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- Member of: ASU Electronic Theses and Dissertations
Description
Muscular weakness is a common manifestation for Stroke survivors and for patients with Anterior Cruciate Ligament reconstruction leading to reduced functional independence, especially mobility. Several rigid orthotic devices are being designed to assist mobility. However, limitations in majority of these devices are: 1) that they are constrained only to level walking applications, 2) are mostly bulky and rigid lacking user comfort. For these reasons, rehabilitation using soft-robotics can serve as a powerful modality in gait assistance and potentially accelerate functional recovery. The characteristics of soft robotic exosuit is that it’s more flexible, delivers high power to weight ratio, and conforms with the user’s body structure making it a suitable choice. This work explores the implementation of an existing soft robotic exosuit in assisting knee joint mechanism during stair ascent for patients with muscular weakness. The exosuit assists by compensating the lack of joint moment and minimizing the load on the affected limb. It consists of two I-cross-section soft pneumatic actuators encased within a sleeve along with insole sensor shoes and control electronics. The exosuit actuators were mechanically characterized at different angles, in accordance to knee flexion in stair gait, to enable the generation of the desired joint moments. A linear relation between the actuator stiffness and internal pressure as a function of the knee angle was obtained. Results from this characterization along with the insole sensor outputs were used to provide assistance to the knee joint. Analysis of stair gait with and without the exosuit ‘active’ was performed, using surface electromyography (sEMG) sensors, for two healthy participants at a slow walking speed. Preliminary user testing with the exosuit presented a promising 16% reduction in average muscular activity of Vastus Lateralis muscle and a 3.6% reduction on Gluteus Maximus muscle during the stance phase and unrestrained motion during the swing phase of ascent thereby demonstrating the applicability of the soft-inflatable exosuit in rehabilitation.
ContributorsMuthukrishnan, Niveditha (Author) / Polygerinos, Panagiotis (Thesis advisor) / Lockhart, Thurmon (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2018
Description
Individuals fluent in sign language who have at least one deaf parent are considered native signers while those with non-signing, hearing parents are non-native signers. Musculoskeletal pain from repetitive motion is more common from non-natives than natives. The goal of this study was twofold: 1) to examine differences in upper extremity (UE) biomechanical measures between natives and non-natives and 2) upon creating a composite measure of injury-risk unique to signers, to compare differences in scores between natives and non-natives. Non-natives were hypothesized to have less favorable biomechanical measures and composite injury-risk scores compared to natives. Dynamometry was used for measurement of strength, electromyography for ‘micro’ rest breaks and muscle tension, optical motion capture for ballistic signing, non-neutral joint angle and work envelope, a numeric pain rating scale for pain, and the modified Strain Index (SI) as a composite measure of injury-risk. There were no differences in UE strength (all p≥0.22). Natives had more rest (natives 76.38%; non-natives 26.86%; p=0.002) and less muscle tension (natives 11.53%; non-natives 48.60%; p=0.008) for non-dominant upper trapezius across the first minute of the trial. For ballistic signing, no differences were found in resultant linear segment acceleration when producing the sign for ‘again’ (natives 27.59m/s2; non-natives 21.91m/s2; p=0.20). For non-neutral joint angle, natives had more wrist flexion-extension motion when producing the sign for ‘principal’ (natives 54.93°; non-natives 46.23°; p=0.04). Work envelope demonstrated the greatest significance when determining injury-risk. Natives had a marginally greater work envelope along the z-axis (inferior-superior) across the first minute of the trial (natives 35.80cm; non-natives 30.84cm; p=0.051). Natives (30%) presented with a lower pain prevalence than non-natives (40%); however, there was no significant difference in the modified SI scores (natives 4.70 points; non-natives 3.06 points; p=0.144) and no association between presence of pain with the modified SI score (r=0.087; p=0.680). This work offers a comprehensive analysis of all the previously identified UE biomechanics unique to signers and helped to inform a composite measure of injury-risk. Use of the modified SI demonstrates promise, although its lack of association with pain does confirm that injury-risk encompasses other variables in addition to a signer’s biomechanics.
ContributorsRoman, Gretchen Anne (Author) / Swan, Pamela (Thesis advisor) / Vidt, Meghan (Committee member) / Peterson, Daniel (Committee member) / Lockhart, Thurmon (Committee member) / Ofori, Edward (Committee member) / Arizona State University (Publisher)
Created2018
Description
This thesis work presents two separate studies:The first study assesses standing balance under various 2-dimensional (2D) compliant environments simulated using a dual-axis robotic platform and vision conditions. Directional virtual time-to-contact (VTC) measures were introduced to better characterize postural balance from both temporal and spatial aspects, and enable prediction of fall-relevant directions. Twenty healthy young adults were recruited to perform quiet standing tasks on the platform. Conventional stability measures, namely center-of-pressure (COP) path length and COP area, were also adopted for further comparisons with the proposed VTC. The results indicated that postural balance was adversely impacted, evidenced by significant decreases in VTC and increases in COP path length/area measures, as the ground compliance increased and/or in the absence of vision (ps < 0.001). Interaction effects between environment and vision were observed in VTC and COP path length measures (ps ≤ 0.05), but not COP area (p = 0.103). The estimated likelihood of falls in anterior-posterior (AP) and medio-lateral (ML) directions converged to nearly 50% (almost independent of the foot setting) as the experimental condition became significantly challenging.
The second study introduces a deep learning approach using convolutional neural network (CNN) for predicting environments based on instant observations of sway during balance tasks. COP data were collected from fourteen subjects while standing on the 2D compliant environments. Different window sizes for data segmentation were examined to identify its minimal length for reliable prediction. Commonly-used machine learning models were also tested to compare their effectiveness with that of the presented CNN model. The CNN achieved above 94.5% in the overall prediction accuracy even with 2.5-second length data, which cannot be achieved by traditional machine learning models (ps < 0.05). Increasing data length beyond 2.5 seconds slightly improved the accuracy of CNN but substantially increased training time (60% longer). Importantly, averaged normalized confusion matrices revealed that CNN is much more capable of differentiating the mid-level environmental condition.
These two studies provide new perspectives in human postural balance, which cannot be
interpreted by conventional stability analyses. Outcomes of these studies contribute to the advancement of human interactive robots/devices for fall prevention and rehabilitation.
ContributorsPhan, Vu Nguyen (Author) / Lee, Hyunglae (Thesis advisor) / Peterson, Daniel (Committee member) / Marvi, Hamidreza (Committee member) / Arizona State University (Publisher)
Created2021
Description
Cannabis use is increasing both medically and recreationally. Over the last decade studies have investigated sex differences associated with Parkinson’s disease (PD) diagnosis and degenerative symptoms. Previous research has shown that cannabis use has had either a beneficial or deleterious effect on PD symptoms. This research will examine whether sex differences exist among the positive or negative effects of cannabis use in PD. In this paper, an analysis of sex-based differences between male and female cohorts categorized across 2,700 participants is completed under the Fox Insight data set. Each cohort will be compared to 14 nonmotor symptoms and 8 motor symptoms commonly associated with PD. In each cohort mean age, cannabis intake, cannabis dose, cannabis type, and PD diagnosis are analyzed within groups. Each symptom (motor and nonmotor) was analyzed between cohort responses to indicate if there was beneficial or worsening effect within cannabis. Results indicated that the designated female cohort reported both beneficial and worsening effects of cannabis use regarding both motor and nonmotor symptoms. The positive symptoms primarily consisted of individual motor functioning (e.g. dyskinesia, stiffness, back pain, etc.) while the worsening symptoms primarily consisted of nonmotor functioning (e.g. anxiety and apathy). Meanwhile, the male cohort only reported beneficial effects towards nonmotor symptoms (e.g. dystonia, muscle cramps, heart rate). These findings suggest the need for further examination of nigrostriatal pathways and hypothalamic integrity in PD, as it may provide more information into the effects of cannabis use based on sex differences.
ContributorsHooten, Madeline Loraine (Author) / Ofori, Edward (Thesis advisor) / Daniulaityte, Raminta (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2022
Description
Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004 and 2008. Globally, LBP occurrence increased by almost 200 million from 1990 to 2017. This problem is further implicated by physical and financial constraints that impact the individual’s quality of life. The medical cost exceeded $87.6 billion, and the lifetime prevalence was 84%. This indicates that the majority of people in the US will experience this symptom. Also, LBP limits Activities of Daily Living (ADL) and possibly affects the gait and postural stability. Prior studies indicated that LBP patients have slower gait speed and postural instability. To alleviate this symptom, the epidural injection is prescribed to treat pain and improve mobility function. To evaluate the effectiveness of LBP epidural injection intervention, gait and posture stability was investigated before and after the injection. While these factors are the fundamental indicator of LBP improvement, ADL is an element that needs to be significantly considered. The physical activity level depicts a person’s dynamic movement during the day, it is essential to gather activity level that supports monitoring chronic conditions, such as LBP, osteoporosis, and falls. The objective of this study was to assess the effects of Epidural Steroid Injection (ESI) on LBP and related gait and postural stability in the pre and post-intervention status. As such, the second objective was to assess the influence of ESI on LBP, and how it influences the participant’s ADL physical activity level. The results indicated that post-ESI intervention has significantly improved LBP patient’s gait and posture stability, however, there was insufficient evidence to determine the significant disparity in the physical activity levels. In conclusion, ESI depicts significant positive effects on LBP patients’ gait and postural parameters, however, more verification is required to indicate a significant effect on ADL physical activity levels.
ContributorsMoon, Seong Hyun (Author) / Lockhart, Thurmon (Thesis advisor) / Honeycutt, Claire (Committee member) / Peterson, Daniel (Committee member) / Lee, Hyunglae (Committee member) / Soangra, Rahul (Committee member) / Arizona State University (Publisher)
Created2023
Description
The present study aimed to compare brain activity changes related to proactive and reactive control strategies in patients with Parkinson’s disease during “On” levodopa and “Off” levodopa conditions. The study consisted of two participants who had received a prior diagnosis of Parkinson’s Disease. The participants completed AX-CPT task as a measure of attention control in two sessions: a) “On Levodopa” and b) “Off Levodopa” while they were in the fMRI scanner. Prior to the analysis, the T1- weighted anatomical scan images and the BOLD multiband functional images of both the participants were BIDS (Brain Imaging Data Structure) validated and preprocessed using the standard FMRIPrep pipeline. The imaging data was then analyzed using SPM12 (Statistical parametric mapping) software. Individual-level analysis of the imaging data was conducted by creating General Linear models for both the participants on “ON” and “OFF” levodopa conditions. The BOLD responses were compared using AY>BY and BX > BY contrasts. Where BX >, BY contrast, measured BOLD activity related to reactive control strategy and AY> BY contrast measured BOLD activity related to the proactive control strategy. It was observed that participants tended towards reactive control strategy in both “On” and “Off” levodopa conditions.
ContributorsDatta, Kalyani (Author) / Brewer, Gene (Thesis advisor) / Braden, B. Blair (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2022
Description
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.
ContributorsAnnan, Theophilus (Author) / Honeycutt, Claire (Thesis advisor) / Abbas, James (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2021
Description
Chronic ankle instability (CAI) is caused by the failure to seek treatment and rehabilitation after an acute ankle sprain. Typically, clinical assessment of ankle sprains is done under unloaded conditions, despite the fact that ankle sprains occur during weight loading. Characterization of ankle stiffness, a representation of ankle stability during weight loading, is crucial to quantify ankle stability. Patients with CAI suffer from gait asymmetry, and the descriptions of the asymmetry ratio vary widely throughout the research community. Bilateral ankle stiffness could be a systematic metric to describe the gait asymmetry of CAI patients. Additionally, women generally have higher ankle joint and ligamentous laxity than men, and lower ankle stiffness, which has been thoroughly investigated in previous literature. However, differences in bilateral ankle stiffness between sexes still need to be investigated. Using twin dual-axis robotic platforms, this study investigated the weight loading effect on ankle stiffness in the frontal plane during standing, the bilateral difference in stiffness between the dominant and non-dominant ankle, and the sex difference in bilateral ankle stiffness during standing for varying weight distribution. The group average results of 20 healthy subjects showed that ankle stiffness increased with increasing weight loading on the ankle, which is speculated to be caused by active muscle contraction and changes in passive structure due to weight loading. For the bilateral difference of the group, the statistical analysis showed that there was no significant difference between dominant and non-dominant ankle stiffness for all the weight distributions considered. Although the group average result of the difference in bilateral ankle stiffness was statistically insignificant, individual analysis confirmed the importance of subject-specific investigation of bilateral ankle stiffness, as there were more cases of dominant ankle stiffness being larger than non-dominant ankle stiffness, and the bilateral difference was subject-specific. Investigations into sex differences in bilateral ankle stiffness showed that ankle stiffness in males is significantly greater than in females, even after normalizing the stiffness by weight, which is speculated to be caused by higher joint and ligamentous laxity in females regardless of laterality.
ContributorsPaing, Soe Lin (Author) / Lee, Hyunglae (Thesis advisor) / Berman, Spring (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2023
Description
Fine control of standing postural balance is essential for completing various tasks in daily activities, which might be compromised when interacting with dynamically challenging environments (e.g., moving ground). Among various biofeedback to improve postural balance control, vibrotactile feedback has an advantage of providing supplementary information about balance control without disturbing other core functions (e.g., seeing and hearing). This paper investigated the effectiveness of a waist vibrotactile feedback device to improve postural control during standing balance on a dynamically moving ground simulated by a robotic balance platform. Four vibration motors of the waist device applied vibration feedback in the anterior-posterior and medio-lateral direction based on the 2-dimensional sway angle, measured by an inertia measurement unit. Experimental results with 15 healthy participants demonstrated that the waist vibrotactile feedback is effective in improving postural control, evidenced by improvements in center-of-mass and center-of-pressure stability measures. In addition, this study confirmed the effectiveness of the waist vibrotactile feedback in improving standing balance control even under muscle fatigue induced by lower body exercise. The study further confirmed that the waist feedback is more effective in people with lower baseline balance performance in both normal and fatigue conditions.
ContributorsJo, Kwanghee (Author) / Lee, Hyunglae (Thesis advisor) / Sugar, Thomas (Committee member) / Peterson, Daniel (Committee member) / Arizona State University (Publisher)
Created2022
Description
One of the long-standing issues that has arisen in the sports medicine field is identifying the ideal methodology to optimize recovery following anterior cruciate ligament reconstruction (ACLR). The perioperative period for ACLR is notoriously heterogeneous in nature as it consists of many variables that can impact surgical outcomes. While there has been extensive literature published regarding the efficacy of various recovery and rehabilitation topics, it has been widely acknowledged that certain modalities within the field of ACLR rehabilitation need further high-quality evidence to support their use in clinical practice, such as blood flow restriction (BFR) training. BFR training involves the application of a tourniquet-like cuff to the proximal aspect of a limb prior to exercise; the cuff is inflated so that it occludes venous flow but allows arterial inflow. BFR is usually combined with low-intensity (LI) resistance training, with resistance as low as 20% of one-repetition maximum (1RM). LI-BFR has been used as an emerging clinical modality to combat postoperative atrophy of the quadriceps muscles for those who have undergone ACLR, as these individuals cannot safely tolerate high muscular tension exercise after surgery. Impairments of the quadriceps are the major cause of poor functional status of patients following an otherwise successful ACLR procedure; however, these impairments can be mitigated with preoperative rehabilitation done before surgery. It was hypothesized that the use of a preoperative LI-BFR training protocol could help improve postoperative outcomes following ACLR; primarily, strength and hypertrophy of the quadriceps. When compared with a SHAM control group, subjects who were randomized to a BFR intervention group made greater preoperative strength gains in the quadriceps and recovered quadriceps mass at an earlier timepoint than that of the SHAM group aftersurgery; however, the gains made in strength were not able to be maintained in the 8-week postoperative period. While these results do not support the use of LI-BFR from the short-term perspective after ACLR, follow-up data will be used to investigate trends in re-injury and return to sport rates to evaluate the efficacy of the use of LI-BFR from a long-term perspective.
ContributorsGlattke, Kaycee Elizabeth (Author) / Lockhart, Thurmon (Thesis advisor) / McDaniel, Troy (Committee member) / Banks, Scott (Committee member) / Peterson, Daniel (Committee member) / Lee, Hyunglae (Committee member) / Arizona State University (Publisher)
Created2022