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Leow XRG, Ng SLA, Lau Y. Overground Robotic Exoskeleton Training for Patients With Stroke on Walking-Related Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2023; 104:1698-1710. [PMID: 36972746 DOI: 10.1016/j.apmr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This review aims to evaluate the effectiveness of solely overground robotic exoskeleton (RE) training or overground RE training with conventional rehabilitation in improving walking ability, speed, and endurance among patients with stroke. DATA SOURCES Nine databases, 5 trial registries, gray literature, specified journals, and reference lists from inception until December 27, 2021. STUDY SELECTION Randomized controlled trials adopting overground robotic exoskeleton training for patients with any phases of stroke on walking-related outcomes were included. DATA EXTRACTION Two independent reviewers extracted items and performed risk of bias using the Cochrane Risk of Bias tool 1 and certainty of evidence using the Grades of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Twenty trials involving 758 participants across 11 countries were included in this review. The overall effect of overground robotic exoskeletons on walking ability at postintervention (d=0.21; 95% confidence interval [CI], 0.01, 0.42; Z=2.02; P=.04) and follow-up (d=0.37; 95% CI, 0.03, 0.71; Z=2.12; P=.03) and walking speed at postintervention (d=0.23; 95% CI, 0.01, 0.46; Z=2.01; P=.04) showed significant improvement compared with conventional rehabilitation. Subgroup analyses suggested that RE training should combine with conventional rehabilitation. A preferable gait training regime is <4 times per week over ≥6 weeks for ≤30 minutes per session among patients with chronic stroke and ambulatory status of independent walkers before training. Meta-regression did not identify any effect of the covariates on the treatment effect. The majority of randomized controlled trials had small sample sizes, and the certainty of the evidence was very low. CONCLUSION Overground RE training may have a beneficial effect on walking ability and walking speed to complement conventional rehabilitation. Further large-scale and long-term, high-quality trials are recommended to enhance the quality of overground RE training and confirm its sustainability.
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Affiliation(s)
- Xin Rong Gladys Leow
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Si Li Annalyn Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Nolan KJ, Ames GR, Dandola CM, Breighner JE, Franco S, Karunakaran KK, Saleh S. Intensity Modulated Exoskeleton Gait Training Post Stroke. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082984 DOI: 10.1109/embc40787.2023.10340452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Stroke is a leading cause of long-term disability. While major advances have been made in early intervention for the treatment of patients post stroke, the majority of survivors have residual mobility challenges. Recovery of motor function is dependent on the interrelationship between dosing, intensity, and task specific practice applied during rehabilitation. Robotic exoskeleton (RE) based gait training utilizes progressive repetitive task-oriented movements to promote functional recovery. The purpose of this investigation was to demonstrate the utilization of intensity modulated exoskeleton gait training on functional outcomes and walking speed post stoke. Preliminary data is presented for individuals diagnosed with stroke who received RE gait training. The intensity modulated RE gait training was delivered by a physical therapist and participants trained at 75-85% of calculated max heart rates at each session, over 10 weeks (30 sessions). After 10 weeks of training participants increased walking speed (10 meter walk test) and functional measures (timed up and go, berg balance assessment, dynamic gait index and functional ambulation category). These preliminary results demonstrate the utilization of intensity modulated gait training for improved functional ambulation and motor recovery using a robotic exoskeleton overground gait training post stroke.Clinical Relevance- Preliminary data provides initial evidence for intensity modulated exoskeleton gait training as a therapeutic intervention post stroke. More research is needed to demonstrate the potential relationships between intensity based gait training, exoskeletons and improved functional ambulation in post stroke rehabilitation.
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Karunakaran KK, Pamula SD, Bach CP, Legelen E, Saleh S, Nolan KJ. Lower extremity robotic exoskeleton devices for overground ambulation recovery in acquired brain injury-A review. Front Neurorobot 2023; 17:1014616. [PMID: 37304666 PMCID: PMC10249611 DOI: 10.3389/fnbot.2023.1014616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/27/2023] [Indexed: 06/13/2023] Open
Abstract
Acquired brain injury (ABI) is a leading cause of ambulation deficits in the United States every year. ABI (stroke, traumatic brain injury and cerebral palsy) results in ambulation deficits with residual gait and balance deviations persisting even after 1 year. Current research is focused on evaluating the effect of robotic exoskeleton devices (RD) for overground gait and balance training. In order to understand the device effectiveness on neuroplasticity, it is important to understand RD effectiveness in the context of both downstream (functional, biomechanical and physiological) and upstream (cortical) metrics. The review identifies gaps in research areas and suggests recommendations for future research. We carefully delineate between the preliminary studies and randomized clinical trials in the interpretation of existing evidence. We present a comprehensive review of the clinical and pre-clinical research that evaluated therapeutic effects of RDs using various domains, diagnosis and stage of recovery.
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Affiliation(s)
- Kiran K. Karunakaran
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Research Staff Children's Specialized Hospital New Brunswick, New Brunswick, NJ, United States
| | - Sai D. Pamula
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Caitlyn P. Bach
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Eliana Legelen
- Department of Psychology, Montclair State University, Montclair, NJ, United States
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
| | - Karen J. Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Research Staff Children's Specialized Hospital New Brunswick, New Brunswick, NJ, United States
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Just IA, Fries D, Loewe S, Falk V, Cesarovic N, Kemper D, Edelmann F, Feuerstein A, Haufe FL, Xiloyannis M, Riener R, Schoenrath F. Movement therapy in lung transplantation candidates assisted by a lightweight wearable robot. Assist Technol 2023; 35:242-247. [PMID: 35438604 DOI: 10.1080/10400435.2022.2067914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 10/18/2022] Open
Abstract
The aim of this pilot-study was to investigate the safety, feasibility and tolerability of an assisted mobilization of patients with advanced pulmonary diseases, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Ten patients performed activities of daily life (ADL) both with and without the device. The mean age was 53.6 (±5.6) years; 70% were male. The assessment of outcome included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnea (PRE, PRD), the ability to perform ADL and the individual acceptability. Robotic-assisted mobilization was feasible in all patients. No adverse events occurred. RPE and RPD showed no significant difference with or without the Myosuit (mean difference in RPE -1.7, 95%-confidence interval (CI) -1.16, 4.49; p = 0.211; mean difference in RPD 0.00, 95%-CI -1.88, 1.88; p = 0.475). 80% of patients were interested to participate in a robotic-assisted training on a regular basis. A robotic exoskeleton-assisted mobilization is safe, feasible, well-tolerated and well-accepted. The results are highly encouraging to further pursue this highly innovative approach.
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Affiliation(s)
- Isabell Anna Just
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Denis Fries
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sina Loewe
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Technologies, Department of Health Sciences, ETH Zürich, Switzerland
| | - Dagmar Kemper
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Anna Feuerstein
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian L Haufe
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Michele Xiloyannis
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin
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Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci 2023; 13:brainsci13050717. [PMID: 37239189 DOI: 10.3390/brainsci13050717] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
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Yoo HJ, Bae CR, Jeong H, Ko MH, Kang YK, Pyun SB. Clinical efficacy of overground powered exoskeleton for gait training in patients with subacute stroke: A randomized controlled pilot trial. Medicine (Baltimore) 2023; 102:e32761. [PMID: 36705351 PMCID: PMC9875981 DOI: 10.1097/md.0000000000032761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To investigate the efficacy and usefulness of 12 sessions of overground robot-assisted gait training (RAGT) in subacute stroke patients. METHODS In this pilot study, 17 subacute stroke survivors were randomly assigned to the intervention (n = 9) and control (n = 8) groups. In addition to the conventional stroke neurorehabilitation program, the intervention group received 30 minutes of overground exoskeletal RAGT, while the control group received 30 minutes of conventional gait training by a physiotherapist. All interventions were performed in 12 sessions (3 times/week for 4 weeks). The primary aim was to assess ambulation ability using the functional ambulation category (FAC). The 10-m walk test, Berg Balance Scale, timed-up-and-go Timed-up-and-go, Fugl-Meyer assessment of lower extremity, pulmonary function test, the Korean version of the modified Barthel index, and Euro quality of life-5 dimensions (EQ-5D) were assessed. All outcomes were evaluated both before and after the intervention. RESULTS The Berg Balance Scale, Korean version of the modified Barthel index, and EQ-5D scores (P < .05) improved significantly in both groups. Only those in the RAGT group improved significantly in the FAC, timed-up-and-go, and 10-m walk test (P < .05). In the FAC and EQ-5D, the intervention group showed greater improvement than the control group (P < .05). CONCLUSION We found that 4 weeks of overground RAGT combined with conventional training may improve walking independence and quality of life in patients with subacute stroke.
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Affiliation(s)
- Hyun-Joon Yoo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cho Rong Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeonsoon Jeong
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Yoon-Kyoo Kang
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Korea
- * Correspondence: Sung-Bom Pyun, Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea (e-mail: )
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Tosto-Mancuso J, Rozanski G, Patel N, Breyman E, Dewil S, Jumreornvong O, Putrino D, Tabacof L, Escalon M, Cortes M. Retrospective case-control study to compare exoskeleton-assisted walking with standard care in subacute non-traumatic brain injury patients. NeuroRehabilitation 2023; 53:577-584. [PMID: 38143393 DOI: 10.3233/nre-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Advanced technologies are increasingly used to address impaired mobility after neurological insults, with growing evidence of their benefits for various populations. However, certain robotic devices have not been extensively investigated in specific conditions, limiting knowledge about optimal application for healthcare. OBJECTIVE To compare effectiveness of conventional gait training with exoskeleton-assisted walking for non-traumatic brain injury during early stage rehabilitation. METHODS Clinical evaluation data at admission and discharge were obtained in a retrospective case-control design. Patients received standard of care physical therapy either using Ekso GT or not. Within- or between-group statistical tests were performed to determine change over time and interventional differences. RESULTS This study analyzed forty-nine individuals (33% female), 20 controls and 29 Ekso participants who were equivalent at baseline. Both groups improved in Functional Independence Measure scores and ambulation ability (p < .00001 and p < .001, respectively). Control subjects demonstrated significantly different distance walked and assistance level values at discharge from those who were treated with the exoskeleton (p < .01). CONCLUSION Robotic locomotion is non-inferior for subacute functional recovery after non-traumatic brain injury. Conventional therapy produced larger gait performance gains during hospitalization. Further research is needed to understand specific factors influencing efficacy and the long-term implications after rehabilitation.
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Affiliation(s)
- Jenna Tosto-Mancuso
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriela Rozanski
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nehal Patel
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Breyman
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sophie Dewil
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oranicha Jumreornvong
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Tabacof
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miguel Escalon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mar Cortes
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kolářová B, Šaňák D, Hluštík P, Kolář P. Randomized Controlled Trial of Robot-Assisted Gait Training versus Therapist-Assisted Treadmill Gait Training as Add-on Therapy in Early Subacute Stroke Patients: The GAITFAST Study Protocol. Brain Sci 2022; 12:brainsci12121661. [PMID: 36552120 PMCID: PMC9775673 DOI: 10.3390/brainsci12121661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
The GAITFAST study (gait recovery in patients after acute ischemic stroke) aims to compare the effects of treadmill-based robot-assisted gait training (RTGT) and therapist-assisted treadmill gait training (TTGT) added to conventional physical therapy in first-ever ischemic stroke patients. GAITFAST (Clinicaltrials.gov identifier: NCT04824482) was designed as a single-blind single-center prospective randomized clinical trial with two parallel groups and a primary endpoint of gait speed recovery up to 6 months after ischemic stroke. A total of 120 eligible and enrolled participants will be randomly allocated (1:1) in TTGT or RTGT. All enrolled patients will undergo a 2-week intensive inpatient rehabilitation including TTGT or RTGT followed by four clinical assessments (at the beginning of inpatient rehabilitation 8-15 days after stroke onset, after 2 weeks, and 3 and 6 months after the first assessment). Every clinical assessment will include the assessment of gait speed and walking dependency, fMRI activation measures, neurological and sensorimotor impairments, and gait biomechanics. In a random selection (1:2) of the 120 enrolled patients, multimodal magnetic resonance imaging (MRI) data will be acquired and analyzed. This study will provide insight into the mechanisms behind poststroke gait behavioral changes resulting from intensive rehabilitation including assisted gait training (RTGT or TTGT) in early subacute IS patients.
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Affiliation(s)
- Barbora Kolářová
- Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence:
| | - Daniel Šaňák
- Comprehensive Stroke Centre, Department of Neurology, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Kolář
- Department of Rehabilitation, University Hospital Olomouc, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
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Semprini M, Lencioni T, Hinterlang W, Vassallo C, Scarpetta S, Maludrottu S, Iandolo R, Carè M, Laffranchi M, Chiappalone M, Ferrarin M, De Michieli L, Jonsdottir J. User-centered design and development of TWIN-Acta: A novel control suite of the TWIN lower limb exoskeleton for the rehabilitation of persons post-stroke. Front Neurosci 2022; 16:915707. [PMID: 36507352 PMCID: PMC9729698 DOI: 10.3389/fnins.2022.915707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Difficulties faced while walking are common symptoms after stroke, significantly reducing the quality of life. Walking recovery is therefore one of the main priorities of rehabilitation. Wearable powered exoskeletons have been developed to provide lower limb assistance and enable training for persons with gait impairments by using typical physiological movement patterns. Exoskeletons were originally designed for individuals without any walking capacities, such as subjects with complete spinal cord injuries. Recent systematic reviews suggested that lower limb exoskeletons could be valid tools to restore independent walking in subjects with residual motor function, such as persons post-stroke. To ensure that devices meet end-user needs, it is important to understand and incorporate their perspectives. However, only a limited number of studies have followed such an approach in the post-stroke population. Methods The aim of the study was to identify the end-users needs and to develop a user-centered-based control system for the TWIN lower limb exoskeleton to provide post-stroke rehabilitation. We thus describe the development and validation, by clinical experts, of TWIN-Acta: a novel control suite for TWIN, specifically designed for persons post-stroke. We detailed the conceived control strategy and developmental phases, and reported evaluation sessions performed on healthy clinical experts and people post-stroke to evaluate TWIN-Acta usability, acceptability, and barriers to usage. At each developmental stage, the clinical experts received a one-day training on the TWIN exoskeleton equipped with the TWIN-Acta control suite. Data on usability, acceptability, and limitations to system usage were collected through questionnaires and semi-structured interviews. Results The system received overall good usability and acceptability ratings and resulted in a well-conceived and safe approach. All experts gave excellent ratings regarding the possibility of modulating the assistance provided by the exoskeleton during the movement execution and concluded that the TWIN-Acta would be useful in gait rehabilitation for persons post-stroke. The main limit was the low level of system learnability, attributable to the short-time of usage. This issue can be minimized with prolonged training and must be taken into consideration when planning rehabilitation. Discussion This study showed the potential of the novel control suite TWIN-Acta for gait rehabilitation and efficacy studies are the next step in its evaluation process.
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Affiliation(s)
- Marianna Semprini
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Tiziana Lencioni
- Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), Universitá degli Studi di Genova, Genoa, Italy
| | - Wiebke Hinterlang
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | | | - Silvia Scarpetta
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | | | - Riccardo Iandolo
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Marta Carè
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), Universitá degli Studi di Genova, Genoa, Italy
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | | | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy,*Correspondence: Maurizio Ferrarin,
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Hu J, Zou J, Wan Y, Yao Q, Dong P, Li G, Wu X, Zhang L, Liang D, Zeng Q, Huang G. Rehabilitation of motor function after stroke: A bibliometric analysis of global research from 2004 to 2022. Front Aging Neurosci 2022; 14:1024163. [PMID: 36408095 PMCID: PMC9667945 DOI: 10.3389/fnagi.2022.1024163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS The mortality rate of stroke has been increasing worldwide. Poststroke somatic dysfunctions are common. Motor function rehabilitation of patients with such somatic dysfunctions enhances the quality of life and has long been the primary practice to achieve functional recovery. In this regard, we aimed to delineate the new trends and frontiers in stroke motor function rehabilitation literature published from 2004 to 2022 using a bibliometric software. METHODS All documents related to stroke rehabilitation and published from 2004 to 2022 were retrieved from the Web of Science Core Collection. Publication output, research categories, countries/institutions, authors/cocited authors, journals/cocited journals, cocited references, and keywords were assessed using VOSviewer v.1.6.15.0 and CiteSpace version 5.8. The cocitation map was plotted according to the analysis results to intuitively observe the research hotspots. RESULTS Overall, 3,302 articles were retrieved from 78 countries or regions and 564 institutions. Over time, the publication outputs increased annually. In terms of national contribution, the United States published the most papers, followed by China, Japan, South Korea, and Canada. Yeungnam University had the most articles among all institutions, followed by Emory University, Fudan University, and National Taiwan University. Jang Sung Ho and Wolf S.L. were the most productive (56 published articles) and influential (cited 1,121 times) authors, respectively. "Effect of constraint-induced movement therapy on upper extremity function 3-9 months after stroke: the Extremity Constraint Induced Therapy Evaluation randomized clinical trial" was the most frequently cited reference. Analysis of keywords showed that upper limbs, Fugl-Meyer assessment, electromyography, virtual reality, telerehabilitation, exoskeleton, and brain-computer interface were the research development trends and focus areas for this topic. CONCLUSION Publications regarding motor function rehabilitation following stroke are likely to continuously increase. Research on virtual reality, telemedicine, electroacupuncture, the brain-computer interface, and rehabilitation robots has attracted increasing attention, with these topics becoming the hotspots of present research and the trends of future research.
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Affiliation(s)
- Jinjing Hu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Yantong Wan
- College of Anesthesiology, Southern Medical University, Guangzhou, China
| | - Qiuru Yao
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Nursing, Southern Medical University, Guangzhou, China
| | - Peng Dong
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Gege Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Wu
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Lijie Zhang
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Donghui Liang
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,*Correspondence: Donghui Liang,
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China,Qing Zeng,
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China,Guozhi Huang,
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11
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Just IA, Fries D, Loewe S, Falk V, Cesarovic N, Edelmann F, Feuerstein A, Haufe FL, Xiloyannis M, Riener R, Schoenrath F. Movement therapy in advanced heart failure assisted by a lightweight wearable robot: a feasibility pilot study. ESC Heart Fail 2022; 9:1643-1650. [PMID: 35320878 PMCID: PMC9065814 DOI: 10.1002/ehf2.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this pilot study was to investigate the safety, feasibility, tolerability, and acceptability of an assisted mobilization of advanced heart failure patients, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). METHODS AND RESULTS Twenty patients in functional NYHA class III performed activities of daily life (ADL, n = 10) or participated in a single, standardized, 60 min rehabilitation exercise unit (REU, n = 10) with and without the Myosuit. The outcome assessment included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnoea (RPE, RPD), the ability to perform ADL or REU, and the individual acceptability. The mean age of the subjects was 49.4 (±11.0) years; 80% were male. The mean left ventricular ejection fraction was 22.1% (±7.4%) and the median NT-proBNP 2054 pg/mL (IQR 677, 3270 pg/mL). In all patients, mobilization with the Myosuit was feasible independently or with minor support. The mean individual difference in the total walking distance of the patients without and with robotic assistance was -26.5 m (95% confidence interval (CI) -142 to 78 m, P = 0.241). No adverse events occurred. RPE and RPD showed no significant difference with or without the device (ADL: RPE -0.1 m, 95% CI -1.42 to 1.62, P = 0.932 and RPD -0.95 m, 95% CI -0.38 to 2.28, P = 0.141; REU: RPE 1.1 m, 95% CI -2.90 to 0.70, P = 0.201 and RPD 0.5 m, 95% CI -2.02 to 1.02, P = 0.435). All median responses in the acceptability questionnaire were positive. The patients felt safe and enjoyed the experience; 85% would be interested in participating in robot-assisted training on a regular basis. CONCLUSION This feasibility pilot trial provides first indications that a robotic exoskeleton-assisted mobilization of patients with advanced heart failure is safe, feasible, well-tolerated, and well-accepted. The results are highly encouraging to further pursue this innovative approach in rehabilitation programmes. This trial was registered at ClinicalTrials.gov: NCT04839133.
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Affiliation(s)
- Isabell Anna Just
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Denis Fries
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
| | - Sina Loewe
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
- Department of Cardiothoracic SurgeryCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Translational Cardiovascular Technologies, Department of Health SciencesETH ZürichZürichSwitzerland
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- Translational Cardiovascular Technologies, Department of Health SciencesETH ZürichZürichSwitzerland
| | - Frank Edelmann
- Department of CardiologyCharité‐Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Anna Feuerstein
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
- Department of CardiologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Florian L. Haufe
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Michele Xiloyannis
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Robert Riener
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
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12
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Lorusso M, Tramontano M, Casciello M, Pece A, Smania N, Morone G, Tamburella F. Efficacy of Overground Robotic Gait Training on Balance in Stroke Survivors: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12060713. [PMID: 35741599 PMCID: PMC9221355 DOI: 10.3390/brainsci12060713] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 12/29/2022] Open
Abstract
Strokes often lead to a deficit in motor control that contributes to a reduced balance function. Impairments in the balance function severely limit the activities of daily living (ADL) in stroke survivors. The present systematic review and meta-analysis primarily aims to explore the efficacy of overground robot-assisted gait training (o-RAGT) on balance recovery in individuals with stroke. In addition, the efficacy on ADL is also investigated. This systematic review identified nine articles investigating the effects of o-RAGT on balance, four of which also assessed ADL. The results of the meta-analysis suggest that o-RAGT does not increase balance and ADL outcomes more than conventional therapy in individuals after stroke. The data should not be overestimated due to the low number of studies included in the meta-analysis and the wide confidence intervals. Subgroup analyses to investigate the influence of participant’s characteristics and training dosage were not performed due to lack of data availability. Further well-designed randomized controlled trials are needed to investigate the efficacy of o-RAGT on balance in individuals with stroke.
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Affiliation(s)
- Matteo Lorusso
- Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy; (M.L.); (M.C.); (F.T.)
| | - Marco Tramontano
- Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy; (M.L.); (M.C.); (F.T.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00185 Rome, Italy
- Correspondence:
| | - Matteo Casciello
- Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy; (M.L.); (M.C.); (F.T.)
| | - Andrea Pece
- Ospedale Israelitico di Roma, Via Fulda 14, 00148 Rome, Italy;
| | - Nicola Smania
- Neurorehabilitation Unit, University Hospital of Verona, 37124 Verona, Italy;
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Federica Tamburella
- Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy; (M.L.); (M.C.); (F.T.)
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13
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Gil-Castillo J, Barria P, Aguilar Cárdenas R, Baleta Abarza K, Andrade Gallardo A, Biskupovic Mancilla A, Azorín JM, Moreno JC. A Robot-Assisted Therapy to Increase Muscle Strength in Hemiplegic Gait Rehabilitation. Front Neurorobot 2022; 16:837494. [PMID: 35574230 PMCID: PMC9100587 DOI: 10.3389/fnbot.2022.837494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
This study examines the feasibility of using a robot-assisted therapy methodology based on the Bobath concept to perform exercises applied in conventional therapy for gait rehabilitation in stroke patients. The aim of the therapy is to improve postural control and movement through exercises based on repetitive active-assisted joint mobilization, which is expected to produce strength changes in the lower limbs. As therapy progresses, robotic assistance is gradually reduced and the patient's burden increases with the goal of achieving a certain degree of independence. The relationship between force and range of motion led to the analysis of both parameters of interest. The study included 23 volunteers who performed 24 sessions, 2 sessions per week for 12 weeks, each lasting about 1 h. The results showed a significant increase in hip abduction and knee flexion strength on both sides, although there was a general trend of increased strength in all joints. However, the range of motion at the hip and ankle joints was reduced. The usefulness of this platform for transferring exercises from conventional to robot-assisted therapies was demonstrated, as well as the benefits that can be obtained in muscle strength training. However, it is suggested to complement the applied therapy with exercises for the maintenance and improvement of the range of motion.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Patricio Barria
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
- Electrical Engineering Department, Universidad de Magallanes, Punta Arenas, Chile
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | | | - Karim Baleta Abarza
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade Gallardo
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | | | - José M. Azorín
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Juan C. Moreno
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14
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Longatelli V, Pedrocchi A, Guanziroli E, Molteni F, Gandolla M. Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation. Front Neurorobot 2021; 15:733738. [PMID: 34899227 PMCID: PMC8663633 DOI: 10.3389/fnbot.2021.733738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been recruited and underwent either conventional gait training or experimental training, including overground gait training using a wearable powered exoskeleton alongside conventional therapy. Before and after the rehabilitation treatment, we assessed: (i) gait functionality by means of clinical scales combined to obtain a Capacity Score, and (ii) gait neuromuscular lower limbs pattern using superficial EMG signals. Both groups improved their ability to walk in terms of functional gait, as detected by the Capacity Score. However, only the group treated with the robotic exoskeleton regained a controlled rhythmic neuromuscular pattern in the proximal lower limb muscles, as observed by the muscular activation analysis. Coherence analysis suggested that the control group (CG) improvement was mediated mainly by spinal cord control, while experimental group improvements were mediated by cortical-driven control. In subacute stroke patients, we hypothesize that exoskeleton multijoint powered fine control overground gait training, alongside conventional care, may lead to a more fine-tuned and efficient gait pattern.
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Affiliation(s)
- Valeria Longatelli
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Marta Gandolla
- Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
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15
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Sanjeevi N, Singh Y, Vashista V. Recent advances in lower-extremity exoskeletons in promoting performance restoration. Current Opinion in Biomedical Engineering 2021. [DOI: 10.1016/j.cobme.2021.100338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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16
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Zhang Y, Cao G, Ling Z, Li W, Cheng H, He B, Cao S, Zhu A. A Multi-Information Fusion Method for Gait Phase Classification in Lower Limb Rehabilitation Exoskeleton. Front Neurorobot 2021; 15:692539. [PMID: 34795571 PMCID: PMC8594738 DOI: 10.3389/fnbot.2021.692539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Gait phase classification is important for rehabilitation training in patients with lower extremity motor dysfunction. Classification accuracy of the gait phase also directly affects the effect and rehabilitation training cycle. In this article, a multiple information (multi-information) fusion method for gait phase classification in lower limb rehabilitation exoskeleton is proposed to improve the classification accuracy. The advantage of this method is that a multi-information acquisition system is constructed, and a variety of information directly related to gait movement is synchronously collected. Multi-information includes the surface electromyography (sEMG) signals of the human lower limb during the gait movement, the angle information of the knee joints, and the plantar pressure information. The acquired multi-information is processed and input into a modified convolutional neural network (CNN) model to classify the gait phase. The experiment of gait phase classification with multi-information is carried out under different speed conditions, and the experiment is analyzed to obtain higher accuracy. At the same time, the gait phase classification results of multi-information and single information are compared. The experimental results verify the effectiveness of the multi-information fusion method. In addition, the delay time of each sensor and model classification time is measured, which shows that the system has tremendous real-time performance.
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Affiliation(s)
- Yuepeng Zhang
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Guangzhong Cao
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Ziqin Ling
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - WenZhou Li
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Haoran Cheng
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Binbin He
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Shengbin Cao
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, Shenzhen University, Shenzhen, China
| | - Aibin Zhu
- Institute of Robotics and Intelligent Systems, Xi'an Jiaotong University, Xi'an, China
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17
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Veerubhotla A, Krantz A, Ibironke O, Pilkar R. Wearable devices for tracking physical activity in the community after an acquired brain injury: A systematic review. PM R 2021; 14:1207-1218. [PMID: 34689426 DOI: 10.1002/pmrj.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The application of wearable devices in individuals with acquired brain injury (ABI) resulting from stroke or traumatic brain injury (TBI) for monitoring physical activity (PA) has been relatively recent. The current systematic review aims to provide insights into the adaption of these devices, outcome metrics, and their transition from the laboratory to the community for PA monitoring of individuals with ABI. LITERATURE SURVEY The PubMed and Google Scholar databases were systematically reviewed using appropriate search terms. A total of 20 articles were reviewed from the past 15 years. METHODOLOGY Articles were classified into three categories - PA measurement studies, PA classification studies, and validation studies. The quality of studies was assessed using a quality appraisal checklist. SYNTHESIS It was found that the transition of wearable devices from in-lab to community-based studies in individuals with stroke has started but is not widespread. The transition of wearable devices in the community has not yet started for individuals with TBI. Accelerometer-based devices were more frequently chosen than pedometers and inertial measurement units. No consensus on a preferred wearable device (make or model) or wear location could be identified, though step count was the most common outcome metric. The accuracy and validity of most outcome metrics used in the community were not reported for many studies. CONCLUSIONS To facilitate future studies use wearable devices for PA measurement in the community, we recommend that researchers provide details on the accuracy and validity of the outcome metrics specific to the study environment. Once the accuracy and validity are established for a specific population, wearable devices and their derived outcomes can provide objective information on mobility impairment as well as the effect of rehabilitation in the community. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Akhila Veerubhotla
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA.,Research Assistant Professor, Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Amanda Krantz
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA
| | - Oluwaseun Ibironke
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA
| | - Rakesh Pilkar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA.,Assistant Research Professor, Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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18
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Gembalczyk G, Gierlak P, Duda S. Control System Design of an Underactuated Dynamic Body Weight Support System Using Its Stability. Sensors (Basel) 2021; 21:5051. [PMID: 34372285 PMCID: PMC8347501 DOI: 10.3390/s21155051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
This paper discusses the stability of systems controlling patient body weight support systems which are used in gait re-education. These devices belong to the class of underactuated mechanical systems. This is due to the application of elastic shock-absorbing connections between the active part of the system and the passive part which impacts the patient. The model takes into account properties of the system, such as inertia, attenuation and susceptibility to the elements. Stability is an essential property of the system due to human-device interaction. In order to demonstrate stability, Lyapunov's theory of stability, which is based on the model of system dynamics, was applied. The stability of the control system based on a model that requires knowledge of the structure and parameters of the equations of motion was demonstrated. Due to inaccuracies in the modeling of the rope (one of the basic elements of the device), an adaptive control system was introduced and its stability was also proved. The authors conducted simulation and experimental tests that illustrate the functionality of the analyzed control systems.
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Affiliation(s)
- Grzegorz Gembalczyk
- Department of Theoretical and Applied Mechanics, Faculty of Mechanical Engineering, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland;
| | - Piotr Gierlak
- Department of Applied Mechanics and Robotics, Faculty of Mechanical Engineering and Aeronautics, Rzeszow University of Technology, 35-959 Rzeszów, Poland;
| | - Slawomir Duda
- Department of Theoretical and Applied Mechanics, Faculty of Mechanical Engineering, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland;
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Treviño LR, Roberge P, Auer ME, Morales A, Torres-Reveron A. Predictors of Functional Outcome in a Cohort of Hispanic Patients Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury. Front Neurorobot 2021; 15:682156. [PMID: 34177511 PMCID: PMC8222710 DOI: 10.3389/fnbot.2021.682156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) and cerebrovascular accidents (CVA) are two of the leading causes of disability in the United States. Robotic exoskeletons (RE) have been approved for rehabilitation by the Federal Drug Administration (FDA) for use after a CVA, and recently received approval for use in patients with TBI. The aim of the study was to determine which factors predict the improvement in functional independence measure (FIM) score after using RE rehabilitation in a population of patients with CVA or TBI. We carried out a retrospective chart-review analysis of the use of the RE (Ekso® GT) in the rehabilitation of patients with TBI and CVA using data from a single, private rehabilitation hospital for patients admitted and discharged between 01/01/2017 and 04/30/2020. From the medical records, we collected presentation date, Glasgow Coma Scale score (GCS) on the date of injury, rehabilitation start date, age, diabetes status on presentation (Yes or No), injury category (TBI or CVA), and both admission and discharge FIM scores. Matching algorithms resulted in one TBI patient matched to three CVA patients resulting in a sample size of 36. The diabetic and non-diabetic populations showed significant differences between age and days from injury to the start of rehabilitation. A multivariate linear regression assessed predictors for discharge motor FIM and found admission motor FIM score and total RE steps to be statistically significant predictors. For each point scored higher on the admission motor FIM the discharge FIM was increased by 1.19 FIM points, and for each 1,000 steps taken in the RE, the discharge motor FIM increased by three points. The type of acquired brain injury (CVA or TBI) was not found to affect functional outcome. The presented results show that key clinic-biologic factors including diabetic status, together with start to rehabilitation play key roles in discharge FIM scores for patients using RE. Clinical Trial Registration: ClinicalTrials.gov, NCT04465019.
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Affiliation(s)
- Lisa R. Treviño
- DHR Health Institute for Research and Development, Edinburg, TX, United States
| | - Peter Roberge
- DHR Health Institute for Research and Development, Edinburg, TX, United States
| | - Michael E. Auer
- The DHR Health Rehabilitation Hospital, Edinburg, TX, United States
| | - Angela Morales
- The DHR Health Rehabilitation Hospital, Edinburg, TX, United States
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Molteni F, Guanziroli E, Goffredo M, Calabrò RS, Pournajaf S, Gaffuri M, Gasperini G, Filoni S, Baratta S, Galafate D, Le Pera D, Bramanti P, Franceschini M, On Behalf Of Italian Eksogait Study Group. Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects. Brain Sci 2021; 11:104. [PMID: 33466749 DOI: 10.3390/brainsci11010104] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.
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