or very restricted pelvic motions. The final finding, that damping fields can be used to induce gait adaptations using a much lower force, can drastically change exoskeleton design and how robotic therapy is provided. Exoskeletons can be made lighter as a result of the force being highly reduced so that lighter weight components can be used, and the dissipative nature of the force reduces dependence on heavy power sources because regenerative breaking can be used to power the device. These factors also make it possible to for devices to be used overground, which may make training more transferable to the real world.

Exoskeletons for gait training commonly use a rigid-linked "skeleton" which makes them heavy and bulky. Cable-driven exoskeletons eliminate the rigid-linked skeleton structure, therefore creating a lighter and more transparent design. Current cable-driven leg exoskeletons are limited to gait assistance use. This thesis presented the Cable-driven Active Leg Exoskeleton (C-ALEX) designed for gait retraining and rehabilitation. Benefited from the cable-driven design, C-ALEX has minimal weight and inertia (4.7 kg) and allows all the degrees-of-freedom (DoF) of the leg of the user. C-ALEX uses an assist-as-needed (AAN) controller to train the user to walk in a new gait pattern. A preliminary design of C-ALEX was first presented, and an experiment was done with this preliminary design to study the effectiveness of the AAN controller. The result on six healthy subjects showed that the subjects were able to follow a new gait pattern significantly more accurately with the help of the AAN controller. After this experiment, C-ALEX was redesigned to improve its functionality. The improved design of C-ALEX is lighter, has more DoFs and larger range-of-motion. The controller of the improved design improved the continuity of the generated cable tensions and added the function to estimate the phase of the gait of the user in real-time. With the improved design of C-ALEX, an experiment was performed to study the effect of the weight and inertia of an exoskeleton on the gait of the user. C-ALEX was used to simulate exoskeletons with different levels of weight and inertia by adding extra mass and change the weight compensation level. The result on ten subjects showed that adding extra mass increased step length and reduced knee flexion. Compensating the weight of the mass partially restored the knee flexion but not the step length, implying that the inertia of the mass is responsible for the change. This study showed the distinctive effect of weight and inertia on gait and demonstrated the benefit of a lightweight exoskeleton. C-ALEX was designed for gait training and rehabilitation, and its training effectiveness was studied in nine healthy subjects and a stroke patient. The healthy subjects trained with C-ALEX to walk in a new gait pattern with 30% increase in step height for 40 min. After the training, the subjects were able to closely repeat the trained gait pattern without C-ALEX, and the step height of the subjects increased significantly. A stroke patient also tested C-ALEX for 40 minutes and showed short-term improvements in step length, step height, and knee flexion after training. The result showed the effectiveness of C-ALEX in gait training and its potential to be used in stroke rehabilitation.

A control method is proposed for exercising specific muscles of a human's lower body. This is accomplished using an exoskeleton that imposes active force feedback control. The proposed method involves a combined dynamic model of the musculoskeletal system of the lower-body with the dynamics of pneumatic actuators. The exoskeleton is designed to allow for individual control of mono-articular or bi-articular muscles to be exercised while not inhibiting the subject's range of motion. The control method has been implemented in a 1-Degree of Freedom (DOF) exoskeleton that is designed to resist the motion of the human knee by applying actuator forces in opposition to a specified muscle force profile. In this research, there is a discussion on the model of the human's lower body and how muscles are affected as a function of joint positions. Then it is discussed how to calculate for the forces needed by a pneumatic actuator to oppose the muscles to create the desired muscle force profile at a given joint angles. The proposed exoskeleton could be utilized either for rehabilitation purposes, to prevent muscle atrophy and bone loss of astronauts, or for muscle training in general.

The human spine is an integral part of the human body. Its functions include mobilizing the torso, controlling postural stability, and transferring loads from upper body to lower body, all of which are essential for the activities of daily living. However, the many complex tasks of the spine leave it vulnerable to damage from a variety of sources. Prolonged walking with a heavy backpack can cause spinal injuries. Spinal diseases, such as scoliosis, can make the spine abnormally deform. Neurological disorders, such as cerebral palsy, can lead to a loss of torso control. External torso support has been used in these cases to mitigate the risk of spinal injuries, to halt the progression of spinal deformities, and to support the torso. However, current torso support designs are limited by rigid, passive, and non-sensorized structures. These limitations were the motivations for this work in developing the science for design of torso exoskeletons that can improve the effectiveness of current external torso support solutions. Central features to the design of these exoskeletons were the abilities to sense and actively control the motion of or the forces applied to the torso. Two applications of external torso support are the main focus in this study, backpack load carriage and correction of spine deformities. The goal was to develop torso exoskeletons for these two applications, evaluate their effectiveness, and exploit novel assistive and/or treatment paradigms. With regard to backpack load carriage, current torso support solutions are limited and do not provide any means to measure and/or adjust the load distribution between the shoulders and the pelvis, or to reduce dynamic loads induced by walking. Because of these limitations, determining the effects of modulating these loads between the shoulders and the pelvis has not been possible. Hence, the first scientific question that this work aims to address is What are the biomechanical and physiological effects of distributing the load and reducing the dynamic load of a backpack on human body during backpack load carriage? Concerning the correction of spinal deformities, the most common treatment is the use of a spine brace. This method has been shown to effectively slow down the progression of spinal deformity. However , a limitation in the effectiveness of this treatment is the lack of knowledge of the stiffness characteristics of the human torso. Previously, there has been no means to measure the stiffness of human torso. An improved understanding of this subject would directly affect treatment outcomes by better informing the appropriate external forces (or displacements) to apply in order to achieve the desired correction of the spine. Hence, the second scientific question that this work aims to address is How can we characterize three dimensional stiffness of the human torso for quantifiable assessment and targeted treatment of spinal deformities? In this work, a torso exoskeleton called the Wearable upper Body Suit (WEBS) was developed to address the first question. The WEBS distributes the backpack load between the shoulders and the pelvis, senses the vertical motion of the pelvis, and provides gait synchronized compensatory forces to reduce dynamic loads of a backpack during walking. It was hypothesized that during typical backpack load carriage, load distribution and dynamic load compensation reduce gait and postural adaptations, the user’s overall effort and metabolic cost. This hypothesis was supported by biomechanical and physiological measurements taken from twelve healthy male subjects while they walked on a treadmill with a 25 percent body weight backpack. In terms of load distribution and dynamic load compensation, the results showed reductions in gait and postural adaptations, muscle activity, vertical and braking ground reaction forces, and metabolic cost. Based on these results, it was concluded that the wearable upper body suit can potentially reduce the risk of musculoskeletal injuries and muscle fatigue associated with carrying heavy backpack loads, as well as reducing the metabolic cost of loaded walking. To address the second question, the Robotic Spine Exoskeleton (ROSE) was developed. The ROSE consists of two parallel robot platforms connected in series that can adjust to fit snugly at different levels of the human torso and dynamically modulate either the posture of the torso or the forces exerted on the torso. An experimental evaluation of the ROSE was performed with ten healthy male subjects that validated its efficacy in controlling three dimensional corrective forces exerted on the torso while providing flexibility for a wide range of torso motions. The feasibility of characterizing the three dimensional stiffness of the human torso was also validated using the ROSE. Based on these results, it was concluded that the ROSE may alleviate some of the limitations in current brace technology and treatment methods for spine deformities, and offer a means to explore new treatment approaches to potentially improve the therapeutic outcomes of the brace treatment.

Robotic exoskeletons are important tools in medicine for characterizing certain aspects of diseases, enabling physical therapy treatments, or providing assistance to those with impairments. One area in particular where these devices can make an impact is the study and treatment of scoliosis. First, I adapt a design of a robotic torso exoskeleton to serve the population most susceptible to scoliosis, female adolescents. I used the device to compare the torso stiffness of members of this group with and without scoliosis, and found an interaction effect of degree of freedom (DOF) and torso segment on translational stiffness, and an interaction effect of DOF and group on rotational stiffness. These results can inform the models used to create rigid orthoses for conservative treatment or to simulate the effects of surgical procedures. Second, I explore the effects of different types of augmented sensory feedback commonly used in scoliosis physical therapy. I compare visual and force feedback provided by the exoskeleton on one’s ability to replicate static poses and dynamic movements. I find that while force feedback leads to faster initial improvement, visual feedback may enable the user to learn finer details of the movement. Third, I design a torso exoskeleton for people with neuromotor impairments. People who are not able to sit up independently are at a high risk of developing neuromuscular scoliosis, and must balance the benefits of treatment with rigid orthoses, with the limits that these devices place on functional movements. The device allows users four degrees of freedom, to support functional movements such as reaching and pressure relief maneuvers, but prevents lateral translation and axial rotation, which can contribute to neuromuscular scoliosis. Together, these results demonstrate the potential for robotic exoskeletons in torso study, training, and assistance.

Knee osteoarthritis (KOA) is the primary cause of chronic immobility in populations over the age of 65. It is a joint degenerative disease in which the articular cartilage in the knee joint wears down over time, leading to symptoms of pain, instability, joint stiffness, and misalignment of the lower extremities. Without intervention, these symptoms gradually worsen over time, decreasing the overall knee range of motion (ROM) and ability to walk. Current clinical interventions include offloading braces, which mechanically realign the lower extremities to alleviate the pain experienced in the medial compartment of the knee joint. Though these braces have proven effective in pain management, studies have shown a significant decrease in knee ROM while using the brace. Concurrently, development of active exoskeletons for rehabilitative gait has increased within recent years in efforts to provide patients with a more effective intervention for dealing with KOA. Though some developed exoskeletons are promising in their efficacy of fostering gait therapy, these devices are heavy, tethered, difficult to control, unavailable to patients, or costly due to the number of complicated components used to manufacture the device. However, the idea that an active component can improve gait therapy for patients motivates this study. This study proposes the design of an adjustable lower extremity exoskeleton which features a single linear actuator adapted onto a commercially available offloading brace. This design hopes to provide patients with pain alleviation from the brace, while also actively driving the knee through flexion and extension. The design and execution of this exoskeleton was accomplished by 3D computer simulation, 3D CAD modeling, and rapid prototyping techniques. The exoskeleton features 3D printed, ABS plastic struts and supports to achieve successful adaptation of the linear actuator to the brace and an electromechanical system with a rechargeable operating capacity of 7 hours. Design validation was completed by running preliminary gait trials of neutral gait (without brace or exoskeleton), offloading brace, and exoskeleton to observe changes between the different gait scenarios. Results from this testing on a single subject show that there was an observed, significant decrease in average knee ROM in the offloading brace trials from the neutral trials and an observed, significant increase in average knee ROM in the exoskeleton trials when compared to the brace trials as hypothesized. Further evaluation must be completed on the clinical efficacy of this device with a larger, and clinically relevant sample size to assess knee ROM, pain while using the device, and overall comfort level. Further development of this design could focus on material assessment, cost analysis, and risk mitigation through failure mode analysis.

Alors que de nombreux exosquelettes destinés à la rééducation neuromotrice ont été développés ces dernières années, ces dispositifs n'ont pas encore permis de vrai progrès dans la prise en charge des patients cérébrolésés. Une des clés pour améliorer les faibles résultats thérapeutiques obtenus serait de constamment adapter la thérapie robotisée en fonction de l'évolution du patient et de sa récupération, en adaptant l'assistance fournie par le robot pour maximiser l'engagement du patient. L'objectif de cette thèse est donc de comprendre les processus d'adaptations réciproques dans un contexte d'interaction physique Homme-Exosquelette. Dans un premier temps nous avons donc développé un nouveau type de contrôleur adaptatif qui assiste le sujet "au besoin", en modulant l'assistance fournie; et évalué différent signaux pour piloter cette adaptation afin de suivre au mieux la récupération du patient. Dans un deuxième temps, nous avons étudié l'adaptation de sujets sains à l'application de champs de forces distribués par un exosquelette sur leur bras durant la réalisation de mouvements dans l'espace. En effet, lors d'une interaction physique homme-robot, le sujet adapte aussi son comportement aux contraintes exercées par le robot. D'importantes différences inter-individuelles ont été observées, avec une adaptation à la contrainte imposée chez seulement 21% des sujets, mais avec des effets à-posteriori persistants mesurés chez 85% d'entre eux; ainsi qu'une généralisation dans l'espace de ces effets et un transfert à des contextes différents (hors du robot). Ces premiers résultats devraient permettre à terme d'améliorer la rééducation neuromotrice robotisée. / While many robotic exoskeletons have been developed for stroke rehabilitation in recent years, there were not yet improvements to the traditional therapy. A key to unleash the potentiality of robotics is to adapt the assistance provided by the robot in order to maximize the subject engagement and effort, by having the robotic therapy evolving with the patient recovery. For this reason, we aim at better understanding the process of reciprocal adaptation in a context of physical Human-Robot Interaction (pHRI). We first developed a new adaptive controller, which assists the subject "as-needed", by regulating its interaction to maximize the human involvement. We further compared different signals driving this adaptation, to better following the functional recovery level of the patients. While the control is performed by the robot, the subject is also adapting his movements, and this adaptation has not yet been studied when dealing with 3D movements and exoskeletons. Therefore, we exposed human motions to distributed force fields, generated by the exoskeleton at the joint level, to produce specific inter-joint coordination and to analyse the effects of this exposition. With healthy participants, we observed important inter-individual difference, with adaptation to the fields in 21% of the participants, but post-effects and persisting retention of these in time in 85% of the subjects, together with spatial generalization, and, preliminarily, transfer of the effects outside of the exoskeleton context. This work towards understanding pHRI could provide insights on innovative ways to develop new controllers for improving stroke motor recovery with exoskeletons.