Design and Preliminary Evaluation of a Wearable Passive Cam-Based Shoulder Exoskeleton.

Mechanically passive exoskeletons may be a practical and affordable solution to meet a growing clinical need for continuous, home-based movement assistance. We designed, fabricated, and preliminarily evaluated the performance of a wearable, passive, cam-driven shoulder exoskeleton (WPCSE) prototype. The novel feature of the WPCSE is a modular spring-cam-wheel module, which generates an assistive force that can be customized to compensate for any proportion of the shoulder elevation moment due to gravity. We performed a benchtop experiment to validate the mechanical output of the WPCSE against our theoretical model. We also conducted a pilot biomechanics study (eight able-bodied subjects) to quantify the effect of a WPCSE prototype on muscle activity and shoulder kinematics during three shoulder movements. The shoulder elevation moment produced by the spring-cam-wheel module alone closely matched the desired theoretical moment. However, when measured from the full WPCSE prototype, the moment was lower (up to 30%) during positive shoulder elevation and higher (up to 120%) during negative shoulder elevation compared to the theoretical moment, due primarily to friction. Even so, a WPCSE prototype, compensating for about 25% of the shoulder elevation moment due to gravity, showed a trend of reducing root-mean-square electromyogram magnitudes of several muscles crossing the shoulder during shoulder elevation and horizontal adduction/abduction movements. Our results also showed that the WPCSE did not constrain or impede shoulder movements during the tested movements. The results provide proof-of-concept evidence that our WPCSE can potentially assist shoulder movements against gravity.

Trunk Dynamic Stability Assessment for Individuals With and Without Nonspecific Low Back Pain During Repetitive Movement.

OBJECTIVE: This study aimed to employ nonlinear dynamic approaches to assess trunk dynamic stability with speed, symmetry, and load during repetitive flexion-extension (FE) movements for individuals with and without nonspecific low back pain (NSLBP). BACKGROUND: Repetitive trunk FE movement is a typical work-related LBP risk factor contingent on speed, symmetry, and load. Improper settings/adjustments of these control parameters could undermine the dynamic stability of the trunk, hence leading to low back injuries. The underlying stability mechanisms and associated control impairments during such dynamic movements remain elusive. METHOD: Thirty-eight male volunteers (19 healthy, 19 NSLBP) enrolled in the current study. All participants performed repetitive trunk FE movements at high/low speeds, in symmetric/asymmetric directions, with/without a wearable loaded vest. Trunk instantaneous rotation angle was computed for each trial to be assessed in terms of local and orbital stability, using maximum finite-time Lyapunov exponents (LyEs) and Floquet multipliers (FMs), respectively. RESULTS: Both groups demonstrated equivalent competency in terms of trunk control and stability, suggesting functional adaptation strategies may be used by the NSLBP group. Wearing the loaded vest magnified the effects of trunk control impairment for the NSLBP group. The combined presence of high-speed and symmetrical FE movements was associated with least trunk local stability. CONCLUSION: Nonlinear dynamic techniques, particularly LyE, are potentially effective for assessing trunk dynamic stability dysfunction for individuals with NSLBP during various activities. APPLICATION: This work can be applied toward the development of quantitative personalized spinal evaluation tools with a wide range of potential occupational and clinical applications.

Estimating Human Upper Limb Impedance Parameters From a State-of-the-Art Computational Neuromusculoskeletal Model.

The human neuro-musculoskeletal system constantly deploys passive (e.g., posture adjustment) and active (e.g., muscle co-contraction) control strategies to regulate upper limb impedance and stability while interacting with the outside world. Upper limb impedance has been assessed through in vivo experiments and model-based simulations. The experiments are practically limited to small samples of able-bodied subjects and few limb postures, and model-based approaches have mostly used simplified upper limb models. Our objective was to develop and validate a computational approach to estimate upper limb impedance parameters - stiffness, viscosity, and inertia - at the endpoint (i.e., hand) using a neuromusculoskeletal model with realistic geometry. We added a planar manipulandum to an existing upper limb model implemented in OpenSim (version 3.3) and used contact modeling to attach the manipulandum's handle to the musculoskeletal model's hand. The hand was placed at several locations lateral to the shoulder joint along anterior/posterior and medial/lateral axes. At each location, during forward dynamics simulations, the manipulandum applied small perturbations to the hand in eight different directions. The spatial variation of the computed, model-based impedance parameters was similar to that of experimentally measured impedance parameters. However, the overall size of the stiffness and viscosity components was larger in the model than from experiments.Clinical Relevance- Computational modeling and simulations can estimate upper limb impedance properties to complement and overcome the limitations of experiments, especially for clinical populations. The computational approach could ultimately inform new interventions and devices to restore limb stability in people with shoulder disabilities.

Wearable Shoulder Exoskeleton with Spring-Cam Mechanism for Customizable, Nonlinear Gravity Compensation.

Wearable, mechanically passive (i.e. spring-powered) exoskeletons may be more practical and affordable than active, motorized exoskeletons for providing continuous, home-based, antigravity movement assistance for people with shoulder disability. However, the biomechanical moment due to gravity is a nonlinear function of shoulder elevation angle and, thus, challenging to counteract proportionally across the shoulder elevation range of motion with a spring alone. We designed, fabricated, and tested an integrated spring-cam-wheel system that can generate a nonlinear moment to proportionally compensate for the expected antigravity moment at the shoulder. We then incorporated the proposed system in a benchtop model and a novel wearable passive cable-driven exoskeleton that was intended to counteract half of the gravitational moment during shoulder elevation movements. The rotational moment measured from the benchtop model closely matched the theoretical moment during simulated positive shoulder elevation. However, a larger moment (up to 12.5% larger) was required during simulated negative shoulder elevation to stretch the spring to its initial length due to spring hysteresis and friction losses. The wearable exoskeleton prototype was qualitatively tested for assisting shoulder elevation movements; we identified several aspects of the prototype design that need to be improved before further testing on human participants. In future studies, we will quantitatively evaluate human kinematics and neuromuscular coordination with the exoskeleton to determine its suitability for assisting patients with shoulder disability.

Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface.

OBJECTIVES: The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface. STUDY DESIGN: An observational cross-sectional study. MAIN OUTCOME MEASURES: The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes. METHODS: Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks. RESULTS: Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05). CONCLUSIONS: Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.

The Amount and Temporal Structure of Center of Pressure Fluctuations During Quiet Standing in Patients With Chronic Low Back Pain.

The characteristics of postural sway were assessed in quiet standing under three different postural task conditions in 14 patients with nonspecific chronic low back pain and 12 healthy subjects using linear and nonlinear center of pressure parameters. The linear parameters consisted of area, the mean total velocity, sway amplitude, the SD of velocity, and the phase plane portrait. The nonlinear parameters included the Lyapunov exponent, sample entropy, and the correlation dimension. The results showed that the amount of postural sway was higher in the patients with low back pain compared with the healthy subjects. Assessing the nonlinear parameters of the center of pressure showed a lower sample entropy and a higher correlation dimension in the patients with low back pain compared with the healthy subjects. The results of this study demonstrate the greater regularity and higher dimensionality of the center of pressure fluctuations in patients with nonspecific chronic low back pain, which suggests that these patients adopt different postural control strategies to maintain an upright stance.

Effects of lumbosacral orthosis on dynamical structure of center of pressure fluctuations in patients with non-specific chronic low back pain: A randomized controlled trial.

BACKGROUND: A few clinical trials have examined the effect of treatment interventions on postural control in patients with chronic low back pain, all of which have exclusively evaluated postural stability using traditional linear measures of postural sway. However, postural control improvement cannot be determined by exclusively relying on linear measurements, because these parameters provide no information on underlying motor control mechanisms. OBJECTIVE: This study aimed to compare the effect of using lumbosacral orthoses (LSO) together with routine physical therapy, compared to routine physical therapy alone on postural control, using nonlinear analysis techniques. METHODS: Forty-four patients with low back pain were randomly allocated to the intervention and control groups. Both groups underwent 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received LSO in addition to routine physical therapy. Before and after the intervention, non-linear dynamical features of center of pressure fluctuations were assessed during quiet standing at 3 difficulty levels of postural tasks, including eyes open while standing on a rigid surface, eyes closed while standing on a rigid surface, and eyes closed while standing on a foam surface. RESULTS: The results of this study showed that a 4-week intervention consisting of LSO and routine physical therapy modalities did not affect the temporal structure of postural sways in patients with low back pain. CONCLUSION: Treatment strategies, such as routine physical therapy modalities or LSO, which exclusively focus on the correction of peripheral mechanics, fail to affect the behavior of the postural control system.

Immediate Effects of Lumbosacral Orthosis on Postural Stability in Patients with Low Back Pain: A Preliminary Study.

BACKGROUND: Lumbosacral orthosis (LSO) is commonly used for the treatment of back pain. The clinical and mechanical effectiveness of this device has been repeatedly investigated in several studies; however, its sensorimotor effectiveness has been rarely considered. Regarding this, the aim of the current study was to investigate the effect of a non-extensible LSO on postural stability (as a construct of sensorimotor function) in patients with nonspecific chronic low back pain (LBP). METHODS: This preliminary study was conducted on 17 patients with nonspecific chronic LBP using a single-group quasi-experimental design. Postural stability was measured while the participants were placed in a quiet standing position, under the combined conditions of base of support (rigid and foam surface), visual input (open eyes and closed eyes), and LSO (with and without orthosis). RESULTS: The findings demonstrated that wearing orthosis during the most challenging postural task (i.e., blindfolded while standing on a foam surface) significantly reduced postural sway parameters related to the position and displacement of the center of pressure (COP; the sway area and sway amplitude in the anteroposterior direction; P<0.001). However, the use of this device had no significant effect on COP velocity. CONCLUSION: As the findings of the present study indicated, the use of a non-extensible LSO decreased the COP displacement; however, it did not affect the COP velocity. Therefore, our data could not utterly support the effectiveness of non-extensible LSO on postural stability as a construct of sensorimotor function. Postural control is an appropriate indicator for assessing the global functioning of the sensorimotor system due to its dependence upon the interaction between the neural and musculoskeletal systems. Consequently, further studies are needed to elucidate the positive effects of LSO on the aspects of sensorimotor function.

The new "Tehran Back Belt": Design then testing during a simulated sitting task improved biomechanical spine muscle activity.

Background: Spinal load and muscle activity in occupation settings is an area of increasing concern. Regarding technological advancements, in diverse occupations the spinal loads have increased through constrained seated postures. Back belts are consequently used in prophylactic and conservative management of occupational low back pain (LBP) in two distinct settings, prevention in industry, and treatment in LBP management. Industrial sites utilize belts for LBPprophylaxis on a large scale with their design and user experience (UE) influencing both the effectiveness and the workers' compliance. This pilot study aims at determining the effectiveness of the new Tehran Back Belt (TBB) and assesses both UE and biomechanical effect (BE) on para-spinal muscle activity in healthy subjects. Methods: A pretest-posttest study. Stage-1, design and fabrication of the TBB. Stage-2, the UE of the designed belt evaluated in healthy volunteers (n=30) via a checklist. The BE was determined from the level of lumbar extensor and trunk flexor muscle activity gauged during two test conditions of sitting posture (with and without belt) over 35-minute periods. Results: Most subjects (>90%) reported high 'ease of use' and 'comfort' while wearing the TBB.The BE statistical analysis showed significantly reduced EMG activity levels for the longissimus(P = 0.012, η2=0.24), rectus abdominis (P=0.024, η2=0.18) and internal oblique (P=0.001,η2=0.44) muscles in belt-use conditions. Conclusion: Decreased muscle activity while using the TBB is potentially advantageous for workers as spinal muscle activity is significantly reduced. Further investigations for longer duration effects and during real work office-based activities are warranted.

The non-coding RNA rprA can increase the resistance to ampicillin in Escherichia coli.

OBJECTIVES: The non-coding RNA rprA can increase the resistance to ampicillin in Escherichia coli. METHODS: Bacterial DNA was extracted by boiling method and then amplified using polymerase chain reaction (PCR) with two different primer sets. Recombinant pET28a/rprA-sense and -antisense plasmids were separately transferred into the competent E. coli BL21 (DE3) by chemical methods using heat shock. The expression was analyzed at the RNA level using Semi quantitative RT PCR. The turbidity difference between the bacteria was checked by Broth Dilution method. RESULTS: The statistical analysis showed that the turbidity difference between the up regulated and control bacteria is significant (p value < 0.0001). The ANOVA test also showed the significant difference between the down regulated and control bacteria (p value < 0.0001). CONCLUSION: Considering this mechanism, there are some reports indicating the role of rprA in antibiotic resistance. However, the role of rprA in ampicillin resistance is remained to be unknown. The aim of this study was to analyze the up regulation and down regulation of rprA and check their effects on ampicillin resistance in Escherichia coli. It was found that the up regulation and down regulation of rprA can lead into more antibiotics resistance and susceptibility, respectively. Our results showed the potential role of rprA expression in the response to ampicillin stress in E. coli.

Cloning and over expression of non-coding RNA rprA in E.coli and its resistance to Kanamycin without osmotic shock.

Recent reports have indicated that small RNAs have key roles in the response of the E.coli to stress and also in the regulating of virulence factors. It seems that some small non-coding RNAs are involved in multidrug resistance. Previous studies have indicated that rprA can increase the tolerance to Kanamycin in RcsB-deficient Escherichia coli K-12 following osmotic shock. The current study aims to clone and over-express the non-coding RNA rprA in E.coli and investigate its effect on the bacterial resistance to Kanamycin without any osmotic shock. For this purpose, rprA gene was amplified by the PCR and then cloned into the PET-28a (+) vector. The recombinant plasmid was transformed into wild type E.coli BL21 (DE3). The over expression was induced by IPTG and confirmed by qRT-PCR. The resistance to the kanamycin was then measured in different times by spectrophotometry. The statistical analysis showed that the rprA can increase the resistance to Kanamycin in Ecoli K12. The interaction between rprA and rpoS was reviewed and analyzed by in silico methods. The results showed that the bacteria with over-expressed rprA were more resistant to Kanamycin. The present study is an important step to prove the role of non-coding RNA rprA in bacterial resistance. The data can be the basis for future works and can also help to develop and deliver next-generation antibiotics.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain.

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain. Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability. Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001). Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.

The effects of movement speed on kinematic variability and dynamic stability of the trunk in healthy individuals and low back pain patients.

BACKGROUND: Comparison of the kinematic variability and dynamic stability of the trunk between healthy and low back pain patient groups can contribute to gaining valuable information about the movement patterns and neuromotor strategies involved in various movement tasks. METHODS: Fourteen chronic low back pain patients with mild symptoms and twelve healthy male volunteers performed repeated trunk flexion-extension movements in the sagittal plane at three different speeds: 20 cycles/min, self-selected, and 40 cycles/min. Mean standard deviations, coefficient of variation and variance ratio as variability measures; maximum finite-time Lyapunov exponents and maximum Floquet multipliers as stability measures were computed from trunk kinematics. FINDINGS: Higher speed significantly reduced the kinematic variability, while it increased short-term Lyapunov exponents. Long-term Lyapunov exponents were higher at self-selected speed and lower in low back pain patients as compared to control volunteers. Floquet multipliers were larger at self-selected speed and during higher pace trunk movements. INTERPRETATION: Our findings suggest that slower pace flexion-extension trunk movements are associated with more motor variation as well as local and orbital stability, implying less potential risk of injury for the trunk. Individuals with and without low back pain consistently recruited a closed-loop control strategy towards achieving trunk stability. Chronic low back pain patients exhibited more stable trunk movements over long-term periods, indicating probable temporary pain relief functional adaption strategies. These results may be used towards the development of more effective personalized rehabilitation strategies and quantitative spinal analysis tools for low back pain detection, diagnosis and treatment, as well as improvement of workspace and occupational settings.