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Quirk DA, Chung J, Applegate M, Cherin JM, Dalton DM, Awad LN, Walsh CJ. Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion. ERGONOMICS 2024; 67:660-673. [PMID: 37482538 PMCID: PMC10803634 DOI: 10.1080/00140139.2023.2240044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.
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Affiliation(s)
- D. Adam Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Megan Applegate
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
| | - Diane M. Dalton
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Lou N. Awad
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Conor J. Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
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2
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Chen YN, Wu YN, Yang BS. The neuromuscular control for lower limb exoskeleton- a 50-year perspective. J Biomech 2023; 158:111738. [PMID: 37562276 DOI: 10.1016/j.jbiomech.2023.111738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Historically, impaired lower limb function has resulted in heavy health burden and large economic loss in society. Although experts from various fields have put large amounts of effort into overcoming this challenge, there is still not a single standard treatment that can completely restore the lost limb function. During the past half century, with the advancing understanding of human biomechanics and engineering technologies, exoskeletons have achieved certain degrees of success in assisting and rehabilitating patients with loss of limb function, and therefore has been spotlighted in both the medical and engineering fields. In this article, we review the development milestones of lower limb exoskeletons as well as the neuromuscular interactions between the device and wearer throughout the past 50 years. Fifty years ago, the lower-limb exoskeletons just started to be devised. We review several prototypes and present their designs in terms of structure, sensor and control systems. Subsequently, we introduce the development milestones of modern lower limb exoskeletons and discuss the pros and cons of these differentiated devices. In addition, we summarize current important neuromuscular control systems and sensors; and discuss current evidence demonstrating how the exoskeletons may affect neuromuscular control of wearers. In conclusion, based on our review, we point out the possible future direction of combining multiple current technologies to build lower limb exoskeletons that can serve multiple aims.
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Affiliation(s)
- Yu-Ning Chen
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, MA, USA; The New England Robotics Validation and Experimentation Center, University of Massachusetts Lowell, MA, USA
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Mechanical and Mechatronics Systems Research Laboratories, Industrial Technology Research Institute, Taiwan; Taiwanese Society of Biomechanics, Taiwan.
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3
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Ebers MR, Rosenberg MC, Kutz JN, Steele KM. A machine learning approach to quantify individual gait responses to ankle exoskeletons. J Biomech 2023; 157:111695. [PMID: 37406604 DOI: 10.1016/j.jbiomech.2023.111695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
Predicting an individual's response to an exoskeleton and understanding what data are needed to characterize responses remains challenging. Specifically, we lack a theoretical framework capable of quantifying heterogeneous responses to exoskeleton interventions. We leverage a neural network-based discrepancy modeling framework to quantify complex changes in gait in response to passive ankle exoskeletons in nondisabled adults. Discrepancy modeling aims to resolve dynamical inconsistencies between model predictions and real-world measurements. Neural networks identified models of (i) Nominal gait, (ii) Exoskeleton (Exo) gait, and (iii) the Discrepancy (i.e., response) between them. If an Augmented (Nominal+Discrepancy) model captured exoskeleton responses, its predictions should account for comparable amounts of variance in Exo gait data as the Exo model. Discrepancy modeling successfully quantified individuals' exoskeleton responses without requiring knowledge about physiological structure or motor control: a model of Nominal gait augmented with a Discrepancy model of response accounted for significantly more variance in Exo gait (median R2 for kinematics (0.928-0.963) and electromyography (0.665-0.788), (p<0.042)) than the Nominal model (median R2 for kinematics (0.863-0.939) and electromyography (0.516-0.664)). However, additional measurement modalities and/or improved resolution are needed to characterize Exo gait, as the discrepancy may not comprehensively capture response due to unexplained variance in Exo gait (median R2 for kinematics (0.954-0.977) and electromyography (0.724-0.815)). These techniques can be used to accelerate the discovery of individual-specific mechanisms driving exoskeleton responses, thus enabling personalized rehabilitation.
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Affiliation(s)
- Megan R Ebers
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA.
| | - Michael C Rosenberg
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA; Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, 98195, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
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4
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Kibushi B. Muscle coordination patterns in regulation of medial gastrocnemius activation during walking. Hum Mov Sci 2023; 90:103116. [PMID: 37327750 DOI: 10.1016/j.humov.2023.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
The ankle plantar flexion in the late stance phase is referred to as the ankle push-off. When the ankle push-off force is enhanced, compensatory adjustments occur in the adjacent phases. The muscle control that achieves these compensatory movements remains unknown, although they are expected to be coordinately regulated across multiple muscles and phases. Muscle synergy is used as a quantification technique for muscle coordination, and this analysis enables the comparison of synchronized activity between multiple muscles. Therefore, this study aimed to elucidate the tuning of muscle synergies in muscle activation adjustment of push-off. It is hypothesized that muscle activation adjustment of push-off is performed in the muscle synergy related to ankle push-off and in the muscle synergy that activates during the adjacent push-off phase. Eleven healthy men participated, and participants manipulated the activity of the medial gastrocnemius during walking through visual feedback. Two conditions were compared as experimental conditions: increasing the muscle activity to 1.6 times that during normal walking (High) and matching it with that during normal walking (Normal). Twelve muscle activities in the trunk and lower limb and kinematic data were recorded. Muscle synergies were extracted by the non-negative matrix factorization. No significant difference was observed in the number of synergies (High: 3.5 ± 0.8, Normal: 3.7 ± 0.9, p = 0.21) and muscle synergy activation timing and duration between the High and Normal conditions (p > 0.27). However, significant differences were observed in the peak muscle activity during the late stance phase of the rectus femoris (RF), biceps femoris (BF) between conditions (RF at High: 0.32 ± 0.21, RF at Normal: 0.45 ± 0.17, p = 0.02; BF at High: 0.16 ± 0.01, BF at Normal: 0.08 ± 0.06 p = 0.02). Although the quantification of force exertion has not been conducted, the modulation of RF and BF activation could have occurred due to the attempts to help knee flexion. Muscle synergies during normal walking are therefore maintained, and slight adjustments in the amplitude of muscle activity occurred for each muscle.
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Affiliation(s)
- Benio Kibushi
- Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada, Kobe, Japan.
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Park H, Kim S, Nussbaum MA, Srinivasan D. A pilot study investigating motor adaptations when learning to walk with a whole-body powered exoskeleton. J Electromyogr Kinesiol 2023; 69:102755. [PMID: 36921425 DOI: 10.1016/j.jelekin.2023.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/16/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Evidence is emerging on how whole-body powered exoskeleton (EXO) use impacts users in basic occupational work scenarios, yet our understanding of how users learn to use this complex technology is limited. We explored how novice users adapted to using an EXO during gait. Six novices and five experienced users completed the study. Novices completed an initial training/familiarization gait session, followed by three subsequent gait sessions using the EXO, while experienced users completed one gait session with the EXO. Spatiotemporal gait measures, pelvis and lower limb joint kinematics, muscle activities, EXO torques, and human-EXO interaction forces were measured. Adaptations among novices were most pronounced in spatiotemporal gait measures, followed by joint kinematics, with smaller changes evident in muscle activity and EXO joint torques. Compared to the experienced users, novices exhibited a shorter step length and walked with significantly greater anterior pelvic tilt and less hip extension. Novices also used lower joint torques from the EXO at the hip and knee, and they had greater biceps femoris activity. Overall, our results may suggest that novices exhibited clear progress in learning, but they had not yet adopted motor strategies similar to those of experienced users after the three sessions. We suggest potential future directions to enhance motor adaptations to powered EXO in terms of both training protocols and human-EXO interfaces.
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Affiliation(s)
- Hanjun Park
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Sunwook Kim
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Divya Srinivasan
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA.
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Asín-Prieto G, Oliveira Barroso F, Martínez-Expósito A, Urendes E, Gonzalez-Vargas J, Moreno JC. Mechanical disturbances applied by motorized ankle foot orthosis to adapt ankle muscles activation—A validation study. Front Bioeng Biotechnol 2023; 11:1079027. [PMID: 37008040 PMCID: PMC10060880 DOI: 10.3389/fbioe.2023.1079027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Reduced function of ankle muscles usually leads to impaired gait. Motorized ankle foot orthoses (MAFOs) have shown potential to improve neuromuscular control and increase volitional engagement of ankle muscles. In this study, we hypothesize that specific disturbances (adaptive resistance-based perturbations to the planned trajectory) applied by a MAFO can be used to adapt the activity of ankle muscles. The first goal of this exploratory study was to test and validate two different ankle disturbances based on plantarflexion and dorsiflexion resistance while training in standing still position. The second goal was to assess neuromuscular adaptation to these approaches, namely, in terms of individual muscle activation and co-activation of antagonists.Methods: Two ankle disturbances were tested in ten healthy subjects. For each subject, the dominant ankle followed a target trajectory while the contralateral leg was standing still: a) dorsiflexion torque during the first part of the trajectory (Stance Correlate disturbance—StC), and b) plantarflexion torque during the second part of the trajectory (Swing Correlate disturbance—SwC). Electromyography was recorded from the tibialis anterior (TAnt) and gastrocnemius medialis (GMed) during MAFO and treadmill (baseline) trials.Results: GMed (plantarflexor muscle) activation decreased in all subjects during the application of StC, indicating that dorsiflexion torque did not enhance GMed activity. On the other hand, TAnt (dorsiflexor muscle) activation increased when SwC was applied, indicating that plantarflexion torque succeeded in enhancing TAnt activation. For each disturbance paradigm, there was no antagonist muscle co-activation accompanying agonist muscle activity changes.Conclusion: We successfully tested novel ankle disturbance approaches that can be explored as potential resistance strategies in MAFO training. Results from SwC training warrant further investigation to promote specific motor recovery and learning of dorsiflexion in neural-impaired patients. This training can potentially be beneficial during intermediate phases of rehabilitation prior to overground exoskeleton-assisted walking. Decreased activation of GMed during StC might be attributed to the unloaded body weight in the ipsilateral side, which typically decreases activation of anti-gravity muscles. Neural adaptation to StC needs to be studied thoroughly in different postures in futures studies.
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Affiliation(s)
- Guillermo Asín-Prieto
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- Gogoa Mobility Robots, Abadiño, Spain
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Filipe Oliveira Barroso,
| | - Aitor Martínez-Expósito
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Eloy Urendes
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
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Hashiguchi Y, Goto R, Naka T. Effects of orthoses on muscle activity and synergy during gait. PLoS One 2023; 18:e0281541. [PMID: 36757940 PMCID: PMC9910715 DOI: 10.1371/journal.pone.0281541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
An orthosis is often used in rehabilitation to improve kinetic and kinematic parameters during gait. However, whether changes in neural control depend on wearing an orthosis during gait is unclear. We measured the muscle activity and synergy of the lower limb muscles without orthosis and with two types of orthoses: ankle-foot orthosis (AFO) and knee-ankle-foot orthosis (KAFO). Muscle activity during gait was measured in 15 healthy adults, and muscle synergies were extracted using non-negative matrix factorization. The results revealed that some muscle activities were significantly different among the three conditions. Post-hoc analysis indicated differences between each condition. Knee extensor muscle activity related to the loading response was significantly increased by wearing the AFO. In the KAFO condition, hip abductor muscle activity related to weight bearing was significantly decreased, and ankle dorsiflexor muscle activity was increased to secure clearance during the swing phase. However, the number of muscle synergies and complexity of muscle synergy did not significantly change among these conditions. However, along with changes in muscle activity, the activation pattern and weightings of muscle synergies tended to change with the use of orthoses. Each muscle activity was changed by wearing the orthosis; however, the immediate mechanical constraint did not change the framework of muscle synergy.
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Affiliation(s)
- Yu Hashiguchi
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma PAZ University, Takasaki-shi, Gunma, Japan
- * E-mail:
| | - Ryosuke Goto
- Department of Speech-Language-Hearing Therapy, Faculty of Rehabilitation, Gunma PAZ University, Takasaki-shi, Gunma, Japan
| | - Toru Naka
- Department of Physical Therapy, Faculty of Rehabilitation, R Professional University of Rehabilitation, Tsuchiura-shi, Ibaraki, Japan
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8
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Zhou Y. Recent advances in wearable actuated ankle-foot orthoses: Medical effects, design, and control. Proc Inst Mech Eng H 2023; 237:163-178. [PMID: 36515408 DOI: 10.1177/09544119221142335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper presents a survey on recent advances of wearable actuated ankle-foot orthoses (AAFOs). First of all, their medical functions are investigated. From the short-term aspect, they lead to rectification of pathological gaits, reduction of metabolic cost, and improvement of gait performance. After AAFO-based walking training with sufficient time, free walking performance can be enhanced. Then, key design factors are studied. First, primary design parameters are investigated. Second, common actuators are analysed. Third, human-robot interaction (HRI), ergonomics, safety, and application places, are considered. In the following section, control technologies are reviewed from the aspects of rehabilitation stages, gait feature quantities, and controller characteristics. Finally, existing problems are discussed; development trends are prospected.
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Affiliation(s)
- Yuan Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
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Geng Y, Chen Z, Zhao Y, Cheung VCK, Li G. Applying muscle synergy analysis to forearm high-density electromyography of healthy people. Front Neurosci 2022; 16:1067925. [PMID: 36605554 PMCID: PMC9807910 DOI: 10.3389/fnins.2022.1067925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Muscle synergy is regarded as a motor control strategy deployed by the central nervous system (CNS). Clarifying the modulation of muscle synergies under different strength training modes is important for the rehabilitation of motor-impaired patients. Methods To represent the subtle variation of neuromuscular activities from the smaller forearm muscles during wrist motion, we proposed to apply muscle synergy analysis to preprocessed high-density electromyographic data (HDEMG). Here, modulation of muscle synergies within and across the isometric and isotonic training modes for strengthening muscles across the wrist were investigated. Surface HDEMGs were recorded from healthy subjects (N = 10). Three different HDEMG electrode configurations were used for comparison and validation of the extracted muscle synergies. The cosine of principal angles (CPA) and the Euclidian distance (ED) between synergy vectors were used to evaluate the intra- and inter-mode similarity of muscle synergies. Then, how the activation coefficients modulate the excitation of specific synergy under each mode was examined by pattern recognition. Next, for a closer look at the mode-specific synergies and the synergies shared by the two training modes, k-means clustering was applied. Results We observed high similarity of muscle synergies across different tasks within each training mode, but decreased similarity of muscle synergies across different training modes. Both intra- and intermode similarity of muscle synergies were consistently robust to electrode configurations regardless of the similarity metric used. Discussion Overall, our findings suggest that applying muscle synergy analysis to HDEMG is feasible, and that the traditional muscle synergies defined by whole-muscle components may be broadened to include sub-muscle components represented by the HDEMG channels. This work may lead to an appropriate neuromuscular analysis method for motor function evaluation in clinical settings and provide valuable insights for the prescription of rehabilitation training therapies.
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Affiliation(s)
- Yanjuan Geng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Yanjuan Geng,
| | - Ziyin Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yang Zhao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Vincent C. K. Cheung
- School of Biomedical Sciences, The Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Guanglin Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,Guanglin Li,
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Chen B, Zi B, Zhou B, Wang Z. Implementation of Robotic Ankle–Foot Orthosis With an Impedance-Based Assist-as-Needed Control Strategy. JOURNAL OF MECHANISMS AND ROBOTICS 2022; 14. [DOI: 10.1115/1.4053218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
In this paper, a robotic ankle–foot orthosis (AFO) is developed for individuals with a paretic ankle, and an impedance-based assist-as-needed controller is designed for the robotic AFO to provide adaptive assistance. First, a description of the robotic AFO hardware design is presented. Next, the design of the finite state machine is introduced, followed by an introduction to the modeling of the robotic AFO. Additionally, the control of the robotic AFO is presented. An impedance-based high-level controller that is composed of an ankle impedance based torque generation controller and an impedance controller is designed for the high-level control. A compensated low-level controller that is composed of a braking controller and a proportional-derivative controller with a compensation part is designed for the low-level control. Finally, a pilot study with eight healthy participants is conducted, and the experimental results demonstrate that with the proposed control algorithm, the robotic AFO has the potential for ankle rehabilitation by providing adaptive assistance. In the assisted condition with a high level of assistance, reductions of 8% and 20.1% of the root mean square of the tibialis anterior and lateral soleus activities are observed, respectively.
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Affiliation(s)
- Bing Chen
- School of Mechanical Engineering, Hefei University of Technology; Intelligent Interconnected Systems Laboratory of Anhui Province (Hefei University of Technology), Hefei, Anhui Province 230009, China
| | - Bin Zi
- School of Mechanical Engineering, Hefei University of Technology; Intelligent Interconnected Systems Laboratory of Anhui Province (Hefei University of Technology), Hefei, Anhui Province 230009, China
| | - Bin Zhou
- School of Mechanical Engineering, Hefei University of Technology; Intelligent Interconnected Systems Laboratory of Anhui Province (Hefei University of Technology), Hefei, Anhui Province 230009, China
| | - Zhengyu Wang
- School of Mechanical Engineering, Hefei University of Technology; Intelligent Interconnected Systems Laboratory of Anhui Province (Hefei University of Technology), Hefei, Anhui Province 230009, China
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Koehn RR, Roelker SA, Pan X, Schmitt LC, Chaudhari AMW, Siston RA. Is modular control related to functional outcomes in individuals with knee osteoarthritis and following total knee arthroplasty? PLoS One 2022; 17:e0267340. [PMID: 35452480 PMCID: PMC9032423 DOI: 10.1371/journal.pone.0267340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Individuals who undergo total knee arthroplasty (TKA) for treatment of knee osteoarthritis often experience suboptimal outcomes. Investigation of neuromuscular control strategies in these individuals may reveal factors that contribute to these functional deficits. The purpose of this pilot study was to determine the relationship between patient function and modular control during gait before and after TKA. METHODS Electromyography data from 36 participants (38 knees) were collected from 8 lower extremity muscles on the TKA-involved limb during ≥5 over-ground walking trials before (n = 30), 6-months after (n = 26), and 24-months after (n = 13) surgery. Muscle modules were estimated using non-negative matrix factorization. The number of modules was determined from 500 resampled trials. RESULTS A higher number of modules was related to better performance-based and patient-reported function before and 6-months after surgery. Participants with organization similar to healthy, age-matched controls trended toward better function 24-months after surgery, though these results were not statistically significant. We also observed plasticity in the participants' modular control strategies, with 100% of participants who were present before and 24-months after surgery (10/10) demonstrating changes in the number of modules and/or organization of at least 1 module. CONCLUSIONS This pilot work suggests that functional improvements following TKA may initially present as increases in the number of modules recruited during gait. Subsequent improvements in function may present as improved module organization. NOTEWORTHY This work is the first to characterize motor modules in TKA both before and after surgery and to demonstrate changes in the number and organization of modules over the time course of recovery, which may be related to changes in patient function. The plasticity of modular control following TKA is a key finding which has not been previously documented and may be useful in predicting or improving surgical outcomes through novel rehabilitation protocols.
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Affiliation(s)
- Rebekah R. Koehn
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Sarah A. Roelker
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Xueliang Pan
- Center for Biostatistics and Bioinformatics, The Ohio State University, Columbus, Ohio, United States of America
| | - Laura C. Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Ajit M. W. Chaudhari
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States of America
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, United States of America
| | - Robert A. Siston
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States of America
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, United States of America
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12
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Afzal T, Zhu F, Tseng SC, Lincoln JA, Francisco GE, Su H, Chang SH. Evaluation of Muscle Synergy during Exoskeleton-assisted Walking in Persons with Multiple Sclerosis. IEEE Trans Biomed Eng 2022; 69:3265-3274. [PMID: 35412969 DOI: 10.1109/tbme.2022.3166705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Gait deficit after multiple sclerosis (MS) can be characterized by altered muscle activation patterns. There is preliminary evidence of improved walking with a lower limb exoskeleton in persons with MS. However, the effects of exoskeleton-assisted walking on neuromuscular modifications are relatively unclear. The objective of this study was to investigate the muscle synergies, their activation patterns and the differences in neural strategies during walking with (EXO) and without (No-EXO) an exoskeleton. METHODS Ten subjects with MS performed walking during EXO and No-EXO conditions. Electromyography signals from seven leg muscles were recorded. Muscle synergies and the activation profiles were extracted using non-negative matrix factorization. RESULTS The stance phase duration was significantly shorter during EXO compared to the No-EXO condition (p<0.05). Moreover, typically 3-5 modules were extracted in each condition. The module-1 (comprising Vastus Medialis and Rectus Femoris muscles), module-2 (comprising Soleus and Medial Gastrocnemius muscles), module-3 (Tibialis Anterior muscle) and module-4 (comprising Biceps Femoris and Semitendinosus muscles) were comparable between conditions. During EXO condition, Semitendinosus and Vastus Medialis emerged in module-5 in 7/10 subjects. Compared to No-EXO, average activation amplitude was significantly reduced corresponding to module-2 during the stance phase and module-3 during the swing phase during EXO. CONCLUSION Exoskeleton-assistance does not alter the existing synergy modules, but could induce a new module to emerge, and alters the control of these modules, i.e., modifies the neural commands indicated by the reduced amplitude of the activation profiles.
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Application of Wearable Sensors in Actuation and Control of Powered Ankle Exoskeletons: A Comprehensive Review. SENSORS 2022; 22:s22062244. [PMID: 35336413 PMCID: PMC8954890 DOI: 10.3390/s22062244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023]
Abstract
Powered ankle exoskeletons (PAEs) are robotic devices developed for gait assistance, rehabilitation, and augmentation. To fulfil their purposes, PAEs vastly rely heavily on their sensor systems. Human–machine interface sensors collect the biomechanical signals from the human user to inform the higher level of the control hierarchy about the user’s locomotion intention and requirement, whereas machine–machine interface sensors monitor the output of the actuation unit to ensure precise tracking of the high-level control commands via the low-level control scheme. The current article aims to provide a comprehensive review of how wearable sensor technology has contributed to the actuation and control of the PAEs developed over the past two decades. The control schemes and actuation principles employed in the reviewed PAEs, as well as their interaction with the integrated sensor systems, are investigated in this review. Further, the role of wearable sensors in overcoming the main challenges in developing fully autonomous portable PAEs is discussed. Finally, a brief discussion on how the recent technology advancements in wearable sensors, including environment—machine interface sensors, could promote the future generation of fully autonomous portable PAEs is provided.
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Visual guidance can help with the use of a robotic exoskeleton during human walking. Sci Rep 2022; 12:3881. [PMID: 35273244 PMCID: PMC8913727 DOI: 10.1038/s41598-022-07736-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Walking is an important activity that supports the health-related quality of life, and for those who need assistance, robotic devices are available to help. Recent progress in wearable robots has identified the importance of customizing the assistance provided by the robot to the individual, resulting in robot adaptation to the human. However, current implementations minimize the role of human adaptation to the robot, for example, by the users modifying their movements based on the provided robot assistance. This study investigated the effect of visual feedback to guide the users in adapting their movements in response to wearable robot assistance. The visual feedback helped the users reduce their metabolic cost of walking without any changes in robot assistance in a given time. In a case with the initially metabolic expensive (IMExp) exoskeleton condition, both training methods helped reduce the metabolic cost of walking. The results suggest that visual feedback training is helpful to use the exoskeleton for various conditions. Without feedback, the training is helpful only for the IMExp exoskeleton condition. This result suggests visual feedback training can be useful to facilitate the use of non-personalized, generic assistance, where the assistance is not tuned for each user, in a relatively short time.
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15
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Tiboni M, Borboni A, Vérité F, Bregoli C, Amici C. Sensors and Actuation Technologies in Exoskeletons: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:884. [PMID: 35161629 PMCID: PMC8839165 DOI: 10.3390/s22030884] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023]
Abstract
Exoskeletons are robots that closely interact with humans and that are increasingly used for different purposes, such as rehabilitation, assistance in the activities of daily living (ADLs), performance augmentation or as haptic devices. In the last few decades, the research activity on these robots has grown exponentially, and sensors and actuation technologies are two fundamental research themes for their development. In this review, an in-depth study of the works related to exoskeletons and specifically to these two main aspects is carried out. A preliminary phase investigates the temporal distribution of scientific publications to capture the interest in studying and developing novel ideas, methods or solutions for exoskeleton design, actuation and sensors. The distribution of the works is also analyzed with respect to the device purpose, body part to which the device is dedicated, operation mode and design methods. Subsequently, actuation and sensing solutions for the exoskeletons described by the studies in literature are analyzed in detail, highlighting the main trends in their development and spread. The results are presented with a schematic approach, and cross analyses among taxonomies are also proposed to emphasize emerging peculiarities.
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Affiliation(s)
- Monica Tiboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
| | - Alberto Borboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
| | - Fabien Vérité
- Agathe Group INSERM U 1150, UMR 7222 CNRS, ISIR (Institute of Intelligent Systems and Robotics), Sorbonne Université, 75005 Paris, France;
| | - Chiara Bregoli
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
| | - Cinzia Amici
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
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Collimore AN, Aiello AJ, Pohlig RT, Awad LN. The Dynamic Motor Control Index as a Marker of Age-Related Neuromuscular Impairment. Front Aging Neurosci 2021; 13:678525. [PMID: 34366824 PMCID: PMC8339561 DOI: 10.3389/fnagi.2021.678525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/11/2021] [Indexed: 12/22/2022] Open
Abstract
Biomarkers that can identify age-related decline in walking function have potential to promote healthier aging by triggering timely interventions that can mitigate or reverse impairments. Recent evidence suggests that changes in neuromuscular control precede changes in walking function; however, it is unclear which measures are best suited for identifying age-related changes. In this study, non-negative matrix factorization of electromyography data collected during treadmill walking was used to calculate two measures of the complexity of muscle co-activations during walking for 36 adults: (1) the number of muscle synergies and (2) the dynamic motor control index. Study participants were grouped into young (18–35 years old), young-old (65–74 years old), and old–old (75+ years old) subsets. We found that the dynamic motor control index [χ2(2) = 9.41, p = 0.009], and not the number of muscle synergies [χ2(2) = 5.42, p = 0.067], differentiates between age groups [χ2(4) = 10.62, p = 0.031, Nagelkerke R2 = 0.297]. Moreover, an impairment threshold set at a dynamic motor control index of 90 (i.e., one standard deviation below the young adults) was able to differentiate between age groups [χ2(2) = 9.351, p = 0.009]. The dynamic motor control index identifies age-related differences in neuromuscular complexity not measured by the number of muscle synergies and may have clinical utility as a marker of neuromotor impairment.
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Affiliation(s)
- Ashley N Collimore
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Ashlyn J Aiello
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE, United States
| | - Louis N Awad
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
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17
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Zhu F, Kern M, Fowkes E, Afzal T, Contreras-Vidal JL, Francisco GE, Chang SH. Effects of an exoskeleton-assisted gait training on post-stroke lower-limb muscle coordination. J Neural Eng 2021; 18. [PMID: 33752175 DOI: 10.1088/1741-2552/abf0d5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/22/2021] [Indexed: 11/11/2022]
Abstract
Objective.Powered exoskeletons have been used to help persons with gait impairment regain some walking ability. However, little is known about its impact on neuromuscular coordination in persons with stroke. The objective of this study is to investigate how a powered exoskeleton could affect the neuromuscular coordination of persons with post-stroke hemiparesis.Approach.Eleven able-bodied subjects and ten stroke subjects participated in a single-visit treadmill walking assessment, in which their motion and lower-limb muscle activities were captured. By comparing spatiotemporal parameters, kinematics, and muscle synergy pattern between two groups, we characterized the normal gait pattern and the post-stroke motor deficits. Five eligible stroke subjects received exoskeleton-assisted gait trainings and walking assessments were conducted pre-intervention (Pre) and post-intervention (Post), without (WO) and with (WT) the exoskeleton. We compared their gait performance between (a) Pre and Post to investigate the effect of exoskeleton-assisted gait training and, (b) WO and WT the exoskeleton to investigate the effect of exoskeleton wearing on stroke subjects.Main results.While four distinct motor modules were needed to describe lower-extremity activities during stead-speed walking among able-bodied subjects, three modules were sufficient for the paretic leg from the stroke subjects. Muscle coordination complexity, module composition and activation timing were preserved after the training, indicating the intervention did not significantly change the neuromuscular coordination. In contrast, walking WT the exoskeleton altered the stroke subjects' synergy pattern, especially on the paretic side. The changes were dominated by the activation profile modulation towards the normal pattern observed from the able-bodied group.Significance.This study gave us some critical insight into how a powered exoskeleton affects the stroke subjects' neuromuscular coordination during gait and demonstrated the potential to use muscle synergy as a method to evaluate the effect of the exoskeleton training.This study was registered at ClinicalTrials.gov (identifier: NCT03057652).
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Affiliation(s)
- Fangshi Zhu
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.,Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Marcie Kern
- Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Erin Fowkes
- Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Taimoor Afzal
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.,Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Jose-Luis Contreras-Vidal
- Department of Electrical and Computer Engineering, The University of Houston, Houston, TX, United States of America
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.,Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
| | - Shuo-Hsiu Chang
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.,Center for Wearable Exoskeletons, NeuroRecovery Research Center, TIRR Memorial Hermann, Houston, TX, United States of America
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18
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Rinaldi L, Yeung LF, Lam PCH, Pang MYC, Tong RKY, Cheung VCK. Adapting to the Mechanical Properties and Active Force of an Exoskeleton by Altering Muscle Synergies in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2203-2213. [DOI: 10.1109/tnsre.2020.3017128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Torricelli D, De Marchis C, d'Avella A, Tobaruela DN, Barroso FO, Pons JL. Reorganization of Muscle Coordination Underlying Motor Learning in Cycling Tasks. Front Bioeng Biotechnol 2020; 8:800. [PMID: 32760711 PMCID: PMC7373728 DOI: 10.3389/fbioe.2020.00800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
The hypothesis of modular control, which stands on the existence of muscle synergies as building blocks of muscle coordination, has been investigated in a great variety of motor tasks and species. Yet, its role during learning processes is still largely unexplored. To what extent is such modular control flexible, in terms of spatial structure and temporal activation, to externally or internally induced adaptations, is a debated issue. To address this question, we designed a biofeedback experiment to induce changes in the timing of muscle activations during leg cycling movements. The protocol consisted in delaying the peak of activation of one target muscle and using its electromyography (EMG) envelope as visual biofeedback. For each of the 10 healthy participants, the protocol was repeated for three different target muscles: Tibialis Anterioris (TA), Gastrocnemius Medialis (GM), and Vastus Lateralis (VL). To explore the effects of the conditioning protocol, we analyzed changes in the activity of eight lower limb muscles by applying different models of modular motor control [i.e., fixed spatial components (FSC) and fixed temporal components (FTC)]. Our results confirm the hypothesis that visual EMG biofeedback is able to induce changes in muscle coordination. Subjects were able to shift the peak of activation of the target muscle, with a delay of (49 ± 27°) across subjects and conditions. This time shift generated a reorganization of all the other muscles in terms of timing and amplitude. By using different models of modular motor control, we demonstrated that neither spatially invariant nor temporally invariant muscle synergies alone were able to account for these changes in muscle coordination after learning, while temporally invariant muscle synergies with adjustments in timing could capture most of muscle activity adaptations observed after the conditioning protocol. These results suggest that short-term learning in rhythmic tasks is built upon synergistic temporal commands that are robust to changes in the task demands.
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Affiliation(s)
- Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Center (CSIC), Madrid, Spain
| | - Cristiano De Marchis
- Biomedical Engineering Laboratory, Department of Engineering, Università Roma TRE, Rome, Italy
| | - Andrea d'Avella
- Laboratory of Neuromotor Physiology, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Università di Messina, Messina, Italy
| | - Daniel Nemati Tobaruela
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Center (CSIC), Madrid, Spain
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Center (CSIC), Madrid, Spain
| | - Jose L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Center (CSIC), Madrid, Spain.,Legs and Walking Lab, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, United States.,Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, United States
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20
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Bekius A, Bach MM, van der Krogt MM, de Vries R, Buizer AI, Dominici N. Muscle Synergies During Walking in Children With Cerebral Palsy: A Systematic Review. Front Physiol 2020; 11:632. [PMID: 32714199 PMCID: PMC7343959 DOI: 10.3389/fphys.2020.00632] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Walking problems in children with cerebral palsy (CP) can in part be explained by limited selective motor control. Muscle synergy analysis is increasingly used to quantify altered neuromuscular control during walking. The early brain injury in children with CP may lead to a different development of muscle synergies compared to typically developing (TD) children, which might characterize the abnormal walking patterns. Objective: The overarching aim of this review is to give an overview of the existing studies investigating muscle synergies during walking in children with CP compared to TD children. The main focus is on how muscle synergies differ between children with CP and TD children, and we examine the potential of muscle synergies as a measure to quantify and predict treatment outcomes. Methods: Bibliographic databases were searched by two independent reviewers up to 22 April 2019. Studies were included if the focus was on muscle synergies of the lower limbs during walking, obtained by a matrix factorization algorithm, in children with CP. Results: The majority (n = 12) of the 16 included studies found that children with CP recruited fewer muscle synergies during walking compared to TD children, and several studies (n = 8) showed that either the spatial or temporal structure of the muscle synergies differed between children with CP and TD children. Variability within and between subjects was larger in children with CP than in TD children, especially in more involved children. Muscle synergy characteristics before treatments to improve walking function could predict treatment outcomes (n = 3). Only minimal changes in synergies were found after treatment. Conclusions: The findings in this systematic review support the idea that children with CP use a simpler motor control strategy compared to TD children. The use of muscle synergy analysis as a clinical tool to quantify altered neuromuscular control and predict clinical outcomes seems promising. Further investigation on this topic is necessary, and the use of muscle synergies as a target for development of novel therapies in children with CP could be explored.
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Affiliation(s)
- Annike Bekius
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Margit M Bach
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Institute of Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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21
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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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22
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Shi B, Chen X, Yue Z, Yin S, Weng Q, Zhang X, Wang J, Wen W. Wearable Ankle Robots in Post-stroke Rehabilitation of Gait: A Systematic Review. Front Neurorobot 2019; 13:63. [PMID: 31456681 PMCID: PMC6700322 DOI: 10.3389/fnbot.2019.00063] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Stroke causes weak functional mobility in survivors and affects the ability to perform activities of daily living. Wearable ankle robots are a potential intervention for gait rehabilitation post-stroke. Objective: The aim of this study is to provide a systematic review of wearable ankle robots, focusing on the overview, classification and comparison of actuators, gait event detection, control strategies, and performance evaluation. Method: Only English-language studies published from December 1995 to July 2018 were searched in the following databases: PubMed, EMBASE, Web of Science, Scopus, IEEE Xplore, Science Direct, SAGE journals. Result: A total of 48 articles were selected and 97 stroke survivors participated in these trials. Findings showed that few comparative trials were conducted among different actuators or control strategies. Moreover, mixed sensing technology which combines kinematic with kinetic information was effective in detecting motion intention of stroke survivors. Furthermore, all the selected clinical studies showed an improvement in the peak dorsiflexion degree of the swing phase, propulsion on the paretic side during push-off, and further enhanced walking speed after a period of robot-assisted ankle rehabilitation training. Conclusions: Preliminary findings suggest that wearable ankle robots have certain clinical benefits for the treatment of hemiplegic gait post-stroke. In the near future, a multicenter randomized controlled clinical trial is extremely necessary to enhance the clinical effectiveness of wearable ankle robots.
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Affiliation(s)
- Bin Shi
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Zan Yue
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Shuai Yin
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Xue Zhang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Jing Wang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
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23
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Esmaeili J, Maleki A. Comparison of muscle synergies extracted from both legs during cycling at different mechanical conditions. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:827-838. [PMID: 31161596 DOI: 10.1007/s13246-019-00767-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
Muscle synergies are the building blocks for generating movement by the central nervous system (CNS). According to this hypothesis, CNS decreases the complexity of motor control by combination of a small number of muscle synergies. The aim of this work is to investigate similarity of muscle synergies during cycling across various mechanical conditions. Twenty healthy subjects performed three 6- min cycling tasks at over a range of rotational speed (40, 50, and 60 rpm) and resistant torque (3, 5, and 7 N/m). Surface electromyography (sEMG) signals were recorded during pedaling from eight muscles of the right and left legs. We extracted four synchronous muscle synergies by using the non-negative matrix factorization (NMF) method. Mean and standard deviation of the goodness of the signal reconstruction (R2) for all subjects was obtained 0.9898 ± 0.0535. We investigated the functional roles of both leg muscles during cycling by synchronous muscle synergy extraction. We compared the muscle synergies extracted from all subjects in all mechanical conditions. The total mean and standard deviation of the similarity of synergy vectors for all subjects in all mechanical conditions was obtained 0.8788 ± 0.0709. We found the high degrees of similarity among the sets of synchronous muscle synergies across mechanical conditions and also across different subjects. Our results demonstrated that different subjects at different mechanical conditions use the same motor control strategies for cycling, despite inter-individual variability of muscle patterns.
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Affiliation(s)
- Javad Esmaeili
- Electrical and Computer Engineering Faculty, Semnan University, Semnan, Iran
| | - Ali Maleki
- Biomedical Engineering Department, Semnan University, Semnan, Iran.
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Motor primitives are determined in early development and are then robustly conserved into adulthood. Proc Natl Acad Sci U S A 2019; 116:12025-12034. [PMID: 31138689 DOI: 10.1073/pnas.1821455116] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Motor patterns in legged vertebrates show modularity in both young and adult animals, comprising motor synergies or primitives. Are such spinal modules observed in young mammals conserved into adulthood or altered? Conceivably, early circuit modules alter radically through experience and descending pathways' activity. We analyze lumbar motor patterns of intact adult rats and the same rats after spinal transection and compare these with adult rats spinal transected 5 days postnatally, before most motor experience, using only rats that never developed hind limb weight bearing. We use independent component analysis (ICA) to extract synergies from electromyography (EMG). ICA information-based methods identify both weakly active and strongly active synergies. We compare all spatial synergies and their activation/drive strengths as proxies of spinal modules and their underlying circuits. Remarkably, we find that spatial primitives/synergies of adult injured and neonatal injured rats differed insignificantly, despite different developmental histories. However, intact rats possess some synergies that differ significantly, although modestly, in spatial structure. Rats injured as adults were more similar in modularity to rats that had neonatal spinal transection than to themselves before injury. We surmise that spinal circuit modules for spatial synergy patterns may be determined early, before postnatal day 5 (P5), and remain largely unaltered by subsequent development or weight-bearing experience. An alternative explanation but equally important is that, after complete spinal transection, both neonatal and mature adult spinal cords rapidly converge to common synergy sets. This fundamental or convergent synergy circuitry, fully determined by P5, is revealed after spinal cord transection.
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Tan CK, Kadone H, Miura K, Abe T, Koda M, Yamazaki M, Sankai Y, Suzuki K. Muscle Synergies During Repetitive Stoop Lifting With a Bioelectrically-Controlled Lumbar Support Exoskeleton. Front Hum Neurosci 2019; 13:142. [PMID: 31114492 PMCID: PMC6503089 DOI: 10.3389/fnhum.2019.00142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/11/2019] [Indexed: 12/27/2022] Open
Abstract
Lower back problems are common in the world, which leads to the development of various lumbar support exoskeletons to alleviate this problem. In general, previous studies evaluating lumbar support devices quantified assistance by reporting the reduction in back muscle activity and perceived fatigue. However, despite the beneficial effects of such devices, the effects of using such exoskeletons on muscle coordination are not well-studied. In this study, we examined the short-term change in muscle coordination of subjects using a bioelectrically-controlled lumbar support exoskeleton in a fatiguing stoop lifting task with muscle synergy analysis. Results indicate that muscle coordination changes were dominated by changes in timing coefficients, with minimal change in muscle synergy vectors. Analysis on muscle coordination changes would be useful to design future generations of exoskeletons.
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Affiliation(s)
- Chun Kwang Tan
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, University of Tsukuba, Tsukuba, Japan
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Shuman BR, Goudriaan M, Desloovere K, Schwartz MH, Steele KM. Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy. J Neuroeng Rehabil 2019; 16:46. [PMID: 30925882 PMCID: PMC6441188 DOI: 10.1186/s12984-019-0502-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 12/23/2022] Open
Abstract
Background Children with cerebral palsy (CP) have altered synergies compared to typically-developing peers, reflecting different neuromuscular control strategies used to move. While these children receive a variety of treatments to improve gait, whether synergies change after treatment, or are associated with treatment outcomes, remains unknown. Methods We evaluated synergies for 147 children with CP before and after three common treatments: botulinum toxin type-A injection (n = 52), selective dorsal rhizotomy (n = 38), and multi-level orthopaedic surgery (n = 57). Changes in synergy complexity were measured by the number of synergies required to explain > 90% of the total variance in electromyography data and total variance accounted for by one synergy. Synergy weights and activations before and after treatment were compared using the cosine similarity relative to average synergies of 31 typically-developing (TD) peers. Results There were minimal changes in synergies after treatment despite changes in walking patterns. Number of synergies did not change significantly for any treatment group. Total variance accounted for by one synergy increased (i.e., moved further from TD peers) after botulinum toxin type-A injection (1.3%) and selective dorsal rhizotomy (1.9%), but the change was small. Synergy weights did not change for any treatment group (average 0.001 ± 0.10), but synergy activations after selective dorsal rhizotomy did change and were less similar to TD peers (− 0.03 ± 0.07). Only changes in synergy activations were associated with changes in gait kinematics or walking speed after treatment. Children with synergy activations more similar to TD peers after treatment had greater improvements in gait. Conclusions While many of these children received significant surgical procedures and prolonged rehabilitation, the minimal changes in synergies after treatment highlight the challenges in altering neuromuscular control in CP. Development of treatment strategies that directly target impaired control or are optimized to an individual’s unique control may be required to improve walking function.
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Affiliation(s)
- Benjamin R Shuman
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA, 98195, USA
| | - Marije Goudriaan
- Department of Human Movement Sciences, VU university, Amsterdam, the Netherlands.,Department of Rehabilitation Science, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Science, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven Campus Pellenberg, Pellenberg, Belgium
| | - Michael H Schwartz
- James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA, 98195, USA.
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Motor Control System for Adaptation of Healthy Individuals and Recovery of Poststroke Patients: A Case Study on Muscle Synergies. Neural Plast 2019; 2019:8586416. [PMID: 31049057 PMCID: PMC6458928 DOI: 10.1155/2019/8586416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
Understanding the complex neuromuscular strategies underlying behavioral adaptation in healthy individuals and motor recovery after brain damage is essential for gaining fundamental knowledge on the motor control system. Relying on the concept of muscle synergy, which indicates the number of coordinated muscles needed to accomplish specific movements, we investigated behavioral adaptation in nine healthy participants who were introduced to a familiar environment and unfamiliar environment. We then compared the resulting computed muscle synergies with those observed in 10 moderate-stroke survivors throughout an 11-week motor recovery period. Our results revealed that computed muscle synergy characteristics changed after healthy participants were introduced to the unfamiliar environment, compared with those initially observed in the familiar environment, and exhibited an increased neural response to unpredictable inputs. The altered neural activities dramatically adjusted through behavior training to suit the unfamiliar environment requirements. Interestingly, we observed similar neuromuscular behaviors in patients with moderate stroke during the follow-up period of their motor recovery. This similarity suggests that the underlying neuromuscular strategies for adapting to an unfamiliar environment are comparable to those used for the recovery of motor function after stroke. Both mechanisms can be considered as a recall of neural pathways derived from preexisting muscle synergies, already encoded by the brain's internal model. Our results provide further insight on the fundamental principles of motor control and thus can guide the future development of poststroke therapies.
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Porciuncula F, Roto AV, Kumar D, Davis I, Roy S, Walsh CJ, Awad LN. Wearable Movement Sensors for Rehabilitation: A Focused Review of Technological and Clinical Advances. PM R 2018; 10:S220-S232. [PMID: 30269807 PMCID: PMC6700726 DOI: 10.1016/j.pmrj.2018.06.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 01/01/2023]
Abstract
Recent technologic advancements have enabled the creation of portable, low-cost, and unobtrusive sensors with tremendous potential to alter the clinical practice of rehabilitation. The application of wearable sensors to track movement has emerged as a promising paradigm to enhance the care provided to patients with neurologic or musculoskeletal conditions. These sensors enable quantification of motor behavior across disparate patient populations and emerging research shows their potential for identifying motor biomarkers, differentiating between restitution and compensation motor recovery mechanisms, remote monitoring, telerehabilitation, and robotics. Moreover, the big data recorded across these applications serve as a pathway to personalized and precision medicine. This article presents state-of-the-art and next-generation wearable movement sensors, ranging from inertial measurement units to soft sensors. An overview of clinical applications is presented across a wide spectrum of conditions that have potential to benefit from wearable sensors, including stroke, movement disorders, knee osteoarthritis, and running injuries. Complementary applications enabled by next-generation sensors that will enable point-of-care monitoring of neural activity and muscle dynamics during movement also are discussed.
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Affiliation(s)
- Franchino Porciuncula
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA(∗)
| | - Anna Virginia Roto
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(†)
| | - Deepak Kumar
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(‡)
| | - Irene Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA(§)
| | - Serge Roy
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(¶)
| | - Conor J Walsh
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA(#)
| | - Louis N Awad
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA; Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA(∗∗).
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