Effect of Tilt Sensor versus Heel Loading on Neuroprosthesis Stimulation Reliability and Timing for Individuals Post-Stroke during Level and Non- Level Treadmill Walking

Study background: Non-level walking may adversely affect stimulation of neuroprostheses as initial programming is performed during level walking. The objectives of this study were to assess stimulation reliability of tilt and heel sensor-based neuroprosthesis stimulation during level and non-level walking, examine stimulation initiation and termination timing during level and non-level walking, and determine whether heel or tilt sensor-based stimulation control is more robust for non-level ambulation. Methods: Eight post-stroke individuals with drop foot who were able to actively ambulate within the community were selected for participation. Each subject acclimated to the neuroprosthesis and walked on a treadmill randomly positioned in inclined, level and declined orientations. The primary measures of interest were stimulation reliability and timing. Results: Statistically significant differences in tilt, but not heel, sensor-based stimulation reliability were observed between level and non-level walking trials. Tilt sensor-based stimulation initiation occurred significantly closer to swing as the treadmill processed from declined to inclined orientations. No statistically significant differences in stimulation reliability or timing were observed between theoretical heel versus clinical tilt sensor-based stimulation control. Discussion and conclusions: Tilt sensor-based stimulation reliability may be adversely affected by non-level walking. Differences in stimulation initiation timing with tilt sensor-based control during non-level walking may be advantageous as stimulation initiation closer to swing during inclined ambulation may allow for greater ankle plantar flexion to assist with forward progression. Despite a lack of significant differences in stimulation reliability or timing between sensors, theoretical heel sensor-based stimulation control exhibited more consistent stimulation timing with less variability than for tilt sensor-based stimulation during non-level ambulation

A Rehabilitation Engineering Course for Biomedical Engineers

This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses myoelectric signal conditioning, signal processing, and associated control strategies for upper extremity prosthetic control. Finally, the rehabilitation engineer presents case studies related to assessment and prescription of mobility aids, environmental control systems, and children\u27s toys. The course also includes visits to a local prosthetic and orthotic facility to observe typical fabrication, fitting, and alignment procedures and a driver rehabilitation program for exposure to driver assessment, training, and common vehicle modifications. These applications of biomedical engineering to persons with disabilities have been well received by the students and have furthered interdisciplinary design and research projects

Nonlinear Elastic Material Property Estimation of Lower Extremity Residual Limb Tissues

The interface stresses between the residual limb and prosthetic socket have been studied to investigate prosthetic fit. Finite-element models of the residual limb-prosthetic socket interface facilitate investigation of the mechanical interface and may serve as a potential tool for future prosthetic socket design. However, the success of such residual limb models to date has been limited, in large part due to inadequate material formulations used to approximate the mechanical behavior of residual limb soft tissues. Nonlinear finite-element analysis was used to simulate force-displacement data obtained during in vivo rate-controlled (1, 5, and 10 mm/s) cyclic indentation of the residual limb soft tissues of seven individuals with transtibial amputation. The finite-element models facilitated determination of an appropriate set of nonlinear elastic material coefficients for bulk soft tissue at discrete clinically relevant test locations. Axisymmetric finite-element models of the residual limb bulk soft tissue in the vicinity of the test location, the socket wall and the indentor tip were developed incorporating contact analysis, large displacement, and large strain, and the James-Green-Simpson nonlinear elastic material formulation. Model dimensions were based on medical imaging studies of the residual limbs. The material coefficients were selected such that the normalized sum of square error (NSSE) between the experimental and finite-element model indentor tip reaction force was minimized. A total of 95% of the experimental data were simulated using the James-Green-Simpson material formulation with an NSSE less than 5%. The respective James-Green-Simpson material coefficients varied with subject, test location, and indentation rate. Therefore, these coefficients cannot be readily extrapolated to other sites or individuals, or to the same site and individual some time after testing

Effect of Ankle Orientation on Heel Loading and Knee Stability for Post-stroke Individuals Wearing Ankle-foot Orthoses

Background: Those who experience lower extremity weakness or paralysis following a stroke often exhibit gait deviations caused by the inability to completely lift their foot during swing. An ankle-foot orthosis (AFO) is commonly prescribed for individuals post stroke with this mobility impairment. Study design: Randomized controlled trial. Objectives: To determine whether significant differences could be observed in post-stroke individuals ambulating with an experimental AFO set at three different ankle orientations. Methods: Gait analysis was conducted for eight post-stroke individuals ambulating with an experimental AFO set in three different randomly selected ankle orientations: 5° dorsiflexion, 5° plantarflexion, and neutral alignment. Temporospatial (velocity, cadence, stride length and step length), kinematic (knee angle), kinetic (external knee moment), and plantar force (heel) data were assessed. Within-subject statistical analysis was conducted using the repeated measures ANOVA to determine whether observed differences between the three orientations were significant. Results: Post-stroke individuals generally exhibited less knee flexion during loading response when their AFO was aligned at 5° plantarflexion. Six of the eight subjects demonstrated increased knee flexion moment during loading response with the plantarflexed versus dorsiflexed alignment. The plantarflexed ankle orientation also resulted in greater peak heel contact force during loading response. Conclusions: Post stroke individuals may demonstrate less knee flexion during loading response and increased knee flexion moment (with respect to a dorsiflexed orientation) when their AFO is aligned in 5° plantarflexion. The fixed plantarflexed ankle orientation consistently resulted in greater peak heel contact force during loading response. Clinical relevance Plantarflexed AFOs are contraindicated for individuals with prior history of pressure sores on their heels. Post stroke individuals placed in 5° dorsiflexion may demonstrate increased knee flexion, enhanced shock absorption, decreased knee flexion moment, and decreased heel pressure (with respect to a plantarflexed orientation) during loading response

Young\u27s Modulus and Volume Porosity Relationships for Additive Manufacturing Applications

Recent advancements in additive manufacturing (or rapid prototyping) technologies allow the fabrication of end-use components with defined porous structures. For example, one area of particular interest is the potential to modify the flexibility (bending stiffness) of orthopedic implants through the use of engineered porosity (i.e., design and placement of pores) and subsequent fabrication of the implant using additive manufacturing processes. However, applications of engineered porosity require the ability to accurately predict mechanical properties from knowledge or characterization of the pore structure and the existence of robust equations characterizing the property–porosity relationships. As Young’s modulus can be altered by variations in pore shape as well as pore distribution, numerous semi-analytical and theoretical relationships have been proposed to describe the dependence of mechanical properties on porosity. However, the utility and physical meaning of many of these relationships is often unclear as most theoretical models are based on some idealized physical microstructure, and the resulting correlations often cannot be applied to real materials and practical applications. This review summarizes the evolution and development of relationships for the effective Young’s modulus of a porous material and concludes that verifiable equations yielding consistently reproducible results tied to specific pore structures do not yet exist. Further research is needed to develop and validate predictive equations for the effective Young’s modulus over a volume porosity range of 20–50 %, the range of interest over which existing equations, whether based on effective medium theories or empirical results, demonstrate the largest disparity and offers the greatest opportunity for beneficial modification of bending stiffness in orthopedic applications using currently available additive manufacturing techniques

Functional Stability of Transfemoral Amputee Gait Using the 3R80 and Total Knee 2000 Prosthetic Knee Units

Prosthetic knee designs have become extremely sophisticated compared to early constant friction single axis mechanisms. Today, prosthetists and physicians have a wide variety of components to choose from for their transfemoral amputee patients. Unfortunately, there are little quantitative data comparing the performance of different types of prosthetic components, and prosthetic prescription is often based on empirical knowledge and experience, rather than objective comparison of prosthetic designs. This study used gait analysis to objectively evaluate the stability characteristics of two types of prosthetic knee designs, the polycentric Total Knee 2000 (Ossur, Aliso Viejo, CA) and the single axis 3R80 stance control knee (Otto Bock Healthcare, Minneapolis, MN). Five healthy, active transfemoral amputees participated in this study by completing two gait analysis sessions, one with the Total Knee 2000 and one with the 3R80. At the end of each session, subjects were asked to complete a questionnaire for comparison of their subjective preferences with the objective biomechanical measures from the gait analysis. Kinematic and kinetic gait data were collected. Stride and temporal parameters (i.e., velocity, cadence, stride length, step length, stance and swing phase durations, and single and double support durations), joint angles and moments were computed from the Vicon data. A within subjects statistical analysis was then conducted, using repeated measures ANOVA, to determine if there were significant differences in performance between the two knee designs. The stride and temporal parameters computed in this study indicated that the Total Knee 2000 demonstrated a high degree of overall stability compared to the 3R80. The differences in inherent mechanical stability in the Total Knee 2000 and the 3R80 resulted in different calculated hip moments. The corresponding required hip moments indicated that the relative stability of the two knee designs changed throughout the gait cycle due to the polycentric nature of the Total Knee 2000. Specifically, the Total Knee 2000 was found to be less stable than the 3R80 in early stance and more stable than the 3R80 in mid- and late-stance. In addition to the biomechanical evidence of increased stability with the Total Knee 2000, the responses to the subjective questionnaires indicated that most subjects felt more stable and more confident bearing weight on the Total Knee 2000 than the 3R80

Within-socket Myoelectric Prediction of Continuous Ankle Kinematics for Control of a Powered Transtibial Prosthesis

Objective. Powered robotic prostheses create a need for natural-feeling user interfaces and robust control schemes. Here, we examined the ability of a nonlinear autoregressive model to continuously map the kinematics of a transtibial prosthesis and electromyographic (EMG) activity recorded within socket to the future estimates of the prosthetic ankle angle in three transtibial amputees. Approach. Model performance was examined across subjects during level treadmill ambulation as a function of the size of the EMG sampling window and the temporal \u27prediction\u27 interval between the EMG/kinematic input and the model\u27s estimate of future ankle angle to characterize the trade-off between model error, sampling window and prediction interval. Main results. Across subjects, deviations in the estimated ankle angle from the actual movement were robust to variations in the EMG sampling window and increased systematically with prediction interval. For prediction intervals up to 150 ms, the average error in the model estimate of ankle angle across the gait cycle was less than 6°. EMG contributions to the model prediction varied across subjects but were consistently localized to the transitions to/from single to double limb support and captured variations from the typical ankle kinematics during level walking. Significance. The use of an autoregressive modeling approach to continuously predict joint kinematics using natural residual muscle activity provides opportunities for direct (transparent) control of a prosthetic joint by the user. The model\u27s predictive capability could prove particularly useful for overcoming delays in signal processing and actuation of the prosthesis, providing a more biomimetic ankle response

Preliminary Investigation of Residual Limb Plantarflexion and Dorsiflexion Muscle Activity During Treadmill Walking for Trans-tibial Amputees

Background: Novel powered prosthetic ankles currently incorporate finite state control, using kinematic and kinetic sensors to differentiate stance and swing phases/sub-phases and control joint impedance and position or torque. For more intuitive control, myoelectric control of the ankle using the remnant residual limb dorsiflexors and plantarflexors, perhaps in concert with kinetic and kinematic sensors, may be possible. Objective: The specific research objective was to assess the feasibility of using myoelectric control of future active or powered prosthetic ankle joints for trans-tibial amputees. Study Design: The project involved human subject trials to determine whether current techniques of myoelectric control of upper extremity prostheses might be readily adapted for lower extremity prosthetic control. Methods: Gait analysis was conducted for three unilateral trans-tibial amputee subjects during ambulation on an instrumented split belt treadmill. Data included ankle plantarflexor and dorsiflexor activity for the residual limb, as well as lower limb kinematics and ground reaction forces and moments of both the sound and prosthetic limbs. Results: These data indicate that: 1) trans-tibial amputees retain some independent ankle plantarflexor and dorsiflexor muscle activity of their residual limb; 2) it is possible to position surface electromyographic electrodes within a trans-tibial socket that maintain contact during ambulation; 3) both the plantarflexors and dorsiflexors of the residual limb are active during gait; 4) plantarflexor and dorsiflexor activity is consistent during multiple gait cycles; and 5) with minimal training, trans-tibial amputees may be able to activate their plantarflexors during push-off. Conclusions: These observations demonstrate the potential for future myoelectric control of active prosthetic ankles. Clinical relevance This study demonstrated the feasibility of applying upper extremity prosthetic myoelectric signal acquisition, processing and control techniques to future myoelectric control of active prosthetic ankles for trans-tibial amputees

Field Experience as the Centerpiece of an Integrated Model for STEM Teacher Preparation

The purpose of this study was to provide a descriptive account of one pathway for preparing high-quality STEM (science, technology, engineering, and mathematics) teachers for work in high-need urban schools. In this account, we discuss the supports that STEM majors need in learning how to think about the content that they know well, through an educational perspective that focuses on teaching and learning. We also describe the approach that we use that integrates content knowledge, pedagogical content knowledge, and three extensive teaching co-op experiences to facilitate the transition from successful STEM undergraduate students to effective teachers of STEM content. We suggest that by using the teaching co-op experiences to both filter and reflect on content and pedagogical content knowledge, the STEM undergraduates develop a particularly strong foundation of knowledge for teaching