LAB MEETING - 7.4.2024: Exoskeleton Pro & Con-siderations

In recent years, exoskeletons have proliferated in various industries, touted for their ability to enhance worker performance and reduce physical strain. Despite their benefits, there are several downstream considerations - on the back end of their purchase and implementation - that warrant our attention.

These issues include establishing Administrative Controls on the OSHA Hierarchy to manage impacts. Such issues include the occlusion of arteriovenous capillary bed perfusion, hygiene and sweat management, redistributed load transfer, tight climate control requirements, limited use in handling diverse tasks, challenges posed by varied work settings and more. Let’s look a little further at each of these points.

Pro & Con-siderations for Exoskeletons

1. Occlusion of Tissue Perfusion: Exoskeletons often apply pressure at various contact points on the wearer's body via straps, pads, etc. to hold them firmly and securely in place. This constant contact can potentially occlude local blood flow and affect normal, patent arteriovenous capillary bed perfusion. Unrecognized or unaddressed, this occlusion can lead to discomfort, numbness, abrasion and even long-term health issues if the device is worn for extended periods without adequate relief.

Administrative Controls in the form of policies, procedures and best practices may have to be established and adopted to ensure relief from extended wearing of the exoskeleton would be factored into its use. This creates a secondary impact of time spent donning and doffing the exoskeleton between break periods, putting a damper on expected productivity benefits.

Implementing regular checks to monitor the fit and pressure points of exoskeletons to prevent occlusion of arteriovenous capillary bed perfusion and ensure user comfort would be an additional Administrative Control that would need to be implemented. This may impact cost / benefit analysis when purchasing and using these devices.

2. Hygiene and Sweat: The contact points where the exoskeleton interfaces with the wearer's body (via said straps, pads, etc.) can become breeding grounds for bacteria due to sweat accumulation. This issue is exacerbated in hot and humid outdoor (and some indoor) environments, leading to potential skin responses and general discomfort. Potential conditions such as contact dermatitis, impetigo, folliculitis, fungal infections and more may pass between workers, if strict hygiene is overlooked.

Administrative Controls In the form of policies, procedures and best practices may have to be established and adopted such as hygiene, disinfectant and maintenance plans would need to be developed and adopted for just such scenarios.

There would be a demand to establish strict hygiene protocols, including regular cleaning and disinfecting of exoskeleton contact points to mitigate sweat and bacteria-related issues. This could mean cleaning, storing, drying, etc. downtime for the device in certain scenarios and settings

One way to limit the passing of such communicable conditions between workers is to limit one exoskeleton per user. This brings into play considerations like worker turnover, absenteeism and other human resource factors that may directly impact return-on-investment projections and value proposition claims.

3. Load Transfer: While exoskeletons are designed to redistribute loads on the bearer's body, the points of contact where the load is transferred can become problematic. Prolonged pressure at these points may cause bruising, pain, and fatigue, negating the intended ergonomic benefits of the exoskeleton.

Administrative Controls in the form of policies, procedures and best practices may have to be established and adopted to include providing comprehensive training for workers on the proper use of exoskeletons, emphasizing techniques to minimize load redistribution transfer issues and avoid prolonged pressure on sensitive areas.

Transfers of symptoms and syndromes from one body part to another may not be a ‘win.’ It may be simply putting off into the distance conditions that reveal themselves later, creating a sourcing problem when attempting to solve such downstream concerns. Workers issued exoskeletons may need to be made aware of this, so that their ongoing vigilance is leveraged.

4. Climate Control and Long-term Comfort: The effectiveness and comfort of exoskeletons are significantly influenced by the working environment's climate control. In outdoor areas subject to weather changes, or indoor settings without tight climate control, workers may experience increased discomfort due to - for instance - overheating and excessive sweating. This factor can limit the practicality of exoskeletons to a much smaller application window of a given industrial setting.

Administrative Controls in the form of policies, procedures and best practices may have to be established and adopted to ensure exoskeletons are only used in working environments that meet tight climate control system requirements - to maintain comfort and hygiene for workers using said exoskeletons. This will set an upper limit on their widespread use impacting initial return-on-investment projections and value proposition estimates as well - as practicality and usability may be constrained.

5. Limited Use with Non-uniform Loads: Exoskeletons are generally optimized for handling uniform tasks and loads. However, in industries where workers handle diverse, non-uniform loads, the benefits of exoskeletons may diminish considerably.

The adaptability of these devices to varying weights, shapes, coupling engagements, friction coefficients, environmental factors like storage freezers, etc. may be limited, reducing their overall effectiveness and value proposition claims.

It may prove necessary to implement Administrative Controls in the form of policies, procedures and best practices for site-specific, material-specific and environment-specific applications of exoskeletons so as not to make workforce bearers subject to mishandling, dropped loads, damaged product, potential injuries, etc. that might otherwise ensue from imposed awkwardness or suboptimal design.

6. Manual Handling and Diverse Movements: Manual handling tasks often require diverse positioning and movement, such as climbing, kneeling, and balancing in varying base-of-support (BoS) and center-of-gravity CoG) scenarios.

Exoskeletons may restrict certain movements, making it challenging for workers to perform their nonroutine duties efficiently. This limitation can lead to reduced productivity and increased risk of injury due to unnatural movements that may naturally occur outside of a worker's base-of-support or when a worker's center-of-gravity is challenged by their setting or circumstance.

Administrative Controls may further include policies, procedures and best practices for restricting exoskeleton use to only approved movements in approved settings - further limiting their use where climbing, kneeling and balancing activities are often present - such as load / unload environments in shipping / receiving, supply chain management, inventory management and warehousing settings.

7. Work Settings with Diverse Footing: Industrial work settings can have varied flooring conditions, where smooth, flat, high-friction, uniform surfaces are not always the norm. Uneven, slippery, or irregular surfaces can complicate the use of exoskeletons, posing additional safety risks and limiting their effectiveness.

Administrative Controls may include policies, procedures and best practices for conduct thorough assessments of work settings to identify and address potential footing hazards. Areas related to slick, uneven, inclined or declined and other diverse flooring conditions would need to be identified and possibly restricted from their use. Ensuring the safe use of exoskeleton by limiting their use to optimal settings and situations - once again - could curtail their return-on-investment and initial value proposition.

Our Takeaways:

While exoskeletons offer promising solutions to reduce physical strain and enhance worker performance, several downstream concerns must be considered for a complete picture. Issues such as occlusion of arteriovenous capillary bed perfusion, hygiene concerns, load transfer problems, discomfort in non-climate-controlled environments, and limited effectiveness in handling diverse loads and movements highlight the need for careful evaluation and improvement of these devices. Addressing these challenges is crucial for maximizing the benefits of exoskeletons in industrial applications.

To mitigate these concerns, several considerable - and considerate - Administrative Controls should be adopted. First, regular monitoring and adjustment of exoskeleton fit is necessary to prevent occlusion of arteriovenous capillary bed perfusion. Implementing strict hygiene protocols, including regular cleaning and disinfection of exoskeleton contact points, is essential for maintaining cleanliness.

Users should be trained on proper load management techniques to redistribute stress evenly and monitor distal body parts. Utilizing climate-controlled environments or cooling solutions can enhance comfort and hygiene. Developing exoskeletons tailored for specific tasks can limit their effectiveness in handling diverse loads and movements. Finally, designing exoskeletons to adapt to varied work environments, including non-uniform flooring, will help maintain stability and performance.

In closing, the added burden of Administrative Controls in the form of new policies, new procedures and new best practices may cap the impact of the return-on-investment (ROI) projections and the initial value proposition of exoskeletons. While these controls are essential for addressing the concerns of exoskeleton use, their implementation incurs additional costs, lengthened time considerations and other operational complexities.

This increased burden can potentially offset the anticipated benefits and savings, possibly making the investment less attractive to companies or industries considering exoskeletons to meet their needs. This is an area worthy of further research - so that exoskeleton vendors and their clients can make more informed, far-sighted decisions when moving forward - whether in unison, or separately.

About Matt Jeffs DPT PSM REAS:

As an independent contractor on-demand, Matt Jeffs DPT is a 30+ year educator, ergonomist, consultant and clinician. As an award-winning Doctor of Physical Therapy, he has successfully rehabilitated >25,000 individuals over his clinical career - before switching his attention to working full time as a sought-after ergonomist in various industrial sectors.

As a work-injury reduction consultant, he has operated successfully across the US in paper plants, food processing plants, boat builders, meat processing plants, theme parks, airplane builders, medical device plants, automotive builders, product assembly plants, high rise office settings, healthcare delivery settings, US defense contractors and more. From national accounts to neighborhood outfits – and everything in between.

Matt Jeffs DPT PSM REAS also serves as TuMeke Ergonomics ' 'Ergo Shaman!'

Where to Read More:

1. Wheeler, J., Rittikaidachar, M., Wood, D., & Calderon, D. (2022). Establishment of the DOE-EM Exoskeleton Testbed. Oak Ridge National Laboratory. Retrieved from [https://www.osti.gov/servlets/purl/2006112](https://www.osti.gov/servlets/purl/2006112)

2. Serebrennikova, L. (2023). Development and Assessment of the Army Exoskeleton. Worcester Polytechnic Institute. Retrieved from [https://digital.wpi.edu/downloads/7s75dg694](https://digital.wpi.edu/downloads/7s75dg694)

3. Tijjani, I., Kumar, S., & Boukheddimi, M. (2022). A survey on design and control of lower extremity exoskeletons for bipedal walking. Applied Sciences, 12(5), 2395. https://doi.org/10.3390/app12052395

4. Alberico, G. (2022). Development of an intervention framework for design, implementation and adoption of occupational exoskeletons (Doctoral dissertation). Retrieved from [https://www.diva-portal.org/smash/get/diva2:1464285/FULLTEXT02](https://www.diva-portal.org/smash/get/diva2:1464285/FULLTEXT02)

5. Cipolla, C., Kurz, D., Finger, J., George, M., & Marchica, M. (2022). Robotic Exoskeleton for Shoulder Complex Assistance. Northern Arizona University. Retrieved from [https://www.ceias.nau.edu/capstone/projects/ME/2022/22F_P11Robotics/P11%20486%20Final%20Report%20Sp22-April23.pdf](https://www.ceias.nau.edu/capstone/projects/ME/2022/22F_P11Robotics/P11%20486%20Final%20Report%20Sp22-April23.pdf)

6. Berdell, J. (2022). A machine learning approach to intended motion prediction for upper extremity exoskeletons (Master's thesis). Northern Illinois University. Retrieved from [https://huskiecommons.lib.niu.edu/cgi/viewcontent.cgi?article=7852&context=allgraduate-thesesdissertations](https://huskiecommons.lib.niu.edu/cgi/viewcontent.cgi?article=7852&context=allgraduate-thesesdissertations)

7. Fu, J., Choudhury, R., Hosseini, S. M., Simpson, R., & Park, J. H. (2022). Myoelectric control systems for upper limb wearable robotic exoskeletons and exosuits—A systematic review. Sensors, 22(21), 8134. https://doi.org/10.3390/s22218134

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