Foot drop is commonly managed using Functional Electrical Stimulation (FES), typically delivered via open-loop controllers with fixed stimulation intensities. While users may manually adjust the intensity through external controls, this approach risks overstimulation, leading to muscle fatigue and discomfort, or understimulation, which compromises dorsiflexion and increases fall risk. In this study, we propose a novel closed-loop FES controller that dynamically adjusts the stimulation intensity based on real-time toe clearance, providing “assistance as needed”. We evaluate this system by inducing foot drop in healthy participants and comparing the effects of the closed-loop controller with a traditional open-loop controller across various walking conditions, including different speeds and surface inclinations. Kinematic data reveal that our closed-loop controller maintains adequate toe clearance without significantly affecting the joint angles of the hips, the knees, and the ankles, and while using significantly lower stimulation intensities compared to the open-loop controller. These findings suggest that the proposed method not only matches the effectiveness of existing systems but also offers the potential for reduced muscle fatigue and improved long-term user comfort and adherence.

Wearable robots offer a promising solution for quantitatively monitoring gait and providing systematic, adaptive assistance to promote patient independence and improve gait. However, due to significant interpersonal and intrapersonal variability in walking patterns, it is important to design robot controllers that can adapt to the unique characteristics of each individual. This paper investigates the potential of human-in-the-loop optimisation (HILO) to deliver personalised assistance in gait training. The Covariance Matrix Adaptation Evolution Strategy (CMA-ES) was employed to continuously optimise an assist-as-needed controller of a lower-limb exoskeleton. Six healthy individuals participated over a two-day experiment. Our results suggest that while the CMA-ES appears to converge to a unique set of stiffnesses for each individual, no measurable impact on the subjects’ performance was observed during the validation trials. These findings highlight the impact of human-robot co-adaptation and human behaviour variability, whose effect may be greater than potential benefits of personalising rule-based assistive controllers. Our work contributes to understanding the limitations of current personalisation approaches in exoskeleton-assisted gait rehabilitation and identifies key challenges for effective implementation of human-in-the-loop optimisation in this domain.

The hybridisation of robot-assisted gait training and functional electrical stimulation (FES) can provide numerous physiological benefits to neurological patients. However, the design of an effective hybrid controller poses significant challenges. In this over-actuated system, it is extremely difficult to find the right balance between robotic assistance and FES that will provide personalised assistance, prevent muscle fatigue and encourage the patient’s active participation in order to accelerate recovery. In this paper, we present an adaptive hybrid robot-FES controller to do this and enable the triadic collaboration between the patient, the robot and FES. A patient-driven controller is designed where the voluntary movement of the patient is prioritised and assistance is provided using FES and the robot in a hierarchical order depending on the patient’s performance and their muscles’ fitness. The performance of this hybrid adaptive controller is tested in simulation and on one healthy subject. Our results indicate an increase in tracking performance with lower overall assistance, and less muscle fatigue when the hybrid adaptive controller is used, compared to its non adaptive equivalent. This suggests that our hybrid adaptive controller may be able to adapt to the behaviour of the user to provide assistance as needed and prevent the early termination of physical therapy due to muscle fatigue.

Physically assistive robots and exoskeletons have great potential to help humans with a wide variety of collaborative tasks. However, a challenging aspect of the control of such devices is to accurately model or predict human behaviour, which can be highly individual and personalised. In this work, we implement a framework for learning subject-specific models of underlying human motion strategies using inverse musculoskeletal optimal control. We apply this framework to a specific motion task: the sit-to-stand transition. By collecting sit-to-stand data from 4 subjects with and without perturbations, we show that humans modulate their sit-to-stand strategy in the presence of instability, and learn the corresponding models of these strategies. In the future, the personalised motion strategies resulting from this framework could be used to inform the design of real-time assistance strategies for human-robot collaboration problems.

Many assistive robotic devices have been developed to augment or assist human locomotion. Despite advancements in design and control algorithms, this task remains challenging. Human walking strategies are unique and complex, and assistance strategies based on the dynamics of unassisted locomotion typically offer only modest reductions to the metabolic cost of walking. Recently, human-in-the-loop (HIL) methodologies have been used to identify subject-specific assistive strategies, which offer significant improvements to energy savings. However, current implementations suffer from long measurement times, necessitating the use of low-dimensional control parameterizations, and possibly requiring multiday collection protocols to avoid subject fatigue. We present a HIL methodology, which optimizes the assistive torques provided by a powered hip exoskeleton. Using musculoskeletal modeling, we are able to evaluate simulated metabolic rate online. We applied our methodology to identify assistive torque profiles for seven subjects walking on a treadmill, and found greater reductions to metabolic cost when compared to generic or off-the-shelf controllers. In a secondary investigation, we directly compare simulated and measured metabolic rate for three subjects experiencing a range of assistance levels. The time investment required to identify assistance strategies via our protocol is significantly lower when compared to existing protocols relying on calorimetry. In the future, frameworks such as these could be used to enable shorter HIL protocols or exploit more complex control parameterizations for greater energy savings.