Archive for category Gait/Drop Foot

[Abstract] Neurotech: Robotic Assist Devices Show Gains in Walking for Crouch Gait in Cerebral Palsy and Post-Stroke Hemiparesis

via Neurotech: Robotic Assist Devices Show Gains in Walking for… : Neurology Today

ARTICLE IN BRIEF

Figure

Developers of robotic devices discuss advances in the technologies to help people improve walking post-stroke and improve couch gait in cerebral palsy. Independent experts in neurorehabilitation review the potential and possible caveats of these devices.

Three novel robotic assistance devices, one for hemiparetic gait following stroke, and two for crouch gait in children with cerebral palsy, have each demonstrated improved walking in preliminary clinical trials.

For stroke patients, a robotic exosuit made of a soft, clothing-like anchor attached to motorized cables was shown to increase the paretic limb’s forward propulsion and the paretic ankle’s swing phase dorsiflexion in both treadmill and over-ground walking.

For children with crouch gait due to cerebral palsy, one trial used a cable-driven robot called a Tethered Pelvic Assist Device, or TPAD. The laboratory-based device is designed to strengthen the extensor muscles, especially the soleus in the calves, by putting downward pressure on them during training. After six weeks of practice with the device, the children’s posture was more upright, with greater step length and toe clearance, when walking without it.

Also for children with crouch gait, the third study examined the use of a wearable exoskeleton that provides a burst of knee extension assistance at just the right moment when a child or adolescent is walking. None of the seven participants, age 5 to 17, fell while using it, and six of the seven showed postural improvements equivalent to those previously reported from surgery.

While promising, the devices will require far more testing in randomized trials before their true value can be known, said a leading specialist in neurological rehabilitation.

“These are foundational studies; they’re just beginning to get started,” said Bruce H. Dobkin, MD, FRCP, distinguished professor of clinical neurology and director of the Neurological Rehabilitation and Research Program at the Geffen School of Medicine at the University of California, Los Angeles. “The cost, safety, user-friendliness, and ability to use at differing levels of disability severity — all those are major challenges.”

Even so, each of the three devices employs a new kind of robotic assistance unlike any existing on the market.

“Most robotics for neurological injuries are heavy, power-hungry exosuits for people with spinal cord injuries who can’t walk at all,” said a coauthor of the study for stroke patients, Terry D. Ellis, PT, PhD, NCS, director of the Center for Neurorehabilitation at Boston University. “But there’s a whole bunch of people who have disabilities, who can walk, but don’t walk well. They need facilitation or augmentation to restore some of the normal components of walking.”

A ROBOT POST-STROKE

Published in the July 26 edition of Science Translational Medicine, the study of a robotic exosuit tested in nine post-stroke patients used what it called “garment-like, functional textile anchors” rather than a hard, metallic exterior. Worn on only the paretic limb, the suit was designed to be as unobtrusive as possible.

“It’s much more compatible with the real world than a rigid device would be,” said the first author of the paper, Louis N. Awad, PT, DPT, PhD, an assistant professor of physical therapy at Boston University, and a research faculty member at Spaulding Rehabilitation Hospital. “Ordinary clothes are made of soft material. We don’t don a metallic pair of pants and walk out the door. That’s our goal — robotic clothing that helps people with difficulty walking.”

Attached to cables tethered to a belt worn around the hips, the exosuit functioned in synchrony with a wearer’s paretic limb to facilitate an immediate increase in the paretic ankle’s swing phase dorsiflexion and forward propulsion (p< 0.05), according to the paper.

The improved movements resulted in a 20 percent reduction in forward propulsion interlimb asymmetry and a 10 percent reduction in the energy cost of walking, which together were equivalent to a nearly one-third lower metabolic burden — a 32 percent reduction — while walking.

Although the study did include some over-ground walking, it was not designed to test whether the exosuit had any therapeutic effects that might carry over to when patients are not wearing it.

“This is a proof of concept paper,” said Dr. Ellis. “Down the road we need to conduct trials in more ecologically valid environments, and to see if it has therapeutic value. For now we wanted to demonstrate that the device can facilitate more normal walking.”

While applauding the study as “clever,” Dr. Dobkin said it remained to be seen whether the robotic exosuit would prove to have significant therapeutic effects that would stand up in randomized trials in natural environments. He pointed to randomized trials published in recent years showing that peroneal nerve functional electrical stimulators have no greater therapeutic effect than do standard ankle-foot orthoses.

“It’s similar to all the work that was done using the electrical stimulation of the ankle,” Dr. Dobkin said. “The real question is whether it will lead to improved function when you walk over-ground. Walking on a treadmill is not terribly natural.”

He also pointed out that the nine patients in the study were able to walk on average at about two miles per hour. “That’s already pretty fast,” he said. In addition, he said, the 20 percent reduction in interlimb asymmetry is relatively modest.

But, said Dr. Dobkin, people can improve their gait by 20 percent just by sustained practice. “When you see modest changes like this with the device, you wonder if the same changes couldn’t have been achieved without it,” he said.

Steven L. Wolf, PhD, PT, FAPTA, FAHA, professor in the department of rehabilitation medicine at Emory University School of Medicine, pointed out that existing robotic devices to help people who are completely unable to walk can cost patients up to $250,000. Perhaps the exosuit might become an improvement over what presently exists both in terms of function and cost, he said.

“Most existing devices are beautiful but incredibly expensive,” Dr. Wolf said. “Is the bang in the buck? Not as yet, in my opinion. The evidence for persistent benefit from these device is just not there.”

IMPROVING CROUCH GAIT IN CP

The first of the two studies using robotic devices to improve crouch gait in children with cerebral palsy was published on July 26 in Science Robotics, led by senior author Sunil K. Agrawal, PhD, professor of mechanical engineering and rehabilitation medicine at Columbia University.

Rather than directly straighten the children’s posture, Dr. Agrawal’s seemingly contradictory approach was to increase the downward force on their pelvis as they attempted to walk on a treadmill. The tension in each wire, attached to a belt on the pelvis, is modulated in real time by a motor placed around the treadmill in response to motion capture data from cameras. Unlike other robotic devices that have been tested for treating crouch gait, the TPAD has no rigid links to the body, permitting free movement of the legs.

After training in the device for 15 sessions of 16 minutes each over the course of six weeks, the six participants showed enhanced upright posture, improved muscle coordination, increased step length, range of motion of the lower limb angles, toe clearance, and heel-to-toe pattern.

“You can see a marked difference before and after,” Dr. Agrawal said. “We heard from families and the children themselves that they were walking faster, with better posture. Now we have to see if we should use a higher magnitude of downward pull, how long each training session should be, and for how many sessions.”

Commenting on the TPAD study, Dr. Dobkin said, “The kids who were selected for inclusion were not necessarily the kind who get surgery. They had less of a crouch, a little bit more of a push-off. The question is whether training like this will lead to good over-ground walking. They got a hint of that.”

The second crouch-gait study, published on August 23 in Science Translational Medicine, involved a wearable exoskeleton designed for over-land use, and was described by the authors as the first robotic device designed specifically to treat a gait disorder in children and adolescents. Rather than force the lower limb to move in a particular way, “the exoskeleton dynamically changed the posture by introducing bursts of knee extension assistance during discrete portions of the walking cycle, a perturbation that resulted in maintained or increase knee extensor muscle activity during exoskeleton use,” the paper stated.

“In the last decade, there’s been a groundswell of work on exoskeletons, but a majority of them are designed to permit mobility after spinal injury in adults who have lost the ability to walk,” said senior author Thomas Bulea, PhD, a staff scientist in the functional and applied biomechanics section of the rehabilitation medicine department at the National Institutes of Health Clinical Center in Bethesda, MD. “There hasn’t been much done for the pediatric population who just need to improve their walking.”

A coauthor of the paper, Diane L. Damiano, PT, PhD, chief of the section in which Dr. Bulea works, said the purpose of the wearable exoskeleton is different than that of the TPAD device developed by Dr. Agrawal.

“His device is designed to strengthen the calf muscles by increasing the resistance on them,” she said. “His results were good, but this is very different from what we are doing. We have a wearable device. It’s not meant to be used in a lab for training. We’re not necessarily trying to strengthen them, although that would be a desired outcome; we are instead trying to assist their abilities to help them practice being more upright while they walk. This is something that they would wear throughout the day for several months with the goal that their posture will ultimately be improved without the device.”

A surprising observation, she added, was that some children saw it as something cool to wear.

LINK UP FOR MORE INFORMATION:

•. Awad LN, Bae J, O’Donnell K, et al A soft robotic exosuit improves walking in patients after stroke http://stm.sciencemag.org/content/9/400/eaai9084. Sci Transl Med 2017; 9 (400). pii: eaai9084.

•. Video of the soft robotic exosuit for stroke patients: http://www.sciencetranslationalmedicine.org/cgi/content/full/9/400/eaai9084/DC1

•. Kang J, Martelli D, Vashista V, et al Robot-driven downward pelvic pull to improve crouch gait in children with cerebral palsy http://robotics.sciencemag.org/content/2/8/eaan2634. Sci Robot 2017;2(8): eaan2634.

•. Video of the robot-driven downward pelvic pull device can be seen at http://engineering.columbia.edu/news/sunil-agrawal-cerebral-palsy-crouch-gait

•. Lerner ZF, Damiano DL, Bulea TC. A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy http://stm.sciencemag.org/content/9/404/eaam9145. Sci Transl Med 2017; 9 (404). pii: eaam9145.
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[WEB SITE] SaeboStep

Get Your FREE Stroke Recovery Exercise Guide! Download

Walk Smarter. Confidence and comfort are one step away.

The SaeboStep consists of a lightweight, uniquely designed foot drop brace that provides convenience and comfort while offering optimum foot clearance and support during walking.

The SaeboStep was designed to replace uncomfortable, stiff, or bulky splints that go inside the shoe as well as poorly manufactured braces designed for outside of the shoe that lack support and durability.

 Learn more about the features and benefits

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Stylish. Safe. Sturdy.

Foot Drop. What is it and how does it affect your recovery?

Foot drop, also known as dropped foot or drop foot, is the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot (National Institute of Neurological Disorders).

Consequentially, people who have foot drop scuff their toes along the ground; they may also bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage” gait.

 Learn more about Foot Drop

Why use the SaeboStep?

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No Laces? No Problem.

The SaeboStep can even be worn comfortably with the majority of male or female shoe styles. Individuals can use their favorite shoes by ordering the accessory kit to enable footwear without eyelets to be modified.

Learn how to customize your favorite shoes.

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[ARTICLE] Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research – Full Text PDF

Abstract

Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.
Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.
Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.
Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.
Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices.
Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

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[Abstract+References] State-of-the-art robotic devices for ankle rehabilitation: Mechanism and control review

There is an increasing research interest in exploring use of robotic devices for the physical therapy of patients suffering from stroke and spinal cord injuries. Rehabilitation of patients suffering from ankle joint dysfunctions such as drop foot is vital and therefore has called for the development of newer robotic devices. Several robotic orthoses and parallel ankle robots have been developed during the last two decades to augment the conventional ankle physical therapy of patients. A comprehensive review of these robotic ankle rehabilitation devices is presented in this article. Recent developments in the mechanism design, actuation and control are discussed. The study encompasses robotic devices for treadmill and over-ground training as well as platform-based parallel ankle robots. Control strategies for these robotic devices are deliberated in detail with an emphasis on the assist-as-needed training strategies. Experimental evaluations of the mechanism designs and various control strategies of these robotic ankle rehabilitation devices are also presented.

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Source: State-of-the-art robotic devices for ankle rehabilitation: Mechanism and control reviewProceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine – Shahid Hussain, Prashant K Jamwal, Mergen H Ghayesh, 2017

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[ARTICLE] Brain lesions affecting gait recovery in stroke patients – Full Text

Abstract

Objectives

Gait recovery is an important goal in stroke patients. Several studies have sought to uncover relationships between specific brain lesions and the recovery of gait, but the effects of specific brain lesions on gait remain unclear. Thus, we investigated the effects of stroke lesions on gait recovery in stroke patients.

Materials and Methods

In total, 30 subjects with stroke were assessed in a retrograde longitudinal observational study. To assess gait function, the functional ambulation category (FAC) was tested four times: initially (within 2 weeks) and 1, 3, and 6 months after the onset of the stroke. Brain lesions were analyzed via overlap, subtraction, and voxel-based lesion symptom mapping (VLSM).

Results

Ambulation with FAC improved significantly with time. Subtraction analysis showed that involvement of the corona radiata, internal capsule, globus pallidus, and putamen were associated with poor recovery of gait throughout 6 months after onset. The caudate nucleus did influence poor recovery of gait at 6 months after onset. VLSM revealed that corona radiata, internal capsule, globus pallidus, putamen and cingulum were related with poor recovery of gait at 3 months after onset. Corona radiata, internal capsule, globus pallidus, putamen, primary motor cortex, and caudate nucleus were related with poor recovery of gait at 6 months after onset.

Conclusion

Results identified several important brain lesions for gait recovery in patients with stroke. These results may be useful for planning rehabilitation strategies for gait and understanding the prognosis of gait in stroke patients.

1 INTRODUCTION

The restoration of gait is an important goal in stroke patients. Gait regulation and control are complex and are managed evolutionarily by higher centers, with locomotor programming at the level of the cerebral cortex in conjunction with the basal ganglia and the cerebellum (Takakusaki, 2013).

Several studies have investigated the effects of brain lesions on the recovery of gait, and showed that the size of brain lesions affected recovery (Alexander et al., 2009; Kaczmarczyk, Wit, Krawczyk, Zaborski, & Gajewski, 2012). Damage to the posterolateral putamen was associated with temporal gait asymmetry (Alexander et al., 2009). Our previous study showed the caudate nucleus was related to motor recovery in the lower limbs (Lee, Kim, Hong, & Lim, 2017). Another recent study failed to reveal specific lesion locations with regard to balance and gait function (Moon, Pyun, Tae, & Kwon, 2016). Previous researches for Parkinson’s disease, s dorsal striatum has been known as a gait pattern generator (Gilat et al., 2017; Peterson, Pickett, Duncan, Perlmutter, & Earhart, 2014; Snijders et al., 2016). However, the role of dorsal striatum for gait recovery is still uncovered in stroke.

Here, we sought to investigate the effects of stroke lesions on gait recovery. Although some studies have demonstrated effects of brain lesions on gait, the effects of specific brain lesions remain unclear. Specifically, we investigated the neurological images and clinical recovery in subjects who had suffered their first supratentorial stroke via lesion symptom mapping. The primary goal of the study was to investigate the effects of stroke lesions on gait recovery in stroke patients.[…]

Continue —> Brain lesions affecting gait recovery in stroke patients – Lee – 2017 – Brain and Behavior – Wiley Online Library

Figure 3

Figure 3 Subtraction analysis, where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability. The top represents the subtraction analysis where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability at 3 months post stroke. The bottom represents subtraction analysis where the overlay of patients without independent walking ability was subtracted from the overlay of those with independent walking ability at 6 months post stroke

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[Brochure] THE FUTURE IS MOVING – Revolutionizing Functional Movement Therapy – HOCOMA

HOCOMA REVOLUTIONIZING REHABILITATION

Conventional therapy today is limited—by time, by number of repetitions, by
the lack of reproducible movement quality and by the fact that it is strenuous for both therapists and patients. In other words: there is a disbalance between the therapy we know we should provide according to motor learning principles and all the factors that prevent us from reaching this goal.[…]

Download Brochure (PDF file)

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[Abstract] Recent Advances on Lower Limb Exoskeleton Rehabilitation Robot

Abstract

Background: Lower limb exoskeleton rehabilitation robot is a bionic robot, which is the product of the combination of medical technology and robot technology, simulating human walking movement. It can be mainly used for rehabilitation training of patients with lower limb dysfunction.

Objective: To provide an overview of recent lower limb exoskeleton rehabilitation robot and introduce their respective characteristics and development.

Method: A recent lower limb exoskeleton rehabilitation robot is divided into passive drive, pneumatic drive, hydraulic drive and motor drive. This paper reviews various representative patents related to lower limb exoskeleton rehabilitation robot. The structural characteristics and applications of the typical lower limb exoskeleton rehabilitation robots are introduced.

Results: The differences between different types of lower limb exoskeleton rehabilitation robots are compared and analyzed, and the structural characteristics are concluded. The main problems in its development are analyzed, the development trend is foreseen, and the current and future research of the patents on lower limb exoskeleton rehabilitation robot is discussed.

Conclusion: There are a lot of patents and articles about the exoskeleton rehabilitation robots, however, if these problems can be solved, such as small size, light weight and high power output are solved at the same time, the consistency with human body will be advanced, with the combination of traditional rehabilitation medicine. It will be possible to maximize the rehabilitation of the lower limbs.

Source: Recent Advances on Lower Limb Exoskeleton Rehabilitation Robot: Ingenta Connect

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[BOOK] Therapeutic Exercise: Foundations and Techniques – Chapter 4: Streching for Improved Mobility – Google Books

F.A. DavisOct 18, 2017
Here is all the guidance you need to customize interventions for individuals with movement dysfunction. YouÕll find the perfect balance of theory and clinical techniqueÑin-depth discussions of the principles of therapeutic exercise and manual therapy and the most up-to-date exercise and management guidelines.

Source: Therapeutic Exercise: Foundations and Techniques – Carolyn Kisner, Lynn Allen Colby, John Borstad – Google Books

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[Abstract] Proposition of a classification of adult patients with hemiparesis in chronic phase

Objective

Patients who have developed hemiparesis after central nervous system lesion often experience reduced walking capacity. Related gaitabnormalities at hip, knee, and ankle joints during swing induce decreased foot clearance and increased risk of falls, and thus need a meticulous management. This study aimed to (1) propose a classification focusing on these abnormalities for adult patients with hemiparesis, (2) evaluate its discriminatory capacity using clinical gait analysis (CGA).

Material/patients and methods

Twenty-six patients (10 women, 16 men) with hemiparesis (13 left, 13 right) in chronic phase (i.e. hemiparesis more than 6 months old) were included in this study. Clinical examination (i.e. passive range of motion, muscle weakness, and spasticity) and video records were conducted on each patient. The following classification was then applied: group I (GI) was mainly characterized by a decreased ankle dorsiflexion during swing, group II (GII) and group III (GIII) by a decreased knee flexion during swing, completed by a reduced range of hip motion and a hip flexors weakness in GIII. Subdivisions were also applied on each group to describe (a) absence or (b) presence of genu recurvatum during stance. The discriminatory capacity of the classification was then evaluated. For that, all patients were instrumented with cutaneous reflective markers and at least 5 gait cycles were recorded using optoelectronic cameras (OQUS, Qualisys, Sweden). A statistical analysis (ANOVA) was then performed between each group and subgroup on 24 kinematic parameters and walking speed.

Results

Only one patient could not be classified, 5 were classified in GI (1 GIa, 4 GIb), 15 in GII (7 GIIa, 8 GIIb), and 5 in GIII (1 GIIIa, 4 GIIIb). When subgroups (a) and (b) were combined, 16 of the 25 assessed parameters revealed a statistically significant difference (P-level < 0.05) between at least two groups. In particular, the maximum knee flexion in swing and the total amplitude of hip flexion-extension were significantly different between groups.

Discussion – conclusion

This classification can be performed in regular clinical practice (using clinical evaluation and video records). It should thus ease the development of clinical management algorithms and the efficiency assessment of related therapies.

Source: Proposition of a classification of adult patients with hemiparesis in chronic phase – ScienceDirect

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[ARTICLE] A wearable somatosensory teaching device with adjustable operating force for gait rehabilitation training robot – Full Text

A novel wearable multi-joint teaching device for lower-limb gait rehabilitation is presented, intended to facilitate the adjustment of training modes in unique requirements of patients. A physiotherapist manipulates this active teaching device to plan the personalized gait trajectory and to construct the individual training mode. A haptic interaction joint module that stems from the friction braking principle is outlined here, with an adjustable operating force exerted by pneumatic film cylinders. With dual functions of somatosensory perception and teaching, it provides physiotherapist with a smooth and comfortable operation and a kind of force telepresence. The main contents are elaborated including the structural design and pneumatic proportional servo system of the teaching device and the joint module, operating force control principle, and gravity compensation method. Through performance tests of the prototype, the adjustable operating force has been demonstrated with the characteristics of good linearity and response speed. The results of master–slave control experiments preliminarily verified the effectiveness of the control approach. The research on the novel somatosensory teaching device with master–slave teaching mode has provided a concise, convenient, and efficient means for the clinical application of lower-limb rehabilitation robots, presumably as a new idea and technical supports for the future design.

Based on the neuroplasticity principle,1 a lower-limb rehabilitation training robot is a kind of automatic equipment that can recover or rebuild neural pathways2,3 for patients with motor dysfunction. The clinical presentation of a spinal cord injury (SCI) or a stroke comprises motor weakness or complete paresis, complete or partial loss of sensory function. The Swedish therapist Brunnstrom proposed the famous six-recovery-stage theory. Based on this theory, the training has different aims in the early stage of rehabilitation (flaccid paralysis stage), middle stage of rehabilitation (spasm stage), and later stage of rehabilitation (recovery stage). One major principle of neurological rehabilitation is that of motor learning. According to the principle of neural plasticity, repetitive and specific training tasks, which make the cerebral cortex learn and store the correct movement patterns, are important and effective. During rehabilitation, patients have to relearn motor tasks in order to overcome disability and limitations in the completion of daily activities. This is the theoretical basis of rehabilitation treatment. For a robot, the control strategy is provided diversely in different stages of rehabilitation to eliminate abnormal movement patterns. In the early rehabilitation, the passive training mode is usually adopted to help patients according to the predetermined trajectory and improve exercise capacity and reduce muscle atrophy. Then the active assist training mode begins for the patients of the middle recovery stage with moderate strength and relieving muscle spasm. In the later rehabilitation stage, the active resist training mode can be used to encourage patients to participate initiatively. The effect and importance of rehabilitation robots have been internationally recognized.48

Giving different state of an illness exhibited by hemiparetic individuals and the different training modes as mentioned above, the gait rehabilitation training robot primarily entails customized designing the parameters including movement trajectory, training speed and strength, and real-time perceiving, adjusting, and controlling. Lower-limb exoskeleton mechanism features of many degrees of freedom, together with the individual and condition differences of patients, so the problems are highlighted about how to accurately plan the correct gait trajectory and how to adjust training modes on time according to the progression. These issues become one of the research foci and technical difficulties of rehabilitation robot.

Most of the typical lower-limb rehabilitation robots in the world are autonomously controlled. The gait training mode planning for them is summarized in two methods, that is, preselected by a physiotherapist and dynamically adjusted by the algorithm. For some representative examples, the horizontal rehabilitation training robot Motion Maker9 can automatically guide patients along a preselected trajectory to perform passive flexion movement training on hip, knee, and ankle joints. The Lokomat1012 is a kind of body-weight-supported treadmill training (BWSTT) robot that adjusts the assisted power or reference trajectory by the impedance algorithm according to the patient interaction force. Patients can be made available to active and passive training mode. In the case of the lower extremity powered exoskeleton (LOPES) gait rehabilitation robot,13,14 limb reference trajectory is generated by instantaneous mapping with the healthy limb movement. The feasibility and functional improvements achieved in response to the emergence of such self-control rehabilitation robot; however, the existing technological bottleneck is obvious, that is, the limited adaptability of training mode.

The objective of this research is to develop a gait trajectory teaching device, with which the physiotherapist can directly and professionally teach to the robot and therefore present complex actions and adjust training modes as needed. Through master–slave teaching method, such system may provide the adaptability of the robot-mediated training and improve the treatment quality and efficiency, and decrease the difficulties in control algorithm study and the contradiction between the complex algorithms and real-time control.

Because of the more elaborate actions of the upper extremity and hand, teaching and playback technology is first applied to upper-limb rehabilitation training robot, for example, the flexible force feedback master–slave exoskeleton manipulator developed by America General Electric Company,15 the wearable master–slave training equipment of upper limbs driven by pneumatic artificial muscles in Okayama University in Japan,16 and the remotely operated upper-limb training robot of Southeast University in China.17 But there are fewer applications for lower-limb rehabilitation training. A single-joint ankle-foot orthoses designed by Canada, the Centre for Interdisciplinary Research in Rehabilitation and Social Integration is introduced in the literature.18The main cylinder driven by a motor controlled the slave cylinder to drive the orthoses. As described in a literature,19 a wearable master–slave lower-limb training robot driven by pneumatic artificial muscle achieves the teaching and training for the knee and ankle rehabilitation by sensors feeding back the trainer joint torque to the main control mechanism. In most of the studies mentioned above, the limitations existing in master–slave teaching for the lower-limb rehabilitation training robot can be summarized as follows: (1) the teaching device has the characteristics of complex structure, large quality and high inertia, so the physiotherapist is laborious and feels fatigue quickly, (2) the coordinate of the multi joints is demanded highly which may lead to the insufficient operating smoothness of the device, and (3) the feedback joint torque cannot be directly perceived by the physiotherapist but only as the control signal for the device.

In light of the above limitations, a novel multi-joint wearable teaching device is developed with adjustable operating force, which is exerted by light film cylinders. Based on the gravity compensation control method, a physiotherapist operates the teaching device to plan training trajectory smoothly and comfortably while also perceive the scene interaction force came from patients. In this manner, our research solved the existing problems, namely, the weight, the difficult manipulation of the teaching and the less force feedback to the physiotherapist. He operates the teaching device with the master–slave mode may provide various training modes fast and intuitively. The force telepresence from patients makes physiotherapist better controlling the training intensity and realizing the individual rehabilitation training consultation.

In this article, we elaborate five major contents that have been derived from this research as follows: master–slave teaching system solution, structural design of the multi-joint wearable master teaching device, operating force regulation principle and gravity compensation method, operating force regulation performance experiments, and master–slave control experiments.

Figure 1. System overall scheme.

Continue —> A wearable somatosensory teaching device with adjustable operating force for gait rehabilitation training robotAdvances in Mechanical Engineering – Bingjing Guo, Jianhai Han, Xiangpan Li, Peng Wu, Yanbin Zhang, Aimin You, 2017

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