Although tremor, rigidity, and bradykinesia are cardinal symptoms of Parkinson's disease (PD), impairments of gait and balance significantly affect quality of life, especially as the disease progresses, and do not respond well to anti-parkinsonism medications. Many studies have shown that people with PD can walk better when appropriate cues are presented but, to the best of our knowledge, the effects of real-time feedback of step length and uprightness of posture on gait and posture have not been specifically investigated. If it can be demonstrated that real-time feedback can improve posture and gait, the resultant knowledge could be used to design effective rehabilitation strategies to improve quality of life in this population.

In this feasibility study, we have developed a treadmill-based experimental paradigm to provide feedback of step length and upright posture in real-time. Ten subjects (mean age 65.9 ± 7.6 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were evaluated in their ability to successfully utilize real-time feedback presented during quiet standing and treadmill walking tasks during a single data collection session in their medication-on state. During quiet standing tasks in which back angle feedback was provided, subjects were asked to utilize the feedback to maintain upright posture. During treadmill walking tasks, subjects walked at their self-selected speed for five minutes without feedback, with feedback of back angle, or with feedback of step length. During walking tasks with back angle feedback, subjects were asked to utilize the feedback to maintain upright posture. During walking tasks with step length feedback, subjects were asked to utilize the feedback to walk with increased step length. During quiet standing tasks, measurements of back angle were obtained; during walking tasks, measurements of back angle, step length, and step time were obtained.

Subjects stood and walked with significantly increased upright posture during the tasks with real-time back angle feedback compared to tasks without feedback. Similarly, subjects walked with significantly increased step length during tasks with real-time step length feedback compared to tasks without feedback. These results demonstrate that people with PD can utilize real-time feedback to improve upright posture and gait.

Gait and balance disorders are the second leading cause of falls in the elderly. Investigating the changes in static and dynamic balance due to aging may provide a better understanding of the effects of aging on postural control system. Static and dynamic balance were evaluated in a total of 21 young (21-35 years) and 22 elderly (50-75 years) healthy subjects while they performed three different tasks: quiet standing, dynamic weight shifts, and over ground walking. During the quiet standing task, the subjects stood with their eyes open and eyes closed. When performing dynamic weight shifts task, subjects shifted their Center of Pressure (CoP) from the center target to outward targets and vice versa while following real-time feedback of their CoP. For over ground walking tasks, subjects performed Timed Up and Go test, tandem walking, and regular walking at their self-selected speed. Various quantitative balance and gait measures were obtained to evaluate the above respective balance and walking tasks. Total excursion, sway area, and mean frequency of CoP during quiet standing were found to be the most reliable and showed significant increase with age and absence of visual input. During dynamic shifts, elderly subjects exhibited higher initiation time, initiation path length, movement time, movement path length, and inaccuracy indicating deterioration in performance. Furthermore, the elderly walked with a shorter stride length, increased stride variability, with a greater turn and turn-to-sit duration. Significant correlations were also observed between measures derived from the different balance and gait tasks. Thus, it can be concluded that aging deteriorates the postural control system affecting static and dynamic balance and some of the alterations in CoP and gait measures may be considered as protective mechanisms to prevent loss of balance.

Advances in implantable MEMS technology has made possible adaptive micro-robotic implants that can track and record from single neurons in the brain. Development of autonomous neural interfaces opens up exciting possibilities of micro-robots performing standard electrophysiological techniques that would previously take researchers several hundred hours to train and achieve the desired skill level. It would result in more reliable and adaptive neural interfaces that could record optimal neural activity 24/7 with high fidelity signals, high yield and increased throughput. The main contribution here is validating adaptive strategies to overcome challenges in autonomous navigation of microelectrodes inside the brain. The following issues pose significant challenges as brain tissue is both functionally and structurally dynamic: a) time varying mechanical properties of the brain tissue-microelectrode interface due to the hyperelastic, viscoelastic nature of brain tissue b) non-stationarities in the neural signal caused by mechanical and physiological events in the interface and c) the lack of visual feedback of microelectrode position in brain tissue. A closed loop control algorithm is proposed here for autonomous navigation of microelectrodes in brain tissue while optimizing the signal-to-noise ratio of multi-unit neural recordings. The algorithm incorporates a quantitative understanding of constitutive mechanical properties of soft viscoelastic tissue like the brain and is guided by models that predict stresses developed in brain tissue during movement of the microelectrode. An optimal movement strategy is developed that achieves precise positioning of microelectrodes in the brain by minimizing the stresses developed in the surrounding tissue during navigation and maximizing the speed of movement. Results of testing the closed-loop control paradigm in short-term rodent experiments validated that it was possible to achieve a consistently high quality SNR throughout the duration of the experiment. At the systems level, new generation of MEMS actuators for movable microelectrode array are characterized and the MEMS device operation parameters are optimized for improved performance and reliability. Further, recommendations for packaging to minimize the form factor of the implant; design of device mounting and implantation techniques of MEMS microelectrode array to enhance the longevity of the implant are also included in a top-down approach to achieve a reliable brain interface.

The efficacy of deep brain stimulation (DBS) in Parkinson's disease (PD) has been convincingly demonstrated in studies that compare motor performance with and without stimulation, but characterization of performance at intermediate stimulation amplitudes has been limited. This study investigated the effects of changing DBS amplitude in order to assess dose-response characteristics, inter-subject variability, consistency of effect across outcome measures, and day-to-day variability. Eight subjects with PD and bilateral DBS systems were evaluated at their clinically determined stimulation (CDS) and at three reduced amplitude conditions: approximately 70%, 30%, and 0% of the CDS (MOD, LOW, and OFF, respectively). Overall symptom severity and performance on a battery of motor tasks - gait, postural control, single-joint flexion-extension, postural tremor, and tapping - were assessed at each condition using the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and quantitative measures. Data were analyzed to determine whether subjects demonstrated a threshold response (one decrement in stimulation resulted in ≥ 70% of the maximum change) or a graded response to reduced stimulation. Day-to-day variability was assessed using the CDS data from the three testing sessions. Although the cohort as a whole demonstrated a graded response on several measures, there was high variability across subjects, with subsets exhibiting graded, threshold, or minimal responses. Some subjects experienced greater variability in their CDS performance across the three days than the change induced by reducing stimulation. For several tasks, a subset of subjects exhibited improved performance at one or more of the reduced conditions. Reducing stimulation did not affect all subjects equally, nor did it uniformly affect each subject's performance across tasks. These results indicate that altered recruitment of neural structures can differentially affect motor capabilities and demonstrate the need for clinical consideration of the effects on multiple symptoms across several days when selecting DBS parameters.

Humans moving in the environment must frequently change walking speed and direction to negotiate obstacles and maintain balance. Maneuverability and stability requirements account for a significant part of daily life. While constant-average-velocity (CAV) human locomotion in walking and running has been studied extensively unsteady locomotion has received far less attention. Although some studies have described the biomechanics and neurophysiology of maneuvers, the underlying mechanisms that humans employ to control unsteady running are still not clear. My dissertation research investigated some of the biomechanical and behavioral strategies used for stable unsteady locomotion. First, I studied the behavioral level control of human sagittal plane running. I tested whether humans could control running using strategies consistent with simple and independent control laws that have been successfully used to control monopod robots. I found that humans use strategies that are consistent with the distributed feedback control strategies used by bouncing robots. Humans changed leg force rather than stance duration to control center of mass (COM) height. Humans adjusted foot placement relative to a "neutral point" to change running speed increment between consecutive flight phases, i.e. a "pogo-stick" rather than a "unicycle" strategy was adopted to change running speed. Body pitch angle was correlated by hip moments if a proportional-derivative relationship with time lags corresponding to pre-programmed reaction (87 ± 19 ms) was assumed. To better understand the mechanisms of performing successful maneuvers, I studied the functions of joints in the lower extremities to control COM speed and height. I found that during stance, the hip functioned as a power generator to change speed. The ankle switched between roles as a damper and torsional spring to contributing both to speed and elevation changes. The knee facilitated both speed and elevation control by absorbing mechanical energy, although its contribution was less than hip or ankle. Finally, I studied human turning in the horizontal plane. I used a morphological perturbation (increased body rotational inertia) to elicit compensational strategies used to control sidestep cutting turns. Humans use changes to initial body angular speed and body pre-rotation to prevent changes in braking forces.

Spinal cord injury (SCI) disrupts the communication between supraspinal circuits and spinal circuits distal to the injury. This disruption causes changes in the motor abilities of the affected individual, but it can also be used as an opportunity to study motor control in the absence or limited presence of control from the brain. In the case of incomplete paraplegia, locomotion is impaired and often results in increased incidence of foot drag and decreased postural stability after injury. The overall goal of this work is to understand how changes in kinematics of movement and neural control of muscles effect locomotor coordination following SCI. Toward this end, we examined musculoskeletal parameters and kinematics of gait in rats with and without incomplete SCI (iSCI) and used an empirically developed computational model to test related hypotheses. The first study tested the hypothesis that iSCI causes a decrease in locomotor and joint angle movement complexity. A rat model was used to measure musculoskeletal properties and gait kinematics following mild iSCI. The data indicated joint-specific changes in kinematics in the absence of measurable muscle atrophy, particularly at the ankle as a result of the injury. Kinematic changes manifested as a decrease in complexity of ankle motion as indicated by measures of permutation entropy. In the second study, a new 2-dimensional computational model of the rat ankle combining forward and inverse dynamics was developed using the previously collected data. This model was used to test the hypothesis that altered coordination of flexor and extensor muscles (specifically alteration in burst shape and timing) acting at the ankle joint could be responsible for increases in incidence of foot drag following injury. Simulation results suggest a time course for changes in neural control following injury that begins with foot drag and decreased delay between antagonistic muscle activations. Following this, beneficial adaptations in muscle activation profile and ankle kinematics counteract the decreased delay to allow foot swing. In both studies, small changes in neural control caused large changes in behavior, particularly at the ankle. Future work will further examine the role of neural control of hindlimb in rat locomotion following iSCI.