2017 International Conference on Rehabilitation Robotics (ICORR)

QEII Centre, London, UK, July 17-20, 2017.

Autonomous Hip Exoskeleton Saves Metabolic Cost of Walking Uphill

Keehong Seo1 Jusuk Lee2 Young Jin Park3

Abstract— We have developed a hip joint exoskeleton to boost

gait function in the elderly and rehabilitation of post-stroke
patients. To quantitatively evaluate the impact of the power
and mass of the exoskeleton, we measured the metabolic cost of
walking on slopes of 0, 5, and 10% grade, once not wearing the
exoskeleton and then wearing it. The exoskeleton reduced the
metabolic cost by 13.5, 15.5 and 9.8% (31.9, 51.6 and 45.6 W) at
0, 5, and 10% grade, respectively. The exoskeleton performance
index was computed as 0.97, 1.24, and 1.24 at each grade,
implicating that the hip exoskeleton was more effective on slopes
than level ground in saving the metabolic cost.
I. INTRODUCTION
Several hip joint exoskeletons have been introduced in Fig. 1. Samsung GEMSv2 a hip exoskeleton for gait assistance in the
recent years seeking practical applications such as supporting elderly and post-stroke patients has two motor-driven joints that rotate in
extension/flexion and passive hinges that rotate freely in ab/adduction.
ambulatory functions in the elderly or patients with gait
impairment. For these hip exoskeletons, novel control al-
gorithms, mechanisms, and trial results have been actively
of walking, encouraging them to walk often, and eventually
reported. For example, Shimada et al. reported that training
leading to a healthy lifestyle. We believe that aiding post-
the elderly with SMA (Honda R&D Corporation, Japan) hip
stroke patients in rehabilitation is also a plausible application
exoskeleton improved gait parameters [1]. Kitatani et al.
for GEMSv2.
reported that using SMA could reduce the metabolic cost
To be useful to the elderly in daily activities, a hip
of walking when compared to no assistance condition. A
exoskeleton needs to save metabolic cost of walking on
major scale intervention trial has also been reported in [2],
slopes as well as on level ground, rendering it a less
where training using SMA improved the gait function of
demanding task. In this regard, we measured the metabolic
post-stroke patients no less than a conventional rehabilitation
impact of GEMSv2 to healthy adults when walking on
method. Giovacchini et al. developed APO (SSSA, Italy) and
inclines of 0, 5 and 10% grade. The result is presented in
presented its mechanism, controller and its effect in [3], and
the paper followed by a discussion about the result from a
another version of hardware and control algorithm has been
biomechanical perspective.
introduced in [4].
Recently at Samsung Electronics (Suwon, Korea) we have
II. T HE H IP E XOSKELETON
developed hip exoskeletons with a prospect to improve gait
function in the elderly. The first prototype was introduced GEMSv2 shown in Fig. 1 is the lightest of the hip
in [5] with a control algorithm that used particularly shaped exoskeletons we have designed so far and weighs 2.4 kg
adaptive oscillators. Its improved design was introduced in including batteries and all. For balanced weight distribution,
[6], where we reported that it had reduced metabolic cost of electronics are packaged on the back and the battery is on
walking for 5 healthy adults by 13% (p = 0.0024) compared the front. The waist frame made of carbon fiber reinforced
to walking without the exoskeleton. It was later named plastic resists the torsion generated by the counteraction of
GEMS (gait enhancing mechatronic system) and some of the left and the right joint actuators and successfully delivers
its mechanical feature was reported in [7] in depth. More assisting power to its user. The thigh frame consists of two
researches on control and recognition algorithms for GEMS flexible plates that are constrained to slide on each other
were reported in [8], [9]. At clinical trials with elderly along the longitudinal direction. Such mechanism allows the
subjects, GEMS reduced the metabolic cost by 6.6% [10]. frame to conform to the thigh while effectively delivering
In this paper, we introduce GEMSv2, the next version of force to its user [7]. Two flat 75-Watt BLDC motors drive
GEMS. It is designed lighter with better mass distribution the hip joints via 47:1 gears with maximum output torque
than the previous version. The torque control issue in [6] has of 12 Nm in the direction of extension and flexion. Below
also been resolved in this version. We seek to benefit the el- the motor-driven joints are hinges to allow free abduction
derly with the hip exoskeleton by reducing the metabolic cost and adduction of hip joints. The height of the exoskeleton
bulging out from the left and the right side of the body
The authors are with Samsung Advanced Institute of Technology, Suwon,
South Korea; 1 keehong.seo 2 jusuk7.lee 3 yaja.park at is only 3-4 cm to minimize interference with arm swings.
samsung.com When fully charged, the battery can support the system for

978-1-5386-2296-4/17/$31.00 ©2017 IEEE 246

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2 hours. Motors are controlled at 1000 Hz and assistance
and recognition algorithms runs at 100 Hz. The prototype is
designed in two sizes and additional adjustment in width and
length is possible to an extent. In this study, exoskeletons in
all two sizes were used to account for different physiques of
the subjects.
Determining assistance torque pattern in response to the
user gait is a crucial part as well as the hardware design of the
exoskeleton. As was explained in [5], [6], the algorithm uses
particularly-shaped adaptive oscillator (PSAO) to estimate
current gait phase, the normalized stride time, for each
Fig. 2. The evaluation system with GEMSv2 fastened. The system is
joint by reading the hip joint angle. The control algorithm controlled to reproduce hip joint angle trajectory of nominal human walking
then looks up a torque table to determine torque values, while GEMSv2 is running on the assistance algorithm. The evaluation
corresponding to the current gait phases, to command to the system can estimate the external perturbation, which corresponds to the
power delivered by GEMSv2.
actuators.
To compose the torque table, we have adopted torque
patterns from gait analysis data for walking on level ground,
slopes, and stairs introduced in [11], [12], [13]. The torque
patterns were then modified empirically through iterative
trials in order to stabilize the dynamics of the exoskeleton
and to minimize discomfort to users. The overall behavior of
the exoskeleton remained stable if the peak torque timings for
one leg and the other were close to each other. Through trials
we realized that users often perceived negative work from the
exoskeleton as uncomfortable sensation limiting natural gait.
After adjusting the torque profile to remove such discomfort,
the power from the exoskeleton was mostly positive over a
stride.
To further address inter-subject variation in the preference Fig. 3. A subject is walking without exoskeleton and then with exoskeleton
for the timing of assistance, the control algorithm has been on incline of 10% grade
designed to trim the timing in order to align the peaks of
the joint angular velocity with those of the joint power with
specified timing offsets in a step-by-step fashion. From pre- III. T HE E XPERIMENT
liminary experiments, we found that the effect of assistance
A. Subjects and Protocol
is maximal at the timing offset of 0 to 4% gait cycle. In this
study, we kept the timing offset to 0% for consistency. Five subjects, all male adults without known medical
The power generated by the exoskeleton diminishes due issues, participated in the experiment. For each subject, we
to friction and dynamics of the exoskeleton before being applied the following protocol.
delivered to a user. To identify the actual power that is Task 1: Stand still
delivered to the user without using additional torque/force Task 2: Walk (0% grade)
sensors, we performed tests to the prototypes. In the tests, Task 3: Walk (10% grade)
the exoskeleton was mounted on an evaluation system as Task 4: Walk (5% grade)
in Fig. 2, whose two motorized joints are programmed to Task 5: Walk (0% grade with exoskeleton)
regenerate typical human hip joint trajectory of walking. The Task 6: Walk (10% grade with exoskeleton)
exoskeleton then generates the torque from the torque table Task 7: Walk (5% grade with exoskeleton)
with extra torque to compensate the loss. Task 8: Walk (0% grade)
From data collected from the evaluation system, we esti- Task 9: Stand still
mated the power that was delivered to the evaluation system. All the standing lasted for 5 minutes and walking 6 minutes
The efficiency, the ratio between the power transferred to the on a treadmill. To account for leg length, the treadmill√speed
system and the power generated by the exoskeleton, was then was determined from the dimensionless speed 0.42 gl as
computed. For the two sizes ‘L’ and ‘M’, and the left and the in [6], where g is the gravitational acceleration and l is
right motors, the efficiency was found as 0.665 (size L, left), the leg length. The experimental setup is shown in Fig. 3.
0.684 (size L, right), 0.815 (size M, left), and 0.647 (size M, The intensity of assistance, manually set by a programmable
right). Throughout the rest of the paper, the term ‘exoskeleton user interface, was set at the same level for all the subjects:
power’ refers to the mean positive power generated by the peak torque of 7 Nm for extension, 5.4 Nm for flexion. The
exoskeleton after applying the efficiency. information of the subjects are summarized in Table I.

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 TABLE I
T READMILL S PEEDS AND S UBJECT I NFORMATION

Gross Metabolic Rate (W)

600 GMR(no exo)
GMR(exo)
Subject Speed (km/h) Age Weight (kg) Size 500 BMR(no exo)
1 4.2 34 63 M BMR(exo)
2 4.3 40 78 L 400
3 4.1 42 65 M
4 4.2 36 76 L 300
5 4.1 46 75 L
200

100
B. Metabolic Cost of Walking 0
To assess the metabolic cost of walking we used K5 0 5 10
(Cosmed, Italy), a pulmonary gas measurement system. The Surface gradient (%)
equipment computed energy expenditure rate in kcal/min Fig. 4. Gross metabolic rate averaged for 3 subjects at different conditions:
based on the measured respiratory gas volume rates. We the bars indicate 1 standard deviation.
computed the mean of the metabolic power for the last 3
minutes from walking tasks and the last 2 minutes from
standing tasks to be safe from transient effect. In the table, the 2nd task of walking on level ground
TABLE II
without exoskeleton was repeated at the 8th task to verify
G ROSS M ETABOLIC R ATE (W)
that the measurement was not seriously flawed. The changes
of GMR between the two tasks ranged from -21 to 14 W
with the mean of -1.9 W, within a permissible error range.
Subject Number
Task
1 2 3 4 5 Measurement in the 8th task was not used when calculating
1. Stand Still 109.0 142.8 98.8 116.7 135.1 the change in NMR.
2. 0% grade, No-exo 292.2 378.5 318.7 344.7 350.5
3. 10% grade, No-exo 502.9 670.8 544.9 622.2 624.8
The mean and standard deviation (s.d.) of the GMR
4. 5% grade, No-exo 383.4 497.4 437.9 455.8 505.0 measured for walking with and without exoskeleton are
5. 0% grade, Exo 274.9 335.5 278.6 295.5 349.0 illustrated in Fig. 4 along with those of BMR for comparison.
6. 10% grade, Exo 443.7 611.3 513.1 552.0 625.8
7. 5% grade, Exo 340.3 455.1 369.2 422.1 443.1
The mean increased linearly with the grade in both cases
8. 0% grade, No-exo 298.7 364.2 325.2 334.6 371.2 of walking with and without exoskeleton. For each incline,
9. Stand Still 110.4 129.5 107.9 125.7 151.6 the mean GMR for walking with exoskeleton was always
No-exo=walking without exoskeleton; Exo=walking with exoskeleton found lower than walking without exoskeleton, indicating
that the exoskeleton reduced metabolic energy expenditure
while walking uphill as well as on level ground.
TABLE III
BASAL M ETABOLIC R ATE (W) TABLE IV
R EDUCED NMR BY E XOSKELETON
Subject Number
Task
1 2 3 4 5 Reduced NMR (W) Reduced NMR (%)
1. Stand Still 109.0 142.8 98.8 116.7 135.1 Subject Surface grade (%) Surface grade (%)
2. 0% grade, No-exo 109.2 141.2 100.0 117.8 137.1 0 5 10 0 5 10
3. 10% grade, No-exo 109.3 139.5 101.1 119.0 139.2 1 17.8 43.6 59.8 9.7 15.9 15.2
4. 5% grade, No-exo 109.5 137.8 102.2 120.1 141.3 2 38.0 37.3 54.4 16.0 10.4 10.2
5. 0% grade, Exo 109.7 136.2 103.4 121.2 143.3 3 43.5 72.1 35.2 19.9 21.5 7.9
6. 10% grade, Exo 109.9 134.5 104.5 122.3 145.4 4 52.6 37.0 73.5 23.2 11.0 14.6
7. 5% grade, Exo 110.0 132.8 105.6 123.5 147.4 5 7.7 68.1 5.2 3.6 18.7 1.1
8. 0% grade, No-exo 110.2 131.1 106.8 124.6 149.5 (Mean) 31.9 51.6 45.6 14.5 15.5 9.8
9. Stand Still 110.4 129.5 107.9 125.7 151.6
No-exo=walking without exoskeleton; Exo=walking with exoskeleton

The reduced NMR by the exoskeleton was computed by

To estimate the metabolic energy expenditure due to walk-
ing, we calculated net metabolic rate (NMR) by subtracting
basal metabolic rate (BMR) from the gross metabolic rate
(GMR). In Table II are the values for GMR, the metabolic
energy consumption rate measured with K5, the pulmonary
gas measurement device. Table III shows the values for BMR
at each task, estimated by interpolating the GMR values for
the 2 standing tasks at the beginning and end of our protocol,
assuming that the BMR drifted linearly as the time elapsed.
comparing the walking tasks without exoskeleton and those
with exoskeleton (Table IV). The mean (and s.d.) of the
percent change from walking without exoskeleton was found
as 14.5 (7.9), 15.5 (4.8) and 9.8 (5.7)%, corresponding to
31.9 (18.6), 51.6 (17.1), and 45.6 (26.4) W, for the inclines
of 0, 5, and 10% grade, respectively. The distributions in
percents and watts are shown in Fig. 5 and Fig. 6, where
p-values from one-sample t-tests are marked. The metabolic
impact was found significant for all inclines.

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 25 120
p = 0.015
p = 0.002 Without Exo
With Exo
20
Reduced NMR (%)

Cadence (step/min)
115
p = 0.019
15
110
10

105
5

0 100
0 5 10 0 5 10
Surface gradient (%) Surface gradient (%)
Fig. 5. The distribution of the reduction rate for NMR due to the hip Fig. 7. The mean cadence while walking on each incline is plotted. The
exoskeleton for 0, 5, and 10% grade is shown. The p-values from one- upward or downward bars indicate 1 s.d. The mean cadence decreased
sample t-test are at the top of the boxes, all the cases indicating statistical slightly as the incline increased. The exoskeleton increased the mean
significance. cadence slightly.

TABLE V
80 p = 0.018 M EAN P OSITIVE E XOSKELETON P OWER D ELIVERED (W)
p = 0.003
Reduced NMR (W)

60 Surface grade (%)

p = 0.018 Subject
0 5 10
1 10.62 10.35 12.57
2 11.79 11.60 12.54
40 3 12.15 12.67 13.70
4 9.81 11.40 12.33
5 10.77 11.78 11.66
20 (Mean) 11.03 11.56 12.56

0 5 10 E. Apparent Efficiency and Performance Index

Surface gradient (%)
We can identify the apparent efficiency and the exoskele-
Fig. 6. The distribution of the reduced NMR in Watts by the exoskeleton. ton performance index from the data obtained. Apparent
They are significantly different from 0 for all three grades. efficiency [14] can be understood as the rate at which muscle-
tendon complex transfers metabolic energy into mechanical
work. 1 In [15], Sawicki and Ferris computed performance
C. Cadence index of an exoskeleton and derived apparent efficiency of
We measured cadence of the subjects during the 4th the ankle joint. The performance index is the rate at which
minute of each walking trial. From recorded video, we the positive mechanical work provided by an exoskeleton
counted 30 strides during that period and measured time replaces the metabolic energy for walking.
taken to calculate the steps per minute, the cadence. The
TABLE VI
mean and s.d. are plotted in Fig. 7. The mean cadence
A PPARENT E FFICIENCY AND P ERFORMANCE I NDEX
decreased as the gradient increased, and wearing the ex-
oskeleton increased cadence. From paired t-test, the increase
Apparent Efficiency Performance Index
of the cadence due to the exoskeleton was significant only Subject Surface grade (%) Surface grade (%)
at 5% grade. 0 5 10 0 5 10
1 0.41 0.20 0.19 0.61 1.24 1.35
D. Exoskeleton Data 2 0.26 0.26 0.20 0.97 0.97 1.24
3 0.24 0.16 0.32 1.06 1.58 0.79
The data collected from our hip exoskeleton for one of 4 0.16 0.25 0.15 1.54 0.98 1.65
5 0.69 0.15 0.89 0.36 1.61 0.28
the subjects walking on the inclines of different grades are (Mean) 0.35 0.20 0.35 0.91 1.28 1.06
shown in Fig 8 regarding joint kinematics, torque, and power. (Median) 0.26 0.20 0.20 0.97 1.24 1.24
We also recorded and analyzed the mechanical power de-
livered by exoskeleton. The mean of positive power delivered
We can compute the performance index of hip exoskeleton
by the exoskeleton during each condition is listed in Table
for walking on different gradients similarly as we did in [6].
V. Fig. 9 shows that the exoskeleton power increases with
the grade even though the assistance torque pattern was the 1 We limit our discussion of the apparent efficiency to the positive one
same throughout the experiment. based on the fact that the assistance power is mostly positive as in Fig. 8.

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 Level 5% grade 10% grade
1 1

Right Joint Angle (rad)

Left Joint Angle (rad)

Exoskeleton Power (W)

13
0.5 0.5

12
0 0

-0.5 -0.5
11
0 50 100 0 50 100

10
Right Joint Torque (Nm)
10 10
Left Joint Torque (Nm)

5 5 0 5 10
Surface gradient (%)
0 0
Fig. 9. Assistance Power by Exoskeleton
-5 -5

-10 -10
0 50 100 0 50 100
0.8
30 30
Right Joint Power (W)

Apparent Efficiency
Left Joint Power (W)

20 20 0.6

10 10
0.4
0 0 0.26
0.20 0.20
0.2
-10 -10
0 50 100 0 50 100
0
Fig. 8. Exoskeleton data recorded from a subject is shown regarding
joint flexion angle, extension torque and generated power. The joint torque 0 5 10
represents the desired assistance torque before adding compensating torque. Surface gradient (%)
The joint power is computed from sensed joint angular velocity (not
illustrated) and motor torque (calculated from motor current), and then Fig. 10. The median of apparent efficiency is higher for walking on level
discounted by the efficiency. ground than walking uphill. However, no significant difference was noticed.

First, the apparent efficiency ηhip for hip is computed using IV. D ISCUSSION
an equation for augmentation factor (AF), introduced in [16]
A. Efficiency for Walking on Different Gradients
p+ + pdis Both the metabolic power saved by the exoskeleton and
ηhip = , (1)
AF + βmexo the exoskeleton power delivered to the subjects increased as
where p+ is the mean positive power added by the exoskele- the gradient increased from 0 to 5 and 10%. The rate of
ton; pdis is the net dissipated power; mexo is the mass of the the increase was much higher in the saved metabolic power
exoskeleton (2.4 kg); β is the location factor (3.3 W/kg for than in the delivered exoskeleton power, resulting in decrease
the waist) for the added mass mexo ; AF corresponds to the in the apparent efficiency and increase in the exoskeleton
saved metabolic power. In our case, we can safely assume performance index.
pdis = 0.2 The performance index Π is then computed using The small increase in the exoskeleton power can be
an equation from [15] as explained by the change in the joint kinematics as the surface
ηmuscle gradient increases. The exoskeleton output torque was fixed
Π= , (2) to the same profile regardless of subject weight or walking
ηhip
speed and grades. From Fig. 8, we could verify that hip joint
where ηmuscle = 0.25 is the efficiency of separated muscle. kinematics had been affected by the surface inclines while
Computed values for the apparent efficiency and the the assistance torque had not changed much.
performance index are shown in Table VI along with the From the apparent efficiency and the exoskeleton perfor-
distribution for the apparent efficiency in Fig. 10. mance index listed in Table VI, we can predict, between
2 One should be careful with the meaning of pdis , different from mean level ground and inclined surfaces, on which surface human
negative power p− . pdis = p+ + p− when p+ + p− < 0 and pdis = 0 hip joint works more efficiently as well as on which one the
otherwise. Hence, it is possible that a passive ankle exoskeleton has positive exoskeleton is more helpful when it does the same amount
AF if it absorbs p− < 0 to its spring for one period and outputs p+ > 0
from the spring for other period and if net power loss pdis is much less of work. The apparent efficiency 0.26 for level walking is in
than p+ so that p+ + pdis > 0. good agreement with the value 0.29 in our previous work [6]

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where GEMSv1 was used. The hip apparent efficiency ηhip
for walking uphill is found as low as 0.20 for both 5 and
10% grade. It suggests that the muscle-tendon complex in
the hip joint works less efficiently when walking uphill than
on level ground. This aligns with [17], where Sawicki et al.
predicted that proximal joints such as hip and knee should
have lower apparent efficiency than ankle and that it will be
even lower when walking uphill.
) R on spatiotemporal gait characteristics
As for the exoskeleton, the performance index Π was 0.97
in level walking and 1.24 in 5 and 10% grade, implying that
assisting in the hip joint is more economical on inclined
surfaces than on level ground. In addition to our previous
suggestion in [6] that hip exoskeletons should be more
economic than ankle exoskeletons in saving metabolic cost
of walking for the same amount of exoskeleton power, this
study implies that assisting the hip joint when walking on
inclined surface is even more economic than on level ground.
We should remark that the apparent efficiency ηhip could
possibly represent the combined apparent efficiency of the
whole lower limb rather than the separate hip joint. In
fact, there exist biarticular muscles mechanically linking the
hip joint and the knee joint. There was also a report that
unilateral assistance in hip joint reduced ankle muscle activ-
ities [18]. To clarify this point, individual muscle activation
should be examined using the electromyography.
More precise estimate of apparent efficiency and perfor-
mance index can be obtained by equipping force sensors
that can measure the interaction between the user and the
exoskeleton. The efficiency of GEMSv2 measured above
using the test jig does not reflect the power lost due to
the interaction with soft human tissue and insecure fastening
of the device. The general observation that the performance
index was greater on inclines than level ground, however,
should not be affected by the precision of the exoskeleton
power because error in estimating the exoskeleton power
should be small when compared to changes in the metabolic
cost.
B. Limitation
Because we did not randomize the trials in the protocol,
we can not exclude the possibility that the result had been
affected by certain types of time effect such as fatigue or
customization to the device and the treadmill.
C. Conclusion
Our result for healthy adults indicates that GEMSv2 can
assist walking to reduce metabolic energy expenditure on
both level ground and slopes. Analysis on the performance
index and the apparent efficiency shows that walking as-
sistance in the hip joint is more efficient for uphill than
level ground, which in turn implies that human leg is no
more efficient for walking on inclined surface than on
level ground. Further research should be directed toward
the possibility that the elderly with lower muscle-tendon
efficiency can benefit even more than young adults can from
the exoskeleton when walking in their neighborhood with
hills.
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