Powered Hip Exoskeleton Reduces Residual Hip Effort Without Affecting Kinematics and Balance in Individuals With Above-Knee Amputations During Walking
Powered Hip Exoskeleton Reduces Residual Hip Effort Without Affecting Kinematics and Balance in Individuals With Above-Knee Amputations During Walking
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DOI：
10.1109/tbme.2022.3211842
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发表时间：
2023-04-01
影响因子：
4.6
通讯作者：
Lenzi, Tommaso
中科院分区：
文献类型：
--
作者：
Ishmael, Marshall K. K.;Gunnell, Andrew;Lenzi, Tommaso
目的：单侧轻型动力髋外骨骼已被证明可以改善膝上截肢患者的步行经济性。然而，导致这种改善的机制尚不清楚。在这项研究中，我们评估了膝上截肢患者在使用或不使用单侧轻型动力髋外骨骼行走时的生物力学。我们假设辅助残肢将减少净残余髋部能量。方法：8 名膝上截肢患者在跑步机上以 1 m/s 的速度行走，无论是否使用单侧动力髋部外骨骼。向残余髋部提供屈曲/伸展辅助。进行运动捕捉和逆动态分析来评估步态运动学、动力学、质心和压力中心。结果：残余髋部的净能量从不带外骨骼的 0.05 +/- 0.04 J/kg 降至带外骨骼的 -0.01 +/- 0.05 J/kg (p = 0.026)。不带外骨骼和带外骨骼时，残余髋部的累积正能量平均下降 18.2%，置信区间 (CI) 分别为 0.20 J/kg、0.24 J/kg 和 (0.16 J/kg、0.20 J/kg)。站立期间，不带外骨骼和带外骨骼时，残肢的髋部伸展扭矩平均分别下降 37.5%、95% CI（0.28 Nm/kg、0.36 Nm/kg）、（0.17 Nm/kg、0.23 Nm/kg）。结论：动力髋部外骨骼辅助显着降低了净残余髋部能量，向心能量是这一变化的主要贡献者。我们认为，站立早期残余髋部伸展扭矩的减少是造成这种减少的主要原因。意义：该分析表明，通过辅助残肢，外骨骼显着降低了残肢产生的净髋能量，这可能解释了之前观察到的步行经济性的改善。
Objective: A unilateral, lightweight powered hip exoskeleton has been shown to improve walking economy in individuals with above-knee amputations. However, the mechanism responsible for this improvement is unknown. In this study we assess the biomechanics of individuals with above-knee amputations walking with and without a unilateral, lightweight powered hip exoskeleton. We hypothesize that assisting the residual limb will reduce the net residual hip energy. Methods: Eight individuals with above-knee amputations walked on a treadmill at 1 m/s with and without a unilateral powered hip exoskeleton. Flexion/extension assistance was provided to the residual hip. Motion capture and inverse dynamic analysis were performed to assess gait kinematics, kinetics, center of mass, and center of pressure. Results: The net energy at the residual hip decreased from 0.05 +/- 0.04 J/kg without the exoskeleton to -0.01 +/- 0.05 J/kg with the exoskeleton (p = 0.026). The cumulative positive energy of the residual hip decreased on average by 18.2% with 95% confidence intervals (CI) (0.20 J/kg, 0.24 J/kg) and (0.16 J/kg, 0.20 J/kg) without and with the exoskeleton, respectively. During stance, the hip extension torque of the residual limb decreased on average by 37.5%, 95% CI (0.28 Nm/kg, 0.36 Nm/kg), (0.17 Nm/kg, 0.23 Nm/kg) without and with the exoskeleton, respectively. Conclusion: Powered hip exoskeleton assistance significantly reduced the net residual hip energy, with concentric energy being the main contributor to this change. We believe that the reduction in residual hip extension torque during early stance is the main contributor to this reduction. Significance: This analysis shows that by assisting the residual hip, the exoskeleton significantly decreased the net hip energy produced by the residual limb, which may explain the improvements in walking economy previously observed.