Engineering to enhance human mobility, play, and exploration
Congratulations to Dr. Charlotte DeVol Caskey on earning her Doctorate in Mechanical Engineering! Dr. Caskey’s PhD thesis dissertation was titled Effects of Spinal Stimulation on Neuromechanics of Gait for Children with Cerebral Palsy. Congratulations and best of luck as you move forward as a Postdoc in the Human Neuromechanics Laboratory at the University of Florida in Gainesville!
Journal Article in Journal of Biomechanics
Cerebral palsy (CP) is a neurologic injury that impacts control of movement. Individuals with CP also often develop secondary impairments like weakness and contracture. Both altered motor control and secondary impairments influence how an individual walks after neurologic injury. However, understanding the complex interactions between and relative effects of these impairments makes analyzing and improving walking capacity in CP challenging.
Aim: The purpose of this study was to investigate the interactions between neuromuscular impairments and gait in CP.
Methods: We used a sagittal-plane musculoskeletal model and neuromuscular control framework to simulate crouch and nondisabled gait. We perturbed each simulation by varying the number of synergies controlling each leg (altered control), and imposed weakness and contracture. A Bayesian Additive Regression Trees (BART) model was also used to parse the relative effects of each impairment on the muscle activations required for each gait pattern.
Results: By using these simulations to evaluate gait-pattern specific effects of neuromuscular impairments, we identified some advantages of crouch gait. For example, crouch tolerated 13 % and 22 % more plantarflexor weakness than nondisabled gait without and with altered control, respectively. Furthermore, BART demonstrated that plantarflexor weakness had twice the effect on total muscle activity required during nondisabled gait than crouch gait. However, crouch gait was also disadvantageous in the presence of vasti weakness: crouch gait increased the effects of vasti weakness on gait without and with altered control.
Interpretation: These simulations highlight gait-pattern specific effects and interactions between neuromuscular impairments. Utilizing computational techniques to understand these effects can elicit advantages of gait deviations, providing insight into why individuals may select their gait pattern and possible interventions to improve energetics.
Journal Article in Journal of NeuroEngineering and Rehabilitation
Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP.
Aim: The aim of this study is to evaluate how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care.
Method: In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation.
Results: Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained.
Interpretation: This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.
Lab members, Charlotte Caskey and Mia Hoffman attended the 2023 American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Annual Meeting in Chicago, IL on September 10-13, 2023.
Charlotte gave a poster presentation on “Short-Burst Interval Treadmill Training Increases Step Length and Stability for Children with Cerebral Palsy.”
Mia gave a podium presentation during the Early Detection and Diagnosis session on “Quantifying the Activity Levels of Toddlers with Down Syndrome Playing in a Partial Body Weight Support System.“
Great work in the Windy City!
Congratulations to Dr. Elijah Kuska on earning his Doctorate in Mechanical Engineering! Dr. Kuska’s PhD thesis dissertation was titled In Silico Techniques to Improve Understanding of Gait in Cerebral Palsy. Congratulations and best of luck as you move forward as an assistant teaching professor at the Colorado School of Mines!