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      Assessing the Involvement of Users During Development of Lower Limb Wearable Robotic Exoskeletons: A Survey Study

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          Abstract

          Objective

          To explore user-centered design methods currently implemented during development of lower limb wearable robots and how they are utilized during different stages of product development.

          Background

          Currently, there appears to be a lack of standardized frameworks for evaluation methods and design requirements to implement effective user-centered design for safe and effective clinical or ergonomic system application.

          Method

          Responses from a total of 191 experts working in the field of lower limb exoskeletons were analyzed in this exploratory survey. Descriptive statistics were used to present responses and measures of frequency, and chi-square tests were used to contrast the answers of respondents who identified as clinicians versus engineers.

          Results

          A vast majority of respondents involve users in their development, in particular at the initial and iterative stages, although some differences were found between disciplines. A variety of methods and metrics are used to capture feedback from users and test devices, and although valuable, some methods used may not be based on validated measures. Guidelines regarding tests on safety of exoskeletons also lack standardization.

          Conclusion

          There seems to be a consensus among experts regarding the importance of a user-centered approach in exoskeleton development; however, standardized frameworks with regard to appropriate testing methods and design approaches are lacking. Such frameworks should consider an interdisciplinary focus on the needs and safety of the intended user during each iteration of the process.

          Application

          This exploratory study provides an overview of current practice among engineers and clinicians regarding the user-centered design of exoskeletons. Limitations and recommendations for future directions are identified.

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          Most cited references26

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          Exoskeletons for industrial application and their potential effects on physical work load.

          The aim of this review was to provide an overview of assistive exoskeletons that have specifically been developed for industrial purposes and to assess the potential effect of these exoskeletons on reduction of physical loading on the body. The search resulted in 40 papers describing 26 different industrial exoskeletons, of which 19 were active (actuated) and 7 were passive (non-actuated). For 13 exoskeletons, the effect on physical loading has been evaluated, mainly in terms of muscle activity. All passive exoskeletons retrieved were aimed to support the low back. Ten-forty per cent reductions in back muscle activity during dynamic lifting and static holding have been reported. Both lower body, trunk and upper body regions could benefit from active exoskeletons. Muscle activity reductions up to 80% have been reported as an effect of active exoskeletons. Exoskeletons have the potential to considerably reduce the underlying factors associated with work-related musculoskeletal injury. Practitioner Summary: Worldwide, a significant interest in industrial exoskeletons does exist, but a lack of specific safety standards and several technical issues hinder mainstay practical use of exoskeletons in industry. Specific issues include discomfort (for passive and active exoskeletons), weight of device, alignment with human anatomy and kinematics, and detection of human intention to enable smooth movement (for active exoskeletons).
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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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              The effects of a passive exoskeleton on muscle activity, discomfort and endurance time in forward bending work.

              Exoskeletons may form a new strategy to reduce the risk of developing low back pain in stressful jobs. In the present study we examined the potential of a so-called passive exoskeleton on muscle activity, discomfort and endurance time in prolonged forward-bended working postures. Eighteen subjects performed two tasks: a simulated assembly task with the trunk in a forward-bended position and static holding of the same trunk position without further activity. We measured the electromyography for muscles in the back, abdomen and legs. We also measured the perceived local discomfort. In the static holding task we determined the endurance, defined as the time that people could continue without passing a specified discomfort threshold. In the assembly task we found lower muscle activity (by 35-38%) and lower discomfort in the low back when wearing the exoskeleton. Additionally, the hip extensor activity was reduced. The exoskeleton led to more discomfort in the chest region. In the task of static holding, we observed that exoskeleton use led to an increase in endurance time from 3.2 to 9.7 min, on average. The results illustrate the good potential of this passive exoskeleton to reduce the internal muscle forces and (reactive) spinal forces in the lumbar region. However, the adoption of an over-extended knee position might be, among others, one of the concerns when using the exoskeleton.
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                Author and article information

                Journal
                Hum Factors
                Hum Factors
                HFS
                sphfs
                Human Factors
                SAGE Publications (Sage CA: Los Angeles, CA )
                0018-7208
                1547-8181
                13 January 2020
                May 2020
                : 62
                : 3 , Special Issue: User Centered Design for Exoskeleton & Exosuit Usage
                : 351-364
                Affiliations
                [1 ]Ringgold 275018; University of Iceland, Reykjavík, Iceland
                [2 ]Ringgold 14311; Technische Universität Dortmund, Germany and Technische Universität Darmstadt, Germany
                [3 ]Ringgold 16379; Spanish National Research Council (CSIC), Cajal Institute, Madrid, Spain
                [4 ]Ringgold 120691; University of Twente, Enschede, The Netherlands
                [5 ]Ringgold 247680; International University of La Rioja, Logroño, Spain
                [6 ]Ringgold 58390; Castilla-La Mancha University, Ciudad Real, Spain
                [7 ]Ringgold 275203; Hocoma AG, Volketswil, Switzerland
                [8 ]Ringgold 275018; University of Iceland, Reykjavík, Iceland
                Author notes
                [*]Kristín Briem, School of Health Sciences, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland.; e-mail: kbriem@ 123456hi.is .
                Author information
                https://orcid.org/0000-0001-5703-6029
                https://orcid.org/0000-0001-9561-7764
                https://orcid.org/0000-0002-0606-991X
                Article
                10.1177_0018720819883500
                10.1177/0018720819883500
                7221858
                31928418
                985cb376-5ed7-46a0-a368-7a3dfc445f22
                © 2019, The Author(s)

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 March 2019
                : 26 September 2019
                Funding
                Funded by: European Cooperation in Science and Technology, FundRef https://doi.org/10.13039/501100000921;
                Award ID: CA16116
                Categories
                Special Section: User Centered Design for Exoskeleton & Exosuit Usage
                Custom metadata
                ts4

                wearable robots,user-centered design strategies,outcome measures,usability testing and evaluation

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