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

Recovery of walking ability using a robotic device

Haan, A. de [Promotor]Gerrits, H.L. [Copromotor]Janssen, T.W.J. [Copromotor

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

Musculoskeletal Modeling of the Human Lower Limb Stiffness for Robotic Applications

This research work presents a physiologically accurate and novel computationally fast neuromusculoskeletal model of the human lower limb stiffness. The proposed computational framework uses electromyographic signals, motion capture data and ground reaction forces to predict the force developed by 43 musculotendon actuators. The estimated forces are then used to compute the musculotendon stiffness and the corresponding joint stiffness. The estimations at each musculotendon unit is constrained to simultaneously satisfy the joint angles and the joint moments of force generated with respect to five degrees of freedom, including: Hip Adduction-Abduction, Hip Flexion-Extension, Hip Internal-External Rotation, Knee Flexion-Extension, and Ankle Plantar-Dorsi Flexion. Advanced methods are used to perform accurate muscle-driven dynamic simulations and to guarantee the dynamic consistency between kinematic and kinetic data. This study presents also the design, simulation and prototyping of a small musculoskeletal humanoid made for replicating the human musculoskeletal structure in an artificial apparatus capable to maintain a quiet standing position using only a completely passive elastic actuation structure. The proposed prototype has a total mass of about 2 kg and its height is 40 cm. It comprises of four segments for each leg and six degrees of freedom, including: Hip Adduction-Abduction, Hip Flexion-Extension, Knee Flexion-Extension, Ankle Plantar-Dorsi Flexion, Ankle Inversion-Eversion, and Toe Flexion-Extension. In order to reconstruct the continuous state space parameters proper of the assembly's control of quiet standing, a hybrid non-linear Extended Kalman Filter based technique is proposed to combine a base-excited inverted pendulum kinematic model of the robot with the discrete-time position measurements. This research work provides effective solutions and readily available software tools to improve the human interaction with robotic assistive devices, advancing the research in neuromusculoskeletal modeling to better understand the mechanisms of actuation provided by human muscles and the rules that govern the lower limb joint stiffness regulation. The obtained results suggest that the neuromusculoskeletal modeling technology can be exploited to address the challenges on the development of musculoskeletal humanoids, new generation human-robot interfaces, motion control algorithms, and intelligent assistive wearable devices capable to effectively ensure a proper dynamic coupling between human and robot

Development of Walk Assistive Orthoses for Elderly

The proportion of elderly people is rapidly growing and the resources to help them will soon be insufficient. An important difficulty faced by the seniors is locomotion. Among the conditions that may be responsible for gait impairment, the reduced muscular force is one of the most frequent in elderly. This thesis focuses on the design and the evaluation of new solutions for assisting people with reduced vigor. Robotic orthoses are then used to support critical movements required for walking. Over the last two decades, the use of actuated orthotic devices for helping people suffering from gait disorders has been made possible. Recently, autonomous devices have even enabled spinal cord injured patients to walk again by mobilizing their paralyzed limbs. Addressing a completely different population, similar devices have been developed to augment healthy users' capabilities, for instance when heavy loads need to be carried. In this case, the wearer is in charge of the movements and the device simply follows the imposed trajectories. Extra load can then be carried by the exoskeleton without being felt by the user. The walk assistive devices developed as part of this thesis being intended for the elderly, they are at the intersection between these two classes of robotic orthosis. Indeed, most of the seniors who have difficulties to walk are able to move and therefore the mobilization devices are not adapted to them. Even though they need assistance, they surely do not want to have their movements imposed by a robotic device. The performance augmentation exoskeletons cannot help them either, as they simply follow the movements and only reject the external perturbations. A device that follows their movements and that adds the right amount of force when needed is therefore required. In order to achieve the demanding characteristics associated with assistive devices, new actuation solutions based on conventional electric motors are proposed. The combination of specifications in terms of overall weight, required assistance torque, dynamics capabilities or transparency when no support is provided is undeniably challenging. Various mechanisms are therefore presented to address these requirements. Two prototypes based on the proposed solutions are presented. The first one is based on a ball-screw transmission combined with linkages which provides a transmission ratio that is adapted to multiple walk related activities. The second one uses a transmission with clutches and an inversion mechanism which notably limits the losses due to the inertia of the actuation and greatly improves the natural transparency. In order to limit the obstructiveness of the assistive device, we propose to use partial devices that support specific movements. Two studies about the influence of such partial devices on gait are therefore presented. The first one focuses on identifying the potential sources of gait disturbance that orthotic device can induce. The second examines the effects of an assistive controller implemented on one of the developed prototypes. These studies demonstrate that even though the passive influence of a hip assistive orthosis on kinematic patterns is limited, the metabolic cost is increased. A moderate assistance cannot compensate for this undesirable effect but a link between the hip assistance and the ankle trajectory could be established. This is of major importance as the elderly tend to compensate for their weak ankle muscles with their hips

Neuromuscular Reflex Control for Prostheses and Exoskeletons

Recent powered lower-limb prosthetic and orthotic (P/O) devices aim to restore legged mobility for persons with an amputation or spinal cord injury. Though various control strategies have been proposed for these devices, specifically finite-state impedance controllers, natural gait mechanics are not usually achieved. The goal of this project was to invent a biologically-inspired controller for powered P/O devices. We hypothesize that a more muscle-like actuation system, including spinal reflexes and vestibular feedback, can achieve able-bodied walking and also respond to outside perturbations. The outputs of the Virtual Muscle Reflex (VMR) controller are joint torque commands, sent to the electric motors of a P/O device. We identified the controller parameters through optimizations using human experimental data of perturbed walking, in which we minimized the error between the torque produced by our controller and the standard torque trajectories observed in the able-bodied experiments. In simulations, we then compare the VMR controller to a four-phase impedance controller. For both controllers the coefficient of determination R^2 and root-mean-square (RMS) error were calculated as a function of the gait cycle. When simulating the hip, knee, and ankle joints, the RMS error and R^2 across all joints and all trials is 15.65 Nm and 0.28 for the impedance controller, respectively, and for the VMR controller, these values are 15.15 Nm and 0.29, respectively. With similar performance, it was concluded that the VMR controller can reproduce characteristics of human walking in response to perturbations as effectively as an impedance controller. We then implemented the VMR controller on the Parker Hannifin powered exoskeleton and performed standard isokinetic and isometric knee rehabilitation exercises to observe the behavior of the virtual muscle model. In the isometric results, RMS error between the measured and commanded extension and flexion torques are 3.28 Nm and 1.25 Nm, respectively. In the isokinetic trials, we receive RMS error between the measured and commanded extension and flexion torques of 0.73 Nm and 0.24 Nm. Since the onboard virtual muscles demonstrate similar muscle force-length and force-velocity relationships observed in humans, we conclude the model is capable of the same stabilizing capabilities as observed in an impedance controller

Neuromuscular Reflex Control for Prostheses and Exoskeletons

Recent powered lower-limb prosthetic and orthotic (P/O) devices aim to restore legged mobility for persons with an amputation or spinal cord injury. Though various control strategies have been proposed for these devices, specifically finite-state impedance controllers, natural gait mechanics are not usually achieved. The goal of this project was to invent a biologically-inspired controller for powered P/O devices. We hypothesize that a more muscle-like actuation system, including spinal reflexes and vestibular feedback, can achieve able-bodied walking and also respond to outside perturbations. The outputs of the Virtual Muscle Reflex (VMR) controller are joint torque commands, sent to the electric motors of a P/O device. We identified the controller parameters through optimizations using human experimental data of perturbed walking, in which we minimized the error between the torque produced by our controller and the standard torque trajectories observed in the able-bodied experiments. In simulations, we then compare the VMR controller to a four-phase impedance controller. For both controllers the coefficient of determination R^2 and root-mean-square (RMS) error were calculated as a function of the gait cycle. When simulating the hip, knee, and ankle joints, the RMS error and R^2 across all joints and all trials is 15.65 Nm and 0.28 for the impedance controller, respectively, and for the VMR controller, these values are 15.15 Nm and 0.29, respectively. With similar performance, it was concluded that the VMR controller can reproduce characteristics of human walking in response to perturbations as effectively as an impedance controller. We then implemented the VMR controller on the Parker Hannifin powered exoskeleton and performed standard isokinetic and isometric knee rehabilitation exercises to observe the behavior of the virtual muscle model. In the isometric results, RMS error between the measured and commanded extension and flexion torques are 3.28 Nm and 1.25 Nm, respectively. In the isokinetic trials, we receive RMS error between the measured and commanded extension and flexion torques of 0.73 Nm and 0.24 Nm. Since the onboard virtual muscles demonstrate similar muscle force-length and force-velocity relationships observed in humans, we conclude the model is capable of the same stabilizing capabilities as observed in an impedance controller

Neuromuscular Reflex Control for Prostheses and Exoskeletons

Recent powered lower-limb prosthetic and orthotic (P/O) devices aim to restore legged mobility for persons with an amputation or spinal cord injury. Though various control strategies have been proposed for these devices, specifically finite-state impedance controllers, natural gait mechanics are not usually achieved. The goal of this project was to invent a biologically-inspired controller for powered P/O devices. We hypothesize that a more muscle-like actuation system, including spinal reflexes and vestibular feedback, can achieve able-bodied walking and also respond to outside perturbations. The outputs of the Virtual Muscle Reflex (VMR) controller are joint torque commands, sent to the electric motors of a P/O device. We identified the controller parameters through optimizations using human experimental data of perturbed walking, in which we minimized the error between the torque produced by our controller and the standard torque trajectories observed in the able-bodied experiments. In simulations, we then compare the VMR controller to a four-phase impedance controller. For both controllers the coefficient of determination R^2 and root-mean-square (RMS) error were calculated as a function of the gait cycle. When simulating the hip, knee, and ankle joints, the RMS error and R^2 across all joints and all trials is 15.65 Nm and 0.28 for the impedance controller, respectively, and for the VMR controller, these values are 15.15 Nm and 0.29, respectively. With similar performance, it was concluded that the VMR controller can reproduce characteristics of human walking in response to perturbations as effectively as an impedance controller. We then implemented the VMR controller on the Parker Hannifin powered exoskeleton and performed standard isokinetic and isometric knee rehabilitation exercises to observe the behavior of the virtual muscle model. In the isometric results, RMS error between the measured and commanded extension and flexion torques are 3.28 Nm and 1.25 Nm, respectively. In the isokinetic trials, we receive RMS error between the measured and commanded extension and flexion torques of 0.73 Nm and 0.24 Nm. Since the onboard virtual muscles demonstrate similar muscle force-length and force-velocity relationships observed in humans, we conclude the model is capable of the same stabilizing capabilities as observed in an impedance controller