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Ivanenko Y, Shapkova EY, Petrova DA, Kleeva DF, Lebedev MA. Exoskeleton gait training with spinal cord neuromodulation. Front Hum Neurosci 2023; 17:1194702. [PMID: 37250689 PMCID: PMC10213721 DOI: 10.3389/fnhum.2023.1194702] [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: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Neuromodulating the locomotor network through spinal cord electrical stimulation (SCES) is effective for restoring function in individuals with gait deficits. However, SCES alone has limited effectiveness without concurrent locomotor function training that enhances activity-dependent plasticity of spinal neuronal networks by sensory feedback. This mini review discusses recent developments in using combined interventions, such as SCES added to exoskeleton gait training (EGT). To develop personalized therapies, it is crucial to assess the state of spinal circuitry through a physiologically relevant approach that identifies individual characteristics of spinal cord function to develop person-specific SCES and EGT. The existing literature suggests that combining SCES and EGT to activate the locomotor network can have a synergistic rehabilitative effect on restoring walking abilities, somatic sensation, and cardiovascular and bladder function in paralyzed individuals.
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Affiliation(s)
| | - Elena Y. Shapkova
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, Saint Petersburg, Russia
| | - Daria A. Petrova
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Daria F. Kleeva
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Mikhail A. Lebedev
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg, Russia
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Neťuková S, Bejtic M, Malá C, Horáková L, Kutílek P, Kauler J, Krupička R. Lower Limb Exoskeleton Sensors: State-of-the-Art. SENSORS (BASEL, SWITZERLAND) 2022; 22:9091. [PMID: 36501804 PMCID: PMC9738474 DOI: 10.3390/s22239091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
Due to the ever-increasing proportion of older people in the total population and the growing awareness of the importance of protecting workers against physical overload during long-time hard work, the idea of supporting exoskeletons progressed from high-tech fiction to almost commercialized products within the last six decades. Sensors, as part of the perception layer, play a crucial role in enhancing the functionality of exoskeletons by providing as accurate real-time data as possible to generate reliable input data for the control layer. The result of the processed sensor data is the information about current limb position, movement intension, and needed support. With the help of this review article, we want to clarify which criteria for sensors used in exoskeletons are important and how standard sensor types, such as kinematic and kinetic sensors, are used in lower limb exoskeletons. We also want to outline the possibilities and limitations of special medical signal sensors detecting, e.g., brain or muscle signals to improve data perception at the human-machine interface. A topic-based literature and product research was done to gain the best possible overview of the newest developments, research results, and products in the field. The paper provides an extensive overview of sensor criteria that need to be considered for the use of sensors in exoskeletons, as well as a collection of sensors and their placement used in current exoskeleton products. Additionally, the article points out several types of sensors detecting physiological or environmental signals that might be beneficial for future exoskeleton developments.
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Zhvansky DS, Sylos-Labini F, Dewolf A, Cappellini G, d’Avella A, Lacquaniti F, Ivanenko Y. Evaluation of Spatiotemporal Patterns of the Spinal Muscle Coordination Output during Walking in the Exoskeleton. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22155708. [PMID: 35957264 PMCID: PMC9370895 DOI: 10.3390/s22155708] [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: 05/29/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 06/01/2023]
Abstract
Recent advances in the performance and evaluation of walking in exoskeletons use various assessments based on kinematic/kinetic measurements. While such variables provide general characteristics of gait performance, only limited conclusions can be made about the neural control strategies. Moreover, some kinematic or kinetic parameters are a consequence of the control implemented on the exoskeleton. Therefore, standard indicators based on kinematic variables have limitations and need to be complemented by performance measures of muscle coordination and control strategy. Knowledge about what happens at the spinal cord output level might also be critical for rehabilitation since an abnormal spatiotemporal integration of activity in specific spinal segments may result in a risk for abnormalities in gait recovery. Here we present the PEPATO software, which is a benchmarking solution to assess changes in the spinal locomotor output during walking in the exoskeleton with respect to reference data on normal walking. In particular, functional and structural changes at the spinal cord level can be mapped into muscle synergies and spinal maps of motoneuron activity. A user-friendly software interface guides the user through several data processing steps leading to a set of performance indicators as output. We present an example of the usage of this software for evaluating walking in an unloading exoskeleton that allows a person to step in simulated reduced (the Moon's) gravity. By analyzing the EMG activity from lower limb muscles, the algorithms detected several performance indicators demonstrating differential adaptation (shifts in the center of activity, prolonged activation) of specific muscle activation modules and spinal motor pools and increased coactivation of lumbar and sacral segments. The software is integrated at EUROBENCH facilities to benchmark the performance of walking in the exoskeleton from the point of view of changes in the spinal locomotor output.
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Affiliation(s)
- Dmitry S. Zhvansky
- Institute for Information Transmission Problems, Russian Academy of Sciences, 127994 Moscow, Russia;
| | - Francesca Sylos-Labini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Arthur Dewolf
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Andrea d’Avella
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98100 Messina, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
- Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (F.S.-L.); (A.D.); (G.C.); (A.d.); (F.L.)
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Stoica SI, Anghelescu A, Onose G. Effectiveness of the multi-/interdisciplinary neurorehabilitati-on program in young patients with incomplete myeloradicualar injuries after spinal cord injury. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nowadays young persons may be frequent victims of traumatic cervical spinal cord injury (CSCI). Material and methods A retrospective study (January 2019-March 2021) we conducted with the approval of the Ethics Commission of THEBA, to assess the results of the complex me-dical rehabilitation program during the subacute period. A selected group of 23 young tetraple-gic patients with traumatic CSCI, were admitted to the THEBA Neuromuscular Rehabilitation Clinic with incomplete (AIS-B, -C, -D) myeloradicular injuries. All patients were males, aged between 19 and 57 years (with a mean of 44.35 years, SD 12.9). Patients came from urban areas 11 (48%) and the remaining 12 (52%) from rural areas. Results The spine lesion location was located at C2 vertebral level (4 men), C3 (4 men), C4 (3 men), C5 (6 men); C6 (in 2 patients); C7 (in 2 men); T6 and T7 in 1 patient each. The patients' neurological levels of injury were: C1 (in 2 pati-ents), C2 (in 2 patients), C3 (in 4 patients), C5 (in 7 patients), C6 (in 4 patients) and C7 (in 2 pati-ents). The AIS/ Frankel degree at admission was: incomplete lesion AIS-B 3 patients, AIS-C 11 pa-tients, AIS-D 9 men. The average muscle strength at admission was 60.72 (SD 25.74). In the study group 20 patients were operated: anterior osteosynthesis was performed in 16 patients and pos-terior vertebral approach in 4 patients. The neurological evolution was favorable: at discharge there were only patients with incomplete AIS-C (8 men), respectively AIS-D (15 men) grade type of lesions, and their average muscle strength at discharge was 71.97 (SD 22.30). The following comorbidities were associated: arterial hypertension (in 2 patients), traumatic brain injury (in 14 patients), alcoholism (in 9 patients), pneumonia (in 6 patients), neoplastic disorders (in 1 pati-ent), gastric ulcer (in 2 patients), depression (in 2 patients). Complications of the immobilization syndrome were: enterocolitis (in 3 men), bronchopneumonia (in 3 patients), urinary tract infec-tions (in 13 patients) and bedsores (in 2 patients). Discussion Effectiveness of the final therapeutic approach was assessed (in percentage) by evaluating the progress of the muscle strength (quanti-fied and compared at discharge vs. admission) reported to the number of days of treatment. The external-internal variations of the numeric scores of the quality of life, FIM, Ashworth and Penn were evaluated. Statistics was performed for small groups (Anova and Pearson) to establish the effectiveness of the rehabilitation program, evaluating the level of correlation between the sco-res quantified with the aforementioned the scales. An inversely proportional relationship was found between spasticity and efficacy of physical therapy (F 0.000, Pearson -0.35), between the scores of Penn scale and the effectiveness of physical therapy (F test 0.000, Pearson -0.18), respec-tively directly proportional relationship between the kinetic therapy and FIM (F test 0.000, Pear-son 0.74), similar to the relationship between physical therapy and the scores assessing the quali-ty of life (F test 0.01, Pearson 0.02). Conclusions These results underline the importance of a multi-interdisciplinary team approach in the management of the tetraplegic patients after CSCI during the subacute post-lesional/ post-operative stage.
Keywords: neurorehabilitation program, incomplete myeloradicualar injuries, spinal cord injury
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Affiliation(s)
- Simona Isabelle Stoica
- 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2 Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Aurelian Anghelescu
- 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2 Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Gelu Onose
- 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2 Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
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A Survey on Design and Control of Lower Extremity Exoskeletons for Bipedal Walking. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Exoskeleton robots are electrically, pneumatically, or hydraulically actuated devices that externally support the bones and cartilage of the human body while trying to mimic the human movement capabilities and augment muscle power. The lower extremity exoskeleton device may support specific human joints such as hip, knee, and ankle, or provide support to carry and balance the weight of the full upper body. Their assistive functionality for physically-abled and disabled humans is demanded in medical, industrial, military, safety applications, and other related fields. The vision of humans walking with an exoskeleton without external support is the prospect of the robotics and artificial intelligence working groups. This paper presents a survey on the design and control of lower extremity exoskeletons for bipedal walking. First, a historical view on the development of walking exoskeletons is presented and various lower body exoskeleton designs are categorized in different application areas. Then, these designs are studied from design, modeling, and control viewpoints. Finally, a discussion on future research directions is provided.
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Chen J, Hochstein J, Kim C, Tucker L, Hammel LE, Damiano DL, Bulea TC. A Pediatric Knee Exoskeleton With Real-Time Adaptive Control for Overground Walking in Ambulatory Individuals With Cerebral Palsy. Front Robot AI 2021; 8:702137. [PMID: 34222356 PMCID: PMC8249803 DOI: 10.3389/frobt.2021.702137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Gait training via a wearable device in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton (P.REX) with a microcontroller based multi-layered closed loop control system to provide individualized control capability. Exoskeleton performance was evaluated through benchtop and human subject testing. Step response tests show the averaged 90% rise was 26 ± 0.2 ms for 5 Nm, 22 ± 0.2 ms for 10 Nm, 32 ± 0.4 ms for 15 Nm. Torque bandwidth of P.REX was 12 Hz and output impedance was less than 1.8 Nm with control on (Zero mode). Three different control strategies can be deployed to apply assistance to knee extension: state-based assistance, impedance-based trajectory tracking, and real-time adaptive control. One participant with typical development (TD) and one participant with crouch gait from CP were recruited to evaluate P.REX in overground walking tests. Data from the participant with TD were used to validate control system performance. Kinematic and kinetic data were collected by motion capture and compared to exoskeleton on-board sensors to evaluate control system performance with results demonstrating that the control system functioned as intended. The data from the participant with CP are part of a larger ongoing study. Results for this participant compare walking with P.REX in two control modes: a state-based approach that provided constant knee extension assistance during early stance, mid-stance and late swing (Est+Mst+Lsw mode) and an Adaptive mode providing knee extension assistance proportional to estimated knee moment during stance. Both were well tolerated and significantly improved knee extension compared to walking without extension assistance (Zero mode). There was less reduction in gait speed during use of the adaptive controller, suggesting that it may be more intuitive than state-based constant assistance for this individual. Future work will investigate the effects of exoskeleton assistance during overground gait training in children with neurological disorders and will aim to identify the optimal individualized control strategy for exoskeleton prescription.
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Affiliation(s)
- Ji Chen
- Biomedical Engineering Program, Department of Mechanical Engineering, University of the District of Columbia, Washington, DC, United States
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Jon Hochstein
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Christina Kim
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Luke Tucker
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Lauren E. Hammel
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Diane L. Damiano
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Thomas C. Bulea
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
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Assistance of a Person with Muscular Weakness Using a Joint-Torque-Assisting Exoskeletal Robot. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11073114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Robotic systems for gait rehabilitation have been actively developed in recent years; many of the rehabilitation robots have been commercialized and utilized for treatment of real patients in hospitals. The first generation of gait rehabilitation robots was a tethered exoskeleton system on a treadmill. While these robots have become a new trend in rehabilitation medicine, there are several arguments about the effectiveness of such robots due to the passiveness of the motions that the robots generate, i.e., the continuous passive motions may limit the active involvement of patients’ voluntary motion control. In order to let a patient be more actively involved by requiring the self-control of whole-body balance, untethered powered exoskeletons, wearable robots that patients can wear and walk on the ground, are receiving great attention. While several powered exoskeletons have been commercialized already, the question about their effectiveness has not been cleared in the viewpoint of rehabilitation medicine because most of the powered exoskeletons provide still continuous passive motions, even though they are on the ground without tethering. This is due to their control strategy; the joints of a powered exoskeleton are position-controlled to repeatedly follow a predefined angle trajectory. This may be effective when a wearer is completely paraplegic such that the powered exoskeleton must generate full actuation power for walking. For people with muscular weakness due to various reasons, the powered exoskeleton must assist only the lack of muscular force without constraining human motion. For assistance and rehabilitation of people with partial impairment in walking ability, Angel Legs is introduced in this paper. The proposed powered exoskeleton system is equipped with a transparent actuation system such that the assistive force is accurately generated. The overall design and control of Angel Legs are introduced in this paper, and a clinical verification with a human subject is also provided.
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Bhardwaj S, Khan AA, Muzammil M. Lower limb rehabilitation robotics: The current understanding and technology. Work 2021; 69:775-793. [PMID: 34180443 DOI: 10.3233/wor-205012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With the increasing rate of ambulatory disabilities and rise in the elderly population, advance methods to deliver the rehabilitation and assistive services to patients have become important. Lower limb robotic therapeutic and assistive aids have been found to improve the rehabilitation outcome. OBJECTIVE The article aims to present the updated understanding in the field of lower limb rehabilitation robotics and identify future research avenues. METHODS Groups of keywords relating to assistive technology, rehabilitation robotics, and lower limb were combined and searched in EMBASE, IEEE Xplore Digital Library, Scopus, Web of Science and Google Scholar database. RESULTS Based on the literature collected from the databases we provide an overview of the understanding of robotics in rehabilitation and state of the art devices for lower limb rehabilitation. Technological advancements in rehabilitation robotic architecture (sensing, actuation and control) and biomechanical considerations in design have been discussed. Finally, a discussion on the major advances, research directions, and challenges is presented. CONCLUSIONS Although the use of robotics has shown a promising approach to rehabilitation and reducing the burden on caregivers, extensive and innovative research is still required in both cognitive and physical human-robot interaction to achieve treatment efficacy and efficiency.
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Affiliation(s)
- Siddharth Bhardwaj
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Abid Ali Khan
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Mohammad Muzammil
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
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Shapkova EY, Pismennaya EV, Emelyannikov DV, Ivanenko Y. Exoskeleton Walk Training in Paralyzed Individuals Benefits From Transcutaneous Lumbar Cord Tonic Electrical Stimulation. Front Neurosci 2020; 14:416. [PMID: 32528238 PMCID: PMC7263322 DOI: 10.3389/fnins.2020.00416] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, advanced technologies featuring wearable powered exoskeletons and neuromodulation of lumbosacral spinal networks have been developed to facilitate stepping and promote motor recovery in humans with paralysis. Here we studied a combined effect of spinal cord electrical stimulation (SCES) and exoskeleton walk training (EWT) during an intensive 2-week rehabilitative protocol in spinal cord injury individuals (n = 19, American Spinal Injury Association Impairment Scale (AIS) A-11, B-5, C-3). The purpose of this study was to evaluate the compatibility of methods and to explore the main effects of combined SCES and EWT. All participants had a chronic state of paralysis (1–11 years after trauma). In addition, in the control group (n = 16, AIS A-7, B-5, C-4), we performed EWT without SCES. For EWT, we used a powered exoskeleton (ExoAtlet), while stability was assisted by crutches, with automatic arrest of stepping if excessive torques were detected. SCES was applied to the level of the mid-lumbar cord over the Th12 vertebra at 1 or 3 pulses/s (4 individuals with severe spasticity were also stimulated in an anti-spastic mode 67 pulses/s). The vertical component of the ground reaction force was recorded using the F-Scan system at the onset and after training with SCES. EWT with SCES significantly increased the foot loading forces, could decrease their asymmetry and 8 out of 19 subjects improved their Hauser Ambulation Index. The anti-spastic mode of stimulation also allowed individuals with severe spasticity to walk with the aid of the exoskeleton. Participants reported facilitation when walking with SCES, paresthesia in leg muscles and new non-differential sensation of passive motion in leg joints. Neurological examination showed an increase of tactile (7) and/or pain (7) sensation and an increase of the AIS motor scale in 9 individuals, including both incomplete and complete paralysis. Improvements in the neurological scores were, however, limited in the control group (EWT without SCES). The results suggest that SCES may facilitate training and walking in the exoskeleton by activating the locomotor networks and augmenting compensative sensitivity.
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Affiliation(s)
- Elena Y Shapkova
- The Spinal Center of Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia.,Institute of Translational Biomedicine, Saint Petersburg State University, Saint Petersburg, Russia
| | - Elena V Pismennaya
- Institute of Mechanics, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitriy V Emelyannikov
- The Spinal Center of Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint Petersburg, Russia
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A method for exoskeletal assistance in squatting to standing movement: a feasibility study. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Onose G, Popescu N, Munteanu C, Ciobanu V, Sporea C, Mirea MD, Daia C, Andone I, Spînu A, Mirea A. Mobile Mechatronic/Robotic Orthotic Devices to Assist-Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review. Front Neurosci 2018; 12:577. [PMID: 30233289 PMCID: PMC6134072 DOI: 10.3389/fnins.2018.00577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
This paper overviews the state-of-the-art in upper limb robot-supported approaches, focusing on advancements in the related mechatronic devices for the patients' rehabilitation and/or assistance. Dedicated to the technical, comprehensively methodological and global effectiveness and improvement in this inter-disciplinary field of research, it includes information beyond the therapy administrated in clinical settings-but with no diminished safety requirements. Our systematic review, based on PRISMA guidelines, searched articles published between January 2001 and November 2017 from the following databases: Cochrane, Medline/PubMed, PMC, Elsevier, PEDro, and ISI Web of Knowledge/Science. Then we have applied a new innovative PEDro-inspired technique to classify the relevant articles. The article focuses on the main indications, current technologies, categories of intervention and outcome assessment modalities. It includes also, in tabular form, the main characteristics of the most relevant mobile (wearable and/or portable) mechatronic/robotic orthoses/exoskeletons prototype devices used to assist-rehabilitate neuromotor impairments in the upper limb.
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Affiliation(s)
- Gelu Onose
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Nirvana Popescu
- Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
| | | | - Vlad Ciobanu
- Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
| | - Corina Sporea
- National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
| | - Marian-Daniel Mirea
- National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
| | - Cristina Daia
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Ioana Andone
- Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Aura Spînu
- Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Andrada Mirea
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
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Li N, Yang T, Yu P, Chang J, Zhao L, Zhao X, Elhajj IH, Xi N, Liu L. Bio-inspired upper limb soft exoskeleton to reduce stroke-induced complications. BIOINSPIRATION & BIOMIMETICS 2018; 13:066001. [PMID: 30088477 DOI: 10.1088/1748-3190/aad8d4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Stroke has become the leading cause of disability and the second-leading cause of mortality worldwide. Dyskinesia complications are the major reason of these high death and disability rates. As a tool for rapid motion function recovery in stroke patients, exoskeleton robots can reduce complications and thereby decrease stroke mortality rates. However, existing exoskeleton robots interfere with the wearer's natural motion and damage joints and muscles due to poor human-machine coupling. In this paper, a novel ergonomic soft bionic exoskeleton robot with 7 degrees of freedom was proposed to address these problems based on the principles of functional anatomy and sports biomechanics. First, the human motion system was analysed according to the functional anatomy, and the muscles were modelled as tension lines. Second, a soft bionic robot was established based on the musculoskeletal tension line model. Third, a robot control method mimicking human muscle control principles was proposed and optimized on a humanoid platform manufactured using 3D printing. After the control method was optimized, the motion trajectory similarities between humans and the platform exceeded 87%. Fourth, the force-assisted effect was tested based on electromyogram signals, and the results showed that muscle signals decreased by 58.17% after robot assistance. Finally, motion-assistance experiments were performed with stroke patients. The joint movement level increased by 174% with assistance, which allowed patients to engage in activities of daily living. With this robot, stroke patients could recover their motion functions, preventing complications and decreasing fatality and disability rates.
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Affiliation(s)
- Ning Li
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, People's Republic of China. University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
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Chen J, Hochstein J, Kim C, Damiano D, Bulea T. Design Advancements toward a Wearable Pediatric Robotic Knee Exoskeleton for Overground Gait Rehabilitation. PROCEEDINGS OF THE ... IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS. IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS 2018; 2018:37-42. [PMID: 37600973 PMCID: PMC10436700 DOI: 10.1109/biorob.2018.8487195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Exoskeleton assisted gait training in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton for gait training outside of a clinical environment. A multi-layered closed loop control system and a microcontroller based data acquisition system were implemented to provide individualized control approaches and achieve device portability for home use. Step response tests show the averaged 90% rise time was 45 ms for 5 Nm, 35 ms for 10 Nm, 40 ms for 15 Nm. The gain-limited closed-loop torque bandwidth was about 9 Hz with a 9 Nm amplitude chirp in knee flexion and extension. The actuator has low output impedance (<0.5 Nm) at low frequencies expected during use. Future work will investigate the long term effects of providing children with CP knee extension assistance during daily walking on gait biomechanics with, and without, the device.
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Affiliation(s)
- Ji Chen
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Jon Hochstein
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Christina Kim
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Diane Damiano
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Thomas Bulea
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892 USA
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Gagnon DH, Vermette M, Duclos C, Aubertin-Leheudre M, Ahmed S, Kairy D. Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton. Disabil Rehabil Assist Technol 2017; 14:138-145. [PMID: 29256640 DOI: 10.1080/17483107.2017.1413145] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The main objectives of this study were to quantify clients' satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton. METHODS A group of 14 wheelchair users with a spinal cord injury, who finished a 6-8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from "0 = totally disagree" to "100 = completely agree". RESULTS Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7 ± 0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3 ± 6.9%), the attributes of the locomotor training program (84.5 ± 6.9%) and their ability to learn to perform sit-stand transfers and walk with the robotic exoskeleton (79.6 ± 17%). Respondents perceived some health benefits (67.9 ± 16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7 ± 8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3 ± 0.1%). CONCLUSION This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials. Implications for Rehabilitation All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6-8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers. All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit-stand transfers and walk with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6-8-week locomotor training program with the robotic exoskeleton. All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise. Additional research on clients' perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.
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Affiliation(s)
- Dany H Gagnon
- a School of Rehabilitation , Université de Montréal , QC , Canada.,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal , QC , Canada
| | - Martin Vermette
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal , QC , Canada
| | - Cyril Duclos
- a School of Rehabilitation , Université de Montréal , QC , Canada.,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal , QC , Canada
| | - Mylène Aubertin-Leheudre
- c Faculty of Science, Department of Exercise Science , Université du Québec à Montréal , QC , Canada
| | - Sara Ahmed
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal , QC , Canada.,d School of Physical and Occupational Therapy , McGill University , Montreal, QC , Canada
| | - Dahlia Kairy
- a School of Rehabilitation , Université de Montréal , QC , Canada.,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal , QC , Canada
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van Dijsseldonk RB, Rijken H, van Nes IJW, van de Meent H, Keijsers NLW. A Framework for Measuring the Progress in Exoskeleton Skills in People with Complete Spinal Cord Injury. Front Neurosci 2017; 11:699. [PMID: 29311780 PMCID: PMC5732998 DOI: 10.3389/fnins.2017.00699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022] Open
Abstract
For safe application of exoskeletons in people with spinal cord injury at home or in the community, it is required to have completed an exoskeleton training in which users learn to perform basic and advanced skills. So far, a framework to test exoskeleton skills is lacking. The aim of this study was to develop and test the hierarchy and reliability of a framework for measuring the progress in the ability to perform basic and advanced skills. Twelve participants with paraplegia were given twenty-four training sessions in 8 weeks with the Rewalk-exoskeleton. During the 2nd, 4th, and 6th training week the Intermediate-skills-test was performed consisting of 27 skills, measured in an hierarchical order of difficulty, until two skills were not achieved. When participants could walk independently, the Final-skills-test, consisting of 20 skills, was performed in the last training session. Each skill was performed at least two times with a maximum of three attempts. As a reliability measure the consistency was used, which was the number of skills performed the same in the first two attempts relative to the total number. Ten participants completed the training program. Their number of achieved intermediate skills was significantly different between the measurements XF2(2) = 12.36, p = 0.001. Post-hoc analysis revealed a significant increase in the median achieved intermediate skills from 4 [1–7] at the first to 10.5 [5–26] at the third Intermediate-skills-test. The rate of participants who achieved the intermediate skills decreased and the coefficient of reproducibility was 0.98. Eight participants met the criteria to perform the Final-skills-test. Their median number of successfully performed final skills was 16.5 [13–20] and 17 [14–19] skills in the first and second time. The overall consistency of >70% was achieved in the Intermediate-skills-test (73%) and the Final-skills-test (81%). Eight out of twelve participants experienced skin damage during the training, in four participants this resulted in missed training sessions. The framework proposed in this study measured the progress in performing basic and advanced exoskeleton skills during a training program. The hierarchical ordered skills-test could discriminate across participants' skill-level and the overall consistency was considered acceptable.
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Affiliation(s)
| | - Hennie Rijken
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Ilse J W van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, Netherlands
| | | | - Noel L W Keijsers
- Department of Research, Sint Maartenskliniek Research, Nijmegen, Netherlands.,Department of Rehabilitation, Radboudumc, Nijmegen, Netherlands
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Gagnon DH, Cunha JD, Boyer-Delestre M, Bosquet L, Duclos C. How does wearable robotic exoskeleton affect overground walking performance measured with the 10-m and six-minute walk tests after a basic locomotor training in healthy individuals? Gait Posture 2017; 58:340-345. [PMID: 28865396 DOI: 10.1016/j.gaitpost.2017.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/19/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
It is still unknown to what extent overground walking with a WRE is equivalent to natural overground walking without a WRE. Hence, the interpretability of the 10-m (10MWT) and six-minute (6MWT) walk tests during overground walking with a WRE against reference values collected during natural overground walking without a WRE is challenging. This study aimed to 1) compare walking performance across three different overground walking conditions: natural walking without a WRE, walking with a WRE providing minimal assistance (active walking), and walking with a WRE proving complete assistance (passive walking) and 2) assess the association and the agreement between the 10MWT and the 6MWT during passive and active walking with a WRE. Seventeen healthy individuals who underwent basic locomotor training with a WRE performed the 10MWT (preferred and maximal speeds) and the 6MWT under the three conditions. For the 10MWT, the speed progressively and significantly decreased from natural walking without a WRE (preferred: 1.40±0.18m/s; maximal: 2.16±0.19m/s), to active walking with a WRE (preferred: 0.48±0.10m/s; maximal: 0.61±0.14m/s), and to passive walking with a WRE (preferred: 0.38±0.09m/s; maximal: 0.42±0.10m/s). For the 6MWT, total distances decreased from walking without a WRE (609±53.9m), to active walking with a WRE (196.6±42.6m), and to passive walking with a WRE (144.3±33.3m). The 10MWT and 6MWT provide distinct information and can't be used interchangeably to document speed only during active walking with the WRE. Speed and distance drastically decrease during active and, even more so, passive walking with the WRE in comparison to walking without a WRE. Selection of walking tests should depend on the level of assistance provided by the WRE.
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Affiliation(s)
- Dany H Gagnon
- École de réadaptation, Université de Montréal, QC, Canada; Laboratoire de pathokinésiologie, Centre de recherche Interdisciplinaire en réadaptation du grand Montréal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada.
| | - Jérémie Da Cunha
- École de réadaptation, Université de Montréal, QC, Canada; Laboratoire de pathokinésiologie, Centre de recherche Interdisciplinaire en réadaptation du grand Montréal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Laboratoire MOVE (EA6314), Faculté des sciences du sport, Université de Poitiers, Poitiers, France
| | - Mael Boyer-Delestre
- École de réadaptation, Université de Montréal, QC, Canada; Laboratoire de pathokinésiologie, Centre de recherche Interdisciplinaire en réadaptation du grand Montréal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Laboratoire MOVE (EA6314), Faculté des sciences du sport, Université de Poitiers, Poitiers, France
| | - Laurent Bosquet
- Laboratoire MOVE (EA6314), Faculté des sciences du sport, Université de Poitiers, Poitiers, France
| | - Cyril Duclos
- École de réadaptation, Université de Montréal, QC, Canada; Laboratoire de pathokinésiologie, Centre de recherche Interdisciplinaire en réadaptation du grand Montréal, Institut de réadaptation Gingras-Lindsay-de-Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
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Gad P, Gerasimenko Y, Zdunowski S, Turner A, Sayenko D, Lu DC, Edgerton VR. Weight Bearing Over-ground Stepping in an Exoskeleton with Non-invasive Spinal Cord Neuromodulation after Motor Complete Paraplegia. Front Neurosci 2017. [PMID: 28642680 PMCID: PMC5462970 DOI: 10.3389/fnins.2017.00333] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We asked whether coordinated voluntary movement of the lower limbs could be regained in an individual having been completely paralyzed (>4 year) and completely absent of vision (>15 year) using two novel strategies-transcutaneous electrical spinal cord stimulation at selected sites over the spine as well as pharmacological neuromodulation by buspirone. We also asked whether these neuromodulatory strategies could facilitate stepping assisted by an exoskeleton (EKSO, EKSO Bionics, CA) that is designed so that the subject can voluntarily complement the work being performed by the exoskeleton. We found that spinal cord stimulation and drug enhanced the level of effort that the subject could generate while stepping in the exoskeleton. In addition, stimulation improved the coordination patterns of the lower limb muscles resulting in a more continuous, smooth stepping motion in the exoskeleton along with changes in autonomic functions including cardiovascular and thermoregulation. Based on these data from this case study it appears that there is considerable potential for positive synergistic effects after complete paralysis by combining the over-ground step training in an exoskeleton, combined with transcutaneous electrical spinal cord stimulation either without or with pharmacological modulation.
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Affiliation(s)
- Parag Gad
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Yury Gerasimenko
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States.,Pavlov Institute of PhysiologySt. Petersburg, Russia
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Amanda Turner
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Dimitry Sayenko
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los AngelesLos Angeles, CA, United States.,Brain Research Institute, University of California, Los AngelesLos Angeles, CA, United States
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos Angeles, CA, United States.,Department of Neurosurgery, University of California, Los AngelesLos Angeles, CA, United States.,Brain Research Institute, University of California, Los AngelesLos Angeles, CA, United States.,Department of Neurobiology, University of California, Los AngelesLos Angeles, CA, United States.,Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de BarcelonaBarcelona, Spain
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