Modeling and simulation of paraplegic ambulation in a reciprocating gait orthosis

Effect of Reciprocating Gait Orthosis with Hip Actuation on Upper Extremity Loading during Ambulation in Patient with Spinal Cord Injury: A Single Case Study

Reciprocating gait orthosis (RGO) is a traditional passive orthosis that provides postural stability and allows for independent upright ambulation with the assistance of walking aids, such as crutches, canes, and walkers. Previous follow-up studies of patients with RGOs have indicated a high frequency of nonusage. One of the main reasons for avoiding the use of RGOs is the excessive upper extremity loading induced by walking aids. The purpose of this study was to investigate the effect of hip actuation on the upper extremity loading induced by crutches when ambulating with an RGO. One female individual with a chronic complete spinal cord injury classified as ASIA A participated in this study. We compared the upper extremity loading during ambulation when individualized hip assistive forces were applied on the RGO (POWERED condition) and when wearing the RGO without actuation (RGO condition). Upper extremity loading was assessed by measuring the forces acting on the crutches. Compared with the RGO condition, the average upper extremity loading per unit distance and per unit time were lower for the POWERED condition by 15.21% (RGO: 0.307 ± 0.056 and POWERED: 0.260 ± 0.034 %bw·m−1) and by 21.19% (RGO: 0.120 ± 0.020 and POWERED: 0.094 ± 0.011 %bw·s−1), respectively. We believe that a substantial reduction in upper extremity loading during ambulation provided by hip actuation holds promise to promote long-term RGO use and enable patients with paraplegia to perform frequent and intensive rehabilitation training. As this is a single case study, subsequent studies should aim to verify this effect through a higher number of patients and to different injury levels.

A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia

BACKGROUND

Functional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord injury (SCI). However, a self-contained muscle-driven controllable exoskeleton approach based on an implanted neural stimulator to restore walking has not been previously demonstrated, which could potentially result in system use outside the laboratory and viable for long term use or clinical testing. In this work, we designed and evaluated an untethered muscle-driven controllable exoskeleton to restore stepping in three individuals with paralysis from SCI.

METHODS

The self-contained HNP combined neural stimulation to activate the paralyzed muscles and generate joint torques for limb movements with a controllable lower limb exoskeleton to stabilize and support the user. An onboard controller processed exoskeleton sensor signals, determined appropriate exoskeletal constraints and stimulation commands for a finite state machine (FSM), and transmitted data over Bluetooth to an off-board computer for real-time monitoring and data recording. The FSM coordinated stimulation and exoskeletal constraints to enable functions, selected with a wireless finger switch user interface, for standing up, standing, stepping, or sitting down. In the stepping function, the FSM used a sensor-based gait event detector to determine transitions between gait phases of double stance, early swing, late swing, and weight acceptance.

RESULTS

The HNP restored stepping in three individuals with motor complete paralysis due to SCI. The controller appropriately coordinated stimulation and exoskeletal constraints using the sensor-based FSM for subjects with different stimulation systems. The average range of motion at hip and knee joints during walking were 8.5°-20.8° and 14.0°-43.6°, respectively. Walking speeds varied from 0.03 to 0.06 m/s, and cadences from 10 to 20 steps/min.

CONCLUSIONS

A self-contained muscle-driven exoskeleton was a feasible intervention to restore stepping in individuals with paraplegia due to SCI. The untethered hybrid system was capable of adjusting to different individuals' needs to appropriately coordinate exoskeletal constraints with muscle activation using a sensor-driven FSM for stepping. Further improvements for out-of-the-laboratory use should include implantation of plantar flexor muscles to improve walking speed and power assist as needed at the hips and knees to maintain walking as muscles fatigue.

The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: A pilot study

BACKGROUND

Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users.

OBJECTIVES

To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension.

STUDY DESIGN

Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses.

METHODS

Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed.

RESULTS

Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation.

CONCLUSION

Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk.

CLINICAL RELEVANCE

Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.

Design and analysis of a new medial reciprocal linkage using a lower limb paralysis simulator

STUDY DESIGN

A feasibility study on the effect of a new reciprocating orthosis on specific gait parameters for use by people with spinal cord injury.

OBJECTIVES

The aim of this study was to design and develop a new medial linkage orthosis (MLO) mechanism incorporating a reciprocating motion and to determine its efficacy in improving specific spatiotemporal, kinematic and kinetic parameters while ambulating when worn by healthy subjects. This was achieved via the use of a lower limb paralysis simulator (LLPS).

METHODS

A reciprocating joint with a remote center of motion was designed for use as an MLO. A prototype was fabricated and incorporated into an orthosis and equipped with a saddle to make the reciprocating motion possible. The efficacy of the orthosis was evaluated on four able-bodied healthy subjects who were trained to walk with the MLO attached to the LLPS.

RESULTS

Mean walking speed, stride length, stride time and cadence was 0.09±0.007 m s(-1), 0.42±0.01 m, 4.89±0.45 s and 29.54±4.32 steps min(-1), respectively, when healthy subjects walked with the new orthosis. The mean hip joint torque produced was 0.36±0.13 Nm.

CONCLUSION

In this study a new MLO was designed and fabricated that provided a reciprocating mechanism using a four-bar mechanism to set the virtual axis of the mechanism in a more proximal position than hinge-type joints. Further investigation is currently underway to assess its effect on gait parameters and energy expenditure in paraplegic patients.

Effect of powered gait orthosis on walking in individuals with paraplegia

BACKGROUND

The important purpose of a powered gait orthosis is to provide active joint movement for patients with spinal cord injury.

OBJECTIVES

The aim of this study was to clarify the effect of a powered gait orthosis on the kinematics and temporal-spatial parameters in paraplegics with spinal cord injury.

STUDY DESIGN

Quasi-experimental.

METHODS

Four spinal cord injury individuals experienced gait training with a powered gait orthosis for a minimum of 6 weeks prior to participating in the following walking trials: walking with an isocentric reciprocating gait orthosis and walking with both separate and synchronized movements with actuated orthotic hip and knee joints in a powered gait orthosis. Specific parameters were calculated and compared for each of the test conditions.

RESULTS

Using separate and synchronized actuated movement of the hip and knee joints in the powered gait orthosis increased gait speed and step length and reduced lateral and vertical compensatory motions when compared to the isocentric reciprocating gait orthosis, but there were no significant differences in these parameters. Using the new powered gait orthosis improved knee and hip joint kinematics.

CONCLUSIONS

The powered gait orthosis increased speed and step length as well as hip and knee joint kinematics and reduced the vertical and lateral compensatory motions compared to an isocentric reciprocating gait orthosis in spinal cord injury patients.

CLINICAL RELEVANCE

This new powered gait orthosis has the potential to improve hip and knee joint kinematics, the temporal-spatial parameters of gait in spinal cord injury patients walking.

Studying the effect of kinematical pattern on the mechanical performance of paraplegic gait with reciprocating orthosis

Paraplegic users of mechanical walking orthoses, e.g. advanced reciprocating gait orthosis (ARGO), often face high energy expenditure and extreme upper body loading during locomotion. We studied the effect of kinematical pattern on the mechanical performance of paraplegic locomotion, in search for an improved gait pattern that leads to lower muscular efforts. A three-dimensional, four segment, six-degrees-of-freedom skeletal model of the advanced reciprocating gait orthosis-assisted paraplegic locomotion was developed based on the data acquired from an experimental study on a single subject. The effect of muscles was represented by ideal joint torque generators. A response surface analysis was performed on the model to determine the impact of the kinematical parameters on the resulting muscular efforts, characterized by net joint torques. Results indicated that a lateral bending manoeuvre at the trunk would facilitate the foot clearance by reducing the torque requirement of the whole body lateral tilting. For swing leg advancement, the trunk posterior bending manoeuvre was found to be more effective and efficient than the whole body axial rotation, owing to the coupled reciprocal action of the advanced reciprocating gait orthosis. It was hypothesized that a modified gait pattern, with larger trunk movements and no axial rotation, could improve the energy expenditure and upper body loading during advanced reciprocating gait orthosis-assisted locomotion. More detailed modelling and experimental studies are needed to verify this hypothesis and evaluate its potential effects on the soft tissue strains.

Control and implementation of a powered lower limb orthosis to aid walking in paraplegic individuals

This paper describes a powered lower-limb orthosis that is intended to provide gait assistance to spinal cord injured (SCI) individuals by providing assistive torques at both hip and knee joints, along with a user interface and control structure that enables control of the powered orthosis via upper-body influence. The orthosis and control structure was experimentally implemented on a paraplegic subject (T10 complete) in order to provide a preliminary characterization of its capability to provide basic walking. Data and video is presented from these initial trials, which indicates that the orthosis and controller are able to effectively provide walking within parallel bars at an average speed of 0.8 km/hr.

Design and simulation of a new powered gait orthosis for paraplegic patients

BACKGROUND AND AIM

This article describes the development and testing of a new powered gait orthosis to potentially assist spinal cord injury patients to walk by producing synchronized hip and knee joint movements.

TECHNIQUE

The first evaluation of the orthosis was performed without users, and was followed by evaluation of the orthosis performance using three healthy subjects to test the structure under weight-bearing conditions. The orthosis was primarily evaluated to ascertain its ability to generate appropriate hip and knee motion during walking. The walking experiments replicated the flexion and extension of both the hip and knee produced by the actuators which had previously been demonstrated during the initial computer simulations.

DISCUSSION

The results suggest that this new orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to ambulate, and may also be suitable for other subjects with impaired lower limb function (e.g. stroke, poliomyelitis, myelomeningocele and traumatic brain injury provided they do not have increased tone or movement disorders.

Modeling the walking patterns of Reciprocating Gait Orthosis users with a novel Lower Limb Paralysis Simulator

A mechanical Lower Limb Paralysis Simulator (LLPS) was developed for able-bodied persons to model the gait of Reciprocating Gait Orthosis (RGO) users. The purpose of this study was to determine if able-bodied subjects ambulating with the LLPS exhibited gait characteristics typical of RGO users. Five able-bodied persons were trained to ambulate with the LLPS and underwent a motion gait analysis. LLPS users were found to exhibit gait patterns that were characteristic of RGO-assisted gait.

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

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

Determination of the Loads Applied on the Anatomy and Orthosis During Ambulation With a New Reciprocal Gait Orthosis

Various types of orthoses have been designed to enable individuals with Spinal Cord Injury (SCI) to stand and walk; however, all of these orthoses have certain problems. A new type of lower limb orthosis was designed and evaluated while five normal subjects walked. Appropriate types of strain gauges were attached on the lateral bar of the orthosis, near the hip joint, in order to measure the loads transmitted through the orthosis. The force applied on the foot, orthosis, and crutch, and the moment applied on the hip joint complex and orthosis were measured during walking with the orthosis. This study showed that the loads applied on the orthosis differed from that reported in the literature and the pattern of the moment and force transmitted through the orthosis was different from those applied on the anatomical structures. The results of this research can be used to enhance lower limb orthotic design for individuals with SCI.

A Powered Lower Limb Orthosis for Providing Legged Mobility in Paraplegic Individuals

This paper presents preliminary results on the development of a powered lower limb orthosis intended to provide legged mobility (with the use of a stability aid, such as forearm crutches) to paraplegic individuals. The orthosis contains electric motors at both hip and both knee joints, which in conjunction with ankle-foot orthoses, provides appropriate joint kinematics for legged locomotion. The paper describes the orthosis and the nature of the controller that enables the SCI patient to command the device, and presents data from preliminary trials that indicate the efficacy of the orthosis and controller in providing legged mobility.

The impact of a systematic reduction in shoe-floor friction on heel contact walking kinematics-- A gait simulation approach

Falls initiated by slips and trips are a serious health hazard to older adults. Experimental studies have provided important descriptions of postural responses to slipping, but it is difficult to determine why some slips result in falls from experiments alone. Computational modeling and simulation techniques can complement experimental approaches by identifying causes of failed recovery attempts. The purpose of this study was to develop a method to determine the impact of a systematic reduction in the foot-floor friction coefficient (mu) on the kinematics of walking shortly after heel contact (approximately 200 s). A walking model that included foot-floor interactions was utilized to find the set of moments that best tracked the joint angles and measured ground reaction forces obtained from a non-slipping (dry) trial. A "passive" slip was simulated by driving the model with the joint-moments from the dry simulation and by reducing mu. Slip simulations with values of mu greater than the subject-specific peak required coefficient of friction (RCOF), an experimental measure of slip-resistant gait, resulted in only minor deviations in gait kinematics from the dry condition. In contrast, slip simulations run in environments characterized by mu<peak RCOF resulted in body kinematics that were substantially different from normal/dry gait patterns, more specifically greater knee extension and hip flexion angles were observed in the slip simulations. These findings imply the need for early and appropriate active corrective responses to prevent a fall in environments with mu values less than the peak RCOF.

Limitations of parallel global optimization for large-scale human movement problems

Global optimization algorithms (e.g., simulated annealing, genetic, and particle swarm) have been gaining popularity in biomechanics research, in part due to advances in parallel computing. To date, such algorithms have only been applied to small- or medium-scale optimization problems (<100 design variables). This study evaluates the applicability of a parallel particle swarm global optimization algorithm to large-scale human movement problems. The evaluation was performed using two large-scale (660 design variables) optimization problems that utilized a dynamic, 27 degree-of-freedom, full-body gait model to predict new gait motions from a nominal gait motion. Both cost functions minimized a quantity that reduced the external knee adduction torque. The first one minimized footpath errors corresponding to an increased toe out angle of 15 degrees, while the second one minimized the knee adduction torque directly without changing the footpath. Constraints on allowable changes in trunk orientation, joint angles, joint torques, centers of pressure, and ground reactions were handled using a penalty method. For both problems, a single run with a gradient-based nonlinear least squares algorithm found a significantly better solution than did 10 runs with the global particle swarm algorithm. Due to the penalty terms, the physically realistic gradient-based solutions were located within a narrow "channel" in design space that was difficult to enter without gradient information. Researchers should exercise caution when extrapolating the performance of parallel global optimizers to human movement problems with hundreds of design variables, especially when penalty terms are included in the cost function.

Knee mechanics: a review of past and present techniques to determine in vivo loads

This review article evaluates various techniques that have been used to determine in vivo loads in the human knee. Two main techniques that have been used are telemetry, which is an experimental approach, and mathematical modeling, which is a theoretical approach. Telemetric analyses have previously been used to determine the in vivo loading of the human hip and more recently evaluated in the determination of in vivo knee loads. Mathematical modeling approaches can be categorized two ways; those that use optimization techniques to solve an indeterminate system and those that utilize a reduction method that minimizes the number of unknowns, keeping the system solvable as the number of equations of motion are equal to the number of unknown quantities. More recently, we have developed an approach that relies fully on the use of in vivo data from fluoroscopy, CT scanning, magnetic resonant imaging and a revised motion analysis technique that involves only two markers on each rigid body. A review of all techniques revealed a wide range of forces at the human knee, ranging from 1.9 to 7.2 times body weight during level walking.

Experimental/analytical analysis of human locomotion using bondgraphs

A new vectorial bondgraph approach for modeling and simulation of human locomotion is introduced. The vectorial bondgraph is applied to an eight-segment gait model to derive the equations of motion for studying ground reaction forces (GRFs) and centers of pressure (COPs) in single and double support phases of ground and treadmill walking. A phase detection technique and accompanying transition equation is proposed with which the GRFs and COPs may be calculated for the transitions from double-to-single and single-to-double support phases. Good agreement is found between model predictions and experimental data obtained from force plate measurements. The bondgraph modeling approach is shown to be both informative and adaptable, in the sense that the model resembles the human body structure, and that modeled body segments can be easily added or removed.

Biomechanics and muscle coordination of human walking: part II: lessons from dynamical simulations and clinical implications

Principles of muscle coordination in gait have been based largely on analyses of body motion, ground reaction force and EMG measurements. However, data from dynamical simulations provide a cause-effect framework for analyzing these measurements; for example, Part I (Gait Posture, in press) of this two-part review described how force generation in a muscle affects the acceleration and energy flow among the segments. This Part II reviews the mechanical and coordination concepts arising from analyses of simulations of walking. Simple models have elucidated the basic multisegmented ballistic and passive mechanics of walking. Dynamical models driven by net joint moments have provided clues about coordination in healthy and pathological gait. Simulations driven by muscle excitations have highlighted the partial stability afforded by muscles with their viscoelastic-like properties and the predictability of walking performance when minimization of metabolic energy per unit distance is assumed. When combined with neural control models for exciting motoneuronal pools, simulations have shown how the integrative properties of the neuro-musculo-skeletal systems maintain a stable gait. Other analyses of walking simulations have revealed how individual muscles contribute to trunk support and progression. Finally, we discuss how biomechanical models and simulations may enhance our understanding of the mechanics and muscle function of walking in individuals with gait impairments.

A dynamic model for simulating a trip and fall during gait

The purpose of this study was to develop an analytical model to simulate a trip and fall during gait. The human body was modeled as a 12 degree-of-freedom linkage system. The kinematics of the lower extremity for one cycle of gait were obtained for a healthy subject using an optoelectronic three-dimensional data acquisition system. Inverse dynamics was used to compute the moments about the hip, knee and ankle joints of the lower extremity. These moments were then used as input actuators to the joints in to a forward dynamics model to simulate the swing phase of gait from toe-off to heel-strike. An optimization procedure to minimize errors associated with the computed experimental torque was applied to correct for mathematical instability. An experiment was performed to measure the three-dimensional foot--obstacle contact force for a healthy subject tripping on an obstacle during gait. The contact force was applied to the swing limb of the forward dynamics model for 0.09 s beginning at 0.04 s after toe-off. Tripping on an obstacle followed by a muscle-relaxed fall was simulated. The simulation results were visualized with animation software.

Modeling and inverse simulation of somersaults on the trampoline

This paper describes a biomechanical model for numerical simulation of front and back somersaults, without twist, performed on the trampoline. The developed mathematical formulation is used to solve an inverse dynamics problem, in which the moments of muscle forces at the joints that result in a given (measured) motion are determined. The nature of the stunts and the way the human body is maneuvered and controlled can be studied. The calculated torques can then be used as control signals for a dynamic simulation. This provides a way to check the inverse dynamics procedures, and influence of typical control errors on somersault performance can be studied. To achieve these goals, the nonlinear dynamical model of the trampolinist and the interacting trampoline bed has been identified, and a methodology for recording the actual somersault performances was proposed. Some results of numerical simulations are reported.

A Dynamic Optimization Solution for Vertical Jumping in Three Dimensions

A three-dimensional model of the human body is used to simulate a maximal vertical jump. The body is modeled as a 10-segment, 23 degree-of-freedom (dof), mechanical linkage, actuated by 54 muscles. Six generalized coordinates describe the position and orientation of the pelvis relative to the ground; the remaining nine segments branch in an open chain from the pelvis. The head, arms, and torso (HAT) are modeled as a single rigid body. The HAT articulates with the pelvis via a 3 dof ball-and-socket joint. Each hip is modeled as a 3 dof ball-and-socket joint, and each knee is modeled as a 1 dof hinge joint. Each foot is represented by a hindfoot and toes segment. The hindfoot articulates with the shank via a 2 dof universal joint, and the toes articulate with the hindfoot via a 1 dof hinge joint. Interaction of the feet with the ground is modeled using a series of spring-damper units placed under the sole of each foot. The path of each muscle is represented by either a series of straight lines or a combination of straight lines and space curves. Each actuator is modeled as a three-element, Hill-type muscle in series with tendon. A first-order process is assumed to model muscle excitation-contraction dynamics. Dynamic optimization theory is used to calculate the pattern of muscle excitations that produces a maximal vertical jump. Quantitative comparisons between model and experiment indicate that the model reproduces the kinematic, kinetic, and muscle-coordination patterns evident when humans jump to their maximum achievable heights.

Static and dynamic optimization solutions for gait are practically equivalent

The proposition that dynamic optimization provides better estimates of muscle forces during gait than static optimization is examined by comparing a dynamic solution with two static solutions. A 23-degree-of-freedom musculoskeletal model actuated by 54 Hill-type musculotendon units was used to simulate one cycle of normal gait. The dynamic problem was to find the muscle excitations which minimized metabolic energy per unit distance traveled, and which produced a repeatable gait cycle. In the dynamic problem, activation dynamics was described by a first-order differential equation. The joint moments predicted by the dynamic solution were used as input to the static problems. In each static problem, the problem was to find the muscle activations which minimized the sum of muscle activations squared, and which generated the joint moments input from the dynamic solution. In the first static problem, muscles were treated as ideal force generators; in the second, they were constrained by their force-length-velocity properties; and in both, activation dynamics was neglected. In terms of predicted muscle forces and joint contact forces, the dynamic and static solutions were remarkably similar. Also, activation dynamics and the force-length-velocity properties of muscle had little influence on the static solutions. Thus, for normal gait, if one can accurately solve the inverse dynamics problem and if one seeks only to estimate muscle forces, the use of dynamic optimization rather than static optimization is currently not justified. Scenarios in which the use of dynamic optimization is justified are suggested.

Dynamic simulation of human movement using large-scale models of the body

A three-dimensional model of the body was used to simulate two different motor tasks: vertical jumping and normal walking on level ground. The pattern of muscle excitations, body motions, and ground-reaction forces for each task were calculated using dynamic optimization theory. For jumping, the performance criterion was to maximize the height reached by the center of mass of the body; for walking, the measure of performance was metabolic energy consumed per meter walked. Quantitative comparisons of the simulation results with experimental data obtained from people indicate that the model reproduces the salient features of maximum-height jumping and normal walking on the level. Analyses of the model solutions will allow detailed explanations to be given about the actions of specific muscles during each of these tasks.

The use of inverse dynamics solutions in direct dynamics simulations

Previous attempts to use inverse dynamics solutions in direct dynamics simulations have failed to replicate the input data of the inverse dynamics problem. Measurement and derivative estimation error, different inverse dynamics and direct dynamics models, and numerical integration error have all been suggested as possible causes of inverse dynamics simulation failure. However, using a biomechanical model of the type typically used in gait analysis applications for inverse dynamics calculations of joint moments, we produce a direct dynamics simulation that exactly matches the measured movement pattern used as input to the inverse dynamic problem. This example of successful inverse dynamics simulation demonstrates that although different inverse dynamics and direct dynamics models may lead to inverse dynamics simulation failure, measurement and derivative estimation error do not. In addition, inverse dynamics simulation failure due to numerical integration errors can be avoided. Further, we demonstrate that insufficient control signal dimensionality (i.e., freedom of the control signals to take on different "shapes"), a previously unrecognized cause of inverse dynamics simulation failure, will cause inverse dynamics simulation failure even with a perfect model and perfect data, regardless of sampling frequency.

The influence of the reciprocal cable linkage in the advanced reciprocating gait orthosis on paraplegic gait performance

A wide variety of mechanical orthoses is available to provide ambulation to paraplegic patients. Evaluation of energy cost during walking in each of these devices has been acknowledged as an important topic in this field of research. In order to investigate the benefits of a ballistic swing on gait performance in the Advanced Reciprocating Gait Orthosis (ARGO) a study was conducted in which the ARGO was compared with an orthosis with freely swinging legs. This Non Reciprocally linked Orthosis (NRO) was obtained by removing the reciprocal linkage in the subjects' own ARGOs. Subsequently, flexion/extension limits were mounted to permit adjustment of stride length. Six male paraplegic subjects with lesions ranging from T4 to T12 were included in the study. A single case experimental design (B-A-B-A) was conducted in order to improve internal validity. Biomechanical and physiological parameters were assessed and the subjects' preference for either ARGO or NRO was determined. It was found that large inter-individual differences produced insufficient evidence in this study to draw general conclusions about difference in energy expenditure between both orthoses. However, individual analysis of the results showed a reduction of oxygen cost (range: 4%-14%) in the NRO in T9 and T12 lesions, while oxygen cost in subjects with T4 lesions increased markedly (22% and 40%). It is concluded that patients with low level lesions could benefit in terms of oxygen lost from removing the reciprocal cable linkage in the ARGO. However, only one subject preferred the NRO for walking, whereas none of the subject chose the NRO for use in daily living activities. Removal of the reciprocal cable linkage in the ARGO may not be desirable for these patients.