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      Mechatronics Design of a Gait-Assistance Exoskeleton for Therapy of Children with Duchenne Muscular Dystrophy

      , , , , ,
      Applied Sciences
      MDPI AG

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          Abstract

          This paper presents a mechatronics design of a gait-assistance exoskeleton for therapy in children with Duchenne muscular dystrophy (DMD). This type of muscular dystrophy is a severe condition that causes muscle wasting, which results in a progressive loss of mobility. Clinical studies have shown the benefits of physical therapy in prolonging the mobility of patients with DMD. However, the therapy sessions are exhaustive activities executed by highly qualified rehabilitation personnel, which makes providing appropriate treatment for every patient difficult. This paper develops a mechatronics design of a gait-assistance exoskeleton to automate therapy sessions. The exoskeleton design uses adaptable mechanisms to adjust the device to the patient’s needs and includes the design of a series-elastic actuator to reduce the effects of nonalignment of the rotation axis between the exoskeleton and the patient. A mathematical dynamic hybrid model of the exoskeleton and a child’s body is developed using anthropometry of a population of six-year-old children. The hybrid model is used to design a nonlinear control strategy, which uses differential geometry to perform feedback linearization and to guarantee stable reference tracking. The proposed control law is numerically validated in a simulation to evaluate the control system’s performance and robustness under parameter variation during therapy with trajectory-tracking routines.

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          Most cited references40

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          Control strategies for active lower extremity prosthetics and orthotics: a review

          Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user. This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user’s sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies. As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os – not as independent devices, but as actors within an ecosystem – is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers. Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use. The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user’s neuromusculoskeletal system and are practical for use in locomotive ADL.
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            State of the Art and Future Directions for Lower Limb Robotic Exoskeletons.

            Research on robotic exoskeletons has rapidly expanded over the previous decade. Advances in robotic hardware and energy supplies have enabled viable prototypes for human testing. This review paper describes current lower limb robotic exoskeletons, with specific regard to common trends in the field. The preponderance of published literature lacks rigorous quantitative evaluations of exoskeleton performance, making it difficult to determine the disadvantages and drawbacks of many of the devices. We analyzed common approaches in exoskeleton design and the convergence, or lack thereof, with certain technologies. We focused on actuators, sensors, energy sources, materials, and control strategies. One of the largest hurdles to be overcome in exoskeleton research is the user interface and control. More intuitive and flexible user interfaces are needed to increase the success of robotic exoskeletons. In the last section, we discuss promising future solutions to the major hurdles in exoskeleton control. A number of emerging technologies could deliver substantial advantages to existing and future exoskeleton designs. We conclude with a listing of the advantages and disadvantages of the emerging technologies and discuss possible futures for the field.
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              Robot assisted gait training with active leg exoskeleton (ALEX).

              Gait training of stroke survivors is crucial to facilitate neuromuscular plasticity needed for improvements in functional walking ability. Robot assisted gait training (RAGT) was developed for stroke survivors using active leg exoskeleton (ALEX) and a force-field controller, which uses assist-as-needed paradigm for rehabilitation. In this paradigm undesirable gait motion is resisted and assistance is provided towards desired motion. The force-field controller achieves this paradigm by effectively applying forces at the ankle of the subject through actuators on the hip and knee joints. Two stroke survivors participated in a 15-session gait training study each with ALEX. The results show that by the end of the training the gait pattern of the patients improved and became closer to a healthy subject's gait pattern. Improvement is seen as an increase in the size of the patients' gait pattern, increased knee and ankle joint excursions and increase in their walking speeds on the treadmill.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                ASPCC7
                Applied Sciences
                Applied Sciences
                MDPI AG
                2076-3417
                January 2023
                January 07 2023
                : 13
                : 2
                : 839
                Article
                10.3390/app13020839
                5a7cef26-b44e-4381-98e9-939466735543
                © 2023

                https://creativecommons.org/licenses/by/4.0/

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