Ankle strategy assistance to improve gait stability using controllers based on in-shoe center of pressure in 2 degree-of-freedom powered ankle-foot orthoses: a clinical study.

BACKGROUND: Although the ankle strategy is important for achieving frontal plane stability during one-leg stance, previously developed powered ankle-foot orthoses (PAFOs) did not involve ankle strategies because of hardware limitations. Weakness of movement in frontal plane is a factor that deteriorates gait stability and increases fall risk so it should not be overlooked in rehabilitation. Therefore, we used PAFO with subtalar joint for frontal plane movement and tried to confirm that the existence of it is important in balancing through clinical experiments. METHODS: We developed a proportional CoP controller to assist ankle strategy or stabilizing moment and enhance eversion to compensate for the tilting moment with 2 dof PAFO. It was true experimental study, and we recruited seven healthy subjects (30 ± 4 years) who did not experience any gait abnormality participated in walking experiments for evaluating the immediate effect of subtalar joint of PAFO on their gait stability. They walked on the treadmill with several cases of controllers for data acquisitions. Indices of gait stability and electromyography for muscle activity were measured and Wilcoxon signed-rank tests were used to identify meaningful changes. RESULTS: We found that subjects were most stable during walking (in terms of largest Lyapunov exponents, p < 0.008) with the assistance of the PAFO when their electromyographic activity was the most reduced (p < 0.008), although postural sway increased when a proportional CoP controller was used to assist the ankle strategy (p < 0.008). Other indices of gait stability, kinematic variability, showed no difference between the powered and unpowered conditions (p > 0.008). The results of the correlation analysis indicate that the actuator of the PAFO enhanced eversion and preserved the location of the CoP in the medial direction so that gait stability was not negatively affected or improved. CONCLUSIONS: We verified that the developed 2 dof PAFO assists the ankle strategy by compensating for the tilting moment with proportional CoP controller and that wearer can walk in a stable state when the orthosis provides power for reducing muscle activity. This result is meaningful because an ankle strategy should be considered in the development of PAFOs for enhancing or even rehabilitating proprioception. Trial registration 7001988-202003-HR-833-03.

Design and Control of a Polycentric Knee Exoskeleton Using an Electro-Hydraulic Actuator.

An exoskeleton robot helps the wearer with mechanical forces by identifying the wearer's intentions and requires high energy efficiency, sufficient load capacity, and a comfortable fit. However, since it is difficult to implement complex anatomical movements of the human body, most exoskeleton robots are designed simply, unlike the anatomy of real humans. This forces the wearer to accept the robot's stiffness entirely, and to use energy inefficiently from the power source. In this paper, a simple 1 degree of freedom (DoF) structure, which was mainly used in the knees of exoskeleton robots, was designed with a polycentric (multi-axial) structure to minimize the misalignment between wearer and robot, so that torque transfer could be carried out efficiently. In addition, the overall robot system was constructed by using an electro-hydraulic actuator (EHA) to solve the problems of the energy inefficiency of conventional hydraulic actuators and the low load capacity of conventional electric actuators. After the configuration of the hardware system, the sliding mode controller was designed to address the EHA nonlinear models and the uncertainty of the plant design. This was configured as Simulink for the first verification, and the experiment was conducted by applying it to the actual model to demonstrate the performance of the sliding mode control. In this process, an optical rotary encoder was used as the main feedback sensor of the controller. The proposed polycentric knee exoskeleton robot system using the EHA was able to reach the desired target value well despite the presence of many model uncertainties.

Terrain Feature Estimation Method for a Lower Limb Exoskeleton Using Kinematic Analysis and Center of Pressure.

While controlling a lower limb exoskeleton providing walking assistance to wearers, the walking terrain is an important factor that should be considered for meeting performance and safety requirements. Therefore, we developed a method to estimate the slope and elevation using the contact points between the limb exoskeleton and ground. We used the center of pressure as a contact point on the ground and calculated the location of the contact points on the walking terrain based on kinematic analysis of the exoskeleton. Then, a set of contact points collected from each step during walking was modeled as the plane that represents the surface of the walking terrain through the least-square method. Finally, by comparing the normal vectors of the modeled planes for each step, features of the walking terrain were estimated. We analyzed the estimation accuracy of the proposed method through experiments on level ground, stairs, and a ramp. Classification using the estimated features showed recognition accuracy higher than 95% for all experimental motions. The proposed method approximately analyzed the movement of the exoskeleton on various terrains even though no prior information on the walking terrain was provided. The method can enable exoskeleton systems to actively assist walking in various environments.

Design of an Artificial Neural Network Algorithm for a Low-Cost Insole Sensor to Estimate the Ground Reaction Force (GRF) and Calibrate the Center of Pressure (CoP).

As an alternative to high-cost shoe insole pressure sensors that measure the insole pressure distribution and calculate the center of pressure (CoP), researchers developed a foot sensor with FSR sensors on the bottom of the insole. However, the calculations for the center of pressure and ground reaction force (GRF) were not sufficiently accurate because of the fundamental limitations, fixed coordinates and narrow sensing areas, which cannot cover the whole insole. To address these issues, in this paper, we describe an algorithm of virtual forces and corresponding coordinates with an artificial neural network (ANN) for low-cost flexible insole pressure measurement sensors. The proposed algorithm estimates the magnitude of the GRF and the location of the foot plantar CoP. To compose the algorithm, we divided the insole area into six areas and created six virtual forces and the corresponding coordinates. We used the ANN algorithm with the input of magnitudes of FSR sensors, 1st and 2nd derivatives of them to estimate the virtual forces and coordinates. Eight healthy males were selected for data acquisition. They performed an experiment composed of the following motions: standing with weight shifting, walking with 1 km/h and 2 km/h, squatting and getting up from a sitting position to a standing position. The ANN for estimating virtual forces and corresponding coordinates was fitted according to those data, converted to c script, and downloaded to a microcontroller for validation experiments in real time. The results showed an average RMSE the whole experiment of 31.154 N for GRF estimation and 8.07 mm for CoP calibration. The correlation coefficients of the algorithm were 0.94 for GRF, 0.92 and 0.76 for the X and Y coordinate respectively.

Effects of a continuous lateral turning device on pressure relief.

[Purpose] The purpose of this study was to examine the pressure-relieving effects of a continuous lateral turning device on common pressure ulcer sites. [Subjects] Twenty-four healthy adults participated. [Methods] The design of our continuous lateral turning device was motivated by the need for an adequate pressure-relieving device for immobile and/or elderly people. The procedure of manual repositioning is embodied in our continuous lateral turning device. The interface pressure and time were measured, and comfort grade was evaluated during sessions of continuous lateral turning at 0°, 15°, 30°, and 45°. We quantified the pressure-relieving effect using peak pressure, mean pressure, and pressure time integration. [Results] Participants demonstrated pressure time integration values below the pressure-time threshold at 15°, 30°, and 45° at all the common pressure ulcer sites. Moreover, the most effective angles for pressure relief at the common pressure ulcer sites were 30° at the occiput, 15° at the left scapula, 45° at the right scapula, 45° at the sacrum, 15° at the right heel, and 30° at the left heel. However, angles greater than 30° induced discomfort. [Conclusion] Continuous lateral turning with our specially designed device effectively relieved the pressure of targeted sites. Moreover, the suggested angles of continuous lateral turning can be used to relieve pressure at targeted sites.

Tricin derivatives as anti-inflammatory and anti-allergic constituents from the aerial part of Zizania latifolia.

Methanol extract of Zizania latifolia was partitioned with EtOAc, n-BuOH, and H2O. From the EtOAc layers, a new flavonolignan along with a known flavone and three known flavonolignans, tricin (1), salcolin A (2), salcolin B (3), and salcolin C (4), were isolated through repeated silica gel and ODS column chromatography. The chemical structure of the new flavonolignan was determined to be tricin-4'-O-[erythro-ß-guaiacyl-(7″-O-methyl)-glyceryl] ether and was named salcolin D (5) based on physicochemical and spectroscopic data, including FT-NMR and ESI-MS. All compounds were isolated for the first time from this plant. Compounds 2-5, tricin derivatives, all exhibited higher anti-inflammatory and anti-allergy activities than tricin. In particular, salcolin D (5) was shown to have the strongest inhibitory activity against LPS-induced NO production in RAW 264.7 cells as well as ß-hexosaminidase release in IgE-sensitized RBL-2H3 cells. These results suggest that the presence of tricin derivatives conveys allergy and inflammation treatment ability to Z. latifolia.

New flavonolignan glycosides from the aerial parts of Zizania latifolia.

Two new flavonolignan glycosides, tricin-4'-O-(threo-ß-guaiacylglyceryl) ether 7''-O-ß-D-glucopyranose (4) and tricin-4'-O-(erythro-ß-guaiacylglyceryl) ether 7''-O-ß-D-glucopyranose (5) were isolated from the roots of Zizania latifolia, together with tricin-7-O-ß-D-glucopyranose (1), tricin-4'-O-(threo-ß-guaiacylglyceryl) ether 7-O-ß-D-glucopyranose (2), and tricin-4'-O-(erythro-ß-guaiacylglyceryl) ether 7-O-ß-D-glucopyranose (3). Their structures were identified on the basis of spectroscopic techniques, including HR-ESI/MS, 1D-NMR (1H, 13C, DEPT), 2D-NMR (gCOSY, gHSQC, gHMBC), and IR spectroscopy.

Effect of Anterioposterior Weight-Shift Training with Visual Biofeedback in Patients with Step Length Asymmetry after Subacute Stroke.

Step length asymmetry is a characteristic feature of gait in post-stroke patients. A novel anterioposterior weight-shift training method with visual biofeedback (AP training) was developed to improve the forward progression of the trunk. This study aimed to investigate the effect of AP training on gait asymmetries, patterns, and gait-related function in subacute stroke patients. Forty-six subacute stroke patients were randomly assigned to the AP training group or the control group. The AP training group received conventional gait training and AP training five times per week for 4 weeks. The control group received the same intensity of conventional gait training with patient education for self-anterior weight shifting. Plantar pressure analysis, gait analysis, energy consumption, and gait-related behavioral parameters were assessed before and after training. The AP training group showed significant improvement in step length asymmetry, forefoot contact area and pressure, Berg balance scale score, and Fugl-Meyer assessment scale of lower extremity score compared to the control group (p < 0.05). However, there was no significant between-group difference with respect to energy cost and kinetic and kinematic gait parameters. In conclusion, AP training may help improve the asymmetric step length in stroke patients, and also improve anterior weight shifting, balance, and motor function in subacute stroke survivors.

Inhibitory effects of actinidiamide from Actinidia polygama on allergy and inflammation.

Actinidia polygama Max. was subjected to supercritical fluid extraction (SFE), and the resulting ethanol extract of marc (SFEM) was subjected to sequential fractionation with various solvents. Each extract and fraction was assayed for anti-inflammatory effect. The ethyl acetate fraction (EtOAc) contained the highest level (70.8% inhibition) of anti-inflammatory activity. In order to identify the active constituents, the EtOAc fraction was further fractionated by silica gel and ODS column chromatography. By activity-guided fractionation, an active ceramide was identified as the anti-inflammatory component, and its structure was determined by NMR and MS analysis. The novel ceramide was named actinidiamide, and was found significantly to inhibit nitric oxide (NO) production (30.6% inhibition at 1 µg/mL) in lipopolysaccaride (LPS)-stimulated RAW 264.7 cells and ß-hexosaminidase release (91.8% inhibition at 1 µg/mL) in IgE-sensitized RBL-2H3 cells. Thus the presence of actinidiamide conveys allergy and inflammation treatment ability to A. polygama.

Effects of the degree of freedom and assistance characteristics of powered ankle-foot orthoses on gait stability.

We studied the use of powered ankle-foot orthoses (PAFOs) and walking stability of the wearers, focusing on the ankle joint, which is known to play a critical role in gait stability. Recognizing that the subtalar joint is an important modulator of walking stability, we conducted the walking experiment on a treadmill by applying varying assistance techniques to the 2-degree-of-freedom (DOF) PAFO, which has the subtalar joint as the rotating axis, and the commonly used 1-DOF PAFO. The participants were 8 healthy men (mean±SD: height, 174.8±7.1 cm; weight, 69.8±6.5 kg; and age, 29.1±4.8 years) with no history of gait abnormality. Center of pressure (COP) was measured with an in-shoe pressure sensor, and stability was estimated on the basis of the angular acceleration measured with the inertial measurement unit attached to the trunk. The experimental results of the 2-DOF PAFO, with or without assistance, showed a significantly higher stability than those of the 1-DOF PAFO (up to 23.78%, p<0.0326). With the 1-DOF PAFO, the stability deteriorated with the increase in the degree of assistance provided. With the 2-DOF PAFO, this tendency was not observed. Thus, the importance of the subtalar joint was proven using PAFOs. The mean position analysis of the COP during the stance phase confirmed that the COP highly correlated with stability (Pearson correlation coefficient: -0.6607). Thus, we conclude that only the 2-DOF PAFO can maintain walking stability, regardless of the assistance characteristics, by preserving the COP in the medial position through eversion. Awareness regarding the role of the subtalar joint is necessary during the manufacture or use of PAFOs, as lack of awareness could lead to the degradation of the wearer's gait stability, regardless of effective assistance, and deteriorate the fundamental functionality of PAFO.

Tyrosinase inhibitory effects of 1,3-diphenylpropanes from Broussonetia kazinoki.

Six 1,3-diphenylpropanes exhibiting inhibitory activities against both the monophenolase and diphenolase actions of tyrosinase were isolated from the methanol (95%) extract of Broussonetia kazinoki. These compounds, 1-6, were identified as kazinol C (1), D (2), F (3), broussonin C (4), kazinol S (5) and kazinol T (6). The latter two species (5 and 6) emerged to be new 1,3-diphenylpropanes which we fully spectroscopically characterized. The IC(50) values of compounds (1, 3-5) for monophenolase inhibition were determined to range between 0.43 and 17.9 microM. Compounds 1 and 3-5 also inhibited diphenolase significantly with IC(50) values of 22.8, 1.7, 0.57, and 26.9 microM, respectively. All four active tyrosinase inhibitors (1, 3-5) were competitive inhibitors. Interestigly they all mainfested simple reversible slow-binding inhibition against diphenolase. The most potent inhibitor, compound 4 diplayed the following kinetic parameters k(3)=0.0993 microM(-1)min(-1), k(4)=0.0048 min(-1), and K(i)(app)=0.0485 microM.

Design of a Pneumatic Actuated Ankle-Foot Orthosis which has Talocrural and Subtalar Joint.

As aging progresses, risk of falls in elderly people increases due to the decreasing the range of motion (RoM) of eversion and the weakening of the plantar flexor. Balance training is performed to reduce the risk of falls and powered ankle-foot orthosis (PAFO) can be utilized in this process. The elderly can conduct training on the narrow roads or on the rugged ground with assistance on rotation of eversion and propulsion by PAFO. However, existing PAFOs were developed just by considering the talocrural joint which make the rotation of sagittal plane of ankle which is called by plantar flexion and dorsiflexion. So, we developed the 2 Degree of Freedom (DoF) PAFO which has the Talocrural and Subtalar joints for frontal plane rotation which is called inversion and eversion. We established the coordinate system and calculated the spatial formulas for talocrural and subtalar joint based on anatomical data. Developed PAFO has the pneumatic artificial muscle (PAM) as an actuator which is controlled by solenoid valve with PWM methods, light-weight 3D printed body and knee orthosis for interfacing with wearer in three area which are thigh, shank and foot. The total weight of developed PAFO is 2. 14kg and it can be 1. 44kg without the weight of knee orthosis (0.7kg). Measurement sensors for PAFO were the absolute encoders to measure the angle of talocrural and subtalar joint, tensile loadcell to measure the magnitude of force from PAM, pressure sensor to measure the pressure of PAM and FSR sensor to judge the phase of the gait cycle. The results of the paper show the validation of design, kinematics and functional capacity for human subject experiments with proportional myoelectric control (PMc) of developed PAFO.

Identification of bitter components from Artemisia princeps Pamp.

Identification of bitter components from the aerial parts of Artemisia princeps Pamp. was performed to search for a method to eliminate the bitter taste from A. princeps products. The aerial parts of A. princeps were extracted in an aqueous EtOH solution, and the obtained extracts were partitioned into essential-oil, flavonoid-rich, n-BuOH, and aqueous fractions. Two purified bitter sesquiterpenoids were identified through repeated column chromatography of the bitterest fraction, the flavonoid-rich fraction, through an activity-guided fractionation method. The compounds were identified to be 1α,6α,8α-trihydroxy-5α,7ßH-guaia-3,9,11(13)-trien-12-oic acid and artecalin, respectively, based on the interpretation of NMR, MS, and IR spectroscopic data. Both compounds were 50 times bitterer than caffeine and had similar bitterness to quinine HCl. Neither eupatilin nor jaceosidin, the major active components of A. princeps, showed any bitterness.

Flavonoids isolated from Lespedeza cuneata G. Don and their inhibitory effects on nitric oxide production in lipopolysaccharide-stimulated BV-2 microglia cells.

BACKGROUND: Lespedeza cuneata (Dum. Cours.) G. Don, a perennial legume native to Eastern Asia, has been used therapeutically in traditional Asian medicine to protect the function of liver, kidneys and lungs. However, its effect on inflammatory nitric oxide (NO) production and the active constituents have not yet been explored. OBJECTIVE: In this study, we investigated the phytochemical constituents of L. cuneata and evaluated their effect on NO production using lipopolysaccharide (LPS)-stimulated BV2 cells. MATERIALS AND METHODS: The 80% methanol extract of the aerial part of L. cuneata were used for the isolation of flavonoids. The isolated compounds were elucidated by various spectroscopic methods including nuclear magnetic resonance and mass spectrometry spectrometry. To evaluate the effect on inflammatory NO production, LPS-stimulated murine microglia BV-2 cells were used as a screening system. RESULTS: Nine flavonoids were isolated from the aerial parts of L. cuneata. Among the isolated flavonoids, compounds 4, 5, 7 and 9 are reported from the genus Lespedeza for the first time. Moreover, compounds 1 and 6 showed significant inhibitory effects on NO production in LPS-stimulated BV2 cells without cell toxicity. CONCLUSION: In this study, nine flavonoids were isolated from L. cuneata. Among the compounds, only 1 and 6, which have free hydroxyl groups at both C3 and C7 showed significant inhibitory activity on NO production in LPS-stimulated BV2 cells. These results suggested L. cuneata and its flavonoid constituents as possible candidate for the treatment of various inflammatory diseases.

Tyrosinase inhibitory polyphenols from roots of Morus lhou.

Twelve polyphenols (1-12) possessing tyrosinase inhibitory properties were isolated from the methanol (95%) extract of Morus lhou. The isolated compounds consisted of four flavanones (1-4), four flavones (5-8), and four phenylbenzofuranes (9-12). Moracin derivative 12 proved to be new a compound which was fully characterized. Compounds 1-12 were evaluated for both monophenolase and diphenolase (the two steps catalyzed by tyrosinase) inhibition to identify the structural characteristics required for mushroom tyrosinase inhibition. We observed that all parent compounds (1, 5, and 9) possessing an unsubstituted resorcinol group were highly effective inhibitors of monophenolase activity (IC(50) values of 1.3, 1.2, and 7.4 microM). The potency of the inhibitors diminished with alkyl substitution on either the aromatic ring or the hydroxyl functions. Interestingly, flavone 5 was shown to possess only monophenolase inhibitory activity, but flavanone 1 and phenylbenzofuran 9 inhibited diphenolase as well as monophenolase significantly. The inhibitory mode of these species was also dependent upon the skeleton: phenylbenzofuran 9 manifested a simple competitive inhibition mode for monophenolase and diphenolase; on the other hand flavanone 1 (monophenolase, k(3) = 0.1966 min(-1) microM(-1), k(4) = 0.0082 min(-1), and K(i)(app) = 0.0468 microM; diphenolase, k(3) = 0.0014 min(-1) microM(-1), k(4) = 0.0013 min(-1), and K(i)(app) = 0.8996 microM) and flavone 5 both showed time-dependent inhibition against monophenolase. Compound 1 operated according to the simple reversible slow binding model whereas compound 5 operated under the enzyme isomerization model.