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Gil-Agudo Á, Megía-García Á, Pons JL, Sinovas-Alonso I, Comino-Suárez N, Lozano-Berrio V, Del-Ama AJ. Correction: Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial. J Neuroeng Rehabil 2023; 20:160. [PMID: 37980478 PMCID: PMC10657615 DOI: 10.1186/s12984-023-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain.
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
- Neurorehabilitation and Biomechanics Unit (HNP‑SESCAM), Associate Unit CSIC, Toledo, Spain.
| | - Álvaro Megía-García
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP‑SESCAM), Associate Unit CSIC, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - José Luis Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP‑SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Natalia Comino-Suárez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP‑SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP‑SESCAM), Associate Unit CSIC, Toledo, Spain
- Electronic Technology Area, Rey Juan Carlos University, Mostoles, Spain
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Herrera-Valenzuela D, Díaz-Peña L, Redondo-Galán C, Arroyo MJ, Cascante-Gutiérrez L, Gil-Agudo Á, Moreno JC, Del-Ama AJ. A qualitative study to elicit user requirements for lower limb wearable exoskeletons for gait rehabilitation in spinal cord injury. J Neuroeng Rehabil 2023; 20:138. [PMID: 37848992 PMCID: PMC10583355 DOI: 10.1186/s12984-023-01264-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE We aim to determine a comprehensive set of requirements, perceptions, and expectations that people with spinal cord injury (SCI) and the clinicians in charge of their rehabilitation have regarding the use of wearable robots (WR) for gait rehabilitation. BACKGROUND There are concerns due to the limited user acceptance of WR for gait rehabilitation. Developers need to emphasize understanding the needs and constraints of all stakeholders involved, including the real-life dynamics of rehabilitation centers. METHODS 15 people with SCI, 9 without experience with WR and 6 with experience with these technologies, and 10 clinicians from 3 rehabilitation centers in Spain were interviewed. A directed content analysis approach was used. RESULTS 78 codes grouped into 9 categories (physical results, usability, psychology-related codes, technical characteristics, activities, acquisition issues, context of use, development of the technologies and clinical rehabilitation context) were expressed by at least 20% of the users interviewed, of whom 16 were not found in the literature. The agreement percentage between each group and subgroup included in the study, calculated as the number of codes that more than 20% of both groups expressed, divided over the total amount of codes any of those two groups agreed on (≥ 20%), showed limited agreement between patients and clinicians (50.00%) and between both types of patients (55.77%). The limited accessibility and availability of lower limb exoskeletons for gait rehabilitation arose in most of the interviews. CONCLUSIONS The limited agreement percentage between patients and clinicians indicates that including both types of users in the design process of these technologies is important, given that their requirements are complementary. Engaging users with prior technology experience is recommended, as they often exhibit strong internal consensus and articulate well-defined requirements. This study adds up the knowledge available in the literature and the new codes found in our data, which enlighten important aspects that ought to be addressed in the field to develop technologies that respond to users' needs, are usable and feasible to implement in their intended contexts. APPLICATION The set of criteria summarized in our study will be useful to guide the design, development, and evaluation of WR for gait rehabilitation to meet user's needs and allow them to be implemented in their intended context of use.
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Affiliation(s)
- Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain.
| | - Laura Díaz-Peña
- Biomedical Engineering Department, Superior Technical School of Telecommunications Engineering, Rey Juan Carlos University, Fuenlabrada, Madrid, Spain
| | - Carolina Redondo-Galán
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, Toledo, Spain
| | - María José Arroyo
- Fundación del Lesionado Medular (Spinal Cord Injured Foundation), Madrid, Spain
| | | | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, Toledo, Spain
- Unit of Neurorehabilitation, Biomechanics and Sensorimotor Function (HNP-SESCAM), Associated Unit of R&D&I to the CSIC, Toledo, Spain
| | - Juan C Moreno
- Unit of Neurorehabilitation, Biomechanics and Sensorimotor Function (HNP-SESCAM), Associated Unit of R&D&I to the CSIC, Toledo, Spain
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, Madrid, Spain
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Sinovas-Alonso I, Herrera-Valenzuela D, de-Los-Reyes-Guzmán A, Cano-de-la-Cuerda R, Del-Ama AJ, Gil-Agudo Á. Construct Validity of the Gait Deviation Index for People With Incomplete Spinal Cord Injury (GDI-SCI). Neurorehabil Neural Repair 2023; 37:705-715. [PMID: 37864467 DOI: 10.1177/15459683231206747] [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: 10/22/2023]
Abstract
BACKGROUND The Gait Deviation Index for Spinal Cord Injury (SCI-GDI) was recently proposed as a dimensionless multivariate kinematic measure based on 21 gait features derived from 3-dimensional kinematic data which quantifies gait impairment of adult population with incomplete spinal cord injury (iSCI) relative to the normative gait of a healthy group. Nevertheless, no validity studies of the SCI-GDI have been published to date. OBJECTIVE To assess the construct validity of the SCI-GDI in adult population following iSCI. Methods. SCI-GDI data were obtained from a sample of 50 healthy volunteers and 35 adults with iSCI. iSCI group was also assessed with the following measures: 10-Meter Walk Test (10MWT) at both self-selected (SS) and maximum speeds, Timed Up and Go Test (TUGT), SS and maximum levels of the Walking Index for Spinal Cord Injury (WISCI) II, mobility items of the Spinal Cord Independence Measure III (SCIM IIIIOMob), Lower Extremity Motor Score (LEMS), and Modified Ashworth Scale (MAS). Spearman's correlation coefficient was used to investigate the relationship with the SCI-GDI. RESULTS SCI-GDI shows strong correlation with the 10MWT (r ≥ -.716) and good correlation with LEMS (r = .638), TUGT (r = -.582), SS WISCI II levels (r = .521), and SCIM IIIIOMob (r = .501). No significant correlations were found with maximum WISCI II levels and MAS (P > .006). CONCLUSIONS Construct validity of the SCI-GDI was demonstrated with the 10MWT, TUGT, LEMS, SCIM IIIIOMob, and SS WISCI II levels for independently walking adults with iSCI. Future work will include assessing the psychometric characteristics with a more heterogeneous sample, also considering the pediatric population.
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Affiliation(s)
- Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Diana Herrera-Valenzuela
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Ana de-Los-Reyes-Guzmán
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Movement Analysis, Biomechanics, Ergonomics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Antonio J Del-Ama
- Department of Applied Mathematics, Materials Science and Engineering, and Electronic Technology, School of Science and Technology, Rey Juan Carlos University, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics (SESCAM), Toledo, Spain
- Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), RDI Associated Unit of the CSIC, Toledo, Spain
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Pérez-Rizo E, Torres-Lacomba M, Payo I, Gil-Agudo Á, Sánchez-Sánchez B. A comparison of elbow and wrist kinematics and kinetics during swing-through versus reciprocal gait with crutches in persons with incomplete spinal cord injury. Spinal Cord 2023; 61:391-398. [PMID: 37248356 DOI: 10.1038/s41393-023-00902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
STUDY DESIGN Descriptive study with cross-sectional data collection. OBJECTIVES To analyse and compare the 3D kinematics and kinetics of thorax, elbow and wrist, and the spatio-temporal parameters during swing-through gait (SG) and reciprocal gait (RG). SETTING Hospital Nacional de Parapléjicos in Toledo, Spain. METHODS An instrumented biomechanical analysis of the upper body of 15 adults with an incomplete lumbar or thoracic spinal cord injury was performed using a marker motion capture system and load cell crutches. Five walks of each gait pattern were analysed. RESULTS The elbow was in flexion, valgus and pronation and the wrist was in extension and ulnar deviation in both SG and RG. Their kinematic patterns were quite similar, except in elbow valgus and wrist extension in which statistically significant differences were observed. In the thorax prevailed flexion movement in SG and rotation movement in RG. The reaction forces in the elbow and the wrist were notably higher in SG than in RG, but the joint moments were similar in both gait patterns. CONCLUSIONS SG showed greater demands and RG showed higher requirements on trunk motor control. In addition, SG could increase the probability of back and neck pain. Therefore RG should be recommended, whenever possible, in incomplete spinal cord injured people. Rehabilitative management should consider adapting properly the crutch height and the inclination cane, loading the minimum weight on the crutches, using cushioning devices, reducing the duration of support phase, and limiting the overall use time of the crutches.
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Affiliation(s)
- Enrique Pérez-Rizo
- National Hospital for Spinal Cord Injury, Research Group, Engineering and Assessment Motor Unit, Toledo, Spain
| | - María Torres-Lacomba
- University of Alcalá, Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, Madrid, Spain.
| | - Ismael Payo
- University of Castilla-La Mancha, School of Industrial and Aerospace Engineering, Toledo, Spain
| | - Ángel Gil-Agudo
- National Hospital for Spinal Cord Injury, Biomechanics and Assistive Devices Unit, Department of Rehabilitation, Toledo, Spain
| | - Beatriz Sánchez-Sánchez
- University of Alcalá, Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, Madrid, Spain
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Ferrero L, Quiles V, Ortiz M, Iáñez E, Gil-Agudo Á, Azorín JM. Brain-computer interface enhanced by virtual reality training for controlling a lower limb exoskeleton. iScience 2023; 26:106675. [PMID: 37250318 PMCID: PMC10214472 DOI: 10.1016/j.isci.2023.106675] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
This study explores the use of a brain-computer interface (BCI) based on motor imagery (MI) for the control of a lower limb exoskeleton to aid in motor recovery after a neural injury. The BCI was evaluated in ten able-bodied subjects and two patients with spinal cord injuries. Five able-bodied subjects underwent a virtual reality (VR) training session to accelerate training with the BCI. Results from this group were compared with a control group of five able-bodied subjects, and it was found that the employment of shorter training by VR did not reduce the effectiveness of the BCI and even improved it in some cases. Patients gave positive feedback about the system and were able to handle experimental sessions without reaching high levels of physical and mental exertion. These results are promising for the inclusion of BCI in rehabilitation programs, and future research should investigate the potential of the MI-based BCI system.
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Affiliation(s)
- Laura Ferrero
- Brain-Machine Interface System Lab, Miguel Hernández University of Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche-I3E, Miguel Hernández University of Elche, Elche, Spain
- The European University of Brain and Technology (NeurotechEU)
| | - Vicente Quiles
- Brain-Machine Interface System Lab, Miguel Hernández University of Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche-I3E, Miguel Hernández University of Elche, Elche, Spain
| | - Mario Ortiz
- Brain-Machine Interface System Lab, Miguel Hernández University of Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche-I3E, Miguel Hernández University of Elche, Elche, Spain
- The European University of Brain and Technology (NeurotechEU)
| | - Eduardo Iáñez
- Brain-Machine Interface System Lab, Miguel Hernández University of Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche-I3E, Miguel Hernández University of Elche, Elche, Spain
| | | | - José M. Azorín
- Brain-Machine Interface System Lab, Miguel Hernández University of Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche-I3E, Miguel Hernández University of Elche, Elche, Spain
- Valencian Graduate School and Research Network of Artificial Intelligence (valgrAI), Valencia, Spain
- The European University of Brain and Technology (NeurotechEU)
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Gil-Agudo Á, Megía-García Á, Pons JL, Sinovas-Alonso I, Comino-Suárez N, Lozano-Berrio V, Del-Ama AJ. Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial. J Neuroeng Rehabil 2023; 20:36. [PMID: 36964574 PMCID: PMC10039497 DOI: 10.1186/s12984-023-01158-z] [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: 03/14/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In recent years, ambulatory lower limb exoskeletons are being gradually introduced into the clinical practice to complement walking rehabilitation programs. However, the clinical evidence of the outcomes attained with these devices is still limited and nonconclusive. Furthermore, the user-to-robot adaptation mechanisms responsible for functional improvement are still not adequately unveiled. This study aimed to (1) assess the safety and feasibility of using the HANK exoskeleton for walking rehabilitation, and (2) investigate the effects on walking function after a training program with it. METHODS A randomized controlled trial was conducted including a cohort of 23 patients with less than 1 year since injury, neurological level of injury (C2-L4) and severity (American Spinal Cord Injury Association Impairment Scale [AIS] C or D). The intervention was comprised of 15 one-hour gait training sessions with lower limb exoskeleton HANK. Safety was assessed through monitoring of adverse events, and pain and fatigue through a Visual Analogue Scale. LEMS, WISCI-II, and SCIM-III scales were assessed, along with the 10MWT, 6MWT, and the TUG walking tests (see text for acronyms). RESULTS No major adverse events were reported. Participants in the intervention group (IG) reported 1.8 cm (SD 1.0) for pain and 3.8 (SD 1.7) for fatigue using the VAS. Statistically significant differences were observed for the WISCI-II for both the "group" factor (F = 16.75, p < 0.001) and "group-time" interactions (F = 8.87; p < 0.01). A post-hoc analysis revealed a statistically significant increase of 3.54 points (SD 2.65, p < 0.0001) after intervention for the IG but not in the CG (0.7 points, SD 1.49, p = 0.285). No statistical differences were observed between groups for the remaining variables. CONCLUSIONS The use of HANK exoskeleton in clinical settings is safe and well-tolerated by the patients. Patients receiving treatment with the exoskeleton improved their walking independence as measured by the WISCI-II after the treatment.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain.
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain.
| | - Álvaro Megía-García
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - José Luis Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Natalia Comino-Suárez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Rey Juan Carlos University, Electronic Technology Area, Móstoles, Spain
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Quiles V, Ferrero L, Iáñez E, Ortiz M, Gil-Agudo Á, Azorín JM. Brain-machine interface based on transfer-learning for detecting the appearance of obstacles during exoskeleton-assisted walking. Front Neurosci 2023; 17:1154480. [PMID: 36998726 PMCID: PMC10043233 DOI: 10.3389/fnins.2023.1154480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionBrain-machine interfaces (BMIs) attempt to establish communication between the user and the device to be controlled. BMIs have great challenges to face in order to design a robust control in the real field of application. The artifacts, high volume of training data, and non-stationarity of the signal of EEG-based interfaces are challenges that classical processing techniques do not solve, showing certain shortcomings in the real-time domain. Recent advances in deep-learning techniques open a window of opportunity to solve some of these problems. In this work, an interface able to detect the evoked potential that occurs when a person intends to stop due to the appearance of an unexpected obstacle has been developed.Material and methodsFirst, the interface was tested on a treadmill with five subjects, in which the user stopped when an obstacle appeared (simulated by a laser). The analysis is based on two consecutive convolutional networks: the first one to discern the intention to stop against normal walking and the second one to correct false detections of the previous one.Results and discussionThe results were superior when using the methodology of the two consecutive networks vs. only the first one in a cross-validation pseudo-online analysis. The false positives per min (FP/min) decreased from 31.8 to 3.9 FP/min and the number of repetitions in which there were no false positives and true positives (TP) improved from 34.9% to 60.3% NOFP/TP. This methodology was tested in a closed-loop experiment with an exoskeleton, in which the brain-machine interface (BMI) detected an obstacle and sent the command to the exoskeleton to stop. This methodology was tested with three healthy subjects, and the online results were 3.8 FP/min and 49.3% NOFP/TP. To make this model feasible for non-able bodied patients with a reduced and manageable time frame, transfer-learning techniques were applied and validated in the previous tests, and were then applied to patients. The results for two incomplete Spinal Cord Injury (iSCI) patients were 37.9% NOFP/TP and 7.7 FP/min.
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Affiliation(s)
- Vicente Quiles
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche - I3E, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Laura Ferrero
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche - I3E, Universidad Miguel Hernández de Elche, Elche, Spain
- The European University of Brain and Technology (NeurotechEU), European Union
| | - Eduardo Iáñez
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche - I3E, Universidad Miguel Hernández de Elche, Elche, Spain
- *Correspondence: Eduardo Iáñez
| | - Mario Ortiz
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche - I3E, Universidad Miguel Hernández de Elche, Elche, Spain
- The European University of Brain and Technology (NeurotechEU), European Union
| | - Ángel Gil-Agudo
- Biomechanics Unit of the National Paraplegic Hospital, Toledo, Spain
| | - José M. Azorín
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Elche, Spain
- Instituto de Investigación en Ingeniería de Elche - I3E, Universidad Miguel Hernández de Elche, Elche, Spain
- The European University of Brain and Technology (NeurotechEU), European Union
- ValGRAI: Valencian Graduated School and Research Network of Artificial Intelligence, Valencia, Spain
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Salas-Monedero M, Lozano-Berrio V, Cazorla-Martínez MJ, Ceruelo-Abajo S, Gil-Agudo Á, Hernández-Sánchez S, Jiménez-Díaz JF, DelosReyes-Guzmán A. Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study. Bioengineering (Basel) 2022; 9:bioengineering9120763. [PMID: 36550969 PMCID: PMC9774606 DOI: 10.3390/bioengineering9120763] [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: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.
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Affiliation(s)
- Miriam Salas-Monedero
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- International Doctoral School, Castilla La-Mancha University, 14507 Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
| | | | - Silvia Ceruelo-Abajo
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Sonsoles Hernández-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - José-Fernando Jiménez-Díaz
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - Ana DelosReyes-Guzmán
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Correspondence:
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9
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Martín-Manjarrés S, Leal-Martín J, Granados C, Mata E, Gil-Agudo Á, Rodríguez-Gómez I, Ara I. Fat Oxidation during Exercise in People with Spinal Cord Injury, and Protocols Used: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10122402. [PMID: 36553926 PMCID: PMC9778437 DOI: 10.3390/healthcare10122402] [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: 10/18/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to summarize evidence on energy metabolism through peak fat oxidation (PFO) and maximum fat oxidation (Fatmax), as well as to analyze the protocols used in people with spinal cord injury (SCI) and to examine the main factors related to fat oxidation ability (i.e., age, sex, level of physical activity, and level and degree of injury). METHODS Studies to determine PFO and Fatmax using indirect calorimetry with an arm exercise protocol for SCI patients were included after a systematic search. Other endpoints included study design, sample size, control group, demographic data, level of injury, physical condition, protocol, outcomes measured, and statistical findings. RESULTS Eight studies (n = 560) were included. The mean value of VO2peak was 1.86 L∙min-1 (range 0.75-2.60 L∙min-1) (lowest value in the tetraplegic subjects). The PFO ranged between 0.06 and 0.30 g∙min-1 (lowest rates: the non-trained subjects with cervical SCI; highest: the tetraplegic subjects). Two types of exercise protocol were found: arm cycle ergometer, and wheelchair propulsion with a computerized ergometer. Five studies used an incremental protocol (2-3 min/stage, different load increments); the rest performed tests of 20 min/stage at three intensities. CONCLUSION There are few existing studies measuring fat oxidation in SCI, many of which used small and heterogeneous samples. PFO was lower in SCI subjects when compared with non-injured people performing lower-limb exercise; however, comparing upper-limb exercise, people with SCI showed higher values.
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Affiliation(s)
- Soraya Martín-Manjarrés
- Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
- GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
| | - Javier Leal-Martín
- GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER on Frailty and Healthy Aging, Instituto de Salud Carlos III (CIBERFES, ISCIII), 28029 Madrid, Spain
| | - Cristina Granados
- Departamento de Educación Física y Deporte, Facultad de Educación y Deporte, Universidad del País Vasco (UPV/EHU), 01007 Vitoria, Spain
| | - Esmeralda Mata
- Facultad Ciencias del Deporte, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
| | - Ángel Gil-Agudo
- Departamento de Medicina Física y Rehabilitación, Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
| | - Irene Rodríguez-Gómez
- GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER on Frailty and Healthy Aging, Instituto de Salud Carlos III (CIBERFES, ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-925-268-800 (ext. 96808)
| | - Ignacio Ara
- GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER on Frailty and Healthy Aging, Instituto de Salud Carlos III (CIBERFES, ISCIII), 28029 Madrid, Spain
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10
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Herrera-Valenzuela D, Sinovas-Alonso I, Moreno JC, Gil-Agudo Á, Del-Ama AJ. Derivation of the Gait Deviation Index for Spinal Cord Injury. Front Bioeng Biotechnol 2022; 10:874074. [PMID: 35875486 PMCID: PMC9299068 DOI: 10.3389/fbioe.2022.874074] [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: 02/11/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
The Gait Deviation Index (GDI) is a dimensionless multivariate measure of overall gait pathology represented as a single score that indicates the gait deviation from a normal gait average. It is calculated using kinematic data recorded during a three-dimensional gait analysis and an orthonormal vectorial basis with 15 gait features that was originally obtained using singular value decomposition and feature analysis on a dataset of children with cerebral palsy. Ever since, it has been used as an outcome measure to study gait in several conditions, including spinal cord injury (SCI). Nevertheless, the validity of implementing the GDI in a population with SCI has not been studied yet. We investigate the application of these mathematical methods to derive a similar metric but with a dataset of adults with SCI (SCI-GDI). The new SCI-GDI is compared with the original GDI to evaluate their differences and assess the need for a specific GDI for SCI and with the WISCI II to evaluate its sensibility. Our findings show that a 21-feature basis is necessary to account for most of the variance in gait patterns in the SCI population and to provide high-quality reconstructions of the gait curves included in the dataset and in foreign data. Furthermore, using only the first 15 features of our SCI basis, the fidelity of the reconstructions obtained in our population is higher than that when using the basis of the original GDI. The results showed that the SCI-GDI discriminates most levels of the WISCI II scale, except for levels 12 and 18. Statistically significant differences were found between both indexes within each WISCI II level except for 12, 20, and the control group (p < 0.05). In all levels, the average GDI value was greater than the average SCI-GDI value, but the difference between both indexes is larger in data with greater impairment and it reduces progressively toward a normal gait pattern. In conclusion, the implementation of the original GDI in SCI may lead to overestimation of gait function, and our new SCI-GDI is more sensitive to larger gait impairment than the GDI. Further validation of the SCI-GDI with other scales validated in SCI is needed.
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Affiliation(s)
- Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.,Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Isabel Sinovas-Alonso
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.,Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Madrid, Spain
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11
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Sinovas-Alonso I, Herrera-Valenzuela D, Cano-de-la-Cuerda R, Reyes-Guzmán ADL, del-Ama AJ, Gil-Agudo Á. Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels. Front Hum Neurosci 2022; 16:826333. [PMID: 35444522 PMCID: PMC9013754 DOI: 10.3389/fnhum.2022.826333] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson’s disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.
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Affiliation(s)
- Isabel Sinovas-Alonso
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- *Correspondence: Isabel Sinovas-Alonso,
| | - Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Faculty of Health Sciences, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Alcorcón, Spain
- Roberto Cano-de-la-Cuerda,
| | | | - Antonio J. del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science, Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
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12
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Comino-Suárez N, Moreno JC, Gómez-Soriano J, Megía-García Á, Serrano-Muñoz D, Taylor J, Alcobendas-Maestro M, Gil-Agudo Á, Del-Ama AJ, Avendaño-Coy J. Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials. J Neuroeng Rehabil 2021; 18:148. [PMID: 34565399 PMCID: PMC8474736 DOI: 10.1186/s12984-021-00941-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 03/22/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method able to modulate neuronal activity after stroke. The aim of this systematic review was to determine if tDCS combined with robotic therapy (RT) improves limb function after stroke when compared to RT alone. METHODS A search for randomized controlled trials (RCTs) published prior to July 15, 2021 was performed. The main outcome was function assessed with the Fugl-Meyer motor assessment for upper extremities (FM/ue) and 10-m walking test (10MWT) for the lower limbs. As secondary outcomes, strength was assessed with the Motricity Index (MI) or Medical Research Council scale (MRC), spasticity with the modified Ashworth scale (MAS), functional independence with the Barthel Index (BI), and kinematic parameters. RESULTS Ten studies were included for analysis (n = 368 enrolled participants). The results showed a non-significant effect for tDCS combined with RT to improve upper limb function [standardized mean difference (SMD) = - 0.12; 95% confidence interval (CI): - 0.35-0.11)]. However, a positive effect of the combined therapy was observed in the lower limb function (SMD = 0.48; 95% CI: - 0.15-1.12). Significant results favouring tDCS combined with RT were not found in strength (SMD = - 0.15; 95% CI: - 0.4-0.1), spasticity [mean difference (MD) = - 0.15; 95% CI: - 0.8-0.5)], functional independence (MD = 2.5; 95% CI: - 1.9-6.9) or velocity of movement (SMD = 0.06; 95% CI: - 0.3-0.5) with a "moderate" or "low" recommendation level according to the GRADE guidelines. CONCLUSIONS Current findings suggest that tDCS combined with RT does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.
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Affiliation(s)
- Natalia Comino-Suárez
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002, Madrid, Spain.
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Álvaro Megía-García
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, 45071, Toledo, Spain
| | - Diego Serrano-Muñoz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Julian Taylor
- Sensorimotor Function Group, National Hospital for Paraplegics, SESCAM, 45071, Toledo, Spain
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Mónica Alcobendas-Maestro
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, 45071, Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, 45071, Toledo, Spain
| | - Antonio J Del-Ama
- Biomechanical and Technical Aids Unit, National Hospital for Paraplegics, SESCAM, 45071, Toledo, Spain
- Rey Juan Carlos University, 28933, Madrid, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
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13
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Rodríguez-Cola M, Jiménez-Velasco I, Gutiérrez-Henares F, López-Dolado E, Gambarrutta-Malfatti C, Vargas-Baquero E, Gil-Agudo Á. Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury. Spinal Cord Ser Cases 2020; 6:39. [PMID: 32404896 PMCID: PMC7220608 DOI: 10.1038/s41394-020-0288-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Cohort study of patients with spinal cord injury (SCI). OBJECTIVES To describe the clinical and analytical features of a coronavirus disease 2019 (Covid-19) infected cohort with SCI to enable accurate diagnosis and to outline prevention measures. SETTING This study was conducted at the National Hospital for Paraplegics (Toledo, Spain). METHODS A cohort analysis of seven patients with SCI infected by Covid-19 was performed. Diagnosis was confirmed with reverse transcriptase polymerase chain reaction (RT-PCR) of nasal exudate or sputum samples. Clinical, analytical, and radiographic findings were registered. RESULTS RT-PCR detected COVID-19 infection in all patients, affecting males and people with a cervical level of injury more often (five out of seven). The average delay for diagnostic confirmation was 4 days (interquartile range, 1-10). Fever was the most frequent symptom (six out of seven). The second most common symptom was asthenia (four out of seven), followed by dyspnea, cough, and expectoration (three out of seven for each symptom). The Modified Early Warning System score for Covid-19 severity rating was classified as severe in five out of seven cases. All but one patient showed radiological alterations evident in chest X-rays at the time of diagnosis. All patients recovered gradually. CONCLUSION Our patients with SCI and Covid-19 infection exhibited fewer symptoms than the general population. Furthermore, they presented similar or greater clinical severity. The clinical evolution was not as pronounced as had been expected. This study recommends close supervision of the SCI population to detect early compatible signs and symptoms of Covid-19 infection.
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Affiliation(s)
- Miguel Rodríguez-Cola
- Department of Internal Medicine, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
| | - Irena Jiménez-Velasco
- Department of Internal Medicine, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
| | | | - Elisa López-Dolado
- Department of Rehabilitation, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
| | | | - Eduardo Vargas-Baquero
- Department of Rehabilitation, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain
| | - Ángel Gil-Agudo
- Department of Rehabilitation, Hospital Nacional de Parapléjicos de Toledo, Toledo, Spain.
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14
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Larraga-García B, Lozano-Berrio V, Gutiérrez Á, Gil-Agudo Á, del-Ama AJ. A Systematic Methodology to Analyze the Impact of Hand-Rim Wheelchair Propulsion on the Upper Limb. Sensors (Basel) 2019; 19:s19214643. [PMID: 31731458 PMCID: PMC6864610 DOI: 10.3390/s19214643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/27/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m/s (3 km/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint.
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Affiliation(s)
- Blanca Larraga-García
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politéncia de Madrid, Av. Complutense 30, 28040 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-06-72168
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain; (V.L.-B.); (Á.G.-A.); (A.J.d.-A.)
| | - Álvaro Gutiérrez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politéncia de Madrid, Av. Complutense 30, 28040 Madrid, Spain;
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain; (V.L.-B.); (Á.G.-A.); (A.J.d.-A.)
| | - Antonio J. del-Ama
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Finca La Peraleda, 45071 Toledo, Spain; (V.L.-B.); (Á.G.-A.); (A.J.d.-A.)
- Rey Juan Carlos University, Calle Tulipán, 0, 28933 Móstoles, Madrid, Spain;
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15
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Rodríguez-Gómez I, Martín-Manjarrés S, Martín-García M, Vila-Maldonado S, Gil-Agudo Á, M. Alegre L, Ara I. Cardiorespiratory fitness and arm bone mineral health in young males with spinal cord injury: the mediator role of lean mass. J Sports Sci 2018; 37:717-725. [DOI: 10.1080/02640414.2018.1522948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Irene Rodríguez-Gómez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Soraya Martín-Manjarrés
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics. SESCAM, Toledo, Spain
| | - María Martín-García
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Sara Vila-Maldonado
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Spinal Cord Injury. SESCAM, Toledo, Spain
| | - Luis M. Alegre
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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16
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Trincado-Alonso F, López-Larraz E, Resquín F, Ardanza A, Pérez-Nombela S, Pons JL, Montesano L, Gil-Agudo Á. A Pilot Study of Brain-Triggered Electrical Stimulation with Visual Feedback in Patients with Incomplete Spinal Cord Injury. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0343-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Pérez-Nombela S, Barroso F, Torricelli D, de Los Reyes-Guzmán A, Del-Ama AJ, Gómez-Soriano J, Pons JL, Gil-Agudo Á. Modular control of gait after incomplete spinal cord injury: differences between sides. Spinal Cord 2016; 55:79-86. [PMID: 27349606 DOI: 10.1038/sc.2016.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/21/2016] [Accepted: 05/24/2016] [Indexed: 01/11/2023]
Abstract
STUDY DESIGN This is an analytical descriptive study. OBJECTIVES The main goal of this study was to compare the modular organization of bilateral lower limb control in incomplete spinal cord injury (iSCI) patients during overground walking, using muscle synergies analysis. The secondary goal was to determine whether the similarity between the patients and control group correlate with clinical indicators of walking performance. SETTING This study was conducted in National Hospital for Spinal Cord Injury (Toledo, Spain). METHODS Eight iSCI patients and eight healthy subjects completed 10 walking trials at matched speed. For each trial, three-dimensional motion analysis and surface electromyography (sEMG) analysis of seven leg muscles from both limbs were performed. Muscle synergies were extracted from sEMG signals using a non-negative matrix factorization algorithm. The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. RESULTS When compared with healthy references, iSCI patients showed fewer muscle synergies in the most affected side and, in both sides, significant differences in the composition of synergy 2. The degree of similarity of these variables with the healthy reference, together with the composition of synergy 3 of the most affected side, presented significant correlations (P<0.05) with walking performance. CONCLUSION The analysis of muscle synergies shows potential to detect differences between the two sides in patients with iSCI. Specifically, the VAF may constitute a new neurophysiological metric to assess and monitor patients' condition throughout the gait recovery process.
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Affiliation(s)
- S Pérez-Nombela
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - F Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,Centre ALGORITMI, University of Minho, Azurém, Guimarães, Portugal
| | - D Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - A de Los Reyes-Guzmán
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - A J Del-Ama
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - J Gómez-Soriano
- Sensoriomotor Function Group, National Hospital for Spinal Cord Injury, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO). Nursing and Physical Therapy School, Castilla-La Mancha, Toledo, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Á Gil-Agudo
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
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18
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Costa Á, Iáñez E, Úbeda A, Hortal E, Del-Ama AJ, Gil-Agudo Á, Azorín JM. Decoding the Attentional Demands of Gait through EEG Gamma Band Features. PLoS One 2016; 11:e0154136. [PMID: 27115740 PMCID: PMC4846000 DOI: 10.1371/journal.pone.0154136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/08/2016] [Indexed: 12/03/2022] Open
Abstract
Rehabilitation techniques are evolving focused on improving their performance in terms of duration and level of recovery. Current studies encourage the patient’s involvement in their rehabilitation. Brain-Computer Interfaces are capable of decoding the cognitive state of users to provide feedback to an external device. On this paper, cortical information obtained from the scalp is acquired with the goal of studying the cognitive mechanisms related to the users’ attention to the gait. Data from 10 healthy users and 3 incomplete Spinal Cord Injury patients are acquired during treadmill walking. During gait, users are asked to perform 4 attentional tasks. Data obtained are treated to reduce movement artifacts. Features from δ(1 − 4Hz), θ(4 − 8Hz), α(8 − 12Hz), β(12 − 30Hz), γlow(30 − 50Hz), γhigh(50 − 90Hz) frequency bands are extracted and analyzed to find which ones provide more information related to attention. The selected bands are tested with 5 classifiers to distinguish between tasks. Classification results are also compared with chance levels to evaluate performance. Results show success rates of ∼67% for healthy users and ∼59% for patients. These values are obtained using features from γ band suggesting that the attention mechanisms are related to selective attention mechanisms, meaning that, while the attention on gait decreases the level of attention on the environment and external visual information increases. Linear Discriminant Analysis, K-Nearest Neighbors and Support Vector Machine classifiers provide the best results for all users. Results from patients are slightly lower, but significantly different, than those obtained from healthy users supporting the idea that the patients pay more attention to gait during non-attentional tasks due to the inherent difficulties they have during normal gait. This study provides evidence of the existence of classifiable cortical information related to the attention level on the gait. This fact could allow the development of a real-time system that obtains the attention level during lower limb rehabilitation. This information could be used as feedback to adapt the rehabilitation strategy.
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Affiliation(s)
- Álvaro Costa
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
- * E-mail:
| | - Eduardo Iáñez
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Andrés Úbeda
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Enrique Hortal
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
| | - Antonio J. Del-Ama
- Biomechanics and Technical Aids Units, Physical Medicine and Rehabilitation Department, National Hospital for Spinal Cord Injury, SESCAM, Finca de la Peraleda S/N, 45071, Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Units, Physical Medicine and Rehabilitation Department, National Hospital for Spinal Cord Injury, SESCAM, Finca de la Peraleda S/N, 45071, Toledo, Spain
| | - José M. Azorín
- Brain-Machine Interface Systems Lab, Miguel Hernández University, Av. de la Universidad S/N, 03202 Elche, Spain
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Dimbwadyo-Terrer I, Trincado-Alonso F, de Los Reyes-Guzmán A, Aznar MA, Alcubilla C, Pérez-Nombela S, Del Ama-Espinosa A, Polonio-López B, Gil-Agudo Á. Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment. Disabil Rehabil Assist Technol 2015; 11:462-7. [PMID: 26181226 DOI: 10.3109/17483107.2015.1027293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Purpose state: The aim of this preliminary study was to test a data glove, CyberTouch™, combined with a virtual reality (VR) environment, for using in therapeutic training of reaching movements after spinal cord injury (SCI). METHOD Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments: patients in the intervention group (IG) conducted a VR training based on the use of a data glove, CyberTouch™ for 2 weeks, while patients in the control group (CG) only underwent the traditional rehabilitation. Furthermore, two functional parameters were implemented in order to assess patient's performance of the sessions: normalized trajectory lengths and repeatability. RESULTS Although no statistical significance was found, the data glove group seemed to obtain clinical changes in the muscle balance (MB) and functional parameters, and in the dexterity, coordination and fine grip tests. Moreover, every patient showed variations in at least one of the functional parameters, either along Y-axis trajectory or Z-axis trajectory. CONCLUSIONS This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation, making it possible to train activities of daily living (ADLs) in motivational environments while measuring objectively the patient's functional evolution. Implications for Rehabilitation Key findings: A motion capture application based on a data glove is presented, for being used as a virtual reality tool for rehabilitation. This application has provided objective data about patient's functional performance. What the study has added: (1) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools, making it possible to train Activities of Daily Living in motivational environments. (2) Furthermore, this study could be a contribution for the development of clinical protocols to identify which types of patients will benefit most from the VR treatments, which interfaces are more suitable to be used in neurorehabilitation, and what types of virtual exercises will work best.
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Affiliation(s)
- Iris Dimbwadyo-Terrer
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Fernando Trincado-Alonso
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Ana de Los Reyes-Guzmán
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | | | | | - Soraya Pérez-Nombela
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Antonio Del Ama-Espinosa
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Begoña Polonio-López
- c Nursing, Physiotherapy and Occupational Therapy Department, University of Castilla la Mancha , Talavera de la Reina , Spain
| | - Ángel Gil-Agudo
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
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López-Larraz E, Montesano L, Gil-Agudo Á, Minguez J, Oliviero A. Evolution of EEG Motor Rhythms after Spinal Cord Injury: A Longitudinal Study. PLoS One 2015; 10:e0131759. [PMID: 26177457 PMCID: PMC4503564 DOI: 10.1371/journal.pone.0131759] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/07/2015] [Indexed: 11/29/2022] Open
Abstract
Spinal cord injury (SCI) does not only produce a lack of sensory and motor function caudal to the level of injury, but it also leads to a progressive brain reorganization. Chronic SCI patients attempting to move their affected limbs present a significant reduction of brain activation in the motor cortex, which has been linked to the deafferentation. The aim of this work is to study the evolution of the motor-related brain activity during the first months after SCI. Eighteen subacute SCI patients were recruited to participate in bi-weekly experimental sessions during at least two months. Their EEG was recorded to analyze the temporal evolution of the event-related desynchronization (ERD) over the motor cortex, both during motor attempt and motor imagery of their paralyzed hands. The results show that the α and β ERD evolution after SCI is negatively correlated with the clinical progression of the patients during the first months after the injury. This work provides the first longitudinal study of the event-related desynchronization during the subacute phase of spinal cord injury. Furthermore, our findings reveal a strong association between the ERD changes and the clinical evolution of the patients. These results help to better understand the brain transformation after SCI, which is important to characterize the neuroplasticity mechanisms involved after this lesion and may lead to new strategies for rehabilitation and motor restoration of these patients.
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Affiliation(s)
- Eduardo López-Larraz
- Dpto. Informática e Ingeniería de Sistemas, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación en Ingeniería de Aragón (I3A), Zaragoza, Spain
- * E-mail:
| | - Luis Montesano
- Dpto. Informática e Ingeniería de Sistemas, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación en Ingeniería de Aragón (I3A), Zaragoza, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Javier Minguez
- Dpto. Informática e Ingeniería de Sistemas, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación en Ingeniería de Aragón (I3A), Zaragoza, Spain
- Bit&Brain Technologies SL, Zaragoza, Spain
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Gil-Agudo Á, Solís-Mozos M, Crespo-Ruiz B, Del-Ama Eng AJ, Pérez-Rizo E, Segura-Fragoso A, Jiménez-Díaz F. Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings. Front Bioeng Biotechnol 2014; 2:77. [PMID: 25566539 PMCID: PMC4275037 DOI: 10.3389/fbioe.2014.00077] [Citation(s) in RCA: 3] [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: 09/02/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022] Open
Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Marta Solís-Mozos
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Beatriz Crespo-Ruiz
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Antonio J Del-Ama Eng
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | - Enrique Pérez-Rizo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Servicio de Salud de Castilla-La Mancha , Toledo , Spain
| | | | - Fernando Jiménez-Díaz
- Laboratory of Performance and Sports Rehabilitation, Faculty of Sport Science, University of Castilla-La Mancha , Toledo , Spain
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López-Larraz E, Montesano L, Gil-Agudo Á, Minguez J. Continuous decoding of movement intention of upper limb self-initiated analytic movements from pre-movement EEG correlates. J Neuroeng Rehabil 2014; 11:153. [PMID: 25398273 PMCID: PMC4247645 DOI: 10.1186/1743-0003-11-153] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [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: 05/30/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain-machine interfaces (BMI) have recently been integrated within motor rehabilitation therapies by actively involving the central nervous system (CNS) within the exercises. For instance, the online decoding of intention of motion of a limb from pre-movement EEG correlates is being used to convert passive rehabilitation strategies into active ones mediated by robotics. As early stages of upper limb motor rehabilitation usually focus on analytic single-joint mobilizations, this paper investigates the feasibility of building BMI decoders for these specific types of movements. METHODS Two different experiments were performed within this study. For the first one, six healthy subjects performed seven self-initiated upper-limb analytic movements, involving from proximal to distal articulations. For the second experiment, three spinal cord injury patients performed two of the previously studied movements with their healthy elbow and paralyzed wrist. In both cases EEG neural correlates such as the event-related desynchronization (ERD) and movement related cortical potentials (MRCP) were analyzed, as well as the accuracies of continuous decoders built using the pre-movement features of these correlates (i.e., the intention of motion was decoded before movement onset). RESULTS The studied movements could be decoded in both healthy subjects and patients. For healthy subjects there were significant differences in the EEG correlates and decoding accuracies, dependent on the moving joint. Percentages of correctly anticipated trials ranged from 75% to 40% (with chance level being around 20%), with better performances for proximal than for distal movements. For the movements studied for the SCI patients the accuracies were similar to the ones of the healthy subjects. CONCLUSIONS This paper shows how it is possible to build continuous decoders to detect movement intention from EEG correlates for seven different upper-limb analytic movements. Furthermore we report differences in accuracies among movements, which might have an impact on the design of the rehabilitation technologies that will integrate this new type of information. The applicability of the decoders was shown in a clinical population, with similar performances between healthy subjects and patients.
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Moreno JC, del Ama AJ, de los Reyes-Guzmán A, Gil-Agudo Á, Ceres R, Pons JL. Neurorobotic and hybrid management of lower limb motor disorders: a review. Med Biol Eng Comput 2011; 49:1119-30. [DOI: 10.1007/s11517-011-0821-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/30/2011] [Indexed: 10/17/2022]
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Peñasco-Martín B, de los Reyes-Guzmán A, Gil-Agudo Á, Bernal-Sahún A, Pérez-Aguilar B, de la Peña-González AI. [Application of virtual reality in the motor aspects of neurorehabilitation]. Rev Neurol 2010; 51:481-488. [PMID: 20925030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Virtual reality allows the user to interact with elements within a simulated scene. In recent times we have been witness to the introduction of virtual reality-based devices as one of the most significant novelties in neurorehabilitation. AIM To review the clinical applications of the developments based on virtual reality for the neurorehabilitation treatment of the motor aspects of the most frequent disabling processes with a neurological origin. DEVELOPMENT A review was carried out of the Medline, Physiotherapy Evidence Database, Ovid and Cochrane Library databases up until April 2009. This was completed with a web search using Google. No clinical trial conducted on its effectiveness has been found to date. The information that was collected is based on the description of the various prototypes produced by the different groups involved in their development. In most cases they are clinical trials conducted with a small number of patients, which have focused more on testing the validity of the device and checking whether it works correctly than on attempting to prove its clinical effectiveness. Although most of the clinical applications refer to patients with stroke, there were also several applications for patients with spinal cord injuries, multiple sclerosis, Parkinson's disease or balance disorders. CONCLUSIONS Virtual reality is a novel tool with a promising future in neurorehabilitation. Further studies are needed to demonstrate its clinical effectiveness as compared to the traditional techniques.
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