Maarten Afschrift

The effect of muscle weakness on the capability gap during gross motor function: a simulation study supporting design criteria for exoskeletons of the lower limb

BackgroundEnabling persons with functional weaknesses to perform activities of daily living (ADL) is one of the main challenges for the aging society. Powered orthoses, or exoskeletons, have the potential to support ADL while promoting active participation of the user. For this purpose, assistive devices should be designed and controlled to deliver assistance as needed (AAN). This means that the level of assistance should bridge the capability gap, i.e. the gap between the capabilities of the subjects and the task requirements. However, currently the actuators of exoskeletons are mainly designed using inverse dynamics (ID) based calculations of joint moments. The goal of the present study is to calculate the capability gap for the lower limb during ADL when muscle weakness is present, which is needed for appropriate selection of actuators to be integrated in exoskeletons.MethodsA musculoskeletal model (MM) is used to calculate the joint kinematics, joint kinetics and muscle forces of eight healthy subjects during ADL (gait, sit-to-stand, stand-to-sit, stair ascent, stair descent). Muscle weakness was imposed to the MM by a stepwise decrease in maximal isometric force imposed to all muscles. Muscle forces were calculated using static optimization. In order to compensate for muscle weakness, ideal moment actuators that represent the motors of an exoskeleton in the simulation were added to deliver AAN required to perform the task.ResultsThe ID approach overestimates the required assistance since it relies solely on the demands of the task, whereas the AAN approach incorporates the capabilities of the subject. Furthermore, the ID approach delivers continuous support whereas the AAN approach targets the period where a capability gap occurs. The level of muscle weakness for which the external demands imposed by ADL can no longer be met by active muscle force production, is respectively 40%, 70%, 80% and 30%.ConclusionsThe present workflow allows estimating the AAN during ADL for different levels of muscle weakness, which can be used in the mechatronic design and control of powered exoskeletons. The AAN approach is a more physiological approach than the ID approach, since the MM accounts for the subject-specific capabilities of the user.

Mechanical effort predicts the selection of ankle over hip strategies in nonstepping postural responses.

Experimental studies have shown that a continuum of ankle and hip strategies is used to restore posture following an external perturbation. Postural responses can be modeled by feedback control with feedback gains that optimize a specific objective. On the one hand, feedback gains that minimize effort have been used to predict muscle activity during perturbed standing. On the other hand, hip and ankle strategies have been predicted by minimizing postural instability and deviation from upright posture. It remains unclear, however, whether and how effort minimization influences the selection of a specific postural response. We hypothesize that the relative importance of minimizing mechanical work vs. postural instability influences the strategy used to restore upright posture. This hypothesis was investigated based on experiments and predictive simulations of the postural response following a backward support surface translation. Peak hip flexion angle was significantly correlated with three experimentally determined measures of effort, i.e., mechanical work, mean muscle activity and metabolic energy. Furthermore, a continuum of ankle and hip strategies was predicted in simulation when changing the relative importance of minimizing mechanical work and postural instability, with increased weighting of mechanical work resulting in an ankle strategy. In conclusion, the combination of experimental measurements and predictive simulations of the postural response to a backward support surface translation showed that the trade-off between effort and postural instability minimization can explain the selection of a specific postural response in the continuum of potential ankle and hip strategies.

Modulation of gluteus medius activity reflects the potential of the muscle to meet the mechanical demands during perturbed walking

Mediolateral stability during walking can be controlled by adjustment of foot placement. Reactive activity of gluteus medius (GM) is modulated during the gait cycle. However, the mechanisms behind the modulation are yet unclear. We measured reactive GM activity and kinematics in response to a mediolateral platform translation during different phases of the gait cycle. Forward simulations of perturbed walking were used to evaluate the isolated effect of the perturbation and the GM response on gait stability. We showed that the potential of GM to adjust lateral foot placement and prevent collisions during swing varies during the gait cycle and explains the observed modulation. The observed increase in stance, swing or combined GM activity causes an outward foot placement and therefore compensates for the loss of stability caused by a perturbation early in the gait cycle. GM activity of the swing leg in response to a platform translation late in the gait cycle counteracts foot placement, but prevents collision of the swing foot with the stance leg. This study provides insights in the neuromechanics of reactive control of gait stability and proposes a novel method to distinguish between the effect of perturbation force and reactive muscle activity on gait stability.

Increased sensory noise and not muscle weakness explains changes in non-stepping postural responses following stance perturbations in healthy elderly

The response to stance perturbations changes with age. The shift from an ankle to a hip strategy with increasing perturbation magnitude occurs at lower accelerations in older than in young adults. This strategy shift has been related to age-related changes in muscle and sensory function. However, the effect of isolated changes in muscle or sensory function on the responses following stance perturbations cannot be determined experimentally since changes in muscle and sensory function occur simultaneously. Therefore, we used predictive simulations to estimate the effect of isolated changes in (rates of change in) maximal joint torques, functional base of support, and sensory noise on the response to backward platform translations. To evaluate whether these modeled changes in muscle and sensory function could explain the observed changes in strategy; simulated postural responses with a torque-driven double inverted pendulum model controlled using optimal state feedback were compared to measured postural responses in ten healthy young and ten healthy older adults. The experimentally observed peak hip angle during the response was significantly larger (5°) and the functional base of support was smaller (0.04m) in the older than in the young adults but peak joint torques and rates of joint torque were similar during the recovery. The addition of noise to the sensed states in the predictive simulations could explain the observed increase in peak hip angle in the elderly, whereas changes in muscle function could not. Hence, our results suggest that strength training alone might be insufficient to improve postural control in elderly.

Real-Time Gait Event Detection Based on Kinematic Data Coupled to a Biomechanical Model †

Real-time detection of multiple stance events, more specifically initial contact (IC), foot flat (FF), heel off (HO), and toe off (TO), could greatly benefit neurorobotic (NR) and neuroprosthetic (NP) control. Three real-time threshold-based algorithms have been developed, detecting the aforementioned events based on kinematic data in combination with a biomechanical model. Data from seven subjects walking at three speeds on an instrumented treadmill were used to validate the presented algorithms, accumulating to a total of 558 steps. The reference for the gait events was obtained using marker and force plate data. All algorithms had excellent precision and no false positives were observed. Timing delays of the presented algorithms were similar to current state-of-the-art algorithms for the detection of IC and TO, whereas smaller delays were achieved for the detection of FF. Our results indicate that, based on their high precision and low delays, these algorithms can be used for the control of an NR/NP, with the exception of the HO event. Kinematic data is used in most NR/NP control schemes and is thus available at no additional cost, resulting in a minimal computational burden. The presented methods can also be applied for screening pathological gait or gait analysis in general in/outside of the laboratory.

A model of human non-stepping postural responses as the basis for a biomimetic control strategy for robot-assisted balance

We present an optimal feedback model of human standing balance that answers three open questions related to the complexity, energy requirements, and robustness of the control architecture and that will serve as the basis for a biomimetic control strategy for robot-assisted balance.