Development and simulation of a passive upper extremity orthosis for amyoplasia

INTRODUCTION: People who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort. METHODS: This study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL. RESULTS: For a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400 Nm(−1) and of 1029 Nm(−1), respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized. CONCLUSION: By augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.