Throughout history, the walking crutch has been used as a type of walking assistance device. Although the crutch has evolved over time, its fundamental design is generally the same. Such crutches, and other walking assistance devices such as canes, have a point tip on which the device can be rolled or pivoted. In the case of a crutch, the user supports himself or herself with the device and swings over the crutch tip. This type of crutch gait cycle is known as swing-through non-weight bearing crutch walking.
The effort of the swing-through crutch gait has a higher net metabolic cost per unit distance than running. This leaves users fatigued and limits their everyday crutch walking range. Although there have been improvements in crutch design, they have generally targeted crutch-user interaction, such as crutch grip and torso support, and limited research has been performed to advance crutch-ground interactions in order to modify or control user dynamics. This is unfortunate as crutch users include chronically disabled individuals who rely on their crutches for everyday ambulation. It would be desirable to be able to manipulate the crutch (or other walking assistance device) and, in turn, the user's dynamics, such that that the device assists user ambulation.
The present disclosure may be better understood with reference to the following figures. Matching reference numerals designate corresponding parts throughout the figures, which are not necessarily drawn to scale.
As described above, conventional walking assistance devices, such as crutches, canes, walking sticks, and the like, have point tips that do not assist or resist the swinging dynamics or motion of the user. It would be desirable to be able to manipulate the device's ground forces to assist user ambulation. Disclosed herein are walking assistance devices have non-constant radius curved tips that are designed to provide a desired assistive motion for the user. Specifically, the radius of the tip changes as a function of the angle as the user swings or rolls over the device. Because a shape always rolls towards a decreasing radius on a flat surface, device tips can be made such that the user's swing or roll is assisted (decreasing radius) or resisted (increasing radius). Such a device tip makes walking uphill much more energy efficient while enabling the user to descend downhill with less speed and with greater control. In some embodiments, the curvature of the tip can be changed, in some cases in real time during use, either manually or automatically.
In the following disclosure, various specific embodiments are described. It is to be understood that those embodiments are example implementations of the disclosed inventions and that alternative embodiments are possible. All such embodiments are intended to fall within the scope of this disclosure.
It is known that a two-dimensional circular object will roll down a decline. Similarly, it is also known that a curved object with a changing radius will roll on a flat surface and toward the decreasing radius. These phenomena are illustrated in
The disclosed walking assistance devices, which can take the form of a crutch, cane, or other device upon which the user places a portion of his or her weight to help him or her to stand or walk, comprise non-constant radius curved tips that function in a similar manner to the non-constant radius curved shape shown in
Extending downward from the bottom ends of the vertical support members 14 is a further vertical support member in the form of an extensible leg 20. In the illustrated embodiment, the leg 20 is housed within an outer tube 22 having multiple adjustment holes 24 and the leg comprises one or more detents 26 that can seat within the holes to fix the axial position of the leg relative to the outer tube, and therefore the vertical support members 14. As shown in
Mounted to the bottom end of the extensible leg 20 is a non-constant radius curved tip 30. As shown in
The non-constant radius of the curved outer surface 32 can also assist the user as he or she walks on a level surface. For example, the orientation shown in
Although the center 34 of the curved outer surface 32 is shown in
It is further noted that two or more non-constant radius curves can be combined to form a unique non-constant radius curve tip that is specifically designed for particular applications, such as particular walking slope angles, types or walking environments, or modes of application (fast walking, slow walking, etc.).
If the non-constant radius curved tip sinks into an elastic or deformable ground or if the tip itself is deformable, its curvature may lose its effect. However, this can be accommodated by defining a more drastic curvature (greater radius change). For example, a compliant (e.g., rubber) non-constant radius tip that is used on a soft grass may need to have a larger radius change (increase or decrease) in order to produce its assistive or resistive function.
It is also noted that a constant radius curve with its center offset from the longitudinal axis of the leg will also produce a non-constant radius curve that has its center along the leg of the walking assistance device.
In the above-described examples, the curved tip of a crutch is described as having a non-constant radius that is fixed, i.e., that cannot be changed. In other embodiments, the radius of the curved tip can be changed.
In other embodiments, the struts 46 (and the radius of the outer curved surface 44) can be actively changed during use of the crutch 40. For example, the lengths of the struts 46 can be automatically adjusted without action by the user by a microcontroller/computer that is programmed to determine the surface curvature that would be best to assist the user and issue adjustment commands that cause the struts to adjust in length. This determination can, in some embodiments, be made by the microcontroller/computer relative to information collected by one or more kinematic or kinetic sensors associated with the crutch. For example, the radius change could be made relative to one or more of a measured speed, acceleration, force, position, or condition (e.g., the user is about to fall). Regardless, in some embodiments, it is preferred that the struts 46 or other means do not require power to maintain a particular radius. In such a case, power consumption is reduced as it is only required when changing the radius.
The above-described principles can be applied to several types of walking assistance devices other than crutches, including as walking canes, quad canes, or assistant walkers.
Mounted to a bottom end of the vertical support member 62 is a non-constant radius curved tip 66. As shown in
The varying radius of the curved outer surface 68 can also assist a user in walking uphill or downhill. The former type of assistance is illustrated in
In the above-described embodiments, the curved outer surface of the walking assistance device and its non-constant radius lie in a plane that is generally parallel to the saggital plane of the user during use. It is noted, however, that the curved outer surface can lie in other planes, such as the coronal plane of the user.
It is noted that, in addition to providing a curved tip having a radius that only increases or decreases, a curved tip can be constructed to have a radius that changes direction during the roll-over motion. For example, a crutch tip can be made such that the front of the tip has a decreasing radius that helps the user roll the crutch tip over during the beginning of the support phase and the rear of the tip has an increasing radius that resists the user during the end of the support phase.
It is further noted that the curved tip of a walking assistance device need not have a curvature that varies only in one direction. In other embodiments, the curvature of the curved tip can vary in multiple directions (e.g., front-to-back and side-to-side) at the same time so as to have a complex three-dimensional shape that assists the user in multiple directions at the same time.
Experiments were performed to test the effect of non-constant radius curved tips in walking assistance devices. Described below are results for a particular embodiment of a non-constant radius curved tip applied to an underarm crutch. In the experimentation, three different crutch tips were investigated:
The non-constant radius tip shown in
The experiments compared the dynamic effects of crutch walking when using different non-constant radius tips and normal crutch tips. The experiment was split into two phases. Phase one focused on step length and swing time gait parameters, while also determining the steady state crutch walking velocity for each participant. In phase two, the subjects' ground reaction forces over the entire crutch gait cycle were measured. Axillary crutches were used for all phases and trials. Crutch height and grip location were adjusted according to crutch sizing standards for each participant. In order to compensate for the added weight of the non-constant radius tip assembly, matching lead weights were attached to the crutches when using a standard tip. Each subject walked one trial per tip setting where the order of crutch tip setting was randomized for each participant.
Four healthy male subjects, ages 24.25±1.7, with minimal to no crutch experience were included in this study. No subjects had any inherent gait or lower limb gait asymmetries and all wore non-constricting clothing with comfortable athletic shoes. Written informed consent was obtained from each subject prior to participation with a protocol approved by the Western Institutional Review Board.
Stride velocity, step length, and swing time were measured for each participant using the ProtoKinetics Zeno Walkway System (ProtoKinetics, LLC, Havertown, Pa.), which is a 2.0 ft. (0.6 m) by 16.0 ft. (4.9 m) walkway consisting of pressure sensors that are able to accurately monitor each step position. As used herein, foot step length is defined as the distance between the point where the crutches first touch down to the location where the foot first touches down. Crutch step length is defined the same way, but between the feet and crutch locations. Swing time is the time interval during which either the foot or crutch are off the ground during a step. Each participant was instructed to crutch walk for five minutes at a self-selected velocity over the Zeno Walkway.
Using a normal tip, a forward forcing/assisting non-constant radius tip, and a backward forcing/resisting non-constant radius tip, the participants walked back and forth over the Zeno Walkway. Participants turned (180 degrees) at a distance of approximately two strides before and after the mat to ensure steady state walking measurements. When turning, participants turned about an approximately 0.5 m radius half-circle. Before each trial, the participants rested until their resting heart rate was achieved. During each five-minute trial, each participant's continuous heart rate was recorded using a Bluetooth 4.0 Wahoo TICKR heart rate monitor controlled with a custom mobile application.
To correlate the gait data to when the participant reached a steady-state heart rate, a least square curve fit was used in MATLAB. The steady-state heart rate was defined as the heart rate after two time constants. The comfortable gait velocity for each participant was determined to be the average stride velocity during this steady state time interval. This is the velocity that was used for phase two as treadmill velocity. Step lengths for crutch step and leg step can be seen in
For the second phase of the experiment, the participants were instructed to walk on a level instrumented split-belt treadmill with force plates (FIT, Bertec Corp., Columbus Ohio) underneath the treads. The treadmill is part of the CAREN (Computer Assisted Rehabilitation Environment) system (Motek Medical, Amsterdam). Participants followed their same crutch tip trial pattern, while walking for two minutes per trial. The treadmill velocity was set at the steady-state velocity from phase one. The instrumented treadmill measured horizontal (anterior-posterior) and vertical ground reaction forces of the participants during crutch walking at 100 Hz.
The introduction of the non-constant radius tip to a swing-through non-weight bearing crutch walk has a quantifiable effect on the dynamics of crutch walking.
The difference between the anterior-posterior horizontal forces created by the forward and backward non-constant radius tip results in the change in momentum and swing velocities of the user. This could lead to the observed crutch and foot swing time shown in
Noticeable trends were observed in the ground reaction forces when using the different non-constant radius tips (
The measured parameter value from the non-constant radius tip (either forward or backward) is denoted as KTip and the measured parameter value from the normal crutch tip as NTip. As used herein, GC stands for gait cycle.
During crutch strike (0-20% GC), the forward forcing non-constant radius tip reduced the posterior force by up to 74% from the normal tip, while the backward orientation increased by up to 34% from the normal tip. It was observed that the ground reaction forces switch from posterior to anterior (equilibrium point) during crutch stance around 21±1% GC for the normal non-constant radius tip, 17±3% GC when using the forward non-constant radius tip, and 24±3% GC for the backward non-constant radius tip. This may be due to the shifting of the entire horizontal ground reaction force curve up for the forward non-constant radius tip and down for the backward non-constant radius tip, which is precisely what the tip was hypothesized to accomplish. Among all subjects, the forward forcing non-constant radius tip creates a larger positive shift in horizontal ground reaction forces as the crutch walking velocity increases.
Along with the force magnitudes during crutch stance, this time shift of crutch stance equilibrium causes changes in impulse (force times time) during crutch strike and crutch push-off. The observed reduction in peak forces and impulses during crutch stance is predicted to alleviate stresses in the user's wrist, elbow, and shoulders, however, joint forces were not directly measured in the study. During foot heel strike (40-60% GC), the forward forcing non-constant radius tip increased the peak force by 15%, while the backward tip decreased the peak force by 24% both compared to the normal tip. Among all participants, the vertical heel impact force with a non-constant radius tip was either equivalent or less than the impact force with a normal tip, however, the crutch walking velocity between subjects appears to affect this peak force change. There was no significant force profile difference between all tested non-constant radius tips during mid foot stance (60-85% GC). For three out of four participants, the horizontal foot push-off force (85-100% GC) was increased when using the backward non-constant radius tip, indicating a slightly higher plantarflexion effort by the user to initiate crutch stance. Although the forward forcing non-constant radius tip resulted in high crutch stance force profile modification, no significant changes or trends using this crutch tip during foot stance or push-off were observed.
In all subjects, the forward forcing non-constant radius tip created additional assistive forces during crutch stance, while a backward forcing non-constant radius tip caused an increase in resistive forces. The changes in forces during crutch stance affected the subsequent leg stance phase forces. Horizontal and vertical heel strike ground reaction forces were reduced for three out of four subjects using a backward forcing non-constant radius tip, while user foot push-off force increased for three out of four subjects. These results indicate that a non-constant radius tip can be used to create desirable variations in crutch walking dynamics. Because the assistive and resistive crutch ground reaction forces on a flat surface could be manipulated, a non-constant radius tip is able to provide controlled resistance for downhill walking while increasing assistance in uphill ambulation.
A study comparing two different non-constant radius tips with the standard point crutch tip was also performed. The highlights of this study are described below. Three distinctly different crutch tips were investigated:
Both BF and FF (1 and 2) crutch tips were the same crutch tip reversed 180 degrees and can be seen in
The recorded movements and ground forces were filtered with a second order Butterworth low-pass filter (15 Hz). The forward velocity of the user's hips for three trials per crutch tip type and crutch type combination were averaged and displayed with a standard deviation cloud. Using the measured trajectory and ground force data of the participant as they pivoted over the crutch, how each crutch tip affected the participant's landing angle, velocity profile, horizontal (front/back, propulsion/braking) force profile, the total work done by the crutch tip Work=∫F(t)v(t)dt, and total impulse applied to the user by the crutch Impulse=∫F(t)dt were examined. The impulse is often times referred to as the crutch-force-time integral (CFTI) and can be used as an indicator of energy consumption.
A summary of the discussed results can be seen in
The net impulse (force applied by the tip over the time spent on the crutch) followed a similar trend (
As seen in
In summary, on all measured performance metrics in this example, the backward forcing non-constant radius tip consistently resisted user dynamics, the forward forcing non-constant radius tip assisted user dynamics, and a conventional crutch tip performed between the two. Hence, with the non-constant radius tip it is possible to systematically and predictably change the dynamics of a person ambulating with a crutch. Note that the prior vast amount of quantitative research has been spent on the analysis of various crutch walking dynamics, however little focus has been done to effectively alter crutch walking dynamics.
The results from this experiment are in agreement with the results of the supplemental numerical computer model of a crutch user walking on a curved crutch tip down a decline with a non-weight bearing swing-through crutch gait. The passive dynamic crutch-walking model, based on the passive dynamic walker, simulates slow walking down a slope based solely on gravitational forces, where its dynamics are determined by the magnitude of the slope, its weight, height, and the curvature of the feet and crutch tips. The model parameters that included the decline angle and crutch tip shape were iterated numerically, while only stable gaits were considered. While actual crutch walking requires shoulder and lower limb actuation, this model gives an insight into the swinging and pivoting dynamics of crutch walking. As seen in
Turning to
This application claims priority to U.S. Provisional Application Ser. No. 62/025,173, filed Jul. 16, 2014, which is hereby incorporated by reference herein in its entirety.
This invention was made with Government support under grant/contract number 1319802 awarded by the National Science Foundation. The Government has certain rights in the invention.
Number | Name | Date | Kind |
---|---|---|---|
3986502 | Gilson | Oct 1976 | A |
4493334 | Semanchik | Jan 1985 | A |
4756524 | Cooney | Jul 1988 | A |
5301704 | Brown | Apr 1994 | A |
5331989 | Stephens | Jul 1994 | A |
5409029 | Davis | Apr 1995 | A |
5533536 | Hong | Jul 1996 | A |
5566700 | Brown | Oct 1996 | A |
6003533 | Midcap | Dec 1999 | A |
7686025 | Dowling | Mar 2010 | B1 |
8342196 | Weber | Jan 2013 | B2 |
8408224 | Ozuna | Apr 2013 | B2 |
8662094 | Amladi | Mar 2014 | B2 |
20080121260 | Stephens | May 2008 | A1 |
20100206348 | Markou | Aug 2010 | A1 |
20100229903 | Ozuna et al. | Sep 2010 | A1 |
20130152986 | Hunter | Jun 2013 | A1 |
20130291913 | Soletski et al. | Nov 2013 | A1 |
20130298953 | Amladi | Nov 2013 | A1 |
20140090677 | Butler | Apr 2014 | A1 |
Number | Date | Country |
---|---|---|
102004043500 | Mar 2006 | DE |
Entry |
---|
Nielsen, David H., et al. “Energy cost, exercise intensity, and gait efficiency of standard versus rocker-bottom axillary crutch walking.” Physical therapy 70.8 (1990): 487-493. |
Basford, J. R., H. L. Rhetta, and M. P. Schleusner. “Clinical evaluation of the rocker bottom crutch.” Orthopedics 13.4 (1990): 457-460. |
Foreign search report for PCT/US15/40806 dated Dec. 8, 2015. |
Number | Date | Country | |
---|---|---|---|
62025173 | Jul 2014 | US |