Bi-articular knee-ankle-foot exoskeleton produces higher metabolic cost reduction than weight-matched mono-articular exoskeleton

The bi-articular m. gastrocnemius and the mono-articular m. soleus have different and complementary functions during walking. Several groups are starting to use these biological functions as inspiration to design prostheses with bi-articular actuation components to replace the function of the m. gastrocnemius. Simulation studies indicate that a bi-articular configuration and spring that mimic the m. gastrocnemius could be beneficial for orthoses or exoskeletons. Our aim was to test the effect of a bi-articular and spring configuration that mimics the m. gastrocnemius and compare this to a no-spring and mono-articular configuration. We tested nine participants during walking with knee-ankle-foot exoskeletons with dorsally mounted pneumatic muscle actuators. In the bi-articular plus spring condition the pneumatic muscles were attached to the thigh segment with an elastic cord. In the bi-articular no-spring condition the pneumatic muscles were also attached to the thigh segment but with a non-elastic cord. In the mono-articular condition the pneumatic muscles were attached to the shank segment. We found the highest reduction in metabolic cost of 13% compared to walking with the exoskeleton powered-off in the bi-articular plus spring condition. Possible explanations for this could be that the exoskeleton delivered the highest total positive work in this condition at the ankle and the knee and provided more assistance during the isometric phase of the biological plantarflexors. As expected we found that the bi-articular conditions reduced m. gastrocnemius EMG more than the mono-articular condition but this difference was not significant. We did not find that the mono-articular condition reduces the m. soleus EMG more than the bi-articular conditions. Knowledge of specific effects of different exoskeleton configurations on metabolic cost and muscle activation could be useful for providing customized assistance for specific gait impairments

Bi-articular Knee-Ankle-Foot Exoskeleton Produces Higher Metabolic Cost Reduction than Weight-Matched Mono-articular Exoskeleton

The bi-articular m. gastrocnemius and the mono-articular m. soleus have different and complementary functions during walking. Several groups are starting to use these biological functions as inspiration to design prostheses with bi-articular actuation components to replace the function of the m. gastrocnemius. Simulation studies indicate that a bi-articular configuration and spring that mimic the m. gastrocnemius could be beneficial for orthoses or exoskeletons. Our aim was to test the effect of a bi-articular and spring configuration that mimics the m. gastrocnemius and compare this to a no- spring and mono-articular configuration. We tested nine participants during walking with knee-ankle-foot exoskeletons with dorsally mounted pneumatic muscle actuators. In the bi-articular plus spring condition the pneumatic muscles were attached to the thigh segment with an elastic cord. In the bi-articular no-spring condition the pneumatic muscles were also attached to the thigh segment but with a non-elastic cord. In the mono-articular condition the pneumatic muscles were attached to the shank segment. We found the highest reduction in metabolic cost of 13% compared to walking with the exoskeleton powered-off in the bi-articular plus spring condition. Possible explanations for this could be that the exoskeleton delivered the highest total positive work in this condition at the ankle and the knee and provided more assistance during the isometric phase of the biological plantarflexors. As expected we found that the bi-articular conditions reduced m. gastrocnemius EMG more than the mono-articular condition but this difference was not significant. We did not find that the mono-articular condition reduces the m. soleus EMG more than the bi-articular conditions. Knowledge of specific effects of different exoskeleton configurations on metabolic cost and muscle activation could be useful for providing customized assistance for specific gait impairments

Consideration of monoarticular and biarticular mechanisms

Aktuelle In-vivo-Methoden zur Bewertung der Belastung und Dehnung der Achillessehne (AT) in der biomechanischen Literatur haben bestimmte Einschränkungen, die sorgfältig berücksichtigt werden müssen. Daher hatte die erste Studie zum Ziel, die AT-Dehnung und -Kraft während der Fortbewegung mithilfe einer genauen, nicht-invasiven Methode zu messen. Die Länge der AT wurde unter Berücksichtigung ihrer Krümmung mit reflektierenden Folienmarkern von der Insertion am Fersenbein bis zum Übergang zwischen der Muskel-Sehnen-Verbindung des Musculus gastrocnemius medialis (GM-MTJ) gemessen. Die Kraft der AT wurde durch Anpassung einer quadratischen Funktion an die experimentelle Kraft-Längen-Kurve der Sehne ermittelt, die aus maximalen freiwilligen isometrischen Kontraktionen (MVC) gewonnen wurde. Die Ergebnisse der zweiten Studie zeigen, dass eine Erhöhung der Gehgeschwindigkeit zu einer 21%igen Abnahme der maximalen AT-Kraft bei höheren Geschwindigkeiten im Vergleich zur bevorzugten Geschwindigkeit führt, während die Nettobelastung der AT-Kraft am Sprunggelenk (ATF-Arbeit) in Abhängigkeit von der Gehgeschwindigkeit zunimmt. Darüber hinaus trugen eine frühere Plantarflexion, erhöhte elektromyografische Aktivität der Muskeln Sol und GM sowie der Energieübertrag von Knie- zu Sprunggelenk durch die biartikulären Musculi gastrocnemii zu einer 1,7- bzw. 2,4-fachen Zunahme der netto ATF-Mechanik-Arbeit bei Übergangs- und maximalen Gehgeschwindigkeiten bei. Das Ziel der dritten Studie war es, die in der ersten Studie vorgeschlagene Methode zu vereinfachen, indem die Anzahl der reflektierenden Folienmarker reduziert wurde, jedoch die hohe Genauigkeit beibehalten wurde. Die Krümmung der AT wurde mithilfe von reflektierenden Folienmarkern zwischen dem Ursprung des GM-MTJ und dem Einführungsmarker am Fersenbein beurteilt. Unsere Ergebnisse zeigen, dass eine Reduzierung der Anzahl der Folienmarker um 70% beim Gehen und um 50% beim Laufen zu einem marginalen Fehler führen würde und somit einen vernachlässigbaren Effekt auf die Länge der AT und die maximale Dehnungsmessung hätte.Current in vivo methods to assess the Achilles tendon (AT) strain and loading in the biomechanics literature have certain limitations that require careful consideration. Therefore, the first study was to measure the AT strain and quantify AT force during locomotion with an accurate non-invasive method. AT length was measured considering its curvature using reflective foil markers from AT insertion at calcaneus to gastrocnemius medialis muscle-tendon junction (GM-MTJ). The force of the AT was calculated by fitting a quadratic function to the experimental tendon force-length curve obtained from maximum voluntary isometric contractions (MVC). The findings in second study indicate that an increase in walking speed leads to a 21% decrease in maximum AT force at higher speeds compared to the preferred speed, yet the net work of the AT force at the ankle joint (ATF-work) increased as a function of walking speed. Additionally, an earlier plantar flexion, increased electromyographic activity of the Sol and GM muscles, and knee-to-ankle joint energy transfer via the biarticular gastrocnemii contributed to a 1.7 and 2.4-fold increase in the net ATF-mechanical work in the transition and maximum walking speeds. The objective of the third study was to simplify the proposed method in the first study by reducing the number of foil reflective markers while preserving high accuracy. The AT curvature was assessed using reflective foil markers between the GM-MTJ origin and the calcaneal insertion marker. Our results indicate that reducing the number of foil markers by 70% during walking and 50% during running would result in a marginal error and, thus, a negligible effect on the AT length and maximum strain measurement

Lower Extremity Passive Range of Motion in Community-Ambulating Stroke Survivors

Background: Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length. Methods: Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs. Results: Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P ≤ 0.05; stroke = 13 degrees, able-bodied = −1 degree). Tmax, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P ≤ 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, Tmax was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P ≤ 0.05, stroke = 25 Nm, able-bodied = 18 Nm). K in the nonparetic leg was also increased during hip flexion (P ≤ 0.05, nonparetic = 0.52 Nm/degree, able-bodied = 0.37 Nm/degree.) Conclusion: This study demonstrates that community-ambulating stroke survivors with residual neuromuscular impairments do not have decreased lower extremity PROM caused by increased muscle stiffness or decreased muscle length. In fact, the population of stroke survivors examined here appears to have more hip extension PROM than age-matched able-bodied individuals. The clinical implications of these data are important and suggest that lower extremity PROM may not interfere with mobility in community-ambulating stroke survivors. Hence, physical therapists may choose to recommend activities other than stretching exercises for stroke survivors who are or will become independent community ambulators

Abnormal coactivation of knee and ankle extensors is related to changes in heteronymous spinal pathways after stroke

<p>Abstract</p> <p>Background</p> <p>Abnormal coactivation of leg extensors is often observed on the paretic side of stroke patients while they attempt to move. The mechanisms underlying this coactivation are not well understood. This study (1) compares the coactivation of leg extensors during static contractions in stroke and healthy individuals, and (2) assesses whether this coactivation is related to changes in intersegmental pathways between quadriceps and soleus (Sol) muscles after stroke.</p> <p>Methods</p> <p>Thirteen stroke patients and ten healthy individuals participated in the study. Levels of coactivation of knee extensors and ankle extensors were measured in sitting position, during two tasks: maximal isometric voluntary contractions in knee extension and in plantarflexion. The early facilitation and later inhibition of soleus voluntary EMG evoked by femoral nerve stimulation were assessed in the paretic leg of stroke participants and in one leg of healthy participants.</p> <p>Results</p> <p>Coactivation levels of ankle extensors (mean ± SEM: 56 ± 7% of Sol EMG max) and of knee extensors (52 ± 10% of vastus lateralis (VL) EMG max) during the knee extension and the ankle extension tasks respectively were significantly higher in the paretic leg of stroke participants than in healthy participants (26 ± 5% of Sol EMG max and 10 ± 3% of VL EMG max, respectively). Early heteronymous facilitation of Sol voluntary EMG in stroke participants (340 ± 62% of Sol unconditioned EMG) was significantly higher than in healthy participants (98 ± 34%). The later inhibition observed in all control participants was decreased in the paretic leg. Levels of coactivation of ankle extensors during the knee extension task were significantly correlated with both the increased facilitation (Pearson r = 0.59) and the reduced inhibition (r = 0.56) in the paretic leg. Measures of motor impairment were more consistently correlated with the levels of coactivation of biarticular muscles than those of monoarticular muscles.</p> <p>Conclusion</p> <p>These results suggest that the heteronymous pathways linking quadriceps to soleus may participate in the abnormal coactivation of knee and ankle extensors on the paretic side of stroke patients. The motor impairment of the paretic leg is strongly associated with the abnormal coactivation of biarticular muscles.</p

Bioinspired template-based control of legged locomotion

cient and robust locomotion is a crucial condition for the more extensive use of legged robots in real world applications. In that respect, robots can learn from animals, if the principles underlying locomotion in biological legged systems can be transferred to their artificial counterparts. However, legged locomotion in biological systems is a complex and not fully understood problem. A great progress to simplify understanding locomotion dynamics and control was made by introducing simple models, coined ``templates'', able to represent the overall dynamics of animal (including human) gaits. One of the most recognized models is the spring-loaded inverted pendulum (SLIP) which consists of a point mass atop a massless spring. This model provides a good description of human gaits, such as walking, hopping and running. Despite its high level of abstraction, it supported and inspired the development of successful legged robots and was used as explicit targets for control, over the years. Inspired from template models explaining biological locomotory systems and Raibert's pioneering legged robots, locomotion can be realized by basic subfunctions: (i) stance leg function, (ii) leg swinging and (iii) balancing. Combinations of these three subfunctions can generate different gaits with diverse properties. Using the template models, we investigate how locomotor subfunctions contribute to stabilize different gaits (hopping, running and walking) in different conditions (e.g., speeds). We show that such basic analysis on human locomotion using conceptual models can result in developing new methods in design and control of legged systems like humanoid robots and assistive devices (exoskeletons, orthoses and prostheses). This thesis comprises research in different disciplines: biomechanics, robotics and control. These disciplines are required to do human experiments and data analysis, modeling of locomotory systems, and implementation on robots and an exoskeleton. We benefited from facilities and experiments performed in the Lauflabor locomotion laboratory. Modeling includes two categories: conceptual (template-based, e.g. SLIP) models and detailed models (with segmented legs, masses/inertias). Using the BioBiped series of robots (and the detailed BioBiped MBS models; MBS stands for Multi-Body-System), we have implemented newly-developed design and control methods related to the concept of locomotor subfunctions on either MBS models or on the robot directly. In addition, with involvement in BALANCE project (\url{http://balance-fp7.eu/}), we implemented balance-related control approaches on an exoskeleton to demonstrate their performance in human walking. The outcomes of this research includes developing new conceptual models of legged locomotion, analysis of human locomotion based on the newly developed models following the locomotor subfunction trilogy, developing methods to benefit from the models in design and control of robots and exoskeletons. The main contribution of this work is providing a novel approach for modular control of legged locomotion. With this approach we can identify the relation between different locomotor subfunctions e.g., between balance and stance (using stance force for tuning balance control) or balance and swing (two joint hip muscles can support the swing leg control relating it to the upper body posture) and implement the concept of modular control based on locomotor subfunctions with a limited exchange of sensory information on several hardware platforms (legged robots, exoskeleton)

Towards Human-like Walking with Biomechanical and Neuromuscular Control Features: Personalized Attachment Point Optimization Method of Cable-Driven Exoskeleton

The cable-driven exoskeleton can avoid joint misalignment, and is substantial alterations in the pattern of muscle synergy coordination, which arouse more attention in recent years to facilitate exercise for older adults and improve their overall quality of life. This study leverages principles from neuroscience and biomechanical analysis to select attachment points for cable-driven soft exoskeletons. By extracting key features of human movement, the objective is to develop a subject-specific design methodology that provides precise and personalized support in the attachment points optimization of cable-driven exoskeleton to achieve natural gait, energy efficiency, and muscle coordination controllable in the domain of human mobility and rehabilitation. To achieve this, the study first analyzes human walking experimental data and extracts biomechanical features. These features are then used to generate trajectories, allowing better natural movement under complete cable-driven exoskeleton control. Next, a genetic algorithm-based method is employed to minimize energy consumption and optimize the attachment points of the cable-driven system. This process identifies connections that are better suited for the human model, leading to improved efficiency and natural movement. By comparing the calculated elderly human model driven by exoskeleton with experimental subject in terms of joint angles, joint torques and muscle forces, the human model can successfully replicate subject movement and the cable output forces can mimic human muscle coordination. The optimized cable attachment points facilitate more natural and efficient collaboration between humans and the exoskeleton, making significant contributions to the field of assisting the elderly in rehabilitation

THE INFLUENCE OF PASSIVE ANKLE JOINT POWER ON BALANCE RECOVERY

Over one–third of Americans over the age of 65 fall each year, costing more than $19 billion in health care costs in 2000. Many adults 65+ who have not experienced a fall still fear falling, and fear can decrease quality of life and increase the likelihood of falls. Several factors such as muscle strength, power, stiffness and tendon properties change in the human body with age affecting balance, which has been tagged as a fall risk predictor. Additionally, balance recovery strategies also differ between young and older adults, with young adults primarily utilizing their ankle joint and older adults utilizing their hip. The role of passive ankle joint power in balance recovery is unknown. Therefore, we conducted three studies. In Study 1, we investigated the role of passive ankle joint power in balance recovery of young subjects and tested if the contribution of passive power to net ankle joint power changed with perturbation speed. In Study 2, we explored the factor of age in the contribution of passive ankle joint power to net ankle joint power. In Study 3, we searched for a link between the contribution of passive ankle joint power to net ankle joint power and balance recovery strategy. Passive joint torque through the full range of motion was collected for each subject. Each subject performed 5 stepping tasks at two speeds, fast and slow. Joint kinematics and kinetics were collected for each trial. Inverse dynamics were performed and net ankle joint torque and net ankle joint work were computed. Passive ankle joint torque models were optimized for each subject, and passive ankle joint powers were determined. In Study 1, there appeared to be no difference in net or passive joint powers with respect to perturbation speed. In Study 2, age affected net ankle joint powers and passive uniarticular plantar- and dorsiflexor powers. In Study 3, we noted a change in balance recovery strategy between young and older adults. We were unable to predict balance recovery strategy index based off of the percent contribution of passive ankle joint work to net ankle joint work. These studies bring greater clarity to the role of passive ankle joint power with respect to balance recovery

Design and evaluation of a powered prosthetic foot with monoarticular and biarticular actuation

To overcome the limitations of passive prosthetic feet, powered prostheses have been developed, that can provide the range of motion and power of their human counterparts. These devices can equalize spatio-temporal gait parameters and improve the metabolic effort compared to passive prostheses, but asymmetries and compensatory motions between the healthy and impaired leg remain. Unlike their human counter part, existing powered prosthetic feet are fully monoarticular actuating only the prosthetic ankle joint, whereas in the biological counter part, ankle and knee joint are additionally coupled by the biarticular gastrocnemius muscle. The goal of this work is to investigate the benefits of a powered biarticular transtibial prosthesis comprising mono- and biarticular actuators similar to the human example. The contributions of the present work are as follows: A biarticular prosthesis prototype is methodically designed to match the capabilities of the monoarticular muscles at the human ankle joint as well as the biarticular gastrocnemius muscle during level walking. The prototype consists of an existing powered monoarticular prosthetic foot, which is extended with a knee orthoses and a stationary biarticular Bowden cable actuator. Both actuators are modeled as serial elastic actuators (SEA) and the identification of the model parameters is conducted. A model based torque control utilizing the measurements commonly available in SEAs, an impedance control law based on human ankle reference trajectories, and a high level control to enable steady walking in the lab are introduced. The proposed hardware setup and control structure can provide sagittal plane angles and torques similar to the mono- and biarticular muscles at the human ankle, with proper torque tracking performance and a freely adjustable allocation of torque between the monoarticular and biarticular actuator. The biarticular prosthesis is evaluated in the gait lab with three subjects with unilateral transtibial amputation utilizing a continuous sweep experimental protocol to investigate the metabolic effort and spatio-temporal gait parameters. All subjects show a tendency to reduced metabolic effort for medium activity of the artificial gastrocnemius, although noise level and time variation are large. In addition to the reduction in metabolic effort, the artificial gastrocnemius is able to influence spatio temporal gait parameters between the impaired and the intact side, but partially opposing effects are observed among the individual subjects. In conclusion, this thesis describes the implementation of an artificial gastrocnemius following the human example and the systematic investigation of metabolic effort and spatio-temporal gait parameters. It is shown that the addition of the artificial gastrocnemius to a monoarticular prosthesis can positively affect the investigated parameters. The meaningfulness of the results should be improved by increased clinical effort in future work