Global Innovation Challenge 2021
Living Assistance Robot Award

Entry Form
2nd Edition

Global Innovation Challenge Executive Committee

Points to note when applying for the Award✓

The Global Innovation Challenge 2021 Living Assistance Robot Award Entry Form (hereinafter,"the Entry Form") must be submitted when applying for the Global Innovation Challenge 2021
Living Assistance Robot Award (hereinafter, "the Award"). The Organiser will screen theapplication based on the submitted Entry Form.

✓When filling out this Entry Form, please read the separately distributed Global InnovationChallenge 2021 Living Assistance Robot Award Application Guidelines (hereinafter,"Application Guidelines") carefully and fill in all the necessary items and submit them together
with the pledge at the end. Please note that Entry Forms with any omissions or incomplete EntryForms will not be accepted.

✓By submitting this Entry Form, you are deemed to have agreed to the terms and conditions ofthis application.

✓The personal information of the applicant and technical information about the robot disclosedin this Entry Form will be used only for the purpose of judging this Award and will not be used
for any other purposes, unless otherwise stated in this Application Guidelines or pledge.

✓If you have any questions about this Entry Form or if you have any questions about the contents
to be filled in, please contact the Executive Committee below by e-mail.
Entry Form submission and enquiries: inquiry@global-innovation-challenge.com

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Update History
Last Updated

VersionSeptember 1, 2020

1st edition

December 8, 2020

2nd edition
Key Changes
Notes on the Award・ Modifications
1. Team・ Change of format
2. Compliance with entry requirements
・ Change of the description about robots to the description aboutpilots
3. Approaches to achieving the Award Tasks
・ Correction of heading and number notation
4. Degree of pilot impairment
・ Change of description items
Pledge・ Change of contents31. Team
The information entered in "A. Team Information" and "B. Team Representative Information" here will
be used by the Organiser to contact the teams and notify them of the event. The information enteredin "C. Team Profile" will be used to introduce the team on the Award's website, etc., so please provide
information that can be disclosed to the public.

NationalityJapan

E-mail Address

robot@gic.co.jp

Telephone number+81

Address

1-2-3 Nagatachou, Chiyoda-ku, Tokyo 100-0014
Japan

B. Team RepresentativeName◯◯ ◯◯NationalityJapan

E-mail Address◯◯◯＠◯◯.co.jp

Telephone number+81

Organisation (Affiliation name)◯◯◯ ◯◯◯Address◯-◯-◯ Aoyama, Minato-ku, Tokyo 107-8010 Japan

C. Team Profile

Information

GIC Robotec

A. TeamInformation

Team nameTeam overview / features

Our team works at the robot laboratory affiliated with

123-456-789◯◯◯-◯◯◯-◯◯◯◯ ◯ University. We have been conducting researchwith a total of 10 engineers since 2010, mainly
researching and developing exoskeleton robots forpeople with lower limb paralysis (paraplegics).
Reason for deciding entry

Although we have been developing robots for 10 years,
we have not had much experience in operating them indaily life situations, and it is unknown to what extent
our robots can be used in daily life. So, we have decided
to participate in this GIC because we thought it would
be a good opportunity to find out where our robots
stand today and what issues we need to address in thefuture.

Motivation for achieving the Task

To accomplish the Task, we will rehearse with the pilotand adjust the robot. We are also planning to use theprize money we get from accomplishing the Task forfurther development of robots. We want people whocannot walk to feel the joy of walking independently assoon as possible.

4Other appeal points

Our robot has a controller attached to two canes, andit controls standing, sitting, walking, and turning whilebalancing with the canes. In the future, we aim toestablish an interface between people and robots
using IoT technology, and to develop robots that canbe operated without a cane.

URLs for websites, social networks,

https://www.gic.co.jp

etc.

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2. Compliance with entry requirements
Please check whether the following entry conditions described in the Application Guidelines for theGlobal Innovation Challenge 2021 are met, and if so, check (✓).
Entry Requirements
1Teams and team members do not belong to organized criminal groups

Check box✓

2The robot is used by people with quadriplegia due to spinal cord injury or paralysed✓both lower limbs (※¹ ASIA Impairment Scale) A to B or (※² Frankel Classification)
A to B
3A robot is an "intelligent mechanical system that has three elemental technologies
of sensors, an intelligence/control system, and a drive system", and is a device/toolthat supports a pilot's independent walking without the care of others✓

4The robot can be used in a general residential environment✓

5The robot is used in contact with the user✓

6

In the case of a manually operated robot, operation is by the user
(Do not operate from the outside except for safety reasons)✓

7

Only one robot is used✓

8The robot is not difficult to use in real life, such as the robot producing a noticeably✓

loud volume
9The robot does not infringe on the intellectual property rights of third parties orother applicable laws and regulations✓※¹ AIS (ASIA Impairment Scale)
Level.
AComplete: complete paralysis of both perception and movement in S4-S5

B

Incomplete: only sensory functions remain below the neurological level, including S4 to S5

C

Incomplete: motor function remains below the neurological level, but more than half of the major muscle groups arebelow muscle strength 3

D

Incomplete: motor function remains below the neurological level, with at least half of the major muscle groups above
muscle strength 3

E

Normal: Normal motion and perception※² Frankel Classification
Classification
ACompleteComplete paralysis of motor perception below the injured high level

B

Sensory only

Complete paralysis of movement, with some preservation of sensation onlyC

Motor useless

A little muscle strength below the injury height, but not practical.

DMotor useful

Utility of muscle strength below the injured height, able to walk with or without
assistive devices

ERecovery

No muscle weakness, no sensory deficits, no sphincter damage, may have abnormalreflexes.

63. Approaches to achieving the Award Tasks
3.1 Award Tasks to be entered
There are seven Tasks for this Award. Please check (✓) the subject to be entered after carefully
reviewing the content and selection criteria in Section 4.1 "Criteria for Selection" in the Application
Guidelines and Appendix "Task Achievement Checklist" in the Selection and Judging Guidelines.
1
ToiletTasks

Check box✓2
Preparation

3
Meal

4
Laundry

5
Package
Receiving

6
Cleaning

7Bathing✓

3.2 Specific measures to achieve the Award Tasks
Please describe in detail your approach and ideas for achieving the Award Tasks.
To accomplish the Tasks, we prepared a residential environment close to the real one and checked
the operation of our robot with a real pilot. And it became clear that it took a long time for the pilot
to put on and take off the robot for the Tasks of “Toilet” and “Preparation”. We will focus on theease of attaching and detaching the robot by the time of the judging for the Award and make itpossible to remove the fixed part of the lower limbs so that the robot can be put on and taken off
more easily to accomplish the Tasks.

3.3 Video and photographs of the Task
Please attach a video (one cut, no editing required) and a photograph of the pilot carrying out theTask. Also, please attach a floor plan of the location where the video was taken.
https://youtu.be/B7qpLBNfupI

3.4 Degree of pilot impairment
Please attach the documentation showing the degree of disability of the pilot as shown in section 3.3"Video and photographs of the Task".
Robot pilots must meet the pilot conditions defined in "2. Compliance with entry requirements".
AIS Classification: A
Frankel Classification: ALocation of spinal injury: L1

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Global Innovation Challenge 2021 Living Assistance Robot AwardPledge
In entering the "Global Innovation Challenge 2021 Living Assistance Robot Award" (hereinafter, "theAward"), we understand the terms and conditions of the Global Innovation Challenge ExecutiveCommittee (hereinafter, "the Organiser"), the content of the Award and accept the following:1) We are all in good health and none of us is in any of the following conditions
・ Having problems, pain or illness in my back or neck that affect robot manipulation
・ May have extreme mental illness due to tension and stress・ Being pregnant
・ Being injured
・ Having a heart disease・ Having a drinking problem
・ Being in a poor physical condition
・ Being restricted by doctors in undertaking such as strenuous exercises2) If the Organiser deems it necessary, we will follow the transportation, first aid, and treatment to
the medical institution designated by the Organiser.
3) Health management of team members including pilots is the responsibility of the participatingteams.
4) We will follow the safety instructions of the Organiser.
5) We understand that there may be a risk of accidents and injuries during the process fromapplication for the Award to the selection process, judgement, and the Award Ceremony.
6) The robot used in this Award does not infringe the intellectual property rights of third parties andwe comply with all applicable laws and regulations.
7) We participate in this Award at our own risks, and in the event of any accident, we will not be liablefor compensation or guarantee.
8) The Organiser will not be held responsible for any disputes between participants, disputes between
participants and the Organiser, and any events caused by this.
9) It is our responsibility to manage our belongings such as participating robots and personalvaluables.
810) We acknowledge that personal information such as portraits, names and self-introductions of theteam and ourselves will be used in the Global Innovation Challenge brochures, results, publicrelations materials related to this Award, news reports, and information media.
11) Regarding the cost burden related to participating in the Award, we follow the instructions of theOrganiser.
12) We understand the objectives of the Organiser and cooperate with them to ensure that the eventis held smoothly even in the event of unforeseen circumstances.
13) We and the organisation to which we belong pledge that the following items do not apply now andwill not apply in the future.
A. Gangsters, organised crime groups such as terrorism groups, associate members of gangsters,
persons involved in organised crime groups such as companies related to gangsters, general
assembly shops, social movements, political activities, or any other similar people (hereinafter,"anti-social forces").
B. Having a socially criticized relationship with antisocial forces.
C. Five years have not passed since the person ceased to fall under A or B.
D. Perform the following acts or similar acts against the Organiser by us or by using a third party.
a. Violent demands
b. Unreasonable demands beyond legal responsibilityc. Acts of threatening behaviour or using violenced. Damage the credibility of this Award or the Organiser, or interfere with the businessof this Award by disseminating of rumours, using counterfeiting or power
14) We agree to resolve any matters not stated in this pledge in accordance with the Global Innovation
Challenge Application Guidelines, entry form, and instructions of the Organiser.

Date: _____ Year _____ Month _____ Day
Name of representative: ＿＿＿＿＿＿＿＿＿＿＿
Signature: ＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿

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