Falls Risk Reduction and Robotics
Understanding and reducing falls in the elderly is an important cornerstone in vestibular and balance rehabilitation, and there may be a new tool on the horizon that could change the way our patients achieve this, namely, exoskeleton technology. Previously, the use of exoskeletons assistance has been limited. Initial prototypes were cumbersome and designed for those with significant motor-control impairment, which left most of the control to the device itself.
This may be changing with the introduction of a new wearable assistive robotic device, the Active Pelvis Orthosis (APO), which is able to detect unexpected perturbations and react to stop a fall. Researchers tested the new lightweight design on a small cohort of elderly subjects (8) as well as transfemoral amputees (2). The suit has two modes, the first mode (Z-mode) is transparent, whereby the user is in control and movements are not hindered or dictated by the exoskeleton. The second (A-mode) is triggered when a sudden shift of the wearer's center of mass is detected.
The exoskeleton immediately responds by applying torque in the lower extremities to quickly counteract the perceived downward motion of the wearer’s center of mass. The A-mode reaction strategy is based upon physiological strategies that are crucial in upright stance maintenance but are shown to slow down as we age. The researchers admit that more tests and modifications are needed, but there may come a day where this technology will be a viable option as a mobility aid much like traditional wheelchairs or walkers are today.
Monaco V, Tropea P, Aprigliano F, Martelli D, Parri A, Cortese M, Molino-Lova R, Vitiello N, Micera S. (2017) An ecologically-controlled exoskeleton can improve balance recovery after slippage Sci Rep 7, 46721, May 11.