Mechanical Characterization of Carbon Fiber and Thermoplastic Ankle Foot Orthoses

The needs of an increasingly young and active orthotic patient population has led to advancements in ankle foot orthosis (AFO) design and materials to enable higher function. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom energy-storing carbon fiber AFO that has demonstrated improved clinical function, allowing patients to return to high-intensity activities such as sports and military service. An improved understanding of AFO mechanical function will aid prescription and fitting, as well as assist in design modifications for different patient populations. This study investigated the mechanical properties of AFOs, specifically structural stiffness, rotational motion, and strut deflection, to discern design characteristics contributing to increased functional outcomes. Seven AFOs of different designs and materials were tested under cyclical loading to characterize their mechanical properties. These AFOs were fitted about a surrogate limb and underwent pseudo-static compressive testing using a materials testing system and motion analysis. Acquired data included: compressive force, vertical displacement, kinematic data, and ankle rotation. Testing was conducted at discrete orientations and loads corresponding to the latter sub-phases of stance: midstance, terminal stance, and pre-swing. The compressive stiffness, posterior strut deflection, and rotational motion of the various AFOs, as well as the ankle range of motion (ROM) of the surrogate limb, were characterized. The deformation of the various AFO designs during loading differed greatly, influencing the observed mechanical behavior. Traditional thermoplastic and carbon fiber designs deformed at the malleolar flares or rotationally at the ankle, demonstrating low proximal rotational motion of the AFO and large surrogate ankle ROM. The mechanical response of the IDEO was unique, with large deflection observed along the posterior strut, minimal footplate deformation, greater proximal rotational motion, and minimal ankle ROM. This design incorporates stiffer materials for fabrication, increasing the potential for energy storage, while restricting ankle motion. Enhanced knowledge of the mechanical behavior and energy storage/release mechanism may improve prescription, custom design and fitting of the IDEO

Healthcare meets tech : the impact of 3D printing for orthopedic immobilizer devices : an industry analysis

To immobilize or replace a limb, custom-made medical devices must be produced by the orthopedic industry, such as casts, orthoses and prostheses. While very little major progress has been made in this area, the development of new technologies makes it now possible to produce immobilization devices through 3D printing that are specific to the anatomical characteristics of patients. This dissertation aims to determine the advantages of 3D orthoses and external prostheses, their barriers and limitations, as well as the feasibility of implementing the technology on the Belgian market. In order to test the viability of the production of 3D printed immobilization devices as an alternative approach, six expert interviews were conducted. The interviewees focused on main stakeholders: orthopedic surgeons, orthotists, 3D manufacturers and regulators. The results subsequently provided viable indications of therapeutic effectiveness and benefits for the patient’s quality of life. The main barriers to adoption are the economic parameter as well as the maturity of the technology. However, technological advances, well-defined crosscollaboration, and an adapted business model combining a ‘SaaS’ and ‘end to end’ solution can overcome these barriers and ensure successful implementation. In conclusion, 3D printing technology in the orthopedic industry proves to have an achievable diffusion. If executed diligently, 3D printed orthoses and prostheses may become common devices.Para imobilizar ou substituir um membro, os aparelhos médicos feitos sob medida devem ser produzidos pela indústria ortopédica, como moldes, ortóteses e próteses. Embora muito pouco progresso tenha ocorrido na área, o desenvolvimento de novas tecnologias possibilita a produção de aparelhos de imobilização através da impressão 3D, específicos às características anatómicas dos pacientes. Esta dissertação tem como objetivo determinar as vantagens das ortóteses 3D e próteses externas, barreiras e limitações, bem como a viabilidade de implementar a tecnologia no mercado belga. Com o propósito de testar a viabilidade da produção de aparelhos de imobilização impressos em 3D como uma abordagem alternativa, foram realizadas sete entrevistas com especialistas. Os intervenientes principais foram entrevistados: cirurgiões ortopédicos, ortopedistas, fabricantes 3D e reguladores. Os resultados subsequentemente proporcionaram indicações viáveis da eficácia terapêutica e dos benefícios para a qualidade de vida do paciente. As principais barreiras à adoção são a vertente económica e a maturidade da tecnologia. No entanto, os avanços tecnológicos, a colaboração cruzada bem definida e um modelo de negócio adaptado que combina uma solução 'SaaS' e ‘end to end’ pode superar as barreiras existentes e garantir uma implementação bemsucedida. Em conclusão, a tecnologia de impressão 3D na indústria ortopédica demonstra uma difusão viável. Se executadas diligentemente, ortóteses e próteses impressas em 3D podem se tornar aparelhos comuns

A case study of technology transfer: Rehabilitative engineering at Rancho Los Amigos Hospital

The transfer of NASA technolgy to rehabilitative applications of artificial limbs is studied. Human factors engineering activities range from orthotic manipulators to tiny dc motors and transducers to detect and transmit voluntary control signals. It is found that bicarbon implant devices are suitable for medical equipment and artificial limbs because of their biological compatibility with human body fluids and tissues

Magnetoencephalography in Stroke Recovery and Rehabilitation

Magnetoencephalography (MEG) is a non-invasive neurophysiological technique used to study the cerebral cortex. Currently, MEG is mainly used clinically to localize epileptic foci and eloquent brain areas in order to avoid damage during neurosurgery. MEG might, however, also be of help in monitoring stroke recovery and rehabilitation. This review focuses on experimental use of MEG in neurorehabilitation. MEG has been employed to detect early modifications in neuroplasticity and connectivity, but there is insufficient evidence as to whether these methods are sensitive enough to be used as a clinical diagnostic test. MEG has also been exploited to derive the relationship between brain activity and movement kinematics for a motor-based brain-computer interface. In the current body of experimental research, MEG appears to be a powerful tool in neurorehabilitation, but it is necessary to produce new data to confirm its clinical utility

Design of a wearable active ankle-foot orthosis for both sides

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Biomateriais, Reabilitação e Biomecânica)Portugal is the west European country with the highest rate of stroke-related mortality, being that, of those who suffer cerebrovascular accidents, 40% feature an impairment which can manifest itself through motor sequelae, namely drop foot. An ankle-foot orthosis is often recommended to passively accommodate these motor problems; however, active/powered exoskeletons are also a suitable solution for post-stroke patients. Due to the high complexity of the human ankle joint, one of the problems regarding these active devices is the misalignment occurring between the rehabilitation device and the human joint, which is a cause of parasitic forces, discomfort, and pain. The present master dissertation proposes the development of an adjustable wearable active ankle-foot orthosis that is able to tackle this misalignment issue concerning commercially available lower limb orthotic devices. This work is integrated on the SmartOs – Smart, Stand-alone Active Orthotic System – project that proposes an innovative robotic technology (a wearable mobile lab) oriented to gait rehabilitation. The conceptual design of a standard version of the SmartOs wearable active orthosis was initiated with the analysis of another ankle-foot orthosis – Exo-H2 (Technaid) – from which the necessary design changes were implemented, aiming at the improvement of the established device. In order to achieve a conceptual solution, both the practical knowledge of the Orthos XXI design team and several design methods were used to ensure the accomplishment of the defined requirements. The detailed design process of the standard SmartOs wearable active orthosis prototype is disclosed. With the purpose of validating the design, the critical components were simulated with the resources available in SolidWorks®, and the necessary CAD model’s adaptations were implemented to guarantee a reliable and safe design. The presented design is currently set for further production in Orthos XXI, followed by the mandatory mechanical tests.Portugal é o país da Europa ocidental com maior taxa de mortalidade por acidente vascular cerebral (AVC), sendo que, dos que sofrem acidentes vasculares cerebrais, 40% apresentam uma deficiência que pode manifestar-se por sequelas motoras, nomeadamente o pé pendente. Uma ortótese do tornozelo é recomendada frequentemente para acomodar passivamente esses problemas motores; no entanto, exoesqueletos ativos são também uma solução adequada para pacientes pós-AVC. Devido à alta complexidade da articulação do tornozelo humano, um dos problemas associados a esses dispositivos ativos é o desalinhamento que ocorre entre o dispositivo de reabilitação e a articulação humana, que é uma causa de forças parasitas, desconforto e dor. A presente dissertação de mestrado propõe o desenvolvimento de uma ortótese ativa do tornozelo ajustável e vestível, que seja capaz de resolver esse problema de desalinhamento relativo aos dispositivos ortóticos de membros inferiores disponíveis comercialmente. Este trabalho está integrado no projeto SmartOs - Smart, Stand-alone Active Orthotic System - projeto que propõe uma tecnologia robótica inovadora (wearable mobile lab) direcionada para a reabilitação da marcha. O projeto conceptual de uma versão padrão da ortótese ativa vestível do projeto SmartOs foi iniciado com a análise de outra ortótese do tornozelo – Exo-H2 (Technaid) - a partir da qual foram implementadas as alterações de projeto necessárias, visando o aprimoramento do dispositivo estabelecido. Para se chegar a uma solução conceptual, tanto o conhecimento prático da equipa de projeto da Orthos XXI como os diversos métodos de projeto foram utilizados para garantir o cumprimento dos requisitos definidos. O processo do desenho detalhado da versão padrão da ortótese ativa SmartOs será também divulgado. Com o objetivo de validar o projeto, os componentes críticos foram simulados com os recursos disponíveis no SolidWorks® e as adaptações necessárias do modelo CAD foram implementadas para garantir um projeto fidedigno e seguro. O projeto apresentado está atualmente em preparação para produção na empresa Orthos XXI, depois do qual se seguem os ensaios mecânicos obrigatórios

Ekonomicky dostupný aktivní exoskeleton pro dolní končetiny pro paraplegiky

After a broad introduction to the medical and biomechanical background and detailed review of orthotic devices, two newly developed lower limbs exoskeletons for paraplegics are presented in this study. There was found out the main challenges of designing devices for paraplegic walking can be summarized into three groups, stability and comfort, high efficiency or low energy consumption, dimensions and weight. These all attributes have to be moreover considered and maintained during manufacturing of affordable device while setting a reasonable price of the final product. A new economical device for people with paraplegia which tackles all problems of the three groups is introduced in this work. The main idea of this device is based on HALO mechanism. HALO is a compact passive medial hip joint orthosis with contralateral hip and ankle linkage, which keeps the feet always parallel to the ground and assists swinging the leg. The medial hip joint is equipped with one actuator in the new design and the new active exoskeleton is called @halo. Due to this update, we can achieve more stable and smoother walking patterns with decreased energy consumption of the users, yet maintain its compact and lightweight features. It was proven by the results from preliminary experiments with able-bodied subjects during which the same device with and without actuator was evaluated. Waddling and excessive vertical elevation of the centre of gravity were decreased by 40% with significantly smaller standard deviations in case of the powered exoskeleton. There was 52% less energy spent by the user wearing @halo which was calculated from the vertical excursion difference. There was measured 38.5% bigger impulse in crutches while using passive orthosis, which produced bigger loads in upper extremities musculature. The inverse dynamics approach was chosen to calculate and investigate the loads applied to the upper extremities. The result of this calculation has proven that all main muscle groups are engaged more aggressively and indicate more energy consumption during passive walking. The new @halo device is the first powered exoskeleton for lower limbs with just one actuated degree of freedom for users with paraplegia.První část práce je věnována obsáhlému úvodu do zdravotnické a biomechanické terminologie a detailnímu souhrnnému představení ortopedických pomůcek. Následně jsou představeny dva nově vyvinuté exoskelety aplikovatelné na dolní končetiny paraplegiků. Bylo zjištěno, že hlavní úskalí konstrukčního návrhu asistenčních zařízení pro paraplegiky lze shrnout do tří hlavních skupin, jako první je stabilita a komfort, druhá je vysoká účinnost a nízká energetická náročnost uživatele a do třetí lze zahrnout rozměry a hmotnost zařízení. Toto všechno je navíc podmíněno přijatelnou výslednou cenou produktu. Nový ekonomicky dostupný exoskelet pro paraplegiky, který řeší problematiku všech tří zmíněných skupin je představen v této práci. Hlavní myšlenka tohoto zařízení je postavena na mechanismu HALO ortézy. HALO je kompaktní pasivní ortéza s mediálním kyčelním kloubem umístěným uprostřed mezi dolními končetinami. Speciální mediální kyčelní kloub je kontralaterálně propojen s kotníkem soustavou ocelových lanek což zajištuje paralelní polohu chodidla se zemí v každém okamžiku chůze a navíc asistuje zhoupnutí končetiny. Tento mediální kyčelní kloub je redesignován a v novém provedení je vybaven jedním aktuátorem, nové řešení aktivního exoskeletu dostalo název @halo. Díky tomuto vylepšení lze dosáhnout stabilnější a plynulejší chůze s výrazně redukovanou energetickou náročností uživatele přičemž dochází k zachování nízké hmotnosti a kompaktnosti zařízení. Toto bylo dokázáno během předběžných experimentů se zdravými subjekty, během kterých byla testována aktivní chůze se zařízením vybaveným odnímatelnou pohonnou jednotkou a pasivní chůze se stejným zařízením bez této aktivní jednotky. Nadměrné naklánění se během chůze ze strany na stranu a nadměrná výchylka pohybu těžiště těla ve vertikálním směru byly sníženy o necelých 40% s velmi významně menšími standardními odchylkami v případě chůze s pohonem. Z rozdílu výchylky pohybu těžiště těla ve vertikální poloze bylo vypočítáno snížení energetické náročnosti uživatele o 52% při chůzi s aktivní konfiguraci @halo. Při pohybu s pasivní ortézou byl naměřen o 38,5% větší reakční silový impuls v berlích, což znamená nárůst zátěže pro svalový aparát horních končetin. Pro podrobné vyšetření zátěže ramenních kloubů byl aplikován model inverzní dynamiky. Výsledek tohoto výpočtu jednoznačně indikuje agresivnější a hlubší zapojení všech svalových skupin ramenního kloubu a tím vyšší spotřebu energie uživatelem během pasivní chůze. Nové asistenční zařízení @halo je prvním exoskeletem svého druhu pro paraplegiky s jediným poháněným stupněm volnosti.354 - Katedra robotikyvyhově

Development of a 4-DoF Active Upper Limb Orthosis

In this paper, the designs and manufacturing process of a powered upper limb orthosis are presented. The orthosis is an exoskeleton worn on one arm by the user and fixed to the trunk. The orthosis’ architecture, design, and manufacturing process are presented and discussed. Estimations of the ranges of movement related to daily living activities are presented. The preliminary tests to verify the functionality of the design show encouraging results

Design and Validation of an MR Conditional Upper Extremity Evaluation System to Study Brain Activation Patterns after Stroke

Stroke is the third leading cause of death and second most frequent cause of disability in the United States. Stroke rehabilitation methods have been developed to induce the cortical reorganization and motor-relearning that leads to stroke recovery. In this thesis, we designed and developed an MR conditional upper extremity reach and grasp movement evaluation system for the stroke survivors to study their kinematic performances in reach and grasp movement and the relationship between kinematic metrics and the recovery level measured by clinical assessment methods. We also applied the system into the functional MRI experiments to identify the ability to study motor performance with the system inside the scanner and the reach, grasp and reach-to-grasp movements related brain activation patterns. Our experiments demonstrates that ours system is an MR conditional system in the 3.0 Tesla magnetic field. It is able to measure the stroke survivors\u27 reach and grasp movement in terms of grasp aperture and elbow joint angles. We used the Mann Whitney U test to examine the significant metrics in each tasks and principle component analysis to decide the major metrics that are associated with the outcome. Then we discovered better recovery scores are associated with these major kinematic metrics such as larger maximal velocity, larger mean velocity, larger maximal movement angle, and longer time to peak velocity. Additional to these metrics, time to maximal angle, time to target and time to peak velocity could also be used as additional metrics to help predict the recovery and assess robot-assisted therapy and optimize task-oriented rehabilitation strategy. We also identified the movement related brain activations in the motor and sensory areas as well as cerebellum in both normal and stroke survivors