The effect of active exoskeleton support with different lumbar-to-hip support ratios on spinal musculoskeletal loading and lumbar kinematics during lifting.

While active back-support exoskeletons can reduce mechanical loading of the spine, current designs include only one pair of actuated hip joints combined with a rigid structure between the pelvis and trunk attachments, restricting lumbar flexion and consequently intended lifting behavior. This study presents a novel active exoskeleton including actuated lumbar and hip joints as well as subject-specific exoskeleton control based on a real-time active low-back moment estimation. We evaluated the effect of exoskeleton support with different lumbar-to-hip (L/H) support ratios on spine loading, lumbar kinematics, and back muscle electromyography (EMG). Eight healthy males lifted 15 kg loads using three techniques without exoskeleton (NOEXO) and with exoskeleton: minimal impedance mode (MINIMP), L/H support ratio in line with a typical L/H net moment ratio (R0.8), lower (R0.5) and higher (R2.0) L/H support ratio than R0.8, and a mechanically fixed lumbar joint (LF; simulating hip joint-only exoskeleton designs). EMG-driven musculoskeletal model results indicated that R0.8 and R0.5 yielded significant reductions in spinal loading (4-11%, p < .004) across techniques when compared to MINIMP, through reducing active moments (14-30%) while not affecting lumbar flexion and passive moments. R2.0 and LF significantly reduced spinal loading (8-17%, p < .001; 22-26%, p < .001, respectively), however significantly restricted lumbar flexion (3-18%, 24-27%, respectively) and the associated passive moments. An L/H support ratio in line with a typical L/H net moment ratio reduces spinal loading, while allowing normal lifting behavior. High L/H support ratios (e.g., in hip joint-only exoskeleton designs) yield reductions in spinal loading, however, restrict lifting behavior, typically perceived as hindrance.