Smart crutches for monitoring recovery and motor control in lower limb exoskeletons: development and exploratory clinical testing

Gait, or the act of walking, is a fundamental human function. Several pathologies, including neurological conditions such as spinal cord injury, Parkinson’s disease, and stroke, as well as orthopedic conditions like post-surgical recovery from total hip arthroplasty, can impair locomotion. Close collaboration between clinicians and engineers has transformed motor rehabilitation through innovative solutions. Crutches are commonly prescribed for patients with motor impairments, yet despite the availability of wearable devices that measure gait parameters, no medically certified devices assess how crutch usage impacts functional capacity and motor recovery. The scenario becomes more complex with wearable robots for motor rehabilitation, such as lower-limb exoskeletons. Although exoskeletons have been shown to improve quality of life for neurological patients, they often rely on crutches for stability and fall prevention. Integrating sensorized crutches into such systems could enhance human-machine interaction by enabling advanced control strategies, improving safety, and adding smart functionalities. This PhD project aims to design, develop, and clinically explore the feasibility of a set of sensorized crutches named mCrutch, which is fully integrable as a personal health system with a lower-limb exoskeleton. Prototype validation, conducted with a motion capture system and force platform, showed that mCrutch measures applied weight with 2.5% RMSE across the full range and estimates orientation in both anteroposterior and mediolateral planes with an RMSE of less than 5° in dynamic conditions. Two clinical studies involving individuals with Total Hip Arthroplasty and Parkinson's Disease, using mCrutch and wearable sensors for gait monitoring, have received ethical approval. Preliminary findings suggest mCrutch’s feasibility for functional capacity assessment, though larger sample sizes are needed for more robust conclusions. Moreover, mCrutch has been integrated with a lower-limb exoskeleton, offering functionalities and advanced control strategies, enabling greater users’ independence and participation in piloting the exoskeleton and more patient safety in mitigating the risk of falls.