Passive Back Support Exoskeleton Research Articles

Effect of Wearable Passive Back Support Exoskeleton on the Peak Muscle Activation of the Erector Spinae Muscles During Lifting

Effect of Wearable Passive Back Support Exoskeleton on the Peak Muscle Activation of the Erector Spinae Muscles During Lifting

Age and gender differences in the perception and use of soft vs. rigid exoskeletons for manual material handling

We investigated age and gender differences in the perception and use of soft (Apex) vs. rigid (Paexo Back) passive back-support exoskeletons (BSE) for repetitive lifting and lowering. A gender-balanced sample of 20 young (18–30 years) and 16 old (45–60 years) individuals were recruited. In the first session, participants’ self-reported maximum acceptable load (MAL) was assessed using a psychophysical approach. Changes in muscle activity and kinematics due to BSE use in repetitive lifting/lowering tasks were also assessed. Overall, both BSEs increased MAL (by ∼7%), and reduced trunk extensor muscle activity across all groups (by ∼7–18%), compared to the control condition. Both BSEs promoted more squatting postures, increased quadriceps muscle activity (by ∼34%) and abdominal muscle activity during asymmetric tasks (by 5–20%). Some age and gender differences were significant, particularly for the trunk kinematics when using the Apex. Future work should include more diverse user groups in studying willingness to adopt BSEs and characterising their consequent effects on the body.

Comparison of active and passive back-support exoskeletons for construction work: range of motion, discomfort, usability, exertion and cognitive load assessments

PurposeLow back disorders are more predominant among construction trade workers than their counterparts in other industry sectors. Floor layers are among the top artisans that are severely affected by low back disorders. Exoskeletons are increasingly being perceived as ergonomic solutions. This study aims to compare the efficacy of passive and active back-support exoskeletons by measuring range of motion, perceived discomfort, usability, perceived rate of exertion and cognitive load during a simulated flooring task experiment.Design/methodology/approachIn this study eight participants were engaged in a repetitive timber flooring task performed with passive and active back-support exoskeletons. Subjective and objective data were collected to assess the risks associated with using both exoskeletons. Descriptive statistics were used for analysis. Scheirer-Ray-Hare test and Wilcoxon signed-rank test were adopted to compare the exoskeleton conditions.FindingsThe results show no significant differences in the range of motion (except for a lifting cycle), perceived level of discomfort and perceived level of exertion between the two exoskeletons. Significant difference in overall cognitive load was observed. The usability results show that the active back-support exoskeleton made task execution easier with less restriction on movement.Research limitations/implicationsThe flooring task is simulated in a laboratory environment with only eight male participants.Originality/valueThis study contributes to the scarce body of knowledge on the usage comparison of passive and active exoskeletons for construction work.

Long-term effects and user acceptance of back-support exoskeletons in the workplace

The aim of our study was to evaluate the long-term effects of back-support exoskeletons (BSEs) in occupational settings. Valuable insights were gained through repeated in-depth interviews with occupational safety professionals over a one-year period regarding the use and impact of BSEs over a one-year period. The results highlight a significant lack of user acceptance, primarily due to movement restrictions and discomfort. Passive BSEs (PassEXOs) were reported to be sometimes uncomfortable, restricting mobility and causing pressure point discomfort, while quasipassive soft BSEs (SoftEXO) received more positive feedback. In addition, factors such as proper fit, adjustability, hygiene maintenance, and the ease of donning and doffing were identified as key determinants of employee acceptance of BSEs. By gaining a deeper understanding of these factors, organisations can facilitate a successful and sustainable integration of BSE technology into the workplace.

Real-time lumbosacral joint loading estimation in exoskeleton-assisted lifting conditions via electromyography-driven musculoskeletal models

Lumbar joint compression forces have been linked to the development of chronic low back pain, which is specially present in occupational environments. Offline methodologies for lumbosacral joint compression force estimation are not commonly integrated in occupational or medical applications due to the highly time-consuming and complex post-processing procedures. Hence, applications such as real-time adjustment of assistive devices (i.e., back-support exoskeletons) for optimal modulation of compression forces remains unfeasible. Here, we present a real-time electromyography (EMG)-driven musculoskeletal model, capable of estimating accurate lumbosacral joint moments and plausible compression forces. Ten participants performed box-lifting tasks (5 and 15 kg) with and without the Laevo Flex back-support exoskeleton using squat and stoop lifting techniques. Lumbosacral kinematics and EMGs from abdominal and thoracolumbar muscles were used to drive, in real-time, subject-specific EMG-driven models, and estimate lumbosacral joint moments and compression forces. Real-time EMG-model derived moments showed high correlations (R2 = 0.76 - 0.83) and estimation errors below 30% with respect to reference inverse dynamic moments. Compared to unassisted lifting conditions, exoskeleton liftings showed mean lumbosacral joint moments and compression forces reductions of 11.9 - 18.7 Nm (6 - 12% of peak moment) and 300 - 450 N (5 - 10%), respectively. Our modelling framework was capable of estimating in real-time, valid lumbosacral joint moments and compression forces in line with in vivo experimental data, as well as detecting the biomechanical effects of a passive back-support exoskeleton. Our presented technology may lead to a new class of bio-protective robots in which personalized assistance profiles are provided based on subject-specific musculoskeletal variables.

Effects of a Passive Back Support Exoskeleton when Lifting and Carrying Lumber Boards.

Passive back support exoskeletons, which support the human trunk using elements like springs and elastic bands, have demonstrated positive results in laboratory-based studies, but have seen significantly less field testing. As an intermediate step between generic lab evaluations and field tests, we conducted a single-session lab evaluation of the HeroWear Apex exoskeleton with mockup construction tasks: 20 adult men (without extensive construction experience) lifted, carried and raised lumber boards (265 cm length, up to 18 kg total load). The exoskeleton significantly reduced mean erector spinae electromyograms, with effect sizes (Cohen's d) ranging from -0.2 to -0.55 - corresponding to reductions of 5-25% relative to noexoskeleton electromyogram values. In asymmetric carrying tasks, the exoskeleton provided more assistance to the more heavily loaded erector spinae muscle. Additionally, in lifting tasks, the exoskeleton decreased trunk/hip flexion/extension range of motion and increased knee range of motion, indicating changes in lifting strategy. These results indicate potential exoskeleton benefits for lumber board carrying and will serve as the basis for further evaluations with workers in the field.Clinical Relevance- This study establishes that a passive back exoskeleton reduces erector spinae electromyograms by 525% when lifting and carrying lumber boards used in construction work.

Evaluation of concrete workers' interaction with a passive back-support exoskeleton

PurposeConcrete workers perform physically demanding work in awkward postures, exposing their backs to musculoskeletal disorders. Back-support exoskeletons are promising ergonomic interventions designed to reduce the risks of back disorders. However, the suitability of exoskeletons for enhancing performance of concrete workers has not been largely explored. This study aims to assess a passive back-support exoskeleton for concrete work in terms of the impact on the body, usability and benefits of the exoskeleton, and potential design modifications.Design/methodology/approachConcrete workers performed work with a passive back-support exoskeleton. Subjective and qualitative measures were employed to capture their perception of the exoskeleton, at the middle and end of the work, in terms of discomfort to their body parts, ease of use, comfort, performance and safety of the exoskeleton, and their experience using the exoskeleton. These were analyzed using descriptive statistics and thematic analysis.FindingsThe exoskeleton reduced stress on the lower back but caused discomfort to other body parts. Significant correlations were observed between perceived discomfort and usability measures. Design modifications are needed to improve the compatibility of the exoskeleton with the existing safety gears, reduce discomfort at chest and thigh, and improve ease of use of the exoskeleton.Research limitations/implicationsThe study was conducted with eight concrete workers who used the exoskeleton for four hours.Originality/valueThis study contributes to existing knowledge on human-wearable robot interaction and provides suggestions for adapting exoskeleton designs for construction work.

Performance and effectiveness of a passive back-support exoskeleton in manual material handling tasks in the construction industry

Performance and effectiveness of a passive back-support exoskeleton in manual material handling tasks in the construction industry

Evaluation of the physiological benefits of a passive back-support exoskeleton during lifting and working in forward leaning postures

Musculoskeletal disorders affecting the back are highly prevalent in fields of occupation involving repetitive lifting and working in forward leaning postures. Back-support exoskeletons are developed to relieve workers in physically demanding occupations. This study investigates the physiological effects of a lightweight exoskeleton which provides support through textile springs worn on the back. We hypothesized that wearing such a passive back-support exoskeleton reduces muscle activity of the back and hip muscles, while not influencing abdominal muscle activity and movement kinematics during typical occupational tasks.We collected electromyography data from the main back and hip muscles as well as whole body kinematics data via optical motion tracking during a set of relevant weight lifting tasks corresponding to typical work conditions. In our sample of 30 healthy volunteers, wearing the exoskeleton significantly reduced muscle activity, with reductions up to 25.59% during forward leaning and 20.52% during lifting in the main back and hip muscles (Erector Spinae at thoracic and lumbar level and Quadratus Lumborum). Simultaneously, no changes in knee and hip range of motion were observed. The stretch of the textile springs correlated with the body mass index and chest circumference of the wearer, and depended on posture, but not on the lifted load.The LiftSuit exoskeleton relieved back and hip muscles during typically straining occupational tasks, while biomechanical parameters were preserved. This suggests that passive lift-support exoskeletons can be safely used to relieve workers during lifting and forward leaning tasks.

A Statistical Parametric Mapping Analysis Approach for the Evaluation of a Passive Back Support Exoskeleton on Mechanical Loading During a Simulated Patient Transfer Task

This study assessed the effectiveness of a passive back support exoskeleton during a mechanical loading task. Fifteen healthy participants performed a simulated patient transfer task while wearing the Laevo (version 2.5) passive back support exoskeleton. Collected metrics encompassed L5-S1 joint moments, back and abdominal muscle activity, lower body and back kinematics, center of mass displacement, and movement smoothness. A statistical parametric mapping analysis approach was used to overcome limitations from discretization of continuous data. The exoskeleton reduced L5-S1 joint moments during trunk flexion, but wearing the device restricted L5-S1 joint flexion when flexing the trunk as well as hip and knee extension, preventing participants from standing fully upright. Moreover, wearing the device limited center of mass motion in the caudal direction and increased its motion in the anterior direction. Therefore, wearing the exoskeleton partly reduced lower back moments during the lowering phase of the patient transfer task, but there were some undesired effects such as altered joint kinematics and center of mass displacement. Statistical parametric mapping analysis was useful in determining the benefits and hindrances produced by wearing the exoskeleton while performing the simulated patient transfer task and should be utilized in further studies to inform design and appropriate usage.

Motor variability during a repetitive lifting task is impaired by wearing a passive back-support exoskeleton.

Evaluate whether wearing a passive back-support exoskeleton during repetitive lifting impairs motor variability of erector spinae muscle and spine movement and whether this association is influenced by lifting style. Thirty-six healthy males performed ten lifts in four randomized conditions with exoskeleton (without, with) and lifting style (squat, stoop) as dependent variables. One lifting cycle contained four phases: bending/straighten without/with load. Erector spinae muscular activity, thoracic kyphosis and lumbar lordosis were measured with surface electromyography and gravimetric position sensors, respectively. Absolute and relative cycle-to-cycle variability were calculated. The effects of exoskeleton and exoskeleton×lifting style were assessed on outcomes during the complete lifting cycle and its four phases. For the complete lifting cycle, muscular variability and thoracic kyphosis variability decreased whereas lumbar lordosis variability increased with exoskeleton. For lifting phases, effects of exoskeleton were mixed. Absolute and relative muscular variability showed a significant interaction effect for the phase straighten with load; variability decreased with exoskeleton during squat lifting. Using the exoskeleton impaired several motor variability parameters during lifting, supporting previous findings that exoskeletons may limit freedom of movement. The impact of this result on longer-term development of muscular fatigue or musculoskeletal disorders cannot yet be estimated.

Passive exoskeletons alter low back load transfer mechanism

Previous studies that tested passive back-support exoskeletons focused only on active low-back tissue. Therefore, this study examines the effect from a passive back-support exoskeleton by investigating changes in the load transfer mechanism between active and passive tissue in the low back. Twelve healthy male participants performed a full range of trunk flexion–extension movements under three conditions—FREE (no exoskeleton), the backX, or the CoreBot exoskeleton—while holding 0 kg, 4 kg, and 8 kg loads. Body kinematics and electromyography were recorded. Results showed that the average muscle activity of the lumbar erector spinae (LES) was significantly reduced while wearing the exoskeletons, with a 5.9%MVC reduction with the backX and a 3.3%MVC reduction with the CoreBot. Earlier occurrence of the flexion-relaxation phenomenon induced by the trunk extension moment of exoskeletons played an important role in reducing LES muscle activity because the LES returned to a relaxed state earlier (EMG-Off: a 3.1° reduction with the backX, and a 1.8° reduction with the CoreBot; EMG-On: a 2.3° reduction with the backX, and a 1.4° reduction with the CoreBot). In addition, the maximum lumbar flexion angle (a 2.2° reduction with the backX and a 1.5° reduction with the CoreBot) showed significant decreases compared to the FREE condition, indicating that exoskeleton use can prevent low-back passive tissue from being fully activated. These results suggested the overall effects of passive back-support exoskeletons in reducing loads on both active and passive tissue in the low back.

A Novel Passive Back-support Exoskeleton with a Spring-cable-differential for Lifting Assistance.

Lower back injuries are the most common work-related musculoskeletal disorders. As a wearable device, a back-support exoskeleton (BSE) can reduce the risk of lower back injuries and passive BSEs can achieve a low device weight. However, with current passive BSEs, there is a problem that the user must push against the device when lifting the leg to walk, which is perceived as particularly uncomfortable due to the resistance. To solve this problem, we propose a novel passive BSE that can automatically distinguish between lifting and walking. A unique spring-cable-differential acts as a torque generator to drive both hip joints, providing adequate assistive torque during lifting and low resistance during walking. The optimization of parameters can accommodate the asymmetry of human gait. In addition, the assistive torque on both sides of the user is always the same to ensure the balance of forces. By using a cable to transmit the spring force, we placed the torque generator on the person's back to reduce the weight on the legs. To test the effectiveness of the device, we performed a series of simulated lifting tasks and walking trials. When lifting a load of 10 kg in a squatting and stooping position, the device was able to reduce the activation of the erector spinae muscles by up to 41%. No significant change in the activation of the leg and back muscles was detected during walking.

Estimating lumbar spine loading when using back-support exoskeletons in lifting tasks

Low-back pain (LBP) continues as the leading cause of work-related musculoskeletal disorders, and the high LBP burden is attributed largely to physical risk factors prevalent in manual material handling tasks. Industrial back-support exoskeletons (BSEs) are a promising ergonomic intervention to help control/prevent exposures to such risk factors. While earlier research has demonstrated beneficial effects of BSEs in terms of reductions in superficial back muscle activity, limited evidence is available regarding the impacts of these devices on spine loads. We evaluated the effects of two passive BSEs (BackX™ AC and Laevo™ V2.5) on lumbosacral compression and shear forces during repetitive lifting using an optimization-based model. Eighteen participants (gender-balanced) completed four minutes of repetitive lifting in nine different conditions, involving symmetric and asymmetric postures when using the BSEs (along with no BSE as a control condition). Using both BSEs reduced estimated peak compression and anteroposterior shear forces (by ∼8–15%). Such reductions, however, were task-specific and depended on the BSE design. Laevo™ use reduced mediolateral shear forces during asymmetric lifting (by ∼35%). We also found that reductions in composite measures of trunk muscle activity may not correspond well with changes in spine forces when using a BSE. These results can help guide the proper selection and application of BSEs during repetitive lifting tasks. Future work is recommended to explore the viability of different biomechanical models to assess changes in spine mechanical loads when using BSEs and whether reasonable estimates would be obtained using such models.

A novel approach to quantify the assistive torque profiles generated by passive back-support exoskeletons

Industrial exoskeletons are a promising ergonomic intervention to reduce the risk of work-related musculoskeletal disorders by providing external physical support to workers. Passive exoskeletons, having no power supplies, are of particular interest given their predominance in the commercial market. Understanding the mechanical behavior of the torque generation mechanisms embedded in passive exoskeletons is, however, essential to determine the efficacy of these devices in reducing physical loads (e.g., in manual material handling tasks). We introduce a novel approach using a computerized dynamometer to quantify the assistive torque profiles of two passive back-support exoskeletons (BSEs) at different support settings and in both static and dynamic conditions. The feasibility of this approach was examined using both human subjects and a mannequin. Clear differences in assistive torque magnitudes were evident between the two BSEs, and both devices generated more assistive torques during trunk/hip flexion than extension. Assistive torques obtained from human subjects were often within similar ranges as those from the mannequin, though values were more comparable over a narrow range of flexion/extension angles due to practical limitations with the dynamometer and human subjects. Characterizing exoskeleton assistive torque profiles can help in better understanding how to select a torque profile for given task requirements and user anthropometry, and aid in predicting the potential impacts of exoskeleton use by incorporating measured torque profiles in a musculoskeletal modeling system. Future work is recommended to assess this approach for other occupational exoskeletons.

Influence of a passive back support exoskeleton on simulated patient bed bathing: results of an exploratory study

Low-back pain is a major concern among healthcare workers. One cause is the frequent adoption of repetitive forward bent postures in their daily activities. Occupational exoskeletons have the potential to assist workers in such situations. However, their efficacy is largely task-dependent, and their biomechanical benefit in the healthcare sector has rarely been evaluated. The present study investigates the effects of a passive back support exoskeleton in a simulated patient bed bathing task. Nine participants performed the task on a medical manikin, with and without the exoskeleton. Results show that working with the exoskeleton induced a significantly larger trunk forward flexion, by 13 deg in average. Due to this postural change, using the exoskeleton did not affect substantially the muscular and cardiovascular demands nor the perceived effort. These results illustrate that postural changes induced by exoskeleton use, whether voluntary or not, should be considered carefully since they may cancel out biomechanical benefits expected from the assistance. Practitioner summary: Low-back pain is a major concern among nurses, associated with bent postures. We observed that using a passive back-support exoskeleton during the typical patient bed bathing activity results in a larger trunk flexion, without changing muscular, cardiovascular or perceived physical effort.

Biomechanical assessment of a passive back-support exoskeleton during repetitive lifting and carrying: Muscle activity, kinematics, and physical capacity

Introduction: Most people have experienced low back pain (LBP) more or less in their lifetime. Heavier load weight could increase the risk of LBP, especially in repetitive lifting and carrying tasks. The risk could also increase with the frequency of lifting. This study aims to investigate the effects of a passive back-support exoskeleton (PBSE) on trunk muscle activation, kinematics, and physical capacity in a repetitive lifting task and a carrying task in consideration of load weights in a laboratory setting. Results: Results showed that using the PBSE, the activities of the thoracic erector spinae and lumbar erector spinae muscles were reduced significantly by nearly 7% MVC and 3% MVC in the repetitive lifting task and the carrying task, respectively. There was no significant effect of the PBSE on the spine kinematics and physical capacity. Practical Applications: This study supports the use of the PBSE to reduce trunk muscle activity in repetitive lifting and carrying tasks.

Effects of a Passive Back-Support Exoskeleton on Knee Joint Loading during Simulated Static Sorting and Dynamic Lifting Tasks.

Due to the load shifting mechanism of many back-support exoskeletons (BSEs), this study evaluated possible side effects of using a BSE on knee joint loading. Twenty-nine subjects (25.9 (±4.4) years, 179.0 (±6.5) cm; 73.6 (±9.4) kg) performed simulated static sorting and dynamic lifting tasks, including stoop and squat styles and different trunk rotation postures. Ground reaction force, body posture and the force between the chest and the BSE’s contact interface were recorded using a force plate, two-dimensional gravimetric position sensors, and a built-in force sensor of the BSE, respectively. Using these parameters and the subject’s anthropometry, median and 90th percentile horizontal (HOR50, HOR90) and vertical (VERT50, VERT90) tibiofemoral forces were calculated via a self-developed inverse quasi-static biomechanical model. BSE use had a variable effect on HOR50 dependent on the working task and body posture. Generally, VERT50 increased without significant interaction effects with posture or task. HOR90 and VERT90 were not affected by using the BSE. In conclusion, utilizing the investigated exoskeleton is likely to induce side effects in terms of changed knee joint loading. This may depend on the applied working task and the user’s body posture. The role of these changes in the context of a negative contribution to work-related cumulative knee exposures should be addressed by future research.

Active and Passive Back-Support Exoskeletons: A Comparison in Static and Dynamic Tasks

Studies on back-support exoskeletons focus mostly on the evaluation of single devices. Also, these studies suggest that passive exoskeletons might be preferred when performing static tasks, whereas active ones, could show their advantage in dynamic tasks. To verify this hypothesis and provide a comparison between different devices, in this study, we analyse the performance of the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">XoTrunk</i> and the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Laevo v2.56</i> , an active back-support exoskeleton and a passive one, respectively. We analyse these devices highlighting their ability to reduce back muscle activation, perceived discomfort and usability. The study was carried out by simulating a dynamic and a static task. The results show that both exoskeletons reduce back-muscle activation levels, although the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">XoTrunk</i> provides a reduction that was more than twice as large as the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Laevo</i> (e.g., 41% vs 16%, respectively). The results also show that, overall, in the dynamic condition, the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">XoTrunk</i> has better scores than the <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Laevo</i> . Conversely, in the static task, the participants in the study had a preference for the passive device, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Laevo</i> . The results presented in this work can help exoskeleton end-users to properly select the best device to fit their needs.

Effects of Back-Support Exoskeleton Use on Lower Limb Joint Kinematics and Kinetics During Level Walking.

We assessed the effects of using a passive back-support exoskeleton (BSE) on lower limb joint kinematics and kinetics during level walking. Twenty young, healthy participants completed level walking trials while wearing a BSE (backXTM) with three different levels of hip-extension support torque (i.e., no torque, low, and high) and in a control condition (no-BSE). When hip extension torques were required for gait-initial 0-10% and final 75-100% of the gait cycle-the BSE with high supportive torque provided ~10 Nm of external hip extension torque at each hip, resulting in beneficial changes in participants' gait patterns. Specifically, there was a ~10% reduction in muscle-generated hip extension torque and ~15-20% reduction in extensor power. During the stance-swing transition, however, BSE use produced undesirable changes in lower limb kinematics (e.g., 5-20% increase in ankle joint velocity) and kinetics (e.g., ~10% increase in hip flexor, knee extensor, and ankle plantarflexor powers). These latter changes likely stemmed from the need to increase mechanical energy for propelling the leg into the swing phase. BSE use may thus increase the metabolic cost of walking. Whether such use also leads to muscle fatigue and/or postural instability in long-distance walking needs to be confirmed in future work.