Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

A Wire-Driven Series Elastic Mechanism Based on Ultrasonic Motor for Walking Assistive System

In order to improve the elderly people's quality of life,supporting their walking behaviors is a promising technology.Therefore,based on one ultrasonic motor,a wire-driven series elastic mechanism for walking assistive system is proposed and investigated in this research.In contrast to tradition,it innovatively utilizes an ultrasonic motor and a wire-driven series elastic mechanism to achieve superior system performances in aspects of simple structure,high torque/weight ratio,quiet operation,quick response,favorable electromagnetic compatibility,strong shock resistance,better safety,and accurately stable force control.The proposed device is mainly composed of an ultrasonic motor,a linear spring,a steel wire,four pulleys and one rotating part.To overcome the ultrasonic motor's insufficient output torque,a steel wire and pulleys are smartly combined to directly magnify the torque instead of using a conventional gear reducer.Among the pulleys,there is one tailored pulley playing an important role to keep the reduction ratio as 4.5 constantly.Meanwhile,the prototype is manufactured and its actual performance is verified by experimental results.In a one-second operating cycle,it only takes 86 ms for this mechanism to output an assistive torque of 1.6 N·m.At this torque,the ultrasonic motor's speed is around 4.1 rad/s.Moreover,experiments with different operation periods have been conducted for different application scenarios.This study provides a useful idea for the application of ultrasonic motor in walking assistance system.

Theoretical and Numerical Studies on the Coupling Deformation of Global Lateral Buckling and Walking of Submarine Pipeline

Buckling initiation devices/techniques,including sleepers,distributed buoyancy,snake lay,and residual curvature method(RCM),have recently been widely applied in engineering.These initiated buckles may induce a long pipeline to transform into multiple short pipeline segments,which promote the occurrence of pipeline walking.Thus,a pipeline,which is designed to buckle laterally,may laterally and axially displace over time when subjected to repeated heating and cooling cycles.This study aims to reveal the coupling mechanism of pipeline walking and global lateral buckling.First,an analytic solution is proposed to estimate the walking of pipeline segments between two adjacent buckles.Then,the sensitivity of this method to heating and cooling cycles is analyzed.Results show the applicability of the proposed walking analytical solution of buckling pipelines.Subsequently,an influence analysis of walking on global buckling,including the capacity of buckling initiation,buckling amplitude,buckling mode,and failure assessment of the buckling pipeline,is performed.The results reveal that the effect of walking on the buckling axial force is negligible.However,pipeline walking will aggravate the asymmetry of the pipeline buckling and the failure parameters of the pipeline during the post-buckling.

A new passive transfemoral prosthesis mechanism based on 3R36 knee and ESAR foot providing walking and squatting

Researchers have proposed various linkage mechanisms to connect knee and ankle joints for above-knee prosthe-ses,but most of them only offer natural walking.However,studies have shown that people assume a squatting posture during daily activities.This paper introduces a novel mechanism that connects the knee joint with the foot-ankle joint to enable both squatting and walking.The prosthetic knee used is the well-known 3R36,while the energy storing and return(ESAR)prosthetic foot is used for the ankle-foot joint.To coordinate knee and ankle joint movements,a six-bar linkage mechanism structure is proposed.Simulation results demonstrate that the proposed modular transfemoral prosthesis accurately mimics the motion patterns of a natural human leg during walking and squatting.For instance,the prosthesis allows a total knee flexion of more than 140°during squatting.The new prosthesis design also incorporates energy-storing mechanisms to reduce energy expenditure during walking for amputees.

A review on the coordinative structure of human walking and the application of principal component analysis

Walking is a complex task which includes hundreds of muscles, bones and joints working together to deliver smooth movements. With the complexity, walking has been widely investigated in order to identify the pattern of multi-segment movement and reveal the control mechanism. The degree of freedom and dimensional properties provide a view of the coordinative structure during walking, which has been extensively studied by using dimension reduction technique. In this paper, the studies related to the coordinative structure, dimensions detection and pattern reorganization during walking have been reviewed. Principal component analysis, as a popular technique, is widely used in the processing of human movement data. Both the principle and the outcomes of principal component analysis were introduced in this paper. This technique has been reported to successfully reduce the redundancy within the original data, identify the physical meaning represented by the extracted principal components and discriminate the different patterns. The coordinative structure during walking assessed by this technique could provide further information of the body control mechanism and correlate walking pattern with injury.

Computational Models to Synthesize Human Walking

The synthesis of human walking is of great interest in biomechanics and biomimetic engineering due to its predictive capabilities and potential applications in clinical biomechanics, rehabilitation engineering and biomimetic robotics. In this paper, the various methods that have been used to synthesize humanwalking are reviewed from an engineering viewpoint. This involves a wide spectrum of approaches, from simple passive walking theories to large-scale computational models integrating the nervous, muscular and skeletal systems. These methods are roughly categorized under four headings： models inspired by the concept of a CPG （Central Pattern Generator）, methods based on the principles of control engineering, predictive gait simulation using optimisation, and models inspired by passive walking theory. The shortcomings and advantages of these methods are examined, and future directions are discussed in the context of providing insights into the neural control objectives driving gait and improving the stability of the predicted gaits. Future advancements are likely to be motivated by improved understanding of neural control strategies and the subtle complexities of the musculoskeletal system during human locomotion. It is only a matter of time before predictive gait models become a practical and valuable tool in clinical diagnosis, rehabilitation engineering and robotics.

Combination of diaphragmatic breathing with therapeutic walking exercise to increase peak expiratory flow rate in asthma patients

Objective:This study aimed to determine the effect of combined diaphragmatic breathing and therapeutic walking exercise on peak expiratory flow in asthma patients.Methods:The research design used a quasi-experiment nonequivalent pretest and posttest design.The research sample contained 38 respondents divided into intervention and control groups,selected by simple random sampling.The control group received standard drug therapy,while the intervention group received standard drug therapy and a combination of diaphragmatic breathing and therapeutic walking exercise for 2 weeks.This exercise was carried out in the morning,6 times a week,with 5 diaphragmatic breathing and exhalations per exercise.After that,a 1-min break was followed by a therapeutic walking exercise of 5–15 min,with an increased duration.Both groups measured the peak expiratory flow before and after the intervention using a peak flow meter.The data analysis used central tendency and t-test.Results:The results showed that the mean peak expiratory flow in the intervention group was 306.84,while in the control group,it was 232.63,with the value of the t-test being-14.17(P<0.0001).Conclusions:Diaphragmatic breathing and therapeutic walking exercise significantly increased the peak expiratory flow in asthma patients.

On the Optimal Modes of Controlled Transfer of Walking Propulsion Devices

The problem of walking machine leg transfer is considered.Optimal laws of transfer are determined with regard to geometrical features ofgroundand underwater.Complex optimality criterion is introduced as the sum of indexes of quality of the movement multiplied each by weight coefficients.The solution is provided based on the walking machine“Ortonog.”

On Determining the Optimal Lifting Law of the Walking Propulsion Device Foot of an Underwater Robot from the Bottom

The problem of lifting the foot of the walking propulsion device of an underwater mobile robot is considered,taking into account the additional"compression""force acting on it.A mathematical model has been developed for the detachment of a propulsion foot from the ground,based on Henry's laws establishing the concentration of dissolved air in a liquid,the law of gas expansion at a constant temperature,Darcy's law on fluid filtration,and the theorem on the motion of the center of mass of a solid body.The linearized model allows to obtain and analytical solutions.Based on the solution of the variat ional problem,optimal modes of lifting the foot of the walking propulsion of an underwater mobile robot are established.

Kinematics and Dynamics Analysis of a Quadruped Walking Robot with Parallel Leg Mechanism

It is desired to require a walking robot for the elderly and the disabled to have large capacity,high stiffness,stability,etc.However,the existing walking robots cannot achieve these requirements because of the weight-payload ratio and simple function.Therefore,Improvement of enhancing capacity and functions of the walking robot is an important research issue.According to walking requirements and combining modularization and reconfigurable ideas,a quadruped/biped reconfigurable walking robot with parallel leg mechanism is proposed.The proposed robot can be used for both a biped and a quadruped walking robot.The kinematics and performance analysis of a 3-UPU parallel mechanism which is the basic leg mechanism of a quadruped walking robot are conducted and the structural parameters are optimized.The results show that performance of the walking robot is optimal when the circumradius R,r of the upper and lower platform of leg mechanism are 161.7 mm,57.7 mm,respectively.Based on the optimal results,the kinematics and dynamics of the quadruped walking robot in the static walking mode are derived with the application of parallel mechanism and influence coefficient theory,and the optimal coordination distribution of the dynamic load for the quadruped walking robot with over-determinate inputs is analyzed,which solves dynamic load coupling caused by the branches’ constraint of the robot in the walk process.Besides laying a theoretical foundation for development of the prototype,the kinematics and dynamics studies on the quadruped walking robot also boost the theoretical research of the quadruped walking and the practical applications of parallel mechanism.

Planning and Control of COP-Switch-Based Planar Biped Walking

Efficient walking is one of the main goals of researches on biped robots. A feasible way is to translate the understanding from human walking into robot walking, for example, an artificial control approach on a human like walking structure. In this paper, a walking pattern based on Center of Pressure （COP） switched and modeled after human walking is introduced firstly. Then, a parameterization method for the proposed walking gait is presented. In view of the complication, a multi-space planning method which divides the whole planning task into three sub-spaces, including simplified model space, work space and joint space, is proposed. Furthermore, a finite-state-based control method is also developed to implement the proposed walking pattern. The state switches of this method are driven by sensor events. For convincing verification, a 2D simulation system with a 9-1ink planar biped robot is developed. The simulation results exhibit an efficient walking gait.

Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system

The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.

Retrospective study of effect of whole-body vibration training on balance and walking function in stroke patients

BACKGROUND Dysfunction in stroke patients has been a problem that we committed to solve and explore.Physical therapy has some effect to regain strength,balance,and coordination.However,it is not a complete cure,so we are trying to find more effective treatments.AIM To observe the effect of whole-body vibration training(WVT)on the recovery of balance and walking function in stroke patients,which could provide us some useful evidence for planning rehabilitation.METHODS The clinical data of 130 stroke participants who underwent conventional rehabilitation treatment in our hospital from January 2019 to August 2020 were retrospectively analyzed.The participants were divided into whole-body vibration training(WVT)group and non-WVT(NWVT)group according to whether they were given WVT.In the WVT group,routine rehabilitation therapy was combined with WVT by the Galileo Med L Plus vibration trainer at a frequency of 20 Hz and a vibration amplitude of 0+ACY-plusmn+ADs-5.2 mm,and in the NWVT group,routine rehabilitation therapy only was provided.The treatment course of the two groups was 4 wk.Before and after treatment,the Berg balance scale(BBS),3 m timed up-and-go test(TUGT),the maximum walking speed test(MWS),and upper limb functional reaching(FR)test were performed.RESULTS After 4 wk training,in both groups,the BBS score and the FR distance respectively increased to a certain amount(WVT=46.08±3.41 vs NWVT=40.22±3.75;WVT=20.48±2.23 vs NWVT=16.60±2.82),with P<0.05.Furthermore,in the WVT group,both BBS score and FR distance(BBS:18.32±2.18;FR:10.00±0.92)increased more than that in the NWVT group(BBS:13.29±1.66;FR:6.16±0.95),with P<0.05.Meanwhile,in both groups,the TUGT and the MWS were improved after training(WVT=32.64±3.81 vs NWVT=39.56±3.68;WVT=12.73±2.26 vs NWVT=15.04±2.27,respectively),with P<0.05.The change in the WVT group(TUGT:17.49±1.88;MWS:6.79±0.81)was greater than that in the NWVT group(TUGT:10.76±1.42;MWS:4.84±0.58),with P<0.05.CONCLUSION The WVT could effectively improve the balance and walking function in stroke patients,which may be good for improving their quality of life.

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury:a prospective self-controlled study

Although a large number of trials in the SCI field have been conducted,few proven gains have been realized for patients.In the present study,we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury(SCI)subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale(AIS)Class A(AIS-A).A total of 320 clinically complete SCI subjects(271 male and 49 female),aged 16–60 years,received early(≤7 days,n=201)or delayed(8–30 days,n=119)surgical interventions to reduce intraspinal or intramedullary pressure.Fifteen days post-surgery,all subjects received a weight-bearing walking training with the“Kunming Locomotion Training Program(KLTP)”for a duration of 6 months.The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale(KLS).We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores.Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days,3 or 6 months indicating continued improvement in walking scores during the 6-month period.In conclusion,combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI,which generally shows little clinical recovery within the first year after injury and most are permanently disabled.This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital,China and registered at ClinicalTrials.gov(Identifier:NCT04034108)on July 26,2019.

The experimental study on the contact process of passive walking

The passive dynamic walking is a new concept of biped walking. Researchers have been working on this area with both theoretical analysis and experimental analysis ever since McGeer. This paper presents our compass-like pas- sive walking model with a new set of testing system. Two gyroscopes are used for measuring the angles of two legs, and ten FlexiForce sensors are used for measuring the con- tact forces on the feet. We got the experimental data on the passive walking process with the validated testing system. A great emphasis was put on the contact process between the feet and the slope. The contact process of the stance leg was divided into four sections, and differences between the real testing contact process and the classic analytical contact process with no bouncing and slipping were summarized

A novel explosion-proof walking system: Twin dual-motor drive tracked units for coal mine rescue robots

A new explosion-proof walking system was designed for the coal mine rescue robot(CMRR) by optimizing the mechanical structure and control algorithm. The mechanical structure innovation lies mainly in the dual-motor drive tracked unit used, which showed high dynamic performance compared with the conventional tracked unit. The control algorithm, developed based on decision trees and neural networking, facilitates autonomous switching between "Velocity-driven Mode" and "Torquedriven Mode". To verify the feasibility and effectiveness of the control strategy, we built a self-designed test platform and used it to debug the control program; we then made a robot prototype and conducted further experiments on single-step, ramp, and rubble terrains. The results show that the proposed walking system has excellent dynamic performance and the control strategy is very efficient, suggesting that a robot with this type of explosion-proof walking system can be successfully applied in Chinese coal mines.

Walking of spider on water surface studied from its leg shadows

Different from sculling forward of water striders with their hairy water-repellent legs, water spiders walked very quickly on water surfaces. By using a shadow method, the walking of water spiders had been studied. The three-dimensional trajectories and the supporting forces of water spider legs during walking forward were achieved. Results showed that the leg movement could be divided into three phases： slap, stroke, and retrieve. Employing an effective strategy to improving walking efficiency, the sculling legs supported most of its body weight while other legs were lifted to reduce the lateral water resistance, which was similar to the strategy of water striders. These findings could help guiding the design of water walking robots with high efficiency.

Stability and control of dynamic walking for a five-link planar biped robot with feet

During dynamic walking of biped robots, the underactuated rotating degree of freedom （DOF） emerges between the support foot and the ground, which makes the biped model hybrid and dimension-variant. This paper addresses the asymptotic orbit stability for dimension-variant hybrid systems （DVHS）. Based on the generalized Poincare map, the stability criterion for DVHS is also presented, and the result is then used to study dynamic walking for a five-link planar biped robot with feet. Time-invariant gait planning and nonlinear control strategy for dynamic walking with fiat feet is also introduced. Simulation results indicate that an asymptotically stable limit cycle of dynamic walking is achieved by the proposed method.

Walking pace and the risk of stroke:A meta-analysis of prospective cohort studies

Purpose:The extent to which walking pace is associated with a reduced risk for stroke remains unclear.This study examined the association between walking pace and stroke risk based on prospective cohort studies.Methods:Databases of PubMed,EMBASE,Web of Science,Scopus,and China National Knowledge Internet were searched from the inception dates to January 31,2019,for prospective cohort studies focusing on walking pace and risk of stroke in adults.Two reviewers independently extracted data and assessed the quality of the studies.The dependent measure was stroke incidence.Using random-effects models,a metaanalysis was performed to estimate the overall relative risks(RR)of stroke incidence and 95%confidence intervals(CIs)for the individuals with the fastest walking paces vs.individuals with the slowest walking paces.A dose-response relationship was also examined.Results:After screening 1294 titles/abstracts and 14 full-text studies identified in the search,7 studies(from 8 cohorts)were included in the metaanalysis.The 7 studies included a total of 135,645 participants(95.2%women;mean age 63.6 years)and 2229 stroke events(median follow-up time=8.0 years).Compared to individuals in the slowest walking-pace category(median=1.6 km/h),individuals in the fastest walking-pace category(median=5.6 km/h)had a 44%lower risk of stroke(pooled RR=0.56,95%CI:0.48-0.65).There was also a linear dose-response relationship(RR=0.87;95%CI:0.83-0.91),with the risk of stroke decreased by 13%for every 1 km/h increment in baseline walking pace.We observed similar results across walking-pace assessment,type of stroke ascertainment,stroke subtypes,sex,sample size,and duration of follow-up.Conclusion:Findings from this meta-analysis indicate that walking pace is inversely associated with the risk of stroke.

Impactless biped walking on a slope

Walking without impacts has been considered in dynamics as a motion/force control problem. In order to avoid impacts, an approach for both the specified motion of the biped and its ground reaction forces was presented yielding a combined motion and force control problem. As an application, a walker on a horizontal plane has been considered. In this paper, it is shown how the control of the ground reaction forces and the energy consumption depend on the gradient of a slope. The biped dynamics and the constraints within the biped system and on the ground are discussed. A motion control synthesis is developed using the inverse dynamics principle proven to be most efficient for human walking research, too. The impactless walking with controlled legs is illustrated by a seven-link biped. The ＂flying＂ biped has nine degrees of freedom, with six control inputs. During locomotion, the standing leg has three scleronomic constraints, and the trunk has three rheonomic constraints. However, there are three rheonomic constraints for the prescribed leg motion or three scleronomic constraints for reaction forces of the trailing leg, respectively. The nominal control action for impactless walking can be precomputed and stored. The model proposed allows the investigation of several problems： uphill and downhill walking, optimization of step length,stiction of the feet on the slope and many more. All these findings are also of interest in biomechanics. C 2013 The Chinese Society of Theoretical and Applied Mechanics. [doi：10.1063/2.1301302]