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Wang X, Wang H, Zhang B, Zheng D, Yu H, Cheng B, Niu J. A Multistage Hemiplegic Lower-Limb Rehabilitation Robot: Design and Gait Trajectory Planning. SENSORS (BASEL, SWITZERLAND) 2024; 24:2310. [PMID: 38610521 PMCID: PMC11013995 DOI: 10.3390/s24072310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Most lower limb rehabilitation robots are limited to specific training postures to adapt to stroke patients in multiple stages of recovery. In addition, there is a lack of attention to the switching functions of the training side, including left, right, and bilateral, which enables patients with hemiplegia to rehabilitate with a single device. This article presents an exoskeleton robot named the multistage hemiplegic lower-limb rehabilitation robot, which has been designed to do rehabilitation in multiple training postures and training sides. The mechanism consisting of the thigh, calf, and foot is introduced. Additionally, the design of the multi-mode limit of the hip, knee, and ankle joints supports delivering therapy in any posture and training sides to aid patients with hemiplegia in all stages of recovery. The gait trajectory is planned by extracting the gait motion trajectory model collected by the motion capture device. In addition, a control system for the training module based on adaptive iterative learning has been simulated, and its high-precision tracking performance has been verified. The gait trajectory experiment is carried out, and the results verify that the trajectory tracking performance of the robot has good performance.
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Affiliation(s)
- Xincheng Wang
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao 066004, China; (X.W.); (H.W.); (B.Z.); (D.Z.)
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Hongbo Wang
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao 066004, China; (X.W.); (H.W.); (B.Z.); (D.Z.)
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
- Academy for Engineering & Technology, Fudan University, Shanghai 200433, China
| | - Bo Zhang
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao 066004, China; (X.W.); (H.W.); (B.Z.); (D.Z.)
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Desheng Zheng
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao 066004, China; (X.W.); (H.W.); (B.Z.); (D.Z.)
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Hongfei Yu
- School of Arts and Design, Yanshan University, Qinhuangdao 066004, China
- Hebei Technology Innovation Center for Intelligent Industrial Design, Qinhuangdao 066004, China
| | - Bo Cheng
- Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066099, China;
| | - Jianye Niu
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao 066004, China; (X.W.); (H.W.); (B.Z.); (D.Z.)
- School of Mechanical Engineering, Yanshan University, Qinhuangdao 066004, China
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Widuch-Spodyniuk A, Tarnacka B, Korczyński B, Wiśniowska J. Impact of Robotic-Assisted Gait Therapy on Depression and Anxiety Symptoms in Patients with Subacute Spinal Cord Injuries (SCIs)-A Prospective Clinical Study. J Clin Med 2023; 12:7153. [PMID: 38002765 PMCID: PMC10672092 DOI: 10.3390/jcm12227153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI. METHODS A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State-Trait Anxiety Inventory (STAI X-1). RESULTS SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p < 0.001, r = 0.43; STAI X-1: Z = -6.20, p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = -4.93; KPD: Z = -5.26; SR: Z = -3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = -4.01; KPD: Z = -3.65; SR: Z = -2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State-Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors. CONCLUSIONS Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT.
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Affiliation(s)
- Alicja Widuch-Spodyniuk
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Justyna Wiśniowska
- Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
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Kim J, Kim Y, Kang S, Kim SJ. Investigation with able-bodied subjects suggests Myosuit may potentially serve as a stair ascent training robot. Sci Rep 2023; 13:14099. [PMID: 37644147 PMCID: PMC10465530 DOI: 10.1038/s41598-023-35769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/23/2023] [Indexed: 08/31/2023] Open
Abstract
Real world settings are seldomly just composed of level surfaces and stairs are frequently encountered in daily life. Unfortunately, ~ 90% of the elderly population use some sort of compensation pattern in order to negotiate stairs. Because the biomechanics required to successfully ascend stairs is significantly different from level walking, an independent training protocol is warranted. Here, we present as a preliminary investigation with 11 able-bodied subjects, prior to clinical trials, whether Myosuit could potentially serve as a stair ascent training robot. Myosuit is a soft wearable exosuit that was designed to assist the user via hip and knee extension during the early stance phase. We hypothesized that clinical studies could be carried out if the lower limb kinematics, sensory feedback via plantar force, and electromyography (EMG) patterns do not deviate from the user's physiological stair ascent patterns while reducing hip and knee extensor demand. Our results suggest that Myosuit conserves the user's physiological kinematic and plantar force patterns. Moreover, we observe approximately 20% and 30% decrease in gluteus maximus and vastus medialis EMG levels in the pull up phase, respectively. Collectively, Myosuit reduces the hip and knee extensor demand during stair ascent without any introduction of significant compensation patterns.
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Affiliation(s)
- Jaewook Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Yekwang Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Seonghyun Kang
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea.
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Hasson CJ, Manczurowsky J, Collins EC, Yarossi M. Neurorehabilitation robotics: how much control should therapists have? Front Hum Neurosci 2023; 17:1179418. [PMID: 37250692 PMCID: PMC10213717 DOI: 10.3389/fnhum.2023.1179418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Robotic technologies for rehabilitating motor impairments from neurological injuries have been the focus of intensive research and capital investment for more than 30 years. However, these devices have failed to convincingly demonstrate greater restoration of patient function compared to conventional therapy. Nevertheless, robots have value in reducing the manual effort required for physical therapists to provide high-intensity, high-dose interventions. In most robotic systems, therapists remain outside the control loop to act as high-level supervisors, selecting and initiating robot control algorithms to achieve a therapeutic goal. The low-level physical interactions between the robot and the patient are handled by adaptive algorithms that can provide progressive therapy. In this perspective, we examine the physical therapist's role in the control of rehabilitation robotics and whether embedding therapists in lower-level robot control loops could enhance rehabilitation outcomes. We discuss how the features of many automated robotic systems, which can provide repeatable patterns of physical interaction, may work against the goal of driving neuroplastic changes that promote retention and generalization of sensorimotor learning in patients. We highlight the benefits and limitations of letting therapists physically interact with patients through online control of robotic rehabilitation systems, and explore the concept of trust in human-robot interaction as it applies to patient-robot-therapist relationships. We conclude by highlighting several open questions to guide the future of therapist-in-the-loop rehabilitation robotics, including how much control to give therapists and possible approaches for having the robotic system learn from therapist-patient interactions.
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Affiliation(s)
- Christopher J. Hasson
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
- Department of Bioengineering, Northeastern University, Boston, MA, United States
- Institute for Experiential Robotics, Northeastern University, Boston, MA, United States
| | - Julia Manczurowsky
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Emily C. Collins
- Institute for Experiential Robotics, Northeastern University, Boston, MA, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
- Institute for Experiential Robotics, Northeastern University, Boston, MA, United States
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
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Swank C, Holden A, McDonald L, Driver S, Callender L, Bennett M, Sikka S. Foundational ingredients of robotic gait training for people with incomplete spinal cord injury during inpatient rehabilitation (FIRST): A randomized controlled trial protocol. PLoS One 2022; 17:e0267013. [PMID: 35536844 PMCID: PMC9089894 DOI: 10.1371/journal.pone.0267013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
As technological advances allow the use of robotic exoskeleton devices with gait training, there is a critical need to establish a robotic gait training (RGT) program to meet the needs of people with spinal cord injury (SCI) during inpatient rehabilitation. The purposes of this study are to prospectively examine the efficacy of a stakeholder informed RGT program compared to usual care gait training (UC) during inpatient rehabilitation in people with incomplete SCI and compare the intensity of RGT and UC gait training during inpatient rehabilitation.
Study design
128 patients with incomplete SCI admitted to our inpatient rehabilitation facility will be screened for eligibility and randomized to either the RGT or UC group. RGT sessions will use the Ekso robotic exoskeleton [class II medical device (United States FDA)]. UC sessions will use traditional gait training approaches such as manually assisted overground gait training with walkers and orthotics and body weight–supported treadmill training (BWSTT). Our primary outcome is gait function as characterized by the Walking Index for Spinal Cord Injury–II (WISCI-II). Secondary outcomes are gait speed, Spinal Cord Independence Measure (SCIM), Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale (FSS), Penn Spasm Frequency Scale (PSFS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder– 7 (GAD-7), International Spinal Cord Injury Quality of Life Basic Data Set, and a Qualitative Questionnaire. Assessments of primary and secondary outcomes will occur at admission and discharge from inpatient rehabilitation. General or generalized linear models will be used to analyze differences between groups for all measures.
Clinical impact
Successful completion of this study will provide a usable, replicable, stakeholder informed RGT intervention for use with individuals with incomplete SCI during inpatient rehabilitation.
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Affiliation(s)
- Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Alexandria Holden
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
- * E-mail:
| | - Lacy McDonald
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Simon Driver
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Librada Callender
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
| | - Monica Bennett
- Baylor Scott & White Health, Dallas, Texas, United States of America
| | - Seema Sikka
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, United States of America
- Baylor Scott & White Health, Dallas, Texas, United States of America
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Shin J, Yang S, Park C, Lee Y, You SJH. Comparative effects of passive and active mode robot-assisted gait training on brain and muscular activities in sub-acute and chronic stroke. NeuroRehabilitation 2022; 51:51-63. [PMID: 35311717 DOI: 10.3233/nre-210304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) was initially developed based on the passive controlled (PC) mode, where the target or ideal locomotor kinematic trajectory is predefined and a patient basically 'rides' the robot instead of actively participating in the actual locomotor relearning process. A new insightful contemporary neuroscience and mechatronic evidence suggest that robotic-based locomotor relearning can be best achieved through active interactive (AI) mode rather than PC mode. OBJECTIVE The purpose of this study was to compare the pattern of gait-related cortical activity, specifically gait event-related spectral perturbations (ERSPs), and muscle activity from the tibialis anterior (TA) and clinical functional tests in subacute and chronic stroke patients during robot-assisted gait training (RAGT) in passive controlled (PC) and active interactive (AI) modes. METHODS The present study involves a two-group pretest-posttest design in which two groups (i.e., PC-RAGT group and AI-RAGT group) of 14 stroke subjects were measured to assess changes in ERSPs, the muscle activation of TA, and the clinical functional tests, following 15- 18 sessions of intervention according to the protocol of each group. RESULTS Our preliminary results demonstrated that the power in the μ band (8- 12 Hz) was increased in the leg area of sensorimotor cortex (SMC) and supplementary motor area (SMA) at post-intervention as compared to pre-intervention in both groups. Such cortical neuroplasticity change was associated with TA muscle activity during gait and functional independence in functional ambulation category (FAC) and motor coordination in Fugl- Meyer Assessment for lower extremity (FMA-LE) test as well as spasticity in the modified Ashworth scale (MAS) measures. CONCLUSIONS We have first developed a novel neuroimaging experimental paradigm which distinguished gait event related cortical involvement between pre- and post-intervention with PC-RAGT and AI-RAGT in individuals with subacute and chronic hemiparetic stroke.
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Affiliation(s)
- Jiwon Shin
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Sejung Yang
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Yongseok Lee
- Myongji-Choonhey Rehabilitation Hospital, Seoul, Republic of Korea
| | - Sung Joshua H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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Suzuki H, Imajo Y, Funaba M, Nishida N, Sakamoto T, Sakai T. Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury. Front Cell Neurosci 2022; 15:794692. [PMID: 35185471 PMCID: PMC8850278 DOI: 10.3389/fncel.2021.794692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic spinal cord injury (SCI) is a devastating condition that results in major neurological deficits and social burden. It continues to be managed symptomatically, and no real therapeutic strategies have been devised for its treatment. Neural stem/neural progenitor cells (NSCs/NPCs) being used for the treatment of chronic SCI in experimental SCI models can not only replace the lost cells and remyelinate axons in the injury site but also support their growth and provide neuroprotective factors. Currently, several clinical studies using NSCs/NPCs are underway worldwide. NSCs/NPCs also have the potential to differentiate into all three neuroglial lineages to regenerate neural circuits, demyelinate denuded axons, and provide trophic support to endogenous cells. This article explains the challenging pathophysiology of chronic SCI and discusses key NSC/NPC-based techniques having the greatest potential for translation over the next decade.
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
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Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Adaptive Direct Teaching Control with Variable Load of the Lower Limb Rehabilitation Robot (LLR-II). MACHINES 2021. [DOI: 10.3390/machines9080142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most lower limb rehabilitation robots use fixed training trajectories and lack participation of physiotherapists. In addition, there is a lack of attention on combining direct teaching function with rehabilitation robots, which enables physiotherapists to plan trajectories directly. In this paper, an adaptive direct teaching function with variable load that can be applied to the sitting/lying lower limb rehabilitation robot-II (LLR-II) is proposed. First, the structural design and electrical system of LLR-II are introduced. The dynamic equation of LLR-II considering joint flexibility is derived and analyzed. Then, the impact of joint flexibility on LLR-II is reduced by introducing the intermediate input variables. Based on this, the control law of the dragging teaching stage and the replay stage in the direct teaching function with variable load is designed and the adaptive control strategy eliminates the influence of different patients. In addition, the control law is simulated and verified. Finally, some preliminary experiments of the adaptive direct teaching function with variable load on LLR-II are carried out, and the results showed that the control law has good performance, which lays the foundation for future work.
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Biomechanical Assessment of Adapting Trajectory and Human-Robot Interaction Stiffness in Impedance-Controlled Ankle Orthosis. J INTELL ROBOT SYST 2021. [DOI: 10.1007/s10846-021-01423-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fricke SS, Bayón C, der Kooij HV, F. van Asseldonk EH. Automatic versus manual tuning of robot-assisted gait training in people with neurological disorders. J Neuroeng Rehabil 2020; 17:9. [PMID: 31992322 PMCID: PMC6986041 DOI: 10.1186/s12984-019-0630-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/27/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In clinical practice, therapists choose the amount of assistance for robot-assisted training. This can result in outcomes that are influenced by subjective decisions and tuning of training parameters can be time-consuming. Therefore, various algorithms to automatically tune the assistance have been developed. However, the assistance applied by these algorithms has not been directly compared to manually-tuned assistance yet. In this study, we focused on subtask-based assistance and compared automatically-tuned (AT) robotic assistance with manually-tuned (MT) robotic assistance. METHODS Ten people with neurological disorders (six stroke, four spinal cord injury) walked in the LOPES II gait trainer with AT and MT assistance. In both cases, assistance was adjusted separately for various subtasks of walking (in this study defined as control of: weight shift, lateral foot placement, trailing and leading limb angle, prepositioning, stability during stance, foot clearance). For the MT approach, robotic assistance was tuned by an experienced therapist and for the AT approach an algorithm that adjusted the assistance based on performances for the different subtasks was used. Time needed to tune the assistance, assistance levels and deviations from reference trajectories were compared between both approaches. In addition, participants evaluated safety, comfort, effect and amount of assistance for the AT and MT approach. RESULTS For the AT algorithm, stable assistance levels were reached quicker than for the MT approach. Considerable differences in the assistance per subtask provided by the two approaches were found. The amount of assistance was more often higher for the MT approach than for the AT approach. Despite this, the largest deviations from the reference trajectories were found for the MT algorithm. Participants did not clearly prefer one approach over the other regarding safety, comfort, effect and amount of assistance. CONCLUSION Automatic tuning had the following advantages compared to manual tuning: quicker tuning of the assistance, lower assistance levels, separate tuning of each subtask and good performance for all subtasks. Future clinical trials need to show whether these apparent advantages result in better clinical outcomes.
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Affiliation(s)
- Simone S. Fricke
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Cristina Bayón
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Jamwal PK, Hussain S, Ghayesh MH. Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies. Proc Inst Mech Eng H 2020; 234:444-457. [PMID: 31916511 DOI: 10.1177/0954411919898293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The application of robotic devices in providing physiotherapies to post-stroke patients and people suffering from incomplete spinal cord injuries is rapidly expanding. It is crucial to provide valid rehabilitation for people who are experiencing abnormality in their gait performance; therefore, design and development of newer robotic devices for the purpose of facilitating patients' recovery is being actively researched. In order to advance the traditional gait treatment among patients, exoskeletons and orthoses were introduced over the last two decades. This article presents a thorough review of existing robotic gait rehabilitation devices. The latest advancements in the mechanical design, types of control and actuation are also covered. The study comprehends discussions on robotic rehabilitation devices developed both for the training on treadmill and over-ground training. The assist-as-needed strategy for the gait training is particularly emphasized while reviewing various control strategies applied to these robotic devices. This study further reviews experimental investigations and clinical assessments of different control strategies and mechanism designs of robotic gait rehabilitation devices using experimental and clinical trials.
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Affiliation(s)
- Prashant K Jamwal
- Department of Electrical and Computer Engineering, Nazarbayev University, Astana, Kazakhstan
| | - Shahid Hussain
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Mergen H Ghayesh
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
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14
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Physiotherapists' Experiences Using the Ekso Bionic Exoskeleton with Patients in a Neurological Rehabilitation Hospital: A Qualitative Study. Rehabil Res Pract 2020; 2020:2939573. [PMID: 32395347 PMCID: PMC7199547 DOI: 10.1155/2020/2939573] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/27/2019] [Indexed: 01/01/2023] Open
Abstract
Use of bionic overground exoskeletons to assist with neurological rehabilitation is becoming increasingly prevalent and has important implications for physiotherapists and their patients. Yet, there is a paucity of research about the impact of integrating this technology on physiotherapists' work. The purpose of this study was to explore how the training and implementation of using the Ekso robotic exoskeleton with patients affects physiotherapists' work. An exploratory qualitative study of three physiotherapists working at a neurological rehabilitation centre in Eastern Canada was conducted using one-on-one semistructured interviews in July 2017. Audio recordings were transcribed verbatim, and data was coded and analyzed using thematic analysis. Six themes emerged from the data: developing organizational capacity; ethical use of technology; benefits of the equipment; challenges of the equipment; cognitive workload; and the technological environment. The results suggest that the adoption and integration of bionic exoskeletons into rehabilitation practice is not as simple as training physiotherapists and giving them the device. More research is needed to understand the increased cognitive demands of working with patients using technologically advanced exoskeletons within a dynamic, technology-rich healthcare environment, while managing patient expectations and ethical use.
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15
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Malik RN, Eginyan G, Lynn AK, Lam T. Improvements in skilled walking associated with kinematic adaptations in people with spinal cord injury. J Neuroeng Rehabil 2019; 16:107. [PMID: 31455357 PMCID: PMC6712602 DOI: 10.1186/s12984-019-0575-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction Individuals with motor-incomplete SCI (m-iSCI) remain limited community ambulators, partly because they have difficulty with the skilled walking requirements of everyday life that require adaptations in inter-joint coordination and range of motion of the lower limbs. Following locomotor training, individuals with SCI show improvements in skilled walking and walking speed, however there is limited understanding of how adaptations in lower limb kinematics following training contribute to improvements in walking. Objective To determine the relationship between changes in lower limb kinematics (range of motion and inter-joint coordination) and improvements in walking function (walking speed and skilled walking) following locomotor training. Methods Lower limb kinematics were recorded from 8 individuals with chronic m-iSCI during treadmill walking before and after a 3-month locomotor training program. Data were also collected from 5 able-bodied individuals to provide normative values. In individuals with SCI, muscle strength was used to define the stronger and weaker limb. Motion analysis was used to determine, hip, knee and ankle angles. Joint angle-angle plots (cyclograms) were used to quantify inter-joint coordination. Shape differences between pre-and post-training cyclograms were used to assess the changes in coordination and their relation to improvements in walking function. Walking function was assessed using the 10MWT for walking speed and the SCI-FAP for skilled walking. Comparing pre- and post-training cyclograms to the able-bodied pattern was used to understand the extent to which changes in coordination involved the recovery of normative motor patterns. Results Following training, improvements in skilled walking were significantly related to changes in hip-ankle coordination (ρ = − .833, p = 0.010) and knee range of motion (ρ = .833, p = 0.010) of the weaker limb. Inter-joint coordination tended to revert towards normative patterns, but not completely. No relationships were observed with walking speed. Conclusion Larger changes in hip-ankle coordination and a decrease in knee range of motion in the weaker limb during treadmill walking were related to improvements in skilled walking following locomotor training in individuals with SCI. The changes in coordination seem to reflect some restoration of normative patterns and the adoption of compensatory strategies, depending on the participant.
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Affiliation(s)
- Raza N Malik
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada. .,International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Andrea K Lynn
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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16
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New Motion Intention Acquisition Method of Lower Limb Rehabilitation Robot Based on Static Torque Sensors. SENSORS 2019; 19:s19153439. [PMID: 31390739 PMCID: PMC6696509 DOI: 10.3390/s19153439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/20/2022]
Abstract
The rehabilitation robot is an application of robotic technology for people with limb disabilities. This paper investigates a new applicable and effective sitting/lying lower limb rehabilitation robot (the LLR-Ro). In order to improve the patient’s training initiative and accelerate the rehabilitation process, a new motion intention acquisition method based on static torque sensors is proposed. This motion intention acquisition method is established through the dynamics modeling of human–machine coordination, which is built on the basis of Lagrangian equations. Combined with the static torque sensors installed on the mechanism leg joint axis, the LLR-Ro can obtain the active force from the patient’s leg. Based on the variation of the patient’s active force and the kinematic functional relationship of the patient’s leg end point, the patient motion intention is obtained and used in the proposed active rehabilitation training method. The simulation experiment demonstrates the correctness of mechanism leg dynamics equations through ADAMS software and MATLAB software. The calibration experiment of the joint torque sensors’ combining limit range filter with an average value filter provides the hardware support for active rehabilitation training. The consecutive variation of the torque sensors from just the mechanism leg weight, as well as both the mechanism leg and the patient leg weights, obtains the feasibility of lower limb motion intention acquisition.
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17
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Abstract
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.
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18
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Zimmermann G, Bolter L, Sluka R, Höller Y, Bathke AC, Thomschewski A, Leis S, Lattanzi S, Brigo F, Trinka E. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: A systematic review. J Evid Based Med 2019; 12:200-208. [PMID: 31231977 PMCID: PMC6771853 DOI: 10.1111/jebm.12356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
AIM Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small-sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. METHODS We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health-related outcomes was assessed by means of a hypothesis test. If at least one group had a size <20, the study was classified as a small sample size study. PubMed was searched for eligible studies; subsequently, data on sample sizes and statistical methods were extracted and summarized descriptively. RESULTS Out of 8897 studies 207 were included. Median total sample size was 18 (range 4-582). Small sample sizes were found in 167/207 (81%) studies, resulting limitations and implications for statistical analyses were mentioned in 109/167 (65%) studies. CONCLUSIONS Although most recent SCI trials have been conducted with small samples, the consequences on statistical analysis methods and the validity of the results are rarely acknowledged.
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Affiliation(s)
- Georg Zimmermann
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | | | - Ronny Sluka
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Yvonne Höller
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Arne C. Bathke
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | - Aljoscha Thomschewski
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Stefan Leis
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Division of NeurologyFranz Tappeiner HospitalMeranoItaly
| | - Eugen Trinka
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Department of Public HealthHealth Services Research and Health Technology Assessment, UMITHall i. T.Austria
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19
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Abstract
OBJECTIVE Advancements in robot-assisted gait rehabilitation and brain-machine interfaces may enhance stroke physiotherapy by engaging patients while providing information about robot-induced cortical adaptations. We investigate the feasibility of decoding walking from brain activity in stroke survivors during therapy using a powered exoskeleton integrated with an electroencephalography-based brain-machine interface. DESIGN The H2 powered exoskeleton was designed for overground gait training with actuated hip, knee, and ankle joints. It was integrated with active-electrode electroencephalography and evaluated in hemiparetic stroke survivors for 12 sessions per 4 wks. A continuous-time Kalman decoder operating on delta-band electroencephalography was designed to estimate gait kinematics. RESULTS Five chronic stroke patients completed the study with improvements in walking distance and speed training for 4 wks, correlating with increased offline decoding accuracy. Accuracies of predicted joint angles improved with session and gait speed, suggesting an improved neural representation for gait, and the feasibility to design an electroencephalography-based brain-machine interface to monitor brain activity or control a rehabilitative exoskeleton. CONCLUSIONS The Kalman decoder showed increased accuracies as the longitudinal training intervention progressed in the stroke participants. These results demonstrate the feasibility of studying changes in patterns of neuroelectric cortical activity during poststroke rehabilitation and represent the first step in developing a brain-machine interface for controlling powered exoskeletons.
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20
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Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health. J Sport Rehabil 2019; 28:505-516. [DOI: 10.1123/jsr.2017-0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Cheung EYY, Yu KKK, Kwan RLC, Ng CKM, Chau RMW, Cheing GLY. Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - a randomized controlled trial. BMC Neurol 2019; 19:140. [PMID: 31234791 PMCID: PMC6591819 DOI: 10.1186/s12883-019-1361-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI. METHODS Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30 min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group. RESULTS Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) (p = 0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score (p < 0.001), bilateral symmetry (p = 0.048), maximal oxygen consumption (p = 0.014) and peak expiratory flow rate (p = 0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level. CONCLUSION The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness. TRIAL REGISTRATION The study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in ClinicalTrials.gov on 20 November 2013, with reference number NCT01989806 .).
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Affiliation(s)
- Eddy Yu Yeung Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.,Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Kevin Ka Ki Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.,University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Rachel Lai Chu Kwan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Carmen Ka Man Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Rosanna Mei Wa Chau
- Physiotherapy Department, Kowloon Hospital, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Gladys Lai Ying Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China. .,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Swank C, Sikka S, Driver S, Bennett M, Callender L. Feasibility of integrating robotic exoskeleton gait training in inpatient rehabilitation. Disabil Rehabil Assist Technol 2019; 15:409-417. [PMID: 30887864 DOI: 10.1080/17483107.2019.1587014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Learning to walk is a major goal of inpatient rehabilitation and robotic exoskeletons may provide a new gait training approach. Our purpose was to determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population.Design: Longitudinal cohort design and convenience sample including physical therapists trained to use the Ekso Bionics Ekso GT™ robotic exoskeleton or inpatients with stroke or SCI. Therapists completed a focus group and survey at baseline and 6 months after initial Ekso training. Patients completed a survey indicating their satisfaction with using the Ekso.Results: Twenty-five patients used the Ekso an average of 4.5 sessions during their 38.5-day rehabilitation stay. Survey and focus group feedback revealed that therapists encountered measurement difficulties with the Ekso and limited treatment time influencing effectiveness of usage. After 6 months, therapists reported an improvement in feasibility. Patients tolerated Ekso sessions well, without any complications or adverse incidents, and reported improved mobility post session.Conclusion: Integrating Ekso gait training into clinical practice was not seamless but appears feasible. Barriers were addressed within the rehabilitation team and received administrative support in a process lasting several months. Patients enjoyed walking in Ekso and felt secure within the device.Implications for rehabilitationIntegrating Ekso gait training into clinical practice during inpatient rehabilitation is feasible.Overcoming barriers to implementation required administrative support and clinician persistence over several months.Patients tolerated Ekso sessions well, without any complications or adverse incidents.
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Affiliation(s)
- Chad Swank
- NCS Research Scientist, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- NCS Research Scientist, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Simon Driver
- NCS Research Scientist, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Monica Bennett
- NCS Research Scientist, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Librada Callender
- NCS Research Scientist, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
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Abstract
Improving walking function is a desirable outcome in rehabilitation and of high importance for social and vocational reintegration for persons with neurologic-related gait impairment. Robots for lower limb gait rehabilitation are designed principally to help automate repetitive labor-intensive training during neurorehabilitation. These include tethered exoskeletons, end-effector devices, untethered exoskeletons, and patient-guided suspension systems. This article reviews the first 3 categories and briefly mentions the fourth. Research is needed to further define the therapeutic applications of these devices. Additional technical improvements are expected regarding device size, controls, and battery life for untethered devices.
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Affiliation(s)
- Alberto Esquenazi
- MossRehab Gait and Motion Analysis Laboratory, 60 Township Line, Elkins Park, PA 19027, USA.
| | - Mukul Talaty
- MossRehab Gait and Motion Analysis Laboratory, 60 Township Line, Elkins Park, PA 19027, USA
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Swank C, Wang-Price S, Gao F, Almutairi S. Walking With a Robotic Exoskeleton Does Not Mimic Natural Gait: A Within-Subjects Study. JMIR Rehabil Assist Technol 2019; 6:e11023. [PMID: 31344681 PMCID: PMC6682279 DOI: 10.2196/11023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/06/2018] [Accepted: 08/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics. Objective The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait. Methods The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 force plates and a surface electromyography (EMG) system captured temporospatial and kinematic gait parameters and lower extremity muscle activity. For each condition, data for 5 walking trials were collected and included for analysis. Results Differences were observed between the 2 conditions in temporospatial gait parameters of speed, stride length, and double-limb support time. When wearing EKSO, hip and ankle range of motion (ROM) were reduced and knee ROM increased during the stance phase. However, during the swing phase, knee and ankle ROM were reduced when wearing the exoskeleton bionic suit. When wearing EKSO, EMG activity decreased bilaterally in the stance phase for all muscle groups of the lower extremities and in the swing phase for the distal muscle groups (tibialis anterior and soleus) as well as the left medial hamstrings. Conclusions Wearing EKSO altered temporospatial gait parameters, lower extremity kinematics, and muscle activity during gait in healthy adults. EKSO appears to promote a type of gait that is disparate from normal gait in first-time users. More research is needed to determine the impact on gait training with EKSO in people with gait impairments.
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Affiliation(s)
- Chad Swank
- Texas Woman's University, Dallas, TX, United States
| | | | - Fan Gao
- University of Kentucky, Lexington, KY, United States
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25
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Kodani A, Kikuchi T, Tohda C. Acteoside Improves Muscle Atrophy and Motor Function by Inducing New Myokine Secretion in Chronic Spinal Cord Injury. J Neurotrauma 2019; 36:1935-1948. [PMID: 30318996 PMCID: PMC6599386 DOI: 10.1089/neu.2018.6000] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic spinal cord injury (SCI) is difficult to cure, even by several approaches effective at the acute or subacute phase. We focused on skeletal muscle atrophy as a detrimental factor in chronic SCI and explored drugs that protect against muscle atrophy and activate secretion of axonal growth factors from skeletal muscle. We found that acteoside induced the secretion of axonal growth factors from skeletal muscle cells and proliferation of these cells. Intramuscular injection of acteoside in mice with chronic SCI recovered skeletal muscle weight reduction and motor function impairment. We also identified pyruvate kinase isoform M2 (PKM2) as a secreted factor from skeletal muscle cells, stimulated by acteoside. Extracellular PKM2 enhanced proliferation of skeletal muscle cells and axonal growth in cultured neurons. Further, we showed that PKM2 might cross the blood–brain barrier. These results indicate that effects of acteoside on chronic SCI might be mediated by PKM2 secretion from skeletal muscles. This study proposes that the candidate drug acteoside and a new myokine, PKM2, could be used for the treatment of chronic SCI.
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Affiliation(s)
- Atsushi Kodani
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
| | - Takahiro Kikuchi
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
| | - Chihiro Tohda
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
- Address correspondence to: Chihiro Tohda, PhD, Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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26
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Ma H, Zhong C, Chen B, Chan KM, Liao WH. User-Adaptive Assistance of Assistive Knee Braces for Gait Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1994-2005. [PMID: 30188836 DOI: 10.1109/tnsre.2018.2868693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patients suffering from neurological and orthopedic diseases or injuries usually have mobility impairment problems, and they require customized rehabilitation training to recover. In recent years, robotic assistive devices have been widely studied for gait rehabilitation. In this paper, methods to determine user-adaptive assistance of assistive knee braces (AKBs) in gait rehabilitation are investigated. A fuzzy expert system, which takes a patient's physical condition and gait analysis results as inputs, is proposed to configure suitable levels of different assistive functions of the AKB. During gait rehabilitation, the AKB generates a reference knee trajectory according to the patient's individual gait pattern, and the interaction force is controlled through a hybrid impedance controller considering the individual assistive function configuration. The proposed methods are verified through clinical pilot studies of a patient with lower limb weakness. Experimental results show that AKB with the proposed control strategies can provide effective assistance to improve the patient's gait performance during gait rehabilitation.
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Hayes SC, James Wilcox CR, Forbes White HS, Vanicek N. The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review. J Spinal Cord Med 2018; 41:529-543. [PMID: 29400988 PMCID: PMC6117598 DOI: 10.1080/10790268.2018.1426236] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Robotic assisted gait training (RAGT) technology can be used as a rehabilitation tool or as an assistive device for spinal cord injured (SCI) individuals. Its impact on upright stepping characteristics of SCI individuals using treadmill or overground robotic exoskeleton systems has yet to be established. OBJECTIVE To systematically review the literature and identify if overground or treadmill based RAGT use in SCI individuals elicited differences in temporal-spatial characteristics and functional outcome measures. METHODS A systematic search of the literature investigating overground and treadmill RAGT in SCIs was undertaken excluding case-studies and case-series. Studies were included if the primary outcomes were temporal-spatial gait parameters. Study inclusion and methodological quality were assessed and determined independently by two reviewers. Methodological quality was assessed using a validated scoring system for randomized and non-randomized trials. RESULTS Twelve studies met all inclusion criteria. Participant numbers ranged from 5-130 with injury levels from C2 to T12, American Spinal Injuries Association A-D. Three studies used overground RAGT systems and the remaining nine focused on treadmill based RAGT systems. Primary outcome measures were walking speed and walking distance. The use of treadmill or overground based RAGT did not result in an increase in walking speed beyond that of conventional gait training and no studies reviewed enabled a large enough improvement to facilitate community ambulation. CONCLUSION The use of RAGT in SCI individuals has the potential to benefit upright locomotion of SCI individuals. Its use should not replace other therapies but be incorporated into a multi-modality rehabilitation approach.
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Affiliation(s)
| | - Christopher Richard James Wilcox
- School of Life Sciences, University of Hull, Hull, UK,Correspondence to: Dr. Christopher Richard James Wilcox, School of Life Sciences, University of Hull, Don Building, Cottingham Road, Hull, HU6 7RX, UK.
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Wang H, Feng Y, Yu H, Wang Z, Vladareanuv V, Du Y. Mechanical design and trajectory planning of a lower limb rehabilitation robot with a variable workspace. INT J ADV ROBOT SYST 2018. [DOI: 10.1177/1729881418776855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The early phase of extremity rehabilitation training has high potential impact for stroke patients. However, most of the lower limb rehabilitation robots in hospitals are proposed just suitable for patients at the middle or later recovery stage. This article investigates a new sitting/lying multi-joint lower limb rehabilitation robot. It can be used at all recovery stages, including the initial stage. Based on man–machine engineering and the innovative design for mechanism, the leg length of the lower limb rehabilitation robot is automatically adjusted to fit patients with different heights. The lower limb rehabilitation robot is a typical human–machine system, and the limb safety of the patient is the most important principle to be considered in its design. The hip joint rotation ranges are different in people’s sitting and lying postures. Different training postures cannot make the training workspace unique. Besides the leg lengths and joint rotation angles varied with different patients, the idea of variable workspace of the lower limb rehabilitation robot is first proposed. Based on the variable workspace, three trajectory planning methods are developed. In order to verify the trajectory planning methods, an experimental study has been conducted. Theoretical and actual curves of the hip rotation, knee rotation, and leg mechanism end point motion trajectories are obtained for three unimpaired subjects. Most importantly, a clinical trial demonstrated the safety and feasibility of the proposed lower limb rehabilitation robot.
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Affiliation(s)
- Hongbo Wang
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China
| | - Yongfei Feng
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China
| | - Hongnian Yu
- Faculty of Science and Technology, Bournemouth University, Dorset, UK
| | - Zhenghui Wang
- Department of Recovery Medicine, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | | | - Yaxin Du
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China
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Abstract
To investigate how motor sensation facilitates learning, we used a sensory–motor association task to determine whether the sensation induced by forced movements contributes to performance improvements in rats. The rats were trained to respond to a tactile stimulus (an air puff) by releasing a lever pressed by the stimulated (compatible condition) or nonstimulated (incompatible condition) forepaw. When error rates fell below 15%, the compatibility condition was changed (reversal learning). An error trial was followed by a lever activation trial in which a lever on the correct or the incorrect response side was automatically elevated at a preset time of 120, 220, 320, or 420 ms after tactile stimulation. This lever activation induced forepaw movement similar to that in a voluntary lever release response, and also induced body movement that occasionally caused elevation of the other forepaw. The effects of lever activation may have produced a sensation similar to that of voluntary lever release by the forepaw on the nonactivated lever. We found that the performance improvement rate was increased by the lever activation procedure on the incorrect response side (i.e., with the nonactivated lever on the correct response side). Furthermore, the performance improvement rate changed depending on the timing of lever activation: Facilitative effects were largest with lever activation on the incorrect response side at 320 ms after tactile stimulation, whereas hindering effects were largest for lever activation on the correct response side at 220 ms after tactile stimulation. These findings suggest that forced movements, which provide tactile and proprioceptive stimulation, affect sensory–motor associative learning in a time-dependent manner.
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A Lower Limb Rehabilitation Robot in Sitting Position with a Review of Training Activities. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:1927807. [PMID: 29808109 PMCID: PMC5901836 DOI: 10.1155/2018/1927807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/03/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
Abstract
Robots for stroke rehabilitation at the lower limbs in sitting/lying position have been developed extensively. Some of them have been applied in clinics and shown the potential of the recovery of poststroke patients who suffer from hemiparesis. These robots were developed to provide training at different joints of lower limbs with various activities and modalities. This article reviews the training activities that were realized by rehabilitation robots in literature, in order to offer insights for developing a novel robot suitable for stroke rehabilitation. The control system of the lower limb rehabilitation robot in sitting position that was introduced in the previous work is discussed in detail to demonstrate the behavior of the robot while training a subject. The nonlinear impedance control law, based on active assistive control strategy, is able to define the response of the robot with more specifications while the passivity property and the robustness of the system is verified. A preliminary experiment is conducted on a healthy subject to show that the robot is able to perform active assistive exercises with various training activities and assist the subject to complete the training with desired level of assistance.
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Chang SH, Afzal T, Berliner J, Francisco GE. Exoskeleton-assisted gait training to improve gait in individuals with spinal cord injury: a pilot randomized study. Pilot Feasibility Stud 2018; 4:62. [PMID: 29556414 PMCID: PMC5839068 DOI: 10.1186/s40814-018-0247-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022] Open
Abstract
Background Robotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. This pilot study investigated the feasibility of offering exoskeleton-assisted gait training (EGT) on gait in individuals with incomplete spinal cord injury (iSCI) in preparation for a phase III RCT. The objective was to assess treatment reliability and potential efficacy of EGT and conventional physical therapy (CPT). Methods Forty-four individuals were screened, and 13 were eligible to participate in the study. Nine participants consented and were randomly assigned to receive either EGT or CPT with focus on gait. Subjects received EGT or CPT, five sessions a week (1 h/session daily) for 3 weeks. American Spinal Injury Association (ASIA) Lower Extremity Motor Score (LEMS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG) test, and gait characteristics including stride and step length, cadence and stance, and swing phase durations were assessed at the pre- and immediate post- training. Mean difference estimates with 95% confidence intervals were used to analyze the differences. Results After training, improvement was observed in the 6MWT for the EGT group. The CPT group showed significant improvement in the TUG test. Both the EGT and the CPT groups showed significant increase in the right step length. EGT group also showed improvement in the stride length. Conclusion EGT could be applied to individuals with iSCI to facilitate gait recovery. The subjects were able to tolerate the treatment; however, exoskeleton size range may be a limiting factor in recruiting larger cohort of patients. Future studies with larger sample size are needed to investigate the effectiveness and efficacy of exoskeleton-assisted gait training as single gait training and combined with other gait training strategies. Trial registration Clinicaltrials.org, NCT03011099, retrospectively registered on January 3, 2017.
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Affiliation(s)
- Shuo-Hsiu Chang
- 1Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston, 1333 Moursund Street, Houston, TX 77030 USA.,2Center for Wearable Exoskeletons, NeuroRecovery Research Center at TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030 USA
| | - Taimoor Afzal
- 1Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston, 1333 Moursund Street, Houston, TX 77030 USA.,2Center for Wearable Exoskeletons, NeuroRecovery Research Center at TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030 USA
| | | | | | - Gerard E Francisco
- 1Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston, 1333 Moursund Street, Houston, TX 77030 USA.,2Center for Wearable Exoskeletons, NeuroRecovery Research Center at TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030 USA.,3TIRR Memorial Hermann, 1333 Moursund Street, Houston, TX 77030 USA
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Rajasekaran V, López-Larraz E, Trincado-Alonso F, Aranda J, Montesano L, Del-Ama AJ, Pons JL. Volition-adaptive control for gait training using wearable exoskeleton: preliminary tests with incomplete spinal cord injury individuals. J Neuroeng Rehabil 2018; 15:4. [PMID: 29298691 PMCID: PMC5751847 DOI: 10.1186/s12984-017-0345-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gait training for individuals with neurological disorders is challenging in providing the suitable assistance and more adaptive behaviour towards user needs. The user specific adaptation can be defined based on the user interaction with the orthosis and by monitoring the user intentions. In this paper, an adaptive control model, commanded by the user intention, is evaluated using a lower limb exoskeleton with incomplete spinal cord injury individuals (SCI). METHODS A user intention based adaptive control model has been developed and evaluated with 4 incomplete SCI individuals across 3 sessions of training per individual. The adaptive control model modifies the joint impedance properties of the exoskeleton as a function of the human-orthosis interaction torques and the joint trajectory evolution along the gait sequence, in real time. The volitional input of the user is identified by monitoring the neural signals, pertaining to the user's motor activity. These volitional inputs are used as a trigger to initiate the gait movement, allowing the user to control the initialization of the exoskeleton movement, independently. A Finite-state machine based control model is used in this set-up which helps in combining the volitional orders with the gait adaptation. RESULTS The exoskeleton demonstrated an adaptive assistance depending on the patients' performance without guiding them to follow an imposed trajectory. The exoskeleton initiated the trajectory based on the user intention command received from the brain machine interface, demonstrating it as a reliable trigger. The exoskeleton maintained the equilibrium by providing suitable assistance throughout the experiments. A progressive change in the maximum flexion of the knee joint was observed at the end of each session which shows improvement in the patient performance. Results of the adaptive impedance were evaluated by comparing with the application of a constant impedance value. Participants reported that the movement of the exoskeleton was flexible and the walking patterns were similar to their own distinct patterns. CONCLUSIONS This study demonstrates that user specific adaptive control can be applied on a wearable robot based on the human-orthosis interaction torques and modifying the joints' impedance properties. The patients perceived no external or impulsive force and felt comfortable with the assistance provided by the exoskeleton. The main goal of such a user dependent control is to assist the patients' needs and adapt to their characteristics, thus maximizing their engagement in the therapy and avoiding slacking. In addition, the initiation directly controlled by the brain allows synchronizing the user's intention with the afferent stimulus provided by the movement of the exoskeleton, which maximizes the potentiality of the system in neuro-rehabilitative therapies.
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Affiliation(s)
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | | | - Joan Aranda
- Departamento de Automatic e Control, Universitat Politécnica de Catalunya, Barcelona-Tech, Barcelona, Spain
| | - Luis Montesano
- Departamento de Informatica e Ingenería de Sistemas and, Instituto de Investigacion en Ingeneria de Aragon (I3A), University of Zaragoza, Zaragoza, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids unit, National Hospital for Spinal cord injury, Toledo, Spain
| | - Jose L Pons
- Neural Rehabilitation group, Spanish National Research Council (CSIC), Cajal Institute, Madrid, Spain
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Holanda LJ, Silva PMM, Amorim TC, Lacerda MO, Simão CR, Morya E. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil 2017; 14:126. [PMID: 29202845 PMCID: PMC5715997 DOI: 10.1186/s12984-017-0338-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is characterized by a total or partial deficit of sensory and motor pathways. Impairments of this injury compromise muscle recruitment and motor planning, thus reducing functional capacity. SCI patients commonly present psychological, intestinal, urinary, osteomioarticular, tegumentary, cardiorespiratory and neural alterations that aggravate in chronic phase. One of the neurorehabilitation goals is the restoration of these abilities by favoring improvement in the quality of life and functional independence. Current literature highlights several benefits of robotic gait therapies in SCI individuals. OBJECTIVES The purpose of this study was to compare the robotic gait devices, and systematize the scientific evidences of these devices as a tool for rehabilitation of SCI individuals. METHODS A systematic review was carried out in which relevant articles were identified by searching the following databases: Cochrane Library, PubMed, PEDro and Capes Periodic. Two authors selected the articles which used a robotic device for rehabilitation of spinal cord injury. RESULTS Databases search found 2941 articles, 39 articles were included due to meet the inclusion criteria. The robotic devices presented distinct features, with increasing application in the last years. Studies have shown promising results regarding the reduction of pain perception and spasticity level; alteration of the proprioceptive capacity, sensitivity to temperature, vibration, pressure, reflex behavior, electrical activity at muscular and cortical level, classification of the injury level; increase in walking speed, step length and distance traveled; improvements in sitting posture, intestinal, cardiorespiratory, metabolic, tegmental and psychological functions. CONCLUSIONS This systematic review shows a significant progress encompassing robotic devices as an innovative and effective therapy for the rehabilitation of individuals with SCI.
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Affiliation(s)
- Ledycnarf J Holanda
- Neuroengineering Program, Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Rodovia RN 160, Km 03, 3001 Distrito Jundiaí, Macaíba, 59280-000, Brazil.
| | - Patrícia M M Silva
- Neuroengineering Program, Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Rodovia RN 160, Km 03, 3001 Distrito Jundiaí, Macaíba, 59280-000, Brazil
| | - Thiago C Amorim
- Neuroengineering Program, Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Rodovia RN 160, Km 03, 3001 Distrito Jundiaí, Macaíba, 59280-000, Brazil
| | - Matheus O Lacerda
- Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho Lagoa Nova, Natal, 59078-970, Brazil
| | - Camila R Simão
- Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho Lagoa Nova, Natal, 59078-970, Brazil.,Anita Garibaldi Center of Education and Research in Health, Santos Dumont Institute, Rodovia RN 160, Km 02, 2010 Distrito Jundiaí, Macaíba, 59280-970, Brazil
| | - Edgard Morya
- Neuroengineering Program, Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Rodovia RN 160, Km 03, 3001 Distrito Jundiaí, Macaíba, 59280-000, Brazil.,Anita Garibaldi Center of Education and Research in Health, Santos Dumont Institute, Rodovia RN 160, Km 02, 2010 Distrito Jundiaí, Macaíba, 59280-970, Brazil
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Liu Q, Liu A, Meng W, Ai Q, Xie SQ. Hierarchical Compliance Control of a Soft Ankle Rehabilitation Robot Actuated by Pneumatic Muscles. Front Neurorobot 2017; 11:64. [PMID: 29255412 PMCID: PMC5722812 DOI: 10.3389/fnbot.2017.00064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022] Open
Abstract
Traditional compliance control of a rehabilitation robot is implemented in task space by using impedance or admittance control algorithms. The soft robot actuated by pneumatic muscle actuators (PMAs) is becoming prominent for patients as it enables the compliance being adjusted in each active link, which, however, has not been reported in the literature. This paper proposes a new compliance control method of a soft ankle rehabilitation robot that is driven by four PMAs configured in parallel to enable three degrees of freedom movement of the ankle joint. A new hierarchical compliance control structure, including a low-level compliance adjustment controller in joint space and a high-level admittance controller in task space, is designed. An adaptive compliance control paradigm is further developed by taking into account patient’s active contribution and movement ability during a previous period of time, in order to provide robot assistance only when it is necessarily required. Experiments on healthy and impaired human subjects were conducted to verify the adaptive hierarchical compliance control scheme. The results show that the robot hierarchical compliance can be online adjusted according to the participant’s assessment. The robot reduces its assistance output when participants contribute more and vice versa, thus providing a potentially feasible solution to the patient-in-loop cooperative training strategy.
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Affiliation(s)
- Quan Liu
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.,Key Lab of Fiber Optic Sensing Technology and Information Processing, Wuhan University of Technology, Wuhan, China
| | - Aiming Liu
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.,Key Lab of Fiber Optic Sensing Technology and Information Processing, Wuhan University of Technology, Wuhan, China
| | - Wei Meng
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.,Key Lab of Fiber Optic Sensing Technology and Information Processing, Wuhan University of Technology, Wuhan, China.,Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand
| | - Qingsong Ai
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.,Key Lab of Fiber Optic Sensing Technology and Information Processing, Wuhan University of Technology, Wuhan, China
| | - Sheng Q Xie
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.,Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand.,School of Electrical and Electronic Engineering, University of Leeds, Leeds, United Kingdom.,School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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Capelari TV, Borin JS, Grigol M, Saccani R, Zardo F, Cechetti F. EVALUATION OF MUSCLE STRENGTH IN MEDULLAR INJURY: A LITERATURE REVIEW. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604179802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the tools used to evaluate muscle strength in subjects with spinal cord injury in both clinical practice and scientific research. Methods: Initially, the literature review was carried out to identify the tools used in scientific research. The search was conducted in the following databases: Virtual Health Library (VHL), Pedro, and PubMed. Studies published between 1990 and 2016 were considered and selected, depicting an evaluation of muscle strength as an endpoint or for characterization of the sample. Next, a survey was carried out with physiotherapists to identify the instruments used for evaluation in clinical practice, and the degree of satisfaction of professionals with respect to them. Results: 495 studies were found; 93 were included for qualitative evaluation. In the studies, we verified the use of manual muscle test with different graduation systems, isokinetic dynamometer, hand-held dynamometer, and manual dynamometer. In clinical practice, the manual muscle test using the motor score recommended by the American Spinal Cord Injury Association was the most used method, despite the limitations highlighted by the physiotherapists interviewed. Conclusion: In scientific research, there is great variation in the methods and tools used to evaluate muscle strength in individuals with spinal cord injury, differently from clinical practice. The tools available and currently used have important limitations, which were highlighted by the professionals interviewed. No instrument depicts direct relationship of muscle strength and functionality of the subject. There is no consensus as to the best method for assessing muscle strength in spinal cord injury, and new instruments are needed that are specific for use in this population.
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Affiliation(s)
| | | | - Melissa Grigol
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Figueiredo J, Felix P, Santos CP, Moreno JC. Towards human-knee orthosis interaction based on adaptive impedance control through stiffness adjustment. IEEE Int Conf Rehabil Robot 2017; 2017:406-411. [PMID: 28813853 DOI: 10.1109/icorr.2017.8009281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rehabilitation interventions involving powered, wearable lower limb orthoses that can provide high-challenging locomotor tasks for repetitive training sessions, mainly when assist-as-needed strategies, such as adaptive impedance control, are designed. In this study, the adaptive behavior was ensured by software control of the robotic stiffness involved in the human-knee orthosis interaction in function of the gait cycle and speed. To estimate the stiffness, we analyzed the interaction torque-angle characteristics with experimental data. The speed-stiffness dependency was more evident when high stiffness values are demanded by the user's effort. Experimental evidence from five healthy subjects highlight that the adaptive control strategy provides a more comfortable, natural motion, and kinematic freedom as compared to the trajectory tracking control, allowing the user to contribute to the gait training. Future insights cover the implementation of gravitational compensation and real-time estimation and control of all inner dynamic properties of the impedance control law.
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Research on Safety and Compliance of a New Lower Limb Rehabilitation Robot. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:1523068. [PMID: 29065571 PMCID: PMC5549508 DOI: 10.1155/2017/1523068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/16/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022]
Abstract
The lower limb rehabilitation robot is an application of robotic technology for stroke people with lower limb disabilities. A new applicable and effective sitting/lying lower limb rehabilitation robot (LLR-Ro) is proposed, which has the mechanical limit protection, the electrical limit protection, and the software protection to prevent the patient from the secondary damage. Meanwhile, as a new type of the rehabilitation robots, its hip joint rotation ranges are different in the patient sitting training posture and lying training posture. The mechanical leg of the robot has a variable workspace to work in both training postures. So, if the traditional mechanical limit and the electrical limit cannot be used in the hip joint mechanism design, a follow-up limit is first proposed to improve the compatibility of human-machine motion. Besides, to eliminate the accident interaction force between the patient and LLR-Ro in the process of the passive training, an amendment impedance control strategy based on the position control is proposed to improve the compliance of the LLR-Ro. A simulation experiment and an experiment with a participant show that the passive training of LLR-Ro has compliance.
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Li J, Chen D, Fan Y. An Open-Structure Treadmill Gait Trainer: From Research to Application. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9053630. [PMID: 29065662 PMCID: PMC5494776 DOI: 10.1155/2017/9053630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/26/2017] [Indexed: 11/17/2022]
Abstract
Lower limb rehabilitation robots are designed to enhance gait function in individuals with motor impairments. Although numerous rehabilitation robots have been developed, only few of these robots have been used in practical health care, particularly in China. The objective of this study is to construct a lower limb rehabilitation robot and bridge the gap between research and application. Open structure to facilitate practical application was created for the whole robot. Three typical movement patterns of a single leg were adopted in designing the exoskeletons, and force models for patient training were established and analyzed under three different conditions, respectively, and then a control system and security strategy were introduced. After establishing the robot, a preliminary experiment on the actual use of a prototype by patients was conducted to validate the functionality of the robot. The experiment showed that different patients and stages displayed different performances, and results on the trend variations across patients and across stages confirmed the validity of the robot and suggested that the design may lead to a system that could be successful in the treatment of patients with walking disorders in China. Furthermore, this study could provide a reference for a similar application design.
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Affiliation(s)
- Jian Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age and Disability and Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs and Engineering Research Center for Rehabilitation Aids of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
- Robotic Institute, Beihang University, Beijing 100191, China
| | - Diansheng Chen
- Robotic Institute, Beihang University, Beijing 100191, China
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age and Disability and Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs and Engineering Research Center for Rehabilitation Aids of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
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Gandhi P, Chan K, Verrier MC, Pakosh M, Musselman KE. Training to Improve Walking after Pediatric Spinal Cord Injury: A Systematic Review of Parameters and Walking Outcomes. J Neurotrauma 2017; 34:1713-1725. [PMID: 27869534 DOI: 10.1089/neu.2016.4501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Walking or locomotor training is often initiated following pediatric spinal cord injury (SCI). There is no synthesis of the literature on interventions targeting walking for pediatric SCI, although this would assist future clinical trials and interventions. To address this need, we completed a systematic review to summarize the who, what, when, and how of walking interventions in children with SCI. Participant characteristics, training parameters, and walking outcomes with training in pediatric SCI were identified and compared with training parameters and outcomes in adults with SCI. The PubMed, Medline, AMED, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for studies that included participants aged 1-17 years with a SCI acquired post-birth, physical interventions, and pre- and post-training walking measures. Two researchers evaluated each study's risk of bias using a domain-based approach. Training parameters and walking outcomes were extracted. Total training duration (duration × frequency × number of weeks) was calculated. Thirteen pediatric studies (n = 43 children) were included; all but one were case series/reports. Risk of bias was high in the pediatric studies. A 2012 adult review was updated (11 studies added). As with adults, the training durations, frequencies, and modes used with the children varied; however, overground walking practice was included in 10/13 pediatric studies. Improvements in walking capacity, speed, and distance were comparable between children and adults. There was a trend for greater gains with greater total training durations. There is a paucity of high-quality research examining interventions targeting walking after pediatric SCI; however, intensive training, including practice overground, results in notable improvements.
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Affiliation(s)
- Payal Gandhi
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Katherine Chan
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Mary C Verrier
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
| | - Maureen Pakosh
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
| | - Kristin E Musselman
- 1 Toronto Rehabilitation Institute-University Health Network , Toronto, Ontario, Canada
- 2 Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto , Toronto, Ontario, Canada
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41
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Mercier C, Roosink M, Bouffard J, Bouyer LJ. Promoting Gait Recovery and Limiting Neuropathic Pain After Spinal Cord Injury. Neurorehabil Neural Repair 2016; 31:315-322. [PMID: 27913797 PMCID: PMC5405804 DOI: 10.1177/1545968316680491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most persons living with a spinal cord injury experience neuropathic pain in the months following their lesion, at the moment where they receive intensive gait rehabilitation. Based on studies using animal models, it has been proposed that central sensitization in nociceptive pathways (maladaptive plasticity) and plasticity related to motor learning (adaptive plasticity) share common neural mechanisms and compete with each other. This article aims to address the discrepancy between the growing body of basic science literature supporting this hypothesis and the general belief in rehabilitation research that pain and gait rehabilitation represent two independent problems. First, the main findings from basic research showing interactions between nociception and learning in the spinal cord will be summarized, focusing both on evidence demonstrating the impact of nociception on motor learning and of motor learning on central sensitization. Then, the generalizability of these findings in animal models to humans will be discussed. Finally, the way potential interactions between nociception and motor learning are currently taken into account in clinical research in patients with spinal cord injury will be presented. To conclude, recommendations will be proposed to better integrate findings from basic research into future clinical research in persons with spinal cord injury.
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Affiliation(s)
- Catherine Mercier
- 1 Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec City, Quebec, Canada.,2 Laval University, Quebec City, Quebec, Canada
| | - Meyke Roosink
- 1 Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec City, Quebec, Canada
| | - Jason Bouffard
- 1 Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec City, Quebec, Canada.,2 Laval University, Quebec City, Quebec, Canada
| | - Laurent J Bouyer
- 1 Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec City, Quebec, Canada.,2 Laval University, Quebec City, Quebec, Canada
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42
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Sharp KG, Gramer R, Page SJ, Cramer SC. Increased Brain Sensorimotor Network Activation after Incomplete Spinal Cord Injury. J Neurotrauma 2016; 34:623-631. [PMID: 27528274 DOI: 10.1089/neu.2016.4503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
After complete spinal cord injury (SCI), activation during attempted movement of paralyzed limbs is sharply reduced, but after incomplete SCI-the more common form of human injury-it is unknown how attempts to move voluntarily are accompanied by activation of brain motor and sensory networks. Here, we assessed brain activation during ankle movement in subjects with incomplete SCI, among whom voluntary motor function is partially preserved. Adults with incomplete SCI (n = 20) and healthy controls (n = 15) underwent functional magnetic resonance imaging that alternated rest with 0.3-Hz right ankle dorsiflexion. In both subject groups, ankle movement was associated with bilateral activation of primary and secondary sensory and motor areas, with significantly (p < 0.001) greater activation in subjects with SCI within right hemisphere areas, including primary sensorimotor cortex and pre-motor cortex. This result was further evaluated using linear regression analysis with respect to core clinical variables. Poorer locomotor function correlated with larger activation within several right hemisphere areas, including pre- and post-central gyri, possibly reflecting increased movement complexity and effort, whereas longer time post-SCI was associated with larger activation in left post-central gyrus and bilateral supplementary motor area, which may reflect behaviorally useful adaptations. The results indicate that brain adaptations after incomplete SCI differ sharply from complete SCI, are related to functional behavioral status, and evolve with increasing time post-SCI. The results suggest measures that might be useful for understanding and treating incomplete SCI in human subjects.
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Affiliation(s)
- Kelli G Sharp
- 1 Reeve-Irvine Research Center, University of California , Irvine, Irvine, California.,2 Department of Dance, University of California , Irvine, Irvine, California
| | - Robert Gramer
- 3 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California , Irvine, Irvine, California
| | - Stephen J Page
- 4 Division of Occupational Therapy, The Ohio State University Medical Center , Columbus, Ohio
| | - Steven C Cramer
- 1 Reeve-Irvine Research Center, University of California , Irvine, Irvine, California.,3 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California , Irvine, Irvine, California.,5 The Sue and Bill Gross Stem Cell Research Center, University of California , Irvine, Irvine, California
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43
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Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, Filoni S. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurol 2016; 16:12. [PMID: 26818847 PMCID: PMC4730780 DOI: 10.1186/s12883-016-0536-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury (SCI) is a severe neurological disorder associated not only with ongoing medical complications but also with a significant loss of mobility and participation. The introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. The aim of this preliminary report were to evaluate the efficacy, the feasibility and the changes in the mobility and in the de-adaptations of a new rehabilitative protocol for EKSO™ a robotic exoskeleton device in subjects with SCI disease with an impairment of lower limbs assessed by gait analysis and clinical outcomes. Method This is a pilot single case experimental A-B (pre-post) design study. Three cognitively intact voluntary participants with SCI and gait disorders were admitted. All subjects were submitted to a training program of robot walking sessions for 45 min daily over 20 sessions. The spatiotemporal parameters at the beginning (T0) and at the end of treatment (T1) were recorded. Other clinical assessments (6 min walking test and Timed Up and Go test) were acquired at T0 and T1. Results Robot training were feasible and acceptable and all participants completed the training sessions. All subjects showed improvements in gait spatiotemporal indexes (Mean velocity, Cadence, Step length and Step width) and in 6 min Walking Test (T0 versus T1). Conclusions Robot training is a feasible form of rehabilitation for people with SCI. Further investigation regarding long term effectiveness of robot training in time is necessary. Trial registration ClinicalTrials.gov NCT02065830.
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Affiliation(s)
- Patrizio Sale
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy.
| | | | - Michele Russo
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Francesco Piccione
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
| | - Rocco Salvatore Calabrò
- Neurobehavioral and Robotic Neurorehabilitation Laboratory Coordinator IRCCS Centro, Neurolesi "Bonino-Pulejo" Messina, Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
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Gomes-Osman J, Cortes M, Guest J, Pascual-Leone A. A Systematic Review of Experimental Strategies Aimed at Improving Motor Function after Acute and Chronic Spinal Cord Injury. J Neurotrauma 2016; 33:425-38. [PMID: 26415105 DOI: 10.1089/neu.2014.3812] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
While various approaches have been proposed in clinical trials aimed at improving motor function after spinal cord injury in humans, there is still limited information regarding the scope, methodological quality, and evidence associated with single-intervention and multi-intervention approaches. A systematic review performed using the PubMed search engine and the key words "spinal cord injury motor recovery" identified 1973 records, of which 39 were selected (18 from the search records and 21 from reference list inspection). Study phase ( clinicaltrials.org criteria) and methodological quality (Cochrane criteria) were assessed. Studies included proposed a broad range of single-intervention (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) (encompassing cell therapies, pharmacology, electrical stimulation, rehabilitation) and multi-intervention approaches (that combined more than one strategy). The highest evidence level was for Phase III studies supporting the role of multi-intervention approaches that contained a rehabilitation component. Quality appraisal revealed that the percentage of selected studies classified with high risk of bias by Cochrane criteria was as follows: random sequence generation = 64%; allocation concealment = 77%; blinding of participants and personnel = 69%; blinding of outcome assessment = 64%; attrition = 44%; selective reporting = 44%. The current literature contains a high proportion of studies with a limited ability to measure efficacy in a valid manner because of low methodological strength in all items of the Cochrane risk of bias assessment. Recommendations to decrease bias are discussed and include increased methodological rigor in the study design and recruitment of study participants, and the use of electrophysiological and imaging measures that can assess functional integrity of the spinal cord (and may be sufficiently sensitive to detect changes that occur in response to therapeutic interventions).
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Affiliation(s)
- Joyce Gomes-Osman
- 1 Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Mar Cortes
- 2 Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke Medical Research Institute , Weill Cornell Medical College, White Plains, New York
| | - James Guest
- 3 Department of Neurological Surgery, The Miami Project to Cure Paralysis, Lois Pope LIFE Centre, Miller School of Medicine , Miami, Florida
| | - Alvaro Pascual-Leone
- 1 Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
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45
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Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci 2016; 37:503-14. [PMID: 26781943 DOI: 10.1007/s10072-016-2474-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/18/2022]
Abstract
Gait abnormalities following neurological disorders are often disabling, negatively affecting patients' quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one's ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson's disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.
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Abedi M, Moghaddam MM, Firoozabadi M. A neuromechanical modeling of spinal cord injury locomotor system for simulating the rehabilitation effects. Biocybern Biomed Eng 2016. [DOI: 10.1016/j.bbe.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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47
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García-Cossio E, Severens M, Nienhuis B, Duysens J, Desain P, Keijsers N, Farquhar J. Decoding Sensorimotor Rhythms during Robotic-Assisted Treadmill Walking for Brain Computer Interface (BCI) Applications. PLoS One 2015; 10:e0137910. [PMID: 26675472 PMCID: PMC4686050 DOI: 10.1371/journal.pone.0137910] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022] Open
Abstract
Locomotor malfunction represents a major problem in some neurological disorders like stroke and spinal cord injury. Robot-assisted walking devices have been used during rehabilitation of patients with these ailments for regaining and improving walking ability. Previous studies showed the advantage of brain-computer interface (BCI) based robot-assisted training combined with physical therapy in the rehabilitation of the upper limb after stroke. Therefore, stroke patients with walking disorders might also benefit from using BCI robot-assisted training protocols. In order to develop such BCI, it is necessary to evaluate the feasibility to decode walking intention from cortical patterns during robot-assisted gait training. Spectral patterns in the electroencephalogram (EEG) related to robot-assisted active and passive walking were investigated in 10 healthy volunteers (mean age 32.3±10.8, six female) and in three acute stroke patients (all male, mean age 46.7±16.9, Berg Balance Scale 20±12.8). A logistic regression classifier was used to distinguish walking from baseline in these spectral EEG patterns. Mean classification accuracies of 94.0±5.4% and 93.1±7.9%, respectively, were reached when active and passive walking were compared against baseline. The classification performance between passive and active walking was 83.4±7.4%. A classification accuracy of 89.9±5.7% was achieved in the stroke patients when comparing walking and baseline. Furthermore, in the healthy volunteers modulation of low gamma activity in central midline areas was found to be associated with the gait cycle phases, but not in the stroke patients. Our results demonstrate the feasibility of BCI-based robotic-assisted training devices for gait rehabilitation.
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Affiliation(s)
- Eliana García-Cossio
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- * E-mail:
| | - Marianne Severens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Research Development & Education Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Bart Nienhuis
- Research Development & Education Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jacques Duysens
- Research Development & Education Department, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Peter Desain
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Nöel Keijsers
- Research Development & Education Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jason Farquhar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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48
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Robot-Assisted Passive Exercise for Ankle Hypertonia in Individuals with Chronic Spinal Cord Injury. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0059-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Menon N, Gupta A, Khanna M, Taly AB. Ambulation following spinal cord injury and its correlates. Ann Indian Acad Neurol 2015; 18:167-70. [PMID: 26019413 PMCID: PMC4445191 DOI: 10.4103/0972-2327.150605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022] Open
Abstract
Objectives: To assess walking ability of spinal cord injury (SCI) patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males) between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years), mean duration of injury was 85.3 ± 97.6 days (range 14-365 days) and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days) in the study. Walking Index for spinal cord injury (WISCI II) was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI) and Spinal Cord Independence Measures (SCIM). Neurological recovery was assessed using ASIA impairment scale (AIS). We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001) when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03). Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6) and neurological recovery were found to be very significant (P < 0.001) when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores) and functional status (using BI and SCIM scores) (P < 0.001). Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.
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Affiliation(s)
- Nitin Menon
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arun B Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Neurology, National Institute of Mental Health and Neuro Sciences National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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50
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Robotic-Assisted Gait Training in Neurological Patients: Who May Benefit? Ann Biomed Eng 2015; 43:1260-9. [DOI: 10.1007/s10439-015-1283-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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