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.

DeepSurNet-NSGA II:Deep Surrogate Model-Assisted Multi-Objective Evolutionary Algorithm for Enhancing Leg Linkage in Walking Robots

This research paper presents a comprehensive investigation into the effectiveness of the DeepSurNet-NSGA II(Deep Surrogate Model-Assisted Non-dominated Sorting Genetic Algorithm II)for solving complex multiobjective optimization problems,with a particular focus on robotic leg-linkage design.The study introduces an innovative approach that integrates deep learning-based surrogate models with the robust Non-dominated Sorting Genetic Algorithm II,aiming to enhance the efficiency and precision of the optimization process.Through a series of empirical experiments and algorithmic analyses,the paper demonstrates a high degree of correlation between solutions generated by the DeepSurNet-NSGA II and those obtained from direct experimental methods,underscoring the algorithm’s capability to accurately approximate the Pareto-optimal frontier while significantly reducing computational demands.The methodology encompasses a detailed exploration of the algorithm’s configuration,the experimental setup,and the criteria for performance evaluation,ensuring the reproducibility of results and facilitating future advancements in the field.The findings of this study not only confirm the practical applicability and theoretical soundness of the DeepSurNet-NSGA II in navigating the intricacies of multi-objective optimization but also highlight its potential as a transformative tool in engineering and design optimization.By bridging the gap between complex optimization challenges and achievable solutions,this research contributes valuable insights into the optimization domain,offering a promising direction for future inquiries and technological innovations.

Effect of Brisk Walking on Self-Care Agency or Care Dependency among Colorectal Cancer Patients with Permanent Stoma

Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.

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.

Estimating walking access area for rail transit station based on discrete choice model

The discrete choice model is used to estimate the walking access area of rail transit stations while considering the influence of existing competition from other traffic modes. The acceptable walking access area is determined according to the willingness of passengers to walk who prefer rail transit compared with bus and automobile. Empirical studies were conducted using the survey data of six stations from the rail transit in Nanjing, China. The results indicate that the rail transit is more preferable compared with bus and private automobile in this case when excluding the influence of individual and environmental factors. It is found that passengers tend to underestimate their willingness to walk. The acceptable walking access area of every rail transit station is different from each other. Suburban stations generally have a larger walking access area than downtown stations. In addition, a better walking environment and a scarcer surrounding traffic environment can also lead to a larger walking area. The model was confirmed to be effective and reasonable according to the model validation. This study can be of benefit to the passenger transportation demand estimation in the location planning and evaluation of rail transit stations.

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.

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.”

Alterations in neuromuscular activation patterns associated with walking in short-leg walking boots

Short-leg walking boots are a common intervention for acute and chronic lower extremity injury.Few studies have examined the neuromuscular adaptations associated with short-leg walking boots and no previous study has investigated timing characteristics of muscle activation during gait.The purpose of the current study was to examine the timing and amplitudes of muscle activation of the extrinsic ankle musculature during walking in two types of short-leg walking boots.Methods:Eleven healthy young adults performed five level walking trials at a self-selected pace in each of three conditions:normal walking,Gait Walker and Equalizer short-leg walking boots.Ground reaction forces were collected from a force platform while surface electromyography (EMG)was collected from the tibialis anterior,peroneus longus and medial gastrocnemius.EMG signals were rectified and smoothed using the root mean squared with a 20-ms smoothing window and were normalized to the largest mean of the normal walking trials.A repeated measures analysis of variance was used to assess the effect of short-leg walking boots on the onset,duration and amplitude of muscle activation.Results:Short-leg walking boots were generally associated with earlier onsets of muscle activation and longer durations of muscle activation.However,there was no reduction in EMG amplitude.Conclusion:The findings of this study show that the induced alterations in muscle activation patterns may limit the short-leg walking boots.Copyright(C)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.

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 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.

Motion Error Compensation of Multi-legged Walking Robots

Existing errors in the structure and kinematic parameters of multi-legged walking robots,the motion trajectory of robot will diverge from the ideal sports requirements in movement.Since the existing error compensation is usually used for control compensation of manipulator arm,the error compensation of multi-legged robots has seldom been explored.In order to reduce the kinematic error of robots,a motion error compensation method based on the feedforward for multi-legged mobile robots is proposed to improve motion precision of a mobile robot.The locus error of a robot body is measured,when robot moves along a given track.Error of driven joint variables is obtained by error calculation model in terms of the locus error of robot body.Error value is used to compensate driven joint variables and modify control model of robot,which can drive the robots following control model modified.The model of the relation between robot＇s locus errors and kinematic variables errors is set up to achieve the kinematic error compensation.On the basis of the inverse kinematics of a multi-legged walking robot,the relation between error of the motion trajectory and driven joint variables of robots is discussed.Moreover,the equation set is obtained,which expresses relation among error of driven joint variables,structure parameters and error of robot＇s locus.Take MiniQuad as an example,when the robot MiniQuad moves following beeline tread,motion error compensation is studied.The actual locus errors of the robot body are measured before and after compensation in the test.According to the test,variations of the actual coordinate value of the robot centroid in x-direction and z-direction are reduced more than one time.The kinematic errors of robot body are reduced effectively by the use of the motion error compensation method based on the feedforward.

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.

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.

Adjustable Mechanism for Walking Robots with Minimum Number of Actuators

Recent literature on walking robots deals predominantly with multi-degrees-of-freedom leg mechanisms and machines capable of adopting several gaits.This paper explores the other end of the spectrum suggesting mechanisms derived from a four bar coupler curve for a one degree of freedom walking robot.Simulation of the walk indicates that body of the robot is able to move with low variation in velocity.The best strategy for changing the gait to enable the robot to walk over obstacles and the effect of change in length of different links are explored to open up the possibility of a two degree of freedom walking robot with the capability of changing its gait,suitable as a low cost unit for several applications.Such rugged units would permit the use of an IC engine as the primary source of power and could be of utility in installations where electronics may not be functional.In simple walking machines the foot of a leg is usually required to trace a D shaped curve with respect to the chassis.In this paper we begin with a Hoecken mechanism capable of tracing such a curve.The foot is required to move parallel to itself and the same could be achieved using a six or eight link mechanism.A few such devices have been synthesized in this paper and their motion properties compared.The study also covers the possibility of providing adjustments to vary the step length and height of the foot＇s movement.

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.