Data-Driven Phase-Based Control of a Powered Knee-Ankle Prosthesis for Variable-Incline Stair Ascent and Descent.

Powered knee-ankle prostheses can offer benefits over conventional passive devices during stair locomotion by providing biomimetic net-positive work and active control of joint angles. However, many modern control approaches for stair ascent and descent are often limited by time-consuming hand-tuning of user/task-specific parameters, predefined trajectories that remove user volition, or heuristic approaches that cannot be applied to both stair ascent and descent. This work presents a phase-based hybrid kinematic and impedance controller (HKIC) that allows for semi-volitional, biomimetic stair ascent and descent at a variety of step heights. We define a unified phase variable for both stair ascent and descent that utilizes lower-limb geometry to adjust to different users and step heights. We extend our prior data-driven impedance model for variable-incline walking, modifying the cost function and constraints to create a continuously-varying impedance parameter model for stair ascent and descent over a continuum of step heights. Experiments with above-knee amputee participants (N=2) validate that our HKIC controller produces biomimetic ascent and descent joint kinematics, kinetics, and work across four step height configurations. We also show improved kinematic performance with our HKIC controller in comparison to a passive microprocessor-controlled device during stair locomotion.

Robustification of Bayesian-Inference-Based Gait Estimation for Lower-limb Wearable Robots.

Lower-limb wearable robots designed to assist people in everyday activities must reliably recover from any momentary confusion about what the user is doing. Such confusion might arise from momentary sensor failure, collision with an obstacle, losing track of gait due to an out-of-distribution stride, etc. Systems that infer a user's walking condition from angle measurements using Bayesian filters (e.g., extended Kalman filters) have been shown to accurately track gait across a range of activities. However, due to the fundamental problem structure and assumptions of Bayesian filter implementations, such estimators risk becoming 'lost' with little hope of a quick recovery. In this paper, we 1) introduce a Monte Carlo-based metric to quantify the robustness of pattern-tracking gait estimators, 2) propose strategies for improving tracking robustness, and 3) systematically evaluate them against this new metric using a publicly available gait biomechanics dataset. Our results, aggregating 2,700 trials of simulated walking of 10 able-bodied subjects under random perturbations, suggest that drastic improvements in robustness (from 8.9% to 99%) are possible using relatively simple modifications to the estimation process without noticeably degrading estimator accuracy.

Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations.

Rationale: The identification of early chronic obstructive pulmonary disease (COPD) is essential to appropriately counsel patients regarding smoking cessation, provide symptomatic treatment, and eventually develop disease-modifying treatments. Disease severity in COPD is defined using race-specific spirometry equations. These may disadvantage non-White individuals in diagnosis and care. Objectives: Determine the impact of race-specific equations on African American (AA) versus non-Hispanic White individuals. Methods: Cross-sectional analyses of the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) cohort were conducted, comparing non-Hispanic White (n = 6,766) and AA (n = 3,366) participants for COPD manifestations. Measurements and Main Results: Spirometric classifications using race-specific, multiethnic, and "race-reversed" prediction equations (NHANES [National Health and Nutrition Examination Survey] and Global Lung Function Initiative "Other" and "Global") were compared, as were respiratory symptoms, 6-minute-walk distance, computed tomography imaging, respiratory exacerbations, and St. George's Respiratory Questionnaire. Application of different prediction equations to the cohort resulted in different classifications by stage, with NHANES and Global Lung Function Initiative race-specific equations being minimally different, but race-reversed equations moving AA participants to more severe stages and especially between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 and preserved ratio impaired spirometry groups. Classification using the established NHANES race-specific equations demonstrated that for each of GOLD stages 1-4, AA participants were younger, had fewer pack-years and more current smoking, but had more exacerbations, shorter 6-minute-walk distance, greater dyspnea, and worse BODE (body mass index, airway obstruction, dyspnea, and exercise capacity) scores and St. George's Respiratory Questionnaire scores. Differences were greatest in GOLD stages 1 and 2. Race-reversed equations reclassified 774 AA participants (43%) from GOLD stage 0 to preserved ratio impaired spirometry. Conclusions: Race-specific equations underestimated disease severity among AA participants. These effects were particularly evident in early disease and may result in late detection of COPD.

CellularPotts.jl: simulating multiscale cellular models in Julia.

SUMMARY: CellularPotts.jl is a software package written in Julia to simulate biological cellular processes such as division, adhesion, and signaling. Accurately modeling and predicting these simple processes is crucial because they facilitate more complex biological phenomena related to important disease states like tumor growth, wound healing, and infection. Here we take advantage of Cellular Potts Modeling to simulate cellular interactions and combine them with differential equations to model dynamic cell signaling patterns. These models are advantageous over other approaches because they retain spatial information about each cell while remaining computationally efficient at larger scales. Users of this package define three key inputs to create valid model definitions: a 2- or 3-dimensional space, a table describing the cells to be positioned in that space, and a list of model penalties that dictate cell behaviors. Models can then be evolved over time to collect statistics, simulated repeatedly to investigate how changing a specific property impacts cellular behavior, and visualized using any of the available plotting libraries in Julia. AVAILABILITY AND IMPLEMENTATION: The CellularPotts.jl package is released under the MIT license and is available at https://github.com/RobertGregg/CellularPotts.jl. An archived version of the code (v0.3.2) at time of submission can also be found at https://doi.org/10.5281/zenodo.10407783.

Automatic Stub Avoidance for a Powered Prosthetic Leg over Stairs and Obstacles.

Passive prosthetic legs require undesirable compensations from amputee users to avoid stubbing obstacles and stairsteps. Powered prostheses can reduce those compensations by restoring normative joint biomechanics, but the absence of user proprioception and volitional control combined with the absence of environmental awareness by the prosthesis increases the risk of collisions. This paper presents a novel stub avoidance controller that automatically adjusts prosthetic knee/ankle kinematics based on suprasensory measurements of environmental distance from a small, lightweight, low-power, low-cost ultrasonic sensor mounted above the prosthetic ankle. In a case study with two transfemoral amputee participants, this control method reduced the stub rate during stair ascent by 89.95% and demonstrated an 87.5% avoidance rate for crossing different obstacles on level ground. No thigh kinematic compensation was required to achieve these results. These findings demonstrate a practical perception solution for powered prostheses to avoid collisions with stairs and obstacles while restoring normative biomechanics during daily activities.

Controlling Powered Prosthesis Kinematics over Continuous Transitions Between Walk and Stair Ascent.

One of the primary benefits of emerging powered prosthetic legs is their ability to facilitate step-over-step stair ascent by providing positive mechanical work. Existing control methods typically have distinct steady-state activity modes for walking and stair ascent, where activity transitions involve discretely switching between controllers and often must be initiated with a particular leg. However, these discrete transitions do not necessarily replicate able-bodied joint biomechanics, which have been shown to continuously adjust over a transition stride. This paper presents a phase-based kinematic controller for a powered knee-ankle prosthesis that enables continuous, biomimetic transitions between walking and stair ascent. The controller tracks joint angles from a data-driven kinematic model that continuously interpolates between the steady-state kinematic models, and it allows both the prosthetic and intact leg to lead the transitions. Results from experiments with two transfemoral amputee participants indicate that knee and ankle kinematics smoothly transition between walking and stair ascent, with comparable or lower root mean square errors compared to variations from able-bodied data.

Effects of Personalization on Gait-State Tracking Performance Using Extended Kalman Filters.

Emerging partial-assistance exoskeletons can enhance able-bodied performance and aid people with pathological gait or age-related immobility. However, every person walks differently, which makes it difficult to directly compute assistance torques from joint kinematics. Gait-state estimation-based controllers use phase (normalized stride time) and task variables (e.g., stride length and ground inclination) to parameterize the joint torques. Using kinematic models that depend on the gait-state, prior work has used an Extended Kalman filter (EKF) to estimate the gait-state online. However, this EKF suffered from kinematic errors since it used a subject-independent measurement model, and it is still unknown how personalization of this measurement model would reduce gait-state tracking error. This paper quantifies how much gait-state tracking improvement a personalized measurement model can have over a subject-independent measurement model when using an EKF-based gait-state estimator. Since the EKF performance depends on the measurement model covariance matrix, we tested on multiple different tuning parameters. Across reasonable values of tuning parameters that resulted in good performance, personalization improved estimation error on average by 8.5 ± 13.8% for phase (mean ± standard deviation), 27.2 ± 8.1% for stride length, and 10.5 ± 13.5% for ground inclination. These findings support the hypothesis that personalization of the measurement model significantly improves gait-state estimation performance in EKF based gait-state tracking (P≪0.05), which could ultimately enable reliable responses to faster human gait changes.

An Energetic Approach to Task-Invariant Ankle Exoskeleton Control.

Robotic ankle exoskeletons have been shown to reduce human effort during walking. However, existing ankle exoskeleton control approaches are limited in their ability to apply biomimetic torque across diverse tasks outside of the controlled lab environment. Energy shaping control can provide task-invariant assistance without estimating the user's state, classifying task, or reproducing pre-defined torque trajectories. In previous work, we showed that an optimally task-invariant energy shaping controller implemented on a knee-ankle exoskeleton reduced the effort of certain muscles for a range of tasks. In this paper, we extend this approach to the sensor suite available at the ankle and present its implementation on a commercially-available, bilateral ankle exoskeleton. An experiment with three healthy subjects walking on a circuit and on a treadmill showed that the controller can approximate biomimetic profiles for varying terrains and task transitions without classifying tasks or switching control modes.

Improving Amputee Endurance over Activities of Daily Living with a Robotic Knee-Ankle Prosthesis: A Case Study.

Robotic knee-ankle prostheses have often fallen short relative to passive microprocessor prostheses in time-based clinical outcome tests. User ambulation endurance is an alternative clinical outcome metric that may better highlight the benefits of robotic prostheses. However, previous studies were unable to show endurance benefits due to inaccurate high-level classification, discretized mid-level control, and insufficiently difficult ambulation tasks. In this case study, we present a phase-based mid-level prosthesis controller which yields biomimetic joint kinematics and kinetics that adjust to suit a continuum of tasks. We enrolled an individual with an above-knee amputation and challenged him to perform repeated, rapid laps of a circuit comprising activities of daily living with both his passive prosthesis and a robotic prosthesis. The participant demonstrated improved endurance with the robotic prosthesis and our mid-level controller compared to his passive prosthesis, completing over twice as many total laps before fatigue and muscle discomfort required him to stop. We also show that time-based outcome metrics fail to capture this endurance improvement, suggesting that alternative metrics related to endurance and fatigue may better highlight the clinical benefits of robotic prostheses.

Optimal Energy Shaping Control for a Backdrivable Hip Exoskeleton.

Task-dependent controllers widely used in exoskeletons track predefined trajectories, which overly constrain the volitional motion of individuals with remnant voluntary mobility. Energy shaping, on the other hand, provides task-invariant assistance by altering the human body's dynamic characteristics in the closed loop. While human-exoskeleton systems are often modeled using Euler-Lagrange equations, in our previous work we modeled the system as a port-controlled-Hamiltonian system, and a task-invariant controller was designed for a knee-ankle exoskeleton using interconnection-damping assignment passivity-based control. In this paper, we extend this framework to design a controller for a backdrivable hip exoskeleton to assist multiple tasks. A set of basis functions that contains information of kinematics is selected and corresponding coefficients are optimized, which allows the controller to provide torque that fits normative human torque for different activities of daily life. Human-subject experiments with two able-bodied subjects demonstrated the controller's capability to reduce muscle effort across different tasks.

Improving Sit/Stand Loading Symmetry and Timing Through Unified Variable Impedance Control of a Powered Knee-Ankle Prosthesis.

Individuals using passive prostheses typically rely heavily on their biological limb to complete sitting and standing tasks, leading to slower completion times and increased rates of osteoarthritis and lower back pain. Powered prostheses can address these challenges, but have control methods that divide sit-stand transitions into discrete phases, limiting user synchronization across the motion and requiring long manual tuning times. This paper extends our preliminary work using a thigh-based phase variable to parameterize optimized data-driven impedance parameter trajectories for sitting, standing, and walking, with only two classification modes. We decouple the stand-to-sit and sit-to-stand equilibrium angles through a knee velocity-dependent scaling term, reducing the model fitting error by approximately half compared to our previous results. We then experimentally validate the controller with three individuals with above-knee amputation performing sitting and standing transitions to/from three different chair heights. We show that our controller implemented on a powered knee-ankle prosthesis produced biomimetic joint mechanics, resulting in significantly reduced sit/stand loading symmetry and time to complete a 5x sit-to-stand task compared to participants' passive prostheses. Integration with a previously developed walking controller also allowed sit/walk transitions between different chair heights. The controller's biomimetic assistance may reduce the overreliance on the biological limb caused by inadequate passive prostheses, helping improve mobility for people with above-knee amputations.

Gait Event Detection with Proprioceptive Force Sensing in a Powered Knee-Ankle Prosthesis: Validation over Walking Speeds and Slopes.

Many powered prosthetic devices use load cells to detect ground interaction forces and gait events. These sensors introduce additional weight and cost in the device. Recent proprioceptive actuators enable an algebraic relationship between actuator torques and ground contact forces. This paper presents a proprioceptive force sensing paradigm which estimates ground reaction forces as a solution to detect gait events without a load cell. A floating body dynamic model is obtained with constraints at the center of pressure representing foot-ground interaction. Constraint forces are derived to estimate ground reaction forces and subsequently timing of gait events. A treadmill experiment is conducted with a powered knee-ankle prosthesis used by an able-bodied subject walking at various speeds and slopes. Results show accurate gait event timing, with pooled data showing heel strike detection lagging by only 6.7 ± 7.2 ms and toe off detection leading by 30.4 ± 11.0 ms compared to values obtained from the load cell. These results establish proof of concept for predicting gait events without a load cell in powered prostheses with proprioceptive actuators.

Real-Time Gait Phase and Task Estimation for Controlling a Powered Ankle Exoskeleton on Extremely Uneven Terrain.

Positive biomechanical outcomes have been reported with lower-limb exoskeletons in laboratory settings, but these devices have difficulty delivering appropriate assistance in synchrony with human gait as the task or rate of phase progression change in real-world environments. This paper presents a controller for an ankle exoskeleton that uses a data-driven kinematic model to continuously estimate the phase, phase rate, stride length, and ground incline states during locomotion, which enables the real-time adaptation of torque assistance to match human torques observed in a multi-activity database of 10 able-bodied subjects. We demonstrate in live experiments with a new cohort of 10 able-bodied participants that the controller yields phase estimates comparable to the state of the art, while also estimating task variables with similar accuracy to recent machine learning approaches. The implemented controller successfully adapts its assistance in response to changing phase and task variables, both during controlled treadmill trials (N=10, phase RMSE: 4.8 ± 2.4%) and a real-world stress test with extremely uneven terrain (N=1, phase RMSE: 4.8 ± 2.7%).

Data-Driven Variable Impedance Control of a Powered Knee-Ankle Prosthesis for Adaptive Speed and Incline Walking.

Most impedance-based walking controllers for powered knee-ankle prostheses use a finite state machine with dozens of user-specific parameters that require manual tuning by technical experts. These parameters are only appropriate near the task (e.g., walking speed and incline) at which they were tuned, necessitating many different parameter sets for variable-task walking. In contrast, this paper presents a data-driven, phase-based controller for variable-task walking that uses continuously-variable impedance control during stance and kinematic control during swing to enable biomimetic locomotion. After generating a data-driven model of variable joint impedance with convex optimization, we implement a novel task-invariant phase variable and real-time estimates of speed and incline to enable autonomous task adaptation. Experiments with above-knee amputee participants (N=2) show that our data-driven controller 1) features highly-linear phase estimates and accurate task estimates, 2) produces biomimetic kinematic and kinetic trends as task varies, leading to low errors relative to able-bodied references, and 3) produces biomimetic joint work and cadence trends as task varies. We show that the presented controller meets and often exceeds the performance of a benchmark finite state machine controller for our two participants, without requiring manual impedance tuning.

Enhancing Voluntary Motion with Modular, Backdrivable, Powered Hip and Knee Orthoses.

Mobility disabilities are prominent in society with wide-ranging deficits, motivating modular, partial-assist, lower-limb exoskeletons for this heterogeneous population. This paper introduces the Modular Backdrivable Lower-limb Unloading Exoskeleton (M-BLUE), which implements high torque, low mechanical impedance actuators on commercial orthoses with sheet metal modifications to produce a variety of hip- and/or knee-assisting configurations. Benchtop system identification verifies the desirable backdrive properties of the actuator, and allows for torque prediction within ±0.4 Nm. An able-bodied human subject experiment demonstrates that three unilateral configurations of M-BLUE (hip only, knee only, and hip-knee) with a simple gravity compensation controller can reduce muscle EMG readings in a lifting and lowering task relative to the bare condition. Reductions in mean muscular effort and peak muscle activation were seen across the primary squat musculature (excluding biceps femoris), demonstrating the potential to reduce fatigue leading to poor lifting posture. These promising results motivate applications of M-BLUE to additional populations, and the expansion of M-BLUE to bilateral and ankle configurations.

Stair Ascent Phase-Variable Control of a Powered Knee-Ankle Prosthesis.

Passive prostheses cannot provide the net positive work required at the knee and ankle for step-over stair ascent. Powered prostheses can provide this net positive work, but user synchronization of joint motion and power input are critical to enabling natural stair ascent gaits. In this work, we build on previous phase variable-based control methods for walking and propose a stair ascent controller driven by the motion of the user's residual thigh. We use reference kinematics from an able-bodied dataset to produce knee and ankle joint trajectories parameterized by gait phase. We redefine the gait cycle to begin at the point of maximum hip flexion instead of heel strike to improve the phase estimate. Able-bodied bypass adapter experiments demonstrate that the phase variable controller replicates normative able-bodied kinematic trajectories with a root mean squared error of 12.66° and 2.64° for the knee and ankle, respectively. The knee and ankle joints provided on average 0.39 J/kg and 0.21 J/kg per stride, compared to the normative averages of 0.34 J/kg and 0.21 J/kg, respectively. Thus, this controller allows powered knee-ankle prostheses to perform net positive mechanical work to assist stair ascent.

Nonholonomic Virtual Constraints for Control of Powered Prostheses Across Walking Speeds.

This paper presents a method to design a nonholonomic virtual constraint (NHVC) controller that produces multiple distinct stance-phase trajectories for corresponding walking speeds. NHVCs encode velocity-dependent joint trajectories via momenta conjugate to the unactuated degree(s)-of-freedom of the system. We recently introduced a method for designing NHVCs that allow for stable bipedal robotic walking across variable terrain slopes. This work extends the notion of NHVCs for application to variable-cadence powered prostheses. Using the segmental conjugate momentum for the prosthesis, an optimization problem is used to design a single stance-phase NHVC for three distinct walking speed trajectories (slow, normal, and fast). This stance-phase controller is implemented with a holonomic swing phase controller on a powered knee-ankle prosthesis, and experiments are conducted with an able-bodied user walking in steady and non-steady velocity conditions. The control scheme is capable of representing 1) multiple, task-dependent reference trajectories, and 2) walking gait variance due to both temporal and kinematic changes in user motion.

Modeling the Transitional Kinematics Between Variable-Incline Walking and Stair Climbing.

Although emerging powered prostheses can enable people with lower-limb amputation to walk and climb stairs over different task conditions (e.g., speeds and inclines), the control architecture typically uses a finite-state machine to switch between activity-specific controllers. Because these controllers focus on steady-state locomotion, powered prostheses abruptly switch between controllers during gait transitions rather than continuously adjusting leg biomechanics in synchrony with the users. This paper introduces a new framework for powered prosthesis control by modeling the lower-limb joint kinematics over a continuum of variable-incline walking and stair climbing, including steady-state and transitional gaits. Steady-state models for walking and stair climbing represent joint kinematics as continuous functions of gait phase, forward speed, and incline. Transition models interpolate kinematics as convex combinations of the two steady-state models, with an additional term to account for kinematics that fall outside their convex hull. The coefficients of this convex combination denote the similarity of the transitional kinematics to each steady-state mode, providing insight into how able-bodied individuals continuously transition between ambulation modes. Cross-validation demonstrates that the model predictions of untrained kinematics have errors within the range of physiological variability for all joints. Simulation results demonstrate the model's robustness to incline estimation and mode classification errors.

Analysis of the Bayesian Gait-State Estimation Problem for Lower-Limb Wearable Robot Sensor Configurations.

Many exoskeletons today are primarily tested in controlled, steady-state laboratory conditions that are unrealistic representations of their real-world usage in which walking conditions (e.g., speed, slope, and stride length) change constantly. One potential solution is to detect these changing walking conditions online using Bayesian state estimation to deliver assistance that continuously adapts to the wearer's gait. This paper investigates such an approach in silico, aiming to understand 1) which of the various Bayesian filter assumptions best match the problem, and 2) which gait parameters can be feasibly estimated with different combinations of sensors available to different exoskeleton configurations (pelvis, thigh, shank, and/or foot). Our results suggest that the assumptions of the Extended Kalman Filter are well suited to accurately estimate phase, stride frequency, stride length, and ramp inclination with a wide variety of sparse sensor configurations.

Optimally Biomimetic Passivity-Based Control of a Lower-Limb Exoskeleton Over the Primary Activities of Daily Life.

Task-specific, trajectory-based control methods commonly used in exoskeletons may be appropriate for individuals with paraplegia, but they overly constrain the volitional motion of individuals with remnant voluntary ability (representing a far larger population). Human-exoskeleton systems can be represented in the form of the Euler-Lagrange equations or, equivalently, the port-controlled Hamiltonian equations to design control laws that provide task-invariant assistance across a continuum of activities/environments by altering energetic properties of the human body. We previously introduced a port-controlled Hamiltonian framework that parameterizes the control law through basis functions related to gravitational and gyroscopic terms, which are optimized to fit normalized able-bodied joint torques across multiple walking gaits on different ground inclines. However, this approach did not have the flexibility to reproduce joint torques for a broader set of activities, including stair climbing and stand-to-sit, due to strict assumptions related to input-output passivity, which ensures the human remains in control of energy growth in the closed-loop dynamics. To provide biomimetic assistance across all primary activities of daily life, this paper generalizes this energy shaping framework by incorporating vertical ground reaction forces and global planar orientation into the basis set, while preserving passivity between the human joint torques and human joint velocities. We present an experimental implementation on a powered knee-ankle exoskeleton used by three able-bodied human subjects during walking on various inclines, ramp ascent/descent, and stand-to-sit, demonstrating the versatility of this control approach and its effect on muscular effort.