{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:30:15Z","timestamp":1769171415254,"version":"3.49.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["688175"],"award-info":[{"award-number":["688175"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurorobot."],"abstract":"<jats:p>Wearable robots are becoming a valuable solution that helps injured, and elderly people regain mobility and improve clinical outcomes by speeding up the rehabilitation process. The XoSoft exosuit identified several benefits, including improvement of assistance, usability, and acceptance with a soft, modular, bio-mimetic, and quasi-passive exoskeleton. This study compares two assistive configurations: (i) a bilateral hip flexion (HA, hips-assistance) and (ii) a bilateral hip flexion combined with ankle plantarflexion (HAA, hips-ankles-assistance) with the main goal of evaluating compensatory actions and synergetic effects generated by the human- exoskeleton interaction. A complete description of this complex interaction scenario with this actuated exosuit is evaluated during a treadmill walking task, using several indices to quantify the human-robot interaction in terms of muscular activation and fatigue, metabolic expenditure, and kinematic motion patterns. Evidence shows that the HAA biomimetic controller is synergetic with the musculature and performs better concerning the other control strategy. The experimentation demonstrated a metabolic expenditure reduction of 8% of Metabolic Equivalent of Task (MET), effective assistance of the muscular activation of 12.5%, a decrease of the muscular fatigue of 0.6% of the mean frequency, and a significant reduction of the compensatory actions, as discussed in this work. Compensatory effects are present in both assistive configurations, but the HAA modality provides a 47% reduction of compensatory effects when considering muscle activation.<\/jats:p>","DOI":"10.3389\/fnbot.2023.1127694","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T06:51:52Z","timestamp":1683874312000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Quasi-passive lower limbs exosuit: an in-depth assessment of fatigue, kinematic and muscular patterns while comparing assistive strategies on an expert subject\u2019s gait analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Christian","family":"Di Natali","sequence":"first","affiliation":[]},{"given":"Jesus","family":"Ortiz","sequence":"additional","affiliation":[]},{"given":"Darwin G.","family":"Caldwell","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/j.apmr.2019.10.192","article-title":"Exoskeleton-assisted gait training in persons with multiple sclerosis: A single-group pilot study.","volume":"101","author":"Afzal","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B2","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1111\/j.1532-5415.2010.02811.x","article-title":"Bedside-to-bench conference: research agenda for idiopathic fatigue and aging.","volume":"58","author":"Alexander","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"B3","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/1050-6411(93)90010-T","article-title":"EMG median power frequency in an exhausting exercise.","volume":"3","author":"Ament","year":"1993","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/ICORR.2013.6650455","article-title":"Biologically-inspired soft exosuit","author":"Asbeck","year":"2013","journal-title":"Proceedings of the 2013 IEEE 13th International Conference on Rehabilitation Robotics (ICORR)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.robot.2014.09.025","article-title":"Soft exosuit for hip assistance.","volume":"73","author":"Asbeck","year":"2015","journal-title":"Robot. Autonom. Syst."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aai9084","article-title":"A soft robotic exosuit improves walking in patients after stroke.","volume":"9","author":"Awad","year":"2017","journal-title":"Sci. Transl. Med."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/978-88-470-2463-2","author":"Barbero","year":"2012","journal-title":"Atlas of muscle innervation zones: understanding surface electromyography and its applications."},{"key":"B8","article-title":"Normal gait,","author":"Bonnefoy","year":"2015","journal-title":"Orthopedic management of children with cerebral palsy: A comprehensive approach"},{"key":"B9","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.clinbiomech.2009.01.010","article-title":"Surface EMG based muscle fatigue evaluation in biomechanics.","volume":"24","author":"Cifrek","year":"2009","journal-title":"Clin. Biomech."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.yspm.2011.03.006","article-title":"Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey.","volume":"22","author":"Colley","year":"2011","journal-title":"Health Rep."},{"key":"B11","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1038\/nature14288","article-title":"Reducing the energy cost of human walking using an unpowered exoskeleton.","volume":"522","author":"Collins","year":"2015","journal-title":"Nature"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1152\/jappl.2000.88.5.1804","article-title":"Age causes a redistribution of joint torques and powers during gait.","volume":"88","author":"DeVita","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/app11083576","article-title":"Quasi-passive resistive exosuit for space activities: proof of concept.","volume":"11","author":"Di Natali","year":"2021","journal-title":"Appl. Sci."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2014","DOI":"10.1017\/S0263574719000067","article-title":"Design and evaluation of a soft assistive lower limb exoskeleton.","volume":"37","author":"Di Natali","year":"2019","journal-title":"Robotica"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fnbot.2020.00031","article-title":"Pneumatic quasi-passive actuation for soft assistive lower limbs exoskeleton.","volume":"14","author":"Di Natali","year":"2020","journal-title":"Front. Neurorobot."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000233794.31659.6d","article-title":"Muscle fatigue during dynamic contractions assessed by new spectral indices.","volume":"38","author":"Dimitrov","year":"2006","journal-title":"Med. Sci. Sports Exerc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1109\/ICRA.2014.6907024","article-title":"Multi-joint actuation platform for lower extremity soft exosuits","author":"Ding","year":"2014","journal-title":"Proceedings of the 2014 IEEE International Conference on Robotics and Automation (ICRA)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1109\/TRO.2008.915453","article-title":"Lower extremity exoskeletons and active orthoses: challenges and state-of-the-art.","volume":"24","author":"Dollar","year":"2008","journal-title":"IEEE Trans. Robot."},{"key":"B19","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/S0749-3797(98)00084-1","article-title":"Lifestyle physical activity interventions: history, short-and long-term effects, and recommendations.","volume":"15","author":"Dunn","year":"1998","journal-title":"Am. J. Prev. Med."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fnbot.2022.982950","article-title":"Assessment methodology for human-exoskeleton interactions: kinetic analysis based on muscle activation.","volume":"16","author":"Fanti","year":"2022","journal-title":"Front. Neurorobot."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1093\/gerona\/glq137","article-title":"Energetics of walking in elderly people: factors related to gait speed.","volume":"65","author":"Fiser","year":"2010","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.gaitpost.2016.11.040","article-title":"Exoskeleton plantarflexion assistance for elderly.","volume":"52","author":"Galle","year":"2017","journal-title":"Gait Posture"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.3505","article-title":"Normality tests for statistical analysis: a guide for non-statisticians.","volume":"10","author":"Ghasemi","year":"2012","journal-title":"Int. J. Endocrinol. Metab."},{"key":"B24","doi-asserted-by":"publisher","first-page":"E1325","DOI":"10.1152\/ajpendo.2000.279.6.E1325","article-title":"Determinants of the variability in respiratory exchange ratio at rest and during exercise in trained athletes.","volume":"279","author":"Goedecke","year":"2000","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007312","article-title":"Realizing the promise of robotic leg prostheses.","volume":"5","author":"Goldfarb","year":"2013","journal-title":"Sci. Transl. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1115\/1.3138397","article-title":"A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.","volume":"105","author":"Grood","year":"1983","journal-title":"J. Biomech. Eng."},{"key":"B27","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1109\/ICORR.2019.8779375","article-title":"User-driven walking assistance: first experimental results using the MyoSuit.","volume":"2019","author":"Haufe","year":"2019","journal-title":"IEEE Int. Conf. Rehabil. Robot."},{"key":"B28","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/S1050-6411(00)00027-4","article-title":"Development of recommendations for SEMG sensors and sensor placement procedures.","volume":"10","author":"Hermens","year":"2000","journal-title":"J. Electromyogr. Kinesiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1111\/j.1748-1716.1982.tb06958.x","article-title":"On the significance of the respiratory exchange ratio after different diets during exercise in man.","volume":"114","author":"Jansson","year":"1982","journal-title":"Acta Physiol. Scand."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1109\/TNSRE.2016.2613886","article-title":"Experimental evaluation of energy efficiency for a soft wearable robotic suit.","volume":"25","author":"Jin","year":"2016","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1016\/j.apmr.2007.06.773","article-title":"Mobility assistive device utilization in a prospective study of patients with first-ever stroke.","volume":"88","author":"Jutai","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B32","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1097\/00003677-200304000-00009","article-title":"Toward a better understanding of gait changes with age and disablement: neuromuscular adaptation.","volume":"31","author":"McGibbon","year":"2003","journal-title":"Exerc. Sport Sci. Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1155\/2009\/712530","article-title":"Analysis of the human interaction with a wearable lower-limb exoskeleton.","volume":"6","author":"Moreno","year":"2009","journal-title":"Appl. Bionics Biomech."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-818538-4.00006-X","author":"Ortiz","year":"2021","journal-title":"XoSoft: Design of a Novel Soft Modular Exoskeleton."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1177\/1178632916686074","article-title":"Cardiac evaluation and monitoring of patients undergoing noncardiac surgery.","volume":"10","author":"Rafiq","year":"2017","journal-title":"Health Serv. Insights"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.04.0070","article-title":"Passive exoskeletons for assisting limb movement.","volume":"43","author":"Rahman","year":"2006","journal-title":"J. Rehabil. Res. Dev."},{"key":"B37","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1093\/gerona\/56.suppl_2.23","article-title":"Physical activity and quality of life in older adults.","volume":"56","author":"Rejeski","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"B38","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1093\/gerona\/glu146","article-title":"Walking energetics, fatigability, and fatigue in older adults: the study of energy and aging pilot.","volume":"70","author":"Richardson","year":"2015","journal-title":"J. Gerontol. A. Biol. Sci. Med. Sci."},{"key":"B39","first-page":"21","article-title":"The mobility needs of the elderly","author":"Rosenbloom","year":"1988","journal-title":"Paper presented by special report 218: transportation in an aging society: improving mobility and safety for older persons: technical papers"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/act8020047","article-title":"A vacuum powered soft textile-based clutch.","volume":"8","author":"Sadeghi","year":"2019","journal-title":"Actuators"},{"key":"B41","doi-asserted-by":"publisher","first-page":"S329","DOI":"10.1111\/j.1532-5415.2010.02913.x","article-title":"The energetic pathway to mobility loss: an emerging new framework for longitudinal studies on aging.","volume":"58","author":"Schrack","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"B42","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1007\/s12311-016-0837-2","article-title":"Progression of gait ataxia in patients with degenerative cerebellar disorders: a 4-year follow-up study.","volume":"16","author":"Serrao","year":"2017","journal-title":"Cerebellum"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1109\/TBME.2014.2307698","article-title":"Design and evaluation of a quasi-passive knee exoskeleton for investigation of motor adaptation in lower extremity joints.","volume":"61","author":"Shamaei","year":"2014","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1111\/j.1532-5415.2005.53372.x","article-title":"Mobility limitations in the Medicare population: prevalence and sociodemographic and clinical correlates.","volume":"53","author":"Shumway-Cook","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"B45","article-title":"Evaluation of XoSoft Beta-1 lower limb exoskeleton on a post stroke patient","author":"Sposito","year":"2018","journal-title":"Proceedings of the sixth national congress of bioengineering, Milan, Italy, 25-27 June 2018"},{"key":"B46","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1080\/24725838.2019.1638331","article-title":"Occupational exoskeletons: overview of their benefits and limitations in preventing work-related musculoskeletal disorders.","volume":"7","author":"Theurel","year":"2019","journal-title":"IISE Trans. Occup. Ergon. Hum. Factors"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/ICORR.2011.5975470","article-title":"A passive exoskeleton with artificial tendons: design and experimental evaluation","author":"Van Dijk","year":"2011","journal-title":"Proceedings of the 2011 IEEE international conference on rehabilitation robotics"},{"key":"B48","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.archger.2011.04.018","article-title":"Lower limb muscle strength (LLMS): why sedentary life should never start? A review.","volume":"54","author":"Volkers","year":"2012","journal-title":"Arch. Gerontol. Geriatr."},{"key":"B49","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/jor.1100010110","article-title":"Comparative cost of walking in young and old adults.","volume":"1","author":"Waters","year":"1983","journal-title":"J. Orthop. Res."},{"key":"B50","doi-asserted-by":"publisher","first-page":"3362","DOI":"10.1109\/ICRA.2013.6631046","article-title":"A lightweight soft exosuit for gait assistance","author":"Wehner","year":"2013","journal-title":"Proceedings of the 2013 IEEE international conference on robotics and automation"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1002\/9780470549148","author":"Winter","year":"2009","journal-title":"Biomechanics and motor control of human movement."},{"key":"B52","year":"2015","journal-title":"World report on ageing and health."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1126\/science.aal5054","article-title":"Human-in-the-loop optimization of exoskeleton assistance during walking.","volume":"356","author":"Zhang","year":"2017","journal-title":"Science"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.mechmachtheory.2020.103840","article-title":"Design of a passive lower limb exoskeleton for walking assistance with gravity compensation.","volume":"150","author":"Zhou","year":"2020","journal-title":"Mech. Mach. Theory"}],"container-title":["Frontiers in Neurorobotics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnbot.2023.1127694\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T06:51:59Z","timestamp":1683874319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnbot.2023.1127694\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,11]]},"references-count":54,"alternative-id":["10.3389\/fnbot.2023.1127694"],"URL":"https:\/\/doi.org\/10.3389\/fnbot.2023.1127694","relation":{},"ISSN":["1662-5218"],"issn-type":[{"value":"1662-5218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,11]]},"article-number":"1127694"}}