Abstract

Predicting the movements, ground reaction forces and neuromuscular activity during gait can be a valuable asset to the clinical rehabilitation community, both to understand pathology, as well as to plan effective intervention. In this work we use an optimal control method to generate predictive simulations of pathological gait in the sagittal plane. We construct a patient-specific model corresponding to a 7-year old child with gait abnormalities and identify the optimal spring characteristics of an ankle-foot orthosis that minimizes muscle effort. Our simulations include the computation of foot-ground reaction forces, as well as the neuromuscular dynamics using computationally efficient muscle torque generators and excitation-activation equations. The optimal control problem (OCP) is solved with a direct multiple shooting method. The solution of this problem is physically consistent synthetic neural excitation commands, muscle activations and whole body motion. Our simulations produced similar changes to the gait characteristics as those recorded on the patient. The orthosis-equipped model was able to walk faster with more extended knees. Notably, our approach can be easily tuned to simulate weakened muscles, produces physiologically realistic ground reaction forces and smooth muscle activations and torques, and can be implemented on a standard workstation to produce results within a few hours. These results are an important contribution toward bridging the gap between research methods in computational neuromechanics and day-to-day clinical rehabilitation.

Highlights

  • The clinical treatment of neuromuscular gait abnormality is a complex process that demands significant investment of time and effort from the patient, surgeons and orthotists

  • We model the human body as an articulated multi-body system with 8 segments, each with one rotational Degree of Freedom (DoF) in the sagittal plane

  • The rotational DoFs at the hips, knees, ankles and the torso were each actuated by a pair of agonist-antagonist Muscle Torque Generators (MTG), which represent the combined torques being generated by muscle forces in that direction (Figure 1)

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Summary

INTRODUCTION

The clinical treatment of neuromuscular gait abnormality is a complex process that demands significant investment of time and effort from the patient (and caregivers), surgeons and orthotists. The ideal combination of model/method would be one that is computationally efficient, includes neuromuscular dynamics, produces realistic ground reaction forces, can be tuned to an individual (healthy or pathological) quickly and accurately, and can predict movements. Each of these requirements is challenging, methodological and technological advances have made some of these possible. Studies such as the one presented here can at the very least compare their results to those measures that are relatively easy to record (e.g., joint kinematics, ground reaction forces, surface EMG) While this is not a full validation, a model that can match these observations can at least assure the clinician of exhibiting behavior that is physiologically realistic. Our simulation results are compared to experimental recordings from a 7-year old patient with neuromuscular deficits

Patient Data
Model Formulation
Patient-Specific Muscle Torque Generator
Parametrized Orthosis Model
Gait as an Optimal Control Problem
MAPD-WS-Orthosis
Evaluation Procedure
RESULTS
DISCUSSION
Choosing an Optimality Criterion for Gait
Limitations and Perspectives
Full Text
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