Background: Occupational exos (rigid exoskeletons and soft exosuits) are emerging technologies designed to reduce the risk of work-related musculoskeletal disorders. Existing occupational exos are standalone accessories worn on top of a userâ\euro™s clothing. Purpose: Our objective was to test and verify that back-assist exosuit capabilities could be integrated into regular clothing in an effective and usable manner, which could make musculoskeletal relief accessible to more workers. Methods: We redesigned a previously validated accessory exosuit so it could integrate into a standard-issue U.S. Army uniform. The uniform-integrated exosuit prototype was low-profile (protruding <30 mm from the body), lightweight (adding 800 grams to the uniform), and could be donned/doffed like normal clothing. We verified the effectiveness and usability of the prototype in lab testing (N=5) and in a case study (N=1) with a U.S. Army Soldier. Results: In lab testing (N=5), this exosuit provided 18-27 Nm of torque about the low back during lifting. Assistance could be engaged or disengaged one-handed in about half a second, and the exosuit did not restrict a userâ\euro™s natural range of motion or cause discomfort. A case study (N=1) with a Soldier performing operationally relevant tasks demonstrated that this type of uniform-integrated exosuit may be well-suited for workers with duties that involve driving in vehicles and intermittent lifting. Conclusions: This work verified that integrating back-assist exosuit capabilities into standard workwear can be effective and usable. The integration resulted in little change to the form factor, weight, range of motion, or comfort of the standard daily uniform while adding lifting assistance. This new sub-class of exosuit could be beneficial to workers who alternate between bending, lifting, and sitting tasks, or to those in customer- or patient-facing jobs where it is important for wearable technology to be discreet.

The objectives of this case series study were to test whether an elastic back exosuit could increase a wearer’s endurance when lifting heavy objects, and to assess whether lifting more cancels out the exosuit’s risk reduction benefits. We found that 88% of participants increased their lifting repetitions while wearing an exosuit, with endurance increases ranging from 28-75%. We then used these empirical data with an ergonomic assessment model based on fatigue failure principles to estimate the effects on cumulative back damage (an indicator of low back disorder risk) when an exosuit is worn and more lifts are performed. Participants exhibited 27-93% lower cumulative back damage when wearing an exosuit. These results confirmed that wearing an exosuit increased participants’ lifting capacity without canceling out injury risk reduction benefits. Back exosuits may make it possible to simultaneously boost productivity and reduce musculoskeletal disorder risks, which is relevant to workers in civilian and defense sectors.