Modeling the Human Gait Phases by Using Bèzier Curves to Generate Walking Trajectories for Lower-Limb Exoskeletons.

The clinical usage of powered exoskeletons for the rehabilitation of patients affected by lower limb disorders has been constantly growing in the last decade. This paper presents a versatile and reliable gait pattern generator for these devices able to accommodate several gait requirements, i.e., step length, clearance, and time, and to suit a wide range of persons. In the proposed method, the human gait phases have been modeled with a set of trajectories as Bèzier curves, enabling a robotic lower-limb exoskeleton to walk in a continuous way, similarly to the physiological gait cycle. The kinematic, kinetic, and spatial requirements for each gait phase are translated into the control points of the Bèzier curves that define the trajectory for that phase. The outcome of this study has been tested on real scenarios with a group of healthy subjects wearing the TWIN lower-limb exoskeleton. They were asked to walk at different speeds, generally defined as slow, medium, and fast. The results are shown in terms of joint positions, velocities, and body-mass-normalized torques. The maximum hip and knee joint torque was observed in the support phase. While, at higher speeds the maximum hip torque was provided in the swing phase due to the mechanical properties and limits of the device. In terms of speed, all the subjects reached 0.44 m/s, which is the minimum required community ambulation.

Exploiting Natural Locomotion Synergies to Incorporate Motion of Crutches for Adaptive Gait Pattern Shaping.

This paper addresses the problem of online and adaptive gait pattern generation for powered lower-limb exoskeletons (PLLEs), exploiting the motion of sensorized crutches. We conduct a series of experiments with subjects walking with and without crutches to investigate the synergies of walking between upper and lower body segments, by adopting principal component analysis (PCA), We also evaluate the effect of using crutches on the walking synergies, and we demonstrate that upper and lower limb walking synergies undergo slight changes in that case. However, the upper and lower limb synergies remain evident and can be exploited in order to use the motion of crutches as an input to PLLEs to identify a desired motion of the lower limb. We propose a method to use the results of synergy analysis to shape gait parameters in the real-time control of PLLEs. To evaluate the scalability of our approach for real-world applications, we conduct a number of experiments with subjects wearing a PLLE and using sensorized crutches to adaptively change the gait parameters of walking steps, depending on upper body actions.

Layout of ancient Greek papyri through lead-drawn ruling lines revealed by Macro X-Ray Fluorescence Imaging.

The use of lead-drawn ruling lines by ancient scribes for the layout of Greek papyrus rolls was known to us only from classical authors and was postulated by a few scholars in modern times. In situ application of noninvasive Macro X-Ray Fluorescence Imaging Spectroscopy (MA-XRF) to unrolled papyri from Herculaneum, dating from about 200 BC to the 1st century AD, has provided the first direct evidence of such practice in ancient book production. The key experimental proof of periodic lines drawn in lead was gathered by a highly sensitive MA-XRF mobile instrument, which allowed detection of ultra-low trace residues of metals with detection limits that rival synchrotron light instruments. Elemental distribution maps of Pb have revealed three different systems of textual layout in ancient papyrus rolls and have resolved the dispute around so-called Maas' Law, by delivering experimental proof that slanted text columns were a deliberate aesthetic choice of scribes.

User-centered design and development of TWIN-Acta: A novel control suite of the TWIN lower limb exoskeleton for the rehabilitation of persons post-stroke.

Introduction: Difficulties faced while walking are common symptoms after stroke, significantly reducing the quality of life. Walking recovery is therefore one of the main priorities of rehabilitation. Wearable powered exoskeletons have been developed to provide lower limb assistance and enable training for persons with gait impairments by using typical physiological movement patterns. Exoskeletons were originally designed for individuals without any walking capacities, such as subjects with complete spinal cord injuries. Recent systematic reviews suggested that lower limb exoskeletons could be valid tools to restore independent walking in subjects with residual motor function, such as persons post-stroke. To ensure that devices meet end-user needs, it is important to understand and incorporate their perspectives. However, only a limited number of studies have followed such an approach in the post-stroke population. Methods: The aim of the study was to identify the end-users needs and to develop a user-centered-based control system for the TWIN lower limb exoskeleton to provide post-stroke rehabilitation. We thus describe the development and validation, by clinical experts, of TWIN-Acta: a novel control suite for TWIN, specifically designed for persons post-stroke. We detailed the conceived control strategy and developmental phases, and reported evaluation sessions performed on healthy clinical experts and people post-stroke to evaluate TWIN-Acta usability, acceptability, and barriers to usage. At each developmental stage, the clinical experts received a one-day training on the TWIN exoskeleton equipped with the TWIN-Acta control suite. Data on usability, acceptability, and limitations to system usage were collected through questionnaires and semi-structured interviews. Results: The system received overall good usability and acceptability ratings and resulted in a well-conceived and safe approach. All experts gave excellent ratings regarding the possibility of modulating the assistance provided by the exoskeleton during the movement execution and concluded that the TWIN-Acta would be useful in gait rehabilitation for persons post-stroke. The main limit was the low level of system learnability, attributable to the short-time of usage. This issue can be minimized with prolonged training and must be taken into consideration when planning rehabilitation. Discussion: This study showed the potential of the novel control suite TWIN-Acta for gait rehabilitation and efficacy studies are the next step in its evaluation process.

A new energetics model for the assessment of the power-duration relationship during over-ground running.

We evaluated the reliability of an over-ground running three-minute all-out test (3MT) and compared this to traditional multiple-visit testing to determine the critical speed (CS) and distance > CS (D´). Using a novel energetics model during the 3MT, critical power (CP) and work > CP (W´) were also evaluated for reliability and compared to the multiple-visit tests. Over-ground running speed was measured using Global Positioning Systems during fixed-speed trials on a 400 m track to exhaustion, at four intensities corresponding to: (i) maximal oxygen uptake (V˙O2max) (Vmax), (ii) 110% V˙O2max(110%Vmax), (iii) Δ70% (i.e. 70% of the difference between gas exchange threshold and Vmax) and (iv) Δ85%. The participants subsequently performed the 3MT across two days to determine its reliability. There were no differences between the multiple-visit testing and the 3MT for CS (P = 0.328) and D´ (P = 0.919); however, CP (P = 0.02) and W´ (P < 0.001) were higher in the 3MT. The reliability of the 3MT was stable (P > 0.05) between trials for all variables, with coefficient of variation ranging from 2.0-8.1%. The current over-ground energetics model can reliably estimate CP and W´ based on GPS speed data during the 3MT, which supports its use for most athletic training and monitoring purposes. The reliability of the over-ground running 3MT for power- and speed-related indices was sufficient to detect typical training adaptations; however, it may overestimate CP (∼ 25 W) and W´ (∼ 7 kJ) compared to multiple-visit tests.

User-Centered Design and Development of the Modular TWIN Lower Limb Exoskeleton.

For decades, powered exoskeletons have been considered for possible employment in rehabilitation and personal use. Yet, these devices are still far from addressing the needs of users. Here, we introduce TWIN, a novel modular lower limb exoskeleton for personal use of spinal-cord injury (SCI) subjects. This system was designed according to a set of user requirements (lightweight and autonomous portability, quick and autonomous donning and setup, stability when standing/walking, cost effectiveness, long battery life, comfort, safety) which emerged during participatory investigations that organically involved patients, engineers, designers, physiatrists, and physical therapists from two major rehabilitation centers in Italy. As a result of this user-centered process, TWIN's design is based on a variety of small mechatronic modules which are meant to be easily assembled and donned on or off by the user in full autonomy. This paper presents the development of TWIN, an exoskeleton for personal use of SCI users, and the application of user-centered design methods that are typically adopted in medical device industry, for its development. We can state that this approach revealed to be extremely effective and insightful to direct and continuously adapt design goals and activities toward the addressment of user needs, which led to the development of an exoskeleton with modular mechatronics and novel lateral quick release systems. Additionally, this work includes the preliminary assessment of this exoskeleton, which involved healthy volunteers and a complete SCI patient. Tests validated the mechatronics of TWIN and emphasized its high potential in terms of system usability for its intended use. These tests followed procedures defined in existing standards in usability engineering and were part of the formative evaluation of TWIN as a premise to the summative evaluation of its usability as medical device.

Cryptogenic organising pneumonia: an unusual cause of pleuritic chest pain.

A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient's clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.

Lumbosacral spondylodiscitis complicated by sepsis, osteomyelitis, epidural abscess formation and deep vein thrombosis.

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2-3 and L5-S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient's clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study.

OBJECTIVE/AIM: Septic arthritis is an uncommon but important disease with significant morbidity and mortality, especially if inadequately managed. The aim of this epidemiological study was to identify the characteristics and outcomes of patients treated for septic arthritis at Mater Dei Hospital, Malta, over a 10-year period. METHODS: This was a retrospective observational study. Patients diagnosed with septic arthritis between 2008 and 2018 were recruited. Cases were identified by reviewing all inhospital episodes of patients diagnosed with septic arthritis according to Newman criteria. RESULTS: There were 124 cases of native joint septic arthritis and 138 of prosthetic joint infection. Cases were present amongst all age groups, with the highest incidence amongst those aged 61-70 years for both native and prosthetic infections. Fever was present in around 40% of cases. Raised white cell count was prevalent in 66.9% of native joint infections and 52.9% of prosthetic joints. Elevated C-reactive protein was overwhelmingly seen in most cases, present in 93.5% (median=159.5 mg/L; IQR=85.8-291) of native joints and 92.0% of prosthetic joint infections (median=68.7 mg/L; IQR=20.5-186). Over 55% of patients had one or more risk factors for joint sepsis, diabetes mellitus being the most prevalent clinical comorbidity (22.6% and 24.6% for native and prosthetic joint infections respectively). Synovial cultures were positive in 66% and 82% of native and prosthetic joint aspirates respectively. Staphylococcus aureus was the most commonly isolated organism from both native and prosthetic joint infection, followed by streptococcal infections in native joints and coagulase negative staphylococci and gram-negative infections in prosthetic joints. Fifteen deaths were directly attributed to joint sepsis. CONCLUSION: Absence of fever and elevated white cell count does not exclude the diagnosis. The mortality rate due to septic arthritis in this cohort of patients was found to be 5.7%. All deaths occurred in elderly patients with clinical comorbidities suggesting that this group is at highest risk.

Exercise tolerance during flat over-ground intermittent running: modelling the expenditure and reconstitution kinetics of work done above critical power.

PURPOSE: We compared a new locomotor-specific model to track the expenditure and reconstitution of work done above critical power (W´) and balance of W´ (W´BAL) by modelling flat over-ground power during exhaustive intermittent running. METHOD: Nine male participants completed a ramp test, 3-min all-out test and the 30-15 intermittent fitness test (30-15 IFT), and performed a severe-intensity constant work-rate trial (SCWR) at the maximum oxygen uptake velocity (vV̇O2max). Four intermittent trials followed: 60-s at vV̇O2max + 50% Δ1 (Δ1 = vV̇O2max - critical velocity [VCrit]) interspersed by 30-s in light (SL; 40% vV̇O2max), moderate (SM; 90% gas-exchange threshold velocity [VGET]), heavy (SH; VGET + 50% Δ2 [Δ2 = VCrit - VGET]), or severe (SS; vV̇O2max - 50% Δ1) domains. Data from Global Positioning Systems were derived to model over-ground power. The difference between critical and recovery power (DCP), time constant for reconstitution of W´ ([Formula: see text]), time to limit of tolerance (TLIM), and W´BAL from the integral (W´BALint), differential (W´BALdiff), and locomotor-specific (OG-W´BAL) methods were compared. RESULTS: The relationship between [Formula: see text] and DCP was exponential (r2 = 0.52). The [Formula: see text] for SL, SM, and SH trials were 119 ± 32-s, 190 ± 45-s, and 336 ± 77-s, respectively. Actual TLIM in the 30-15 IFT (968 ± 117-s) compared closely to TLIM predicted by OG-W´BAL (929 ± 94-s, P > 0.100) and W´BALdiff (938 ± 84-s, P > 0.100) but not to W´BALint (848 ± 91-s, P = 0.001). CONCLUSION: The OG-W´BAL accurately tracked W´ kinetics during intermittent running to exhaustion on flat surfaces.

How do walkers behave when crossing the way of a mobile robot that replicates human interaction rules?

Previous studies showed the existence of implicit interaction rules shared by human walkers when crossing each other. Especially, each walker contributes to the collision avoidance task and the crossing order, as set at the beginning, is preserved along the interaction. This order determines the adaptation strategy: the first arrived increases his/her advance by slightly accelerating and changing his/her heading, whereas the second one slows down and moves in the opposite direction. In this study, we analyzed the behavior of human walkers crossing the trajectory of a mobile robot that was programmed to reproduce this human avoidance strategy. In contrast with a previous study, which showed that humans mostly prefer to give the way to a non-reactive robot, we observed similar behaviors between human-human avoidance and human-robot avoidance when the robot replicates the human interaction rules. We discuss this result in relation with the importance of controlling robots in a human-like way in order to ease their cohabitation with humans.

How do walkers avoid a mobile robot crossing their way?

Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.