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1.
Front Comput Neurosci ; 18: 1355855, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38873285

RESUMEN

How our central nervous system efficiently controls our complex musculoskeletal system is still debated. The muscle synergy hypothesis is proposed to simplify this complex system by assuming the existence of functional neural modules that coordinate several muscles. Modularity based on muscle synergies can facilitate motor learning without compromising task performance. However, the effectiveness of modularity in motor control remains debated. This ambiguity can, in part, stem from overlooking that the performance of modularity depends on the mechanical aspects of modules of interest, such as the torque the modules exert. To address this issue, this study introduces two criteria to evaluate the quality of module sets based on commonly used performance metrics in motor learning studies: the accuracy of torque production and learning speed. One evaluates the regularity in the direction of mechanical torque the modules exert, while the other evaluates the evenness of its magnitude. For verification of our criteria, we simulated motor learning of torque production tasks in a realistic musculoskeletal system of the upper arm using feed-forward neural networks while changing the control conditions. We found that the proposed criteria successfully explain the tendency of learning performance in various control conditions. These result suggest that regularity in the direction of and evenness in magnitude of mechanical torque of utilized modules are significant factor for determining learning performance. Although the criteria were originally conceived for an error-based learning scheme, the approach to pursue which set of modules is better for motor control can have significant implications in other studies of modularity in general.

2.
Clin Biomech (Bristol, Avon) ; 115: 106263, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38744222

RESUMEN

BACKGROUND: Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis. METHODS: Seventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system. FINDINGS: Ankle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions. INTERPRETATION: Applying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.


Asunto(s)
Articulación del Tobillo , Ortesis del Pié , Marcha , Paresia , Humanos , Articulación del Tobillo/fisiopatología , Paresia/fisiopatología , Paresia/rehabilitación , Paresia/etiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos Neurológicos de la Marcha/etiología , Rango del Movimiento Articular , Fenómenos Biomecánicos , Adulto
3.
Front Bioeng Biotechnol ; 12: 1240339, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38567085

RESUMEN

The differences in kinetic mechanisms of decreased gait speed across brain lesion sides have not been elucidated, including the arrangement of motor modules reflected by kinetic interjoint coordination. The purpose of this study was to elucidate the differences in the kinetic factors of slow gait speed in patients with stroke on the lesion sides. A three-dimensional motion analysis system was employed to assess joint moment in the lower limb and representative gait parameters in 32 patients with right hemisphere brain damage (RHD) and 38 patients with left hemisphere brain damage (LHD) following stroke as well as 20 healthy controls. Motor module composition and timing were determined using principal component analysis based on the three joint moments in the lower limb in the stance phase, which were the variances accounted for principal components (PCs) and the peak timing in the time series of PCs. A stepwise multiple linear regression analysis was performed to identify the most significant joint moment and PC-associated parameter in explaining gait speed. A negligible difference was observed in age, weight, height, and gait speed among patients with RHD and LHD and controls. The following factors contributed to gait speed: in patients with RHD, larger ankle plantarflexion moment on the paretic (p = 0.001) and nonparetic (p = 0.002) sides and ankle dorsiflexion moment on the nonparetic side (p = 0.004); in patients with LHD, larger ankle plantarflexion moment (p < 0.001) and delayed peak timing of the first PC (p = 0.012) on the paretic side as well as ankle dorsiflexion moment on the nonparetic side (p < 0.001); in the controls, delayed peak timing of the first PC (p = 0.002) on the right side and larger ankle dorsiflexion moment (p = 0.001) as well as larger hip flexion moment on the left side (p = 0.023). The findings suggest that the kinetic mechanisms of gait speed may differ among patients with RHD following patients with stroke with LHD, and controls.

4.
Sensors (Basel) ; 24(2)2024 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-38257621

RESUMEN

The steady increase in the aging population worldwide is expected to cause a shortage of doctors and therapists for older people. This demographic shift requires more efficient and automated systems for rehabilitation and physical ability evaluations. Rehabilitation using mixed reality (MR) technology has attracted much attention in recent years. MR displays virtual objects on a head-mounted see-through display that overlies the user's field of vision and allows users to manipulate them as if they exist in reality. However, tasks in previous studies applying MR to rehabilitation have been limited to tasks in which the virtual objects are static and do not interact dynamically with the surrounding environment. Therefore, in this study, we developed an application to evaluate cognitive and motor functions with the aim of realizing a rehabilitation system that is dynamic and has interaction with the surrounding environment using MR technology. The developed application enabled effective evaluation of the user's spatial cognitive ability, task skillfulness, motor function, and decision-making ability. The results indicate the usefulness and feasibility of MR technology to quantify motor function and spatial cognition both for static and dynamic tasks in rehabilitation.


Asunto(s)
Realidad Aumentada , Médicos , Navegación Espacial , Humanos , Anciano , Envejecimiento , Cognición
5.
PLoS Comput Biol ; 20(1): e1011771, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38241215

RESUMEN

Humans can generate and sustain a wide range of walking velocities while optimizing their energy efficiency. Understanding the intricate mechanisms governing human walking will contribute to the engineering applications such as energy-efficient biped robots and walking assistive devices. Reflex-based control mechanisms, which generate motor patterns in response to sensory feedback, have shown promise in generating human-like walking in musculoskeletal models. However, the precise regulation of velocity remains a major challenge. This limitation makes it difficult to identify the essential reflex circuits for energy-efficient walking. To explore the reflex control mechanism and gain a better understanding of its energy-efficient maintenance mechanism, we extend the reflex-based control system to enable controlled walking velocities based on target speeds. We developed a novel performance-weighted least squares (PWLS) method to design a parameter modulator that optimizes walking efficiency while maintaining target velocity for the reflex-based bipedal system. We have successfully generated walking gaits from 0.7 to 1.6 m/s in a two-dimensional musculoskeletal model based on an input target velocity in the simulation environment. Our detailed analysis of the parameter modulator in a reflex-based system revealed two key reflex circuits that have a significant impact on energy efficiency. Furthermore, this finding was confirmed to be not influenced by setting parameters, i.e., leg length, sensory time delay, and weight coefficients in the objective cost function. These findings provide a powerful tool for exploring the neural bases of locomotion control while shedding light on the intricate mechanisms underlying human walking and hold significant potential for practical engineering applications.


Asunto(s)
Sistema Musculoesquelético , Caminata , Humanos , Caminata/fisiología , Marcha/fisiología , Locomoción , Reflejo/fisiología , Fenómenos Biomecánicos
6.
Soft Robot ; 11(1): 105-117, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37590488

RESUMEN

The pneumatic and hydraulic dual actuation of pressure-driven soft actuators (PSAs) is promising because of their potential to develop novel practical soft robots and expand the range of soft robot applications. However, the physical characteristics of air and water are largely different, which makes it challenging to quickly adapt to a selected actuation method and achieve method-independent accurate control performance. Herein, we propose a novel LAtent Representation-based Feedforward Neural Network (LAR-FNN) for dual actuation. The LAR-FNN consists of an autoencoder (AE) and a feedforward neural network (FNN). The AE generates a latent representation of a PSA from a 30-s stairstep response. Subsequently, the FNN provides an individual inverse model of the target PSA and calculates feedforward control input by using the latent representation. The experimental results with PSAs demonstrate that the LAR-FNN can meet the requirements of dual actuation control (i.e., accurate control performance regardless of the actuation method with a short adaptation time) with a single neural network. The results suggest that a LAR-FNN can contribute to soft dual-actuation robot development and the field of soft robotics.

7.
Elife ; 122023 09 13.
Artículo en Inglés | MEDLINE | ID: mdl-37703327

RESUMEN

Cyborg control of insect movement is promising for developing miniature, high-mobility, and efficient biohybrid robots. However, considering the inter-individual variation of the insect neuromuscular apparatus and its neural control is challenging. We propose a hierarchical model including inter-individual variation of muscle properties of three leg muscles involved in propulsion (retractor coxae), joint stiffness (pro- and retractor coxae), and stance-swing transition (protractor coxae and levator trochanteris) in the stick insect Carausius morosus. To estimate mechanical effects induced by external muscle stimulation, the model is based on the systematic evaluation of joint torques as functions of electrical stimulation parameters. A nearly linear relationship between the stimulus burst duration and generated torque was observed. This stimulus-torque characteristic holds for burst durations of up to 500ms, corresponding to the stance and swing phase durations of medium to fast walking stick insects. Hierarchical Bayesian modeling revealed that linearity of the stimulus-torque characteristic was invariant, with individually varying slopes. Individual prediction of joint torques provides significant benefits for precise cyborg control.


Hybrid insect-computer robots ­ an exciting fusion of biology and technology ­ herald a future of small, highly mobile and efficient devices. However, these robots require a way to control the movements of the insects, a task made complex due to the differences between different insects' nervous and muscle systems. To bridge this gap, Owaki, Dürr and Schmitz studied the relationship between electrical stimulation of three leg muscles in the legs of stick insects and the resultant torque. To do these experiments, the scientists kept the body of the stick insects fixed and electrically stimulated one out of three leg muscles to produce walking-like movements. The results of these electrical stimulations allowed Owaki, Dürr and Schmitz to propose a model that predicts the torque created in the insect's joints when different patterns of electrical stimulation are applied to a leg muscle. The researchers identified a near-linear relationship between the duration of the electrical stimulus and the resultant torque. Moreover, the slope of this linear relationship can be estimated for individual animals with a few measurements only. This finding refines the precision of the motor control required to build individually tuned biohybrid robots. Investigating the precise control of insect biohybrid robots, particularly using stick insects, can lead to advancements in biohybrid robotics and enrich our understanding of insect locomotion. Owaki, Dürr and Schmitz's insights could lead to the creation of adaptable and highly mobile devices with many applications, but key challenges need to be addressed. First, model testing must be implemented in free-walking insects, and the electrical stimuli must be refined to mimic natural neuromuscular signals more closely.


Asunto(s)
Insectos , Movimiento , Animales , Teorema de Bayes , Estimulación Eléctrica , Músculos
8.
Cyborg Bionic Syst ; 4: 0016, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37000191

RESUMEN

Motion prediction based on kinematic information such as body segment displacement and joint angle has been widely studied. Because motions originate from forces, it is beneficial to estimate dynamic information, such as the ground reaction force (GRF), in addition to kinematic information for advanced motion prediction. In this study, we proposed a method to estimate GRF and ground reaction moment (GRM) from electromyography (EMG) in combination with and without an inertial measurement unit (IMU) sensor using a machine learning technique. A long short-term memory network, which is suitable for processing long time-span data, was constructed with EMG and IMU as input data to estimate GRF during posture control and stepping motion. The results demonstrate that the proposed method can provide the GRF estimation with a root mean square error (RMSE) of 8.22 ± 0.97% (mean ± SE) for the posture control motion and 11.17 ± 2.16% (mean ± SE) for the stepping motion. We could confirm that EMG input is essential especially when we need to predict both GRF and GRM with limited numbers of sensors attached under knees. In addition, we developed a GRF visualization system integrated with ongoing motion in a Unity environment. This system enabled the visualization of the GRF vector in 3-dimensional space and provides predictive motion direction based on the estimated GRF, which can be useful for human motion prediction with portable sensors.

9.
Sensors (Basel) ; 23(6)2023 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-36992041

RESUMEN

One of the fundamental limitations in human biomechanics is that we cannot directly obtain joint moments during natural movements without affecting the motion. However, estimating these values is feasible with inverse dynamics computation by employing external force plates, which can cover only a small area of the plate. This work investigated the Long Short-Term Memory (LSTM) network for the kinetics and kinematics prediction of human lower limbs when performing different activities without using force plates after the learning. We measured surface electromyography (sEMG) signals from 14 lower extremities muscles to generate a 112-dimensional input vector from three sets of features: root mean square, mean absolute value, and sixth-order autoregressive model coefficient parameters for each muscle in the LSTM network. With the recorded experimental data from the motion capture system and the force plates, human motions were reconstructed in a biomechanical simulation created using OpenSim v4.1, from which the joint kinematics and kinetics from left and right knees and ankles were retrieved to serve as output for training the LSTM. The estimation results using the LSTM model deviated from labels with average R2 scores (knee angle: 97.25%, knee moment: 94.9%, ankle angle: 91.44%, and ankle moment: 85.44%). These results demonstrate the feasibility of the joint angle and moment estimation based solely on sEMG signals for multiple daily activities without requiring force plates and a motion capture system once the LSTM model is trained.


Asunto(s)
Extremidad Inferior , Memoria a Corto Plazo , Humanos , Electromiografía/métodos , Músculos/fisiología , Articulación de la Rodilla/fisiología
10.
IEEE Trans Neural Netw Learn Syst ; 34(7): 3444-3459, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34587101

RESUMEN

The state-of-the-art reinforcement learning (RL) techniques have made innumerable advancements in robot control, especially in combination with deep neural networks (DNNs), known as deep reinforcement learning (DRL). In this article, instead of reviewing the theoretical studies on RL, which were almost fully completed several decades ago, we summarize some state-of-the-art techniques added to commonly used RL frameworks for robot control. We mainly review bioinspired robots (BIRs) because they can learn to locomote or produce natural behaviors similar to animals and humans. With the ultimate goal of practical applications in real world, we further narrow our review scope to techniques that could aid in sim-to-real transfer. We categorized these techniques into four groups: 1) use of accurate simulators; 2) use of kinematic and dynamic models; 3) use of hierarchical and distributed controllers; and 4) use of demonstrations. The purposes of these four groups of techniques are to supply general and accurate environments for RL training, improve sampling efficiency, divide and conquer complex motion tasks and redundant robot structures, and acquire natural skills. We found that, by synthetically using these techniques, it is possible to deploy RL on physical BIRs in actuality.


Asunto(s)
Robótica , Aprendizaje , Redes Neurales de la Computación , Refuerzo en Psicología
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1801-1804, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-36086142

RESUMEN

In recent years, markerless motion capture using a depth camera or RGB camera without any restriction on the subject has been attracting attention. Especially, depth cameras such as Kinect and RealSense allow instantaneous motion capture even at home outside lab environment, which is attractive for rehabilitation usage. However, single depth camera can capture steadily skeleton only when the subject stands facing to camera for the limited range, thus it is hard to apply to track skeletons while walking. Multiple depth cameras setting may allow to expand the range, but it can involve non-practical calibration process and can affect instantaneous capture advantage of depth camera. In this study, we propose a systematic method to integrate the motion information of skeletal models obtained from multiple depth cameras. The proposed method can perform a quick calibration using skeletal models instead of external reference objects, and estimate the spatial relationship of the sensors that allows the depth camera to move. The result demonstrates stable skeleton tracking free from occlusion problem keeping instantaneous capture capability of depth cameras.


Asunto(s)
Movimiento , Sistema Musculoesquelético , Movimiento (Física) , Esqueleto , Caminata
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 4354-4357, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-36086233

RESUMEN

In the field of rehabilitation, there is a great demand for an automatic and quantitative evaluation system. The balance ability is an essential factor for motor function evaluation related to posture control. Although balance ability is assessed using various indices in current clinical situations, most of previous studies developing an automatic evaluation system have used only a single particular index for balance evaluation. In this study, we developed a system that evaluates whole-body motor function using multiple indices based on the trajectory of the center of mass (CoM) and the motion smoothness. The system is inexpensive and little physical burden because the evaluation indices are calculated from the skeleton tracked by Kinect in a game environment. We attempt to capture the differences in individual motor functions which are difficult to be detected by qualitative visual observation.


Asunto(s)
Movimiento , Equilibrio Postural , Movimiento (Física) , Modalidades de Fisioterapia
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 1121-1124, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-36086327

RESUMEN

Multiple tasks are simultaneously performed during walking in our daily life. Distracted walk by smartphone usage is recently getting a social problem. The term dual-task gait refers to the secondary task added to the walking. Attention demanding tasks may influence how a person walks. Since in-lab measurement may not accurately reflect the daily living gait, wearable sensors approach have been proposed for gait analysis in an out-of-lab setting. This study addresses the potential of using only two inertial measurement units (IMUs) attached to the shoes for the assessment of cognitive dual-task gait and how it differs from single-task gait. We found that the proposed system is sensitive to recognizing a tiny change in gait features such as on the double support time and gait indices when subject performing dual-task gait compared to the single-task gait experiment.


Asunto(s)
Cognición , Marcha , Análisis de la Marcha , Humanos , Teléfono Inteligente , Caminata
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2556-2559, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-36086474

RESUMEN

In our aging world, the need to measure and evaluate motor and cognitive functions and to automate physical and occupational therapy will increase in the future. Many studies on VR-based rehabilitation systems are already underway. However, there are some issues such as the risk of falling or crashing due to the complete blockage of visual information, VR sickness, and lack of reality. The purpose of this research is to develop a system that simultaneously measures and evaluates multiple abilities and functions, such as motor function, cognitive function, and prediction ability, by using mixed reality (MR) smartglasses technology that enables interaction with spatially arranged objects while maintaining real-world information. In this study, we focused on the motor function of the upper limbs and cognitive function, and measured finger and gaze movements during a reaching task. In addition, we developed a game-based task for occupational therapy in a MR environment and reported the results.


Asunto(s)
Realidad Aumentada , Gafas Inteligentes , Cognición , Extremidad Superior , Interfaz Usuario-Computador
15.
16.
Front Neurorobot ; 16: 1054239, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36756534

RESUMEN

Generating multimodal locomotion in underactuated bipedal robots requires control solutions that can facilitate motion patterns for drastically different dynamical modes, which is an extremely challenging problem in locomotion-learning tasks. Also, in such multimodal locomotion, utilizing body morphology is important because it leads to energy-efficient locomotion. This study provides a framework that reproduces multimodal bipedal locomotion using passive dynamics through deep reinforcement learning (DRL). An underactuated bipedal model was developed based on a passive walker, and a controller was designed using DRL. By carefully planning the weight parameter settings of the DRL reward function during the learning process based on a curriculum learning method, the bipedal model successfully learned to walk, run, and perform gait transitions by adjusting only one command input. These results indicate that DRL can be applied to generate various gaits with the effective use of passive dynamics.

17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 4583-4587, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34892236

RESUMEN

Quadruped system is an animal-like model which has long been analyzed in terms of energy efficiency during its various gait locomotion. The generation of certain gait modes on these systems has been achieved by classical controllers which demand highly specific domain-knowledge and empirical parameter tuning. In this paper, we propose to use deep reinforcement learning (DRL) as an alternative approach to generate certain gait modes on quadrupeds, allowing potentially the same energetic analysis without the difficulty of designing an ad hoc controller. We show that by specifying a gait mode in the process of learning, it allows faster convergence of the learning process while at the same time imposing a certain gait type on the systems as opposed to the case without any gait specification. We demonstrate the advantages of using DRL as it can exploit automatically the physical condition of the robots such as the passive spring effect between the joints during the learning process, similar to the adaptation skills of an animal. The proposed system would provide a framework for quadrupedal trot-gallop energetic analysis for different body structures, body mass distributions and joint characteristics using DRL.


Asunto(s)
Marcha , Locomoción , Animales , Aprendizaje , Refuerzo en Psicología
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 6835-6840, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34892677

RESUMEN

In this study, we proposed a framework for extracting gait events and extensive temporal features, seamlessly, during walking and running on a treadmill by constructing a finite state machine (FSM) transition rules based on two IMU sensors attached to the back of the shoes. Detailed innerclass states were defined to recognize the double support phase on walking gait and the double flight phase on running gait. Further, an in-depth speed-based analysis of temporal gait features can be performed for each tested speed with an automatic speed change detection algorithm based on the moving average filter applied to motion intensity data. The results have demonstrated that the FSM can accurately distinguish walking gait and running gait while also extract a detailed gait phase, respectively. This finding may contribute to a more flexible gait analysis where a change in speed or transition from walk to run can be anticipated and recognized accordingly.


Asunto(s)
Carrera , Caminata , Marcha , Análisis de la Marcha , Zapatos
19.
Brain Sci ; 11(11)2021 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-34827460

RESUMEN

Walking rehabilitation is challenging in stroke patients with sensory impairments. In this study, we examined the two-week effect of an auditory biofeedback prosthesis, Auditory Foot (AF), on the change in the frontal whole body angular momentum (WBAM) range, before and after a two-week walking rehabilitation. We conducted a pilot randomized controlled trial (RCT). We employed statistical Bayesian modeling to understand the mechanism of the rehabilitation effect and predict the expected effect in new patients. The best-performing model indicated that the frontal WBAM range was reduced in the AF group by 12.9-28.7%. This suggests that the use of kinesthetic biofeedback in gait rehabilitation contributes to the suppression of frontal WBAM, resulting in an improved walking balance function in stroke patients.

20.
Brain Sci ; 11(11)2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34827512

RESUMEN

Categorization based on quasi-joint stiffness (QJS) may help clinicians select appropriate ankle foot orthoses (AFOs). The objectives of the present study were to classify the gait pattern based on ankle joint stiffness, also called QJS, of the gait in patients after stroke and to clarify differences in the type of AFO among 72 patients after stroke. Hierarchical cluster analysis was used to classify gait patterns based on QJS at least one month before the study, which revealed three distinct subgroups (SGs 1, 2, and 3). The proportion of use of AFOs, articulated AFOs, and non-articulated AFOs were significantly different among SGs 1-3. In SG1, with a higher QJS in the early and middle stance, the proportion of the patients using articulated AFOs was higher, whereas in SG3, with a lower QJS in both stances, the proportion of patients using non-articulated AFOs was higher. In SG2, with a lower QJS in the early stance and higher QJS in the middle stance, the proportion of patients using AFOs was lower. These findings indicate that classification of gait patterns based on QJS in patients after stroke may be helpful in selecting AFO. However, large sample sizes are required to confirm these results.

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