Injury Risk Estimation Expertise: Interdisciplinary Differences in Performance on the ACL Injury Risk Estimation Quiz

Background: Simple observational assessment of movement is a potentially low-cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many individuals utilize some form of observational assessment of movement, there are currently no substantial data on group skill differences in observational screening of ACL injury risk. Purpose/Hypothesis: The purpose of this study was to compare various groups’ abilities to visually assess ACL injury risk as well as the associated strategies and ACL knowledge levels. The hypothesis was that sports medicine professionals would perform better than coaches and exercise science academics/students and that these subgroups would all perform better than parents and other general population members. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 428 individuals, including physicians, physical therapists, athletic trainers, strength and conditioning coaches, exercise science researchers/students, athletes, parents, and members of the general public participated in the study. Participants completed the ACL Injury Risk Estimation Quiz (ACL-IQ) and answered questions related to assessment strategy and ACL knowledge. Results: Strength and conditioning coaches, athletic trainers, physical therapists, and exercise science students exhibited consistently superior ACL injury risk estimation ability (þ2 SD) as compared with sport coaches, parents of athletes, and members of the general public. The performance of a substantial number of individuals in the exercise sciences/sports medicines (approximately 40%) was similar to or exceeded clinical instrument-based biomechanical assessment methods (eg, ACL nomogram). Parents, sport coaches, and the general public had lower ACL-IQ, likely due to their lower ACL knowledge and to rating the importance of knee/thigh motion lower and weight and jump height higher. Conclusion: Substantial cross-professional/group differences in visual ACL injury risk estimation exist. The relatively profound differences in injury risk estimation accuracy and their potential implications for risk screening suggest the need for additional training and outreach

Design of an Elastic Actuation System for a Gait-Assistive Active Orthosis for Incomplete Spinal Cord Injured Subjects

A spinal cord injury severely reduces the quality of life of affected people. Following the injury, limitations of the ability to move may occur due to the disruption of the motor and sensory functions of the nervous system depending on the severity of the lesion. An active stance-control knee-ankle-foot orthosis was developed and tested in earlier works to aid incomplete SCI subjects by increasing their mobility and independence. This thesis aims at the incorporation of elastic actuation into the active orthosis to utilise advantages of the compliant system regarding efficiency and human-robot interaction as well as the reproduction of the phyisological compliance of the human joints. Therefore, a model-based procedure is adapted to the design of an elastic actuation system for a gait-assisitve active orthosis. A determination of the optimal structure and parameters is undertaken via optimisation of models representing compliant actuators with increasing level of detail. The minimisation of the energy calculated from the positive amount of power or from the absolute power of the actuator generating one human-like gait cycle yields an optimal series stiffness, which is similar to the physiological stiffness of the human knee during the stance phase. Including efficiency factors for components, especially the consideration of the electric model of an electric motor yields additional information. A human-like gait cycle contains high torque and low velocities in the stance phase and lower torque combined with high velocities during the swing. Hence, the efficiency of an electric motor with a gear unit is only high in one of the phases. This yields a conceptual design of a series elastic actuator with locking of the actuator position during the stance phase. The locked position combined with the series compliance allows a reproduction of the characteristics of the human gait cycle during the stance phase. Unlocking the actuator position for the swing phase enables the selection of an optimal gear ratio to maximise the recuperable energy. To evaluate the developed concept, a laboratory specimen based on an electric motor, a harmonic drive gearbox, a torsional series spring and an electromagnetic brake is designed and appropriate components are selected. A control strategy, based on impedance control, is investigated and extended with a finite state machine to activate the locking mechanism. The control scheme and the laboratory specimen are implemented at a test bench, modelling the foot and shank as a pendulum articulated at the knee. An identification of parameters yields high and nonlinear friction as a problem of the system, which reduces the energy efficiency of the system and requires appropriate compensation. A comparison between direct and elastic actuation shows similar results for both systems at the test bench, showing that the increased complexity due to the second degree of freedom and the elastic behaviour of the actuator is treated properly. The final proof of concept requires the implementation at the active orthosis to emulate uncertainties and variations occurring during the human gait

Proprioception and reaction for walking among entanglements

Entanglements like vines and branches in natural settings or cords and pipes in human spaces prevent mobile robots from accessing many environments. Legged robots should be effective in these settings, and more so than wheeled or tracked platforms, but naive controllers quickly become entangled and stuck. In this paper we present a method for proprioception aimed specifically at the task of sensing entanglements of a robot's legs as well as a reaction strategy to disentangle legs during their swing phase as they advance to their next foothold. We demonstrate our proprioception and reaction strategy enables traversal of entanglements of many stiffnesses and geometries succeeding in 14 out of 16 trials in laboratory tests, as well as a natural outdoor environment.Comment: Submitted to 2023 IEEE/RSJ International Conference on Intelligent Robots and System

Tele-impedance based assistive control for a compliant knee exoskeleton

This paper presents a tele-impedance based assistive control scheme for a knee exoskeleton device. The proposed controller captures the user’s intent to generate task-related assistive torques by means of the exoskeleton in different phases of the subject’s normal activity. To do so, a detailed musculoskeletal model of the human knee is developed and experimentally calibrated to best match the user’s kinematic and dynamic behavior. Three dominant antagonistic muscle pairs are used in our model, in which electromyography (EMG) signals are acquired, processed and used for the estimation of the knee joint torque, trajectory and the stiffness trend, in real time. The estimated stiffness trend is then scaled and mapped to a task-related stiffness interval to agree with the desired degree of assistance. The desired stiffness and equilibrium trajectories are then tracked by the exoskeleton’s impedance controller. As a consequence, while minimum muscular activity corresponds to low stiffness, i.e. highly transparent motion, higher co-contractions result in a stiffer joint and a greater level of assistance. To evaluate the robustness of the proposed technique, a study of the dynamics of the human–exoskeleton system is conducted, while the stability in the steady state and transient condition is investigated. In addition, experimental results of standing-up and sitting-down tasks are demonstrated to further investigate the capabilities of the controller. The results indicate that the compliant knee exoskeleton, incorporating the proposed tele-impedance controller, can effectively generate assistive actions that are volitionally and intuitively controlled by the user’s muscle activity

Cross-professional differences in real-time assessment of ACL injury risk

Simple visual inspection of movement is a potentially low cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many professionals, athletes, and coaches utilize some form of visual inspection of movement/injury risk, there is currently no substantial data on group skill differences. Sports medicine professionals, exercise science students/academics, and strength and conditioning coaches exhibited consistently superior ACL injury risk estimation skill compared to sport coaches, parents of athletes and the general public (about 2 standard deviations). In addition, many individuals’ visual risk assessment accuracy was similar to or exceeded clinical instrument-based biomechanical assessment methods (i.e., ACL nomogram). Perceptual-cognitive mechanisms are discussed

Non-invasive computer-assisted measurement of knee alignment

The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1° larger than for the rigid model with statistically similar variance (p=0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost ±1°, with up to ±0.5° loss of repeatability for coronal alignment measured before and after stress maneuvers, and a ±0.2° loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were ±1.6° and ±2.3°, respectively. Varus and valgus stress measurements agreed to within ±1.3° and ±1.1°, respectively. Agreement limits for standing MFT angles were ±2.9° (coronal) and ±5.0° (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs

Possibilities of Articular Cartilage Quantification Based on High-Frequency Ultrasound Scans and Ultrasound Palpation

In der Diagnostik und Reparatur von hyalinem Gelenkknorpel sind neue Methoden zur Quantifizierung von Struktur und mechanischer Belastbarkeit gefragt, um die Behandlung von Knorpelschäden an Millionen von Patienten weltweit zu verbessern. Mittels hochfrequentem, fokussierten Ultraschall werden Oberflächenparameter für Reflektivität und Rauheit an Gelenkknorpel bestimmt. Es wird gezeigt wie die Oberflächenneigung kontrolliert werden kann. Die Ergebnisse vermitteln ein besseres Verständnis über die Zusammensetzung der Ultraschallsignale aus reflektierten und gestreuten Komponenten. 3D Ultraschallscans von Knorpelregeneraten erlauben die Defektstellen volumetrisch zu Quantifizieren. Die Proben wurden zusätzlich nach etablierten Bewertungssystemen benotet, welche auf makroskopischer Beurteilungen, MRT-Scans und Histologie basieren. Die ultraschallbasierten Volumendaten zeigten dabei gute Korrelationen mit den Punktwertungen. Die im Labor verwendeten Messaufbauten zur biomechanischen Charakterisierung von Gelenkknorpel können am Patienten nicht angewandt werden. Daher können Ärzte die Festigkeit von Knorpel bisher nur mittels manueller Palpation abschätzen. Diese Arbeit entwickelt eine Methode der Ultraschall-Palpation (USP), die es erlaubt, die während der manuellen Palpation erzeugte Kraft und Deformation, basierend auf Ultraschallechos, aufzunehmen. Es wurde einen Prototyp entwickelt womit gezeigt werden konnte, dass USP eine ausreichende Genauigkeit und Reproduzierbarkeit aufweist. Wiederholte Messungen können zusätzlich zeitabhängige biomechanische Parameter von Knorpel ableiten. Zusammenfassend zeigt diese Arbeit verbesserte und neue Möglichkeiten zur strukturellen und biomechanischen Charakterisierung von hyalinem Gelenkknorpel bzw. den Ergebnissen von Knorpelreparatur basierend auf Ultraschalldaten. Diese Methoden haben das Potenzial die Diagnostik von Gelenkknorpel und die Quantifizierung von Knorpelreparatur zu verbessern.In the diagnostics and repair of hyaline articular cartilage, new methods to quantify structure and mechanical capacity are required to improve the treatment of cartilage defects for millions of patients worldwide. This thesis uses high frequency focused ultrasound to derive surface parameters for reflectivity and roughness from articular cartilage. It is shown how to control the inclination dependency to gain more reliable results. Furthermore, the results provided a better understanding of the composition of ultrasonic signals from reflected and scattered components. 3D ultrasound scans of cartilage repair tissue were performed to quantify defect sites after cartilage repair volumetrically. The samples were also graded according to established scoring systems based on macroscopic evaluation, MRI scans and histology. The ultrasound-based volumetric parameters showed good correlation with these scores. Complex biomechanical measurement setups used in laboratories cannot be applied to the patient. Therefore, currently physicians have to estimate the stiffness of cartilage by means of manual palpation. In the last part of this thesis, a method denoted as ultrasound palpation is developed, which allows for measuring the applied force and strain during manual palpation in real time, solely based on the evaluation of the time of flight of ultrasound pulses. A prototype was developed and its measurement accuracy and reproducibility were characterized. It could be shown that ultrasound palpation has sufficient accuracy and reproducibility. Additionally, by repeated measurements it was possible to derive time-dependent biomechanical parameters of cartilage. In summary, this work shows improved and new possibilities for structural and biomechanical characterization of hyaline articular cartilage and the outcomes of cartilage repair based on ultrasound data. The methods have the potential to improve the diagnostics of articular cartilage and quantification of its repair

Neural network based patient recovery estimation of a PAM-based rehabilitation robot

Rehabilitation robots have shown a promise in aiding patient recovery by supporting them in repetitive, systematic training sessions. A critical factor in the success of such training is the patient’s recovery progress, which can guide suitable treatment plans and reduce recovery time. In this study, a neural network-based approach is proposed to estimate the patient’s recovery, which can aid in the development of an assist-as-needed training strategy for the gait training system. Experimental results show that the proposed method can accurately estimate the external torques generated by the patient to determine their recovery. The estimated patient recovery is used for an impedance control of a 2-DOF robotic orthosis powered by pneumatic artificial muscles, which improves the robot joint compliance coefficients and makes the patient more comfortable and confident during rehabilitation exercises