A comparison of variability and gait dynamics in spatiotemporal variables between different self-paced treadmill control modes

Gait variability of outdoor vs treadmill walking with bilateral robotic ankle exoskeletons under proportional myoelectric control

Lower limb robotic exoskeletons are often studied in the context of steady-state treadmill walking in laboratory environments. However, the end goal of these devices is often adoption into our everyday lives. To move outside of the laboratory, there is a need to study exoskeletons in real world, complex environments. One way to study the human-machine interaction is to look at how the exoskeleton affects the user's gait. In this study we assessed changes in gait spatiotemporal variability when using a robotic ankle exoskeleton under proportional myoelectric control both inside on a treadmill and outside overground. We hypothesized that walking with the exoskeletons would not lead to significant changes in variability inside on a treadmill or outside compared to not using the exoskeletons. In addition, we hypothesized that walking outside would lead to higher variability both with and without the exoskeletons compared to treadmill walking. In support of our hypothesis, we found significantly higher coefficients of variation of stride length, stance time, and swing time when walking outside both with and without the exoskeleton. We found a significantly higher variability when using the exoskeletons inside on the treadmill, but we did not see significantly higher variability when walking outside overground. The value of this study to the literature is that it emphasizes the importance of studying exoskeletons in the environment in which they are meant to be used. By looking at only indoor gait spatiotemporal measures, we may have assumed that the exoskeletons led to higher variability which may be unsafe for certain target populations. In the context of the literature, we show that variability due to robotic ankle exoskeletons under proportional myoelectric control does not elicit different changes in stride time variability than previously found in other daily living tasks (uneven terrain, load carriage, or cognitive tasks).

Adaptive treadmill walking encourages persistent propulsion

BACKGROUND

Adaptive treadmills allow real-time changes in walking speed by responding to changes in step length, propulsion, or position on the treadmill. The stride-to-stride variability, or persistence, of stride time during overground, fixed-speed, and adaptive treadmill walking has been studied, but persistence of propulsion during adaptive treadmill walking remains unknown. Because increased propulsion is often a goal of post-stroke rehabilitation, knowledge of the stride-to-stride variability may aid rehabilitation protocol design.

RESEARCH QUESTION

How do spatiotemporal and propulsive gait variables vary from stride to stride during adaptive treadmill walking, and how do they compare to fixed-speed treadmill walking?

METHODS

Eighteen young healthy subjects walked on an instrumented split-belt treadmill in the adaptive and fixed-speed modes for 10 minutes at their comfortable speed. Kinetic data was collected from the treadmill. Detrended fluctuation analysis was applied to the time series data. Shapiro-Wilk tests assessed normality and one-way repeated measures ANOVAs compared between adaptive, fixed-speed, and randomly shuffled conditions at a Bonferroni-corrected significance level of 0.0055.

RESULTS

Stride time, stride length, step length, and braking impulse were persistent (α > 0.5) in the adaptive and fixed-speed conditions. Adaptive and fixed-speed were different from each other. Stride speed was persistent in the adaptive condition and anti-persistent (α < 0.5) in the fixed-speed condition. Peak propulsive force, peak braking force, and propulsive impulse were persistent in the adaptive condition but not the fixed-speed condition (α ≈ 0.5). Net impulse was non-persistent in the adaptive and fixed-speed conditions. All variables were non-persistent in the shuffled condition.

SIGNIFICANCE

During adaptive treadmill walking, increases in propulsive force and impulse persist for multiple strides. Persistence was stronger on the adaptive treadmill, where increased propulsion translates into increased walking speed. For post-stroke gait rehabilitation where increasing propulsion and speed are goals, the stronger persistence of adaptive treadmill walking may be beneficial.

Self-paced and fixed speed treadmill walking yield similar energetics and biomechanics across different speeds

BACKGROUND

Treadmill assessments are often performed at a fixed speed. Feedback-controlled algorithms allow users to adjust the treadmill speed, hereby potentially better resembling natural self-paced locomotion. However, it is currently unknown whether the energetics and biomechanics of self-paced differ from fixed-paced treadmill walking. Such information is important for clinicians and researchers using self-paced locomotion for assessing gait.

RESEARCH QUESTION

To investigate whether energy cost and biomechanics are different between self-paced and matched-speed fixed-paced locomotion.

METHODS

18 healthy participants (9 males/9 females, mean ± standard deviation age 24.8 ± 3.3 years, height 1.71 ± 0.81 m, weight 65.9 ± 8.1 kg) walked at four different self-paced speeds (comfortable, slow, very slow, fast) in randomized order on an instrumented treadmill while three-dimensional motion capture and gas exchange were measured continuously. The average walking speed during the last 2 min of the self-paced trials was used to match the speed in fixed-paced conditions. Linear mixed models were used to assess differences in mean values and within-subject variations between conditions (self-paced and fixed-paced) and speeds. Statistical Parametric Mapping was used to assess differences in kinematics of the lower limb between conditions.

RESULTS

Although self-paced walking consistently resulted in a 4-6% higher net cost of walking, there were no significant differences in the net cost of walking between conditions. Further, there were also no differences of clinical relevance in spatiotemporal outcomes and sagittal-plane lower-limb kinematics between the self-paced and fixed-paced conditions. Within-trial variability was also not significantly different between conditions.

SIGNIFICANCE

Self-paced and fixed-paced treadmill walking yield similar energetics and kinematics in healthy young individuals when mean values or linear measures of variation are of interest.

Optimal Frequency and Amplitude of Vertical Viewpoint Oscillation for Improving Vection Strength and Reducing Neural Constrains on Gait

Inducing self-motion illusions referred as vection are critical for improving the sensation of walking in virtual environments (VE). Adding viewpoint oscillations to a constant forward velocity in VE is effective for improving vection strength under static conditions. However, the effects of oscillation frequency and amplitude on vection strength under treadmill walking conditions are still unclear. Besides, due to the visuomotor entrainment mechanism, these visual oscillations would affect gait patterns and be detrimental for achieving natural walking if not properly designed. This study was aimed at determining the optimal frequency and amplitude of vertical viewpoint oscillations for improving vection strength and reducing gait constraints. Seven subjects walked on a treadmill while watching a visual scene. The visual scene presented a constant forward velocity equal to the treadmill velocity with different vertical viewpoint oscillations added. Five oscillation patterns with different combinations of frequency and amplitude were tested. Subjects gave verbal ratings of vection strength. The mediolateral (M-L) center of pressure (CoP) complexity was calculated to indicate gait constraints. After the experiment, subjects were asked to give the best and the worst oscillation pattern based on their walking experience. The oscillation frequency and amplitude had strong positive correlations with vection strength. The M-L CoP complexity was reduced under oscillations with low frequency. The medium oscillation amplitude had greater M-L CoP complexity than the small and large amplitude. Besides, subjects preferred those oscillation patterns with large gait complexity. We suggested that the oscillation amplitude with largest M-L CoP complexity should first be chosen to reduce gait constraints. Then, increasing the oscillation frequency to improve vection strength until individual preference or the boundary of motion sickness. These findings provide important guidelines to promote the sensation of natural walking in VE.

Improved cortical activity and reduced gait asymmetry during poststroke self-paced walking rehabilitation

Background

For patients with gait impairment due to neurological disorders, body weight-supported treadmill training (BWSTT) has been widely used for gait rehabilitation. On a conventional (passive) treadmill that runs at a constant speed, however, the level of patient engagement and cortical activity decreased compared with gait training on the ground. To increase the level of cognitive engagement and brain activity during gait rehabilitation, a self-paced (active) treadmill is introduced to allow patients to actively control walking speed, as with overground walking.

Methods

To validate the effects of self-paced treadmill walking on cortical activities, this paper presents a clinical test with stroke survivors. We hypothesized that cortical activities on the affected side of the brain would also increase during active walking because patients have to match the target walking speed with the affected lower limbs. Thus, asymmetric gait patterns such as limping or hobbling might also decrease during active walking.

Results

Although the clinical test was conducted in a short period, the patients showed higher cognitive engagement, improved brain activities assessed by electroencephalography (EEG), and decreased gait asymmetry with the self-paced treadmill. As expected, increases in the spectral power of the low γ and β bands in the prefrontal cortex (PFC), premotor cortex (PMC), and supramarginal gyrus (SG) were found, which are possibly related to processing sensory data and planning voluntary movements. In addition, these changes in cortical activities were also found with the affected lower limbs during the swing phase. Since our treadmill controller tracked the swing speed of the leg to control walking speed, such results imply that subjects made substantial effort to control their affected legs in the swing phase to match the target walking speed.

Conclusions

The patients also showed reduced gait asymmetry patterns. Based on the results, the self-paced gait training system has the potential to train the symmetric gait and to promote the related cortical activities after stroke.

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