A two-degree-of-freedom motor-powered gait orthosis for spinal cord injury patients

A number of orthoses have been developed to restore stance and walking in paraplegic subjects. Compliance, however, has been limited, mainly owing to walking effort. Use of the forces produced by actuators is an effective way to solve the problem of the considerable effort required for orthotic gait, namely high muscular effort and high energy expenditure. The purpose of the present study was to investigate the effects of assistance by external actuators on the orthotic gait of spinal cord injury (SCI) patients. Two kinds of linear actuator were developed by using direct current (d.c.) motors for assisting the knee and hip joint of a gait orthosis. They were mounted on the knee and hip joint of a commercial advanced reciprocating gait orthosis (ARGO), and a new two-degree-of-freedom externally powered gait orthosis was thus developed. The orthosis was assessed through inter-subject experiments on five male adult complete SCI patients. Owing to the short training period available for the assisted gait, simultaneous operation of both joint actuators was not conducted: either the knee actuation or the hip actuation was executed only. Thus, the knee actuator and the hip actuator were assessed with a T12 subject and with subjects for T5, T8, T11, and T12 respectively. The motions of the gaits, assisted by the linear actuators, were measured by a Vicon 370 system, and the general gait parameters and compensatory motions were evaluated. Results demonstrated that (a) all subjects could walk without falling, assisted either by the knee or the hip actuator; (b) both the knee and hip joint actuator increased the gait speed and the step length; (c) the knee flexion produced by the orthosis improved the dynamic cosmesis of walking; and (d) lateral compensatory motions as well as vertical ones tended to decrease when the hip joint was assisted, which could contribute to a reduction in walking effort.     

Analysis of the assistance characteristics for the knee extension motion of knee orthosis using muscular stiffness force feedback

In this paper, we are interested in the characteristics of a knee joint when the knee extension motion was assisted by a powered knee orthosis using a muscular stiffness force feedback. For this purpose, we developed the powered knee orthosis with an artificial pneumatic actuator, which is intended for the assistance and the enhancement of muscular activities of lower limbs. The objective of this study was to confirm the effectiveness of the powered knee orthosis that generated a knee extension torque in the motion related to a knee joint. Twenty healthy subjects participated in this study and their lower limb muscular activities were measured to identify the effectiveness of the powered knee orthosis during sit-to-stand (STS) and squat motion. The muscular activities between with and without assistance of knee extension motion were compared and analyzed for the assistance characteristics of the powered knee orthosis. To generate the knee extension torque, the knee orthosis was controlled using muscular stiffness force (MSF) feedback that is controlled by muscular activities of the vastus intermedius muscle that mainly related to the knee extension motion. For analysis of muscular activities, the surface electromyography of the muscles related to the knee extension motion, i.e., RF, vastus lateralis, vastus medialis and vastus intermedius muscles in lower limbs of the right side were recorded and biodex dynamometer was used to measure the maximal concentric isokinetic strength of the knee extensors. The experimental result showed that muscular activities in lower limbs with the assistance of the powered knee orthosis was reduced by 25.62% in rectus femoris muscle and 29.82% in biceps femoris muscle, respectively and knee extension torque of an knee joint wearing knee orthosis was increased by 17.68% in averaged peak torque. Based on the effectiveness of the powered knee orthosis, weaken elder people may have benefited from the knee extension motion augmented by the powered knee orthosis during activity of daily living, e.g., stair ascent.     

Design of active orthoses for a robotic gait rehabilitation system

An active orthosis (AO) is a robotic device that assists both human gait and rehabilitation therapy. This work proposes portable AOs, one for the knee joint and another for the ankle joint. Both AOs will be used to complete a robotic system that improves gait rehabilitation. The requirements for actuator selection, the biomechanical considerations during the AO design, the finite element method, and a control approach based on electroencephalographic and surface electromyographic signals are reviewed. This work contributes to the design of AOs for users with foot drop and knee flexion impairment. However, the potential of the proposed AOs to be part of a robotic gait rehabilitation system that improves the quality of life of stroke survivors requires further investigation.     

Kinematic modelling of a robotic gait device for early rehabilitation of walking

Rehabilitation of walking is an essential element in the treatment of incomplete spinal cord injured (SCI) patients. During the early post injury period, patients find it challenging to practice upright walking. Simulating stepping movements in a supine posture may be easier and promote earlier rehabilitation. A robotic orthotic device for early intervention in spinal cord injury that does not require the patient to be in an upright posture has been modelled. The model comprises a two-bar mechanical system that is configured and powered to provide limb kinematics that approximate normal overground walking. The modelling work has been based on gait analysis performed on healthy subjects walking at 50 per cent, 75 per cent, and 100 per cent of normal cadence. Simulated angles of hip, knee, and ankle joints show a comparable range of motion (ROM) to the experimental walking data measured in healthy subjects. The model provides operating parameters for a prospective recumbent gait orthosis that could be used in early walking rehabilitation of incomplete SCI patients.     

Design method and verification of a hybrid prosthetic mechanism with energy-damper clutchable device for transfemoral amputees

Transfemoral amputees (TAs) have difficulty in mobility during walking, such as restricted movement of lower extremity and body instability, yet few transfemoral prostheses have explored human-like multiple motion characteristics by simple structures to fit the kinesiology, biomechanics, and stability of human lower extremity. In this work, the configurations of transfemoral prosthetic mechanism are synthesized in terms of human lower-extremity kinesiology. A hybrid transfemoral prosthetic (HTP) mechanism with multigait functions is proposed to recover the gait functions of TAs. The kinematic and mechanical performances of the designed parallel mechanism are analyzed to verify their feasibility in transfemoral prosthetic mechanism. Inspired by motion–energy coupling relationship of the knee, a wearable energy-damper clutched device that can provide energy in knee stance flexion to facilitate the leg off from the ground and can impede the leg’s swing velocity for the next stance phase is proposed. Its co-operation with the springs in the prismatic pairs enables the prosthetic mechanism to have the energy recycling ability under the gait rhythm of the knee joint. Results demonstrate that the designed HTP mechanism can replace the motion functions of the knee and ankle to realize its multimode gait and effectively decrease the peak power of actuators from 94.74 to 137.05 W while maintaining a good mechanical adaptive stability.     

下肢步态矫形器轨迹控制设计

为了模拟正常人的行走步态,设计了具有外骨骼结构的动力步态矫形器。采用LabVIEW软件和多功能数据采集卡以及交流伺服平台,完成了下肢步态矫形器步态轨迹的半闭环控制,同时介绍了步态生成方法以及软件的设计。研究结果表明,步态矫形器能够较好地复原正常人的行走步态,并已应用到下肢康复机器人的控制系统中。     

Computer control of a powered two degree freedom reciprocating gait orthosis

The design of a motion control system for a powered reciprocating gait orthosis is considered. Models for the orthosis are obtained using least squares identification. The control system design is based on pole-placement techniques and a restricted Youla parametrization of the controller. Experimental results are included.     

Influence of joint models on lower-limb musculo-tendon forces and three-dimensional joint reaction forces during gait

Several three-dimensional (3D) lower-limb musculo-skeletal models have been developed for gait analysis and different hip, knee and ankle joint models have been considered in the literature. Conversely to the influence of the musculo-tendon geometry, the influence of the joint models--i.e. number of degrees of freedom and passive joint moments--on the estimated musculo-tendon forces and 3D joint reaction forces has not been extensively examined. In this paper musculo-tendon forces and 3D joint reaction forces have been estimated for one subject and one gait cycle with nine variations of a musculoskeletal model and outputs have been compared to measured electromyographic signals and knee joint contact forces. The model outputs are generally in line with the measured signals. However, the 3D joint reaction forces were higher than published values and the contact forces measured for the subject. The results of this study show that, with more degrees of freedom in the model, the musculo-tendon forces and the 3D joint reaction forces tend to increase but with some redistribution between the muscles. In addition, when taking into account passive joint moments, the 3D joint reaction forces tend to decrease during the stance phase and increase during the swing phase. Although further investigations are needed, a five-degree-of-freedom lower-limb musculo-skeletal model with some angle-dependent joint coupling and stiffness seems to provide satisfactory musculo-tendon forces and 3D joint reaction forces.     

Design and control of an active artificial knee joint

A passive above knee prosthesis being currently in use does not respond adequately to the needs of daily living activities of an amputee due to its limited functions. Therefore, this study deals with design and testing of an active above knee prosthesis. The essential part of this prosthesis is the knee joint actuator based on active control of basic flexion and extension functions of the knee joint with the motor. The imitation of walking gait pattern by the proposed prosthesis was provided with a trajectory control scheme for the knee joint angle in accordance with the necessity of rule-based control approach.     

Three-dimensional contact dynamic model of the human knee joint during walking

It is well known that the geometry of the articular surface has a major role in determining the position of articular contact and the lines of action for the contact forces. The contact force calculation of the knee joint under the effect of sliding and rolling is one of the most challenging issues in this field. We present a 3-D human knee joint model including sliding and rolling motions and major ligaments to calculate the lateral and medial condyle contact forces from the recovered total internal reaction force using inverse dynamic contact modeling and the Least-Square method. As results, it is believed that the patella, muscles and tendon affect a lot for the internal reaction forces at the initial heel contact stage. With increasing flexion angles during gait, the decreasing contact area is progressively shifted to the posterior direction on the tibia plateau. In addition, the medial side contact force is larger than the lateral side contact force in the knee joint during normal human walking. The total internal forces of the knee joint are reasonabe compared to previous studies.     

Assistance of the elbow flexion motion on the active elbow orthosis using muscular stiffness force feedback

An elbow orthosis with pneumatic artificial muscles has been developed to assist and enhance upper limbs movements and has been examined for effectiveness. The effectiveness of the elbow orthosis was examined by comparing muscular activities during alternate dumbbell curl motion wearing and without wearing the orthosis. The subjects participating in the experiment were young adults in their twenties. The subjects were instructed to perform a dumbbell curl motion in a sitting position with and without wearing an orthosis in turn, and a dynamometer was used to measure elbow joint torque in isokinetic mode. The measurements were done with four various dumbbell loads: 0, 1, 3, and 5 kg. We examined the effectiveness of the elbow orthosis in two control methods. First, the orthosis was pneumatically actuated and controlled in the passive control mode. Then, it was controlled in the active control mode using the muscular stiffness force of the muscle that is measured from a force sensor through a cDAQ-9172 board. For the analysis of muscular power, the muscular activities of the subject were measured during alternate dumbbell curl motion using MP150 (BIOPAC Systems, Inc.). The muscles of interest were biceps brachii muscle, triceps brachii muscle, brachioradialis muscle, and flexor carpi ulnaris muscle in the upper limbs of the right side. The elbow joint torque was measured during elbow flexion motion using a dynamometer at 60° per second for isokinetic strength. The experimental result showed that the muscular activities wearing the elbow orthosis were reduced and elbow joint torque wearing the elbow orthosis was higher because of the assist of the orthosis. As a result of this experiment, the effectiveness of the developed elbow orthosis was confirmed and the level of assistance was quantified. With this, we confirmed the effectiveness of the developed elbow orthosis.     

The biomechanics of a validated finite element model of stress shielding in a novel hybrid total knee replacement

This study proposes a novel hybrid total knee replacement (TKR) design to improve stress transfer to bone in the distal femur and, thereby, reduce stress shielding and consequent bone loss. Three-dimensional finite element (FE) models were developed for a standard and a hybrid TKR and validated experimentally. The Duracon knee system (Stryker Canada) was the standard TKR used for the FE models and for the experimental tests. The FE hybrid device was identical to the standard TKR, except that it had an interposing layer of carbon fibre-reinforced polyamide 12 lining the back of the metallic femoral component. A series of experimental surface strain measurements were then taken to validate the FE model of the standard TKR at 3000 N of axial compression and at 0 degreeof knee flexion. Comparison of surface strain values from FE analysis with experiments demonstrated good agreement, yielding a high Pearson correlation coefficient of R(2)= 0.94. Under a 3000N axial load and knee flexion angles simulating full stance (0O degree, heel strike (200 degrees, and toe off (600 degrees during normal walking gait, the FE model showed considerable changes in maximum Von Mises stress in the region most susceptible to stress shielding (i.e. the anterior region, just behind the flange of the femoral implant). Specifically, going from a standard to a hybrid TKR caused an increase in maximum stress of 87.4 per cent (O0 degree from 0.15 to 0.28 MPa), 68.3 per cent (200 degrees from 1.02 to 1.71 MPa), and 12.6 per cent (600 degrees from 2.96 to 3.33 MPa). This can potentially decrease stress shielding and subsequent bone loss and knee implant loosening. This is the first report to propose and biomechanically to assess a novel hybrid TKR design that uses a layer of carbon fibrereinforced polyamide 12 to reduce stress shielding.     

Effect of ultra-high molecular weight polyethylene thickness on contact mechanics in total knee replacement

One of the important design parameters in current knee joint replacements is the thickness of the ultra-high molecular weight polyethylene (UHMWPE) tibial insert, yet there is no clear definition of the upper limit of the 'thick' polyethylene insert. Using one design knee implant and subjecting it to the physiological loads encountered throughout the gait cycle, measurements of the lengths of contact imprints generated were compared with the corresponding theoretical predictions for different insert thicknesses under the same applied load. Multiple regression analysis was applied to test whether the dimensions of contact imprints are influenced by UHMWPE thickness. Good agreement was obtained between the theoretical predictions and the experimental measurements of the dimensions of contact imprints when the knee was at 60 degrees flexion. Therefore, it was possible to estimate the contact pressure at the articulating surface using the theoretical model. Contact imprint dimensions increased with increasing applied load. Statistical analysis of the experimental data revealed that, at 0 degree flexion, the overall imprint dimensions increased as the UHMWPE thickness increased from 8 to 20 mm. However, the increment was not significant when the thickness subinterval 10-15 mm was considered. Furthermore, at 60 degrees flexion, thickness was not a significant factor for the overall imprint dimensions. No evidence was found from the data to suggest that an increment in polyethylene thickness over 10 mm would significantly reduce the contact imprint dimensions. These findings suggest that thicker inserts can be avoided, as they require unnecessary bone resection.     

一种新型仿生变胞膝关节外骨骼机器人及其多体运动尺度综合方法研究

针对人体步态周期的摆动相与承载相生物力学特征,创新性的提出一种集变胞仿生膝关节外骨骼机器人与具有“J”型轨迹特征运动副人体等效下肢为一体的人-机并联研究原型,在深入解析其变胞运动承载仿生工作机理的基础上,系统提出一种多体运动尺度综合方法。该方法首先基于多体运动学,系统构建人-机并联运动学模型;其次针对该外骨骼对其穿戴位置滑移与下肢个体差异的有效几何包容,提出一种新型运动学综合性能评价指标——仿生灵巧包容度;再次将多体运动尺度综合问题归结为一类多目标优化问题;最后计及不同人群的步态差异性,采用压缩粒子群算法,深入开展膝关节外骨骼系统多体运动尺度综合数值仿真。通过仿真数据对比与参数敏感性分析,佐证该膝关节外骨骼机器人所具有的变胞仿生运动学综合性能,以及多体运动尺度综合方法的合理性与有效性,为后续研究原型承载有效性的相关研究,提供理论基础。     

Pneumatic interactive gait rehabilitation orthosis: design and preliminary testing

Motor rehabilitation techniques based on passive movement of the lower limbs have been developed over the past 15 years. Gait training automation is the latest innovation in these techniques. This paper describes the design and development of a pneumatic interactive gait rehabilitation orthosis (PIGRO), as well as the first experimental results obtained with healthy subjects. PIGRO consists of a modular and size-adaptable exoskeleton, pneumatic actuation systems for the six actuated degrees of freedom (DoF), and a control unit. The foot orthosis and ankle actuation can be removed and/or replaced with orthopaedic shoes so as to permit gait rehabilitation while advancing between parallel bars with ground contact and partial body weight support (i.e. not walking in place). Control logic provides closed-loop position control independently on each joint, with position feedback for each joint in real time. Imposed curves are physiological joint angles: it is also possible to choose between activating one or both legs and to modify curves to obtain different gait patterns if required. The paper concludes with a presentation of experimental results for the device's performance.     

A method for the reduction of skin marker artifacts during walking : Application to the knee

Previous studies have demonstrated the importance of joint angle errors mainly due to skin artifact and measurement errors during gait analysis. Joint angle errors lead to unreliable kinematics and kinetic analyses in the investigation of human motion. The purpose of this paper is to present the Joint Averaging Coordinate System (JACS) method for human gait analysis. The JACS method is based on the concept of statistical data reduction of anatomically referenced marker data. Since markers are not attached to rigid bodies, different marker combinations lead to slightly different predictions of joint angles. These different combinations can be averaged in order to provide a “best” estimate of joint angle. Results of a gait analysis are presented using clinically meaningful terminology to provide better communication with clinical personal. In order to verify the developed JACS method, a simple three-dimensional knee joint contact model was developed, employing an absolute coordinate system without using any kinematics constraint in which thigh and shank segments can be derived independently. In the experimental data recovery, the separation and penetration distance of the knee joint is supposed to be zero during one gait cycle if there are no errors in the experimental data. Using the JACS method, the separation and penetration error was reduced compared to well-developed existing methods such as ACRS and Spoor & Veldpaus method. The separation and penetration distance ranged up to 15 mm and 12 mm using the Spoor & Veldpaus and ACRS method, respectively, compared to 9 mm using JACS method. Statistical methods like the JACS can be applied in conjunction with existing techniques that reduce systematic errors in marker location, leading to an improved assessment of human gait.     

基于人行走能耗分析的踝关节外骨骼设计

基于对人体行走的能耗分析,设计了一种新型有源无动力踝关节外骨骼。首先,基于耦合摆模型建立人体行走摆动相动力学方程并采用打靶法求解。根据动量守恒原理分别计算摆动腿膝关节锁定、脚跟着地以及关节摩擦引起的能耗率。计算结果表明,脚跟着地引起的能耗率远大于膝关节锁定和关节摩擦引起的能耗率。然后,基于该能耗分析结果设计了一种足底弹性储能机构将脚跟着地时的能耗存储起来,在跖屈蹬地阶段释放助力。通过前脚掌压力信号控制电磁铁驱动的离合机构,实现对助力弹簧夹紧与释放的状态切换。样机实验结果表明：足底储能机构可以提高外骨骼的输出力矩和功率,提升助行能力;外骨骼的最大输出力矩为19N·m;穿戴该外骨骼行走时小腿三头肌激活度相较于不穿戴时最大下降约8.6%。踝关节角度测量结果表明,在摆动相期间外骨骼很少干扰穿戴者踝关节的正常活动。     

Concurrent validation of magnetic and inertial measurement units in estimating upper body posture during gait

We assessed the concurrent validity of commercially available magnetic and inertial measurement units (MIMUs) for estimating mean postural angles for head flexion, thorax flexion and shoulder girdle elevation during gait in seven healthy individuals. Postural angles estimated with the MIMUs were compared with angles calculated using marker data from a gold standard motion capture system. Coefficients of determination of mean postural angles between measurement systems were 0.82 for head flexion, 0.58 for thorax flexion, and 0.77 for shoulder girdle elevation. Bland–Altman analysis showed good agreement between measurement systems. Intraclass correlation coefficients were 0.9 for head flexion, 0.73 for thorax flexion, and 0.87 for shoulder girdle elevation. Root mean square errors were less than 3° between measurement systems for all body segments. The present findings suggest that the MIMUs tested in this study are valid for estimating head flexion, thorax flexion and shoulder girdle elevation during gait.     

A design concept for a swing-lock knee joint for whole-leg calipers

Whole-leg calipers, extending from the heel to the groin region, have traditionally employed knee joints that remain locked throughout the gait cycle, thereby imposing disadvantages in the dynamics, energy utilization and cosmesis of the resulting gait. A design concept is presented for a knee joint that will allow the knee joint to automatically unlock and relock at appropriate points in the gait cycle, to allow a swing-through gait style to be used.     

Does the choice of stair gait cycle affect resulting knee joint kinematics and moments?

Stair gait is a useful activity for the assessment of knee function. The aim of this study was to determine whether knee joint kinematics and moments are affected by the choice of stair gait cycle (SGC) and the step used to measure ground reaction forces (GRFs). This was investigated through motion analysis of ten non-pathological subjects as they ascended and descended a four-step staircase. The SGCs compared for ascent were, first, step 1 (measuring GRFs) to step 3 and, second, step 2 (measuring GRFs) to step 4, and vice versa for stair descent. Knee joint kinematics were not significantly influenced by the choice of SGC. For ascent, significantly larger peak adduction moments were measured for SGCs beginning on step 1 (0.30 +/- 0.08 N m/kg) than for SGCs beginning on step 2 (0.23 +/- 0.09 N m/kg). For descent, the second flexion moment peak was found to be significantly larger for SGCs ending on step 2 (1.17 +/- 0.25 N m/kg) than for SGCs ending on step 1 (0.97 +/- 0.19 N m/kg), and the first adduction moment peak was found to be significantly larger for SGCs ending on step 2 (0.28 +/- 0.15 N m/kg) than for SGCs ending on step 1 (0.21 +/- 0.18 N m/kg). This study highlights important considerations when planning stair gait measurement protocols and comparing results from studies made by other laboratories.