Influence of musculoskeletal model parameter values on prediction of accurate knee contact forces during walking

Treatment design for musculoskeletal disorders using in silico patient-specific dynamic simulations is becoming a clinical possibility. However, these simulations are sensitive to model parameter values that are difficult to measure experimentally, and the influence of uncertainties in these parameter values on the accuracy of estimated knee contact forces remains unknown. This study evaluates which musculoskeletal model parameters have the greatest influence on estimating accurate knee contact forces during walking. We performed the evaluation using a two-level optimization algorithm where musculoskeletal model parameter values were adjusted in the outer level and muscle activations were estimated in the inner level. We tested the algorithm with different sets of design variables (combinations of optimal muscle fiber lengths, tendon slack lengths, and muscle moment arm offsets) resulting in nine different optimization problems. The most accurate lateral knee contact force predictions were obtained when tendon slack lengths and moment arm offsets were adjusted simultaneously, and the most accurate medial knee contact force estimations were obtained when all three types of parameters were adjusted together. Inclusion of moment arm offsets as design variables was more important than including either tendon slack lengths or optimal muscle fiber lengths alone to obtain accurate medial and lateral knee contact force predictions. These results provide guidance on which musculoskeletal model parameter values should be calibrated when seeking to predict in vivo knee contact forces accurately.Postprint (updated version

Evaluation of Optimal Control Approaches for Predicting Active Knee-Ankle-Foot-Orthosis Motion for Individuals With Spinal Cord Injury

Gait restoration of individuals with spinal cord injury can be partially achieved using active orthoses or exoskeletons. To improve the walking ability of each patient as much as possible, it is important to personalize the parameters that define the device actuation. This study investigates whether using an optimal control-based predictive simulation approach to personalize pre-defined knee trajectory parameters for an active knee-ankle-foot orthosis (KAFO) used by spinal cord injured (SCI) subjects could potentially be an alternative to the current trial-and-error approach. We aimed to find the knee angle trajectory that produced an improved orthosis-assisted gait pattern compared to the one with passive support (locked knee). We collected experimental data from a healthy subject assisted by crutches and KAFOs (with locked knee and with knee flexion assistance) and from an SCI subject assisted by crutches and KAFOs (with locked knee). First, we compared different cost functions and chose the one that produced results closest to experimental locked knee walking for the healthy subject (angular coordinates mean RMSE was 5.74°). For this subject, we predicted crutch-orthosis-assisted walking imposing a pre-defined knee angle trajectory for different maximum knee flexion parameter values, and results were evaluated against experimental data using that same pre-defined knee flexion trajectories in the real device. Finally, using the selected cost function, gait cycles for different knee flexion assistance were predicted for an SCI subject. We evaluated changes in four clinically relevant parameters: foot clearance, stride length, cadence, and hip flexion ROM. Simulations for different values of maximum knee flexion showed variations of these parameters that were consistent with experimental data for the healthy subject (e.g., foot clearance increased/decreased similarly in experimental and predicted motions) and were reasonable for the SCI subject (e.g., maximum parameter values were found for moderate knee flexion). Although more research is needed before this method can be applied to choose optimal active orthosis controller parameters for specific subjects, these findings suggest that optimal control prediction of crutch-orthosis-assisted walking using biomechanical models might be used in place of the trial-and-error method to select the best maximum knee flexion angle during gait for a specific SCI subject.Peer ReviewedPostprint (published version

Evaluation of optimal control formulations for obtaining dynamically consistent walking motions

n recent years, interest has grown in predicting human motion, for example, to study cause-effect relations for a specific task [1]. To predict human motion, researchers typically use optimization-based methods that minimize a certain cost function. The objective of this study is to analyze two different optimal control formulations that track experimental data from a healthy gait cycle to obtain a dynamically consistent walking motion, i.e., with minimal residual wrench applied to the pelvis.Postprint (published version

Prediction of three-dimensional crutch walking patterns using a torque-driven model

Computational prediction of 3D crutch-assisted walking patterns is a challenging problem that could be applied to study different biomechanical aspects of crutch walking in virtual subjects, to assist physiotherapists to choose the optimal crutch walking pattern for a specific subject, and to help in the design and control of exoskeletons, when crutches are needed for balance. The aim of this work is to generate a method to predict three-dimensional crutch-assisted walking motions following different patterns without tracking any experimental data. To reach this goal, we collected gait data from a healthy subject performing a four-point non-alternating crutch walking pattern, and developed a 3D torque-driven full-body model of the subject including the crutches and foot- and crutch-ground contact models. First, we developed a predictive (i.e., no tracking of experimental data) optimal control problem formulation to predict crutch walking cycles following the same pattern as the experimental data collected, using different cost functions. To reduce errors with respect to reference data, a cost function combining minimization terms of angular momentum, mechanical power, joint jerk and torque change was chosen. Then, the problem formulation was adapted to handle different foot- and crutch-ground conditions to make it capable of predicting three new crutch walking patterns, one of them at different speeds. A key aspect of our algorithm is that having ground reactions as additional controls allows one to define phases inside the cycle without the need of formulating a multiple-phase problem, thus facilitating the definition of different crutch walking patterns.Postprint (author's final draft

Computational evaluation of psoas muscle influence on walking function following internal hemipelvectomy with reconstruction

An emerging option for internal hemipelvectomy surgery is custom prosthesis reconstruction. This option typically recapitulates the resected pelvic bony anatomy with the goal of maximizing post-surgery walking function while minimizing recovery time. However, the current custom prosthesis design process does not account for the patient’s post-surgery prosthesis and bone loading patterns, nor can it predict how different surgical or rehabilitation decisions (e.g., retention or removal of the psoas muscle, strengthening the psoas) will affect prosthesis durability and post-surgery walking function. These factors may contribute to the high observed failure rate for custom pelvic prostheses, discouraging orthopedic oncologists from pursuing this valuable treatment option. One possibility for addressing this problem is to simulate the complex interaction between surgical and rehabilitation decisions, post-surgery walking function, and custom pelvic prosthesis design using patient-specific neuromusculoskeletal models. As a first step toward developing this capability, this study used a personalized neuromusculoskeletal model and direct collocation optimal control to predict the impact of ipsilateral psoas muscle strength on walking function following internal hemipelvectomy with custom prosthesis reconstruction. The influence of the psoas muscle was targeted since retention of this important muscle can be surgically demanding for certain tumors, requiring additional time in the operating room. The post-surgery walking predictions emulated the most common surgical scenario encountered at MD Anderson Cancer Center in Houston. Simulated post-surgery psoas strengths included 0% (removed), 50% (weakened), 100% (maintained), and 150% (strengthened) of the pre-surgery value. However, only the 100% and 150% cases successfully converged to a complete gait cycle. When post-surgery psoas strength was maintained, clinical gait features were predicted, including increased stance width, decreased stride length, and increased lumbar bending towards the operated side. Furthermore, when post-surgery psoas strength was increased, stance width and stride length returned to pre-surgery values. These results suggest that retention and strengthening of the psoas muscle on the operated side may be important for maximizing post-surgery walking function. If future studies can validate this computational approach using post-surgery experimental walking data, the approach may eventually influence surgical, rehabilitation, and custom prosthesis design decisions to meet the unique clinical needs of pelvic sarcoma patients.Peer ReviewedObjectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (published version

Exoskeleton design using subject-specific synergy-driven neuromusculoskeletal models

Most assistive devices available today are unable to improve gait asymmetries due to the lack of knowledge on how to directly enforce kinematic symmetry in the formulation of cost functions. We designed a cost function to potentially target kinematic symmetry, and observed improvements in gait asymmetries specifically at the hip and ankle.Postprint (published version

Exoskeleton Design Using Subject-Specific Synergy-Driven Neuromusculoskeletal Models

Most assistive devices available today are unable to improve gait asymmetries due to the lack of knowledge on how to directly enforce kinematic symmetry in the formulation of cost functions. We designed a cost function to potentially target kinematic symmetry, and observed improvements in gait asymmetries specifically at the hip and ankle.Peer ReviewedPostprint (published version

The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates

Objectives Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. Materials and Methods A 10° opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of osteotomy gap healing simulating up to six weeks postoperatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (TomoFix). Results For both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared with the TomoFix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy. Conclusion We demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.Peer Reviewe

Personalised active orthoses for SCI subjects based on optimal control prediction

The authors are working on the personalisation of an innovative low-cost, lightweight, and easy-to-use active orthosis to facilitate over-ground walking with crutches by individuals with spinal cord injury (SCI) who possess remaining hip function. Personalisation will involve selection of the best knee motor control strategy for each subject, using predictive walking simulations that combine OpenSim patient-specific models with GPOPS-II optimal control predictions. In the present work, we describe a direct collocation optimal control framework to obtain a dynamically consistent walking motion that reproduces experimental measurements.Postprint (published version