An Able-Bodied Study for Potential Usage of a Knee Scooter as a Constraint-Induced Movement Therapy (CIMT) Gait Training Device.

Post-stroke gait is characterized by slow and asymmetrical hemiparetic gait. This is attributed to the paretic lower limb which has limited plantar propulsion. The most effective method to restore paretic limb function is constraint-induced movement therapy (CIMT), which promotes the usage of the paretic limb by restricting the movement of the unafflicted limb. However, due to the necessity of both lower limbs to perform gait, CIMT methods could not be directly applied for gait rehabilitation. In this study, we explore the feasibility of utilizing a knee scooter as a means to facilitate CIMT gait training. We hypothesize that if lower limb kinematics and muscle activation patterns during gait with a knee scooter match that of natural gait, the knee scooter could be utilized for CIMT gait training. We measured the lower-limb joint angles, plantar force, EMG patterns, stride length, and step times of 13 healthy subjects during gait with a knee scooter and natural gait. The results suggest that the gait patterns while using the knee scooter closely resemble those of natural gait.

A Novel Tilted-Plane Ergometer System for Subject-Specific Rehabilitation.

Immobilization due to various reasons can lead to disuse muscle atrophy. If prolonged, the circumstance is exacerbated and may lead to joint contracture, dysfunction, and long-term sequela. Thus, a balanced exercise regimen is crucial. While able-bodied individuals can perform a variety of exercises, bedridden patients typically resort to exercising primarily with bicycle ergometers. However, since the pedaling trajectory with ergometers is confined to the sagittal plane, muscles responsible for medial-lateral movement and balance are not effectively trained. Furthermore, the direction of joint reaction forces, which is crucial for specific patients with ligament injuries, recurrent dislocations, and medial osteoarthritis, is not well facilitated. Thus, it would be beneficial for patients without full body weight support ability to train ab-/ad-ductor muscles by altering the direction of extrinsic load via ergometers. In this study, we present a novel Tilted-Plane Ergometer and proof-of-concept experiment with one healthy subject. The results suggest that subtle changes in ergometer configurations lead to different movements, joint alignments, and muscle recruitment patterns.

Investigation with able-bodied subjects suggests Myosuit may potentially serve as a stair ascent training robot.

Real world settings are seldomly just composed of level surfaces and stairs are frequently encountered in daily life. Unfortunately, ~ 90% of the elderly population use some sort of compensation pattern in order to negotiate stairs. Because the biomechanics required to successfully ascend stairs is significantly different from level walking, an independent training protocol is warranted. Here, we present as a preliminary investigation with 11 able-bodied subjects, prior to clinical trials, whether Myosuit could potentially serve as a stair ascent training robot. Myosuit is a soft wearable exosuit that was designed to assist the user via hip and knee extension during the early stance phase. We hypothesized that clinical studies could be carried out if the lower limb kinematics, sensory feedback via plantar force, and electromyography (EMG) patterns do not deviate from the user's physiological stair ascent patterns while reducing hip and knee extensor demand. Our results suggest that Myosuit conserves the user's physiological kinematic and plantar force patterns. Moreover, we observe approximately 20% and 30% decrease in gluteus maximus and vastus medialis EMG levels in the pull up phase, respectively. Collectively, Myosuit reduces the hip and knee extensor demand during stair ascent without any introduction of significant compensation patterns.

Classification of gait phases based on a machine learning approach using muscle synergy.

The accurate detection of the gait phase is crucial for monitoring and diagnosing neurological and musculoskeletal disorders and for the precise control of lower limb assistive devices. In studying locomotion mode identification and rehabilitation of neurological disorders, the concept of modular organization, which involves the co-activation of muscle groups to generate various motor behaviors, has proven to be useful. This study aimed to investigate whether muscle synergy features could provide a more accurate and robust classification of gait events compared to traditional features such as time-domain and wavelet features. For this purpose, eight healthy individuals participated in this study, and wireless electromyography sensors were attached to four muscles in each lower extremity to measure electromyography (EMG) signals during walking. EMG signals were segmented and labeled as 2-class (stance and swing) and 3-class (weight acceptance, single limb support, and limb advancement) gait phases. Non-negative matrix factorization (NNMF) was used to identify specific muscle groups that contribute to gait and to provide an analysis of the functional organization of the movement system. Gait phases were classified using four different machine learning algorithms: decision tree (DT), k-nearest neighbors (KNN), support vector machine (SVM), and neural network (NN). The results showed that the muscle synergy features had a better classification accuracy than the other EMG features. This finding supported the hypothesis that muscle synergy enables accurate gait phase classification. Overall, the study presents a novel approach to gait analysis and highlights the potential of muscle synergy as a tool for gait phase detection.

Biomechanical Analysis of the Unaffected Limb While Using a Hands-Free Crutch.

Basic human ambulation relies on a bipedal gait, which has been reported to be directly related to quality of life. However, injuries to the lower limb can cause an inability to walk and require non-weightbearing periods to heal. Among the many ambulatory aids, standard axillary crutches are prescribed. However, due to the disadvantages of having to use both hands, a slow gait, pain, nerve damage, and gait patterns that differ from that of healthy subjects, currently, a new generation of ambulatory aids has emerged. Among such aids, hands-free crutches (HFCs) are of particular interest due to their form factor, which does not require the use of the hands and facilitates a bipedal gait. In this study, we present an assessment of whether any different gait patterns, compared to overground gait, appeared on the unaffected limb during walking with an HFC. The spatiotemporal parameters, plantar force, lower-limb joint angles, and EMG patterns were evaluated. In conclusion, the results from 10 healthy subjects suggest that wearing an HFC causes only slight changes in the biomechanical gait patterns examined in the unaffected limb compared with overground walking without an HFC.

Estimation of Functional Reserve in Patients with Hospital-Associated Deconditioning.

BACKGROUND: This study aimed to analyze the applicability of sit-to-stand (STS) muscle power tests for evaluating functional reserve in patients with hospital-associated deconditioning (HAD). METHODS: This study is a single group preliminary observational study. STS tests were performed in the early stages of comprehensive rehabilitation treatment, and the interval changes in the clinical indicators were assessed after four weeks of clinical observation. A STS capacity ratio was estimated by the time duration of five STS repetitions (5r-STS) and the maximum number of STS repetitions over 30 s (30s-STS); the activities were measured using a three-dimension motion capture system and force plate. RESULTS: After 4 weeks of comprehensive rehabilitation, the 10 m gait speed (p = 0.004), hand grip power (p = 0.022), hip extensor power (p = 0.002), Berg balance scale (p < 0.001), and modified Barthel index (MBI) (p = 0.001), respectively, were significantly improved. The force plate-derived (FPD) 30s-STS power and the number of repeats in the FPD 30s-STS showed a positive correlation with improvements in the hand grip power (Spearman's Rho = 0.477, p = 0.045), hip extensor power (Spearman's Rho = 0.482, p = 0.043), and MAI (Spearman's Rho = 0.481, p = 0.043), respectively. The STS capacity ratio was correlated with higher improvements in the 10 m gait speed (Spearman's Rho = 0.503, p = 0.034), hip extensor power (Spearman's Rho = 0.494, p = 0.037), and MBI (Spearman's Rho = 0.595, p = 0.009). Despite individual variability in the differences between the FPD and estimated STS power, the results for the correlation between the STS capacity ratio and clinical outcomes were consistent. CONCLUSIONS: The STS capacity ratio showed a positive correlation with the clinical outcomes, including gait speed, and may reflect a part of the functional reserve excluding the individual variability of performance.

Biomechanical Analysis Suggests Myosuit Reduces Knee Extensor Demand during Level and Incline Gait.

An FDA-approved soft wearable robot, the Myosuit, which was designed to provide hip and knee extension torque has recently been commercialized. While studies have reported reductions in metabolic costs, increased gait speeds, and improvements in clinical test scores, a comprehensive analysis of electromyography (EMG) signals and joint kinematics is warranted because the recruitment of appropriate muscle groups during physiological movement patterns facilitates effective motor learning. Here, we compared the lower limb joint kinematics and EMG patterns while wearing the Myosuit with that of unassisted conditions when performing level overground and incline treadmill gait. The level overground gait sessions (seven healthy subjects) were performed at self-selected speeds and the incline treadmill gait sessions (four healthy subjects) were performed at 2, 3, 4, and 5 km/h. In order to evaluate how the user is assisted, we conducted a biomechanical analysis according to the three major gait tasks: weight acceptance (WA), single-limb support, and limb advancement. The results from the gait sessions suggest that Myosuit not only well preserves the users' natural patterns, but more importantly reduce knee extensor demand during the WA phase for both level and incline gait.

A smart insole system capable of identifying proper heel raise posture for chronic ankle instability rehabilitation.

Heel raise is widely prescribed to patients with chronic ankle instability in order to strengthen the Peroneus Longus muscle (PL) which supports the weakened lateral collateral ligaments. While the exercise itself is intuitive, ankle orientation is of particular importance because heel raises performed with inversion do not well recruit the PL. This implies that proper execution is imperative and a means to assess heel raise training sessions is needed. In this study we present a smart insole system capable of identifying heel raise events and its corresponding rise, hold and drop phases, which allows for a more descriptive analysis. The results from our heel raise sessions, which consist of four different variants performed by five healthy subjects, suggest that medial-lateral foot pressure distribution and foot orientation are needed to differentiate heel raises performed with ankle eversion and inversion. We go further and substantiate that proper execution, detected by our system, indeed leads to increased PL activation by analyzing the electromyography signals. We believe that the proposed system may provide clinicians with invaluable information regarding onsite as well as at-home training and possibly, with biofeedback, serve as foundation for software as a medical device.

Pathological gait clustering in post-stroke patients using motion capture data.

BACKGROUND: Analyzing the complex gait patterns of post-stroke patients with lower limb paralysis is essential for rehabilitation. RESEARCH QUESTION: Is it feasible to use the full joint-level kinematic features extracted from the motion capture data of patients directly to identify the optimal gait types that ensure high classification performance? METHODS: In this study, kinematic features were extracted from 111 gait cycle data on joint angles, and angular velocities of 36 post-stroke patients were collected eight times over six months using a motion capture system. Simultaneous clustering and classification were applied to determine the optimal gait types for reliable classification performance. RESULTS: In the given dataset, six optimal gait groups were identified, and the clustering and classification performances were denoted by a silhouette coefficient of 0.1447 and F1 score of 1.0000, respectively. SIGNIFICANCE: There is no distinct clinical classification of post-stroke hemiplegic gaits. However, in contrast to previous studies, more optimal gait types with a high classification performance fully utilizing the kinematic features were identified in this study.

Cyclic Stretching Induces Maturation of Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes through Nuclear-Mechanotransduction.

BACKGROUND: During cardiogenesis, cardiac cells receive various stimuli, such as biomechanical and chemical cues, from the surrounding microenvironment, and these signals induce the maturation of heart cells. Mechanical force, especially tensile force in the heart, is one of the key stimuli that induce cardiomyocyte (CM) maturation through mechanotransduction, a process through which physical cues are transformed into biological responses. However, the effects and mechanisms of tensile force on cell maturation are poorly studied. METHODS: In this study, we developed a cyclic stretch system that mimics the mechanical environment of the heart by loading tensile force to human-induced pluripotent stem cell (hiPSC)-derived CMs. hiPSC-CMs cultured with the cyclic stretch system analyzed morphological change, immunofluorescent staining, expression of maturation markers in mRNA, and beating properties compared to static cultures. RESULTS: hiPSC-CMs cultured with the cyclic stretch system showed increased cell alignment, sarcomere length and expression of maturation markers in mRNA, such as TNNI3, MYL2 and TTN, compared to static cultures. Especially, the expression of genes related to nuclear mechanotransduction, such as Yap1, Lamin A/C, plectin, and desmin, was increased in the cyclically stretched hiPSC-CMs. Furthermore, the volume of the nucleus was increased by as much as 120% in the cyclic stretch group. CONCLUSION: These results revealed that nuclear mechanotransduction induced by tensile force is involved in CM maturation. Together, these findings provide novel evidence suggesting that nuclear mechanotransduction induced by tensile force is involved in the regulation of cardiac maturation.

The effect of pelvic movements of a gait training system for stroke patients: a single blind, randomized, parallel study.

BACKGROUND: Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. METHOD: Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. EXPERIMENT: Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. RESULT: Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. CONCLUSION: Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. CLINICAL TRIAL REGISTRATION: KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310<ype=&rtype=.

Development of Magnetic Torque Stimulation (MTS) Utilizing Rotating Uniform Magnetic Field for Mechanical Activation of Cardiac Cells.

Regulation of cell signaling through physical stimulation is an emerging topic in biomedicine. BACKGROUND: While recent advances in biophysical technologies show capabilities for spatiotemporal stimulation, interfacing those tools with biological systems for intact signal transfer and noncontact stimulation remains challenging. Here, we describe the use of a magnetic torque stimulation (MTS) system combined with engineered magnetic particles to apply forces on the surface of individual cells. MTS utilizes an externally rotating magnetic field to induce a spin on magnetic particles and generate torsional force to stimulate mechanotransduction pathways in two types of human heart cells-cardiomyocytes and cardiac fibroblasts. METHODS: The MTS system operates in a noncontact mode with two magnets separated (60 mm) from each other and generates a torque of up to 15 pN µm across the entire area of a 35-mm cell culture dish. The MTS system can mechanically stimulate both types of human heart cells, inducing maturation and hypertrophy. RESULTS: Our findings show that application of the MTS system under hypoxic conditions induces not only nuclear localization of mechanoresponsive YAP proteins in human heart cells but also overexpression of hypertrophy markers, including ß-myosin heavy chain (ßMHC), cardiotrophin-1 (CT-1), microRNA-21 (miR-21), and transforming growth factor beta-1 (TGFß-1). CONCLUSIONS: These results have important implications for the applicability of the MTS system to diverse in vitro studies that require remote and noninvasive mechanical regulation.

Development of a Novel Robotic Rehabilitation System With Muscle-to-Muscle Interface.

In this study, we developed a novel robotic system with a muscle-to-muscle interface to enhance rehabilitation of post-stroke patients. The developed robotic rehabilitation system was designed to provide patients with stage appropriate physical rehabilitation exercise and muscular stimulation. Unlike the position-based control of conventional bimanual robotic therapies, the developed system stimulates the activities of the target muscles, as well as the joint movements of the paretic limb. The robot-assisted motion and the electrical stimulation on the muscles of the paretic side are controlled by on-line comparison of the motion and the muscle activities between the paretic and unaffected sides. With the developed system, the rehabilitation exercise can be customized and modulated depending on the patient's stage of motor recovery after stroke. The system can be operated in three different modes allowing both passive and active exercises. The effectiveness of the developed system was verified with healthy human subjects, where the subjects were paired to serve as the unaffected side and the paretic side of a hemiplegic patient.

Gaussian Process Trajectory Learning and Synthesis of Individualized Gait Motions.

This paper proposes a Gaussian process-based method for trajectory learning and generation of individualized gait motions at arbitrary user-designated walking speeds, intended to be used in generating reference motions for robotic gait rehabilitation systems. We utilize a nonlinear dimension reduction technique based on Gaussian process dynamical models (GPDMs), in which the internal dynamics is modeled as a second-order Markov process evolving in a lower-dimensional latent space. After the GPDM parameters are identified with training data obtained from gait motions of healthy subjects walking at different speeds, our method then employs Gaussian process regression (GPR) to predict the initial two states of the latent space dynamics from any arbitrary desired walking speed and the anthropometric parameters of the test subject. Motions are then generated by directly mapping the latent space dynamics to joint trajectories. Experimental studies involving more than 100 subjects indicate that our method generates gait patterns with 30% less mean square prediction errors compared to recent state-of-the-art methods, while also allowing for arbitrary user-specified walking speeds.

Prediction Method of Walking Speed at Swing Phase using Soleus Electromyogram Signal at Previous Stance Phase.

A recent research has proposed a prediction method of walking speed with soleus electromyogram (EMG) signal activation level at push-off phase. However, the prediction of walking speed at low speed is inaccurate and the coefficients of determination (R2 values) of the used linear regression model is low. In this study, we propose a new method for predicting walking speed during swing phase with soleus EMG signal activation levels at pre-load and push-off phases, and square root value is used as a feature. The proposed method is verified by walking experiment with 5 nondisabled subjects. (R2 values) of the new method is improved by 10.3 % than that of the method used in the previous study. And the proposed method improves accuracy mainly at low speed and precision at high speed to predict a correct walking speed throughout walking speed range. Thus, the proposed method enhances the performance of the prediction model of walking speed without being biased in the range of high or low speed. The proposed method has potential to be used to control the gait speed of a lower-limb exoskeleton according to wearer's gait intention.

Development of Gait Rehabilitation System Capable of Assisting Pelvic Movement of Normal Walking.

Gait rehabilitation training with robotic exoskeleton is drawing attention as a method for more advanced gait rehabilitation training. However, most of the rehabilitation robots are mainly focused on locomotion training in the sagittal plane. This study introduces a novel gait rehabilitation system with actuated pelvic motion to generate natural gait motion. The rehabilitation robot developed in this study, COWALK, is a lower-body exoskeleton system with 15 degrees of freedom (DoFs). The COWALK can generate multi-DoF pelvic movement along with leg movements. To produce natural gait patterns, the actuation of pelvic movement is essential. In the COWALK, the pelvic movement mechanism is designed to help hemiplegic patients regain gait balance during gait training. To verify the effectiveness of the developed system, the gait patterns with and without pelvic movement were compared to the normal gait on a treadmill. The experimental results show that the active control of pelvic movement combined with the active control of leg movement can make the gait pattern much more natural.

Walking speed intention model using soleus electromyogram signal of nondisabled and post-stroke hemiparetic patients.

It is well known that the activation of plantar flexors have a strong influence on the walking speed. If the gait speed can be predicted using this relationship, a post-stroke hemiparetic patient could control a gait rehabilitation robot according to his or her gait intention, and the robotic gait rehabilitation effect could be further improved. To find out this relationship, 9 nondisabled subjects and 4 chronic post-stroke hemiparetic subjects performed overground level walking at a comfortable pace, a slow pace, a fast pace, and an increasing pace with electromyogram sensors attached on plantar flexors. Soleus among plantar flexors showed the most stable relationship with walking speed. The relationship between maximum activation level of soleus electromyogram during stance phase before toe-off and walking speed during swing phase after the same toe-off was modeled by a polynomial regression model. The model outputs were then compared to the measured walking speeds using coefficients of determination (R2). The average R2 values are 0.594 and 0.692 for 1st· and 2nd order models respectively in the nondisabled subjects. The average R2 values are 0.598 and 0.623 for the unaffected side and 0.388 and 0.394 for the affected side in the chronic subjects. The results show the feasibility of applying the soleus-walking speed relationship to control the robot gait speed at will. A walking speed estimation method is proposed using only a walking step in real time.

Intentional Movement Performance Ability (IMPA): a method for robot-aided quantitative assessment of motor function.

The purpose of this paper is to propose a new assessment method for evaluating motor function of the patients who are suffering from physical weakness after stroke, incomplete spinal cord injury (iSCI) or other diseases. In this work, we use a robotic device to obtain the information of interaction occur between patient and robot, and use it as a measure for assessing the patients. The Intentional Movement Performance Ability (IMPA) is defined by the root mean square of the interactive torque, while the subject performs given periodic movement with the robot. IMPA is proposed to quantitatively determine the level of subject's impaired motor function. The method is indirectly tested by asking the healthy subjects to lift a barbell to disturb their motor function. The experimental result shows that the IMPA has a potential for providing a proper information of the subject's motor function level.

Axial type self-bearing motor for axial flow blood pump.

An axial self-bearing motor is proposed which can drive an axial blood pump without physical contact. It is a functional combination of the bi-directional disc motor and the axial active magnetic bearing, where it actively controls single degree-of-freedom motion, while other motions such as lateral vibration are passively stable. For application to a blood pump, the proposed self-bearing motor has the advantages of simple structure and small size. Through the finite element method (FEM) analysis and the experimental test, its good feasibility is verified. Finally, the axial flow pump is fabricated using the developed magnetically suspended motor. The pump test is carried out and the results are discussed in detail.

Magnetically suspended centrifugal blood pump with a self bearing motor.

A magnetically suspended centrifugal blood pump with a self bearing motor has been developed for long-term ventricular assistance. A rotor of the self bearing motor is actively suspended and rotated by an electromagnetic field without mechanical bearings. Radial position of the rotor is controlled actively, and axial position of the rotor is passively stable within the thin rotor structure. An open impeller and a semiopened impeller were examined to determine the best impeller structure. The outer diameter and height of the impeller are 63 and 34 mm, respectively. Both the impellers indicated similar pump performance. Single volute and double volute structures were also tested to confirm the performance of the double volute. Power consumption for levitation and radial displacement of the impeller with a rotational speed of 1,500 rpm were 0.7 W and 0.04 mm in the double volute, while those in the single volute were 1.3 W and 0.07 mm, respectively. The stator of the self bearing motor was redesigned to avoid magnetic saturation and improve motor performance. Maximum flow rate and pressure head were 9 L/min and 250 mm Hg, respectively. The developed magnetically suspended centrifugal blood pump is a candidate for an implantable left ventricular assist device.