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Liu W, Chen J. The efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury: A meta-analysis. J Spinal Cord Med 2023:1-10. [PMID: 37534920 DOI: 10.1080/10790268.2023.2214482] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To discuss the efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury (SCI). METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched systematically from their inception to April 2022 for studies on exoskeleton robotic training in patients with SCI. The language was restricted to English. The retrieved studies were screened to select eligible clinical trials. Meta-analysis was performed using Review Manager 5.4. RESULTS Eleven randomized clinical trials (RCTs) involving 456 participants were included in the meta-analysis. The results of the meta-analysis showed that exoskeleton robotic training was more effective in improving FIM [SMD = 0.58, 95%CI = (0.07, 1.10), P = 0.03], LEMS [MD = 4.64, 95%CI = (3.58, 5.70), P<0.05], MAS [MD = 0.76, 95%CI = (0.48, 1.03), P<0.05] and BBS [MD = -3.11, 95%CI = (-12.59, 6.36), P<0.05] in patients with SCI, compared to conventional gait training(CGT). Subgroup analysis showed that the exoskeleton robotic could significantly improve the walking endurance and walking speed of patients with a duration of injury within 6 months. The sensitivity of inverted funnel plot analysis is low, suggesting that the analysis results of this study are relatively stable. CONCLUSION Exoskeleton robotic training improves ambulation in patients with SCI, especially for patients with a course of injury within six months.
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Affiliation(s)
- Wentan Liu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, People's Republic of China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, People's Republic of China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013 Hangzhou, Zhejiang, People's Republic of China
- Neurorehabilitation Department, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, People's Republic of China
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Hsu TH, Tsai CL, Chi JY, Hsu CY, Lin YN. Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis. Ann Phys Rehabil Med 2023; 66:101674. [PMID: 35525427 DOI: 10.1016/j.rehab.2022.101674] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wearable exoskeletons are a recently developed technology. OBJECTIVES The present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking. METHODS We systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living. RESULTS We included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56). CONCLUSIONS Exoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.
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Affiliation(s)
- Ting-Hsuan Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ju-Yang Chi
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Pinto D, Heinemann AW, Chang SH, Charlifue S, Field-Fote EC, Furbish CL, Jayaraman A, Tefertiller C, Taylor HB, French DD. Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury. J Neuroeng Rehabil 2023; 20:10. [PMID: 36681852 PMCID: PMC9867867 DOI: 10.1186/s12984-023-01134-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Shuo-Hsiu Chang
- Neurorecovery Research Center, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Edelle C Field-Fote
- Spinal Cord Injury, Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Emory University, Atlanta, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Heather B Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Health Services Research and Development Service, US Department of Veterans Affairs, Chicago, USA
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Lim CY, Ko MJ, Lee JW, Bok SK, Paik NJ, Nam YG, Kwon BS. Efficacy and safety of EXOWALK® on electromechanical-assisted gait training: study protocol for randomized controlled trial. Trials 2022; 23:729. [PMID: 36056399 PMCID: PMC9438256 DOI: 10.1186/s13063-022-06660-8] [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: 03/31/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-intensity repetitive task-specific practice might be the most effective strategy to promote motor recovery after stroke, and electromechanical-assisted gait training represents one of the treatment options. However, there is still difficulty in clarifying the difference between conventional gait training and electromechanically assisted gait training. Methods The study is a multicenter, randomized, parallel-group clinical trial for stroke patients. Three clinical research centers in Korea (Dongguk University Ilsan Hospital, Chungnam National University Hospital, and Seoul National University Bundang Hospital) will participate in the clinical trial and 144 stroke patients will be registered. Enrolled patients are assigned to two groups, an experimental group and a control group, according to a randomization table. In addition, patients are treated for half an hour (one session) five times a week for 4 weeks. Both groups carry out basic rehabilitation (central nervous system development therapy and strength exercise) and the experimental group executes robotic walking rehabilitation treatment, and the control group executes conventional gait rehabilitation treatment. The primary endpoint variable is the Functional Ambulation Category (FAC) that determines the degree of independent walking and is measured before, after, and after 4 weeks of treatment. Secondary endpoint variables are 11 variables that take into account motor function and range, measured at the same time as the primary endpoint variable. Discussion There are still insufficient data on the effectiveness of electromechanical-assisted gait training for stroke patients and large-scale research is lacking. Thus, the research described here is a large-scale study of stroke patients that can supplement the limitations mentioned in other previous studies. In addition, the clinical studies described here include physical epidemiological analysis parameters that can determine walking ability. The results of this study can lead to prove the generalizable effectiveness and safety of electromechanical-assisted gait training with EXOWALK®. Trial registration Clinical Research Information Service (CRIS), Republic of Korea KCT0003411, Registered on 30 October 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06660-8.
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Affiliation(s)
- Chi-Yeon Lim
- Department of Biostatistics, School of Medicine, Dongguk University, Goyang, South Korea
| | | | | | - Soo Kyung Bok
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yeon Gyo Nam
- Dongguk University Posture Science Institute, Dongguk University College of Medicine, Goyang, South Korea
| | - Bum Sun Kwon
- Dongguk University Posture Science Institute, Dongguk University College of Medicine, Goyang, South Korea. .,Department of Rehabilitation Medicine, Dongguk University College of Medicine, Goyang, South Korea.
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Yu CS, Nam YG, Kwon BS. Comparison of high-intensive and low-intensive electromechanical-assisted gait training by Exowalk® in patients over 3-month post-stroke. BMC Sports Sci Med Rehabil 2022; 14:126. [PMID: 35818062 PMCID: PMC9275251 DOI: 10.1186/s13102-022-00515-0] [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: 02/10/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study was conducted to assess the effect of electromechanical-assisted gait training intensity on walking ability in patients over 3-month post-stroke. METHODS Data from two randomized controlled trials (RCTs) were collected under the same study design of assessment and intervention, excluding intervention time per session. After matching the inclusion criteria of two RCTs, the experimental groups of each RCT were defined as low-intensive (LI) and high-intensive (HI) group according to the intervention time per session. Primary outcome was the difference of the change in Functional Ambulatory Categories (FAC) between LI and HI gait training. Secondary outcomes were the difference of changes in mobility, walking speed, walking capacity, leg-muscle strength, balance and daily activity evaluated with Rivermead Mobility Index (RMI), 10 m walk test (10MWT), 6-min walk test (6MWT), Motricity Index (MI), Berg Balance Scale (BBS) and Modified Barthel Index (MBI) respectively. RESULTS The FAC improved after gait training in both groups. The secondary outcomes also improved in both groups except RMI and MI in HI group. The change of all outcomes were not different between groups except RMI. The change of RMI in the LI group was greater than that in the HI group statistically, but it did not meet minimal clinically important difference. CONCLUSIONS The improvement of walking ability after LI or HI gait training was not different if providing the same total gait training time. By providing the electromechanical gait training intensively, we could shorten the gait training period to improve walking ability and customize the training program according to the patient training abilities. TRIAL REGISTRATION Name of the registry: Clinical Research Information Service. TRIAL REGISTRATION NUMBER No. KCT0002195(RCT1), No. KCT0002552(RCT2). Date of registration: 10/04/2016(RCT1), 10/05/2017(RCT2). URL of the trial registry record: https://cris.nih.go.kr/cris/search.
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Affiliation(s)
- Chang Seon Yu
- Department of Rehabilitation Medicine, School of Medicine, Dongguk University, Seoul, 04620, Republic of Korea
| | - Yeon-Gyo Nam
- Institute of Posture Science, School of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, School of Medicine, Dongguk University, Seoul, 04620, Republic of Korea. .,Institute of Posture Science, School of Medicine, Dongguk University, Gyeongju, Republic of Korea. .,Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea.
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Triolo ER, BuSha BF. Design and experimental testing of a force-augmenting exoskeleton for the human hand. J Neuroeng Rehabil 2022; 19:23. [PMID: 35189922 PMCID: PMC8862586 DOI: 10.1186/s12984-022-00997-6] [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: 01/25/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many older Americans suffer from long-term upper limb dysfunction, decreased grip strength, and/or a reduced ability to hold objects due to injuries and a variety of age-related illnesses. The objective of this study was to design and build a five-fingered powered assistive exoskeleton for the human hand, and to validate its ability to augment the gripping and pinching efforts of the wearer and assist in performing ADLs. Methods The exoskeleton device was designed using CAD software and 3-D printed in ABS. Each finger’s movement efforts were individually monitored by a force sensing resistor at each fingertip, and proportionally augmented via the microcontroller-based control scheme, linear actuators, and rigid exoskeleton structure. The force production of the device and the force augmenting capability were assessed on ten healthy individuals with one 5-digit grasping test, three pinching tests, and two functional tests. Results Use of the device significantly decreased the forearm muscle activity necessary to maintain a grasping effort (67%, p < 0.001), the larger of two pinching efforts (30%, p < 0.05), and the palmer pinching effort (67%, p < 0.001); however, no benefit by wearing the device was identified while maintaining a minimal pinching effort or attempting one of the functional tests. Conclusion The exoskeleton device allowed subjects to maintain independent control of each digit, and while wearing the exoskeleton, in both the unpowered and powered states, subjects were able to grasp, hold, and move objects such as a water bottle, bag, smartphone, or dry-erase marker.
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Affiliation(s)
- Emily R Triolo
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Brett F BuSha
- Department of Biomedical Engineering, The College of New Jersey, 2000 Pennington Road, STEM Building, Ewing, NJ, 08628, USA.
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Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [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: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
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Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Evans RW, Shackleton CL, West S, Derman W, Laurie Rauch HG, Baalbergen E, Albertus Y. Robotic Locomotor Training Leads to Cardiovascular Changes in Individuals With Incomplete Spinal Cord Injury Over a 24-Week Rehabilitation Period: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2021; 102:1447-1456. [PMID: 33839105 DOI: 10.1016/j.apmr.2021.03.018] [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: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the effect of robotic locomotor training (RLT) and activity-based training (ABT) on cardiovascular indices during various physiological positions in individuals with spinal cord injury. DESIGN Randomized controlled pilot study. SETTING Private practice: Therapy & Beyond Centre - Walking with Brandon Foundation, Sports Science Institute of South Africa, Cape Town, South Africa. PARTICIPANTS Participants with chronic traumatic motor incomplete tetraplegia (N=16) who resided in the Western Cape, South Africa. INTERVENTION Robotic locomotor training (Ekso GT) and activity-based training over a 24-week intervention. MAIN OUTCOME MEASURES Brachial and ankle blood pressure, heart rate, heart rate variability, and cardiovascular efficiency during 4 physiological positions. RESULTS No differences between groups or over time were evident in resting systolic and diastolic blood pressure, ankle systolic pressure, ankle brachial pressure index, and heart rate variability. Standing heart rate at 24 weeks was significantly higher in the ABT group (95.58±12.61 beats/min) compared with the RLT group (75.14±14.96 beats/min) (P=.05). In the RLT group, no significant changes in heart rate variability (standard deviation R-R interval and root mean square of successive differences) was found between the standing and 6-minute walk test physiological positions throughout the intervention. Cardiovascular efficiency in the RLT group during the 6-minute walk test improved from 11.1±2.6 at baseline to 7.5±2.8 beats per meter walked at 6 weeks and was maintained from 6 to 24 weeks. CONCLUSIONS Large effect sizes and significant differences between groups found in this pilot study support the clinical effectiveness of RLT and ABT for changing cardiovascular indices as early as 6 weeks and up to 24 weeks of rehabilitation. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress. Based on heart rate variability metrics, the stimulus of standing has comparable effects to RLT on the parasympathetic nervous system. Cardiovascular efficiency of exoskeleton walking improved, particularly over the first 6 weeks. Both the RLT and ABT interventions were limited in their effect on brachial and ankle blood pressure. A randomized controlled trial with a larger sample size is warranted to further examine these findings.
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Affiliation(s)
- Robert W Evans
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Claire L Shackleton
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town; IOC Research Centre, South Africa
| | - H G Laurie Rauch
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Ed Baalbergen
- Rehabilitation Unit, Life Vincent Pallotti Hospital, Cape Town, South Africa
| | - Yumna Albertus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Perry B, Sivak J, Stokic D. Providing unloading by exoskeleton improves shoulder flexion performance after stroke. Exp Brain Res 2021; 239:1539-1549. [PMID: 33693984 DOI: 10.1007/s00221-021-06070-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/28/2022]
Abstract
Robotic devices can be engaged actively or passively to unload arm weight or impose additional loading. The conditions of variable loading and unloading offer an opportunity to investigate motor performance of the arm affected by a stroke. The objective of this study was to investigate the interactive effects of the proximal arm impairment and passive weight compensation on shoulder flexion performance in the sagittal plane after stroke. Twenty-eight participants (age 57 ± 10 years, 21/28 ≤ 6 weeks post-stroke) played a shoulder flexion game under five standardized weight compensation configurations provided by the Armeo®Spring exoskeleton. Percent of targets acquired and root mean square error were calculated to derive three behavioral and three kinematic outcomes: total score/overall error (loading/unloading conditions and five configurations combined), loading and unloading score/error (five configurations combined), and weight compensation configuration score/error for each setting separately. The total score was positively related and the overall error was negatively related to proximal arm impairment (Fugl-Meyer upper extremity movement subscale, maximum 30, FM30). The unloading score (80 ± 27%) and error (5 ± 4°) were significantly better than the loading score (45 ± 38%, p < 0.01) and error (14± 9°, p < 0.01) with improvements most pronounced in the mid-range of FM30 (4-15 points). The configuration scores/error gradually improved with each increment in unloading for the mid-range FM30 participants, while only error improved in those with low FM30. In conclusion, shoulder flexion performance depends on proximal arm impairment, but it is also influenced by the degree of unloading/loading provided, particularly among individuals with moderate paresis after stroke.
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Affiliation(s)
- Bonnie Perry
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA.
| | - Jenn Sivak
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Dobrivoje Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
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Drużbicki M, Guzik A, Przysada G, Phd LP, Brzozowska-Magoń A, Cygoń K, Boczula G, Bartosik-Psujek H. Effects of Robotic Exoskeleton-Aided Gait Training in the Strength, Body Balance, and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study. Arch Phys Med Rehabil 2021; 102:175-84. [PMID: 33181115 DOI: 10.1016/j.apmr.2020.10.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up. DESIGN Single-group longitudinal preliminary study. SETTING Individuals with multiple sclerosis (MS) at a hospital neurology ward. PARTICIPANTS Participants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5. INTERVENTIONS Exoskeleton-assisted walk training. MAIN OUTCOME MEASURES Primary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3). RESULTS At the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant. CONCLUSIONS Individuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.
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Asselin P, Cirnigliaro CM, Kornfeld S, Knezevic S, Lackow R, Elliott M, Bauman WA, Spungen AM. Effect of Exoskeletal-Assisted Walking on Soft Tissue Body Composition in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2020; 102:196-202. [PMID: 33171129 DOI: 10.1016/j.apmr.2020.07.018] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the effect of overground walking using a powered exoskeleton on soft tissue body composition in persons with spinal cord injury (SCI). DESIGN A prospective, single group observational pilot study. SETTING Medical center. PARTICIPANTS Persons (N=8) with chronic (>6mo) SCI between 18 and 65 years old who weighed less than 100 kg. INTERVENTIONS Overground ambulation training using a powered exoskeleton (ReWalk) for 40 sessions, with each session lasting up to 2 hours, with participants training 3 times per week. MAIN OUTCOME MEASURE(S) Dual-energy x-ray absorptiometry (DXA) was used to measure lean mass (LM) and fat mass (FM) from the whole body, arms, legs and trunk. DXA was also used to assess visceral adipose tissue (VAT). Walking performance was measured by 6-minute walk test. RESULTS Participants significantly lost total body FM (-1.8±1.2kg, P=.004) with the loss of adiposity distributed over several regional sites. Six of the 8 participants lost VAT, with the average loss in VAT trending toward significance (-0.141kg, P=.06). LM for the group was not significantly changed. CONCLUSIONS Sustained and weekly use of powered exoskeletons in persons with SCI has the potential to reduce FM with inferred improvements in health.
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Affiliation(s)
- Pierre Asselin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Christopher M Cirnigliaro
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - Stephen Kornfeld
- Spinal Cord Injury Service, James J. Peters VA Medical Center, Bronx, NY
| | - Steven Knezevic
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - Rachel Lackow
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - Michael Elliott
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ann M Spungen
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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12
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Ehrlich-Jones L, Crown DS, Kinnett-Hopkins D, Field-Fote E, Furbish C, Mummidisetty CK, Bond RA, Forrest G, Jayaraman A, Heinemann AW. Clinician Perceptions of Robotic Exoskeletons for Locomotor Training After Spinal Cord Injury: A Qualitative Approach. Arch Phys Med Rehabil 2020; 102:203-215. [PMID: 33171130 DOI: 10.1016/j.apmr.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/26/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the experiences of clinicians who have used robotic exoskeletons in their practice and acquire information that can guide clinical decisions and training strategies related to robotic exoskeletons. DESIGN Qualitative, online survey study, and 4 single-session focus groups followed by thematic analysis to define themes. SETTING Focus groups were conducted at 3 regional rehabilitation hospitals and 1 Veteran's Administration (VA) Medical Center. PARTICIPANTS Clinicians (N=40) reported their demographic characteristics and clinical experience using robotic exoskeletons. Twenty-nine clinicians participated in focus groups at regional hospitals that use robotic exoskeletons, as well as 1 VA Medical Center. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Clinicians' preferences, experiences, training strategies, and clinical decisions on how robotic exoskeleton devices are used with Veterans and civilians with spinal cord injury. RESULTS Clinicians had an average of 3 years of experience using exoskeletons in clinical and research settings. Major themes emerging from focus group discussions included appropriateness of patient goals, patient selection criteria, realistic patient expectations, patient and caregiver training for use of exoskeletons, perceived benefits, preferences regarding specific exoskeletons, and device limitations and therapy recommendations. CONCLUSIONS Clinicians identified benefits of exoskeleton use including decreased physical burden and fatigue while maximizing patient mobility, increased safety of clinicians and patients, and expanded device awareness and preferences. Suitability of exoskeletons for patients with various characteristics and managing expectations were concerns. Clinicians identified research opportunities as technology continues to advance toward safer, lighter, and hands-free devices.
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Affiliation(s)
- Linda Ehrlich-Jones
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL.
| | - Deborah S Crown
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL
| | - Dominique Kinnett-Hopkins
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Edelle Field-Fote
- Shepherd Center, Spinal Cord Injury Research, Atlanta, GA; Emory University, Division of Physical Therapy, Atlanta, GA
| | - Cathy Furbish
- Shepherd Center, Spinal Cord Injury Research, Atlanta, GA
| | - Chaithanya K Mummidisetty
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Rachel A Bond
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL
| | - Gail Forrest
- Kessler Foundation, Center for Spinal Stimulation, East Hanover, NJ; Rutgers New Jersey Medical School, Newark, NJ
| | - Arun Jayaraman
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Allen W Heinemann
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
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13
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Brihmat N, Loubinoux I, Castel-Lacanal E, Marque P, Gasq D. Kinematic parameters obtained with the ArmeoSpring for upper-limb assessment after stroke: a reliability and learning effect study for guiding parameter use. J Neuroeng Rehabil 2020; 17:130. [PMID: 32993695 PMCID: PMC7523068 DOI: 10.1186/s12984-020-00759-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/11/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients. METHODS This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the 'horizontal catch' exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring' data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). RESULTS We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%. CONCLUSIONS After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.
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Affiliation(s)
- Nabila Brihmat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Isabelle Loubinoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Evelyne Castel-Lacanal
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France. .,Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France. .,Service des Explorations Fonctionnelles Physiologiques, Hôpital Rangueil, 1 Avenue du Pr Poulhes, 31059, Toulouse, France.
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14
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Evans RW, Bantjes J, Shackleton CL, West S, Derman W, Albertus Y, Swartz L. "I was like intoxicated with this positivity": the politics of hope amongst participants in a trial of a novel spinal cord injury rehabilitation technology in South Africa. Disabil Rehabil Assist Technol 2020; 17:712-718. [PMID: 32886532 DOI: 10.1080/17483107.2020.1815086] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE This study discussed the reports by participants in a randomised controlled trial of a novel intervention for spinal cord injury (SCI) rehabilitation in Cape Town, South Africa. MATERIALS AND METHODS Sixteen participants were randomised to rehabilitation involving the use of robotic locomotor training, a novel technology, or to a group receiving an activity-based intervention. All participants were interviewed before the intervention and at six months follow-up. RESULTS In a context in which rehabilitation services for SCI are virtually non-existent, all participants approached the study with enthusiasm and expressed gratitude for participation. They had high hopes for what the programme could achieve, with many believing, perhaps incorrectly, that the programme would help them walk independently again. While hope and enthusiasm are useful for adherence to experimental intervention studies, there is a danger, especially in poorly resourced contexts, for participants to experience considerable disappointment following false hope not being realised. This raises important ethical issues for researchers interested in the potential of new technologies to promote health in poorly resourced contexts. CONCLUSIONS For clinicians, the path between supporting positive emotions (which may lead to positive outcomes), and confronting unrealistic hope (which may lead to negative outcomes) may be difficult. Follow-up with participants after re-integration into their communities is important to determine long-term psychological impact.Pan African Clinical Trial Number: PACTR201608001647143IMPLICATIONS FOR REHABILITATIONIn low-resource contexts where there is a low level of access to rehabilitation services, such access in the context of a trial of a new intervention may engender hope in a group of people with spinal cord injury. This hope may increase when a new technology is used, as was the case in this study.Hope can be very helpful to people entering rehabilitation, but unrealistic hope and expectations may have negative implications in the longer term.In this study, expectations of participants centred, unrealistically, around regaining the ability to walk again, despite past experiences and medical advice suggesting otherwise.A thin line exists between supporting high expectations and confronting unrealistic hope. This conundrum is difficult for the clinician, as both inappropriate hope and undue pessimism about an intervention have the potential to cause harm.Participant follow-up after the end of any innovative trial is important, not just to monitor physical progress, but also, where necessary, to support participants through a potential period of disillusionment when they find their expectations have not been fully met.
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Affiliation(s)
- Robert W Evans
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jason Bantjes
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, South Africa
| | - Claire L Shackleton
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,IOC Research Centre, Cape Town, South Africa
| | - Yumna Albertus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, South Africa
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15
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Caliandro P, Molteni F, Simbolotti C, Guanziroli E, Iacovelli C, Reale G, Giovannini S, Padua L. Exoskeleton-assisted gait in chronic stroke: An EMG and functional near-infrared spectroscopy study of muscle activation patterns and prefrontal cortex activity. Clin Neurophysiol 2020; 131:1775-1781. [PMID: 32506008 DOI: 10.1016/j.clinph.2020.04.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/28/2020] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Gait impairment dramatically affects stroke patients' functional independence. The Ekso™ is a wearable powered exoskeleton able to improve over-ground gait abilities, but the relationship between the cortical gait control mechanisms and lower limbs kinematics is still unclear. Our aims are: to assess whether the Ekso™ induces an attention-demanding process with prefrontal cortex activation during a gait task; to describe the relationship between the gait-induced muscle activation pattern and the prefrontal cortex activity. METHODS We enrolled 22 chronic stroke patients and 15 matched controls. We registered prefrontal cortex (PFC) activity with functional Near-Infrared Spectroscopy (fNIRS) and muscle activation with surface-electromyography (sEMG) during an over-ground gait task, performed with and without the Ekso™. RESULTS We observed prefrontal cortex activation during normal gait and a higher activation during Ekso-assisted walking among stroke patients. Furthermore, we found that muscle hypo-activation and co-activation of non-paretic limb are associated to a high prefrontal metabolism. CONCLUSIONS Among stroke patients, over-ground gait is an attention-demanding task. Prefrontal activity is modulated both by Ekso-assisted tasks and muscle activation patterns of non-paretic lower limb. Further studies are needed to elucidate if other Ekso™ settings induce different cortical and peripheral effects. SIGNIFICANCE This is the first study exploring the relationship between central and peripheral mechanisms during an Ekso-assisted gait task.
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Affiliation(s)
- Pietro Caliandro
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17 23845 Costa Masnaga, Lecco, Italy
| | - Chiara Simbolotti
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17 23845 Costa Masnaga, Lecco, Italy
| | | | - Giuseppe Reale
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Giovannini
- Rehabilitation Units, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.
| | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy; Neurorehabilitation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
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16
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Kwon SH, Lee BS, Lee HJ, Kim EJ, Lee JA, Yang SP, Kim TY, Pak HR, Kim HK, Kim HY, Jung JH, Oh SW. Energy Efficiency and Patient Satisfaction of Gait With Knee-Ankle-Foot Orthosis and Robot (ReWalk)-Assisted Gait in Patients With Spinal Cord Injury. Ann Rehabil Med 2020; 44:131-141. [PMID: 32392652 PMCID: PMC7214138 DOI: 10.5535/arm.2020.44.2.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/21/2019] [Accepted: 10/10/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries. METHODS Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation. RESULTS The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction. CONCLUSION The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.
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Affiliation(s)
- Seung Hyun Kwon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Bum Suk Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hye Jin Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Jung Ah Lee
- Department of Clinical Research on Rehabilitation, National Rehabilitation Research Institute, Seoul, Korea
| | - Sung Phil Yang
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Tae Young Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Han Ram Pak
- Department of Clinical Research on Rehabilitation, National Rehabilitation Research Institute, Seoul, Korea
| | - Hyun Ki Kim
- Department of Clinical Research on Rehabilitation, National Rehabilitation Research Institute, Seoul, Korea
| | - Hae Young Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Joo Hwan Jung
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Sang Wook Oh
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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17
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Heinemann AW, Kinnett-Hopkins D, Mummidisetty CK, Bond RA, Ehrlich-Jones L, Furbish C, Field-Fote E, Jayaraman A. Appraisals of robotic locomotor exoskeletons for gait: focus group insights from potential users with spinal cord injuries. Disabil Rehabil Assist Technol 2020; 15:762-772. [PMID: 32255369 DOI: 10.1080/17483107.2020.1745910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/24/2022]
Abstract
Purpose: To describe appraisals of robotic exoskeletons for locomotion by potential users with spinal cord injuries, their perceptions of device benefits and limitations, and recommendations for manufacturers and therapists regarding device use.Materials and methods: We conducted focus groups at three regional rehabilitation hospitals and used thematic analysis to define themes.Results: Across four focus groups, 35 adults participated; they were predominantly middle-aged, male, and diverse in terms of race and ethnicity, well educated, and not working. Participants had been living with SCI an average of two decades. Most participants were aware of exoskeletons. Some were enthusiastic about the usability of the devices while others were more circumspect. They had many questions about device affordability and usability, and were discerning in their appraisal of benefits and suitability to their particular circumstances. They reflected on device cost, the need for caregiver assistance, use of hands, and environmental considerations. They weighed the functional benefits relative to the cost of preferred activities. Their recommendations focused on cost, battery life, and independent use.Conclusions: Potential users' appraisals of mobility technology reflect a nuanced appreciation of device costs; functional, social, and psychological benefits; and limitations. Results provide guidance to therapists and manufacturers regarding device use.Implications for RehabilitationPotential users of robotic locomotor exoskeletons with spinal cord injuries appreciate the functional, social, and psychological benefits that these devices may offer.Their appraisals reflect nuanced consideration of device cost and features, and the suitability of the assistive technology to their circumstances.They recommend that manufacturers focus on reducing cost, extending battery life, and features that allow independent use.
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Affiliation(s)
- Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | | | - Rachel A Bond
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Catherine Furbish
- Spinal Cord Injury Research Program, Shepherd Center, Atlanta, GA, USA
| | - Edelle Field-Fote
- Spinal Cord Injury Research Program, Shepherd Center, Atlanta, GA, USA.,Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Arun Jayaraman
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
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Miura K, Kadone H, Abe T, Koda M, Funayama T, Noguchi H, Kumagai H, Nagashima K, Mataki K, Shibao Y, Sato K, Kawamoto H, Sankai Y, Yamazaki M. Successful Use of the Hybrid Assistive Limb for Care Support to Reduce Lumbar Load in a Simulated Patient Transfer. Asian Spine J 2020; 15:40-45. [PMID: 32008308 PMCID: PMC7904485 DOI: 10.31616/asj.2019.0111] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Prospective experimental study in humans. PURPOSE To determine whether the hybrid assistive limb (HAL) for Care Support can reduce lumbar load during a patient transfer. OVERVIEW OF LITERATURE The prevalence of work-related low back pain (LBP) among nurses is high. In particular, transferring patients poses a high risk for LBP due to the large lumbar load. Attempts to reduce the lumbar load are crucial to avoid the risk of LBP. Therefore, we investigated the effects of the HAL for Care Support. METHODS Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip. RESULTS Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers. CONCLUSIONS The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.
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Affiliation(s)
- Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kentaro Mataki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Maher JL, Baunsgaard CB, van Gerven J, Palermo AE, Biering-Sorensen F, Mendez A, Irwin RW, Nash MS. Differences in Acute Metabolic Responses to Bionic and Nonbionic Ambulation in Spinal Cord Injured Humans and Controls. Arch Phys Med Rehabil 2019; 101:121-129. [PMID: 31465760 DOI: 10.1016/j.apmr.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/18/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To (1) compare energy expenditure during seated rest, standing, and prolonged bionic ambulation or bipedal ambulation in participants with spinal cord injury (SCI) and noninjured controls, respectively, and (2) test effects on postbionic ambulation glycemia in SCI. DESIGN Two independent group comparison of SCI and controls. SETTING Academic Medical Center. PARTICIPANTS Ten participants with chronic SCI (C7-T1, American Spinal Injury Association Impairment Scale A-C) and 10 controls (N=20). INTERVENTIONS A commercial bionic exoskeleton. MAIN OUTCOME MEASURES Absolute and relative (to peak) oxygen consumption, perceived exertion, carbohydrate/fat oxidation, energy expenditure, and postbionic ambulation plasma glucose/insulin. RESULTS Average work intensity accompanying 45 minutes of outdoor bionic ambulation was <40% peak oxygen consumption, with negligible drift after reaching steady state. Rating of perceived exertion (RPE) did not differ between groups and reflected low exertion. Absolute energy costs for bionic ambulation and nonbionic ambulation were not different between groups despite a 565% higher ambulation velocity in controls and 3.3× higher kilocalorie per meter in SCI. Fuel partitioning was similar between groups and the same within groups for carbohydrate and fat oxidation. Nonsignificant (9%) lowering of the area under a glucose tolerance curve following bionic ambulation required 20% less insulin than at rest. CONCLUSION Work intensity during prolonged bionic ambulation for this bionic exoskeleton is below a threshold for cardiorespiratory conditioning but above seated rest and passive standing. Bionic ambulation metabolism is consistent with low RPE and unchanged fuel partitioning from seated rest. Bionic ambulation did not promote beneficial effects on glycemia in well-conditioned, euglycemic participants. These findings may differ in less fit individuals with SCI or those with impaired glucose tolerance. Observed trends favoring this benefit suggest they are worthy of testing.
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Affiliation(s)
- Jennifer L Maher
- Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida.
| | | | - Jan van Gerven
- Radboud University, Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Anne E Palermo
- Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida
| | | | - Armando Mendez
- Division of Endocrinology, Diabetes and Metabolism, Diabetes Research Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Robert W Irwin
- Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida
| | - Mark S Nash
- Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida; Department of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida
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20
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Kandilakis C, Sasso-Lance E. Exoskeletons for Personal Use After Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:331-7. [PMID: 31228407 DOI: 10.1016/j.apmr.2019.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/11/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023]
Abstract
Before the development of robotic exoskeletons, mobility options beyond a wheelchair were very limited for most people lacking leg movement due to spinal cord injury (SCI). Over the years, robotic exoskeletons have become more widely available and now have the potential to be successfully used for personal use at home and in the community. However, it is important that users set realistic expectations. The features and capabilities of each robotic exoskeleton differ, and how exoskeletons are used may vary greatly between individuals. Robotic exoskeletons can allow individuals with SCI with varying levels of injury to safely and functionally walk for personal mobility or exercise. The following special communication will discuss important considerations surrounding exoskeleton use including feasibility, safety, cost, speed, and potential health benefits of using an exoskeleton for everyday life for people with SCI.
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Dijkers MP, Akers KG, Dieffenbach S, Galen SS. Systematic Reviews of Clinical Benefits of Exoskeleton Use for Gait and Mobility in Neurologic Disorders: A Tertiary Study. Arch Phys Med Rehabil 2019; 102:300-313. [PMID: 30849306 DOI: 10.1016/j.apmr.2019.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/20/2018] [Revised: 12/20/2018] [Accepted: 01/29/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe systematic reviews (SRs) of the use of exoskeletons for gait and mobility by persons with neurologic disorders and to evaluate their quality as guidance for research and clinical practice. DATA SOURCES PubMed, EMBASE, Web of Science, CINAHL Complete, PsycINFO, Cochrane Database of Systematic Reviews, PEDro, and Google Scholar were searched from database inception to January 23, 2018. STUDY SELECTION A total of 331 deduplicated abstracts from bibliographic database and ancestor searching were independently screened by 2 reviewers, resulting in 109 articles for which full text was obtained. Independent screening of those 109 articles by 2 reviewers resulted in a final selection of 17 SRs. DATA EXTRACTION Data were extracted by 1 reviewer using a pretested Excel form with 158 fields and checked by a second reviewer. Key data included the purpose of the SR, methods used, outcome measures presented, and conclusions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and A MeaSurement Tool to Assess Systematic Reviews version 2 were used to evaluate reporting and methodological quality, respectively, of the SRs. DATA SYNTHESIS The SRs generally were of poor methodological and reporting quality. They failed to report some information on patients (eg, height, weight, baseline ambulatory status) and interventions (eg, treatment hours or sessions planned and delivered) that clinicians and other stakeholders might want to have, and often failed to notice that the primary studies duplicated subjects. CONCLUSIONS Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. Future primary and secondary studies need to address the multiple methodological limitations.
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Affiliation(s)
- Marcel P Dijkers
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan, the United States.
| | - Katherine G Akers
- Shiffman Medical Library, Wayne State University, Detroit, Michigan, the United States
| | - Sabrina Dieffenbach
- School of Medicine, Wayne State University, Detroit, Michigan, the United States
| | - Sujay S Galen
- Physical Therapy Program, Wayne State University, Detroit, Michigan, the United States
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22
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Kang MG, Yun SJ, Shin HI, Kim E, Lee HH, Oh BM, Seo HG. Effects of robot-assisted gait training in patients with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2019; 20:15. [PMID: 30616685 PMCID: PMC6322303 DOI: 10.1186/s13063-018-3123-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/06/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson's disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects. METHODS This is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant's height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44. DISCUSSION This study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT03490578 . Registered on 21 March 2018.
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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23
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Nam YG, Lee JW, Park JW, Lee HJ, Nam KY, Park JH, Yu CS, Choi MR, Kwon BS. Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 100:26-31. [PMID: 30055163 DOI: 10.1016/j.apmr.2018.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/15/2017] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity. DESIGN Randomized controlled trial. SETTING University rehabilitation hospital. PARTICIPANTS Individuals (N=40) with stroke who could stand alone. INTERVENTIONS Patients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 minutes each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups. MAIN OUTCOME MEASURES Functional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity, and balance were secondary outcomes. RESULTS FAC in the control group was 2.44±1.55 in the pretraining and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pretraining and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group. CONCLUSIONS Electromechanical exoskeleton-assisted gait training is as effective as conventional gait training by a physical therapist when administered by a gait trainer. As an overground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.
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Affiliation(s)
- Yeon-Gyo Nam
- Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea
| | | | - Jin Woo Park
- Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Ho Jun Lee
- Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Ki Yeun Nam
- Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jun Hyung Park
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Chang Seon Yu
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Myong Ryol Choi
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Graduate School of Dongguk University, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
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24
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Abstract
The digitalization in medicine has led to almost universal availability of information to different healthcare professionals and accelerated clinical pathways. Fast-track concepts and short hospital stays require intelligent and practicable systems in preventive and rehabilitation medicine. This includes optimization of movement analysis by innovative tools such as detectors sensing skin movements, portable feedback systems for monitoring, robot-assisted devices, and prevention programs based on reliable data. Finally, clinical structures are needed to exploit the maximal potential of artificial intelligence (AI) and deep learning. One example is the establishment of inter- and transdisciplinary professional teams such as a RehaBoard. In contrast to other cost-intensive disciplines such as oncology, the introduction of AI into rehabilitation orthopedics and trauma surgery with the support of cross-sectoral cooperation has great potential for performing well in patient benefit-orientated competition (value-based competition).
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Affiliation(s)
- M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45274, Essen, Deutschland.
| | - C Mayer
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45274, Essen, Deutschland
| | - H Hefter
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Siebler
- Neurologie, MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
| | - A Kecskeméthy
- Lehrstuhl für Mechanik und Robotik, Universität Duisburg-Essen, Duisburg, Deutschland
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25
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Mao HF, Huang HP, Lu TW, Wang TM, Wu CH, Hu JS. Balance Control and Energetics of Powered Exoskeleton-Assisted Sit-to-Stand Movement in Individuals With Paraplegic Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:1982-1990. [PMID: 29709521 DOI: 10.1016/j.apmr.2018.04.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify the effects of initial hip angle and angular hip velocity settings of a lower-limb wearable robotic exoskeleton (WRE) on the balance control and mechanical energy requirements in patients with paraplegic spinal cord injuries (SCIs) during WRE-assisted sit-to-stand (STS). DESIGN Observational, cross-sectional study. SETTING A university hospital gait laboratory with an 8-camera motion analysis system, 3 forceplates, a pair of instrumented crutches, and a WRE. PARTICIPANTS Patients (N=12) with paraplegic SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The inclination angle (IA) of the body's center of mass (COM) relative to the center of pressure (COP), and the rate of change of IA (RCIA) for balance control, and the mechanical energy and forward COM momentum before and after seat-off for energetics during WRE-assisted STS were compared between conditions with 2 initial hip angles (105° and 115°) and 3 initial hip angular velocities (800, 1000, 1200 rpm). RESULTS No interactions between the main factors (ie, initial hip angle vs angular velocity) were found for any of the calculated variables. Greater initial hip angle helped the patients with SCI move the body forward with increased COM momentum but reduced RCIA (P<.05). With increasing initial angular hip velocity, the IA and RCIA after seat-off (P<.05) increased linearly while total mechanical energy reduced linearly (P<.05). CONCLUSIONS The current results suggest that a greater initial hip angle with smaller initial angular velocity may provide a favorable compromise between momentum transfer and balance of the body for people with SCI during WRE-assisted STS. The current data will be helpful for improving the design and clinical use of the WRE.
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Affiliation(s)
- Hui-Fen Mao
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Po Huang
- Institute of Biomedical Engineering, National Taiwan University, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taiwan; Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Hua Wu
- Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Jwu-Sheng Hu
- Institute of Electrical Control Engineering, National Chiao Tung University, Hsinchu, Taiwan
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Watanabe H, Goto R, Tanaka N, Matsumura A, Yanagi H. Effects of gait training using the Hybrid Assistive Limb® in recovery-phase stroke patients: A 2-month follow-up, randomized, controlled study. NeuroRehabilitation 2017; 40:363-367. [PMID: 28222558 DOI: 10.3233/nre-161424] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 11/15/2022]
Abstract
BACKGROUND Gait training using the Hybrid Assistive Limb® (HAL®) may have beneficial effects on post-stroke gait function and independent walking. However, the long-term and medium-term efficacies of gait training using HAL® in stroke patients remain unclear. OBJECTIVE To compare the medium-term efficacy of gait training using a single-leg version of the Hybrid Assistive Limb® (HAL®) on the paretic side with conventional gait training (CGT) in recovery-phase stroke patients. METHODS Twenty-four post-stroke participants (HAL® group: n = 12, CGT group: n = 12) completed the trial. Over 4 weeks, all participants received twelve 20-min sessions of either HAL® (using the single-leg version of HAL® on the paretic side) or conventional (performed by skilled and experienced physical therapists) gait training. Outcome measures were evaluated prior to training, after 12 sessions, and at 8 and 12 weeks after intervention initiation. Functional Ambulation Category (FAC) was the primary outcome measure. RESULTS The HAL® group showed significant improvement in FAC after 12 sessions, and at 8 and 12 weeks compared to the conventional group (P = 0.02). CONCLUSIONS The results suggested that a gait training program based on HAL® may improve independent walking more efficiently than CGT at 1 and 2 months after intervention.
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Affiliation(s)
- Hiroki Watanabe
- Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryohei Goto
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Naoki Tanaka
- Department of Rehabilitation, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hisako Yanagi
- Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
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Bayón C, Lerma S, Ramírez O, Serrano J, Del Castillo M, Raya R, Belda-Lois J, Martínez I, Rocon E. Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report. J Neuroeng Rehabil 2016; 13:98. [PMID: 27842562 PMCID: PMC5109815 DOI: 10.1186/s12984-016-0206-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 03/17/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increased. Nevertheless, current gait trainers are focused on controlling complete joint trajectories, avoiding postural control and the adaptation of the therapy to a specific patient. This paper presents the applicability of a new robotic platform called CPWalker in children with spastic diplegia. FINDINGS CPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks. After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41.97 %), cadence (29.19 ± 33.36 %) and step length (26.49 ± 19.58 %) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments. CONCLUSIONS The results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children's participation during therapies. Moreover, participants' postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient's trunk control while the locomotion therapy is executed. Although results are promising, further studies with bigger sample size are required.
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Affiliation(s)
- C. Bayón
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - S. Lerma
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - O. Ramírez
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - J.I. Serrano
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - M.D. Del Castillo
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - R. Raya
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | | | - I. Martínez
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - E. Rocon
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
- Postgraduate Program, Universidade Federal do Espírito Santo, Vitória, Brazil
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