Gait recovery in healthy subjects: Perturbations to the knee motion with a Smart Knee Brace

Smart Knee Brace (SKB) is designed to provide controlled perturbations to the human knee during walking. A dynamic model of human walking is then used to evaluate the human applied joint torques to hypothesize how the human neuro-muscular system modulates the joint torques as a response to the perturbations caused on the gait. Our results show that the neuro-muscular response to perturbations can be reasonably well characterized by including the following features in the model: (i) normal gait in the absence of perturbation, (ii) corrective torque at a joint in response to the error at that joint and other joints, (iii) a characteristic time shift in the response. We believe that these parameters can be used to characterize subjects who are more prone to falling under gait perturbations.

[1]  David A. Winter,et al.  Human balance and posture control during standing and walking , 1995 .

[2]  T. Masud,et al.  Epidemiology of falls. , 2001, Age and ageing.

[3]  H. Menz,et al.  Falls in Older People: Risk Factors and Strategies for Prevention , 2000 .

[4]  Joseph Paul White.  Real time event detection and control of a smart knee brace for gait rehabilitation , 2007 .

[5]  E. Finkelstein,et al.  The costs of fatal and non-fatal falls among older adults , 2006, Injury Prevention.

[6]  A. Patla,et al.  Visual control of locomotion: strategies for changing direction and for going over obstacles. , 1991, Journal of experimental psychology. Human perception and performance.

[7]  A. Patla,et al.  Adapting locomotion to different surface compliances: neuromuscular responses and changes in movement dynamics. , 2005, Journal of neurophysiology.

[8]  S. Prentice,et al.  Adaptation to unilateral change in lower limb mechanical properties during human walking , 2006, Experimental Brain Research.

[9]  V. Dietz,et al.  Obstacle avoidance during human walking: transfer of motor skill from one leg to the other , 2002, The Journal of physiology.

[10]  T. M. Owings,et al.  Mechanisms leading to a fall from an induced trip in healthy older adults. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  M. Woollacott,et al.  Control of reactive balance adjustments in perturbed human walking: roles of proximal and distal postural muscle activity , 1998, Experimental Brain Research.

[12]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[13]  Daniel P. Ferris,et al.  Learning to walk with a robotic ankle exoskeleton. , 2007, Journal of biomechanics.

[14]  David J. Reinkensmeyer,et al.  A robotic device for manipulating human stepping , 2006, IEEE Transactions on Robotics.

[15]  P. Corso,et al.  The acute medical care costs of fall-related injuries among the U.S. older adults. , 2005, Injury.

[16]  J. Smit,et al.  Balance and mobility performance as treatable risk factors for recurrent falling in older persons. , 2003, Journal of clinical epidemiology.

[17]  Reed Ferber,et al.  Reactive balance adjustments to unexpected perturbations during human walking. , 2002, Gait & posture.

[18]  Shobha S Rao.  Prevention of falls in older patients. , 2005, American family physician.

[19]  Avril Mansfield,et al.  A perturbation-based balance training program for older adults: study protocol for a randomised controlled trial , 2007, BMC geriatrics.

[20]  V. Dietz,et al.  Contribution of feedback and feedforward strategies to locomotor adaptations. , 2006, Journal of neurophysiology.

[21]  David A. Winter,et al.  Biomechanics and Motor Control of Human Movement , 1990 .

[22]  S. Hesse,et al.  A mechanized gait trainer for restoration of gait. , 2000, Journal of rehabilitation research and development.

[23]  Wenwei Yu,et al.  An artificial reflex improves the perturbation-resistance of a human walking simulator , 2007, Medical & Biological Engineering & Computing.

[24]  Rein Tideiksaar.  Falls in Older People: Prevention & Management , 2010 .

[25]  M. Bobbert,et al.  Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. , 2005, Gait & posture.

[26]  J. Duysens,et al.  Mechanically induced stumbling during human treadmill walking , 1996, Journal of Neuroscience Methods.

[27]  D.J. Reinkensmeyer,et al.  Optimizing Compliant, Model-Based Robotic Assistance to Promote Neurorehabilitation , 2008, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[28]  Dawn A Skelton,et al.  Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. , 2002, Age and ageing.

[29]  M. Woollacott,et al.  Balance control during walking in the older adult: research and its implications. , 1997, Physical therapy.

[30]  E. Zehr,et al.  Cutaneous reflexes during human gait: electromyographic and kinematic responses to electrical stimulation. , 1997, Journal of neurophysiology.

[31]  Conrad Wall,et al.  Recovery from perturbations during paced walking. , 2004, Gait & posture.

[32]  E. Taub,et al.  Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. , 1999, Stroke.

[33]  Maarten F. Bobbert,et al.  Age-related intrinsic limitations in preventing a trip and regaining balance after a trip , 2005 .