Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A textile exomuscle that assists the shoulder during functional movements for everyday life

Nature Machine Intelligence volume 4, pages 574–582 (2022)Cite this article

Subjects

Abstract

Effortlessly performing activities of daily living constitutes a cornerstone of our personal independence. Naturally, various forms of upper limb impairments can have a substantial impact on quality of life. We developed the Myoshirt, a textile-based soft wearable robot, or exomuscle, that autonomously follows the user’s movements and thereby assists the shoulder against gravity. With the Myoshirt, participants without impairments (n = 10, 5 male) experienced a delayed onset of muscular fatigue by 51.1 s (36.1%, P < 0.001), while during a functional task their muscular activity decreased by 49.1% (P < 0.001). Analogously, two participants with upper limb impairments due to a muscular dystrophy and a spinal cord injury experienced a delayed onset of muscular fatigue during unloaded arm lifts by 256.4 s (61.5%) and by 450.6 s (210.3%), respectively. Our evidence suggests that the Myoshirt is an effective tool that intuitively assists the shoulder during functional reaching tasks, with the potential of increasing the personal independence of people with upper limb impairments.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Design of the Myoshirt.
Fig. 2: Muscular endurance task for participants without impairments.
Fig. 3: Muscle activity in a functional task.
Fig. 4: Range of motion while unassisted (None, grey) and while assisted by the Myoshirt (blue).
Fig. 5: Case study of participants with neuromuscular impairments.
Fig. 6: Gravity assistance controller.

Data availability

All (other) data needed to evaluate the conclusions in the Article are presented in the Article or Supplementary Information. The data have been deposited in the online repository at https://doi.org/10.5281/zenodo.5070434 (ref. 58) and may be reused for ethical, scientific purposes.

Code availability

The exemplary scripts for data processing and analysis for this study have been deposited in the online repository at https://doi.org/10.5281/zenodo.5070434 (ref. 59) and may be reused for ethical, scientific purposes.

References

  1. Gassert, R. & Dietz, V. Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective. J. Neuroeng. Rehabil. 15, 46 (2018).

    Article  Google Scholar 

  2. Weber, L. M. & Stein, J. The use of robots in stroke rehabilitation: a narrative review. NeuroRehabilitation 43, 99–110 (2018).

    Article  Google Scholar 

  3. Mehrholz, J., Thomas, S., Kugler, J., Pohl, M. & Elsner, B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst. Rev. 2020, CD006185 (2020).

    Google Scholar 

  4. Mehrholz, J., Pohl, M., Platz, T., Kugler, J. & Elsner, B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst. Rev. 2018, CD006876 (2018).

    Google Scholar 

  5. Nef, T., Guidali, M. & Riener, R. ARMin III—arm therapy exoskeleton with an ergonomic shoulder actuation. Appl. Bionics Biomech. 6, 127–142 (2009).

    Article  Google Scholar 

  6. Keller, U., Van Hedel, H. J. A., Klamroth-Marganska, V. & Riener, R. ChARMin: the first actuated exoskeleton robot for pediatric arm rehabilitation. IEEE/ASME Trans. Mechatron. 21, 2201–2213 (2016).

    Article  Google Scholar 

  7. Hayward, K. S., Neibling, B. A. & Barker, R. N. Self-administered, home-based SMART (Sensorimotor Active Rehabilitation Training) arm training: a single-case report. Am. J. Occup. Ther. 69, 6904210020 (2015).

    Article  Google Scholar 

  8. Xiloyannis, M. et al. Soft robotic suits: state of the art, core technologies and open challenges. IEEE Trans. Robot. https://doi.org/10.1109/TRO.2021.3084466 (2021).

  9. Simpson, C. S., Okamura, A. M. & Hawkes, E. W. Exomuscle: an inflatable device for shoulder abduction support. In Proc. IEEE International Conference on Robotics and Automation (ICRA) 6651–6657 (2017); https://doi.org/10.1109/ICRA.2017.7989785

  10. Simpson, C. et al. Upper extremity exomuscle for shoulder abduction support. IEEE Trans. Med. Robot. Bionics 2, 474–484 (2020).

    Article  Google Scholar 

  11. Veeger, H. E. J. & van der Helm, F. C. T. Shoulder function: the perfect compromise between mobility and stability. J. Biomech. 40, 2119–2129 (2007).

    Article  Google Scholar 

  12. Inman, V. T., Saunders, J. B. & Abbott, L. C. Observations on the function of the shoulder joint. J. Bone Jt Surg. 26, 1–30 (1944).

    Google Scholar 

  13. Sukal, T. M., Ellis, M. D. & Dewald, J. P. A. Shoulder abduction-induced reductions in reaching work area following hemiparetic stroke: neuroscientific implications. Exp. Brain Res. 183, 215–223 (2007).

    Article  Google Scholar 

  14. Ellis, M. D., Sukal-Moulton, T. & Dewald, J. P. A. Progressive shoulder abduction loading is a crucial element of arm rehabilitation in chronic stroke. Neurorehabilit. Neural Repair 23, 862–869 (2009).

    Article  Google Scholar 

  15. Prange, G. B. et al. Influence of gravity compensation on muscle activation patterns during different temporal phases of arm movements of stroke patients. Neurorehabilit. Neural Repair 23, 478–485 (2009).

    Article  Google Scholar 

  16. Perry, B., Sivak, J. & Stokic, D. Providing unloading by exoskeleton improves shoulder flexion performance after stroke. Exp. Brain Res. 239, 1539–1549 (2021).

  17. Kesner, S. B., Jentoft, L., Hammond, F. L. III, Howe, R. D. & Popovic, M. Design considerations for an active soft orthotic system for shoulder rehabilitation. In 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society 8130–8134 (IEEE, 2011).

  18. Galiana, I., Hammond, F. L. III, Howe, R. D. & Popovic, M. Wearable soft robotic device for post-stroke shoulder rehabilitation: identifying misalignments. In 2012 IEEE/RSJ International Conference on Intelligent Robots and Systems 317–322 (IEEE, 2012).

  19. Lessard, S. et al. CRUX: a compliant robotic upper-extremity exosuit for lightweight, portable, multi-joint muscular augmentation. In 2017 International Conference on Rehabilitation Robotics (ICORR) 1633–1638 (IEEE, 2017).

  20. Li, N. et al. Bio-inspired upper limb soft exoskeleton to reduce stroke-induced complications. Bioinspir. Biomim. 13, 66001 (2018).

    Article  Google Scholar 

  21. Lessard, S. et al. A soft exosuit for flexible upper-extremity rehabilitation. IEEE Trans. Neural Syst. Rehabil. Eng. 26, 1604–1617 (2018).

    Article  Google Scholar 

  22. Samper-Escudero, J. L., Gimenez, A., Sanchez-Uran, M. A. & Ferre, M. A cable-driven exosuit for upper limb flexion based on fibres compliance. IEEE Access 8, 153297–153310 (2020).

  23. Natividad, R. F. & Yeow, C. H. Development of a soft robotic shoulder assistive device for shoulder abduction. In 2016 6th IEEE International Conference on Biomedical Robotics and Biomechatronics (BioRob) 989–993 (IEEE, 2016).

  24. O’Neill, C. T., Phipps, N. S., Cappello, L., Paganoni, S. & Walsh, C. J. A soft wearable robot for the shoulder: design, characterization, and preliminary testing. IEEE Int. Conf. Rehabil. Robot. 02129, 1672–1678 (2017).

    Google Scholar 

  25. Georgarakis, A. M., Wolf, P. & Riener, R. Simplifying exosuits: kinematic couplings in the upper extremity during daily living tasks. In 2019 IEEE 16th International Conference on Rehabilitation Robotics (ICORR) 423–428 (IEEE, 2019).

  26. Zhou, Y. M., Hohimer, C., Proietti, T., O’Neill, C. T. & Walsh, C. J. Kinematics-based control of an inflatable soft wearable robot for assisting the shoulder of industrial workers. IEEE Robot. Autom. Lett. 6, 2155–2162 (2021).

    Article  Google Scholar 

  27. Proietti, T. et al. Sensing and control of a multi-joint soft wearable robot for upper-limb assistance and rehabilitation. IEEE Robot. Autom. Lett. 6, 2381–2388 (2021).

    Article  Google Scholar 

  28. Georgarakis, A. M., Song, J., Wolf, P., Riener, R. & Xiloyannis, M. Control for gravity compensation in tendon-driven upper limb exosuits. In 2020 8th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob) 340–345 (IEEE, 2020).

  29. Wu, G. et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: Shoulder, elbow, wrist and hand. J. Biomech. 38, 981–992 (2005).

    Article  Google Scholar 

  30. Gaponov, I., Popov, D., Lee, S. J. & Ryu, J. Auxilio: a portable cable-driven exosuit for upper extremity assistance. Int. J. Control Autom. Syst. 15, 73–84 (2016).

    Article  Google Scholar 

  31. O’Neill, C. T. et al. Inflatable soft wearable robot for reducing therapist fatigue during upper extremity rehabilitation in severe stroke. IEEE Robot. Autom. Lett. 5, 3899–3906 (2020).

    Article  Google Scholar 

  32. Yozbatiran, N., Der-Yeghiaian, L. & Cramer, S. C. A standardized approach to performing the action research arm test. Neurorehabilit. Neural Repair 22, 78–90 (2008).

    Article  Google Scholar 

  33. Stern, E. B. Stability of the Jebsen–Taylor Hand Function Test across three test sessions. Am. J. Occup. Ther. 46, 647–649 (1991).

    Article  Google Scholar 

  34. Bemben, M. G. Age-related alterations in muscular endurance. Sports Med. 25, 259–269 (1998).

    Article  Google Scholar 

  35. Merletti, R., Knaflitz, M. & De Luca, C. J. Myoelectric manifestations of fatigue in voluntary and electrically elicited contractions. J. Appl. Physiol. 69, 1810–1820 (1990).

    Article  Google Scholar 

  36. Burden, A. in Biomechanical Evaluation of Movement in Sport and Exercise (eds Payton, C. J. & Burden, A.) 273–310 (Wiley, 2017); https://doi.org/10.4324/9780203095546-7

  37. Gates, D. H., Walters, L. S., Cowley, J., Wilken, J. M. & Resnik, L. Range of motion requirements for upper-limb activities of daily living. Am. J. Occup. Ther. 70, 7001350010 (2015).

    Google Scholar 

  38. Brooke, M. H. et al. Clinical trial in Duchenne dystrophy. I. The design of the protocol. Muscle Nerve 4, 186–197 (1981).

    Article  Google Scholar 

  39. Borg, G. A. V. Psychophysical bases of perceived exertion. Med. Sci. Sports Exerc. 14, 377–381 (1982).

    Google Scholar 

  40. Balasubramanian, S., Melendez-Calderon, A. & Burdet, E. A robust and sensitive metric for quantifying movement smoothness. IEEE Trans. Biomed. Eng. 59, 2126–2136 (2012).

    Article  Google Scholar 

  41. Kim, J. et al. Reducing the metabolic rate of walking and running with a versatile, portable exosuit. Science 365, 668–672 (2019).

    Article  Google Scholar 

  42. Ding, Y., Kim, M., Kuindersma, S. & Walsh, C. J. Human-in-the-loop optimization of hip assistance with a soft exosuit during walking. Sci. Robot. 3, eaar5438 (2018).

    Article  Google Scholar 

  43. Lotti, N. et al. Adaptive model-based myoelectric control for a soft wearable arm exosuit: a new generation of wearable robot control. IEEE Robot. Autom. Mag. 27, 43–53 (2020).

    Article  Google Scholar 

  44. Hosseini, M. et al. A sEMG-driven soft exosuit based on twisted string actuators for elbow assistive applications. IEEE Robot. Autom. Lett. 5, 4094–4101 (2020).

    Article  Google Scholar 

  45. Park, D. & Cho, K. J. Development and evaluation of a soft wearable weight support device for reducing muscle fatigue on shoulder. PLoS ONE 12, e0173730 (2017).

    Article  Google Scholar 

  46. Kim, S. et al. Assessing the influence of a passive, upper extremity exoskeletal vest for tasks requiring arm elevation: part I—“Expected” effects on discomfort, shoulder muscle activity, and work task performance. Appl. Ergon. 70, 315–322 (2018).

    Article  Google Scholar 

  47. Kim, S. et al. Assessing the influence of a passive, upper extremity exoskeletal vest for tasks requiring arm elevation: part II—“Unexpected” effects on shoulder motion, balance, and spine loading. Appl. Ergon. 70, 323–330 (2018).

    Article  Google Scholar 

  48. Gemperle, F., Kasabach, C., Stivoric, J., Bauer, M. & Martin, R. Design for wearability. In Digest of Papers. Second International Symposium on Wearable Computers (Cat. No.98EX215) 116–122 (IEEE, 1998); https://doi.org/10.1109/ISWC.1998.729537

  49. Koo, S. H. Design factors and preferences in wearable soft robots for movement disabilities. Int. J. Cloth. Sci. Technol. 30, 477–495 (2018).

    Article  Google Scholar 

  50. Myers, M. & Steudel, K. Effect of limb mass and its distribution on the energetic cost of running. J. Exp. Biol. 116, 363–373 (1985).

    Article  Google Scholar 

  51. Lee, G. et al. Improved assistive profile tracking of soft exosuits for walking and jogging with off-board actuation. In 2017 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) 1699–1706 (IEEE, 2017).

  52. Xiloyannis, M., Chiaradia, D., Frisoli, A. & Masia, L. Physiological and kinematic effects of a soft exosuit on arm movements. J. Neuroeng. Rehabil. 16, 29 (2019).

    Article  Google Scholar 

  53. Johnston, T. B. The movements of the shoulder joint—a plea for the use of the ‘plane of the scapula’ as the plane of reference for movements occurring at the humero-scapular joint. Br. J. Surg. 25, 252–260 (1937).

    Article  Google Scholar 

  54. Levin, M. F., Liebermann, D. G., Parmet, Y. & Berman, S. Compensatory versus noncompensatory shoulder movements used for reaching in stroke. Neurorehabilit. Neural Repair 30, 635–646 (2016).

    Article  Google Scholar 

  55. Merletti, R. & Parker, P. J. Electromyography: Physiology, Engineering, and Non-Invasive Applications (Wiley, 2004).

  56. Haufe, F. L., Wolf, P., Riener, R. & Grimmer, M. Biomechanical effects of passive hip springs during walking. J. Biomech. 98, 109432 (2020).

    Article  Google Scholar 

  57. Haufe, F. L., Kober, A. M., Wolf, P., Riener, R. & Xiloyannis, M. Learning to walk with a wearable robot in 880 simple steps: a pilot study on motor adaptation. J. Neuroeng. Rehabil. 18, 157 (2021).

    Article  Google Scholar 

  58. Georgarakis, A.-M., Xiloyannis, M., Wolf, P. & Riener, R. The Myoshirt data repository. Zenodo https://doi.org/10.5281/zenodo.5070434 (2021).

  59. Georgarakis, A.-M., Xiloyannis, M., Wolf, P. & Riener, R. The Myoshirt code repository. Zenodo https://doi.org/10.5281/zenodo.5070434 (2021).

Download references

Acknowledgements

We thank J. Song and D. Hollinger for their valuable contributions during the development and evaluation of the Myoshirt, and furthermore the students and research staff at the Sensory–Motor Systems Lab for their contributions and helpful feedback: F. Haufe, S. Brendle, F. Teuscher, D. Ozan and M. Macuglia. Finally, we would like to thank our participants for their time and insightful feedback. This work was supported by the Swiss National Center of Competence in Research (NCCR) Robotics, Swiss National Science Foundation 51_NF_40_185543, received by R.R.

Author information

Authors and Affiliations

  1. Sensory–Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich, Switzerland

    Anna-Maria Georgarakis, Michele Xiloyannis, Peter Wolf & Robert Riener

  2. Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland

    Anna-Maria Georgarakis, Michele Xiloyannis & Robert Riener

Authors
  1. Anna-Maria Georgarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Xiloyannis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Riener
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.-M.G. designed and created the textile human–robot interface. A.-M.G. and M.X. led the design and implementation of the actuator box and the gravity assistance controller. A.-M.G., M.X., P.W. and R.R. designed the study. A.-M.G. and M.X. led the conduct of the study. A.-M.G. analysed the data and prepared the figures and manuscript. All authors reviewed the manuscript and provided critical feedback.

Corresponding author

Correspondence to Anna-Maria Georgarakis.

Ethics declarations

Competing interests

The authors declare no competing interests.

Peer review

Peer review information

Nature Machine Intelligence thanks Leonardo Cappello, Nicola Vitiello, Alessandra Pedrocchi and Lorenzo Masia for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary Information

Supplementary Figs. 1–5, Tables 1–5 and Sections 1 and 2.

Supplementary Video 1

The Myoshirt—a textile exomuscle that assists the shoulder during functional movements for everyday life.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Georgarakis, AM., Xiloyannis, M., Wolf, P. et al. A textile exomuscle that assists the shoulder during functional movements for everyday life. Nat Mach Intell 4, 574–582 (2022). https://doi.org/10.1038/s42256-022-00495-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s42256-022-00495-3

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing