(Inria-COVID project; 2020-2021)
ExoTurn is an interdisciplinary project that was rapidly started in March 2020 to help the Hospital of Nancy in the fight against the COVID-19. The project is coordinated jointly by Serena Ivaldi (Inria) and Dr. Nicla Settembre (Hospital of Nancy) with the participation of INRS, CNRS and University of Lorraine.
The goal of the project is to investigate the feasibility and help of back-support exoskeletons to assist the medical staff during the exhausting procedures of Prone Positioning (PP) maneuvers in the ICU. Prone Positioning is a complex procedure that is necessary during treatment of acute respiratory distress syndrome (ARDS) to optimise oxygenation.
Between March and April 2020, we conducted a pilot study in simulation at the Simulation Center of the Hospital of Nancy (Hôpital Virtuel de Lorraine – HVL), to evaluate the need of back-support and probe into 4 commercial exoskeleton to find the most suitable to assist the medical staff in this task. We identified a promising candidate in the passive exoskeleton Laevo. In a second phase, the Laevo was used in the ICU by volunteers of a PP team. The participants perceived a physical benefit in using the exoskeleton, and a positive acceptance of this technology was observed in both the users of the exoskeleton and their colleagues. A short letter describing the pilot study was published in May 2020 in the journal Annals of Physical and Rehabilitation Medecine.
We conducted further experiments to clarify the beneficial effects of the exoskeleton for PP maneuvers, particularly with validated physiological measures (EMG, EKG). The experiments were carried out again in the HVL, with the Laevo exoskeleton worn by two volunteer physicians that used it in the ICU.
During the second wave of COVID-19 (October 2020 – May 2021) 4 exoskeletons were deployed in the ICU of the Hospital of Nancy to face with the increasing workload of physicians. In a first phase, the exoskeletons were shared among the physicians: more than 60 physicians used it. However, the shared mode was not optimal in terms of workflow and was causing organizational issues and sometimes frustration due to extra fitting time. In a second phase, the exoskeletons were assigned to specific individuals: this use was more efficient for the selected physicians. A paper describing the experimental studies, the feedback from the use in ICU and providing all the materials and methods was published in July 2021 in the Applied Human Factors and Ergonomics conference (AHFE 2021).
The project Exoturn is over, but we are continuing to investigate other ways to assist the physicians and the nurses in daily tasks with exoskeletons.
- Hospital of Nancy (CHRU Nancy): Dr. Nicla Settembre (co-coordinator), Prof. Bruno Chenuel, Prof. Jean Paysant, Dr. Jean-Marc Sellal, Dr. Antoine Kimmoun, Prof. Bruno Levy
- Inria / CNRS / Loria: Serena Ivaldi (co-coordinator), Pauline Maurice
- Virtual Hospital of Lorraine / Hôpital Virtuel de Lorraine (CUESIM): Hind Hani, Catherine Strasser
- INRS: Jean Theurel, Laurent Claudon, Agnes Aublet-Cuvelier, Lien Wiolande
- Settembre, N.; Maurice, P.; Paysant, J.; Theurel, J.; Claudon, L.; Kimmoun, A.; Levy, B.; Chenuel, B.; Ivaldi, S. (2020) The use of exoskeletons to help with prone positioning in the intensive care unit during COVID-19. Annals of Physical and Rehabilitation Medecine. https://doi.org/10.1016/j.rehab.2020.05.004
[PDF | web]
- Ivaldi, S.; Maurice, P.; Gomez, W.; Theurel, J.; Wioland, L.; Atain-Kouadio, J.-J.; Claudon, L.; Hani, H.; Kimmoun, A.; Sellal, J.-M.; Levy, B.; Paysant, J.; Malikov, S.; Chenuel, B.; Settembre, N. (2102) Using exoskeletons to assist medical staff during prone positioning of mechanically ventilated COVID-19 patients: a pilot study. Int. Conf. Applied Human Factors and Ergonomics (AHFE 2021).
[PDF preprint with all supplementary materials]
Video (in English)
Presentation of our work at the international conference Applied Human Factors and Ergonomics (AHFE 2021):
Video (in French)
Présentation des travaux au congrès de la Société de Biomécanique 2021:
Présentation de l’Hopital Virtuel de Lorraine (CUESIM):
Click on the photo to get it in high resolution
The Xsens MVN suit is used to track the motion of the humans performing the PP maneuver.
Two Laevo exoskeletons tested by physicians performing a PP on a patient simulator in the Virtual Hospital of Lorraine (CUESim).
The Laevo exoskeleton must be worn under the protective blouse in the ICU.
The real situation of Prone Positioning in the ICU (this is a screenshot from the France 5 TV reportage).
In the press
- Official article in the French government website La Recherche mobilisée – COVID-19
- Article in Inria’s website (French, English)
- La Semaine (2020) Des exosquelettes pour soulager le personnel de réanimation
- L’Est Républicain (2020) Un exosquelette pour aider les soignants du Covid-19 en réa
- Travail & Securité (2020) Des exosquelettes en renfort à la réanimation.
- Le Journal CNRS (2020) Exoskeletons to relieve health workers
- Essentiel Santé Magazine (2021) L’hôpital face au Covid-19 : les exosquelettes prêtent main forte aux équipes de réanimation
- Les Echos (2021) ExoTurn aide les soignants à retourner les patients en réanimation
France 5 (2020) Reportage with nice images of the exoskeletons used in the ICU (tweet)
France 3 (2020) Reportage at the Virtual Hospital (CUESim) (link to article of France 3 with the video extract) (article of the CHRU Nancy) (link video on youtube)
This project was partially funded by Inria, INRS and CHRU Nancy (internal funding), and partially by the European Commission through the project AnDy.