A Preliminary Study on Robot-Assisted Ankle Rehabilitation for the Treatment of Drop Foot

VR-Aided Ankle Rehabilitation Decision-Making Based on Convolutional Gated Recurrent Neural Network

Traditional rehabilitation training for stroke patients with ankle joint issues typically relies on the expertise of physicians. However, when confronted with complex challenges, such as online decision-making or assessing rehabilitation progress, even seasoned experts may not anticipate all potential hurdles. A novel approach is necessary-one that effectively addresses these complexities without solely leaning on expert experience. Previous studies have introduced a rehabilitation assessment method based on fuzzy neural networks. This paper proposes a novel approach, which is a VR-aided ankle rehabilitation decision-making model based on a convolutional gated recurrent neural network. This model takes various inputs, including ankle dorsiflexion range of motion, angular velocity, jerk, and motion performance scores, gathered from wearable motion inertial sensors during virtual reality rehabilitation. To overcome the challenge of limited data, data augmentation techniques are employed. This allows for the simulation of five stages of rehabilitation based on the Brunnstrom staging scale, providing tailored control parameters for virtual training scenarios suited to patients at different stages of recovery. Experiments comparing the classification performance of convolutional neural networks and long short-term memory networks were conducted. The results were compelling: the optimized convolutional gated recurrent neural network outperformed both alternatives, boasting an average accuracy of 99.16% and a Macro-F1 score of 0.9786. Importantly, it demonstrated a strong correlation (correlation coefficient r > 0.9) with the assessments made by clinical rehabilitation experts, showing its effectiveness in real-world applications.

Ankle dorsiflexion assistance of patients with foot drop using a powered ankle-foot orthosis to improve the gait asymmetry

BACKGROUND

Foot drop is a neuromuscular disorder that causes abnormal gait patterns. This study developed a pneumatically powered ankle-foot orthosis (AFO) to improve the gait patterns of patients with foot drop. We hypothesized that providing unilateral ankle dorsiflexion assistance during the swing phase would improve the kinematics and spatiotemporal gait parameters of such patients. Accordingly, this study aims to examine the efficacy of the proposed assistance system using a strategy for joint kinematics and spatiotemporal gait parameters (stride length, swing velocity, and stance phase ratio). The analysis results are expected to provide knowledge for better design and control of AFOs in patients with foot drop.

METHOD

Ten foot drop patients with hemiparesis (54.8 y ± 14.1 y) were fitted with a custom AFO with an adjustable calf brace and portable air compressor for ankle dorsiflexion assistance in the gait cycle during the swing phase. All subjects walked under two different conditions without extensive practice: (1) barefoot and (2) wearing a powered AFO. Under each condition, the patients walked back and forth on a 9-m track with ten laps of level ground under the supervision of licensed physical therapists. The lower-limb joint and trunk kinematics were acquired using 12 motion-capture cameras.

RESULTS

We found that kinematic asymmetry decreased in the three lower-limb joints after ankle dorsiflexion assistance during the swing phase. The average ankle-joint angle increased after using the AFO during the entire gait cycle. Similarly, the knee-joint angle showed a slight increase while using the AFO, leading to a significantly decreased standard deviation within patients. Conversely, the hip-joint angle showed no significant improvements with assistance. While several patients exhibited noticeably lower levels of asymmetry, no significant changes were observed in the average asymmetry of the swing velocity difference between the affected and unaffected sides while using the AFO.

CONCLUSION

We experimentally validated that ankle dorsiflexion assistance during the swing phase temporarily improves gait asymmetry in foot-drop patients. The experimental results also prove the efficacy of the developed AFO for gait assistance in foot-drop patients.

[New technologies and robotics]

The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business" of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient" prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.

Design and Workspace Analysis of a Parallel Ankle Rehabilitation Robot (PARR)

The ankle rehabilitation robot is essential equipment for patients with foot drop and talipes valgus to make up deficiencies of the manual rehabilitation training and reduce the workload of rehabilitation physicians. A parallel ankle rehabilitation robot (PARR) was developed which had three rotational degrees of freedom around a virtual stationary center for the ankle joint. The center of the ankle should be coincided with the virtual stationary center during the rehabilitation process. Meanwhile, a complete information acquisition system was constructed to improve the human-machine interactivity among the robot, patients, and physicians. The physiological motion space (PMS) of ankle joint in the autonomous and boundary elliptical movements was obtained with the help of the RRR branch and absolute encoders. The natural extreme postures of the ankle complex are the superposition of the three typical movements at the boundary motions. Based on the kinematic model of PARR, the theoretical workspace (TWS) of the parallel mechanism was acquired using the limit boundary searching method and could encircle PMS completely. However, the effective workspace (EWS) was smaller than TWS due to the physical structure, volume, and interference of mechanical elements. In addition, EWS has more clinical significance for the ankle rehabilitation. The PARR prototype satisfies all single-axis rehabilitations of the ankle and can cover most compound motions of the ankle. The goodness of fit of PMS can reach 93.5%. Hence, the developed PARR can be applied to the ankle rehabilitation widely.

A Review on the Control of the Mechanical Properties of Ankle Foot Orthosis for Gait Assistance

In the past decade, advanced technologies in robotics have been explored to enhance the rehabilitation of post-stroke patients. Previous works have shown that gait assistance for post-stroke patients can be provided through the use of robotics technology in ancillary equipment, such as Ankle Foot Orthosis (AFO). An AFO is usually used to assist patients with spasticity or foot drop problems. There are several types of AFOs, depending on the flexibility of the joint, such as rigid, flexible rigid, and articulated AFOs. A rigid AFO has a fixed joint, and a flexible rigid AFO has a more flexible joint, while the articulated AFO has a freely rotating ankle joint, where the mechanical properties of the AFO are more controllable compared to the other two types of AFOs. This paper reviews the control of the mechanical properties of existing AFOs for gait assistance in post-stroke patients. Several aspects that affect the control of the mechanical properties of an AFO, such as the controller input, number of gait phases, controller output reference, and controller performance evaluation are discussed and compared. Thus, this paper will be of interest to AFO researchers or developers who would like to design their own AFOs with the most suitable mechanical properties based on their application. The controller input and the number of gait phases are discussed first. Then, the discussion moves forward to the methods of estimating the controller output reference, which is the main focus of this study. Based on the estimation method, the gait control strategies can be classified into subject-oriented estimations and phase-oriented estimations. Finally, suggestions for future studies are addressed, one of which is the application of the adaptive controller output reference to maximize the benefits of the AFO to users.