PRIN 2022: ASSIST

In the last years digitalization and novel devices have improved the treatment of many diseases, many of which can be treated from home by the patients themselves. This has improved the recovery of the patients, while reducing the hospital burden. Good results are achieved when rehabilitation takes place in an environment that is familiar to a patient [1].

Among novel devices, motion-assisting devices can be useful in rehabilitation therapies and exercises of elderly people training [2]. Such therapies and trainings span across long period of times, especially if stoke [3] and COVID-19 post-acute phase [4-5] are considered. Stroke patients require appropriate and persistent rehabilitation to recover lost abilities and to get back to their normal daily lives. Hence, a large number of therapists are needed to cope with the demand of assistive therapies since, in general, patients receive rehabilitation sessions with therapist assistance [6]. To cope with this problem, rehabilitation support system that allows patients to carry out rehabilitation exercises by themselves becomes essential as pointed out for example in Ref. [7]. In fact, by using motion-assisting devices the patient can perform the exercises alone or with little help, reducing the burden on the therapists. A rehabilitation therapy that can be performed by the patient themselves at home is called self-controlled rehabilitation [8] and requires system which can find a large market.

There is a growing interest in rehabilitation devices. Many of them focus on the rehabilitation of stroke patients [9], but the recent pandemic has shown the importance of such devices to treat other diseases [5], such as the repurposing of devices to cure COVID-19 patients [10]. In order to be used at home by the patients and help the therapists, a device must address, among them [10]:

• Comfortability, portability and wearability, since they limit the both the functionality and the user autonomy;
• Auto-regulation, since every patient is different, and so must be the therapy;
• Monitoring and home use, since data is important for the log of the rehabilitation phase, and the user must be able to activate the exercise on its own;
• Safety.

There are many typologies of motion-assisting devices [11-12]. Among them, Cable Driven Parallel Robots (CDPRs) have gained interest during the years. Such devices use cables to move structures in 3D space and perform exercises. Motion-assisting devices can be useful mainly in rehabilitation therapies and training exercises of elderly people training. Not only stroke patients require appropriate and persistent rehabilitation to recover lost abilities and to get back to their normal daily lives. Physiotherapists commonly help elderly individuals with problems, such as reduced mobility, muscle weakness and decreased independence. Elderly rehabilitation and exercises may include exercising to increase muscle strength, range of movements and activities for better fitness levels. On other hand, CDPRs offer structures which can be more portable, user-oriented solutions and with lower manufacturing costs. The actuating cables are intrinsically safe for the user thanks to the lack of moving parts with high inertia often seen in other devices. Moreover, CDPRs are well-known to be more appealing than classical parallel robots (i.e., made of rigid links) in terms of large workspace, reconfigurability, large payload capacity and high dynamic performance [13].

One of the most known CDPR is NeReBot [14], which has great performances but lacks in portability, thus is not suitable for home use. Most of the systems that can be found in literature [11-12] have proven to be valuable tools in the recovery of arm function, but they seem not suitable for selfcontrolled rehabilitation therapy.

The focus of the ASSIST project is on the rehabilitation of the entire upper limb, by improving a cable-driven device called CADEL [1]. Such device is made up of two structures, one attached to the arm and the other to the forearm, connected via cables. The cables are pulled via electric motors, and are set in couples, such as one of the two is the antagonist of the other, acting as a couple of muscles. CADEL is a device is focused on the home use [10], but is currently limited to the rehabilitation of the elbow, although similar design has been used for ankle rehabilitation [15].

In this project, the device to be designed will aim at helping the rehabilitation of both the elbow and the shoulder, while maintaining the features shown in [10] and adding new features, such as tele-monitoring. To do so, the control devices, the actuators and the power sources must be designed to ensure both functionality, safety, portability and easiness of use.

The ASSIST project is aimed at the development of ASSIST exoskeleton, a modular structure portable cable system for easy wearing on arms and legs in limb motion assistance. The ASSIST exoskeleton that we intend to define as a result of the project is based on an idea presented at a conceptual level in an Italian patent application and will be further elaborated in the activities of this project in an efficient solution to be designed with user-oriented features for practical implementation of a market product in a near future.

The concept that underlies the development of the portable exoskeleton considers that the skeletal structure and therefore of the limb, in the example arm, is actuated/moved by the muscles with antagonistic actions in a parallel architecture configuration that can be realized with fixing rings for relative movement.

The design solution under investigation is more specifically outlined in term of the cable driven design using ring-shaped fixtures on the limb body that are connected to each other by the actuating cables that are driven by servomotors in those limb-worn fixtures.  It is to be noted that the exoskeleton device is conceived in a conceptual structure with a design solution that is characterized by high portability and user-oriented operation for autonomous use by a user considering that the fastening rings can be made with suitable solutions both of new conception and using products such as pneumatic straps for blood pressure monitoring and adopting suitable cables or tensioning solutions to achieve the relative motion of these fastenings.

The interaction of the requirements and expected functions both on the user side and on the medical operator side is emphasized with the main aspects that must be taken into consideration to create an effective solution with the aforementioned characteristics of portability and autonomy and ease of operation. Those main aspect will affect the technical characteristics relating to the design structure, its control, limb motion assistance with wide capacity, and the characteristics of materials and construction procedures that can ensure the definition and therefore the construction of a prototype with those expected characteristics. In particular, the requirements and expected final characteristics on the patient side, left side in the scheme, can be identified in aspects related to wearing and operating comfort, the possibility of use in a home environment without particular assistance from other operators in easy de vice running, the possibility to use and operate the skeleton in complete autonomy by the user, the suitable systems and sensors of relative sensing for suitable man-machine interactions and creation of the interfaces necessary for monitoring, displaying and storing data in an exercise session, and last but not least the possibility that the exoskeleton system is endowed with such capacity and intelligence as to ensure a certain level of self-regulation to the user’s needs and situation during exercise with or without her/his intervention.

For the part of medical users, the right side of the diagram, it can be considered that the requirements and targets of the exoskeleton device resulting from the research can be considered with aspects that are related to the definition of movements in limb motion assistance with parameters customized to the user, the portability that allows to use the device in home environments but also in hospitals, the possibility of an adjustment of the exercise characteristics by the medical operator on situ and  in telematic form, the possibility of interaction between the patient and the healthcare operator during the definition phase of the exercise of motion  assistance and  during its implementation for monitoring and adjustment in physiotherapy aspects, the necessary medical interfaces to monitor and document the progress of motion exercise and above all its effects with a specific monitoring system that can be adequately installed and implemented on the same exoskeleton device.

The project activities will be focused on the aspects of biomechanical design, exoskeleton sensing and controlling parts. The subjects of research, design and prototyping are indicated in each aspect as referring to the exoskeleton device with a cable-driven parallel architecture integrated with actuators (Act), current sensors (I), and motion sensors of IMU structure (IMU) that are used for motion regulation by the control unit, that will be realized with microprocessor, very likely a NanArduino or similar. The activity will be carried out to design, to install and to operate the components in a proper coordinated way. Medical sensors, as identified during the project activity, will be installed to monitor the status and the effect of the motion assistance in addition to a commercial small EMG. The data will be acquired and processed in a suitable storage unit, that could be part of the electronics on board of the system. very likely a Bluetooth or wife data transmission will be also designed to have online monitoring and data transmission to external computer devices for post-processing and diagnostic analysis.  The system in its configuration for portability and user-oriented features with proper elaboration code for the running of all the systems under the control of the control unit. An energy source in the form of a battery will be also identified with the minimum size for the required power.

The methodologies implemented during the project will refer to analysis, both in numerical and experimental procedures that will be properly developed, to design algorithms and component selections, and to testing experiences to check the feasibility of the components and then the overall performance for a final validation.

The planned design and experimentation activities are planned with task distribution in accordance with the skills of the partners at the University of Rome Tor Vergata and at the University of Padova, as indicated in WP distribution. The expertise of the members is summarized below with indication of few references in reference list of the unit leaders. In addition to research assistants, it is planned to involve also master and PhD students both for their formation and support to the project activity.

The Rome Tor Vergata unit at the industrial engineering department coordinated by Prof. Marco Ceccarelli has three sections, with main activity and repsoability in WP 1 and 3:

1- Coordination and dissemination of the project activities;

2 – Design and biomechanics of the design solutions;

3 – Selection and validation of components for the prototype assembly and testing.

Marco Ceccarelli (Rome, 26 May 1958) received his Ph.D. in Mechanical Engineering from La Sapienza University of Rome, Italy, in 1988. He is Professor of Mechanics of Machines at the University of Rome Tor Vergata, Italy, where he chairs LARM2: Laboratory of Robot Mechatronics. His research interests cover subjects of robot design, mechanism kinematics, experimental mechanics with special attention to parallel kinematics machines, service robotic devices, mechanism design, and history of machines and mechanisms whose expertise is documented by several published papers in the fields of Robotics and Mechanical Engineering. He has been visiting professor in several universities in the world. He is ASME fellow. Professor Ceccarelli serves in several Journal editorial boards and conference scientific committees. He is editor-in-chief of the MDPI journal Robotics and of the SAGE International Journal on Advanced Robotic Systems for the area on Service Robotics He is editor of the Springer book series on Mechanism and Machine Science (MMS) and History of MMS. He has been the President of IFToMM, the International Federation for the Promotion of MMS in 2008-11 and 2016-19. He has started several IFToMM sponsored conferences including (HMM) Symposium on History of Machines and Mechanisms, MEDER (Mechanism Design for Robotics) and MUSME (Multibody Systems and Mechatronics).

The Padova unit has two sections, with main activity and responsibility in WP 2 and 4:

1- Requirements on the functionality of the device;

2- Prototype assembly and implementation.

Giovanni Boschetti (Padova, 09 August 1973) received his Ph.D. in Mechanics of Machines, curriculum Robotics, from the University of Brescia, Italy, in 2005. He is Professor of Mechanics of Machines at the University of Padova, Italy, and since October 2019 he is president of the bachelor and of the graduate program in Mechatronics Engineering of the University of Padova. His current research interests include parallel robotics, cable direct driven robots and industrial automation. He is author or co-author of several papers published in international journals or presented at international conferences and workshops, dealing with theoretical and experimental studies of mechanisms and machine science, performances of parallel robotics, and industrial automation. He is member of the IFToMM Technical Commission for Robotics and Mechatronics. Professor Boschetti serves in several Journal editorial boards and conference scientific committees. He is Guest Editor of several Special Issues of International Journals, also Q1 in the sector of Mechanical Engineering. He holds three international patents and has been involved in multiple international projects, some of which has been funded by the European Commission.

The visibility and dissemination activities of the project results are planned in terms of visibility in social media, publications in national and international contexts, meetings with stakeholders and interested entities, organization of a workshop. It is planned to launch a reference web page with information on the project and on the activities with its results to be updated during the two years of the project. It is also planned to develop an information brochure that can be disclosed and distributed both in the electronic field and on the occasion of meetings, conferences, fairs and other promotional activities. The results of the project will be documented with presentations at both national and international congresses with proceedings published for distribution not only to the congress participants. It is planned to publish the results of the project activities in terms of methodologies and solutions in articles in journals not only to attract interest in the project activity to its results but also to solicit and participate in broader discussions on themes and perspectives of the results of the project activities. Visits and meetings with interested stakeholder identities are planned to promote interest in the project’s activities also with the aim of proposing future collaborations for further research and application in the local, national, and international context, even in European projects. A particular initiative is the organization of a workshop at the end of the project. The workshop will be organized with the aim of discussing the problems of the project activities and at the same time sharing the perspectives of the project results in a colloquial context. Each partner of the project will organize seminars in their academic, local and regional frames, to attract interest for further developments even of a professional nature in the new generations.

Because of the effects of limb disabilities, even in temporary or diminished level of capability, limb motion reduced capabilities have a significant socio-economic cost when considering both the efforts in recovering exercise and therapies in hospital or home environments and the breaks in workload of the affected persons.

The ASSIST project aims to develop a device to help for limb motion exercise and rehabilitation with an innovative solution in terms of structure and operation ensuring portability, easy-wearing, user-oriented operation and regulation. The application potentialities of the project results can be identified not only in an innovative and easy structure design both in production and usage, but also in terms of the user-oriented operation with low-cost and operation simplicity. The scientific problems associated with the development of the proposed modular limb exoskeleton are connected with the research and development of a light weighted directly operated cable-driven parallel manipulator structure integrated with all the sensing, control and power systems on board. The scientific problems concern also the validation and testing of the efficiency in the specific application in limb motion assistance with flexibility and modularity, especially in relation to the expected time of usage. The technological challenge is to obtain an adequate combination of materials and synergistic behaviors that satisfy the clinical-exercise application purpose of motion assistance of limbs directly by the users. The research activities of the project are aimed at investigating the basis of the motion assistance and the related devices and procedures considering the specificities of user who can be patients under recovering or elderly people in exercising for health. The project activities will be carried out within infrastructures available at the partners of units of Tor Vergata and Padova in available spaces both for laboratories and specific study areas with the possibility of also using frames in hospitals or gymnasium. The expected impact is configured in the medical, technological, economic, and social aspects. In particular, the benefits from the medical point of view can be summarized as mentioned above in the user-oriented device that can be operated by the user with proper monitoring of the motion assistance and its effect with evaluation of diagnosis parameter coming from the sensors. From a technological point of view, the result of the research can be considered significant as it considerably simplifies the devoices for limb motion assistance both in structure and operation, with the achievement of a reduction in costs both in production and operating procedures that can be reduced in complexity and timing. Thus, the project is proactive for a considerable reduction in costs related to the exercising elderly people in keeping good health and to the treatment of limb recovering related to stroke or fractures both from a medical-clinical point of view and also from the patient’s point of view as it will also greatly reduce the hospitalization necessary for the treatment of the recovering physiotherapy. This aspect certainly also affects social benefits as the patient can be treated not only in shorter hospitalizations but also with a more rapid recovery and above all with a more reduced immobilization that can also allow a certain regular activity even during the period of recovering the limb motion capabilities.

The problems and solutions for limb motion assistance are objects of investigation and design all around the world both for the increase of elderly people and for the need of fast physiotherapy recovering with solutions even already in the marked that nevertheless show bulky systems and the need of operators for their application and usage by the final users. The expected results of this project in term of a new solution with features that overpass the limits of existing solution mainly in terms of comfort, portability, easy wearing, user-oriented operation, and control will be disseminated at local and international frames with publications and presentation in forum and conferences. The expected exploitation will be planned for a preliminary update of patent release and consequently with attraction of stakeholders interested in a proper marked development of the modular limb exoskeleton device both with home-oriented solutions and structure for hospital frames.

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