Direct biomechanical manipulation of human gait stability: A systematic review.

People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.

Uncovering the rural-urban gap in determinants of infant mortality in Punjab-Pakistan.

OBJECTIVE: The main objective of this research is to observe the various socio-economic, demographic, health-seeking, and environmental factors influencing infant mortality and the rural-urban division in Punjab, Pakistan. METHODS: The study used the data of 38,405 households from the Multiple Indicator Cluster Survey that was conducted by the Bureau of Statistics Punjab during 2017-18. This survey assessed 125 indicators i.e., health, education, etc. created by UNICEF to assess the well-being of mothers and children in Punjab, Pakistan. RESULTS AND CONCLUSION: The mother, the child, and the family are the three main risk factors for infant death, according to our research in Pakistan. The socioeconomic position of the household, social practices, environment, and usage of medical services are the key factors that help in reducing infant death. Women's education, birth spacing, and household economic position all played a significant role in the decline in infant mortality. The health of infants born in rural Punjab is at risk due to a large rural-urban gap in the determinants of infant mortality. Uncovering and addressing this disparity has become a pressing health priority in Pakistan.

An overview of diarrhea among infants and under-five in Punjab-Pakistan.

BACKGROUND: Diarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0-59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030. AIM: This study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0-59 months in Punjab Pakistan. METHODS: The study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017-18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis. FINDINGS: The results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0-59 months). DISCUSSION: The results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after. APPLICATION TO PRACTICE: Interventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan.

Reaction moments matter when designing lower-extremity robots for tripping recovery.

Balance recovery after tripping often requires an active adaptation of foot placement. Thus far, few attempts have been made to actively assist forward foot placement for balance recovery employing wearable devices. This study aims to explore the possibilities of active forward foot placement through two paradigms of actuation: assistive moments exerted with the reaction moments either internal or external to the human body, namely 'joint' moments and 'free' moments, respectively. Both paradigms can be applied to manipulate the motion of segments of the body (e.g., the shank or thigh), but joint actuators also exert opposing reaction moments on neighbouring body segments, altering posture and potentially inhibiting tripping recovery. We therefore hypothesised that a free moment paradigm is more effective in assisting balance recovery following tripping. The simulation software SCONE was used to simulate gait and tripping over various ground-fixed obstacles during the early swing phase. To aid forward foot placement, joint moments and free moments were applied either on the thigh to augment hip flexion or on the shank to augment knee extension. Two realizations of joint moments on the hip were simulated, with the reaction moment applied to either the pelvis or the contralateral thigh. The simulation results show that assisting hip flexion with either actuation paradigm on the thigh can result in full recovery of gait with a margin of stability and leg kinematics closely matching the unperturbed case. However, when assisting knee extension with moments on the shank, free moment effectively assist balance but joint moments with the reaction moment on the thigh do not. For joint moments assisting hip flexion, placement of the reaction moment on the contralateral thigh was more effective in achieving the desired limb dynamics than placing the reaction on the pelvis. Poor choice of placement of reaction moments may therefore have detrimental consequences for balance recovery, and removing them entirely (i.e., free moment) could be a more effective and reliable alternative. These results challenge conventional assumptions and may inform the design and development of a new generation of minimalistic wearable devices to promote balance during gait.

Controller synthesis and clinical exploration of wearable gyroscopic actuators to support human balance.

Gyroscopic actuators are appealing for wearable applications due to their ability to provide overground balance support without obstructing the legs. Multiple wearable robots using this actuation principle have been proposed, but none has yet been evaluated with humans. Here we use the GyBAR, a backpack-like prototype portable robot, to investigate the hypothesis that the balance of both healthy and chronic stroke subjects can be augmented through moments applied to the upper body. We quantified balance performance in terms of each participant's ability to walk or remain standing on a narrow support surface oriented to challenge stability in either the frontal or the sagittal plane. By comparing candidate balance controllers, it was found that effective assistance did not require regulation to a reference posture. A rotational viscous field increased the distance healthy participants could walk along a 30mm-wide beam by a factor of 2.0, compared to when the GyBAR was worn but inactive. The same controller enabled individuals with chronic stroke to remain standing for a factor of 2.5 longer on a narrow block. Due to its wearability and versatility of control, the GyBAR could enable new therapy interventions for training and rehabilitation.

Assisting gait with free moments or joint moments on the swing leg.

Wearable actuators in lower-extremity active orthoses or prostheses have the potential to address a variety of gait disorders. However, whenever conventional joint actuators exert moments on specific limbs, they must simultaneously impose opposing reaction moments on other limbs, which may reduce the desired effects and perturb posture. Momentum exchange actuators exert free moments on individual limbs, potentially overcoming or mitigating these issues.We simulate unperturbed gait to compare conventional joint actuators placed on the knee or hip of the swing leg, and equivalent angular momentum exchange actuators placed on the shank or thigh. Our results indicate that, while conventional joint actuators excel at increasing toe clearance when assisting knee flexion, free moments can yield greater increases in stride length when assisting knee extension or hip flexion.