Indications and Contraindications for Exoskeletal-Assisted Walking in Persons with Spinal Cord Injury

Spungen, Ann M.; Gorman, Peter H.; Forrest, Gail; Asselin, Pierre; Kornfeld, Stephen; Hong, Eunkyoung; Bauman, William A.

doi:10.1007/978-3-030-69547-7_37

Cited by 2 publications

(6 citation statements)

References 9 publications

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“…We can only observe the effects during swing, while misalignments probably create a much larger risk during the stance phase, in which the knee load -and therefore presumably the effect of misalignment -is substantially increased. Especially during sit-to-stand, the load on the knee is high and misalignments are assumed to be causing high risks [103], [210]. For reasons of practical feasibility, these limitations had to be accepted.…”

Section: Discussionmentioning

confidence: 99%

“…Forces at the musculoskeletal level need to be kept within a safe range to avoid musculoskeletal adverse events such as joint pain or bone fractures, which were found to be the second most frequent type of adverse events (Chapter 2 and [103], [210]). Two challenges regarding assessment of the effects of forces on internal body structures are very present and often discussed: (1) How can the internal loads be assessed?…”

Section: Discussionmentioning

confidence: 99%

“…Research has shown that discomfort and soft tissue injuries can often be resolved by making adjustments to the fitting or material at the interface [74], [229], [230]. Furthermore, circumstances such as obesity, materials present at the interface, unexpected movements due to a (near-)fall incident, low bone mineral density or blood pressure fluctuations can increase the risk for injuries in some robotic devices [49], [82], [103], [210]. Therapists should be able to identify these factors and mitigate the risk or exclude patients from the training as to avoid harm.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

“…This does not only relate to the amount and properties of soft tissue but also to body height, weight and bone mass. While bone mineral density and previously sustained fractures might be difficult to mimic in a dummy, they should be considered in the safety thresholds for loads on the musculoskeletal system and potential exclusion criteria for the use of a device [44], [60], [210]. Defining those thresholds requires additional research.…”

Section: The Future Of Safety Assessments In Physical Human-robot Int...mentioning

confidence: 99%

“…Weight effects are therefore not accurately reconstructed. In addition to that, we are simulating the situation during swing and are not considering a weight bearing situation, which would increase the forces on the musculoskeletal system considerably, especially during sit-to-stand movements [210]. This is supported by a report of a tibia fracture in exoskeleton use which occurred during sit-to-stand motion after an unexpected shutdown that likely caused a misalignment [103].…”

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confidence: 98%

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Safety first in rehabilitation robots! Investigating how safety-related physical human-robot interaction ca be assessed

Bessler¹

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Chapter 1 General introduction Chapter 2 Occurrence and type of adverse events during the use of stationary gait robots -A systematic literature review Chapter 3 Safety assessment of rehabilitation robots: A review identifying safety skills and knowledge gaps Chapter 4 Prototype measuring device for assessing interaction forces between Human Limbs and Rehabilitation Robots -A Proof of Concept Study Chapter 5 Assessing effects of exoskeleton misalignment on knee joint load during swing using an instrumented leg simulator Chapter 6 Soft tissue characteristics affect the relation between leg-exoskeleton misalignments and knee joint loads in a dummy leg Chapter 7 Investigating change of discomfort during repetitive force exertion though an exoskeleton cuff Chapter 8 General discussion & References, List of abbreviations, Summaries, Acknowledgements, About the author, Progress range RIS K

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Implications For Clinical Practicementioning

confidence: 99%

Section: The Future Of Safety Assessments In Physical Human-robot Int...mentioning

confidence: 99%

mentioning

confidence: 98%

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Safety first in rehabilitation robots! Investigating how safety-related physical human-robot interaction ca be assessed

Bessler¹

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Assessing effects of exoskeleton misalignment on knee joint load during swing using an instrumented leg simulator

Bessler

Schaake

Prange-Lasonder

et al. 2022

J NeuroEngineering Rehabil

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Background Exoskeletons are working in parallel to the human body and can support human movement by exerting forces through cuffs or straps. They are prone to misalignments caused by simplified joint mechanics and incorrect fit or positioning. Those misalignments are a common safety concern as they can cause undesired interaction forces. However, the exact mechanisms and effects of misalignments on the joint load are not yet known. The aim of this study was therefore to investigate the influence of different directions and magnitudes of exoskeleton misalignment on the internal knee joint forces and torques of an artificial leg. Methods An instrumented leg simulator was used to quantify the changes in knee joint load during the swing phase caused by misalignments of a passive knee brace being manually flexed. This was achieved by an experimenter pulling on a rope attached to the distal end of the knee brace to create a flexion torque. The extension was not actuated but achieved through the weight of the instrumented leg simulator. The investigated types of misalignments are a rotation of the brace around the vertical axis and a translation in anteroposterior as well as proximal/distal direction. Results The amount of misalignment had a significant effect on several directions of knee joint load in the instrumented leg simulator. In general, load on the knee joint increased with increasing misalignment. Specifically, stronger rotational misalignment led to higher forces in mediolateral direction in the knee joint as well as higher ab-/adduction, flexion and internal/external rotation torques. Stronger anteroposterior translational misalignment led to higher mediolateral knee forces as well as higher abduction and flexion/extension torques. Stronger proximal/distal translational misalignment led to higher posterior and tension/compression forces. Conclusions Misalignments of a lower leg exoskeleton can increase internal knee forces and torques during swing to a multiple of those experienced in a well-aligned situation. Despite only taking swing into account, this is supporting the need for carefully considering hazards associated with not only translational but also rotational misalignments during wearable robot development and use. Also, this warrants investigation of misalignment effects in stance, as a target of many exoskeleton applications.

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Indications and Contraindications for Exoskeletal-Assisted Walking in Persons with Spinal Cord Injury

Cited by 2 publications

References 9 publications

Safety first in rehabilitation robots! Investigating how safety-related physical human-robot interaction ca be assessed

Safety first in rehabilitation robots! Investigating how safety-related physical human-robot interaction ca be assessed

Assessing effects of exoskeleton misalignment on knee joint load during swing using an instrumented leg simulator

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