Lower-extremity movement biomechanical characteristics during in-bed rehabilitation
PAN Feiyu1, JIA Yanbing1, YANG Menghui1, LÜ Yifei1, ZHAO Jun2, HAO Zhixiu1, WANG Rencheng1
1. Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; 2. Department of Neurology, China Rehabilitation Research Center, Beijing 100068, China
Abstract：[Objective] With the increasing of the disabled elderly population, the demand for in-bed rehabilitation robots increases. However, the clinical utilization rate of in-bed rehabilitation robots remains low because biomechanical studies on lying posture rehabilitation training are few. The function of an in-bed rehabilitation robot is relatively simple. However, its rehabilitation efficiency should be improved. Therefore, this study aimed to evaluate the joint motion and muscle activation with different movements of lying posture and provide a theoretical basis for designing the motor function of lower-extremity rehabilitation robots.[Methods] We designed a measurement experiment of three typical in-bed rehabilitation training movements, including cycling and straight leg raising in supine and lateral decubitus positions. Furthermore, different variables of velocity and amplitude/distance were set for each movement. Ten healthy subjects performed three movements during the experiment. Kinematics data were collected using a Vicon motion capture system and electromyography data were collected using a Noraxon electromyography acquisition device. A musculoskeletal model for the simulation of supine motion was developed using the software OpenSim. This model included 23 degrees of freedom and 92 muscles of the trunk and lower limbs, which could simulate a larger range of hip and knee flexion than the usual models. Further, a weld constraint was added between the trunk and the ground in the musculoskeletal model to compensate for human-ground contact force. Kinematics data were then imported into the OpenSim model for model scaling, inverse kinematics, and static optimization calculation steps. Then, joint angle and muscle activation were obtained. Electromyography data were compared to the simulation data to verify the musculoskeletal model's reliability.[Results] The OpenSim model was confirmed to be reliable and accurate for simulation. Cycling in supine position showed a higher range of motion (ROM) in the knee and ankle. However, the overall muscle activation was lower than that of the other two movements. Additionally, the greater the movement's ROM during cycling, the higher the muscle activation. Concurrently, the subjects' translation of the center of mass relative to the ground became larger, which should be avoided during patients' in-bed rehabilitation. Straight leg raising in supine position improved hip flexion ROM and activated related muscle groups, such as iliopsoas, sartorius, and rectus femoris. Straight leg raising in lateral decubitus position improved hip abduction ROM and activated related muscle groups such as the gluteus maximus, gluteus medius, gluteus minimus, piriformis, and tensor fascia lata. Muscle activation became higher when subjects lifted their leg faster. However, the subjects' displacement of the center of mass relative to the ground became larger when they lifted their leg faster. Overall, when the angle of the leg lift increased, the mean value of muscle activation decreased and subjects' displacement of the center of mass relative to the ground increased.[Conclusions] Three typical in-bed rehabilitation movements have different benefits to the joints and muscles. Various movement combinations in supine and lateral decubitus positions can improve the rehabilitation effect in clinical training. The rehabilitation robot should provide more sagittal and coronal rehabilitation training functions.
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