Effect of Assistance Timing in Knee Extensor Muscle Activation During Sit-to-Stand Using a Bilateral Robotic Knee Exoskeleton.

The population of older adults experiences a significant degradation in musculoskeletal structure, which hinders daily physical activities. Standing up from a seated position is difficult for mobility-challenged individuals since a significant amount of knee extensor moment is required to lift the body's center of mass. One solution to reduce the required muscle work during sit-to-stand is to utilize a powered exoskeleton system that can provide relevant knee extension assistance. However, the optimal exoskeleton assistance strategy for maximal biomechanical benefit is unknown for sit-to-stand tasks. To answer this, we explored the effect of assistance timing using a bilateral robotic exoskeleton on the user's knee extensor muscle activation. Assistance was provided at both knee joints from 0% to 65% of the sit-to-stand movement, with a maximum torque occurring at four different timings (10%, 25%, 40%, and 55%). Our experiment with five able-bodied subjects showed that the maximal benefit in knee extensor activation, 19.3% reduction, occurred when the assistance timing was delayed relative to the user's biological joint moment. Among four assistance conditions, two conditions with each peak occurring at 25% and 40% significantly reduced the muscle activation relative to the no assistance condition (p < 0.05). Additionally, our study results showed a U-shaped trend (R