The biomechanics of human locomotion

Includes bibliographical references. The thesis on CD-ROM includes Animate, GaitBib, GaitBook and GaitLab, four quick time movies which focus on the functional understanding of human gait. The CD-ROM is available at the Health Sciences Library

Body sensor networks: smart monitoring solutions after reconstructive surgery

Advances in reconstructive surgery are providing treatment options in the face of major trauma and cancer. Body Sensor Networks (BSN) have the potential to offer smart solutions to a range of clinical challenges. The aim of this thesis was to review the current state of the art devices, then develop and apply bespoke technologies developed by the Hamlyn Centre BSN engineering team supported by the EPSRC ESPRIT programme to deliver post-operative monitoring options for patients undergoing reconstructive surgery. A wireless optical sensor was developed to provide a continuous monitoring solution for free tissue transplants (free flaps). By recording backscattered light from 2 different source wavelengths, we were able to estimate the oxygenation of the superficial microvasculature. In a custom-made upper limb pressure cuff model, forearm deoxygenation measured by our sensor and gold standard equipment showed strong correlations, with incremental reductions in response to increased cuff inflation durations. Such a device might allow early detection of flap failure, optimising the likelihood of flap salvage. An ear-worn activity recognition sensor was utilised to provide a platform capable of facilitating objective assessment of functional mobility. This work evolved from an initial feasibility study in a knee replacement cohort, to a larger clinical trial designed to establish a novel mobility score in patients recovering from open tibial fractures (OTF). The Hamlyn Mobility Score (HMS) assesses mobility over 3 activities of daily living: walking, stair climbing, and standing from a chair. Sensor-derived parameters including variation in both temporal and force aspects of gait were validated to measure differences in performance in line with fracture severity, which also matched questionnaire-based assessments. Monitoring the OTF cohort over 12 months with the HMS allowed functional recovery to be profiled in great detail. Further, a novel finding of continued improvements in walking quality after a plateau in walking quantity was demonstrated objectively. The methods described in this thesis provide an opportunity to revamp the recovery paradigm through continuous, objective patient monitoring along with self-directed, personalised rehabilitation strategies, which has the potential to improve both the quality and cost-effectiveness of reconstructive surgery services.Open Acces

Enhancing Biomechanical Function through Development and Testing of Assistive Devices for Shoulder Impairment and Total Limb Amputation

Assistive devices serve as a potential for restoring sensorimotor function to impaired individuals. My research focuses on two assistive devices: a passive shoulder exoskeleton and a muscle-driven endoprosthesis (MDE). Previous passive shoulder exoskeletons have focused on testing during static loading conditions in the shoulder. However, activities of daily living are based on dynamic tasks. My research for passive shoulder exoskeletons analyzes the effect that a continuous passive assistance has on shoulder biomechanics. In my research I showed that passive assistance decreases the muscular activation in muscles responsible for positive shoulder exoskeleton. An MDE has the potential to have accurate and precise control of movement as well as restore a sense of proprioception to the user. Such a transformative and invasive device has never previously been tested. Therefore, my research focused on analyzing fundamental principles of the MDE in an in-vivo rabbit model. The two concepts I tested in my research were the feasibility of implanting an orthopedic device underneath the skin at the distal end of a limb following amputation and the locomotor restorative capabilities of an artificial tendon used for muscle-device connection. In my work I proved the feasibility of implanting fully-footed rigid endoprostheses underneath the skin and isolated the primary factors for a successful surgery and recovery. In addition, my research showed that although artificial tendons have the potential to restore locomotor function, proper in-situ tendon lengths must be achieved for optimal movement. This research informed the design and testing of a fully jointed muscle-driven endoprosthesis prototype

Book of Abstracts 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization

In this edition, the two events will run together as a single conference, highlighting the strong connection with the Taylor & Francis journals: Computer Methods in Biomechanics and Biomedical Engineering (John Middleton and Christopher Jacobs, Eds.) and Computer Methods in Biomechanics and Biomedical Engineering: Imaging and Visualization (JoãoManuel R.S. Tavares, Ed.). The conference has become a major international meeting on computational biomechanics, imaging andvisualization. In this edition, the main program includes 212 presentations. In addition, sixteen renowned researchers will give plenary keynotes, addressing current challenges in computational biomechanics and biomedical imaging. In Lisbon, for the first time, a session dedicated to award the winner of the Best Paper in CMBBE Journal will take place. We believe that CMBBE2018 will have a strong impact on the development of computational biomechanics and biomedical imaging and visualization, identifying emerging areas of research and promoting the collaboration and networking between participants. This impact is evidenced through the well-known research groups, commercial companies and scientific organizations, who continue to support and sponsor the CMBBE meeting series. In fact, the conference is enriched with five workshops on specific scientific topics and commercial software.info:eu-repo/semantics/draf

Evaluating footwear “in the wild”: Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products

Assessment and understanding of unilateral trans-tibial amputee gait using principal component analysis and discriminant function analysis

The general aim of this thesis was to develop analytical techniques for the assessment and understanding of lower-limb amputee (LLA) gait. The number of individuals with lower limb amputation (LLA) worldwide is growing and being able to optimise rehabilitation and prosthetic prescriptions are becoming more important. Gait analysis may be able to inform these processes, in particular at the individual level. In study one, a machine learning algorithm was developed and optimised using Principal Component Analysis (PCA) and Discriminant Function Analysis (DFA) to distinguish between barefoot and shod running. An iterative process was used to optimise the algorithm, exploring all possible iterations of ten individuals out of twenty, finding the combination of people with the greatest generic features and thus the lowest error rate for classification. The outcome showed 93.5% classification accuracy between barefoot and shod running. This study demonstrated that an iteration procedure could optimise a machine learning algorithm to overcome the issues of overfitting, which is particularly useful when working with a small sample size as is common in gait analysis. In study two, PCA and DFA were used to identify differences between the gait of individuals with unilateral trans-tibial amputation (UTTA) and able-bodied individuals. Different approaches were explored, establishing that PCA conducted on normalised temporal-waveforms yielded the best outcome. Results revealed that UTTA and able-bodied gait differed with regards to certain biomechanical variables, providing a better understanding of LLA function. Although differences between individuals with LLA and able-bodied individuals have previously been investigated, this study demonstrates that using multivariate statistical analyses a vast number of variables can be investigated simultaneously, identifying the hierarchy of variables and thus which need to be targeted during treatment. Clinical diagnosis is based on individual patients, thus in study three PCA was used to determine whether one individual with a UTTA displayed unique gait characteristics when compared to a group of able-bodied individuals. Both covariance and correlation matrices were used during PCA, providing information about variation and magnitude of the data, respectively. Results revealed that each individual with UTTA has subject-specific gait characteristics, which highlights that this method can be used to identify variables which can be targeted during treatment. In the fourth and final study, PCA was used to understand the effects of attempted symmetry on dynamic stability of individuals with UTTA. Although in rehabilitation symmetrical gait is often sought for since asymmetrical gait is said to cause long term adverse effects, results revealed that asymmetry might be playing a functional role and in fact aids better stability in UTTA gait. This outcome may suggest that after a certain symmetry has been reached, the target of rehabilitation may need to be reconsidered to aim for better stability. In conclusion, multivariate statistical analysis could be used to assess and understand LLA function. In a clinical setting, the ability to identify important variables during a task, particularly at patient-specific level has the potential to improve the development of treatment recommendations. Prosthetic prescription and rehabilitation processes can be tailored and in turn the outcome may be more successful which could increase the likelihood of independent living of patients and therefore improve the quality of life of individuals with LLA

Motor patterns evaluation of people with neuromuscular disorders for biomechanical risk management and job integration/reintegration

Neurological diseases are now the most common pathological condition and the leading cause of disability, progressively worsening the quality of life of those affected. Because of their high prevalence, they are also a social issue, burdening both the national health service and the working environment. It is therefore crucial to be able to characterize altered motor patterns in order to develop appropriate rehabilitation treatments with the primary goal of restoring patients' daily lives and optimizing their working abilities. In this thesis, I present a collection of published scientific articles I co-authored as well as two in progress in which we looked for appropriate indices for characterizing motor patterns of people with neuromuscular disorders that could be used to plan rehabilitation and job accommodation programs. We used instrumentation for motion analysis and wearable inertial sensors to compute kinematic, kinetic and electromyographic indices. These indices proved to be a useful tool for not only developing and validating a clinical and ergonomic rehabilitation pathway, but also for designing more ergonomic prosthetic and orthotic devices and controlling collaborative robots