Abstract
BackgroundAnkle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains. Our goal was to design and validate a lightweight untethered ankle exoskeleton that was effective across moderate-to-high intensity ambulation in children through adults with and without walking impairment.MethodsFollowing benchtop validation of custom hardware, we assessed the group-level improvements in walking economy while wearing the device in a diverse unimpaired cohort (n = 6, body mass = 42–92 kg). We also conducted a maximal exertion experiment on a stair stepping machine in a small cohort of individuals with cerebral palsy (CP, n = 5, age = 11–33 years, GMFCS I-III, body mass = 40–71 kg). Device usability metrics (device don and setup times and System Usability Score) were assessed in both cohorts.ResultsThere was a 9.9 ± 2.6% (p = 0.012, range = 0–18%) reduction in metabolic power during exoskeleton-assisted inclined walking compared to no device in the unimpaired cohort. The cohort with CP was able to ascend 38.4 ± 23.6% (p = 0.013, range = 3–132%) more floors compared to no device without increasing metabolic power (p = 0.49) or perceived exertion (p = 0.50). Users with CP had mean device don and setup times of 3.5 ± 0.7 min and 28 ± 6 s, respectively. Unimpaired users had a mean don time of 1.5 ± 0.2 min and setup time of 14 ± 1 s. The average exoskeleton score on the System Usability Scale was 81.8 ± 8.4 (“excellent”).ConclusionsOur battery-powered ankle exoskeleton was easy to use for our participants, with initial evidence supporting effectiveness across different terrains for unimpaired adults, and children and adults with CP.Trial registration Prospectively registered at ClinicalTrials.gov (NCT04119063) on October 8, 2019.
Highlights
Ankle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains
Achieving improvements in walking economy with untethered ankle exoskeletons has apparently been more challenging, with only a small number of studies reporting activity performance benefits compared to walking without the device [1, 3, 16,17,18]
Mooney et al [3] took a shank mounted motor approach instead, and addressed the metabolic detriment of adding mass distally on the leg by incorporating a clever mechanical design achieving high torque and power output, and demonstrated improvements in loaded and unloaded walking in healthy adults; this appears to be the only published work demonstrating a group-level improvement in energy efficiency in unimpaired individuals when walking with an untethered, battery-powered ankle exoskeleton compared to no device
Summary
Ankle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains. Achieving improvements in walking economy with untethered ankle exoskeletons has apparently been more challenging, with only a small number of studies reporting activity performance benefits compared to walking without the device [1, 3, 16,17,18]. Mooney et al [3] took a shank mounted motor approach instead, and addressed the metabolic detriment of adding mass distally on the leg by incorporating a clever mechanical design achieving high torque and power output, and demonstrated improvements in loaded and unloaded walking in healthy adults; this appears to be the only published work demonstrating a group-level improvement in energy efficiency in unimpaired individuals when walking with an untethered, battery-powered ankle exoskeleton compared to no device
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