Trunk Rehabilitation Using Cable-Driven Robotic Systems

Upper body control is required to complete many daily tasks. One needs to stabilize the head and trunk over the pelvis, as one shifts the center of mass to interact with the world. While healthy individuals can perform activities that require leaning, reaching, and grasping readily, those with neurological and musculoskeletal disorders present with control deficits. These deficits can lead to difficulty in shifting the body center of mass away from the stable midline, leading to functional limitations and a decline in the quality of activity. Often these patient groups use canes, walkers, and wheelchairs for support, leading to occasional strapping or joint locking of the body for trunk stabilization. Current rehabilitation strategies focus on isolated components of stability. This includes strengthening, isometric exercises, hand-eye coordination tasks, isolated movement, and proprioceptive training. Although all these components are evidence based and directly correlate to better stability, motor learning theories such as those by Nikolai Bernstein, suggest that task and context specific training can lead to better outcomes. In specific, based on our experimentation, we believe functional postural exploration, while encompassing aspects of strengthening, hand-eye coordination, and proprioceptive feedback can provide better results. In this work, we present two novel cable robotic platforms for seated and standing posture training. The Trunk Support Trainer (TruST) is a platform for seated posture rehabilitation that provides controlled external wrench on the human trunk in any direction in real-time. The Stand Trainer is a platform for standing posture rehabilitation that can control the trunk, pelvis, and knees, simultaneously. The system works through the use of novel force-field algorithms that are modular and user-specific. The control uses an assist-as-needed strategy to apply forces on the user during regions of postural instability. The device also allows perturbations for postural reactive training. We have conducted several studies using healthy adult populations and pilot studies on patient groups including cerebral palsy, cerebellar ataxia, and spinal cord injury. We propose new training methods that incorporate motor learning theory and objective interventions for improving posture control. We identify novel methods to characterize posture in form of the “8-point star test”. This is to assess the postural workspace. We also demonstrate novel methods for functional training of posture and balance. Our results show that training with our robotic platforms can change the trunk kinematics. Specifically, healthy adults are able to translate the trunk further and rotate the trunk more anteriorly in the seated position. In the standing position, they can alter their reach strategy to maintain the upper trunk more vertically while reaching. Similarly, Cerebral Palsy patients improve their trunk translations, reaching workspace, and maintain a more vertical posture after training, in the seated position. Our results also showed that an Ataxia patient was able to improve their reaching workspace and trunk translations in the standing position. Finally, our results show that the robotic platforms can successfully reduce trunk and pelvis sway in spinal cord injury patients. The results of the pilot studies suggest that training with our robotic platforms and methods is beneficial in improving trunk control

The role of biomechanical analysis of horse and rider in equitation science

Equestrian sports are unique in that they involve the participation of two athletes that differ greatly in morphology yet are able to move together harmoniously; experienced riders not only move in phase with the horse, they can even improve the consistency of the horse’s movements. The motion of the horse imposes perturbations on the rider that differ in magnitude and direction according to gait. In faster gaits where suspension phases are present, the rider must accommodate greater vertical and horizontal accelerations of the horse’s trunk through three-dimensional movements of their axial body segments. The rider, in turn, can improve the horse’s performance through correct training, or cause it to deteriorate through faults in the rider’s position or incorrect application of the aids. This review addresses the current state of knowledge of the biomechanics of the horse-rider interaction, with reference to the ways in which the emerging field of equitation science can help to improve equine welfare by enhancing rider awareness of horse behaviour and movement, as well as the impact of the rider on the horse

In vitro biomechanical testing of the stability of primary and revision hip acetabular implants

Hip acetabular stability is the capability of acetabular implants to resist to the forces acting in the acetabulum during patient activities after surgery. If implant motions are sufficiently low, primary stability is achieved and the osteointegration process between the implant and the surrounding bone may occur. In this context, measuring implant motions is essential to predict the implant failure. In clinical practise, these measurements are limited to implant migration, while elastic motions and periacetabular strains are not monitored. So far, to obtain a complete set of stability measurements in vitro testing is the most reliable option. Despite the importance of the experimental analysis, a general consensus about the application of biomechanical tools to solve clinical problems is still missing. The aim of my Ph.D project was to develop and apply reliable in vitro methods to assess the hip acetabular stability in case of primary and revision reconstructions. First, two methodological studies were conducted (1) to define and implement a robust reference frame for the human hemipelvis based on a morphological analysis of this anatomical district and (2) to create a robust procedure to measure the implant motions and the periacetabular strains with the Digital Image Correlation technique. Secondly, I applied these methods to answer the following clinical questions: 1. How do changes in the motor task affect the cup stability and the periacetabular strains? 2. Does the cup medialization affect implant stability? 3. Which is the effect on cup stability of defect reconstructions with an innovative synthetic bone substitute or with human bone graft in revision surgery? All these clinical questions were answered in three experimental studies. In conclusion, this project provided a reliable set of in vitro methods to perform biomechanical testing on human hemipelvis and to assess the stability of acetabular reconstructions by mean of Digital Image Correlation

Walker-Assisted Gait in Rehabilitation: A Study of Biomechanics and Instrumentation

While walkers are commonly prescribed to improve patient stability and ambulatory ability, quantitative study of the biomechanical and functional requirements for effective walker use is limited. To date no one has addressed the changes in upper extremity kinetics that occur with the use of a standard walker, which was the objective of this study. A strain gauge-based walker instrumentation system was developed for the six degree-of-freedom measurement of resultant subject hand loads. The walker dynamometer was integrated with an upper extremity biomechanical model. Preliminary system data were collected for seven healthy, right-handed young adults following informed consent. Bilateral upper extremity kinematic data were acquired with a six camera Vicon motion analysis system using a Micro-VAX workstation. Internal joint moments at the wrist, elbow, and shoulder were determined in the three clinical planes using the inverse dynamics method. The walker dynamometer system allowed characterization of upper extremity loading demands. Significantly differing upper extremity loading patterns were Identified for three walker usage methods. Complete description of upper extremity kinetics and kinematics during walker-assisted gait may provide insight into walker design parameters and rehabilitative strategies

In vitro assessment of the primary stability of the acetabular component in hip arthroplasty

In Europa, più di 700'000 interventi di artroplastica d’anca vengono effettuati annualmente. Il tasso di fallimento della chirurgia è del 2-8 % (a 10 anni). Di questo, più del 50% è dovuto alla mobilizzazione asettica della componente acetabolare (più che ad un fallimento legato alla componente femorale). Lo scopo centrale di questo progetto di tesi è quello di creare un pilot-test per la valutazione in vitro della stabilità primaria di una componente acetabolare commerciale, impiantata in una emipelvi sintetica (senza cemento, attraverso la procedura chirurgica press-fit). La valutazione dei micromovimenti prevede un approccio multiplo, costituito dall’utilizzo della Digital Image Correlation (DIC) e di sensori lineari di spostamento. Per adeguare e migliorare le prestazioni dei due strumenti di misura, lo studio prevede: (1.a) l’ottimizzazione delle misure ottenute dalla correlazione di immagini, (1.b) creare ed effettuare la procedura di calibrazione interna dei sensori di spostamento e l’ottimizzazione delle misure ottenute dai sensori stessi come monitor dell’intero pilot-test. La seconda parte del lavoro si prone di implementare una metodologia affidabile per il calcolo delle roto-traslazioni relative tra coppa e osso. La creazione di un algoritmo dedicato, prevede, quindi, di valutare: (2.a) la migrazione permanente e (2.b) i micromovimenti inducibili dai picchi di carico.L’utilizzo della correlazione di immagini è risultato un gran punto di forza dello studio. Grazie al potere della DIC nell’elaborare spostamenti e deformazioni a tutto campo, senza contatto e in stereofotogrammetria, per la prima volta è stato possibile ottenere informazioni 3D del vettore migrazione della coppa. Inoltre, creando una procedura ottimizzata dell’allineamento del provino sotto la macchina, si sono potute riferire tutte le misure ottenute dal pilot-test, all’Aneterior Pelvic Plane (sistema di riferimento di rilevanza clinica)

Development and Application of 3D Kinematic Methodologies for Biomechanical Modelling in Adaptive Sports and Rehabilitation

Biomechanical analysis is widely used to assess human movement sciences, specifically using three-dimensional motion capture modelling. There are unprecedented opportunities to increase quantitative knowledge of rehabilitation and recreation for disadvantaged population groups. Specifically, 3D models and movement profiles for human gait analysis were generated with emphasis on post-stroke patients, with direct model translation to analyze equivalent measurements while horseback riding in use of the alternative form of rehabilitation, equine assisted activities and therapies (EAAT) or hippotherapy (HPOT). Significant improvements in gait symmetry and velocity were found within an inpatient rehabilitation setting for patients following a stroke, and the developed movement profiles for patients have the potential to address patient recovery timelines. For population groups, such as those following a cerebral incident, alternative forms of rehabilitation like EAAT and HPOT are largely unexplored. Within these studies, relevant muscular activations were found between healthy human gait and horseback riding, supporting the belief that horseback riding can stimulate similar movements within the rider. Even more, there was a strong correlation between the horse’s pelvic rotations, and the responsive joint moments and rotations of the rider. These findings could have greater implications in choosing horses, depending on the desired physical outcome, for EAAT and HPOT purposes. Similar approaches were also used to address another biomechanically disadvantage population, adaptive sport athletes. Utilizing similar methodologies, a novel 3D wheelchair tennis athlete model was created to analyze match-simulation assessments. Significant findings were present in the energy expenditure between two drill assessments. Overall, the quantitative results, coupled with the qualitative assessment chapter, provide a robust assessment of the effects of 3D movement analysis on rehabilitation and adaptive activities

Development of Gait Rehabilitation System Capable of Assisting Pelvic Movement of Normal Walking

Gait rehabilitation training with robotic exoskeleton is drawing attention as a method for more advanced gait rehabilitation training. However, most of the rehabilitation robots are mainly focused on locomotion training in the sagittal plane. This study introduces a novel gait rehabilitation system with actuated pelvic motion to generate natural gait motion. The rehabilitation robot developed in this study, COWALK, is a lower-body exoskeleton system with 15 degrees of freedom (DoFs). The COWALK can generate multi-DoF pelvic movement along with leg movements. To produce natural gait patterns, the actuation of pelvic movement is essential. In the COWALK, the pelvic movement mechanism is designed to help hemiplegic patients regain gait balance during gait training. To verify the effectiveness of the developed system, the gait patterns with and without pelvic movement were compared to the normal gait on a treadmill. The experimental results show that the active control of pelvic movement combined with the active control of leg movement can make the gait pattern much more natural

Load-displacement behavior of sacroiliac joints

We measured the load-displacement behavior of both single and paired sacroiliac (SI) joints in fresh cadaver specimens obtained from eight adults between the ages of 59 and 74 years. With both ilia fixed, static test loads were applied to the center of the sacrum along and about axes parallel and normal to the superior S1 endplate. Test forces up to 294 N were applied in the superior, inferior, anterior, posterior, and lateral directions. Moments up to 42 N-m were applied in flexion, extension, lateral bending, and axial torsion. Displacement of the center of the sacrum were measured 60 s after each load increment was applied, using dial gauges and an optical lever system. The tests were then repeated with only one ilium fixed. Finally, the three-dimensional location and overall geometry of each SI joint were measured. For an isolated left joint at the maximum test loads, the mean (SD) sacral displacements in the direction of the force ranged from 0.76 mm (1.41) in the medial to 2.74 mm (1.07) in the anterior direction. The mean rotations in the direction of the moments ranged from 1.40° (0.71) in right lateral bending to 6.21° (3.29) in clockwise axial torsion viewed from above. We also examined load-displacement behavior under larger loads. Single sacroiliac joints resisted loads from 500 to 1440 N, and from 42 to 160 N-m without over failure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50378/1/1100050112_ftp.pd

Biomechanics of Contemporary Implants and Prosthesis: Modeling, Experiments, and Clinical Application

Modern medicine is now more oriented towards patient-based treatments. Taking into account individual biological features allows for increasing the quality of the healing process. Opportunities for modern hardware and software allow not only the complex behavior of implants and prostheses to be simulated, but also take into account any peculiarities of the patient. Moreover, the development of additive manufacturing expands the opportunities for materials. Technical limits for composite materials, biomaterials, and metamaterials are decreasing. On the other hand, there is a need for more detailed analyses of biomechanics research. A deeper understanding of the technological processes of implants, and the mechanobiological interactions of implants and organisms will potentially allow us to raise the level of medical treatment. Modern trends of the biomechanics of contemporary implants and prostheses, including experimental and mathematical modeling and clinical application, are discussed in this book