Humans Can Continuously Optimize Energetic Cost during Walking

Exploration-based learning of a stabilizing controller predicts locomotor adaptation

Humans adapt their locomotion seamlessly in response to changes in the body or the environment. It is unclear how such adaptation improves performance measures like energy consumption or symmetry while avoiding falling. Here, we model locomotor adaptation as interactions between a stabilizing controller that reacts quickly to perturbations and a reinforcement learner that gradually improves the controller's performance through local exploration and memory. This model predicts time-varying adaptation in many settings: walking on a split-belt treadmill (i.e. with both feet at different speeds), with asymmetric leg weights, or using exoskeletons - capturing learning and generalization phenomena in ten prior experiments and two model-guided experiments conducted here. The performance measure of energy minimization with a minor cost for asymmetry captures a broad range of phenomena and can act alongside other mechanisms such as reducing sensory prediction error. Such a model-based understanding of adaptation can guide rehabilitation and wearable robot control.

Enhanced motor learning and motor savings after acute intermittent hypoxia are associated with a reduction in metabolic cost

Breathing mild bouts of low oxygen air (i.e. acute intermittent hypoxia, AIH) has been shown to improve locomotor function in humans after a spinal cord injury. How AIH-induced gains in motor performance are achieved remains unclear. We examined the hypothesis that AIH augments motor learning and motor retention during a locomotor adaptation task. We further hypothesized that gains in motor learning and retention will be associated with reductions in net metabolic power, consistent with the acquisition of energetically favourable mechanics. Thirty healthy individuals were randomly allocated into either a control group or an AIH group. We utilized a split-belt treadmill to characterize adaptations to an unexpected belt speed perturbation of equal magnitude during an initial exposure and a second exposure. Adaptation was characterized by changes in spatiotemporal step asymmetry, anterior-posterior force asymmetry, and net metabolic power. While both groups adapted by reducing spatial asymmetry, only the AIH group achieved significant reductions in double support time asymmetry and propulsive force asymmetry during both the initial and the second exposures to the belt speed perturbation. Net metabolic power was also significantly lower in the AIH group, with significant reductions from the initial perturbation exposure to the second. These results provide the first evidence that AIH mediates improvements in both motor learning and retention. Further, our results suggest that reductions in net metabolic power continue to be optimized upon subsequent learning and are driven by more energetically favourable temporal coordination strategies. Our observation that AIH facilitates motor learning and retention can be leveraged to design rehabilitation interventions that promote functional recovery. KEY POINTS: Brief exposures to low oxygen air, known as acute intermittent hypoxia (AIH), improves locomotor function in humans after a spinal cord injury, but it remains unclear how gains in motor performance are achieved. In this study, we tested the hypothesis that AIH induces enhancements in motor learning and retention by quantifying changes in interlimb coordination, anterior-posterior force symmetry and metabolic cost during a locomotor adaptation task. We show the first evidence that AIH improves both motor learning and savings of newly learned temporal interlimb coordination strategies and force asymmetry compared to untreated individuals. We further demonstrate that AIH elicits greater reductions in metabolic cost during motor learning that continues to be optimized upon subsequent learning. Our findings suggest that AIH-induced gains in locomotor performance are facilitated by enhancements in motor learning and retention of more energetically favourable coordination strategies.

A Novel Personalized Strategy for Hip Joint Flexion Assistance Based on Human Physiological State

Soft exosuits have emerged as potent assistive tools for walking support and rehabilitation training. However, most existing soft exosuit systems rely on preset assistance modes, which may not accurately align with individual physiological states and movement requirements, leading to variable user experiences and efficacy. While existing human-in-the-loop (HIL) research predominantly focuses on optimizing metabolic cost and torque difference parameters, there is a notable absence of real-time monitoring methods that closely reflect the human body's physiological state and strategies that dynamically indicate walking efficiency. Motivated by this, we developed a novel personalized power-assist system. This system optimizes the power-assist output of the hip joint by monitoring the user's physiological and motion signals in real time, including heart rate (HR), blood oxygen saturation (SpO2), and inertial measurement unit (IMU) data, to assist hip flexion based on feedback. The findings from a metabolic expenditure trial demonstrate that the innovative soft exosuit, which is based on a Physiological State Monitoring Control (PSMC) system, achieves a reduction of 7.81% in metabolic expenditure during treadmill walking at a speed of 3.5 km/h compared to walking without the assistance of the exosuit. Additionally, during continuous exercise with varying intensities, the metabolic consumption level is reduced by 5.1%, 5.8%, and 8.2% at speeds of 2, 4, and 6 km per hour, respectively. These results support the design of a novel hip flexion-assisting soft exosuit, demonstrating that applying different assistance forces in consideration of different physiological states is a reasonable approach to reducing metabolic consumption.

Force reserve predicts compensation in reaching movement with induced shoulder strength deficit

Following events such as fatigue or stroke, individuals often move their trunks forward during reaching, leveraging a broader muscle group even when only arm movement would suffice. In previous work, we showed the existence of a "force reserve": a phenomenon where individuals, when challenged with a heavy weight, adjusted their motor coordination to preserve approximately 40% of their shoulder's force. Here, we investigated if such reserve can predict hip, shoulder, and elbow movements and torques resulting from an induced shoulder strength deficit. We engaged 20 healthy participants in a reaching task with incrementally heavier dumbbells, analyzing arm and trunk movements via motion capture and joint torques through inverse dynamics. We simulated these movements using an optimal control model of a 3-degree-of-freedom upper body, contrasting three cost functions: traditional sum of squared torques, a force reserve function incorporating a nonlinear penalty, and a normalized torque function. Our results demonstrate a clear increase in trunk movement correlated with heavier dumbbell weights, with participants employing compensatory movements to maintain a shoulder force reserve of approximately 40% of maximum torque. Simulations showed that while traditional and reserve functions accurately predicted trunk compensation, only the reserve function effectively predicted joint torques under heavier weights. These findings suggest that compensatory movements are strategically employed to minimize shoulder effort and distribute load across multiple joints in response to weakness. We discuss the implications of the force reserve cost function in the context of optimal control of human movements and its relevance for understanding compensatory movements poststroke.NEW & NOTEWORTHY Our study reveals key findings on compensatory movements during upper limb reaching tasks under shoulder strength deficits, as observed poststroke. Using heavy dumbbells with healthy volunteers, we demonstrate how forward trunk displacement conserves around 40% of shoulder strength reserve during reaching. We show that an optimal controller employing a cost function combining squared motor torque and a nonlinear penalty for excessive muscle activation outperforms traditional controllers in predicting torques and compensatory movements in these scenarios.

Foothold selection during locomotion in uneven terrain: Results from the integration of eye tracking, motion capture, and photogrammetry

Relatively little is known about the way vision is used to guide locomotion in the natural world. What visual features are used to choose paths in natural complex terrain? To answer this question, we measured eye and body movements while participants walked in natural outdoor environments. We incorporated measurements of the 3D terrain structure into our analyses and reconstructed the terrain along the walker's path, applying photogrammetry techniques to the eyetracker's scene camera videos. Combining these reconstructions with the walker's body movements, we demonstrate that walkers take terrain structure into account when selecting paths through an environment. We find that they change direction to avoid taking steeper steps that involve large height changes, instead of choosing more circuitous, relatively flat paths. Our data suggest walkers plan the location of individual footholds and plan ahead to select flatter paths. These results provide evidence that locomotor behavior in natural environments is controlled by decision mechanisms that account for multiple factors, including sensory and motor information, costs, and path planning.

Understanding the influence of context on real-world walking energetics

Speeds that minimize energetic cost during steady-state walking have been observed during lab-based investigations of walking biomechanics and energetics. However, in real-world scenarios, humans walk in a variety of contexts that can elicit different walking strategies, and may not always prioritize minimizing energetic cost. To investigate whether individuals tend to select energetically optimal speeds in real-world situations and how contextual factors influence gait, we conducted a study combining data from lab and real-world experiments. Walking kinematics and context were measured during daily life over a week (N=17) using wearable sensors and a mobile phone. To determine context, we utilized self-reported activity logs, GPS data and follow-up exit interviews. Additionally, we estimated energetic cost using respirometry over a range of gait speeds in the lab. Gross and net cost of transport were calculated for each participant, and were used to identify energetically optimal walking speed ranges for each participant. The proportion of real-world steady-state stride speeds within these ranges (gross and net) were identified for all data and for each context. We found that energetically optimal speeds predicted by gross cost of transport were more predictive of walking speeds used during daily life than speeds that would minimize net cost of transport. On average, 82.2% of all steady-state stride speeds were energetically optimal for gross cost of transport for all contexts and participants, while only 45.6% were energetically optimal for net cost of transport. These results suggest that while energetic cost is a factor considered by humans when selecting gait speed in daily life, it is not the sole determining factor. Context contributes to the observed variability in movement parameters both within and between individuals.

A biomechanics and energetics dataset of neurotypical adults walking with and without kinematic constraints

Numerous studies have explored the biomechanics and energetics of human walking, offering valuable insights into how we walk. However, prior studies focused on changing external factors (e.g., walking speed) and examined group averages and trends rather than individual adaptations in the presence of internal constraints (e.g., injury-related muscle weakness). To address this gap, this paper presents an open dataset of human walking biomechanics and energetics collected from 21 neurotypical young adults. To investigate the effects of internal constraints (reduced joint range of motion), the participants are both the control group (free walking) and the intervention group (constrained walking - left knee fully extended using a passive orthosis). Each subject walked on a dual-belt treadmill at three speeds (0.4, 0.8, and 1.1 m/s) and five step frequencies ( - 10% to 20% of their preferred frequency) for a total of 30 test conditions. The dataset includes raw and segmented data featuring ground reaction forces, joint motion, muscle activity, and metabolic data. Additionally, a sample code is provided for basic data manipulation and visualisation.

Perception of task duration affects metabolic cost during split-belt adaptation

Humans continuously adapt locomotor patterns. Whether metabolic cost reduction is the primary objective or a by-product of the observed biomechanical changes during adaptation is not known. The main goal of our study is to determine if perception of task duration affects the adaptation of locomotor patterns to reduce energetic cost during split-belt walking. We tested the hypothesis that individuals who believe they will sustain a locomotor adaptation task for a prolonged time will reduce metabolic cost by adapting toward a walking pattern associated with lower mechanical work. N=14 participants walked on a split-belt treadmill for 10 minutes with knowledge of task duration (group K), while N=15 participants performed the task under the assumption that they would walk for 30 minutes (group U). Both groups walked for 10 minutes with the belts moving at 1.5 and 0.5 m/s, followed by 6 minutes of walking with both belts at 1.0 m/s. We observed a significant main effect of Time (p<0.001, observed power 1.0) and the interaction of Time×Group (p=0.004, observed power 0.84) on metabolic cost. Participants in the U group had a metabolic cost that was 12% lower during adaptation compared to the K group, which did not reduce metabolic cost during adaptation. The metabolic cost reduction observed in group U was not associated with biomechanical changes during adaptation. Our results indicate that metabolic cost reduction has a primary role in tasks that need to be sustained for a prolonged time, and this reduction is not only related to biomechanical factors.

Minimization of metabolic cost of transport predicts changes in gait mechanics over a range of ankle-foot orthosis stiffnesses in individuals with bilateral plantar flexor weakness

Neuromuscular disorders often lead to ankle plantar flexor muscle weakness, which impairs ankle push-off power and forward propulsion during gait. To improve walking speed and reduce metabolic cost of transport (mCoT), patients with plantar flexor weakness are provided dorsal-leaf spring ankle-foot orthoses (AFOs). It is widely believed that mCoT during gait depends on the AFO stiffness and an optimal AFO stiffness that minimizes mCoT exists. The biomechanics behind why and how an optimal stiffness exists and benefits individuals with plantar flexor weakness are not well understood. We hypothesized that the AFO would reduce the required support moment and, hence, metabolic cost contributions of the ankle plantar flexor and knee extensor muscles during stance, and reduce hip flexor metabolic cost to initiate swing. To test these hypotheses, we generated neuromusculoskeletal simulations to represent gait of an individual with bilateral plantar flexor weakness wearing an AFO with varying stiffness. Predictions were based on the objective of minimizing mCoT, loading rates at impact and head accelerations at each stiffness level, and the motor patterns were determined via dynamic optimization. The predictive gait simulation results were compared to experimental data from subjects with bilateral plantar flexor weakness walking with varying AFO stiffness. Our simulations demonstrated that reductions in mCoT with increasing stiffness were attributed to reductions in quadriceps metabolic cost during midstance. Increases in mCoT above optimum stiffness were attributed to the increasing metabolic cost of both hip flexor and hamstrings muscles. The insights gained from our predictive gait simulations could inform clinicians on the prescription of personalized AFOs. With further model individualization, simulations based on mCoT minimization may sufficiently predict adaptations to an AFO in individuals with plantar flexor weakness.

A sensorimotor enhanced neuromusculoskeletal model for simulating postural control of upright standing

The human's upright standing is a complex control process that is not yet fully understood. Postural control models can provide insights into the body's internal control processes of balance behavior. Using physiologically plausible models can also help explaining pathophysiological motion behavior. In this paper, we introduce a neuromusculoskeletal postural control model using sensor feedback consisting of somatosensory, vestibular and visual information. The sagittal plane model was restricted to effectively six degrees of freedom and consisted of nine muscles per leg. Physiologically plausible neural delays were considered for balance control. We applied forward dynamic simulations and a single shooting approach to generate healthy reactive balance behavior during quiet and perturbed upright standing. Control parameters were optimized to minimize muscle effort. We showed that our model is capable of fulfilling the applied tasks successfully. We observed joint angles and ranges of motion in physiologically plausible ranges and comparable to experimental data. This model represents the starting point for subsequent simulations of pathophysiological postural control behavior.

Disentangling the effects of metabolic cost and accuracy on movement speed

On any given day, we make countless reaching movements to objects around us. While such ubiquity may suggest uniformity, each movement's speed is unique-why is this? Reach speed is known to be influenced by accuracy; we slow down to sustain high accuracy. However, in other forms of movement like walking or running, metabolic cost is often the primary determinant of movement speed. Here we bridge this gap and ask: how do metabolic cost and accuracy interact to determine speed of reaching movements? First, we systematically measure the effect of increasing mass on the metabolic cost of reaching across a range of movement speeds. Next, in a sequence of three experiments, we examine how added mass affects preferred reaching speed across changing accuracy requirements. We find that, while added mass consistently increases metabolic cost thereby leading to slower metabolically optimal movement speeds, self-selected reach speeds are slower than those predicted by an optimization of metabolic cost alone. We then demonstrate how a single model that considers both accuracy and metabolic costs can explain preferred movement speeds. Together, our findings provide a unifying framework to illuminate the combined effects of metabolic cost and accuracy on movement speed and highlight the integral role metabolic cost plays in determining reach speed.

Muscle fibre typology affects whole-body metabolic rate during isolated muscle contractions and human locomotion

The wide variation in muscle fibre type distribution across individuals, along with the very different energy consumption rates in slow versus fast muscle fibres, suggests that muscle fibre typology contributes to inter-individual differences in metabolic rate during exercise. However, this has been hard to demonstrate due to the gap between a single muscle fibre and full-body exercises. We investigated the isolated effect of triceps surae muscle contraction velocity on whole-body metabolic rate during cyclic contractions in individuals a priori selected for their predominantly slow (n = 11) or fast (n = 10) muscle fibre typology by means of proton magnetic resonance spectroscopy (1H-MRS). Subsequently, we examined their whole-body metabolic rate during walking and running at 2 m/s, exercises with comparable metabolic rates but distinct triceps surae muscle force and velocity demands (walking: low force, high velocity; running: high force, low velocity). Increasing triceps surae contraction velocity during cyclic contractions elevated net whole-body metabolic rate for both typology groups. However, the slow group consumed substantially less net metabolic energy at the slowest contraction velocity, but the metabolic difference between groups diminished at faster velocities. Consistent with the more economic force production during slow contractions, the slow group exhibited lower metabolic rates than the fast group while running, whereas metabolic rates were similar during walking. These findings provide important insights into the influence of muscle fibre typology on whole-body metabolic rate and emphasize the importance of considering muscle mechanical demands to understand muscle fibre typology related differences in whole-body metabolic rates. KEY POINTS: Muscle fibre typology is often suggested to affect whole-body metabolic rate, yet convincing in vivo evidence is lacking. Using isolated plantar flexor muscle contractions in individuals a priori selected for their predominantly slow or fast muscle fibre typology, we demonstrated that having predominantly slow muscle fibres provides a metabolic advantage during slow muscle contractions, but this benefit disappeared at faster contractions. We extended these results to full-body exercises, where we demonstrated that higher proportions of slow fibres associated with better economy during running but not when walking. These findings provide important insights into the influence of muscle fibre typology on whole-body metabolic rate and emphasize the importance of considering muscle mechanical demands to understand muscle fibre typology related differences in whole-body metabolic rate.

Human-in-the-loop optimization of rocker shoes via different cost functions during walking

Personalised footwear could be used to enhance the function of the foot-ankle complex to a person's maximum. Human-in-the-loop optimization could be used as an effective and efficient way to find a personalised optimal rocker profile (i.e., apex position and angle). The outcome of this process likely depends on the selected optimization objective and its responsiveness to the rocker parameters being tuned. This study aims to explore whether and how human-in-the-loop optimization via different cost functions (i.e., metabolic cost, collision work as measure for external mechanical work, and step distance variability as measure for gait stability) affects the optimal apex position and angle of a rocker profile differently for individuals during walking. Ten healthy individuals walked on a treadmill with experimental rocker shoes in which apex position and angle were optimized using human-in-the-loop optimization using different cost functions. We compared the obtained optimal apex parameters for the different cost functions and how these affected the selected gait related objectives. Optimal apex parameters differed substantially between participants and optimal apex positions differed between cost functions. The responsiveness to changes in apex parameters differed between cost functions. Collision work was the only cost function that resulted in a significant improvement of its performance criteria. Improvements in metabolic cost or step distance variability were not found after optimization. This study showed that cost function selection is important when human-in-the-loop optimization is used to design personalised footwear to allow conversion to an optimum that suits the individual.

Human movement modifications induced by different levels of transparency of an active upper limb exoskeleton

Active upper limb exoskeletons are a potentially powerful tool for neuromotor rehabilitation. This potential depends on several basic control modes, one of them being transparency. In this control mode, the exoskeleton must follow the human movement without altering it, which theoretically implies null interaction efforts. Reaching high, albeit imperfect, levels of transparency requires both an adequate control method and an in-depth evaluation of the impacts of the exoskeleton on human movement. The present paper introduces such an evaluation for three different "transparent" controllers either based on an identification of the dynamics of the exoskeleton, or on force feedback control or on their combination. Therefore, these controllers are likely to induce clearly different levels of transparency by design. The conducted investigations could allow to better understand how humans adapt to transparent controllers, which are necessarily imperfect. A group of fourteen participants were subjected to these three controllers while performing reaching movements in a parasagittal plane. The subsequent analyses were conducted in terms of interaction efforts, kinematics, electromyographic signals and ergonomic feedback questionnaires. Results showed that, when subjected to less performing transparent controllers, participants strategies tended to induce relatively high interaction efforts, with higher muscle activity, which resulted in a small sensitivity of kinematic metrics. In other words, very different residual interaction efforts do not necessarily induce very different movement kinematics. Such a behavior could be explained by a natural human tendency to expend effort to preserve their preferred kinematics, which should be taken into account in future transparent controllers evaluation.

Behavioral Motor Performance

The human sensorimotor control system has exceptional abilities to perform skillful actions. We easily switch between strenuous tasks that involve brute force, such as lifting a heavy sewing machine, and delicate movements such as threading a needle in the same machine. Using a structure with different control architectures, the motor system is capable of updating its ability to perform through our daily interaction with the fluctuating environment. However, there are issues that make this a difficult computational problem for the brain to solve. The brain needs to control a nonlinear, nonstationary neuromuscular system, with redundant and occasionally undesired degrees of freedom, in an uncertain environment using a body in which information transmission is subject to delays and noise. To gain insight into the mechanisms of motor control, here we survey movement laws and invariances that shape our everyday motion. We then examine the major solutions to each of these problems in the three parts of the sensorimotor control system, sensing, planning, and acting. We focus on how the sensory system, the control architectures, and the structure and operation of the muscles serve as complementary mechanisms to overcome deviations and disturbances to motor behavior and give rise to skillful motor performance. We conclude with possible future research directions based on suggested links between the operation of the sensorimotor system across the movement stages. © 2024 American Physiological Society. Compr Physiol 14:5179-5224, 2024.

Ground Contact Force and Moment Estimation for Human-Exoskeleton Systems Using Dynamic Decoupled Coordinate System and Minimum Energy Hypothesis

Estimating the contact forces and moments (CFMs) between exoskeletons' feet and the ground is a prerequisite for calculating exoskeletons' joint moments. However, comfortable, portable, and high-precision force sensors for CFM detection are difficult to design and manufacture. In addition, there are many unknown CFM components (six force components and six moment components in the double-support phase). These reasons make it challenging to estimate CFMs precisely. In this paper, we propose a novel method for estimating these CFMs based on a proposed dynamic decoupled coordinate system (DDCS) and the minimum energy hypothesis. By decomposing these CFMs into a DDCS, the number of unknowns can be significantly reduced from twelve to two. Meanwhile, the minimum energy hypothesis provides a relatively reliable target for optimizing the remaining two unknown variables. We verify the accuracy of this method using a public data set about human walking. The validation shows that the proposed method is capable of estimating CFMs. This study provides a practical way to estimate the CFMs under the soles, which contributes to reducing the research and development costs of exoskeletons by avoiding the need for expensive plantar sensors. The sensor-free approach also reduces the dependence on high-precision, portable, and comfortable CFM detection sensors, which are usually difficult to design.

Reoptimization of single-joint motor patterns to non-Earth gravity torques induced by a robotic exoskeleton

Gravity is a ubiquitous component of our environment that we have learned to optimally integrate in movement control. Yet, altered gravity conditions arise in numerous applications from space exploration to rehabilitation, thereby pressing the sensorimotor system to adapt. Here, we used a robotic exoskeleton to reproduce the elbow joint-level effects of arbitrary gravity fields ranging from 1g to -1g, passing through Mars- and Moon-like gravities, and tested whether humans can reoptimize their motor patterns accordingly. By comparing the motor patterns of actual arm movements with those predicted by an optimal control model, we show that our participants (N = 61 ) adapted optimally to each gravity-like torque. These findings suggest that the joint-level effects of a large range of gravities can be efficiently apprehended by humans, thus opening new perspectives in arm weight support training in manipulation tasks, whether it be for patients or astronauts.

Effect of hip abduction assistance on metabolic cost and balance during human walking

The use of wearable robots to provide walking assistance has rapidly grown over the past decade, with notable advances made in robot design and control methods toward reducing physical effort while performing an activity. The reduction in walking effort has mainly been achieved by assisting forward progression in the sagittal plane. Human gait, however, is a complex movement that combines motions in three planes, not only the sagittal but also the transverse and frontal planes. In the frontal plane, the hip joint plays a key role in gait, including balance. However, wearable robots targeting this motion have rarely been investigated. In this study, we developed a hip abduction assistance wearable robot by formulating the hypothesis that assistance that mimics the biological hip abduction moment or power could reduce the metabolic cost of walking and affect the dynamic balance. We found that hip abduction assistance with a biological moment second peak mimic profile reduced the metabolic cost of walking by 11.6% compared with the normal walking condition. The assistance also influenced balance-related parameters, including the margin of stability. Hip abduction assistance influenced the center-of-mass movement in the mediolateral direction. When the robot assistance was applied as the center of mass moved toward the opposite leg, the assistance replaced some of the efforts that would have otherwise been provided by the human. This indicates that hip abduction assistance can reduce physical effort during human walking while influencing balance.

Normalized economical speed is influenced by aging and not by exercise habituation

OBJECTIVE

A U-shaped relationship between energy cost of walking (Cw) and walking speed indicates that there is a specific speed minimizing the Cw, called economical speed (ES). It is mostly slower in older adults than young adults; however, effects of leg length on the ES have been ignored. We investigated effects of aging and exercise habituation on the normalized ES by leg length (ESnormalized). We quantified time delay of stride length and step frequency in sedentary young (SY), active young (AY), and active elderly (AE) adults in response to sinusoidal gait speed change at 30-s and 180-s periods with an amplitude of ± 0.56 m･s- 1.

RESULTS

The ES was significantly slower in the following sequence: AE, SY, and AY, whereas ESnormalized was slower in the AE than in other young groups, with no difference between AY and SY. AE and SY showed greater step variabilities at the 180-s period, whereas AY showed relatively smaller step variabilities at both periods. Collectively, the ESnormalized slowed due to aging, not due to exercise habituation. When optimizing the appropriate SL-SF combination for sinusoidal speed changes, young and elderly adults may adopt different strategies. Exercise habituation may reduce step variabilities in young adults.

Toe-walking and its impact on first and second rocker in gait patterns with different degrees of artificially emulated soleus and gastrocnemius contracture

BACKGROUND

Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking.

METHOD

An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0-5 % of the gait cycle (first rocker) and on 12-31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures.

FINDINGS

The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers.

INTERPRETATION

This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear.

Methods for integrating postural control into biomechanical human simulations: a systematic review

Understanding of the human body's internal processes to maintain balance is fundamental to simulate postural control behaviour. The body uses multiple sensory systems' information to obtain a reliable estimate about the current body state. This information is used to control the reactive behaviour to maintain balance. To predict a certain motion behaviour with knowledge of the muscle forces, forward dynamic simulations of biomechanical human models can be utilized. We aim to use predictive postural control simulations to give therapy recommendations to patients suffering from postural disorders in the future. It is important to know which types of modelling approaches already exist to apply such predictive forward dynamic simulations. Current literature provides different models that aim to simulate human postural control. We conducted a systematic literature research to identify the different approaches of postural control models. The different approaches are discussed regarding their applied biomechanical models, sensory representation, sensory integration, and control methods in standing and gait simulations. We searched on Scopus, Web of Science and PubMed using a search string, scanned 1253 records, and found 102 studies to be eligible for inclusion. The included studies use different ways for sensory representation and integration, although underlying neural processes still remain unclear. We found that for postural control optimal control methods like linear quadratic regulators and model predictive control methods are used less, when models' level of details is increasing, and nonlinearities become more important. Considering musculoskeletal models, reflex-based and PD controllers are mainly applied and show promising results, as they aim to create human-like motion behaviour considering physiological processes.

Utilization of overground exoskeleton gait training during inpatient rehabilitation: a descriptive analysis

BACKGROUND

Overground exoskeleton gait training (OEGT) after neurological injury is safe, feasible, and may yield positive outcomes. However, no recommendations exist for initiation, progression, or termination of OEGT. This retrospective study highlights the clinical use and decision-making of OEGT within the physical therapy plan of care for patients after neurological injury during inpatient rehabilitation.

METHODS

The records of patients admitted to inpatient rehabilitation after stroke, spinal cord injury, or traumatic brain injury who participated in at least one OEGT session were retrospectively reviewed. Session details were analyzed to illustrate progress and included: "up" time, "walk" time, step count, device assistance required for limb swing, and therapist-determined settings. Surveys were completed by therapists responsible for OEGT sessions to illuminate clinical decision-making.

RESULTS

On average, patients demonstrated progressive tolerance for OEGT over successive sessions as shown by increasing time upright and walking, step count, and decreased assistance required by the exoskeleton. Therapists place preference on using OEGT with patients with more functional dependency and assess feedback from the patient and device to determine when to change settings. OEGT is terminated when other gait methods yield higher step repetitions or intensities, or to prepare for discharge.

CONCLUSION

Our descriptive retrospective data suggests that patients after neurological injury may benefit from OEGT during inpatient rehabilitation. As no guidelines exist, therapists' clinical decisions are currently based on a combination of knowledge of motor recovery and experience. Future efforts should aim to develop evidence-based recommendations to facilitate functional recovery after neurological injury by leveraging OEGT.

Generating variability from motor primitives during infant locomotor development

Motor variability is a fundamental feature of developing systems allowing motor exploration and learning. In human infants, leg movements involve a small number of basic coordination patterns called locomotor primitives, but whether and when motor variability could emerge from these primitives remains unknown. Here we longitudinally followed 18 infants on 2-3 time points between birth (~4 days old) and walking onset (~14 months old) and recorded the activity of their leg muscles during locomotor or rhythmic movements. Using unsupervised machine learning, we show that the structure of trial-to-trial variability changes during early development. In the neonatal period, infants own a minimal number of motor primitives but generate a maximal motor variability across trials thanks to variable activations of these primitives. A few months later, toddlers generate significantly less variability despite the existence of more primitives due to more regularity within their activation. These results suggest that human neonates initiate motor exploration as soon as birth by variably activating a few basic locomotor primitives that later fraction and become more consistently activated by the motor system.

Using human-in-the-loop optimization for guiding manual prosthesis adjustments: a proof-of-concept study

Introduction: Human-in-the-loop optimization algorithms have proven useful in optimizing complex interactive problems, such as the interaction between humans and robotic exoskeletons. Specifically, this methodology has been proven valid for reducing metabolic cost while wearing robotic exoskeletons. However, many prostheses and orthoses still consist of passive elements that require manual adjustments of settings. Methods: In the present study, we investigated if human-in-the-loop algorithms could guide faster manual adjustments in a procedure similar to fitting a prosthesis. Eight healthy participants wore a prosthesis simulator and walked on a treadmill at 0.8 ms-1 under 16 combinations of shoe heel height and pylon height. A human-in-the-loop optimization algorithm was used to find an optimal combination for reducing the loading rate on the limb contralateral to the prosthesis simulator. To evaluate the performance of the optimization algorithm, we used a convergence criterium. We evaluated the accuracy by comparing it against the optimum from a full sweep of all combinations. Results: In five out of the eight participants, the human-in-the-loop optimization reduced the time taken to find an optimal combination; however, in three participants, the human-in-the-loop optimization either converged by the last iteration or did not converge. Discussion: Findings from this study show that the human-in-the-loop methodology could be helpful in tasks that require manually adjusting an assistive device, such as optimizing an unpowered prosthesis. However, further research is needed to achieve robust performance and evaluate applicability in persons with amputation wearing an actual prosthesis.

Neuromuscular control: from a biomechanist's perspective

Understanding neural control of movement necessitates a collaborative approach between many disciplines, including biomechanics, neuroscience, and motor control. Biomechanics grounds us to the laws of physics that our musculoskeletal system must obey. Neuroscience reveals the inner workings of our nervous system that functions to control our body. Motor control investigates the coordinated motor behaviours we display when interacting with our environment. The combined efforts across the many disciplines aimed at understanding human movement has resulted in a rich and rapidly growing body of literature overflowing with theories, models, and experimental paradigms. As a result, gathering knowledge and drawing connections between the overlapping but seemingly disparate fields can be an overwhelming endeavour. This review paper evolved as a need for us to learn of the diverse perspectives underlying current understanding of neuromuscular control. The purpose of our review paper is to integrate ideas from biomechanics, neuroscience, and motor control to better understand how we voluntarily control our muscles. As biomechanists, we approach this paper starting from a biomechanical modelling framework. We first define the theoretical solutions (i.e., muscle activity patterns) that an individual could feasibly use to complete a motor task. The theoretical solutions will be compared to experimental findings and reveal that individuals display structured muscle activity patterns that do not span the entire theoretical solution space. Prevalent neuromuscular control theories will be discussed in length, highlighting optimality, probabilistic principles, and neuromechanical constraints, that may guide individuals to families of muscle activity solutions within what is theoretically possible. Our intention is for this paper to serve as a primer for the neuromuscular control scientific community by introducing and integrating many of the ideas common across disciplines today, as well as inspire future work to improve the representation of neural control in biomechanical models.

Habitual exercise evokes fast and persistent adaptation during split-belt walking

Changing movement patterns in response to environmental perturbations is a critical aspect of gait and is related to reducing the energetic cost of the movement. Exercise improves energetic capacity for submaximal exercise and may affect how people adapt movement to reach an energetic minimum. The purpose of this study was to determine whether self-reported exercise behavior influences gait adaptation in young adults. Young adults who met the optimal volume of exercise according to the Physical Activity Guidelines for Americans (MOVE; n = 19) and young adults who did not meet the optimal volume of exercise (notMOVE; n = 13) walked on a split-belt treadmill with one belt moving twice the speed of the other belt for 10 minutes. Step length asymmetry (SLA) and mechanical work done by each leg were measured. Nonlinear mixed effects models compared the time course of adaptation between MOVE and notMOVE, and t-tests compared net work at the end of adaptation between MOVE and notMOVE. Compared to notMOVE, MOVE had a faster initial response to the split belt treadmill, and continued to adapt over the duration of split-belt treadmill walking. Young adults who engage in sufficient amounts of exercise responded more quickly to the onset of a perturbation, and throughout the perturbation they continued to explore movement strategies, which might be related to reduction of energetic cost. Our findings provide insights into the multisystem positive effects of exercise, including walking adaptation.

Data-Driven Variable Impedance Control of a Powered Knee-Ankle Prosthesis for Adaptive Speed and Incline Walking

Most impedance-based walking controllers for powered knee-ankle prostheses use a finite state machine with dozens of user-specific parameters that require manual tuning by technical experts. These parameters are only appropriate near the task (e.g., walking speed and incline) at which they were tuned, necessitating many different parameter sets for variable-task walking. In contrast, this paper presents a data-driven, phase-based controller for variable-task walking that uses continuously-variable impedance control during stance and kinematic control during swing to enable biomimetic locomotion. After generating a data-driven model of variable joint impedance with convex optimization, we implement a novel task-invariant phase variable and real-time estimates of speed and incline to enable autonomous task adaptation. Experiments with above-knee amputee participants (N=2) show that our data-driven controller 1) features highly-linear phase estimates and accurate task estimates, 2) produces biomimetic kinematic and kinetic trends as task varies, leading to low errors relative to able-bodied references, and 3) produces biomimetic joint work and cadence trends as task varies. We show that the presented controller meets and often exceeds the performance of a benchmark finite state machine controller for our two participants, without requiring manual impedance tuning.

Biomechanical Analysis of the Unaffected Limb While Using a Hands-Free Crutch

Basic human ambulation relies on a bipedal gait, which has been reported to be directly related to quality of life. However, injuries to the lower limb can cause an inability to walk and require non-weightbearing periods to heal. Among the many ambulatory aids, standard axillary crutches are prescribed. However, due to the disadvantages of having to use both hands, a slow gait, pain, nerve damage, and gait patterns that differ from that of healthy subjects, currently, a new generation of ambulatory aids has emerged. Among such aids, hands-free crutches (HFCs) are of particular interest due to their form factor, which does not require the use of the hands and facilitates a bipedal gait. In this study, we present an assessment of whether any different gait patterns, compared to overground gait, appeared on the unaffected limb during walking with an HFC. The spatiotemporal parameters, plantar force, lower-limb joint angles, and EMG patterns were evaluated. In conclusion, the results from 10 healthy subjects suggest that wearing an HFC causes only slight changes in the biomechanical gait patterns examined in the unaffected limb compared with overground walking without an HFC.

How Connecting the Legs with a Spring Improves Human Running Economy

Connecting the legs with a spring attached to the shoelaces reduces the energy cost of running, but how the spring reduces the energy burden of individual muscles remains unknown. We generated muscle-driven simulations of seven individuals running with and without the spring to discern whether savings occurred during the stance phase or the swing phase, and to identify which muscles contributed to energy savings. We computed differences in muscle-level energy consumption, muscle activations, and changes in muscle-fiber velocity and force between running with and without the spring. Across participants, running with the spring reduced the measured rate of energy expenditure by 0.9 W/kg (8.3%). Simulations predicted a 1.4 W/kg (12.0%) reduction in the average rate of energy expenditure and correctly identified that the spring reduced rates of energy expenditure for all participants. Simulations showed most of the savings occurred during stance (1.5 W/kg), though the rate of energy expenditure was also reduced during swing (0.3 W/kg). The energetic savings were distributed across the quadriceps, hip flexor, hip abductor, hamstring, hip adductor, and hip extensor muscle groups, whereas no changes in the rate of energy expenditure were observed in the plantarflexor or dorsiflexor muscles. Energetic savings were facilitated by reductions in the rate of mechanical work performed by muscles and their estimated rate of heat production. The simulations provide insight into muscle-level changes that occur when utilizing an assistive device and the mechanisms by which a spring connecting the legs improves running economy.

The Interplay Between Walking Speed, Economy, and Stability After Stroke

BACKGROUND AND PURPOSE

Energy minimization is thought to underlie the naturally selected, preferred walking speed; however, people post-stroke walk slower than their most economical speed, presumably to optimize other objectives, such as stability. The purpose of this study was to examine the interplay between walking speed, economy, and stability.

METHODS

Seven individuals with chronic hemiparesis walked on a treadmill at 1 of 3 randomized speeds: slow, preferred, and fast. Concurrent measurements of speed-induced changes in walking economy (ie, the energy needed to move 1 kg of bodyweight 1 ml O 2 /kg/m) and stability were made. Stability was quantified as the regularity and divergence of the mediolateral motion of the pelvic center of mass (pCoM) during walking, as well as pCoM motion relative to the base of support.

RESULTS

Slower walking speeds were more stable (ie, pCoM motion was 10% ± 5% more regular and 26% ± 16% less divergent) but 12% ± 5% less economical. Conversely, faster walking speeds were 9% ± 8% more economical, but also less stable (ie, pCoM motion was 17% ± 5% more irregular). Individuals with slower walking speeds had an enhanced energetic benefit when walking faster ( rs = 0.96, P < 0.001). Individuals with greater neuromotor impairment had an enhanced stability benefit when walking slower ( rs = 0.86, P = 0.01).

DISCUSSION AND CONCLUSIONS

People post-stroke appear to prefer walking speeds that are faster than their most stable speed but slower than their most economical speed. The preferred walking speed after stroke appears to balance stability and economy. To encourage faster and more economical walking, deficits in the stable control of the mediolateral motion of the pCoM may need to be addressed.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A416 ).

The visual control of locomotion when stepping onto moving surfaces: A comparison of younger and older adults

Stepping between static and moving surfaces presents a locomotor challenge associated with increased injury frequency and severity in older adults. The current study evaluates younger and older adults' behaviours when overcoming challenges sampling moving walkway and escalator environments. Twelve younger adults (18-40 years, Male = 8) and 15 older adults (60-81 years, Male = 5) were examined using an integration of optoelectronic motion capture and mobile eye-tracking. Participants were investigated approaching and stepping onto a flat conveyor belt (static or moving; with or without surface (demarcation) lines). Specifically, the four conditions were: (i) static surface without demarcation lines; (ii) static surface with demarcation lines; (iii) moving surface without demarcation lines; and (iv) moving surface with demarcation lines. A two (age group) x two (surface-condition) x two (demarcation-condition) linear mixed-model revealed no main or interaction effects (p > .05) for perturbation magnitude, indicating participants maintained successful locomotion. However, different adaptive behaviours were identified between conditions with moving and accuracy demands (e.g., moving surfaces increased step length, demarcations reduced step length). Between subject effects identified differences between age groups. Older adults utilised different behaviours, such as earlier gaze transfer from the final approach walkway step location. Overall, the current study suggests that adaptive behaviours emerge relative to the environment's specific demands and the individual's action capabilities.

Metabolic costs of walking and arm reaching in persons with mild multiple sclerosis

Movement slowness is a common and disruptive symptom of multiple sclerosis (MS). A potential cause is that individuals with MS slow down to conserve energy as a behavioral adjustment to heightened metabolic costs of movement. To investigate this prospect, we measured the metabolic costs of both walking and seated arm reaching at five speeds in persons with mild MS (pwMS; n = 13; 46.0 ± 7.7 yr) and sex- and age-matched controls (HCs; n = 13; 45.8 ± 7.8 yr). Notably, the cohort of pwMS was highly mobile and no individuals required a cane or aid when walking. We found that the net metabolic power of walking was approximately 20% higher for pwMS across all speeds (P = 0.0185). In contrast, we found no differences in the gross power of reaching between pwMS and HCs (P = 0.492). Collectively, our results suggest that abnormal slowness of movement in MS-particularly reaching-is not the consequence of heightened effort costs and that other sensorimotor mechanisms are playing a considerable role in slowing.NEW & NOTEWORTHY Individuals with multiple sclerosis (MS) often move more slowly than those without the disease. A possible cause is that movements in MS are more energetically expensive and slowing is an adaptation to conserve metabolic resources. Here, we find that while walking is more costly for persons with MS, arm-reaching movements are not. These results bring into question the driving force of movement slowness in MS and implicate other motor-related networks contributing to slowing.

Recruit-aged adults may preferentially weight task goals over deleterious cost functions during short duration loaded and imposed gait tasks

Optimal motor control that is stable and adaptable to perturbation is reflected in the temporal arrangement and regulation of gait variability. Load carriage and forced-marching are common military relevant perturbations to gait that have been implicated in the high incidence of musculoskeletal injuries in military populations. We investigated the interactive effects of load magnitude and locomotion pattern on motor variability, stride regulation and spatiotemporal complexity during gait in recruit-aged adults. We further investigated the influences of sex and task duration. Healthy adults executed trials of running and forced-marching with and without loads at 10% above their gait transition velocity. Spatiotemporal parameters were analyzed using a goal equivalent manifold approach. With load and forced-marching, individuals used a greater array of motor solutions to execute the task goal (maintain velocity). Stride-to-stride regulation became stricter as the task progressed. Participants exhibited optimal spatiotemporal complexity with significant but not meaningful differences between sexes. With the introduction of load carriage and forced-marching, individuals relied on a strategy that maximizes and regulates motor solutions that achieve the task goal of velocity specifically but compete with other task functions. The appended cost penalties may have deleterious effects during prolonged execution, potentially increasing the risk of musculoskeletal injuries.

Fascicle dynamics of the tibialis anterior muscle reflect whole-body walking economy

Humans can inherently adapt their gait pattern in a way that minimizes the metabolic cost of transport, or walking economy, within a few steps, which is faster than any known direct physiological sensor of metabolic energy. Instead, walking economy may be indirectly sensed through mechanoreceptors that correlate with the metabolic cost per step to make such gait adaptations. We tested whether velocity feedback from tibialis anterior (TA) muscle fascicles during the early stance phase of walking could potentially act to indirectly sense walking economy. As participants walked within a range of steady-state speeds and step frequencies, we observed that TA fascicles lengthen on almost every step. Moreover, the average peak fascicle velocity experienced during lengthening reflected the metabolic cost of transport of the given walking condition. We observed that the peak TA muscle activation occurred earlier than could be explained by a short latency reflex response. The activation of the TA muscle just prior to heel strike may serve as a prediction of the magnitude of the ground collision and the associated energy exchange. In this scenario, any unexpected length change experienced by the TA fascicle would serve as an error signal to the nervous system and provide additional information about energy lost per step. Our work helps provide a biomechanical framework to understand the possible neural mechanisms underlying the rapid optimization of walking economy.

How frequent is the spontaneous occurrence of synchronized walking in daily life?

Experimental work has suggested that individuals walking side by side may frequently synchronize their steps. The present study created video records of pedestrian activity on pedestrian pathways in order to estimate the frequency of continuous synchronization among pairs of walkers going about their daily lives. About 6% of 498 coded pairs were continuously synchronized. Analysis and modeling of the distributions of frequency differences suggested that while different walkers will tend to have different preferred frequencies for a given speed (i.e., a preferred ratio of step length to step frequency, or walk ratio), they may tend to adjust their walk ratios slightly toward one another's even when they are not synchronizing their steps.

Optimality, Stability, and Agility of Human Movement: New Optimality Criterion and Trade-Offs

This review of movement stability, optimality, and agility is based on the theory of motor control with changes in spatial referent coordinates for the effectors, the principle of abundance, and the uncontrolled manifold hypothesis. A new optimality principle is suggested based on the concept of optimal sharing corresponding to a vector in the space of elemental variables locally orthogonal to the uncontrolled manifold. Motion along this direction is associated with minimal components along the relatively unstable directions within the uncontrolled manifold leading to a minimal motor equivalent motion. For well-practiced actions, this task-specific criterion is followed in spaces of referent coordinates. Consequences of the suggested framework include trade-offs among stability, optimality, and agility, unintentional changes in performance, hand dominance, finger specialization, individual traits in performance, and movement disorders in neurological patients.

Concept design of hybrid-actuated lower limb exoskeleton to reduce the metabolic cost of walking with heavy loads

This paper proposes the conceptual design method for a hybrid-actuated lower limb exoskeleton based on energy consumption simulation. Firstly, the human-machine coupling model is established in OpenSim based on the proposed three passive assistance schemes. On this basis, the method of simulating muscle driving is used to find out the scheme that can reduce the metabolic rate the most with 3 passive springs models. Then, an active-passive cooperative control strategy is designed based on the finite state machine to coordinate the operation of the power mechanism and the passive energy storage structure and improve the mobility of the wearer. In the end, a simulation experiment based on the human-machine coupled model with the addition of active actuation is proceeded to evaluate its assistance performance according to reducing metabolic rate. The results show that the average metabolic cost decreased by 7.2% with both spring and motor. The combination of passive energy storage structures with active actuators to help the wearer overcome the additional consumption of energy storage can further reduce the body's metabolic rate. The proposed conceptual design method can also be utilized to implement the rapid design of a hybrid-actuated lower limb exoskeleton.

Be Careful What You Wish for: Cost Function Sensitivity in Predictive Simulations for Assistive Device Design

Software packages that use optimization to predict the motion of dynamic systems are powerful tools for studying human movement. These “predictive simulations” are gaining popularity in parameter optimization studies for designing assistive devices such as exoskeletons. The cost function is a critical component of the optimization problem and can dramatically affect the solution. Many cost functions have been proposed that are biologically inspired and that produce reasonable solutions, but which may lead to different conclusions in some contexts. We used OpenSim Moco to generate predictive simulations of human walking using several cost functions, each of which produced a reasonable trajectory of the human model. We then augmented the model with motors that generated hip flexion, knee flexion, or ankle plantarflexion torques, and repeated the predictive simulations to determine the optimal motor torques. The model was assumed to be planar and bilaterally symmetric to reduce computation time. Peak torques varied from 41.3 to 79.0 N·m for the hip flexion motors, from 48.0 to 94.2 N·m for the knee flexion motors, and from 42.6 to 79.8 N·m for the ankle plantarflexion motors, which could have important design consequences. This study highlights the importance of evaluating the robustness of results from predictive simulations.

Humans trade off whole-body energy cost to avoid overburdening muscles while walking

Metabolic cost minimization is thought to underscore the neural control of locomotion. Yet, avoiding high muscle activation, a cause of fatigue, often outperforms energy minimization in computational predictions of human gait. Discerning the relative importance of these criteria in human walking has proved elusive, in part, because they have not been empirically decoupled. Here, we explicitly decouple whole-body metabolic cost and 'fatigue-like' muscle activation costs (estimated from electromyography) by pitting them against one another using two distinct gait tasks. When experiencing these competing costs, participants (n = 10) chose the task that avoided overburdening muscles (fatigue avoidance) at the expense of higher metabolic power (p < 0.05). Muscle volume-normalized activation more closely models energy use and was also minimized by the participants' decision (p < 0.05), demonstrating that muscle activation was, at best, an inaccurate signal for metabolic energy. Energy minimization was only observed when there was no adverse effect on muscle activation costs. By decoupling whole-body metabolic and muscle activation costs, we provide among the first empirical evidence of humans embracing non-energetic optimality in favour of a clearly defined neuromuscular objective. This finding indicates that local muscle fatigue and effort may well be key factors dictating human walking behaviour and its evolution.

Women carry for less: body size, pelvis width, loading position and energetics

The energetic cost of walking varies with mass and speed; however, the metabolic cost of carrying loads has not consistently increased proportionally to the mass carried. The cost of carrying mass, and the speed at which human walkers carry this mass, has been shown to vary with load position and load description (e.g. child vs. groceries). Additionally, the preponderance of women carriers around the world, and the tendency for certain kinds of population-level sexual dimorphism has led to the hypothesis that women might be more effective carriers than men. Here, I investigate the energetic cost and speed changes of women (N = 9) and men (N = 6) walking through the woods carrying their own babies (mean baby mass = 10.6 kg) in three different positions - on their front, side and back using the same Ergo fabric baby sling. People carrying their babies on their backs are able to maintain their unloaded walking speed (1.4 m/s) and show the lowest increase in metabolic cost per distance (J/m, 17.4%). Women carry the babies for a lower energetic cost than men at all conditions (p < 0.01). Further energetic and kinematic evidence elucidates the preponderance of back-carrying cross-culturally, and illustrates the importance of relatively wider bi-trochanteric breadths for reducing the energetic costs of carrying.

Modulating Energy Among Foot-Ankle Complex With an Unpowered Exoskeleton Improves Human Walking Economy

Over the course of both evolution and development, the human musculoskeletal system has been well shaped for the cushion function of the foot during foot-strike and the impulsive function of the ankle joint during push-off. Nevertheless, an efficient energy interaction between foot structure and ankle joint is still lacking in the human body itself, which may limit the further potential of economical walking. Here we showed the metabolic expenditure of walking can be lessened by an unpowered exoskeleton robot that modulates energy among the foot-ankle complex towards a more effective direction. The unpowered exoskeleton recycles negative mechanical energy of the foot that is normally dissipated in heel-strike, retains the stored energy before mid-stance, and then transfers the energy to the ankle joint to assist the push-off. The modulation process of the exoskeleton consumes no input energy, yet reduces the metabolic cost of walking by 8.19 ± 0.96 % (mean ± s.e.m) for healthy subjects. The electromyography measurements demonstrate the activities of target ankle plantarflexors decreased significantly without added effort for the antagonistic muscle, suggesting the exoskeleton enhanced the subjects' energy efficiency of the foot-ankle complex in a natural manner. Furthermore, the exoskeleton also provides cushion assistance for walking, which leads to significantly decreased activity of the quadriceps muscle during heel-strike. Rather than strengthening the functions of existing biological structures, developing the complementary energy loop that does not exist in the human body itself also shows its potential for gait assistance.

Predictive Simulations to Replicate Human Gait Adaptations and Energetics With Exoskeletons

Robotic exoskeletons have the potential to restore and enhance human mobility. However, optimally controlling these devices, to work in concert with human users, is challenging. Accurate model simulations of the interaction between exoskeletons and users may expedite the design process and improve control. Here, as a proof of principle, we tested if we could use predictive simulations to replicate human gait adaptations and changes in energy expenditure from an experiment where participants walked with exoskeletons. We recreated a past experimental paradigm, where robotic exoskeletons were used to shift people's energetically optimal step frequency to frequencies higher and lower than normally preferred. To match the experimental controller, we modelled knee-worn exoskeletons that applied resistive torques, either proportional or inversely proportional to step frequency-decreasing or increasing the energy optimal step frequency, respectively. We were able to replicate the experiment, finding higher and lower optimal step frequencies than in natural walking under each respective condition. Our simulated resistive torques and objective landscapes resembled the measured experimental resistive torque and energy landscapes. Individual muscle energetics revealed distinct coordination strategies consistent with each exoskeleton controller condition. Increasing the accuracy of step frequency and energetic predictions was best achieved by increasing the number of virtual participants (varying whole-body anthropometrics), rather than the number of muscle parameter sets (varying muscle anthropometrics). In future, our approach can be used to design controllers in advance of human testing, to help identify reasonable solution spaces or tailor design to individual users.

Cooperativity Model for Improving the Walking-Assistance Efficiency of the Exoskeleton

(1) Background: To enhance the walking-assistance efficiencies of exoskeletons, this paper proposed the biomechanical-based cooperativity model based on a passive exoskeleton prototype to fill the technical gap in exoskeleton design regarding the torque transmission law between humans and exoskeletons. (2) Methods: The cooperativity model was used to solve the key system parameters based on the minimum average dispersion degree, in which the average dispersion degree algorithm based on the joint angle was designed and applied. (3) Results: The influence of the cooperativity model on the exoskeleton was indicated by comparing the walking-assistance efficiencies of the exoskeletons with the same structure but with different elastic parameters of the energy storage components, in which the exoskeleton based on the cooperativity design exhibited the highest walking-assistance performance. The walking-assistance efficiency of the exoskeleton with the optimal parameter combinations was also tested by comparing the respiratory metabolisms with and without the exoskeleton, in which the exoskeleton provided the average walking-assistance efficiency of 14.45% for more than 80% of the subjects. (4) Conclusions: The effects of the cooperativity model on exoskeletons were proven, but the accuracy and efficiency of the model still have room for improvement, especially the accuracy of the offset principle.

Passive Knee Exoskeleton Increases Vertical Jump Height

Most exoskeletons are designed to reduce the metabolic costs of performing aerobic tasks such as walking, running, and hopping. This study presents an exoskeleton that boosts vertical jumping-a fast, short movement during which the muscles are exerted at peak capacity. It was hypothesized that a passive exoskeleton would increase vertical jump height without requiring external energy input. The device comprises springs that work in parallel with the muscles of the quadriceps femoris. The springs store mechanical energy during knee flexion (the negative work phase) and release that energy during the subsequent knee extension (the positive work phase), augmenting the muscles. Ten healthy participants were evaluated in two experimental sessions. In the first session, the participants jumped without receiving instructions on how to use the exoskeleton, and the results showed no difference in jump height when jumping with the exoskeleton or jumping without it. In the second session, the participants were instructed to achieve deeper initial squat heights at the start of the jump. This resulted in a 6.4% increase in average jump height compared to jumping without the exoskeleton (each participant performed five jumps for each the two conditions). This is the first time that a passive exoskeleton has been shown to improve the height of a vertical jump from a dead stop.

Muscle coordination retraining inspired by musculoskeletal simulations reduces knee contact force

Humans typically coordinate their muscles to meet movement objectives like minimizing energy expenditure. In the presence of pathology, new objectives gain importance, like reducing loading in an osteoarthritic joint, but people often do not change their muscle coordination patterns to meet these new objectives. Here we use musculoskeletal simulations to identify simple changes in coordination that can be taught using electromyographic biofeedback, achieving the therapeutic goal of reducing joint loading. Our simulations predicted that changing the relative activation of two redundant ankle plantarflexor muscles—the gastrocnemius and soleus—could reduce knee contact force during walking, but it was unclear whether humans could re-coordinate redundant muscles during a complex task like walking. Our experiments showed that after a single session of walking with biofeedback of summary measures of plantarflexor muscle activation, healthy individuals reduced the ratio of gastrocnemius-to-soleus muscle activation by 25 ± 15% (p = 0.004, paired t test, n = 10). Participants who walked with this “gastrocnemius avoidance” gait pattern reduced late-stance knee contact force by 12 ± 12% (p = 0.029, paired t test, n = 8). Simulation-informed coordination retraining could be a promising treatment for knee osteoarthritis and a powerful tool for optimizing coordination for a variety of rehabilitation and performance applications.

A simple method reveals minimum time required to quantify steady-rate metabolism and net cost of transport for human walking

The U-shaped net cost of transport (COT) curve of walking has helped scientists understand the biomechanical basis that underlies energy minimization during walking. However, to produce an individual's net COT curve, data must be analyzed during periods of steady-rate metabolism. Traditionally, studies analyze the last few minutes of a 6-10 min trial, assuming that steady-rate metabolism has been achieved. Yet, it is possible that an individual achieves steady rates of metabolism much earlier. However, there is no consensus on how to objectively quantify steady-rate metabolism across a range of walking speeds. Therefore, we developed a simple slope method to determine the minimum time needed for humans to achieve steady rates of metabolism across slow to fast walking speeds. We hypothesized that a shorter time window could be used to produce a net COT curve that is comparable to the net COT curve created using traditional methods. We analyzed metabolic data from twenty-one subjects who completed several 7-min walking trials ranging from 0.50-2.00 m/s. We partitioned the metabolic data for each trial into moving 1-min, 2-min, and 3 min intervals and calculated their slopes. We statistically compared these slope values to values derived from the last 3-min of the 7-min trial, our 'gold' standard comparison. We found that a minimum of 2 min is required to achieve steady-rate metabolism and that data from 2-4 min yields a net COT curve that is not statistically different from the one derived from experimental protocols that are generally accepted in the field.

Relating Underlying Performance Objectives of Overground Walking to Observable Walking Mechanics using Predictive Musculoskeletal Simulations

There exists motor redundancy during human gait that allows individuals to perform the same task in different observable ways (i.e., with varied styles). However, how differences in observable walking mechanics depend on unique and underlying biomechanical objectives is unclear. As an example, these objectives could include metabolic energy consumption, sum of muscle activations, limb mechanical loading, balance and combinations thereof. In this study, we develop predictive neuromuscular simulations to investigate the relationships between these biomechanical objectives and observable mechanics during level walking. We simulated 3D normal walking of five healthy subjects, while optimizing each of the aforementioned objectives-resulting in 25 forward dynamics simulations for analysis. We compared the resulting joint kinematics and moments of different simulations. One of main findings suggests that decreased hip abduction angle is tightly related to when the regulation of dynamic balance (computed as whole-body angular momentum) is included in a movement cost function. We also find that increased joint moments are related to including metabolic cost (i.e., objectives associated with improving the energy economy of movement). Further, the timing of joint kinematics is adjusted for different performance objectives. These findings could guide the development of rehabilitation training and assistive devices that target specific individuals, tasks, and specific styles of movement.

Varying Joint Patterns and Compensatory Strategies Can Lead to the Same Functional Gait Outcomes: A Case Study

This paper analyses joint-space walking mechanisms and redundancies in delivering functional gait outcomes. Multiple biomechanical measures are analysed for two healthy male adults who participated in a multi-factorial study and walked during three sessions. Both participants employed varying intra- and inter-personal compensatory strategies (e.g., vaulting, hip hiking) across walking conditions and exhibited notable gait pattern alterations while keeping task-space (functional) gait parameters invariant. They also preferred various levels of asymmetric step length but kept their symmetric step time consistent and cadence-invariant during free walking. The results demonstrate the importance of an individualised approach and the need for a paradigm shift from functional (task-space) to joint-space gait analysis in attending to (a)typical gaits and delivering human-centred human-robot interaction.

Foot contact forces can be used to personalize a wearable robot during human walking

Individuals with below-knee amputation (BKA) experience increased physical effort when walking, and the use of a robotic ankle-foot prosthesis (AFP) can reduce such effort. The walking effort could be further reduced if the robot is personalized to the wearer using human-in-the-loop (HIL) optimization of wearable robot parameters. The conventional physiological measurement, however, requires a long estimation time, hampering real-time optimization due to the limited experimental time budget. This study hypothesized that a function of foot contact force, the symmetric foot force-time integral (FFTI), could be used as a cost function for HIL optimization to rapidly estimate the physical effort of walking. We found that the new cost function presents a reasonable correlation with measured metabolic cost. When we employed the new cost function in HIL ankle-foot prosthesis stiffness parameter optimization, 8 individuals with simulated amputation reduced their metabolic cost of walking, greater than 15% (p < 0.02), compared to the weight-based and control-off conditions. The symmetry cost using the FFTI percentage was lower for the optimal condition, compared to all other conditions (p < 0.05). This study suggests that foot force-time integral symmetry using foot pressure sensors can be used as a cost function when optimizing a wearable robot parameter.

Everything Comes at a Price: Considerations in Modeling Effort-Based Choice

When observing human behavior, one of the key factors determining choice is effort. It is often assumed that people prefer an easier course of action when the alternative yields the same benefits. However, recent research demonstrates that this is not always the case: effort is not always costly and can also add value. A promising avenue to study effort-based choice is to utilize formal decision models that enable quantitative modeling. In this paper, we aim to present an overview of the current approaches to modeling effort-based choice and discuss some considerations that stem from theoretical and practical issues (present and previous) in studies on the role of effort, focusing on the connections and discrepancies between formal models and the findings from the body of empirical research. Considering that effort can, in some circumstances, act as a cost and as a benefit, reconciling these discrepancies is a practical and theoretical challenge that can ultimately lead to better predictions and increased model validity. Our review identifies and discusses these discrepancies providing direction for future empirical research.