QUANTIFYING GAIT ADAPTABILITY: FRACTALITY, COMPLEXITY, AND STABILITY DURING ASYMMETRIC WALKING

Successful walking necessitates modifying locomotor patterns when encountering organism, task, or environmental constraints. The structure of stride-to-stride variance (fractal dynamics) may represent the adaptive capacity of the locomotor system. To date, however, fractal dynamics have been assessed during unperturbed walking. Quantifying gait adaptability requires tasks that compel locomotor patterns to adapt. The purpose of this dissertation was to determine the potential relationship between fractal dynamics and gait adaptability. The studies presented herein represent a necessary endeavor to incorporate both an analysis of gait fractal dynamics and a task requiring adaptation of locomotor patterns. The adaptation task involved walking asymmetrically on a split-belt treadmill, whereby individuals adapted the relative phasing between legs. This experimental design provided a better understanding of the prospective relationship between fractal dynamics and adaptive capacity. Results from the first study indicated there was no association between unperturbed walking fractal dynamics and gait adaptability in young, healthy adults. However, there was an emergent relationship between asymmetric walking fractal dynamics and gait adaptability. Moreover, fractal dynamics increased during asymmetric walking. The second study investigated fractal dynamics and gait adaptability in healthy, active young and older adults. The findings from study 2 showed no differences between young and older adults regarding unperturbed or asymmetric walking fractal dynamics, or gait adaptability performance. The second study provided further evidence for the lack of association between unperturbed fractal dynamics and gait adaptability. Furthermore, study 2 delivered additional support that asymmetric walking not only yields increased fractal scaling values, but also associates with adaptive gait performance in older adults. Finally, while the first two studies explored stride time monofractality during various walking tasks, the third study aimed to understand the potential multifractality, i.e. temporal evolution of fractal dynamics, of unperturbed and asymmetric walking. The results suggest that unperturbed walking is monofractal in nature, while more challenging asymmetric walking reveals multifractal characteristics, and that multifractality does not associate with adaptive gait performance. This dissertation provides preliminary evidence for the lack of relationship between gait adaptability and unperturbed fractal dynamics, and the emergent association between adaptive gait and asymmetric walking fractality

On the Effect of Walking Surface Stiffness on Inter-leg Coordination during Human Walking: a Unique Perspective to Robot-assisted Gait Rehabilitation

abstract: Millions of individuals suffer from gait impairments due to stroke or other neurological disorders. A primary goal of patients is to walk independently, but most patients only achieve a poor functional outcome five years after injury. Despite the growing interest in using robotic devices for rehabilitation of sensorimotor function, state-of-the-art robotic interventions in gait therapy have not resulted in improved outcomes when compared to traditional treadmill-based therapy. Because bipedal walking requires neural coupling and dynamic interactions between the legs, a fundamental understanding of the sensorimotor mechanisms of inter-leg coordination during walking is needed to inform robotic interventions in gait therapy. This dissertation presents a systematic exploration of sensorimotor mechanisms of inter-leg coordination by studying the effect of unilateral perturbations of the walking surface stiffness on contralateral muscle activation in healthy populations. An analysis of the contribution of several sensory modalities to the muscle activation of the opposite leg provides new insight into the sensorimotor control mechanisms utilized in human walking, including the role of supra-spinal neural circuits in inter-leg coordination. Based on these insights, a model is created which relates the unilateral deflection of the walking surface to the resulting neuromuscular activation in the opposite leg. Additionally, case studies with hemiplegic walkers indicate the existence of the observed mechanism in neurologically impaired walkers. The results of this dissertation suggest a novel approach to gait therapy for hemiplegic patients in which desired muscle activity is evoked in the impaired leg by only interacting with the healthy leg. One of the most significant advantages of this approach over current rehabilitation protocols is the safety of the patient since there is no direct manipulation of the impaired leg. Therefore, the methods and results presented in this dissertation represent a potential paradigm shift in robot-assisted gait therapy.Dissertation/ThesisDoctoral Dissertation Mechanical Engineering 201

The influence of peripheral neuropathy on walking kinematics and physical function

The 108th Congress (2005) has reported that 20 million U.S. citizens suffer from Peripheral Neuropathy (PN). Characterized by sensory nerve deterioration, PN reduces somatosensation (Padua et al., 2005) and increases the risk of fall-related injury (Richardson et al., 1992). The purpose of this dissertation was to provide insight into 1) the effects of acute loss of foot sole sensation on locomotor system health, 2) the effects of PN on locomotor system health, and 3) the underlying impairments associated with reduced physical function within the older adult and PN populations. Locomotor system health was assessed by the magnitude of stride-to-stride variability and local instability contained in the kinematics of treadmill walking. In healthy young adults, ice-induced reduction of foot sole sensation did not alter the magnitude of stride-to-stride variability during treadmill walking. It did, however, increase lower-extremity joint local instability, or the sensitivity to small scale perturbations. Compared to controls, individuals with PN walked with similar local instability yet increased variability, at relatively slow speeds. When walking at relatively fast speeds, individuals with PN exhibited exaggerated increases in local instability. In healthy older adults, locomotion-based physical function (LBPF), as defined by 6-minute walk and Timed Up-and-Go performance, was correlated to leg strength and measures of locomotor system health. However, only measures of locomotor system health provided independent predictive information of LBPF. The PN group exhibited reduced LBPF. As opposed to healthy old adults, correlates of LBPF were not leg strength but instead standing balance variables. Multiple variables of leg strength, standing balance, and locomotor system health provided independently predictive information regarding each test of LBPF. The opposing effects of ice-induced reduction in foot sole sensation and PN on locomotor system health suggest that the chronic nature of PN allows for the implementation of partially effective compensatory strategies. Yet, the inability to adapt to relatively fast speeds suggests that falls likely occur during challenging situations. The fundamentally different correlates and predictors of LBPF between older adults and those with PN highlight the uniqueness of the movement disorder associated with PN

Functional Resistance Training During Walking: Design, Testing, and Evaluation of Passive and Semi-Passive Wearable Devices for Providing Targeted Resistance to the Leg During Gait

Injuries to the neuromusculoskeletal systems often result in muscle weakness, abnormal coordination strategies, and gait impairments. Functional resistance training during walking—where a patient walks while a device increases loading on the leg—is an emerging approach to combat these symptoms. While simple passive devices (i.e., ankle weights and resistance bands) can be applied for this training, rehabilitation robots have more potential upside because they can be controlled to treat multiple gait abnormalities and can be monitored by clinicians. However, the cost of conventional robotic devices limits their use in the clinical or home setting. Hence, in this dissertation, we designed, developed, and tested passive and semi-passive wearable exoskeleton devices as low-cost solutions for providing controllable/configurable functional resistance training during walking. We developed and tested two passive exoskeleton devices for providing resistance to walking and tested their effects on able-bodied participants and stroke survivors. First, we created a patented device that used a passive magnetic brake to provide a viscous (i.e., velocity-dependent) resistance to the knee. The resistive properties of the device could be placed under computer control (i.e., made semi-passive) to control resistance in real-time. Next, we created a passive exoskeleton that provided an elastic (i.e., position-dependent) resistance. While not controllable, this device was highly configurable. Meaning it could be used to provide resistance to joint flexion, extension, or to both (i.e., bidirectionally). Human subjects testing with these devices indicated they increased lower-extremity joint moments, powers, and muscle activation during training. Training also resulted in significant aftereffects—a potential indicator of therapeutic effectiveness—once the resistance was removed. A separate experiment indicated that individuals often kinematically slack (i.e., reduce joint excursions to minimize effort) when resistance is added to the limb. We also found that providing visual feedback of joint angles during training significantly increased muscle activation and kinematic aftereffects (i.e., reduced slacking). With passive devices, the type of passive element used largely dictates the muscle groups, types of muscle contraction, joint actions, and the phases of gait when a device is able to apply resistance. To examine this issue, we compared the training effects of viscous and elastic devices that provided bidirectional resistance to the knee during gait. Additionally, we compared training with viscous resistances at the hip and knee joints. While the resistance type and targeted joint altered moments, powers, and muscle activation patterns, these methods did not differ in their ability to produce aftereffects, alter neural excitability, or induce fatigue in the leg muscles. While this may indicate that the resistance type does not have a large effect on functional resistance training during walking, it is possible that an extended training with these devices could produce a different result. Lastly, we used musculoskeletal modeling in OpenSim to directly compare several strategies that have been used to provide functional resistance training to gait in the clinic or laboratory setting. We found that devices differed in their ability to alter gait parameters during walking. Hence, these findings could help clinicians when selecting a resistive strategy for their patients, or engineers when designing new devices or control schemes. Collectively, this dissertation introduces a new class of wearable devices for functional resistance training during walking and establishes the biomechanical and neurophysiological effects and the clinical potential of these devices in able-bodied and stroke survivors.PHDBiomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/169867/1/epwiv_1.pd

The effects of peripheral nerve impairments on postural control and mobility among people with peripheral neuropathy

Approximately 20 million Americans are suffering Peripheral Neuropathy (PN). It is estimated that the prevalence of all-cause PN is about 2.4% in the entire adult population, whereas over 8-10% in the population segment over the age of 55 (Martyn & Hughes, 1997). Peripheral Neuropathy leads to a high risk of falling, resulting from the deficits of postural control caused by the impaired peripheral nerves, especially the degenerative somatosensory system. To date, there is no effective medical treatment for the disease but pain managements. The deficits of postural control decrease the life quality of this population. The degeneration of peripheral nerves reduces sensory inputs from the somatosensory system to central nervous system via spinal reflexive loop, which should provide valuable real-time information for balance correction. Therefore, it is necessary to investigate how PN affects the somatosensory system regarding postural control. Besides that, people with PN may develop a compensatory mechanism which could be reinforced by exercise training, ultimately to improve balance and mobility in their daily life. The neuroplasticity may occur within somatosensory system by relying on relative intact sensory resources. Hence, unveiling the compensatory mechanism in people with PN may help in understanding (a) essential sensations or function of peripheral nerves to postural control, (b) effective strategy of physical treatments for people with PN, and (c) task-dependent sensory information requirements. Therefore, this dissertation discussed the roles of foot sole sensation, ankle proprioception, and stretch reflex on balance as well as gait among people with PN. Furthermore, the discussion of the coupling between small and large afferent reflexive loops may spot the compensatory mechanism in people with PN

Robotics 2010

Without a doubt, robotics has made an incredible progress over the last decades. The vision of developing, designing and creating technical systems that help humans to achieve hard and complex tasks, has intelligently led to an incredible variety of solutions. There are barely technical fields that could exhibit more interdisciplinary interconnections like robotics. This fact is generated by highly complex challenges imposed by robotic systems, especially the requirement on intelligent and autonomous operation. This book tries to give an insight into the evolutionary process that takes place in robotics. It provides articles covering a wide range of this exciting area. The progress of technical challenges and concepts may illuminate the relationship between developments that seem to be completely different at first sight. The robotics remains an exciting scientific and engineering field. The community looks optimistically ahead and also looks forward for the future challenges and new development

Simulation And Control At the Boundaries Between Humans And Assistive Robots

Human-machine interaction has become an important area of research as progress is made in the fields of rehabilitation robotics, powered prostheses, and advanced exercise machines. Adding to the advances in this area, a novel controller for a powered transfemoral prosthesis is introduced that requires limited tuning and explicitly considers energy regeneration. Results from a trial conducted with an individual with an amputation show self-powering operation for the prosthesis while concurrently attaining basic gait fidelity across varied walking speeds. Experience in prosthesis development revealed that, though every effort is made to ensure the safety of the human subject, limited testing of such devices prior to human trials can be completed in the current research environment. Two complementary alternatives are developed to fill that gap. First, the feasibility of implementing impulse-momentum sliding mode control on a robot that can physically replace a human with a transfemoral amputation to emulate weight-bearing for initial prototype walking tests is established. Second, a more general human simulation approach is proposed that can be used in any of the aforementioned human-machine interaction fields. Seeking this general human simulation method, a unique pair of solutions for simulating a Hill muscle-actuated linkage system is formulated. These include using the Lyapunov-based backstepping control method to generate a closed-loop tracking simulation and, motivated by limitations observed in backstepping, an optimal control solver based on differential flatness and sum of squares polynomials in support of receding horizon controlled (e.g. model predictive control) or open-loop simulations. v The backstepping framework provides insight into muscle redundancy resolution. The optimal control framework uses this insight to produce a computationally efficient approach to musculoskeletal system modeling. A simulation of a human arm is evaluated in both structures. Strong tracking performance is achieved in the backstepping case. An exercise optimization application using the optimal control solver showcases the computational benefits of the solver and reveals the feasibility of finding trajectories for human-exercise machine interaction that can isolate a muscle of interest for strengthening

Neuromuscular Control Strategy during Object Transport while Walking: Adaptive Integration of Upper and Lower Limb Movements

When carrying an object while walking, a significant challenge for the central nervous system (CNS) is to preserve the object’s stability against the inter-segmental interaction torques and ground reaction forces. Studies documented several strategies used by the CNS: modulation of grip force (GF), alterations in upper limb kinematics, and gait adaptations. However, the question of how the CNS organizes the multi-segmental joint and muscle coordination patterns to deal with gait-induced perturbations remains poorly understood. This dissertation aimed to explore the neuromuscular control strategy utilized by the CNS to transport an object during walking successfully. Study 1 examined the inter-limb coordination patterns of the upper limbs when carrying a cylinder-shaped object while walking on a treadmill. It was predicted that transporting an object in one hand would affect the movement pattern of the contralateral arm to maintain the overall angular momentum. The results showed that transporting an object caused a decreased anti-phase coordination, but it did not induce significant kinematic and muscle activation changes in the unconstrained arm. Study 2 examined muscle synergy patterns for upper limb damping behavior by using non-negative matrix factorization (NNMF) method. Four synergies were identified, showing a proximal-to-distal pattern of activation preceding heel contacts. Study 3 examined the effect of different precision demands (carrying a cup with or without a ball) and altered visual information (looking forward vs. looking at an object) on the upper limb damping behavior and muscle synergies. Increasing precision demand induced stronger damping behavior and increased the electromyography (EMG) activation of wrist/hand flexors and extensors. The NNMF results replicated Study 2 in that the stabilization of proximal joints occurred before the distal joints. The results indicated that the damping incorporates tonic and phasic muscle activation to ensure object stabilization. Overall, three experiments showed that the CNS adopts a similar synergy pattern regardless of task constraint or altered gaze direction while modulating the amount of muscle activation for object stabilization. Kinematic changes can differ depending on the different levels of constraint, as shown in the smaller movement amplitude of the shoulder joint in the transverse plane during the task with higher precision demand

ASSESSMENT OF REACTIVE BALANCE RESPONSES DURING WALKING IN ADULTS WITH CEREBRAL PALSY

People with cerebral palsy commonly experience balance deficits in walking. In adulthood, many experience a decline in walking and balance, which increases their falls risk and disability. When loss of balance occurs, effective reactive balance responses ¬ — quick body realignment and change in base of support — are essential to balance recovery. Reactive balance responses to unpredicted balance perturbations have been studied in different populations with balance deficits. Evidence suggests that reactive balance training improves the ability to recover balance and walking related outcomes and can lead to a reduction in falls risk. Reactive balance responses to balance perturbation during walking have not been previously assessed in adults with CP (ACP) and the relationships of these responses to known deficits of balance and walking have not been established. Identifying such relationships could facilitate assessment of falls risk and guide intervention research. The goals of this project were to (1) assess the test-retest reliability of clinical measures of balance and walking in ACP, (2) describe the differences between reactive balance responses to perturbations during treadmill walking of ACP and adults without disabilities (AWD), and compare the changes in responses following repeated exposure to balance perturbation between the two groups, and (3) assess the relationships between measures of reactive balance responses and clinical measures of balance and walking in ACP. Results: Most clinical measures demonstrated good to excellent test-retest reliability and were sufficiently sensitive in capturing the broad range of balance deficits of ACP. Compared with AWD, the walking of ACP was more disturbed by balance perturbations, and they required more steps to return to regular walking. Both AWD and ACP improved reactive balance responses following repeated exposure. The measured responses had moderate correlations with several clinical measures of balance, walking and falls count which suggested that adding measures of reactive balance responses during walking would provide a more comprehensive evaluation of mobility-related balance. Further research is needed to develop clinical assessment of reactive balance responses during walking and evaluate the ability of reactive balance training to improve balance and walking and reduce falls risk in ACP.Doctor of Philosoph