In the ever-evolving landscape of assistive technologies, “Advanced and Hybrid solutions for Wearable Assistive Technologies” is a groundbreaking special session that explores the cutting-edge developments in the field. Wearable technologies and prostheses have made remarkable strides in enhancing the quality of life for individuals with motor impairments and disabilities. Among all the developments brought by one century of modern research in the field, the search for intuitive and naturally perceived human-machine interfaces still remains a hot research topic. “Advanced and Hybrid solutions for wearable assistive technologies” promises to be an invaluable opportunity for researchers and practitioners in the field. This special session delves into innovative strategies that empower users and improve the functionality of these devices. In particular, it will feature a collection of research articles and case studies that shed light on the latest advancements on novel control methods, including sensorimotor integration in assistive wearable technologies. The selected line of speakers will share their expertise in the mentioned relevant topics: we will span from latest advances in context-awareness applied to soft robotic suits to invasive technologies aiming at restoring lost motor functions in amputees. Finally, after the speech of the invited speakers, attendees will engage in an open discussion centered around shaping the future of assistive technology with a human-in-the-loop approach.

Stroke is one of the major causes of adult disability worldwide. According to the World Stroke Organization, one in four people will experience stroke in their lifetime, and over 50% of the survivors will live with chronic disability. Stroke often leads to motor impairment, such as spasticity, muscle weakness, and abnormal motor coordination. Impaired, stereotypical motor coordination patterns emerge during stroke recovery and can be quantified as abnormal intermuscular coordination patterns. This multi-muscle coordination is a key contributor to motor impairment and suggests an underlying neural reorganization within the motor control system. Abnormal intermuscular coordination does not entirely resolve after spontaneous recovery or after conventional physical or occupational therapy. Thus, there is an important gap in our ability to effectively assess the recovery process of the motor impairment and reduce it after a stroke. This Special Session will provide examples of how muscle coordination in stroke can be modified and improved using bioengineering interventions, i.e., myoelectric interfacing and robotics, and muscle synergy analysis to improve the motor function of stroke survivors. In particular, we will present how assistive and resistive forces provided by a robot, robotic task settings, and robotic-aided training can impact upper limb muscle synergies in chronic and subacute stroke patients. Also, a personalized neuromusculoskeletal model will be introduced to identify the most “broken” muscle synergy in the paretic leg of an individual post-stroke and performs a walking simulation using the subject’s personalized model to predict how walking speed and bilateral symmetry would improve if this one “broken” synergy activation could be “fixed.” Furthermore, we will demonstrate how targeted brain stimulation can alter cortical activity and motor impairment after stroke. A panel discussion on the current challenges in the field will follow.

The development of upper limb rehabilitation robotics have arguably been dominated by arm assistive robots that account for the gross reaching movements. The design of wrist and hand robotic devices for rehabilitation purposes is no less studied but relatively less developed in the translational sense, primarily due to the complexity of the human hand as well as the engineering and clinical requirements for the application. However, the need for the assistive and rehabilitation devices for the distal end of the upper limb is as important, if not more, as it completes the purpose of the gross reaching movements (ie. we reach out our arm usually to grasp and manipulate an object), thus it provides functional context for the reaching movement therapy. In this session, we would explore the latest in the development of concepts and devices for the rehabilitation of the distal end of the upper limb with a view to integrate and provide a more complete functional context to the upper limb movement therapies.

Robotics for functional movement therapy are used in neurorehabilitation to (re-)train gait, balance, as well as arm and hand functions, since over two decades. Immersive Virtual Reality systems are also increasingly used in clinical contexts over the recent years and show promise for use in combination with robotic devices for functional movement therapy. In this Special Session, current research and first learnings about the combined use of robotics and immersive VR systems in the context of movement rehabilitation will be discussed. Specific attention will be given to following topics: a) applications either specifically in gait and balance training, or specifically in arm and hand training, focusing on the specifics of such a context, b) direct coupling between the physical and virtual environment, for example first person representation of ego-movement, or using haptic feedback to support virtual illusions, c) observations from usability and feasibility studies with patients, d) Additional presentations of treatment approaches, novel technical solutions, as well as studies on feasibility, acceptance or clinical relevance of such combined use will be accepted.

In this session, we will integrate knowledge from various fields in neurological rehabilitation. Sarah will present the concept of digital twins of traumatic spinal cord injury patients as an in silico version of an individual, allowing for the simulation of expected recovery achieved through standard rehabilitation protocols. Sarah will also present a comprehensive overview of the concept of data-driven (AI) methods to generate recovery predictions and showcase their application for personalized predictions, and synthetic controls in clinical trials. Daniel’s presentation will examine the evolution of rehabilitation and devices in the context of robotics and digitalization. While acknowledging the field’s high potential in areas such as intensity, measurability, and home training, Daniel will highlight challenges such as human factors, limited financing models, market constraints, and susceptibility to errors. He will bring hope for future advancements, particularly with the integration of AI technologies? Jose’s talk will challenge conventional beliefs surrounding gait recovery in chronic stroke patients. His systematic review will reveal promising findings that challenge the notion of limited improvement post six months. By identifying factors influencing improvement, Jose will shed light on effective interventions for motor and functional rehabilitation beyond perceived recovery limits. Liliana will close the session focusing on the usability and feasibility of Myosuit-based gait training for ambulatory neurological patients with gait disorders. Through an interventional study, Liliana and colleagues assess the safety, feasibility, acceptability, and motivation of patients and therapists using the Myosuit in clinical and home settings. In summary, these presentations underscore the importance of innovative technologies and interdisciplinary approaches in advancing digital health and rehabilitation. We will highlight challenges, opportunities, and promising avenues for improving patient outcomes in neurological rehabilitation.

After neurological injuries such as stroke individuals commonly suffer from sensorimotor impairments that limit their ability to participate in activities of daily living. Intensive neurorehabilitation starting early after a neurological injury or accident in the clinic and continuing all the way after discharge is essential for promoting functional recovery. Robotics and technology-aided therapies hold the promise in providing the possibility of high-quality therapy. Previous research has demonstrated the non-inferiority of technology-assisted therapy to improve functional impairments and increase motor learning compared to the standard of care in the clinic. Along the continuum of care, robot-mediated therapy provides the opportunity to overcome many limits such as decreased therapy intensity after discharge from a clinic. However, there are still limitations in how therapy with robots is provided currently. As such the accessibility to therapy remains limited and the collaborative aspect of traditional one-on-one therapy with a therapist is lacking which often results in a feeling of social isolation. By shifting to providing high-quality, robot-mediated therapy in decentralized settings such as patients‘ homes and by incorporating the human touch through the latest state-of-the-art algorithms some of these barriers could be addressed and overcome. In this special session, we aim to discuss how collaborative robotics will shape the future of neurorehabilitation with international experts from the vast field of rehabilitation robotics who thrive in pushing the boundaries of how robots are currently used for providing therapy and enhancing motor learning.

Neurorehabilitation aims at recovery of neural control of physically impaired body parts. Engineering tools including wearable robots (or exoskeletons) and functional electric stimulation (FES) have been implemented by expert clinicians to create a variety of therapeutic training methods. These strategies can leverage devices in multiple ways, including augmentation of motor function through amplification and assistance of movement and enhancement of volitional motor output through on-demand therapeutic training by manipulation of efferent and/or afferent pathways. Thus, the same engineering tools can be deployed in a variety of ways to address specific symptoms in specific patient groups. In this special session, we will discuss methods for tailoring neurorehabilitation strategies to meet the individual needs of specific patient groups, with a focus on role the ability to accurately and reliably detect movement intent plays in the effective delivery of personalized rehabilitation approaches. Further, we will share clinical experiences of how these strategies are used in the context of multiple, distinct patient groups and the corresponding outcomes that were observed. Finally, we will integrate these findings from specific applications into a discussion of future directions for optimal use of engineering tools such as wearable robotics and FES to facilitate effective neurorehabilitation and functional recovery in individuals with neurological disorders.

While barrier-free policies are being increasingly adopted across industries and public locations, persons with reduced mobility still face limited freedom of movement even with specific services in places such as hospitals, malls and airports. Robotic autonomy has advanced significantly in recent years and has enormous potential for assisting and improving the quality of life for persons with reduced mobility. Post acute rehabilitation, a life-long of functional rehabilitation is required to adapt to new mobility methods, wheelchairs remain the best mobility device for lower-body impairment due to their speed and reliability. Electric-powered wheelchairs are some of the most popular and performant personal mobility assistance in use. The gap between the current state-of-the-art autonomy in robotics and the capabilities of assistive mobility devices is still large, from control interfaces and required cognitive load for the user to the actual intelligence of the devices themselves. This special section is set to explore recent advances in the wide field of assistive mobility. In particular, topics of interest cover the areas of (i) control interfaces; (ii) shared autonomy; and (iii) autonomous assistive devices. These include research in areas such as user-intention prediction, ease of use, intuitive and learnable interfaces, human-centric control, user-centric navigation, and adaptive autonomy, among others.

Individuals post-stroke commonly show deficits in balance and walking function. In this session, novel evidence that advance our understanding of the motor recovery mechanisms will be presented. The ability to release effective balance responses after a slip or trip is critical to prevent a fall. An understanding of the neural mechanisms that underlie these responses is important to the development of evidence based and targeted interventions. Dr. Bhatt will present her work from functional neuroimaging on imagined and observed slipping and how they related with reactive stability during treadmill gait-slips. She will also present data from training-induced changes in brain activations during imagined slipping. Dr. Bhatt will present results from their randomized controlled study that examined long-term retention of gait-slip perturbation training and if degree of motor impairment affected it. Recent studies have shown that lateral movements of standing/walking surface triggered reactive responses that increased lower extremity muscle activities, likely related to spinal and supraspinal mediated neuromuscular mechanisms. By applying small and predictable lateral walking surface oscillations, leg muscle activity could be enhanced through both triggered reactions and anticipatory proactive control mechanisms and therefore improve limb loading without disrupting gait progression. Dr. Hsiao will present their recent findings on the immediate and short-term effect of a Treadmill Oscillation Walking intervention on balance and functional mobility outcomes. A stroke induces a cascade of neurophysiologic changes in cortical and spinal circuits that result in biomechanical gait impairments and gait dysfunction. In this presentation, Dr. Kesar will summarize their recent and ongoing research probing neurobiological and biomechanics mechanisms underlying post-stroke gait rehabilitation. She will present data elucidating neural mechanisms of treadmill training interventions combined with functional electrical stimulation, probed using non-invasive brain and peripheral nerve stimulation techniques. The presentation will also discuss their recent work on real-time gait biofeedback, including game-based biofeedback interfaces for stroke gait retraining.

In an aging society, assistive and rehabilitation technologies are essential to preserve and improve mobility of older adults in daily living activities such as walking, climbing stairs or standing up from a chair. Particularly the frail population can benefit from robotic devices that provide assistance during these activities. This session focuses on assistive and rehabilitation robots targeted to the special needs of elderly frail users, ranging from mobile and stationary exoskeletons to robotic rollators and wheeled devices. The aim is to bring together interdisciplinary researchers and clinicians interested in improving geriatric mobility. Talks in this session can present new hardware and design approaches, novel control concepts and user interfaces, modeling and simulation studies or clinical tests and user studies.

Persons with disability due to stroke, spinal cord injury (SCI), multiple sclerosis (MS), or other neurological disorders face severe mobility deficits in their upper extremity (UE) and lower extremity (LE), even after rehabilitation. These mobility problems negatively affect patients’ ability to perform activities of daily life (e.g., impaired standing, balancing, walking, eating, drinking, dressing). In cases of lost mobility for LE or UE, recovery of function is based on neural adaptation through repetitive, task-oriented training, such as extended periods of walking [6]. Robotic exoskeletons orthotic devices have a potential application in this field due to the ability to 1) provide a regulated and controlled method of assistance to the user for long periods of time; 2) reduce burden on patient and clinical staff; 3) quantitatively measure torques and interaction forces; 4) be a highly repeatable method of controlled training. Objectives of this session are as follows:

• To provide an overview with clinical/engineering outcomes on the utilization of recently developed, FDA and commercially available robotic exoskeleton and orthotic devices for persons with SCI, stroke and MS.
• To provide detailed and objective biomechanical outcomes resulting from utilizing robotic exoskeleton for gait training, including quantification of the dynamics of exoskeletal-assisted walking (EAW) in FDA-approved devices to quantify:
• Human-robot dynamics (joint kinematics and kinetics)
• Hip, knee, and ankle joint forces from persons with SCI during EAW in FDA-approved robots.
• To provide an overview of a newly developed robotic exoskeleton controller for lower limb rehabilitation exoskeletons (LLRE) based on a neural network control policy. Using such pioneering approach based on deep reinforcement learning (DRL) for LLRE control, the controlled robotic device will assist users with diverse neuromuscular conditions during various activities such as squatting, sit-to-stand, and walking.
• To provide scientific evidence and outcomes showing the importance of early implementation of UE orthotics in persons with SCI in the acute phase.
• To discuss the benefits of continued utilization in clinic/community of light-weight FDA approved orthotics for persons with neurological disability in the chronic phase.