Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons

Grimmer, Martin; Riener, Robert; Walsh, Conor James; Seyfarth, André

doi:10.1186/s12984-018-0458-8

Cited by 249Prosthetics and Rehabilitation RoboticsBalance, Gait, and Falls PreventionAssistive Technology in Communication and Mobility

Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons

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Grimmer, Martin, Riener, Robert, Walsh, Conor James, Seyfarth, André·2019·Journal of NeuroEngineering and Rehabilitation

DOI 10.1186/s12984-018-0458-8PMC PMC6318939

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Abstract

Background: Physical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons. Methods: A narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases. Results: The study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25–75 yrs) and in maximum oxygen consumption (40%, 20–80 yrs) occur for older adults compared to young adults. Reaction times more than double (18–90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60–85 yrs), maximum walking speed (24% 25–75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20–85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30–90 yrs) and deaths caused by fall (4000%, 65–90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns. Discussion: This review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support. Conclusions: Exoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.

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Reducing the metabolic rate of walking and running with a versatile, portable exosuit
Kim, J., Lee, G., Heimgartner, R., Revi, D. A., Karavas, N. C., Nathanson, D., Galiana, I., Eckert-Erdheim, A. M., Murphy, P., Perry, D., et al. (2019) · Science · doi:10.1126/science.aav7536 · Cited by 491 · see citing works
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Review of control strategies for lower-limb exoskeletons to assist gait
Baud, R., Manzoori, A. R., Ijspeert, A. J., & Bouri, M. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00906-3 · Cited by 384 · see citing works
Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions
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Stance and Swing Detection Based on the Angular Velocity of Lower Limb Segments During Walking
Grimmer, M., Schmidt, K., Duarte, J. E., Neuner, L., Koginov, G., & Riener, R. (2019) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2019.00057 · Cited by 86 · see citing works
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Soft pneumatic elbow exoskeleton reduces the muscle activity, metabolic cost and fatigue during holding and carrying of loads
Nassour, J., Zhao, G., & Grimmer, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-91702-5 · Cited by 85 · see citing works
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Doppler Radar for the Extraction of Biomechanical Parameters in Gait Analysis
Seifert, A.-K., Grimmer, M., & Zoubir, A. M. (2020) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2020.2994471 · Cited by 82 · see citing works
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Environment Classification for Robotic Leg Prostheses and Exoskeletons Using Deep Convolutional Neural Networks
Laschowski, B., McNally, W., Wong, A. K. C., & McPhee, J. (2022) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2021.730965 · Cited by 82 · see citing works
Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group
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Optimizing exoskeleton assistance to improve walking speed and energy economy for older adults
Lakmazaheri, A., Song, S., Vuong, B. B., Biskner, B., Kado, D. M., & Collins, S. H. (2024) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-023-01287-5 · Cited by 75 · see citing works
Review of balance recovery in response to external perturbations during daily activities
Tokur, D. S., Grimmer, M., & Andre Seyfarth, A. (2019) · Human Movement Science · doi:10.1016/j.humov.2019.102546 · Cited by 66 · see citing works
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A Proprioceptive Bellows (PB) Actuator With Position Feedback and Force Estimation
Zhou, J., Chen, Y., Chen, X., Wang, Z., Li, Y., & Liu, Y. (2020) · IEEE Robotics and Automation Letters · doi:10.1109/lra.2020.2969920 · Cited by 65 · see citing works
Enhancing Voluntary Motion With Modular, Backdrivable, Powered Hip and Knee Orthoses
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Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses
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Biarticular muscles in light of template models, experiments and robotics: a review
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Lower limb rehabilitation robotics: The current understanding and technology
Bhardwaj, S., Khan, A. A., & Muzammil, M. (2021) · Work · doi:10.3233/wor-205012 · Cited by 49 · see citing works
Human Lower Limb Joint Biomechanics in Daily Life Activities: A Literature Based Requirement Analysis for Anthropomorphic Robot Design
Grimmer, M., Elshamanhory, A., & Beckerle, P. (2020) · Frontiers in Robotics and AI · doi:10.3389/frobt.2020.00013 · Cited by 49 · see citing works
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Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: A randomised controlled trial
da Silva, L. D., Shiel, A., & McIntosh, C. D. (2022) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2022.02.020 · Cited by 42 · see citing works
Bio-Inspired Balance Control Assistance Can Reduce Metabolic Energy Consumption in Human Walking
Zhao, G., Sharbafi, M. A., Vlutters, M., van Asseldonk, E. H. F., & Andre Seyfarth, A. (2019) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2019.2929544 · Cited by 40 · see citing works
Measures of dynamic balance during level walking in healthy adult subjects: Relationship with age, anthropometry and spatio-temporal gait parameters
Lencioni, T., Carpinella, I., Rabuffetti, M., Cattaneo, D., & Ferrarin, M. (2019) · Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine · doi:10.1177/0954411919889237 · Cited by 38 · see citing works
Lower limb joint biomechanics-based identification of gait transitions in between level walking and stair ambulation
Grimmer, M., Zeiss, J., Weigand, F., Zhao, G., Lamm, S., Steil, M. J., & Heller, A. (2020) · PLoS ONE · doi:10.1371/journal.pone.0239148 · Cited by 37 · see citing works
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Multicomponent exercise program effects on fitness and cognitive function of elderlies with mild cognitive impairment: Involvement of oxidative stress and BDNF
Rondão, C., Mota, M. P., Oliveira, M. M., Peixoto, F., & Esteves, D. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.950937 · Cited by 37 · see citing works
Relationship Between Sarcopenia, Obesity, Osteoporosis, and Cardiometabolic Health Conditions and Physical Activity Levels in Korean Older Adults
Park, H., Jung, W., Kim, S.-W., & Lim, K. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.706259 · Cited by 36 · see citing works
ExoNet Database: Wearable Camera Images of Human Locomotion Environments
Laschowski, B., McNally, W., Wong, A. K. C., & McPhee, J. (2020) · Frontiers in Robotics and AI · doi:10.3389/frobt.2020.562061 · Cited by 34 · see citing works
Ageing-related markers and risks of cancer and cardiovascular disease: a prospective study in the EPIC-Heidelberg cohort
Srour, B., Kaaks, R., Johnson, T., Hynes, L. C., Kuhn, T. E., & Katzke, V. A. (2021) · European Journal of Epidemiology · doi:10.1007/s10654-021-00828-3 · Cited by 34 · see citing works
Energy-Efficient Actuator Design Principles for Robotic Leg Prostheses and Exoskeletons: A Review of Series Elasticity and Backdrivability
Laschowski, B., & McPhee, J. (2023) · Journal of Computational and Nonlinear Dynamics · doi:10.1115/1.4056919 · Cited by 33 · see citing works
From a biological template model to gait assistance with an exosuit
Firouzi, V., Davoodi, A., Bahrami, F., & Sharbafi, M. A. (2021) · Bioinspiration & Biomimetics · doi:10.1088/1748-3190/ac2e0d · Cited by 32 · see citing works
Simulation of Stand-to-Sit Biomechanics for Robotic Exoskeletons and Prostheses With Energy Regeneration
Laschowski, B., Razavian, R. S., & McPhee, J. (2021) · IEEE Transactions on Medical Robotics and Bionics · doi:10.1109/tmrb.2021.3058323 · Cited by 31 · see citing works
Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques
Bustos, A. S. O., Belluscio, V., Camomilla, V., Lucangeli, L., Rizzo, F., Sciarra, T., Martelli, F., & Giacomozzi, C. (2021) · Sensors · doi:10.3390/s21072438 · Cited by 31 · see citing works
Trends in Telecare Use among Community-Dwelling Older Adults: A Scoping Review
Yaylagül, N. K., Kirisik, H., Bernardo, J., Dantas, C., van Staalduinen, W. H., Illario, M., Luca, V. D., Apóstolo, J., & da Silva, R. C. G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416672 · Cited by 30 · see citing works
An Insight into the Characteristics of 3D Printed Polymer Materials for Orthoses Applications: Experimental Study
Mian, S. H., Nasr, E. A., Moiduddin, K., Saleh, M., & Alkhalefah, H. (2024) · Polymers · doi:10.3390/polym16030403 · Cited by 28 · see citing works
Stair Recognition for Robotic Exoskeleton Control using Computer Vision and Deep Learning
Kurbis, A. G., Laschowski, B., & Mihailidis, A. (2022) · International Conference on Rehabilitation Robotics · doi:10.1109/icorr55369.2022.9896501 · Cited by 27 · see citing works
Retrograde tibiotalocalcaneal nailing for the treatment of acute ankle fractures in the elderly: a systematic review and meta-analysis
Lu, V., Tennyson, M., Zhou, A., Patel, R., Fortune, M. D., Thahir, A., & Krkovič, M. (2022) · EFORT Open Reviews · doi:10.1530/eor-22-0017 · Cited by 26 · see citing works
A State-of-the-Art of Exoskeletons in Line with the WHO’s Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities
Laic, R. A. G., Firouzi, M., Claeys, R., Bautmans, I., Swinnen, E., & Beckwée, D. (2024) · Sensors · doi:10.3390/s24072230 · Cited by 25 · see citing works
Assisted Walking Program on Walking Ability in In‐Hospital Geriatric Patients: A Randomized Trial
Gazineo, D., Godino, L., Decaro, R., Calogero, P., Pinto, D., Chiari, P., Zoli, M., & Ambrosi, E. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16922 · Cited by 25 · see citing works
The mechanisms and mechanical energy of human gait initiation from the lower-limb joint level perspective
Zhao, G., Grimmer, M., & Andre Seyfarth, A. (2021) · Scientific Reports · doi:10.1038/s41598-021-01694-5 · Cited by 23 · see citing works
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Does a Passive Unilateral Lower Limb Exoskeleton Affect Human Static and Dynamic Balance Control?
Ringhof, S., Patzer, I., Beil, J., Asfour, T., & Stein, T. (2019) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2019.00022 · Cited by 23 · see citing works
Neuromechanical force-based control of a powered prosthetic foot
Naseri, A., Grimmer, M., Andre Seyfarth, A., & Sharbafi, M. A. (2020) · Wearable Technologies · doi:10.1017/wtc.2020.6 · Cited by 22 · see citing works
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Combined Chair-Based Exercises Improve Functional Fitness, Mental Well-Being, Salivary Steroid Balance, and Anti-microbial Activity in Pre-frail Older Women
Furtado, G. E., Letieri, R. V., Caldo‐Silva, A., Trombeta, J. C. D. S., Monteiro, C. I., Rodrigues, R. N., Pedrosa, A., Barros, M. P., Cavaglieri, C. R., Hogervorst, E., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.564490 · Cited by 25 · see citing works
Lower-Limb Exoskeletons Appeal to Both Clinicians and Older Adults, Especially for Fall Prevention and Joint Pain Reduction
Raitor, M., Ruggles, S. W., Delp, S. L., Liu, C. K., & Collins, S. H. (2024) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2024.3381979 · Cited by 22 · see citing works
Tissue-integrated bionic knee restores versatile legged movement after amputation
Shu, T., Levine, D., Yeon, S. H., Chun, E., Shallal, C., McCullough, J., Brånemark, R., Carty, M. J., Ferrone, M. L., Boerhout, S., et al. (2025) · Science · doi:10.1126/science.adv3223 · Cited by 21 · see citing works
Exploring surface electromyography (EMG) as a feedback variable for the human-in-the-loop optimization of lower limb wearable robotics
Grimmer, M., Zeiss, J., Weigand, F., & Zhao, G. (2022) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2022.948093 · Cited by 21 · see citing works
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A Review of Gait Analysis Using Gyroscopes and Inertial Measurement Units
Lin, S., Evans, K. A., Hartley, D., Morrison, S., McDonald, S., Veidt, M., & Wang, G. (2025) · Sensors · doi:10.3390/s25113481 · Cited by 20 · see citing works
Characteristics of Gait Variability in the Elderly While Walking on a Treadmill with Gait Speed Variation
Kim, B., Youm, C., Park, H., Lee, M., & Noh, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094704 · Cited by 19 · see citing works
Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study
Moon, S., Oh, E., Chung, D., & Hong, G. S. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296796 · Cited by 19 · see citing works
Patterns of whole-body muscle activations following vertical perturbations during standing and walking
Porras, D. C., Jacobs, J. V., Inzelberg, R., Bahat, Y., Zeilig, G., & Plotnik, M. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00836-0 · Cited by 19 · see citing works
Force Myography for Motion Intention Detection Based on 3D-Printed Piezoelectric Sensors
Schaumann, S., Latsch, B., Schäfer, N., Dali, O. B., Seiler, J., Raynaud, J., Grimmer, M., Flor, H., Beckerle, P., & Kupnik, M. (2024) · IEEE Sensors Letters · doi:10.1109/lsens.2024.3417278 · Cited by 18 · see citing works
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Joint power, joint work and lower limb muscle activity for transitions between level walking and stair ambulation at three inclinations
Grimmer, M., Zeiss, J., Weigand, F., & Zhao, G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294161 · Cited by 17 · see citing works
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Are Functional Measures Sufficient to Capture Acceptance? A Qualitative Study on Lower Limb Exoskeleton Use for Older People
Carral, M. D. R., Bourqui, V., Vuilleumier, N., Ortieb, A., & Bouri, M. (2021) · International Journal of Social Robotics · doi:10.1007/s12369-021-00810-9 · Cited by 17 · see citing works
Adaptive hip exoskeleton control using heart rate feedback reduces oxygen cost during ecological locomotion
Manzoori, A. R., Malatesta, D., Mortier, A., Garcia, J., Ijspeert, A. J., & Bouri, M. (2025) · Scientific Reports · doi:10.1038/s41598-024-84253-y · Cited by 16 · see citing works
Psychometric properties of a computerized and hand-reaction time tests in older adults using long-term facilities with and without mild cognitive impairment
Ferreira, S. D. P., Raimundo, A. M. D. M., del Pozo-Cruz, J., & Marmeleira, J. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111271 · Cited by 15 · see citing works
Switched Concurrent Learning Adaptive Control for Treadmill Walking Using a Lower Limb Hybrid Exoskeleton
Casas, J., Chang, C.-H., & Duenas, V. H. (2023) · IEEE Transactions on Control Systems Technology · doi:10.1109/tcst.2023.3305913 · Cited by 15 · see citing works
Development and Mobile Deployment of a Stair Recognition System for Human–Robot Locomotion
Kurbis, A. G., Mihailidis, A., & Laschowski, B. (2024) · IEEE Transactions on Medical Robotics and Bionics · doi:10.1109/tmrb.2024.3349602 · Cited by 15 · see citing works
Effects of Aquatic Exercise on Physical Performance in Older Adults: A Systematic Review and Meta-Analysis
Buitrago-Restrepo, C. M., Villada, F. A. P., & Arango-Paternina, C. M. (2024) · Journal of Aging and Physical Activity · doi:10.1123/japa.2023-0192 · Cited by 14 · see citing works
The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study
Yao, J., Sado, T., Wang, W., Gao, J., Zhao, Y., Qi, Q., & Mukherjee, M. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-020-00795-y · Cited by 14 · see citing works
Requesting Workplace Accommodation among Individuals with Mobility Disabilities: A Qualitative Investigation on Barriers and Facilitators
Dong, S., Hespe, P., & Monagas, K. (2022) · Journal of Applied Rehabilitation Counseling · doi:10.1891/jarc-d-21-00005 · Cited by 14 · see citing works
Association between low level of physical activity and mobility limitation in older adults: evidence from the SABE study
Gomes, I. C., Neto, L. D. O., Tavares, V. D. D. O., & Duarte, Y. A. O. (2022) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232022273.02402021 · Cited by 13 · see citing works
Preliminary Biomechanical Evaluation of a Novel Exoskeleton Robotic System to Assist Stair Climbing
Böhme, M., Köhler, H.-P., Thiel, R., Jäkel, J., Zentner, J., & Witt, M. (2022) · Applied Sciences · doi:10.3390/app12178835 · Cited by 13 · see citing works
Continuous locomotion mode recognition and gait phase estimation based on a shank-mounted IMU with artificial neural networks
Weigand, F., Höhl, A., Zeiss, J., Konigorski, U., & Grimmer, M. (2022) · IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) · doi:10.1109/iros47612.2022.9981154 · Cited by 13 · see citing works
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Automated vehicles for older adults with cognitive impairment: a survey study
Park, J., Zahabi, M., Zheng, X., Ory, M. G., Benden, M. E., McDonald, A. D., & Li, W. (2024) · Ergonomics · doi:10.1080/00140139.2024.2302020 · Cited by 13 · see citing works
Toward Task-Independent Optimal Adaptive Control of a Hip Exoskeleton for Locomotion Assistance in Neurorehabilitation
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Authors: Grimmer, M., Riener, R., Walsh, C. J., & Seyfarth, A.
Affiliations: Technische Universität Darmstadt (DE)
ETH Zurich (CH)
Harvard University (US)
Corresponding author: Grimmer, Martin
ORCID: Grimmer, Martin
Riener, Robert
Walsh, Conor James
Venue: Journal of NeuroEngineering and Rehabilitation
Publisher: Springer Science and Business Media LLC
Published: 2019-01-03
Volume: 16
Issue: 1
Pages: 2-2
ISSN: 1743-0003 (ISSN-L)
DOI: 10.1186/s12984-018-0458-8
PMC: PMC6318939
OpenAlex: W2945684207
Cited by: 249
References: 206
Citations by year: 2026: 33 · 2025: 61 · 2024: 43 · 2023: 25 · 2022: 30 · 2021: 35 · 2020: 14 · 2019: 8
FWCI: 1.75
Type: journal article
Language: en
Update notices: correction (2020-02-19)
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Journal of NeuroEngineering and Rehabilitation (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Technischen Universität Darmstadt (acceptedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Infoscience (Ecole Polytechnique Fédérale de Lausanne) (submittedVersion, cc-by-nc-nd)
TUbilio (Technical University of Darmstadt) (submittedVersion)
Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
Technischen Universität Darmstadt (cc-by)
ETH Zürich Research Collection (cc-by)
Funders: H2020 European Research Council (601003)
Robert Bosch Stiftung (32.5.G412.0003.0)
Deutsche Forschungsgemeinschaft (GR 4689/2-1)
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Topics: Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Health Professions › Occupational Therapy › Assistive Technology in Communication and Mobility
Keywords: aging, mobility loss, lower limb exoskeleton, assistive devices, VO2max, reaction time, sensory impairment, falls, walking speed, gait, cardiovascular disease, musculoskeletal disorders, neurological disorders, respiratory diseases, functional compensation, mobility training
MeSH terms: Exoskeleton Device, Adult, Aged, Aged, 80 and over, Aging, Cardiovascular Diseases, Female, Humans, Lung Diseases, Male, Middle Aged, Motor Activity, Neuromuscular Diseases, Quality of Life, Lower Extremity, Young Adult

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Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons

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