Leg Movements Research Articles

A Systematic Review and Meta-Analysis of the Effectiveness of Mulligan Mobilization with Movement on Pain, Range of Motion, Function, and Flexibility in Patients with Sciatica

Background The Mulligan techniques address lumbar disc lesions and related dysfunctions. However, the current body of evidence of its effectiveness remains limited. Aims To assess the effectiveness of the Mulligan concept on pain alleviation, range of motion, function, and flexibility in patients with sciatica. Methods This meta-analysis included randomized controlled trials that applied Mulligan techniques to patients with sciatica and assessed outcomes such as pain, range of motion, function, or flexibility. We searched six electronic databases to identify the relevant trials. The methodological quality of the studies was evaluated using the Cochrane risk of bias assessment. Results A total of 21 randomized controlled trials (RCTs) were included in this study. Three primary Mulligan techniques were performed: spinal mobilization with leg movement (SMWLM), bent leg raise (BLR), and traction straight leg raise (TSLR). In this review, seven trials exhibited a high to moderate risk of bias, while the remaining trials demonstrated a low risk of bias. The analysis revealed that SMWLG could be beneficial in improving pain (standardized mean difference [SMD] = −0.58, 95% confidence interval [CI] = −0.82 to −0.33, p < .001) and function (SMD = −1.02, 95% CI = −1.87 to −0.17, p = .02). Additionally, BLR showed potential benefits in improving flexibility, particularly when combined with standard treatment (SMD = 0.59, 95% CI = 0.30 to 0.88, p < .001). Conclusions SMWLG demonstrates greater improvements in pain and function compared to other Mulligan techniques in patients with sciatica. However, the limited number of trials and the overall low quality of the existing literature highlight the need for future high-quality research that encompasses all related Mulligan techniques.

Design and Performance Analysis of a Parallel Pipeline Robot

A parallel four-legged pipeline robot is designed to mitigate the issue of uneven motor loading on the single-leg linkage responsible for movement along the pipe diameter. This issue occurs because the drive motor located closer to the robot body requires higher torque when the serial robot operates along the inner wall of a circular polyethylene gas pipe in an urban environment. The forward and inverse kinematic equations for a single-leg linkage are derived to establish the relationship between joint angles and foot trajectories. Building on this analysis, the forward and inverse kinematic solutions for all four legs are also derived. An optimized diagonal trotting gait is selected as the robot’s walking pattern to ensure a balance between stability and movement efficiency, considering the robot’s structural configuration. Motion simulations for both the serial and parallel robots are performed using simulation software, with a detailed analysis of the displacement of the robot’s center of mass and the leg centers during movement. The driving torque of the leg motors in both configurations is controlled and examined. Simulation results indicate that the designed parallel four-legged pipeline robot achieves lower motion error and smoother leg movements within the pipe. Compared to the serial robot, the maximum torque required to drive the leg motors is reduced by approximately 33%, demonstrating the effectiveness and validity of the overall structural design.

Applying closed-loop equations for kinematic analysis of an eight-bar walking mechanism

Bionic mechanisms are used in constructing robotic systems that perform complex tasks similar to the movement of animals. With advancements in scientific research and breakthroughs in simulation techniques and computational methods, the design of these systems has become increasingly detailed and refined. This paper proposes using the closed-loop method to analyze the operational characteristics of a wheelless walking mechanism designed to traverse complex terrains. In addition to evaluating fundamental factors affecting system operation, the study determines kinematic parameters such as leg trajectory, movement velocity, and tilt angle. The results demonstrate the effectiveness of numerical methods in analyzing and simulating real-world systems, thus extending the use of computational tools for analyzing similar linkages.

Waiting for in-Lab Polysomnography May Unnecessarily Prolong Treatment Start in Patients with Moderate or Severe OSA at Home Sleep Apnea Testing.

The gold standard in obstructive sleep apnea (OSA) diagnostics is nocturnal full-night polysomnography (PSG). Due to high costs and high time effort portable respiratory polygraphy (PG or home sleep apnea testing-HSAT) has been developed. In contrast to PG the PSG gains relevant further information concerning sleep stages, arousals and leg movements. However, the role of PG in the diagnostic of OSA remains largely undefined. The aim of this study was to investigate the difference of PG- and PSG- related metrics in OSA, to understand if there is a difference in PG and PSG-based treatment decision and show up the time between performed PG and PSG. 99 consecutive patients with existing outpatient performed PG and followed PSG in our tertiary care otorhinolaryngology department between February 2020 and December 2023 were retrospectively assessed. All patients were treatment-naive at the time of consultation. The time between performed outpatient PG and PSG was calculated. Furthermore, clinical baseline parameter and PG as well as PSG data were evaluated. All data were then blinded presented with relevant comorbid diseases to two experts in sleep medicine in our tertiary care centre to decide whether PAP therapy was indicated or not. Mean AHI was significantly higher in PSG (32.32 ± 22.78/h) compared to PG (22.60 ± 15.12/h) (p<0.001). Mean duration between performed PG and PSG was 194.99 ± 131.96 days (range between 37 and 842 days). Only in two patients PAP-therapy was indicated with PG results but not with PSG results. Only in one case PAP-therapy was not indicated with PG results but with PSG results. These data suggest initiating OSA therapy based on PG results for patients with at least moderate OSA on PG, followed by a confirming PSG and a control PSG under treatment to avoid unnecessary prolongation of treatment start.

Quadruped Robots Gait Planning and Kinematic Analysis

Quadruped robots imitate the gait of animals in nature to achieve flexible and stable movement. Their superior mobility and adaptability have secured an important position in modern robotics. However, quadruped robots still face numerous technical challenges, including complex gait planning. Gait refers to the swinging and supporting movements of the legs and the relative timing of these movements. Different gaits determine various movement forms for quadruped robots, and studying these gaits plays a crucial role in the stable periodic motion of the robot. This paper analyzes three types of gaitsstatic gait, dynamic gait, and quasi-static gaitbased on traditional gait planning methods. Additionally, this paper analyze the movement of the single leg, including the forward and inverse kinematics and the endpoint cycloidal trajectory. Finally, we simulate the stable trot gait in MATLAB, returning the force curve at the foot, joint angles, angular velocity, and angular acceleration curves to complete the verification of the theory.

Calculation of dose conversion coefficients for radiation workers in various postures

The present study investigates the impact of various body postures on dose assessment. Existing radiation protection systems that assume a standing posture are generally valid in most situations; however, they may not be effective in assessing the dose received by individuals in specific conditions such as radiation accidents. To address this, we used the Geant4 simulation code and mesh-type reference computational phantoms (MRCPs) to model and calculate the dose conversion coefficients (DCCs) for 19 representative working postures. These representative postures were developed by referencing existing industrial posture categories, combining movements of arms, torso, and legs. The exposure geometries considered in the present study include generalized parallel beams such as anterior-posterior (AP), posterior-anterior (PA), left-lateral (LLAT), and right-lateral (RLAT), and isotropic exposures from all sides (rotational (ROT) and isotropic (ISO)), along with semi-isotropic forms of ground and ceiling contamination ranging from 30 cm to 50 m in radius. The results demonstrate that the dose ratios between a personal dosimeter and whole-body (i.e. DCCs) are significantly influenced by the body posture and the exposure geometry. Particularly, exposures involving significant body shielding, such as ground and ceiling contamination and PA direction exposures, were mainly affected by the degree of torso bending. For instance, a DCC of 2.3 was recorded for a posture with approximately 45 degrees of torso bending under PA exposure. Additionally, in a ground contamination scenario having a 1 m radius beam, DCCs ranged from 0.8 to 2.5 depending on the degree of torso bending, and in a 2 m radius ceiling contamination scenario, DCCs of 1.2–1.7 were observed in postures with 90 degrees of torso bending. These findings emphasize the importance of posture-specific dose assessments in various contamination scenarios.

Model approach of artificial muscle and leg movements

In this work, two flexible ropes are winded to an electronic motor in opposite directions and the other terminal ends are pinned to two jointed points for mimicking the artificial muscles. Electrical signals from a neural circuit are used to control the rotation of electronic motor(s), and the pulling forces along the flexible ropes control the rotation angles of the jointed pendulums as legs. The leg gaits are investigated in dynamics by changing the channel current shunted from the neural circuit, and the electronic motor-controlled flexible ropes behave as artificial muscles. A single neural circuit and two coupled neural circuits are used to control the electromechanical legs by adjusting the forcing current. The neural circuit drives the electronic motor and then jointed pendulums are controlled. The circuit equations, rotation equations and energy description are presented. It provides possible guidance to design artificial muscles for aiding disabled legs and arms.

The prevalence of sleep disorders in Iranian adults - an epidemiological study

BackgroundSleep disorders can be harmful to our health and treating them can also be expensive. Due to the widespread occurrence and impact of sleep disorders, it is valuable to investigate and study them from an epidemiological perspective. Therefore, this study aimed to determine the prevalence of sleep disorders among Iranian adults in 2022.MethodThis is a cross-sectional study that examines the prevalence of sleep disorders and problems in Iranian society. The participants were selected using a mixed sampling approach (utilizing virtual space and cluster sampling). A two-part package was used for evaluating participants sleep problems, which included a demographic profile form and the Holland Sleep Disorders Questionnaire. After collecting the data, appropriate statistical tests in SPSS version 25 were utilized for analysis.ResultsA total of 6013 questionnaires were fully filled out for this research, with participants answering the specific questions. The participants’ score on sleep disorders was 1.94, which means 44.1% of them suffer from sleep disorders. The results indicated that the prevalence of sleep disorders in this study was as follows: insomnia (35%), parasomnia (35.3%), circadian rhythm sleep disorder (38.4%), hypersomnia and excessive daytime sleepiness (39%), restless leg syndrome and leg movements during sleep (43%), and breathing disorders related to sleep (38.4%). The prevalence of sleep disorders among the study participants demonstrated a significant relationship with most of their demographic variables (P < 0.001). The Pearson correlation coefficient also revealed an inverse and significant relationship between the prevalence of sleep disorders in the study participants and their age, monthly household income, and BMI (P < 0.001).ConclusionOverall, the results depicted a relatively high prevalence of sleep disorders in the studied community. These findings emphasize the need for interventions to prevent and treat sleep disorders in society.

A Wushu Leg Gesture Recognition Algorithm Based on Random Forest and Bone Feature Extraction (RF-SFE)

Addressing the challenges of complex movement trajectories and rapid action changes in martial arts performances, this study introduces a novel posture recognition algorithm based on Random Forest and Skeletal Feature Extraction (RF-SFE) for martial arts leg movements. Unlike traditional posture recognition methods that struggle with accuracy, RF-SFE aims to provide intelligent analysis of training postures to assist practitioners in efficient training. The algorithm initially employs advanced skeletal feature extraction techniques to identify and articulate the relative positions and movements specific to martial arts. These extracted spatial features enhance the flexibility in modeling the unique dynamics of martial arts. Subsequently, Random Forest classification is utilized to categorize different leg movements, leveraging its strength in handling high-dimensional data and providing robust classification. Comparative experiments on diverse martial arts posture datasets demonstrate a significant improvement in recognition rates over baseline methods. This validates the effectiveness of the RF-SFE method in recognizing martial arts postures, offering scientific guidance for practitioners’ training regimens.

Type Synthesis of a Novel Class of One-DOF Multi-Mode Parallel Mechanisms

Abstract Multi-mode parallel mechanisms (PMs) are a class of reconfigurable mechanisms that can switch between different operation modes without the need for disconnection and reassembly. Although a number of multi-DOF multi-mode PMs have been presented in the literature, very few 1-DOF multi-mode PMs have been proposed. This paper deals with the type synthesis of a novel class of 1-DOF multi-mode PMs, which have one 1-DOF translation mode and at least one 1-DOF planar motion mode, using a construction method by leveraging symmetry of mechanisms and merging two multi-mode mechanisms. By inserting a revolute (R) joint into Sarrus-6R like six-joint mechanisms, 1-DOF two-mode two-legged PMs, which are composed of a moving platform and a base connected by one three-joint leg and one four-joint leg, are constructed first. From each 1-DOF two-mode two-legged PM, one can construct a 1-DOF two-mode three-legged PM by adding a third four-joint leg which is the mirror image of the four-joint leg about the plane of motion of the three-joint leg. Subsequently, 1-DOF three- and four-mode three-legged PMs are constructed by merging two 1-DOF multi-mode three-legged PMs. The instantaneous DOF of the above multi-mode PMs in a transition configuration is analyzed using screw theory. This work complements the existing approaches to the type synthesis of multi-mode PMs and hybrid reconfigurable mechanisms.

Spectral EEG and heart rate changes associated with leg movements during the suggested immobilization test in patients with restless legs syndrome.

Restless legs syndrome is usually associated with periodic limb movements during sleep, which are defined as repetitive, stereotyped movements in sleep. Changes in spectral analysis of electroencephalography and heart rate were shown to be associated with periodic limb movements during sleep and non-periodic leg movements in sleep. Considering the circadian distribution of symptoms of restless legs syndrome, we investigated spectral electroencephalography and heart rate accompanying periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test. The mean age of 53 patients was 51.9 ± 13 years, 54.7% were females. Prominent increases in electroencephalography activation were associated with periodic limb movements, isolated leg movements and short-interval leg movements during the suggested immobilization test, which were significant in all spectral bands (p < 0.001). An increase in all electroencephalography bands started ~10 s before periodic limb movements, isolated leg movements and short-interval leg movements; increases in delta and theta band activities ended ~10 s after the movements, while increases in alpha and beta band activities lasted for about ~20 s. Maximum increases in delta, theta, alpha and beta bands were all observed after periodic limb movements and short-interval leg movements, but before isolated leg movements in theta and alpha bands, and after isolated leg movements in delta and beta bands. A notably longer increase in alpha and beta bands was evident for periodic limb movements and short-interval leg movements. An increase in heart rate was prominent at 4-12 s after movement onset in short-interval leg movements, being significantly higher than those associated with periodic limb movements and isolated leg movements. Our study shows that, in patients with restless legs syndrome, periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test are associated with prominent cortical and cardiac activation, which warrants confirmation in larger restless legs syndrome cohorts and requires long-term follow-up studies to delineate its possible clinical consequences.

Development of a Load‐Bearing, Terrain‐Adaptive Hexapod Robot With Chebyshev‐Linkage Legs

ABSTRACTThis study introduces an exploratory design for a hexapod load‐carrying robot, aiming to address challenges commonly associated with quadruped robots, including limited load capacity and high control complexity. By leveraging a Chebyshev linkage‐based overconstrained leg‐foot architecture that combines high rigidity and low friction, along with a multi‐drive system for lateral movement, we propose a robot with improved adaptability to diverse terrains, such as snow, sand, puddles, ice, and deserts. This versatility suggests potential applications in areas such as factory inspection, field reconnaissance and transport, and desert exploration. Using static and dynamic analyses, we evaluated the leg structure's stress distribution and motion requirements, employing simulations in Workbench and Adams to cross‐validate our theoretical calculations. The development of a prototype and its subsequent testing under various environmental conditions aimed to demonstrate the design's practicality and the robot's operational capabilities in real‐world settings. Although the findings indicate progress toward enhancing load‐bearing capabilities and terrain adaptability with reduced control complexity, further research and development are necessary to fully realize the potential of such robotic systems in practical applications.

Utilizing Multiple Triboelectric Nanogenerator Sensors and Signal Processing Technology for Monitoring Periodic Leg Movements of Sleep.

High-quality sleep is essential for both physiological and cognitive functions. However, periodic leg movements of sleep (PLMS), an involuntary phenomenon during sleep, affects millions of people worldwide, contributing to sleep fragmentation and functional impairments. The accurate monitoring of PLMS is important for identifying and addressing these issues. Traditional methods, such as polysomnography (PSG), which monitor the bare tibialis muscle movements in clinical environments, may not adequately reflect the natural sleep patterns at home. They are costly and unsuitable for long-term studies. In recent years, there has been growing interest in using flexible sensors for sleep monitoring. Previous studies have applied triboelectric nanogenerators (TENGs) as flexible sensors to detect muscle movements during sleep. However, distinguishing true PLMS from false signals caused by external factors, such as blankets, remains a challenge. This study proposes a method using three TENG sensors placed on the dorsum, ankle, and tibialis, respectively, along with signal processing techniques to enhance the accuracy of PLMS detection. This study provides a cost-effective, comfortable method for PLMS monitoring, with the potential for widespread use in home-based sleep studies and long-term care in the future.

Nature's All-in-One: Multitasking Robots Inspired by Dung Beetles.

Dung beetles impressively coordinate their 6 legs to effectively roll large dung balls. They can also roll dung balls varying in the weight on different terrains. The mechanisms underlying how their motor commands are adapted to walk and simultaneously roll balls (multitasking behavior) under different conditions remain unknown. This study unravels the mechanisms of how dung beetles roll dung balls and adapt their leg movements to stably roll balls over different terrains for multitasking robots. A modular neural-based loco-manipulation control inspired by and based on ethological observations of the ball-rolling behavior of dung beetles is synthesized. The proposed neural-based control contains a central pattern generator (CPG) module, a pattern formation network (PFN) module, and a robot orientation control (ROC) module. The integrated control mechanisms can control a dung beetle-like robot (ALPHA) with biomechanical feet to perform adaptive (multitasking) loco-manipulation (walking and ball-rolling) on various terrains (flat and uneven). It can deal with different ball weights (2.0 and 4.6kg) and ball types (soft and rigid). The control mechanisms can serve as guiding principles for solving sensory-motor coordination for multitasking robots. Furthermore, this study contributes to biological research by enhancing the understanding of sensory-motor coordination for adaptive (multitasking) loco-manipulation behavior in animals.

Do pregnant women with restless legs syndrome experience better sleep with physical activity?

Pregnant women benefit greatly from exercise due to its powerful impact on maternal and perinatal outcomes. The purpose of our study was to assess whether exercise improves objective sleep quality in pregnant women suffering from restless legs syndrome. This cross-sectional study is based on data from a large, naturalistic, consecutive cohort study in pregnant women recruited by four sleep centres, in Bologna, Milan and Turin (Italy), and Lugano (Switzerland), named the Life-ON study. Objective sleep parameters of 316 pregnant women were measured using polysomnographic recordings during the second trimester of pregnancy, and a self-reported assessment was used to evaluate physical activity. Pregnant women with restless legs syndrome (n = 91) who engaged in physical activity (n = 28) experienced better sleep efficiency (84.20% versus 82.10%, p = 0.01), less stage 1 sleep (10.50% versus 11.40%, p = 0.04) and wake after sleep onset (52.20 min versus 76.40 min, p ≤ 0.001), as well as reduced periodic leg movements during sleep (5.50 per hr versus 16.40 per hr, p < 0.001) when compared with the sedentary restless legs syndrome group (n = 63). Sleep structure was also better conserved in physically active pregnant women without restless legs syndrome compared with the inactive restless legs syndrome negative group. Overall, this study provides further evidence of the benefits of physical activity in pregnant women by illustrating its positive impact on sleep structure.

Design of a Bionic Spider Robot with a Two-Degrees-of-Freedom Leg Structure and Body Frame

Spiders have unique biological characteristics and excellent maneuverability, making them an ideal model for bionic robot design. However, traditional bionic spider robot designs usually have multiple degrees of freedom and confront many challenges. These challenges include complex control requirements, higher energy consumption, larger size and weight, higher risk of failure, and higher cost. This study proposes a leg design with two degrees of freedom to reduce its control and manufacturing costs. It can better control leg movement and improve leg force through a multi-link mechanism and a dual-motor system. In addition, the triangular gait and hexagonal body structure align the weight of the body with the support point, thereby enhancing stability. This study offers a comprehensive and organized approach to bio-inspired robot design, providing a valuable reference for future bionic robot development.

The Validation of the SOMNOwatch™ Actigraphy System for Periodic Limb Movements in Sleep Assessment.

There is a growing body of evidence regarding the clinical significance of PLMS, and this movement disorder is of concern in both clinical and scientific contexts. Leg actigraphy is a convenient and promising method for screening periodic limb movements in sleep (PLMSs). This study aims to demonstrate the reliability of the SOMNOwatch™ actigraph for detecting periodic limb movements in sleep. Twenty-eight patients, referred to a sleep laboratory for various sleep problems, underwent nocturnal polysomnography with simultaneous one-sided actigraphy using the SOMNOwatch™ actigraph. Recordings of leg movements obtained from both methods were manually scored, calculating the periodic limb movement index (PLMI). The agreement between the methods was assessed through correlation analysis and event-by-event comparison. The correlation between the PLMI derived from PSG and SOMNOwatch™ was high and statistically significant (r = 0.98, p < 0.0001). The SOMNOwatch™ demonstrated a sensitivity of 86.7% and a specificity of 92.3% in detecting PLMS. Similarly, for detecting patients with a PLMI equal to or greater than 15, the sensitivity was 85.7%, and the specificity was 95.2%.

Parental Management Choices and Discordant Ultrasound Findings in Referrals for Fetal Spina Bifida.

The severity of spina bifida aperta can be assessed prenatally by ultrasound. Morphological findings assist parents in choosing between management options. We aimed to document those management choices since the introduction of fetal surgery, and compare initial ultrasound findings prior to referral to findings in a fetal surgery center. Single center cohort study of 245 consecutive fetuses with a second-trimester diagnosis of SBA. Data included nature of referral (for assessment or for surgery), condition-specific findings on ultrasound, and further management. We compared the reported findings on the initial ultrasound to ours for the presence of hindbrain herniation, lesion level, ventricular width, kyphosis, leg movement, and club feet. Seventy-two percent (n=177) of fetuses met the eligibility criteria for surgery; in 60% (n=106) parents opted for fetal surgery. Of 136 patients specifically referred for surgery, 27 were ineligible (20%). Of the others, 93 proceeded with surgery. In up to 28% (n=30) of surgery referrals, eligibility criteria such as lesion level (n=30, 28%) or leg movement (72%, n=78) as severity indicators were not reported. Fetal surgery uptake was high in patients referred for surgery. Second assessment in a fetal surgery center often reveals additional relevant information.

Technical development and preliminary physiological response investigation of a tendon-based robotic system for gait rehabilitation

Cable-driven robots are commonly applied in the rehabilitation field. Many tendon-based systems use parallel end-effector structures because of the advantages of fast reactions and high force outputs. We previously developed an active cable-driven robotic system that enabled accurate force control and was applied while walking on a treadmill. However, the kinematic and kinetic assistance methods need to be improved. Given the advantages of tendon-based parallel systems, this study investigated walking generated by four cables that were directly attached around the ankle. The aim of this work was to develop a tendon-based parallel robotic system to provide assisted walking on a treadmill with gait-specific position guidance and force compensation. To demonstrate the assistance effects, preliminary physiological responses of leg muscles during walking with the system were investigated. A parallel robotic system with four cable-driven units was developed. Kinematic and kinetic analyses of walking were performed, followed by the development of control algorithms for walking with impedance assistance only and walking with impedance assistance plus kinetic compensation. The muscle activity of the rectus femoris, vastus lateralis, gluteus maximus, biceps femoris, and gastrocnemius muscles was recorded and analyzed. On the basis of the kinematic and kinetic analyses, the tendon-based parallel robotic system produced treadmill walking with position and force assistance. The force control algorithms tracked the target force profile with a mean error of 6.4 N. During impedance-assisted walking, the rectus femoris, gluteus maximus and biceps femoris muscles produced a mean electromyography of 115.1% of the activity during independent walking (without assistance). However, the activity of the vastus lateralis and gastrocnemius reduced to only 82.5% of that during independent walking. Further kinetic compensation generally reduced the muscle activity, with the mean electromyography result being 88.7% of that during independent walking. From a technical point of view, the tendon-based parallel robotic system provided walking-specific position and force assistance in leg movement, accompanied by reduced muscle activity compared with independent walking. A technical feasibility study will be conducted to evaluate whether the tendon-based parallel robotic system is feasible for assisted treadmill walking in the general population and whether position guidance and force assistance are acceptable.

Soft robotic shorts improve outdoor walking efficiency in older adults

Peoples' walking efficiency declines as they grow older, posing constraints on mobility, and affecting independence and quality of life. Although wearable assistive technologies are recognized as a potential solution for age-related movement challenges, few have proven effective for older adults, predominantly within controlled laboratory experiments. Here we present WalkON, a pair of soft robotic shorts designed to enhance walking efficiency for older individuals by assisting hip flexion. The system features a compact and lightweight tendon-driven design, using a controller based on natural leg movements to autonomously assist leg propagation. To assess WalkON's impact on daily walking, we initially conducted a technology assessment with young adults on a demanding outdoor uphill 500 m hiking trail. We then validated our findings with a group of older adults walking on a flat outdoor 400 m track. WalkON considerably reduced the metabolic cost of transport by 17.79% for young adults during uphill walking. At the same time, participants reported high perceived control over their voluntary movements (a self-reported mean score of 6.20 out of 7 on a Likert scale). Similarly, older adults reduced their metabolic cost by 10.48% when using WalkON during level ground walking, while retaining a strong sense of movement control (mean score of 6.09 out of 7). These findings emphasize the potential of wearable assistive devices to improve efficiency in outdoor walking, suggesting promising implications for promoting physical well-being and advancing mobility, particularly during the later stages of life.