A Wearable Upper Extremity Rehabilitation Device for Inducing Arm Swing in Gait Training.

This paper presents the design and validation of a proof-of-concept prototype for a wearable rehabilitation device to incorporate arm swing during gait rehabilitation. Unlike current stationary exoskeletons used for rehabilitation of upper limbs' function, assisting arm swing during gait requires inducing faster arm flexion/extension movements while maintaining the users' arms unconstrained in other directions. We developed a portable and underactuated system with features such as a large workspace and backdrivability to induce arm swing. Its wide workspace allowed the wearers to easily move their arms in different directions without any constraints. A modified double parallelogram linkage (mDPL) is proposed to allow the device to mimic the natural workspace of an arm. Additionally, a pulley drive and weight compensation system were created to place the motor on the users' back reducing the hindering weight of the actuators on their arms. Our experiments demonstrated this arm-swing rehabilitator could successfully induce arm movements at different arm configurations with low (0.67 Hz) and high (1.1 Hz) frequencies corresponding to slow and fast walking.

Investigating the efficacy of a tactile feedback system to increase the gait speed of older adults.

The objective of this study was to determine (1) if a novel haptic feedback system could increase the walking speed of older adults while it is being employed during overground walking and (2) whether the frequency at which this feedback was presented would have a differential impact on the ability of users to change walking speed while it was present. Given that peak thigh extension has been found to be a biomechanical surrogate for stride length, and consequently gait speed, vibrotactile haptic feedback was provided to the participants' thighs as a cue to increase peak thigh extension while the effect on gait speed was monitored. Ten healthy community-dwelling older adults (68.4 ± 4.1 years) participated. Participants' peak thigh extension, cadence, normalized stride length and velocity, along with their coefficients of variation (COV) were compared across baseline normal and fast walking (with no feedback) and three different frequency of feedback conditions. The findings indicated that, compared to self-selected normal and fast walking speeds, peak thigh extension was significantly increased when feedback was present and after it was withdrawn in a post-test. An increase in thigh extension led to an increase in stride length and, consequently, an increase in stride velocity compared to normal speed. There were no significant differences in the gait parameters as a function of feedback frequency during its application. In conclusion, while present, the haptic feedback system increased thigh extension and walking speed in older adults regardless of the feedback frequency and when the feedback was withdrawn, participants could maintain an increase in those parameters.

Modulation of Arm Swing Frequency and Gait Using Rhythmic Tactile Feedback.

Due to the neural coupling between upper and lower limbs and the importance of interlimb coordination in human gait, focusing on appropriate arm swing should be a part of gait rehabilitation in individuals with walking impairments. Despite its vital importance, there is a lack of effective methods to exploit the potential of arm swing inclusion for gait rehabilitation. In this work, we present a lightweight and wireless haptic feedback system that provides highly synchronized vibrotactile cues to the arms to manipulate arm swing and investigate the effects of this manipulation on the subjects' gait in a study with 12 participants (20-44 years). We found the developed system effectively adjusted the subjects' arm swing and stride cycle times by significantly reducing and increasing those parameters by up to 20% and 35%, respectively, compared to their baseline values during normal walking with no feedback. Particularly, the reduction of arms' and legs' cycle times translated into a substantial increase of up to 19.3% (on average) in walking speed. The response of the subjects to the feedback was also quantified in both transient and steady-state walking. The analysis of settling times from the transient responses revealed a fast and similar adaptation of both arms' and legs' movements to the feedback for reducing cycle time (i.e., increasing speed). Conversely, larger settling times and the time differences between arms' and legs' responses were observed due to feedback for increasing cycle times (i.e., reducing speed). The results clearly demonstrate the potential of the developed system to induce different arm-swing patterns as well as the ability of the proposed method to modulate key gait parameters through leveraging the interlimb neural coupling, with implications for gait training.

Development and comprehensive evaluation of a new spring-steel-driven glove for grasping assistance during activities of daily living.

Millions of people suffer from a decline in grip strength and hand function due to conditions such as chronic disease, injuries, and aging. Hand function decline results in difficulties with performing activities of daily living, where grasping, lifting, and releasing objects are essential. There is an increasing demand for assistive gloves to enhance users' hand function and improve their independence. This paper presents the design of a new bidirectional lightweight assistive glove and demonstrates its capabilities through comprehensive experiments using human subjects. The developed glove can provide adequate power augmentation for grasping and releasing objects due to its simple yet effective design using spring steel strips and linear actuators. The glove directly transfers assistive forces to users' fingertips without any complex intermediate mechanism, and its low weight of 196 g promotes its usability. The rigorous experiment design provided a thorough assessment of the developed glove by accounting for both parameters of size and weight of objects and by including subjects with different hand sizes. To quantify the glove's performance, the subjects' muscle activity, their finger and thumb joints' trajectories, and their grasping forces while using the glove were investigated. The glove could generate the necessary grasping forces to assist with lifting common-household objects. The subjects' muscle activity significantly decreased when using the glove for object manipulation. The trajectories of the index finger and thumb joints when using the glove were dependent on the size of objects similar to natural unassisted grasping. The obtained results demonstrate the glove's ability for grip power augmentation of individuals with declining hand strength.

Design and evaluation of the Afari: a three-wheeled mobility and balance support device for outdoor exercise.

This article presents the engineering design and preliminary testing of the AfariTM mobility device and the integrated IntracTM activity tracking system. The patented Afari design is a three-wheeled device that assists users of any age with mobility impairments with outdoor exercise and movement in various environments and surfaces. We devised methods for testing of the Afari to ensure safe and flexible mobility assistance and demonstrated a high level of stability and structural integrity suitable for vigorous outdoor exercise. A smartphone-based sensing system, the Intrac, was designed for and integrated with the Afari to monitor the user's interaction forces and important gait parameters. The Intrac offers a graphical user interface for displaying and sharing measurements with users and providers, and the accuracy of its measurements was validated by testing its individual components. A preliminary subject study showed that the participants could use the Afari for various levels of weight compensation during walking, while the Intrac enabled the measurement of interactive forces on their arms and key gait parameters. The results demonstrate the potential of the Afari and Intrac to provide a safe walking experience in a variety of terrains and continuously monitor users' gait.

The effects of forearm movements on human gait during walking with various self-selected speeds.

The forearms significantly contribute to the upper extremity movements and, consequently, whole-body responses during locomotion. The purpose of this study is to provide a more in-depth understanding of the mechanism controlling forearm movements during walking by comprehensively investigating the effects of the forearms on the lower and upper limb movements. Such an understanding can provide critical information for the design and control of robotic upper-limb prostheses. Twelve healthy young participants were recruited to compare their gait during (1) natural walking, (2) walking while wearing a pair of artificial passive forearms and having their actual forearms restrained by orthopedic braces, and (3) walking with only having their forearms restrained by the braces (i.e., no artificial forearms). While the passive forearms in condition 2 were to determine if the forearm movements were passively or actively controlled, condition 3 was to account for the effects of restraining the forearms in condition 2. The participants' lower-limb joint angles and spatiotemporal parameters remained unchanged across the three conditions while walking at their normal and fast self-selected gait speeds. However, significant decreases were observed in the shoulder and trunk angles, the interlimb coordination, and the shoulder-trunk correlations when walking with the artificial forearms. These observations were in tandem with the increased muscle activity of the biceps, trapeziuses, and posterior deltoids, which controlled the shoulder motion and trunk rotation during walking with the artificial forearms across both normal and fast self-selected speeds. Although not significant, the metabolic energy analysis of five participants revealed an increase during walking with artificial forearms. The results support the idea that the body actively controls the forearm movements through the shoulder and trunk rotations to mitigate the undesired disturbances induced by the passive forearm movements during locomotion.

A Lightweight Linear Actuating System for Finger Articulation: A Proof-of-Concept Study.

This paper provides a proof of concept for an actuating system comprised of a linear actuator and a spring steel strip that enables bidirectional articulation of a finger by transmitting the force directly to the finger tip. This proposed design can be distinguished from other orthosis designs, which use rigid linkages or cables with DC motors or fluidic systems for force generation and transmission. We designed an experimental setup with a 3D-printed model finger to mimic a passive human finger on which the actuation system was mounted and tested. The finger was positioned such that it would curl upward to lift various masses when articulated by the actuating system to demonstrate the system's force generation capability. We tested two linear actuators and two steel strips, using a wide range of masses to determine which would be the most suitable components for our design. We analyzed motion profiles, joint angles, force generation, and actuator stroke velocities during various experimental trials. Our results demonstrate that our actuating system is capable of generating sufficient forces and motions with an adequate response time to be used in the design of a hand orthosis for grasping/releasing assistance. From our tests, a prototype was designed with three linear actuators positioned on the dorsal side of the hand and actuated the thumb, index, and middle fingers. Future work will include sensor integration and performance evaluation of the orthosis.

The Treadport: Natural Gait on a Treadmill.

OBJECTIVE: To evaluate the differences between walking on an advanced robotic locomotion interface called the Treadport and walking overground with healthy subjects. BACKGROUND: Previous studies have compared treadmill-based and overground walking in terms of gait parameters. The Treadport's unique features including self-selected speed capability, large belt, kinesthetic force feedback, and virtual reality environment distinguish it from other locomotion interfaces and could provide a natural walking experience for the users. METHOD: Young, healthy subjects (N = 17) walked 10 meters 10 times each for both overground and the Treadport environments. Comparison between walking conditions used spatiotemporal and kinematic parameters. In addition, electromyographic data was collected for five of the 17 subjects to compare muscle activity between the two conditions. RESULTS: Gait on the Treadport was found to have no significant differences (p > .05) with overground walking in terms of hip and knee joint angles, cadence and stride length and stride speed, and muscle activation of the four muscle groups measured. Differences (p < .05) were observed in ankle dorsiflexion which was reduced by 2.47 ± 0.01 degrees on the Treadport. CONCLUSION: Walking overground and on the Treadport is highly correlated and not significantly different in 13 of 14 parameters. APPLICATION: This study suggests that the Treadport creates an environment for natural walking experience, where natural gait of users is almost preserved, with great potential to be useful for other applications, such as gait rehabilitation of individuals with walking impairments.

A Shoulder Mechanism for Assisting Upper Arm Function with Distally Located Actuators.

This paper presents a new design for a shoulder assistive device based on a modified double parallelogram linkage (DPL). The DPL allows for active support of the arm motion in the sagittal plane, while enabling the use of a distally located motor that can be mounted around the user's waist to improve the weight distribution. The development of the DPL provides an unobtrusive mechanism for assisting the movement of the shoulder joint with a wide range of motion. This design contains three degrees-of-freedom (DOFs) and a rigid structure for supporting the arm. The modified DPL uses a cable-driven system to transfer the torque of the motor mounted on the user's back through the links to the arm. The proposed design assists with the flexion/extension of the arm, while allowing the adduction/abduction and internal/external rotations to be unconstrained. A kinematic analysis of the cable system and linkage interaction is presented, and a prototype is fabricated to verify the proposed concept.

Generating Arm-Swing Trajectories in Real-Time Using a Data-Driven Model for Gait Rehabilitation With Self-Selected Speed.

Gait rehabilitation is often focused on the legs and overlooks the role of the upper limbs. However, a variety of studies have demonstrated the importance of proper arm swing both during healthy walking and during rehabilitation. In this paper, we describe a method for generating proper arm-swing trajectories in real time using only measurements of the angular velocity of a person's thighs, to be used during gait rehabilitation with self-selected walking speed. A data-driven linear time-invariant transfer function is developed, using frequency-response methods, which captures the frequency-dependent magnitude and phase relationship between the thighs' angular velocities and the arm angles (measured at the shoulder, in the sagittal plane), using a data set of 30 healthy adult subjects. We show that the proposed method generates smooth trajectories for both healthy individuals and patients with mild to moderate Parkinson disease. The proposed method can be used in future robotic devices that integrate arm swing in gait rehabilitation of patients with walking impairments to improve the efficacy of their rehabilitation.

Comprehensive quantitative investigation of arm swing during walking at various speed and surface slope conditions.

Previous studies have shown that inclusion of arm swing in gait rehabilitation leads to more effective walking recovery in patients with walking impairments. However, little is known about the correct arm-swing trajectories to be used in gait rehabilitation given the fact that changes in walking conditions affect arm-swing patterns. In this paper we present a comprehensive look at the effects of a variety of conditions on arm-swing patterns during walking. The results describe the effects of surface slope, walking speed, and physical characteristics on arm-swing patterns in healthy individuals. We propose data-driven mathematical models to describe arm-swing trajectories. Thirty individuals (fifteen females and fifteen males) with a wide range of height (1.58-1.91m) and body mass (49-98kg), participated in our study. Based on their self-selected walking speed, each participant performed walking trials with four speeds on five surface slopes while their whole-body kinematics were recorded. Statistical analysis showed that walking speed, surface slope, and height were the major factors influencing arm swing during locomotion. The results demonstrate that data-driven models can successfully describe arm-swing trajectories for normal gait under varying walking conditions. The findings also provide insight into the behavior of the elbow during walking.

Kinesthetic Force Feedback and Belt Control for the Treadport Locomotion Interface.

This paper describes an improved control system for the Treadport immersive locomotion interface, with results that generalize to any treadmill that utilizes an actuated tether to enable self-selected walking speed. A new belt controller is implemented to regulate the user's position; when combined with the user's own volition, this controller also enables the user to naturally self-select their walking speed as they would when walking over ground. A new kinesthetic-force-feedback controller is designed for the tether that applies forces to the user's torso. This new controller is derived based on maintaining the user's sense of balance during belt acceleration, rather than by rendering an inertial force as was done in our prior work. Based on the results of a human-subjects study, the improvements in both controllers significantly contribute to an improved perception of realistic walking on the Treadport. The improved control system uses intuitive dynamic-system and anatomical parameters and requires no ad hoc gain tuning. The control system simply requires three measurements to be made for a given user: the user's mass, the user's height, and the height of the tether attachment point on the user's torso.

Investigation of the Treadport for gait rehabilitation of spinal cord injury.

The goal of this study is to compare the effect of training by the University of Utah's Treadport versus a conventional treadmill on gait improvement of spinal-cord-injury (SCI) patients. Four incomplete SCI subjects who had reached a rehabilitation plateau were selected to have training first on the treadmill and then the Treadport. Spatiotemporal and gait parameters were utilized to make a comparison between the two training conditions. Overall, the results demonstrated statically significant improvements in most of the spatiotemporal as well as some of the gait parameters during training with the Treadport relative to the traditional treadmill.