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Immediate effects of the honda walking assist on spatiotemporal gait characteristics in individuals after stroke. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Livolsi C, Conti R, Guanziroli E, Friðriksson Þ, Alexandersson Á, Kristjánsson K, Esquenazi A, Molino Lova R, Romo D, Giovacchini F, Crea S, Molteni F, Vitiello N. An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study. Sci Rep 2022; 12:19343. [PMID: 36369462 PMCID: PMC9652374 DOI: 10.1038/s41598-022-23283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
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Affiliation(s)
- Chiara Livolsi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | | | | | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | | | | | | | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Duddy D, Doherty R, Connolly J, McNally S, Loughrey J, Faulkner M. The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:3207. [PMID: 34063123 PMCID: PMC8124924 DOI: 10.3390/s21093207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Patients with neurological impairments often experience physical deconditioning, resulting in reduced fitness and health. Powered exoskeleton training may be a successful method to combat physical deconditioning and its comorbidities, providing patients with a valuable and novel experience. This systematic review aimed to conduct a search of relevant literature, to examine the effects of powered exoskeleton training on cardiovascular function and gait performance. Two electronic database searches were performed (2 April 2020 to 12 February 2021) and manual reference list searches of relevant manuscripts were completed. Studies meeting the inclusion criteria were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. n = 63 relevant titles were highlighed; two further titles were identified through manual reference list searches. Following analysis n = 23 studies were included. Data extraction details included; sample size, age, gender, injury, the exoskeleton used, intervention duration, weekly sessions, total sessions, session duration and outcome measures. Results indicated that exoskeleton gait training elevated energy expenditure greater than wheelchair propulsion and improved gait function. Patients exercised at a moderate-intensity. Powered exoskeletons may increase energy expenditure to a similar level as non-exoskeleton walking, which may improve cardiovascular function more effectively than wheelchair propulsion alone.
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Affiliation(s)
- Damien Duddy
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
| | - Rónán Doherty
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
| | - James Connolly
- Department of Computing, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland;
| | - Stephen McNally
- No Barriers Foundation, Letterkenny, F92 TW27 Donegal, Ireland; (S.M.); (J.L.)
| | - Johnny Loughrey
- No Barriers Foundation, Letterkenny, F92 TW27 Donegal, Ireland; (S.M.); (J.L.)
| | - Maria Faulkner
- Sports Lab North West, Letterkenny Institute of Technology, Port Road, Letterkenny, F92 FC93 Donegal, Ireland; (R.D.); (M.F.)
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Carswell C, Rea PM. What the Tech? The Management of Neurological Dysfunction Through the Use of Digital Technology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1317:131-145. [PMID: 33945135 DOI: 10.1007/978-3-030-61125-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Worldwide, it is estimated that millions of individuals suffer from a neurological disorder which can be the result of head injuries, ischaemic events such as a stroke, or neurodegenerative disorders such as Parkinson's disease (PD) and multiple sclerosis (MS). Problems with mobility and hemiparesis are common for these patients, making daily life, social factors and independence heavily affected. Current therapies aimed at improving such conditions are often tedious in nature, with patients often losing vital motivation and positive outlook towards their rehabilitation. The interest in the use of digital technology in neuro-rehabilitation has skyrocketed in the past decade. To gain insight, a systematic review of the literature in the field was conducting following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for three categories: stroke, Parkinson's disease and multiple sclerosis. It was found that the majority of the literature (84%) was in favour of the use of digital technologies in the management of neurological dysfunction; with some papers taking a "neutral" or "against" standpoint. It was found that the use of technologies such as virtual reality (VR), robotics, wearable sensors and telehealth was highly accepted by patients, helped to improve function, reduced anxiety and make therapy more accessible to patients living in more remote areas. The most successful therapies were those that used a combination of conventional therapies and new digital technologies.
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Affiliation(s)
- Caitlin Carswell
- Anatomy Facility, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul M Rea
- School of Life Sciences, University of Glasgow, Glasgow, UK.
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Awad LN, Kudzia P, Revi DA, Ellis TD, Walsh CJ. Walking faster and farther with a soft robotic exosuit: Implications for post-stroke gait assistance and rehabilitation. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:108-115. [PMID: 33748765 PMCID: PMC7971412 DOI: 10.1109/ojemb.2020.2984429] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Soft robotic exosuits can improve the mechanics and energetics of walking after stroke. Building on this prior work, we evaluated the effects of the first prototype of a portable soft robotic exosuit. Methods: Exosuit-induced changes in the overground walking speed, distance, and energy expenditure of individuals post-stroke were evaluated statistically and compared to minimal clinically important difference scores. Results: Compared to walking without the exosuit worn, the \documentclass[12pt]{minimal}
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}{}$< $\end{document}5 kg exosuit did not substantially modify speed, distance, or energy expenditure when worn unpowered. In contrast, when powered on to provide an average 22.87 \documentclass[12pt]{minimal}
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}{}$\pm$\end{document} 0.58 %bodyweight of paretic plantarflexor force assistance during stance phase and assist the paretic dorsiflexors during swing phase to reduce drop-foot, study participants walked a median 0.14 \documentclass[12pt]{minimal}
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}{}$\pm$\end{document} 0.06 m/s faster during the 10-meter walk test and traveled 32 \documentclass[12pt]{minimal}
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}{}$\pm$\end{document} 8 m farther during the six minute walk test (\documentclass[12pt]{minimal}
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}{}$P < 0.05$\end{document}). Conclusions: Individuals post-stroke can leverage the paretic plantarflexor and dorsiflexor assistance provided by soft robotic exosuits to achieve clinically-meaningful increases in speed and distance.
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Affiliation(s)
- Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA
| | - Pawel Kudzia
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA
| | - Dheepak Arumukhom Revi
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA
| | - Terry D Ellis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA
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