Technology for health s2981106

Individual assignment 3: Technology Research.

Innovation is the introduction of new things, ideas, or ways of doing something.
Technology in relation to innovation is considered as an enabler of theorical and practical
knowledge that can be used to develop products. Technology development is defined as a direct
effort at developing new knowledge skills and artefacts that in turn will facilitate platform
development, which leads in product process development. There are a lot of models for TDP. They
all attempt to consider the uncertain and risky nature of technology development, its benefits in the
long-term strategic landscape of the firm, and its differences from traditional NPD processes. The
TDP have lacked behind on their distinction from traditional product development processes and
the models and means to support them. All these models share the same purpose of managing the
TDP and facilitating rational decision making in evaluation technology projects. However, the true
benefit, appropriate design, and the underlying decision support mechanisms of such structured
technology development processes is still largely unexploited. The most common industry model to
conduct product development is the stage-gate model, in which the process must be adapted to the
special characteristics inherent in exploratory work, where the outcome is new knowledge rather
than a product. There us also a technology realization and commercialization (TRAC) model based
on an structured methodology, a technology development team, a technology review process
(Technology readiness level) and a senior review committee. Talking about the Capita Selecta
topic, individuals with spinal cord injuries (SCI) experience reduced or complete loss of mobility,
but wearable technologies such as lower-limb exoskeletons could be used to assist gait and help
improve their quality of life. Several commercially available exoskeletons have been developed for
and used by subjects with a complete SCI. One solution for SCI individuals is Symbitron. Its main
goal is to enhance functional walking abilities of people with Spinal Cord Injury by improving the
symbiotic interaction between the human and the exoskeleton. The Symbitron exoskeleton is a
force-controlled exoskeleton with actuation on hip, knee, and ankle. It provides the necessary
support to people with complete or incomplete paralysis of the legs. The project started in 2013, and
since that, it has work on theorical insights such as Adjustments for walking on different surfaces,
tackling steps and ramps for first pilot, it has also acquired different sponsors such as Hankamp
rehab, and The University of Twente and Reboocon Bionics teamed up to participate in the
Cybathlon 2020 Prosthesis race. It had also made different improvements such as making the
exoskeleton modular (Ankle, knee and hip module) and making it emulate walking. Symbitron is
composed of a wide team that includes all kind of engineers, project coordinators, project managers,
postdoctoral researchers, PhD students and technicians.

Second, talking about technology readiness level, this is a method for estimating the
maturity of technologies during the acquisition phase of a program. They enable consistent and
uniform discussions of the technical maturity across different types of technology. It is determined
during a technology readiness assessment (TRA) that examines program concepts, technology
requirements, and demonstrated technology capabilities. It consists of nine levels, starting with the
basic technology review and ending with the system test, launch and operations. It has many
advantages such as common understanding of technology status, risk management, helps making
decisions on technology funding and transition of it. However, it also has some limits. First,
readiness does not necessarily fit with appropriateness of technology maturity. Also, a mature
product may possess a greater or lesser degree od readiness for use in a particular system context
that one of lower maturity. Finally, numerous factors must be considered such as relevance of the
products. Talking about the Capita Selecta Topic, Symbitron is in TRL-5 (Technology validated in
relevant environment). The exoskeleton consists of a set of powered modules, one for each lower

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limb joint. Personalization was accomplished by selecting only those joint modules required to
compensate for the loss of function for that specific person and tailoring the control and human-
machine interface. The Symbitron exoskeleton is heavier due the higher number of actuators. With
this exoskeleton, complete SCI individuals were able to walk slowly at 0.1 m/s without using
crutches. Other devices do (mainly) use direct actuation, while Symbitron employs SEA. The
advantage of using SEA is to have much better force control capacity, which is essential for
implementing bio-inspired controllers and for partial support of gait and balance. Lower-leg
exoskeletons for SCI do not actuate the ankle, while Symbitron does. However, Symbitron still
needs to make demonstrations in relevant environments, prototype demonstrations, a complete and
qualified system and an actual application of the technology in its final form to achieve TRL 9.

Still, as every science-based technology development, the exoskeleton will be considered as

successful when the results match the model predictions. Future development for the exoskeleton
will be aimed at reducing weight, increasing robustness, and increasing maintainability and further
developing high level control software. Weight reduction was a major goal in design of the
actuators. The structure, however, was harder to optimize due to the many available size-
adjustments of the exoskeleton. Additionally, its modularity needs to be reconsidered because it
increases the number of interfaces even further. Future development will be aimed at finding fast
and low-cost ways to produce a one-to-one structure for each SCI test pilot to minimize mass and
volume. Also, the weight of the backpack will be reduced significantly. Large sources of failure in
the exoskeleton were the cables and connectors. Again, because of the number of available size
adjustments, the cables were running external to the exoskeleton structure, creating vulnerabilities.
Here, modularity also creates additional complexity by demanding an additional connection and
requiring variable cable length. More effort needs to be made in the integration of the cables and
connectors in the structure. Finally, design for maintenance was greatly underestimated in the
project. In future designs, electronics should be accessible and easily replaced. To improve the
functionality of the exoskeleton, we will also improve the high-level controller to support balance
during walking to reduce the reliance on crutches for complete SCI individuals when wearing the
exoskeleton. We are also developing a flexible path planner such that the exoskeleton can cope with
more challenging environments, such as those used in the Cybathlon competition. While our future
improvements will further advance exoskeleton performance and usability, the Symbitron
exoskeleton shown here demonstrates that tailored assistance through modularity in hardware and
control is promising for restoring the gait of individuals with a spinal cord injury, whether they
required targeted aid or full support.

References:

[1] W. H. O. organization, “Spinal Cord Injury,” World Health Organization, 2013. [Online]. Available at:
https://www.who.int/news-room/fact-sheets/detail/spinal-cord-
injury#:~:text=Spinal%20cord%20injury%20is%20associated%20with%20a%20risk%20of%20developing,chronic%20pa
in%2C%20and%20respiratory%20complications

[2] W. H. O. organization, “Towards a common language for functioning, disability and Health ICF,” World Health
Organization, 2018. [Online]. Available at:
https://cdn.who.int/media/docs/defaultsource/classification/icf/icfbeginnersguide.pdf

[3] “Leben mit Querschnittslähmung,” Symbitron. [Online]. Available at: https://symbitron.eu/

[4] Balogh EP, Miller BT, Ball JR, “The Diagnostic Process”. Improving Diagnosis in Health Care, 2015. [Online].
Available at: https://www.ncbi.nlm.nih.gov/books/NBK338593/

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[5] Michael G. Fehlings, “Diagnosis of traumatic spinal cord injury - spineuniverse,” Spineuniverse, 2019. [Online].
Available at: https://www.spineuniverse.com/conditions/spinal-cord-injury/diagnosistraumatic-spinal-cord-injury

[6] “Spinal Cord Injury diagnosis,” Diagnostic Tests for Spinal Cord Injury | Shepherd Center. [Online]. Available at:
https://www.shepherd.org/patient-programs/spinal-cord-injury/levels-and-
types/diagnosis#:~:text=Diagnostic%20tests%20for%20spinal%20cord%20injuries%20may%20include%20a%20CT,spin
al%20cord%20injury%20has%20occurred

[7] A. S. Yusuf, M. R. Mahmud, D. J. Alfin, S. I. Gana, S. Timothy, E. E. Nwaribe, N. K. Dalhat, A. A. Aruna, and M. M.
Idris, “Clinical characteristics and challenges of management of traumatic spinal cord injury in a trauma center of a
developing country,” Journal of neurosciences in rural practice, Jul-2019. [Online]. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779583/

[8] A. S. Burns and C. O'Connell, “The challenge of Spinal Cord Injury Care in the developing world,” The journal of
spinal cord medicine, Jan-2012. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240914/

[9] “HTA 101: II. fundamental concepts,” U.S. National Library of Medicine. [Online]. Available at:
https://www.nlm.nih.gov/nichsr/hta101/ta10104.html

[10] “Symbitron+ exoskeleton race team: Symbitron+ exoskeleton: Wearable robotics lab,” Universiteit Twente. [Online].
Available at: https://www.wearableroboticslab.nl/cybathlon-2020/SymbitronExoskeleton-Race-Team/

[11] Meijneke, C.; van Oort, G.; Sluiter, V.; van Asseldonk, E.; Tagliamonte, N. L.; Tamburella, F.; Pisotta, I.; Masciullo,
M.; Arquilla, M.; Molinari, M., “Symbitron Exoskeleton: Design, control, and evaluation of a modular exoskeleton for
incomplete and complete spinal cord injured individuals,” IEEE Xplore Full-text PDF: 2021. [Online]. Available at:
https://ieeexplore.ieee.org/Xplore/cookiedetectresponse.jsp