Control Of Human Gait Research Articles

Development of an artificial spinal cord circuit for a musculoskeletal humanoid robot mimicking the neural network involved in human gait control

Development of an artificial spinal cord circuit for a musculoskeletal humanoid robot mimicking the neural network involved in human gait control

Quantifying Human Gait Symmetry During Blindfolded Treadmill Walking.

Bilateral gait symmetry is an essential requirement for normal walking since asymmetric gait patterns increase the risk of falls and injuries. While human gait control heavily relies on the contribution of sensory inputs, the role of sensory systems in producing symmetric gait has remained unclear. This study evaluated the influence of vision as a dominant sensory system on symmetric gait production. Ten healthy adults performed treadmill walking with and without vision. Twenty-two gait parameters including ground reaction forces, joint range of motion, and other spatial-temporal gait variables were evaluated to quantify gait symmetry and compared between both visual conditions. Visual block caused increased asymmetry in most parameters of ground reaction force, however mainly in the vertical direction. When vision was blocked, symmetry of the ankle and knee joint range of motion decreased, but this change did not occur in the hip joint. Stance and swing time symmetry decreased during no-vision walking while no significant difference was found for step length symmetry between the two conditions. This study provides a comprehensive analysis to reveal how the visual system influences bilateral gait symmetry and highlights the important role of vision in gait control. This approach could be applied to investigate how vision alters gait symmetry in patients with disorders to help better understand the role of vision in pathological gaits.

Generation and Switching of Human Gait Control Signals by Hardware CPG Model Mimicking the Brainstem Spinal Projection System

Generation and Switching of Human Gait Control Signals by Hardware CPG Model Mimicking the Brainstem Spinal Projection System

Human-prosthesis cooperation: combining adaptive prosthesis control with visual feedback guided gait

BackgroundPersonalizing prosthesis control is often structured as human-in-the-loop optimization. However, gait performance is influenced by both human control and intelligent prosthesis control. Hence, we need to consider both human and prosthesis control, and their cooperation, to achieve desired gait patterns. In this study, we developed a novel paradigm that engages human gait control via user-fed visual feedback (FB) of stance time to cooperate with automatic prosthesis control tuning. Three initial questions were studied: (1) does user control of gait timing (via visual FB) help the prosthesis tuning algorithm to converge faster? (2) in turn, does the prosthesis control influence the user’s ability to reach and maintain the target stance time defined by the feedback? and (3) does the prosthesis control parameters tuned with extended stance time on prosthesis side allow the user to maintain this potentially beneficial behavior even after feedback is removed (short- and long-term retention)?MethodsA reinforcement learning algorithm was used to achieve prosthesis control to meet normative knee kinematics in walking. A visual FB system cued the user to control prosthesis-side stance time to facilitate the prosthesis tuning goal. Seven individuals without amputation (AB) and four individuals with transfemoral amputation (TFA) walked with a powered knee prosthesis on a treadmill. Participants completed prosthesis auto-tuning with three visual feedback conditions: no FB, self-selected stance time FB (SS FB), and increased stance time FB (Inc FB). The retention of FB effects was studied by comparing the gait performance across three different prosthesis controls, tuned with different visual FB.Results(1) Human control of gait timing reduced the tuning duration in individuals without amputation, but not for individuals with TFA. (2) The change of prosthesis control did not influence users’ ability to reach and maintain the visual FB goal. (3) All participants increased their prosthesis-side stance time with the feedback and maintain it right after feedback was removed. However, in the post-test, the prosthesis control parameters tuned with visual FB only supported a few participants with longer stance time and better stance time symmetry.ConclusionsThe study provides novel insights on human-prosthesis interaction when cooperating in walking, which may guide the future successful adoption of this paradigm in prosthesis control personalization or human-in-the-loop optimization to improve the prosthesis user’s gait performance.

Cortical contributions to locomotor primitives in toddlers and adults

SummaryThe neural locomotor system strongly relies on spinal circuitries. Yet, the control of bipedal gait is accompanied by activity in motor cortex. In human gait control, the functional interaction between these cortical contributions and their spinal counterparts are largely elusive. We focused on four spinal activation patterns during walking and explored their cortical signatures in toddlers and adults. In both groups, cortico-spinal coherence analysis revealed activity in primary motor cortex to be closely related to two of the four spinal patterns. Their corresponding muscle synergies are known to develop around the onset of independent walking. By hypothesis, the cortex hence contributes to the emergence of these synergies. In contrast, the other two spinal patterns investigated here resembled those present during newborn stepping. As expected, they did not show any cortical involvement. Together, our findings suggest a crucial role of motor cortex for independent walking in humans.

Targeting CNS Neural Mechanisms of Gait in Stroke Neurorehabilitation.

The central nervous system (CNS) control of human gait is complex, including descending cortical control, affective ascending neural pathways, interhemispheric communication, whole brain networks of functional connectivity, and neural interactions between the brain and spinal cord. Many important studies were conducted in the past, which administered gait training using externally targeted methods such as treadmill, weight support, over-ground gait coordination training, functional electrical stimulation, bracing, and walking aids. Though the phenomenon of CNS activity-dependent plasticity has served as a basis for more recently developed gait training methods, neurorehabilitation gait training has yet to be precisely focused and quantified according to the CNS source of gait control. Therefore, we offer the following hypotheses to the field: Hypothesis 1. Gait neurorehabilitation after stroke will move forward in important ways if research studies include brain structural and functional characteristics as measures of response to treatment. Hypothesis 2. Individuals with persistent gait dyscoordination after stroke will achieve greater recovery in response to interventions that incorporate the current and emerging knowledge of CNS function by directly engaging CNS plasticity and pairing it with peripherally directed, plasticity-based motor learning interventions. These hypotheses are justified by the increase in the study of neural control of motor function, with emerging research beginning to elucidate neural factors that drive recovery. Some are developing new measures of brain function. A number of groups have developed and are sharing sophisticated, curated databases containing brain images and brain signal data, as well as other types of measures and signal processing methods for data analysis. It will be to the great advantage of stroke survivors if the results of the current state-of-the-art and emerging neural function research can be applied to the development of new gait training interventions.

MR Tractography-Based Targeting and Physiological Identification of the Cuneiform Nucleus for Directional DBS in a Parkinson's Disease Patient With Levodopa-Resistant Freezing of Gait.

BackgroundFreezing of gait (FOG) is a debilitating motor deficit in a subset of Parkinson’s Disease (PD) patients that is poorly responsive to levodopa or deep brain stimulation (DBS) of established PD targets. The proposal of a DBS target in the midbrain, known as the pedunculopontine nucleus (PPN), to address FOG was based on its observed neuropathology in PD and its hypothesized involvement in locomotor control as a part of the mesencephalic locomotor region (MLR). Initial reports of PPN DBS were met with enthusiasm; however, subsequent studies reported mixed results. A closer review of the MLR basic science literature, suggests that the closely related cuneiform nucleus (CnF), dorsal to the PPN, may be a superior site to promote gait. Although suspected to have a conserved role in the control of gait in humans, deliberate stimulation of a homolog to the CnF in humans using directional DBS electrodes has not been attempted.MethodsAs part of an open-label Phase 1 clinical study, one PD patient with predominantly axial symptoms and severe FOG refractory to levodopa therapy was implanted with directional DBS electrodes (Boston Science Vercise CartesiaTM) targeting the CnF bilaterally. Since the CnF is a poorly defined reticular nucleus, targeting was guided both by diffusion tensor imaging (DTI) tractography and anatomical landmarks. Intraoperative stimulation and microelectrode recordings were performed near the targets with leg EMG surface recordings in the subject.ResultsPost-operative imaging revealed accurate targeting of both leads to the designated CnF. Intraoperative stimulation near the target at low thresholds in the awake patient evoked involuntary electromyography (EMG) oscillations in the legs with a peak power at the stimulation frequency, similar to observations with CnF DBS in animals. Oscillopsia was the primary side effect evoked at higher currents, especially when directed posterolaterally. Directional DBS could mitigate oscillopsia.ConclusionDTI-based targeting and intraoperative stimulation to evoke limb EMG activity may be useful methods to help target the CnF accurately and safely in patients. Long term follow-up and detailed gait testing of patients undergoing CnF stimulation will be necessary to confirm the effects on FOG.Clinical Trial RegistrationClinicaltrials.gov identifier: NCT04218526.

Research on blood oxygen activity in cerebral cortical motor function areas with adjustment intention during gait.

The study of the neural mechanism of human gait control can provide a theoretical basis for the treatment of walking disorders or the improvement of rehabilitation strategies, and further promote the functional rehabilitation of patients with movement disorders. However, the performance and changes of cerebral cortex activity corresponding to gait adjustment intentions are still not clear. The purpose of this study was to detect the blood oxygen activation characterization of the cerebral cortex motor function area when people have the intention to adjust gait during walking. Thirty young volunteers (21 ± 1 years old) performed normal walking, speed increase, speed reduction, step increase, and step reduction, during which oxygenated hemoglobin (HbO), deoxygenated hemoglobin (HbR), and total oxyhemoglobin (HbT) information in the prefrontal cortex (PFC), premotor cortex (PMC), supplementary motor area (SMA) was continuous monitored using near-infrared brain functional imaging. (1) With the intention to adjust gait, the HbO concentration in the SMA increased significantly, while the HbT concentration in the medial-PFC decreased significantly. (2) In the HbO concentration, step reduction is more activated than the step increase in the left-PMC (p= 0.0130); step adjustment is more activated than speed adjustment in the right-PMC (p= 0.0067). In the HbR concentration, the speed reduction is more activated than the speed increase in the left-PFC (p= 0.0103). When the intention of gait adjustment occurs, the increase of HbO concentration in the SMA indicates the initial stage of gait adjustment will increase the cognitive-locomotor demand of the brain. The left brain area meets the additional nerve needs of speed adjustment. The preliminary findings of this study can lay an important theoretical foundation for the realization of gait control based on fNIRS-BCI technology.

Measuring Gait-Event-Related Brain Potentials (gERPs) during Instructed and Spontaneous Treadmill Walking: Technical Solutions and Automated Classification through Artificial Neural Networks

The investigation of the neural correlates of human gait, as measured by means of non-invasive electroencephalography (EEG), is of central importance for the understanding of human gait and for novel developments in gait rehabilitation. Particularly, gait-event-related brain potentials (gERPs) may provide information about the functional role of cortical brain regions in human gait control. The purpose of this paper is to explore possible experimental and technical solutions for time-sensitive analysis of human gait ERPs during spontaneous and instructed treadmill walking. A solution (hardware/software) for synchronous recording of gait and EEG data was developed, tested and piloted. The solution consists of a custom-made USB synchronization interface, a time-synchronization module, and a data-merging module, allowing the temporal synchronization of recording devices, time-sensitive extraction of gait markers for the analysis of gERPs, and the training of artificial neural networks. In the present manuscript, the hardware and software components were tested with the following devices: A treadmill with an integrated pressure plate for gait analysis (zebris FDM-T) and an Acticap non-wireless 32-channel EEG system (Brain Products GmbH). The usability and validity of the developed solution was investigated in a pilot study (n = 3 healthy participants, n = 3 females, mean age = 22.75 years). The recorded continuous EEG data were segmented into epochs according to the detected gait markers for the analysis of gERPs. Finally, the EEG epochs were used to train a deep learning artificial neural network as classifier of gait phases. The results obtained in this pilot study, although preliminary, support the feasibility of the solution for the application of gait-related EEG analysis.

Anticipatory control of human gait following simulated slip exposure

A cautious gait (CG), marked by wider and shorter steps, is typically employed to mitigate expected perturbations proactively. However, it is not well understood if and how CG is informed by the task requirements. Therefore, we assessed how CG is adjusted to these requirements. Three groups of ten healthy young adults were exposed to a single uninterrupted protocol of treadmill walking that consisted of three distinct phases. Spatiotemporal step characteristics and margins of stability of the unperturbed strides were compared when participants were (i) only warned of a perturbation, (ii) exposed to fifty unilateral (right) slip-like perturbations and (iii) kept unaware of perturbation removal. Only the perturbation intensity predictability differed between groups. This was either kept consistent or pseudo-randomly or randomly varied. Participants walked with wider and shorter steps following the perturbation warning. However, this extinguished in continuing perturbation absence. Next, during perturbation exposure, participants shortened the step of the perturbed but increased the step of the unperturbed leg. This did not differ between groups. Finally, participants persisted in displaying CG on perturbation removal, but this extinguished over time. Collectively, we show that CG is functionally adjusted to the task requirements. These findings may have practical implications for fall-prevention training.

Human Gait Control Using Functional Electrical Stimulation Based on Controlling the Shank Dynamics.

Introduction:Efficient gait control using Functional Electrical Stimulation (FES) is an open research problem. In this research, a new intermittent controller has been designed to control the human shank movement dynamics during gait.Methods:In this approach, first, the three-dimensional phase space was constructed using the human shank movement data recorded from the healthy subjects. Then, three iterated sine-circle maps were extracted in the mentioned phase space. The three identified one-dimensional maps contained the essential information about the shank movement dynamics during a gait cycle. Next, an intermittent fuzzy controller was designed to control the shank angle. According to the adopted intermittent control strategy, the fuzzy controller is activated whenever the shank angle is far enough from the specific. The specific points are described using the identified iterated maps in the constructed phase space. In this manner, the designed controller is activated during a short-time fraction of the gait cycle time.Results:The designed intermittent controller was evaluated through some simulation studies on a two-joint musculoskeletal model. The obtained results suggested that the pattern of the obtained hip and knee joint trajectories, the outputs of the musculoskeletal model, were acceptably similar to the joints’ trajectories pattern of healthy subjects.Conclusion:The intriguing similarity was observed between the dynamics of the recorded human data and those of the controlled musculoskeletal model. It supports the acceptable performance of the proposed control strategy.

EEG time-frequency analysis provides arguments for arm swing support in human gait control

Background: Human gait benefits from arm swing, which requires four-limb co-ordination. The Supplementary Motor Area (SMA) is involved in multi-limb coordination. With its location anterior to the leg motor cortex and the pattern of its connections, this suggests a distinct role in gait control.Research question: Is the SMA functionally implicated in gait-related arm swing?Methods: Ambulant electroencephalography (EEG) was employed during walking with and without arm swing in twenty healthy subjects (mean age: 64.9yrs, SD 7.2). Power changes across the EEG frequency spectrum were assessed by Event Related Spectral Perturbation (ERSP) analysis over both the putative SMA at electrode position Fz and additional sensorimotor regions.Results: During walking with arm swing, midline electrodes Fz and Cz showed a step-related pattern of Event Related Desynchronization (ERD) followed by Event Related Synchronization (ERS). Walking without arm swing was associated with significant ERD-ERS power reduction in the high-beta/low-gamma band over Fz and a power increase over Cz. Electrodes C3 and C4 revealed a pattern of ERD during contralateral- and ERS during ipsilateral leg swing. This ERD power decreased in gait without arm swing (low-frequency band). The ERSP pattern during walking with arm swing was similar at CP1 and CP2: ERD was seen during double support and the initial swing phase of the right leg, while a strong ERS emerged during the second half of the left leg’s swing. Walking without arm swing showed a significant power reduction of this ERD-ERS pattern over CP2, while over CP1, ERS during left leg’s swing turned into ERD.Conclusion: The relation between arm swing in walking and a step-related ERD-ERS pattern in the high-beta/low-gamma band over the putative SMA, points at an SMA contribution to integrated cyclic anti-phase movements of upper- and lower limbs. This supports a cortical underpinning of arm swing support in gait control.

Dynamics of corticospinal motor control during overground and treadmill walking in humans.

Increasing evidence suggests cortical involvement in the control of human gait. However, the nature of corticospinal interactions remains poorly understood. We performed time-frequency analysis of electrophysiological activity acquired during treadmill and overground walking in 22 healthy, young adults. Participants walked at their preferred speed (4.2, SD 0.4 km/h), which was matched across both gait conditions. Event-related power, corticomuscular coherence (CMC), and intertrial coherence (ITC) were assessed for EEG from bilateral sensorimotor cortices and EMG from the bilateral tibialis anterior (TA) muscles. Cortical power, CMC, and ITC at theta, alpha, beta, and gamma frequencies (4-45 Hz) increased during the double support phase of the gait cycle for both overground and treadmill walking. High beta (21-30 Hz) CMC and ITC of EMG was significantly increased during overground compared with treadmill walking, as well as EEG power in theta band (4-7 Hz). The phase spectra revealed positive time lags at alpha, beta, and gamma frequencies, indicating that the EEG response preceded the EMG response. The parallel increases in power, CMC, and ITC during double support suggest evoked responses at spinal and cortical populations rather than a modulation of ongoing corticospinal oscillatory interactions. The evoked responses are not consistent with the idea of synchronization of ongoing corticospinal oscillations but instead suggest coordinated cortical and spinal inputs during the double support phase. Frequency-band dependent differences in power, CMC, and ITC between overground and treadmill walking suggest differing neural control for the two gait modalities, emphasizing the task-dependent nature of neural processes during human walking. NEW & NOTEWORTHY We investigated cortical and spinal activity during overground and treadmill walking in healthy adults. Parallel increases in power, corticomuscular coherence, and intertrial coherence during double support suggest evoked responses at spinal and cortical populations rather than a modulation of ongoing corticospinal oscillatory interactions. These findings identify neurophysiological mechanisms that are important for understanding cortical control of human gait in health and disease.

Feedforward neural control of toe walking in humans.

Activation of ankle muscles at ground contact during toe walking is unaltered when sensory feedback is blocked or the ground is suddenly dropped. Responses in the soleus muscle to transcranial magnetic stimulation, but not peripheral nerve stimulation, are facilitated at ground contact during toe walking. We argue that toe walking is supported by feedforward control at ground contact. Toe walking requires careful control of the ankle muscles in order to absorb the impact of ground contact and maintain a stable position of the joint. The present study aimed to clarify the peripheral and central neural mechanisms involved. Fifteen healthy adults walked on a treadmill (3.0kmh-1 ). Tibialis anterior (TA) and soleus (Sol) EMG, knee and ankle joint angles, and gastrocnemius-soleus muscle fascicle lengths were recorded. Peripheral and central contributions to the EMG activity were assessed by afferent blockade, H-reflex testing, transcranial magnetic brain stimulation (TMS) and sudden unloading of the planter flexor muscle-tendon complex. Sol EMG activity started prior to ground contact and remained high throughout stance. TA EMG activity, which is normally seen around ground contact during heel strike walking, was absent. Although stretch of the Achilles tendon-muscle complex was observed after ground contact, this was not associated with lengthening of the ankle plantar flexor muscle fascicles. Sol EMG around ground contact was not affected by ischaemic blockade of large-diameter sensory afferents, or the sudden removal of ground support shortly after toe contact. Soleus motor-evoked potentials elicited by TMS were facilitated immediately after ground contact, whereas Sol H-reflexes were not. These findings indicate that at the crucial time of ankle stabilization following ground contact, toe walking is governed by centrally mediated motor drive rather than sensory driven reflex mechanisms. These findings have implications for our understanding of the control of human gait during voluntary toe walking.

Real-time EEG-based brain-computer interface to a virtual avatar enhances cortical involvement in human treadmill walking

Recent advances in non-invasive brain-computer interface (BCI) technologies have shown the feasibility of neural decoding for both users’ gait intent and continuous kinematics. However, the dynamics of cortical involvement in human upright walking with a closed-loop BCI has not been investigated. This study aims to investigate the changes of cortical involvement in human treadmill walking with and without BCI control of a walking avatar. Source localization revealed significant differences in cortical network activity between walking with and without closed-loop BCI control. Our results showed sustained α/µ suppression in the Posterior Parietal Cortex and Inferior Parietal Lobe, indicating increases of cortical involvement during walking with BCI control. We also observed significant increased activity of the Anterior Cingulate Cortex (ACC) in the low frequency band suggesting the presence of a cortical network involved in error monitoring and motor learning. Additionally, the presence of low γ modulations in the ACC and Superior Temporal Gyrus may associate with increases of voluntary control of human gait. This work is a further step toward the development of a novel training paradigm for improving the efficacy of rehabilitation in a top-down approach.

The effect of vision impairment on dynamic balance

Relevance/Impact The control of human gait and the maintenance of balance depend upon the complex integration of visual, vestibular and somatosensory information. Dysfunction of any of these components can result in deficits in the body’s ability to maintain equilibrium of the centre of mass by counteracting the constant destabilising forces that challenge it. The role of vision in the control of balance is well documented. Vision can improve bipedal upright stability during standing and locomotion as part of the integrated sensory feedback system. Alternatively vision impairment has been demonstrated as reducing postural stability. Postural stability is traditionally evaluated by the motion associated with changes in Centre-of-Pressure (CoP) during quiet standing. CoP measures have been shown to high reliability and clinical relevance when assessing postural stability. However there are few studies that have assessed the effectiveness of these measures for dynamic stability.

Advancements in functional electrical stimulator technology

One of the most exciting recent advances in the neuroprosthetics field has been the application of biosignals in the design of functional electrical stimulation (FES) devices. This review discusses the different approaches in the field of functional electrical stimulation (FES) enabling control of human gait and address fundamental perquisites to enable FES walking systems to become safer, more practical, comfortable and therefore, clinically efficacious. In many forms of disability in humans due to paralysis, it appears possible to regain some measure of functional control of movement through direct electrical stimulation of paralysed muscles. This review provides a comprehensive overview of the advancements in clinical uses of functional electrical stimulation functional and therapeutic applications in subjects with spinal cord injury or stroke. Perspectives on future developments and clinical applications of FES are also presented herewith in this paper.

Cerebral oxygenation in health and disease.

Monitoring cerebral blood flow (CBF) and oxygenation has implications for both clinical practice and research interests; e.g., to provide insight into functional neurovascular coupling, to better understand orthostatic hypotension, and to evaluate the influence of vasopressors on cerebral oxygenation during anesthesia and/or surgery. These topics, and others, are addressed in this e-book by presenting original research, reviews, and opinion papers covering new, exciting but also controversial issues related to cerebral oxygenation in health and disease as evaluated by near-infrared spectroscopy (NIRS).

AB1122 Effects of Proprioceptive Exercises in Rheumatoid Arthritis Postmenopausal Women: GAIT Biomechanical Parameters Related with Falls, Functional Capacity and Disease Activity (Preliminary Results)

BackgroundRheumatoid arthritis (RA) patients1 and postmenopausal women2 showed an increased fall risk. Research pointed to some gait biomechanical parameters related with falls (GBPRF)3 and found differences in these parameters between...

Possibilities for examining the neural control of gait in humans with fNIRS.

Although the existence of a central pattern generator system modulated by sensory information has become broadly accepted in the control of gait, many findings indicate that the cortex also plays a role of primary importance in human walking (Miyai et al., 2001; Gwin et al., 2011; Petersen et al., 2012). Examining the neural control of gait in humans requires recording cortical activity during gait. Direct evidence for cortical involvement in human locomotion comes from neuroimaging studies using position emission tomography (la Fougere et al., 2010), electroencephalography (EEG, Gwin et al., 2011) and functional near-infrared spectroscopy (fNIRS, Miyai et al., 2001) methods. Among possible neuroimaging methods, fNIRS is ideally suited to perform brain imaging during walking as it represents several advantages over other methods (Perrey, 2008).