Generic simulations of tremor propagation through the upper limb have been achieved using a previously developed postural tremor model, but this model had not yet been compared with experimental data or utilized for subject-specific studies. This work addressed these two issues, which are important for optimizing peripheral tremor suppression techniques. For tractability, we focused on a subsystem of the upper limb: the isolated wrist, including the four prime wrist muscles (extensor carpi ulnaris, flexor carpi ulnaris, extensor carpi radialis, and flexor carpi radialis) and the two degrees of freedom of the wrist (flexion-extension and radial-ulnar deviation). Muscle excitation and joint displacement signals were collected while subjects with Essential Tremor resisted gravity. System identification was implemented for three subjects who experienced significant tremor using two approaches: 1. Generic linear time-invariant (LTI) models, including autoregressive-exogenous (ARX) and state-space forms, were identified from the experimental data, and characteristics including model order and modal parameters were compared with the previously developed postural tremor model; 2. Subject-specific parameters for the previously developed postural tremor model were directly estimated from experimental data using nonlinear least-squares optimization combined with regularization. The identified LTI models fit the experimental data well, with coefficients of determination of 0.74 ± 0.18 and 0.83 ± 0.13 for ARX and state-space forms, respectively. The optimal model orders identified from the experimental data (4.8 ± 1.9 and 6.4 ± 1.9) were slightly lower than the orders of the ARX and state-space forms of the previously developed model (6 and 8). For each subject, at least one pair of identified complex poles aligned with the complex poles of the previously developed model, whereas the identified real poles were assumed to represent drift in the data rather than characteristics of the system. Subject-specific parameter estimates reduced the sum of squared-error (SSE) between the measured and predicted joint displacement signals to be between 10% and 50% of the SSE using generic literature parameters. The predicted joint displacements maintained high coherence at the tremor frequency for flexion-extension (0.90 ± 0.10), which experienced the most tremor. We successfully applied multiple system identification techniques to identify tremor propagation models using only tremorogenic muscle activity as the input. These techniques identified model order, poles, and subject-specific model parameters, and indicate that tremor propagation at the wrist is well approximated by an LTI model.

Upper Limb work-related musculoskeletal disorders (WMSDs) present a significant health risk to industrial workers. To address this, rigid-body exoskeletons have been widely used in industrial settings to mitigate these risks while exosuits offer advantages such as reduced weight, lower inertia, and no need for precise joint alignment, However, they remain in the early stages of development, especially for reducing muscular effort in repetitive and forceful tasks like heavy lifting and overhead work. This study introduces a multiple degrees-of-freedom cable-driven upper limb bilateral exosuit for human power augmentation. Two control schemes were developed and compared: an IMU based controller, and a myoelectric controller to compensate for joint torque exerted by the wearer. The results of preliminary experiments showed a substantial reduction in muscular effort with the exosuit's assistance, with the myoelectric control scheme exhibiting reduced operational delay. In parallel, the neuromusculoskeletal modeling and simulator (NMMS) has been widely applied in various fields. Most of the research works implements the PD-based internal model of human’s central nervous system to simulate the generated muscle activation. However, the PD-based internal models in recent works are tuned by the empirical data which requires empirical data from human subject experiments. In this dissertation, an off-policy DRL algorithm, Deep Deterministic Policy Gradient was implemented to tune the PD-based internal model of human’s central nervous system. Compared to the conventional approaches, the DRL-based auto-tuner can learn the optimal policy through trial-and-error which doesn’t require human subject experiment and empirical data. The experiment this work showed promising results of this DRL-based auto-tuner for internal-model of human’s central nervous system.

This work presents a computer mathematical model of the human neuromusculoskeletal system specially designed to study the postural balance in standing. In addition to the extrafusal muscle tissue properties commonly used in traditional muscle models applied to study human movement and posture, this model includes two components physiologically important of postural control system: the intrafusal muscle tissue properties and intrinsic reflex responses provided by three neuromuscular organs (muscle spindles, Golgi tendon and Rhenshaw cells). The global model treats the body as a single-link inverted pendulum supported by a pair of muscle-reflex actuators (Winters, 1995) controlled by a proportional-integral-derivative controller. Model simulations were made with and without the contribution of the modelled reflex responses. The results were compatible with those presented in other investigations based on experimental data. In this manner, three fundamental properties of somatosensory feedback system were mathematically had been proven: (i) its anticipatory characteristic, (ii) its capacity to maintain alone the human body in standing posture and (iii) the incapacity of the body in supporting itself in that position in the absence of the modelled reflex responses. This model analysis allows one to conclude that the modelled reflex responses plays a fundamental role when a subject maintains an upright posture. This model can be used to formulate hypothesis about the origin of the feedback somatosensory deficits on human postural control in standing. / Este trabalho apresenta um modelo matemático computacional do sistema neuro-músculo-esquelético humano especialmente desenvolvido para o estudo da estabilidade da postura ereta quasi-estática. Em adição ao sistema muscular extrafusal abordado nos modelos musculares usualmente empregados para estudar o movimento e a postura humana, o modelo inclui dois outros componentes fisiologicamente importantes do sistema de controle postural: o sistema muscular intrafusal e as respostas reflexas intrínsecas provenientes de três estruturas neuromusculares (fusos musculares, órgãos tendinosos de Golgi e interneurônios inibitórios). O modelo global consiste num pêndulo simples invertido sustentado por um par de atuadores músculo-reflexo (Winters, 1995) acionados por um controlador proporcional-integral-derivativo (PID). Simulações do modelo foram processadas com e sem a contribuição dos reflexos modelados. Os resultados se apresentaram compatíveis com aqueles apresentados em outros trabalhos baseados em observações experimentais. Deste modo, três propriedades fundamentais do sistema de realimentação sensorial foram matematicamente comprovadas: (i) sua característica antecipatória, (ii) sua capacidade de manter de forma autônoma o corpo na postura ereta quasi-estática e (iii) a incapacidade do corpo em se sustentar naquela postura na ausência dos reflexos modelados. Isto permite concluir que tais reflexos desempenham um papel fundamental no controle da postura ereta quasi-estática humana. Este modelo pode ser usado para formular hipóteses a respeito da causa de déficits de feedback somatosensorial no controle postural durante a postura ereta. / Doutor em Ciências

Le tremblement, défini comme un mouvement rythmique involontaire, est un des mouvements anormaux les plus fréquents. Le tremblement n'est pas une pathologie mortelle, mais elle diminue souvent considérablement la qualité de vie de la personne. Les traitements efficaces ne sont pas encore disponibles, puisque les solutions pharmacologiques et chirurgicales souffrent encore de limitations en termes d'efficacité, de risques et de coûts. Une alternative consiste à utiliser des technologies d'assistance, tels que les exosquelettes ou la Stimulation Électrique Fonctionnelle (SEF).Néanmoins, la conception de systèmes actifs de compensation des tremblements présente plusieurs défis. Un tel système doit être capable, par exemple, d'atténuer les tremblements tout en minimisant la fatigue, la douleur et l'inconfort induit. Il doit aussi distinguer entre le tremblement et le mouvement volontaire, afin de réduire les interférences sur les mouvements intentionnels.Cette thèse se concentre donc sur l'évaluation de l'usage de la SEF pour atténuer le tremblement. Une première contribution concerne le développement des modèles neuromusculosquelettiques pour étudier l'influence des boucles réflexes sur la dynamique du tremblement, ainsi que la modulation de l'impédance de l'articulation via la co-contraction induite par la SEF. Un algorithme pour estimer en ligne le tremblement et ses caractéristiques tout en filtrant le mouvement volontaire a été proposé et validé sur patients. Enfin, un système SEF pour atténuer le tremblement basé sur le contrôle d'impédance a été conçu et évalué sur patients, alors qu'une deuxième stratégie en boucle fermée a été testée sur des sujets sains. / Tremor, defined as an involuntary, approximately rhythmic and roughly sinusoidal movement, is one of the most common movement disorders. It is not a life-threatening pathology, but it often decreases significantly the person's quality of life. Today, effective treatments for pathological tremor are not yet available, since current pharmacological and surgical alternatives still present limitations with respect to effectiveness, risks, and costs. A different approach is the use of assistive technologies, such as upper limb exoskeletons or Functional Electrical Stimulation (FES).Nevertheless, the design of active tremor compensation systems based on these technologies presents several challenges. Such a system must be able, for instance, to attenuate tremor while minimizing the induced fatigue, pain, and discomfort. Also, it must be able to distinguish between pathological tremor and voluntary motion, in order to reduce interference on intentional movements.This thesis is focused then in evaluating the use of FES to attenuate the effects of tremor. A first contribution concerns the use of neuromusculoskeletal models to study the effects reflex pathways may produce on tremor dynamics, as well as how FES-induced co-contraction may modulate joint impedance. Also, an online algorithm to estimate tremor and its features while simultaneously filtering voluntary motion has been proposed and validated with tremor patients. Finally, a FES system to attenuate tremor based on impedance control has been designed and evaluated on tremor patients, while a second strategy using closed-loop FES control has been tested on healthy subjects.

Dans certaines conditions de vol, les aéronefs à voilure tournante souffrent parfois de l’émergence d’oscillations indésirables, phénomènes potentiellement instables connus sous le nom de Couplages Pilote-Aéronef aéroélastiques (CPA). Ces phénomènes affectent de manière critique la sécurité et la performance des aéronefs. Par conséquent, il est important d’être capable de prédire l’émergence de tels phénomènes dynamiques, le plus tôt possible dans le processus de conception des hélicoptères. Une revue de la littérature révèle que ces phénomènes sont le résultat d’interactions entre les comportements biodynamique du pilote et aéroélastique des hélicoptères. Afin d’avoir une plus grande modularité et granularité dans le processus de modélisation de systèmes complexes, une approche par bond graphs est adoptée. Un modèle aéromécanique d’hélicoptère et un modèle neuro-musculo-squelettique d’un des membres supérieurs du pilote sont développés en bond graphs. Parmi les représentations proposées, trois sont originales, notamment afin de modéliser : des efforts aérodynamiques quasi-statiques, la liaison traînée-battement-pas entre pale et moyeu rotor, et les efforts musculaires à partir d’un modèle de Hill qui tient compte d’une boucle de rétroaction neuromusculaire. Des résultats encourageants sont obtenus lorsque l’on compare la transmissibilité, entre l’angle de manche de pas cyclique imposé par le pilote et des accélérations latérales de la cabine, calculée à partir du modèle biodynamique, et à partir des résultats expérimentaux tirés de la littérature. Un modèle du système bioaéroélastique homme-machine est linéarisé, au voisinage d’un vol stationnaire, et analysé en termes de stabilité. L’étude révèle, comme conjecturé dans la littérature, que le mode régressif de traînée peut être déstabilisé. De plus, il apparaît que le mode progressif de traînée peut également être déstabilisé lors d’un CPA sur l’axe latéral-roulis. Un critère d’analyse de la stabilité d’un équilibre d’un système dynamique à partir d’un modèle linéaire limite la possibilité de prendre en compte certains comportements non-linéaires et donc réduit l’espace de conception. Les premières pierres vers une méthode basée sur des fonctions de Chetaev sont posées, afin de déterminer si l’équilibre d’un système dynamique est instable, directement à partir d’un modèle mathématique non-linéaire de grande dimension, à un coût de calcul potentiellement intéressant. Afin d’illustrer la pertinence de la proposition, le cas de la résonance sol d’un hélicoptère est présentée. / Under certain flight conditions, rotorcrafts might suffer from the emergence of undesirable oscillations, potentially unstable phenomena, known as aeroelastic Rotorcraft-Pilot Couplings (RPCs). These phenomena critically affect the safety and performance of rotorcraft designs. Therefore, there is an important interest in being able to predict the emergence of such dynamic phenomena, as soon as possible during the design process of helicopters. A review of the state-of-the-art reveals that these phenomena are the result of interactions between pilots’ biodynamics and helicopters’ aeroelastic behaviors. In order to provide more modularity and granularity in the modeling of complex systems, a bond graph based approach is used. A helicopter aeromechanical model and a pilot upper limb neuromusculoskeletal model are developed using bond graphs. Three original bond graph representations are proposed, to model: quasi-steady aerodynamic forces, lag-flap-pitch joint at blades’ roots, and a Hill-type muscle force model that accounts for muscle reflexive feedback. Encouraging results are found when comparing the pilot biodynamic model transmissibility cyclic lever angle to lateral cockpit accelerations computations to literature experimental results. A linear model of the coupled human-machine bioaeroelastic system around hover is analyzed in terms of stability. It reveals not only the regressing lag mode, as conjectured in literature, but also the advancing lag mode can be destabilized during a lateral-roll aeroelastic RPC. Furthermore, a criterion to assess the stability of the equilibrium of a dynamic system from a linear model limits the possibility to take into account nonlinear physical behaviors, reducing the design space. The first blocks towards a method based on Chetaev functions is proposed, to determine if an equilibrium is unstable, directly from its large nonlinear mathematical model, at a potentially interesting computational cost. The helicopter ‘ground resonance’ case illustrates the soundness of the proposal.

Cotutelle entre l'Université de Montréal et l'Université Claude Bernard Lyon 1 / Le fauteuil roulant manuel (FRM) est nécessaire à la participation de ses usagers lors de la vie active. Cependant, le geste répétitif de propulsion est contraignant pour l’épaule, ce qui mène à l’apparition de lésions au niveau des tendons de la coiffe des rotateurs, impactant négativement la mobilité, l’autonomie et la qualité de vie de l’usager. Bien que plusieurs études aient essayé de caractériser la propulsion pour identifier des prédicteurs de douleurs, la complexité technique de la propulsion associée à celle anatomique de l’épaule entravent la compréhension des pathomécanismes associés à l’usage du FRM. Aussi, la variabilité des contextes de propulsion en milieu urbain (trottoirs, pentes, etc.) nécessite d’identifier les adaptations de l’usager pour mieux représenter son quotidien. L’objectif principal de cette thèse était d’approfondir notre compréhension des pathomécanismes de l’épaule associés à la propulsion en FRM. À cet égard, il était important de comprendre l’effet de la charge imposée par le FRM sur l’épaule à différentes échelles allant de la cinématique à la contrainte au sein des tissus mous, en passant par les forces articulaires. Nos objectifs spécifiques étaient de (1) Identifier les adaptations de la technique de propulsion à la présence d’un dévers, habileté représentative de la propulsion le long des trottoirs ; (2) Prédire des forces musculaires physiologiquement plausibles qui expriment le rôle des muscles dans la stabilité articulaire ; (3) Prédire le champ de déformations au niveau de la coiffe des rotateurs en utilisant un simulateur hybride de l’épaule, c’est-à-dire un modèle éléments-finis piloté par les excitations musculaires et la cinématique articulaire prédite par un modèle multi-corps rigides. (1) À partir des données cinématiques, cinétiques et électromyographiques de neuf utilisateurs de FRM, nous avons analysé l’adaptation de leurs techniques de propulsion sur un dévers. Si tous les participants ont réussi à se propulser, leurs techniques d’adaptation variaient en termes d’efficacité et de risque de blessures. Ce qui souligne l’importance de l’enseignement des habiletés en FRM. (2) Nous avons adapté une boite à outils de calibration de modèle neuro-musculo-squelettique pour exprimer les contraintes de stabilité gléno-humérale. Le modèle calibré a été ensuite implémenté pour prédire les forces musculaires et de réaction gléno-humérale. Cette approche nous a permis d’exprimer le rôle de la co-contraction musculaire dans la stabilité articulaire. Les forces de réaction prédites indiquaient que la propulsion est une tâche déstabilisante pour l’articulation gléno-humérale. Enfin, la comparaison des modèles calibrés de participants avec des capacités fonctionnelles variées a mis en en évidence les limites de la calibration numérique. (3) Un modèle éléments-finis de l’épaule avec muscles tridimensionnels a été développé pour simuler un cycle de propulsion. Les muscles ont été activés à partir des données électromyographiques expérimentales. La scapula et l’humérus ont été pilotés par la cinématique articulaire extraite d’un modèle multi-corps rigides. L’analyse des déformations de l’unité musculo-tendineuse du supra-épineux nous a permis de proposer des explications potentielles pour la prévalence des déchirures tendineuses chez les utilisateurs de FRM, particulièrement au niveau de la zone antérieure et interstitielle de ce tendon. Notre analyse semble rejoindre la littérature, soulignant que la répétitivité de la propulsion pourrait être plus contraignante que sa charge. Cette thèse a permis de développer des outils numériques de modélisation biomécanique, qui pourraient être implémentés pour l’étude d’autres pathologies qui touchent les muscles de la coiffe. Elle a aussi permis d’identifier des pathomécanismes potentiels de l’épaule associés à la propulsion en FRM. Plus d’études restent nécessaires pour valider nos résultats pour des populations plus larges et plus hétérogènes. / Manual wheelchairs (MWC) are essential for their users’ participation in active life. However, the repetitive propulsion motion is straining on the shoulder, leading to the injury of the rotor cuff tendons, which negatively impacts the mobility, autonomy, and life quality of the users. While numerous studies tried to characterise propulsion to identify pain predictors, the technical and anatomical complexities of the propulsion and shoulder, respectively, hinder the understanding of the pathomecanisms associated with the MWC use. Additionally, the variability of the propulsion conditions within an urban environment (sidewalks, slopes, etc.) entails assessing users’ adaptations to better represent their daily life. The main objective of this thesis was to further our understanding of the shoulder pathomecanisms associated with MWC propulsion. For this purpose, it was important to understand the effect of the load imposed by MWC propulsion on the shoulder at different scales ranging from the kinematics to soft tissue stress through joint forces. Our specific objectives were to (1) Identify adaptations of the propulsion technique across a cross-slope, as this skill is representative of propulsion along sidewalks; (2) Predict physiologically plausible muscle forces that express the role of muscles in joint stability; (3) Predict the deformation field at the rotator cuff using a hybrid shoulder simulator, i.e., a finite element model driven by muscle excitations and joint kinematics predicted by a rigid multi-body model. (1) Using kinematic, kinetic and electromyographic data from nine MWC users, we analysed the adaption of their propulsion techniques across a cross-slope. While all participants propelled themselves, their adaptation techniques varied in terms of efficiency and injury risk. This highlighted the importance of training of MWC skills. (2) We adapted a neuromusculoskeletal calibration toolbox to express glenohumeral stability constraints. The calibrated models were then implemented to predict muscle and glenohumeral joint reaction forces. This approach allowed us to express the role of co-contraction in joint stability. The predicted joint reaction forces indicated that propulsion is a destabilizing task for the glenohumeral joint. Finally, the comparison of models calibrated to participants with varying functional abilities highlighted the limitations of numerical calibration. (3) A finite element model of the shoulder with three-dimensional muscles was developed to simulate a propulsion cycle. The muscles were activated using experimental electromyographic data. The scapula and humerus were driven by joint kinematics extracted from a rigid multi-body model. The analysis of the deformations of the supraspinatus muscle-tendon unit suggested potential explanations for the prevalence of tendon tears in MWC users, particularly in the anterior and interstitial zone of this tendon. Our analysis seems to agree with the literature, emphasizing that the high repetition of the propulsion cycle might be more taxing than its load. Through this thesis, we developed numeric tools for biomechanical modelling, which could be implemented for the study of other pathologies that affect the rotator cuff. We were also able to identify potential pathomecanisms of the shoulder that are associated with MWC propulsion. Mores studies are still needed to validate our results for larger and more heterogeneous populations.

Title: Playing-related musculoskeletal disorders in drummers Objectives: The aim of this study is to collect literature resources focusing on the field of performing arts medicine in musicians with a special focus on drummers. The main focus will be directed on the therapeutic, preventive, educational and ergonomic influence of musculoskeletal disabilities. Methods: This is a literature review, written mainly from foreign sources in English. Electronic databases like Pubmed, Pedro, Science Direct, Springer and Wiley were used. Special attention was given to studies that describe health problems of musicians associated with playing drums. Instrument ergonomics, prevention and education in this field is also described. Results: 128 studies corresponded to the entry criteria. 88 of these studies were devoted to health problems of playing a musical instrument in general, 5 studies were directly addressing particular health risks associated with playing drums. Another 11 studies were describing percussionists within a larger sample of musicians. Conclusion: There are not many studies dealing with health issues associated with playing the drums. Their authors are often speaking from personal experience. On the internet, there is a number of websites containing information about the most common ailments...

Malgré l’amélioration du taux de survie, les survivants de la leucémie aiguë lymphoblastique (LAL) pédiatrique souffrent toujours de séquelles de la maladie et des traitements, dont au niveau neuromusculosquelettique (NMSQ). L’objectif de ce mémoire était de décrire les déficiences, limitations d’activité et restrictions de participation que présentent les survivants de LAL pédiatrique à long terme ainsi que d’explorer la prise en charge usuelle en physiothérapie de ces séquelles NMSQ. Le premier article est un d’étude descriptive rétrospective. Les résultats de cette étude supportent les séquelles NMSQ documentées dans la littérature en plus d’apporter des précisions sur les différences entre les survivants présentant ou non une ostéonécrose de la hanche. Le niveau d’association a également été évalué entre certaines variables de déficiences et limitations d’activité. Le second article est une étude de cas unique. Cette étude a permis de constater que, bien que les physiothérapeutes d’un des centres spécialisés en hémato-oncologie pédiatrique du Québec soient expertes dans le domaine, il n’existe actuellement aucune prise en charge standardisée des séquelles NMSQ des survivants de la LAL à long terme. L’identification des barrières et facilitateurs à l’implantation d’une prise en charge perçue comme optimale par les physiothérapeutes apporte des pistes de solution pertinentes à l’amélioration des pratiques. Les projets de recherche présentés dans ce mémoire permettent de constater que les déficiences et les limitations d’activité des survivants de la LAL pédiatrique sont importantes. Les physiothérapeutes sont parmi les détenteurs d’enjeux clés dans l’optimisation de la prise en charge de cette population grandissante. / Although survival rate has improved, survivors of childhood acute lymphoblastic leukemia (cALL) still suffer from late adverse effects related to the disease and its treatment including neuromusculoskeletal (NMSK) morbidities. The aims of this research were to describe the impairments, activity limitations, and participation restrictions of long-term survivors of cALL and explore current physiotherapy clinical practice regarding these NMSK late adverse effects. The first manuscript is a retrospective descriptive study. Results of this study confirm the long-term NMSK late adverse effects documented in the literature and provide additional information about differences between survivors with and without hip osteonecrosis. Furthermore, relationships between some variables of impairments and activity limitations were identified. The second manuscript is a case study. A focus group with expert physiotherapists in pediatric hemato-oncology from a specialized centre revealed that standardized clinical practice guidelines for the management of long term NMSK late adverse effects of survivors of cALL are lacking. Identification of barriers and facilitators to the implementation of clinical practice perceived as optimal by physiotherapists provides relevant solutions to improve long-term care of this population. Findings from these studies highlight that impairments and activity limitations of survivors of cALL are important. Physiotherapists are key stakeholders in optimizing long-term care of this growing population.