Awardees, Research, Stories

Refining Kinematics Assessments

Motion and Gait Lab
Center for Restorative and Regenerative Medicine, Providence VA

In 2007, a research collaboration between Brown University and the Providence Veterans Administration Medical Center received one of the first STAC grants. Their goal: to study the gait of amputees in order to design prosthetics that more closely simulate normal human movement. Today, five years later, the Center for Restorative and Regenerative Medicine (CRRM) at the Providence VA has developed into one of the nation’s premiere research and testing facilities for limb function and prosthetic technology.

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Dr. Roy Aaron in his office at the Veterans Administration Hospital. Photo by: RI STAC.

Limb trauma is a widespread problem; it includes common emergency room issues, sports injuries, and — on the rise — war or combat-related trauma. Regardless of limb trauma’s origins, assessing recovery and function is tricky business. Dr. Roy Aaron, who led the STAC work, is Director of CRRM; he also serves as Director of Clinical Research in the Department of Orthopaedics at Brown University. Dr. Aaron recalls that the 2007 STAC grant went entirely towards purchase of equipment for the first, functioning Gait Lab, the first in Rhode Island. At the time, the lab was set up in the Butler offices of University Orthopedics, where Dr. Aaron serves on the medical staff.

Today, the Motion and Gait Lab occupies airy offices inside a handsome building on the Providence VA Medical Center campus. While the lab has been updated with state-of-the-art additions like animation software and lighting equipment, it still employs the equipment purchased with the 2007 STAC monies.

Susan D’Andrea, PhD, oversees day-to-day operations and research at the lab. The bulk of research, Dr. D’Andrea explains, “Focuses on lower extremity kinematics, characterization of disabilities, and quantification of responses to treatment with the goal of improving evidence-based clinical decision-making in (limb) trauma.”

Dr. Aaron points out, “One of the greatest challenges in orthopedic medicine involves collecting quantifiable data.” Quantifiable data: precisely what the Motion and Gait Lab is designed to collect.

The lab puts one in mind of a Hollywood special effects studio. It is a large space, ringed with cameras and lighting equipment, much of it mounted on scaffolding. An impressive-looking computer bay occupies one corner. At the center is the focus of the lab’s operations: the runway. The runway has force plates built into it. Dr. D’Andrea explains: “When you stand on the runway, it measures the amount of force, as well as the time your stance happens at a particular spot.” Cameras around the room simultaneously videotape runway subjects, who “wear small reflectors on spots like the hip, knee, or ankle-wherever researchers are focused.” The reflectors help the computer “figure out the angles,” and how much motion there is at these points, while surface electrodes record which muscles are firing. As a subject moves, the computer correlates all the information, figuring out the kinematics, which are then translated and interrelated to create a stunningly detailed computer animation of the subject’s gait.

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Melany Westwell applies reflective markers to subject, Lorraine Bonynge. Photo by: RI STAC

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Lorraine Bonynge walks across the runway force plates. Photo by: RI STAC

There are other gait labs in the United States, but Dr. Aaron and his colleagues believe, “Our focus and capabilities make it unique. And when we figure out how to prove this, Rhode Island will be the leader and pave the way.” To this end, Dr. Aaron and Brown University colleagues will be putting in an NIH grant in October.

More evidence of the Gait Lab’s worthiness: researchers have figured out how to combine its capabilities with those of Brown University’s Visual Environmental Navigation (VEN) lab, which operates under the Direction of Professor William Warren. VEN lab subjects, wearing virtual vision goggles, can now be put through their paces in a variety of virtual environments.

Collaborations comprise the majority of CRRM’s work. For example, Dr. D’Andrea is currently collaborating with a team from University of Rhode Island on the study, “Towards Design of A Stumble Detection System for Artificial Legs,” another STAC award-winner. The hope is that this study will lead to design of a stumble detection system for instrumented, powered artificial legs. D’Andrea reports that the work is going well.

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Computer animation of the subject’s gait. Photo by: RI STAC.

Other studies are keeping Motion and Gait Lab staff busy. One involves helping a post-doc from MIT assess a new, above-the-knee prosthetic. Another recent effort involved assessing a high-end, microprocessor-controlled prosthetic that recently hit the market — one in a series of indicators that prove how STAC’s investment in the Motion and Gait Lab has proven fertile, indeed.

The Center’s stated mission is,”To improve function for individuals with limb trauma by developing technologically advanced solutions for the restoration of limb function.” As such, the focus of CRRM’s efforts is its Motion and Gait Lab. One of just a few a such labs in the Northeast, the lab is concerned with collecting exquisitely detailed, quantifiable data related to limb function. Researchers use computers to translate the data into animations that better their understanding of limb or prosthetic function. The lab has already overseen research contributing to the development of prosthetic devices of extraordinary refinement.