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Chang SR, Nandor MJ, Li L, Kobetic R, Foglyano KM, Schnellenberger JR, Audu ML, Pinault G, Quinn RD, Triolo RJ. A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia. J Neuroeng Rehabil 2017; 14:48. [PMID: 28558835 PMCID: PMC5450339 DOI: 10.1186/s12984-017-0258-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord injury (SCI). However, a self-contained muscle-driven controllable exoskeleton approach based on an implanted neural stimulator to restore walking has not been previously demonstrated, which could potentially result in system use outside the laboratory and viable for long term use or clinical testing. In this work, we designed and evaluated an untethered muscle-driven controllable exoskeleton to restore stepping in three individuals with paralysis from SCI. METHODS The self-contained HNP combined neural stimulation to activate the paralyzed muscles and generate joint torques for limb movements with a controllable lower limb exoskeleton to stabilize and support the user. An onboard controller processed exoskeleton sensor signals, determined appropriate exoskeletal constraints and stimulation commands for a finite state machine (FSM), and transmitted data over Bluetooth to an off-board computer for real-time monitoring and data recording. The FSM coordinated stimulation and exoskeletal constraints to enable functions, selected with a wireless finger switch user interface, for standing up, standing, stepping, or sitting down. In the stepping function, the FSM used a sensor-based gait event detector to determine transitions between gait phases of double stance, early swing, late swing, and weight acceptance. RESULTS The HNP restored stepping in three individuals with motor complete paralysis due to SCI. The controller appropriately coordinated stimulation and exoskeletal constraints using the sensor-based FSM for subjects with different stimulation systems. The average range of motion at hip and knee joints during walking were 8.5°-20.8° and 14.0°-43.6°, respectively. Walking speeds varied from 0.03 to 0.06 m/s, and cadences from 10 to 20 steps/min. CONCLUSIONS A self-contained muscle-driven exoskeleton was a feasible intervention to restore stepping in individuals with paraplegia due to SCI. The untethered hybrid system was capable of adjusting to different individuals' needs to appropriately coordinate exoskeletal constraints with muscle activation using a sensor-driven FSM for stepping. Further improvements for out-of-the-laboratory use should include implantation of plantar flexor muscles to improve walking speed and power assist as needed at the hips and knees to maintain walking as muscles fatigue.
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Affiliation(s)
- Sarah R Chang
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA. .,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Mark J Nandor
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lu Li
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rudi Kobetic
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Kevin M Foglyano
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - John R Schnellenberger
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Musa L Audu
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Gilles Pinault
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Roger D Quinn
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ronald J Triolo
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Orthopaedics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
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Van der Heide LA, van Ninhuijs B, Bergsma A, Gelderblom GJ, van der Pijl DJ, de Witte LP. An overview and categorization of dynamic arm supports for people with decreased arm function. Prosthet Orthot Int 2014; 38:287-302. [PMID: 23950551 DOI: 10.1177/0309364613498538] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assistive devices that augment arm function were already introduced during the polio era. Devices are still being developed, but a review has not been performed thus far. OBJECTIVE To create an overview and categorize assistive devices facilitating arm function in activities of daily living for people with decreased arm function. STUDY DESIGN Literature review. METHODS A systematic review in three scientific literature databases. Conference proceedings, assistive technology databases, and references were searched and experts consulted. This resulted in a database of dynamic arm supports. Product information was added, and the devices were categorized. RESULTS A total of 104 dynamic arm supports were found. These could be categorized as nonactuated devices (N = 39), passively actuated devices (N = 24), actively actuated devices (N = 34), or devices using the functional electrical stimulation principle (N = 7). Functionality analysis resulted in second-level categorization: tremor suppression, facilitation of anti-gravity movement, and assistance of specific joint motion. CONCLUSION All devices could be ordered in a categorization of low complexity. Many have been developed; most have disappeared and have been succeeded by similar devices. Limitations of the devices found mainly concern interfacing and the range of motion facilitated. Future devices could make use of whatever residual strength is available in the users' arm for control. CLINICAL RELEVANCE The provided overview of devices in this article and the classification developed is relevant for practitioners seeking assistive solutions for their clients as it makes the range of developed solutions both accessible and comprehensible.
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Affiliation(s)
- Loek A Van der Heide
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bob van Ninhuijs
- Department of Electrical Engineering, Electromechanics and Power Electronics Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arjen Bergsma
- Nijmegen Centre of Evidence Based Practice, Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert Jan Gelderblom
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | | | - Luc P de Witte
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Ragnarsson KT. Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions. Spinal Cord 2007; 46:255-74. [PMID: 17846639 DOI: 10.1038/sj.sc.3102091] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Repair of the injured spinal cord by regeneration therapy remains an elusive goal. In contrast, progress in medical care and rehabilitation has resulted in improved health and function of persons with spinal cord injury (SCI). In the absence of a cure, raising the level of achievable function in mobility and self-care will first and foremost depend on creative use of the rapidly advancing technology that has been so widely applied in our society. Building on achievements in microelectronics, microprocessing and neuroscience, rehabilitation medicine scientists have succeeded in developing functional electrical stimulation (FES) systems that enable certain individuals with SCI to use their paralyzed hands, arms, trunk, legs and diaphragm for functional purposes and gain a degree of control over bladder and bowel evacuation. This review presents an overview of the progress made, describes the current challenges and suggests ways to improve further FES systems and make these more widely available.
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Affiliation(s)
- K T Ragnarsson
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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