A Narrative Review of Alternate Gait Training Using Knee-ankle-foot Orthosis in Stroke Patients with Severe Hemiparesis

Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce “locomotor-like” coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.     

White matter hyperintensities and dynamics of postural control

Background

White matter hyperintensities (WMHs) on MRI have been associated with age, cardiovascular risk factors and falls in the elderly. This study evaluated the relationship between WMHs and dynamics of postural control in older adults without history of falls.

Methods

We studied 76 community-living subjects without history of falls (age 64.5±7.3 years). Brain and WMH volume calculations and clinical rating were done on fluid-attenuation inversion recovery (FLAIR) and MP-RAGE MR images on 3 T. Balance was assessed from the center of pressure displacement using the force platform during 3 min of quiet standing using traditional and dynamic measures (using stabilogram-diffusion analysis). Gait speed was measured from 12-min walk.

Results

Age-adjusted periventricular and focal WMHs were associated with changes in certain dynamic balance measures, including reduced range of postural sway in anteroposterior direction (fronto-temporal WMHs, P=.045; parieto-occipital WMHs, P=.009) and more irregular long-term mediolateral fluctuations (P=.046). Normal walking speed was not affected by WMHs.

Conclusions

Periventricular and focal WMHs affect long-term dynamics of postural control, which requires engagement of feedback mechanisms, and may contribute to mobility decline in the elderly.     

基于虚拟样机技术的四足机器人静态稳定步态规划

针对现有技术文献中广泛使用的多种静态稳定步态中速度稳定性与稳定裕度不可兼得的通病,在随动质心的静态步态基础上,利用参数化坐标变换矩阵方法规划出一种四足机器人前进过程中质心以曲线轨迹移动的静态步态方法,使该步态方法以连续性速度运动的过程中保证一定稳定裕度。通过D-H法求得四足机器人的逆运动学坐标变换矩阵,分别在三维空间中对四足机器人的四组足端轨迹方程进行规划,并带入MATLAB软件后以逆运动学方程计算出关节夹角驱动方程,利用步态规划图求出机器人四条腿各自对应的夹角驱动方程以及机体质心轨迹方程。最后在MSC.ADAMS软件中建立四足机器人虚拟样机并对规划的步态进行虚拟仿真,仿真结果验证了该步态对提升四足机器人对于速度连续性以及稳定裕度的提升。     

Cutoff Value for a Nutritional Indicator Related to Gait Independence in Elderly Fracture Patients: A Preliminary Study

Objective: Previous studies have reported the relationship between nutritional status and gait independence in elderly fracture patients. However, the degree to which nutritional indicators are related to gait independence is unclear. The purpose of this study is to calculate a cutoff value for a nutritional indicator related to gait independence in patients with hip and vertebral compression fractures. Method: This study included 69 patients (33 hip fracture, 36 vertebral compression fracture) who underwent rehabilitation at a convalescent rehabilitation ward. The relationships between nutritional indexes (Mini-Nutritional Assessment-Short Form [MNA^Ⓡ-SF] and skeletal muscle mass index [SMI] ) at admission and gait independence at discharge were analyzed using logistic regression. In addition, receiver operating characteristic analysis was performed to calculate a cutoff value that predicts gait independence. Results: Among the nutritional indicators used in this study, only MNA^Ⓡ-SF was significantly able to predict gait independence at discharge, and this association was maintained, even after adjustment for confounders. The calculated MNA^Ⓡ-SF cutoff values were 5.5 (sensitivity 100%, specificity 46.3%) and 7.5 points (sensitivity 67.9%, specificity 78.0%). Conclusion: This study suggests that MNA^Ⓡ-SF may be an index for predicting gait independence in patients with hip or vertebral compression fractures in the convalescent rehabilitation ward. The cutoff values calculated in this study were simple and useful index for physical therapists to interpret the results of MNA^Ⓡ-SF.     

Revisiting the stability of 2D passive biped walking: Local behavior

Models of biped walking have demonstrated that stable walking motions are possible without active control. Stability of these motions has typically been quantified by studying the stability of an associated Poincaré map (orbital stability). However, additional insight may be obtained by examining how perturbations evolve over the short-term (local stability). For example, there may be regions where small perturbations actually diverge from the unperturbed trajectory, even if over the entire cycle small (but perhaps not large) perturbations are dissipated. We present techniques to calculate local stability, and demonstrate the utility of these techniques by examining the local stability of the 2D compass biped. These techniques are relevant to the design of controllers to maintain stability in robots, and in understanding how the neuromuscular system maintains stability in humans.     

Limb dominance changes in walking evolution explored by asymmetric correlations in gait dynamics

Fluctuations in the stride interval time series of unconstrained walking are not random but seem to exhibit long-range correlations that decay as a power law (Hausdorff et al. (1995) [35]). Here, we examine whether asymmetries are present in the long-range correlations of different gait parameters (stride, swing and stance intervals) for the left and right limbs. Gait dynamics corresponding to 16 healthy subjects were obtained from the Physionet database, which contains stride, stance and swing intervals for both left and right limbs. Detrended Fluctuation Analysis (DFA) revealed the presence of asymmetric long-range correlations in all gait cycle variables investigated. A rich variety of scaling exponent dynamics was found, with the presence of synchronicity, decreased correlations and dominant correlations. The results are discussed in terms of the hypothesis that reduced strength of long-range correlations reflect both enhanced stability and adaptability.     

下肢负重外骨骼机器人的初步设计

研究设计了一种能够增强人体负重的下肢外骨骼机器人,该负重外骨骼机器人具有8个自由度,可实现髋关节的外展与内收、屈/伸运动;膝关节的屈/伸运动以及踝关节的弯曲运动。根据人体步态分析研究出各个关节的运动角度范围,结合目标负重进行结构优化设计。对机器人的结构进行简化,建立了外骨骼机器人的连杆模型,根据其几何关系,采用D-H准则对外骨骼机器人进行了数学建模。以计算机、六轴运动控制卡和STM32为核心构建了控制系统,结合ZMP(Zero Moment Point)零力矩点稳定性判据及三次样条插值进行了步态规划,并将此步态规划应用于样机上。样机实验结果表明,此结构能够满足不同体型的人进行穿戴,并能够根据规划的步态轻松行走,验证了其结构和控制系统的合理性。     

Fluctuation and synchronization of gait intervals and gait force profiles distinguish stages of Parkinson's disease

We study the effects of Parkinson's disease (PD) on the long-term fluctuation and phase synchronization properties of gait timing (series of interstride intervals) as well as gait force profiles (series characterizing the morphological changes between the steps). We find that the fluctuations in the gait timing are significantly larger for PD patients and early PD patients, who were not treated yet with medication, compared to age-matched healthy controls. Simultaneously, the long-term correlations and the phase synchronization of right and left leg are significantly reduced in both types of PD patients. Surprisingly, long-term correlations of the gait force profiles are relatively weak for treated PD patients and healthy controls, while they are significantly larger for early PD patients. The results support the idea that timing and morphology of recordings obtained from a complex system can contain complementary information.     

The Design of Structural Design Norms

Abstract

This paper deals with the analysis of prismatic and nonprismatic members with axial restraints, where their material is permitted to be stressed well beyond its elastic limit. This loading on the members causes the modulus of elasticity of the material to vary along their length. The mathematical formulation of this problem, as well as its analysis, is based on the method of equivalent systems that was developed by the first author. This method permits replacement of the original nonlinear member of variable stiffness E^xI^x, with one of uniform stiffness E¹I^l, that has the same length, boundary conditions, and elastic line as the original variable stiffness member. It is proven mathematically that this equivalency exists and that the solution of the equivalent system using linear analysis yields the same results as the solution of the original nonlinear variable stiffness member. Deflections and rotations may be easily obtained using equivalent systems, and the member can be analyzed in both elastic and inelastic ranges, all the way to failure, thus permitting observation of progressive deterioration of the ability of the member to resist load, stress, and de-formation. In this manner, practical critical limits regarding these modes of behavior can be established.