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Mahdian ZS, Wang H, Refai MIM, Durandau G, Sartori M, MacLean MK. Tapping Into Skeletal Muscle Biomechanics for Design and Control of Lower Limb Exoskeletons: A Narrative Review. J Appl Biomech 2023; 39:318-333. [PMID: 37751903 DOI: 10.1123/jab.2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
Lower limb exoskeletons and exosuits ("exos") are traditionally designed with a strong focus on mechatronics and actuation, whereas the "human side" is often disregarded or minimally modeled. Muscle biomechanics principles and skeletal muscle response to robot-delivered loads should be incorporated in design/control of exos. In this narrative review, we summarize the advances in literature with respect to the fusion of muscle biomechanics and lower limb exoskeletons. We report methods to measure muscle biomechanics directly and indirectly and summarize the studies that have incorporated muscle measures for improved design and control of intuitive lower limb exos. Finally, we delve into articles that have studied how the human-exo interaction influences muscle biomechanics during locomotion. To support neurorehabilitation and facilitate everyday use of wearable assistive technologies, we believe that future studies should investigate and predict how exoskeleton assistance strategies would structurally remodel skeletal muscle over time. Real-time mapping of the neuromechanical origin and generation of muscle force resulting in joint torques should be combined with musculoskeletal models to address time-varying parameters such as adaptation to exos and fatigue. Development of smarter predictive controllers that steer rather than assist biological components could result in a synchronized human-machine system that optimizes the biological and electromechanical performance of the combined system.
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Affiliation(s)
- Zahra S Mahdian
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Huawei Wang
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | | | - Guillaume Durandau
- Department of Mechanical Engineering, McGill University, Montreal, QC, Canada
| | - Massimo Sartori
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Mhairi K MacLean
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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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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Gillespie J, Arnold D, Trammell M, Bennett M, Ochoa C, Driver S, Callender L, Sikka S, Dubiel R, Swank C. Utilization of overground exoskeleton gait training during inpatient rehabilitation: a descriptive analysis. J Neuroeng Rehabil 2023; 20:102. [PMID: 37542322 PMCID: PMC10401799 DOI: 10.1186/s12984-023-01220-w] [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: 03/07/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Overground exoskeleton gait training (OEGT) after neurological injury is safe, feasible, and may yield positive outcomes. However, no recommendations exist for initiation, progression, or termination of OEGT. This retrospective study highlights the clinical use and decision-making of OEGT within the physical therapy plan of care for patients after neurological injury during inpatient rehabilitation. METHODS The records of patients admitted to inpatient rehabilitation after stroke, spinal cord injury, or traumatic brain injury who participated in at least one OEGT session were retrospectively reviewed. Session details were analyzed to illustrate progress and included: "up" time, "walk" time, step count, device assistance required for limb swing, and therapist-determined settings. Surveys were completed by therapists responsible for OEGT sessions to illuminate clinical decision-making. RESULTS On average, patients demonstrated progressive tolerance for OEGT over successive sessions as shown by increasing time upright and walking, step count, and decreased assistance required by the exoskeleton. Therapists place preference on using OEGT with patients with more functional dependency and assess feedback from the patient and device to determine when to change settings. OEGT is terminated when other gait methods yield higher step repetitions or intensities, or to prepare for discharge. CONCLUSION Our descriptive retrospective data suggests that patients after neurological injury may benefit from OEGT during inpatient rehabilitation. As no guidelines exist, therapists' clinical decisions are currently based on a combination of knowledge of motor recovery and experience. Future efforts should aim to develop evidence-based recommendations to facilitate functional recovery after neurological injury by leveraging OEGT.
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Affiliation(s)
- Jaime Gillespie
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA.
| | - Dannae Arnold
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Molly Trammell
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Monica Bennett
- Baylor Scott and White Research Institute, 3434 Live Oak St., Dallas, TX, 75204, USA
| | - Christa Ochoa
- Baylor Scott and White Research Institute, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Simon Driver
- Baylor Scott and White Research Institute, 3434 Live Oak St., Dallas, TX, 75204, USA
| | - Librada Callender
- Baylor Scott and White Research Institute, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Rosemary Dubiel
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA
| | - Chad Swank
- Baylor Scott and White Research Institute and Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA
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Kim J, Kim Y, Moon J, Kong J, Kim SJ. Biomechanical Analysis of the Unaffected Limb While Using a Hands-Free Crutch. J Funct Morphol Kinesiol 2023; 8:jfmk8020056. [PMID: 37218852 DOI: 10.3390/jfmk8020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Basic human ambulation relies on a bipedal gait, which has been reported to be directly related to quality of life. However, injuries to the lower limb can cause an inability to walk and require non-weightbearing periods to heal. Among the many ambulatory aids, standard axillary crutches are prescribed. However, due to the disadvantages of having to use both hands, a slow gait, pain, nerve damage, and gait patterns that differ from that of healthy subjects, currently, a new generation of ambulatory aids has emerged. Among such aids, hands-free crutches (HFCs) are of particular interest due to their form factor, which does not require the use of the hands and facilitates a bipedal gait. In this study, we present an assessment of whether any different gait patterns, compared to overground gait, appeared on the unaffected limb during walking with an HFC. The spatiotemporal parameters, plantar force, lower-limb joint angles, and EMG patterns were evaluated. In conclusion, the results from 10 healthy subjects suggest that wearing an HFC causes only slight changes in the biomechanical gait patterns examined in the unaffected limb compared with overground walking without an HFC.
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Affiliation(s)
- Jaewook Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Yekwang Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Juhui Moon
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Joo Kong
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Otálora S, Ballen-Moreno F, Arciniegas-Mayag L, Cifuentes CA, Múnera M. Biomechanical Effects of Adding an Ankle Soft Actuation in a Unilateral Exoskeleton. BIOSENSORS 2022; 12:bios12100873. [PMID: 36291010 PMCID: PMC9599070 DOI: 10.3390/bios12100873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 06/01/2023]
Abstract
Stroke disease leads to a partial or complete disability affecting muscle strength and functional mobility. Early rehabilitation sessions might induce neuroplasticity and restore the affected function or structure of the patients. Robotic rehabilitation minimizes the burden on therapists by providing repetitive and regularly monitored therapies. Commercial exoskeletons have been found to assist hip and knee motion. For instance, unilateral exoskeletons have the potential to become an effective training system for patients with hemiparesis. However, these robotic devices leave the ankle joint unassisted, essential in gait for body propulsion and weight-bearing. This article evaluates the effects of the robotic ankle orthosis T-FLEX during cooperative assistance with the AGoRA unilateral lower-limb exoskeleton (hip and knee actuation). This study involves nine subjects, measuring muscle activity and gait parameters such as stance and swing times. The results showed a reduction in muscle activity in the Biceps Femoris of 50%, Lateral Gastrocnemius of 59% and Tibialis Anterior of 35% when adding T-FLEX to the AGoRA unilateral lower-limb exoskeleton. No differences were found in gait parameters. Nevertheless, stability is preserved when comparing the two legs. Future works should focus on evaluating the devices in ground tests in healthy subjects and pathological patients.
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Affiliation(s)
- Sophia Otálora
- Graduate Program of Electrical Engineering, Federal University of Espirito Santo, Vitoria 29075-910, Brazil
| | - Felipe Ballen-Moreno
- Robotics & Multibody Mechanics (R&MM) Research Group, Department of Mechanical Engineering, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Flanders Make, 1050 Brussels, Belgium
| | - Luis Arciniegas-Mayag
- Graduate Program of Electrical Engineering, Federal University of Espirito Santo, Vitoria 29075-910, Brazil
| | - Carlos A. Cifuentes
- Bristol Robotics Laboratory, University of the West of England, Bristol BS16 1QY, UK
- School of Engineering, Science and Technology, Universidad del Rosario, Bogota 111711, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota 111166, Colombia
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Stroke survivor perceptions of using an exoskeleton during acute gait rehabilitation. Sci Rep 2022; 12:14185. [PMID: 35986162 PMCID: PMC9391354 DOI: 10.1038/s41598-022-18188-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022] Open
Abstract
Robotic-assisted gait training (RAGT) devices allow intensive high repetition of the gait cycle in individuals with locomotor disability, with reduced therapist effort. In addition to usual rehabilitation, RAGT post-stroke improves the likelihood of regaining independent walking, with maximum efficacy identified in the acute and subacute phases of stroke. This study explores the usability and acceptance of RAGT among persons with stroke in an acute hospital setting and examines users’ perceptions of two different modes of robotic assistance provided during rehabilitation. A mixed-methods approach comprised semi-structed interviews of end-user perspectives of RAGT in an acute hospital setting following stroke and two 10-point Likert scales rating how comfortable and how natural robotic gait felt using different assistance modes. Content analysis of qualitative data was undertaken with results synthesised by common meaning units. Quantitative data were reported using summary statistics, with Spearmann’s correlation co-efficient examining the relationship between Likert scale ratings and measures of participants’ stroke related disability. Ten individuals (6 men; 4 women; mean age of 64.5. ± 13 years) were recruited in an acute hospital setting following admission with a stroke diagnosis. Content analysis of interview transcripts identified discussion units centring around positive aspects of how helpful the device was, negative aspects related to set-up time, weight of the device and multiple instructions delivered during use. Initially participants identified that the device could look intimidating, and they feared falling in the device but they subsequently identified the correct mindset for using the device is to trust the technology and not be afraid. Mean ratings for device comfort (7.94 ± 1.4) and how natural walking felt (7.05 ± 1.9) were favourable. Interestingly, a strong relationship was identified, whereby the higher the level of disability, the more natural participants rated walking in the device during maximal assistance mode (rho = 0.62; p = 0.138). This study suggests individuals in the early phases of stroke perceive RAGT to be acceptable and helpful in the main, with some associated negative aspects. Walking in the device was rated as comfortable and natural. Those with greater disability rated the assisted walking as more natural.
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Kim J, Kim Y, Kang S, Kim SJ. Biomechanical Analysis Suggests Myosuit Reduces Knee Extensor Demand during Level and Incline Gait. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166127. [PMID: 36015888 PMCID: PMC9413953 DOI: 10.3390/s22166127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 05/31/2023]
Abstract
An FDA-approved soft wearable robot, the Myosuit, which was designed to provide hip and knee extension torque has recently been commercialized. While studies have reported reductions in metabolic costs, increased gait speeds, and improvements in clinical test scores, a comprehensive analysis of electromyography (EMG) signals and joint kinematics is warranted because the recruitment of appropriate muscle groups during physiological movement patterns facilitates effective motor learning. Here, we compared the lower limb joint kinematics and EMG patterns while wearing the Myosuit with that of unassisted conditions when performing level overground and incline treadmill gait. The level overground gait sessions (seven healthy subjects) were performed at self-selected speeds and the incline treadmill gait sessions (four healthy subjects) were performed at 2, 3, 4, and 5 km/h. In order to evaluate how the user is assisted, we conducted a biomechanical analysis according to the three major gait tasks: weight acceptance (WA), single-limb support, and limb advancement. The results from the gait sessions suggest that Myosuit not only well preserves the users' natural patterns, but more importantly reduce knee extensor demand during the WA phase for both level and incline gait.
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Kinematic Analysis of Exoskeleton-Assisted Community Ambulation: An Observational Study in Outdoor Real-Life Scenarios. SENSORS 2022; 22:s22124533. [PMID: 35746315 PMCID: PMC9228687 DOI: 10.3390/s22124533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: In neurorehabilitation, Wearable Powered Exoskeletons (WPEs) enable intensive gait training even in individuals who are unable to maintain an upright position. The importance of WPEs is not only related to their impact on walking recovery, but also to the possibility of using them as assistive technology; however, WPE-assisted community ambulation has rarely been studied in terms of walking performance in real-life scenarios. (2) Methods: This study proposes the integration of an Inertial Measurement Unit (IMU) system to analyze gait kinematics during real-life outdoor scenarios (regular, irregular terrains, and slopes) by comparing the ecological gait (no-WPE condition) and WPE-assisted gait in five able-bodied volunteers. The temporal parameters of gait and joint angles were calculated from data collected by a network of seven IMUs. (3) Results: The results showed that the WPE-assisted gait had less knee flexion in the stance phase and greater hip flexion in the swing phase. The different scenarios did not change the human–exoskeleton interaction: only the low-speed WPE-assisted gait was characterized by a longer double support phase. (4) Conclusions: The proposed IMU-based gait assessment protocol enabled quantification of the human–exoskeleton interaction in terms of gait kinematics and paved the way for the study of WPE-assisted community ambulation in stroke patients.
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Almutairi SM, Swank C, Wang-Price SS, Gao F, Medley A. Walking with and without a robotic exoskeleton in people with incomplete spinal cord injury compared to a typical gait pattern. NeuroRehabilitation 2021; 49:585-596. [PMID: 34542041 DOI: 10.3233/nre-210187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic exoskeleton (RE) enables individuals with lower extremity weakness or paralysis to stand and walk in a stereotypical pattern. OBJECTIVE Examine whether people with chronic incomplete spinal cord injury (SCI) demonstrate a more typical gait pattern when walking overground in a RE than when walking without. METHODS Motion analysis system synchronized with a surface electromyographic (EMG) was used to obtain temporospatial gait parameters, lower extremity kinematics, and muscle activity in ambulatory individuals with SCI and healthy adults. RESULTS Temporospatial parameters and kinematics for participants with SCI (n = 12; age 41.4±12.5 years) with and without RE were significantly different than a typical gait (healthy adults: n = 15; age 26.2±8.3 years). EMG amplitudes during the stance phase of a typical gait were similar to those with SCI with and without RE, except the right rectus femoris (p = 0.005) and left gluteus medius (p = 0.014) when participants with SCI walked with RE. EMG amplitudes of participants with SCI during the swing phase were significantly greater compared to those of a typical gait, except for left medial hamstring with (p = 0.025) and without (p = 0.196) RE. CONCLUSIONS First-time walking in a RE does not appear to produce a typical gait pattern in people with incomplete SCI.
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Affiliation(s)
- Sattam M Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, USA
| | | | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, USA
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, USA
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Infarinato F, Romano P, Goffredo M, Ottaviani M, Galafate D, Gison A, Petruccelli S, Pournajaf S, Franceschini M. Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke. Brain Sci 2021; 11:brainsci11040448. [PMID: 33915808 PMCID: PMC8066552 DOI: 10.3390/brainsci11040448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. Methods: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. Conclusions: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. Results: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects’ characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns.
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Affiliation(s)
- Francesco Infarinato
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Paola Romano
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Correspondence: ; Tel.: +39-0652252319
| | - Marco Ottaviani
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Daniele Galafate
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Annalisa Gison
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Simone Petruccelli
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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Swank C, Almutairi S, Wang-Price S, Gao F. Immediate kinematic and muscle activity changes after a single robotic exoskeleton walking session post-stroke. Top Stroke Rehabil 2020; 27:503-515. [PMID: 32077382 DOI: 10.1080/10749357.2020.1728954] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Robotic Exoskeletons (EKSO) are novel technology for retraining common gait dysfunction in people post-stroke. EKSO's capability to influence gait characteristics post-stroke is unknown. Objectives: To compare temporospatial, kinematic, and muscle activity gait characteristics before and after a single EKSO session and examine kinematic symmetry between involved and uninvolved limbs. Methods: Participants post-stroke walked under two conditions: pre-EKSO, and immediately post-EKSO. A 10-camera motion capture system synchronized with 6 force plates was used to obtain temporospatial and kinematic gait characteristics from 5 walking trials of 9 meters at a self-selected speed. Surface EMG activity was obtained from bilateral gluteus medius, rectus femoris, medial hamstrings, tibialis anterior, and soleus muscles. Wilcoxon Signed Rank tests were used to analyze differences pre- and post-EKSO. Single EKSO session consisted of 22.3±6.8 minutes total time (walk time=7.2±1.5 minutes) with 250±40 steps. Results: Six ambulatory (Functional Ambulation Category, range=4-5) adults (3 female; 44.7±14.6 years) with chronic stroke (4.5±1.9 years post-stroke) participated. No significant differences were observed for temporospatial gait characteristics. Muscle activity was significantly less post-EKSO in the involved leg rectus femoris during swing phase (p=0.028). Ankle dorsiflexion range of motion on the involved leg post-EKSO was significantly less during stance phase (p=0.046). Differences between involved and uninvolved joint range of motion symmetry were found pre-EKSO but not post-EKSO in swing phase hip flexion and stance phase knee flexion and knee extension. Conclusions: EKSO training appears capable of altering gait in people with chronic stroke and a viable intervention to reduce gait dysfunction post-stroke.
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Affiliation(s)
- Chad Swank
- Department of Rehabilitation Research, Baylor Scott & White Institute for Rehabilitation , Dallas, TX, USA
| | - Sattam Almutairi
- College of Medical Rehabilitation, Qassim University , Buraydah, Saudi Arabia
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA
| | - Fan Gao
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky , Lexington, KY, USA
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Exoskeleton for Gait Rehabilitation: Effects of Assistance, Mechanical Structure, and Walking Aids on Muscle Activations. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9142868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several exoskeletons have been developed and increasingly used in clinical settings for training and assisting locomotion. These devices allow people with severe motor deficits to regain mobility and sustain intense and repetitive gait training. However, three factors might affect normal muscle activations during walking: the assistive forces that are provided during walking, the crutches or walker that are always used in combination with the device, and the mechanical structure of the device itself. To investigate these effects, we evaluated eight healthy volunteers walking with the Ekso, which is a battery-powered, wearable exoskeleton. They walked supported by either crutches or a walker under five different assistance modalities: bilateral maximum assistance, no assistance, bilateral adaptive assistance, and unilateral adaptive assistance on each leg. Participants also walked overground without the exoskeleton. Surface electromyography was recorded bilaterally, and the statistical parametric mapping approach and muscle synergies analysis were used to investigate differences in muscular activity across different walking conditions. The lower limb muscle activations while walking with the Ekso were not influenced by the use of crutches or walker aids. Compared to normal walking without robotic assistance, the Ekso reduced the amplitude of activation for the distal lower limb muscles while changing the timing for the others. This depended mainly on the structure of the device, and not on the type or level of assistance. In fact, the presence of assistance did not change the timing of the muscle activations, but instead mainly had the effect of increasing the level of activation of the proximal lower limb muscles. Surprisingly, we found no significant changes in the adaptive control with respect to a maximal fixed assistance that did not account for subjects’ performance. These are important effects to take into careful considerations in clinics where these devices are used for gait rehabilitation in people with neurological diseases.
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