According to the CDC in 2010, there were 2.8 million emergency room visits costing $7.9 billion dollars for treatment of nonfatal falling injuries in emergency departments across the country. Falls are a recognized risk factor for unintentional injuries among older adults, accounting for a large proportion of fractures, emergency department visits, and urgent hospitalizations. The objective of this research was to identify and learn more about what factors affect balance using analysis techniques from nonlinear dynamics. Human balance and gait research traditionally uses linear or qualitative tests to assess and describe human motion; however, it is growing more apparent that human motion is neither a simple nor a linear task. In the 1990s Collins, first started applying stochastic processes to analyze human postural control system. Recently, Zakynthinaki et al. modeled human balance using the idea that humans will remain erect when perturbed until some boundary, or physical limit, is passed. This boundary is similar to the notion of basins of attraction in nonlinear dynamics and is referred to as the basin of stability. Human balance data was collected using dual force plates and Vicon marker position data for leans using only ankle movements and leans that were unrestricted. With this dataset, Zakynthinaki’s work was extended by comparing different algorithms used to create the critical curve (basin of stability boundary) that encloses the experimental data points as well as comparing the differences between the two leaning conditions.

Fall accident is a significant problem associated with our society both in terms of economic losses and human suffering [1]. In 2016, more than 800,000 people were hospitalized and over 33,000 deaths resulted from falling. Health costs associated with falling in 2016 yielded at 33% of total medical expenses in the US- mounting to approximately $31 billion per year. As such, it is imperative to find intervention strategies to mitigate deaths and injuries associated with fall accidents. In order for this goal to be realized, it is necessary to understand the mechanisms associated with fall accidents and more specifically, the movement profiles that may represent the cogent behavior of the locomotor system that may be amendable to rehabilitation and intervention strategies. In this light, this Thesis is focused on better understanding the factors influencing dynamic stability measure (as measured by Lyapunov exponents) during over-ground ambulation utilizing wireless Inertial Measurement Unit (IMU).

Four pilot studies were conducted: the First study was carried out to verify if IMU system was sophisticated enough to determine different load-carrying conditions. Second, to test the effects of walking inclinations, three incline levels on gait dynamic stability were examined. Third, tested whether different sections from the total gait cycle can be stitched together to assess LDS using the laboratory collected data. Finally, the fourth study examines the effect of “stitching” the data on dynamic stability measure from a longitudinally assessed (3-day continuous data collection) data to assess the effects of free-range data on assessment of dynamic stability.

Results indicated that load carrying significantly influenced dynamic stability measure but not for the floor inclination levels – indicating that future use of such measure should further implicate normalization of dynamic stability measures associated with different activities and terrain conditions. Additionally, stitching method was successful in obtaining dynamic stability measure utilizing free-living IMU data.

Progressive gait disorder in Parkinson's disease (PD) is usually exhibited as reduced step/stride length and gait speed. People with PD also exhibit stooped posture, which can contribute to reduced step length and arm swing. Since gait and posture deficits in people with PD do not respond well to pharmaceutical and surgical treatments, novel rehabilitative therapies to alleviate these impairments are necessary. Many studies have confirmed that people with PD can improve their walking patterns when external cues are presented. Only a few studies have provided explicit real-time feedback on performance, but they did not report how well people with PD can follow the cues on a step-by-step basis. In a single-session study using a novel-treadmill based paradigm, our group had previously demonstrated that people with PD could follow step-length and back angle feedback and improve their gait and posture during treadmill walking. This study investigated whether a long-term (6-week, 3 sessions/week) real-time feedback training (RTFT) program can improve overground gait, upright posture, balance, and quality of life. Three subjects (mean age 70 ± 2 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were enrolled and participated in the program. The RTFT sessions involved walking on a treadmill while following visual feedback of step length and posture (one at any given time) displayed on a monitor placed in front of the subject at eye-level. The target step length was set between 110-120% of the step length obtained during a baseline non-feedback walking trial and the target back angle was set at the maximum upright posture exhibited during a quiet standing task. Two subjects were found to significantly improve their posture and overground walking at post-training and these changes were retained six weeks after RTFT (follow-up) and the third subject improved his upright posture and gait rhythmicity. Furthermore, the magnitude of the improvements observed in these subjects was greater than the improvements observed in reports on other neuromotor interventions. These results provide preliminary evidence that real-time feedback training can be used as an effective rehabilitative strategy to improve gait and upright posture in people with PD.

Between 20%-30% of stroke survivors have foot drop. Foot drop is characterized by inadequate dorsiflexion required to clear the foot of the ground during the swing phase of gait, increasing the risk of stumbles and falls (Pouwels et al. 2009; Hartholt et al. 2011). External postural perturbations such as trips and slips are associated with high rate of falls in individuals with stroke (Forster et al. 1995). Falls often results in head, hip, and wrist injuries (Hedlund et al 1987; Parkkari et al. 1999). A critical response necessary to recover one’s balance and prevent a fall is the ability to evoke a compensatory step (Maki et al. 2003; Mansfield et al. 2013). This is the step taken to restore one’s balance and prevent a fall. However, this is difficult for stroke survivors with foot drop as normal gait is impaired and this translates to difficulty in evoking a compensatory step. To address both foot drop and poor compensatory stepping response, assistive devices such as the ankle-foot-orthosis (AFO) and functional electrical stimulator (FES) are generally prescribed to stroke survivors (Kluding et al. 2013; S. Whiteside et al. 2015). The use of these assistive devices improves walking speed, foot clearance, cadence, and step length of its users (Bethoux et al. 2014; Abe et al. 2009; Everaert et al. 2013; Alam et al. 2014). However, their impact on fall outcome in individuals with stroke in not well evaluated (Weerdesteyn et al. 2008). A recent study (Masood Nevisipour et al. 2019) where stroke survivors experienced a forward treadmill perturbation, mimicking a trip, reports that the impaired compensatory stepping response in stroke survivors in not due to the use of the assistive devices but to severe ankle impairments which these devices do not fully address. However, falls can also occur because of a slip. Slips constitute 40% of outdoor falls (Luukinen et al. 2000). In this study, results for fall rate and compensatory stepping response when subjects experience backward perturbations, mimicking slips, reveal that these devices do not impair the compensatory stepping response of its users.

Nearly one percent of the population over 65 years of age is living with Parkinson’s disease (PD) and this population worldwide is projected to be approximately nine million by 2030. PD is a progressive neurological disease characterized by both motor and cognitive impairments. One of the most serious challenges for an individual as the disease progresses is the increasing severity of gait and posture impairments since they result in debilitating conditions such as freezing of gait, increased likelihood of falls, and poor quality of life. Although dopaminergic therapy and deep brain stimulation are generally effective, they often fail to improve gait and posture deficits. Several recent studies have employed real-time feedback (RTF) of gait parameters to improve walking patterns in PD. In earlier work, results from the investigation of the effects of RTF of step length and back angle during treadmill walking demonstrated that people with PD could follow the feedback and utilize it to modulate movements favorably in a manner that transferred, at least acutely, to overground walking. In this work, recent advances in wearable technologies were leveraged to develop a wearable real-time feedback (WRTF) system that can monitor and evaluate movements and provide feedback during daily activities that involve overground walking. Specifically, this work addressed the challenges of obtaining accurate gait and posture measures from wearable sensors in real-time and providing auditory feedback on the calculated real-time measures for rehabilitation. An algorithm was developed to calculate gait and posture variables from wearable sensor measurements, which were then validated against gold-standard measurements. The WRTF system calculates these measures and provides auditory feedback in real-time. The WRTF system was evaluated as a potential rehabilitation tool for use by people with mild to moderate PD. Results from the study indicated that the system can accurately measure step length and back angle, and that subjects could respond to real-time auditory feedback in a manner that improved their step length and uprightness. These improvements were exhibited while using the system that provided feedback and were sustained in subsequent trials immediately thereafter in which subjects walked without receiving feedback from the system.

Studies using transcranial direct current stimulation (tDCS) to enhance motor training areoften irreproducible. This may be partly due to differences in stimulation parameters across
studies, but it is also plausible that uncontrolled placebo effects may interact with the true
‘treatment’ effect of tDCS. Thus, the purpose of this study was to test whether there was a
placebo effect of tDCS on motor training and to identify possible mechanisms of such an effect.
Fifty-one participants (age: 22.2 ± 4.16; 26 F) were randomly assigned to one of three groups:
active anodal tDCS (n=18), sham tDCS (n=18), or no stimulation control (n=15). Participant
expectations about how much tDCS could enhance motor function and their general suggestibility
were assessed. Participants then completed 30 trials of functional upper extremity motor training
with or without online tDCS. Stimulation (20-min, 2mA) was applied to the right primary motor
cortex (C4) in a double-blind, sham-controlled fashion, while the control group was unblinded and
not exposed to any stimulation. Following motor training, expectations about how much tDCS
could enhance motor function were assessed again for participants in the sham and active tDCS
groups only. Results showed no effect of active tDCS on motor training (p=.67). However, there
was a significant placebo effect, such that the collapsed sham and active tDCS groups improved
more during motor training than the control group (p=.02). This placebo effect was significantly
influenced by post-training expectations about tDCS (p=.0004). Thus, this exploratory study
showed that there is a measurable placebo effect of tDCS on motor training, likely driven by
participants’ perceptions of whether they received stimulation. Future studies should consider
placebo effects of tDCS and identify their underlying mechanisms in order to leverage them in
clinical care.

There are 6 methods of persuasion: reciprocity, scarcity, authority, commitment, liking, and social proof. Although these are typically used in economic scenarios, they may be present between professors and their students as well. We surveyed ASU students to find out which methods of persuasion professors may be implementing in their classrooms, and whether or not these were effective in improving student outcomes (performance, memory, etc.).

Mechanical impedance is a concept that is used to model biomechanical propertiesof human joints. These models can then be utilized to provide insight into the inner
workings of the human neuromuscular system or to provide insight into how to best
design controllers for robotic applications that either attempt to mimic capabilities of
the human neuromuscular system or physically interact with it. To further elucidate
patterns and properties of how the human neuromuscular system modulates mechanical
impedance at the human ankle joint, multiple studies were conducted. The first
study was to assess the ability of linear regression models to characterize the change
in stiffness - a component of mechanical impedance - seen at the human ankle during
the stance phase of walking in the Dorsiflexion-Plantarflexion (DP) direction. A
collection of biomechanical variables were used as input variables. The R^2 value of
the best performing model was 0.71. The second and third studies were performed to
showcase the ability of a newly developed twin dual-axis platform, which goes beyond
the limits of a single dual-axis platform, to quantify bilateral stiffness properties. The
second study quantified the bilateral mechanical stiffness of the human ankle joint
for healthy able-bodied subjects during the stance phase of walking and during quiet
standing in both the DP and inversion-eversion directions. Subjects showed a high
level of subject specific symmetry. Lastly, a similar bilateral ankle characterization
study was conducted on a set of subjects with multiple sclerosis, but only during
quiet standing and in the DP direction. Results showed a high level of discrepancy
between the subject’s most-affected and least-affected limbs with a larger range and
variance than in the healthy population.

This research seeks to present the design and testing of exoskeletons capable of assisting with walking gait, squatting, and fall prevention activities. The dissertation introduces wearable
robotics and exoskeletons and then progresses into specific applications and developments in the
targeted field. Following the introduction, chapters present and discuss different wearable
exoskeletons built to address known issues with workers and individuals with increased risk of fall.
The presentation is concluded by an overall analysis of the resulting developments and identifying
future work in the field.

Most daily living tasks consist of pairing a series of sequential movements, e.g., reaching to a cup, grabbing the cup, lifting and returning the cup to your mouth. The process by which we control and mediate the smooth progression of these tasks is not well understood. One method which we can use to further evaluate these motions is known as Startle Evoked Movements (SEM). SEM is an established technique to probe the motor learning and planning processes by detecting muscle activation of the sternocleidomastoid muscles of the neck prior to 120ms after a startling stimulus is presented. If activation of these muscles was detected following a stimulus in the 120ms window, the movement is classified as Startle+ whereas if no sternocleidomastoid activation is detected after a stimulus in the allotted time the movement is considered Startle-. For a movement to be considered SEM, the activation of movements for Startle+ trials must be faster than the activation of Startle- trials. The objective of this study was to evaluate the effect that expertise has on sequential movements as well as determining if startle can distinguish when the consolidation of actions, known as chunking, has occurred. We hypothesized that SEM could distinguish words that were solidified or chunked. Specifically, SEM would be present when expert typists were asked to type a common word but not during uncommon letter combinations. The results from this study indicated that the only word that was susceptible to SEM, where Startle+ trials were initiated faster than Startle-, was an uncommon task "HET" while the common words "AND" and "THE" were not. Additionally, the evaluation of the differences between each keystroke for common and uncommon words showed that Startle was unable to distinguish differences in motor chunking between Startle+ and Startle- trials. Explanations into why these results were observed could be related to hand dominance in expert typists. No proper research has been conducted to evaluate the susceptibility of the non-dominant hand's fingers to SEM, and the results of future studies into this as well as the results from this study can impact our understanding of sequential movements.