An upper-body can improve the stability and efficiency of passive dynamic walking

The compass-gait walker proposed by McGeer can walk down a shallow slope with a self-stabilizing gait that requires no actuation or control. However, as the slope goes to zero so does the walking speed, and dynamic gait stability is only possible over a very narrow range of slopes. Gomes and Ruina have results demonstrating that by adding a torso to the compass-gait walker, it can walk passively on level-ground with a non-infinitesimal constant average speed. However, the gait involves exaggerated joint movements, and for energetic reasons horizontal passive dynamic walking cannot be stable. We show in this research that in addition to collision-free walking, adding a torso improves stability and walking speed when walking downhill. Furthermore, adding arms to the torso results in a collision-free periodic gait with natural-looking torso and limb movements. Overall, in contrast to the suggestions that active control may be needed to balance an upper-body on legs, it turns out that the upper and lower bodies can be integrated to improve the stability, efficiency and speed of a passive dynamic walker.     

Gait dynamics on an inclined walkway

OBJECTIVE: This paper documents research that quantifies and describes the biomechanics of normal gait on inclined surfaces. DESIGN: Experimental, investigative. BACKGROUND: It is necessary to walk on inclined surfaces to negotiate the natural and built environments. Little research has been conducted on the biomechanics of normal gait on inclined surfaces. METHODS: The gait of 11 healthy male volunteers was measured using a Vicon system 370 on an inclinable walkway. Gait was measured at 0 degrees , 5 degrees , 8 degrees and 10 degrees of incline. Passive optical markers were placed on each subject and they walked at a self-selected speed up and down the walkway. Ground reaction forces and EMG were measured. Gait data were analysed in Vicon Clinical Manager. RESULTS: Changes in the dynamics of the lower limbs with respect to incline angles are described. Between subject and between condition differences in biomechanical parameters were significant. Hip flexion increased at heel strike with inclines from -10 degrees to +10 degrees . Knee flexion and ankle dorsiflexion at heel strike increased with increasing angle walking up, but not down. Changes in joint moments and powers due to change in the angle of incline or direction of walking were observed. CONCLUSIONS: The mechanisms by which the body enables walking up and downhill, specifically raising and lowering the centre of mass, and preventing slipping, can be seen in the alteration in the dynamics of the lower limbs. Increases in range of motion and muscle strength requirements need to be considered in the design of lower limb prostheses and in orthopaedic and neurological rehabilitation. RELEVANCE: Gait, prosthetics, rehabilitation, balance and falls.     

Invariant hip moment pattern while walking with a robotic hip exoskeleton

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 min of the powered condition and the unpowered condition. After completing three 30-min training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed.     

A model of bipedal locomotion on compliant legs.

Simple mathematical models capable of walking or running are used to compare the merits of bipedal gaits. Stride length, duty factor (the fraction of the stride, for which the foot is on the ground) and the pattern of force on the ground are varied, and the optimum gait is deemed to be the one that minimizes the positive work that the muscles must perform, per unit distance travelled. Even the simplest model, whose legs have neither mass nor elastic compliance, predicts the changes of duty factor and force pattern that people make as they increase their speed of walking. It predicts a sudden change to running at a critical speed, but this is much faster than the speed at which people make the change. When elastic compliance is incorporated in the model, unnaturally fast walking becomes uncompetitive. However, a slow run with very brief foot contact becomes the optimum gait at low speeds, at which people would walk, unless severe energy dissipation occurs in the compliance. A model whose legs have mass as well as elastic compliance predicts well the relationship between speed and stride length in human walking.     

The effects of rhythmic sensory cues on the temporal dynamics of human gait

Walking is a complex, rhythmic task performed by the locomotor system. However, natural gait rhythms can be influenced by metronomic auditory stimuli, a phenomenon of particular interest in neurological rehabilitation. In this paper, we examined the effects of aural, visual and tactile rhythmic cues on the temporal dynamics associated with human gait. Data were collected from fifteen healthy adults in two sessions. Each session consisted of five 15-minute trials. In the first trial of each session, participants walked at their preferred walking speed. In subsequent trials, participants were asked to walk to a metronomic beat, provided through visually, aurally, tactile or all three cues (simultaneously and in sync), the pace of which was set to the preferred walking speed of the first trial. Using the collected data, we extracted several parameters including: gait speed, mean stride interval, stride interval variability, scaling exponent and maximum Lyapunov exponent. The extracted parameters showed that rhythmic sensory cues affect the temporal dynamics of human gait. The auditory rhythmic cue had the greatest influence on the gait parameters, while the visual cue had no statistically significant effect on the scaling exponent. These results demonstrate that visual rhythmic cues could be considered as an alternative cueing modality in rehabilitation without concern of adversely altering the statistical persistence of walking.     

Similar sensorimotor transformations control balance during standing and walking

Standing and walking balance control in humans relies on the transformation of sensory information to motor commands that drive muscles. Here, we evaluated whether sensorimotor transformations underlying walking balance control can be described by task-level center of mass kinematics feedback similar to standing balance control. We found that delayed linear feedback of center of mass position and velocity, but not delayed linear feedback from ankle angles and angular velocities, can explain reactive ankle muscle activity and joint moments in response to perturbations of walking across protocols (discrete and continuous platform translations and discrete pelvis pushes). Feedback gains were modulated during the gait cycle and decreased with walking speed. Our results thus suggest that similar task-level variables, i.e. center of mass position and velocity, are controlled across standing and walking but that feedback gains are modulated during gait to accommodate changes in body configuration during the gait cycle and in stability with walking speed. These findings have important implications for modelling the neuromechanics of human balance control and for biomimetic control of wearable robotic devices. The feedback mechanisms we identified can be used to extend the current neuromechanical models that lack balance control mechanisms for the ankle joint. When using these models in the control of wearable robotic devices, we believe that this will facilitate shared control of balance between the user and the robotic device.     

Computational Models to Synthesize Human Walking

The synthesis of human walking is of great interest in biomechanics and biomimetic engineering due to its predictive capabilities and potential applications in clinical biomechanics, rehabilitation engineering and biomimetic robotics. In this paper, the various methods that have been used to synthesize humanwalking are reviewed from an engineering viewpoint. This involves a wide spectrum of approaches, from simple passive walking theories to large-scale computational models integrating the nervous, muscular and skeletal systems. These methods are roughly categorized under four headings： models inspired by the concept of a CPG （Central Pattern Generator）, methods based on the principles of control engineering, predictive gait simulation using optimisation, and models inspired by passive walking theory. The shortcomings and advantages of these methods are examined, and future directions are discussed in the context of providing insights into the neural control objectives driving gait and improving the stability of the predicted gaits. Future advancements are likely to be motivated by improved understanding of neural control strategies and the subtle complexities of the musculoskeletal system during human locomotion. It is only a matter of time before predictive gait models become a practical and valuable tool in clinical diagnosis, rehabilitation engineering and robotics.     

Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis

The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.     

Dynamic gait stability of treadmill versus overground walking in young adults

Treadmill has been broadly used in laboratory and rehabilitation settings for the purpose of facilitating human locomotion analysis and gait training. The objective of this study was to determine whether dynamic gait stability differs or resembles between the two walking conditions (overground vs. treadmill) among young adults. Fifty-four healthy young adults (age: 23.9 ± 4.7 years) participated in this study. Each participant completed five trials of overground walking followed by five trials of treadmill walking at a self-selected speed while their full body kinematics were gathered by a motion capture system. The spatiotemporal gait parameters and dynamic gait stability were compared between the two walking conditions. The results revealed that participants adopted a “cautious gait” on the treadmill compared with over ground in response to the possible inherent challenges to balance imposed by treadmill walking. The cautious gait, which was achieved by walking slower with a shorter step length, less backward leaning trunk, shortened single stance phase, prolonged double stance phase, and more flatfoot landing, ensures the comparable dynamic stability between the two walking conditions. This study could provide insightful information about dynamic gait stability control during treadmill ambulation in young adults.     

Development of an advanced mechanised gait trainer, controlling movement of the centre of mass, for restoring gait in non-ambulant subjects.

The study aimed at further development of a mechanised gait trainer which would allow non-ambulant people to practice a gait-like motion repeatedly. To simulate normal gait, discrete stance and swing phases, lasting 60% and 40% of the gait cycle respectively, and the control of the movement of the centre of mass were required. A complex gear system provided the gait-like movement of two foot plates with a ratio of 60% to 40% between the stance and swing phases. A controlled propulsion system adjusted its output according to patient's efforts. Two eccenters on the central gear controlled phase-adjusted the vertical and horizontal position of the centre of mass. The patterns of sagittal lower limb joint kinematics and of muscle activation of a normal subject were similar when using the mechanised trainer and when walking on a treadmill. A non-ambulatory hemiparetic subject required little help from one therapist on the gait trainer, while two therapists supported treadmill walking. Gait movements on the trainer were highly symmetrical, impact-free, and less spastic. The weight-bearing muscles were activated in a similar fashion during both conditions. The vertical displacement of the centre of mass was bi-instead of mono-phasic during each gait cycle on the new device. In conclusion, the gait trainer allowed wheelchair-bound subjects the repetitive practice of a gait-like movement without overstraining therapists.     

Combining muscle synergies and biomechanical analysis to assess gait in stroke patients

The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance.To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAF_total values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function.This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals.     

The effects of muscle vibration on gait control: a review

Abstract

Background: The purpose of the review is to summarize the literature surrounding the use of muscle vibration as it relates to modifying human gait.

Methods: After a brief introduction concerning historical uses and early research identifying the effect of vibration on muscle activation, we reviewed 32 articles that used muscle vibration during walking. The review is structured to address the literature within four broad categories: the effect of vibration to ‘trigger’ gait-like lower limb motions, the effect of vibration on gait control of healthy individuals and individuals with clinical conditions in which gait disorders are a prominent feature, and the effect of vibration training protocols on gait.

Results: The acute effects of vibration during gait involving healthy participants is varied. Some authors reported differences in segmental kinematic and spatiotemporal measures while other authors reported no differences in these outcome measures. The literature involving participants with clinical conditions revealed that vibration consistently had a significant impact on gait, suggesting vibration may be an effective rehabilitation tool. All of the studies that used vibration therapy over time reported significant improvement in gait performance.

Conclusions: This review highlights the difficulties in drawing definitive conclusions as to the impact of vibration on gait control, partly because of differences in walking protocols, site of vibration application, and outcome measures used across different investigative teams. It is suggested that the development of common investigative methodologies and outcome measures would accelerate the identification of techniques that may provide optimal rehabilitation protocols for individuals experiencing disordered gait control.     

Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial

ABSTRACT: BACKGROUND: Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation. In current clinical practice, visual feedback of movement performance is often limited to the use of mirrors or video. However, neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment. However, such data are currently presented in numerical or graphical format, which is often impractical in a clinical setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation software, which is tailored for gait rehabilitation after stroke, will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients. This will result in increased patient understanding of their rehabilitation and will enable progress to be tracked in a more accessible way. METHODS: The hypothesis will be assessed using an exploratory (phase II) randomised controlled trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability (Functional Ambulation Classification of 1 or more). Participants (n = 45) will be randomised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group. The primary outcome measure will be walking speed. Secondary measures will be Functional Ambulation Category, Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal parameters associated with walking. Additional qualitative measures will be used to assess the participant's experience of the visual feedback provided in the study. DISCUSSION: Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient understanding of their rehabilitation.Trial registrationCurrent Controlled Trials ISRCTN79005974.     

Quantitative Progress Evaluation of Post-stroke Patients Using a Novel Bimanual Cable-driven Robot

Rehabilitation is the most effective way to reduce motor impairments in post-stroke patients.This process demands several hours with a specialized therapist.Given resources and personnel shortages,the literature reports a high interest in robotic assisted rehabilitation solutions.Recently,cable-driven robotic architectures are attracting significant research interest for post-stroke rehabilitation.However,the existing cable-driven robots are mostly unilateral devices allowing the rehabilitation only of the most affected limb.This leaves unaddressed the rehabilitation of bimanual activities,which are predominant within the common Activities of Daily Living(ADL).Thus,this paper presents a specific novel design to achieve bimanual rehabilitation tasks that has been named as BiCAR robot.Specifically,this paper provides a full insight on the BiCAR sys-tem as well as on its dedicated developed software BiEval.In particular,BiEval software has been developed as based on a serious game strategy and a virtual reality environment to track the patient exercising duration,motion ranges,speeds,and forces over time for achieving a quantitative assessment of the rehabilitation progress.Finally,the paper presents the BiCAR/BiEval capabilities by referring to a pilot Randomized Controlled Trial(RCT).The clinical trials have been used to validate the BiCAR/BiEval in terms of engineering feasibility and user acceptance to achieve an innovative cost-oriented integrated hardware/software device for the bimanual assistive rehabilitation of post-stroke patients.     

A Pilot Study on the Feasibility of Robot-Aided Leg Motor Training to Facilitate Active Participation

Robot-aided gait therapy offers a promising approach towards improving gait function in individuals with neurological disorders such as stroke or spinal cord injury. However, incorporation of appropriate control strategies is essential for actively engaging the patient in the therapeutic process. Although several control algorithms (such as assist-as-needed and error augmentation) have been proposed to improve active patient participation, we hypothesize that the therapeutic benefits of these control algorithms can be greatly enhanced if combined with a motor learning task to facilitate neural reorganization and motor recovery. Here, we describe an active robotic training approach (patient-cooperative robotic gait training combined with a motor learning task) using the Lokomat and pilot-tested whether this approach can enhance active patient participation during training. Six neurologically intact adults and three chronic stroke survivors participated in this pilot feasibility study. Participants walked in a Lokomat while simultaneously performing a foot target-tracking task that necessitated greater hip and knee flexion during the swing phase of the gait. We computed the changes in tracking error as a measure of motor performance and changes in muscle activation as a measure of active subject participation. Repeated practice of the motor-learning task resulted in significant reductions in target-tracking error in all subjects. Muscle activation was also significantly higher during active robotic training compared to simply walking in the robot. The data from stroke participants also showed a trend similar to neurologically intact participants. These findings provide a proof-of-concept demonstration that combining robotic gait training with a motor learning task enhances active participation.     

Kinematic Validation of a Multi-Kinect v2 Instrumented 10-Meter Walkway for Quantitative Gait Assessments

Walking ability is frequently assessed with the 10-meter walking test (10MWT), which may be instrumented with multiple Kinect v2 sensors to complement the typical stopwatch-based time to walk 10 meters with quantitative gait information derived from Kinect’s 3D body point’s time series. The current study aimed to evaluate a multi-Kinect v2 set-up for quantitative gait assessments during the 10MWT against a gold-standard motion-registration system by determining between-systems agreement for body point’s time series, spatiotemporal gait parameters and the time to walk 10 meters. To this end, the 10MWT was conducted at comfortable and maximum walking speed, while 3D full-body kinematics was concurrently recorded with the multi-Kinect v2 set-up and the Optotrak motion-registration system (i.e., the gold standard). Between-systems agreement for body point’s time series was assessed with the intraclass correlation coefficient (ICC). Between-systems agreement was similarly determined for the gait parameters’ walking speed, cadence, step length, stride length, step width, step time, stride time (all obtained for the intermediate 6 meters) and the time to walk 10 meters, complemented by Bland-Altman’s bias and limits of agreement. Body point’s time series agreed well between the motion-registration systems, particularly so for body points in motion. For both comfortable and maximum walking speeds, the between-systems agreement for the time to walk 10 meters and all gait parameters except step width was high (ICC ≥ 0.888), with negligible biases and narrow limits of agreement. Hence, body point’s time series and gait parameters obtained with a multi-Kinect v2 set-up match well with those derived with a gold standard in 3D measurement accuracy. Future studies are recommended to test the clinical utility of the multi-Kinect v2 set-up to automate 10MWT assessments, thereby complementing the time to walk 10 meters with reliable spatiotemporal gait parameters obtained objectively in a quick, unobtrusive and patient-friendly manner.     

Multi-sensor assessment of dynamic balance during gait in patients with subacute stroke

The capacity to maintain upright balance by minimising upper body oscillations during walking, also referred to as gait stability, has been associated with a decreased risk of fall. Although it is well known that fall is a common complication after stroke, no study considered the role of both trunk and head when assessing gait stability in this population. The primary aim of this study was to propose a multi-sensor protocol to quantify gait stability in patients with subacute stroke using gait quality indices derived from pelvis, sternum, and head accelerations. Second, the association of these indices with the level of walking ability, with traditional clinical scale scores, and with fall events occurring within the six months after patients’ dismissal was investigated. The accelerations corresponding to the three abovementioned body levels were measured using inertial sensors during a 10-Meter Walk Test performed by 45 inpatients and 25 control healthy subjects. A set of indices related to gait stability were estimated and clinical performance scales were administered to each patient. The amplitude of the accelerations, the way it is attenuated/amplified from lower to upper body levels, and the gait symmetry provide valuable information about subject-specific motor strategies, discriminate between different levels of walking ability, and correlate with clinical scales. In conclusion, the proposed multi-sensor protocol could represent a useful tool to quantify gait stability, support clinicians in the identification of patients potentially exposed to a high risk of falling, and assess the effectiveness of rehabilitation protocols in the clinical routine.     

Walking speed changes in response to novel user-driven treadmill control

Implementing user-driven treadmill control in gait training programs for rehabilitation may be an effective means of enhancing motor learning and improving functional performance. This study aimed to determine the effect of a user-driven treadmill control scheme on walking speeds, anterior ground reaction forces (AGRF), and trailing limb angles (TLA) of healthy adults. Twenty-three participants completed a 10-m overground walking task to measure their overground self-selected (SS) walking speeds. Then, they walked at their SS and fastest comfortable walking speeds on an instrumented split-belt treadmill in its fixed speed and user-driven control modes. The user-driven treadmill controller combined inertial-force, gait parameter, and position based control to adjust the treadmill belt speed in real time. Walking speeds, peak AGRF, and TLA were compared among test conditions using paired t-tests (α = 0.05). Participants chose significantly faster SS and fast walking speeds in the user-driven mode than the fixed speed mode (p > 0.05). There was no significant difference between the overground SS walking speed and the SS speed from the user-driven trials (p < 0.05). Changes in AGRF and TLA were caused primarily by changes in walking speed, not the treadmill controller. Our findings show the user-driven treadmill controller allowed participants to select walking speeds faster than their chosen speeds on the fixed speed treadmill and similar to their overground speeds. Since user-driven treadmill walking increases cognitive activity and natural mobility, these results suggest user-driven treadmill control would be a beneficial addition to current gait training programs for rehabilitation.     

Modulation of shoulder muscle and joint function using a powered upper-limb exoskeleton

Robotic-assistive exoskeletons can enable frequent repetitive movements without the presence of a full-time therapist; however, human-machine interaction and the capacity of powered exoskeletons to attenuate shoulder muscle and joint loading is poorly understood. This study aimed to quantify shoulder muscle and joint force during assisted activities of daily living using a powered robotic upper limb exoskeleton (ArmeoPower, Hocoma). Six healthy male subjects performed abduction, flexion, horizontal flexion, reaching and nose touching activities. These tasks were repeated under two conditions: (i) the exoskeleton compensating only for its own weight, and (ii) the exoskeleton providing full upper limb gravity compensation (i.e., weightlessness). Muscle EMG, joint kinematics and joint torques were simultaneously recorded, and shoulder muscle and joint forces calculated using personalized musculoskeletal models of each subject’s upper limb. The exoskeleton reduced peak joint torques, muscle forces and joint loading by up to 74.8% (0.113 Nm/kg), 88.8% (5.8%BW) and 68.4% (75.6%BW), respectively, with the degree of load attenuation strongly task dependent. The peak compressive, anterior and superior glenohumeral joint force during assisted nose touching was 36.4% (24.6%BW), 72.4% (13.1%BW) and 85.0% (17.2%BW) lower than that during unassisted nose touching, respectively. The present study showed that upper limb weight compensation using an assistive exoskeleton may increase glenohumeral joint stability, since deltoid muscle force, which is the primary contributor to superior glenohumeral joint shear, is attenuated; however, prominent exoskeleton interaction moments are required to position and control the upper limb in space, even under full gravity compensation conditions. The modeling framework and results may be useful in planning targeted upper limb robotic rehabilitation tasks.     

Step length determines minimum toe clearance in older adults and people with Parkinson’s disease

Reduced foot clearance when walking may increase the risk of trips and falls in people with Parkinson’s disease (PD). Changes in foot clearance in people with PD are likely to be associated with temporal-spatial characteristics of gait such as walking slowly which evokes alterations in the temporal-spatial control of stepping patterns. Enhancing our understanding of the temporal-spatial determinants of foot clearance may inform the design of falls prevention therapies.Thirty-six people with PD and 38 age-matched controls completed four intermittent walks under two conditions: self-selected and fast gait velocity. Temporal-spatial characteristics of gait and foot (heel and toe) clearance outcomes were obtained using an instrumented walkway and 3D motion capture, respectively. A general linear model was used to quantify the effect of PD and gait velocity on gait and foot clearance. Regression evaluated the temporal and spatial gait predictors of minimum toe clearance (MTC).PD walked slower regardless of condition (p = .016) and tended to increase their step length to achieve a faster gait velocity. Step length and the walk ratio consistently explained the greatest proportion of variance in MTC (>28% and >33%, respectively) regardless of group or walking condition (p < .001).Our results suggest step length is the primary determinant of MTC regardless of pathology. Interventions that focus on increasing step length may help to reduce the risk of trips and falls during gait, however, clinical trials are required for robust evaluation.