{"id":8147,"date":"2018-02-20T20:29:57","date_gmt":"2018-02-21T01:29:57","guid":{"rendered":"http:\/\/www.bu.edu\/federal\/?p=8147"},"modified":"2018-02-22T20:47:55","modified_gmt":"2018-02-23T01:47:55","slug":"move-over-iron-man-2","status":"publish","type":"post","link":"https:\/\/www.bu.edu\/federal\/2018\/02\/20\/move-over-iron-man-2\/","title":{"rendered":"Move Over, Iron Man"},"content":{"rendered":"<h2>BU profs on team working on a wearable robot could help stroke suffers walk farther and faster<\/h2>\n<div class=\"entry-title\">\n<h2><\/h2>\n<\/div>\n<div class=\"banner-container banner-has-html\">\n<div class=\"full-width \">\n<div class=\"buvideoWrapper youtube-video\">\n<div class=\"buvideoWrapperInner\"><iframe loading=\"lazy\" width=\"550\" height=\"310\" src=\"https:\/\/www.youtube.com\/embed\/YuksGLVhrZY\" allow=\"autoplay; encrypted-media\" allowfullscreen=\"allowfullscreen\" frameborder=\"0\" data-mce-fragment=\"1\"><\/iframe><\/div>\n<\/div>\n<p class=\"caption\"><em>This video demonstrates how the soft exosuit may help people retrain their gait after a stroke. The exosuit allows the wearer to walk more symmetrically, while using less energy. Video by the Wyss Institute.<\/em><\/p>\n<\/div>\n<\/div>\n<p>Powered by a chunky robotic suit, Iron Man can leap from buildings and soar into space. The superhero\u2019s gold and titanium getup might look great when taking down villains, but it\u2019d be overkill for spending a morning with the grandkids. For people who are recovering from a stroke and want to get back to enjoying their favorite activities, there\u2019s something better: a soft, lightweight, bionic walking aid that straps to the leg and can be worn anywhere.<\/p>\n<p><a href=\"https:\/\/www.bu.edu\/sargent\/profile\/louis-awad\/\">Lou Awad<\/a> and <a href=\"https:\/\/www.bu.edu\/sargent\/profile\/terry-ellis-pt-phd-ncs\/\">Terry Ellis<\/a>, both Sargent College of Health &amp; Rehabilitation Sciences assistant professors of physical therapy, are part of the team behind the medical exosuit, a wearable robot that can help people who have had a stroke walk faster, farther, and more safely. Instead of Iron Man\u2019s titanium, it has breathable wraps made from proprietary materials, thin cables, and a series of small motors that help it mimic human muscles and tendons.<\/p>\n<p>The technology has already been licensed and a suit could be commercially available for use in clinics within the next few years. That would be life-changing for thousands. Every year, 795,000 Americans have a stroke, which stops blood flowing to parts of the brain and can leave survivors with chronic weakness or paralysis, turning walking into a frustrating\u2014even dangerous\u2014chore. For 15 to 35 percent of survivors, learning to walk independently can take more than six months. Many of those who do learn to walk again will not regain their former speed or stability. According to <em><a href=\"http:\/\/www.strokeassociation.org\/STROKEORG\/LifeAfterStroke\/RegainingIndependence\/PhysicalChallenges\/Keeping-Your-Balance-After-Stroke_UCM_309772_Article.jsp#.WXftPYqQxAY\">Stroke Connection<\/a><\/em> magazine, about 40 percent of all survivors have a serious fall within a year of their stroke.<\/p>\n<h3>Equaling nature<\/h3>\n<p>For a robot, the exosuit is understated, more high-tech sports brace than sci-fi cyborg; it weighs only about 10 pounds. A matchbox-sized sensor attaches to the outside collar of the shoe close to the ankle, while two black wraps cover most of the lower leg and the waist. Cables, similar to those used to control bicycle brakes, run from inside the wearer\u2019s shoe to their calf and from the shoe\u2019s tongue to their shin. Motors\u2014worn around the waist and regulated by a computer unit loaded with algorithms\u2014apply forces through the cables to help the wearer walk<\/p>\n<p>\u201cPeople who have had a stroke have trouble with dorsiflexion, or foot clearance,\u201d says Ellis\u2014they have a reduced ability to bend their ankle and lift their foot. When they try to plant their heel on the ground to walk, they instead \u201cdrag their toes and their foot gets caught.\u201d The exosuit counteracts that issue by retracting the cable attached to the shoe\u2019s tongue, applying a small amount of force to bring the toes up. When the wearer needs to take a step forward, the rear cable contracts to ensure that their foot pushes off the ground, a movement called plantar flexion.<\/p>\n<p>The exosuit traces its roots to a soft robot designed for the military by a team at the <a href=\"https:\/\/biodesign.seas.harvard.edu\/\">Harvard Biodesign Lab<\/a> at the <a href=\"https:\/\/wyss.harvard.edu\/\">Wyss Institute for Biologically Inspired Engineering<\/a> at Harvard University. That suit, developed in collaboration with <a href=\"https:\/\/www.bu.edu\/sargent\/profile\/kenneth-g-holt-pt-phd\/\">Kenneth Holt<\/a>, a Sargent College associate professor emeritus of physical therapy and athletic training, is intended to help soldiers and emergency personnel carry heavy loads with minimum effort. With a similar cable, wrap, and motor combination, it works in harmony with the body to help reduce the strain associated with lugging hefty packs. By applying assistive forces to the ankle and hip, the suit\u2014which is still in development\u2014reduces the amount of energy needed to carry a load equivalent to 30 percent of a wearer\u2019s body weight by around 7 percent, according to a <a href=\"https:\/\/jneuroengrehab.biomedcentral.com\/articles\/10.1186\/s12984-016-0150-9\">study<\/a> published in the May 2016 <em>Journal of NeuroEngineering and Rehabilitation<\/em>.<\/p>\n<div class=\"full-width \">\n<p><img loading=\"lazy\" src=\"http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001.jpg\" alt=\"Terry Ellis and Lou Awad, professors of physical therapy at Boston University Sargent College of Health and Rehabilitation Sciences\" class=\" wp-image-122285\" srcset=\"http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001.jpg 995w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001-83x55.jpg 83w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001-332x222.jpg 332w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001-768x513.jpg 768w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001-550x367.jpg 550w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-17-1557-AWADELLIS-001-165x110.jpg 165w\" sizes=\"(max-width: 995px) 100vw, 995px\" width=\"824\" height=\"550\" \/><\/p>\n<p class=\"caption\"><em>Terry Ellis (left) and Lou Awad both Sargent assistant professors of physical therapy, are developing the medical exosuit to help people relearn to walk after a stroke. Photo by Dana Smith.<\/em><\/p>\n<\/div>\n<p>To adapt the suit to a medical purpose, the Wyss Institute invited Ellis and Awad to join its team of engineers, computer scientists, and business developers. They needed \u201cresearchers who are embedded in the clinical world and work with patients,\u201d says Ellis, director of the <a href=\"http:\/\/www.bu.edu\/neurorehab\/\">BU Center for Neurorehabilitation<\/a>. The first major challenge was a practical one. The military suit was designed for \u201cfit individuals who can handle the high amount of force\u201d the exosuit applies to the body, Awad says.<\/p>\n<p>For the suit to work, the wearer needs to be able to bear the typical forces our muscles, tendons, and bones absorb every day, as well as those the exosuit adds. That\u2019s less of an issue for an athletic solider than it is for a senior who has suffered a stroke.<\/p>\n<p>When developing the medical version, the team began by exploring less rigid textiles than those used for the military suit. \u201cThe first prototypes used seatbelt webbing,\u201d says Awad, director of the <a href=\"http:\/\/sites.bu.edu\/nrl\/\">BU Neuromotor Recovery Laboratory<\/a>.\u00a0In contrast, the medical suit is made of \u201ccomposite materials that create a secure, breathable, and form-fitting interface with the wearer\u2019s leg.\u201d They made other changes, too. Although the original is worn on both legs versus the medical suit\u2019s one leg, it assists only with the pushing off\u2014the military doesn\u2019t have to worry about soldiers dragging their toes. \u201cThe goal with the military suit is to beat nature, break that barrier that nature provided,\u201d says Awad. \u201cWith the medical exosuit, the goal is to bring people back to where they were.\u201d<\/p>\n<p>Both versions of the suit have sensors that tell the computer control unit\u2014Awad calls it the brain\u2014where a person is in their stride, so it can deliver the right amount of force for each individual. The brain is adaptive, he says, \u201cso if a person suddenly starts walking faster or changes their cadence, it recognizes that and responds accordingly.\u201d It should eventually allow wearers to navigate uneven terrain, although testing has so far been limited to the lab.<\/p>\n<p>Awad says the suit\u2019s on-the-fly thinking is one of the features that sets it apart from others in development\u2014and one of the Sargent team\u2019s major contributions. Like the less rigid fabrics, the algorithms plugged into the medical exosuit\u2019s control unit also help ensure that it doesn\u2019t put too much pressure on the wearer\u2019s body.<\/p>\n<p>\u201cIt\u2019s a product of a deep understanding of how people move and how movement goes awry after something like a stroke,\u201d he says. \u201cThat came from our discussions with the biomechanics team, the engineers, teaching them how people with a stroke move; they didn\u2019t have that experience.\u201d<\/p>\n<h3>\u201cOMG! OMG! OMG!\u201d<\/h3>\n<p>The medical exosuit is light years ahead of the current alternative for rehabilitation after a stroke: the ankle foot orthosis, an ungainly contraption of molded plastic that\u2019s been in use since the early 1980s. The stiff boot runs down the calf and under the heel, holding the leg and foot at a 90-degree angle. By keeping the ankle locked, the orthosis prevents the wearer from stubbing their toes and tripping, \u201cbut because you have a rigid 90-degree angle, you can\u2019t push off, so you sort of lift the leg and lose some of the key features of a normal gait,\u201d says Ellis. The boot allows people to gain a degree of independence, but it doesn\u2019t get them back to the activities they love. And, Awad adds, it may bring its own complications. \u201cIf you had a stroke at a young age,\u201d he says, \u201cthe muscles that may not have been directly impacted by the stroke are going to suffer.\u201d<\/p>\n<p>In testing, some participants wearing the medical exosuit have been able to nearly regain their prestroke walking speeds. In one exosuit testing session, the user began outpacing the physical therapist monitoring his progress. In another, Awad watched as a participant began shouting, \u201cOMG! OMG! OMG!\u201d He says she told him, \u201c\u2018I was thinking about my grocery list; I\u2019m never able to think about anything except walking, the next step in front of me, otherwise I\u2019m going to fall.\u2019\u201d<\/p>\n<div class=\"full-width \">\n<p><img loading=\"lazy\" src=\"http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R.jpg\" alt=\"Man walking in a medical exosuit designed to help stroke victims walk\" class=\" wp-image-122288\" srcset=\"http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R.jpg 995w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R-83x55.jpg 83w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R-332x222.jpg 332w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R-768x513.jpg 768w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R-550x367.jpg 550w, http:\/\/www.bu.edu\/today\/files\/2018\/02\/resize-ALT_RAE16Walsh_16fm_224R-165x110.jpg 165w\" sizes=\"(max-width: 995px) 100vw, 995px\" width=\"824\" height=\"550\" \/><\/p>\n<p class=\"caption\"><em>One of the future goals for the exosuit\u2019s developers is to improve the bionic walking aid\u2019s sensors to help it better adapt to different activities. Photo by Rolex\/Fred Merz.<\/em><\/p>\n<\/div>\n<p>In a series of presentations and journal articles, the researchers have quantified the suit\u2019s impact. They found participants pushed off from the ground more effectively and used less energy, and they walked faster over longer distances. The research, which began with military funding through the <a href=\"https:\/\/www.darpa.mil\/program\/warrior-web\">DARPA Warrior Web Project<\/a> and has also been supported by the <a href=\"https:\/\/www.nsf.gov\/\">National Science Foundation<\/a>, the Wyss Institute, <a href=\"http:\/\/www.seas.harvard.edu\/\">Harvard Paulson School<\/a>, and the <a href=\"http:\/\/www.heart.org\/HEARTORG\/\">American Heart Association<\/a>, was published in the <a href=\"http:\/\/stm.sciencemag.org\/content\/9\/400\/eaai9084\">July 26, 2017, edition of <em>Science Translational Medicine<\/em><\/a>. The principal investigator is <a href=\"https:\/\/wyss.harvard.edu\/team\/core-faculty\/conor-walsh\/\">Conor Walsh<\/a>, an associate professor of engineering and applied sciences at Harvard and a core faculty member at the Wyss Institute.<\/p>\n<p>Ellis doesn\u2019t intend for the suit to replace physical therapists in stroke rehabilitation. Instead, it could be used to help people relearn walking in the immediate aftermath of a stroke and allow them to practice walking at home after being discharged.<\/p>\n<p>\u201cIn this country, once you\u2019ve had a stroke, after about three months, you\u2019re done with all the rehab,\u201d she says. \u201cIt\u2019s a real drawback, because there are a lot of studies that show that rehab in the chronic phases is very effective and can enhance function. A therapist could prescribe the exosuit with parameters helpful for each individual.\u201d<\/p>\n<h3>Perfecting the science<\/h3>\n<p>The team is pursuing funding to investigate how best to use the exosuit beyond the lab and recently won a <a href=\"https:\/\/www.nih.gov\/\">National Institutes of Health<\/a> grant, awarded through the\u00a0<a href=\"https:\/\/www.nichd.nih.gov\/Pages\/index.aspx\">National Institute of Child Health and Human Development<\/a>, to continue developing the technology. It plans to explore other applications, like customizing the suit to help people with Parkinson\u2019s disease, multiple sclerosis, and cerebral palsy. For now, though, the primary goal is getting the suit ready for people who have had a stroke. The medical exosuit currently augments only the ankle, but a new project with Harvard will focus on a system that integrates support for the knee and hip.<\/p>\n<p>In a separate project, funded by a <a href=\"https:\/\/www.bu.edu\/ctsi\/support-for-research\/pilot-awards\/\">BU Clinical &amp; Translational Science Institute pilot grant<\/a>, Awad is studying ways to improve how wearable devices like exosuits sense and assist impaired movement. He says the current sensors are good at tracking data like joint angle and joint speed\u2014how fast the leg is moving\u2014but not as successful at determining the activity associated with that movement: is the user walking or marching in place, are they turning or walking in a straight line? With <a href=\"https:\/\/www.bu.edu\/eng\/profile\/roberto-tron\/\">Roberto Tron<\/a>, a College of Engineering assistant professor of mechanical engineering and of systems engineering, he\u2019s exploring systems that could compute both.<\/p>\n<p>According to <a href=\"http:\/\/rewalk.com\/\">ReWalk Robotics<\/a>, the company that has licensed the technology, the current version of the medical exosuit could\u2014pending FDA approval\u2014be ready to ship sometime this year. It won\u2019t help anyone swoop into the stratosphere like Iron Man, but it could give plenty of grandparents the chance to play superheroes again.<\/p>\n<p><em>Author, Andrew Thurston can be reached at <a href=\"mailto:thurston@bu.edu\">thurston@bu.edu<\/a>.<\/em><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>BU profs on team working on a wearable robot could help stroke suffers walk farther and faster This video demonstrates how the soft exosuit may help people retrain their gait after a stroke. The exosuit allows the wearer to walk more symmetrically, while using less energy. Video by the Wyss Institute. Powered by a chunky [&hellip;]<\/p>\n","protected":false},"author":7048,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[8],"tags":[438,183,88,109,119,30,439,429,13,55,40,390,93,32,65],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/8147"}],"collection":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/users\/7048"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/comments?post=8147"}],"version-history":[{"count":4,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/8147\/revisions"}],"predecessor-version":[{"id":8151,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/posts\/8147\/revisions\/8151"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/media?parent=8147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/categories?post=8147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/federal\/wp-json\/wp\/v2\/tags?post=8147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}