Comparison of walking overground and in a Computer Assisted Rehabilitation Environment (CAREN) in individuals with and without transtibial amputation

Background Due to increased interest in treadmill gait training, recent research has focused on the similarities and differences between treadmill and overground walking. Most of these studies have tested healthy, young subjects rather than impaired populations that might benefit from such training. These studies also do not include optic flow, which may change how the individuals integrate sensory information when walking on a treadmill. This study compared overground walking to treadmill walking in a computer assisted virtual reality environment (CAREN) in individuals with and without transtibial amputations (TTA). Methods Seven individuals with traumatic TTA and 27 unimpaired controls participated. Subjects walked overground and on a treadmill in a CAREN at a normalized speed. The CAREN applied optic flow at the same speed that the subject walked. Temporal-spatial parameters, full body kinematics, and kinematic variability were collected during all trials. Results Both subject groups decreased step time and control subjects decreased step length when walking in the CAREN. Differences in lower extremity kinematics were small (\u3c 2.5○) and did not exceed the minimal detectable change values for these measures. Control subjects exhibited decreased transverse and frontal plane range of motion of the pelvis and trunk when walking in the CAREN, while patients with TTA did not. Both groups exhibited increased step width variability during treadmill walking in the CAREN, but only minor changes in kinematic variability. Conclusions The results of this study suggest that treadmill training in a virtual environment should be similar enough to overground that changes should carry over. Caution should be made when comparing step width variability and step time results from studies utilizing a treadmill to those overground

Characterization of ankle function during stair ambulation

The aim of this study was to examine the ankle joint during level walking, stair ascent, and stair descent to determine models for use in the design of prosthetic and orthotic systems. Ten healthy subjects were asked to walk (1) across a level walkway, (2) up, and (3) down an instrumented stairway. Sagittal plane kinematic and kinetic data were analyzed to obtain ankle biomechanics during the stance phase of each task. Each stance phase was broken down into sub-phases based on the power trajectory. The ideal model was taken to be the simplest combination of mechanical elements (springs, dampers, and torque actuators) that could reproduce the patterns observed in ankle biomechanics. Besides, we studied the transitions from level walking to stair ascent and from stair descent to level walking and showed that mechanical elements can be used to model these transitions as well. These results are promising to the design of next generation ankle orthotic and prosthetic systems because they show that relatively simple mechanical elements can be utilized to mimic ankle biomechanics

Upper limb prostheses: bridging the sensory gap

Replacing human hand function with prostheses goes far beyond only recreating muscle movement with feedforward motor control. Natural sensory feedback is pivotal for fine dexterous control and finding both engineering and surgical solutions to replace this complex biological function is imperative to achieve prosthetic hand function that matches the human hand. This review outlines the nature of the problems underlying sensory restitution, the engineering methods that attempt to address this deficit and the surgical techniques that have been developed to integrate advanced neural interfaces with biological systems. Currently, there is no single solution to restore sensory feedback. Rather, encouraging animal models and early human studies have demonstrated that some elements of sensation can be restored to improve prosthetic control. However, these techniques are limited to highly specialized institutions and much further work is required to reproduce the results achieved, with the goal of increasing availability of advanced closed loop prostheses that allow sensory feedback to inform more precise feedforward control movements and increase functionality

The Role of Muscle Fatigue on Movement Timing and Stability during Repetitive Tasks

textRepetitive stress injuries are common in the workplace where workers perform repetitive tasks continuously throughout the day. Muscle fatigue may lead to injury either directly through muscle damage or indirectly through changes in coordination, development of muscle imbalances, kinematic and muscle activation variability, and/or movement instability. To better understand the role of muscle fatigue in changes in movement parameters, we studied how muscle fatigue and muscle imbalances affected the control of movement timing, variability, and stability during a repetitive upper extremity sawing task. Since muscle fatigue leads to delayed muscle and cognitive response times, we might expect the ability to maintain movement timing would decline with muscle fatigue. We compared timing errors pre- and post-fatigue as subjects performed this repetitive sawing task synchronized with a metronome using standard techniques and a goal-equivalent manifold (GEM) approach. No differences in basic performance parameters were found. Significant decreases in the temporal correlations of the timing errors and velocities indicated that subjects made more frequent corrections to their movements post-fatigue. Muscle fatigue may lead to movement instability through a variety of mechanisms including delayed muscle response times and muscle imbalances. To measure movement stability, we must first define a state space that describes the movement. We compared a variety of different state space definitions and found that state spaces composed of angles and velocities with little redundant information provide the most consistent results. We then studied the affect of fatigue on the shoulder flexor muscles and general fatigue of the arm on movement stability. Subjects were able to maintain stability in spite of muscle fatigue, shoulder strength imbalance and decreased muscle cocontraction. Little is known about the time course for adaptations in response to fatigue. We studied the effect of muscle fatigue on movement coordination, kinematic variability and movement stability while subjects performed the same sawing task at two work heights. Increasing the height of the task caused subjects to make more adjustments to their movement patterns in response to muscle fatigue. Subjects also exhibited some increases in kinematic variability at the shoulder but no changes in movement stability. These findings suggest that people alter their kinematic patterns in response to fatigue possibly to maintain stability at the expense of increased variability.Biomedical Engineerin

Proximal and distal muscle fatigue differentially affect movement coordination

<div><p>Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005) in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005), and increased elbow flexion (4°, p < 0.01). In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05), increased velocity of wrench movement relative to the hand (17°/s, p < 0.001), and earlier wrist extension (4%, p < 0.005). Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05). Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.</p></div

Changes in movement variability post fatigue.

<p>Change in MeanSD (post—pre fatigue) at the trunk (<b>A</b>), shoulder (<b>B</b>), elbow and wrist (<b>C</b>), and hand and wrench (<b>D</b>) after proximal (squares) and distal (circles) fatigue. Positive values indicate that variability increased after fatigue. Error bars represent the 95% confidence interval. * indicates PROX/DIST × PRE/POST interaction effect.</p

Fatigue and joint angle.

<p>Average joint angles across subjects for the ratcheting motion pre (blue) and post (red) two different fatigue protocols. Angles are normalized to 100% of the movement cycle (top position to top position). The angles shown represent those most affected by fatigue.</p

The influence of powered prostheses on user perspectives, metabolics, and activity: a randomized crossover trial

Abstract Background Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility. Methods Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants’ metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson’s correlations. Results Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506). Conclusions There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription. Trial registration:  https://clinicaltrials.gov , #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982http://deepblue.lib.umich.edu/bitstream/2027.42/173760/1/12984_2021_Article_842.pd