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

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

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

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

Applications of EMG in Clinical and Sports Medicine

This second of two volumes on EMG (Electromyography) covers a wide range of clinical applications, as a complement to the methods discussed in volume 1. Topics range from gait and vibration analysis, through posture and falls prevention, to biofeedback in the treatment of neurologic swallowing impairment. The volume includes sections on back care, sports and performance medicine, gynecology/urology and orofacial function. Authors describe the procedures for their experimental studies with detailed and clear illustrations and references to the literature. The limitations of SEMG measures and methods for careful analysis are discussed. This broad compilation of articles discussing the use of EMG in both clinical and research applications demonstrates the utility of the method as a tool in a wide variety of disciplines and clinical fields

Physical Diagnosis and Rehabilitation Technologies

The book focuses on the diagnosis, evaluation, and assistance of gait disorders; all the papers have been contributed by research groups related to assistive robotics, instrumentations, and augmentative devices

EEG and ECoG features for Brain Computer Interface in Stroke Rehabilitation

The ability of non-invasive Brain-Computer Interface (BCI) to control an exoskeleton was used for motor rehabilitation in stroke patients or as an assistive device for the paralyzed. However, there is still a need to create a more reliable BCI that could be used to control several degrees of Freedom (DoFs) that could improve rehabilitation results. Decoding different movements from the same limb, high accuracy and reliability are some of the main difficulties when using conventional EEG-based BCIs and the challenges we tackled in this thesis. In this PhD thesis, we investigated that the classification of several functional hand reaching movements from the same limb using EEG is possible with acceptable accuracy. Moreover, we investigated how the recalibration could affect the classification results. For this reason, we tested the recalibration in each multi-class decoding for within session, recalibrated between-sessions, and between sessions. It was shown the great influence of recalibrating the generated classifier with data from the current session to improve stability and reliability of the decoding. Moreover, we used a multiclass extension of the Filter Bank Common Spatial Patterns (FBCSP) to improve the decoding accuracy based on features and compared it to our previous study using CSP. Sensorimotor-rhythm-based BCI systems have been used within the same frequency ranges as a way to influence brain plasticity or controlling external devices. However, neural oscillations have shown to synchronize activity according to motor and cognitive functions. For this reason, the existence of cross-frequency interactions produces oscillations with different frequencies in neural networks. In this PhD, we investigated for the first time the existence of cross-frequency coupling during rest and movement using ECoG in chronic stroke patients. We found that there is an exaggerated phase-amplitude coupling between the phase of alpha frequency and the amplitude of gamma frequency, which can be used as feature or target for neurofeedback interventions using BCIs. This coupling has been also reported in another neurological disorder affecting motor function (Parkinson and dystonia) but, to date, it has not been investigated in stroke patients. This finding might change the future design of assistive or therapeuthic BCI systems for motor restoration in stroke patients