Funding treatment and rehabilitation processes for patients with musculoskeletal conditions is an important part of public health insurance in European Union countries. By 2030, these processes will be planned in national health strategies . Today, in many countries of the world (including the EU countries), these processes tend not to be very effective and to be expensive for both patients and insurance companies. This article aims to raise awareness of the need for process re-engineering and describes possible tools for assessing patient treatment and rehabilitation processes . This article presents the research methodology prepared for the purpose of process evaluation. The use of this methodology will confirm the hypothesis that the use of EMG signals and selected Industry 4.0 solutions will improve the effectiveness and efficiency of treatment and rehabilitation processes for patients with musculoskeletal injuries. Patient treatment and rehabilitation is an important part of public health insurance and a key measure in achieving Sustainable Development Goal 3—“Ensure healthy lives and promote well-being for all at all ages” . The treRe-engineering is particularly necessary for rehabilitation processes. It is estimated that 2.4 billion people worldwide currently suffer from musculoskeletal conditions and need rehabilitation . The demand for rehabilitation is expected to increase worldwide due to changes in health status and population characteristics. People live longer but are more likely to suffer from chronic diseases and disability. Today, the need for rehabilitation is largely unmet. In some low- and middle-income countries, more than 50% of people do not receive the rehabilitation services they need. Rehabilitation services are also among those health services that have been most affected by the COVID-19 pandemic.The treatment and rehabilitation of an orthopaedic patient aim to achieve full mobility and a return to an active lifestyle. This goal can be reached through active collaboration between the physician, diagnostician and physiotherapist. An important aspect of orthopaedic treatment and rehabilitation is to assess the progress of recovery by monitoring the patient’s body, e.g., during rehabilitation training  ,7,8. By The treatment and rehabilitation of the musculoskeletal system should be highly patient-centred, as it depends on many factors and needs individual modification of the recovery process. The existing system of treatment and rehabilitation does not allow individualisation and control of the processes taking place in multiple facilities. The patient makes their own appointments at outpatient clinics, hospitals and rehabilitation centres, always submitting medical records to healthcare professionals. Medical staff lose time in reviewing medical records. Sometimes the patient changes medical institution/physician and, consequently, tests are duplicated, and sometimes are incomplete. Recovery is difficult and time-consuming for the patient and requires patience and funding. Funding (excluding funding for treatments in public centres) for illness and rehabilitation is provided by the insurance companies post factum . This period is filled with anxiety about one’s own health, full of pain, lack of money and know-how, which are not conducive to recovery .The patient’s treatment and rehabilitation processes take place in various medical facilities . The staff involved in the process consist of a variety of healthcare professionals, including but not limited to physiotherapists, occupational therapists, orthopaedists and orthotists, clinical psychologists, physical and rehabilitation physicians and rehabilitation nurses. Each medical facility and even an individual healthcare professional have an effect on the effectiveness and efficiency of processes. In the age of the development of medical engineering and Industry 4.0, however, these indicators can be improved further.Two processes can be distinguished: treatment and rehabilitation. The treatment process starts with the injury and its diagnosis, or with a diagnostic evaluation that identifies degenerative changes. Sometimes a surgical procedure is necessary, followed immediately by rehabilitation to provide an easier postoperative period.If the injury or degeneration does not require surgical treatment, conservative rehabilitation is used. A consultation with a physiotherapist starts the rehabilitation process. An effective rehabilitation process consists of pain relief followed by restoration of mobility and muscle strengthening. The later stage of rehabilitation involves injury prevention through specialised functional exercises and proprioception.In the above description of the processes of treatment and rehabilitation of the musculoskeletal system, further measures/tasks faced by healthcare can be distinguished. However, in the turbulent reality experienced by healthcare and patients after the COVID-19 pandemic, it is difficult to find standard measures, and there is a lack of follow-up procedures for the aforementioned processes. Meanwhile, insurance companies seem to look for savings on patient treatment and rehabilitation processes.Electroencephalography (EEG);Electromyography (EMG);Electrooculography (EOG);Electrogastrography (EGG).Biological signals can be divided according to their source into :Bioelectrical ;Bioimpedance (tissue impedance measurement);Bioacoustic ;Biomagnetic ;Biomechanical ;Bio-optical , other .Biomedical signals make it possible to monitor the status of the patient’s body. For example, an electrocardiogram (ECG) verifies the state of the heart. Other similar examinations include :ElectroeThe biofeedback concept uses various signals to reflect the physiological activity of the human body, so that the user  can obtain information (which cannot be manipulated) about the state of selected organs. Following behavioural stimulation supplemented by feedback, devices suggest a therapeutic concept. Some of the devices have a therapeutic effect. Long-term therapy with feedback allows the best therapeutic effect to be achieved.In the medical biofeedback concept, an EMG signal is used to detect any condition associated with damage to the peripheral nervous system or muscular system. Motor disabilities can have two main causes: a damaged nervous system—an inability to transmit the nerve impulse that stimulates the muscles, or a damaged muscle that moves the limb. Unfortunately, the effect is the same in both cases—motor disability. EMG testing can detect the cause of the lack of motor skills of the musculoskeletal system . EMG sigState-of-the-art EMG information and communication technology are based on biofeedback. This technology can be used for the enhancement of normal movement patterns after injury and the better monitoring of home-based autotherapy . BiofeedA portable system for muscle rehabilitation is one of the biofeedback devices that use an EMG signal. Invasive and non-invasive methods are used to record signals . The maiA signal processor connected between the surface myoelectric sensor and the signal transmitter;An electrode sensor, a signal amplification circuit connected to the electrode sensor and a signal connected to the signal amplification circuit. The circuit and the signal smoothing circuit are connected to the signal full-wave rectifying circuit;The electrode sensor includes a reference electrode, a muscle intermediate electrode and a muscle end electrode;The signal processor contains an A/D converter and a digital signal processor, and the A/D converter is connected to the connector of the digital signal processor;A remote monitor coupled to the renderer and configured to receive feedback from the renderer.The portable system for muscle rehabilitation is easy to carry and allows the physician or therapist to monitor the patient’s muscles in a remote manner. By using this device, the patient can perform rehabilitation exercises in more places (even at home), their posture is more relaxed and the interaction of the device means that the long-term treatment process is no longer burdened by errors . The devAll the optional elements listed and those not mentioned above support the monitoring and recording of signals from the affected muscle or muscle group . The porThe EMG signal is a bioelectrical signal that is analogue in its original form. It is digitised so that it can be used and analysed by computers. In the portable EMG signal-based treatment system for muscle rehabilitation, the signal transmitter is a wireless transmitter that works with a computer via Bluetooth, infrared transmitter or Wi-Fi. Energy saving is an important feature of the transmitter. Extremely low power consumption during operation and standby can make a button cell last for several years. Its main advantages include very low peak, medium and standby power consumption; low price; increased wireless coverage; full backward compatibility and low latency. Signals can be transmitted to servers or other computers using special software .The portable system for muscle rehabilitation can send information from the human body via a computer, and this information can be recorded and stored using new Industry 4.0 solutions, thereby improving the patient’s treatment and rehabilitation processes.Blockchain technology is constantly being tested for use in data storage or data protection in a wide variety of industries and sectors. In addition to industries such as charity and the supply chain, healthcare is one of the most discussed use cases for blockchain networks. There are many aspects of blockchain that make the blockchain technology suitable for the healthcare industry. As most blockchain networks are designed as distributed systems that record and protect files using, among other things, cryptography, it is extremely difficult for anyone to launch an effective attack against them or alter the data stored in them without obtaining the consent of all other network participants. Immutability is the very feature of blockchains that offers the possibility of creating secure medical databases. Furthermore, the peer-to-peer (P2P) architecture used in blockchain networks allows all copies of patient’s medical records to be synchronised with each other when they are updated, even if they are stored on different computers and in different locations. In fact, each network node has a copy of the entire blockchain and regularly communicates with other nodes to ensure that this copy is up to date and its data are authentic. Decentralisation and distributed data distribution are other important and useful features in the healthcare industry. Blockchain networks, despite being distributed, are not necessarily decentralised . In terms of healthcare, blockchain networks most often function as private networks (requiring appropriate rights to be obtained). Unlike traditional databases, which are usually based on a single centralised server, the use of a distributed system allows data to be exchanged while achieving a higher level of security and reducing administrative costs. The decentralised nature of blockchain networks makes stored data less susceptible to technical failures or external attacks. The security provided by blockchain networks can be particularly useful in hospitals that face hacker attacks or malware such as ransomware.Another advantage of relying on a blockchain for medical records is its ability to improve interoperability between clinics, hospitals and other healthcare providers. Technological differences in data storage systems often make it difficult for organisations to share collected documentation with each other. Blockchains can solve this problem by allowing authorised parties/persons to access a unified database containing all the information and files on patients, or even the history of medicines prescribed to them. This gives service providers the opportunity to undertake mutual collaboration and exchange the data they need. In addition to simplifying the process of sharing medical records, image files and other patient records, blockchain networks can also provide patients themselves with a higher level of accessibility to and transparency of the information collected about them. By implementing a blockchain, unauthorised changes to patient records and the risk of typical human errors, such as spelling mistakes, are eliminated.The blockchain technology can also be used against insurance fraud, e.g., claiming compensation for situations that never happened. From the patient’s perspective, the application of blockchain technology will save them from having to complete documents to prove health events to the insurer .Identifying patients who could benefit from the potential good effects of the drugs being tested;Qualifying patients for medical treatment and rehabilitation based on the urgency of needs;Monitoring the progress of treatment and rehabilitation.Another potential use of blockchain in healthcare is for improving the quality and effectiveness of tests, treatment and rehabilitation. Medical data stored in blockchains can be encrypted and then used for:In recent years, some blockchain-based medical data sharing systems have been used by the academic community. Encrypted patient data are used for medical science and education. However, information privacy and accessibility are still problematic . A publiA private blockchain  also needs some thought. The designated organisation to create blockchain alliance needs to rethink the data authentication plan. This is because the following questions arise: Can each participant have a backup of all patient data? Can any participant be involved in data recording and storage? Should the patient authorise access to data in the cloud each time? The idea is that in a distributed P2P network without a central control node , a self-organising network is established. Such a blockchain solution has many advantages, such as decentralisation, fast distribution, limited data manipulation and traceability . Work onThe main objective set for the research model was to evaluate the treatment and rehabilitation processes for patients with a musculoskeletal injury.The subject of the study was the processes of treatment and rehabilitation of the musculoskeletal system. The next steps in the treatment and rehabilitation processes are listed in Research subjects: The research subjects included two groups of purposively selected patients. The main selection criteria included sex—women were studied; age—female patients aged 50 (plus or minus 5 years) were studied; type of injury—female patients with a historical ankle joint injury in the form of a trimalleolar fracture  were studied. In the first group of patients (15 women), there were those who were not supported with an EMG-based biofeedback device during treatment and rehabilitation. The second group of patients (15 women) included those who were assisted with an EMG-based biofeedback device during treatment and rehabilitation. It was also important that the patients consciously monitor the course of their condition, i.e., they remember the medical facilities providing assistance, measure the recovery time of the joint and muscles of the limb and document the expenses they incurred during treatment (reimbursed and not reimbursed by the insurer).The analysis of the medical records of the patients to classify them for the study and to clarify the possible course of treatment and rehabilitation processes for the patients with a selected disease entity;Diagnostic survey, technique: questionnaire, research tool: survey questionnaire completed face-to-face by an interviewer.Research methods: Two research methods were used:Miller, Pniewski and Polakowski (2000), who suggested a subjective three-grade assessment of the value added in each activity; Wee and Wu (2009) , who mapEisenhardt and Martin (2000), who suggested the measurement of process times . BehrouzWilden et al. (2016), who suggested measuring risks .During the creation of a model of the treatment and rehabilitation processes , strategThe survey questionnaire presented a detailed treatment and rehabilitation process with columns to allow the patient to assess the effectiveness and efficiency of the process .Data were collected using a form (from two groups of patients). The quantitative data were summarised and averaged. The processes whose selected steps were assisted by the EMG-based feedback device were carried out in the second group of participants. Following the assessment of the processes carried out in the first and second groups, an additional simulation evaluation was carried out (assuming the application of blockchain and Big Data technologies in these processes). The simulation was carried out using the form shown in A comprehensive assessment of treatment and rehabilitation processes (following implementation of an EMG-based biofeedback device) can be an important achievement for the re-engineering of these processes . This study aims to assess the course of these processes before and after the implementation of the innovation. According to Gunasekaran et al. (2005), the main dimension of innovation performance is the number and quality of solutions implemented in the final process; however, in the case of treatment and rehabilitation processes, their effectiveness and efficiency are more important .Efficiency ;Effectiveness .The respondents gave similar ratings for the DL1  stage. All assessment criteria, i.e., cost, value for mental health, time and identified risks, received the same rating. This is because the respondents were injured . Similar studies conducted among doctors would probably show differences in the assessment of the DL1 stage for the criteria of cost, value for the patient’s mental health, time and identified risks. It is planned to conduct similar studies among doctors and physiotherapists in the future.The analysis of the collected data, shown in The analysis of the collected data, shown in The analysis of the collected data, shown in Diagnostic problems in patients with co-morbidities or diseases acquired during treatment of the underlying injury .Doubts/discussions regarding the diagnosis of the interdisciplinary case conference.Doubts/discussions regarding the use of preoperative rehabilitation.Delegation of tasks/problems with designating medical or rehabilitation staff.Patient doubts about the treatment given/lack of full internal patient involvement.Long, uncoordinated postoperative recovery period/overdue rehabilitation appointments.Necessity of repeating diagnostic evaluation and return to the treatment process.Error in choosing a rehabilitation facility that does not specialise in treating the condition.Lack of progress in recovery at the health facility chosen by patient/poor atmosphere/lack of empathy.Strain during rehabilitation.Unexpected/unwanted emotional problems in social, occupational and psychological rehabilitation.Willingness to change the rehabilitation facility during the project.Numerous changes in the composition of consulting physicians who monitor the results of treatment and rehabilitation.In rehabilitation, scheduled hours and appointments reimbursed by the insurer were overrun.Unclear, restrictive attitude towards the patient/lack of standardisation of patient management.Incomplete access to critical information regarding payments by the insurer.Relapse of the formally cured disease.The analysis of the collected data, shown in The above-mentioned problems represent the largest group of risks mentioned in treatment and rehabilitation processes without innovation. They are also usually the most severe and have the greatest impact on the effectiveness and efficiency of treatment. The assessment of the process by the number of risks occurred is not authoritative. Therefore, an individual risk assessment is recommended. Generally, the highest incidence of specific problems in processes without innovation may be indicative of weaknesses in the management of the current health system.Problems with e-rehabilitation devices, their lack/lack of funding, problems with the communication interface.Lack of staff to remotely monitor the convalescent’s progress.However, studies reveal that the implementation of biofeedback into medical processes also carries risks, e.g.:Transparency/standardisation of data on rehabilitation services, assessment of rehabilitation and post-rehabilitation effectiveness, assessment of rehabilitation facilities, assessments of individual rehabilitation services.The effortfulness associated with the need to describe the cases of rehabilitation patients, the time delays involved, the high error rate, the high labour costs, the lack of standardisation of the documents prepared.Privacy, which is more difficult to provide in a rehabilitation facility. Original documents are available to numerous staff members.Currently, the development of a blockchain and Big Data for the assessment and support of rehabilitation processes also faces several problems to be solved. These include :TransparUniversality—assuming that everyone has the right to rehabilitation, regardless of diagnosis, age or prognosis;Earliness—starting rehabilitation at the earliest possible stage, from the first day in hospital;Comprehensiveness—comprehensive coordinated actions carried out by a team of specialists, targeting all levels of the person’s life and responding to his/her individual needs;Continuity—the systematic provision of rehabilitation interventions and continuing them for as long as a given person needs them.Treatment and rehabilitation processes can be defined as a comprehensive action aimed at restoring as much mobility and ability to function independently in society as possible to a person who has lost this ability as a result of an illness or injury. A coordinated effort between physicians, rehabilitation specialists, psychologists, physiotherapists and vocational counsellors is needed for the comprehensive rehabilitation process to be implemented properly. The foundations of comprehensive rehabilitation were laid as early as the 1950s by Wiktor Dega, an orthopaedic surgeon. This model was considered by the World Health Organisation to be worthy of imitation and promotion. The Polish School of Rehabilitation included four basic assumptions as part of the characteristics of the rehabilitation process:Prepare for situation assessment;Collect data and information;Conduct assessment in the country;Write, revise and finalise report, disseminate and communicate findings;Prepare for strategic planning;Consult, revise, finalise and complete costing of plan;Identify priorities and produce first draft of plan;Endorse and disseminate the strategic plan;Develop monitoring framework with indicators, baselines and targets;Establish evaluation and review processes;Establish a recurring implementation “plan, do, evaluate” cycle;Increase capacity of rehabilitation leadership and governance .Comprehensive rehabilitation consists of four different types of rehabilitation: medical, psychological, social and occupational. The model of comprehensive rehabilitation developed by the Polish School of Rehabilitation took hold in many European countries and would still be used today if it had not been for the lack of procedures and funding. Comprehensive rehabilitation must undoubtedly be defined in the form of a process . It is not, only because the standardisation of the activities of this process  would exceed the costs of current insurance systems. The implementation of this process into the social security system is an investment in people. This investment will be several times more than compensated. Fortunately, the WHO has taken care of future changes and re-engineering of treatment and rehabilitation processes. The guidelines by the WHO include :Prepare Conducting remote rehabilitation ,39,40;Focusing on patients by keeping detailed records of their health status;Digitising treatment and rehabilitation information.Treatment and rehabilitation processes can be re-engineered by implementing innovative inventions of biomedical engineering and Industry 4.0. The advantage of re-engineering treatment and rehabilitation processes by implementing innovations is the improvement in effectiveness  and efficiency (cost reduction) of such processes. The innovations described in this paper enable process improvements by:Rehabilitation information is an important reference point for monitoring and updating the patient’s health status. Big Data will enable the continuous advancement of data mining technology, can effectively extract diagnostic information regarding cured patients and make comparisons of the data with other similar data, which is helpful for physicians to develop a treatment and rehabilitation process .Online medical and rehabilitation appointment scheduling, etc.;Reducing data storage costs;Storing and sharing data that increasingly contribute to the efficiency of treatment and rehabilitation processes ;Reducing costs for individual patients, which is particularly important for patients with reduced mobility or who live far from health centres .The innovations described in this paper make it possible to improve process efficiency by:


Finding the risk factors for thromboembolic (TE) disease and preventing its development in pregnant women is important. Allergic rhinitis (AR) is a common chronic disease. We aim to find if AR is a risk factor. From 2004 to 2011, 55,057 pregnant women were recruited from a Taiwan database. They were grouped into AR and non-AR groups. The rate of TE and venous complications during pregnancy and 60 days after childbirth were compared between non-AR and the AR group. Those with AR diagnosed both before and after childbirth, meaning AR was not changed during pregnancy, the rates of TE (OR 2.64) and venous complications (OR 1.35) were higher compared to non-AR subjects. In those who underwent cesarean delivery, the rate was also higher in group 3 (OR 4.14). Those with AR before childbirth, without after, meaning AR was well controlled during pregnancy, the rate of TE was not higher than that of the non-AR subjects. Pregnant women with AR have an increased rate of TE. An increased rate of venous complications in these subjects might explain the increase in TE. If AR is well controlled during pregnancy, the rate of TE does not appear to increase. TE, including pulmonary embolism (PE), was one of the main causes of maternal death during pregnancy in developed countries3. However, the symptoms and signs of TE and PE are non-specific, and the diagnosis may be delayed or missed. Earlier diagnoses of TE or PE could reduce the morbidity and mortality4. Therefore, in pregnant women, finding the risk factors for VTE (venous thromboembolism) may remind physicians to pay more attention to these patients and then find TE earlier.Pregnant women have an increased risk of developing thromboembolism (TE) disease compared with non-pregnant women of the same age5, enhanced platelet activation6 and formation of dense fibrin clots7 were reported to be the underlying mechanisms. Immunoglobulin E (IgE), a biological marker of allergic disease, was reported to exert some prothrombotic and antifibrinolytic activities8.Previous studies indicated that allergic disease is associated with pro-thrombotic alterations. Activation of the coagulation system during allergic response10. Total IgE levels, a predictor of the severity of allergic disease, also change before, during and after pregnancy11. As mentioned before, the risk of embolic disease has been correlated with the severity of allergic disease. However, in pregnant women, when the severity of their allergic disease attenuates during pregnancy, does the risk of embolic disease decrease? When the severity of their allergic disease is promoted during pregnancy, does the risk of embolic disease increase? This data has not been studied before.Twenty to thirty percent of pregnant women are affected by allergies. Allergic symptoms existing before pregnancy may be either attenuated, or equally often promoted through pregnancy12. However, the association between AR and TE in pregnant women has not been researched up to now. The aim of this study is to understand if AR improves or worsens during pregnancy and if the rate of TE increases or decreases by comparing the rate of TE between non-AR subjects and subjects with AR.Allergic rhinitis (AR) is a common allergic disease in adults. An association between AR and TE has been reported14, and this sample served as our data source. Information on basic patient demographics and medical care received, including outpatient, inpatient claims and childbirth was gathered. The study flowchart is presented in Fig. A representative sample of 1 million participants from the National Health Insurance Research Database was provided by Taiwan’s National Health Research InstitutesFrom 2004 to 2011, 55,057 pregnant women were selected for the study. To prevent the complex conditions of patients that would influence the results of the study, those with the diagnosis of malignancy, major illnesses such as chronic psychosis, paralysis or severe trauma before childbirth were excluded from the study. The claim data of these subjects, 3 years before and 2 years after childbirth were gathered for the study. Those with and without the diagnosis of AR during the 5 years were grouped into the AR group and non-AR group. The AR subjects were further divided into three groups. Group 1: with AR before; without AR after childbirth (well controlled AR after childbirth). Group 2: without AR before; with AR after childbirth (poor control of AR or new onset of AR). Group 3: with AR before; with AR after childbirth. The criterion for “with AR before childbirth” was: at least one diagnosis of AR 3 years before childbirth. The criterion for “with AR after childbirth” was: at least one diagnosis of AR 2 years after childbirth. TE selected in our study is presented in Table Those with TE diagnosis were counted as “with TE”. The criteria of “with TE” were: had one or more TE diagnosis during pregnancy and 60 days after childbirth. The rates of TE were compared between AR and non-AR subjects. The rates of TE in groups 1, 2 and 3 were also compared to the non-AR subjects. In those with cesarean delivery, the rates of TE were also compared between groups.Those with “venous complications in pregnancy and puerperium” were counted as “with venous complications”. The criteria of “with venous complications” were: had one or more venous complication diagnosis during pregnancy and 60 days after childbirth. The rates of venous complications in groups 1, 2 and 3 were compared to those of the non-AR subjects.15, risk factors for TE during pregnancy and puerperium were viewed as the confounding factors. These confounding factors include birth type , mother’s age . Other factors including medical comorbidities, pregnancy characteristics and delivery complications are presented in Table 16, urbanization levels were grouped into seven levels: levels 1–2 for urban residents, and levels 3–7 for country residents. Asthma (AS) was considered to be a risk factor of TE17, and was then adjusted. The criterion of AS was: at least 2 AS diagnoses during the 5 years.According to the guidelines of the Royal College of Obstetricians and Gynecologists (RCOG)p values of < 0.05 were defined as significant.All statistical analyses were performed using SAS software version 9.1 , and PASW Statistics 18 . The chi-square test was used to compare the rate of TE between groups. Multivariate logistic regression analyses were used for adjusting for the confounding factors. Two-sided The study flowchart is presented in Fig. p value was 0.264, OR 1.39; and 95% CI  0.78 ~ 2.50. After adjusting for the confounding factors, the p-value was 0.521. The rate of venous complications in the AR group was 7.54‰, and the rate in the non-AR group was 6.40‰. The p value was 0.113 , and the rate in the non-AR group was 0.70 per 1000 subjects (0.70‰). The p = 0.005, OR 2.64, 95% CI 1.31 ~ 5.34). After adjusting for the confounding factors, the p value = 0.027. There was no difference between group 1 , group 2  and the non-AR group.The results of TE in different AR groups are presented in Table p = 0.046, OR 1.35, 95% CI 1.01 ~ 1.80). After adjusting for the confounding factors, p value = 0.037. The rate was similar between group 1, group 2 and the non-AR group.The results of venous complications in different AR groups are presented in Table p = 0.000, OR 4.14, 95% CI 1.76 ~ 9.77). After adjusting for the confounding factors, p value = 0.006. The rate was similar between group 1, group 2 and the non-AR group.For those who underwent cesarean delivery, the rates of TE in different groups are presented in Table In this population based, retrospective cohort study, we did not find an association between AR and thromoembolic (TE) disease in pregnant women. When we divided the AR subjects into those with AR diagnosis both before and after childbirth (group 3), their rate of TE was higher compared to the non-AR subjects. The increased rate was more prominent in women who underwent cesarean delivery . In these subjects (group 3), the rate of venous complications was also higher. Venous complications including varicose veins were risk factors for TE. From the findings, we speculate that through the increased occurrence of venous complications, women with AR diagnosed both before and after childbirth had a higher rate of TE when they were pregnant.7. The risk of pulmonary embolism and deep venous thrombosis also increase in AS patients18. Therefore, whether the association between AR and TE in pregnancy comes from the cofactor of AS or not, is questionable. In our study, after adjusting for AS, the rate of TE in pregnancy was still higher in those who had AR diagnosed both before and after childbirth (group 3). Therefore, AR itself was the risk factor for TE in pregnancy.AS and AR often coexist. AS is associated with a pro-coagulant state19. An increased IgE level is a marker of allergic disease including AR. When allergen-IgE complex binds to mast cells, the cells are activated, and release histamines and other cytokines. Elevated levels of histamines and cytokines then induce the development of varicose veins. Increased concentrations of IL-8 (interleukin-8) and MCP-1 (Monocyte chemoattractant protein-1) were noted to increase at the site of varicose veins20. Studies suggest that MCP-1 and IL-8 may participate in the pathogenesis of allergic rhinitis21. The two mechanisms could explain our findings that in pregnant women diagnosed with AR before and after pregnancy(group 3), the rate of venous complications including varicose veins increased. The increased rate of venous complications will indirectly increase the rate of TE.Vaso-active compounds  released from mast cells play an important role in the development of varicose veins9, nasal symptoms of AR may improve (34%), worsen (15%) or remain (51%) during pregnancy10. AR may also occur or be noticed for the first time during pregnancy. With allergen prevention, life control and appropriate medical treatment, AR may subside or disappear after pregnancy. Decreasing the severity of allergic disease may also influence the formation of TE. In our study, compared to non-AR subjects, those with AR both before and after childbirth (group 3) had an increased rate of TE. Importantly, those whose AR was well controlled during pregnancy , did not have an increased rate of TE compared to non-AR subjects. Thus, well controlled AR during pregnancy, could decrease the rate of TE.Similar with asthma5, enhance platelet activation6, and induce prothrombotic and antifibrinolytic activities through the rise of IgE8, and then induce the formation of TE. Histamine, an organic nitrogenous compound, is a key mediator of allergic reactions, and is a pro-coagulant too22. In a normal pregnancy, maternal blood histamine levels decrease during the second and third trimester23. Reduced histamine may decrease the symptoms of allergic disease and decrease the development of coagulation. Decreased blood histamine and well controlled allergic conditions through different methods may explain why some AR subjects had a decrease in AR symptoms after pregnancy. When AR is well controlled in patients during pregnancy, their blood histamine may decrease. Lower histamine could decrease the rate of TE. The mechanism could explain our findings that in those with AR before but no AR after childbirth , TE in pregnancy would not increase.Allergic phenomenons activate the coagulation system10. Although the hormonal changes can worsen the symptoms of AR, some non-AR subjects may be misdiagnosed as having AR during this period. These non-AR subjects, without allergic disease, could have been misdiagnosed as AR subjects and may have been grouped into group 2  in our study. TE induced by allergic mechanisms did not occur in these non-allergic subjects. With some non-allergic subjects being misgrouped into group 2, the rate of TE would decrease. This might explain our findings that TE was not significantly higher in group 2, compared to non-AR subjects.When AR developed or worsened during pregnancy, the rate of TE should have increased. However, the rate of TE did not increase in these subjects (group 2) in our study, compared to non-AR subjects. Hormonal changes during pregnancy can induce an increase of circulating blood volume and activity of nasal mucosa cells. It results in nasal mucosa swelling and increased secretionThere are limitations in our study. First, there is no laboratory data to evaluate the clinical condition of AR and TE. Second, there were no data in part of the AR severity , AR classification  and AR duration to show the biologic gradient on the association. There is no treatment to show the biological plausibility. Third, the temporal relationship between these two conditions could not demonstrate the temporal sequence of AR before TE due to the definitions of AR that apply the time of childbirth as a cut-off point, not the time of conception. Fourth, there is no radiological data. Radiological data is important to evaluate the profile of TE. Fifth, PE is one of the most severe diseases in TE. Evaluating the association between AR and PE in pregnant women is important. However, because patient numbers of PE were too few, it could not be calculated. Future investigation with the recruitment of more subjects, including AR classification, treatment, radiological and biological data is necessary to find the association more accurate.Through this population based, retrospective cohort study, an association between AR and TE was found in pregnant women. The association was only noted in those diagnosed with AR both before and after childbirth. An increase of venous complications in pregnancy and puerperium in these subjects could explain the increased rate of TE. This association serves to remind pregnant women with AR to exercise regularly, avoid wearing tight clothing and so on to prevent the development of venous complications such as varicose veins and TE. In those with AR before pregnancy but not after pregnancy , there was no increase of TE. This result suggests that different methods, such as allergen prevention and appropriate medical treatment to improve the symptoms of AR, are important to prevent the development of TE.


In recent years, due to the increase in the incidence of traffic accidents, the number of people with limb injuries has also increased. At the same time, among the aging population, neurological diseases or cardiovascular and cerebrovascular diseases have caused many people to have limb hemiplegia. It has been clinically proven that the use of rehabilitation equipment can help patients with limb injuries to restore limb motor function. This paper takes wearable lower limb rehabilitation exoskeleton as the research object, and its main contents are mechanical structure design, kinematics analysis, gait planning, virtual prototype simulation, and experimental verification and analysis. Based on the physiological characteristics of human body and the principle of comfortable and reliable wearing, this paper designs wearable exoskeleton for lower limb rehabilitation. Firstly, the physiological structure characteristics and movement mechanism of human lower limbs were studied and analyzed. By referring to the rotation range and height and size of each joint of human lower limbs, the overall scheme of wearable lower limb rehabilitation exoskeleton was designed and the degree of freedom was allocated. At the same time, Solidworks was used to establish a three-dimensional model. On the basis of a 3D model, a kinematics model was established, and the forward kinematics solution was obtained by using homogeneous coordinate transformation. Since the inverse kinematics solution was relatively complicated, the inverse kinematics solution was conducted in this paper according to the geometric relations of the joints of the lower limbs. Kinematics analysis of the exoskeleton structure of wearable lower limb rehabilitation was carried out to lay a theoretical foundation for gait planning. The off-line gait planning was carried out by using the method based on ZMP stability criterion, and the gait planning was divided into five stages: squat, start, middle step, stop and rise, and the motion trajectory of the center of mass and ankle joint was planned. Based on the inverse kinematics formula, the function of the change of joint angle with time in walking process is derived. The virtual prototype is established in ADAMS, and the simulation of virtual prototype is carried out by using the function of gait planning's joint angle and time. The correctness of structural design and gait planning was verified by measuring the trajectories of the centroid and ankle joints in each gait stage and the functional relationship between the rotation angle of each joint and time. Then, using a 3D dynamic capture system to capture the human lower limb motion trajectory of each joint, each joint trajectory data output, using the MATLAB software to output data, gets the joint trajectory change over time function curve and is used to verify feasibility and applicability of human gait planning. Through the research and analysis of the joints of the lower limbs of the human body, it can be concluded that the hip joint and the knee joint have 3 degrees of freedom, respectively, and the knee joint has 1 degree of freedom. In recent years, a new mechanical mechanism applied in the medical field has become a research hotspot, which is called rehabilitation equipment and an important branch of rehabilitation training .In recent years, the incidence of traffic accidents has greatly increased, resulting in an increase in the number of physical injuries. At the same time, due to the accelerated pace of life and increasing pressure on life, the fertility rate has been declining, medical technology: technical progress, improved public health level, and extended life expectancy, resulting in China's entry into the ranks of aging population countries, and in the aging population, the age of these people is getting younger and younger. Among them, neurological diseases or cardiovascular and cerebrovascular diseases cause hemiplegia of many people's limbs, and the number has been increasing. For these people, the use of rehabilitation equipment can help them recover the function of physical movement. According to clinical medicine, under the guidance of therapists, patients can improve and restore the motor function of injured limbs through reasonable training of rehabilitation equipment , but it Wearable lower limb rehabilitation exoskeleton is a man-machine integration system, its main function is to lower extremity injuries or lower limb paralysis patients wear on the outer edge of the lower limb itself, and it will give patients the need to walk the power, makes the posture of patients and normal person basic consistent, and also protect and support the role of body . At the The United States, the United Kingdom, and Canada began working on rehabilitation robots in the 1980s and have been leading the way in other countries. Before 1990, 56 research centers around the world were composed of North America, Canada, the Commonwealth of Nations, Scandinavia, continental Europe, and Japan, distributed in 5 industrial zones. Since the 1990s, the research on the rehabilitation robot has just developed into a comprehensive stage. In recent years, the rehabilitation robot has been the main research direction in the field of rehabilitation robot, such as rehabilitation manipulator, medical robot, intelligent wheelchair, and rehabilitation robot .In the 1960s, the United States and Japan made a plan on the research and development of rehabilitation robots, which is to research and develop exoskeletons that can be worn on people and have power devices of their own, just like coats . By usinIn 1978, Massachusetts Institute of Technology (MIT), a famous American university, began to research and develop exoskeleton walking robot with enhanced human movement function .In terms of lower limb medical rehabilitation training equipment, the Lokomat gait rehabilitation robot system is now a relatively advanced product in the world. It was jointly developed by Hocoma, a Swiss medical company, and the spinal injury rehabilitation center of Balgrist University in Zurich , 12. TheAt present, the LokoHelp type lower limb rehabilitation machine is the earliest in the electromechanical system for training and improving gait of patients, which is mainly targeted at people with brain tissue injury. This device should be used together with the treadmill, and it is easy to disassemble and assemble , 16.As the exoskeleton structure of wearable lower limb rehabilitation directly touches the human body, it realizes coordinated movement with the human lower limb. Therefore, a mechanical structure design must be carried out in accordance with the characteristics of personification . An anthIn order to describe the motion of human joints, the human body is usually divided into the vertical axis, sagittal axis, and coronal axis, which are perpendicular to each other. Coronal axis is an axis running through the body perpendicular to the sagittal plane. Sagittal axis is an axis that runs through the body in front and back, perpendicular to the frontal surface. Horizontal axis is an axis through which the body is perpendicular to a horizontal plane. According to the vertical axis, sagittal axis, and coronal axis, the sagittal plane, coronal plane, and horizontal plane can be established in human body. Sagittal plane is the plane perpendicular to the ground along the front and rear diameters of the body. Coronal plane is found along the body around the diameter of the vertical plane and the ground. Horizontal plane is a horizontal plane that cuts through the body and is parallel to the ground.Hip, knee, and ankle joints constitute the lower limb joints, which play a leading role in the movement of lower limbs and complete the movements required by human beings. Human lower extremity joints mainly have three modes of motion: adduction/evening extension, flexion/extension, and internal rotation/external rotation. For adduction/abduction, abduction is the movement of the link around the sagittal axis, in the frontal plane to the lateral movement, adduction and abduction of the opposite movement. For flexion/extension, flexion is the forward motion of the link around the frontal axis in the sagittal plane, while extension is the opposite of flexion. Internal rotation is when a link moves inward and inward in the horizontal plane around a vertical axis. External rotation is the opposite of internal rotation.Wearable lower limb rehabilitation exoskeleton is an artificial exoskeleton applied to patients with lower limb motor dysfunction. The mechanical structure design is an important link in the work of this paper. The advantages and disadvantages of the structural design can directly affect the use effect and safety performance of the whole wearable lower limb rehabilitation exoskeleton.The design of the wearable lower limb rehabilitation exoskeleton is based on the basic ideas of anthropomorphism and ergonomics. The degree of freedom of exoskeleton is consistent with the degree of freedom of human lower limbs, and the function of human lower limbs can be simulated as far as possibleWearable lower limb rehabilitation exoskeletons should be designed to be adjustable in size. Due to the difference in human height, wearable lower limb rehabilitation exoskeleton is targeted at the mass population, so its structure size can be adjusted within a certain range, so as to meet the purpose of massThe wearable lower limb rehabilitation exoskeleton should be light in weight, small in size, convenient to carry, and durable. The lower extremity exoskeleton has 7 degrees of freedom on one side and 14 degrees of freedom on both sides, of which the unilateral hip joint and ankle joint have 3 degrees of freedom each, and the unilateral knee joint has 1 degree of freedomThis project is aimed at designing an exoskeleton to help disabled patients walk. The following principles should be followed in the design of wearable lower limb rehabilitation exoskeleton:Based on the above theoretical analysis, a wearable exoskeleton for lower limb rehabilitation was designed and Solidworks was used to establish a 3d model, as shown in The hip joint has three degrees of freedom, including flexion/extension, adduction/abduction, and internal and external rotation. In this paper, the cross-axis universal joint structure is used to design the hip joint. There are three movements of the hip joint, the main one is the flexion/extension movement in the sagittal plane, and the other one is to assist in improving the applicability of the mechanism. Since the movement of each joint of human lower limbs is within a certain range, considering the safety of patients, it is necessary to limit the movement of each joint and make it rotate within a certain range. When the human body moves forward, it mainly USES hip joint flexion “extension movement, abduction/adduction movement.” Therefore, it is necessary to install the driving device on these two degrees of freedom. The internal and external rotation of the hip joint does not require the installation of a driving device, but a spring damping device should be installed. The purpose is to help patients maintain the balance of lower limbs when they are disturbed by external forces during walking. When the external forces disappear, they will return to the original state. Since the ankle joint also has three degrees of freedom in the process of lower limb walking and its motion mode is flexion/extension, adduction/abduction, and internal rotation/external rotation, its structure is designed to be the same as that of the hip joint.In order to make the overall structure relatively simple and easy to realize, this paper simplifies the design of the knee joint and designs it as a structure of one degree of freedom . Flexing/stretching motion is achieved by connecting the thigh and calf with the shaft and bearing. Similar to the hip joint, it is necessary to install a drive device at this degree of freedom and limit the flexion/extension motion.The structure is designed to be suitable for the general population, each person's height is different. Therefore, the length of the connecting plate between the thigh, calf, waist, ankle joint, and sole plate of the wearable lower limb rehabilitation exoskeleton is designed to be adjustable.The driving scheme plays an important role in the stability and rapid response of the whole wearable lower limb rehabilitation exoskeleton. A good drive scheme enables wearable lower limb rehabilitation exoskeletons to easily achieve planned movements while reducing the weight and volume of the entire exoskeleton. The driving scheme should have the characteristics of rapidity, stability, sensitivity, and centralized control, as well as reliability, high efficiency, lightweight, and small volume. At present, the commonly used driving modes are motor driving, hydraulic driving, and pneumatic driving.The motor drive is to convert electrical energy into mechanical energy to directly drive the load, less energy conversion, high transmission efficiency, which can directly achieve the desired mechanism movement state. The advantages of the motor drive are obvious: high motion accuracy, easy control, quick response, high efficiency, convenient signal transmission, processing and detection, and small size, low noise, low cost, convenient maintenance, and pollution-free features. At present, the motor drive is more mature, and the motor model, choice space, can achieve high precision control. Servo motor is the most common driving element in the field of high precision control.The hydraulic drive is a sliding fit between the piston and the rigid body. The hydraulic oil enters from one end of the cylinder and pushes the piston to the other end of the cylinder. The movement of the piston can be controlled by adjusting the amount of oil entering the cylinder and the liquid pressure at both ends of the piston. Hydraulic drive can be a wide range of stepless speed change, unit mass output power, and large driving torque. In addition, compared with other driving modes, it has the characteristics of small size, lightweight, and good dynamic performance under the same output power condition. But the disadvantage is that in its work engineering, due to two energy conversions, it reduces the transmission efficiency, and at the same time, because of the compressibility of hydraulic oil and leakage problems, cannot guarantee a strict transmission ratio; failure should not be checked and removed.A pneumatic drive is used to compressed air as the working medium to drive the load to work, its working principle is compressed air to push the cylinder for linear or rotary movement, and the use of solenoid valve or manual control, and hydraulic drive is similar. Its advantage is compressed air cost is low, do not have pollution, working pressure is low, reaction is fast, action is rapid, maintenance is convenient, it can realize overload protection, drop temperature is simple, exhaust can drop temperature, and it is not easy to produce overheating phenomenon. Disadvantages are high sealing requirements and low transmission efficiency. The noise pollution is large, the accuracy requirement is low, and the movement stability is poor.The articular portion of the wearable lower limb rehabilitation exoskeleton is compact in design, highly accurate and efficient in transmission, and capable of providing the output torque and speed required by the movement of the mechanism. From a comprehensive perspective, this paper chooses the servo motor drive as the driving mode of wearable lower limb rehabilitation exoskeleton. Because the speed of servo motor is larger, but the torque is smaller, it cannot directly affect the wearable lower limb rehabilitation exoskeleton structure, so it needs to decelerate and increase the torque through the transmission device. The transmission device of a servo motor mainly includes harmonic reduction gear, synchronous belt, and rolling screw. But the screw rod system of reduction ratio is associated with the location of the connecting rod installation, so the wearable lower limb rehabilitation exoskeleton structure in the process of the movement, the speed of the connecting rod when installed in a location, and installation position are corresponding to each other; at some point, there might be a need for bigger torque deceleration smaller phenomenon; however, the motor overloads or becomes motionless. Therefore, the servo motor and harmonic reduction gear combined with synchronous belt are selected as the driving mode of wearable lower limb rehabilitation exoskeleton. This drive mode can improve the flexibility of the movable joint and can change the speed reduction ratio of a synchronous belt wheel, compared to that of the replacement of harmonic reducer which is simple and cheap.The maximum driving moment of the wearable lower limb rehabilitation exoskeleton structure should be the same as the maximum driving moment of the human body. Taking all factors into consideration, we finally chose RE series dc servo motor of Swiss max011 with the model of RE40.According to the motor speed, we choose the harmonic reducer ratio of 200 : l. However, it cannot meet the requirements of wearable exoskeleton walking. Therefore, harmonic reducer and synchronous belt are combined to form a transmission device of wearable exoskeleton structure for lower limb rehabilitation.Wearable lower limb rehabilitation exoskeleton is a relatively complex multilink structure. In its movement, the open loop and the closed loop appear alternately, and the walking process is unstable. Therefore, it is necessary to conduct kinematics analysis on the exoskeleton of wearable lower limb rehabilitation, so as to ensure that it can walk stably in the process of walking and lay a foundation for gait planning.The kinematics of wearable lower limb rehabilitation exoskeleton mainly takes its motion relative to the reference coordinate system as an analytical function of time for analysis and research and does not consider the force and torque required by these movements. In particular, the relationship between the spatial variables of each joint and the foot position of wearable lower limb rehabilitation exoskeleton is studied. Kinematics analysis mainly includes forward kinematics solution and inverse kinematics solution. (1) Forward kinematics solution is to calculate the position and posture of the end-effector element (foot) given the length and joint angle of each link of the wearable lower limb rehabilitation exoskeleton. (2) Inverse kinematics solution is to know the position and posture of the end (foot) of the wearable lower limb rehabilitation exoskeleton and solve the rotation angle of each joint. Kinematics analysis of wearable lower limb rehabilitation exoskeleton is the basis of mechanism analysis, velocity analysis, acceleration analysis, and motion control.Gait refers to a coordinated movement of the joints of the lower limbs in time sequence and space during the walking process of wearable lower limb rehabilitation exoskeleton. A set of time trajectory functions are used to describe these movements. In gait planning for wearable lower limb rehabilitation exoskeletons, factors such as realistic environment, functions to be achieved (such as obstacle crossing), and stability must be taken into account. Reasonable gait planning is a necessary condition for stable walking of the wearable lower limb rehabilitation exoskeleton.∗ extension to make the speed of the center of mass along the x axis reach the speed required by the middle step. In the initial stage, the speed of wearable lower limb rehabilitation exoskeleton starts from 0 and reaches the speed required by the middle step. If it is achieved through one step, the acceleration is relatively large and it is easy to cause the instability of walking. Therefore, the transition from the initial stage to the middle step in this paper is completed through two steps. After the initial stage, it is the middle step stage. In this stage, the center of mass of the wearable lower limb rehabilitation exoskeleton moves forward at a constant speed along the x axis. The walking cycle is cyclic. At the end of the middle step stage, it is the stop stage, which makes the speed of wearable lower limb rehabilitation exoskeleton become zero, while swinging the leg closer to the supporting leg. The end of the stop is followed by the ascent stage to restore the wearable lower limb rehabilitation exoskeleton to an upright posture. In gait planning, the gait period is set as 1 s, and the leg support period is 20% of the gait period, i.e., 0.2 s, and squat stage and rise stage are also set to 1 s. This process is connected back and forth and coherent from top to bottom, which is an important part of the whole process of gait planning.The basic gait of the wearable lower limb rehabilitation exoskeleton can be divided into the forward gait and lateral gait. The walking process can be divided into five stages: squat stage, start stage, middle step stage, stop stage, and rise stage. The squat stage is when the exoskeleton of the wearable lower limb rehabilitation falls from the upright posture for a certain distance. The initial stage is when the exoskeleton of the wearable lower limb rehabilitation moves through buckling/tH, the height of the center of mass from the ground, is constantDuring walking, X directionIn the middle step, the center of mass moves uniformly in the In the process of walking, the floor of swinging legs and feet is always parallel to the groundThe waist connector is always parallel to the groundWhen walking, the single-leg support stage and the two-leg support stage alternately occur, along with the open-chain structure and the closed-chain structure, and the swinging leg and foot floor will have impact on the ground when it touches the ground or leaves the ground. In order to avoid the impact on the ground during walking and achieve stable walking, the walking mode of wearable lower limb rehabilitation exoskeleton was deeply studied in this paper. Since wearable lower limb rehabilitation exoskeleton is a multisolution system, certain constraints must be added to obtain a unique solution:Vukobratovic et al. proposed the concept of ZMP (zero moment point) in 1969. ZMP (zero moment point) is the intersection point between the extension line of the resultant force vector of gravity, inertia force, and ground reaction force received by the bipedal robot and the ground. When bipedal robot walks, the left and right feet alternately touch the ground for support, which is accompanied by the alternation of one-leg support stage and two-leg support stage. ZMP (zero moment point) should always be in the effective support area of the minimum convex polygon formed by the contact between the base plate of the supporting leg and foot and the ground, so as to enable the bipedal robot to walk steadily. The stable region range of the support leg is the minimum convex polygon region range formed by the contact between the base of the support leg and the ground. The stable region range of the foot support is the minimum convex polygon region range formed by the contact between the foot base of the two feet support legs and the ground. This method provides a reliable theoretical basis for gait analysis and planning of bipedal robots.d boron. Evaluate the planned gait. Stability margin refers to the minimum value of the distance between ZMP point and the boundary of the stable region when the bipedal robot walks. The larger the value, the better, indicating that the stability of wearable lower limb rehabilitation exoskeleton is better when walking.In the actual gait planning, wearable exoskeleton gait planning for lower limb rehabilitation should be carried out according to the principle of maximum stability, usually using the stability margin X direction of the trajectory of the center of massPlanning of the Centroid trajectory planning:k is k = 3, 4, 5 ⋯ N.The value of When the legs are supported, the center of mass of the wearable lower limb rehabilitation exoskeleton is between the legs, which is stable. During the single-leg support period, the center of the mass of the wearable rehabilitation exoskeleton of the lower limbs must be suspended, which is in an unstable state and tends to tip towards the side of the swinging leg. It can be adjusted by lateral degrees of freedom of hip joint and ankle joint of lower limbs to make it in a stable state. Because the distance between the center of mass and hip joint is relatively close, it has little effect on the adjustment of the center of mass. In this paper, lateral freedom of the ankle joint is considered to adjust the stability of wearable exoskeleton of lower limb.Virtual prototype technology  is a digital design method based on virtual prototype based on the development and extension of CAX/DFX technology in various fields. It mainly includes kinematics and dynamic simulation technology of mechanical system, which has been applied in many fields. Compared with the traditional product design, virtual prototype technology can shorten product development cycle, reduce cost, and improve product performance and quality. At present, ADAMS software developed by MDI Company in the United States is the most comprehensive and applied mechanical system simulation software for virtual prototype technology.DAMS  is a mechanical system automation dynamics simulation software developed by MDI Company of the United States. It is the most authoritative and dominant software in the dynamics analysis software market.A parameterized dynamic model of the mechanical system was established by using interactive graphics environment, part library, constraint library, and force library. When building the model, ADAMS can customize the material density, stiffness, elastic deformation, gravity acceleration, and name of each componentThe analysis of parametric model of the mechanical system mainly includes static analysis, kinematics analysis, quasistatic analysis, linear and nonlinear dynamic analysis, and automatic detection of the degree of freedom of the mechanismThe solver of the ADAMS software uses the Lagrangian equations of the first kind to establish the system's maximum coordinate dynamic differential algebraic equations, and the solution is fast and accurateIt has the functions of analyzing, assembling, and dynamically displaying various models and provides many “virtual prototype” schemesThe function library is fully functional and can provide users with customized force and motion generatorThe program structure is open, and the interface is diversified. Users can integrate subroutines according to their own needsWith the function of output displacement, velocity, acceleration, and reaction curves, users can better analyze the performance of the virtual prototypeADAMS software has the following characteristics:ADAMS' main function is to carry out dynamic simulation analysis of the mechanical system model, and it also has certain modeling function, but the modeling function is relatively weak. Generally, the creation of complex mechanical system model requires professional mechanical model modeling software, such as Solidworks, Pro/E, and CATIA. In this paper, Solidworks is adopted to establish a mechanical 3D model, which is then converted into parasolid format and can be directly imported into ADAMS. The wearable lower limb rehabilitation exoskeleton has 14 degrees of freedom, four of them did not install the driver device, so the dynamics model is established; the wearable lower limb rehabilitation exoskeleton model itself has 14 degrees of freedom, it will now be reduced to 10 degrees of freedom, of which there are rotation constraints, including hip and ankle joint of two degrees of freedom to achieve buckling/f “movement, outreach/adduction, and knee 1 degree of freedom to achieve buckling/stretching. In ADAMS, motion constraints and motion pairs should be added to these joints. The data files of 10 joint rotation angles of wearable lower limb rehabilitation exoskeleton legs generated in MATLAB with time changes were saved as follows. TXT format is imported into ADAS, and the spline interpolation function AKISPL is used to take the data generated by MATLAB as the control function of motion to control the corresponding joint rotation to realize the motion of the virtual prototype. In addition to its freedom constraint, the exoskeleton structure of wearable lower limb rehabilitation also has contact constraint with the ground. The contact constraint in ADAMS can be used to define the constraint between the foot plate of wearable lower limb rehabilitation exoskeleton and the ground. Increasing the collision constraint must ensure that there is enough friction between the footplate and the ground. Otherwise, in the process of walking, the exoskeleton of wearable lower limb rehabilitation will slip between the floor and the ground or slide to the ground, thus affecting the normal walking. Due to the complexity of the mechanical model and the large number of parts, when establishing the virtual prototype, the parts that do not move relative to each other and are adjacent to each other are simplified into one part by the Boolean operation. At this point, the virtual prototype modeling of wearable lower limb rehabilitation exoskeleton has been completed. In the simulation, in order to better approach the actual situation, the simulation environment set in ADAMS is as consistent as possible with the actual environment. In this way, by adjusting the simulation parameters, the relatively ideal simulation data can be directly applied to the physical prototype, thus reducing the debugging time of the prototype.The wearable lower limb rehabilitation exoskeleton designed in this project has 10 degrees of freedom after simplification and has a complex structure. After importing ADAMS, constraints and drivers should be added. In order to ensure the smooth completion of simulation, the model should be tested after constraints and drivers are added to avoid underconstraints and overconstraints. As the wearable rehabilitation exoskeleton of the lower extremity has 10 joints and the wearable rehabilitation exoskeleton of the lower extremity is located in a three-dimensional space, the wearable rehabilitation exoskeleton of the lower extremity has 12 degrees of freedom.After setting the simulation time and number of steps, the virtual prototype is simulated. The view before the virtual prototype walks is shown in The main function of ADAMS\Postprocessor is to postprocess simulation results. This module can output animation and various data curves after virtual prototype simulation, such as angles, speeds, accelerations, forces, and torques, as well as edit curves and output corresponding data.In ADAMS, the centroid of the virtual prototype of wearable lower limb rehabilitation exoskeleton, the trajectory of the ankle joint, and the rotation angle of each joint were measured, as shown in Figures According to the data in Figures With the continuous progress of computer science and technology and sensor technology, dynamic capture technology has been widely applied in gait analysis, motion analysis, physiotherapy and rehabilitation, nervous system, product design and development, ergonomics, film art, industrial research, and other fields. Dynamic capture technology refers to the measurement, tracking, and recording of the motion track of an object in three-dimensional space. At present, an optical dynamic capture system is the most widely used in various fields.According to the principle of computer vision, specific points of light are firstly placed on the target, and then, the motion capture task is realized by monitoring and tracking these specific points of light. Theoretically, at a certain moment, for any point in the three-dimensional space, when two cameras simultaneously capture this point, the location information of the point can be captured and recorded according to the captured image and camera performance parameters.Human motion analysis is used to obtain human limb motion parameters by using a 3D dynamic capture system, to study human motion and apply it. This paper mainly studies the changes of motion trajectory and rotation angle of each joint of human lower limbs. The main equipment used is the optical dynamic capture system . Eagle digital motion capture system is an optical dynamic capture system, consisting of Eagle digital capture lens, EagleHub, and Cortex software. The motion capture system has the real-time function, the user can observe a small action of the target at the same time, and the use of the motion capture system to capture the complex action can achieve a high precision.Cortex software operation is very simple to learn, and its processing function is powerful. Users can set system parameters, capture and model targets, and calibrate, match, edit, identify, analyze, and output data in a unified environment.Through the study and analysis of the joints of the human lower limbs, it can be concluded that the hip joint and the knee joint have 3 degrees of freedom, respectively, and the knee joint has 1 degree of freedom. In order to obtain the motion trajectory of each joint, one marker was fixed at the waist, hip, thigh, calf, toe, and heel, and two markers were fixed at both sides of knee and ankle. These markers, also known as marker, are made of plastic material. The surface of these markers is coated with special materials reflecting infrared ray, which makes them especially bright. When the camera is working, infrared ray emitted by the camera reflecting from the marker can be captured. When two cameras can take pictures of this marker at the same time, its motion trajectory will be captured and recorded according to the captured image and camera performance parameters.The experiment was carried out in a closed room with 6 eagles 4 digital motion capture lens and quadrilateral arrangement. Before the experiment, a small four-point calibration device was used to set up and adjust the coordinate system of the system, and 500 mm stick was used to establish the linear parameters of the lens. After the completion of coordinate system setting, the experiment needs to be determined by debugging 6 cameras, so that the area captured by the lens is 1.5 m × 5.0 m, and these 6 eagles 4 digital motion capture shots can be clearly displayed in the Cortex software interface and can be shot on a calibration device, and no artifacts appear.Normal gait refers to the gait of healthy people who walk periodically according to their normal gait parameters. Before starting the experiment, the subjects first practiced walking in the captured area and adjusted their walking posture to the most natural state, so as to adapt to the experimental environment and try to be close to their normal walking gait. The specific requirements are as follows: there should be no large amplitude of before and after the left and right sway, have the appropriate step length, and have the least energy consumption. During the experiment, the system frequency is set to 60 Hz. The subject walks along a straight line from one end of the region and follows his normal gait.Based on the analysis of the motion characteristics and degrees of freedom of the joints of human lower limbs, this paper designs the structure and the degrees of freedom of the wearable lower limb rehabilitation exoskeleton and establishes a three-dimensional model. By referring to the rotation range and height size of each joint of human beings, the rotation range of the hip, knee, and ankle joints of the wearable lower limb rehabilitation exoskeleton and the size of each component were determined to meet the requirements of patients with different heightsThe wearable carried out a kinematical analysis on the lower limb rehabilitation exoskeleton: in the bar system, using the homogeneous coordinate transformation to the forward kinematics modeling and analysis, from the homogeneous transformation matrix of forward kinematics solution, you can see that as long as the control of the wearable lower limb rehabilitation exoskeleton of the hip, knee, and ankle rotation angle can be achieved, movement of each component is observedAccording to the designed wearable exoskeleton for lower limb rehabilitation, the offline gait planning was firstly completed by using the method based on ZMP stability criterion. The gait planning was divided into five stages: squat, start, middle step, stop and rise, and the movement trajectory of the center of mass and ankle joint was planned. Based on the inverse kinematics formula, the function of the hip, knee, and ankle angle changing with time in the walking process of wearable lower limb rehabilitation exoskeleton is derivedEstablish a 3D model of wearable lower limb rehabilitation exoskeleton in Solidworks, convert it into parasolid format, and import it into ADAMS to establish a virtual prototype model. The trajectory of the center of mass and ankle joint and the curve of rotation angle of the hip, knee, and ankle joints with time were measured, which verified the feasibility and applicability of structural design and gait planning. At the same time, the driving torque of hip, knee, and ankle joints was measured, which provided theoretical basis for the selection of motor for subsequent physical prototypeThe use of 3D dynamic capture system to capture the human lower limb movement trajectory of the center of mass and the ankle outputs the centroid trajectory data and the ankle in MATLAB; the output of the data processing gets the center of mass and ankle trajectory at any time change function curve and is used to verify the feasibility and applicability of human gait planningIn this paper, on the basis of reference materials, the structure design, modeling analysis, gait planning, and simulation analysis of wearable exoskeleton for lower limb rehabilitation were carried out, and experimental verification and analysis were carried out. The main research work and conclusions are as follows:The simulation in this paper mainly analyzes the stability of the gait, but it involves less dynamic analysis and control and needs further discussion and research.