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IEEE WearRAcon 2020 Innovation Challenge winning Proposal: Team SR-AFO -

Soft Robotic AFO for Active Stroke Rehabilitation

Research Proposal · March 2020

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TEAM SR-AFO: WEARRACON 2020 INNOVATION CHALLENGE COMPETITION APPLICATION
Soft Robotic AFO for Active Stroke
Rehabilitation
Marielle Debeurre1 , Carly M. Thalman2 , Tiffany Hertzell2 , and Hyunglae Lee3
Index Terms—Soft Robotics, Wearable Robotics, Mechatronics, Rehabilitation
Fig. 1. This is the concept illustration of an ankle foot orthosis that helps
impaired users walk again through active plantarflexion assistance, as
well as support for lateral ankle buckling for prevention of trips and falls.
Project Lead: Marielle Debeurre studies Mechanical Engineering (MS)
at Arizona State University. 23867 N 73rd St, Scottsdale, AZ 85255.
602.748.6369. mdebeurr@asu.edu.
Key Collaborator: Carly Thalman studies Systems Engineering (PhD)
at Arizona State University and is funded by the National Science
Foundation (GRFP). 602.628.7739. cmthalma@asu.edu.
Key Collaborator: Tiffany Hertzell studies Mechanical Engineering
(BSE) at Arizona State University and is graduating from Barrett, the
Honors College. 224.678.4193. thertzel@asu.edu.
Senior Collaborator: Dr. Hyunglae Lee is an Assistant Profes-
sor for the School for Engineering of Matter, Transport and Energy
(SEMTE) at Arizona State University, and director of the Neuromuscular
Control and Human Robotics Laboratory (ASU Neurorobotics Lab).
Hyunglae.Lee@asu.edu.
1 Project Lead
2 Key Collaborator
3 Senior Collaborator, Corresponding Author
M. Debeurre, C.M. Thalman, T. Hertzell, and H. Lee are with the Neuromus-
cular Control and Human Robotics Laboratory in the Ira A. Fulton Schools of
Engineering, Arizona State University, AZ , USA.
1
1 P ROJECT S UMMARY
Our team presents a pneumatic soft robotic ankle-foot or-
thosis (SR-AFO) to improve gait abnormalities in impaired
individuals treated using rehabilitation or ankle braces. Our
novel design is lightweight and operates in multiple degrees
of freedom to provide active assistance in ankle plantarflex-
ion and inversion/eversion support while walking.
2 I MPACT TO W EARABLE R OBOTICS I NDUSTRY
Ankle-foot orthoses (AFOs) are the most commonly-used
orthoses available to patients, accounting for as many as
26% of all orthoses provided to patients in the United States
[1], [2]. In particular, AFOs are commonly prescribed for
stroke victims suffering from hemiparesis, which affects
around 80% of stroke survivors [1], [3], [4]. According to
the 2002 World Health Report, around 15 million people
suffer from strokes each year, yielding potentially as many
as 8 million survivors affected by hemiparesis [5], [6]. While
there are many versions of AFOs available on the market,
they are largely made out of rigid materials like plastics
and carbon fiber [1], [2]. With the rise in popularity of the
wearable robotic industry, new robotic devices are being cre-
ated to replace existing rehabilitative technology. The field
of soft robotics is rapidly becoming a trend for wearable and
rehabilitative robotics due to the compliant, affordable, and
comfortable nature of the materials used.
The team working in Arizona State University’s Neuro-
muscular Control and Human Robotics Laboratory presents
one such wearable robotic device to improve rehabilitation
for gait-impaired individuals using a soft robotic ankle-
foot orthosis (SR-AFO). Traditional AFOs are designed to
provide ankle support to the impaired individuals without
active corrective action. This can subsequently lead to com-
plications with mobility, increased risk of injuries, or pain
due to gait adaptations attributable to limited ankle function
[7], [8]. The SR-AFO integrates soft, pneumatic actuators
made from garment-like fabrics that simulate the behavior
of the soleus (SOL) and gastrocnemius (GA) muscles in the
walking gait cycle into the traditional rehabilitative AFO
design, reducing the amount of muscle activation needed
by the patient [9]. This novel design operates in multiple
degrees of freedom (DoF), providing both assistance in
ankle plantarflexion and inversion and eversion support,
two critical motions which occur at different points in the
gait cycle [9], [10]. The SR-AFO is designed to provide
TEAM SR-AFO: WEARRACON 2020 INNOVATION CHALLENGE COMPETITION APPLICATION
Fig. 2. Logic control box for the SR-AFO exosuit, which controls the
timing of actuation, monitors pressure levels, and collects kinematic
behavioral data of the user through FSR sensors.
Fig. 3. (a) Side and posterior views of the SR-AFO attached over the
wearer’s shoe and secured at the knee, actuator pressure at atmo-
sphere (inactive). (b) Side and posterior views of the exosuit, actuator
pressure at 100 kPa (active).
safe, active assistance at the precise intervals where it is
needed while walking without impacting the comfort or
range of motion (ROM) of the wearer. Inversion/eversion
(IE) actuation is required in the loading response right after
heel strike in order to improve ankle stability in the medi-
olateral direction. In fact, IE actuation may even provide a
slight assistance to prevent “foot slap“ in this gait phase.
Plantarflexion actuation is required to assist push off in the
late stance phase [11].
The main goal of the project is to produce a wearable
robotic AFO that achieves a higher level of performance
than competing designs. A “higher performing” device
would accomplish three main goals: (1) increase human
comfort and adaptability to the orthosis, (2) extend the
rehabilitative capabilities of current AFO designs, and (3)
have a competitive market price. The team believes that
the proposed SR-AFO project attains each of these goals,
and therefore predicts that this project will greatly impact
traditional methods of gait rehabilitation.
2
TABLE 1
Go/No Go Decision Points and Constraints
Design Requirements Characteristics
Design Considerations and Criteria [12] [13]
Soft, compliant material Neoprene, Spandex and Nylon
Low profile ∼ 5mm
Easy don/doff ≤ 30 s
Light weight ≤ 200 g
Motion and Force Considerations [14], [15], [16], [17], [18]
Support Plantarflexion 1.6 N m/kg
PF Muscle Assistance GA, SOL muscles
Assists Pre-Swing Active during late stance
Minimum ROM ≥ 30◦ Dorsiflexion-Plantarflexion (DP)
Lateral Stiffness 70 N m/rad
Controls Criteria [11], [19], [20]
Perturbation Timing + 10% natural weight on toe
Gait Cycle % Assisted 40% to 60% of gait
Pressure Threshold 100 kP a
Walk at a natural pace ≥ 0.8 m/s
3 N OVELTY OF D ESIGN
Our soft robotic AFO is a novel advancement that extends
rehabilitative capabilities beyond the basic assistance pro-
vided by rigid AFO designs. The SR-AFO is a lightweight,
compliant alternative to traditional AFOs or heavy and
expensive exoskeletons, and can be worn as clothing during
use. The SR-AFO is affordable and provides active assis-
tance in multiple DoF without adding excessive weight to
the user’s leg or restricting natural motion [9], [10].
4 D ESIGN P LAN
To achieve the final production of a higher-performing
soft robotic AFO, a five-year design timeline for product
optimization is proposed (Fig. 4). Key Go/No Go decision
points occur at each level of the design plan to reflect
critical design requirements (Table 1). Human subject ex-
perimentation is integrated into the design process [21]. The
team will partner with Dr. Carolyn Kinney and Dr. Megan
Eikenberry1 , clinicians at Mayo Clinic and Midwestern
University, to ensure that the SR-AFO functions optimally
for gait-impaired patients. Clinical trials are scheduled for
September 2020. Pending the success of the clinical trials, the
final design will be moved to production, and permanently
implemented into rehabilitation facilities.
5 I NTELLECTUAL P ROPERTY AND F UNDING
The team will develop a method to make the system
portable as in previous work [22]. Portability allows cus-
tomers to purchase the orthosis for at-home rehabilitation.
Designing for personal comfort will naturally draw con-
sumers to our product. The corrective ability of the SR-AFO
across many gait abnormalities cements its market demand.
A patent has been filed for an early version of the prototype
[23], and the team plans to file a second patent for the new
design prior to commercialization.
1. Dr. C. Kinney, MD, Department of Physical Medicine and Rehabil-
itation, Mayo Clinic, AZ, and Dr. M. Eikenberry, DPT, Department of
Physical Therapy, Midwestern University, AZ
TEAM SR-AFO: WEARRACON 2020 INNOVATION CHALLENGE COMPETITION APPLICATION
Fig. 4. A detailed plan presenting current work done on the SR-AFO
project, as well as the continued plan project out until May of 2021,
where future funding and partnerships will be critical in the success and
validation of the SR-AFO.
6 A NTICIPATED USE OF $5,000
The current SR-AFO prototype costs approximately $100.00
to manufacture, as shown in Table 2, excluding the cost of
the controller, electricity and compressor used to actuate the
exosuit. The cost of the control and pneumatic system is
outlined in Table 3. The manufacturing cost of the current
prototype is comparable to the price of plastic AFOs that
do not include any robotic components. Additionally, the
team’s SR-AFO project eclipses the cost of rigid robotic
competitors, which can cost up to $80,000 to implement for
similar rehabilitative studies [24].
The $5,000 research budget will allow the team to im-
prove the final design, particularly by addressing the use
of a tether between the control box and the AFO. A tether
has been used to contain wiring necessary to read force
data from toe and heel sensors within the shoe. The air
supply used to actuate the pneumatic system is also tied
to the tether. The team proposes several alternatives to the
existing tether, such as the integration of wireless inertial
measurement unit (WIMU) sensors connected to a smaller
control box that could be fixed to the patient. This alterna-
tive would allow the SR-AFO and its controller to be more
portable, as it would only require a connection to housed air
supplies. The team also intends to investigate the integration
of an improved portable pneumatic system as used in early
versions of the SR-AFO [22].
Additionally, the team is currently working on a de-
sign iteration that would integrate plantarflexion assistance
and inversion/eversion support into the human gait cycle.
Currently, the SR-AFO has the capacity to perform both
functions, particularly in the actuator design and timing
of pneumatic actuation. The team’s next step is to inte-
grate both functions together seamlessly, so that both inver-
sion/eversion support and plantarflexion assistance occur
at precisely the optimal moment for assistance within the
gait cycle for individuals with abnormal or highly varied
3
TABLE 2
SR-AFO Bill of Materials
TABLE 3
Controller and Pneumatic System Bill of Materials
gait patterns.
The team has not yet implemented such design changes
due to research budgeting, and therefore a $5,000 increase
would allow these design improvements to be realized.
Such improvements ensure that the team’s SR-AFO incor-
porates and refines many thoughtful design features that
would prompt a customer to select our product over a
competitor’s.
ACKNOWLEDGMENTS
The authors would like to thank Dr. Carolyn Kinney and
Dr. Megan Eikenberry for their partnerships with the ASU
Neurorobotics Lab, and Varun Nalam for assistance in ex-
perimental testing. C. M. Thalman is funded by the Na-
tional Science Foundation, Graduate Research Fellowship
Program (NSF-GRFP) award #1841051.
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