Improving stability of people wearing a lower extremity Wearable Exoskeleton (WE) is one of the biggest challenges in the field. The goal of this preliminary study was to improve balance recovery from perturbations in people with incomplete Spinal Cord Injury (SCI) assisted by a WE with specifically developed balance controller. The WE has actuated ankle and knee joints, which were controlled by using a body sway-based balance controller. Two test pilots participated in 5 training sessions, devoted to enhance the use of the robot, and in pre/post assessments. Their balance during quiet standing was perturbed through pushes in forward direction. The controller was effective in supporting balance recovery in both tests pilots as reflected by a smaller sway amplitude and recovery time when compared with a minimal impedance controller. Moreover, the training resulted in a further reduction of the sway amplitude and recovery time in one of the test pilots whereas it had not an additional beneficial effect for the other subject. In conclusion, the novel balance controller can effectively assist people with incomplete SCI in maintaining standing balance and a dedicated training has the potential to further improve balance.

Versatility is important for a wearable exoskeleton controller to be responsive to both the user and the environment. These characteristics are especially important for subjects with spinal cord injury (SCI), where active recruitment of their own neuromuscular system could promote motor recovery. Here we demonstrate the capability of a novel, biologically-inspired neuromuscular controller (NMC) which uses dynamical models of lower limbmuscles to assist the gait of SCI subjects. Advantages of this controller include robustness, modularity, and adaptability. The controller requires very few inputs (i.e., joint angles, stance, and swing detection), can be decomposed into relevant control modules (e.g., only knee or hip control), and can generate walking at different speeds and terrains in simulation. We performed a preliminary evaluation of this controller on a lower-limb knee and hip robotic gait trainer with seven subjects (N = 7, four with complete paraplegia, two incomplete, one healthy) to determine if the NMC could enable normal-like walking. During the experiment, SCI subjects walked with body weight support on a treadmill and could use the handrails. With controller assistance, subjects were able to walk at fast walking speeds for ambulatory SCI subjects-from 0.6 to 1.4 m/s. Measured joint angles and NMC-provided joint torques agreed reasonably well with kinematics and biological joint torques of a healthy subject in shod walking. Some differences were found between the torques, such as the lack of knee flexion near mid-stance, but joint angle trajectories did not seem greatly affected. The NMC also adjusted its torque output to provide more joint work at faster speeds and thus greater joint angles and step length. We also found that the optimal speed-step length curve observed in healthy humans emerged formost of the subjects, albeit with relatively longer step length at faster speeds. Therefore, with very few sensors and no predefined settings for multiple walking speeds or adjustments for subjects of differing anthropometry and walking ability, NMC enabled SCI subjects to walk at several speeds, including near healthy speeds, in a healthy-like manner. These preliminary results are promising for future implementation of neuromuscular controllers on wearable prototypes for real-world walking conditions.