EC Kuska, KM Steele (2024) “Does crouch alter the effects of neuromuscular impairments on gait? A simulation study”

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.

A sagittal-plane musculoskeletal model and neuromuscular simulation framework that tracked average nondisabled (ND) kinematics and moderate and severe crouch gait. The model contains nine degrees-of-freedom (pelvic tilt and translation, and right and left hip, knee, and ankle flexion) actuated by eight Hill-type musculotendinous units per leg. The objective function minimized deviations from tracked kinematics and the sum of muscle activations squared (a2). We perturbed each gait simulation with multi-modal neuromuscular impairments—altered control, weakness, and contracture—of varying severities. Altered control was simulated by reducing the number of fixed synergies controlling each leg, and weakness and contracture were simulated by reducing a muscle’s maximum isometric force ( ) and tendon slack length ( ), respectively. A Bayesian Additive Regression Trees (BART) model then predicted resultant a2 from the simulated neuromuscular impairments for crouch and ND gait to evaluate the relative effects of each simulated neuromuscular impairment on the muscle activations required to maintain each gait pattern.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.

NL Zaino, Z McKee, CD Caskey, KM Steele, HA Feldner (2024) “Perceptions and experiences of first mobility aid provision for young children with cerebral palsy in the United States: a mixed-methods study”

Journal Article in Disability and Rehabilitation: Assistive Technology 

This research provides insights into the lived experiences of clinicians and caregivers of young children with CP regarding the prescription, provision, use and impact of first mobility aids, specifically ankle foot orthoses and walkers/gait trainers.

Caregiver views of impact of first orthoses (n = 8) and walkers (n = 4). Proportional bar graph depicting caregiver perceptions on the impacts of their child’s ankle foot orthoses and/or walkers on various activities.Aim: The purpose of this study was to establish and understand the provision process and impacts of first mobility aids for children with cerebral palsy (CP) in the United States – specifically orthoses, walkers and gait-trainers.

Methods: We performed a mixed-methods study including surveys and semi-structured interviews of caregivers of young children with CP (n = 10) and clinicians who work with young children with CP (n = 29). We used content analysis for the surveys and inductive coding for the interviews.

Results: Four themes emerged: (1) first mobility aids have mixed impacts and use patterns, (2) there is varied caregiver education and understanding about mobility aids, (3) clinician knowledge, consistency and connection impact care and (4) numerous access barriers exist for families, and there are still opportunities for improvement across all domains.

Interpretation: This study not only provides researchers and clinicians with an understanding of the current status of the prescription and provision process in the United States, but also offers suggestions for improvements of the process and mobility aids themselves. These results have implications for future research, mobility aid, design and the provision process of first mobility aids.

MC Rosenberg, JL Proctor, KM Steele (2024) “Quantifying changes in individual-specific template-based representations of center-of-mass dynamics during walking with ankle exoskeletons using Hybrid-SINDy”

Journal Article in Scientific Reports

Ankle exoskeletons alter whole-body walking mechanics, energetics, and stability by altering center-of-mass (CoM) motion. Controlling the dynamics governing CoM motion is, therefore, critical for maintaining efficient and stable gait. However, how CoM dynamics change with ankle exoskeletons is unknown, and how to optimally model individual-specific CoM dynamics, especially in individuals with neurological injuries, remains a challenge.

Depictions of walking conditions, phase variables, and example template state variables. (A) Two-dimensional depictions of template model applied to human walking without and with ankle exoskeletons (left). The phase portrait (right) defined a phase variable, , used to cluster kinematically similar measurements for model fitting. Colors denote gait phases corresponding to first and second double-limb support, single-limb support, and swing of the right leg. (B) Stride-averaged global CoM position, velocity, and acceleration for an exemplary unimpaired adult in the anterior–posterior, vertical, and mediolateral directions. The three exoskeleton conditions are shown in panels (B) and (C): shoes-only (solid lines), zero-stiffness exoskeletons (K0; dashed lines), and stiff exoskeletons (KH; dotted lines). (C) Template position and velocity states used to fit the template signatures were defined by sagittal- and frontal-plane leg angles, and leg length.Aim: Evaluate individual-specific changes in CoM dynamics in unimpaired adults and one individual with post-stroke hemiparesis while walking in shoes-only and with zero-stiffness and high-stiffness passive ankle exoskeletons.

Methods: To identify optimal sets of physically interpretable mechanisms describing CoM dynamics, termed template signatures, we leveraged hybrid sparse identification of nonlinear dynamics (Hybrid-SINDy), an equation-free data-driven method for inferring sparse hybrid dynamics from a library of candidate functional forms.

Results: In unimpaired adults, Hybrid-SINDy automatically identified spring-loaded inverted pendulum-like template signatures, which did not change with exoskeletons (p > 0.16), except for small changes in leg resting length (p < 0.001). Conversely, post-stroke paretic-leg rotary stiffness mechanisms increased by 37–50% with zero-stiffness exoskeletons.

Interpretation: While unimpaired CoM dynamics appear robust to passive ankle exoskeletons, how neurological injuries alter exoskeleton impacts on CoM dynamics merits further investigation. Our findings support Hybrid-SINDy’s potential to discover mechanisms describing individual-specific CoM dynamics with assistive devices.

UW Data Science Seminar with Megan Ebers

Title slide from the UW eScience Data Science seminar that says "Mobile sensing with shallow recurrent decoder networks. Megan R. Ebers"

Steele lab member and postdoctoral scholar, Megan Ebers, was featured in the Winter 2024 UW Data Science Seminar series. You can watch her full presentation on “Mobile sensing with shallow recurrent decoder networks” linked HERE on UW eScience Institute’s YouTube channel.

Abstract: Sensing is a fundamental task for the monitoring, forecasting, and control of complex systems. In many applications, a limited number of sensors are available and must move with the dynamics, such as with wearable technology or ocean monitoring buoys. In these dynamic systems, the sensors’ time history encodes a significant amount of information that can be extracted for critical tasks. We show that by leveraging the time-history of a sparse set of sensors, we can encode global information of the measured high-dimensional system using shallow recurrent decoder networks. This paradigm has important applications for technical challenges in climate modeling, natural disaster evaluation, and personalized health monitoring; we focus especially on how this paradigm has the potential to transform the way we monitor and manage movement-related health outcomes.

Bio: Megan Ebers is a postdoctoral scholar in applied mathematics with UW’s NSF AI Institute in Dynamic Systems. In her PhD research, she developed and applied machine learning methods for dynamics systems to understand and enable human mobility. Her postdoctoral research focuses on data-driven and reduced-order methods for complex systems, so as to continue her work in human-centered research challenges, as well as to extend her research to a broader set of technical challenges, including turbulent flow modeling, natural disaster monitoring, and acoustic object detection.

Steele Lab presents at CREATE Research Showcase

A group of Steele Lab members posing for a photo

The Center for Research and Education on Accessible Technology and Experiences (CREATE) hosted a Research Showcase and Holiday party on December 12, 2023. CREATE’s mission is to make technology accessible and to make the world accessible through technology.

Steele Lab members, Kate, Victoria (Tori), and Charlotte presented posters at the CREATE Research Showcase to highlight design, development & research of tech to support individuals with disabilities.

Way to go, team!