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Castelli E, Beretta E, De Tanti A, Arduini F, Biffi E, Colazza A, Di Pede C, Guzzetta A, Lucarini L, Maghini I, Mandalà M, Nespoli M, Pavarelli C, Policastro F, Polverelli M, Rossi A, Sgandurra G, Boldrini P, Bonaiuti D, Mazzoleni S, Posteraro F, Benanti P, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Saviola D, Turchetti G. Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE. NeuroRehabilitation 2022; 51:665-679. [PMID: 36530098 DOI: 10.3233/nre-220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.
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Affiliation(s)
| | - Elena Beretta
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Antonio De Tanti
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
| | | | - Emilia Biffi
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | | | - Chiara Di Pede
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Andrea Guzzetta
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | | | - Irene Maghini
- Department of Women's and Children's Health, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
| | - Martina Mandalà
- IRCCS Santa Maria Nascente - Fondazione Don C. Gnocchi, Milan, Italy
| | | | - Claudia Pavarelli
- Servizio di Neuropsichiatria Infanzia e dell'Adolescenza (NPIA), Vignola, Italy
| | - Francesca Policastro
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Trieste, Trieste, Italy
| | - Marco Polverelli
- Dipartimento Riabilitazione, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Rossi
- ASST Spedali Civili di Brescia, Ospedale dei Bambini, Brescia, Italy
| | - Giuseppina Sgandurra
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Donatella Bonaiuti
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Autority) Euganea, Camposampietro Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Donatella Saviola
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
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Tiboni M, Borboni A, Vérité F, Bregoli C, Amici C. Sensors and Actuation Technologies in Exoskeletons: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:884. [PMID: 35161629 PMCID: PMC8839165 DOI: 10.3390/s22030884] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023]
Abstract
Exoskeletons are robots that closely interact with humans and that are increasingly used for different purposes, such as rehabilitation, assistance in the activities of daily living (ADLs), performance augmentation or as haptic devices. In the last few decades, the research activity on these robots has grown exponentially, and sensors and actuation technologies are two fundamental research themes for their development. In this review, an in-depth study of the works related to exoskeletons and specifically to these two main aspects is carried out. A preliminary phase investigates the temporal distribution of scientific publications to capture the interest in studying and developing novel ideas, methods or solutions for exoskeleton design, actuation and sensors. The distribution of the works is also analyzed with respect to the device purpose, body part to which the device is dedicated, operation mode and design methods. Subsequently, actuation and sensing solutions for the exoskeletons described by the studies in literature are analyzed in detail, highlighting the main trends in their development and spread. The results are presented with a schematic approach, and cross analyses among taxonomies are also proposed to emphasize emerging peculiarities.
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Affiliation(s)
- Monica Tiboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
| | - Alberto Borboni
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
| | - Fabien Vérité
- Agathe Group INSERM U 1150, UMR 7222 CNRS, ISIR (Institute of Intelligent Systems and Robotics), Sorbonne Université, 75005 Paris, France;
| | - Chiara Bregoli
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (CNR), Via Previati 1/E, 23900 Lecco, Italy;
| | - Cinzia Amici
- Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze, 38, 25123 Brescia, Italy; (M.T.); (C.A.)
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Narayan J, Kumar Dwivedy S. Preliminary design and development of a low-cost lower-limb exoskeleton system for paediatric rehabilitation. Proc Inst Mech Eng H 2021; 235:530-545. [PMID: 33588634 DOI: 10.1177/0954411921994940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this work, the design, modeling, and development of a low-cost lower limb exoskeleton (LLES) system are presented for paediatric rehabilitation (age: 8-12 years, mass: 25-40 kg, height: 115-125 cm). The exoskeleton system, having three degrees-of-freedom (DOFs) for each limb, is designed in the SolidWorks software. A wheel support module is introduced in the design to ensure the user's stability and safety. The finite element analysis of the hip joint connector along with the wheel support module is realized for maximum loading conditions. The holding torque capacity of exoskeleton joints is estimated using an affordable spring-based experimental setup. A working prototype of the LLES is developed with holding torque rated actuators. Thereafter, the dynamic analysis for the human-exoskeleton coupled system is carried out using the Euler-Lagrange principle and SimMechanics model. The simulation results of estimating joint actuator torques are obtained for two paraplegic subjects (Case I: 10 years age, 30 kg mass, 120 cm height and Case II: 12 years age, 40 kg mass, 125 cm height). The details of input parameters such as body mass, link lengths, joint angles, and contact forces are discussed. The simulation results of dynamic analysis have shown the potential of estimating the torques of joint actuators for the developed prototype during motion assistance and gait rehabilitation.
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Affiliation(s)
- Jyotindra Narayan
- Mechanical Engineering Department, Indian Institute of Technology Guwahati, Guwahati, India
| | - Santosha Kumar Dwivedy
- Mechanical Engineering Department, Indian Institute of Technology Guwahati, Guwahati, India
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He Y, Eguren D, Luu TP, Contreras-Vidal JL. Risk management and regulations for lower limb medical exoskeletons: a review. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:89-107. [PMID: 28533700 PMCID: PMC5431736 DOI: 10.2147/mder.s107134] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Gait disability is a major health care problem worldwide. Powered exoskeletons have recently emerged as devices that can enable users with gait disabilities to ambulate in an upright posture, and potentially bring other clinical benefits. In 2014, the US Food and Drug Administration approved marketing of the ReWalk™ Personal Exoskeleton as a class II medical device with special controls. Since then, Indego™ and Ekso™ have also received regulatory approval. With similar trends worldwide, this industry is likely to grow rapidly. On the other hand, the regulatory science of powered exoskeletons is still developing. The type and extent of probable risks of these devices are yet to be understood, and industry standards are yet to be developed. To address this gap, Manufacturer and User Facility Device Experience, Clinicaltrials.gov, and PubMed databases were searched for reports of adverse events and inclusion and exclusion criteria involving the use of lower limb powered exoskeletons. Current inclusion and exclusion criteria, which can determine probable risks, were found to be diverse. Reported adverse events and identified risks of current devices are also wide-ranging. In light of these findings, current regulations, standards, and regulatory procedures for medical device applications in the USA, Europe, and Japan were also compared. There is a need to raise awareness of probable risks associated with the use of powered exoskeletons and to develop adequate countermeasures, standards, and regulations for these human-machine systems. With appropriate risk mitigation strategies, adequate standards, comprehensive reporting of adverse events, and regulatory oversight, powered exoskeletons may one day allow individuals with gait disabilities to safely and independently ambulate.
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Affiliation(s)
- Yongtian He
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - David Eguren
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - Trieu Phat Luu
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - Jose L Contreras-Vidal
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
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