In the mid-1990s, a number of key publications and meetings of experts identified major technical issues associated with prosthetic technologies intended for de...

Motion capture systems are widely used to quantify human gait. Two-dimensional (2D) video systems are simple to use, easily accessible, and affordable. However, their performance as compared to other systems (i.e. three-dimensional (3D) gait analysis) is not well established. This work provides a comprehensive review of design specifications and performance characteristics (validity and reliability) of two-dimensional motion capture systems. Systematic review. A systematic literature search was conducted in three databases from 1990 to 2019 and identified 30 research articles that met the inclusion/exclusion criteria. Reliability of measurements of two-dimensional video motion capture was found to vary greatly from poor to excellent. Results relating to validity were also highly variable. Comparisons between the studies were challenging due to differences in protocols, instrumentation, parameters assessed, and analyses performed. Variability in performance could be attributed to study design, gait parameters being measured, and technical aspects. The latter includes camera specifications (i.e. resolution and frame rate), setup (i.e. camera position), and analysis software. Given the variability in performance, additional validation testing may be needed for specific applications involving clinical or research-based assessments, including specific patient populations, gait parameters, mobility tasks, and data collection protocols. This review article provides guidance on the application of 2D video gait analysis in a clinical or research setting. While not suitable in all instances, 2D gait analysis has promise in specific applications. Recommendations are provided about the patient populations, gait parameters, mobility tasks, and data collection protocols.

Individuals with lower-limb amputation often have gait deficits and diminished mobility function. Biofeedback systems have the potential to improve gait rehabilitation outcomes. Research on biofeedback has steadily increased in recent decades, representing the growing interest toward this topic. This systematic review highlights the methodological designs, main technical and clinical challenges, and evidence relating to the effectiveness of biofeedback systems for gait rehabilitation. This review provides insights for developing an effective, robust, and user-friendly wearable biofeedback system. The literature search was conducted on six databases and 31 full-text articles were included in this review. Most studies found biofeedback to be effective in improving gait. Biofeedback was most commonly concurrently provided and related to limb loading and symmetry ratios for stance or step time. Visual feedback was the most used modality, followed by auditory and haptic. Biofeedback must not be obtrusive and ideally provide a level of enjoyment to the user. Biofeedback appears to be most effective during the early stages of rehabilitation but presents some usability challenges when applied to the elderly. More research is needed on younger populations and higher amputation levels, understanding retention as well as the relationship between training intensity and performance.

Lower-limb biomechatronic devices (i.e., prostheses and exoskeletons) depend upon onboard batteries to power wearable sensors, actuators, and microprocessors, therein inherently limiting their operating durations. Regenerative braking, also termed electrical energy regeneration, represents a promising solution to the aforementioned shortcomings. Regenerative braking converts the otherwise dissipated mechanical energy during locomotion into electrical energy for recharging the onboard batteries, while simultaneously providing negative mechanical work for controlled system deceleration. This paper reviewed the electromechanical design and optimization of lower-limb biomechatronic devices with electrical energy regeneration. The technical review starts by examining human walking biomechanics (i.e., mechanical work, power, and torque about the hip, knee, and ankle joints) and proposes general design principles for regenerative braking prostheses and exoskeletons. Analogous to electric and hybrid electric vehicle powertrains, there are numerous mechatronic design components that could be optimized to maximize electrical energy regeneration, including the mechanical power transmission, electromagnetic machine, electrical drive, device mass and moment of inertia, and energy storage devices. Design optimization of these system components is individually discussed while referencing the latest advancements in robotics and automotive engineering. The technical review demonstrated that existing systems (1) are limited to level-ground walking applications and (2) have maximum energy regeneration efficiencies between 30% and 37%. Accordingly, potential future directions for research and innovation include (1) regenerative braking during dynamic movements like sitting down and slope and staircase descent and (2) utilizing high-torque-density electromagnetic machines and low-impedance mechanical power transmissions to maximize energy regeneration efficiencies.

Many individuals with lower limb amputations or neuromuscular impairments face mobility challenges attributable to suboptimal assistive device design. Forward dynamic modeling and simulation of human walking using conventional biomechanical gait models offer an alternative to intuition-based assistive device design, providing insight into the biomechanics underlying pathological gait. Musculoskeletal models enable better understanding of prosthesis and/or exoskeleton contributions to the human musculoskeletal system, and device and user contributions to both body support and propulsion during gait. This paper reviews current literature that have used forward dynamic simulation of clinical population musculoskeletal models to perform assistive device design optimization using optimal control, optimal tracking, computed muscle control (CMC) and reflex-based control. Musculoskeletal model complexity and assumptions inhibit forward dynamic musculoskeletal modeling in its current state, hindering computational assistive device design optimization. Future recommendations include validating musculoskeletal models and resultant assistive device designs, developing less computationally expensive forward dynamic musculoskeletal modeling methods, and developing more efficient patient-specific musculoskeletal model generation methods to enable personalized assistive device optimization.

Prosthetic services, including the provision of an appropriate prosthesis, are a crucial part of the rehabilitation process for individuals with lower limb amputations. However, globally there exist unique challenges in the delivery of prosthetic services that are limiting rehabilitation outcomes and consequently the well-being and socio-economic status of individuals with lower limb amputations. The objective of this work was to explore the issues related to the provision of appropriate prosthetic technologies and to compare these across different economies of the world. Cross-sectional survey. An online survey was developed and distributed to prosthetic practitioners providing services in countries around the world. An open-coding thematic content analysis procedure was applied to extract key themes from the data. The response codes defined three overall themes of lower limb prosthetic delivery, and several key differences between higher and lower income countries emerged. Namely, a higher emphasis on part/material availability, practitioner training and durability in lower income countries was found. High costs were an issue raised by practitioners in all countries. Practitioners around the world share many of the same concerns; however, some lower income countries face important and pressing issues that limit their ability to provide adequate prosthetic services. This work highlights the most crucial service and technology-related needs, as perceived by trained prosthetic practitioners, of populations requiring lower limb prosthetic treatment around the world. Additionally, the results may be used to prioritize prosthetic-related health-care initiatives led by other researchers, governments and organizations working to improve services internationally.