Combining biomechanical modeling with robotic physiotherapy is a promising direction to provide real-time insights during the rehabilitation of patients with musculoskeletal injuries, such as rotator-cuff tears. One aspect is to prevent re-injuries caused by high strain in the injured tissues while allowing patients to perform the required rehabilitation exercises. In this paper, we propose a novel shared control method for robots to limit unsafe patient movements, through physical guidance based on a strain-space representation of the human rotator cuff. The method provides motion corrections through two complementary predictive modules. The first module exerts a lower degree of intervention and is analogous to rumble strips or speed bumps for cars on the road. In this case, an impedance controller induces variable damping to slow down the patient's movement when a danger zone is approached. The second module produces a higher degree of intervention and is analogous to lane-assist in cars. In this case, the robot plans an optimal deflection trajectory and temporarily takes over control of the movement to avoid an unsafe situation. We performed experiments with a healthy participant acting as a patient and evaluated the effect of different human-robot interaction modalities on the resulting human movement in terms of avoidance of high-strain areas of the rotator-cuff tendons and contact forces exchanged.

Annually, 14-41 per 100 000 infants get mildly to lethally injured or severely disabled through violent shaking. The incidence and mortality of inflicted head injury by shaking trauma (IHI-ST) are highest in the early months and decrease with age. This may partly be due to the age-related physical characteristics of infants. Younger, smaller infants are more vulnerable owing to their size and material properties. In addition, from basic biomechanics, it is expected that larger or heavier infants may be more difficult to fiercely shake and will exhibit different motion patterns when being shaken violently. Therefore, the aim of this study was to compare the kinematics of shaking a smaller versus a larger infant dummy. We recorded the kinematics of two dummies, representing a 6-week-old and a 1-year-old, while they were violently shaken by volunteers. We found that participants induced higher head and torso accelerations when shaking the 6-week-old, than with the 1-year-old dummy. Moreover, higher peak sagittal angular accelerations coincide with smaller radii of rotation in the 6-week-old than in the 1-year-old. Because it has been suggested in the literature that sagittal angular acceleration of the head is an important mechanism in inducing the injuries associated with IHI-ST; the results of this study show that shaking a smaller/younger infant is more likely to cause the kinematics possibly responsible for IHI-ST.

Common optimization approaches for solving the muscle redundancy problem in musculoskeletal simulations can predict shoulder contact forces that either violate or barely satisfy joint stability requirements, with force directions falling outside or near the perimeter of the glenoid cavity. In this study, several glenohumeral stability formulations were tested against in vivo measurements of glenohumeral contact forces from the Orthoload dataset on one participant data in lateral, posterior, and anterior dumbbell raises. The investigated formulations either constrained the contact force direction to remain within different shapes of a stability perimeter, or added a penalty term that discouraged contact force directions from deviating from the glenoid cavity center. All stability formulations predicted contact force magnitudes that agreed relatively well to the in vivo measured forces except for the strictest formulation that constrained the joint contact force directly to the glenoid cavity center. Constraint and conditional penalty models estimated force vectors that largely lay along the perimeters. Continuous penalty models estimated relatively more accurate contact force directions within the glenoid cavity than constraint models. Our findings support the proposed penalty formulations as more reasonable and accurate than other investigated existing glenohumeral stability formulations.

Human gait simulation plays a crucial role in providing insights into various aspects of locomotion, such as diagnosing injuries and impairments, assessing abnormal gait patterns, and developing assistive and rehabilitation technologies. To achieve more realistic gait simulation results, it is essential to use a comprehensive model that accurately replicates the kinematics and kinetics of human movement. Human skeletal models in OpenSim software provide anatomically accurate and anthropomorphic structures, enabling users to create personalized models that accurately replicate individual human behavior. However, these torque-driven models encounter challenges in stabilizing unactuated degree of freedom of pelvis tilt in forward dynamic simulations Adopting a bio-inspired strategy that ensures human balance with a minimized energy expenditure during walking, this paper addresses a gait controller for a torque-driven human skeletal model to achieve stable walking. The proposed controller employs a nonlinear model-based approach to calculate a balance-equivalent control torque and utilizes the hip-ankle strategy to distribute this torque across the lower-limb joints during the stance phase. To optimize the parameters of the trajectory tracking controller and the balance distribution coefficients, we developed a forward dynamic simulation interface established between MATLAB and OpenSim. The simulation results indicated that the torque-driven model achieves a natural gait, with joint torques closely aligning with the experimental data. The robustness of the bio-inspired gait controller was further evaluated by applying a range of external forces on the skeletal model. The robustness analysis demonstrated efficient balance recovery mechanism of the proposed bio-inspired gait controller in response to external disturbances.

People suffering from conditions affecting their activities of daily living and those who do straining repetitive tasks could be assisted using supportive devices. These devices have generally been stiff in design, with more recent advances exploring soft suits, removing the need for heavier structural components. These supportive devices are often fitted with rigid actuators that lack inherent compliance and rely on feedback to regulate the assistive force. Compl iant actuators able to control stiffness and pretension have only been applied in rigid assistive devices with these devices being designed for controllable stiffness in rotation and not linear motion. This work briefly presents the results of a user study on the effects of a compliant actuator in a soft supportive device for arm flexion, the development and testing of a variable linear stiffness mechanism for a linear motion capable of controlling the stiffness and equilibrium position, and the integration of said actuator in an exosuit.

In this work, we propose a method of capturing the patient’s discomfort during robotic shoulder physiotherapy, creating "discomfort maps". These maps depict the personalized distribution of discomfort that each patient perceived across their shoulder range of motion, facilitating both robotic devices and human therapists to account for patient-specific characteristics during the therapeutic process. Our system enables a patient to communicate and map discomfort in space and time during movement via a handheld push-button device, while interacting with a robotic physical therapy device capable of moving the patient and estimating their pose. We validated our method through human factors experiments simulating shoulder physiotherapy sessions with 10 healthy participants. To avoid the risk of injury to the participants and to allow for ground truth map information, we emulate perceived discomfort via an auditory signal. Our experimental apparatus enabled participants to reconstruct synthetic discomfort maps, demonstrating the feasibility of automatically capturing and storing patient discomfort during robotic physiotherapy.

While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of <1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of <1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.

Neuromuscular disorders often lead to ankle plantar flexor muscle weakness, which impairs ankle push-off power and forward propulsion during gait. To improve walking speed and reduce metabolic cost of transport (mCoT), patients with plantar flexor weakness are provided dorsal-leaf spring ankle-foot orthoses (AFOs). It is widely believed that mCoT during gait depends on the AFO stiffness and an optimal AFO stiffness that minimizes mCoT exists. The biomechanics behind why and how an optimal stiffness exists and benefits individuals with plantar flexor weakness are not well understood. We hypothesized that the AFO would reduce the required support moment and, hence, metabolic cost contributions of the ankle plantar flexor and knee extensor muscles during stance, and reduce hip flexor metabolic cost to initiate swing. To test these hypotheses, we generated neuromusculoskeletal simulations to represent gait of an individual with bilateral plantar flexor weakness wearing an AFO with varying stiffness. Predictions were based on the objective of minimizing mCoT, loading rates at impact and head accelerations at each stiffness level, and the motor patterns were determined via dynamic optimization. The predictive gait simulation results were compared to experimental data from subjects with bilateral plantar flexor weakness walking with varying AFO stiffness. Our simulations demonstrated that reductions in mCoT with increasing stiffness were attributed to reductions in quadriceps metabolic cost during midstance. Increases in mCoT above optimum stiffness were attributed to the increasing metabolic cost of both hip flexor and hamstrings muscles. The insights gained from our predictive gait simulations could inform clinicians on the prescription of personalized AFOs. With further model individualization, simulations based on mCoT minimization may sufficiently predict adaptations to an AFO in individuals with plantar flexor weakness.

Inflicted shaking trauma can cause injury in infants, but exact injury mechanisms remain unclear. Controversy exists, particularly in courts, whether additional causes such as impact are required to produce injuries found in cases of (suspected) shaking. Publication rates of studies on animal and biomechanical models of inflicted head injury by shaking trauma (IHI-ST) in infants continue rising. Dissention on the topic, combined with its legal relevance, makes maintaining an up-to-date, clear and accessible overview of the current knowledge-base on IHI-ST essential. The current work reviews recent (2017–2023) studies using models of IHI-ST, serving as an update to two previously published reviews. A systematic review was conducted in Scopus and PubMed for articles using animal, physical and mathematical models for IHI-ST. Using the PRISMA methodology, two researchers independently screened the publications. Two, five, and ten publications were included on animal, physical, and mathematical models of IHI-ST, respectively. Both animal model studies used rodents. It is unknown to what degree these can accurately represent IHI-ST. Physical models were used mostly to investigate gross head-kinematics during shaking. Most mathematical models were used to study local effects on the eye and the head’s internal structures. All injury thresholds and material properties used were based on scaled adult or animal data. Shaking motions used as inputs for animal, physical and mathematical models were mostly greatly simplified. Future research should focus on using more accurate shaking inputs for models, and on developing or and validating accurate injury thresholds applicable for shaking.

The advancement and development of human modeling have greatly benefited from principles used in robotics, for instance, multibody dynamics laid the foundations for physics engines of human movement simulation, and the robotics and control theory were used to contextualize human sensorimotor control. There are many common interests and interconnections between the fields of human modeling and robotics. In recent years, as robots have become safer and smarter, they actively participate in our lives and help us in various scenarios. Roboticists need tools and data from human modeling to build next-generation robots that better assist humans. In this survey, we focus on the connections between physical human-robot interaction and human modeling. On one hand, human neuromusculoskeletal and sensorimotor control models provide novel insights into the human response that robots can utilize to improve human performance. On the other hand, robots are becoming instrumental in quantifying the performance of the (neuro)musculoskeletal system. Thus, the combined use of human modeling and robotic methods in physical human-robot interaction can lead to both improved human understanding and functional assistance.

The complexity of the human shoulder girdle enables the large mobility of the upper extremity, but also introduces instability of the glenohumeral (GH) joint. Shoulder movements are generated by coordinating large superficial and deeper stabilizing muscles spanning numerous degrees-of-freedom. How shoulder muscles are coordinated to stabilize the movement of the GH joint remains widely unknown. Musculoskeletal simulations are powerful tools to gain insights into the actions of individual muscles and particularly of those that are difficult to measure. In this study, we analyze how enforcement of GH joint stability in a musculoskeletal model affects the estimates of individual muscle activity during shoulder movements. To estimate both muscle activity and GH stability from recorded shoulder movements, we developed a Rapid Muscle Redundancy (RMR) solver to include constraints on joint reaction forces (JRFs) from a musculoskeletal model. The RMR solver yields muscle activations and joint forces by minimizing the weighted sum of squared-activations, while matching experimental motion. We implemented three new features: first, computed muscle forces include active and passive fiber contributions; second, muscle activation rates are enforced to be physiological, and third, JRFs are efficiently formulated as linear functions of activations. Muscle activity from the RMR solver without GH stability was not different from the computed muscle control (CMC) algorithm and electromyography of superficial muscles. The efficiency of the solver enabled us to test over 3600 trials sampled within the uncertainty of the experimental movements to test the differences in muscle activity with and without GH joint stability enforced. We found that enforcing GH stability significantly increases the estimated activity of the rotator cuff muscles but not of most superficial muscles. Therefore, a comparison of shoulder model muscle activity to EMG measurements of superficial muscles alone is insufficient to validate the activity of rotator cuff muscles estimated from musculoskeletal models.

In this research, we propose a novel method to estimate and monitor rotator cuff tendon strains during active robotic-assisted rehabilitation. This is a significant step forward from our previous work which estimated these tendon strains during passive exercises (i.e., no muscle activity). Physiotherapists adopt a cautious approach to rehabilitation treatment to prevent (re-) injury given the limited available information about the shoulder's internal condition. By leveraging a robotic device and a musculoskeletal model, our approach provides quantitative information on the risk of re-injury by monitoring the strains of the rotator cuff tendons during shoulder movements with the application of external loads. Muscle strains depend on the shoulder kinematic state and muscle activations, which makes it crucial to obtain physiologically realistic joint kinematics to estimate real-time muscle function. To obtain the strains, we utilize our muscle redundancy solver that incorporates constraints on model accelerations, the glenohumeral joint reaction forces, and active muscle dynamics. Using this algorithm along with force and pose data from a collaborative robotic arm, we demonstrate the ability to update our tendon strain estimates based on muscle activation during robotic-assisted rehabilitation exercises. The findings of our research pave the way for establishing improved therapy that considers the risk of injury to individual muscles and explores a broader and more personalized range of motion. By providing physiotherapists with valuable quantitative information on rotator cuff tendon strains, our method empowers them to optimize rehabilitation protocols and deliver more personalized and effective care. In addition, the system and method presented here comprise a tool capable of offering new insights into the relationship between the rotator cuff muscles, external forces, and shoulder kinematics.

Markerless estimation of 3D Kinematics has the great potential to clinically diagnose and monitor movement disorders without referrals to expensive motion capture labs; however, current approaches are limited by performing multiple de-coupled steps to estimate the kinematics of a person from videos. Most current techniques work in a multi-step approach by first detecting the pose of the body and then fitting a musculoskeletal model to the data for accurate kinematic estimation. Errors in training data of the pose detection algorithms, model scaling, as well the requirement of multiple cameras limit the use of these techniques in a clinical setting. Our goal is to pave the way toward fast, easily applicable and accurate 3D kinematic estimation . To this end, we propose a novel approach for direct 3D human kinematic estimation D3KE from videos using deep neural networks. Our experiments demonstrate that the proposed end-to-end training is robust and outperforms 2D and 3D markerless motion capture based kinematic estimation pipelines in terms of joint angles error by a large margin (35% from 5.44 to 3.54 degrees). We show that D3KE is superior to the multi-step approach and can run at video framerate speeds. This technology shows the potential for clinical analysis from mobile devices in the future.

Background: The ability to measure joint kinematics in natural environments over long durations using inertial measurement units (IMUs) could enable at-home monitoring and personalized treatment of neurological and musculoskeletal disorders. However, drift, or the accumulation of error over time, inhibits the accurate measurement of movement over long durations. We sought to develop an open-source workflow to estimate lower extremity joint kinematics from IMU data that was accurate and capable of assessing and mitigating drift. Methods: We computed IMU-based estimates of kinematics using sensor fusion and an inverse kinematics approach with a constrained biomechanical model. We measured kinematics for 11 subjects as they performed two 10-min trials: walking and a repeated sequence of varied lower-extremity movements. To validate the approach, we compared the joint angles computed with IMU orientations to the joint angles computed from optical motion capture using root mean square (RMS) difference and Pearson correlations, and estimated drift using a linear regression on each subject’s RMS differences over time. Results: IMU-based kinematic estimates agreed with optical motion capture; median RMS differences over all subjects and all minutes were between 3 and 6 degrees for all joint angles except hip rotation and correlation coefficients were moderate to strong (r = 0.60–0.87). We observed minimal drift in the RMS differences over 10 min; the average slopes of the linear fits to these data were near zero (− 0.14–0.17 deg/min). Conclusions: Our workflow produced joint kinematics consistent with those estimated by optical motion capture, and could mitigate kinematic drift even in the trials of continuous walking without rest, which may obviate the need for explicit sensor recalibration (e.g. sitting or standing still for a few seconds or zero-velocity updates) used in current drift-mitigation approaches when studying similar activities. This could enable long-duration measurements, bringing the field one step closer to estimating kinematics in natural environments.

Soft exosuits can help to prevent work-related musculoskeletal disorders by offloading human muscles through the application of external forces across the human joints. Many exosuits achieve this through tension producing elements called as exotendons. However, the design of these devices is based on intuition and experience. This leads to potentially sub-optimal or even harmful designs that could cause discomfort or injury to the wearer. This paper deals with automatically finding appropriate attachments and routing locations for exotendons. We propose to do that by accurate musculoskeletal modeling and design parameter optimization of soft exosuits. We focus here on a soft exosuit with a single passive exotendon to assist the shoulder. Using three arm raising-lowering and internal-external rotation motions as examples, we optimize the attachment point and rest-length of the exotendon to reduce overall muscle effort. We then fabricate the exosuit and validate the model predictions by testing with six participants. Supporting the predictions from simulations, measured muscle activity shows reductions in the deltoid and trapezius muscles. This work represents the first instance of explicitly optimizing functional and geometric parameters of exotendons in wearable assistive devices for minimizing human effort.

In this work, we propose a method for monitoring and managing rotator-cuff (RC) tendon strains in human-robot collaborative physical therapy for shoulder rehabilitation. We integrate a high-resolution biomechanical model with a collaborative industrial robot arm and an impedance controller to provide feedback to a human subject, therapist or both, which prevents the subject from entering unsafe poses during rehabilitation. The biomechanical model estimates RC tendon strain as a function of human shoulder configuration, muscle activation and applied external forces. Subject- and injury-specific data are model estimates of strain that compose strain maps, which capture the relationship between the RC strains and movement of the shoulder degrees of freedom (DoF). High-strain regions of the strain map are identified as unsafe zones by clustering and ellipse fitting to smoothly demarcate these zones. These unsafe areas, which reflect increased risks of (re-)injury, are used to define parameters of an impedance controller and reference pose for real-time biomechanical safety control. Using strain maps we demonstrate both safe patient-led movements and teleoperated movements that prevent the subject from entering unsafe zones. In the teleoperated case, the physical therapist leads the patient remotely using a haptic device. The proposed method has the potential to improve the safety, range of motion, and volume of activity that a patient receives through robot-mediated physical therapy. We validated our approach using three experiments that demonstrate shoulder joint torques of less than 1 Nm during free motion with larger torques occurring only when the subject was asked to actively push into the unsafe boundary or, in the case of teleoperation, to resist the physical therapist.

Neuromusculoskeletal models can be used to evaluate aberrant muscle function in cerebral palsy (CP), for example by estimating muscle and joint contact forces during gait. However, to be accurate, models should include representative musculotendon parameters. We aimed to estimate personalised parameters that capture the mechanical behaviour of the plantarflexors in children with CP and typically developing (TD) children. Ankle angle (using motion capture), torque (using a load-cell), and medial gastrocnemius fascicle lengths (using ultrasound) were measured during slow passive ankle dorsiflexion rotation for thirteen children with spastic CP and thirteen TD children. Per subject, the measured rotation was input to a scaled OpenSim model to simulate the torque and fascicle length output. Musculotendon model parameters were personalised by the best match between simulated and experimental torque–angle and fascicle length-angle curves according to a least-squares fit. Personalised tendon slack lengths were significantly longer and optimal fibre lengths significantly shorter in CP than model defaults and than in TD. Personalised tendon compliance was substantially higher in both groups compared to the model default. The presented method to personalise musculotendon parameters will likely yield more accurate simulations of subject-specific muscle mechanics, to help us understand the effects of altered musculotendon properties in CP.

Humans typically coordinate their muscles to meet movement objectives like minimizing energy expenditure. In the presence of pathology, new objectives gain importance, like reducing loading in an osteoarthritic joint, but people often do not change their muscle coordination patterns to meet these new objectives. Here we use musculoskeletal simulations to identify simple changes in coordination that can be taught using electromyographic biofeedback, achieving the therapeutic goal of reducing joint loading. Our simulations predicted that changing the relative activation of two redundant ankle plantarflexor muscles-the gastrocnemius and soleus-could reduce knee contact force during walking, but it was unclear whether humans could re-coordinate redundant muscles during a complex task like walking. Our experiments showed that after a single session of walking with biofeedback of summary measures of plantarflexor muscle activation, healthy individuals reduced the ratio of gastrocnemius-to-soleus muscle activation by 25 ± 15% (p = 0.004, paired t test, n = 10). Participants who walked with this "gastrocnemius avoidance" gait pattern reduced late-stance knee contact force by 12 ± 12% (p = 0.029, paired t test, n = 8). Simulation-informed coordination retraining could be a promising treatment for knee osteoarthritis and a powerful tool for optimizing coordination for a variety of rehabilitation and performance applications.

Humans are able to negotiate downstep behaviors-both planned and unplanned-with remarkable agility and ease. The goal of this paper is to systematically study the translation of this human behavior to bipedal walking robots, even if the morphology is inherently different. Concretely, we begin with human data wherein planned and unplanned downsteps are taken. We analyze this data from the perspective of reduced-order modelling of the human, encoding the center of mass (CoM) kinematics and contact forces, which allows for the translation of these behaviors into the corresponding reduced-order model of a bipedal robot. We embed the resulting behaviors into the full-order dynamics of a bipedal robot via nonlinear optimization-based controllers. The end result is the demonstration of planned and unplanned downsteps in simulation on an underactuated walking robot.

Estimating kinematics from optical motion capture with skin-mounted markers, referred to as an inverse kinematic (IK) calculation, is the most common experimental technique in human motion analysis. Kinematics are often used to diagnose movement disorders and plan treatment strategies. In many such applications, small differences in joint angles can be clinically significant. Kinematics are also used to estimate joint powers, muscle forces, and other quantities of interest that cannot typically be measured directly. Thus, the accuracy and reproducibility of IK calculations are critical. In this work, we isolate and quantify the uncertainty in joint angles, moments, and powers due to two sources of error during IK analyses: errors in the placement of markers on the model (marker registration) and errors in the dimensions of the model’s body segments (model scaling). We demonstrate that IK solutions are best presented as a distribution of equally probable trajectories when these sources of modeling uncertainty are considered. Notably, a substantial amount of uncertainty exists in the computed kinematics and kinetics even if low marker tracking errors are achieved. For example, considering only 2 cm of marker registration uncertainty, peak ankle plantarflexion angle varied by 15.9°, peak ankle plantarflexion moment varied by 26.6 N⋅m, and peak ankle power at push off varied by 75.9 W during healthy gait. This uncertainty can directly impact the classification of patient movements and the evaluation of training or device effectiveness, such as calculations of push-off power. We provide scripts in OpenSim so that others can reproduce our results and quantify the effect of modeling uncertainty in their own studies.