Work-related musculoskeletal disorders (WMSDs) due to overexertion and consequently the low back pain (LBP) are one of the most prevalent sources of nonfatal occupational injuries and illnesses in all over the world. In the past several years, the industrial exoskeletons especially the passive ones have been proposed as alternative intervention and assistive devices, which are capable of reducing the risk of WMSDs and LBP. However, more research is warranted to validate the applicability of these exoskeletons. In addition, because the majority of previous studies have been limited to specific lifting tasks using only one type of lift assistive exoskeleton, more research is needed to examine the effect of alteration of different lift-assistive exoskeletons on reducing the activity of back muscles and metabolic reduction. The main objective of this dissertation is to render an overview of three studies that attempt to improve the literature by providing comprehensive biomechanical evaluations and metabolic assessments of three passive lift-assistive exoskeletons (VT-Lowe's Exoskeleton (developed in ARLab at VT), Laevo and SuitX).

This dissertation has been composed of three related studies. The first study aimed to investigate and examine the capability of a novel lift assistive exoskeleton, VT-Lowe's exoskeleton, in reducing the peak and mean activity of back and leg muscles. Findings revealed that the exoskeleton significantly decreased the peak and mean activity of back muscles (IL(iliocostalis lumborum) and LT(longissimus thoracis)) by 31.5% and 29.3% respectively for symmetric lifts, and by 28.2% and 29.5% respectively for asymmetric lifts. Furthermore, the peak and mean EMG of leg muscles were significantly reduced by 19.1% and 14.1% during symmetric lifts, and 17.4% and 14.6% during asymmetric lifts. Interestingly, the VT-Lowe's exoskeleton showed higher reduction in activity of back and leg muscles compared to other passive lift-assistive exoskeletons available in the literatures.

In the second study, the metabolic cost reduction associated with the use of VT-Lowe's exoskeleton during freestyle lifting was theoretically modelled, validated and corresponding metabolic savings were reported. The metabolic cost and the oxygen consumption results supported the hypothesis that the VT-Lowe's exoskeleton could significantly reduce the metabolic demands (~7.9% on average) and oxygen uptake (~8.7% on average) during freestyle lifting. Additionally, we presented a prediction model for the metabolic cost of exoskeleton during repetitive freestyle lifting tasks. The prediction models were very accurate as the absolute prediction errors were small for both 0% (< 1.4%) and 20% (< 0.7%) of body weight.

In the third study, the biomechanical evaluation, energy expenditure and subjective assessments of two passive back-support exoskeletons (Laevo and SuitX) were examined in the context of repetitive lifting tasks. The experimental lifting tasks in this study were simulated in a laboratory environment for two different levels of lifting symmetry (symmetric vs. asymmetric) and lifting posture (standing vs. kneeling). Results of this study demonstrated that using both exoskeletons during dynamic lifting tasks could significantly lower the peak activity of trunk extensor muscles by ~10-28%. In addition, using both exoskeletons could save the energy expenditure by ~4-13% in all conditions tested by partially offsetting the weight of the torso. Such reductions were, though, task-dependent and differed between the two tested exoskeletons. Overall, the results of all three studies in this dissertation showed the capability of passive lift-assistive exoskeletons in reducing the activity of back and leg muscles and providing metabolic savings during repetitive lifting tasks.