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      Gait training using a robotic hip exoskeleton improves metabolic gait efficiency in the elderly

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          Abstract

          Robotic exoskeletons are regarded as promising technologies for neurological gait rehabilitation but have been investigated comparatively little as training aides to facilitate active aging in the elderly. This study investigated the feasibility of an exoskeletal Active Pelvis Orthosis (APO) for cardiopulmonary gait training in the elderly. Ten healthy elderly volunteers exhibited a decreased (−26.6 ± 16.1%) Metabolic Cost of Transport (MCoT) during treadmill walking following a 4-week APO-assisted training program, while no significant changes were observed for a randomly assigned control group (n = 10) performing traditional self-paced overground walking. Moreover, robot-assisted locomotion was found to require 4.24 ± 2.57% less oxygen consumption than free treadmill walking at the same speed. These findings support the adoption of exoskeletal devices for the training of frail individuals, thus opening new possibilities for sustainable strategies for healthy aging.

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          Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review.

          How has adherence been measured in recent prospective studies focusing on adherence to exercise programs among older people? What is the range of adherence rates? Which factors are associated with better adherence?
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            Lower Extremity Exoskeletons and Active Orthoses: Challenges and State-of-the-Art

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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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                Author and article information

                Contributors
                elena.martini@santannapisa.it
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                9 May 2019
                9 May 2019
                2019
                : 9
                : 7157
                Affiliations
                [1 ]ISNI 0000 0004 1762 600X, GRID grid.263145.7, The BioRobotics Institute, , Scuola Superiore Sant’Anna, ; Pisa, Italy
                [2 ]ISNI 0000 0001 1090 9021, GRID grid.418563.d, Fondazione Don Carlo Gnocchi, ; Milan, Italy
                [3 ]ISNI 0000 0001 1940 4177, GRID grid.5326.2, Institute of Clinical Physiology, , National Research Council, ; Pisa, Italy
                Article
                43628
                10.1038/s41598-019-43628-2
                6509339
                31073188
                8974a6b9-637e-4443-8be4-f2dee8f6b7ee
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 January 2019
                : 23 April 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/100007368, Fondazione Pisa (Pisa Foundation);
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award ID: prog 154/11
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award ID: prog. 154/11
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/501100000780, European Commission (EC);
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award ID: 287894
                Award ID: 731931
                Award Recipient :
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Uncategorized
                geriatrics,biomedical engineering
                Uncategorized
                geriatrics, biomedical engineering

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