With recent improvements in healthcare, individuals with Duchenne muscular dystrophy (DMD) have prolonged life expectancy, and it is therefore vital to preserve their independence. Hand function plays a central role in maintaining independence in daily living. This requires sufficient grip force and the ability to modulate it with no substantially added effort. Individuals with DMD have low residual grip force and its modulation is challenging and fatiguing. To assist their hand function, we developed a novel dynamic hand orthosis called SymbiHand, where the user's hand motor intention is decoded by means of surface electromyography, enabling the control of an electrohydraulic pump for actuation. Mechanical work is transported using hydraulic transmission and flexible structures to redirect interaction forces, enhancing comfort by minimizing shear forces. This paper outlines SymbiHand's design and control, and a case study with an individual with DMD. Results show that SymbiHand increased the participant's maximum grasping force from 2.4 to 8 N. During a grasping force-tracking task, muscular activation was decreased by more than 40% without compromising task performance. These results suggest that SymbiHand has the potential to decrease muscular activation and increase grasping force for individuals with DMD, adding to the hand a total mass of no more than 241 g. Changes in mass distributions and an active thumb support are necessary for improved usability, in addition to larger-scale studies for generalizing its assistive potential.@en

Upper extremity function is affected by a variety of neurological conditions. Robotic exoskeletons offer a potential solution for motor restoration. However, their systematic adoption is limited by challenges relative to human intention detection and device control. This position article offers a focused perspective on this topic. That is, on how knowledge gained from the design and implementation of human-machine interfaces (HMIs) for bionic arms can benefit the field of rehabilitation exoskeletons. Three broadly used HMIs in bionic arms are here investigated, including surface electromyography, impedance, and body-powered control. We propose that combinations of these HMIs could push forward upper extremity exoskeleton development. In this context, we provide concrete applicative examples in two selected clinical scenarios, including post-stroke and Duchenne muscular dystrophy individuals. The discussed solutions can open new avenues for the translation of robotic exoskeletons in a large set of clinical settings and enable a class of exoskeleton technologies that could support a broader range of impairment and disease types.@en

Upper extremity function is affected by a variety of neurological conditions. Robotic exoskeletons offer a potential solution for motor restoration. However, their systematic adoption is limited by challenges relative to human intention detection and device control. This position article offers a focused perspective on this topic. That is, on how knowledge gained from the design and implementation of human-machine interfaces (HMIs) for bionic arms can benefit the field of rehabilitation exoskeletons. Three broadly used HMIs in bionic arms are here investigated, including surface electromyography, impedance, and body-powered control. We propose that combinations of these HMIs could push forward upper extremity exoskeleton development. In this context, we provide concrete applicative examples in two selected clinical scenarios, including post-stroke and Duchenne muscular dystrophy individuals. The discussed solutions can open new avenues for the translation of robotic exoskeletons in a large set of clinical settings and enable a class of exoskeleton technologies that could support a broader range of impairment and disease types.@en

Upper extremity function is affected by a variety of neurological conditions. Robotic exoskeletons offer a potential solution for motor restoration. However, their systematic adoption is limited by challenges relative to human intention detection and device control. This position article offers a focused perspective on this topic. That is, on how knowledge gained from the design and implementation of human-machine interfaces (HMIs) for bionic arms can benefit the field of rehabilitation exoskeletons. Three broadly used HMIs in bionic arms are here investigated, including surface electromyography, impedance, and body-powered control. We propose that combinations of these HMIs could push forward upper extremity exoskeleton development. In this context, we provide concrete applicative examples in two selected clinical scenarios, including post-stroke and Duchenne muscular dystrophy individuals. The discussed solutions can open new avenues for the translation of robotic exoskeletons in a large set of clinical settings and enable a class of exoskeleton technologies that could support a broader range of impairment and disease types.@en

Upper extremity function is affected by a variety of neurological conditions. Robotic exoskeletons offer a potential solution for motor restoration. However, their systematic adoption is limited by challenges relative to human intention detection and device control. This position article offers a focused perspective on this topic. That is, on how knowledge gained from the design and implementation of human-machine interfaces (HMIs) for bionic arms can benefit the field of rehabilitation exoskeletons. Three broadly used HMIs in bionic arms are here investigated, including surface electromyography, impedance, and body-powered control. We propose that combinations of these HMIs could push forward upper extremity exoskeleton development. In this context, we provide concrete applicative examples in two selected clinical scenarios, including post-stroke and Duchenne muscular dystrophy individuals. The discussed solutions can open new avenues for the translation of robotic exoskeletons in a large set of clinical settings and enable a class of exoskeleton technologies that could support a broader range of impairment and disease types.@en

In vivo joint stiffness estimation during time-varying conditions remains an open challenge. Multiple communities, e.g. system identification and biomechanics, have tackled the problem from different perspectives and using different methods, each of which entailing advantages and limitations, often complementary. System identification formulations provide data-driven estimates of stiffness at the joint level, while biomechanics often relies on musculoskeletal models to estimate stiffness at multiple levels, i.e. joint, muscle, and tendon. Collaboration across these two scientific communities seems to be a logical step toward a reliable multi-level understanding of joint stiffness. However, differences at the theoretical, computational, and experimental levels have limited inter-community interaction. In this article we present a roadmap to achieve a unified framework for the estimation of time-varying stiffness in the composite human neuromusculoskeletal system during movement. We present our perspective on future developments to obtain data-driven system identification and musculoskeletal models that are compatible at the theoretical, computational, and experimental levels. Moreover, we propose a novel combined closed-loop paradigm, in which reference estimates of joint stiffness via system identification are decomposed into underlying muscle and tendon contribution via high-density-electromyography-driven musculoskeletal modeling. We highlight the need for aligning experimental requirements to be able to compare both joint stiffness formulations. Unifying both biomechanics' and system identification's formulations is a necessary step for truly generalizing stiffness estimation across individuals, movement conditions, training and impairment levels. From an application point of view, this is central for enabling patient-specific neurorehabilitation therapies, as well as biomimetic control of assistive robotic technologies. The roadmap we propose could serve as an inspiration for future collaborations across broadly different scientific communities to truly understand joint stiffness bio- and neuromechanics.@en

Quantifying human joint stiffness in vivo during movement remains challenging. Well established stiffness estimation methods include system identification and the notion of quasi-stiffness, with experimental and conceptual limitations, respectively. Joint stiffness computation via biomechanical models is an emerging solution to overcome such limitations. However, these models make assumptions that hamper their generalization across muscle architectures. Here we present a stiffness formulation that considers the muscle’s pennation angle, and its comparison to a simpler formulation that does not. Model-based stiffness estimates are evaluated against joint-perturbation-based system identification. Results on muscles with different pennation angle show that our formulation seamlessly adjusts the muscle-tendon units’ stiffness depending on their architecture. At the joint level, our new model improved the stiffness estimations. Our study’s relevance is the creation and validation of a modeling formulation that does not require joint perturbation. This will enable better estimations and understanding of stiffness properties and human movement.@en