The present invention is directed to an ankle-foot orthosis device. More particularly, the invention is directed to an improved ankle-foot orthosis device providing two degrees-of-freedom motion, specifically addressing both inversion-eversion and dorsiflexion-plantarflexion.
An ankle-foot orthosis (AFO) is commonly used to help subjects with weakness of ankle dorsiflexor muscles due to peripheral or central nervous system disorders. Both of these disorders are due to the weakness of the tibialis anterior muscle which results in lack of dorsiflexion assist moment. The deformity and muscle weakness of one joint in the lower extremity influences the stability of the adjacent joints, thereby requiring compensatory adaptations.
During level ambulation, the ankle should be close to a neutral position (a right angle) each time the foot strikes the floor. Insufficient dorsiflexion may be the result of hyperactive plantarflexion muscles that produce a very high plantarflexion moment at the ankle, or weakness of the dorsiflexion muscles. This affects the ability of the ankle to dorsiflex. Both of these cause the patient to make a forefoot contact instead of the normal “heel-strike”. If there is a weak push-off, the stride length reduces, and the gait velocity fails. Similarly, during the swing phase of the gait, the ankle is dorsiflexed to allow the foot to clear the ground while the extremity is advanced. Hyperactive or weak dorsiflexors may result in insufficient dorsiflexion, which must be compensated for by alterations in the gait patterns so that the toes do not drag. This insufficient dorsiflexion during the swing phase of the gait is termed as “foot-drop”. In addition to the toes dragging, the foot may become abnormally supinated, which may result in an ankle sprain or fracture, when the weight is applied to the limb. Foot-drop is commonly seen in subjects who have had a stroke or who have sustained a personal nerve injury.
There are several possible treatments for foot-drop including medicinal, orthotic, or surgical interventions. Of these, orthotic treatment is the most common. Orthotic devices are intended to support the ankle, correct deformities, and prevent further occurrences. A key goal of orthotic treatment is to assist the patient in achieving a measure of normal function.
There are a number of commercially available ankle-foot orthoses. All, however, are single axis or elastically deformable. While inversion-eversion motion in all of these orthoses is accommodated through the flexibility of the material, such as polypropylene, the limitation in normal inversion-eversion does not provide a natural motion to the ankle and adds discomfort. Thus, there is a need for an ankle foot orthosis allowing for a more natural motion of the ankle during movement.
An ankle-foot orthosis comprising a leg member 12, a foot member 14, and a frame 16 connecting the leg member to the foot member. The frame comprises a first revolute joint 18 that rotates about a first axis 20 and a second revolute joint 22 that rotates about a second axis 24. The first and second axes are non-parallel. The frame can further comprise a foot member segment 30 secured to the foot member 14 and extending to the second revolute joint 22. The orthosis includes a first force-torque sensor 36 located on the leg member, a second force-torque sensor 38 located on the foot member, and an encoder positioned on one of the revolute joints. The invention includes a method of measuring ankle-foot-related forces comprising positioning a subject's leg and foot in an ankle-foot orthosis, collecting data from the first and second force-torque sensors, and analyzing the collected data to determine the motion of the subject's ankle.
The present invention provides an ankle-foot orthosis device with two degrees-of-freedom. The two motions incorporated are dorsiflexion-plantarflexion and inversion-eversion. This orthosis is useful to assist subjects with weakness of ankle dorsiflexor muscles. It allows two degrees-of-freedom motion, i.e., dorsiflexion-plantarflexion and inversion-eversion motion, while serving to maintain proper foot position for subjects during gait.
Referring to
The foot member 14 can be adapted to fit the patient's foot, or a portion thereof. For both the leg cradle and the foot member, portions adapted to fit the patient can be custom manufactured to provide optimal patient comfort, or may be shaped generally to fit the legs and feet of many patients adequately.
The frame 16 comprises a first revolute joint 18 that rotates about a first axis 20. The first revolute joint correlates to the dorsiflexion-plantarflexion center of rotation in the human ankle. Motion along this axis occurs in the sagittal plane; the foot plantar flexes when it moves downwards away from the tibia, and dorsilflexes when it moves upwards toward the tibia. To facilitate symmetric motion, as shown in
The position of the first rotational axis varies among users of different sizes and mobility. In one embodiment, the frame may be adjusted through a variety of mechanisms to locate the appropriate axis for a given user. One such mechanism is to assemble the frame using telescopic components to adjust the position of the axis, while keeping the orientation of the axis to the frame fixed. Alternatively, the position of the axis may be fixed, while the orientation relative to the patient's foot is adjustable.
The frame also comprises a second revolute joint 22 that rotates about a second axis 24. The first and second axes are non-parallel. The second revolute joint correlates to the inversion-eversion center of rotation in the human ankle. Motion along this axis occurs in the frontal plane; the foot inverts when it twists inwards and upwards, moving the sole towards the midline. The foot everts when it twists outwards and upwards, moving the sole away from the midline. While reference is made throughout this application to the inversion-eversion joint and axis, this degree of freedom may also be referred to as the pronation-supination axis or joint. Pronation and supination movements involve simultaneous movement in the frontal, sagittal, and transverse planes. Because it is clinically difficult to assess these triplane movements, the degree of motion about the inversion-eversion axis typically signifies the amount of protonation and supination. Accordingly, reference herein to the inversion-eversion motion encompasses protonation-supination motion in clinical assessment contexts.
The first and second revolute joints are connected in the frame through segments that can be rigid, adjustable, or malleable. Again referring to
Details of one embodiment of the frame 16′ of the present invention is shown in
In one embodiment of the present invention, the second rotational axis 24, that corresponding to the inversion-eversion axis, is oriented through a single obliquely cut orientation component 46 (enlarged as 46′). While not as easily viewed in
By providing two degrees-of-freedom, the device allows ankle motion to be measured as a function of movement in both rotational axes. Measurement of the forces and torques applied by a user is useful in many applications. The collected data can be useful in diagnosing mobility disorders, identifying movement and gait attributes, such as protonation in gait, and assessing the nature and severity of injuries. The data can be used in conjunction with a kinematics model for the motion of the foot, as discussed in more detail in Example 1.
The ankle-foot orthosis of the present invention can be equipped to collect force and torque data. In one embodiment, illustrated in
Standard, commercially available force torque sensors can be used to collect the force and torque applied in locations around the orthosis of the invention. As explained in Example 1, the positions of the force-torque sensors on the leg member and beneath the sole of the foot on the foot member are appropriate for collecting data for use with a kinematics model that includes two-degrees-of-freedom. Other positions, or additional points of data may be appropriate for use with the device when employing an alternate kinematics model for data analysis.
Appropriate commercially available force-torque sensors include the ATI Force Torque Sensor Mini45 model available from ATI Industrial Automation and the JR3 Force Torque Sensor 67M25S-M40B-A 135L350 model from JR3, although any sensor providing sufficiently precise force and torque data can be used.
Additionally, data can be collected at the revolute joints via encorders. Encoders produce outputs which indicate the speed, angle, and direction of the rotational shaft in a joint. With reference to
Referring to
In addition to diagnostic and research applications of the orthosis of the invention, the orthosis can be used in conjunction with control mechanisms to provide mechanical assistance to the user and serve as a therapy aid or an ambulatory aid. In one embodiment, the ankle-foot orthosis of the invention comprises a means for controlling one of the revolute joints, such as a motor. Also, springs or other actuators can be used to impart forces on the joints. The amount of the force exerted by a motor or other device can be adjusted in view of data collected through force-torque sensors, encoders, or other devices. The adjustment may occur in real time as the user moves. Alternatively, the motor, spring, or other device imparting forces on the joints may be calibrated in view of measurements collected for a particular users.
Measuring the ankle-foot-related forces in accordance with the invention includes positioning a subject's leg and foot in the ankle-foot orthosis. As discussed above, various options exist for securing the leg and foot to the orthosis, with hook and loop straps as an example shown in
Additionally, depending on the kinematics model employed, data from an encoder, or multiple encoders can be collected and analyzed in determining the forces and features of the motion of the subject's ankle.
Ankle-mobility disorders can be treated using the orthosis by using the measured data from the orthosis to manipulate and adjust motors and other devices that can control the subject's foot motion, or exert forces to aide in achieving proper motion. Similarly, a corrective orthosis may be designed by using the collected and analyzed data from the orthosis sensors and encoders and using the resulting profile of the user's gait to providing means to compensate for a joint force deficiency identified by the data analysis. Ideally, the means to compensate are proportional to the joint force deficiency, or otherwise optimized to correct for the deficiency of a particular user. The means for compensating can include springs, motors and other actuators.
The orthosis can also be an integral part of another rehabilitation device. In any application, the position of the leg in the gait cycle is available at all times, and the motion of the ankle can be controlled accurately.
In this example, the motion of the ankle is modeled based on two degrees-of-freedom. The first degree-of-freedom is a rotation in the vertical plane about an axis (Z1) passing through the ankle joint. This axis is known as the dorsiflexion-plantarflexion (D/P) motion axis. The second degree-of-freedom is a rotation about an axis (Z2). This motion is known as inversion-eversion (I/E) motion. For this model, segments of the foot are assumed to be rigid links, and the dorsiflexion-plantarflexion and inversion-eversion motions are approximated by revolute joints.
The orientations of the two joint axes considered in this study are shown in
The Denavit-Hartenberg (DH) parameters of the kinematic model as described with reference to in
x=r cos γ sin φ,
y=r sin γ cos φ,
z=r cos φ
Because the projections {right arrow over (Z1)} and {right arrow over (Z2)} in {right arrow over (Z0)} are known empirically, the spherical coordinates can be computed, with values γ1=196.7°, φ1=25.9° for Z1 and γ2=42°, φ2=102.0° for Z2.
Subsequently, {right arrow over (X1)}, {right arrow over (Y1)} axes and {right arrow over (X2)}, {right arrow over (Y2)} axes are defined as follows:
The Denavit-Hartenberg parameters θi, αi, a1, and d1 were used to locate the frames on the bodies. Once all the unit vectors {right arrow over (X)}i, {right arrow over (Y)}i and {right arrow over (Z)}i are known, θi and αi are computed using vector algebra. ai and di were computed using anthropomorphic data and loop closure equation, T03=T01T12T23, where Tii+1 denotes the transformation matrix between two successive bodies i and i+1. In the nominal configuration of the foot, when the foot is flat on the ground and perpendicular to the leg shank, the DH parameters computed are:
T01, θ0=286.7° and α0=25.9°
T12, θ1=210.6° and α1=125.0°
T23, θ2=13.1° and α2=0°
θi are the joint variables, which take the particular values shown above for the mentioned configuration of the foot. With these parameters calculated, the complete kinematics model is established.
In measuring the forces and torques at the revolute joints of the orthosis, a Newton-Euler analysis can be used to convert the raw force-torque sensor and encoder data into joint forces and torques. When using telescopic joints on the orthosis, the device can be adjusted to allow the axes of the device to coincide with the axes of the human motion. The device then moves largely synchronously with little or no relative motion compared to the subject's ankle and foot. The device can be adjusted until the subject is able to execute the normal motion of the foot. Perfect alignment between the human and device axes can be difficult, but there are several techniques to facilitate adequate agreement. The device and the subject's ankle and foot are kept largely fixed.
The free body diagram shown in
{right arrow over (F)}1M, {right arrow over (τ)}1M and {right arrow over (F)}2M, {right arrow over (τ)}2M are the forces and torques between the first-second and second-third links of the device at the dorsalflexion/plantarflexion (D/P) and inversion/eversion (I/E) joints respectively.
{right arrow over (F)}1H, {right arrow over (τ)}1H and {right arrow over (F)}2H, {right arrow over (τ)}2H are the forces and torques in between the segments of the human lower leg at the D/P and I/E joints, respectively. The gravitational force is acting at the center of mass of each body and is not shown in the figure for the sake of clarity.
{right arrow over (F)}kH, {right arrow over (τ)}kH are the force and the torque at the knee joint. Each of the bodies shown in
The vector unknowns are {right arrow over (F)}1M, {right arrow over (τ)}1M, {right arrow over (F)}2M, {right arrow over (τ)}2M {right arrow over (F)}1H, {right arrow over (τ)}1H, {right arrow over (F)}2H, {right arrow over (τ)}2H, {right arrow over (F)}kH and {right arrow over (τ)}kH so there are thirty scalar unknowns. The system is uniquely solvable. Solving the force and moment balance equations for the bodies one through five in the order 1-4-5-3-2 gives all the unknown forces and moments without any matrix inversions or iterative procedures. The force due to previous body on the next body is taken as positive and is expressed in the reference frame of the next body. The position vectors and gravity force of a particular body are expressed in the body frame.
Frame 0 is fitted to bodies 1 and 2; bodies 3 and 4 move together, so their coordinate frame have same orientations but different origins. These frames are represented by the same index 1 for the purpose of rotation matrices and finally frame 2 is attached to body 5. Bodies 3 and 4 have the same angular velocity and acceleration {right arrow over (ω)}1 and {right arrow over (α)}1, respectively. Body five has angular velocity and acceleration, {right arrow over (ω)}2 and {right arrow over (α)}2, respectively. The vector {right arrow over (r)}1M;1 represents a vector from the D/P joint to the center of mass of body 1. Other position vectors follow similarly. The vector {right arrow over (F)}w represents the weight vector of respective bodies. Weights of the various human segments are obtained from the average anthropological data.
The force and moment balance equations for different bodies can be written as follows:
The analysis presented in this section can be used to determine joint forces and moments for arbitrary motions of the ankle while the leg shank is inertially fixed. During walking, the shank is not inertially fixed and the rear foot experiences large ground reaction forces during heel strike. The orthosis can be used for walking experiments by adding a second force torque sensor between the rear foot and ground and by recording the motion information of the shank.
Experimental results were obtained using a device in accordance with the present invention. Experiments were performed with a healthy subject who was asked to perform primarily motion about the D/P joint. Exemplary orientations of the D/P and I/E frames are shown in
The net torque applied by the shank to the foot at the D/P joint obtained by taking square root of the sum of squares of all the three components of moment, is about 8.5 Nm. The weight of foot is about 1 Kg and the weight of the relevant parts of orthosis is about 3 Kg, and the center of mass of the this weight is 20 cm from the D/P joint. This yields a torque of 8 Nm. Because there is some friction at the joints of the device the subject has to apply torques to overcome that as well, this explains the slightly higher magnitude of the experimental mean torque. From
While preferred embodiments of the invention have been shown and described herein, it will be understood that such embodiments are provided by way of example only. Numerous variations, changes and substitutions will occur to those skilled in the art without departing from the spirit of the invention. Accordingly, it is intended that the appended claims cover all such variations as fall within the spirit and scope of the invention.
This application claims the benefit of U.S. Provisional Application No. 60/690,857, filed Jun. 15, 2005, the contents of which are incorporated herein by reference.
The work described in this application was sponsored by the following Federal Agencies: NIH, grant number 1R01 HD38582-01A2.
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