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Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain

Authors: Petrini, Francesco Maria; Bumbasirevic, Marko; Valle, Giacomo; Ilic, Vladimir; Mijović, Pavle; Čvančara, Paul, Barberi, Federica; Katic, Natalija; Bortolotti, Dario; Andreu, David; Lechler, Knut; Lesic, Aleksandar; Mazic, Sanja; Mijović, Bogdan, Guiraud, David; Stieglitz, Thomas; Alexandersson, Asgeir; Micera, Silvestro; Raspopovic, Stanisa

 

Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.

Reference

Posted on: November 7, 2019

Biomechanical effects of passive hip springs during walking

Authors: Haufe, Florian L; Wolf, Peter; Riener, Robert; Grimmer, Martin

 

Passive spring-like structures can store and return energy during cyclic movements and thereby reduce the energetic cost of locomotion. That makes them important components of the human body and wearable assistive devices alike. This study investigates how springs placed anteriorly across the hip joint affect leg joint angles and powers, and leg muscle activities during level walking at 0.5 to 2.1 m/s.

We hypothesized that the anterior hip springs (I) load hip extension, (II) support hip flexion and (III) affect ankle muscle activity and dynamics during walking. Effects at the ankle were expected because hip and ankle redistribute segmental power in concert to achieve forward progression.

We observed that the participants’ contribution to hip power did not increase during hip extension as the spring stored energy. Simultaneously, the activities of plantarflexor muscles that modulate energy storage in the Achilles tendon were reduced by 28% (gastrocnemius medialis) and 9% (soleus). As the spring returned energy with the onset of hip flexion, the participants’ contribution to hip power was reduced by as much as 23%. Soleus activity before push-off increased by up to 9%.

Instead of loading hip extension, anterior hip springs seem to store and return parts of the energy normally exchanged with the Achilles tendon. Thereby, the springs support hip flexion but may reduce elastic energy storage in and hence recoil from the Achilles tendon. This interaction should be considered during the design and simulation of wearable assistive devices as it might – depending on user characteristics – enhance or diminish their overall functionality.

Reference

Posted on: November 7, 2019