Footwear Affects Biomechanical Work And Knee Adduction Moment During Stance Phase In Medial Knee Osteoarthritic Male Pakistani Adults

OBJECTIVE

The objective of this study was to explore the effects of commonly used footwear in urban Pakistan on knee adduction moment (KAM), knee adduction angular impulse (KAAI) and biomechanical work at lower limb joints (both individually and collectively).

METHODOLOGY

Cinematographic gait analysis of 20 medial knee osteoarthritis patients (Kellgren-Lawrence Grade I and II, age: 55.48 ± 5.78 years; weight: 68.92 ± 9.61 kg, height: 1.62 ± 0.15m) was done, walking barefoot, with casual shoes, party shoes and traditional Pakistani sandals, at a walking speed of 1.2m/sec.

RESULTS

Repeated measures ANOVA with Tukey corrections showed that all the shoes were found to be increasing first & second peaks external KAM and decreasing net joint work and total limb work significantly, at p < 0.05.

CONCLUSION

Effects of footwear were found to be majorly favouring knee osteoarthritis progression. This might be one of the risk factors of increased kOA rate in urban Pakistan.

Effect of toe joint stiffness and toe shape on walking biomechanics

During typical human walking, the metatarsophalangeal joints undergo extension/flexion, which we term toe joint articulation. This toe joint articulation impacts locomotor performance, as evidenced by prior studies on prostheses, footwear, sports and humanoid robots. However, a knowledge gap exists in our understanding of how individual toe properties (e.g. shape, joint stiffness) affect bipedal locomotion. To address this gap, we designed and built a pair of adjustable foot prostheses that enabled us to independently vary different toe properties, across a broad range of physiological and non-physiological values. We then characterized the effects of varying toe joint stiffness across a range of different ankle joint stiffness conditions, and the effects of varying toe shape on walking biomechanics. Ten able-bodied individuals walked on a treadmill with prostheses mounted bilaterally underneath simulator boots (which immobilized their biological ankles). We collected motion capture and ground reaction force data, then computed joint kinematics and kinetics, and center-of-mass (COM) power and work. To our surprise, we found that varying toe joint stiffness affected COM Push-off dynamics during walking as much as, or in some cases even more than, varying ankle joint stiffness. Increasing toe joint stiffness increased COM Push-off work by up to 48% (6 J), and prosthetic anklefoot Push-off work by up to 181% (12 J). In contrast, large changes in toe shape had little effect on gait. This study brings attention to the toes, an aspect of prosthetic and robotic foot design that is often overlooked or overshadowed by design of the ankle. Optimizing toe joint stiffness in assistive and robotic devices (e.g. prostheses, exoskeletons, robot feet) may provide a complementary means of enhancing Push-off or other aspects of locomotor performance, in conjunction with the more conventional approach of augmenting ankle dynamics. Future studies are needed to isolate the effects of additional toe properties (e.g. toe length).

Rethinking the evolution of the human foot: insights from experimental research

Adaptive explanations for modern human foot anatomy have long fascinated evolutionary biologists because of the dramatic differences between our feet and those of our closest living relatives, the great apes. Morphological features, including hallucal opposability, toe length and the longitudinal arch, have traditionally been used to dichotomize human and great ape feet as being adapted for bipedal walking and arboreal locomotion, respectively. However, recent biomechanical models of human foot function and experimental investigations of great ape locomotion have undermined this simple dichotomy. Here, we review this research, focusing on the biomechanics of foot strike, push-off and elastic energy storage in the foot, and show that humans and great apes share some underappreciated, surprising similarities in foot function, such as use of plantigrady and ability to stiffen the midfoot. We also show that several unique features of the human foot, including a spring-like longitudinal arch and short toes, are likely adaptations to long distance running. We use this framework to interpret the fossil record and argue that the human foot passed through three evolutionary stages: first, a great ape-like foot adapted for arboreal locomotion but with some adaptations for bipedal walking; second, a foot adapted for effective bipedal walking but retaining some arboreal grasping adaptations; and third, a human-like foot adapted for enhanced economy during long-distance walking and running that had lost its prehensility. Based on this scenario, we suggest that selection for bipedal running played a major role in the loss of arboreal adaptations.

Use of a powered ankle-foot prosthesis reduces the metabolic cost of uphill walking and improves leg work symmetry in people with transtibial amputations

People with transtibial amputations (TTAs) who use a powered ankle-foot prosthesis have equivalent metabolic costs and step-to-step transition work for level-ground walking over a range of speeds compared to non-amputees. The effects of using a powered compared to passive-elastic prosthesis for sloped walking are unknown. We sought to understand how the use of passive-elastic compared to powered ankle-foot prostheses affect metabolic cost and step-to-step transition work during sloped walking. Ten people (six M, four F) with TTAs walked 1.25 m s-1 at 0°, ±3°, ±6° and ±9° using their own passive-elastic prosthesis and the BiOM powered ankle-foot prosthesis, while we measured metabolic rates, kinematics and kinetics. We calculated net metabolic power, individual leg step-to-step transition work and individual leg net work symmetry. The net metabolic power was 5% lower during walking on +3° and +6° uphill slopes when subjects used the BiOM compared to their passive-elastic prosthesis (p < 0.05). The use of the BiOM compared to a passive-elastic prosthesis did not affect individual leg step-to-step transition work (p > 0.05), but did improve individual leg net work symmetry on +6° and +9° uphill slopes (p < 0.01). People with TTAs who use a powered ankle-foot prosthesis have the potential to reduce metabolic costs and increase symmetry during walking on uphill slopes.

The contributions of ankle, knee and hip joint work to individual leg work change during uphill and downhill walking over a range of speeds

The muscles surrounding the ankle, knee and hip joints provide 42, 16 and 42%, respectively, of the total leg positive power required to walk on level ground at various speeds. However, each joint's contribution to leg work when walking up/downhill at a range of speeds is not known. Determining each biological joint's contribution to leg work over a range of speeds and slopes can inform the design of biomimetic assistive devices (i.e. prostheses). Twenty healthy adults walked 1.00, 1.25 and 1.50 m s-1 on 0°, ±3°, ±6° and ±9° while we collected kinematic and kinetic data. We calculated sagittal plane joint work and individual leg work over the entire stance phase. The ratio of ankle joint to total individual leg positive work (summed ankle, knee and hip joint work) did not change (0.42) with speed or slope, but the ratio of ankle joint to individual leg negative work was 0.38 at -9°, 0.42 at 0° and 0.27 at +9° across all speeds. The ratio of ankle joint to total individual leg negative work was 0.41 at 1.00 m s-1 and 0.32 at 1.50 m s-1 across all slopes. The ratio of knee joint to total individual positive leg work (0.22) did not change with speed or slope. The ratio of knee joint to total individual leg negative work was 0.39 at 1.00 m s-1 and 0.45 at 1.50 m s-1 across all slopes. The ratio of hip joint to total individual leg positive work did not change with speed but was 0.34 at -9°, 0.33 at 0° and 0.37 at +9° across all speeds. The ratio of hip joint to total individual leg negative work was 0.21 at 1.00 m s-1, and 0.24 at 1.50 m s-1 across all slopes and 0.17 at -9°, 0.19 at 0° and 0.29 at +9° across all speeds. The ankle significantly contributes to walking on slopes and this contribution changes during sloped compared with level-ground walking, thus assistive devices that provide biomimetic ankle function must adapt to accommodate walking at different speeds and slopes; whereas assistive biomimetic devices for the knee only need to adapt at different speeds.

Experimental estimation of energy absorption during heel strike in human barefoot walking

Metabolic energy expenditure during human gait is poorly understood. Mechanical energy loss during heel strike contributes to this energy expenditure. Previous work has estimated the energy absorption during heel strike as 0.8 J using an effective foot mass model. The aim of our study is to investigate the possibility of determining the energy absorption by more directly estimating the work done by the ground reaction force, the force-integral method. Concurrently another aim is to compare this method of direct determination of work to the method of an effective foot mass model. Participants of our experimental study were asked to walk barefoot at preferred speed. Ground reaction force and lower leg kinematics were collected at high sampling frequency (3000 Hz; 1295 Hz), with tight synchronization. The work done by the ground reaction force is 3.8 J, estimated by integrating this force over the foot-ankle deformation. The effective mass model is improved by dropping the assumption that foot-ankle deformation is maximal at the instant of the impact force peak. On theoretical grounds it is clear that in the presence of substantial damping that peak force and peak deformation do not occur simultaneously. The energy absorption results, due the vertical force only, corresponding to the force-integral method is similar to the results of the improved application of the effective mass model (2.7 J; 2.5 J). However the total work done by the ground reaction force calculated by the force-integral method is significantly higher than that of the vertical component alone. We conclude that direct estimation of the work done by the ground reaction force is possible and preferable over the use of the effective foot mass model. Assuming that energy absorbed is lost, the mechanical energy loss of heel strike is around 3.8 J for preferred walking speeds (≈ 1.3 ^m/_s), which contributes to about 15–20% of the overall metabolic cost of transport.

Ankle and foot power in gait analysis: Implications for science, technology and clinical assessment

In human gait analysis studies, the entire foot is typically modeled as a single rigid-body segment; however, this neglects power generated/absorbed within the foot. Here we show how treating the entire foot as a rigid body can lead to misunderstandings related to (biological and prosthetic) foot function, and distort our understanding of ankle and muscle-tendon dynamics. We overview various (unconventional) inverse dynamics methods for estimating foot power, partitioning ankle vs. foot contributions, and computing combined anklefoot power. We present two case study examples. The first exemplifies how modeling the foot as a single rigid-body segment causes us to overestimate (and overvalue) muscle-tendon power generated about the biological ankle (in this study by up to 77%), and to misestimate (and misinform on) foot contributions; corroborating findings from previous multi-segment foot modeling studies. The second case study involved an individual with transtibial amputation walking on 8 different prosthetic feet. The results exemplify how assuming a rigid foot can skew comparisons between biological and prosthetic limbs, and lead to incorrect conclusions when comparing different prostheses/interventions. Based on analytical derivations, empirical findings and prior literature we recommend against computing conventional ankle power (between shank-foot). Instead, we recommend using an alternative estimate of power generated about the ankle joint complex (between shank-calcaneus) in conjunction with an estimate of foot power (between calcaneus-ground); or using a combined anklefoot power calculation. We conclude that treating the entire foot as a rigid-body segment is often inappropriate and ill-advised. Including foot power in biomechanical gait analysis is necessary to enhance scientific conclusions, clinical evaluations and technology development.

Biomechanical mechanisms underlying exosuit-induced improvements in walking economy after stroke

Stroke-induced hemiparetic gait is characteristically asymmetric and metabolically expensive. Weakness and impaired control of the paretic ankle contribute to reduced forward propulsion and ground clearance - walking subtasks critical for safe and efficient locomotion. Targeted gait interventions that improve paretic ankle function after stroke are therefore warranted. We have developed textile-based, soft wearable robots that transmit mechanical power generated by off-board or body-worn actuators to the paretic ankle using Bowden cables (soft exosuits) and have demonstrated the exosuits can overcome deficits in paretic limb forward propulsion and ground clearance, ultimately reducing the metabolic cost of hemiparetic walking. This study elucidates the biomechanical mechanisms underlying exosuit-induced reductions in metabolic power. We evaluated the relationships between exosuit-induced changes in the body center of mass (COM) power generated by each limb, individual joint power and metabolic power. Compared with walking with an exosuit unpowered, exosuit assistance produced more symmetrical COM power generation during the critical period of the step-to-step transition (22.4±6.4% more symmetric). Changes in individual limb COM power were related to changes in paretic (R2=0.83, P=0.004) and non-paretic (R2=0.73, P=0.014) ankle power. Interestingly, despite the exosuit providing direct assistance to only the paretic limb, changes in metabolic power were related to changes in non-paretic limb COM power (R2=0.80, P=0.007), not paretic limb COM power (P>0.05). These findings contribute to a fundamental understanding of how individuals post-stroke interact with an exosuit to reduce the metabolic cost of hemiparetic walking.

Prosthetic energy return during walking increases after 3 weeks of adaptation to a new device

Background

There are many studies that have investigated biomechanical differences among prosthetic feet, but not changes due to adaptation over time. There is a need for objective measures to quantify the process of adaptation for individuals with a transtibial amputation. Mechanical power and work profiles are a primary focus for modern energy-storage-and-return type prostheses, which strive to increase energy return from the prosthesis. The amount of energy a prosthesis stores and returns (i.e., negative and positive work) during stance is directly influenced by the user’s loading strategy, which may be sensitive to alterations during the course of an adaptation period. The purpose of this study was to examine changes in lower limb mechanical work profiles during walking following a three-week adaptation to a new prosthesis.

Methods

A retrospective analysis was performed on 22 individuals with a unilateral transtibial amputation. Individuals were given a new prosthesis at their current mobility level (K3 or above) and wore it for three weeks. Kinematic and kinetic measures were recorded from overground walking at 0, 1.5, and 3 weeks into the adaptation period at a self-selected pace. Positive and negative work done by the prosthesis and sound ankle-foot were calculated using a unified deformable segment model and a six-degrees-of-freedom model for the knee and hip.

Results

Positive work from the prosthesis ankle-foot increased by 6.1% and sound ankle-foot by 5.7% after 3 weeks (p = 0.041, 0.036). No significant changes were seen in negative work from prosthesis or sound ankle-foot (p = 0.115, 0.192). There was also a 4.1% increase in self-selected walking speed after 3 weeks (p = 0.038). Our data exhibited large inter-subject variations, in which some individuals followed group trends in work profiles while others had opposite trends in outcome variables.

Conclusions

After a 3-week adaptation, 14 out of 22 individuals with a transtibial amputation increased energy return from the prosthesis. Such findings could indicate that individuals may better utilize the spring-like function of the prosthesis after an adaptation period.

Electronic supplementary material

The online version of this article (10.1186/s12984-018-0347-1) contains supplementary material, which is available to authorized users.

Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss

Recent studies on relatively young and fit individuals with limb loss suggest that maintaining muscle strength after limb loss may mitigate the high metabolic cost of walking typically seen in the larger general limb loss population. However, these data are cross-sectional and the muscle strength prior to limb loss is unknown, and it is therefore difficult to draw causal inferences on changes in strength and gait energetics. Here we used musculoskeletal modeling and optimal control simulations to perform a longitudinal study (25 virtual “subjects”) of the metabolic cost of walking pre- and post-limb loss (unilateral transtibial). Simulations of walking were first performed pre-limb loss on a model with two intact biological legs, then post-limb loss on a model with a unilateral transtibial prosthesis, with a cost function that minimized the weighted sum of gait deviations plus metabolic cost. Metabolic costs were compared pre- vs. post-limb loss, with systematic modifications to the muscle strength and prosthesis type (passive, powered) in the post-limb loss model. The metabolic cost prior to limb loss was 3.44±0.13 J/m/kg. After limb loss, with a passive prosthesis the metabolic cost did not increase above the pre-limb loss cost if pre-limb loss muscle strength was maintained (mean -0.6%, p = 0.17, d = 0.17). With 10% strength loss the metabolic cost with the passive prosthesis increased (mean +5.9%, p < 0.001, d = 1.61). With a powered prosthesis, the metabolic cost was at or below the pre-limb loss cost for all subjects with strength losses of 10% and 20%, but increased for all subjects with strength loss of 30% (mean +5.9%, p < 0.001, d = 1.59). The results suggest that maintaining muscle strength may prevent an increase in the metabolic cost of walking following unilateral transtibial limb loss, and that a gait with minimal deviations can be achieved when muscle strength is sufficiently high, even when using a passive prosthesis.

A mathematical analysis to address the 6 degree-of-freedom segmental power imbalance

Segmental power is used in human movement analyses to indicate the source and net rate of energy transfer between the rigid bodies of biomechanical models. Segmental power calculations are performed using segment endpoint dynamics (kinetic method). A theoretically equivalent method is to measure the rate of change in a segment's mechanical energy state (kinematic method). However, these two methods have not produced experimentally equivalent results for segments proximal to the foot, with the difference in methods deemed the "power imbalance." In a 6 degree-of-freedom model, segments move independently, resulting in relative segment endpoint displacement and non-equivalent segment endpoint velocities at a joint. In the kinetic method, a segment's distal end translational velocity may be defined either at the anatomical end of the segment or at the location of the joint center (defined here as the proximal end of the adjacent distal segment). Our mathematical derivations revealed the power imbalance between the kinetic method using the anatomical definition and the kinematic method can be explained by power due to relative segment endpoint displacement. In this study, we tested this analytical prediction through experimental gait data from nine healthy subjects walking at a typical speed. The average absolute segmental power imbalance was reduced from 0.023 to 0.046 W/kg using the anatomical definition to ≤0.001 W/kg using the joint center definition in the kinetic method (95.56-98.39% reduction). Power due to relative segment endpoint displacement in segmental power analyses is substantial and should be considered in analyzing energetic flow into and between segments.

Variability Analysis on Gestures for People With Quadriplegia

Gesture-based interfaces have become an effective control modality within the human computer interaction realm to assist individuals with mobility impairments in accessing technologies for daily living to entertainment. Recent studies have shown that gesture-based interfaces in tandem with gaming consoles are being used to complement physical therapies at rehabilitation hospitals and in their homes. Because the motor movements of individuals with physical impairments are different from persons without disabilities, the gesture sets required to operate those interfaces must be customized. This limits significantly the number and quality of available software environments for users with motor impairments. Previous work presented an analytic approach to convert an existing gesture-based interface designed for individuals without disabilities to be usable by people with motor disabilities. The objective of this paper is to include gesture variability analysis into the existing framework using robotics as an additional validation framework. Based on this, a physical metric (referred as work) was empirically obtained to compare the physical effort of each gesture. An integration method was presented to determine the accessible gesture set based on stability and empirical robot execution. For all the gesture types, the accessible gestures were found to lie within 34% of the optimality of stability and work. Lastly, the gesture set determined by the proposed methodology was practically evaluated by target users in experiments while solving a spatial navigational problem.

Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking

The human foot and ankle system is equipped with structures that can produce mechanical work through elastic (e.g., Achilles tendon, plantar fascia) or viscoelastic (e.g., heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution among various subsections of the foot and ankle can be difficult, in large part due to a lack of objective methods for partitioning the forces acting underneath the stance foot. In this study, we deconstructed the mechanical work production during barefoot walking in a segment-by-segment manner (hallux, forefoot, hindfoot, and shank). This was accomplished by isolating the forces acting within each foot segment through controlling the placement of the participants’ foot as it contacted a ground-mounted force platform. Combined with an analysis that incorporated non-rigid mechanics, we quantified the total work production distal to each of the four isolated segments. We found that various subsections within the foot and ankle showed disparate work distribution, particularly within structures distal to the hindfoot. When accounting for all sources of positive and negative work distal to the shank (i.e., ankle joint and all foot structures), these structures resembled an energy-neutral system that produced net mechanical work close to zero (−0.012 ± 0.054 J/kg).

A unified perspective on ankle push-off in human walking

Muscle-tendon units about the ankle joint generate a burst of positive power during the step-to-step transition in human walking, termed ankle push-off, but there is no scientific consensus on its functional role. A central question embodied in the biomechanics literature is: does ankle push-off primarily contribute to leg swing, or to center of mass (COM) acceleration? This question has been debated in various forms for decades. However, it actually presents a false dichotomy, as these two possibilities are not mutually exclusive. If we ask either question independently, the answer is the same: yes! (1) Does ankle push-off primarily contribute to leg swing acceleration? Yes. (2) Does ankle push-off primarily contribute to COM acceleration? Yes. Here, we summarize the historical debate, then synthesize the seemingly polarized perspectives and demonstrate that both descriptions are valid. The principal means by which ankle push-off affects COM mechanics is by a localized action that increases the speed and kinetic energy of the trailing push-off limb. Because the limb is included in body COM computations, this localized segmental acceleration also accelerates the COM, and most of the segmental energy change also appears as COM energy change. Interpretation of ankle mechanics should abandon an either/or contrast of leg swing versus COM acceleration. Instead, ankle push-off should be interpreted in light of both mutually consistent effects. This unified perspective informs our fundamental understanding of the role of ankle push-off, and has important implications for the design of clinical interventions (e.g. prostheses, orthoses) intended to restore locomotor function to individuals with disabilities.

Stable, Robust Hybrid Zero Dynamics Control of Powered Lower-Limb Prostheses

To improve the quality of life for lower-limb amputees, powered prostheses are being developed. Advanced control schemes from the field of bipedal robots, such as hybrid zero dynamics (HZD), may provide great performance. HZD-based control specifies the motion of the actuated joints using output functions to be zeroed, and the required torques are calculated using input-output linearization. For one-step periodic gaits, there is an analytic metric of stability. To apply HZD-based control on a powered prosthesis, several modifications must be made. Because the prosthesis and amputee are only connected via the socket, the prosthesis controller does not have access to the full state of the biped, which decentralizes the form of the input-output linearization. The differences between the amputated and contralateral sides result in a two-step periodic gait, which requires the orbital stability metric to be extended. In addition, because human gait is variable, the prosthesis controller must be robust to continuous moderate perturbations. This robustness is proved using local input-to-state stability and demonstrated with simulations of an above-knee amputee model.

The critical phase for visual control of human walking over complex terrain

To walk efficiently over complex terrain, humans must use vision to tailor their gait to the upcoming ground surface without interfering with the exploitation of passive mechanical forces. We propose that walkers use visual information to initialize the mechanical state of the body before the beginning of each step so the resulting ballistic trajectory of the walker's center-of-mass will facilitate stepping on target footholds. Using a precision stepping task and synchronizing target visibility to the gait cycle, we empirically validated two predictions derived from this strategy: (1) Walkers must have information about upcoming footholds during the second half of the preceding step, and (2) foot placement is guided by information about the position of the target foothold relative to the preceding base of support. We conclude that active and passive modes of control work synergistically to allow walkers to negotiate complex terrain with efficiency, stability, and precision.

It's positive to be negative: Achilles tendon work loops during human locomotion

Ultrasound imaging is increasingly used with motion and force data to quantify tendon dynamics during human movement. Frequently, tendon dynamics are estimated indirectly from muscle fascicle kinematics (by subtracting muscle from muscle-tendon unit length), but there is mounting evidence that this Indirect approach yields implausible tendon work loops. Since tendons are passive viscoelastic structures, when they undergo a loading-unloading cycle they must exhibit a negative work loop (i.e., perform net negative work). However, prior studies using this Indirect approach report large positive work loops, often estimating that tendons return 2–5 J of elastic energy for every 1 J of energy stored. More direct ultrasound estimates of tendon kinematics have emerged that quantify tendon elongations by tracking either the muscle-tendon junction or localized tendon tissue. However, it is unclear if these yield more plausible estimates of tendon dynamics. Our objective was to compute tendon work loops and hysteresis losses using these two Direct tendon kinematics estimates during human walking. We found that Direct estimates generally resulted in negative work loops, with average tendon hysteresis losses of 2–11% at 1.25 m/s and 33–49% at 0.75 m/s (N = 8), alluding to 0.51–0.98 J of tendon energy returned for every 1 J stored. We interpret this finding to suggest that Direct approaches provide more plausible estimates than the Indirect approach, and may be preferable for understanding tendon energy storage and return. However, the Direct approaches did exhibit speed-dependent trends that are not consistent with isolated, in vitro tendon hysteresis losses of about 5–10%. These trends suggest that Direct estimates also contain some level of error, albeit much smaller than Indirect estimates. Overall, this study serves to highlight the complexity and difficulty of estimating tendon dynamics non-invasively, and the care that must be taken to interpret biological function from current ultrasound-based estimates.

Constituent Lower Extremity Work (CLEW) approach: A novel tool to visualize joint and segment work

Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.

Physical interface dynamics alter how robotic exosuits augment human movement: implications for optimizing wearable assistive devices

BACKGROUND

Wearable assistive devices have demonstrated the potential to improve mobility outcomes for individuals with disabilities, and to augment healthy human performance; however, these benefits depend on how effectively power is transmitted from the device to the human user. Quantifying and understanding this power transmission is challenging due to complex human-device interface dynamics that occur as biological tissues and physical interface materials deform and displace under load, absorbing and returning power.

METHODS

Here we introduce a new methodology for quickly estimating interface power dynamics during movement tasks using common motion capture and force measurements, and then apply this method to quantify how a soft robotic ankle exosuit interacts with and transfers power to the human body during walking. We partition exosuit end-effector power (i.e., power output from the device) into power that augments ankle plantarflexion (termed augmentation power) vs. power that goes into deformation and motion of interface materials and underlying soft tissues (termed interface power).

RESULTS

We provide empirical evidence of how human-exosuit interfaces absorb and return energy, reshaping exosuit-to-human power flow and resulting in three key consequences: (i) During exosuit loading (as applied forces increased), about 55% of exosuit end-effector power was absorbed into the interfaces. (ii) However, during subsequent exosuit unloading (as applied forces decreased) most of the absorbed interface power was returned viscoelastically. Consequently, the majority (about 75%) of exosuit end-effector work over each stride contributed to augmenting ankle plantarflexion. (iii) Ankle augmentation power (and work) was delayed relative to exosuit end-effector power, due to these interface energy absorption and return dynamics.

CONCLUSIONS

Our findings elucidate the complexities of human-exosuit interface dynamics during transmission of power from assistive devices to the human body, and provide insight into improving the design and control of wearable robots. We conclude that in order to optimize the performance of wearable assistive devices it is important, throughout design and evaluation phases, to account for human-device interface dynamics that affect power transmission and thus human augmentation benefits.

Two biomechanical strategies for locomotor adaptation to split-belt treadmill walking in subjects with and without transtibial amputation

Locomotor adaptation is commonly studied using split-belt treadmill walking, in which each foot is placed on a belt moving at a different speed. As subjects adapt to split-belt walking, they reduce metabolic power, but the biomechanical mechanism behind this improved efficiency is unknown. Analyzing mechanical work performed by the legs and joints during split-belt adaptation could reveal this mechanism. Because ankle work in the step-to-step transition is more efficient than hip work, we hypothesized that control subjects would reduce hip work on the fast belt and increase ankle work during the step-to-step transition as they adapted. We further hypothesized that subjects with unilateral, trans-tibial amputation would instead increase propulsive work from their intact leg on the slow belt. Control subjects reduced hip work and shifted more ankle work to the step-to-step transition, supporting our hypothesis. Contrary to our second hypothesis, intact leg work, ankle work and hip work in amputees were unchanged during adaptation. Furthermore, all subjects increased collisional energy loss on the fast belt, but did not increase propulsive work. This was possible because subjects moved further backward during fast leg single support in late adaptation than in early adaptation, compensating by reducing backward movement in slow leg single support. In summary, subjects used two strategies to improve mechanical efficiency in split-belt walking adaptation: a CoM displacement strategy that allows for less forward propulsion on the fast belt; and, an ankle timing strategy that allows efficient ankle work in the step-to-step transition to increase while reducing inefficient hip work.

Inferring Muscle-Tendon Unit Power from Ankle Joint Power during the Push-Off Phase of Human Walking: Insights from a Multiarticular EMG-Driven Model

INTRODUCTION

Inverse dynamics joint kinetics are often used to infer contributions from underlying groups of muscle-tendon units (MTUs). However, such interpretations are confounded by multiarticular (multi-joint) musculature, which can cause inverse dynamics to over- or under-estimate net MTU power. Misestimation of MTU power could lead to incorrect scientific conclusions, or to empirical estimates that misguide musculoskeletal simulations, assistive device designs, or clinical interventions. The objective of this study was to investigate the degree to which ankle joint power overestimates net plantarflexor MTU power during the Push-off phase of walking, due to the behavior of the flexor digitorum and hallucis longus (FDHL)-multiarticular MTUs crossing the ankle and metatarsophalangeal (toe) joints.

METHODS

We performed a gait analysis study on six healthy participants, recording ground reaction forces, kinematics, and electromyography (EMG). Empirical data were input into an EMG-driven musculoskeletal model to estimate ankle power. This model enabled us to parse contributions from mono- and multi-articular MTUs, and required only one scaling and one time delay factor for each subject and speed, which were solved for based on empirical data. Net plantarflexing MTU power was computed by the model and quantitatively compared to inverse dynamics ankle power.

RESULTS

The EMG-driven model was able to reproduce inverse dynamics ankle power across a range of gait speeds (R2 ≥ 0.97), while also providing MTU-specific power estimates. We found that FDHL dynamics caused ankle power to slightly overestimate net plantarflexor MTU power, but only by ~2-7%.

CONCLUSIONS

During Push-off, FDHL MTU dynamics do not substantially confound the inference of net plantarflexor MTU power from inverse dynamics ankle power. However, other methodological limitations may cause inverse dynamics to overestimate net MTU power; for instance, due to rigid-body foot assumptions. Moving forward, the EMG-driven modeling approach presented could be applied to understand other tasks or larger multiarticular MTUs.

Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking

Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors' mechanical advantage.

The motor and the brake of the trailing leg in human walking: leg force control through ankle modulation and knee covariance

Human walking is a complex task, and we lack a complete understanding of how the neuromuscular system organizes its numerous muscles and joints to achieve consistent and efficient walking mechanics. Focused control of select influential task-level variables may simplify the higher-level control of steady-state walking and reduce demand on the neuromuscular system. As trailing leg power generation and force application can affect the mechanical efficiency of step-to-step transitions, we investigated how joint torques are organized to control leg force and leg power during human walking. We tested whether timing of trailing leg force control corresponded with timing of peak leg power generation. We also applied a modified uncontrolled manifold analysis to test whether individual or coordinated joint torque strategies most contributed to leg force control. We found that leg force magnitude was adjusted from step to step to maintain consistent leg power generation. Leg force modulation was primarily determined by adjustments in the timing of peak ankle plantar-flexion torque, while knee torque was simultaneously covaried to dampen the effect of ankle torque on leg force. We propose a coordinated joint torque control strategy in which the trailing leg ankle acts as a motor to drive leg power production while trailing leg knee torque acts as a brake to refine leg power production.

Imaging and simulation of Achilles tendon dynamics: Implications for walking performance in the elderly

The Achilles tendon (AT) is a complex structure, consisting of distinct fascicle bundles arising from each triceps surae muscle that may act as mechanically independent structures. Advances in tissue imaging are rapidly accelerating our understanding of the complexities of functional Achilles tendon behavior, with potentially important implications for musculoskeletal injury and performance. In this overview of our recent contributions to these efforts, we present the results of complementary experimental and computational approaches to investigate AT behavior during walking and its potential relevance to reduced triceps surae mechanical performance due to aging. Our experimental evidence reveals that older tendons exhibit smaller differences in tissue deformations than young adults between regions of the AT presumed to arise from the gastrocnemius and soleus muscles. These observations are consistent with a reduced capacity for inter-fascicle sliding within the AT, which could have implications for the mechanical independence of the triceps surae muscles. More uniform AT deformations are also correlated with hallmark biomechanical features of elderly gait - namely, a loss of net ankle moment, power, and positive work during push-off. Simulating age-related reductions in the capacity for inter-fascicle sliding in the AT during walking predicts detriments in gastrocnemius muscle-tendon mechanical performance coupled with underlying shifts in fascicle kinematics during push-off. AT compliance, also suspected to vary due to age, systematically modulates those effects. By integrating in vivo imaging with computational modeling, we have gained theoretical insight into multi-scale biomechanical changes due to aging, hypotheses regarding their functional effects, and opportunities for experiments that validate or invalidate these assertions.

Preferred Barefoot Step Frequency is Influenced by Factors Beyond Minimizing Metabolic Rate

Humans tend to increase their step frequency in barefoot walking, as compared to shod walking at the same speed. Based on prior studies and the energy minimization hypothesis we predicted that people make this adjustment to minimize metabolic cost. We performed an experiment quantifying barefoot walking metabolic rate at different step frequencies, specifically comparing preferred barefoot to preferred shod step frequency. We found that subjects increased their preferred frequency when walking barefoot at 1.4 m/s (~123 vs. ~117 steps/min shod, P = 2e-5). However, average barefoot walking metabolic rates at the preferred barefoot and shod step frequencies were not significantly different (P = 0.40). Instead, we observed subject-specific trends: five subjects consistently reduced (−8% average), and three subjects consistently increased (+10% average) their metabolic rate at preferred barefoot vs. preferred shod frequency. Thus, it does not appear that people ubiquitously select a barefoot step frequency that minimizes metabolic rate. We concluded that preferred barefoot step frequency is influenced by factors beyond minimizing metabolic rate, such as shoe properties and/or perceived comfort. Our results highlight the subject-specific nature of locomotor adaptations and how averaging data across subjects may obscure meaningful trends. Alternative experimental designs may be needed to better understand individual adaptations.

Mechanical and energetic consequences of reduced ankle plantar-flexion in human walking

The human ankle produces a large burst of 'push-off' mechanical power late in the stance phase of walking, reduction of which leads to considerably poorer energy economy. It is, however, uncertain whether the energetic penalty results from poorer efficiency when the other leg joints substitute for the ankle's push-off work, or from a higher overall demand for work due to some fundamental feature of push-off. Here, we show that greater metabolic energy expenditure is indeed explained by a greater demand for work. This is predicted by a simple model of walking on pendulum-like legs, because proper push-off reduces collision losses from the leading leg. We tested this by experimentally restricting ankle push-off bilaterally in healthy adults (N=8) walking on a treadmill at 1.4 m s(-1), using ankle-foot orthoses with steel cables limiting motion. These produced up to ∼50% reduction in ankle push-off power and work, resulting in up to ∼50% greater net metabolic power expenditure to walk at the same speed. For each 1 J reduction in ankle work, we observed 0.6 J more dissipative collision work by the other leg, 1.3 J more positive work from the leg joints overall, and 3.94 J more metabolic energy expended. Loss of ankle push-off required more positive work elsewhere to maintain walking speed; this additional work was performed by the knee, apparently at reasonably high efficiency. Ankle push-off may contribute to walking economy by reducing dissipative collision losses and thus overall work demand.

Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints

Background

Previous reports of the mechanics and energetics of post-stroke hemiparetic walking have either not combined estimates of mechanical and metabolic energy or computed external mechanical work based on the limited combined limbs method. Here we present a comparison of the mechanics and energetics of hemiparetic and unimpaired walking at a matched speed.

Methods

Mechanical work done on the body centre of mass (COM) was computed by the individual limbs method and work done at individual leg joints was computed with an inverse dynamics analysis. Both estimates were converted to average powers and related to simultaneous estimates of net metabolic power, determined via indirect calorimetry. Efficiency of positive work was calculated as the ratio of average positive mechanical power \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\overline{P}}^{+} $$\end{document}P¯+ to net metabolic power.

Results

Total \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\overline{P}}^{+} $$\end{document}P¯+ was 20% greater for the hemiparetic group (H) than for the unimpaired control group (C) (0.49 vs. 0.41 W · kg⁻¹). The greater \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\overline{P}}^{+} $$\end{document}P¯+ was partly attributed to the paretic limb of hemiparetic walkers not providing appropriately timed push-off \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\overline{P}}^{+} $$\end{document}P¯+ in the step-to-step transition. This led to compensatory non-paretic limb hip and knee \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\overline{P}}^{+} $$\end{document}P¯+ which resulted in greater total mechanical work. Efficiency of positive work was not different between H and C.

Conclusions

Increased work, not decreased efficiency, explains the greater metabolic cost of hemiparetic walking post-stroke. Our results highlighted the need to target improving paretic ankle push-off via therapy or assistive technology in order to reduce the metabolic cost of hemiparetic walking.