Zachary Lerner

Northern Arizona University | NAU · Department of Mechanical Engineering

Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We develope...

Crouch gait, a pathological pattern of walking characterized by excessive knee flexion, is one of the most common gait disorders observed in children with cerebral palsy (CP). Effective treatment of crouch during childhood is critical to maintain mobility into adulthood, yet current interventions do not adequately alleviate crouch in most individua...

The ability to walk contributes considerably to physical health and overall well-being, particularly in children with motor disability, and is therefore prioritized as a rehabilitation goal. However, half of ambulatory children with cerebral palsy (CP), the most prevalent childhood movement disorder, cease to walk in adulthood. Robotic gait trainer...

Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessive burden placed on the knee extensor muscles as m...

The high energy cost of walking in individuals with cerebral palsy (CP) contributes significantly to reduced mobility and quality of life. The purpose of this study was to develop and clinically evaluate an untethered ankle exoskeleton with the ability to reduce the metabolic cost of walking in children and young adults with gait pathology from CP....

Background Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is c...

The clinical efficacy of robotic rehabilitation interventions hinges on appropriate neuromuscular recruitment from the patient. The first purpose of this study was to evaluate the use of supervised machine learning techniques to predict neuromuscular recruitment of the ankle plantar flexors during walking with ankle exoskeleton resistance in indivi...

Slowing the decline in walking mobility in the elderly is critical for maintaining the quality of life. Wearable assistive devices may 1 day facilitate mobility in older adults; however, we need to ensure that such devices do not impair stability in this population that is predisposed to fall-related injuries. This study sought to quantify the effe...

Despite medical treatment focused on addressing walking disability, many millions of people with neurological conditions, like cerebral palsy (CP), struggle to maintain independent mobility. Lower limb exoskeletons and exosuits may hold potential for augmenting walking ability. However, it remains unknown whether these wearable robots are safe and...

Background Electromyography (EMG)-based audiovisual biofeedback systems, developed and tested in research settings to train neuromuscular control in patient populations such as cerebral palsy (CP), have inherent implementation obstacles that may limit their translation to clinical practice. The purpose of this study was to design and validate an al...

A current limitation in the development of robotic gait training interventions is understanding the factors that predict responses to treatment. The purpose of this study was to explore the application of an interpretable machine learning method, Bayesian Additive Regression Trees (BART), to identify factors influencing neuromuscular responses to a...

Individuals with cerebral palsy (CP) display motor control patterns that suggest decreased supraspinal input, but it remains unknown if they are able to modulate lower-limb reflexes in response to more complex tasks, or whether global motor control patterns relate to reflex modulation capacity in this population. Eight ambulatory individuals with C...

Graded terrains, like slopes and stairs, are particularly challenging for people with neurological disorders like cerebral palsy (CP) due to increased selective muscle control and muscle strength requirements. Lower-limb exoskeletons may be able to assist individuals with CP when navigating graded terrains. This study sought to determine the effect...

Neurological impairment from stroke or cerebral palsy often presents with diminished ankle plantar flexor function during the propulsive phase of gait. This deficit often results in slow, energy-expensive walking patterns that limit community mobility. Robotic gait training interventions may prove effective in improving functional outcomes, includi...

Background Age-related deficits in plantar flexor muscle function during the push-off phase of walking likely contribute to the decline in mobility that affects many older adults. New mobility aids and/or functional training interventions may help slow or prevent ambulatory decline in the elderly. Objective The overarching objective of this study...

The widespread adoption of powered lower-limb exoskeletons for augmenting mobility requires energy-efficient actuation to provide meaningful assistance over relevant walking durations. We designed, modeled, and validated an ankle exoskeleton design with a parallel elastic element in the form of a carbon fiber leaf spring that stored and returned en...

Aim To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. Method PubMed, Embase, Scopus, and Cochrane databases were searched from 1980–January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard...

People with lower-limb hemiparesis have impaired function on one side of the body that affects their walking ability. Wearable robotic assistance has been investigated to treat hemiparetic gait by applying assistance to the paretic limb. In this exploratory case series, we sought to compare the effects of bilateral vs. paretic-limb-only ankle exosk...

Objective: Many individuals with cerebral palsy (CP) experience gait deficits resulting in metabolically-inefficient ambulation that is exacerbated by graded walking terrains. The primary goal of this study was to clinically-validate the accuracy and efficacy of adaptive ankle exoskeleton assistance during steady-state incline walking and stair as...

Objective: To determine the effects of providing battery-powered ankle dorsiflexor and plantar flexor exoskeleton assistance on six-minute walk test performance and efficiency in children and young adults with cerebral palsy by comparing distance walked under exoskeleton assisted (Assisted) and no device (Shod) walking conditions, and explore the...

Background Ankle exoskeletons can improve walking mechanics and energetics, but few untethered devices have demonstrated improved performance and usability across a wide range of users and terrains. Our goal was to design and validate a lightweight untethered ankle exoskeleton that was effective across moderate-to-high intensity ambulation in child...

Background A primary goal of treatment for children with cerebral palsy is improved walking ability to allow for a more active and independent lifestyle. With the importance of ankle function to walking ability, and the deficits in ankle function associated with cerebral palsy, there is good rationale for targeting this joint in an effort to improv...

Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this study was to determine the neuromuscular and biomechanical response t...

Ankle exoskeletons hold potential to augment human walking ability, yet their use in free-living environments has been limited by the absence of practical and effective control strategies that can appropriately adapt to variable terrain. To address this challenge, we derived a novel analytical ankle joint moment estimation model using custom wearab...

Lower-limb exoskeletons have the potential to improve mobility in individuals with movement disabilities, such as cerebral palsy (CP). The goal of this study was to assess the impact of plantar-flexor assistance from an untethered ankle exoskeleton on dynamic stability during unperturbed and perturbed walking in individuals with CP. Seven participa...

Most people with cerebral palsy (CP) suffer from impaired walking ability and pathological gait patterns. Seeking to improve the effectiveness of gait training in this patient population, this study developed and assessed the feasibility of a real-time biofeedback mechanism to augment untethered ankle exoskeleton-assisted walking performance in ind...

Background Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP. Research question. How does over-ground gait training with an untethered ankle exoskeleton prov...

Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this pilot clinical trial was to determine the response to four weeks of e...

Lower-limb exoskeletons are widely researched to improve walking performance and mobility. Low-level sensor-less exoskeleton motor control is attractive for consumer applications due to reduced device complexity and cost, but complex and variable transmission system configurations make the development of effective open-loop motor controllers that a...

Background This is a feasibility study aimed to investigate the effects of a novel lightweight ankle exoskeleton on gait and balance in an individual with Parkinson disease (PD). Case Description An 85-year old woman with a 5-year history of PD (Hoehn and Yahr stage 2.5) participated in the study. The participant received 4 visits over 4 weeks inc...

Individuals with cerebral palsy can have weak and poorly coordinated ankle plantar flexor muscles that contribute to inefficient walking patterns. Previous studies attempting to improve plantar flexor function have had inconsistent effects on mobility, likely due to a lack of task-specificity. The goal of this study was to develop, validate, and te...

Individuals with neuromuscular impairment from conditions like cerebral palsy face reduced quality of life due to diminishing mobility and independence. Lower-limb exoskeletons have potential to aid mobility, yet few studies have investigated their use during over-ground walking – an exercise that may contribute to our understanding of potential be...

Human-like motion is a primary goal for many robotic assistive devices. Emulating the strategy of the human neuromuscular system may aid the control of such powered devices, yet many challenges remain. In this study, we investigated the potential for using the winding filament model (WFM) of muscle to predict the net muscle moment of the ankle. The...

Goal: To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). Methods: Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten,...

Background: Obesity increases a child's risk of developing knee pain across the lifespan, potentially through elevated patellofemoral joint loads that occur during habitual weight-bearing activities. Research question: Do obese children have greater absolute and patellar-area-normalized patellofemoral joint forces compared to healthy weight chil...

Advanced control strategies that can adjust assistance based volitional effort from the user may be beneficial for deploying exoskeletons for overground gait training in ambulatory populations, such as children with cerebral palsy (CP). In this study, we evaluate the ability to predict biological knee moment during stance phase of walking with an e...

Lower-limb exoskeletons used to improve free-living mobility for individuals with neuromuscular impairment must be controlled to prescribe assistance that adapts to the diverse locomotor conditions encountered during daily life, including walking at different speeds and across varied terrain. The goal of this study was to design and establish clini...

Neuromuscular impairment associated with cerebral palsy (CP) often leads to life-long walking deficits. Our goal was to evaluate the ability of a novel untethered wearable ankle exoskeleton to reduce the severity of gait pathology from CP. In this clinical feasibility study of five individuals with CP, we used instrumented gait analysis to quantify...

Predicting subject-specific responses to exoskeleton assistance may aid in maximizing functional gait outcomes, such as achieving full knee-extension at foot contact in individuals with crouch gait from cerebral palsy (CP). The purpose of this study was to investigate the role of volitional and non-volitional muscle activity in subject-specific res...

Human-like motion is a primary goal for many robotic assistive devices. Emulating the strategy of the human neuromuscular system may aid the control of such powered devices, yet many challenges remain. In this study, we investigated the potential for using the winding filament model (WFM) of muscle to predict the net muscle moment of the ankle. The...

Effective solutions for gait rehabilitation in children with cerebral palsy (CP) remain elusive. Wearable robotic exoskeletons offer the potential to greatly increase the dosage and intensity of gait training in this population, which may improve outcomes. We recently reported that a robotic exoskeleton significantly improved knee extension in chil...

Introduction: Cerebral palsy (CP) often results in pathological gait patterns that emerge during development and persist throughout life. More effective, sustainable treatments are needed for gait rehabilitation in CP and wearable exoskeletons provide an untapped resource. A robotic exoskeleton providing knee extension assistance improved walking i...

Effective rehabilitation of children with cerebral palsy (CP) requires intensive task-specific exercise but many in this population lack the motor capabilities to complete the desired training tasks. Providing robotic assistance is a potential solution yet the effects of this assistance are unclear. We combined a novel exoskeleton and exercise vide...

Crouch or "flexed knee" gait is a pathological gait pattern affecting many individuals with cerebral palsy. One proposed method to alleviate crouch is to provide robotic assistance to knee extension during walking. The purpose of this study was to evaluate how the magnitude of knee extensor torque affects knee kinematics, kinetics, and muscle activ...

Background Cerebral palsy (CP) is a prevalent group of neuromotor disorders caused by early injury to brain regions or pathways that control movement. Patients with CP exhibit a range of functional motor disabilities and pathologic gait patterns. Crouch gait, characterized by increased knee flexion throughout stance, is a common gait pattern in CP...

A robotic exoskeleton was designed for individuals with crouch gait caused by cerebral palsy with the intent to supplement existing muscle function during walking. The aim of this study was to evaluate how powered knee extension assistance provided during stance and swing phases of the gait cycle affect knee kinematics, and knee flexor and extensor...

Individuals with cerebral palsy frequently exhibit crouch gait, a pathological walking pattern characterized by excessive knee flexion. Knowledge of the knee joint moment during crouch gait is necessary for the design and control of assistive devices used for treatment. Our goal was to 1) develop statistical models to estimate knee joint moment ext...

Obese children exhibit altered gait mechanics compared to healthy-weight children and have an increased prevalence of hip pain and pathology. This study sought to determine the relationships between body mass and compressive and shear hip joint contact forces during walking. Kinematic and kinetic data were collected during treadmill walking at 1ms(...

The literature is deficient with regard to how the localized mechanical environment of skeletal tissue is altered during reduced gravitational loading and how these alterations affect fracture healing. Thus, a finite element model of the ovine hindlimb was created to characterize the local mechanical environment responsible for the inhibited fractu...

With the high prevalence of pediatric obesity there is a need for structured physical activity during childhood. However, altered tibiofemoral loading during physical activity in obese children likely contribute to their increased risk of orthopedic disorders of the knee. The goal of this study was to determine the effects of pediatric obesity and...

Anterior cruciate ligament (ACL) deficient individuals are at a much higher risk of developing osteoarthritis (OA) compared to those with intact ACLs, likely due to altered biomechanical loading [1]. Research indicates the ACL is comprised of two “bundles”, the anteromedial (AM) and posterolateral (PL) bundles [2]. Although the function of both bun...

Osteoarthritis (OA) is a degenerative condition characterized by the breakdown and loss of joint articular cartilage. While the cause of OA is not precisely known, obesity is a known risk factor [1]. Particular effort has gone towards understanding the relationship between obesity and knee OA because obesity is more strongly linked to OA at the kne...

Sheep are a predominant animal model used to study a variety of orthopaedic conditions. Understanding and controlling the in-vivo loading environment in the sheep hind limb is often necessary for investigations relating to bone and joint mechanics. The purpose of this study was to develop a musculoskeletal model of an adult sheep hind limb and inve...

The accuracy of muscle and joint contact forces estimated from dynamic musculoskeletal simulations are dependent upon the experimental kinematic data used as inputs. Subcutaneous adipose tissue makes the measurement of representative kinematics from motion analysis particularly challenging in overweight and obese individuals. The purpose of this st...

We determined if slow, uphill walking (0.75 m/s, 6°) reduced tibiofemoral (TF) loading compared to faster, level walking (1.50 m/s) in obese and nonobese adults. We collected kinematic, kinetic, and electromyographic data as 9 moderately obese and 10 nonobese participants walked on a dual-belt instrumented treadmill. We used OpenSim to scale a musc...

Walking is a recommended form of physical activity for obese adults, yet the effects of obesity and walking speed on the biomechanics of walking are not well understood. The purpose of this study was to examine joint kinematics, muscle force requirements and individual muscle contributions to the walking ground reaction forces (GRFs) at two speeds...

Net muscle moments (NMMs) have been used as proxy measures of joint loading, but musculoskeletal models can estimate contact forces within joints. The purpose of this study was to use a musculoskeletal model to estimate tibiofemoral forces and to examine the relationship between NMMs and tibiofemoral forces across walking speeds. We collected kinem...