Optimal locations and computational frameworks of FSR and IMU sensors for measuring gait abnormalities

Neuromuscular diseases cause abnormal joint movements and drastically alter gait patterns in patients. The analysis of abnormal gait patterns can provide clinicians with an in-depth insight into implementing appropriate rehabilitation therapies. Wearable sensors are used to measure the gait patterns of neuromuscular patients due to their non-invasive and cost-efficient characteristics. FSR and IMU sensors are the most popular and efficient options. When assessing abnormal gait patterns, it is important to determine the optimal locations of FSRs and IMUs on the human body, along with their computational framework. The gait abnormalities of different types and the gait analysis systems based on IMUs and FSRs have therefore been investigated. After studying a variety of research articles, the optimal locations of the FSR and IMU sensors were determined by analysing the main pressure points under the feet and prime anatomical locations on the human body. A total of seven locations (the big toe, heel, first, third, and fifth metatarsals, as well as two close to the medial arch) can be used to measure gate cycles for normal and flat feet. It has been found that IMU sensors can be placed in four standard anatomical locations (the feet, shank, thigh, and pelvis). A section on computational analysis is included to illustrate how data from the FSR and IMU sensors are processed. Sensor data is typically sampled at 100 Hz, and wireless systems use a range of microcontrollers to capture and transmit the signals. The findings reported in this article are expected to help develop efficient and cost-effective gait analysis systems by using an optimal number of FSRs and IMUs

Assessing Walking Strategies Using Insole Pressure Sensors for Stroke Survivors

Insole pressure sensors capture the different forces exercised over the different parts of the sole when performing tasks standing up such as walking. Using data analysis and machine learning techniques, common patterns and strategies from different users to achieve different tasks can be automatically extracted. In this paper, we present the results obtained for the automatic detection of different strategies used by stroke survivors when walking as integrated into an Information Communication Technology (ICT) enhanced Personalised Self-Management Rehabilitation System (PSMrS) for stroke rehabilitation. Fourteen stroke survivors and 10 healthy controls have participated in the experiment by walking six times a distance from chair to chair of approximately 10 m long. The Rivermead Mobility Index was used to assess the functional ability of each individual in the stroke survivor group. Several walking strategies are studied based on data gathered from insole pressure sensors and patterns found in stroke survivor patients are compared with average patterns found in healthy control users. A mechanism to automatically estimate a mobility index based on the similarity of the pressure patterns to a stereotyped stride is also used. Both data gathered from stroke survivors and healthy controls are used to evaluate the proposed mechanisms. The output of trained algorithms is applied to the PSMrS system to provide feedback on gait quality enabling stroke survivors to self-manage their rehabilitation

Technology assisted screening and balance training systems for stroke patients

by Deepesh KumarPh.D

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

Treadmill training augmented with real-time visualisation feedback and function electrical stimulation for gait rehabilitation after stroke : a feasibility study

Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery.Motor rehabilitation typically requires patients to perform task-specific training, in which biofeedback can be instrumental for encouraging neuroplasticity after stroke. Treadmill training augmented with real-time visual feedback and functional electrical stimulation (FES) may have a beneficial synergistic effect on this process. This study aims to develop a multi-channel FES (MFES) system with stimulation triggers based on the phase of gait cycle, determined using a 3D motion capture system. A feasibility study was conducted to determine whether this enhanced treadmill gait training systemis suitable for stroke survivors in clinical practice. The real-time biomechanical visual feedback system with computerised MFES was developed using six motion-capture cameras installed around a treadmill.;This system was designed to stimulate the pretibial muscle for correcting foot drop problems, gastro-soleus for facilitating push-off, and quadriceps and hamstring for improving knee stability. Dynamic avatar movement and step length/ratio were displayed on a monitor, providing patients with real-time visual biofeedback. Participants received up to 20 minutes of enhanced treadmill training once or twice per week for 6 weeks. Training programme, pre- and post-training ability, and adverse events of each participant were recorded. Feedback was also collected from participants and physiotherapists regarding their experience. Eight out of ten participants fully completed their programme.;In total, 67 training sessions were carried out. All participants had a good attendance rate. The number and duration of training sessions ranged from 5 to 20, and 11 to 20 minutes, respectively. The MFES system successfully improved gait patterns during training, and feedback from participants and physiotherapists regarding their experience of the research intervention was overwhelmingly positive. In conclusion, this enhanced treadmill gait training system is feasible for use in gait rehabilitation after stroke. However, a well-designed clinical trial with a larger sample size is needed to determine clinical efficacy on gait recovery

Fifteen years of wireless sensors for balance assessment in neurological disorders

Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined

DEVELOPMENT AND EVALUATION OF A NOVEL OVER-GROUND WALKING DEVICE: A ROBOTIC WALKER

Ph.DDOCTOR OF PHILOSOPH

Neuroimaging of human motor control in real world scenarios: from lab to urban environment

The main goal of this research programme was to explore the neurophysiological correlates of human motor control in real-world scenarios and define mechanism-specific markers that could eventually be employed as targets of novel neurorehabilitation practice. As a result of recent developments in mobile technologies it is now possible to observe subjects' behaviour and monitor neurophysiological activity whilst they perform natural activities freely. Investigations in real-world scenarios would shed new light on mechanisms of human motor control previously not observed in laboratory settings and how they could be exploited to improve rehabilitative interventions for the neurologically impaired. This research programme was focussed on identifying cortical mechanisms involved in both upper- (i.e. reaching) and lower-limb (i.e. locomotion) motor control. Complementary results were obtained by the simultaneous recordings of kinematic, electromyographic and electrocorticographic signals. To study motor control of the upper-limb, a lab­based setup was developed, and the reaching movement of healthy young individuals was observed in both stable and unstable (i.e. external perturbation) situations. Robot-mediated force-field adaptation has the potential to be employed in rehabilitation practice to promote new skills learning and motor recovery. The muscular (i.e. intermuscular couplings) and neural (i.e. spontaneous oscillations and cortico­muscular couplings) indicators of the undergoing adaptation process were all symbolic of adaptive strategies employed during early stages of adaptation. The medial frontal, premotor and supplementary motor regions appeared to be the principal cortical regions promoting adaptive control and force modulation. To study locomotion control, a mobile setup was developed and daily life human activities (i.e. walking while conversing, walking while texting with a smartphone) were investigated outside the lab. Walking in hazardous environments or when simultaneously performing a secondary task has been demonstrated to be challenging for the neurologically impaired. Healthy young adults showed a reduced motor performance when walking in multitasking conditions, during which whole-brain and task-specific neural correlates were observed. Interestingly, the activity of the left posterior parietal cortex was predictive of the level of gait stability across individuals, suggesting a crucial role of this area in gait control and determination of subject specific motor capabilities. In summary, this research programme provided evidence on different cortical mechanisms operative during two specific scenarios for "real­world" motor behaviour in and outside the laboratory-setting in healthy subjects. The results suggested that identification of neuro-muscular indicators of specific motor control mechanisms could be exploited in future "real-world" rehabilitative practice

Human Gait Model Development for Objective Analysis of Pre/Post Gait Characteristics Following Lumbar Spine Surgery

Although multiple advanced tools and methods are available for gait analysis, the gait and its related disorders are usually assessed by visual inspection in the clinical environment. This thesis aims to introduce a gait analysis system that provides an objective method for gait evaluation in clinics and overcomes the limitations of the current gait analysis systems. Early identification of foot drop, a common gait disorder, would become possible using the proposed methodology