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Article ; Online: Gait quality in prosthesis users is reflected by force-based metrics when learning to walk on a new research-grade powered prosthesis.

Herrin, Kinsey R / Kwak, Samuel T / Rock, Chase G / Chang, Young-Hui

Frontiers in rehabilitation sciences

2024 Volume 5, Page(s) 1339856

Abstract: Introduction: Powered prosthetic feet require customized tuning to ensure comfort and long-term success for the user, but tuning in both clinical and research settings is subjective, time intensive, and the standard for tuning can vary depending on the ... ...

Abstract	Introduction: Powered prosthetic feet require customized tuning to ensure comfort and long-term success for the user, but tuning in both clinical and research settings is subjective, time intensive, and the standard for tuning can vary depending on the patient's and the prosthetist's experience levels. Methods: Therefore, we studied eight different metrics of gait quality associated with use of a research-grade powered prosthetic foot in seven individuals with transtibial amputation during treadmill walking. We compared clinically tuned and untuned conditions with the goal of identifying performance-based metrics capable of distinguishing between good (as determined by a clinician) from poor gait quality. Results: Differences between the tuned and untuned conditions were reflected in ankle power, both the vertical and anterior-posterior impulse symmetry indices, limb-force alignment, and positive ankle work, with improvements seen in all metrics during use of the tuned prosthesis. Discussion: Notably, all of these metrics relate to the timing of force generation during walking which is information not directly accessible to a prosthetist during a typical tuning process. This work indicates that relevant, real-time biomechanical data provided to the prosthetist through the future provision of wearable sensors may enhance and improve future clinical tuning procedures associated with powered prostheses as well as their long-term outcomes.
Language	English
Publishing date	2024-02-02
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2024.1339856
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Article ; Online: Towards meaningful community ambulation in individuals post stroke through use of a smart hip exoskeleton: A preliminary investigation.

Herrin, Kinsey / Upton, Emily / Young, Aaron

Assistive technology : the official journal of RESNA

2023 Volume 36, Issue 3, Page(s) 198–208

Abstract: Stroke is the leading cause of long-term disability in the United States, leaving survivors with profound mobility challenges that impact independent community ambulation. Evidence shows assistance at the hip during walking may be beneficial for stroke ... ...

Abstract	Stroke is the leading cause of long-term disability in the United States, leaving survivors with profound mobility challenges that impact independent community ambulation. Evidence shows assistance at the hip during walking may be beneficial for stroke survivors. In this cross-over design study, we examine the impact of a novel hip exoskeleton on both functional and patient reported outcomes measuring speed, fall risk, gait symmetry, energy expenditure and perceived walking ability during both indoors and outdoors in single and serial counting dual task paradigms. Nine ambulatory stroke survivors with hemiplegia were included. No differences were seen between the exoskeleton and baseline conditions for any outcomes. Only the patient reported outcome in which subjects were asked to rate their ability to walk outdoors approached statistical significance (
MeSH term(s)	Humans ; Exoskeleton Device ; Stroke Rehabilitation/instrumentation ; Stroke Rehabilitation/methods ; Male ; Female ; Walking/physiology ; Middle Aged ; Aged ; Cross-Over Studies ; Stroke/physiopathology
Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1014913-2
ISSN	1949-3614 ; 1040-0435
ISSN (online)	1949-3614
ISSN	1040-0435
DOI	10.1080/10400435.2023.2239555
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Article ; Online: Towards comprehensive evaluation of the FLEXotendon glove-III: a case series evaluation in pediatric clinical cases and able-bodied adults.

Tran, Phillip / Elliott, Drew / Herrin, Kinsey / Desai, Jaydev P

Biomedical engineering letters

2023 Volume 13, Issue 3, Page(s) 485–494

Abstract: Injuries involving the nervous system, such as a brachial plexus palsy or traumatic brain injury, can lead to impairment in the functionality of the hand. Assistive robotics have been proposed as a possible method to improve patient outcomes in ... ...

Abstract	Injuries involving the nervous system, such as a brachial plexus palsy or traumatic brain injury, can lead to impairment in the functionality of the hand. Assistive robotics have been proposed as a possible method to improve patient outcomes in rehabilitation. The work presented here evaluates the FLEXotendon Glove-III, a 5 degree-of-freedom, voice-controlled, tendon-driven soft robotic hand exoskeleton, with two human subjects with hand impairments and four able-bodied subjects. The FLEXotendon Glove-III was evaluated on four unimpaired subjects, in conjunction with EMG sensor data, to determine the quantitative performance of the glove in applied pinch force, perturbation resistance, and exertion reduction. The exoskeleton system was also evaluated on two subjects with hand impairments, using two standardized hand function tests, the Jebsen-Taylor Hand Function Test and the Toronto Rehabilitation Institute Hand Function Test. The subjects were also presented with three qualitative questionnaires, the Capabilities of Upper Extremities Questionnaire, the Quebec User Evaluation of Satisfaction with Assistive Technology, and the Orthotics Prosthetics User Survey-Satisfaction module. From the previous design, minor design changes were made to the exoskeleton. The quick connect system was redesigned for improved performance, the number of motors was reduced to decrease overall footprint, and the entire system was placed into a compact acrylic case that can be placed into a backpack for increased portability.
Language	English
Publishing date	2023-04-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2602422-6
ISSN	2093-985X ; 2093-9868
ISSN (online)	2093-985X
ISSN	2093-9868
DOI	10.1007/s13534-023-00280-0
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Article ; Online: Biomechanical Evaluation of Stair Ambulation Using Impedance Control on an Active Prosthesis.

Camargo, Jonathan / Bhakta, Krishan / Herrin, Kinsey / Young, Aaron

Journal of biomechanical engineering

2022 Volume 145, Issue 2

Abstract: Active prostheses can provide net positive work to individuals with amputation, offering more versatility across locomotion tasks than passive prostheses. However, the effect of powered joints on bilateral biomechanics has not been widely explored for ... ...

Abstract	Active prostheses can provide net positive work to individuals with amputation, offering more versatility across locomotion tasks than passive prostheses. However, the effect of powered joints on bilateral biomechanics has not been widely explored for ambulation modes different than level ground and treadmill walking. In this study, we present the bilateral biomechanics of stair ascent and descent with a powered knee-ankle prosthesis compared to the biomechanical profiles of able-bodied subjects at different configurations of stair height between 102 mm and 178 mm. In addition, we include reference profiles from users with passive prostheses for the nominal stair height of 152 mm to place our findings in relation to the typical solution for individuals with transfemoral amputation (TFA). We report the biomechanical profiles of kinematics, kinetics, and power, together with temporal and waveform symmetry and distribution of mechanical energy across the joints. We found that an active prosthesis provides a substantial contribution to mechanical power during stair ascent and power absorption during stair descent and gait patterns like able-bodied subjects. The active prosthesis enables step-over-step gait in stair ascent. This translates into a lower mechanical energy requirement on the intact side, with a 57% reduction of energy at the knee and 26% at the hip with respect to the passive prosthesis. For stair descent, we found a 28% reduction in the negative work done by the intact ankle. These results reflect the benefit of active prostheses, allowing the users to complete tasks more efficiently than passive legs. However, in comparison to able-bodied biomechanics, the results still differ from the ideal patterns. We discuss the limitations that explain this difference and suggest future directions for the design of impedance controllers by taking inspiration from the biological modulation of the knee moment as a function of the stair height.
MeSH term(s)	Artificial Limbs ; Biomechanical Phenomena ; Electric Impedance ; Gait ; Humans ; Knee Joint ; Walking
Language	English
Publishing date	2022-09-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	243094-0
ISSN	1528-8951 ; 0148-0731
ISSN (online)	1528-8951
ISSN	0148-0731
DOI	10.1115/1.4055759
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Article ; Online: Evaluation of the FLEXotendon glove-III through a human subject case study.

Tran, Phillip / Elliott, Drew / Herrin, Kinsey / Bhatia, Shovan / Desai, Jaydev P

Biomedical engineering letters

2023 Volume 13, Issue 2, Page(s) 153–163

Abstract: Cervical spinal cord injury (SCI) can significantly impair an individual's hand functionality due to the disruption of nerve signals from the brain to the upper extremity. Robotic assistive hand exoskeletons have been proposed as a potential technology ... ...

Abstract	Cervical spinal cord injury (SCI) can significantly impair an individual's hand functionality due to the disruption of nerve signals from the brain to the upper extremity. Robotic assistive hand exoskeletons have been proposed as a potential technology to facilitate improved patient rehabilitation outcomes, but few exoskeleton studies utilize standardized hand function tests and questionnaires to produce quantitative data regarding exoskeleton performance. This work presents the human subject case study evaluation of the FLEXotendon Glove-III, a 5 degree-of-freedom voice-controlled, tendon-driven soft robotic assistive hand exoskeleton for individuals with SCI. The exoskeleton system was evaluated in a case study with two individuals with SCI through two standardized hand function tests namely, the Jebsen-Taylor Hand Function Test and the Toronto Rehabilitation Institute Hand Function Test and three questionnaires (Capabilities of Upper Extremities Questionnaire, Orthotics Prosthetics Users Survey, Quebec User Evaluation of Satisfaction with Assistive Technology). Minor design changes were made to the exoskeleton: integrated fingertip force sensors to sense excessive grasp force, a quick connect system to expedite the exoskeleton glove swapping process between users, compact tendon tension sensors to measure tendon force for admittance control, and a redesigned smartphone app to encompass all aspects of exoskeleton use.
Language	English
Publishing date	2023-01-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2602422-6
ISSN	2093-985X ; 2093-9868
ISSN (online)	2093-985X
ISSN	2093-9868
DOI	10.1007/s13534-023-00262-2
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Article ; Online: Quantifying Asymmetry Between Medial and Lateral Compartment Knee Loading Forces Using Acoustic Emissions.

Jeong, Hyeon Ki / An, Sungtae / Herrin, Kinsey / Scherpereel, Keaton / Young, Aaron / Inan, Omer T

IEEE transactions on bio-medical engineering

2022 Volume 69, Issue 4, Page(s) 1541–1551

Abstract: Objective: Osteoarthritis is the most common type of knee arthritis that can be affected by excessive and compressive loads and can affect one or more compartments of the knee: medial, lateral, and patellofemoral. The medial compartment tends to be the ... ...

Abstract	Objective: Osteoarthritis is the most common type of knee arthritis that can be affected by excessive and compressive loads and can affect one or more compartments of the knee: medial, lateral, and patellofemoral. The medial compartment tends to be the most vulnerable to injuries and research suggests that a better understanding of the medial to lateral load distribution conditions could provide insights to the quantitative usage of knee compartments in activities of daily life. Methods: Prior to study in an osteoarthritic clinical population which may present with various complicating anatomical and physiological changes, we investigate knee acoustical emissions of able-bodied individuals during a varying width squat exercise which simulates loading asymmetries that would typically be seen in this clinical population. To that end, we present a novel method to quantify the directional bias of asymmetry between the medial and lateral compartment knee joint load in healthy individuals by recording knee acoustical emissions and analyzing them using a deep neural network in a subject independent model. We placed four miniature contact microphones on the medial and lateral sides of the patella on both the left and right leg. We compared the handcrafted audio features with the automated features extracted from the convolutional autoencoder which is an unsupervised model that learns the comprehensive representation of the input to determine whether these automated features can better represent the signal's characteristic in regard to the structural asymmetry of the knee joint. The input to the convolutional auto encoder (CAE) is a time-frequency representation and different types of these images such as spectrogram and scalogram are compared. We alsocompared the multi-sensor fusion approach with the performance of a single sensor to determine the robustness of using multiple sensors. Results: Using a representation learning based approach, we developed a subject independent classification model capable of classifying the asymmetry of the medial and lateral joint load across subjects (accuracy = 83%). Conclusion: The result indicates that wavelet coherence which is the time-frequency correlation of two signals using a wavelet transform yields the best accuracy. Significance: These findings suggest that acoustic signals could potentially quantify the direction of medial to lateral load distribution which would broaden the implications for wearable sensing technology for monitoring cartilage health and factors responsible for cartilage breakdown and assessing appropriate rehabilitation exercises without overloading on one side.
MeSH term(s)	Acoustics ; Biomechanical Phenomena/physiology ; Humans ; Knee ; Knee Joint/physiology ; Leg ; Osteoarthritis, Knee
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2021.3124487
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Article ; Online: A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial.

Herrin, Kinsey / Geil, Mark

Prosthetics and orthotics international

2016 Volume 40, Issue 2, Page(s) 262–269

Abstract: Background: Orthotic treatment of idiopathic toe walking is complicated by the lack of a known etiology. This study compared control of toe walking using an articulated ankle-foot orthosis versus a rigid carbon fiber footplate attached to a foot ... ...

Abstract	Background: Orthotic treatment of idiopathic toe walking is complicated by the lack of a known etiology. This study compared control of toe walking using an articulated ankle-foot orthosis versus a rigid carbon fiber footplate attached to a foot orthosis. Objectives: Ascertain differences between two orthoses in the control of idiopathic toe walking. Study design: Randomized controlled trial. Methods: A total of 18 children with idiopathic toe walking were randomized to either the ankle-foot orthosis or foot orthosis treatment group in a Parallel Randomized Controlled Trial with no blinding. Prior to and after 6 weeks of treatment, participants completed three-dimensional gait assessment and the L-test of Functional Mobility. Parents completed a satisfaction survey and a subset of the Orthotic and Prosthetic User Survey after treatment. Results: Nine participants were analyzed in each group. Both groups showed significant improvement in kinematics versus baseline with orthoses; however, when the orthoses were removed, the ankle-foot orthosis group did not immediately sustain this improvement, while the foot orthosis group did. Parents preferred the foot orthosis for donning and appearance. Conclusion: The ankle-foot orthosis controls idiopathic toe walking, but subjects may revert to earlier patterns following treatment. The foot orthosis does not control idiopathic toe walking as well but is less restrictive and more accepted by children and their parents, with similar out-of-brace effects. Clinical relevance: This study suggests that sequential orthotic treatment for children with idiopathic toe walking (ITW) may be beneficial. Initial treatment could include a less restrictive orthosis like a foot orthosis (FO); if this is unsuccessful within a set time frame, then the patient may require a more restrictive form of treatment such as an ankle-foot orthosis (AFO).
MeSH term(s)	Child ; Child, Preschool ; Equipment Design ; Female ; Foot Orthoses ; Gait/physiology ; Gait Disorders, Neurologic/etiology ; Gait Disorders, Neurologic/physiopathology ; Gait Disorders, Neurologic/therapy ; Humans ; Male ; Range of Motion, Articular/physiology ; Toes ; Treatment Outcome ; Weight-Bearing/physiology
Language	English
Publishing date	2016-04
Publishing country	England
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	753382-2
ISSN	1746-1553 ; 0309-3646
ISSN (online)	1746-1553
ISSN	0309-3646
DOI	10.1177/0309364614564023
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Zs.A 1510: Show issues

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Article ; Online: Effects of Bilateral Assistance for Hemiparetic Gait Post-Stroke Using a Powered Hip Exoskeleton.

Pan, Yi-Tsen / Kang, Inseung / Joh, James / Kim, Patrick / Herrin, Kinsey R / Kesar, Trisha M / Sawicki, Gregory S / Young, Aaron J

Annals of biomedical engineering

2022 Volume 51, Issue 2, Page(s) 410–421

Abstract: Hemiparetic gait due to stroke is characterized by an asymmetric gait due to weakness in the paretic lower limb. These inter-limb asymmetries increase the biomechanical demand and reduce walking speed, leading to reduced community mobility and quality of ...

Abstract	Hemiparetic gait due to stroke is characterized by an asymmetric gait due to weakness in the paretic lower limb. These inter-limb asymmetries increase the biomechanical demand and reduce walking speed, leading to reduced community mobility and quality of life. With recent progress in the field of wearable technologies, powered exoskeletons have shown great promise as a potential solution for improving gait post-stroke. While previous studies have adopted different exoskeleton control methodologies for restoring gait post-stroke, the results are highly variable due to limited understanding of the biomechanical effect of exoskeletons on hemiparetic gait. In this study, we investigated the effect of different hip exoskeleton assistance strategies on gait function and gait biomechanics of individuals post-stroke. We found that, compared to walking without a device, powered assistance from hip exoskeletons improved stroke participants' self-selected overground walking speed by 17.6 ± 2.5% and 11.1 ± 2.7% with a bilateral and unilateral assistance strategy, respectively (p < 0.05). Furthermore, both bilateral and unilateral assistance strategies significantly increased the paretic and non-paretic step length (p < 0.05). Our findings suggest that powered assistance from hip exoskeletons is an effective means to increase walking speed post-stroke and tuning the balance of assistance between non-paretic and paretic limbs (i.e., a bilateral strategy) may be most effective to maximize performance gains.
MeSH term(s)	Humans ; Exoskeleton Device ; Quality of Life ; Stroke Rehabilitation/methods ; Gait ; Stroke/complications ; Walking ; Biomechanical Phenomena
Language	English
Publishing date	2022-08-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	185984-5
ISSN	1573-9686 ; 0191-5649 ; 0090-6964
ISSN (online)	1573-9686
ISSN	0191-5649 ; 0090-6964
DOI	10.1007/s10439-022-03041-9
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Zs.A 1018: Show issues

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Article ; Online: Reducing Knee Hyperextension With an Exoskeleton in Children and Adolescents With Genu Recurvatum: A Feasibility Study.

Lee, Dawit / Shepherd, Max K / Mulrine, Sierra C / Schneider, Julianne D / Moore, Kelly F / Eggebrecht, Erin M / Rogozinski, Benjamin M / Herrin, Kinsey R / Young, Aaron J

IEEE transactions on bio-medical engineering

2023 Volume 70, Issue 12, Page(s) 3312–3320

Abstract: Genu recurvatum, or knee hyperextension, is a complex gait pattern with a variety of etiologies, and is often connected with knee weakness, lack of motor control, and spasticity. Because of the atypical forces placed on the soft tissues, early treatment ... ...

Abstract	Genu recurvatum, or knee hyperextension, is a complex gait pattern with a variety of etiologies, and is often connected with knee weakness, lack of motor control, and spasticity. Because of the atypical forces placed on the soft tissues, early treatment or prevention of knee hyperextension may help prevent further degradation of the knee joint. In this study, we assessed the feasibility of a knee exoskeleton to mitigate hyperextension and increase swing range of motion in five children/adolescents who presented with unilateral genu recurvatum. Over the course of three visits, each participant practiced walking with the exoskeleton, which provided torque assistance during both stance and swing based on an impedance control law. In final validation trials, the exoskeleton was effective in reducing knee hyperextension (0.2 ± 4.7° average peak knee extension without exo to 9.9 ± 10.3° with exo) and improving swing range of motion by 14.0 ± 4.5° increase on average. However, while the exoskeleton was effective in normalizing the kinematics, it did not lead to improved spatio-temporal asymmetry measures. This work showcases a promising potential application of a robotic knee exoskeleton for improving the kinematic characteristics of genu recurvatum gait.
MeSH term(s)	Humans ; Child ; Adolescent ; Feasibility Studies ; Exoskeleton Device ; Knee Joint ; Knee ; Walking ; Gait ; Biomechanical Phenomena ; Range of Motion, Articular
Language	English
Publishing date	2023-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2023.3282165
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Article: Electrical Stimulation of Distal Tibial Nerve During Stance Phase of Walking May Reverse Effects of Unilateral Paw Pad Anesthesia in the Cat.

Park, Hangue / Klishko, Alexander N / Oh, Kyunggeune / Zhang, Celina / Grenga, Gina / Herrin, Kinsey R / Dalton, John F / Kistenberg, Robert S / Lemay, Michel A / Pitkin, Mark / DeWeerth, Stephen P / Prilutsky, Boris I

Motor control

2022 Volume 27, Issue 1, Page(s) 71–95

Abstract: Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the ...

Abstract	Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the cat could be reduced/reversed by electrical stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve during stance. Several split-belt conditions were investigated in four adult female cats. In addition, we investigated the effects of similar distal tibial nerve stimulation on overground walking of one male cat that had a transtibial, bone-anchored prosthesis for 29 months and, thus, had no cutaneous/proprioceptive feedback from the foot. In all treadmill conditions, cats walked with intact cutaneous feedback (control), with right fore- and hindpaw pads anesthetized by lidocaine injections, and with a combination of anesthesia and electrical stimulation of the ipsilateral distal tibial nerve during the stance phase at 1.2× threshold of afferent activation. Electrical stimulation of the distal tibial nerve during the stance phase of walking with anesthetized ipsilateral paw pads reversed or significantly reduced the effects of paw pad anesthesia on several kinematic variables, including lateral center of mass shift, cycle and swing durations, and duty factor. We also found that stimulation of the residual distal tibial nerve in the prosthetic hindlimb often had different effects on kinematics compared with stimulation of the intact hindlimb with paw anesthetized. We suggest that stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve provides functionally meaningful motion-dependent sensory feedback, and stimulation responses depend on limb conditions.
MeSH term(s)	Animals ; Male ; Female ; Humans ; Walking/physiology ; Locomotion/physiology ; Electric Stimulation ; Tibial Nerve ; Anesthesia
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ISSN	1087-1640
ISSN	1087-1640
DOI	10.1123/mc.2022-0096
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