Exoskeletons can support workers on physically demanding tasks, but in industry they lack of acceptance. This contribution gives an insight into design aspects for upper body exoskeletons, especially how active exoskeletons for industrial applications differ from military and medical use-cases. To overcome typical rigid exoskeleton problems, we suggest the use of modular soft-exosuit support systems and therefore checked different types of soft actuation principles for their eligibility for the use on upper body joints. Most promising approach is using two-layered actuators sting of robust fabric with embedded rubber tubes as pressure chambers. By inflating the tubes, it is possible to vary the stiffness of the chambers, which can be effectively used to generate assisting forces and moments at human joints (shoulder, elbow, wrist, finger).

Absence from work caused by overloading the musculoskeletal system lowers the life quality of the worker and gains unnecessary costs for both the employer and the health system. Classical (rigid link) body-worn exoskeletons can help to reduce critical loading but show many disadvantages, preventing exoskeletons from extensive use in industrial environment. The presented PowerGrasp system is a very robust modular softrobotic arm exosuit sting of robust fabric with embedded rubber tubes as pressure chambers and soft-electronics and who’s design is capable to overcome the critical limiting factors of classical exoskeletons. By inflating the tubes via pressure-control valves, it is possible to vary the stiffness of the chambers, which can be effectively used to generate assisting forces and moments at human joints. By using a joint based pressure control, it is possible to decrease the physical demand of overhead working for the wearer. Although the system is designed for industrial overhead assembly, it can also be used in rehabilitation, craftsmanship and construction due to its portable and stand-alone concept. For assessing the impact of the PowerGrasp system, the raise of about 50 percent was shown. Finally, an evaluation study of the overall system has been conducted, showing very high user acceptance and usability.

This paper presents a novel concept and first modules for a soft-robotic arm support system for application in overhead assembly in automotive industry. Repetitive manual tasks and associated body movements are still typical in industrial assembly jobs. Even without an additional load or tool, such tasks are monotonous and often lead to stress in the musculoskeletal system, which frequently causes pain and injuries. In light of ageing industrial workforce, solving this problem becomes a major challenge for ergonomics researchers and engineers. In this paper we present a novel active soft orthotic device which is not an exoskeleton, even though there are some similarities. It is designed to induce only moderate external forces into the human skeleton for muscle fatigue compensation, without causing harm. The concept involves different soft-robotic actuators, depending on the human arm joints to be supported, as well as concepts for control, energy storage and sensors. By detecting muscle fatigue of the worker we created an active assist-as-needed system, which has advantages in energy consumption on the one hand and prevents muscle atrophy of the worker on the other hand. To fulfill these requirements we developed pneumatic actuators, which adjust themselves to the user without external calibration. This automatic calibration process requires no special knowledge of the employees and takes place only by using separated pneumatic chambers and adjustable straps and buckles. By using strain gauges and inertial measurement units, as well as pressure sensors and force sensors we measure and analyze all necessary information for the position related force control in real time. We also present first evaluation results with static overhead retaining tasks.

Our area of interest is robotic-based rehabilitation after stroke, and our goal is to help patients achieve optimal motor learning during high-intensity repetitive movement training through the assistance of robots. It is important, that the robotic assistance is adapted to the patients' abilities, thereby ensuring that the device is only supporting the patient as necessary ("assist-as-needed"). We hypothesize that natural and learning-effective human-machine interaction can be achieved by programming the robot's control, so that it emulates how a physiotherapist adaptively supports the patients' limb movement during stroke rehabilitation. This paper introduces the design of a novel interactive device Bi-Manu-Interact. This device is suited to be used as an experimental setup for the investigation of haptic human-human interaction and for collecting data to model therapists' haptic behavior. In this paper, we present mechanical and sensory specifications as well as tasks visualizations for future investigations. Results of a pilot clinical evaluation of the Bi-Manu-Interact with nine stroke patients are also presented in this work.

This paper presents an analysis of two distinct human lifting movements regarding acceleration and angular velocity. For the first movement, the ergonomic one, the test persons produced the lifting power by squatting down, bending at the hips and knees only. Whereas performing the unergonomic one they bent forward lifting the box mainly with their backs. The measurements were taken by using a vest equipped with five Inertial Measurement Units (IMU) with 9 Dimensions of Freedom (DOF) each. In the following the IMU data captured for these two movements will be evaluated using statistics and visualized. It will also be discussed with respect to their suitability as features for further machine learning classifications. The reason for observing these movements is that occupational diseases of the musculoskeletal system lead to a reduction of the workers’ quality of life and extra costs for companies. Therefore, a vest, called CareJack, was designed to give the worker a real-time feedback about his ergonomic state while working. The CareJack is an approach to reduce the risk of spinal and back diseases. This paper will also present the idea behind it as well as its main components.

Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.

Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke.Method: We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals.Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted.Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients.IMPLICATIONS FOR REHABILITATIONComputerised Mirror Therapy is feasible for clinical useAugmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient settingVirtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation

Abstract: Robot based therapy is one of the prevalent therapeutic approaches in motor stroke rehabilitation. It is often used in hospitals in combination with conventional therapy. In order to optimize human-robot interaction, we aim to investigate how a therapist physically supports patients during motor training of the upper extremities. This paper presents the design of a flexible textile sensor matrix, which measures the pressure exerted between therapist and patient during direct haptic interaction as well as the hand position and orientation in space. The matrix contains 144 sensors which enables measuring pressure intensity and localization of areas where the pressure is applied. The measurement matrix was evaluated with four healthy participants.

Background: Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user's movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application.Methods: A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV.Results: In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study.Conclusions: The review demonstrates that individuals' movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.

This Paper presents an intelligent ortheses-vest, developed in respect of usability aspects to increase the ergonomic working conditions, especially in physical hard working conditions like the field of industry or healthcare. In the process of development all relevant issues from usability and user requirements to constructing realization to an intelligent multisensor-, signal processing and motion tracking were considered and presented in this paper. The major focus is in the field of motion recognition a method is presented where the current movement is compared to a non-linear regression of a single motion. The purpose is to have automatic information about the ergonomic quality. The user gets feedback about his quality of movement from a configurable, easy to use, vest integrated, multimodal system in real-time.

Anhand eines Systems zur motorischen Neurorehabilitation nach Schlaganfall, das darauf abzielt, die Vorteile von Virtueller Realität für therapeutische Zwecke nutzbar zu machen, werden die Herausforderungen der nutzerzentrierten Gestaltung von Therapiesystemen mit Virtueller Realität an sich und im besonderen Maße bei der Einbeziehung von Patienten mit verschiedenen motorischen und perzeptiv-kognitiven Einschränkungen skizziert. Der Entwicklungsprozess erfolgt mehrstufig, wobei Methoden des nutzerzentrierten Designs auf Kompatibilität mit Einschränkungen von Patienten geprüft werden.

Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper proposes a novel multimodal home therapy concept and robot based system for motor telerehabilitation which is currently being further developed. The system is based on two haptic rehabilitation devices i) the Bi-Manu-Track (BMT) 2×1 DOF robotic haptic rehabilitation device with assist-as-needed control algorithms and ii) an enhanced version of the 3 DOF passive Reha-Slide system. The paper describes the technical system setup as well as user centered design aspects.

Automation of neurologic rehabilitation becomes more important as the number of age correlated dysfunctions increases. Starting from existing Assist-As-Needed control schemes we designed new algorithms specifically for bilateral tasks. We propose three approaches for controlling an arm rehabilitation device that assists hemiparetic subjects. Design goals are 1) Users should use there healthy arm to generate the desired movement pattern. 2) Force contribution and freedom of movement should be as high as possible for the affected arm. 3) Large errors of the affected arm must be compensated by the device. Simulations and first clinical evaluations support the following results. Goal 1) is achieved by making support independent of time and a set trajectory. Goals 2) and 3) can be achieved with an iterative learning controller that learns a supportive force. Adaptation speed and error sensitivity can be improved with model based approaches. Frequency dependent shifting of the force profile shifts the acceleration to the movement phase in which it is needed resulting in earlier acceleration and deceleration. An additional stiffness should only be used, if the patient's behavior varies to much.

Band: Abstracts der Vorträge des 6. Workshops der Automed 2006 Editors: T. Ellerbrock

Einleitung Der therapeutische Nutzen robotergestützter Therapie-Übungsgeräte in der Neurologischen Rehabilitation, insbesondere bei schwer betroffenen subakuten Schlaganfallpatienten, konnte inzwischen in klinischen Studien nachgewiesen werden (Hesse et al., 2008; Mehrholz et al., 2008). Bisher sind solche Geräte jedoch nur für die stationäre Reha-Therapie verfügbar. Da jeder Patient die Reha-Behandlung ambulant und zu Hause so intensiv wie möglich fortsetzen sollte, besteht ein großer Bedarf an intelligenten robotergestützten Therapiegeräten, die in neu zu entwickelnde Behandlungskonzepte einer fernbetreuten Therapie eingebunden werden. Hierfür bietet sich die Weiterentwicklung telemedizinischer Therapiekonzepte für eine haptische Telerehabilitation an, über die in diesem Beitrag berichtet wird.

In industrialized countries stroke is the major cause for physical disabilities in adults. In various clinical studies gait therapy with the help of the electromechanical gait trainer GT-I proved to enhance the rehabilitation outcome for subacute stroke patients. This paper presents control methods that were developed to enable variability during treatment in order to further improve gait therapy with this class of devices. The algorithms suitable for the gait trainer GT-I are analyzed in a simulation study. Therefore models which simulate the practicing subjects' behaviour were developed. A purely mechanical mass-damper system models the passive subjects behaviour while motor learning models were adopted to simulate patient adaptation different types of footplate guidance characteristics. Several adaptive approaches have been developed for other rehabilitation devices in the past. In this work two controllers were developed and evaluated. The first features a one dimensional control window along the footplate trajectory within which the patient is only slightly guided. Outside the window a force field draws the subject back to the window. The second algorithm extends the window controller with a human motor learning strategy for to adapt the window size and thereby the assistance provided to the subjects. They were tested in a simulation study with different human behaviour models, the results are presented in this paper.

Summary Numerous clinical studies have proved the efficacy of therapy robots in Neurological Motor Rehabilitation and their potential benefits for clinical outcome results. A major challenge of current technological and clinical research is the transfer of this new technology from the rehab hospital to the patient's home, thus enabling him to continue high level rehab training for further improvement of motor control of the affected limbs. This article focuses on motivational aspects and tele-rehabilitation concepts, which play an important role in the development of robotic training systems for home rehabilitation.