Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 8833461, 8 pages https://doi.org/10.1155/2021/8833461 Research Article Lower-Limb-Assisting Robotic Exoskeleton Reduces Energy Consumption in Healthy Young Persons during Stair Climbing 1 1,2 2,3 Hanseung Woo , Kyoungchul Kong , and Dong-wook Rha Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea Angel Robotics, Seoul 04798, Republic of Korea Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea Correspondence should be addressed to Kyoungchul Kong; email@example.com and Dong-wook Rha; firstname.lastname@example.org Received 3 July 2020; Accepted 12 April 2021; Published 26 April 2021 Academic Editor: Nan Xiao Copyright © 2021 Hanseung Woo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Many robotic exoskeletons for lower limb assistance aid walking by reducing energy costs. However, investigations examining stair- climbing assistance have remained limited, generally evaluating reduced activation of related muscles. This study sought to investigate how climbing assistance by a robotic exoskeleton aﬀects energy consumption. Ten healthy young participants wearing a robotic exoskeleton that assists ﬂexion and extension of hip and knee joints walked up nine ﬂights of stairs twice at a self-selected speed with and without stair-climbing assistance. Metabolic cost was assessed by measuring oxygen consumption, heart rate, and the time to climb each ﬂight of stairs. Net oxygen cost (NOC) and total heart beats (THB) were used as measures of metabolic cost, accounting for diﬀerent climbing speeds. Stair-climbing assistance reduced NOC and THB by 9.3% (P <0:001 ) and 6.9% (P =0:003), respectively, without aﬀecting climbing speed. Despite lack of individual optimization, assistive joint torque applied to the hip and knee joints reduced metabolic cost and cardiovascular burden of stair climbing in healthy young males. These results may be used to improve methods for stair ascent assistance. 1. Introduction pressure source, with the energy cost advantage observed only on a treadmill at a constant walking speed. Various robotic exoskeletons for lower limb assistance have The metabolic cost beneﬁts of the portable autonomous been developed to aid walking, the most common method ankle exoskeleton developed by Mooney et al. [6, 7] were similarly veriﬁed in a controlled environment. Recent studies of human locomotion. Investigations of walking mechanics have provided the foundation for the development of such demonstrated that walking assistance by a tethered multi- robots. Kinematics of lower limb joints have been used to joint soft exosuit signiﬁcantly reduced metabolic costs [8, determine the range of motion and the degree of freedom 9]. Furthermore, an autonomous version of the soft exosuit of robotic joints , whereas kinetics have been used to reduced the metabolic cost of walking together with a carry- determine the required robot joint power . Together, kine- ing load [10, 11]. In a case study of overground walking assis- matics and kinetics have provided important insights into the tance with two subjects, the autonomous soft exosuit also development of appropriate walking assistance methods. reduced the metabolic cost of loaded walking over a 500 m The beneﬁts of walking assistance provided by robotic cross-country trail . exoskeletons have been evidenced as reduced energy costs. Although stair climbing is almost as frequent as walking, For instance, ankle exoskeletons utilizing pneumatic muscles the biomechanical characteristics of the two types of motion to assist ankle plantar ﬂexion have been shown to reduce the are distinct from each other. Relative to walking, stair climb- metabolic cost of walking [3–5]. However, these exoskeletons ing, characterized by large joint moment and power, were not fully mobile, as they were powered by an external air increases joint ﬂexion in the hip, knee, and ankle in the 2 Applied Bionics and Biomechanics Control board & battery Signal processing Control algorithm implementation Active hip joint Gait phase detection 1 active DOF (F/E) 2 passive DOF Rotation angle measurement Active knee joint 1 active DOF (F/E) Rotation angle measurement Passive ankle joint 3 passive DOF Air pressure sensors AFO Ground reaction force estimation (Modular Dynamic AFO, Fillauer, Chattanooga, TN, USA) Figure 1: A robotic exoskeleton for lower limb assistance. DOF: degree of freedom; AFO: ankle-foot orthosis; F/E: ﬂexion/extension. sagittal plane. During stair climbing, power generation in the passive ankle joints. Active joints were powered by electrical knee joint is dominant relative to power absorption, and the motors with a gear ratio of 76 : 1, with assistive torque deliv- total positive network of the joints is larger than that during ered to the wearer’s joints in the sagittal plane. Active joints walking [13, 14]. Given that stair climbing requires consider- adopted a series elastic actuation mechanism [21, 22], able joint torque, positive power, and positive network, assis- enabling accurate control of the interaction torque between tance provided by a wearable robot is expected to reduce the robot and human joints. Dynamic ankle-foot orthosis was energetic cost of ascent by providing assistive torque to the used as the passive ankle joint to support the weight of the wearer’s joints. exoskeleton and to provide a suﬃcient degree of freedom in Previous reports have proposed climbing assistance the wearer’s ankle joint. Foot pressure under the metatarsal methods facilitated by robotic exoskeletons. Despite utilizing joint and the heel was measured using silicon tubes and air diﬀerent exoskeletons, actuators, sensors, and target users, pressure sensors to estimate the ground reaction force . several studies have veriﬁed, using electromyography, the All algorithms required to operate the exoskeleton, such as eﬀects of stair-climbing assistance on subjects capable of per- sensor signal processing and the control algorithm, were forming voluntary leg motions [15–17]. Yet, to date, the implemented using the embedded control board (sbrio eﬀects of exoskeleton-mediated climbing assistance on ener- 9651, National Instruments, TX, USA) and software (Lab- getic costs have not been considered, with a limited number VIEW 2015, National Instruments, TX, USA). The embed- of studies analyzing the metabolic eﬀects of assistance for ded control board and battery, enclosed in a backpack, other related motions. For instance, assistance provided by enabled the exoskeleton to be fully mobile. The total weight a knee exoskeleton during step-up-and-down  and squat- of the robotic exoskeleton was 13 kg. ting  exercises has been shown to reduce the heart rate and the metabolic equivalent of task , respectively. Pres- 2.3. Assistance Strategy for a Stair-Climbing Motion. Com- ently, we sought to investigate the energy consumption eﬀect mon robotic joints are actuated by motors and gear reducers of stair-climbing assistance provided by a robotic exoskele- to amplify output torque to the desired magnitude. However, ton. Speciﬁcally, we tested oxygen consumption and heart such a gear train is associated with large resistive torque. To rate during a nine-ﬂight stair climb in the absence or pres- remove the resistance and allow the wearer to move freely ence of assistance from an autonomous (i.e., fully mobile) without discomfort, the robotic exoskeleton used a zero- robotic exoskeleton with rigid frames and braces providing impedance control (ZIC) algorithm [21, 24–26]. As shown assistive torque to the hip and knee joints. in Figure 2, the ZIC application reduced the interaction tor- que between robotic and human joints such that it lies under 0.87 Nm. Also, it allowed the wearer to move the joint much 2. Materials and Methods faster with reduced resistive force. 2.1. Participants. Nondisabled male subjects (N =10, age = Following ZIC-mediated removal of resistance, assistive torque can be provided via an assist-as-needed strategy [27, 28:3±1:7 years, weight = 68:8±5:5 kg, height = 173:8± 5:1 cm) participated in this study. None of the subjects have 28], which requires the determination of the timing for the been diagnosed with musculoskeletal or neurologic disorders application of the assistive torque. Previous studies [5, 29, 30] have used actuation onset timing, with a predeﬁned assis- aﬀecting walking or stair climbing. Ethical approval was granted by the institutional review board and ethics commit- tive force provided at onset timing determined based on the percentages of a gait cycle. Presently, we employed a similar tee (4-2017-0578). strategy for the stair-climbing assistance. 2.2. Robotic Exoskeleton. The robotic exoskeleton used in this An investigation by Riener et al. of stair-climbing biome- study (Figure 1) consisted of active hip and knee joints and chanics and motor coordination  revealed substantial Applied Bionics and Biomechanics 3 2.5 1.5 0.5 0 510 15 20 Time (sec.) ZIC on ZIC off (a) –2 –4 05 10 15 20 Time (sec.) ZIC on ZIC off (b) Mechanical impedance of PID controlled SEA –20 0 1 10 10 Frequency (Hz) ZIC on ZIC off (c) Figure 2: Reduced mechanical impedance (resistive force) on the knee joint of the robotic exoskeleton after applying ZIC: (a) an arbitrary motion applied to the joint; (b) a resistive force against motion inputs; (c) a mechanical impedance deﬁned as the magnitude of the ratio of the resistive force to the joint velocity in the frequency domain. extension torque of the hip and knee joints during the early where t , τ , and t indicate onset time, peak value of the i p p section of the stance phase. Flexion torques are also observed assistive torque, and time to reach, τ , respectively. When in both joints during the initial section of the swing phase. τ ðtÞ =0, the desired interaction torque is zero, indicating a The developed assistive joint torque proﬁle for stair climbing zero-impedance mode. Positive and negative values of τ emulated the joint torques during the early sections of the indicate extension and ﬂexion torque, respectively. To pro- stance and swing phases. The assistive torque proﬁle for the vide assistive torque during the early section of both phases, hip and knee joints can be simpliﬁed and parameterized as t can be set as the time when each phase is detected by ana- ! ! > lyzing the ground reaction forces . Determination of −0:5 τ cos ðÞ t − t − τ ,if t ∈ t , t +2t , p i p i i p onset timing by phase detection, rather than via percentage τ ðÞ t = p > of gait cycle assessment, allowed the synchronization of assis- 0, otherwise, tive torque with the wearer’s motion regardless of climbing ð1Þ speed changes. To prevent assistive torque for level-ground Angle (rad) Magnitude (dB) Resistive torque (Nm) 4 Applied Bionics and Biomechanics walking during the stair climb, the assistance algorithm ZIC assessed the current ground state. The workﬂow of stair- climbing assistance is shown in Figure 3. The τ and t , not optimized for each subject, were set p p no On stair? empirically using preliminary experiments (Table 1). The assistive torques deﬁned in the time domain were equally yes applied to all subjects after initiation of motion. However, their application varied in a subject-speciﬁc manner based Stair-climbing assistance on stair-climbing speed and stance cycles (Figure 4). no no Stance Swing 2.4. Experimental Protocol. The subjects were asked to rest for detected? detected? at least 5 min in a sitting position. Subsequently, oxygen con- sumption and heart rates were measured for 2 min in a stand- yes yes ing position using a portable metabolic system (K4b2, Extension assistance Flexion assistance COSMED, Rome, Italy) and a heart rate monitor (TICKR (hip & knee) (hip & knee) X, Wahoo, Atlanta, United States), respectively. Following the establishment of the resting heart rate (±5 beats per Figure 3: Workﬂow schematic of the stair-climbing assistance provided by the robotic exoskeleton. ZIC: zero-impedance control. min), the subjects climbed nine ﬂights of stairs (total of 195 steps; 20 steps per level through the 7th ﬂoor and 25 steps Table 1: Deﬁned assistive torque parameters. τ : peak value of the per level from the 7th ﬂoor to the 10th ﬂoor) twice at a self- p assistive torque; t : time taken to reach the τ . selected speed. One trial was carried out without assistance p p (i.e., zero-impedance mode), with stair-climbing assistance Stance phase Swing phase applied for the other trial, and the order of trials was random- Joint τ t τ t p p p p ized. Subjects rested for at least 10 min between trials. During Hip -27 Nm 0.25 s 16 Nm 0.2 s climbing, oxygen consumption, heart rate, and time to climb Knee -29 Nm 0.25 s 12 Nm 0.2 s each level were measured. A practice period was provided to help subjects adapt to the wearable robot, with a maximum of two practice periods allowed. 2.5. Data Processing. Acustom m-ﬁle (MATLAB, Math- Works, Natick, MA, USA) was used for data processing. Oxy- 20 gen consumption and heart rate values were smoothed to 15 1.32 s eliminate measurement noise and outliers using smooth.m, 1.16 s with span = 10%,and method = rloess, where span is the 1.00 s length of the moving window as a percentage of the raw data, with the rloess method applying a second-order regression to the raw data from which the outlier is excluded . Net oxy- gen cost (NOC) was calculated as the diﬀerence between the 0 102030405060708090 100 oxygen consumption rate and the average resting oxygen con- Stance cycle (%) sumption rate divided by the stair-climbing speed . Total heart beats (THB)  during the climbing session were cal- AVG - STD culated by numerical integration of the heart rate. The average AVG AVG + STD climbing speed was calculated by dividing the number of steps by the climbing time. NOC, THB, and average climbing speed Figure 4: Example of knee extension torque for diﬀerent stance of the two climbing trials were compared using a paired t-test, times with the same t (0.25 s). AVG and STD indicate the mean with P values < 0.05 considered statistically signiﬁcant. The and standard deviation of the stance time of the subject, respectively. paired t-test was performed using SPSS ver. 24 (SPSS Inc., Chicago, IL, USA). 4. Discussion 4.1. Stair-Climbing Speed. In contrast to previous studies uti- 3. Results and Discussion lizing treadmills, the present experiments were conducted 3.1. Results. On average, stair-climbing assistance reduced using nine ﬂights of physical stairs. Despite the lack of a con- trolled experimental environment with strict regulation of NOC and THB by 9.3% (P <0:001) and 6.9% (P =0:003), respectively (Figure 5). For all subjects, although the average climbing speed and motion analysis, these results more closely speed per level varied during climbing, no signiﬁcant reﬂect real-life circumstances. With the ability to self-select climbing speed, the subjects demonstrated individual and between-trial diﬀerences were observed (Figure 6). Knee extension torque (Nm) Applied Bionics and Biomechanics 5 P < 0.001 P = 0.003 0.5 0.45 0.4 0.35 0.3 0.25 0.2 ZIC ASSIST ZIC ASSIST (a) (b) Figure 5: Stair-climbing net oxygen cost (NOC) and total heart beats (THB). NOC (a) and THB (b) were calculated for a 9-level stair climb with (ASSIST) and without climbing assistance (ZIC). 2345678 910 Level (a) 2345678 910 Level (b) Figure 6: Average climbing speed. Climbing speed was measured under zero-impedance control (a) or climbing assistance (b) conditions. Net oxygen cost (ml/kg/step) Stair-climbing speed (steps/min) Stair-climbing speed (steps/min) Total heart beats (beats) 6 Applied Bionics and Biomechanics drawback, this study demonstrated, for the ﬁrst time, reduc- within-climb diﬀerences in ascent speeds. However, the ZIC and assist conditions did not result in signiﬁcant diﬀerences tion in climbing-associated energy consumption using a in the average stair-climbing speeds. These results indicated THKAF-type exoskeleton. Presently, equal assistive torque was provided to all sub- that, under the conditions tested, stair-climbing assistance has no eﬀect on climbing speed. jects, with parameters (Table 1) empirically determined using preliminary studies. However, subject-speciﬁc assistive tor- 4.2. NOC Reduction. Multiple studies of exoskeleton assis- que parameters may maximize the assistance eﬀect for tance [3–11], utilizing a treadmill environment to regulate individual subjects. Recent studies have demonstrated that optimization of individual assistive force proﬁles can further walking speed, evaluated steady-state values of oxygen con- sumption and heart rate as indices of metabolic cost. Pres- reduce energy consumption [11, 36]. Thus, subject-speciﬁc ently, we also considered the self-selected climbing speed optimization of the assistive torque provided by the exoskel- for the assessment of metabolic cost. Plasschaert et al. previ- eton tested here may result in improved climbing assistance ously deﬁned NOC as the diﬀerence between the average eﬀects. However, despite identical assistive torques, the pres- ent study demonstrated eﬀective stair-climbing assistance for oxygen consumption rate during walking and that during resting divided by the average walking speed . Substitut- all subjects. ing the average climbing speed (steps/min) into the equation, Multiple studies have compared metabolic costs between we found that the metabolic cost decreased by 9.3% in the robotic assistance and no-robot or unpowered conditions [5, presence of stair-climbing assistance. 8, 9, 36, 37]. However, the use of nondisabled subjects proﬁ- cient in performing the tested physical tasks unassisted can 4.3. THB Reduction. In a manner similar to NOC, the heart mask the eﬀects of assistance. The assistance eﬀect can only rate should also be analyzed in a nonsteady state induced emerge when the assistance overcomes the negative eﬀects by climbing speed changes. Hood et al. deﬁned the THB on energy consumption of factors such as exoskeleton index as the ratio of THB during the exercise period to the weight, robot-imposed limitations in joint degree of freedom, and resistive forces of robotic joints . Ding and colleagues total traveled distance . As the subjects covered the same climbing distance in the present study, unadjusted THB [8, 36] used a tethered actuation system to facilitate assis- values were considered. In addition to serving as an accurate tance without increasing the weight load on the subjects. In and convenient estimate of energy expenditure, the heart rate cases where power sources could not be separated from the also directly reﬂects the cardiac burden of a person. Pres- robot body, unpowered conditions have been used as con- trols to identify the assistance eﬀect [5, 37]. However, it is ently, THB decreased by 6.9% following robotic exoskeleton assistance, suggesting that climbing assistance can reduce also necessary to guarantee compliance of the robotic joints cardiovascular burden. using speciﬁc mechanisms or control algorithms. Presently, as the actuation parts of the exoskeleton could not be 4.4. Methodological Issues and Limitations. The present study separated from the robot body, ZIC was applied to ensure compliance of the robotic joints, with the metabolic cost used a trunk-hip-knee-ankle-foot- (THKAF-) type multi- joint robotic exoskeleton . Exoskeletons of this type have compared to that under conditions of applied assistance. been used to provide full assistance to paraplegic patients to Thus, the possibility that the exoskeleton increases metabolic costs relative to no-robot conditions represents another move their legs. Using such exoskeletons on nondisabled wearers requires the exoskeletal joints to have zero imped- limitation of this study. Such limitations, reported in other studies [3, 4], can be addressed by reducing exoskeleton ance, or zero torque . Ankle exoskeletons for walking assistance have provided energetic cost advantages due to weight, improving wearability, and ensuring greater degree negligible device weight and minimal interference in joint of freedom of leg joints. function. Multijoint soft exosuits, utilizing special actuation and power transmission mechanisms, have also considerably 5. Conclusions reduced metabolic costs due to limited weight and minimized resistive force. During stair climbing, the function of the knee Stair-climbing assistance provided by an exoskeleton that joint (i.e., torque, power, and work) supersedes that of other assists ﬂexion and extension of hip and knee joints reduced joints , with most exoskeletons for stair-climbing the metabolic cost and cardiovascular burden in healthy assistance previously developed as knee-type devices. Thus, young males climbing nine ﬂoors of stairs. stair-climbing assistance using a THKAF-type exoskeleton was expected to be eﬀective for metabolic cost reduction. Data Availability Despite its considerable weight, the THKAF-type exo- skeleton was suﬃciently portable to perform experiments The data used to support the ﬁndings of this study are avail- using a physical stair environment. 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Published: Apr 26, 2021