CHAPTER 1

Introduction

1.1. Motivation
Locomotion is necessary to accomplish tasks in personal and professional life. Locomotion al-
lows a person to move from a given point to a target point. It describes a person’s ability to
do tasks independently and is necessary for well being. Neuromuscular disorders caused due to
old age or pathological gait can affect a person’s well being and ability to carry out daily tasks.
To improve the condition of people suffering with gait disorders orthotic devices can provide as-
sistance. These orthotic devices target reducing gait asymmetry and equalizing load distribution
under the feet. Development of these orthotic devices is facilitated by measurement of biome-
chanical parameters. These biomechanical parameters can be broadly classified into observable
and non-observable categories. Observable categories include step length, stance duration and
join angles. These parameters can be measured using devices such inertial measurement units
(IMUs) [80]. IMUs are used to measure gait events like touch down (TD) and lift off (LO) of
the foot by detecting change in acceleration of the lower limbs. However, non-observable pa-
rameters such as dynamic leg stiffness requires computational models that rely on leg modeling.
Jakubowski suggested that [46] developing computational models can help in improvement of or-
thotic devices. Computational models that can reproduce experimental gait dynamics can explain
leg stiffness variation for different pathological gaits. Moreover, walking speed, GRF and leg TD
angle affect dynamic leg stiffness [2, 27, 34]. Thus, an appropriate computational model can lead
towards improvement in lower limb orthotic design.
Different leg designs are used in various generic walking templates [32]. Computational models
such as inverted pendulum (IP) help in reproducing human like gait dynamics [14]. IP model has
evolved from using a rigid leg to compliant leg models. The addition of compliant leg stiffness
helps in reproducing human like GRF and center of mass (COM) trajectory [9, 33, 34]. These
spring mass models provide different stiffness values corresponding to different combination of
walking speeds, GRF and stance leg angles. Apart from gait simulation, the leg stiffness values
can help in optimization of compliant foot orthoses. We believe, apart from GRF, walking speed
and leg TD angle, more gait parameters should be used to improve post-stroke gait estimation.
Kobayashi et al. [54] showed that ankle foot orthoses (AFO) stiffness can regulate ankle stiff-
ness. However, pathological gaits such as post stroke hemiparesis often portray altered foot orien-
tation and foot placement which consequently affects their center of pressure (COP) progression.

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1. Introduction

Moreover, studies on plantar pressure show its growing relevance in improvement and assessing
post-stroke gait [43, 48, 104, 105]. In addition, COP progression in computational models has
shown to improve gait estimation in healthy subjects [49, 85]. Thus, we believe provision of COP
progression can provide reliable leg stiffness values for post stroke gait.
Foot orthoses share certain biomechanical similarities with shoes. Hence, we believe to improve
foot orthoses design, computational models that can differentiate between barefoot and gait with
footwear can be useful. By incorporating biomechanical parameters that can relate barefoot and
gait with footwear can provide a foundation for foot orthotic design. Shoes prevent transmission
of unwanted shear and normal forces underneath the foot and decrease loading stress on the limbs
[79]. However, footwear can sometimes constrain movement and cause instability, such as heeled
footwear. The added discomfort, due to heeled gait, constraints joints, reduces speed and leads
to concentration of plantar pressure at the toes. Similar discomfort is observed in post-stroke
hemiparesis. In case of heeled gait, a healthy person can just switch to ergonomic shoes for
comfort, like sport shoes. But for post-stroke gait this transition to a comfortable gait depends on
many biomechanical factors. Switching from heeled shoes to sport shoes is simply altering the
physical interaction with the foot-floor interface. But due to hemiparesis, the subject experiences
loss of neuromuscular coordination. Hence, in order to design gait-assisstive devices like soft
orthosis for comfort and gait symmetry, subject specific customization of orthoses is required. We
believe, by generating a relation between barefoot and heeled gait, we would obtain a transition
function that can describe barefoot and gait with footwear. By establishing such a relationship,
we would be in a position to develop foot orthoses for post-stroke gait depending on any gait
similarities in non observable gait parameters for the two gaits Fig. 1.1.

Figure 1.1.: Overview of our study. COP progression can provide the missing link in between
heeled gait and barefoot walking gait. We further expect, COP progression can help in
estimating changes in post-stroke gait. Similarities in COP dynamics for heeled gait
and post-stroke gait can aid in foot orthotic design.

This dissertation tries to answer if COP translation can be a good measure to estimate gait
changes due to heeled footwear and asymmetric gait of stroke patients. By doing so, computa-
tionally effective models can be used to model different footwear or estimate gait asymmetry in
pathological gait. Moreover, such models can explain in vivo biomechanical changes such as ac-
tive and passive stiffness for different walking speeds. By developing a relation between barefoot
and heeled gait, we would gain more insights into how COP movement affects shoe compliance
and plantar pressure progression. By obtaining similarities in COP dynamics for heeled gait and
hemiparetic gait would eventually help in recommending design parameters for soft orthotics. In
this study we try to answer the following question
Can these generic dynamic models estimate gait changes due to footwear? And can they esti-
mate gait changes observed in chronic stroke patients?

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 1.2. Structure of thesis

1.2. Structure of thesis

Chapter 1
This chapter contains the motivation of our studies with consisting of the major attributes of the
two gaits that led to this dissertation. In essence, it describes major features of heeled footwear that
affect gait. It brings to light similarities in between heeled gait and post-stroke gait and how these
similar aspects can be estimated through provision of COP progression models. Furthermore, it
provides an overview of how the two gaits are approached from a modeling perspective along with
the scope of this study.

Chapter 2
This chapter describes the current approaches for gait modeling using generic inverted pendu-
lum models. This is followed up by describing various types of footwear and their effect on gait
kinematics, kinetics and foot injuries. We then explain the effects on COP progression and what
features of COP progression can help in developing a hypothesis for COP progression in barefoot
and heeled gait. It is followed up by injuries occurring due to uncomfortable footwear. Second
part of this chapter deals with post-stroke gait features and techniques to estimate spatio-temporal
parameters in healthy and post-stroke gait. Towards the end we describe features of soft orthotics
and role played by orthotic compliance in providing comfort to pathological gait.

Chapter 3
This chapter deals with testing the hypothesis that connects barefoot gait with heeled gait through
transition curves. First part of the chapter deals with describing the bipedal model and generation
of COP constraint curves. Second part deals with simulation of the bipedal model by provision of
an apex return map. Third part deals with validating the results of the bipedal model by estimating
ground reaction forces and spatio-temporal parameters. The spatio-temporal parameters are esti-
mated on an individual leg and on a combined leg basis to test the two COP models. Finally, the
chapter ends with the main findings, limitations and how COP movement can be manipulated to
provide comfort.

Chapter 4
This chapter deals with simulating the two COP progression models for post-stroke gait. We start
by obtaining correlation for spatio-temporal parameters and linear fits for leg stiffness. Secondly,
the COP constraint curves are described for both COP models. We then follow up by describing
the attributes of an asymmetric bipedal model. Thirdly, both COP models are simulated to obtain
steady state walking solutions which are then compared with GRF profiles and spatio-temporal
data. Finally, GRF profiles for very slow gait are re-estimated by providing an alternative heel
strike condition and a predefined relative leg stiffness. Towards the end, we discuss the main
findings, limitations and model applications.

Chapter 5
This chapter summarizes the main findings of both chapters and model limitations of the COP
progression models.

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1. Introduction

1.3. Publication note

The articles in this thesis are either accepted or submitted to journals.

Chapter 3
Karna Potwar and Dongheui Lee, A center of pressure progression model for walking with non
heeled and heeled footwear, In Gait & Posture, pages 300-307, 2020.

Chapter 4
Karna Potwar, Elizabeth Chandler, Valerie Pomeroy, Leif Johannsen and Dongheui Lee, Estima-
tion of stroke gait's spatio-temporal events using a passive dynamic bipedal model (submitted) to
Journal of Applied Biomechanics.

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