Angular-Velocity Control Approach for Stance-Control Orthoses

Currently, stance-control knee orthoses require external control mechanisms to control knee flexion during stance and allow free knee motion during the swing phase of gait. A new angular-velocity control approach that uses a rotary-hydraulic device to resist knee flexion when the knee angular velocity passes a preset threshold is presented. This angular-velocity approach for orthotic stance control is based on the premise that knee-flexion angular velocity during a knee-collapse event, such as a stumble or fall, is greater than that during walking. The new hydraulic knee-flexion control device does not require an external control mechanism to switch from free motion to stance control mode. Functional test results demonstrated that the hydraulic angular-velocity activated knee joint provided free knee motion during walking, engaged upon knee collapse, and supported body weight while the end-user recovered to a safe body position. The joint was tested to 51.6 Nm in single loading tests and passed 200$thinspace$000 repeated loading cycles with a peak load of 88 Nm per cycle. The hydraulic, angular velocity activation approach has potential to improve safety and security for people with lower extremity weakness or when recovering from joint trauma.      

Preliminary evaluation of a powered lower limb orthosis to aid walking in paraplegic individuals

This paper describes a powered lower-limb orthosis that is intended to provide gait assistance to spinal cord injured (SCI) individuals by providing assistive torques at both hip and knee joints. The orthosis has a mass of 12 kg and is capable of providing maximum joint torques of 40 Nm with hip and knee joint ranges of motion from 105° flexion to 30° extension and 105° flexion to 10° hyperextension, respectively. A custom distributed embedded system controls the orthosis with power being provided by a lithium polymer battery which provides power for one hour of continuous walking. In order to demonstrate the ability of the orthosis to assist walking, the orthosis was experimentally implemented on a paraplegic subject with a T10 complete injury. Data collected during walking indicates a high degree of step-to-step repeatability of hip and knee trajectories (as enforced by the orthosis) and an average walking speed of 0.8 km/hr. The electrical power required at each hip and knee joint during gait was approximately 25 and 27 W, respectively, contributing to the 117 W overall electrical power required by the device during walking. A video of walking corresponding to the aforementioned data is included in the supplemental material.     

Design and evaluation of the LOPES exoskeleton robot for interactive gait rehabilitation.

This paper introduces a newly developed gait rehabilitation device. The device, called LOPES, combines a freely translatable and 2-D-actuated pelvis segment with a leg exoskeleton containing three actuated rotational joints: two at the hip and one at the knee. The joints are impedance controlled to allow bidirectional mechanical interaction between the robot and the training subject. Evaluation measurements show that the device allows both a "patient-in-charge" and "robot-in-charge" mode, in which the robot is controlled either to follow or to guide a patient, respectively. Electromyography (EMG) measurements (one subject) on eight important leg muscles, show that free walking in the device strongly resembles free treadmill walking; an indication that the device can offer task-specific gait training. The possibilities and limitations to using the device as gait measurement tool are also shown at the moment position measurements are not accurate enough for inverse-dynamical gait analysis.     

Robot Assisted Gait Training With Active Leg Exoskeleton (ALEX)

Gait training of stroke survivors is crucial to facilitate neuromuscular plasticity needed for improvements in functional walking ability. Robot assisted gait training (RAGT) was developed for stroke survivors using active leg exoskeleton (ALEX) and a force-field controller, which uses assist-as-needed paradigm for rehabilitation. In this paradigm undesirable gait motion is resisted and assistance is provided towards desired motion. The force-field controller achieves this paradigm by effectively applying forces at the ankle of the subject through actuators on the hip and knee joints. Two stroke survivors participated in a 15-session gait training study each with ALEX. The results show that by the end of the training the gait pattern of the patients improved and became closer to a healthy subject's gait pattern. Improvement is seen as an increase in the size of the patients' gait pattern, increased knee and ankle joint excursions and increase in their walking speeds on the treadmill.      

Biomechanical evaluation of a prototype foot/ankle prosthesis.

In this paper, we report on our pilot evaluation of a prototype foot/ankle prosthesis. This prototype has been designed and fabricated with the intention of providing decreased ankle joint stiffness during the middle portion of the stance phase of gait, and increased (i.e., more normal) knee range of motion during stance. Our evaluation involved fitting the existing prototype foot/ankle prosthesis, as well as a traditional solid ankle cushioned heel (SACH) foot, to an otherwise healthy volunteer with a below-knee (BK) amputation. We measured this individual's lower extremity joint kinematics and kinetics during walking using a video motion analysis system and force platform. These measurements permitted direct comparison of prosthetic ankle joint stiffness and involved side knee joint motion, as well as prosthetic ankle joint moment and power.     

Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait

An active ankle-foot orthoses (AAFO) is presented where the impedance of the orthotic joint is modulated throughout the walking cycle to treat drop-foot gait. During controlled plantar flexion, a biomimetic torsional spring control is applied where orthotic joint stiffness is actively adjusted to minimize forefoot collisions with the ground. Throughout late stance, joint impedance is minimized so as not to impede powered plantar flexion movements, and during the swing phase, a torsional spring-damper control lifts the foot to provide toe clearance. To assess the clinical effects of variable-impedance control, kinetic and kinematic gait data were collected on two drop-foot participants wearing the AAFO. For each participant, zero, constant, and variable impedance control strategies were evaluated and the results were compared to the mechanics of three age, weight, and height matched normals. We find that actively adjusting joint impedance reduces the occurrence of slap foot allows greater powered plantar flexion and provides for less kinematic difference during swing when compared to normals. These results indicate that a variable-impedance orthosis may have certain clinical benefits for the treatment of drop-foot gait compared to conventional ankle-foot orthoses having zero or constant stiffness joint behaviors.     

Optimal control of walking with functional electrical stimulation: a computer simulation study.

Bipedal locomotion was simulated to generate a pattern of activating muscles for walking using electrical stimulation in persons with spinal cord injury (SCI) or stroke. The simulation presented in this study starts from a model of the body determined with user-specific parameters, individualized with respect to the lengths, masses, inertia, muscle and joint properties. The trajectory used for simulation was recorded from an able-bodied subject while walking with ankle-foot orthoses. A discrete mathematical model and dynamic programming were used to determine the optimal control. A cost function was selected as the sum of the squares of the tracking errors from the desired trajectories, and the weighted sum of the squares of agonist and antagonist activations of the muscle groups acting around the hip and knee joints. The aim of the simulation was to study plausible trajectories keeping in mind the limitations imposed by the spinal cord injury or stroke (e.g., spasticity, decreased range of movements in some joints, limited strength of paralyzed, externally activated muscles). If the muscles were capable of generating the movements required and the trajectory was achieved, then the simulation provided two kinds of information: 1) timing of the onset and offset of muscle activations with respect to the various gait events and 2) patterns of activation with respect to the maximum activation. These results are important for synthesizing a rule-based controller.     

Simulation of a functional neuromuscular stimulation powered mechanical gait orthosis with coordinated joint locking.

The purpose of this study was to examine a hybrid orthosis system (HOS) for walking after spinal-cord injury (SCI) that coordinates the mechanical locking and unlocking of knee and ankle joints of a reciprocating gait orthosis (RGO), while propulsive forces are injected and unlocked joints controlled with functional neuromuscular stimulation (FNS). The likely effectiveness of the HOS in terms of forward progression, stability, and posture of paraplegic gait was determined in this simulation study. A three-dimensional computer model of a HOS combining FNS with an RGO incorporating feedback control of muscle activation and joint locking was developed. An anthropomorphic human model included passive joint moments and a foot-ground contact model adapted from other studies. A model of the RGO reciprocally coupled the hips and locked and unlocked the knee and ankle joints during stance and swing respectively. The actions of muscles under FNS activation were modeled via closed-loop control of joint torque inputs. A walking aid that mimicked canes and voluntary upper extremity actions maintained lateral stability by providing the necessary shoulder forces and moments. The simulated HOS achieved gait speeds of 0.51 +/- 0.03 m/s, stride lengths of 0.85 +/- 0.04 m, and cadences of 72 +/- 4 steps/min, exceeding the reported performance of other assistive gait systems. Although minimal forward trunk tilt was found to be necessary during specific phases of gait, posture, and stability were significantly improved over FNS-only systems.     

被动踝足外骨骼对平地行走时运动表现的影响

被动踝关节外骨骼(unpowered-ankle exoskeleton)可实现人体步态行走良好辅助作用,但对其助行增强效果研究多局限于跑步机行走范式,现少有在平地行走下穿戴外骨骼对穿戴者运动生物力学影响的研究。本研究设计组装了一款低成本模块化的被动踝关节外骨骼,首次研究了平地行走下穿戴被动踝关节外骨骼对健康年轻穿戴者肌肉激活与运动表现的影响。实验招募5名穿戴者,在无外骨骼、仅穿戴外骨骼框架和穿戴外骨骼3种实验条件下完成直线行走任务,过程中同步采集人体下肢主要肌群的肌电和关节运动轨迹。提取了肌电激活特征和关节角度特征,采用双因素方差分析方法揭示了不同外骨骼穿戴状态对相关特征的影响。结果表明,外骨骼框架会对人体提供支撑,降低站立阶段腓肠肌内侧肌肉激活。而穿戴外骨骼在站立阶段使腓肠肌内侧的平均肌肉激活显著降低20%,也显著降低了踝关节的峰值力矩及功率。外骨骼会使髋膝关节的运动学和动力学表现发生变化,这可能与下肢关节间的能量交换有关。因此,被动踝关节外骨骼可在平地行走下对踝关节实现支撑相和推离阶段有效辅助,但穿戴者同时也会适应外骨骼穿戴而改变其步态。     

A reliable gait phase detection system

A new highly reliable gait phase detection system, which can be used in gait analysis applications and to control the gait cycle of a neuroprosthesis for walking, is described. The system was designed to detect in real-time the following gait phases: stance, heel-off, swing, and heel-strike. The gait phase detection system employed a gyroscope to measure the angular velocity of the foot and three force sensitive resistors to assess the forces exerted by the foot on the shoe sole during walking. A rule-based detection algorithm, which was running on a portable microprocessor board, processed the sensor signals. In the presented experimental study ten able bodied subjects and six subjects with impaired gait tested the device in both indoor and outdoor environments (0-25°C). The subjects were asked to walk on flat and irregular surfaces, to step over small obstacles, to walk on inclined surfaces, and to ascend and descend stairs. Despite the significant variation in the individual walking styles the system achieved an overall detection reliability above 99% for both subject groups for the tasks involving walking on flat, irregular, and inclined surfaces. In the case of stair climbing and descending tasks the success rate of the system was above 99% for the able body subjects and above 96% for the subjects with impaired gait. The experiments also showed that the gait phase detection system, unlike other similar devices, was insensitive to perturbations caused by nonwalking activities such as weight shifting between legs during standing, feet sliding, sitting down, and standing up     

Design and quantitative evaluation of a stance-phase controlled prosthetic knee joint for children.

The aims of this study were to demonstrate a theoretical basis for the design of a stance-phase controlled paediatric prosthetic knee joint, clinically test prototypes of the knee, and use a questionnaire to evaluate its efficacy. Biomechanical models were used to analyze the stance-phase control characteristics of the proposed knee, and those of three other commonly prescribed paediatric knee joint mechanisms, which were also the conventional knee joints used by the six participants of this study (mean age 10.8 years). A questionnaire pertaining to stance-phase control was designed and administered twice to each child; once for the evaluation of the prototype knee joint and once for the conventional knee joint. Stance-phase modeling results indicated decreased zones of instability for the new knee as compared to other paediatric knee joints. Questionnaire results revealed a decrease in the frequency of falls with the prototype compared to other knees, especially in highly active children. The children also reported worrying less about the knee collapsing during walking. No differences were evident for stance-phase stability during running, walking on uneven terrain, ambulating up and down stairs and inclines, fatigue, and types of activities performed.     

Assessment of motion of a swing leg and gait rehabilitation with a gravity balancing exoskeleton.

The gravity balancing exoskeleton, designed at University of Delaware, Newark, consists of rigid links, joints and springs, which are adjustable to the geometry and inertia of the leg of a human subject wearing it. This passive exoskeleton does not use any motors but is designed to unload the human leg joints from the gravity load over its range-of-motion. The underlying principle of gravity balancing is to make the potential energy of the combined leg-machine system invariant with configuration of the leg. Additionally, parameters of the exoskeleton can be changed to achieve a prescribed level of gravity assistance, from 0% to 100%. The goal of the results reported in this paper is to provide preliminary quantitative assessment of the changes in kinematics and kinetics of the walking gait when a human subject wears such an exoskeleton. The data on kinematics and kinetics were collected on four healthy and three stroke patients who wore this exoskeleton. These data were computed from the joint encoders and interface torque sensors mounted on the exoskeleton. This exoskeleton was also recently used for a six-week training of a chronic stroke patient, where the gravity assistance was progressively reduced from 100% to 0%. The results show a significant improvement in gait of the stroke patient in terms of range-of-motion of the hip and knee, weight bearing on the hemiparetic leg, and speed of walking. Currently, training studies are underway to assess the long-term effects of such a device on gait rehabilitation of hemiparetic stroke patients.     

Kinetics of stiff-legged gait: induced acceleration analysis.

Treating spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, holds a high priority in the rehabilitation of patients with upper motor neuron lesions. We propose a method to determine the relative contributions of hip, knee, and ankle impairments to this disability. We analyzed the gait of ten patients with stiff-legged gait (SLG) due to a single stroke and ten healthy, able-bodied controls. Using subject specific models, we analyzed the induced accelerations (IA's) at the knee. Knee IA's throughout the gait cycle were calculated and the sum of the IA's was compared to the knee joint angular acceleration estimated from kinematic data. The preswing and early swing IA's were the focus of our examination as these largely determine knee kinematics in swing. Knee angular accelerations estimated from IA's and kinematic data agreed for both controls and patients. Gait cycle IA analysis of individual patients identified highly variable causes of SLG including ankle and hip joint impairments. Induced acceleration analysis (IAA) suggested that multiple impairments, not just about the knee, but also about the hip and ankle, lead to this disability. Individual subjects are likely to have individual reasons for their stiff-legged gait. Defining the link between the patients specific impairments and their gait disability should be a goal of clinical gait analysis. IAA is a useful tool for this purpose with a strong potential for clinical application.     

Myoelectric activation pattern during gait in total knee replacement: relationship with kinematics, kinetics, and clinical outcome.

Gait usually presents an excellent improvement after total knee replacement. Nevertheless, some abnormalities persist even after a long period of time. The abnormal knee patterns have been attributed to several possible causes, such as implant geometry and surgical technique, posterior cruciate ligament sparing/sacrificing, preoperative "stiff-knee" pattern due to pain and altered biomechanics, weakness of the extensor muscles, preoperative arthritic pattern, proprioceptive deficiency, and multijoint degenerative involvement. Cocontraction of the knee flexors and extensors is a common strategy adopted to reduce strain and shear forces at the joint, but it increases compressive forces and joint loading. Even in patients with an excellent functional score, the duration of the implant may be compromised by an altered neuromuscular control of the knee. In this paper, we report a single case study carried out over two years on a patient that underwent total knee replacement. The aim of this work is to show that quantitative gait analysis is essential to augment the understanding of the mechanisms underlying gait, thus enabling clinicians to adapt the rehabilitation program to the specific patient. Although the limits of single case reports are obvious, we believe that this evaluation methodology could be beneficial for assessing the effectiveness of rehabilitation programs aimed at achieving an active control of the knee during gait through a correct muscular activation pattern.     

A novel method for automatic treadmill speed adaptation.

Robot-aided treadmill training is an innovative rehabilitation method for patients with locomotor dysfunctions. However, in current rehabilitation systems treadmill speed is restricted to constant values or adjusted by the therapist, whereas self-determined phases of accelerations and decelerations cannot be performed by the patient in an interactive and intuitive way. We present a new approach that allows treadmill walking with intuitive gait speed adaptation. In this approach, the user's trunk position is fixed in walking direction. The horizontal interaction forces applied by the user intending to accelerate or decelerate the gait are measured at the trunk connection and fed to the treadmill controller. The desired gait acceleration is calculated by means of a virtual admittance. Integration yields the desired speed which is fed into the underlying velocity controller of the treadmill. The method was verified by two experimental setups and tested on ten healthy subjects. In one setup, the subject's trunk was rigidly connected by a tether, whereas in the second setup the subject was placed in a robotic gait orthosis. All subjects were able to use both systems immediately and intuitively. The treadmill speed profile during the gait cycle corresponds to that of normal walking. The controller can be extended to simulate different walking conditions, such as slope walking. The method can be used for patient-cooperative control strategies performed with a robotic gait orthosis as well as for any other user-interactive applications in fitness and sports.     

两足辅助行走机器人步态控制

智能两足辅助行走机器人,可以辅助残疾人在复杂环境中进行仿人行走.介绍了该机器人的机构和控制系统硬件,在机器人系统的步态特性基础上建立了人机一体的运动模型.运用零力矩点（ZMP）理论规划了机器人的行走步态,提出了局部步态调整与人体主动补偿运动相结合的实时步态稳定性控制策略.通过仿真实验对该控制策略进行了验证和分析.     

The Effects on Kinematics and Muscle Activity of Walking in a Robotic Gait Trainer During Zero-Force Control

“Assist as needed” control algorithms promote activity of patients during robotic gait training. Implementing these requires a free walking mode of a device, as unassisted motions should not be hindered. The goal of this study was to assess the normality of walking in the free walking mode of the LOPES gait trainer, an 8 degrees-of-freedom lightweight impedance controlled exoskeleton. Kinematics, gait parameters and muscle activity of walking in a free walking mode in the device were compared with those of walking freely on a treadmill. Average values and variability of the spatio-temporal gait variables showed no or small (relative to cycle-to-cycle variability) changes and the kinematics showed a significant and relevant decrease in knee angle range only. Muscles involved in push off showed a small decrease, whereas muscles involved in acceleration and deceleration of the swing leg showed an increase of their activity. Timing of the activity was mainly unaffected. Most of the observed differences could be ascribed to the inertia of the exoskeleton. Overall, walking with the LOPES resembled free walking, although this required several adaptations in muscle activity. These adaptations are such that we expect that Assist as Needed training can be implemented in LOPES.      

Evaluation of a Prosthetic Swing-Phase Controller With Electrical Power Generation

With the increased presence of microprocessor-based prostheses in the market place, the availability of a self-energizing system has practical applicability. At present, most commercially available systems require the user to routinely recharge on-board batteries, which reduces the utility of these prostheses. To address this limitation, we have proposed a unique system based on an electromechanical generator to not only continually recharge batteries that are on-board the prostheses, but to also serve as a real time swing-phase damper. A prototype system was developed and evaluated with three active individuals with above-knee amputations across four damping conditions and two gait speeds. Gait and power generation performance were assessed via selected temporal, kinematic and kinetic parameters. Gait parameters including cadence and knee angle symmetry were found to be acceptable when knee damping was adapted for each participant. Across the three subjects and two walking speeds, between 0.57 and 1.57 W of electrical power was produced. These results indicate that this technology may be utilized for prosthetic swing-phase control and ultimately may alleviate the need for manually charging of microprocessor-based prostheses.      

A new hybrid spring brake orthosis for controlling hip and kneeflexion in the swing phase

It is proposed that active contraction of muscles might be artificially replaced by a spring brake orthosis (SBO) to provide near-natural knee and hip swing phase trajectories for gait in spinal cord injured subjects. The SBO is a new gait restoration system in which stored spring elastic energy and potential energy of limb segments are utilized to aid gait. It is also shown that hip flexion can be produced without the need for withdrawal reflex, hip flexor stimulus or any mechanical actuator at the hip. A hip flexion angle of 21 degrees was achieved by a nonimpaired subject wearing a prototype orthosis     

Decoding intra-limb and inter-limb kinematics during treadmill walking from scalp electroencephalographic (EEG) signals

Brain-machine interface (BMI) research has largely been focused on the upper limb. Although restoration of gait function has been a long-standing focus of rehabilitation research, surprisingly very little has been done to decode the cortical neural networks involved in the guidance and control of bipedal locomotion. A notable exception is the work by Nicolelis' group at Duke University that decoded gait kinematics from chronic recordings from ensembles of neurons in primary sensorimotor areas in rhesus monkeys. Recently, we showed that gait kinematics from the ankle, knee, and hip joints during human treadmill walking can be inferred from the electroencephalogram (EEG) with decoding accuracies comparable to those using intracortical recordings. Here we show that both intra- and inter-limb kinematics from human treadmill walking can be achieved with high accuracy from as few as 12 electrodes using scalp EEG. Interestingly, forward and backward predictors from EEG signals lagging or leading the kinematics, respectively, showed different spatial distributions suggesting distinct neural networks for feedforward and feedback control of gait. Of interest is that average decoding accuracy across subjects and decoding modes was ~0.68±0.08, supporting the feasibility of EEG-based BMI systems for restoration of walking in patients with paralysis.