by an actuation device operated by the wearer or the caregiver automatic actuation may be as described in fig2 a b where the actuation device comprises spring arms 53 the spring arms 53 are automatically actuated by the weight of the wearer similarly fig3 a c depicts an actuation device comprising paddles wherein the paddles are also automatically actuated by the weight of the wearer another suitable means of actuation may be by an actuation device which is operably connected to the active external change aid 39 s effect generating element and actuated by the caregiver such activation devices may include manually operated devices such as a foot pedal knee operated pedal push button switch or other manual device the effect generating element may also be actuated by a device capable of remote actuation an actuation device capable of remote actuation may include sensors responsive to signals such as voice actuation radio frequency infrared acoustic sensors or any other form of signal communication systems suitable voice controlled actuation systems are disclosed in u s pat nos 4 178 472 4 388 495 5 303 384 5 370 567 5 455 889 5 471 557 and 5 790 754 suitable radio frequency systems are disclosed in u s pat no.