Development of a robotic walking simulator for gait rehabilitation]

Restoration of gait is a major concern of rehabilitation after stroke or spinal cord injury. Modern concepts of motor learning favour a task-specific repetitive approach, i.e. "whoever wants to learn to walk again must walk." However, the physical demands this places on the therapist, is a limiting factor in the clinical routine setting. This article describes a robotic walking simulator for gait training that enables wheelchair-bound subjects to freely carry out repetitive practicing of an individually adapted gait pattern under simulation of the manual guidance of an experienced therapist. The technical principle applied makes use of programmable footplates with permanent foot/machine contact in combination with compliance control. The solution chosen comprises a planar parallel-serial hybrid kinematic system with three degrees of freedom that moves the feet in the sagittal plane. Gait analysis while floor walking and stair climbing, clinical practicability and safety aspects were the basis for the design. A variable compliance control enables man-machine interaction, ranging from purely position controlled movement to full compliance during swing phase above a virtual ground profile. In full compliance mode the robotic walking simulator behaves like a haptic device. The concept presented offers new prospects for individualized gait rehabilitation.     

Design of a robotic gait trainer using spring over muscle actuators for ankle stroke rehabilitation

Repetitive task training is an effective form of rehabilitation for people suffering from debilitating injuries of stroke. We present the design and working concept of a robotic gait trainer (RGT), an ankle rehabilitation device for assisting stroke patients during gait. Structurally based on a tripod mechanism, the device is a parallel robot that incorporates two pneumatically powered, double-acting, compliant, spring over muscle actuators as actuation links which move the ankle in dorsiflex ion/plantarflexion and inversion/eversion. A unique feature in the tripod design is that the human anatomy is part of the robot, the first fixed link being the patient's leg. The kinematics and workspace of the tripod device have been analyzed determining its range of motion. Experimental gait data from an able-bodied person wearing the working RGT prototype are presented.     

An efficient robotic tendon for gait assistance

A robotic tendon is a spring based, linear actuator in which the stiffness of the spring is crucial for its successful use in a lightweight, energy efficient, powered ankle orthosis. Like its human analog, the robotic tendon uses its inherent elastic nature to reduce both peak power and energy requirements for its motor. In the ideal example, peak power required of the motor for ankle gait is reduced from 250 W to just 77 W. In addition, ideal energy requirements are reduced from nearly 36 J to just 21 J. Using this approach, an initial prototype has provided 100% of the power and energy necessary for ankle gait in a compact 0.95 kg package, seven times less than an equivalent motor/gearbox system.     

Speed-dependent reference joint trajectory generation for robotic gait support

For the control of actuated orthoses, or gait rehabilitation robotics, kinematic reference trajectories are often required. These trajectories, consisting of joint angles, angular velocities and accelerations, are highly dependent on walking-speed. We present and evaluate a novel method to reconstruct body-height and speed-dependent joint trajectories. First, we collected gait kinematics in fifteen healthy (middle) aged subjects (47–68), at a wide range of walking-speeds (0.5–5 kph). For each joint trajectory multiple key-events were selected (among which its extremes). Second, we derived regression-models that predict the timing, angle, angular velocity and acceleration for each key-event, based on walking-speed and the subject?s body-height. Finally, quintic splines were fitted between the predicted key-events to reconstruct a full gait cycle. Regression-models were obtained for hip ab-/adduction, hip flexion/extension, knee flexion/extension and ankle plantar-/dorsiflexion. Results showed that the majority of the key-events were dependent on walking-speed, both in terms of timing and amplitude, whereas the body-height had less effect. The reconstructed trajectories matched the measured trajectories very well, in terms of angle, angular velocity and acceleration. For the angles the RMSE between the reconstructed and measured trajectories was 2.6°. The mean correlation coefficient between the reconstructed and measured angular trajectories was 0.91. The method and the data presented in this paper can be used to generate speed-dependent gait patterns. These patterns can be used for the control of several robotic gait applications. Alternatively they can assist the assessment of pathological gait, where they can serve as a reference for “normal” gait.     

Dynamic motion planning of 3D human locomotion using gradient-based optimization

Since humans can walk with an infinite variety of postures and limb movements, there is no unique solution to the modeling problem to predict human gait motions. Accordingly, we test herein the hypothesis that the redundancy of human walking mechanisms makes solving for human joint profiles and force time histories an indeterminate problem best solved by inverse dynamics and optimization methods. A new optimization-based human-modeling framework is thus described for predicting three-dimensional human gait motions on level and inclined planes. The basic unknowns in the framework are the joint motion time histories of a 25-degree-of-freedom human model and its six global degrees of freedom. The joint motion histories are calculated by minimizing an objective function such as deviation of the trunk from upright posture that relates to the human model's performance. A variety of important constraints are imposed on the optimization problem, including (1) satisfaction of dynamic equilibrium equations by requiring the model's zero moment point (ZMP) to lie within the instantaneous geometrical base of support, (2) foot collision avoidance, (3) limits on ground-foot friction, and (4) vanishing yawing moment. Analytical forms of objective and constraint functions are presented and discussed for the proposed human-modeling framework in which the resulting optimization problems are solved using gradient-based mathematical programming techniques. When the framework is applied to the modeling of bipedal locomotion on level and inclined planes, acyclic human walking motions that are smooth and realistic as opposed to less natural robotic motions are obtained. The aspects of the modeling framework requiring further investigation and refinement, as well as potential applications of the framework in biomechanics, are discussed.     

Linear approximations for swing leg motion during gait

The applicability of a linear systems analysis of two-dimensional swing leg motion was investigated. Two different linear systems were developed. A linear time-varying system was developed by linearizing the nonlinear equations describing swing leg motion about a set of nominal system and control trajectories. Linear time invariant systems were developed by linearizing about three different fixed limb positions. Simulations of swing leg motion were performed with each of these linear systems. These simulations were compared to previously performed nonlinear simulations of two-dimensional swing leg motion and the actual subject motion. Additionally, a linear system analysis was used to gain some insight into the interdependency of the state variables and controls. It was shown that the linear time varying approximation yielded an accurate representation of limb motion for the thigh and shank but with diminished accuracy for the foot. In contrast, all the linear time invariant systems, if used to simulate more than a quarter of the swing phase, yielded generally inaccurate results for thigh shank and foot motion.     

In vivo measurement of surface skin strain during human gait to improve the design of rehabilitation devices

Abstract

When designing any rehabilitation, sportswear or exoskeleton device the mechanical behaviour of the body segment must be known, specifically the skin, because an excessive tissue strain may lead to ulceration and bedsores. To date, it is not known if the kinematic variability between subjects have an effect on the skin strain field, and therefore, in the design and manufacturing of rehabilitation products, such as orthoses. Several studies have analysed the skin deformation during human motion, nevertheless, the comparison between the skin strain field in different subjects during normal or pathological gait has not been reported yet. This work presents a comparison of skin strain analysis for different gait patterns to study the differences between people and, specifically, if it is possible to standardize the orthotic design between subjects with the same gait disorder. Moreover, the areas with relatively minimum strain during the ankle-foot motion are compared to improve the design of structural parts of rehabilitation devices. In this case, a validated 3D digital image correlation system has been used for this purpose combined with strain ellipse theory. The results demonstrate variations in the skin strain field between subjects with the same pathology and similarities between subjects with normal gait. However, more studies and experiments are necessaries to validate this hypothesis and also to test it between different gait pathologies.     

A conductive rubber footswitch design for gait analysis

The performance of a footswitch which uses conductive rubber modules in foam, sandwiched between two brass shims in the form of an inner sole placed between the foot and the shoe is reported. Contact switching force decreases with module density, whilst position of the conductivity plugs in the footswitch is irrelevant. Comments on the construction of a footswich using these modules are made, in particular no modification of the conductive rubber is needed and a density throughout greater than 4 modules per square inch leads to threshold switch forces of 30 N and less which is totally acceptable for gait analysis use without fears of contact being made whilst inserting and positioned in the subject's shoe.     

A mobile gait monitoring system for abnormal gait diagnosis and rehabilitation: a pilot study for Parkinson disease patients

Conventional gait rehabilitation treatment does not provide quantitative information on abnormal gait kinematics, and the match of the intervention strategy to the underlying clinical presentation may be limited by clinical expertise and experience. Also the effect of rehabilitation treatment may be reduced as the rehabilitation treatment is achieved only in a clinical setting. In this paper, a mobile gait monitoring system (MGMS) is proposed for the diagnosis of abnormal gait and rehabilitation. The proposed MGMS consists of Smart Shoes and a microsignal processor with a touch screen display. It monitors patients' gait by observing the ground reaction force (GRF) and the center of GRF, and analyzes the gait abnormality. Since visual feedback about patients' GRFs and normal GRF patterns are provided by the MGMS, patients can practice the rehabilitation treatment by trying to follow the normal GRF patterns without restriction of time and place. The gait abnormality proposed in this paper is defined by the deviation between the patient's GRFs and normal GRF patterns, which are constructed as GRF bands. The effectiveness of the proposed gait analysis methods with the MGMS has been verified by preliminary trials with patients suffering from gait disorders.     

Tibiofemoral kinematics and condylar motion during the stance phase of gait

Accurate knowledge of the dynamic knee motion in-vivo is instrumental for understanding normal and pathological function of the knee joint. However, interpreting motion of the knee joint during gait in other than the sagittal plane remains controversial. In this study, we utilized the dual fluoroscopic imaging technique to investigate the six-degree-of-freedom kinematics and condylar motion of the knee during the stance phase of treadmill gait in eight healthy volunteers at a speed of 0.67 m/s. We hypothesized that the 6DOF knee kinematics measured during gait will be different from those reported for non-weightbearing activities, especially with regards to the phenomenon of femoral rollback. In addition, we hypothesized that motion of the medial femoral condyle in the transverse plane is greater than that of the lateral femoral condyle during the stance phase of treadmill gait. The rotational motion and the anterior–posterior translation of the femur with respect to the tibia showed a clear relationship with the flexion–extension path of the knee during the stance phase. Additionally, we observed that the phenomenon of femoral rollback was reversed, with the femur noted to move posteriorly with extension and anteriorly with flexion. Furthermore, we noted that motion of the medial femoral condyle in the transverse plane was greater than that of the lateral femoral condyle during the stance phase of gait (17.4±2.0 mm vs. 7.4±6.1 mm, respectively; p<0.01). The trend was opposite to what has been observed during non-weightbearing flexion or single-leg lunge in previous studies. These data provide baseline knowledge for the understanding of normal physiology and for the analysis of pathological function of the knee joint during walking. These findings further demonstrate that knee kinematics is activity-dependent and motion patterns of one activity (non-weightbearing flexion or lunge) cannot be generalized to interpret a different one (gait).     

Muscular coordination of knee motion during the terminal-swing phase of normal gait

Children with cerebral palsy often walk with diminished knee extension during the terminal-swing phase, resulting in a troublesome "crouched" posture at initial contact and a shortened stride. Treatment of this gait abnormality is challenging because the factors that extend the knee during normal walking are not well understood, and because the potential of individual muscles to limit terminal-swing knee extension is unknown. This study analyzed a series of three-dimensional, muscle-driven dynamic simulations to quantify the angular accelerations of the knee induced by muscles and other factors during swing. Simulations were generated that reproduced the measured gait dynamics and muscle excitation patterns of six typically developing children walking at self-selected speeds. The knee was accelerated toward extension in the simulations by velocity-related forces (i.e., Coriolis and centrifugal forces) and by a number of muscles, notably the vasti in mid-swing (passive), the hip extensors in terminal swing, and the stance-limb hip abductors, which accelerated the pelvis upward. Knee extension was slowed in terminal swing by the stance-limb hip flexors, which accelerated the pelvis backward. The hamstrings decelerated the forward motion of the swing-limb shank, but did not contribute substantially to angular motions of the knee. Based on these data, we hypothesize that the diminished knee extension in terminal swing exhibited by children with cerebral palsy may, in part, be caused by weak hip extensors or by impaired hip muscles on the stance limb that result in abnormal accelerations of the pelvis.     

Ultrasonic motion analysis system--measurement of temporal and spatial gait parameters

The duration of stance and swing phase and step and stride length are important parameters in human gait. In this technical note a low-cost ultrasonic motion analysis system is described that is capable of measuring these temporal and spatial parameters while subjects walk on the floor. By using the propagation delay of sound when transmitted in air, this system is able to record the position of the subjects' feet. A small ultrasonic receiver is attached to both shoes of the subject while a transmitter is placed stationary on the floor. Four healthy subjects were used to test the device. Subtracting positions of the foot with zero velocity yielded step and stride length. The duration of stance and swing phase was calculated from heel-strike and toe-off. Comparison with data obtained from foot contact switches showed that applying two relative thresholds to the speed graph of the foot could reliably generate heel-strike and toe-off. Although the device is tested on healthy subjects in this study, it promises to be extremely valuable in examining pathological gait. When gait is asymmetrical, walking speed is not constant or when patients do not completely lift their feet, most existing devices will fail to correctly assess the proper gait parameters. Our device does not have this shortcoming and it will accurately demonstrate asymmetries and variations in the patient's gait. As an example, the recording of a left hemiplegic patient is presented in the discussion.     

Axial pelvis range of motion affects thorax-pelvis timing during gait

During gait, patients with pelvic girdle pain and low back pain demonstrate an altered phase relationship between axial thorax and pelvis rotations (thorax-pelvis relative phase). This could be the result of an increase in axial pelvis range of motion (ROM) which has been observed in these patients as well. To establish this relationship, we investigated if altered axial pelvis ROM during gait affects thorax-pelvis relative phase in 12 healthy subjects. These subjects walked on a treadmill and received real-time feedback on axial pelvis rotations. Subjects were asked to (1) walk normal, and walk with (2) decreased and (3) increased pelvis ROM. Gait speed and stride frequency were matched between trials. Subjects were able to increase pelvis ROM to a large extent, but the reduction in pelvis ROM was relatively small. Walking with large pelvis ROM resulted in a change in thorax-pelvis relative phase similar to that in pelvic girdle pain and low back pain. A forward dynamic model was used to predict the effect of manipulation of pelvis ROM on timing of thorax rotations independent of apparent axial trunk stiffness and arm swing amplitude (which can both affect thorax-pelvis relative phase). The model predicted a similar, even larger, effect of large axial pelvis ROM on thorax-pelvis relative phase, as observed experimentally. We conclude that walking with actively increased ROM of axial pelvis rotations in healthy subjects is associated with a shift in thorax-pelvis relative phase, similar to observations in patients with pelvic girdle pain and low back pain.     

Insights for robotic design from studies of the control of abdominal position in crayfish

Studies of the control of position and movement of the abdomen of crayfish illustrate a number of features of invertebrate sensory-motor systems that have implications for their use to inform robotic design. We use the abdominal slow extensor motor system to illustrate three of them here: first, the way in which a behaviorally flexible length-servo device can be achieved with very few elements; second, the importance of knowledge of the biological and behavioral context in which the elements operate; third, that design solutions resulting from natural selection have been constrained by the previous evolutionary history of the animal, which can affect the outcomes in ways that may not be immediately apparent in a design context.     

Mantisbot is a robotic model of visually guided motion in the praying mantis

Insects use highly distributed nervous systems to process exteroception from head sensors, compare that information with state-based goals, and direct posture or locomotion toward those goals. To study how descending commands from brain centers produce coordinated, goal-directed motion in distributed nervous systems, we have constructed a conductance-based neural system for our robot MantisBot, a 29 degree-of-freedom, 13.3:1 scale praying mantis robot. Using the literature on mantis prey tracking and insect locomotion, we designed a hierarchical, distributed neural controller that establishes the goal, coordinates different joints, and executes prey-tracking motion. In our controller, brain networks perceive the location of prey and predict its future location, store this location in memory, and formulate descending commands for ballistic saccades like those seen in the animal. The descending commands are simple, indicating only 1) whether the robot should walk or stand still, and 2) the intended direction of motion. Each joint's controller uses the descending commands differently to alter sensory-motor interactions, changing the sensory pathways that coordinate the joints' central pattern generators into one cohesive motion. Experiments with one leg of MantisBot show that visual input produces simple descending commands that alter walking kinematics, change the walking direction in a predictable manner, enact reflex reversals when necessary, and can control both static posture and locomotion with the same network.     

A computational method for reliable gait event detection and abnormality detection for feedback in rehabilitation

In this paper, a gait event detection algorithm is presented that uses computer intelligence (fuzzy logic) to identify seven gait phases in walking gait. Two inertial measurement units and four force-sensitive resistors were used to obtain knee angle and foot pressure patterns, respectively. Fuzzy logic is used to address the complexity in distinguishing gait phases based on discrete events. A novel application of the seven-dimensional vector analysis method to estimate the amount of abnormalities detected was also investigated based on the two gait parameters. Experiments were carried out to validate the application of the two proposed algorithms to provide accurate feedback in rehabilitation. The algorithm responses were tested for two cases, normal and abnormal gait. The large amount of data required for reliable gait-phase detection necessitate the utilisation of computer methods to store and manage the data. Therefore, a database management system and an interactive graphical user interface were developed for the utilisation of the overall system in a clinical environment.     

A computational method for reliable gait event detection and abnormality detection for feedback in rehabilitation

In this paper, a gait event detection algorithm is presented that uses computer intelligence (fuzzy logic) to identify seven gait phases in walking gait. Two inertial measurement units and four force-sensitive resistors were used to obtain knee angle and foot pressure patterns, respectively. Fuzzy logic is used to address the complexity in distinguishing gait phases based on discrete events. A novel application of the seven-dimensional vector analysis method to estimate the amount of abnormalities detected was also investigated based on the two gait parameters. Experiments were carried out to validate the application of the two proposed algorithms to provide accurate feedback in rehabilitation. The algorithm responses were tested for two cases, normal and abnormal gait. The large amount of data required for reliable gait-phase detection necessitate the utilisation of computer methods to store and manage the data. Therefore, a database management system and an interactive graphical user interface were developed for the utilisation of the overall system in a clinical environment.     

Geometry and motion of the knee for implant and orthotic design

By analysing sections of distal femurs in the computer, and by making direct measurements, the posterior femoral condyles were shown to closely fit spherical surfaces. The center of the spheres were then used as reference points and used to define reference axes in a motion study. In flexing from 0 to 120 degrees the medial femoral condyle moved little, the lateral moved posteriorly by 17 mm, and there was an axial rotation of 20 degrees. The data were applied to implant and orthotic design and evaluation.     

Evaluation of the influence of muscle deactivation on other muscles and joints during gait motion

When any muscle in the human musculoskeletal system is damaged, other muscles and ligaments tend to compensate for the role of the damaged muscle by exerting extra effort. It is beneficial to clarify how the roles of the damaged muscles are compensated by other parts of the musculoskeletal system from the following points of view: From a clinical point of view, it will be possible to know how the abnormal muscle and joint forces caused by the acute compensations lead to further physical damage to the musculoskeletal system. From the viewpoint of rehabilitation, it will be possible to know how the role of the damaged muscle can be compensated by extra training of the other muscles. A method to evaluate the influence of muscle deactivation on other muscles and joints is proposed in this report. Methodology based on inverse dynamics and static optimization, which is applicable to arbitrary motion was used in this study. The evaluation method was applied to gait motion to obtain matrices representing (1) the dependence of muscle force compensation and (2) the change to bone-on-bone contact forces. These matrices make it possible to evaluate the effects of deactivation of one of the muscles of the musculoskeletal system on the forces exerted by other muscles as well as the change to the bone-on-bone forces when the musculoskeletal system is performing the same motion. Through observation of this matrix, it was found that deactivation of a muscle often results in increment/decrement of force developed by muscles with completely different primary functions and bone-on-bone contact force in different parts of the body. For example, deactivation of the iliopsoas leads to a large reduction in force by the soleus. The results suggest that acute deactivation of a muscle can result in damage to another part of the body. The results also suggest that the whole musculoskeletal system must go through extra retraining in the case of damage to certain muscles.