Musculoskeletal simulation framework for impairment-based exoskeletal assistance post-stroke

Assistive technology for the lower extremities has shown great promise towards improving gait function in people following neuromuscular injuries. However, our previous work assisting knee flexion torque in post-stroke Stiff-Knee gait found that augmenting strength can induce secondary complications such as spasticity due to stretching of the rectus femoris. In this work we explore whether we could have obtained improved knee flexion but avoided a spastic response by simulating combinations of hip and knee flexion torques using musculoskeletal modeling and simulation. We explore previously collected data on a case-by-case basis to determine individual-specific quadriceps reflex thresholds based on estimated rectus femoris muscle fiber stretch velocities. We then implemented a forward simulation framework to identify the subject-specific hip-knee assistance prescription to improve knee range of motion without initiating a spastic response. The obtained subject-specific assistive prescription informs the development of new gait assistance strategies for post-stroke gait and could be extended to other neuromuscular gait impairments.