Human Lower Limb Joint Biomechanics in Daily Life Activities: A Literature Based Requirement Analysis for Anthropomorphic Robot Design

Changes in Dynamic Mean Ankle Moment Arm in Unimpaired Walking Across Speeds, Ramps, and Stairs

Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint-effectively, how "forefoot-dominated" or "hindfoot-dominated" a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at "slow," "normal," and "fast" self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their "normal" speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices.

Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis

Introduction

Motion analysis can be used to gain information needed for disease diagnosis as well as for the design and evaluation of intervention strategies in patients with hip osteoarthritis (HOA). Thereby, joint kinematics might be of great interest due to their discriminative capacity and accessibility, especially with regard to the growing usage of wearable sensors for motion analysis. So far, no comprehensive literature review on lower limb joint kinematics of patients with HOA exists. Thus, the aim of this systematic review and meta-analysis was to synthesise existing literature on lower body joint kinematics of persons with HOA compared to those of healthy controls during locomotion tasks.

Methods

Three databases were searched for studies on pelvis, hip, knee and ankle kinematics in subjects with HOA compared to healthy controls during locomotion tasks. Standardised mean differences were calculated and pooled using a random-effects model. Where possible, subgroup analyses were conducted. Risk of bias was assessed with the Downs and Black checklist.

Results and Discussion

A total of 47 reports from 35 individual studies were included in this review. Most studies analysed walking and only a few studies analysed stair walking or turning while walking. Most group differences were found in ipsi- and contralateral three-dimensional hip and sagittal knee angles with reduced ranges of motion in HOA subjects. Differences between subjects with mild to moderate and severe HOA were found, with larger effects in severe HOA subjects. Additionally, stair walking and turning while walking might be promising extensions in clinical gait analysis due to their elevated requirements for joint mobility. Large between-study heterogeneity was observed, and future studies have to clarify the effects of OA severity, laterality, age, gender, study design and movement execution on lower limb joint kinematics.

Systematic Review Registration

PROSPERO (CRD42021238237).

Joint power, joint work and lower limb muscle activity for transitions between level walking and stair ambulation at three inclinations

To enhance human mobility, training interventions and assistive lower limb wearable robotic designs must draw insights from movement tasks from daily life. This study aimed to analyze joint peak power, limb and joint work, and muscle activity of the lower limb during a series of stair ambulation conditions. We recruited 12 subjects (25.4±4.5 yrs, 180.1±4.6 cm, 74.6±7.9 kg) and studied steady gait and gait transitions between level walking, stair ascent and stair descent for three staircase inclinations (low 19°, normal 30.4°, high 39.6°). Our analysis revealed that joint peak power, limb and joint work, and muscle activity increased significantly compared to level walking and with increasing stair inclination for most of the conditions analyzed. Transition strides had no increased requirements compared to the maxima found for steady level walking and steady stair ambulation. Stair ascent required increased lower limb joint positive peak power and work, while stair descent required increased lower limb joint negative peak power and work compared to level walking. The most challenging condition was high stair inclination, which required approximately thirteen times the total lower limb joint positive and negative net work during ascent and descent, respectively. These findings suggest that training interventions and lower limb wearable robotic designs must consider the major increases in lower limb joint and muscle effort during stair ambulation, with specific attention to the demands of ascent and descent, to effectively improve human mobility.

Unilateral transtibial prosthesis users load their intact limb more than their prosthetic limb during sit-to-stand, squatting, and lifting

BACKGROUND

Lower limb prosthesis users exhibit high rates of joint pain and disease, such as osteoarthritis, in their intact limb. Overloading of their intact limb during daily activities may be a contributing factor. Limb loading biomechanics have been extensively studied during walking, but fewer investigations into limb loading during other functional movements exist. The purpose of this study was to characterize the lower limb loading of transtibial prosthesis users during three common daily tasks: sit-to-stand, squatting, and lifting.

METHODS

Eight unilateral transtibial prosthesis users performed sit-to-stand (from three chair heights), squatting, and lifting a 10 kg box. Peak vertical ground reaction forces and peak knee flexion moments were computed for each limb (intact and prosthetic) to characterize limb loading and asymmetry. Ranges of motion of the intact and prosthetic ankles were also quantified.

FINDINGS

Users had greater peak ground reaction forces and knee flexion moments in their intact limb for all tasks (p < 0.02). On average, the intact limb had 36-48% greater peak ground reaction forces and 168-343% greater peak knee flexion moments compared to the prosthetic limb. The prosthetic ankle provided <10° of ankle range of motion for all tasks, less than half the range of motion provided by the intact ankle.

INTERPRETATION

Prosthesis users overloaded their intact limb during all tasks. This asymmetric loading may lead to an accumulation of damage to the intact limb joints, such as the knee, and may contribute to the development of osteoarthritis. Prosthetic design and rehabilitation interventions that promote more symmetric loading should be investigated for these tasks.

A mechatronic leg replica to benchmark human-exoskeleton physical interactions

Evaluating human-exoskeleton interaction typically requires experiments with human subjects, which raises safety issues and entails time-consuming testing procedures. This paper presents a mechatronic replica of a human leg, which was designed to quantify physical interaction dynamics between exoskeletons and human limbs without the need for human testing. In the first part of this work, we present the mechanical, electronic, sensory system and software solutions integrated in our leg replica prototype. In the second part, we used the leg replica to test its interaction with two types of commercially available wearable devices, i.e. an active full leg exoskeleton and a passive knee orthosis. We ran basic test examples to demonstrate the functioning and benchmarking potential of the leg replica to assess the effects of joint misalignments on force transmission. The integrated force sensors embedded in the leg replica detected higher interaction forces in the misaligned scenario in comparison to the aligned one, in both active and passive modalities. The small standard deviation of force measurements across cycles demonstrates the potential of the leg replica as a standard test method for reproducible studies of human-exoskeleton physical interaction.

An Analysis of Lower Limb Coordination Variability in Unilateral Tasks in Healthy Adults: A Possible Prognostic Tool

Interlimb coordination variability analysis can shed light into the dynamics of higher order coordination and motor control. However, it is not clear how the interlimb coordination of people with no known injuries change in similar activities with increasing difficulty. This study aimed to ascertain if the interlimb coordination variability range and patterns of healthy participants change in different unilateral functional tasks with increasing complexity and whether leg dominance affects the interlimb coordination variability. In this cross-sectional study fourteen younger participants with no known injuries completed three repeated unilateral sit-to-stands (UniSTS), step-ups (SUs), and continuous-hops (Hops). Using four inertial sensors mounted on the lower legs and thighs, angular rotation of thighs and shanks were recorded. Using Hilbert transform, the phase angle of each segment and then the continuous relative phase (CRP) of the two segments were measured. The CRP is indicative of the interlimb coordination. Finally, the linear and the nonlinear shank-thigh coordination variability of each participant in each task was calculated. The results show that the linear shank-thigh coordination variability was significantly smaller in the SUs compared to both UniSTS and Hops in both legs. There were no significant differences found between the latter two tests in their linear coordination variability. However, Hops were found to have significantly larger nonlinear shank-thigh coordination variability compared to the SUs and the UniSTS. This can be due to larger vertical and horizontal forces required for the task and can reveal inadequate motor control during the movement. The combination of nonlinear and linear interlimb coordination variability can provide more insight into human movement as they measure different aspects of coordination variability. It was also seen that leg dominance does not affect the lower limb coordination variability in participants with no known injuries. The results should be tested in participants recovering from lower limb injuries.

Phase-Variable Control of a Powered Knee-Ankle Prosthesis over Continuously Varying Speeds and Inclines

Most controllers for lower-limb robotic prostheses require individually tuned parameter sets for every combination of speed and incline that the device is designed for. Because ambulation occurs over a continuum of speeds and inclines, this design paradigm requires tuning of a potentially prohibitively large number of parameters. This limitation motivates an alternative control framework that enables walking over a range of speeds and inclines while requiring only a limited number of tunable parameters. In this work, we present the implementation of a continuously varying kinematic controller on a custom powered knee-ankle prosthesis. The controller uses a phase variable derived from the residual thigh angle, along with real-time estimates of ground inclination and walking speed, to compute the appropriate knee and ankle joint angles from a continuous model of able-bodied kinematic data. We modify an existing phase variable architecture to allow for changes in speeds and inclines, quantify the closed-loop accuracy of the speed and incline estimation algorithms for various references, and experimentally validate the controller by observing that it replicates kinematic trends seen in able-bodied gait as speed and incline vary.

Soft pneumatic elbow exoskeleton reduces the muscle activity, metabolic cost and fatigue during holding and carrying of loads

To minimize fatigue, sustain workloads, and reduce the risk of injuries, the exoskeleton Carry was developed. Carry combines a soft human-machine interface and soft pneumatic actuation to assist the elbow in load holding and carrying. We hypothesize that the assistance of Carry would decrease, muscle activity, net metabolic rate, and fatigue. With Carry providing 7.2 Nm of assistance, we found reductions of up to 50% for the muscle activity, up to 61% for the net metabolic rate, and up to 99% for fatigue in a group study of 12 individuals. Analyses of operation dynamics and autonomous use demonstrate the applicability of Carry to a variety of use cases, presumably with increased benefits for increased assistance torque. The significant benefits of Carry indicate this device could prevent systemic, aerobic, and/or possibly local muscle fatigue that may increase the risk of joint degeneration and pain due to lifting, holding, or carrying.

Lower limb joint biomechanics-based identification of gait transitions in between level walking and stair ambulation

Lower limb exoskeletons and lower limb prostheses have the potential to reduce gait limitations during stair ambulation. To develop robotic assistance devices, the biomechanics of stair ambulation and the required transitions to level walking have to be understood. This study aimed to identify the timing of these transitions, to determine if transition phases exist and how long they last, and to investigate if there exists a joint-related order and timing for the start and end of the transitions. Therefore, this study analyzed the kinematics and kinetics of both transitions between level walking and stair ascent, and between level walking and stair descent (12 subjects, 25.4 yrs, 74.6 kg). We found that transitions primarily start within the stance phase and end within the swing phase. Transition phases exist for each limb, all joints (hip, knee, ankle), and types of transitions. They have a mean duration of half of one stride and they do not last longer than one stride. The duration of the transition phase for all joints of a single limb in aggregate is less than 35% of one stride in all but one case. The distal joints initialize stair ascent, while the proximal joints primarily initialize the stair descent transitions. In general, the distal joints complete the transitions first. We believe that energy- and balance-related processes are responsible for the joint-specific transition timing. Regarding the existence of a transition phase for all joints and transitions, we believe that lower limb exoskeleton or prosthetic control concepts should account for these transitions in order to improve the smoothness of the transition and to thus increase the user comfort, safety, and user experience. Our gait data and the identified transition timings can provide a reference for the design and the performance of stair ambulation- related control concepts.