Design Approaches of an Exoskeleton for Human Neuromotor Rehabilitation

Round 1

Reviewer 1 Report

Dear author,
The article ‘‘Design Approaches of an Exoskeleton for Human Neuromotor Rehabilitation‘’is well written, nevertheless i invite you to increase the paper. 
Preferably the length of a published Research articles should be of 4000-6000 words with 75 or more references excluding figures, structures, photographs, schemes, tables, etc.
 I suggest you to increase the Introduction focusing on:

Describe the most widespread physical rehabilitation as manual therapy TENS therapy etc.

• Mandibular coronoid process hypertrophy: Diagnosis and 20-year follow-up with CBCT, MRI and EMG evaluations DOI: 10.3390/app11104504

And the use of drugs or other products for the joint management pre-port surgery

• Polyphenols as potential agents in the management of temporomandibular disorders
  DOI: 10.3390/APP10155305

Add also few lines to the importance of TAC and MRI for the joint visualization.

• Temporomandibular disc displacement with reduction treated with anterior repositioning splint: A 2-year clinical and magnetic resonance imaging (MRI) follow-up PMID: 32064850
• Unilateral superior condylar neck fracture with dislocation in a child treated with an acrylic splint in the upper arch for functional repositioning of the mandible PMID: 27398739

Finally the readers would be facilitated in reading by List of abbreviations.

I’m sure that adding this concepts and using all these suggested references the paper will be certainly improved and accepted

Good luck and best Regards

Author Response

Thank you for your remarks. We need to obtain a good quality of the submitted article.  We review the article and we made changes in the introduction part by having good documentation of the indicated articles and also domains. We add a few sentences and we cite in References list some articles that you recommend to us. Thus you can remark the improved article with blue color paragraphs in the resubmitted article. 

For example in introduction section we add the following paragraph:

”

In addition, the elaborated robotic system let the physician adapt alternative recovery therapies like TENS (Transcutaneous Electrical Nerve Stimulation) as it can be found in [30]. The elaborated robotic system will permit manual motions of the exoskeleton limbs together with the patient's lower limbs in a controlled mode, and the robotic system command&control unit will memorize these motions under a special function called teaching-mode. Similar procedures are mentioned in [31,32].    ”

Reference list: 

1. d’Apuzzo, F.; Minervini, G.; Grassia, V.; Rotolo, R.P.; Perillo, L.; Nucci, L. Mandibular Coronoid Process Hypertrophy: Diagnosis and 20-Year Follow-Up with CBCT, MRI and EMG Evaluations. Appl. Sci. 2021, 11, 4504. https://doi.org/10.3390/app11104504
2. Minervini G, Nucci L, Lanza A, Femiano F, Contaldo M, Grassia V. Temporomandibular disc displacement with reduction treated with anterior repositioning splint: a 2-year clinical and magnetic resonance imaging (MRI) follow-up. J Biol Regul Homeost Agents. 2020 Jan-Feb;34(1 Suppl. 1):151-160. DENTAL SUPPLEMENT. PMID: 32064850.
3. Minervini G, Lucchese A, Perillo L, Serpico R, Minervini G. Unilateral superior condylar neck fracture with dislocation in a child treated with an acrylic splint in the upper arch for functional repositioning of the mandible. Cranio. 2017 Sep;35(5):337-341. doi: 10.1080/08869634.2016.1203560. Epub 2016 Jul 11. PMID: 27398739.

Reviewer 2 Report

The paper includes the complex investigation of dynamic analysis of exoskeleton structure enhancing the walking process. The work consisted of elaborating the mathematical models and direct solving in Maple, 3d model of exoskeleton with human simulated using the ADAMS software and the results were compared with the physical model. It is a very tiered work consists very professional analytical methods. The main of my remark is that the paper does not include the aim of the presented investigation. The results are presented without any error analysis and the comparison between simulation and physical model is not clearly presented. The conclusion should present whether the aim was achieved or not. Without them, the paper is not completed.

Author Response

Thank you for your remarks. First of all, these will help us to improve the quality of the submitted manuscript. Thus, the revised manuscript has a few paragraphs in blue color that can be easy identified the suggested revisions. 

In the Introduction section we describe the main objective of the investigation: ”

The research aim is to develop a new robotic system based on an exoskeleton structure. For this, it is necessary to elaborate a conceptual solution, experimental analyses with healthy persons and neuromotor disabled persons, which are considered input data for the mathematical models specially developed for dynamic analysis and experimental tests. Thus the experimental tests, which represent the purpose of this research, will be defined as preliminary ones, which do not involve any human volunteers and these will be performed only for checking the exoskeleton functionality.”

2. We add a new section with a comparative analysis and results in discussion where the error of the acquired results was represented. This section you can identify at page 25. 

3. We improve the final conclusions with several paragraphs for understanding the achievements in the presented article such as:

”

Through this research, there were accomplished the following objectives: obtaining a database after experimental analyses of 30 human healthy subjects and 5 subjects with neuromotor deficiencies. This analysis consists of angle variations motion laws of human locomotion main joints (hips, knees, and angles). 

It was performed a dynamic analysis of the exoskeleton mechanism where the input data for motor joints were established through an inverse kinematic analysis based on the experimental motion laws of hips, knees, and ankles.

Thus there were established connection forces variation laws that occurs at the exoskeleton joints during motions and these were used for design and manufacturing phases.

There were performed experimental tests of the entire robotic system, and for these tests, there were considered as input data, for servomotor motions, the ones established through analytical way and numerically verified with MSC Adams software.

The obtained results through this comparative analysis present small accuracy errors under 3% and this confirms that mathematical models and numerical simulation developed in the virtual environment are correct ones.

It was accomplished a comparative analysis between experimental motion laws versus experimental motions developed by the exoskeleton for each main joint (hips, knees, and ankles).

The experimental tests performed with the entire robotic system were done without a patient and the evaluated motions were not entered in contact with the ground.

It was considered that the following objectives were accomplished by: the comparative results through mathematical models processing, numerical and virtual simulations with MSC Adams program, experimental analysis onto human subjects, and experimental tests of the entire robotic system.

Through this research, there were achieved all the proposed investigation objectives and the conceptual solution was validated through a comparative analysis which certifies the use of the prototype in future research.”

Round 2

Reviewer 1 Report

Dear Author,

I’m satisfied and in my opinion the paper is ready for the pubblication

Best regards