ZOSS A B , KAZEROONI H , CHU A . Biomechanical design of the Berkeley lower extremity exoskeleton (BLEEX) [J ] . IEEE/ASME Transactions on Mechatronics , 2006 , 11 ( 2 ): 128 - 138 .

KAWAMOTO H , SANKAI Y . Power assist method based on phase sequence and muscle force condition for HAL [J ] . Advanced Robotics , 2005 , 19 ( 7 ): 717 - 734 .

TALATY M , ESQUENAZI A , BRICENO J E . Differentiating ability in users of the ReWalk TM powered exoskeleton: an analysis of walking kinematics [C ] //Proceedings of IEEE 13th International Conference on Rehabilitation Robotics (ICORR). Seattle, WA , US : IEEE , 2013 : 1 - 5 .

WEHNER M , QUINLIVAN B , AUBIN P M , et al. A lightweight soft exosuit for gait assistance [C ] //Proceedings of IEEE International Conference on Robotics and Automation (ICRA). Karlsruhe , Germany : IEEE , 2013 : 3362 - 3369 .

GARCIA E , SATER J M , MAIN J . Exoskeletons for human performance augmentation (EHPA): a program summary [J ] . Journal of the Robotics Society of Japan , 2002 , 20 ( 8 ): 822 - 826 .

JANSEN J . Exoskeleton for soldier enhancement systems feasibility study: ORNL/TM-2000/256 [R ] . Oak Ridge, TN , US : Oak Ridge National Laboratory , 2000 .

LAMOTHE D . New competition launched in development of US military's ‘Iron Man'suit [N ] . The Washington Post , 2014-10-27.

王晓明 , 李宁 , 王新兴 , 等 . 美国人效能增强技术发展应用 [J ] . 科技导报 , 2021 , 39 ( 7 ): 96 - 101 . DOI: 10.3981/j.issn.1000-7857.2021.07.011 http://doi.org/10.3981/j.issn.1000-7857.2021.07.011 美国一直在进行士兵“超级”能力方面的研究，采用多项举措推动人效能增强技术发展。从顶层战略设计、科研机构任务、经费持续投入3个方面对美国人效能增强技术发展特点进行了综合分析，概述了美国人效能增强技术在体能、技能、智能等领域研究成果与进展，并分析了美国人效能增强技术的发展趋势和可能导致的社会伦理学问题。

WANG X M , LI N , WANG X X , et al. Overall layout and development trend of the application of human efficiency enhancement technology in the US [J ] . Science & Technology Review , 2021 , 39 ( 7 ): 96 - 101 . (in Chinese)

颉翔宇 , 周利坤 , 司玉昌 . 军用动力外骨骼的发展现状及关键技术综述 [J ] . 兵工自动化 , 2022 , 41 ( 10 ): 14 - 20 .

XIE X Y , ZHOU L K , SI Y C . Overview on development status and key technologies of military powered exoskeleton [J ] . Ordnance Industry Automation , 2022 , 41 ( 10 ): 14 - 20 . (in Chinese)

张子琛 , 刘鸣 , 王博崇 , 等 . 智能消防外骨骼的经验基础性整理与分析 [J ] . 今日消防 , 2021 , 6 ( 6 ): 13 - 14 .

ZHANG Z C , LIU M , WANG B C , et al. Experience and analysis of intelligent fire exoskeleton [J ] . Fire Protection Today , 2021 , 6 ( 6 ): 13 - 14 . (in Chinese)

GREGORCZYK K N , HASSELQUIST L , SCHIFFMAN J M , et al. Effects of a lower-body exoskeleton device on metabolic cost and gait biomechanics during load carriage [J ] . Ergonomics , 2010 , 53 ( 10 ): 1263 - 1275 . DOI: 10.1080/00140139.2010.512982 http://doi.org/10.1080/00140139.2010.512982 This study investigated the effects on metabolic cost and gait biomechanics of using a prototype lower-body exoskeleton (EXO) to carry loads. Nine US Army participants walked at 1.34 m/s on a 0% grade for 8 min carrying military loads of 20 kg, 40 kg and 55 kg with and without the EXO. Mean oxygen consumption (VO(2)) scaled to body mass and scaled to total mass were significantly higher, by 60% and 41% respectively, when the EXO was worn, compared with the control condition. Mean VO(2) and mean VO(2) scaled to body mass significantly increased with load. The kinematic and kinetic data revealed significant differences between EXO and control conditions, such as walking with a more flexed posture and braking with higher ground reaction force at heel strike when wearing the EXO. Study findings demonstrate that the EXO increased users' metabolic cost while carrying various loads and altered their gait biomechanics compared with conventional load carriage. STATEMENT OF RELEVANCE: An EXO designed to assist in load bearing was found to raise energy expenditure substantially when tested by soldiers carrying military loads. EXO weight, weight distribution and design elements that altered users' walking biomechanics contributed to the high energy cost. To realise the potential of EXOs, focus on the user must accompany engineering advances.

丁逸苇 , 涂利娟 , 刘怡希 , 等 . 可穿戴式下肢外骨骼康复机器人研究进展 [J ] . 机器人 , 2022 , 44 ( 5 ): 522 - 532 . DOI: 10.13973/j.cnki.robot.220256 http://doi.org/10.13973/j.cnki.robot.220256 对于脊髓损伤、脑损伤等因素导致下肢运动障碍的患者，利用下肢外骨骼康复机器人可在患者损伤早期进行精准康复，并在康复过程中优化康复策略。本文详细对比了下肢外骨骼康复机器人相比于传统康复方法的优势，并结合国内外研究现状阐述了不同外骨骼机器人的设备特点及应用场景，详细分析了机器人的驱动方式、控制系统以及训练模式等关键技术。最后，着重探讨了下肢外骨骼康复机器人未来发展所面对的挑战，并针对机械结构优化、驱动算法优化、康复流程智能化、基于虚拟现实技术的应用场景优化及康复效果评估等5方面提出了可行的探讨，对下肢外骨骼康复机器人未来的技术发展趋势作出可行分析。

DING Y W , TU L J , LIU Y X , et al. Progress of wearable lower-limb exoskeleton rehabilitation robots [J ] . Robot , 2022 , 44 ( 5 ): 522 - 532 . (in Chinese) DOI: 10.13973/j.cnki.robot.220256 http://doi.org/10.13973/j.cnki.robot.220256 For patients with lower-limb movement disorders caused by spinal cord injury, brain injury, and other factors, the lower-limb exoskeleton rehabilitation robot can be applied to performing precise rehabilitation in the early stage of the patient injury, and optimizing the rehabilitation strategy during the rehabilitation process. This paper compares the advantages of lower-limb exoskeleton rehabilitation robots over the traditional rehabilitation methods, and expounds the equipment characteristics and application scenarios of different exoskeleton robots based on the research status at home and abroad. The key technologies for exoskeleton rehabilitation robots are analyzed in detail, including driving methods, control systems, and training modes. Finally, the challenges to lower-limb exoskeleton rehabilitation robots in future development are emphatically discussed, and feasible discussions are put forward from five aspects, such as mechanical structure optimization, driving algorithm optimization, intelligent rehabilitation process, application scenario optimization based on virtual reality technology, and evaluation of rehabilitation effect. The future technology trends of the lower-limb exoskeleton rehabilitation robot are analyzed feasibly.

汪宗保 , 周玲玲 , 王从振 . 下肢外骨骼康复机器人在脑卒中病人中的临床应用研究 [J ] . 赤峰学院学报(自然科学版) , 2021 , 37 ( 7 ): 50 - 53 .

WANG Z B , ZHOU L L , WANG C Z . Clinical application of lower extremity exoskeleton rehabilitation robot in stroke patients [J ] . Journal of Chifeng University(Natural Science Edition) , 2021 , 37 ( 7 ): 50 - 53 . (in Chinese)

陈俞鹏 , 王海波 , 薛朝军 , 等 . 工业装配抗振外骨骼动力学仿真及试验 [J ] . 中国机械工程 , 2023 , 34 ( 4 ): 404 - 413 .

CHEN Y P , WANG H B , XUE Z J , et al. Dynamics simulation and experimental study of industrial assembly anti-vibration exoskeletons [J ] . China Mechanical Engineering , 2023 , 34 ( 4 ): 404 - 413 . (in Chinese)

陈勇刚 , 王军 , 王道昌 . 敏捷型无动力人体外骨骼在飞机装配中的探索与应用 [J ] . 科技创新与应用 , 2021 , 11 ( 20 ): 23 - 25 .

CHEN Y G , WANG J , WANG D C . Exploration and application of agile non-powered human exoskeleton in aircraft assembly [J ] . Technology Innovation and Application , 2021 , 11 ( 20 ): 23 - 25 . (in Chinese)

田大肥 , 王哲 . 工业装配外骨骼的发展现状 [J ] . 现代制造技术与装备 , 2020 , 278 ( 1 ): 155 - 156 .

TIAN D F , WANG Z . Development of exoskeleton in industrial assembly [J ] . Modern Manufacturing Technology and Equipment , 2020 , 278 ( 1 ): 155 - 156 . (in Chinese)

Robots and robotic devices—Safety requirements for personal care robots : ISO13482:2014[S ] . Geneva , Switzerland : International Organization for Standardization , 2014 .

Medical electrical equipment— Part 2- 78 : particular requirements fo r basic safety and essential performance of medical robots for rehabilitation, assessment, compensation or alleviation: IEC80601-2-78:2019[S ] . Geneva , Switzerland : International Organization for Standardization , 2019 .

FARRIS D J , HICKS J L , DELP S L , et al. Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping [J ] . Journal of Experimental Biology , 2014 , 217 ( 22 ): 4018 - 4028 .

KOUMPOUROS Y . A systematic review on existing measures for the subjective assessment of rehabilitation and assistive robot devices [J ] . Journal of Healthcare Engineering , 2016 , 2016 ( 4 ): 1048964.

DE LOOZE M P , BOSCH T , KRAUSE F , et al. Exoskeletons for industrial application and their potential effects on physical work load [J ] . Ergonomics , 2016 , 59 ( 5 ): 671 - 681 . DOI: 10.1080/00140139.2015.1081988 http://doi.org/10.1080/00140139.2015.1081988 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).

刘则渊 , 陈悦 , 侯海燕 . 科学知识图谱:方法与应用 [M ] . 北京 : 人民出版社 , 2008 .

LIU Z Y , CHEN Y , HOU H Y . Maps knowledge domains methods and application [M ] . Beijing : People's Publishing House , 2008 . (in Chinese)

BOT S , HOLLANDER A . The relationship between heart rate and oxygen uptake during non-steady state exercise [J ] . Ergonomics , 2000 , 43 ( 10 ): 1578 - 1592 . In this study the validity of using heart rate (HR) responses to estimate oxygen uptake (VO2) during varying non-steady state activities was investigated. Dynamic and static exercise engaging large and small muscle masses were studied in four different experiments. In the first experiment, 16 subjects performed an interval test on a cycle ergometer, and 12 subjects performed a field test consisting of various dynamic leg exercises. Simultaneous HR and VO2 measurements were made. Linear regression analyses revealed high correlations between HR and VO2 during both the interval test (r = 0.90 +/- 0.07) and the field test (r = 0.94 +/- 0.04). In the second experiment, 14 non-wheelchair-bound subjects performed both an interval wheelchair test on a motor driven treadmill, and a wheelchair field test consisting of dynamic and static arm exercise. Significant relationships were found for all subjects during both the interval test (r = 0.91 +/- 0.06) and the field test (r = 0.86 +/- 0.09). During non-steady state exercise using both arms and legs in a third experiment, contradictory results were found. For 11 of the 15 subjects who performed a field test consisting of various nursing tasks no significant relationship between HR and VO2 was found (r = 0.42 +/- 0.16). All tasks required almost the same physiological strain, which induced a small range in data points. In a fourth experiment, the influence of a small data range on the HR-VO2 relationship was investigated: five subjects performed a field test that involved both low and high physiological strain, non-steady state arm and leg exercise. Significant relationships were found for all subjects (r = 0.86 +/- 0.04). Although the r-values found in this study were less than under steady state conditions, it can be concluded that VO2 may be estimated from individual HR-VO2 regression lines during non-steady state exercise.

SCHANTZ P , ERIKSSON J S , ROSDAHL H . The heart rate method for estimating oxygen uptake: analyses of reproducibility using a range of heart rates from commuter walking [J ] . European Journal of Applied Physiology , 2019 , 119 ( 11/12 ): 2655 - 2671 .

MOONEY L M , HERR H M . Biomechanical walking mechanisms underlying the metabolic reduction caused by an autonomous exoskeleton [J ] . Journal of NeuroEngineering and Rehabilitation , 2016 , 13 : 4 . DOI: 10.1186/s12984-016-0111-3 http://doi.org/10.1186/s12984-016-0111-3 Background: Ankle exoskeletons can now reduce the metabolic cost of walking in humans without leg disability, but the biomechanical mechanisms that underlie this augmentation are not fully understood. In this study, we analyze the energetics and lower limb mechanics of human study participants walking with and without an active autonomous ankle exoskeleton previously shown to reduce the metabolic cost of walking. Methods: We measured the metabolic, kinetic and kinematic effects of wearing a battery powered bilateral ankle exoskeleton. Six participants walked on a level treadmill at 1.4 m/s under three conditions: exoskeleton not worn, exoskeleton worn in a powered-on state, and exoskeleton worn in a powered-off state. Metabolic rates were measured with a portable pulmonary gas exchange unit, body marker positions with a motion capture system, and ground reaction forces with a force-plate instrumented treadmill. Inverse dynamics were then used to estimate ankle, knee and hip torques and mechanical powers. Results: The active ankle exoskeleton provided a mean positive power of 0.105 +/- 0.008 W/kg per leg during the push-off region of stance phase. The net metabolic cost of walking with the active exoskeleton (3.28 +/- 0.10 W/kg) was an 11 +/- 4 % (p = 0.019) reduction compared to the cost of walking without the exoskeleton (3.71 +/- 0.14 W/kg). Wearing the ankle exoskeleton significantly reduced the mean positive power of the ankle joint by 0.033 +/- 0.006 W/kg (p = 0.007), the knee joint by 0.042 +/- 0.015 W/kg (p = 0.020), and the hip joint by 0.034 +/- 0.009 W/kg (p = 0.006). Conclusions: This study shows that the ankle exoskeleton does not exclusively reduce positive mechanical power at the ankle joint, but also mitigates positive power at the knee and hip. Furthermore, the active ankle exoskeleton did not simply replace biological ankle function in walking, but rather augmented the total (biological + exoskeletal) ankle moment and power. This study underscores the need for comprehensive models of human-exoskeleton interaction and global optimization methods for the discovery of new control strategies that optimize the physiological impact of leg exoskeletons.

GALLE S , MALCOLM P , COLLINS S H , et al. Reducing the metabolic cost of walking with an ankle exoskeleton: interaction between actuation timing and power [J ] . Journal of NeuroEngineering and Rehabilitation , 2017 , 14 : 35 . DOI: 10.1186/s12984-017-0235-0 http://doi.org/10.1186/s12984-017-0235-0 Background: Powered ankle-foot exoskeletons can reduce the metabolic cost of human walking to below normal levels, but optimal assistance properties remain unclear. The purpose of this study was to test the effects of different assistance timing and power characteristics in an experiment with a tethered ankle-foot exoskeleton.Methods: Ten healthy female subjects walked on a treadmill with bilateral ankle-foot exoskeletons in 10 different assistance conditions. Artificial pneumatic muscles assisted plantarflexionduring ankle push-off using one of four actuation onset timings (36, 42, 48 and 54% of the stride) and three power levels (average positive exoskeleton power over a stride, summed for both legs, of 0.2, 0.4 and 0.5 W.kg(-1)). We compared metabolic rate, kinematics and electromyography (EMG) between conditions.Results: Optimal assistance was achieved with an onset of 42% stride and average power of 0.4 W.kg(-1), leading to 21% reduction in metabolic cost compared to walking with the exoskeleton deactivated and 12% reduction compared to normal walking without the exoskeleton. With suboptimal timing or power, the exoskeleton still reduced metabolic cost, but substantially less so. The relationship between timing, power and metabolic rate was well-characterized by a two-dimensional quadratic function. The assistive mechanisms leading to these improvements included reducing muscular activity in the ankle plantarflexors and assisting leg swing initiation.Conclusions: These results emphasize the importance of optimizing exoskeleton actuation properties when assisting or augmenting human locomotion. Our optimal assistance onset timing and average power levels could be used for other exoskeletons to improve assistance and resulting benefits.

COLLINS S H , WIGGIN M B , SAWICKI G S . Reducing the energy cost of human walking using an unpowered exoskeleton [J ] . Nature , 2015 , 522 ( 7555 ): 212 - 215 .

WALSH C J . Biomimetic design of an under-actuated leg exoskeleton for load-carrying augmentation:0704-0188 [R ] . Cambridge, MA , US : Massachusetts Institute of Technology , MIT Media Laboratory, 2006 .

赵明升 , 宋遒志 , 刘亚丽 , 等 . 外骨骼机器人助力效率测试技术研究 [J ] . 机械设计与制造 , 2022 , 43 ( 5 ): 257 - 260 .

ZHAO M S , SONG Q Z , LIU Y L , et al. Research on assisted efficiency testing technology of exoskeleton robot [J ] . Machinery Design & Manufacture , 2022 , 43 ( 5 ): 257 - 260 . (in Chinese)

MO F H , ZHANG Q , ZHANG H T , et al. A simulation-based framework with a proprioceptive musculoskeletal model for evaluating the rehabilitation exoskeleton system [J ] . Computer Methods and Programs in Biomedicine , 2021 , 208 ( 9 ): 106270.

DING Y , KIM M , KUINDERSMA S , et al. Human-in-the-loop optimization of hip assistance with a soft exosuit during walking [J ] . Science Robotics , 2018 , 3 ( 15 ): eaar5438.

PANIZZOLO F A , GALIANA I , ASBECK A T , et al. A biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking [J ] . Journal of NeuroEngineering and Rehabilitation , 2016 , 13 : 43 . DOI: 10.1186/s12984-016-0150-9 http://doi.org/10.1186/s12984-016-0150-9 Background: Carrying load alters normal walking, imposes additional stress to the musculoskeletal system, and results in an increase in energy consumption and a consequent earlier onset of fatigue. This phenomenon is largely due to increased work requirements in lower extremity joints, in turn requiring higher muscle activation. The aim of this work was to assess the biomechanical and physiological effects of a multi-joint soft exosuit that applies assistive torques to the biological hip and ankle joints during loaded walking. Methods: The exosuit was evaluated under three conditions: powered (EXO_ON), unpowered (EXO_OFF) and unpowered removing the equivalent mass of the device (EXO_OFF_EMR). Seven participants walked on an instrumented split-belt treadmill and carried a load equivalent to 30 % their body mass. We assessed their metabolic cost of walking, kinetics, kinematics, and lower limb muscle activation using a portable gas analysis system, motion capture system, and surface electromyography. Results: Our results showed that the exosuit could deliver controlled forces to a wearer. Net metabolic power in the EXO_ON condition (7.5 +/- 0.6 W kg(-1)) was 7.3 +/- 5.0 % and 14.2 +/- 6.1 % lower than in the EXO_OFF_EMR condition (7.9 +/- 0.8 W kg(-1); p = 0.027) and in the EXO_OFF condition (8.5 +/- 0.9 W kg(-1); p = 0.005), respectively. The exosuit also reduced the total joint positive biological work (sum of hip, knee and ankle) when comparing the EXO_ON condition (1.06 +/- 0.16 J kg(-1)) with respect to the EXO_OFF condition (1.28 +/- 0.26 J kg(-1); p = 0.020) and to the EXO_OFF_EMR condition (1.22 +/- 0.21 J kg(-1); p = 0.007). Conclusions: The results of the present work demonstrate for the first time that a soft wearable robot can improve walking economy. These findings pave the way for future assistive devices that may enhance or restore gait in other applications.

高增桂 . 柔性穿戴式搬运辅助装备人机工程设计与评价研究 [D ] . 杭州 : 浙江大学 , 2016 .

GAO Z G . On the design and assessment of a wearable load-carrying device [D ] . Hangzhou : Zhejiang University , 2016 . (in Chinese)

SLADE P , KOCHENDERFER M J , DELP S L , et al. Personalizing exoskeleton assistance while walking in the real world [J ] . Nature , 2022 , 610 ( 7931 ): 277 - 304 .

刘亚丽 , 宋遒志 , 赵明升 , 等 . 基于力位混合控制的踝关节外骨骼机器人四段式助力技术 [J ] . 兵工学报 , 2021 , 42 ( 12 ): 2722 - 2730 . DOI: 10.3969/j.issn.1000-1093.2021.12.020 http://doi.org/10.3969/j.issn.1000-1093.2021.12.020 外骨骼机器人的助力策略是影响外骨骼机器人助力效率的关键因素。相对于平地行走模式下的外骨骼机器人，坡地行走模式的助力机器人助力机理尚不明确。针对上述问题，以人体运动特征为切入点，研究坡地行走模式下的关节做功规律，阐述人体关节运动机理，并提出力位混合控制的四段式踝关节外骨骼助力策略。进一步研制柔性踝关节助力外骨骼机器人，并通过关节力矩与代谢试验验证该助力外骨骼机器人的助力效率。研究结果表明，坡地行走过程中，外骨骼机器人能够提供人体运动所需7%的关节运动力矩，并能够降低约3.5%的行走代谢能耗。

LIU Y L , SONG Q Z , ZHAO M S , et al. The four-stage assisted technology of flexible ankle exoskeleton robot based on force and position hybrid control [J ] . Acta Armamentarii , 2021 , 42 ( 12 ): 2722 - 2730 . (in Chinese) DOI: 10.3969/j.issn.1000-1093.2021.12.020 http://doi.org/10.3969/j.issn.1000-1093.2021.12.020 The assistant strategy for lower extremity joints is a key factor influencing the assistant efficiency of exoskeleton robots. The exoskeleton robots during walking on level ground have been widely explored and proved to be effective. However，the performance of exoskeleton robots during walking on a slope has not been widely analyzed，and even the assistant characteristics of exoskeleton robots during walking on a slope has not been explored.An exoskeleton robot was developed to study the physiological characteristics and joint power characteristics of human during walking on a slope.A four-stage force-position hybrid control method for ankle assisted exoskeleton robot was proposed based on the rationale of human movement. A flexible ankle exoskeleton was deverloped based on the analysis，and the assisting efficiency testing experiment of the assistance torque and energy consumption was made. The results demonstrate that the exoskeleton robot can provide the assisted ankle joint torque of 7% and decrease the oxygen uptake by 3.5% during walking on a slope.

杨国庆 . 负重外骨骼性能评估与疲劳寿命试验 [D ] . 重庆 : 重庆理工大学 , 2022 .

YANG G Q . Performance evaluation and fatigue life test of weight-bearing exoskeleton [D ] . Chongqing : Chongqing University of Technology , 2022 . (in Chinese)

LEFEBER N , DE KEERSMAECKER E , TROCH M , et al. Robot-assisted overground walking: physiological responses and perceived exertion in nonambulatory stroke survivors [J ] . IEEE Robotics & Automation Magazine , 2020 , 27 ( 1 ): 22 - 31 .

BADESA F J , DIEZ J A , CATALAN J M , et al. Physiological responses during hybrid BNCI control of an upper-limb exoskeleton [J ] . Sensors , 2019 , 19 ( 22 ): 4931.

ESCALONA M J , BROSSEAU R , VERMETTE M , et al. Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: a cross-sectional study [J ] . Annals of Physical and Rehabilitation Medicine , 2018 , 61 ( 4 ): 215 - 223 . DOI: S1877-0657(18)30005-8 http://doi.org/S1877-0657(18)30005-8 Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground robotic exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology.To determine cardiorespiratory demands during sitting, standing and overground walking with a robotic exoskeleton and to verify whether such overground walking results in at least moderate-intensity physical exercise.We enrolled 13 long-term wheelchair users with complete motor spinal cord injury in a walking program with an overground robotic exoskeleton. Cardiorespiratory measures and rate of perceived exertion (RPE) were recorded by using a portable gas analyzer system during sitting, standing and four 10m walking tasks with the robotic exoskeleton. Each participant also performed an arm crank ergometer test to determine maximal cardiorespiratory ability (i.e., peak heart rate and O uptake [HR, VO]).Cardiorespiratory measures increased by a range of 9%-35% from sitting to standing and further increased by 22%-52% from standing to walking with the robotic exoskeleton. During walking, median oxygen cost (O), relative HR (%HR), relative O consumption (%VO) and respiratory exchange ratio (RER) reached 0.29mL/kg/m, 82.9%, 41.8% and 0.9, respectively, whereas median RPE reached 3.2/10. O was moderately influenced by total number of sessions and steps taken with the robotic exoskeleton since the start of the walking program.Overground walking with the robotic exoskeleton over a short distance allowed wheelchair users to achieve a moderate-intensity level of exercise. Hence, an overground locomotor training program with a robotic exoskeleton may have cardiorespiratory health benefits in the population studied.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

BROCKWAY J M . Derivation of formulae used to calculate energy expenditure in man [J ] . Human Nutrition-Clinical Nutrition , 1987 , 41 ( 6 ): 463 - 471 .

余红刚 . 下肢柔性外骨骼的研究与设计 [D ] . 成都 : 电子科技大学 , 2020 .

YÜ H G . Research and design of flexible exoskeleton of lower extremity [D ] . Chengdu : University of Electronic Science and Technology , 2020 . (in Chinese)

FUGLEI E , ORITSLAND N . Body composition, resting and running metabolic rates, and net cost of running in rats during starvation [J ] . Acta physiologica scandinavica , 1999 , 165 ( 2 ): 203 - 210 . Resting metabolic rate decreases during starvation. However, effects of starvation on the cost of running are not clear. The aim of this study was to examine the effects of 5 days starvation on body composition, resting metabolic rates, running metabolic rates, and net cost of running in male rats. Five days starvation resulted in reductions of 70% fat, 8% protein and 12% carbohydrates. Mass(-0.75) specific resting metabolic rate was significantly reduced from 3.69 +/- 0.27 to 2.73 +/- 0.17 W kg(-0.75) after 5 days starvation. The reduction in metabolic rate after 5 days starvation was maintained during running, in that running metabolic rate was reduced from 10.65 +/- 0.41 to 8.97 +/- 0.47 W kg(-0.75). The net costs of running were calculated and expressed as the costs of moving 1 kg a distance of 1 m. After 5 days of starvation it was reduced from 31.16 +/- 2.03-29.79 +/- 1.69 J m(-1) kg(-1). The reduction however was not significant. The present results therefore suggest that 5 days starvation resulted in a metabolic depression of the resting metabolic rate that was maintained during running. However, the net cost of running remained unchanged, suggesting that the muscle tissues are not significantly involved in the metabolic changes during starvation.

MCDANIEL J , DURSTINE J L , HAND G A , et al. Determinants of metabolic cost during submaximal cycling [J ] . Journal of Applied Physiology , 2002 , 93 ( 3 ): 823 - 828 . The metabolic cost of producing submaximal cycling power has been reported to vary with pedaling rate. Pedaling rate, however, governs two physiological phenomena known to influence metabolic cost and efficiency: muscle shortening velocity and the frequency of muscle activation and relaxation. The purpose of this investigation was to determine the relative influence of those two phenomena on metabolic cost during submaximal cycling. Nine trained male cyclists performed submaximal cycling at power outputs intended to elicit 30, 60, and 90% of their individual lactate threshold at four pedaling rates (40, 60, 80, 100 rpm) with three different crank lengths (145, 170, and 195 mm). The combination of four pedaling rates and three crank lengths produced 12 pedal speeds ranging from 0.61 to 2.04 m/s. Metabolic cost was determined by indirect calorimetery, and power output and pedaling rate were recorded. A stepwise multiple linear regression procedure selected mechanical power output, pedal speed, and pedal speed squared as the main determinants of metabolic cost (R(2) = 0.99 +/- 0.01). Neither pedaling rate nor crank length significantly contributed to the regression model. The cost of unloaded cycling and delta efficiency were 150 metabolic watts and 24.7%, respectively, when data from all crank lengths and pedal speeds were included in a regression. Those values increased with increasing pedal speed and ranged from a low of 73 +/- 7 metabolic watts and 22.1 +/- 0.3% (145-mm cranks, 40 rpm) to a high of 297 +/- 23 metabolic watts and 26.6 +/- 0.7% (195-mm cranks, 100 rpm). These results suggest that mechanical power output and pedal speed, a marker for muscle shortening velocity, are the main determinants of metabolic cost during submaximal cycling, whereas pedaling rate (i.e., activation-relaxation rate) does not significantly contribute to metabolic cost.

ZUNTZ N . Significance of different nutrients as a generator of muscle power [J ] . Archiv Fur Die Gesamte Physiologie Des Menschen Und Der Tiere , 1901 , 83 ( 10/12 ): 557 - 571 .

DEL-AMA A J , GIL-AGUDO A , BRAVO-ESTEBAN E , et al. Hybrid therapy of walking with Kinesis overground robot for persons with incomplete spinal cord injury: a feasibility study [J ] . Robotics and Autonomous Systems , 2015 , 73 ( 11 ): 44 - 58 .

KHAN A S , LIVINGSTONE D C , HURD C L , et al. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity [J ] . Journal of NeuroEngineering and Rehabilitation , 2019 , 16 : 145 . DOI: 10.1186/s12984-019-0585-x http://doi.org/10.1186/s12984-019-0585-x Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment.Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2-3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts.Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28-0.60 m/s, and distances of 0.74-1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments.For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries.NCT02322125 Registered 22 December 2014.

CAO E G , REN M Y , CUI Y T , et al. Design of a multi-resiliency exoskeleton and its physiologic cost evaluation in uphill walking and stair climbing locomotion [J ] . Journal of Mechanical Engineering Science , 2022 , 236 ( 5 ): 2115 - 2127 .

ARELLANO C J , KRAM R . Partitioning the metabolic cost of human running: a task-by-task approach [J ] . Integrative and Comparative Biology , 2014 , 54 ( 6 ): 1084 - 1098 . DOI: 10.1093/icb/icu033 http://doi.org/10.1093/icb/icu033 Compared with other species, humans can be very tractable and thus an ideal "model system" for investigating the metabolic cost of locomotion. Here, we review the biomechanical basis for the metabolic cost of running. Running has been historically modeled as a simple spring-mass system whereby the leg acts as a linear spring, storing, and returning elastic potential energy during stance. However, if running can be modeled as a simple spring-mass system with the underlying assumption of perfect elastic energy storage and return, why does running incur a metabolic cost at all? In 1980, Taylor et al. proposed the "cost of generating force" hypothesis, which was based on the idea that elastic structures allow the muscles to transform metabolic energy into force, and not necessarily mechanical work. In 1990, Kram and Taylor then provided a more explicit and quantitative explanation by demonstrating that the rate of metabolic energy consumption is proportional to body weight and inversely proportional to the time of foot-ground contact for a variety of animals ranging in size and running speed. With a focus on humans, Kram and his colleagues then adopted a task-by-task approach and initially found that the metabolic cost of running could be "individually" partitioned into body weight support (74%), propulsion (37%), and leg-swing (20%). Summing all these biomechanical tasks leads to a paradoxical overestimation of 131%. To further elucidate the possible interactions between these tasks, later studies quantified the reductions in metabolic cost in response to synergistic combinations of body weight support, aiding horizontal forces, and leg-swing-assist forces. This synergistic approach revealed that the interactive nature of body weight support and forward propulsion comprises ∼80% of the net metabolic cost of running. The task of leg-swing at most comprises ∼7% of the net metabolic cost of running and is independent of body weight support and forward propulsion. In our recent experiments, we have continued to refine this task-by-task approach, demonstrating that maintaining lateral balance comprises only 2% of the net metabolic cost of running. In contrast, arm-swing reduces the cost by ∼3%, indicating a net metabolic benefit. Thus, by considering the synergistic nature of body weight support and forward propulsion, as well as the tasks of leg-swing and lateral balance, we can account for 89% of the net metabolic cost of human running. © The Author 2014. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

TAKANO N , DEGUCHI H . Sensation of breathlessness and respiratory oxygen cost during cycle exercise with and without conscious entrainment of the breathing rhythm [J ] . European Journal of Applied Physiology and Occupational Physiology , 1997 , 76 ( 3 ): 209 - 213 . The conscious entrainment of respiratory rhythm to exercise rhythm (ENT) has been hypothesized to alleviate breathing discomfort and reduce the oxygen (O2) cost of ventilation with a resulting decrease in total O2 uptake (VO2) during rhythmic exercise. This hypothesis has been tested in the study reported here. Eight female subjects performed cycle exercise at 50 rpm under two work load conditions of 40% and 60% of maximal VO2. During a 30-min exercise period at each work load, each subject was asked to breathe under two conditions for 15 min each: (1) spontaneously (non-ENT run), and (2) deliberately entraining the breathing rhythm to the cycling rhythm at preferred coupling ratios of the two rhythms (ENT run). In the ENT run, most subjects chose a ratio of 1:2. In each run, pulmonary ventilation (VE), total VO2 and the breathlessness sensation (BS) were measured at 4-5 min. BS was assessed according to a Borg category scale. The remaining 10 min of each 15-min run were allotted for measurement of the O2 cost of ventilation (delta VO2/delta VE), assessed by a hypercapnia-induced hyperventilation method in which the VO2 of the respiratory muscles (VO2RM) was calculated by multiplying delta VO2/delta VE by the prevailing VE. On average, there were no significant differences in any of the variables, VO2, delta VO2/delta VE, VO2RM and BS, between the non-ENT and ENT runs performed at any work load. However, there were wide variations among the subjects in the differences (delta) between the two runs, and significant correlations were found between delta VO2 vs delta VE, delta VO2 vs delta VO2RM, and delta BS vs delta VO2RM of individual subjects. These results indicate that reductions of the total VO2 and BS with ENT could occur in subjects in whom the VO2RM decreased during ENT.

FOLGHERAITER M , JORDAN M , STRAUBE S , et al. Measuring the improvement of the interaction comfort of a wearable exoskeleton [J ] . International Journal of Social Robotics , 2012 , 4 ( 3 ): 285 - 302 .

MO F , ZHANG Q , ZHANG H T , et al. A simulation-based framework with a proprioceptive musculoskeletal model for evaluating the rehabilitation exoskeleton system [J ] . Computer Methods and Programs in Biomedicine , 2021 , 208 : 106270 .

王健 , 金小刚 . 表面肌电信号分析及其应用研究 [J ] . 中国体育科技 , 2000 , 36 ( 8 ): 26 - 28 .

WANG J , JIN X G . sEMG signal analysis method and its application research [J ] . China Sport Science and Technology , 2000 , 36 ( 8 ): 26 - 28 . (in Chinese)

ABE D , FUKUOKA Y , MURAKI S , et al. Effects of load and gradient on energy cost of running [J ] . Journal of physiological anthropology , 2011 , 30 ( 4 ): 153 - 160 . This study quantified the interaction of electromyography (EMG) obtained from the vastus lateralis and metabolic energy cost of running (C(r); mL·[mass+load](-1)·meter(-1)), an index of running economy, during submaximal treadmill running. Experiments were conducted with and without load on the back on a motor-driven treadmill on the downhill, level and uphill slopes. The obtained EMG was full-wave rectified and integrated (iEMG). The iEMG was divided into eccentric (ECC) and concentric (CON) phases with a foot sensor and a knee-joint goniometer. The ratio of ECC to CON (ECC/CON ratio) was regarded as the muscle elastic capacity during running on each slope. The C(r) was determined as the ratio of the 2-min steady-state VO(2) to the running speed. We found a significant decrease in the C(r) when carrying the load at all slopes. The ECC/CON ratio was significantly higher in the load condition at the downhill and level slopes, but not at the uphill slope. A significant gradient difference was observed in the C(r) (down<level<up) and ECC/CON ratio (down=level>uphill). Thus, an alteration of Cr by the gradient and load was almost consistent with that of the ECC/CON ratio. The ECC/CON ratio, but not the rotative torque (T) functioning around the center of body mass, significantly correlated with C(r) (r=-0.41, p<0.05). These results indicated that the ECC/CON ratio, rather than T, contributed to one of the energy-saving mechanisms during running with load.

ALEXANDER L D , BLACK S E , PATTERSON K K , et al. Association between gait asymmetry and brain lesion location in stroke patients [J ] . Stroke , 2009 , 40 ( 2 ): 537 - 544 . DOI: 10.1161/STROKEAHA.108.527374 http://doi.org/10.1161/STROKEAHA.108.527374 Associations between the site of brain injury and poststroke gait impairment are poorly understood. Temporal gait asymmetry after stroke is a salient index of gait dysfunction that has important functional consequences. The current study investigated whether subtraction lesion analysis could distinguish brain regions associated with persisting temporal gait asymmetry in chronic stroke patients.Analysis was conducted on 37 chronic ambulatory stroke patients (17 symmetrical gait, 20 asymmetrical gait). Spatiotemporal gait parameters were recorded using an instrumented walking surface. Lesions were traced from 3D T1-MRI, and region of interest images were generated. The lesion overlay of patients with symmetrical gait was subtracted from patients with asymmetrical gait to highlight voxels more frequently lesioned in asymmetrical patients and relatively spared in symmetrical patients.Demographic data were comparable between the 2 groups. Asymmetrical patients exhibited significantly higher National Institute of Health Stroke Scale neglect scores and more severe motor impairment. Gait asymmetry was significantly correlated to Chedoke-McMaster Stroke Scale leg (r=-0.767, P<0.001) and foot (r=-0.759, P<0.001) scores, whereas gait speed correlated less strongly. After subtraction analysis, injury to the posterolateral putamen was evident 60% to 80% more frequently in the asymmetrical group compared to the symmetrical group.In this sample of ambulatory chronic stroke patients, damage to the posterolateral putamen was associated with temporal gait asymmetry. Further advances in our understanding of the neural correlates of gait asymmetry may provide prognostic markers for future persistent gait dysfunction and lead to early targeted rehabilitation when key regions are damaged.

汤纬地 . 基于表面肌电的上肢运动分析关健技术研究 [D ] . 合肥 : 中国科学技术大学 , 2021 .

TANG W D . Research on key technologies of upper limb motor analysis based on surface EMG [D ] . Hefei : University of Science and Technology of China , 2021 . (in Chinese)

王笃明 , 王健 , 葛列众 . 肌肉疲劳的sEMG时频分析技术及其在工效学中的应用 [J ] . 航天医学与医学工程 , 2003 , 16 ( 5 ): 387 - 390 .

WANG D M , WANG J , GE L Z . sEMG time-frequency analysis techniques for evaluation of muscle fatigue and it's application in ergonomic studies [J ] . Space Medicine & Medical Engineering , 2003 , 16 ( 5 ): 387 - 390 . (in Chinese)

ZHANG T , TRAN M , HUANG H . Admittance shaping-based assistive control of SEA-driven robotic hip exoskeleton [J ] . IEEE-ASME Transactions on Mechatronics , 2019 , 24 ( 4 ): 1508 - 1519 .

JEONG M , WOO H , KONG K . A study on weight support and balance control method for assisting squat movement with a wearable robot, angel-suit [J ] . International Journal of Control Automation and Systems , 2020 , 18 ( 1 ): 114 - 123 .

曹恩国 , 徐祺 , 沈峰岑 , 等 . 多运动复合型被动式下肢外骨骼设计及其智能交互评估 [J ] . 机械工程学报 , 2023 , 59 ( 11 ): 43 - 53 . DOI: 10.3901/JME.2023.11.043 http://doi.org/10.3901/JME.2023.11.043 目前被动式外骨骼辅助的运动姿态较为单一，设计多运动复合型被动式外骨骼可以扩展此类装备的适用性。通过分析不同运动状态下人体姿态变化的几何规律，在储能阶段采用弹性元件储存运动中人体动能与重力势能损失，在助力阶段释放能量以实现运动助力，从而进行外骨骼产品的原型设计，并通过智能传感系统实时监测人体动力学与肌肉活动数据。建立D-H参数模型，对外骨骼进行人机兼容性分析。对6名被试者进行外骨骼穿戴实验，结合动力学与肌电分析，评估外骨骼的效能。人机兼容性分析结果显示外骨骼在矢状面内的行走空间可以覆盖人体踝关节运动轨迹，动力学仿真结果显示穿戴外骨骼后，行走和蹲起运动关节做功总量分别减小了20.17%和19.49%，表面肌电结果显示穿戴外骨骼后下肢主要肌肉贡献率分布规律有一定程度的变化，总体积分值明显降低。通过智能交互系统设计，用户能直观地了解身体运动状态与控制助力程度，获得更好的使用体验。智能人机交互实验验证外骨骼对人体运动辅助的有效性，为相关领域的研究提供实例化参考。

CAO E G , XU Q , SHEN F C , et al. Multi-motion compound passive lower limb exoskeleton design and its intelligent interaction evaluation [J ] . Journal of Mechanical Engineering , 2023 , 59 ( 11 ): 43 - 53 . (in Chinese) DOI: 10.3901/JME.2023.11.043 http://doi.org/10.3901/JME.2023.11.043 At present, the motion posture assisted by most of passive exoskeletons is single posture, and the design of multi-motion composite passive exoskeleton can expand the applicability of this type of equipment. By analyzing the geometric law of human body posture changes under different motion states, elastic elements are used to store the human body's kinetic energy and gravitational potential energy loss during the energy storage phase, and the energy is released in the assist phase to achieve sports assistance, so as to carry out the prototype design of the exoskeleton product, and real-time monitor of human body dynamics and muscle activity data through an intelligent sensor system. The D-H parameter model is established, and the compatibility of man-machine of the exoskeleton is analyzed. The exoskeleton wearing experiment was performed on 6 subjects, combined with dynamics and electromyography data analysis, to evaluate the effectiveness of the exoskeleton. The analysis of human-machine compatibility shows that the walking space of the exoskeleton in the sagittal plane can cover the motion trajectory of the human ankle joint. The dynamics simulation results show that after wearing the exoskeleton, the total work done by the joints is reduced by 20.17% and 19.49% during walking and squatting movements, respectively. The surface electromyography results show that after wearing the exoskeleton, the main muscles contribution rate has a certain degree of change, and the overall score is significantly reduced. Through the mobile intelligent interactive system, the user can understand the body motion state and control the assistance, and then acquire a better user experience. The intelligent human-computer interaction experiment verifies the effectiveness of the exoskeleton prototype for human motion assistance, and provides an example reference for research in related fields.

DUDLEY D R , KNARR B A , SIU K C , et al. Testing of a 3D printed hand exoskeleton for an individual with stroke: a case study [J ] . Disability and Rehabilitation-Assistive Technology , 2021 , 16 ( 2 ): 209 - 213 .

周炜 , 罗志增 . 基于直方图和功率谱比值的肌电信号识别方法 [J ] . 杭州电子科技大学学报 , 2009 , 29 ( 4 ): 63 - 66 .

ZHOU W , LUO Z Z . Identification of EMG signal based on the histogram and power spectrum [J ] . Journal of Hangzhou Dianzi University , 2009 , 29 ( 4 ): 63 - 66 . (in Chinese)

王立玲 , 杨铮 , 刘瑾 . 基于积分肌电值结合双阈值的s-EMG活动段的检测 [J ] . 东北师大学报(自然科学版) , 2018 , 50 ( 3 ): 65 - 71 .

WANG L L , YANG Z , LIU J . s-EMG signal detection based on combining moving average of integrated EMG window with double threshold [J ] . Journal of Northeast Normal University(Natural Science Edition) , 2018 , 50 ( 3 ): 65 - 71 . (in Chinese)

KOSEKI K , MUTSUZAKI H , YOSHIKAWA K , et al. Gait training using the Honda Walking Assistive Device in a patient who underwent total hip arthroplasty: a single-subject study [J ] . Medicina , 2019 , 55 ( 3 ): 69.

向馗 , 李涛 , 宋全军 , 等 . 面向外骨骼助力的肌张力信息实时获取 [J ] . 华中科技大学学报(自然科学版) , 2011 , 39 ( 增刊2 ): 259 - 263 .

XIANG K , LI T , SONG Q J , et al. Power-assistance exoskeleton oriented muscle tension information real-time acquisition [J ] . Journal of Huazhong University of Science and Technology(Natural Science Edition) , 2011 , 39 ( S2 ): 259 - 263 . (in Chinese)

霍金月 , 喻洪流 , 王峰 , 等 . 穿戴式下肢外骨骼助行机器人系统研究 [J ] . 中国康复理论与实践 , 2019 , 25 ( 4 ): 481 - 486 . DOI: 10.3969/j.issn.1006-9771.2019.04.021 http://doi.org/10.3969/j.issn.1006-9771.2019.04.021 目的 提出一种新型轻量化穿戴式下肢外骨骼助行机器人系统，探究其辅助步态紊乱者和T₄脊髓节段以下损伤的截瘫患者(排除双下肢肌痉挛和明显疼痛者)实现行走及姿态变换康复训练的可行性。 方法 设计髋关节双电机主动驱动，膝关节被动四连杆模拟人体运动瞬心变化的主被动混合式可穿戴下肢外骨骼助行机器人结构，基于模块化设计思想，提出以STM32F767IGT6及外围电路为主控制器，包含姿态采集、电源和拐杖模块的控制系统。以正常人穿戴该外骨骼机器人进行平地、斜坡及姿态变换实验，分析运动过程中髋、膝、踝关节角度，并对比正常人穿戴和未穿戴该机器人股外侧肌和股内侧肌的肌电信号。 结果 穿戴者可实现仅基于该外骨骼机器人系统辅助的坐下-站立姿态变换以及平地/斜坡行走，且髋、膝、踝关节角度与正常人行走变化趋势基本一致，穿戴该机器人相比未穿戴行走时，股外侧肌和股内侧肌肌电信号均降低。 结论 该主被动混合式可穿戴下肢外骨骼助行机器人在仅髋关节两个电机驱动下，依然可实现行走及姿态变换的康复训练，验证了髋关节双电机主动驱动、膝关节被动四连杆结构的下肢外骨骼助行机器人系统帮助截瘫患者和步态紊乱者行走康复的可行性。

HUO J Y , YU H L , WANG F , et al. Research of a wearable lower extremity assisted exoskeleton robot system [J ] . Chinese Journal of Rehabilitation Theory and Practice , 2019 , 25 ( 4 ): 481 - 486 . (in Chinese)

郑立京 , 王卓 , 陈灵星 . 一种踝关节柔性助力外骨骼系统设计 [J ] . 机电工程技术 , 2022 , 51 ( 4 ): 47 - 50 , 193.

ZHENG L J , WANG Z , CHEN L X . Design of an ankle-assisted soft exosuit system [J ] . Mechanical & Electrical Engineering Technology , 2022 , 51 ( 4 ): 47 - 50 , 193. (in Chinese)

WANG T M , PEI X , HOU T G , et al. An untethered cable-driven ankle exoskeleton with plantarflexion-dorsiflexion bidirectional movement assistance [J ] . Frontiers of Information Technology & Electronic Engineering , 2020 , 21 ( 5 ): 723 - 739 .

JOUDZADEH P , HADI A , TARVIRDIZADEH B , et al. Design and fabrication of a lower limb exoskeleton to assist in stair ascending [J ] . Industrial Robot-the International Journal of Robotics Research and Application , 2019 , 46 ( 2 ): 290 - 299 .

EMMENS A R , van ASSELDONK E H F , van der KOOIJ H. Effects of a powered ankle-foot orthosis on perturbed standing balance [J ] . Journal of NeuroEngineering and Rehabilitation , 2018 , 15 : 50 . DOI: 10.1186/s12984-018-0393-8 http://doi.org/10.1186/s12984-018-0393-8 Background: Lower extremity exoskeletons are mainly used to provide stepping support, while balancing is left to the user. Designing balance controllers is one of the biggest challenges in the development of exoskeletons. The goal of this study was to design and evaluate a balance controller for a powered ankle-foot orthosis and assess its effect on the standing balance of healthy subjects.Methods: We designed and implemented a balance controller based on the subject's body sway. This controller was compared to a simple virtual-ankle stiffness and a zero impedance controller. Ten healthy subjects wearing a powered ankle-foot orthosis had to maintain standing balance without stepping while receiving anteroposterior pushes. Center of mass kinematics, ankle torques and muscle activity of the lower legs were analyzed to assess the balance performance of the user and exoskeleton.Results: The different controllers did not significantly affect the center of mass responses. However, the body sway based controller resulted in a decrease of 29% in the biological ankle torque compared to the zero impedance controller and a decrease of 32% compared to the virtual-ankle stiffness. Furthermore, the soleus muscle activity of the left and right leg decreased on average with 8%, while the tibialis anterior muscle activity increased with 47% compared to zero impedance.Conclusion: The body sway based controller generated human-like torque profiles, whereas the virtual-ankle stiffness did not. As a result, the powered ankle-foot orthosis with the body sway based controller was effective in assisting the healthy subjects in maintaining balance, although the improvements were not seen in the body sway response, but in the subjects' decreased biological ankle torques to counteract the perturbations. This decrease was a combined effect of decreased soleus muscle activity and increased tibialis anterior muscle activity.

XIAO F Y , GAO Y S , WANG Y , et al. Design and evaluation of a 7-DOF cable-driven upper limb exoskeleton [J ] . Journal of Mechanical Science and Technology , 2018 , 32 ( 2 ): 855 - 864 .

高志华 , 郭君扬 , 潘春生 . 下肢支撑外骨骼在模拟装配任务中的辅助效果评估 [J ] . 机械设计 , 2021 , 38 ( 5 ): 93 - 98 .

GAO Z H , GUO J Y , PAN C S . Evaluation of the auxiliary effect of the lower-limb supporting exoskeleton in the simulated assembly task [J ] . Journal of Machine Design , 2021 , 38 ( 5 ): 93 - 98 . (in Chinese)

王存金 , 董林杰 , 李杰 , 等 . 基于人行走能耗分析的踝关节外骨骼设计 [J ] . 机械工程学报 , 2021 , 57 ( 19 ): 79 - 92 . DOI: 10.3901/JME.2021.19.008 http://doi.org/10.3901/JME.2021.19.008 基于对人体行走的能耗分析，设计了一种新型有源无动力踝关节外骨骼。首先，基于耦合摆模型建立人体行走摆动相动力学方程并采用打靶法求解。根据动量守恒原理分别计算摆动腿膝关节锁定、脚跟着地以及关节摩擦引起的能耗率。计算结果表明，脚跟着地引起的能耗率远大于膝关节锁定和关节摩擦引起的能耗率。然后，基于该能耗分析结果设计了一种足底弹性储能机构将脚跟着地时的能耗存储起来，在跖屈蹬地阶段释放助力。通过前脚掌压力信号控制电磁铁驱动的离合机构，实现对助力弹簧夹紧与释放的状态切换。样机实验结果表明：足底储能机构可以提高外骨骼的输出力矩和功率，提升助行能力；外骨骼的最大输出力矩为19N&#183;m；穿戴该外骨骼行走时小腿三头肌激活度相较于不穿戴时最大下降约8.6%。踝关节角度测量结果表明，在摆动相期间外骨骼很少干扰穿戴者踝关节的正常活动。

WANG C J , DONG L J , LI J , et al. Design of ankle exoskeleton based on analysis on energy cost of human walking [J ] . Journal of Mechanical Engineering , 2021 , 57 ( 19 ): 79 - 92 . (in Chinese) DOI: 10.3901/JME.2021.19.008 http://doi.org/10.3901/JME.2021.19.008 A new type of active unpowered ankle exoskeleton is designed based on the analysis on the energy cost of human walking. Firstly, dynamical equations of swing phase of human walking are built based on a coupled pendulum model and shooting method is used to solve the equations. Energy cost rate of knee-lock, heel-strike and joint friction of the swing leg are calculated based on the principle of momentum conservation. The calculation results show that the energy cost rate of heel-strike is much greater than the energy cost rate resulted from knee-lock and joint friction. Then, based on the results of analysis of the energy cost, an plantar elastic storage mechanism is designed to store the energy cost of heel-strike, which is released during the plantar flexion push-off phase. Pressure signals from forefoot are used to control the clutch mechanism driven by electromagnet, the clamping and releasing states switching of assistive spring is achieved. Experimental results of the prototype shown that plantar energy storage mechanism can increase the output torque and power of the ankle exoskeleton, enhance the ability of assisting walking. The maximum output torque is 19Nm. The muscle activity of the triceps surae is reduced by 8.6% when wearing the exoskeleton compared with the state without wearing the exoskeleton. The measurement results of ankle joint angle show that the exoskeleton rarely interferes with the normal range of motion of the wearer’s ankle during swing phase.

YU S N , LEE H D , LEE S H , et al. Design of an under-actuated exoskeleton system for walking assist while load carrying [J ] . Advanced Robotics , 2012 , 26 ( 5/6 ): 561 - 580 .

BAE E , PARK S E , MOON Y , et al. A robotic gait training system with stair-climbing mode based on a unique exoskeleton structure with active foot plates [J ] . International Journal of Control Automation and Systems , 2020 , 18 ( 1 ): 196 - 205 .

YOSHIKAWA K , MUTSUZAKI H , KOSEKI K , et al. Gait training using a wearable robotic device for non-traumatic spinal cord injury: a case report [J/OL ] . Geriatric Orthopaedic Surgery & Rehabilitation , 2020 ( 2020-10-28 ). https://doi.org/10.1177/2151459320956960 https://doi.org/10.1177/2151459320956960 https://doi.org/10.1177/2151459320956960.

LEE H J , LEE S H , SEO K , et al. Training for walking efficiency with a wearable hip-assist robot in patients with stroke: a pilot randomized controlled trial [J ] . Stroke , 2019 , 50 ( 12 ): 3545 - 3552 .

DE VRIES A W , KRAUSE F , DE LOOZE M P . The effectivity of a passive arm support exoskeleton in reducing muscle activation and perceived exertion during plastering activities [J ] . Ergonomics , 2021 , 64 ( 6 ): 712 - 721 .

MARINOU G , SLOOT L , MOMBAUR K , et al. Towards efficient lower-limb exoskeleton evaluation: defining biomechanical metrics to quantify assisted gait familiarization [C ] //Proceedings of the 9th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob). Seoul , South Korea : IEEE , 2022 : 1 - 8 .

黄耐寒 . 基于表面肌电的肌疲劳分析与肌力预测研究及实现 [D ] . 合肥 : 中国科学技术大学 , 2014 .

HUANG N H . Research and implementation of muscle fatigue analysis and muscle force prediction based on surface electromyography [D ] . Hefei : University of Science and Technology of China , 2014 . (in Chinese)

丁其川 , 熊安斌 , 赵新刚 , 等 . 基于表面肌电的运动意图识别方法研究及应用综述 [J ] . 自动化学报 , 2016 , 42 ( 1 ): 13 - 25 .

DING Q C , XIONG A B , ZHAO X G , et al. A review on researches and applications of sEMG-based motion intent recognition methods [J ] . Acta Automatica Sinica , 2016 , 42 ( 1 ): 13 - 25 . (in Chinese)

SETOGUCHI N , KANAZAKI M . Low-speed and high angle of attack aerodynamic characteristics of supersonic business jet with forward swept wing [C ] //Proceedings of the AIAA Scitech 2020 Forum. Orlando, FL, US:AIAA , 2020 : AIAA 2020 - 0534 .

XU F S , HUANG R , CHENG H , et al. Stair-ascent strategies and performance evaluation for a lower limb exoskeleton [J ] . International Journal of Intelligent Robotics and Applications , 2020 , 4 ( 3 ): 278 - 293 .

SETOGUCHI D , KINOSHITA K , KAMADA S , et al. Hybrid assistive limb improves restricted hip extension after total hip arthroplasty [J ] . Assistive Technology , 2022 , 34 ( 1 ): 112 - 120 .

YANG M X , WANG X S , ZHU Z Y , et al. Development and control of a robotic lower limb exoskeleton for paraplegic patients [J ] . Proceedings of the Institution of Mechanical Engineers Part C—Journal of Mechanical Engineering Science , 2019 , 233 ( 3 ): 1087 - 1098 .

WANG L T , WANG S Q , VAN ASSELDONK E H F , et al. Actively controlled lateral gait assistance in a lower limb exoskeleton [C ] //Proceedings of the IEEE/RSJ International Conference on Intelligent Robots and Systems. Tokyo , Japan : IEEE , 2013 : 965 - 970 .

FARRIS R J , QUINTERO H A , GOLDFARB M . Preliminary evaluation of a powered lower limb orthosis to aid walking in paraplegic individuals [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2011 , 19 ( 6 ): 652 - 659 . DOI: 10.1109/TNSRE.2011.2163083 http://doi.org/10.1109/TNSRE.2011.2163083 This paper describes a powered lower-limb orthosis that is intended to provide gait assistance to spinal cord injured (SCI) individuals by providing assistive torques at both hip and knee joints. The orthosis has a mass of 12 kg and is capable of providing maximum joint torques of 40 Nm with hip and knee joint ranges of motion from 105° flexion to 30° extension and 105° flexion to 10° hyperextension, respectively. A custom distributed embedded system controls the orthosis with power being provided by a lithium polymer battery which provides power for one hour of continuous walking. In order to demonstrate the ability of the orthosis to assist walking, the orthosis was experimentally implemented on a paraplegic subject with a T10 complete injury. Data collected during walking indicates a high degree of step-to-step repeatability of hip and knee trajectories (as enforced by the orthosis) and an average walking speed of 0.8 km/hr. The electrical power required at each hip and knee joint during gait was approximately 25 and 27 W, respectively, contributing to the 117 W overall electrical power required by the device during walking. A video of walking corresponding to the aforementioned data is included in the supplemental material.

BORTOLE M , VENKATAKRISHNAN A , ZHU F S , et al. The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study [J ] . Journal of NeuroEngineering and Rehabilitation , 2015 , 12 ( 6 ): 54.

ZHA F S , SHENG W T , GUO W , et al. The exoskeleton balance assistance control strategy based on single step balance assessment [J ] . Applied Sciences-Basel , 2019 , 9 ( 5 ): 884.

HIDAYAH R , BISHOP L , JIN X , et al. Gait adaptation using a cable-driven active leg exoskeleton (C-ALEX) with post-stroke participants [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2020 , 28 ( 9 ): 1984 - 1993 . DOI: 10.1109/TNSRE.2020.3009317 http://doi.org/10.1109/TNSRE.2020.3009317 Individuals with chronic hemiparesis post-stroke exhibit gait impairments that require functional rehabilitation through training. Exoskeletal robotic assistive devices can provide a user with continuous assistance but impose movement restrictions. There are currently devices that allow unrestricted movement but provide assistance only intermittently at specific points of the gait cycle. Our design, a cable-driven active leg exoskeleton (C-ALEX), allows the user both unrestricted movement and continuous force assistance throughout the gait cycle to assist the user in new walking patterns. In this study, we assessed the ability of C-ALEX to induce a change in the walking patterns of ten post-stroke participants using a single-session training protocol. The ability of C-ALEX to accurately provide forces and torques in the desired directions was also evaluated to compare its design performance to traditional rigid-link designs. Participants were able to reach 91% ± 12% of their target step length and 89% ± 13% of their target step height. The achieved step parameters differed significantly from participant baselines ( ). To quantify the performance, the forces in each cable's out of the plane movements were evaluated relative to the in-plane desired cable tension magnitudes. This corresponded to an error of under 2Nm in the desired controlled joint torques. This error magnitude is low compared to the system command torques and typical adult biological torques during walking (2-4%). These results point to the utility of using non-restrictive cable-driven architectures in gait retraining, in which future focus can be on rehabilitating gait pathologies seen in stroke survivors.

AGUIRRE-OLLINGER G , NARAYAN A , YU H Y . Phase-synchronized assistive torque control for the correction of kinematic anomalies in the gait cycle [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2019 , 27 ( 11 ): 2305 - 2314 .

CHANG S R , NANDOR M J , LI L , et al. A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia [J ] . Journal of NeuroEngineering and Rehabilitation , 2017 , 14 ( 5 ): 48.

SWIFT T A , STRAUSSER K A , ZOSS A B , et al. Control and experimental results for post stroke gait rehabilitation with a prototype mobile medical exoskeleton [C ] //Proceedings of the ASME Dynamic Systems and Control Conference. Cambridge, UK:ASME , 2010 : 405 - 411 .

ESQUENAZI A , TALATY M , PACKEL A , et al. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury [J ] . American Journal of Physical Medicine & Rehabilitation , 2012 , 91 ( 11 ): 911 - 921 .

OH S , BAEK E , SONG S K , et al. A generalized control framework of assistive controllers and its application to lower limb exoskeletons [J ] . Robotics and Autonomous Systems , 2015 , 73 ( 11 ): 68 - 77 .

CHINIMILLI P T , QIAO Z , SORKHABADI S M R , et al. Automatic virtual impedance adaptation of a knee exoskeleton for personalized walking assistance [J ] . Robotics and Autonomous Systems , 2019 , 114 ( 4 ): 66 - 76 .

LI Y B , GUAN X Y , HAN X Y , et al. Design and preliminary validation of a lower limb exoskeleton with compact and modular actuation [J ] . IEEE Access , 2020 , 8 ( 4 ): 66338 - 66352 .

RAJASEKARAN V , ARANDA J , CASALS A , et al. An adaptive control strategy for postural stability using a wearable robot [J ] . Robotics and Autonomous Systems , 2015 , 73 ( 11 ): 16 - 23 .

MA Y , WU X Y , YANG S X , et al. Online gait planning of lower-limb exoskeleton robot for paraplegic rehabilitation considering weight transfer process [J ] . IEEE Transactions on Automation Science and Engineering , 2021 , 18 ( 2 ): 414 - 425 .

HYUN D J , PARK H , HA T , et al. Biomechanical design of an agile, electricity-powered lower-limb exoskeleton for weight-bearing assistance [J ] . Robotics and Autonomous Systems , 2017 , 95 ( 9 ): 181 - 195 .

陆阿明 , 王国栋 , 王芳 . 运动性疲劳对跑运动学与下肢肌电的影响 [J ] . 体育科学 , 2012 , 32 ( 6 ): 44 - 49 , 80.

LU A M , WANG G D , WANG F . The effect of exercise fatigue on body kinematics and leg electromyography during running [J ] . China Sport Science , 2012 , 32 ( 6 ): 44 - 49 , 80. (in Chinese)

KWON J , PARK J H , KU S , et al. A soft wearable robotic ankle-foot-orthosis for post-stroke patients [J ] . IEEE Robotics and Automation Letters , 2019 , 4 ( 3 ): 2547 - 2552 . DOI: 10.1109/LRA.2019.2908491 http://doi.org/10.1109/LRA.2019.2908491 We propose a soft robotic ankle-foot-orthosis for post-stroke patients, which is inexpensive, lightweight, easy to wear, and capable of gait assistance for rehabilitation not only in the clinic but also in daily life. The device includes a 3D-printed flexible brace and an ankle supportthat allows natural flexion and extension of the ankle but provides support in the vertical direction preventing the structure from buckling. A bi-directional tendon-driven actuator was used for assisting both dorsiflexion and plantarflexion. The device also contains a wearable gait sensing module for measuring the leg trajectory and the foot pressures in real time for feedback control. Since the device is powered by a rechargeable battery and communicates with the main controller wirelessly, it is fully untethered, making it mobile and comfortable. Using the measured sensor data and the biomechanics of the legs, the real-time gait phase is detected, and then a gait assistance algorithm for both dorsiflexion and plantarflexion provides an accurate prediction of a control phase and timing although there are variations in the gait trajectories among individuals. As a feasibility test, the walking experiment was conducted with a post-stroke patient. The result showed improvement in both gait propulsion and foot-drop prevention.

MALEKI M , BADRI S , SHAYESTEHEPOUR H , et al. Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury [J ] . Disability and Rehabilitation—Assistive Technology , 2019 , 14 ( 4 ): 333 - 337 .

LERNER Z F , DAMIANO D L , PARK H S , et al. A robotic exoskeleton for treatment of crouch gait in children with cerebral palsy: design and initial application [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2017 , 25 ( 6 ): 650 - 659 . DOI: 10.1109/TNSRE.2016.2595501 http://doi.org/10.1109/TNSRE.2016.2595501 Crouch gait, a pathological pattern of walking characterized by excessive knee flexion, is one of the most common gait disorders observed in children with cerebral palsy (CP). Effective treatment of crouch during childhood is critical to maintain mobility into adulthood, yet current interventions do not adequately alleviate crouch in most individuals. Powered exoskeletons provide an untapped opportunity for intervention. The multiple contributors to crouch, including spasticity, contracture, muscle weakness, and poor motor control make design and control of such devices challenging in this population. To our knowledge, no evidence exists regarding the feasibility or efficacy of utilizing motorized assistance to alleviate knee flexion in crouch gait. Here, we present the design of and first results from a powered exoskeleton for extension assistance as a treatment for crouch gait in children with CP. Our exoskeleton, based on the architecture of a knee-ankle-foot orthosis, is lightweight (3.2 kg) and modular. On board sensors enable knee extension assistance to be provided during distinct phases of the gait cycle. We tested our device on one six-year-old male participant with spastic diplegia from CP. Our results show that the powered exoskeleton improved knee extension during stance by 18.1° while total knee range of motion improved 21.0°. Importantly, we observed no significant decrease in knee extensor muscle activity, indicating the user did not rely solely on the exoskeleton to extend the limb. These results establish the initial feasibility of robotic exoskeletons for treatment of crouch and provide impetus for continued investigation of these devices with the aim of deployment for long term gait training in this population.

MANIKOWSKA F , BRAZEVIC S , KRZYZANSKA A , et al. Effects of robot-assisted therapy on gait parameters in pediatric patients with spastic cerebral palsy [J ] . Frontiers in Neurology , 2021 , 12 : 724009 .

邹晓峰 . 士兵在负重行军时步态的生物力学特征 [D ] . 北京 : 北京体育大学 , 2010 .

ZHOU X F . The biomechanical characteristics of gait during soldiers’ loads march [D ] . Beijing : Beijing Sport University , 2010 . (in Chinese)

KUBOTA S , ABET T , KADONE H , et al. Walking ability following hybrid assistive limb treatment for a patient with chronic myelopathy after surgery for cervical ossification of the posterior longitudinal ligament [J ] . Journal of Spinal Cord Medicine , 2019 , 42 ( 1 ): 128 - 136 . DOI: 10.1080/10790268.2017.1313932 http://doi.org/10.1080/10790268.2017.1313932 The hybrid assistive limb (HAL) (the wearable robot) can assist kinesis during voluntary control of hip and knee joint motion by detecting the wearer's bioelectric signals on the surface of their skin. The purpose of this study was to report on walking ability following the wearable robot treatment in a patient with chronic myelopathy after surgery for cervical ossification of the posterior longitudinal ligament (OPLL).The patient was a 66-year-old woman with cervical OPLL who was able to ambulate independently with the aid of bilateral crutches. The wearable robot treatment was received once every 2 weeks for ten sessions beginning approximately 14 years after surgery. Improvements were observed in gait speed (BL 22.5; post 46.7 m/min), step length (BL 0.36; post 0.57 m), and cadence (BL 61.9; post 81.6 m/min) based on a 10-m walk test and a 2-minute walk test (BL 63.4; post 103.7 m) assessing total walking distance. The improvements in walking ability were maintained after the wearable robot treatment for 6 months.We report the functional recovery in the walking ability of a patient with chronic cervical myelopathy following the wearable robot treatment, suggesting that as a rehabilitation tool, the wearable robot has the potential to effectively improve functional ambulation in chronic cervical myelopathy patients whose walking ability has plateaued, even many years after surgery.

UENO T , WATANABE H , KAWAMOTO H , et al. Feasibility and safety of robot suit HAL treatment for adolescents and adults with cerebral palsy [J ] . Journal of Clinical Neuroscience , 2019 , 68 ( 10 ): 101 - 104 .

SCHRADE S O , DATWYLER K , STUCHELI M , et al. Development of VariLeg, an exoskeleton with variable stiffness actuation: first results and user evaluation from the Cybathlon 2016 [J ] . Journal of NeuroEngineering and Rehabilitation , 2018 , 15 : 18 . DOI: 10.1186/s12984-018-0360-4 http://doi.org/10.1186/s12984-018-0360-4 Background: Powered exoskeletons are a promising approach to restore the ability to walk after spinal cord injury (SCI). However, current exoskeletons remain limited in their walking speed and ability to support tasks of daily living, such as stair climbing or overcoming ramps. Moreover, training progress for such advanced mobility tasks is rarely reported in literature. The work presented here aims to demonstrate the basic functionality of the VariLeg exoskeleton and its ability to enable people with motor complete SCI to perform mobility tasks of daily life.Methods: VariLeg is a novel powered lower limb exoskeleton that enables adjustments to the compliance in the leg, with the objective of improving the robustness of walking on uneven terrain. This is achieved by an actuation system with variable mechanical stiffness in the knee joint, which was validated through test bench experiments. The feasibility and usability of the exoskeleton was tested with two paraplegic users with motor complete thoracic lesions at Th4 and Th12. The users trained three times a week, in 60 min sessions over four months with the aim of participating in the CYBATHLON 2016 competition, which served as a field test for the usability of the exoskeleton. The progress on basic walking skills and on advanced mobility tasks such as incline walking and stair climbing is reported. Within this first study, the exoskeleton was used with a constant knee stiffness.Results: Test bench evaluation of the variable stiffness actuation system demonstrate that the stiffness could be rendered with an error lower than 30 Nm/rad. During training with the exoskeleton, both users acquired proficient skills in basic balancing, walking and slalom walking. In advanced mobility tasks, such as climbing ramps and stairs, only basic (needing support) to intermediate (able to perform task independently in 25% of the attempts) skill levels were achieved. After 4 months of training, one user competed at the CYBATHLON 2016 and was able to perform 3 (stand-sit-stand, slalom and tilted path) out of 6 obstacles of the track. No adverse events occurred during the training or the competition.Conclusion: Demonstration of the applicability to restore ambulation for people with motor complete SCI was achieved. The CYBATHLON highlighted the importance of training and gaining experience in piloting an exoskeleton, which were just as important as the technical realization of the robot.

MURRAY S A , HA K H , HARTIGAN C , et al. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2015 , 23 ( 3 ): 441 - 449 . DOI: 10.1109/TNSRE.2014.2346193 http://doi.org/10.1109/TNSRE.2014.2346193 This paper presents a control approach for a lower-limb exoskeleton intended to facilitate recovery of walking in individuals with lower-extremity hemiparesis after stroke. The authors hypothesize that such recovery is facilitated by allowing the patient rather than the exoskeleton to provide movement coordination. As such, an assistive controller that provides walking assistance without dictating the spatiotemporal nature of joint movement is described here. Following a description of the control laws and finite state structure of the controller, the authors present the results of an experimental implementation and preliminary validation of the control approach, in which the control architecture was implemented on a lower limb exoskeleton, and the exoskeleton implemented in an experimental protocol on three subjects with hemiparesis following stroke. In a series of sessions in which each patient used the exoskeleton, all patients showed substantial single-session improvements in all measured gait outcomes, presumably as a result of using the assistive controller and exoskeleton.

BAUNSGAARD C B , NISSEN U V , BRUST A K , et al. Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics [J ] . Spinal Cord , 2018 , 56 ( 2 ): 106 - 116 . DOI: 10.1038/s41393-017-0013-7 http://doi.org/10.1038/s41393-017-0013-7 Prospective quasi-experimental study, pre- and post-design.Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics.Nine European rehabilitation centres.Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS).Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) < 1 year, N = 25; > 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI < 1 year and gait function increased from 20 to 56% (P = 0.004) and 10MWT, TUG, BBS and LEMS results improved (P < 0.05). The number of participants with TSI > 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P < 0.05).Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.

JANSEN O , GRASMUECKE D , MEINDL R C , et al. Hybrid assistive limb exoskeleton HAL in the rehabilitation of chronic spinal cord injury: proof of concept; the results in 21 patients [J ] . World Neurosurgery , 2018 , 110 : e73 -e78.

王月朋 . 下肢外骨骼助力机器人稳定性判别研究 [D ] . 合肥 : 安徽工程大学 , 2021 .

WANG Y P . Research on stability criterion of power-assisted robot for lower limb exoskeleton [D ] . Hefei : Anhui University of Technology , 2021 . (in Chinese)

ZHOU N B , LIU Y L , SONG Q Z , et al. Analysis , design and preliminary evaluation of an anthropometric self-stabilization passive exoskeleton for enhancing the ability of walking with loads [J ] . Robotics and Autonomous Systems , 2022 , 153 : 104079 .

雷兵 . 协行助力机械腿结构优化及性能评估系统研究 [D ] . 上海 : 华东理工大学 , 2011 .

LEI B . Structure optimization and performance evaluation of leg exoskeleton for load-carrying augument [D ] . Shanghai : East China University of Science and Technology , 2011 . (in Chinese)

AVEDIKOV G E , BEREZII E S , PISMENNAYA E V , et al. Method for evaluation of user unloading efficiency during cargo transportation and holding by means of exoskeleton: RU2723606-C1 [P ] . 2020-06-17.

MUDIE K L , BILLING D , BISHOP D . Reducing load carriage during walking using a lower limb passive exoskeleton [C ] //Proceedings of the 26th Congress of the International Society of Biomechanics. Brisbane, Australia , 2017 : 51 .

KIM H G , LEE J W , JANG J , et al. Design of an exoskeleton with minimized energy consumption based on using elastic and dissipative elements [J ] . International Journal of Control Automation and Systems , 2015 , 13 ( 2 ): 463 - 474 .

YANG W , ZHANG J Y , ZHANG S , et al. Lower limb exoskeleton gait planning based on crutch and human-machine foot combined center of pressure [J ] . Sensors , 2020 , 20 ( 24 ): 7216.

LUGER T , SEIBT R , COBB T J , et al. Influence of a passive lower-limb exoskeleton during simulated industrial work tasks on physical load, upper body posture, postural control and discomfort [J ] . Applied Ergonomics , 2019 , 80 ( 10 ): 152 - 160 .

ZHONG B , CAO J H , GUO K Q , et al. Fuzzy logic compliance adaptation for an assist-as-needed controller on the Gait Rehabilitation Exoskeleton (GAREX) [J ] . Robotics and Autonomous Systems , 2020 , 133 : 103642 .

GIOVACCHINI F , VANNETTI F , FANTOZZI M , et al. A light-weight active orthosis for hip movement assistance [J ] . Robotics and Autonomous Systems , 2015 , 73 ( 11 ): 123 - 134 .

DI NATALI C , SADEGHI A , MONDINI A , et al. Pneumatic quasi-passive actuation for soft assistive lower limbs exoskeleton [J ] . Frontiers in Neurorobotics , 2020 , 14 : 31 . DOI: 10.3389/fnbot.2020.00031 http://doi.org/10.3389/fnbot.2020.00031 There is a growing international interest in developing soft wearable robotic devices to improve mobility and daily life autonomy as well as for rehabilitation purposes. Usability, comfort and acceptance of such devices will affect their uptakes in mainstream daily life. The XoSoft EU project developed a modular soft lower-limb exoskeleton to assist people with low mobility impairments. This paper presents the bio-inspired design of a soft, modular exoskeleton for lower limb assistance based on pneumatic quasi-passive actuation. The design of a modular reconfigurable prototype and its performance are presented. This actuation centers on an active mechanical element to modulate the assistance generated by a traditional passive component, in this case an elastic belt. This study assesses the feasibility of this type of assistive device by evaluating the energetic outcomes on a healthy subject during a walking task. Human-exoskeleton interaction in relation to task-based biological power assistance and kinematics variations of the gait are evaluated. The resultant assistance, in terms of overall power ratio (Λ) between the exoskeleton and the assisted joint, was 26.6% for hip actuation, 9.3% for the knee and 12.6% for the ankle. The released maximum power supplied on each articulation, was 113.6% for the hip, 93.2% for the knee, and 150.8% for the ankle.Copyright © 2020 Di Natali, Sadeghi, Mondini, Bottenberg, Hartigan, De Eyto, O'Sullivan, Rocon, Stadler, Mazzolai, Caldwell and Ortiz.

LIU X H , WANG Q N . Real-time locomotion mode recognition and assistive torque control for unilateral knee exoskeleton on different terrains [J ] . IEEE-ASME Transactions on Mechatronics , 2020 , 25 ( 6 ): 2722 - 2732 .

MALCOLM P , LEE S , CREA S , et al. Varying negative work assistance at the ankle with a soft exosuit during loaded walking [J ] . Journal of NeuroEngineering and Rehabilitation , 2017 , 14 : 62 . DOI: 10.1186/s12984-017-0267-5 http://doi.org/10.1186/s12984-017-0267-5 Background: Only very recently, studies have shown that it is possible to reduce the metabolic rate of unloaded and loaded walking using robotic ankle exoskeletons. Some studies obtained this result by means of high positive work assistance while others combined negative and positive work assistance. There is no consensus about the isolated contribution of negative work assistance. Therefore, the aim of the present study is to examine the effect of varying negative work assistance at the ankle joint while maintaining a fixed level of positive work assistance with a multi-articular soft exosuit.Methods: We tested eight participants during walking at 1.5 ms(-1) with a 23-kg backpack. Participants wore a version of the exosuit that assisted plantarflexion via Bowden cables tethered to an off-board actuation platform. In four active conditions we provided different rates of exosuit bilateral ankle negative work assistance ranging from 0. 015 to 0.037 W kg(-1) and a fixed rate of positive work assistance of 0.19 W kg(-1).Results: All active conditions significantly reduced metabolic rate by 11 to 15% compared to a reference condition, where the participants wore the exosuit but no assistance was provided. We found no significant effect of negative work assistance. However, there was a trend (p =.08) toward greater reduction in metabolic rate with increasing negative work assistance, which could be explained by observed reductions in biological ankle and hip joint power and moment.Conclusions: The non-significant trend of increasing negative work assistance with increasing reductions in metabolic rate motivates the value in further studies on the relative effects of negative and positive work assistance. There may be benefit in varying negative work over a greater range or in isolation from positive work assistance.

TAMEZ-DUQUE J , COBIAN-UGALDE R , KILICARSLAN A , et al. Real-time strap pressure sensor system for powered exoskeletons [J ] . Sensors , 2015 , 15 ( 2 ): 4550 - 4563 .

袁小庆 , 姬俊杰 , 刘宇轩 , 等 . 主被动结合的上下肢一体化助力外骨骼机器人的设计与效能评估 [J ] . 机械工程学报 , 2022 , 58 ( 21 ): 27 - 37 . DOI: 10.3901/JME.2022.21.027 http://doi.org/10.3901/JME.2022.21.027 针对上肢外骨骼机器人对使用者腰背产生过重负荷的问题，设计了一种主被动结合的上下肢一体化助力外骨骼机器人，利用无源下肢外骨骼来承担部分负荷。基于助力外骨骼应用场景和人体结构特征分析，建立外骨骼机器人的机械结构模型，完成运动学仿真分析，验证了模型的合理性。为解决外骨骼机器人效能评估问题，提出一种模糊综合评估模型，详细介绍了外骨骼机器人的效能评估方法，评估结果为性能良好。研制外骨骼机器人样机，搭建总体控制系统，开展助力性能和负重性能测试实验。实验结果表明，所设计的上下肢一体化助力外骨骼机器人可承受20 kg的负载且对穿戴者提供一定的助力效果。所提出的模糊综合评估模型，为外骨骼机器人的优化设计提供了方向和理论依据。

YUAN X Q , JI J J , LIU Y X , et al. Design and performance evaluation of active-passive integrated exoskeleton robot with upper and lower limbs [J ] . Journal of Mechanical Engineering , 2022 , 58 ( 21 ): 27 - 37 . (in Chinese) DOI: 10.3901/JME.2022.21.027 http://doi.org/10.3901/JME.2022.21.027 Aiming at the problem that the upper limb exoskeleton robot has heavy load on the user's waist and back, an upper and lower limb integrated power exoskeleton robot with active and passive combination is designed, and the passive lower limb exoskeleton is used to bear part of the load. Based on the analysis of the application scenarios of the powered exoskeleton and the structural characteristics of the human body, the mechanical structure model of the exoskeleton robot is established, and the kinematics simulation analysis is completed to verify the rationality of the model. In order to solve the efficiency evaluation of exoskeleton robot, a fuzzy comprehensive evaluation model is proposed. The efficiency evaluation method of exoskeleton robot is introduced in detail, and the evaluation result is excellent. The prototype of the exoskeleton robot is developed, the overall control system is built, and the test experiments of power assist performance and load-bearing performance are carried out. The experimental results show that the designed upper and lower limb integrated power exoskeleton robot can bear a load of 20 kg and has a certain power assist effect for wearers. The proposed fuzzy comprehensive evaluation model provides direction and theoretical basis for the optimal design of exoskeleton robot.

AWAD L N , PALMER J A , POHLIG R T , et al. Walking speed and step length asymmetry modify the energy cost of walking after stroke [J ] . Neurorehabilitation and Neural Repair , 2015 , 29 ( 5 ): 416 - 423 .

GUZIK A , DRUZBICKI M , PRZYSADA G , et al. Validity of the gait variability index for individuals after a stroke in a chronic stage of recovery [J ] . Gait & Posture , 2019 , 68 ( 2 ): 63 - 67 .

MERLETTI R , HERMENS H . Introduction to the special issue on the SENIAM European Concerted Action [J ] . Journal of Electromyography and Kinesiology , 2000 , 5 ( 10 ): 283 - 286 .

张苹苹 . 工业用下肢支撑外骨骼设计与评估研究 [J ] . 现代制造工程 , 2021 , 2021 ( 7 ): 16 - 22 .

ZHANG P P . Design and evaluation study of industrial lower limb support exoskeleton [J ] . Modern Manufacturing Engineering , 2021 , 2021 ( 7 ): 16 - 22 . (in Chinese)

LEONARDIS D , BARSOTTI M , LOCONSOLE C , et al. An EMG-controlled robotic hand exoskeleton for bilateral rehabilitation [J ] . IEEE Transactions on Haptics , 2015 , 8 ( 2 ): 140 - 151 . DOI: 10.1109/TOH.2015.2417570 http://doi.org/10.1109/TOH.2015.2417570 This paper presents a novel electromyography (EMG)-driven hand exoskeleton for bilateral rehabilitation of grasping in stroke. The developed hand exoskeleton was designed with two distinctive features: (a) kinematics with intrinsic adaptability to patient's hand size, and (b) free-palm and free-fingertip design, preserving the residual sensory perceptual capability of touch during assistance in grasping of real objects. In the envisaged bilateral training strategy, the patient's non paretic hand acted as guidance for the paretic hand in grasping tasks. Grasping force exerted by the non paretic hand was estimated in real-time from EMG signals, and then replicated as robotic assistance for the paretic hand by means of the hand-exoskeleton. Estimation of the grasping force through EMG allowed to perform rehabilitation exercises with any, non sensorized, graspable objects. This paper presents the system design, development, and experimental evaluation. Experiments were performed within a group of six healthy subjects and two chronic stroke patients, executing robotic-assisted grasping tasks. Results related to performance in estimation and modulation of the robotic assistance, and to the outcomes of the pilot rehabilitation sessions with stroke patients, positively support validity of the proposed approach for application in stroke rehabilitation.

XIANG X N , DING M F , ZONG H Y , et al. The safety and feasibility of a new rehabilitation robotic exoskeleton for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI): an observational study [J ] . Spinal Cord , 2020 , 58 ( 7 ): 787 - 794 .

MCINTOSH K , CHARBONNEAU R , BENSAADA Y , et al. The safety and feasibility of exoskeletal-assisted walking in acute rehabilitation after spinal cord injury [J ] . Archives of Physical Medicine and Rehabilitation , 2020 , 101 ( 1 ): 113 - 120 . DOI: S0003-9993(19)31119-0 http://doi.org/S0003-9993(19)31119-0 To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton.Case series observational study.A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units.Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training.Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI.Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity.No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01).Exoskeletal-assisted walking in acute rehabilitation (<6mo) following SCI appears to be both safe and feasible.Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

NAM Y G , LEE J W , PARK J W , et al. Effects of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients: a randomized controlled trial [J ] . Archives of Physical Medicine and Rehabilitation , 2019 , 100 ( 1 ): 26 - 31 .

SCZESNY-KAISER M , TROST R , AACH M , et al. A randomized and controlled crossover study investigating the improvement of walking and posture functions in chronic stroke patients using HAL exoskeleton-the HALESTRO study (HAL-Exoskeleton STROke Study) [J ] . Frontiers in Neuroscience , 2019 , 13 : 259 .

TEFERTILLER C , HAYS K , JONES J , et al. Initial outcomes from a multicenter study utilizing the indego powered exoskeleton in spinal cord injury [J ] . Topics in Spinal Cord Injury Rehabilitation , 2018 , 24 ( 1 ): 78 - 85 . DOI: 10.1310/sci17-00014 http://doi.org/10.1310/sci17-00014 To assess safety and mobility outcomes utilizing the Indego powered exoskeleton in indoor and outdoor walking conditions with individuals previously diagnosed with a spinal cord injury (SCI). We conducted a multicenter prospective observational cohort study in outpatient clinics associated with 5 rehabilitation hospitals. A convenience sample of nonambulatory individuals with SCI ( = 32) completed an 8-week training protocol consisting of walking training 3 times per week utilizing the Indego powered exoskeleton in indoor and outdoor conditions. Participants were also trained in donning/doffing the exoskeleton during each session. Safety measures such as adverse events (AEs) were monitored and reported. Time and independence with donning/doffing the exoskeleton as well as walking outcomes to include the 10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed Up & Go test (TUG), and 600-meter walk test were evaluated from midpoint to final evaluations. All 32 participants completed the training protocol with limited device-related AEs, which resulted in no interruption in training. The majority of participants in this trial were able to don and doff the Indego independently. Final walking speed ranged from 0.19 to 0.55 m/s. Final average indoor and outdoor walking speeds among all participants were 0.37 m/s ( = 0.08, 0.09, respectively), after 8 weeks of training. Significant (<.05) improvements were noted between midpoint and final gait speeds in both indoor and outdoor conditions. Average walking endurance also improved among participants after training. The Indego was shown to be safe for providing upright mobility to 32 individuals with SCIs who were nonambulatory. Improvements in speed and independence were noted with walking in indoor and outdoor conditions as well as with donning/doffing the exoskeleton.

AACH M , CRUCIGER O , SCZESNY-KAISER M , et al. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study [J ] . Spine Journal , 2014 , 14 ( 12 ): 2847 - 2853 . DOI: 10.1016/j.spinee.2014.03.042 http://doi.org/10.1016/j.spinee.2014.03.042 Treadmill training after traumatic spinal cord injury (SCI) has become an established therapy to improve walking capabilities. The hybrid assistive limb (HAL) exoskeleton has been developed to support motor function and is tailored to the patients' voluntary drive.To determine whether locomotor training with the exoskeleton HAL is safe and can increase functional mobility in chronic paraplegic patients after SCI.A single case experimental A-B (pre-post) design study by repeated assessments of the same patients. The subjects performed 90 days (five times per week) of HAL exoskeleton body weight supported treadmill training with variable gait speed and body weight support.Eight patients with chronic SCI classified by the American Spinal Injury Association (ASIA) Impairment Scale (AIS) consisting of ASIA A (zones of partial preservation [ZPP] L3-S1), n=4; ASIA B (with motor ZPP L3-S1), n=1; and ASIA C/D, n=3, who received full rehabilitation in the acute and subacute phases of SCI.Functional measures included treadmill-associated walking distance, speed, and time, with additional analysis of functional improvements using the 10-m walk test (10MWT), timed-up and go test (TUG test), 6-minute walk test (6MWT), and the walking index for SCI II (WISCI II) score. Secondary physiologic measures including the AIS with the lower extremity motor score (LEMS), the spinal spasticity (Ashworth scale), and the lower extremity circumferences.Subjects performed standardized functional testing before and after the 90 days of intervention.Highly significant improvements of HAL-associated walking time, distance, and speed were noticed. Furthermore, significant improvements have been especially shown in the functional abilities without the exoskeleton for over-ground walking obtained in the 6MWT, TUG test, and the 10MWT, including an increase in the WISCI II score of three patients. Muscle strength (LEMS) increased in all patients accompanied by a gain of the lower limb circumferences. A conversion in the AIS was ascertained in one patient (ASIA B to ASIA C). One patient reported a decrease of spinal spasticity.Hybrid assistive limb exoskeleton training results in improved over-ground walking and leads to the assumption of a beneficial effect on ambulatory mobility. However, evaluation in larger clinical trials is required.Copyright © 2014 Elsevier Inc. All rights reserved.

NILSSON A , VREEDE K S , HAGLUND V , et al. Gait training early after stroke with a new exoskeleton-the hybrid assistive limb: a study of safety and feasibility [J ] . Journal of NeuroEngineering and Rehabilitation , 2014 , 11 : 92 .

YOSHIMOTO T , SHIMIZU I , HIROI Y , et al. Feasibility and efficacy of high-speed gait training with a voluntary driven exoskeleton robot for gait and balance dysfunction in patients with chronic stroke: nonrandomized pilot study with concurrent control [J ] . International Journal of Rehabilitation Research , 2015 , 38 ( 4 ): 338 - 343 . DOI: 10.1097/MRR.0000000000000132 http://doi.org/10.1097/MRR.0000000000000132 The aim of this pilot study was to investigate the feasibility of high-speed gait training with an exoskeleton robot hybrid assistive limb (HAL) in patients with chronic stroke, and to examine the efficacy of eight sessions (8 weeks) of gait training with a HAL compared with conventional physical therapy. Eighteen patients with chronic stroke were included in this study (nine each in the HAL and control groups). The HAL group underwent high-speed gait training with the HAL once a week for 8 weeks (20 min/session). The control group underwent conventional physical therapy for gait disturbance. Outcome measures were walking speed, number of steps, and cadence during a 10 m walking test, a timed up and go test, a functional reach test, and the Berg Balance Scale. Assessments were performed in the absence of the HAL before training and after the fourth and eighth training sessions. All patients in the HAL group completed the high-speed gait training without adverse events. The HAL group improved significantly in walking speed (55.9% increase, P<0.001), number of steps (17.6% decrease, P<0.01), and cadence (32.8% increase, P<0.001) during the 10 m walking test. The patients also exhibited significant improvements in the timed up and go test, the functional reach test, and the Berg Balance Scale after HAL training (P<0.01 in all). No statistical time-dependent changes were observed in any parameter in the control group. For chronic stroke patients, high-speed gait training with a HAL appears to be feasible and effective in improving gait and balance dysfunction despite the limitations of this nonrandomized pilot study.

YATSUGI A , MORISHITA T , FUKUDA H , et al. Feasibility of neurorehabilitation using a hybrid assistive limb for patients who underwent spine surgery [J ] . Applied Bionics and Biomechanics , 2018 , 2018 : 7435746 .

CALABRO R S , NARO A , RUSSO M , et al. Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial [J ] . Journal of NeuroEngineering and Rehabilitation , 2018 , 15 : 35 . DOI: 10.1186/s12984-018-0377-8 http://doi.org/10.1186/s12984-018-0377-8 Background: The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the wearable exoskeleton, Ekso (TM), could get higher gait performance than conventional overground gait training (OGT) in patients with hemiparesis due to stroke in a chronic phase, and foster the recovery of specific brain plasticity mechanisms.Methods: We enrolled forty patients in a prospective, pre-post, randomized clinical study. Twenty patients underwent Ekso (TM) gait training (EGT) (45-min/session, five times/week), in addition to overground gait therapy, whilst 20 patients practiced an OGT of the same duration. All individuals were evaluated about gait performance (10 m walking test), gait cycle, muscle activation pattern (by recording surface electromyography from lower limb muscles), frontoparietal effective connectivity (FPEC) by using EEG, cortico-spinal excitability (CSE), and sensorymotor integration (SMI) from both primary motor areas by using Transcranial Magnetic Stimulation paradigm before and after the gait training.Results: A significant effect size was found in the EGT-induced improvement in the 10 m walking test (d = 0.9, p < 0.001), CSE in the affected side (d = 0.7, p = 0.001), SMI in the affected side (d = 0.5, p = 0.03), overall gait quality (d = 0.8, p = 0.001), hip and knee muscle activation (d = 0.8, p = 0.001), and FPEC (d = 0.8, p = 0.001). The strengthening of FPEC (r = 0.601, p < 0.001), the increase of SMI in the affected side (r = 0.554, p < 0.001), and the decrease of SMI in the unaffected side (r = -0.540, p < 0.001) were the most important factors correlated with the clinical improvement.Conclusions: Ekso (TM) gait training seems promising in gait rehabilitation for post-stroke patients, besides OGT. Our study proposes a putative neurophysiological basis supporting Ekso T after-effects. This knowledge may be useful to plan highly patient-tailored gait rehabilitation protocols.

VAN DIJSSELDONK R B , VAN NES I J W , GEURTS A C H , et al. Exoskeleton home and community use in people with complete spinal cord injury [J ] . Scientific Reports , 2020 , 10 ( 1 ): 15600.

HUYSAMEN K , BOSCH T , DE LOOZE M , et al. Evaluation of a passive exoskeleton for static upper limb activities [J ] . Applied Ergonomics , 2018 , 70 ( 7 ): 148 - 155 .

AMBROSINI E , ZAJC J , FERRANTE S , et al. A hybrid robotic system for arm training of stroke survivors: concept and first evaluation [J ] . IEEE Transactions on Biomedical Engineering , 2019 , 66 ( 12 ): 3290 - 3300 .

OZKUL F , BARKANA D E . Upper-extremity rehabilitation robot rehabroby: methodology, design, usability and validation regular paper [J ] . International Journal of Advanced Robotic Systems , 2013 , 10 ( 12 ): 10.5772/57261.

YOO H J , LEE S , KIM J , et al. Development of 3D-printed myoelectric hand orthosis for patients with spinal cord injury [J ] . Journal of NeuroEngineering and Rehabilitation , 2019 , 16 : 162 .

WRIGHT M A , HERZOG F , MAS-VINYALS A , et al. Multicentric investigation on the safety, feasibility and usability of the ABLE lower-limb robotic exoskeleton for individuals with spinal cord injury: a framework towards the standardisation of clinical evaluations [J ] . Journal of NeuroEngineering and Rehabilitation , 2023 , 20 : 45 . DOI: 10.1186/s12984-023-01165-0 http://doi.org/10.1186/s12984-023-01165-0 Robotic lower-limb exoskeletons have the potential to provide additional clinical benefits for persons with spinal cord injury (SCI). However, high variability between protocols does not allow the comparison of study results on safety and feasibility between different exoskeletons. We therefore incorporated key aspects from previous studies into our study protocol and accordingly conducted a multicentre study investigating the safety, feasibility and usability of the ABLE Exoskeleton in clinical settings.In this prospective pretest-posttest quasi-experimental study across two SCI centres in Germany and Spain, in- and outpatients with SCI were recruited into a 12-session training and assessment protocol, utilising the ABLE Exoskeleton. A follow-up visit after 4 weeks was included to assess after-training outcomes. Safety outcomes (device-related adverse events (AEs), number of drop-outs), feasibility and usability measures (level of assistance, donning/doffing-time) were recorded at every session together with changes in gait parameters and function. Patient-reported outcome measures including the rate of perceived exertion (RPE) and the psychosocial impact of the device were performed. Satisfaction with the device was evaluated in both participants and therapists.All 24 participants (45 ± 12 years), with mainly subacute SCI (< 1 year after injury) from C5 to L3, (ASIA Impairment Scale A to D) completed the follow-up. In 242 training sessions, 8 device-related AEs (pain and skin lesions) were reported. Total time for don and doff was 6:50 ± 2:50 min. Improvements in level of assistance and gait parameters (time, steps, distance and speed, p < 0.05) were observed in all participants. Walking function and RPE improved in participants able to complete walking tests with (n = 9) and without (n = 6) the device at study start (p < 0.05). A positive psychosocial impact of the exoskeleton was reported and the satisfaction with the device was good, with best ratings in safety (participants), weight (therapists), durability and dimensions (both).Our study results prove the feasibility of safe gait training with the ABLE Exoskeleton in hospital settings for persons with SCI, with improved clinical outcomes after training. Our study protocol allowed for consistent comparison of the results with other exoskeleton trials and can serve as a future framework towards the standardisation of early clinical evaluations. Trial Registration https://trialsearch.who.int/, DRKS00023503, retrospectively registered on November 18, 2020.© 2023. The Author(s).

TABORRI J , SALVATORI S , MARIANN G , et al. BEAT: balance evaluation automated testbed for the standardization of balance assessment in human wearing exoskeleton [C ] //Proceedings of the IEEE International Workshop on Metrology for Industry 40 and IoT. Roma , Italy : IEEE , 2020 : 526 - 531 .

BEQUETTE B , NORTON A , JONES E , et al. Physical and cognitive load effects due to a powered lower-body exoskeleton [J ] . Human Factors , 2020 , 62 ( 3 ): 411 - 423 . DOI: 10.1177/0018720820907450 http://doi.org/10.1177/0018720820907450 The aim of this study is to determine the effects of a powered exoskeleton on measures of physical and cognitive performance.US warfighters carry heavy equipment into battle, and exoskeletons may reduce that burden. While exoskeletons are currently evaluated for their effects on physical performance, their cognitive effects are not currently considered.Twelve military members participated in a simulated patrol task under three conditions: wearing a powered exoskeleton (PWR), an unpowered exoskeleton (UNP), and without wearing an exoskeleton (OFF). While following a confederate over obstacles at a constant pace, participants performed additional audio and visual tasks. Dependent measures included visual misses, visual reaction time, audio misses, audio reaction time, incremental lag time, and NASA-TLX scores.The variability in the follow-task lag time was lowest with OFF and highest with UNP, highlighting reduced ability to maintain pace with the exoskeleton. Visual reaction time was significantly slower with PWR compared to OFF for 5 of 12 subjects. The NASA-TLX overall workload scores were lower for OFF compared to PWR and UNP.Efforts to understand individual variability are warranted such that exoskeleton designs can be used for a wider set of the population. While not all subjects had measurable differences in the selected performance tasks, the perception of increased workload was present across subjects. It remains to be determined what difference in reaction time would be operationally relevant for task-specific settings.Findings draw attention to the need to consider "cognitive fit" and subject differences in the design and implementation of exoskeletons.

LI T P , CHEN J S , HU C H , et al. Automatic timed up-and-go sub-task segmentation for Parkinson's disease patients using video-based activity classification [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2018 , 26 ( 11 ): 2189 - 2199 . DOI: 10.1109/TNSRE.2018.2875738 http://doi.org/10.1109/TNSRE.2018.2875738 The timed up-and-go (TUG) test has been widely accepted as a standard assessment for measuring the basic functional mobility of patients with Parkinson's disease. Several basic mobility sub-tasks "Sit," "Sit-to-Stand," "Walk," "Turn," "Walk-Back," and "Sit-Back" are included in a TUG test. It has been shown that the time costs of these sub-tasks are useful clinical parameters for the assessment of Parkinson's disease. Several automatic methods have been proposed to segment and time these sub-tasks in a TUG test. However, these methods usually require either well-controlled environments for the TUG video recording or information from special devices, such as wearable inertial sensors, ambient sensors, or depth cameras. In this paper, an automatic TUG sub-task segmentation method using video-based activity classification is proposed and validated in a study with 24 Parkinson's disease patients. Videos used in this paper are recorded in semi-controlled environments with various backgrounds. The state-of-the-art deep learning-base 2-D human pose estimation technologies are used for feature extraction. A support vector machine and a long short-term memory network are then used for the activity classification and the subtask segmentation. Our method can be used to automatically acquire clinical parameters for the assessment of Parkinson's disease using TUG videos-only, leading to the possibility of remote monitoring of the patients' condition.

崔谨想 . 下肢外骨骼机器人系统建模与仿真实验研究 [D ] . 哈尔滨 : 哈尔滨工业大学 , 2014 .

CUI J X . Research on modeling and simulation experiment of the lower extremity exoskeleton robot [D ] . Harb in:Harbin Institute of Technology, 2014 . (in Chinese)

李玟卓 , 喻洪流 , 王多琎 . 穿戴式下肢外骨骼机器人测试平台设计与动力学分析 [J ] . 生物医学工程学进展 , 2022 , 43 ( 2 ): 63 - 67 .

LI W Z , YU H L , WANG D J . Design and dynamic analysis of test platform for wearable lower limb exoskeleton robot [J ] . Progress in Biomedical Engineering , 2022 , 43 ( 2 ): 63 - 67 . (in Chinese)

鲁泽华 , 管小荣 , 樊黎霞 . 面向助力外骨骼效能评估的灰色层次分析法 [J ] . 机械设计与制造 , 2018 , 39 ( 5 ): 249 - 252 .

LU Z H , GUAN X R , FAN L X . Efficiency evaluation based on grey-ahp method for powered exoskeleton [J ] . Machinery Design & Manufacture , 2018 , 39 ( 5 ): 249 - 252 . (in Chinese)

李佳璐 , 涂细凯 , 伍赛 , 等 . 基于用户体验的外骨骼机器人舒适性研究 [J ] . 机械设计 , 2019 , 36 ( 7 ): 125 - 130 .

LI J L , TU X K , WU S , et al. Study of exoskeleton robot comfort based on user experience [J ] . Journal of Machine Design , 2019 , 36 ( 7 ): 125 - 130 . (in Chinese)

陈建华 , 穆希辉 , 杜峰坡 , 等 . 评价指标体系下的外骨骼支撑相控制效果 [J ] . 科技导报 , 2019 , 37 ( 13 ): 88 - 92 . DOI: 10.3981/j.issn.1000-7857.2019.13.013 http://doi.org/10.3981/j.issn.1000-7857.2019.13.013 针对一种下肢外骨骼机器人，设计了一种基于步态识别的阻抗自调整控制方法，并通过实验验证，与传统的位置控制、阻抗恒定控制方法进行了对比分析。通过建立一套基于雷达图的指标体系，对不同的外骨骼支撑相控制实验结果进行了科学评价，发现阻抗自调整控制能够保证外骨骼在支撑相不同阶段满足不同的运动需求，与传统阻抗控制方法相比具有最优的总体运动效果。

CHEN J H , MU X H , DU F P , et al. Study on control effect of exoskeleton during support phase through an evaluation indicator system [J ] . Science & Technology Review , 2019 , 37 ( 13 ): 88 - 92 . (in Chinese)

徐兰兰 . 助力外骨骼性能评价指标和方法 [D ] . 成都 : 电子科技大学 , 2021 .

XU L L . Performance evaluation index and method of assisted exoskeleton [D ] . Chengdu : University of Electronic Science and Technology , 2021 . (in Chinese)

SHORE L , POWER V , HARTIGAN B , et al. Exoscore: a design tool to evaluate factors associated with technology acceptance of soft lower limb exosuits by older adults [J ] . Human Factors , 2020 , 62 ( 3 ): 391 - 410 . DOI: 10.1177/0018720819868122 http://doi.org/10.1177/0018720819868122 This pilot study proposed and performs initial testing with Exoscore, a design evaluation tool to assess factors related to acceptance of exoskeleton by older adults, during the technology development and testing phases.As longevity increases and our aging population continues to grow, assistive technologies such as exosuits and exoskeletons can provide enhanced quality of life and independence. Exoscore is a design and prototype stage evaluation method to assess factors related to perceptions of the technology, the aim being to optimize technology acceptance.In this pilot study, we applied the three-phase Exoscore tool during testing with 11 older adults. The aims were to explore the feasibility and face validity of applying the design evaluation tool during user testing of a prototype soft lower limb exoskeleton.The Exoscore method is presented as part of an iterative design evaluation process. The method was applied during an exoskeleton research and development project. The data revealed the aspects of the concept design that rated favorably with the users and the aspects of the design that required more attention to improve their potential acceptance when deployed as finished products.Exoscore was effectively applied to three phases of evaluation during a testing session of a soft exoskeleton. Future exoskeleton development can benefit from the application of this design evaluation tool.This study reveals how the introduction of Exoscore to exoskeleton development will be advantageous when assessing technology acceptance of exoskeletons by older adults.

MIZUKAMI M , YOSHIKAWA K , KAWAMOTO H , et al. Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study [J ] . Disability and Rehabilitation—Assistive Technology , 2017 , 12 ( 2 ): 197 - 204 .

YEH Y Y , WICKENS C D . Dissociation of performance and subjective measures of workload [J ] . Human factors , 1988 , 30 ( 1 ): 111 - 120 .

BADESA F J , DIEZ J A , BARIOS J A , et al. Evaluation of performance and heart rate variability during intensive usage of a BCI-controlled hand exoskeleton [C ] //Proceedings of the 2020 8th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob). New York, NY , US : IEEE , 2020 : 164 - 169 .

CATALAN J M , TRIGILI E , NANN M , et al. Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs) [J ] . Journal of NeuroEngineering and Rehabilitation , 2023 , 20 : 61 . DOI: 10.1186/s12984-023-01185-w http://doi.org/10.1186/s12984-023-01185-w The aging of the population and the progressive increase of life expectancy in developed countries is leading to a high incidence of age-related cerebrovascular diseases, which affect people's motor and cognitive capabilities and might result in the loss of arm and hand functions. Such conditions have a detrimental impact on people's quality of life. Assistive robots have been developed to help people with motor or cognitive disabilities to perform activities of daily living (ADLs) independently. Most of the robotic systems for assisting on ADLs proposed in the state of the art are mainly external manipulators and exoskeletal devices. The main objective of this study is to compare the performance of an hybrid EEG/EOG interface to perform ADLs when the user is controlling an exoskeleton rather than using an external manipulator.Ten impaired participants (5 males and 5 females, mean age 52 ± 16 years) were instructed to use both systems to perform a drinking task and a pouring task comprising multiple subtasks. For each device, two modes of operation were studied: synchronous mode (the user received a visual cue indicating the sub-tasks to be performed at each time) and asynchronous mode (the user started and finished each of the sub-tasks independently). Fluent control was assumed when the time for successful initializations ranged below 3 s and a reliable control in case it remained below 5 s. NASA-TLX questionnaire was used to evaluate the task workload. For the trials involving the use of the exoskeleton, a custom Likert-Scale questionnaire was used to evaluate the user's experience in terms of perceived comfort, safety, and reliability.All participants were able to control both systems fluently and reliably. However, results suggest better performances of the exoskeleton over the external manipulator (75% successful initializations remain below 3 s in case of the exoskeleton and bellow 5s in case of the external manipulator).Although the results of our study in terms of fluency and reliability of EEG control suggest better performances of the exoskeleton over the external manipulator, such results cannot be considered conclusive, due to the heterogeneity of the population under test and the relatively limited number of participants.© 2023. The Author(s).

LIU D , CHEN W H , PEI Z C , et al. A brain-controlled lower-limb exoskeleton for human gait training [J ] . Review of Scientific Instruments , 2017 , 88 : 104302 .

EICHER C , HAESNER M , SPRANGER M , et al. Usability and acceptability by a younger and older user group regarding a mobile robot-supported gait rehabilitation system [J ] . Assistive Technology , 2019 , 31 ( 1 ): 25 - 33 . DOI: 10.1080/10400435.2017.1352051 http://doi.org/10.1080/10400435.2017.1352051 The aim of the study was to identify differences regarding usability, acceptability, and barriers of usage of a robot-supported gait rehabilitation system between a younger and older group of patients with gait impairments. A mobile robot-supported gait rehabilitation prototype was tested on a group of geriatric patients aged 60 and above, and on a group of young patients aged 59 and below in a clinical setting during five therapy sessions. The involved therapists received 2 days training with the system and could test it profoundly. Data on usability, acceptability, and barriers to system usage were collected with questionnaires and structured interviews with the patients. The robotic system received overall moderate usability and good acceptability ratings; it was rated as clearly structured, practical, and safe. Analyses identified a few barriers, such as time-intensive setup of the system or tight leg shells, which can be minimized with regular training and system adaptations. Differences between the two user groups could be revealed and will be used for future investigation. This study showed the potential of the mobile robot-supported system for gait rehabilitation, but also pointed out further need for action. Efficacy studies are the next step in the evaluation process.

TSAI Y L , HUANG J J , PU S W , et al. Usability assessment of a cable-driven exoskeletal robot for hand rehabilitation [J ] . Frontiers in Neurorobotics , 2019 , 13 : 3 .

RESQUIN F , GONZALEZ-VARGAS J , IBANEZ J , et al. Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study [J ] . Journal of NeuroEngineering and Rehabilitation , 2017 , 14 : 104 . DOI: 10.1186/s12984-017-0312-4 http://doi.org/10.1186/s12984-017-0312-4 Background: Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function.Methods: The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed.Results: In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool.Conclusions: The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients' reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system.

ARMANNSDOTTIR A L , BECKERLE P , MORENO J C , et al. Assessing the involvement of users during development of lower limb wearable robotic exoskeletons: a survey study [J ] . Human Factors , 2020 , 62 ( 3 ): 351 - 364 . DOI: 10.1177/0018720819883500 http://doi.org/10.1177/0018720819883500 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.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.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.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.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.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.

赵新刚 , 谈晓伟 , 张弼 . 柔性下肢外骨骼机器人研究进展及关键技术分析 [J ] . 机器人 , 2020 , 42 ( 3 ): 365 - 384 . DOI: 10.13973/j.cnki.robot.190474 http://doi.org/10.13973/j.cnki.robot.190474 首先简要描述了下肢外骨骼机器人在康复、工业以及军事等领域的应用需求，并对刚性与柔性下肢外骨骼系统（RLEEX/SLEEX）的优缺点、研究难点和适用人群进行了分析与对比．然后，对国内外研究机构在柔性下肢外骨骼机器人方面的研究历程与进展进行详细综述，重点描述了系统样机的结构与驱动特点、传感器布局方式、控制策略搭建以及助力效能评估等几项研究内容．最后，围绕柔性结构、意图识别、控制策略及助力评估共四方面关键技术进行了总结，并对未来发展趋势进行展望．

ZHAO X G , TAN X W , ZHANG B . Development of soft lower extremity exoskeleton and its key technologies: a survey [J ] . Robot , 2020 , 42 ( 3 ): 365 - 384 . (in Chinese) DOI: 10.13973/j.cnki.robot.190474 http://doi.org/10.13973/j.cnki.robot.190474 Firstly, the application requirements of lower extremity exoskeletons in rehabilitation, industry as well as military fields are introduced briefly, and the pros and cons, research problems and applicable population of rigid and soft lower extremity exoskeletons (RLEEX/SLEEX) are analyzed and compared. Subsequently, the research process and progress of SLEEX at home and abroad are illustrated in great detail, especially in mechanisms and actuation, sensors layout, development of control strategies as well as assessment of the assistance performance. Finally, the key technologies related to the SLEEX, including soft structure, human intention recognition, control strategies and assistance assessment, are summarized, and the future research direction is prospected.

WANG D J , GU X P , LI W Z , et al. Evaluation of safety-related performance of wearable lower limb exoskeleton robot (WLLER): a systematic review [J ] . Robotics and Autonomous Systems , 2023 , 160 : 104308 .

DE BOCK S , GHILLEBERT J , GOVAERTS R , et al. Passive shoulder exoskeletons: more effective in the lab than in the field? [J ] . IEEE Transactions on Neural Systems and Rehabilitation Engineering , 2021 , 29 ( 12 ): 173 - 183 .

李龙飞 , 朱凌云 , 苟向锋 . 可穿戴下肢外骨骼康复机器人研究现状与发展趋势 [J ] . 医疗卫生装备 , 2019 , 40 ( 12 ): 89 - 97 .

LI L F , ZHU L Y , GOU X F . Current status and development trend of wearable lower-limb exoskeleton rehabilitation robot [J ] . Chinese Medical Equipment Journal , 2019 , 40 ( 12 ): 89 - 97 . (in Chinese)