{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:37:53Z","timestamp":1760233073931,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Project EUROBENCH","award":["N\u00b0 779963"],"award-info":[{"award-number":["N\u00b0 779963"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Robotics"],"abstract":"<jats:p>Assessing the performance of exoskeletons in assisting human balance is important for their design process. This study proposes a novel testbed, the B.E.A.T (Balance Evaluation Automated Testbed) to address this aim. We applied the B.E.A.T to evaluate how the presence of a lower limb exoskeleton influenced human balance. The B.E.A.T. consists of a robotic platform, standardized protocols, and performance indicators. Fifteen healthy subjects were enrolled and subjected to repeatable step-type ground perturbations in different directions using the multi-axis robotic platform. Each participant performed three trials, both with and without the exoskeleton (EXO and No-EXO conditions). Nine performance indicators, divided into kinematic and body stability indicators, were computed. The reliability of performance indicators was assessed by computing the Inter Class Correlation (ICC). The indicators showed good (0.60 \u2264 ICC &lt; 0.75) to excellent (ICC \u2265 0.75) reliability. The comparison between the EXO and No-EXO conditions revealed a significant increase in the joint range of motion and the center of pressure displacement while wearing the exoskeleton. The main differences between the EXO and No-EXO conditions were found in the range of motion of the knee joints, with an increment up to 17\u00b0 in the sagittal plane.<\/jats:p>","DOI":"10.3390\/robotics11060151","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T01:46:51Z","timestamp":1671155211000},"page":"151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility and Application of the B.E.A.T. Testbed for Assessing the Effects of Lower Limb Exoskeletons on Human Balance"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1064-7962","authenticated-orcid":false,"given":"Ilaria","family":"Mileti","sequence":"first","affiliation":[{"name":"Department of Engineering, University Niccol\u00f2 Cusano, 00166 Rome, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8997-7605","authenticated-orcid":false,"given":"Juri","family":"Taborri","sequence":"additional","affiliation":[{"name":"Department of Economics Engineering Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9503-8508","authenticated-orcid":false,"given":"David","family":"Rodriguez-Cianca","sequence":"additional","affiliation":[{"name":"Neuralrehabilitation Group of the Spanish National Research Council (CSIC), 28006 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-3395","authenticated-orcid":false,"given":"Diego","family":"Torricelli","sequence":"additional","affiliation":[{"name":"Neuralrehabilitation Group of the Spanish National Research Council (CSIC), 28006 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0006-7013","authenticated-orcid":false,"given":"Stefano","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Economics Engineering Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy"}]},{"given":"Fabrizio","family":"Patan\u00e8","sequence":"additional","affiliation":[{"name":"Department of Engineering, University Niccol\u00f2 Cusano, 00166 Rome, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"ref_2","doi-asserted-by":"crossref","unstructured":"Cardona, M., Destarac, M., and Cena, C.G. (2020). Robotics for Rehabilitation: A State of the Art. Exoskeleton Robots for Rehabilitation and Healthcare Devices, Springer. SpringerBriefs in Applied Sciences and Technology.","DOI":"10.1007\/978-981-15-4732-4_1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s10033-019-0389-8","article-title":"A Review on Lower Limb Rehabilitation Exoskeleton Robots","volume":"32","author":"Shi","year":"2019","journal-title":"Chin. J. Mech. Eng."},{"key":"ref_4","first-page":"5751391","article-title":"A Review on Compliant Joint Mechanisms for Lower Limb Exoskeletons","volume":"2016","year":"2016","journal-title":"J. Robot."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"561774","DOI":"10.3389\/frobt.2020.561774","article-title":"Benchmarking Wearable Robots: Challenges and Recommendations from Functional, User Experience, and Methodological Perspectives","volume":"7","author":"Torricelli","year":"2020","journal-title":"Front. Robot. AI"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.mechmachtheory.2017.12.013","article-title":"Design of hip joint assistant asymmetric parallel mechanism and optimization of singularity-free workspace","volume":"122","author":"Zhang","year":"2018","journal-title":"Mech. Mach. Theory"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Olivier, J., Ortlieb, A., Bertusi, P., Vouga, T., Bouri, M., and Bleuler, H. (2015, January 11\u201314). Impact of ankle locking on gait implications for the design of hip and knee exoskeletons. Proceedings of the 2015 IEEE International Conference on Rehabilitation Robotics (ICORR), Singapore.","DOI":"10.1109\/ICORR.2015.7281269"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1109\/TRO.2013.2256309","article-title":"Rehabilitation exoskeleton design: Exploring the effect of the anterior lunge degree of freedom","volume":"29","author":"Stegall","year":"2013","journal-title":"IEEE Trans. Robot."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1249\/mss.0b013e31802b3562","article-title":"The effects of adding mass to the legs on the energetics and biomechanics of walking","volume":"39","author":"Browning","year":"2007","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1242\/jeb.012443","article-title":"The effect of increasing inertia upon vertical ground reaction forces and temporal kinematics during locomotion","volume":"211","author":"Hagan","year":"2008","journal-title":"J. Exp. Biol."},{"key":"ref_11","first-page":"5975415","article-title":"Effects of added inertia and body weight support on lateral balance control during walking","volume":"2011","author":"Pennycott","year":"2011","journal-title":"IEEE Int. Conf. Rehabil. Robot."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/s00221-005-0162-3","article-title":"Adaptation to unilateral change in lower limb mechanical properties during human walking","volume":"169","author":"Noble","year":"2005","journal-title":"Exp. Brain Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1109\/TRO.2015.2450414","article-title":"Knee Joint Misalignment in Exoskeletons for the Lower Extremities: Effects on User\u2019s Gait","volume":"31","author":"Zanotto","year":"2015","journal-title":"IEEE Trans. Robot."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3389\/fspor.2019.00022","article-title":"Does a Passive Unilateral Lower Limb Exoskeleton Affect Human Static and Dynamic Balance Control?","volume":"1","author":"Ringhof","year":"2019","journal-title":"Front. Sports Act Living"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.apergo.2019.05.018","article-title":"Influence of a passive lower-limb exoskeleton during simulated industrial work tasks on physical load, upper body posture, postural control and discomfort","volume":"80","author":"Luger","year":"2019","journal-title":"Appl. Ergon."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/978-3-030-01887-0_24","article-title":"COVR\u2014Towards Simplified Evaluation and Validation of Collaborative Robotics Applications Across a Wide Range of Domains Based on Robot Safety Skills","volume":"22","author":"Bessler","year":"2018","journal-title":"Biosyst. Biorobotics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/978-3-030-01887-0_72","article-title":"EUROBENCH: Preparing Robots for the Real World","volume":"22","author":"Torricelli","year":"2018","journal-title":"Biosyst. Biorobotics"},{"key":"ref_18","unstructured":"(2021, October 12). COST ACTION CA16116 WEARABLE ROBOTS FOR AUGMENTATION, ASSISTANCE OR SUBSTITUTION OF HUMAN MOTOR FUNCTIONS | Jan F Veneman | 5 Updates | 1 Publications | Research Project. Available online: https:\/\/www.researchgate.net\/project\/COST-Action-CA16116-Wearable-Robots-for-Augmentation-Assistance-or-Substitution-of-Human-Motor-Functions."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zampogna, A., Mileti, I., Palermo, E., Celletti, C., Paoloni, M., Manoni, A., Mazzetta, I., Costa, G.D., P\u00e9rez-L\u00f3pez, C., and Camerota, F. (2020). Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. Sensors, 20.","DOI":"10.3390\/s20113247"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.ijporl.2007.03.012","article-title":"Balance in healthy individuals assessed with Equitest: Maturation and normative data for children and young adults","volume":"71","author":"Ionescu","year":"2007","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.apmr.2008.06.025","article-title":"A Comparison of Balance Performance: Computerized Dynamic Posturography and a Random Motion Platform","volume":"90","author":"Broglio","year":"2009","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1016\/j.ijporl.2006.03.012","article-title":"Vestibular assessment with Balance Quest: Normative data for children and young adults","volume":"70","author":"Ionescu","year":"2006","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.medengphy.2006.06.004","article-title":"Kinematic response characteristics of the CAREN moving platform system for use in posture and balance research","volume":"29","author":"Lees","year":"2007","journal-title":"Med. Eng. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Taborri, J., Salvatori, S., Mariani, G., Rossi, S., and Patane, F. (2020, January 3\u20135). BEAT: Balance Evaluation Automated Testbed for the standardization of balance assessment in human wearing exoskeleton. Proceedings of the 2020 IEEE International Workshop on Metrology for Industry 4.0 and IoT, MetroInd 4.0 and IoT 2020\u2014Proceedings, Roma, Italy.","DOI":"10.1109\/MetroInd4.0IoT48571.2020.9138245"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1109\/TNSRE.2010.2089535","article-title":"A 3-DOF parallel robot with spherical motion for the rehabilitation and evaluation of balance performance","volume":"19","author":"Patane","year":"2010","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Taborri, J., Mileti, I., Del Prete, Z., Rossi, S., and Palermo, E. (2018, January 26\u201329). Yaw Postural Perturbation Through Robotic Platform: Aging Effects on Muscle Synergies. Proceedings of the 2018 7th IEEE International Conference on Biomedical Robotics and Biomechatronics (Biorob), Enschede, The Netherlands.","DOI":"10.1109\/BIOROB.2018.8488085"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Mileti, I., Taborri, J., Rossi, S., Del Prete, Z., Paoloni, M., Suppa, A., and Palermo, E. (2018, January 11\u201313). Measuring age-related differences in kinematic postural strategies under yaw perturbation. Proceedings of the 2018 IEEE International Symposium on Medical Measurements and Applications (MeMeA), Rome, Italy.","DOI":"10.1109\/MeMeA.2018.8438804"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s12984-015-0048-y","article-title":"The H2 robotic exoskeleton for gait rehabilitation after stroke: Early findings from a clinical study","volume":"12","author":"Bortole","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.measurement.2014.03.004","article-title":"Experimental evaluation of accuracy and repeatability of a novel body-to-sensor calibration procedure for inertial sensor-based gait analysis","volume":"52","author":"Palermo","year":"2014","journal-title":"Measurement"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.gaitpost.2008.04.013","article-title":"Effect of changing visual condition and frequency of horizontal oscillations on postural balance of standing healthy subjects","volume":"28","author":"Cappa","year":"2008","journal-title":"Gait Posture"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1037\/1040-3590.6.4.284","article-title":"Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology","volume":"6","author":"Cicchetti","year":"1994","journal-title":"Psychol. Assess."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1016\/j.clinph.2021.06.023","article-title":"Early balance impairment in Parkinson\u2019s Disease: Evidence from Robot-assisted axial rotations","volume":"132","author":"Zampogna","year":"2021","journal-title":"Clin. Neurophysiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12984-016-0216-8","article-title":"Quantification of postural stability in minimally disabled multiple sclerosis patients by means of dynamic posturography: An observational study","volume":"14","author":"Grassi","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"161018","DOI":"10.1098\/rsos.161018","article-title":"Balance control strategies during perturbed and unperturbed balance in standing and handstand","volume":"4","author":"Blenkinsop","year":"2017","journal-title":"R. Soc. Open Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105194","DOI":"10.1016\/j.clinbiomech.2020.105194","article-title":"Gender difference of hip-ankle compensations following a novel trip perturbation in young adults","volume":"80","author":"Sung","year":"2020","journal-title":"Clin. Biomech."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Batcir, S., Shani, G., Shapiro, A., Alexander, N., and Melzer, I. (2020). The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01650-4"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.gaitpost.2020.09.019","article-title":"Validation of an ankle-hip model of balance on a balance board via kinematic frequency-content","volume":"82","author":"Yang","year":"2020","journal-title":"Gait Posture"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"200111","DOI":"10.1098\/rsos.200111","article-title":"Centre of pressure versus centre of mass stabilization strategies: The tightrope balancing case","volume":"7","author":"Morasso","year":"2020","journal-title":"R. Soc. Open Sci."},{"key":"ref_39","first-page":"593","article-title":"Balance Control Strategies during Standing in a Locked-Ankle Passive Exoskeleton","volume":"2019","author":"Fasola","year":"2019","journal-title":"IEEE Int. Conf. Rehabil. Robot."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102546","DOI":"10.1016\/j.humov.2019.102546","article-title":"Review of balance recovery in response to external perturbations during daily activities","volume":"69","author":"Tokur","year":"2019","journal-title":"Hum. Mov. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"496","DOI":"10.3389\/fphys.2020.00496","article-title":"Cross-Education Related to the Ipsilateral Limb Activity on Monopedal Postural Control of the Contralateral Limb: A Review","volume":"11","author":"Paillard","year":"2020","journal-title":"Front. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100964","DOI":"10.1016\/j.mex.2020.100964","article-title":"A comprehensive method for assessing postural control during dynamic balance testing","volume":"7","author":"Mandalidis","year":"2020","journal-title":"MethodsX"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1123\/ijatt.2016-0004","article-title":"Postural control strategies are dependent on reach direction in the star excursion balance test","volume":"21","author":"Keith","year":"2016","journal-title":"Int. J. Athl. Ther. Train."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1152\/jn.00131.2009","article-title":"Direction-dependent control of balance during walking and standing","volume":"102","author":"Kuo","year":"2009","journal-title":"J. Neurophysiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"104323","DOI":"10.1016\/j.mechmachtheory.2021.104323","article-title":"Design and optimisation of load-adaptive actuator with variable stiffness for compact ankle exoskeleton","volume":"161","author":"Shao","year":"2021","journal-title":"Mech. Mach. Theory"}],"container-title":["Robotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-6581\/11\/6\/151\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:53Z","timestamp":1760146913000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-6581\/11\/6\/151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["robotics11060151"],"URL":"https:\/\/doi.org\/10.3390\/robotics11060151","relation":{},"ISSN":["2218-6581"],"issn-type":[{"type":"electronic","value":"2218-6581"}],"subject":[],"published":{"date-parts":[[2022,12,15]]}}}