Gait Evaluation of a Novel Hip Constraint Orthosis With Implication for Walking in Paraplegia
Gait Evaluation of a Novel Hip Constraint Orthosis With Implication for Walking in Paraplegia
复制标题
DOI：
10.1109/tnsre.2010.2047594
复制
发表时间：
2010-12-01
影响因子：
4.9
通讯作者：
Triolo, Ronald J.
中科院分区：
文献类型：
--
作者：
Audu, Musa L.;To, Curtis S.;Triolo, Ronald J.
本研究的目的是确定一种新开发的交互式步态矫形器（RGO）与可变约束髋关节机构（VCHM）对正常步态的运动学和动力学的影响。比较VCHM与等中心往复式步态矫形器（IRGO）对截瘫后步行的影响。VCHM和IRGO都是在身体健全的志愿者中进行评估的，髋关节往复运动机制耦合和解耦。VCHM进一步评估与上下文相关的耦合的基础上，利用从支架安装的传感器的信息的有限状态控制算法。每种支具条件下的行走性能也与没有矫形器的正常行走进行了比较。在没有髋关节控制器的情况下，VCHM以与IRGO类似的方式影响髋关节的运动学，而不管髋关节往复运动器是耦合还是解耦。在控制器激活的情况下，VCHM的髋关节运动学比IRGO或任何其他测试条件更接近正常步态（组内相关系数，ICC=0.96）。支具对膝关节和踝关节角度的影响不如对髋关节角度的影响那么显著。在动力学方面，控制器激活的VCHM允许产生比髋关节耦合的IRGO（ICC=0.68）更接近正常的关节力矩（ICC =0.80）。在步长方面，各种测试条件之间没有统计学显著差异（p < 0.01），并且在IRGO和正常步行之间的首选步行速度方面没有统计学显著差异，无论髋关节是否耦合。然而，与正常步态相比，VCHM的步行速度降低了25%，并且VCHM的三块肌肉（胫骨前肌、四头肌和腘绳肌）的EMG活动的相对幅度也高于IRGO或正常步态，这可能是由于该机制的额外重量。总体而言，具有控制器活动的VCHM通过上下文相关耦合提供了对髋关节的平滑控制，并允许相对于IRGO增加髋关节屈曲。结果表明，VCHM与控制关节耦合可能最终是一个有价值的组成部分的混合系统结合功能性电刺激（FES）与矫形器。
The aim of this study was to determine the effects of a newly developed reciprocal gait orthosis (RGO) with a variable constraint hip mechanism (VCHM) on the kinematics and kinetics of normal gait. The VCHM was compared with the isocentric reciprocating gait orthosis (IRGO) for walking after paraplegia. Both the VCHM and the IRGO were evaluated with able-bodied volunteers with the hip reciprocating mechanisms coupled and uncoupled. The VCHM was further evaluated with context-dependent coupling based on a finite-state control algorithm utilizing information from brace-mounted sensors. Walking performance for each brace condition was also compared to normal walking without an orthosis. Without the hip controller, the VCHM affected the kinematics of the hip joint in a similar manner as the IRGO, regardless of whether the hip reciprocator was coupled or uncoupled. With the controller active, hip kinematics with the VCHM were closer to normal gait than with the IRGO or any other condition tested (Intraclass correlation coefficient, ICC=0.96). The effects of the braces on the knee and ankle angles were not as prominent as their effects on the hip angles. In terms of kinetics, the VCHM with controller active allowed the generation of joint moments that were closer to normal (ICC=0.80) than the IRGO with hips coupled (ICC=0.68). There was no statistically significant difference between the various conditions tested in terms of step-length (p < 0.01) and no statistically significant difference in the preferred walking speed between the IRGO and normal walking, whether or not the hips were coupled. However, there was a 25% reduction in walking speed with the VCHM when compared to normal, and the relative magnitudes of the EMG activity of three muscles (tibialis anterior, quadriceps, and hamstrings) were also higher with the VCHM than with either the IRGO or normal gait, likely due to the additional weight of the mechanism. Overall, the VCHM with controller active provided smooth control of the hip joints via context-dependent coupling and allowed for increased hip flexion relative to the IRGO. The results suggest that the VCHM with controlled joint coupling may eventually be a valuable component of a hybrid system combining functional electrical stimulation (FES) with orthotics.