Predictive Dynamic Simulation of Healthy Sit-to-Stand Movement

This thesis situates itself at the intersection of biomedical modelling and predictive simulation to synthesize healthy human sit-to-stand movement. While the importance of sit-to-stand to physical and social well-being is known, the reasons for why and how people come to perform sit-to-stand the way we do is largely unknown. This thesis establishes the determinants of sit-to-stand in healthy people so that future researchers may investigate the effects of compromised health on sit-to-stand and then explore means of intervening to preserve and restore this motion. Previous researchers have predicted how a person rises from seated. However aspects of their models, most commonly contact and muscle models, are biomechanically inconsistent and restrict their application. These researchers also have not validated their prediction results. To address these limitations and further the study of sit-to-stand prediction, the underlying themes of this thesis are in biomechanical modelling, predictive simulation, and validation. The goal of predicting sit-to-stand inspired the creation of three new models: a model of biomechanics, a model of motion, and performance criteria as a model of preference. First, the human is represented as three rigid links in the sagittal plane. As buttocks are kinetically important to sit-to-stand, a new constitutive model of buttocks is made from experimental force-deformation data. Ten muscles responsible for flexion and extension of the hips, knees, and ankles are defined in the model. Second, candidate sit-to-stand trajectories are described geometrically by a set of Bézier curves, for the first time. Third, with the assumption that healthy people naturally prioritize mechanical efficiency, disinclination to a motion is described as a cost function of joint torques, muscle stresses, and physical infeasibility including slipping and falling. This new dynamic optimization routine allows for motions of gradually increasing complexity, by adding control points to the Bézier curves, while the model's performance is improving. By comparing the predictive simulation results to normative sit-to-stand as described in the literature, for the first time, it is possible to say that the use of these models and optimal control strategy together has produced motions characteristic of healthy sit-to-stand. This work bridges the gap between predictive simulation results and experimental human results and in doing so establishes a benchmark in sit-to-stand prediction. In predicting healthy sit-to-stand, it makes a necessary step toward predicting pathological sit-to-stand, and then to predicting the results of intervention to inform medical design and planning

Muscle synergy analysis of lower-limb movements

Dissertação de mestrado integrado em Biomedical Engineering (área de especialização em Medical Electronics)Neurological disorders and trauma often lead to impaired lower-limb motor coordination. Understanding how muscles combine to produce movement can directly benefit assistive solutions to those afflicted with these impairments. A theory in neuromusculoskeletal research, known as muscle synergies, has shown promising results in applications for this field. This hypothesis postulates that the Central Nervous System controls motor tasks through the time-variant combinations of modules (or synergies), each representing the co-activation of a group of muscles. There is, however, no unifying, evidence-based framework to ascertain muscle synergies, as synergy extraction methods vary greatly in the literature. Publications also focus on gait analysis, leaving a knowledge gap when concerning motor tasks important to daily life such as sitting and standing. The purpose of this dissertation is the development of a robust, evidence-based, task-generic synergy extraction framework unifying the divergent methodologies of this field of study, and to use this framework to study healthy muscle synergies on several activities of daily living: walking, sit-to-stand, stand-to-sit and knee flexion and extension. This was achieved by designing and implementing a cross-validated Non-Negative Matrix Factorization process and applying it to muscle electrical activity data. A preliminary study was undertaken to tune this configuration regarding cross-validating proportions, data structuring prior to factorization and evaluating criteria quantifying accuracy in modularity findings. Muscle synergies results were then investigated for different performing speeds to determine if their structure differed, and for consistency across subjects, to ascertain if a common set of muscle synergies underlay control on all subjects equally. Results revealed that the implemented framework was consistent in its ability to capture modularity (p < 0:05). The movements’ synergies also did not differ across the studied range of speeds (except one module in Knee Flexion) (p < 0:05). Additionally, a common set of muscle synergies was present across several subjects (p < 0:05), but shared commonality across every participant was only observed for the walking trials, for which much larger amounts of data were collected. Overall, the established framework is versatile and applicable for different lower-limb movements; muscle synergies findings for the examined movements may also be used as control references in assistive devices.As perturbações e traumas neurológicos afetam frequentemente a coordenação motora dos membros inferiores. Uma teoria recente em investigação neuromusculo-esquelética, denominada de sinergias musculares, tem demonstrado resultados promissores em soluções de assistência à população afetada por estes distúrbios. Esta teoria propõe que o Sistema Nervoso Central controla as tarefas motoras através de combinações variantes no tempo de módulos (ou sinergias), sendo que cada um representa a co-ativação de um grupo de músculos. No entanto, não existe nenhum processo uniformizante, empiricamente justificado para determinar sinergias musculares, porque os métodos de extração de sinergias variam muito na literatura. Para além disso, as publicações normalmente focam-se em análise da marcha, deixando uma lacuna de conhecimento em tarefas motoras do dia-a-dia, tais como sentar e levantar. O objetivo desta dissertação é o desenvolvimento de um processo robusto, genérico e empiricamente justificado de extração de sinergias em várias tarefas motoras, unindo as metodologias divergentes neste campo de estudo, e subsequentemente utilizar este processo para estudar sinergias musculares de sujeitos saudáveis em várias atividades do dia-a-dia: marcha, erguer-se de pé partir de uma posição sentada, sentar-se a partir de uma posição de pé e extensão e flexão do joelho. Isto foi alcançado através da implementação de um processo de cross-validated Non-Negative Matrix Factorization e subsequente aplicação em dados de atividade elétrica muscular. Um estudo preliminar foi realizado para configurar este processo relativamente às proporções de cross-validation, estruturação de dados antes da fatorização e seleção de critério que quantifique o sucesso da representação modular dos dados. Os resultados da extração de sinergias de diferentes velocidades de execução foram depois examinados no sentido de descobrir se este fator influenciava a estrutura dos módulos motores, assim como se semelhanças entre as sinergias de diferentes sujeitos apontavam para um conjunto comum de sinergias musculares subjacente ao controlo do movimento. Os resultados revelaram que o processo implementado foi consistente na sua capacidade de capturar a modularidade nos dados recolhidos (p < 0:05). As sinergias de todos os movimentos também não diferiram para toda a gama de velocidades estudada (exceto um módulo na flexão do joelho) (p < 0:05). Por fim, um conjunto comum de sinergias musculares esteve presente em vários sujeitos (p < 0:05), mas só esteve presente em todos os sujeitos de igual forma para a marcha, para a qual a quantidade de dados recolhida foi muito maior. Globalmente, o processo implementado é versátil e aplicável a diferentes movimentos dos membros inferiores; os resultados das sinergias musculares para os movimentos examinados podem também ser utilizado como referências de controlo para dispositivos de assistência

Temporal and spatial muscle synergy features and its neural origins during sit-to-stand and stand-to-sit tasks

Sit-to-stand (STS) and stand-to-sit (StandTS) play a vital role in our daily lives. These two transitional motions are considered crucial for independent living. Many people with neurological disorders that lack neuromuscular control lose the ability to perform the transition tasks normally. Several muscles act together to achieve these motions and the inability to perform these daily life tasks, therefore, present the need to understand why they are important and what is the role of muscle synergy in the performance of such tasks. Reduced number of synergies have been found in populations with neurological disorders and the differences in the number of muscle synergies reflect descending neural pathway disruptions and present a correlation with motor deficits. Therefore, this review aims to understand the importance of these two transitional motions and muscle synergy extensively to help develop targeted interventions for healthy and clinical populations.Kinesiology and Health Educatio

Visual and Vestibular Inputs Affect Muscle Synergies Responsible for Body Extension and Stabilization in Sit-to-Stand Motion

The sit-to-stand motion is a common movement in daily life and understanding the mechanism of the sit-to-stand motion is important. Our previous study shows that four muscle synergies can characterize the sit-to-stand motion, and they have specific roles, such as upper body flexion, rising from a chair, body extension, and posture stabilization. The time-varying weight of these synergies are changed to achieve adaptive movement. However, the relationship between sensory input and the activation of the muscle synergies is not completely understood. In this paper, we aim to clarify how vestibular and visual inputs affect the muscle synergy in sit-to-stand motion. To address this, we conducted experiments as follows. Muscle activity, body kinematics, and ground reaction force were measured for the sit-to-stand motion under three different conditions: control, visual-disturbance, and vestibular-disturbance conditions. Under the control condition, the participants stood without any intervention. Under the visual-disturbance condition, the participants wore convex lens glasses and performed the sit-to-stand motion in a dark room. Under the vestibular-disturbance condition, a caloric test was performed. Muscle synergies were calculated for these three conditions using non-negative matrix factorization. We examined whether the same four muscle synergies were employed under each condition, and the changes in the time-varying coefficients were determined. These experiments were conducted on seven healthy, young participants. It was found that four muscle synergies could explain the muscle activity in the sit-to-stand motion under the three conditions. However, there were significant differences in the time-varying weight coefficients. When the visual input was disturbed, a larger amplitude was found for the muscle synergy that activated mostly in the final posture stabilization phase of the sit-to-stand motion. Under vestibular-disturbance condition, a longer activation was observed for the synergies that extended the entire body and led to posture stabilization. The results implied that during human sit-to-stand motion, visual input has less contribution to alter or correct activation of muscle synergies until the last phase. On the other hand, duration of muscle synergies after the buttocks leave are prolonged in order to adapt to the unstable condition in which sense of verticality is decreased under vestibular-disturbance

Combined musculoskeletal and finite element modelling of the lumbar spine and lower limbs

Bone health deterioration is a major public health issue increasing the risk of fragility fracture with a substantial associated psychosocioeconomic impact. In the lumbar spine, physical deconditioning associated with ageing and chronic pain is a potential promoter of bone structural degradation. General guidelines for the limitation of bone loss and the management of pain have been issued, prescribing a healthy lifestyle and a minimum level of physical activity. However, there is no specific recommendation regarding targeted activities that can effectively maintain lumbar spine bone health in populations at risk. The aim of this thesis was to develop a new predictive computational modelling framework for the study of bone structural adaptation to healthy and pathological conditions in the lumbar spine. The approach is based on the combination of a musculoskeletal model of the lumbar spine and lower limbs with structural finite element models of the lumbar vertebrae. These models are built with bone and muscle geometries derived from healthy individuals. Based on daily living activities, musculoskeletal simulations provide physiological loading conditions to the finite element models. Cortical and trabecular bone are modelled with shell and truss elements whose thicknesses and radii are adapted to withstand the physiological mechanical environment using a strain driven optimisation algorithm. This modelling framework allows to generate healthy bone architecture when a loading envelope representative of a healthy lifestyle is applied to the vertebrae, and identify influential activities. Prediction of bone remodelling under altered loading scenarios characteristic of lumbar pathologies can also be achieved. The modelling approach developed in this thesis is a powerful tool for the investigation of bone remodelling in the lumbar spine. Preliminary results indicate that locomotion activities are insufficient to maintain lumbar spine bone health. Specific recommendations to limit the effect of physical deconditioning related to muscle weakening back pain are suggested. The approach is also promising for the investigation of other lumbar pathologies such as age related osteoporosis and scoliosis.Open Acces

Tele-impedance based assistive control for a compliant knee exoskeleton

This paper presents a tele-impedance based assistive control scheme for a knee exoskeleton device. The proposed controller captures the user’s intent to generate task-related assistive torques by means of the exoskeleton in different phases of the subject’s normal activity. To do so, a detailed musculoskeletal model of the human knee is developed and experimentally calibrated to best match the user’s kinematic and dynamic behavior. Three dominant antagonistic muscle pairs are used in our model, in which electromyography (EMG) signals are acquired, processed and used for the estimation of the knee joint torque, trajectory and the stiffness trend, in real time. The estimated stiffness trend is then scaled and mapped to a task-related stiffness interval to agree with the desired degree of assistance. The desired stiffness and equilibrium trajectories are then tracked by the exoskeleton’s impedance controller. As a consequence, while minimum muscular activity corresponds to low stiffness, i.e. highly transparent motion, higher co-contractions result in a stiffer joint and a greater level of assistance. To evaluate the robustness of the proposed technique, a study of the dynamics of the human–exoskeleton system is conducted, while the stability in the steady state and transient condition is investigated. In addition, experimental results of standing-up and sitting-down tasks are demonstrated to further investigate the capabilities of the controller. The results indicate that the compliant knee exoskeleton, incorporating the proposed tele-impedance controller, can effectively generate assistive actions that are volitionally and intuitively controlled by the user’s muscle activity

Musculoskeletal Models in a Clinical Perspective

This book includes a selection of papers showing the potential of the dynamic modelling approach to treat problems related to the musculoskeletal system. The state-of-the-art is presented in a review article and in a perspective paper, and several examples of application in different clinical problems are provided

Effects of overground walking with a robotic exoskeleton on lower limb muscle synergies

Les exosquelettes robotisés de marche (ERM) représentent une intervention prometteuse dans le domaine de la réadaptation locomotrice. Sur le plan clinique, les ERM facilitent la mise en application de principes de neuroplasticité. Jusqu'à présent, la majorité des études analysant les effets de l’ERM a été menée avec des ERM fournissant une assistance robotique complète le long d’une trajectoire de mouvements prédéfinie des membres inférieurs (MI) de façon à reproduire la marche de façon quasi parfaite à très basse vitesse. La nouvelle génération d’ERM, maintenant disponible sur le marché, propose de nouveaux modes de contrôles qui permettent, entre autres, une liberté de mouvement accrue aux MIs (c.-à-d. trajectoire non imposée) et une possibilité d’offrir une assistance ou résistance aux mouvements de différentes intensités surtout pendant la phase d’oscillation du cycle de marche. Cependant, les effets de ces modes de contrôles sur la coordination musculaire des MI pendant la marche au sol avec l’ERM, caractérisé via l’extraction de synergies musculaires (SM), restent méconnus. Cette thèse mesure et compare les caractéristiques des SM (c.-à-d. nombre, profils d’activation, composition musculaire et contribution relative des muscles) pendant la la marche au sol sans ou avec un ERM paramétré avec six différents modes de contrôle chez des individus en bonne santé (articles #1 et #2) et d’autres ayant une lésion médullaire incomplète (LMI) (article #3). Les signaux électromyographiques (EMG) des différents muscles clés des MI, enregistrés lors de la marche, ont été utilisés afin d’extraire les SM avec un algorithme de factorisation matricielle non négative. La similarité des cosinus et les coefficients de corrélation ont caractérisé les similitudes entre les caractéristiques des SM. Les résultats montrent que: 1) les profils d'activation temporelle et le nombre de SM sont modifiés en fonction de la vitesse de marche avec, entre autres une augmentation de la vitesse de marche entrainant une fusion de SM, chez les individus en bonne santé marchant sans ERM ; 2) lorsque ces derniers marchent avec un ERM, les différents modes de contrôle testés ne dupliquent pas adéquatement les SM retrouvées lors de la marche sans ERM. En fait, uniquement le mode de contrôle libérant la contrainte de trajectoire de mouvements des MIs dans le plan sagittal lors de la phase d’oscillation reproduit les principales caractéristiques des SM retrouvées pendant la marche sans ERM ; 3) le nombre et la composition musculaire des SM sont modifiés pendant la marche sans ERM chez les personnes ayant une LMI. Cependant, parmi tous les modes de contrôle étudiés, seul le mode de contrôle libérant le contrôle de la trajectoire de mouvements des MI et assistant l’oscillation du MIs (c.-à-d. HASSIST) permets l’extraction de SM similaire à celles observées chez des individus en santé lors d'une marche sans ERM. Dans l’ensemble, cette thèse a mis en évidence le fait que différentes demandes biomécaniques liées à la marche (c.-à-d. vitesse de marche, modes de contrôle de l’ERM) modifient le nombre et les caractéristiques de SM chez les personnes en santé. Cette thèse a également confirmé que la coordination musculaire, mise en évidence via l’analyse de SM, est altérée chez les personnes ayant une LMI et a tendance à se normaliser lors de la marche avec l’ERM paramétré dans le mode de HASSIST. Les nouvelles preuves appuieront les professionnels de la réadaptation dans le processus de prise de décision concernant la sélection du mode de contrôle des MIs lors de l’entrainement locomoteur utilisant avec un ERM.Wearable robotic exoskeletons (WRE) represent a promising rehabilitation intervention for locomotor rehabilitation training that aligns with activity-based neuroplasticity principles in terms of optimal sensory input, massed repetition, and proper kinematics. Thus far, most studies that investigated the effects of WRE have used WRE that provide full robotic assistance and fixed trajectory guidance to the lower extremity (L/E) to generate close-to-normal walking kinematics, usually at very slow speeds. Based on clinicians’ feedback, current commercially-available WRE have additional control options to be able to integrate these devices into the recovery process of individuals who have maintained some ability to walk after an injury to the central nervous system. In this context, WRE now offer additional degrees of movements for the L/E to move freely and different strategies to assist or resist movement, particularly during the gait cycle’s swing phase. However, the extent that these additional WRE control options affect L/E neuromuscular control during walking, typically characterized using muscle synergies (MSs), remains unknown. This thesis measures and compares MSs characteristics (i.e., number, temporal activation profile, and muscles contributing to a specific synergy [weightings]) during typical overground walking, with and without a WRE, in six different control modes, in abled-bodied individuals (Articles #1 and #2) and individuals with incomplete spinal cord injury (iSCI; Article #3). Surface EMG of key L/E muscles were recorded while walking and used to extract MSs using a non-negative matrix factorization algorithm. Cosine similarity and correlation coefficients characterized, grouped, and indicated similarities between MS characteristics. Results demonstrated that: 1) the number of MSs and MS temporal activation profiles in able-bodied individuals walking without WRE are modified by walking speed and that, as speed increased, specific MSs were fused or merged compared to MSs at slow speeds; 2) In able-bodied individuals walking with WRE, few WRE control modes maintained the typical MSs characteristics that were found during overground walking without WRE. Moreover, freeing the L/E swing trajectory imposed by the WRE best reproduced those MSs characteristics during overground walking without the WRE; and 3) After an iSCI, alterations to the number and the composition of MSs were observed during walking without WRE. However, of all WRE control modes that were investigated, only HASSIST (i.e., freeing WRE control over L/E swing trajectory while assisting the user’s self-selected trajectory) reproduced the number and composition of MSs found in abled-bodied individuals during overground walking without WRE. Altogether, the results of this thesis demonstrated that different walking-related biomechanical demands (i.e., walking speed) and most of the WRE control modes can alter some MSs, and their characteristics, in able-bodied individuals. This research also confirmed that impaired muscle coordination, assessed via MSs, can adapt when walking with a WRE set with specific control options (e.g., HASSIST). These MS adaptations mimicked typical MS characteristics extracted during overground walking. The evidence generated by this thesis will support the decision-making process when selecting specific L/E control options during WRE walking, allowing rehabilitation professionals to refine WRE locomotor training protocols

シミュレーションを用いた筋力不足による座位から立位への適応とそれを補完する補助軌道の予測

Sit-to-stand (STS) transition is one of the most bio-mechanically challenging task necessary for performing activities of daily life. With muscle strength being the most dominant, many co-occurring factors influence how individuals perform STS. This work investigated the STS changes and the STS failure caused by muscle strength deficits using the trajectories generated employing open-loop single shooting optimization and musculoskeletal models. It also presents the external assistance trajectories that can complement strength deficits for successful STS transition using the same framework. The muscle strength deficits were introduced by simultaneously scaling the maximum isometric strength of muscles in steps of 20%. The optimization could generate successful STS transition for models with up to 60% strength deficits. The joint angle, muscle activation and ground reaction force trajectories for the 0% strength deficit model’s STS transition agree with those experimentally observed for a healthy adult. Comparison of different strength deficit trajectories shows that when the vasti muscle gets saturated, the activation of antagonistic hamstrings muscles reduces to relieve it. The reduction in hamstring muscle activation subsequently increases the load on the gluteus maximus muscle. This adaptation and the motion tracking results are used to suggest the vastus muscle weakness to be responsible for STS breakdown. Finally, the successful STS trajectory generated for the externally assisted 80% strength deficit model is presented. The trajectory features utilization of external assistance as and when needed to complement strength deficits for successful STS transition. Our results will help plan intervention and design novel STS assistance devices.九州工業大学博士学位論文 学位記番号：生工博甲第442号 学位授与年月日：令和4年6月27日1 Introduction|2 Human Model|3 Optimization Framework|4 Analysis Tools|5 Results|6 Conclusion九州工業大学令和4年

Trunk and respiratory motor control in typically developing children and its implications in children with chronic spinal cord injury.

Independent sitting is a major milestone and is also a prerequisite for optimal performance of activities of daily living (ADLs). Development of sitting posture control is a dynamic process involving control of degrees of freedom of head and trunk. Traditionally, trunk has been modeled as a single unit (segment). However, recent studies have suggested that it is made up multiple spinal units, controlled by a combination of trunk muscles. During typical development, posture control of trunk is different for different trunk segments. This motor development of trunk control is a complex process due to constant interaction between the nervous system and environment. Any interruption in the normal processes would further complicate it, affecting the typical development of the child. Poor trunk control and respiratory complications are characteristic features among children, adolescents, and adults with neuromuscular disorders. Pediatric spinal cord injuries (SCIs) also pose a unique challenge compared to SCI in adults because of the continuous physical and cognitive development. Children with SCI exhibit deficits in trunk motor control, which impair their ability to sit or ambulate. These motor deficits can lead to compensatory changes in other segments of the body, which cause further deviations from typical postures. Trunk muscles have the dual function of supporting both, breathing and trunk posture. Therefore, in children with SCI, impairment of posture control will also affect respiratory functions. Depending on level and severity of the injury, can potentially lead to severe respiratory insufficiency. Symptoms of respiratory insufficiency are highly correlated with the level and severity of spinal lesions. Injury at higher cervical and thoracic cord levels causes paresis and paralysis of most of the respiratory muscles, which increase the workload of breathing. As a result, respiratory complications are the leading cause of death among children with SCI. Therefore, impairment of posture control following SCI also affects respiratory functions. Lack of appropriate tools to evaluate trunk motor control following SCI restricts the ability to understand its development and therefore it is a challenge to design treatments and strategies to slow down or prevent the progress of long-term effects of SCI in children. In this dissertation, we studied the postural control using a Segmental Assessment Trunk Control (SATCo) test and respiratory motor control using Respiratory Motor Control Assessment (RMCA) protocol in typically developing (TD) children and compared their results to age-matched children with SCI