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Bonanno M, De Pasquale P, De Marchis C, Lombardo Facciale A, Paladina G, Fonti B, Quartarone A, Calabrò RS. Might patients with cerebellar ataxia benefit from the Computer Assisted Rehabilitation ENvironment (CAREN)? A pilot study focusing on gait and balance. Front Bioeng Biotechnol 2024; 12:1385280. [PMID: 39011156 PMCID: PMC11247328 DOI: 10.3389/fbioe.2024.1385280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction: Ataxia is a neurological symptom that causes decreased balance, loss of coordination, and gait alterations. Innovative rehabilitation devices like virtual reality (VR) systems can provide task-oriented, repetitive and intensive training with multisensorial feedback, thus promoting neuroplastic processes. Among these VR technologies, the Computer Assisted Rehabilitation ENvironment (CAREN) associates a split belt treadmill on a 6-degrees of freedom platform with a 180° VR screen and a Vicon motion capture system to monitor patients' movements during training sessions. Methods: Eight patients affected by cerebellar ataxia were enrolled and received 20 sessions of CAREN training in addition to standard rehabilitation treatment. Each patient was evaluated at the beginning and at the end of the study with 3D gait analysis and clinical scales to assess balance, gait function and risk of falls. Results: We found improvements in kinematic, kinetic, and electromyographic parameters (as per pre-post- CAREN training), as well as in clinical outcomes, such as balance and risk of falls in ataxic patients. In addition, we found that trunk rotation improved, after CAREN intervention, approximating to the normative values. Discussion: Our results suggested that CAREN might be useful to improve specific biomechanical parameters of gait in ataxic patients.
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Affiliation(s)
| | | | | | | | | | - Bartolo Fonti
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Prasad R, El-Rich M, Awad MI, Agrawal SK, Khalaf K. Muscle-inspired bi-planar cable routing: a novel framework for designing cable driven lower limb rehabilitation exoskeletons (C-LREX). Sci Rep 2024; 14:5158. [PMID: 38431744 PMCID: PMC10908813 DOI: 10.1038/s41598-024-55785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/27/2024] [Indexed: 03/05/2024] Open
Abstract
There is a growing interest in the research and development of Cable Driven Rehabilitation Devices (CDRDs) due to multiple inherent features attractive to clinical applications, including low inertia, lightweight, high payload-to-weight ratio, large workspace, and modular design. However, previous CDRDs have mainly focused on modifying motor impairment in the sagittal plane, despite the fact that neurological disorders, such as stroke, often involve postural control and gait impairment in multiple planes. To address this gap, this work introduces a novel framework for designing a cable-driven lower limb rehabilitation exoskeleton which can assist with bi-planar impaired posture and gait. The framework used a lower limb model to analyze different cable routings inspired by human muscle architecture and attachment schemes to identify optimal routing and associated parameters. The selected cable routings were safeguarded for non-interference with the human body while generating bi-directional joint moments. The subsequent optimal cable routing model was then implemented in simulations of tracking reference healthy trajectory with bi-planar impaired gait (both in the sagittal and frontal planes). The results showed that controlling joints independently via cables yielded better performance compared to dependent control. Routing long cables through intermediate hinges reduced the peak tensions in the cables, however, at a cost of induced additional joint forces. Overall, this study provides a systematic and quantitative in silico approach, featured with accessible graphical user interface (GUI), for designing subject-specific, safe, and effective lower limb cable-driven exoskeletons for rehabilitation with options for multi-planar personalized impairment-specific features.
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Affiliation(s)
- Rajan Prasad
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, UAE
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, UAE.
- Health Engineering Innovation Center, Khalifa University, Abu Dhabi, UAE.
| | - Mohammad I Awad
- Health Engineering Innovation Center, Khalifa University, Abu Dhabi, UAE
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, UAE
- Khalifa University Center for Autonomous Robotic Systems (KUCARS), Khalifa University, Abu Dhabi, UAE
| | - Sunil K Agrawal
- Department of Mechanical Engineering and Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
| | - Kinda Khalaf
- Health Engineering Innovation Center, Khalifa University, Abu Dhabi, UAE
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Funk CJ, Krupenevich RL, Sawicki GS, Franz JR. American Society of Biomechanics Journal of Biomechanics Award 2021: Exploring the Functional Boundaries and Metabolic Consequences of Triceps Surae Force-Length Relations during Walking. J Biomech 2023; 158:111771. [PMID: 37647673 PMCID: PMC10529775 DOI: 10.1016/j.jbiomech.2023.111771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
The relationship between individual muscle dynamics and whole-body metabolic cost is not well established. Here we use biofeedback to modulate triceps surae (TS) activity during walking to test the following hypotheses based on basic principles of muscle physiology: (1) increased TS activity would increase metabolic cost via shorter muscle fascicle lengths and thus reduced force capacity and (2) decreased TS activity would decrease metabolic cost via longer muscle fascicle lengths and thus increased force capacity. 23 young adults walked on an instrumented treadmill at 1.25 m/s using electromyographic (EMG) biofeedback to match targets corresponding to ±20 and ±40% TS activity during push-off (late stance). B-mode ultrasound imaged the medial gastrocnemius (MG). Participants increased net metabolic power up to 85% and 21% when targeting increased and decreased TS activity, respectively (p < 0.001). At the instant of peak gastrocnemius force, MG fascicle length was 7% shorter (p < 0.001) and gastrocnemius force was 6% larger (p < 0.001) when targeting + 40% TS activity. Fascicle length was 3% shorter (p = 0.004) and force was 7% lower (p = 0.010) when targeting -40% TS activity; participants were unable to achieve decreased activation targets. MG fascicle length and activity mediated 11.7% (p = 0.036) and 57.2% (p = 0.006) of the changes in net metabolic power, respectively. MG force did not mediate changes in net metabolic power (p = 0.948). These findings suggest that changes in the functional operating length of muscle, induced here by volitional changes in TS activity, mediated changes in the metabolic cost of walking, relatively independently of force. Thus, shifts to shorter fascicle lengths (e.g., aging) may mediate activity-induced increases in metabolic cost.
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Affiliation(s)
- Callum J Funk
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca L Krupenevich
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, NC, USA
| | - Gregory S Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Tech, Atlanta, GA, USA
| | - Jason R Franz
- 10206C Mary Ellen Jones Building, CB 7575, Chapel Hill, NC 27599, USA.
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Pennel Z, McGeehan M, Ong KG. An Optoelectronics-Based Compressive Force Sensor with Scalable Sensitivity. SENSORS (BASEL, SWITZERLAND) 2023; 23:6513. [PMID: 37514807 PMCID: PMC10385828 DOI: 10.3390/s23146513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
There is an increasing need to accurately measure compressive force for biomedical and industrial applications. However, this need has not been fully addressed, as many sensors are bulky, have high power requirements, and/or are susceptible to electromagnetic interference. This paper presents an optoelectronics-based force sensor that can overcome the limitations of many sensors in the market. The sensor uses a light emitting diode (LED) to transmit visible broad-spectrum light into a photoresistor through an optically clear spacer on top of an elastomeric medium. In the absence of an external force, the light path is mostly blocked by the opaque elastomeric medium. Under a compressive force, the clear spacer compresses the elastomer, moving itself into the light path, and thus increasing the overall light transmission. The amount of light received by the photoresistor is used to quantify compressive force based on elastomer displacement/compression and a priori knowledge of elastomer stiffness. This sensing scheme was tested under eight different configurations: two different sized sensors with four types of elastomers per size (20A neoprene, 30A neoprene, 50A neoprene, and 75A styrene-butadiene rubber (SBR)). All configurations measured force with R2 > 0.97, RMSE < 1.9 N, and sensitivity values ranging from 17 to 485 N/V. This sensing scheme provides a low-cost, low-power method for accurate force sensing with a wide force range.
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Affiliation(s)
- Zachary Pennel
- Department of Bioengineering, Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
- Department of Physics, University of Oregon, Eugene, OR 97403, USA
| | - Michael McGeehan
- Department of Bioengineering, Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
| | - Keat Ghee Ong
- Department of Bioengineering, Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
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Santucci V, Alam Z, Liu J, Spencer J, Faust A, Cobb A, Konantz J, Eicholtz S, Wolf S, Kesar TM. Immediate improvements in post-stroke gait biomechanics are induced with both real-time limb position and propulsive force biofeedback. J Neuroeng Rehabil 2023; 20:37. [PMID: 37004111 PMCID: PMC10064559 DOI: 10.1186/s12984-023-01154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Paretic propulsion [measured as anteriorly-directed ground reaction forces (AGRF)] and trailing limb angle (TLA) show robust inter-relationships, and represent two key modifiable post-stroke gait variables that have biomechanical and clinical relevance. Our recent work demonstrated that real-time biofeedback is a feasible paradigm for modulating AGRF and TLA in able-bodied participants. However, the effects of TLA biofeedback on gait biomechanics of post-stroke individuals are poorly understood. Thus, our objective was to investigate the effects of unilateral, real-time, audiovisual TLA versus AGRF biofeedback on gait biomechanics in post-stroke individuals. METHODS Nine post-stroke individuals (6 males, age 63 ± 9.8 years, 44.9 months post-stroke) participated in a single session of gait analysis comprised of three types of walking trials: no biofeedback, AGRF biofeedback, and TLA biofeedback. Biofeedback unilaterally targeted deficits on the paretic limb. Dependent variables included peak AGRF, TLA, and ankle plantarflexor moment. One-way repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons were conducted to detect the effect of biofeedback on gait biomechanics variables. RESULTS Compared to no-biofeedback, both AGRF and TLA biofeedback induced unilateral increases in paretic AGRF. TLA biofeedback induced significantly larger increases in paretic TLA than AGRF biofeedback. AGRF biofeedback increased ankle moment, and both feedback conditions increased non-paretic step length. Both types of biofeedback specifically targeted the paretic limb without inducing changes in the non-paretic limb. CONCLUSIONS By showing comparable increases in paretic limb gait biomechanics in response to both TLA and AGRF biofeedback, our novel findings provide the rationale and feasibility of paretic TLA as a gait biofeedback target for post-stroke individuals. Additionally, our results provide preliminary insights into divergent biomechanical mechanisms underlying improvements in post-stroke gait induced by these two biofeedback targets. We lay the groundwork for future investigations incorporating greater dosages and longer-term therapeutic effects of TLA biofeedback as a stroke gait rehabilitation strategy. Trial registration NCT03466372.
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Affiliation(s)
- Vincent Santucci
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Zahin Alam
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Justin Liu
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Jacob Spencer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Alec Faust
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Aijalon Cobb
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Joshua Konantz
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Steven Eicholtz
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
| | - Steven Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
- Center for Visual and Neurocognitive Rehabilitation, VA Medical Center, Atlanta, GA, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA.
- Emory Rehabilitation Hospital, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Kramer PA, Feuerriegel EM, Lautzenheiser SG, Sylvester AD. Sensitivity of musculoskeletal models to variation in muscle architecture parameters. EVOLUTIONARY HUMAN SCIENCES 2022; 4:e6. [PMID: 37588892 PMCID: PMC10426084 DOI: 10.1017/ehs.2022.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Musculoskeletal models, like all theoretical models of physical processes, depend on the assumptions needed to construct the model. For musculoskeletal models, these assumptions include, among other things, the kinematic data, the kinetic data and the muscle parameters. The former (dynamic) data can be acquired relatively easily from living subjects, but the latter are usually based on limited information, frequently determined from cadaver studies performed on elderly individuals. Previously, we determined the sensitivity of forces to dynamic differences among 10 humans walking on a straight path. Here, we assess the sensitivity of the muscle and joint reaction forces developed in human walking to variable muscle parameters obtained from 10 living adults, whose data were recently reported, and compared the results with the values from a standard model that depends on cadaveric data. We found that, while the force patterns across the stance cycle were similar among muscle parameter models, differences of as much as 15% in the force magnitude were produced. Whether or not the variation between the standard model and other muscle parameters is important depends on why the forces are required.
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Affiliation(s)
- Patricia Ann Kramer
- Department of Anthropology, University of Washington, Denny Hall, Seattle, WA98195, USA
| | - Elen M. Feuerriegel
- Department of Anthropology, University of Washington, Denny Hall, Seattle, WA98195, USA
- Evolutionary Studies Institute, University of Witwatersrand, Private Bag 3, Wits, 2050, South Africa
| | - Steven G. Lautzenheiser
- Department of Anthropology, University of Washington, Denny Hall, Seattle, WA98195, USA
- Department of Anthropology, The University of Tennessee, Knoxville, Strong Hall, Knoxville, TN37996, USA
| | - Adam D. Sylvester
- Center for Functional Anatomy and Evolution, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD21205, USA
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Kramer PA, Lautzenheiser SG. Foot morphology influences the change in arch index between standing and walking conditions. Anat Rec (Hoboken) 2022; 305:3254-3262. [DOI: 10.1002/ar.24890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/07/2022]
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