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1. User and Environmental Context Adaptive Knee Exoskeleton Assistance using Electromyography

   https://doi.org/10.1109/ISMR57123.2023.10130260  

   Lee, Dawit ; Kang, Inseung ; Kogler, Géza F. ; Hammond, Frank L. ; Young, Aaron J. ( April 2023 , IEEE 2023 International Symposium on Medical Robotics (ISMR))

   Proportional myoelectric controller (PMC) has been one of the most common assistance strategies for robotic exoskeletons due to its ability to modulate assistance level directly based on the user's muscle activation. However, existing PMC strategies (static or user-adaptive) scale torque linearly with muscle activation level and fail to address complex and non-linear mapping between muscle activation and joint torque. Furthermore, previously presented adaptive PMC strategies do not allow for environmental changes (such as changes in ground slopes) and modulate the system's assistance level over many steps. In this work, we designed a novel user- and environment-adaptive PMC for a knee exoskeleton that modulates the peak assistance level based on the slope level during locomotion. We recruited nine able-bodied adults to test and compare the effects of three different PMC strategies (static, user-adaptive, and user- and environment-adaptive) on the user's metabolic cost and the knee extensor muscle activation level during load-carriage walking (6.8 kg) in three inclination settings (0°, 4.5°, and 8.5°). The results showed that only the user- and environment-adaptive PMC was effective in significantly reducing user's metabolic cost (5.8% reduction) and the knee extensor muscle activation (19% reduction) during 8.5° incline walking compared to the unpowered condition while other PMCs did not have as large of an effect. This control framework highlights the viability of implementing an assistance paradigm that can dynamically adjust to the user's biological demand, allowing for a more personalized assistance paradigm. 

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2. A Potential Energy Shaping Controller with Ground Reaction Force Feedback for a Multi-Activity Knee-Ankle Exoskeleton

   https://doi.org/10.1109/BioRob49111.2020.9224341  

   Divekar, Nikhil V. ; Lin, Jianping ; Nesler, Christopher ; Borboa, Sara ; Gregg, Robert D. ( November 2020 , 2020 8th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob))

   This paper presents the design and implementation of a novel multi-activity control strategy for a backdrivable knee-ankle exoskeleton. Traditionally, exoskeletons have used trajectory-based control of highly geared actuators for complete motion assistance. In contrast, we develop a potential energy shaping controller with ground reaction force (GRF) feedback that facilitates multi-activity assistance from a backdrivable exoskeleton without prescribing pre-defined kinematics. Although potential energy shaping was previously implemented in an exoskeleton to reduce the user’s perceived gravity, this model-based approach assumes the stance leg is fully loaded with the weight of the user, resulting in excessive control torques as weight transfers to the contralateral leg during double support. The presented approach uses GRF feedback to taper the torque control output for any activity involving multiple supports, leading to a closer match with normative joint moments in simulations based on pre-recorded human data during level walking. To implement this strategy, we present a custom foot force sensor that provides GRF feedback to the previously designed exoskeleton. Finally, results from an able-bodied human subject experiment demonstrate that the exoskeleton is able to reduce muscular activation of the primary muscles related to the knee and ankle joints during sit-to-stand, stand-to-sit, level walking, and stair climbing. 

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3. Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study

   https://doi.org/10.1177/1941738120955184  

   Brown, Scott R. ; Washabaugh, Edward P. ; Dutt-Mazumder, Aviroop ; Wojtys, Edward M. ; Palmieri-Smith, Riann M. ; Krishnan, Chandramouli ( December 2020 , Sports Health: A Multidisciplinary Approach)

   Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, “nonfunctional” training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR.

   FRT would improve knee strength and function after ACLR.

   Case report.

   Level 5.

   A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention.

   Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR leg was 72%, compared with the non-ACLR leg at 75%. Knee angle and moment during late stance phase decreased (ie, improved) in the ACLR leg and appeared more similar to the non-ACLR leg after FRT training (18° to 14° [−23.4] and 0.07 to −0.02 N·m·kg⁻¹·m⁻¹[−122.8%], respectively). Corticospinal and spinal excitability in the ACLR leg decreased (3511 to 2511 [−28.5%] and 0.42 to 0.24 [−43.7%], respectively) from pre- to posttraining.

   A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training.

   FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.

    

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4. Muscle coordination retraining inspired by musculoskeletal simulations reduces knee contact force

   https://doi.org/10.1038/s41598-022-13386-9  

   Uhlrich, Scott D. ; Jackson, Rachel W. ; Seth, Ajay ; Kolesar, Julie A. ; Delp, Scott L. ( July 2022 , Scientific Reports)

   Humans typically coordinate their muscles to meet movement objectives like minimizing energy expenditure. In the presence of pathology, new objectives gain importance, like reducing loading in an osteoarthritic joint, but people often do not change their muscle coordination patterns to meet these new objectives. Here we use musculoskeletal simulations to identify simple changes in coordination that can be taught using electromyographic biofeedback, achieving the therapeutic goal of reducing joint loading. Our simulations predicted that changing the relative activation of two redundant ankle plantarflexor muscles—the gastrocnemius and soleus—could reduce knee contact force during walking, but it was unclear whether humans could re-coordinate redundant muscles during a complex task like walking. Our experiments showed that after a single session of walking with biofeedback of summary measures of plantarflexor muscle activation, healthy individuals reduced the ratio of gastrocnemius-to-soleus muscle activation by 25 ± 15% (p = 0.004, paired t test, n = 10). Participants who walked with this “gastrocnemius avoidance” gait pattern reduced late-stance knee contact force by 12 ± 12% (p = 0.029, paired t test, n = 8). Simulation-informed coordination retraining could be a promising treatment for knee osteoarthritis and a powerful tool for optimizing coordination for a variety of rehabilitation and performance applications.

    

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5. Understanding muscle function during perturbed in vivo locomotion using a muscle avatar approach

   https://doi.org/10.1242/jeb.244721  

   Rice, Nicole ; Bemis, Caitlin M. ; Daley, Monica A. ; Nishikawa, Kiisa ( July 2023 , Journal of Experimental Biology)

   ABSTRACT The work loop technique has provided key insights into in vivo muscle work and power during steady locomotion. However, for many animals and muscles, ex vivo experiments are not feasible. In addition, purely sinusoidal strain trajectories lack variations in strain rate that result from variable loading during locomotion. Therefore, it is useful to develop an ‘avatar’ approach in which in vivo strain and activation patterns from one muscle are replicated in ex vivo experiments on a readily available muscle from an established animal model. In the present study, we used mouse extensor digitorum longus (EDL) muscles in ex vivo experiments to investigate in vivo mechanics of the guinea fowl lateral gastrocnemius (LG) muscle during unsteady running on a treadmill with obstacle perturbations. In vivo strain trajectories from strides down from obstacle to treadmill, up from treadmill to obstacle, strides with no obstacle and sinusoidal strain trajectories at the same amplitude and frequency were used as inputs in work loop experiments. As expected, EDL forces produced with in vivo strain trajectories were more similar to in vivo LG forces (R2=0.58–0.94) than were forces produced with the sinusoidal trajectory (average R2=0.045). Given the same stimulation, in vivo strain trajectories produced work loops that showed a shift in function from more positive work during strides up from treadmill to obstacle to less positive work in strides down from obstacle to treadmill. Stimulation, strain trajectory and their interaction had significant effects on all work loop variables, with the interaction having the largest effect on peak force and work per cycle. These results support the theory that muscle is an active material whose viscoelastic properties are tuned by activation, and which produces forces in response to deformations of length associated with time-varying loads. 

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