Akbas Tunc, Sulzer James
IEEE Int Conf Rehabil Robot. 2019 Jun;2019:1185-1190. doi: 10.1109/ICORR.2019.8779564.
Assistive technology for the lower extremities has shown great promise towards improving gait function in people following neuromuscular injuries. However, our previous work assisting knee flexion torque in post-stroke Stiff-Knee gait found that augmenting strength can induce secondary complications such as spasticity due to stretching of the rectus femoris. In this work we explore whether we could have obtained improved knee flexion but avoided a spastic response by simulating combinations of hip and knee flexion torques using musculoskeletal modeling and simulation. We explore previously collected data on a case-by-case basis to determine individual-specific quadriceps reflex thresholds based on estimated rectus femoris muscle fiber stretch velocities. We then implemented a forward simulation framework to identify the subject-specific hip-knee assistance prescription to improve knee range of motion without initiating a spastic response. The obtained subject-specific assistive prescription informs the development of new gait assistance strategies for post-stroke gait and could be extended to other neuromuscular gait impairments.
下肢辅助技术在改善神经肌肉损伤患者的步态功能方面显示出了巨大的潜力。然而，我们之前在中风后僵膝步态中辅助膝关节屈曲扭矩的工作发现，增强力量可能会引发继发性并发症，如由于股直肌拉伸导致的痉挛。在这项工作中，我们通过使用肌肉骨骼建模和模拟来模拟髋部和膝部屈曲扭矩的组合，探索是否能够在改善膝关节屈曲的同时避免痉挛反应。我们逐案分析先前收集的数据，根据估计的股直肌纤维拉伸速度确定个体特异性的股四头肌反射阈值。然后，我们实施了一个正向模拟框架，以确定特定于个体的髋膝辅助处方，从而在不引发痉挛反应的情况下改善膝关节活动范围。所获得的特定于个体的辅助处方为中风后步态的新步态辅助策略的开发提供了参考，并且可以扩展到其他神经肌肉步态障碍。
