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Assistive Technology: Biomechanics in Rehabilitation Engineering

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (20 March 2022) | Viewed by 30859

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Special Issue Editor

Dr. Philip Fink

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Guest Editor

School of Sport, Exercise and Nutrition, Massey University of New Zealand, Palmerston North, New Zealand
Interests: sensory–motor integration; biomechanics; pediatric obesity; virtual reality; nonlinear dynamics; mountain biking science

Special Issue Information

Dear Colleagues,

This Special Issue will focus on the use of technology to address biomechanical and control of movement issues in individuals with impaired health, whether as a result of disability, disease, or injury. The research can include (but is not limited to) development of new technology to promote more effective movement, the use of existing technology to assess and treat movement disorders, the use and effectiveness of virtual rehabilitation, or theoretical issues such as modeling which underlie the biomechanics or motor control of movement disorders.

Dr. Philip Fink
Guest Editor

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Keywords

technology
movement disorder
virtual reality
modeling
prosthetics
kinetics
motion analysis

Published Papers (12 papers)

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Research

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34 pages, 6737 KiB

Open AccessArticle

Human-Robot Interaction Torque Estimation Methods for a Lower Limb Rehabilitation Robotic System with Uncertainties

by Juan C. Yepes, Santiago Rúa, Marisol Osorio, Vera Z. Pérez, Jaime A. Moreno, Adel Al-Jumaily and Manuel J. Betancur

Appl. Sci. 2022, 12(11), 5529; https://0-doi-org.brum.beds.ac.uk/10.3390/app12115529 - 29 May 2022

Cited by 1 | Viewed by 2160

Abstract

Lower limb rehabilitation robot (LLRR) users, to successfully conduct isotonic exercises, require real-time feedback on the torque they exert on the robot to meet the goal of the treatment. Still, direct torque measuring is expensive, and indirect encoder-based estimation strategies, such as inverse dynamics (ID) and Nonlinear Disturbance Observers (NDO), are sensitive to Body Segment Inertial Parameters (BSIPs) uncertainties. We envision a way to minimize such parametric uncertainties. This paper proposes two human–robot interaction torque estimation methods: the Identified ID-based method (IID) and the Identified NDO-based method (INDO). Evaluating in simulation the proposal to apply, in each rehabilitation session, a sequential two-phase method: (1) An initial calibration phase will use an online parameter estimation to reduce sensitivity to BSIPs uncertainties. (2) The torque estimation phase uses the estimated parameters to obtain a better result. We conducted simulations under signal-to-noise ratio (SNR) = 40

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and 20% BSIPs uncertainties. In addition, we compared the effectiveness with two of the best methods reported in the literature via simulation. Both proposed methods obtained the best Coefficient of Correlation, Mean Absolute Error, and Root Mean Squared Error compared to the benchmarks. Moreover, the IID and INDO fulfilled more than 72.2% and 88.9% of the requirements, respectively. In contrast, both methods reported in the literature only accomplish 27.8% and 33.3% of the requirements when using simulations under noise and BSIPs uncertainties. Therefore, this paper extends two methods reported in the literature and copes with BSIPs uncertainties without using additional sensors. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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16 pages, 37298 KiB

Open AccessArticle

Optimal Assistance Timing to Induce Voluntary Dorsiflexion Movements: A Preliminary Study in Healthy Participants

by Jing-Chen Hong, Kazuhiro Yasuda, Hiroki Ohashi and Hiroyasu Iwata

Appl. Sci. 2022, 12(4), 2248; https://0-doi-org.brum.beds.ac.uk/10.3390/app12042248 - 21 Feb 2022

Cited by 2 | Viewed by 1985

Abstract

Swing-phase dorsiflexion assistance with robotic ankle–foot orthosis could improve toe clearance and limb shortening such that compensatory movements are suppressed. However, facilitating voluntary effort under assistance remains a challenge. In our previous study, we examined assistance effects of swing-phase dorsiflexion with different delay times after toe-off on a dorsiflexion-restricted gait with a high-dorsiflexion assistive system. Results showed that later dorsiflexion assistance could lead to an increase in the tibialis anterior’s surface electromyography but could also deteriorate compensatory movement. Thus, we concluded that there is a suitable assistance timing to simultaneously achieve voluntary effort and optimal gait. In the present research, we derived a method to identify a suitable dorsiflexion assistance delay time via a multiple linear regression analysis on ankle data of stroke patients with a pathological gait with insufficient dorsiflexion. With the identification method, an experiment was conducted on six healthy participants with restricted dorsiflexion. Results showed that the identified assistance timing improved the amplitude of the tibialis anterior’s surface electromyography while also suppressing limb shortening during circumduction and hip hiking. Although a practical study of stroke survivors is required, observations from this research indicate the potential to successfully induce voluntary efforts with the identified dorsiflexion assistance timing. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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15 pages, 1982 KiB

Open AccessArticle

Analysis of Body-Slip and Buttock Pressure Characteristics during Operation of a Double-Sliding Reclining Wheelchair in Patients with Spinal Cord Injury

by Yunhee Chang, Jungsun Kang, Bora Jeong, Yongcheol Kim, Eung-Pyo Hong and Gyoosuk Kim

Appl. Sci. 2021, 11(22), 10651; https://0-doi-org.brum.beds.ac.uk/10.3390/app112210651 - 12 Nov 2021

Cited by 1 | Viewed by 1700

Abstract

To minimize body collapse due to repetitive reclining and repositioning when using a reclining wheelchair, reclining wheelchairs with a sliding backrest function have been developed. This study compared the differences in body-slip and buttock pressure according to the presence or absence of the sliding function of the backrest during reclining and repositioning motions in 10 patients with spinal cord injury. When reclining from 100° to 130°, backrest sliding and total body-slip in the double-sliding wheelchair were significantly decreased by 21.4 mm and 16.4 mm, respectively, compared to a non-sliding wheelchair, and the peak pressure on the ischial tuberosity was significantly decreased by 8.7 kPa. Upon comparison of the buttock pressure between the initial upright position before reclining and the return upright position after repositioning, the force and mean pressure with the double-sliding wheelchair were significantly reduced compared with those with the non-sliding wheelchair. It was confirmed that the double-sliding system improved body-slip and buttock pressure more effectively than the non-sliding system. This study’s results are expected to provide the basic data necessary for the prescription and selection of wheelchairs in clinical practice and to be utilized in the development of related devices. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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12 pages, 4285 KiB

Open AccessArticle

Development of Immersive VR Device for Gait Training Rehabilitation with Biofeedback System-Preliminary Study

by Jeong-Woo Seo, Dae-Hyeok Kim, Jeeyoun Jung, Jung-Joon Kim and Hyeong-Sic Kim

Appl. Sci. 2021, 11(21), 10394; https://0-doi-org.brum.beds.ac.uk/10.3390/app112110394 - 05 Nov 2021

Cited by 2 | Viewed by 1868

Abstract

Gait-training rehabilitation machines (MGTR) are contraptions used for the motor rehabilitation of patients with movement disorders resulting from stroke and Parkinson’s disease. This study was aimed at implementing a walking pattern similar to the normal gait. Background: Immersion and motivation are important factors in repetitive rehabilitation exercises. This was addressed by synchronizing walking speed and virtual reality (VR) visons to provide a sense of immersion in a convergence environment of MGTR and VR. Methods: The difference in joint angle and gait event was confirmed when the step length was adjusted in this system to control the joint movement. Results: It was confirmed that the joint range of motion also increased significantly as the step length increased. Conclusions: The possibility of developing a more immersive MGTR system that feedback the actual gait state in the VR system was confirmed by applying that the joint movement varies according to the step length. It will be possible to provide an immersive feeling more similar to the actual walking by modifying the gait trajectory of the MGTR. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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11 pages, 1503 KiB

Open AccessArticle

Podiatric and Stabilographic Examinations of the Effects of School Bag Carrying in Children Aged 11 to 15 Years

by Joanna M. Bukowska, Małgorzata Jekiełek, Dariusz Kruczkowski, Tadeusz Ambroży, Łukasz Rydzik, Michał Spieszny and Jarosław Jaszczur-Nowicki

Appl. Sci. 2021, 11(19), 9357; https://0-doi-org.brum.beds.ac.uk/10.3390/app11199357 - 08 Oct 2021

Cited by 5 | Viewed by 2374

Abstract

Background: The issues raised in this study were inspired by the concern for the musculoskeletal status of school children. Carrying excess weight in the form of a school bag in this period of life affects the correct body posture of school children. The aim of the study was to analyze the influence of school bags on the feet force distribution on the ground and postural balance in children of both sexes between 11 and 15 years of age. Methods: The study investigated the distribution of pressure forces on the sole of the foot and its arch. The center of pressure for both feet and the whole body was also examined. The participants were 100 students from primary schools in Gdańsk, aged 11 to 15, including 54 girls and 46 boys. The research used a podobarographic platform that measures the distribution of foot pressure to the ground. The examinations included two measurements: in the first, the children stood on the platform in a natural position. Then, a 5 kg backpack was put on and they stood on the platform again. Results: Statistically significant differences were found in the distribution of the foot pressure on the ground in the left metatarsus (p = 0.000) and heel (p = 0.000) after putting on the backpack in both girls and boys. However, in the right foot, these differences concerned the metatarsal area (p = 0.001). The results of the balance tests were only statistically significant in the group of girls in the right foot sway area (p = 0.020). Conclusions: The school backpack load led to an increase in the values of the heel and metatarsal area measured in the students, causing its flattening. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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12 pages, 2729 KiB

Open AccessArticle

Comparison Method of Biomechanical Analysis of Trans-Tibial Amputee Gait with a Mechanical Test Machine Simulation

by Christophe Lecomte, Anna Lára Ármannsdóttir, Felix Starker, Kristin Briem and Sigurður Brynjólfsson

Appl. Sci. 2021, 11(12), 5318; https://0-doi-org.brum.beds.ac.uk/10.3390/app11125318 - 08 Jun 2021

Viewed by 2694

Abstract

Energy-storing-and-returning prosthetic feet are frequently recommended for lower limb amputees. Functional performance and stiffness characteristics are evaluated by state-of-the-art biomechanical testing, while it is common practice for design engineers and researchers to use test machines to measure stiffness. The correlation between user-specific biomechanical measures and machine evaluation has not been thoroughly investigated, and mechanical testing for ramps is limited. In this paper, we propose a novel test method to assess prosthetic foot stiffness properties in the sagittal plane. First, biomechanical data were collected on five trans-tibial users using a variable stiffness prosthetic foot on a split-belt treadmill. Gait trials were performed on level ground and on an incline and a decline of 7.5°. The same prosthetic foot was tested on a roll-over test machine for the three terrains. The sagittal ankle moment and angle were compared for the two test methods. The dorsiflexion moment and angle were similar, while more variability was observed in the plantarflexion results. A good correlation was found for level-ground walking, while decline walking showed the largest differences in the results of the maximum angles. The roll-over test machine is a useful tool to speed up design iterations with a set design goal prior to user testing. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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16 pages, 3600 KiB

Open AccessArticle

Development and Preliminary Evaluation of a Lower Body Exosuit to Support Ankle Dorsiflexion

by Tim Schubert, Bettina Wollesen and Robert Weidner

Appl. Sci. 2021, 11(11), 5007; https://0-doi-org.brum.beds.ac.uk/10.3390/app11115007 - 28 May 2021

Cited by 3 | Viewed by 4614

Abstract

For patients suffering from drop foot due to weakness of ankle dorsiflexion muscles, an ankle foot orthosis provides increased foot clearance during the swing phase of gait, but often restricts other gait functions, such as plantarflexion. Due to steady progress in the development of lighter and smaller actuator technologies, active wearable devices such as exosuits become relevant for rehabilitation, since they can offer an extended functionality including a more comfortable wear than passive plastic orthosis. The aim of the paper is to present a lightweight exosuit supporting dorsiflexion during gait with autonomous recognition of gait phases and conditions. One main requirement during the iterative development of the exosuit is a non-restrictive function, thus no differences between the assisted and non-assisted gait of a healthy subject should occur. We therefore conducted a pilot biomechanics study using statistical parametric mapping to analyze kinematics of the ankle joint and muscle activity of m. tibialis anterior of nine subjects without any gait anomalies walking with and without the exosuit. The results show no significant difference between with and without support. In contrast to passive orthosis, the developed system could be an enhanced solution to assist patients suffering from drop foot, which should be analyzed in the next step for evaluating the development. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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11 pages, 1940 KiB

Open AccessArticle

Comparison of 360° Turn Cycles among Individuals after Stroke and Healthy Older Adults

by Rahul Soangra, Vennila Krishnan, Joby John, Ehsan Rashedi and Alison McKenzie

Appl. Sci. 2021, 11(7), 3202; https://0-doi-org.brum.beds.ac.uk/10.3390/app11073202 - 02 Apr 2021

Cited by 4 | Viewed by 1932

Abstract

Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The purpose of the current study was to characterize differences between healthy older adults and adults after stroke in 360° turn kinematics. Fourteen individuals with chronic stroke (mean age: 69 ± 8.4 years) and 14 healthy older adults (mean age: 74 ± 8.7 years) performed three trials of 360° turning. Kinematics data were collected using 26 reflective markers at several body landmarks. This new method for quantifying turning revealed that stroke significantly affected the number of turn cycles, number of single support (SS) critical phases, and critical time. In some cases, falls among individuals with stroke may be related to the combination of impaired movement patterns and the complexity of tasks such as turning. Understanding turning kinematics can inform clinical interventions targeting improvements in turning ability and consequently, fall risk reduction in individuals after stroke. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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13 pages, 2802 KiB

Open AccessArticle

Designing and Analyzing 3D-Printed Personal Steering Controller for Outdoor Electric-Powered Wheelchair Users: A Randomized Controlled Trial on Stroke Patients

by Seoyoon Heo and Wansuk Choi

Appl. Sci. 2021, 11(6), 2743; https://0-doi-org.brum.beds.ac.uk/10.3390/app11062743 - 18 Mar 2021

Cited by 1 | Viewed by 1674

Abstract

While the physical conditions of stroke patients are diverse, the joystick-type steering controller of the electric-powered wheelchair (EPW) is almost the same, making the user uncomfortable and not fully utilizing the function of the wheelchair. The purpose of this study was to investigate the effects of the EPW steering controller, specifically the so-called joystick type (3DSC; 3D-printed steering controller, conventional steering controllers; CSC), on surface electromyography (sEMG), Wheelchair Skills Test 4.2 (WST), and QUEST 2.0. The participants were 23 hemiplegic stroke patients (14 males and 9 females) (range 40–65 years) recruited from multi-center process. The 3DSC manufacturing process used a scanner (Precision Laser Probe SLP-500) and a modelling program (SOLIDWORKS 2015). The CSC users’ muscle activities were generally higher than those of the 3DSC users in both males and females (p < 0.05). WST total performance score of CSC is statistically significantly lower than those of 3DSC for both males (3DSC = 49.28 ± 2.19; CSC = 42.85 ± 4.31) (z = −3.935; p < 0.05) and females (3DSC = 48.17 ± 0.44; CSC = 41.11 ± 0.78) (z = −1.910; p < 0.05). QUEST 2.0 scores in CSC (male = 2.40 ± 0.70; female = 2.11 ± 0.78) were significantly lower than those of 3DSC (male = 3.50 ± 0.85; female = 2.90 ± 0.51) in effectiveness categories (p < 0.05). We suggest that 3DSC contributes to reducing the user’s muscle activities and raising the scores of WST performance and QUEST. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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20 pages, 19389 KiB

Open AccessArticle

Modeling and Control of an Underactuated System for Dynamic Body Weight Support

by Grzegorz Gembalczyk, Piotr Gierlak and Slawomir Duda

Appl. Sci. 2021, 11(3), 905; https://0-doi-org.brum.beds.ac.uk/10.3390/app11030905 - 20 Jan 2021

Cited by 4 | Viewed by 2003

Abstract

This article concerns the stability analysis of a control system for a dynamic body weight support system in a rehabilitation device for the re-education of human gait. The paper presents a physical model of the device, which characterizes the most important physical phenomena associated with the movement of the system, i.e., inertia, damping, and elasticity. The device has one active and one passive element. They are connected by a connector with elastic and damping properties. This solution provides the kinematic chain required due to interactions with humans, while at the same time ensures that the device is an underactuated system. The article also presents the methodology used to verify the stability of the control system while acting as an active body weight support system. The paper formulates the mathematical model of the system that was used in the synthesis of control using the Lyapunov theory of stability. The results of simulation and experimental tests are also presented. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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19 pages, 1401 KiB

Open AccessArticle

Post-Effect on the Centre of Feet Pressure during Stance by Continuous Asymmetric Mediolateral Translations of a Supporting Platform—A Preliminary Study in Healthy Young Adults

by Stefania Sozzi, Antonio Nardone, Stefano Corna and Marco Schieppati

Appl. Sci. 2020, 10(17), 5969; https://0-doi-org.brum.beds.ac.uk/10.3390/app10175969 - 28 Aug 2020

Viewed by 1927

Abstract

Various diseases are associated with the impaired control of the medio-lateral (ML) position of the centre of feet pressure (CoP), and several manoeuvres have been proposed for enhancing the CoP symmetry. Here, we assessed in healthy standing subjects the feasibility and outcome of a novel protocol entailing a reaction to a continuous asymmetric ML displacement (10 cm) of the support base. The periodic perturbation consisted of a fast half-cycle (0.5 Hz) followed by a slow half-cycle (0.18 Hz). One hundred successive horizontal translation cycles were delivered in sequence. Eyes were open or closed. CoP was recorded before, after, and during the stimulation by a dynamometric platform fixed onto the translating platform. We found that the post-stimulation CoP was displaced towards the direction of the fast half-cycles. The displacement lasted several tens of seconds. Vision did not affect the amplitude or duration of the post-stimulation effect. The magnitude of post-stimulation CoP displacement was related to the perturbation-induced ML motion of CoP recorded during the stimulation. Over the successive perturbation cycles, the time-course of this motion revealed an adaptation phenomenon. Vision moderately reduced the adaptation rate. The findings support the feasibility of the administration of a simple asymmetric balance perturbation protocol in clinical settings to help patients recover the symmetry of the CoP. This protocol needs to be further validated in older populations and in patients. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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Review

Jump to: Research

18 pages, 1086 KiB

Open AccessFeature PaperReview

Lower-Limb Exosuits for Rehabilitation or Assistance of Human Movement: A Systematic Review

by Martin Andreas Koch and Josep M. Font-Llagunes

Appl. Sci. 2021, 11(18), 8743; https://0-doi-org.brum.beds.ac.uk/10.3390/app11188743 - 19 Sep 2021

Cited by 9 | Viewed by 3784

Abstract

Background: The aim of this review is to provide a comprehensive overview of the technological state-of-the-art of exosuits and the clinical results obtained when applied to users with mobility impairment. Methods: Searches are carried out in the COCHRANE, PubMed, IEEE Xplore and MEDLINE databases. Titles, abstracts and full texts are screened for inclusion criteria. Technological and clinical data are extracted. The quality of the studies is evaluated via a study quality assessment tool. Results: 19 studies are identified as relevant. Active (47%) and passive exosuits (53%) are used. Most are used untethered (84%), accommodating the demand of mobility. No study reports power consumption, which is important for dimensioning power systems. Fields of applications are post-stroke (79%), osteoarthritis (16%) and post-trauma (5%). Mostly the ankle joint is addressed (57%), while less studies address multiple joints (21%). The outcomes of clinical evaluations of lower-limb exosuits with patients suffering from mobility impairments are positive in the correction of gait pattern and reducing metabolic energy consumption during hemiparetic walking. Conclusions: Lower-limb exosuits for clinical applications are still facing technological challenges. Fields of application are limited to stroke, osteoarthritis and trauma. While clinical outcomes are overall positive, improvements in the study protocols are suggested. Full article

(This article belongs to the Special Issue Assistive Technology: Biomechanics in Rehabilitation Engineering)

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