{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:00:39Z","timestamp":1790791239890,"version":"4.1.0"},"reference-count":59,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"unspecified","delay-in-days":357,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Nederlandse Organisatie voor Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["project P16-05"],"award-info":[{"award-number":["project P16-05"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Wearable Technol."],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>While active back-support exoskeletons can reduce mechanical loading of the spine, current designs include only one pair of actuated hip joints combined with a rigid structure between the pelvis and trunk attachments, restricting lumbar flexion and consequently intended lifting behavior. This study presents a novel active exoskeleton including actuated lumbar and hip joints as well as subject-specific exoskeleton control based on a real-time active low-back moment estimation. We evaluated the effect of exoskeleton support with different lumbar-to-hip (L\/H) support ratios on spine loading, lumbar kinematics, and back muscle electromyography (EMG). Eight healthy males lifted 15\u00a0kg loads using three techniques without exoskeleton (NOEXO) and with exoskeleton: minimal impedance mode (MINIMP), L\/H support ratio in line with a typical L\/H net moment ratio (R0.8), lower (R0.5) and higher (R2.0) L\/H support ratio than R0.8, and a mechanically fixed lumbar joint (LF; simulating hip joint-only exoskeleton designs).<\/jats:p>\n\t  <jats:p>EMG-driven musculoskeletal model results indicated that R0.8 and R0.5 yielded significant reductions in spinal loading (4\u201311%, p\u00a0&lt;\u00a0.004) across techniques when compared to MINIMP, through reducing active moments (14\u201330%) while not affecting lumbar flexion and passive moments. R2.0 and LF significantly reduced spinal loading (8\u201317%, p\u00a0&lt;\u00a0.001; 22\u201326%, p\u00a0&lt;\u00a0.001, respectively), however significantly restricted lumbar flexion (3\u201318%, 24\u201327%, respectively) and the associated passive moments.<\/jats:p>\n\t  <jats:p>An L\/H support ratio in line with a typical L\/H net moment ratio reduces spinal loading, while allowing normal lifting behavior. High L\/H support ratios (e.g., in hip joint-only exoskeleton designs) yield reductions in spinal loading, however, restrict lifting behavior, typically perceived as hindrance.<\/jats:p>","DOI":"10.1017\/wtc.2024.7","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T06:02:13Z","timestamp":1734933733000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["The effect of active exoskeleton support with different lumbar-to-hip support ratios on spinal musculoskeletal loading and lumbar kinematics during lifting"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7613-9947","authenticated-orcid":false,"given":"Niels 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