A usability study on the inGAIT-VSO: effects of a variable-stiffness ankle-foot orthosis on the walking performance of children with cerebral palsy.

Background: Ankle-foot orthoses (AFOs) are commonly used by children with cerebral palsy (CP), but traditional solutions are unable to address the heterogeneity and evolving needs amongst children with CP. One key limitation lies in the inability of current passive devices to customize the torque-angle relationship, which is essential to adapt the support to the specific individual needs. Powered alternatives can provide customized behavior, but often face challenges with reliability, weight, and cost.

Experiment-free exoskeleton assistance via learning in simulation.

Exoskeletons have enormous potential to improve human locomotive performance. However, their development and broad dissemination are limited by the requirement for lengthy human tests and handcrafted control laws. Here we show an experiment-free method to learn a versatile control policy in simulation.

Reliability and minimal detectable change of stiffness and other mechanical properties of the ankle joint in standing and walking.

Background: Ankle joint stiffness and viscosity are fundamental mechanical descriptions that govern the movement of the body and impact an individual's walking ability. Hence, these internal properties of a joint have been increasingly used to evaluate the effects of pathology (e.g.

Comparison of Two Design Principles of Unpowered Ankle-Foot Orthoses for Supporting Push-Off: A Case Study.

Ankle propulsion is essential for efficient human walking. In recent years, several working principles have been investigated and applied to ankle-foot orthoses (AFOs) to enhance the work of the plantarflexor muscles and achieve proper propulsion during gait. Comparing the performance and effectiveness of different designs is difficult because researchers do not have a standardized set of criteria and procedures to follow.

Design of a Quasi-Passive Ankle-Foot Orthosis with Customizable, Variable Stiffness.

Most commercial ankle-foot orthoses (AFOs) are passive structures that cannot modulate stiffness to assist with a diverse range of activities, such as stairs and ramps. It is sometimes possible to change the stiffness of passive AFOs through reassembly or benchtop adjustment, but they cannot change stiffness during use. Passive AFOs are also limited in their ankle mechanics and cannot replicate a biomimetic, nonlinear torque-angle relationship.

User preference optimization for control of ankle exoskeletons using sample efficient active learning.

One challenge to achieving widespread success of augmentative exoskeletons is accurately adjusting the controller to provide cooperative assistance with their wearer. Often, the controller parameters are "tuned" to optimize a physiological or biomechanical objective. However, these approaches are resource intensive, while typically only enabling optimization of a single objective.

Data-Driven Variable Impedance Control of a Powered Knee-Ankle Prosthesis for Adaptive Speed and Incline Walking.

Most impedance-based walking controllers for powered knee-ankle prostheses use a finite state machine with dozens of user-specific parameters that require manual tuning by technical experts. These parameters are only appropriate near the task (., walking speed and incline) at which they were tuned, necessitating many different parameter sets for variable-task walking.

Real-Time Gait Phase and Task Estimation for Controlling a Powered Ankle Exoskeleton on Extremely Uneven Terrain.

Positive biomechanical outcomes have been reported with lower-limb exoskeletons in laboratory settings, but these devices have difficulty delivering appropriate assistance in synchrony with human gait as the task or rate of phase progression change in real-world environments. This paper presents a controller for an ankle exoskeleton that uses a data-driven kinematic model to continuously estimate the phase, phase rate, stride length, and ground incline states during locomotion, which enables the real-time adaptation of torque assistance to match human torques observed in a multi-activity database of 10 able-bodied subjects. We demonstrate in live experiments with a new cohort of 10 able-bodied participants that the controller yields phase estimates comparable to the state of the art, while also estimating task variables with similar accuracy to recent machine learning approaches.

Enhancing Voluntary Motion with Modular, Backdrivable, Powered Hip and Knee Orthoses.

Mobility disabilities are prominent in society with wide-ranging deficits, motivating modular, partial-assist, lower-limb exoskeletons for this heterogeneous population. This paper introduces the Modular Backdrivable Lower-limb Unloading Exoskeleton (M-BLUE), which implements high torque, low mechanical impedance actuators on commercial orthoses with sheet metal modifications to produce a variety of hip- and/or knee-assisting configurations. Benchtop system identification verifies the desirable backdrive properties of the actuator, and allows for torque prediction within ±0.

Designing Custom Mechanics in Running-Specific Prosthetic Feet via Shape Optimization.

Objective: Running-specific prosthetic feet are curved cantilever springs, distinguished from ordinary prosthetic feet by their size, shape, and greater ability to store and return elastic potential energy. Finite element analyses show how modifications to prosthesis shape alter the multidimensional and nonlinear mechanics, but designers seeking to prescribe custom mechanics are limited by the complex constraints and high dimensionality of possible geometries.

Methods: We introduce two simple formulations for describing foot mechanics, and use them with a custom spline-based shape optimization to generate new prosthetic foot shapes given desired endpoint mechanics.

Analysis of the Bayesian Gait-State Estimation Problem for Lower-Limb Wearable Robot Sensor Configurations.

Many exoskeletons today are primarily tested in controlled, steady-state laboratory conditions that are unrealistic representations of their real-world usage in which walking conditions (.., speed, slope, and stride length) change constantly.

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.

Can humans perceive the metabolic benefit provided by augmentative exoskeletons?

Background: The purpose of augmentative exoskeletons is to help people exceed the limitations of their human bodies, but this cannot be realized unless people choose to use these exciting technologies. Although human walking efficiency has been highly optimized over generations, exoskeletons have been able to consistently improve this efficiency by 10-15%. However, despite these measurable improvements, exoskeletons today remain confined to the laboratory.

How Does Ankle Mechanical Stiffness Change as a Function of Muscle Activation in Standing and During the Late Stance of Walking?

Objective: Ankle joint stiffness is known to be modulated by co-contraction of the ankle muscles; however, it is unclear to what extent changes in agonist muscle activation alone affect ankle joint stiffness. This study tested the effects of varying levels of ankle muscle activation on ankle joint mechanical stiffness in standing and during the late stance phase of walking.

Methods: Dorsiflexion perturbations were applied at various levels of ankle muscle activation via a robotic platform in standing and walking conditions.

Understanding patient preference in prosthetic ankle stiffness.

Background: User preference has the potential to facilitate the design, control, and prescription of prostheses, but we do not yet understand which physiological factors drive preference, or if preference is associated with clinical benefits.

Methods: Subjects with unilateral below-knee amputation walked on a custom variable-stiffness prosthetic ankle and manipulated a dial to determine their preferred prosthetic ankle stiffness at three walking speeds. We evaluated anthropomorphic, metabolic, biomechanical, and performance-based descriptors at stiffness levels surrounding each subject's preferred stiffness.

Characterization and clinical implications of ankle impedance during walking in chronic stroke.

Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering, these concepts are described as stiffness and damping, or collectively as joint mechanical impedance, when considered with limb inertia. Typical clinical assessments of these properties are obtained while the patient is at rest using qualitative measures, and the link between the assessments and functional outcomes and mobility is unclear.

A passive mechanism for decoupling energy storage and return in ankle-foot prostheses: A case study in recycling collision energy.

Individuals with lower limb amputation experience reduced ankle push-off work in the absence of functional muscles spanning the joint, leading to decreased walking performance. Conventional energy storage and return (ESR) prostheses partially compensate by storing mechanical energy during midstance and returning this energy during the terminal stance phase of gait. These prostheses can provide approximately 30% of the push-off work performed by a healthy ankle-foot during walking.

Validation of Methods for Estimation of Knee Joint Mechanical Impedance During Locomotion Using a Torque-Controllable Knee Exoskeleton.

The mechanical impedance of the joints of the leg governs the body's response to external disturbances, and its regulation is essential for the completion of tasks of daily life. However, it is still unclear how this quantity is regulated at the knee during dynamic tasks. In this work, we introduce a method to estimate the mechanical impedance of spring-mass systems using a torque-controllable exoskeleton with the intention of extending these methods to characterize the mechanical impedance of the human knee during locomotion.

Design and clinical implementation of an open-source bionic leg.

In individuals with lower-limb amputations, robotic prostheses can increase walking speed, and reduce energy use, the incidence of falls and the development of secondary complications. However, safe and reliable prosthetic-limb control strategies for robust ambulation in real-world settings remain out of reach, partly because control strategies have been tested with different robotic hardware in constrained laboratory settings. Here, we report the design and clinical implementation of an integrated robotic knee-ankle prosthesis that facilitates the real-world testing of its biomechanics and control strategies.

Comparing preference of ankle-foot stiffness in below-knee amputees and prosthetists.

When fitting prosthetic feet, prosthetists fuse information from their visual assessment of patient gait with the patient's communicated perceptions and preferences. In this study, we sought to simultaneously and independently assess patient and prosthetist preference for prosthetic foot stiffness using a custom variable-stiffness prosthesis. In the first part of the experiment, seven subjects with below-knee amputation walked on the variable-stiffness prosthetic foot set to a randomized stiffness, while several prosthetist subjects simultaneously observed their gait.

Mapping the relationships between joint stiffness, modeled muscle stiffness, and shear wave velocity.

Joint stiffness is often measured to make inferences about the stiffness of muscle groups, but little can be gleaned about individual muscles. Decomposing the muscular origins of joint stiffness may inform treatment targets for conditions like spasticity. To complement joint stiffness, shear wave ultrasound elastography has been used to estimate the material properties of individual muscles.

Neuromotor Regulation of Ankle Stiffness is Comparable to Regulation of Joint Position and Torque at Moderate Levels.

Joint mechanical impedance, which describes the instantaneous relationship between kinematic perturbations and the resulting torque response, plays an important role in the way humans ambulate, interact with the environment, and respond to disturbances. Recent studies have quantified how the stiffness component of mechanical impedance varies during walking. However, the extent to which humans can voluntarily regulate leg joint stiffness is not yet known.

Ankle Mechanical Impedance During the Stance Phase of Running.

Objective: Differences in locomotor biomechanics between walking and running provide fundamental information about human ambulation. Joint mechanical impedance is a biomechanical property that governs the body's instantaneous response to disturbances, and is important for stability and energy transfer. Ankle impedance has been characterized during walking, but little is known about how humans alter joint impedance during running.

Methods for Describing and Characterizing the Mechanical Behavior of Running-Specific Prosthetic Feet.

Current methods for describing and characterizing the mechanical behavior of running-specific prosthetic feet are incomplete, and this has limited our understanding of how design parameters impact athlete performance. Deflections induced by most ground reaction forces consist of vertical, horizontal, and angular components, but previous work has focused only on the vertical component. Furthermore, the deflection depends heavily on the direction of the force, which changes throughout stance phase of running.

Ankle Mechanical Impedance During Waling in Chronic Stroke: Preliminary Results.

Dynamic joint mechanics, collectively known as mechanical impedance, are often altered following upper motoneuron disease, which can hinder mobility for these individuals. Typically, assessments of altered limb mechanics are obtained while the patient is at rest, which differs from the dynamic conditions of mobility. The purpose of this study was to quantify ankle impedance during walking in individuals post-stroke, determine differences from the healthy population, and assess the relationship between impedance impairment and clinical outcome measures.