Sensorized Tip for Monitoring People with Multiple Sclerosis that Require Assistive Devices for Walking

Multiple Sclerosis (MS) is a neurological degenerative disease with high impact on our society. In order to mitigate its effects, proper rehabilitation therapy is mandatory, in which individualisation is a key factor. Technological solutions can provide the information required for this purpose, by monitoring patients and extracting relevant indicators. In this work, a novel Sensorized Tip is proposed for monitoring People with Multiple Sclerosis (PwMS) that require Assistive Devices for Walking (ADW) such as canes or crutches. The developed Sensorized Tip can be adapted to the personal ADW of each patient to reduce its impact, and provides sensor data while naturally walking in the everyday activities. This data that can be processed to obtain relevant indicators that helps assessing the status of the patient. Different from other approaches, a full validation of the proposed processing algorithms is carried out in this work, and a preliminary study-case is carried out with PwMS considering a set of indicators obtained from the Sensorized Tip’s processed data. Results of the preliminary study-case demonstrate the potential of the device to monitor and characterise patient status

Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study

Introduction: Tuning the control parameters is one of the main challenges in robotic gait therapy. Control strategies that vary the control parameters based on the user’s performance are still scarce and do not exploit the potential of using spatiotemporal metrics. The goal of this study was to validate the feasibility of using shank-worn Inertial Measurement Units (IMUs) for clinical gait analysis after stroke and evaluate their preliminary applicability in designing an automatic and adaptive controller for a knee exoskeleton (ABLE-KS). Methods: First, we estimated the temporal (i.e., stride time, stance, and swing duration) and spatial (i.e., stride length, maximum vertical displacement, foot clearance, and circumduction) metrics in six post-stroke participants while walking on a treadmill and overground and compared these estimates with data from an optical motion tracking system. Next, we analyzed the relationships between the IMU-estimated metrics and an exoskeleton control parameter related to the peak knee flexion torque. Finally, we trained two machine learning algorithms, i.e., linear regression and neural network, to model the relationship between the exoskeleton torque and maximum vertical displacement, which was the metric that showed the strongest correlations with the data from the optical system [r = 0.84; ICC(A,1) = 0.73; ICC(C,1) = 0.81] and peak knee flexion torque (r = 0.957). Results: Offline validation of both neural network and linear regression models showed good predictions (R2 = 0.70–0.80; MAE = 0.48–0.58 Nm) of the peak torque based on the maximum vertical displacement metric for the participants with better gait function, i.e., gait speed > 0.7 m/s. For the participants with worse gait function, both models failed to provide good predictions (R2 = 0.00–0.19; MAE = 1.15–1.29 Nm) of the peak torque despite having a moderate-to-strong correlation between the spatiotemporal metric and control parameter. Discussion: Our preliminary results indicate that the stride-by-stride estimations of shank-worn IMUs show potential to design automatic and adaptive exoskeleton control strategies for people with moderate impairments in gait function due to stroke.Peer ReviewedPostprint (published version

Projeto do sistema de controle de um exoesqueleto do membro inferior direito

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Mecânica, 2017.Nesta pesquisa o modelo de um exoesqueleto do membro inferior direita para melhorar a mobilidade do usuário e seu sistema de controle foram desenvolvidos. O projeto físico do modelo do exoesqueleto consiste em três partes principais: um quadril e a parte superior e inferior da perna conectados um com o outro por juntas revolutas. Cada uma das juntas é atuado por um motor Brushless DC (BLDC) com caixa de redução para aumentar torque. Os motores a serem usados na construção possuem sensores de velocidade e de posição para fornecer os dados necessários para o sistema de controle. Solidworks Computer Aided Design (CAD) software é usado para desenvolver o modelo do exoesqueleto, que é salvo em formato extensible markup language (XML) para depois ser importado em Simmechanics, permitindo a integração de modelos de corpos físicos com componentes de Simulink. A cinemática inversa do exoesqueleto é desenvolvido e projetado em Very high speed integrated circuit Hardware Description Language (VHDL) usando aritmética em ponto flutuante para ser executado a partir de um dispositivo Field Programmable Gate Array (FPGA). Quatro representações diferentes do projeto de hardware do modelo cinematico do exoesqueleto foram desenvolvidos fazendo análise de erro com Mean Square Error (MSE) e Average Relative Error (ARE). Análise de trade-off de desempenho e área em FPGA é feito. A estratégia de controle Proportional-Integrative-Derivative (PID) é escolhido para desenvolver o sistema de controle do exoesqueleto por ser relativamente simples e eficiente para desenvolver e por ser amplamente usado em muitas áreas de aplicação. Duas estratégias de sistemas de controle combinado de posiçaõ e velocidade são desenvolvidos e comparados um com o outro. Cada sistema de controle consiste em dois controladores de velocidade e dois de posição. Os parâmetros PID são calculados usando os métodos de sintonização Ziegler-Nichols e Particle Swarm Optimization (PSO). PSO é um método de sintonização relativamente simples porém eficiente que é aplicado em muitos problemas de otimização. PSO é baseado no comportamento supostamente inteligente de cardumes de peixes e bandos de aves em procura de alimento. O algoritmo, junto com o método Ziegler-Nichols, é usado para achar parâmetros PID apropriados para os blocos de controle nas duas estratégias te controle desenvolvidos. A resposta do sistema de controle é avaliada, analisando a resposta a um step input. Simulação da marcha humana é também feito nos dois modelos de sistema de controle do exoesqueleto fornecendo dados de marcha humana ao modelo e analisando visualmente os movimentos do exoesqueleto em Simulink. Os dados para simulação da marcha humana são extraídos de uma base de dados existente e adaptados para fazer simulações nos modelos de sistema de controle do exoesqueleto.In this research a model of an exoskeleton of the right lower limb for user mobility enhancement and its control system are designed. The exoskeleton design consists of three major parts: a hip, an upper leg and a lower leg part, connected to one another with revolute joints. The joints will each be actuated by Brushless DC (BLDC) Motors equipped with gearboxes to increase torque. The motors are also equipped with velocity and position sensors which provide the necessary data for the designed control systems. Solidworks Computer Aided Design (CAD) software is used to develop a model of the exoskeleton which is then exported in extensible markup language (XML) format to be imported in Simmechanics, enabling the integration of physical body components with Simulink components. The inverse kinematics of the exoskeleton model is calculated and designed in Very high speed integrated circuit Hardware Description Language (VHDL) using floating-point numbers, to be executed from a Field Programmable Gate Array (FPGA) Device. Four different bit width representations of the hardware design of the kinematics model of the exoskeleton are developed, performing error analysis with the Mean Square Error (MSE) and the Average Relative Error (ARE) approaches. Trade-off analysis is then performed against performance and area on FPGA. The Proportional-Integrative-Derivative (PID) control strategy is chosen to develop the control system for the exoskeleton for its relatively simple design and proven efficient implementation in a very broad range of real life application areas. Two control system strategies are developed and compared to one another. Each control system design is comprised of two velocity- and two position controllers. PID parameters are calculated using the Ziegler-Nichols method and Particle Swarm Optimization (PSO). PSO is a relatively simple yet powerful optimization method that is applied in many optimization problem areas. It is based on the seemingly intelligent behaviour of fish schools and bird flocks in search of food. The algorithm, alongside the Ziegler-Nichols method, is used to find suitable PID parameters for control system blocks in the two designs. The system response of the control systems is evaluated analyzing step response. Human gait simulation is also performed on the developed exoskeleton control systems by observing the exoskeleton model movements in Simulink. The gait simulation data is extracted from a human gait database and adapted to be fed as input to the exoskeleton control system models

Pathological Gait Abnormality Detection and Segmentation by Processing the Hip Joints Motion Data to Support Mobile Gait Rehabilitation

An accurate detection of the gait sub-phases is fundamental in clinical gait analysis to interpret kinetic and kinematic data. In general, detecting the gait events that mark the transition from one gait sub-phase to another as well as the sequence of sub-phases is essential to evaluate gait abnormalities. However, finding a reliable segmentation for pathological gait has been a challenging task. This manuscript entails a generic approach for the gait segmentation into sub-phases in the CORBYS1 system. A number of distinctive features are extracted from the Hip joints motion data which are able to partition and segment the gait cycles in an efficient way. The degree of deviation (i.e. anomaly) in each sub-phase is then calculated with respect to an optimal gait reference which is used for robot-assisted gait rehabilitation. The proposed gait segmentation method is applicable to gait with many types of pathology since training on the pathology specific templates is not required. Performance of the proposed algorithm is evaluated by statistical analysis of results which produced 100% gait segmentation accuracy for healthy subjects and over 99% for pathological subjects

A new lower limb portable exoskeleton for gait assistance in neurological patients: a proof of concept study

Background: Few portable exoskeletons following the assist-as-needed concept have been developed for patients with neurological disorders. Thus, the main objectives of this proof-of-concept study were 1) to explore the safety and feasibility of an exoskeleton for gait rehabilitation in stroke and multiple sclerosis patients, 2) to test different algorithms for gait assistance and measure the resulting gait changes and 3) to evaluate the user's perception of the device. Methods: A cross-sectional study was conducted. Five patients were recruited (4 patients with stroke and 1 with multiple sclerosis). A robotic, one-degree-of-freedom, portable lower limb exoskeleton known as the Marsi Active Knee (MAK) was designed. Three control modes (the Zero Force Control mode, Mode 1 and Mode 3) were implemented. Spatiotemporal gait parameters were measured by the 10-m walking test (10MWT), the Gait Assessment and Intervention Tool (G.A.I.T.) and Tinetti Performance Oriented Mobility Assessment (gait subscale) before and after the trials. A modified QUEST 2.0 questionnaire was administered to determine each participant's opinion about the exoskeleton. The data acquired by the MAK sensors were normalized to a gait cycle, and adverse effects were recorded. Results: The MAK exoskeleton was used successfully without any adverse effects. Better outcomes were obtained in the 10MWT and G.A.I.T. when Mode 3 was applied compared with not wearing the device at all. In 2 participants, Mode 3 worsened the results. Additionally, Mode 3 seemed to improve the 10MWT and G.A.I.T. outcomes to a greater extent than Mode 1. The overall score for the user perception of the device was 2.8 ± 0.4 95% CI. Conclusions: The MAK exoskeleton seems to afford positive preliminary results regarding safety, feasibility, and user acceptance. The efficacy of the MAK should be studied in future studies, and more advanced improvements in safety must be implemented.G. Puyuelo-Quintana has received financial support by the “Doctorado Industrial” grant of Ministerio de Ciencia, Innovación y Universidades de España (reference DI-16- 08731). A. Plaza-Flores and E. Garces-Castellote have received financial support by the “Doctorado Industrial” grant of Comunidad de Madrid (reference IND2017/TIC-7698 and IND2018/TIC-9618, respectively).Peer reviewe

Instrumentation and validation of a robotic cane for transportation and fall prevention in patients with affected mobility

Dissertação de mestrado integrado em Engenharia Física, (especialização em Dispositivos, Microssistemas e Nanotecnologias)O ato de andar é conhecido por ser a forma primitiva de locomoção do ser humano, sendo que este traz muitos benefícios que motivam um estilo de vida saudável e ativo. No entanto, há condições de saúde que dificultam a realização da marcha, o que por consequência pode resultar num agravamento da saúde, e adicionalmente, levar a um maior risco de quedas. Nesse sentido, o desenvolvimento de um sistema de deteção e prevenção de quedas, integrado num dispositivo auxiliar de marcha, seria essencial para reduzir estes eventos de quedas e melhorar a qualidade de vida das pessoas. Para ultrapassar estas necessidades e limitações, esta dissertação tem como objetivo validar e instrumentar uma bengala robótica, denominada Anti-fall Robotic Cane (ARCane), concebida para incorporar um sistema de deteção de quedas e um mecanismo de atuação que possibilite a prevenção de quedas, ao mesmo tempo que assiste a marcha. Para esse fim, foi realizada uma revisão do estado da arte em bengalas robóticas para adquirir um conhecimento amplo e aprofundado dos componentes, mecanismos e estratégias utilizadas, bem como os protocolos experimentais, principais resultados, limitações e desafios em dispositivos existentes. Numa primeira fase, foi estipulado o objetivo de: (i) adaptar a missão do produto; (ii) estudar as necessidades do consumidor; e (iii) atualizar as especificações alvo da ARCane, continuação do trabalho de equipa, para obter um produto com design e engenharia compatível com o mercado. Foi depois estabelecida a arquitetura de hardware e discutidos os componentes a ser instrumentados na ARCane. Em seguida foram realizados testes de interoperabilidade a fim de validar o funcionamento singular e coletivo dos componentes. Relativamente ao controlo de movimento, foi desenvolvido um sistema inovador, de baixo custo e intuitivo, capaz de detetar a intenção do movimento e de reconhecer as fases da marcha do utilizador. Esta implementação foi validada com seis voluntários saudáveis que realizaram testes de marcha com a ARCane para testar sua operabilidade num ambiente de contexto real. Obteve-se uma precisão de 97% e de 90% em relação à deteção da intenção de movimento e ao reconhecimento da fase da marcha do utilizador. Por fim, foi projetado um método de deteção de quedas e mecanismo de prevenção de quedas para futura implementação na ARCane. Foi ainda proposta uma melhoria do método de deteção de quedas, de modo a superar as limitações associadas, bem como a proposta de dispositivos de deteção a serem implementados na ARCane para obter um sistema completo de deteção de quedas.The act of walking is known to be the primitive form of the human being, and it brings many benefits that motivate a healthy and active lifestyle. However, there are health conditions that make walking difficult, which, consequently, can result in worse health and, in addition, lead to a greater risk of falls. Thus, the development of a fall detection and prevention system integrated with a walking aid would be essential to reduce these fall events and improve people quality of life. To overcome these needs and limitations, this dissertation aims to validate and instrument a cane-type robot, called Anti-fall Robotic Cane (ARCane), designed to incorporate a fall detection system and an actuation mechanism that allow the prevention of falls, while assisting the gait. Therefore, a State-of-the-Art review concerning robotic canes was carried out to acquire a broad and in-depth knowledge of the used components, mechanisms and strategies, as well as the experimental protocols, main results, limitations and challenges on existing devices. On a first stage, it was set an objective to (i) enhance the product's mission statement; (ii) study the consumer needs; and (iii) update the target specifications of the ARCane, extending teamwork, to obtain a product with a market-compatible design and engineering that meets the needs and desires of the ARCane users. It was then established the hardware architecture of the ARCane and discussed the electronic components that will instrument the control, sensory, actuator and power units, being afterwards subjected to interoperability tests to validate the singular and collective functioning of cane components altogether. Regarding the motion control of robotic canes, an innovative, cost-effective and intuitive motion control system was developed, providing user movement intention recognition, and identification of the user's gait phases. This implementation was validated with six healthy volunteers who carried out gait trials with the ARCane, in order to test its operability in a real context environment. An accuracy of 97% was achieved for user motion intention recognition and 90% for user gait phase recognition, using the proposed motion control system. Finally, it was idealized a fall detection method and fall prevention mechanism for a future implementation in the ARCane, based on methods applied to robotic canes in the literature. It was also proposed an improvement of the fall detection method in order to overcome its associated limitations, as well as detection devices to be implemented into the ARCane to achieve a complete fall detection system

Cálculo da eficiência da simetria usando a relação de simetria da marcha, aplicando deformação dinâmica normalizada ao longo do tempo

In this paper we propose a new method for symmetry calculation in wearable devices. The problem in this domain is that only discrete features such as stride length, stride duration, or duration of gait phases are used for the symmetry calculation. However, this can lead to failures, since the use of features can result in partial loss of information from the time series. From this we present a possibility to calculate the symmetry by using Dynamic Time Warping (DTW). DTW uses the complete time series for the analysis and is therefore independent of certain features.En este artículo proponemos un nuevo método para el cálculo de la simetría para la resistencia sensible a la fuerza (FSR) en dispositivos portátiles. El problema en este dominio es que solo se utilizan características discretas como la longitud de la zancada, la duración de la zancada o la duración de las fases de la marcha para el cálculo de la simetría. Sin embargo, esto puede conducir a fallas, ya que el uso de funciones puede resultar en una pérdida parcial de información de la serie temporal. A partir de esto, presentamos la posibilidad de calcular la simetría utilizando el método de Dynamic Time Warping (DTW). El DTW utiliza la serie de tiempo completa para el análisis y, por lo tanto, es independiente de ciertas características.Neste artigo propomos um novo método para cálculo de simetria para resistência sensível à força (FSR) em dispositivos portáteis. O problema neste domínio é que apenas são utilizadas características discretas, como comprimento da passada, duração da passada ou duração da fase da marcha para o cálculo de simetria. No entanto, isso pode levar a falhas, pois o uso de funções pode resultar em perda parcial de informações da série temporal. A partir disso, apresentamos a possibilidade de calcular a simetria utilizando o método Dynamic Time Warping (DTW). O DTW usa toda a série temporal para a análise e, portanto, é independente de determinados recursos

Stability of Mina v2 for Robot-Assisted Balance and Locomotion

The assessment of the risk of falling during robot-assisted locomotion is critical for gait control and operator safety, but has not yet been addressed through a systematic and quantitative approach. In this study, the balance stability of Mina v2, a recently developed powered lower-limb robotic exoskeleton, is evaluated using an algorithmic framework based on center of mass (COM)- and joint-space dynamics. The equivalent mechanical model of the combined human-exoskeleton system in the sagittal plane is established and used for balance stability analysis. The properties of the Linear Linkage Actuator, which is custom-designed for Mina v2, are analyzed to obtain mathematical models of torque-velocity limits, and are implemented as constraint functions in the optimization formulation. For given feet configurations of the robotic exoskeleton during flat ground walking, the algorithm evaluates the maximum allowable COM velocity perturbations along the fore-aft directions at each COM position of the system. The resulting velocity extrema form the contact-specific balance stability boundaries (BSBs) of the combined system in the COM state space, which represent the thresholds between balanced and unbalanced states for given contact configurations. The BSBs are obtained for the operation of Mina v2 without crutches, thus quantifying Mina v2's capability of maintaining balance through the support of the leg(s). Stability boundaries in single and double leg supports are used to analyze the robot's stability performance during flat ground walking experiments, and provide design and control implications for future development of crutch-less robotic exoskeletons

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI