Archive for category Gait/Drop Foot

[VIDEO] Bioness L300 Go Technology Introduction – YouTube

Published on Sep 25, 2017
L300 Go is a functional electrical stimulation (FES) system that satisfies the productivity demands of today’s value-based healthcare system. Key aspects of the L300 experience have been dramatically improved with 3D Motion Detection, multi-channel stimulation, Smart Bluetooth® programming and a home user mobile app that tracks activity to keep patients engaged in the rehabilitation process. All of this in a streamlined design, with a fitting process that is faster and easier than ever before.
Advertisements

, , , , ,

Leave a comment

[Abstract] EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

Abstract:

Lower extremity function recovery is one of the most important goals in stroke rehabilitation. Many paradigms and technologies have been introduced for the lower limb rehabilitation over the past decades, but their outcomes indicate a need to develop a complementary approach. One attempt to accomplish a better functional recovery is to combine bottom-up and top-down approaches by means of brain-computer interfaces (BCIs). In this study, a BCI-controlled robotic mirror therapy system is proposed for lower limb recovery following stroke. An experimental paradigm including four states is introduced to combine robotic training (bottom-up) and mirror therapy (top-down) approaches. A BCI system is presented to classify the electroencephalography (EEG) evidence. In addition, a probabilistic model is presented to assist patients in transition across the experiment states based on their intent. To demonstrate the feasibility of the system, both offline and online analyses are performed for five healthy subjects. The experiment results show a promising performance for the system, with average accuracy of 94% in offline and 75% in online sessions.

Source: EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

, , , , , , ,

Leave a comment

[REVIEW] Technical Developments for Rehabilitation of Mobility – Full Text

Abstract

Technically assisted rehabilitation of mobility after stroke has been well established for several years. There is good evidence for the use of end-effector devices, exoskeletons and treadmill training with and without body weight support. New developments provide the possibility for functional training during mobilization, even in intensive care units. Mobile exoskeleton devices have been developed, but their clinical effects need still to be evaluated. All devices should not only focus on increasing the number of repetitions, but also include motivational aspects such as virtual reality environments. Hygienic aspects impose a special challenge. All devices should be integrated into a rational and clearly-defined therapy concept.

Introduction

Technicallyassisted rehabilitation of mobility after stroke has been well established for several years [1]. The premise “if you want to learn to walk, you have to walk” is of primary importance. In 1995, the working group led by Stefan Hesse showed that repetitive training of walking movements using a treadmill leads to greater improvement of walking ability in stroke patients compared to conventional physiotherapy [2].

Since using a treadmill for severely affected patients is not an optimal approach, alternative solutions have been sought [3]. Almost simultaneously two technical solutions were developed. By developing the electromechanical Gangtrainer GT1®, the Berlin group created a so-called end-effector device in which the trajectory of the gait cycle is predefined and the body’s center of gravity is controlled by a belt system in the vertical and horizontal direction. An alternative technical solution, the Lokomat®, was developed by a Zürich working group as an exoskeleton which uses motors to control the knee and hip joints, so that the patient can perform gait exercises even in the case of complete paraplegia.

These approaches can now be classified as clearly evidence-based. Within the framework of the guideline initiative of the German Society for Neurorehabilitation, the guideline “Rehabilitation of Motor Function after Stroke” (ReMos) was published in 2015. Based on a systematic literature search, a total of 188 randomized clinical trials and 11 systematic reviews were identified that met stipulated quality criteria [4]. This literature was grouped not only according to interventions, but also according to the target criteria and thus the severity of the patients’ disability. Based on available evidence, different recommendations were made for gaining and improving mobility, improving walking speed, walking distance and balance [5].

However, during the last few years the rehabilitation landscape in Germany has been particularly characterized by earlier admissions of patients who are still quite disabled when leaving the primary care hospitals. This is demonstrated by massive increases in early rehabilitation treatment capacity, including those with possibilities of mechanical ventilation [6]. For patients, this development offers the advantage of being transferred early in structured rehabilitative environments where new solutions are being developed. The current state of the art as well as new developments will be discussed below. […]

Continue —>  Thieme E-Journals – Neurology International Open / Full Text

Fig. 1 Verticalization in conjunction with initiation of walking movements (Erigo®, image rights: Hocoma, Zürich, Switzerland).

 

, , , ,

Leave a comment

[WEB SITE] Bioness Begins Shipping L300 Go Systems for Foot Drop 

Published on August 30, 2017

Bioness announces it has begun shipping the L300 Go Systems, cleared by the FDA in early 2017 and available in four configurations for use in patients with foot drop and/or muscle weakness related to upper motor neuron disease/injury.

The L300 Go System succeeds the NESS L300 Foot Drop System and NESS L300 Plus System, and includes numerous advancements designed to optimize therapy sessions and promote functional gains at home.

Among these is comprehensive 3D motion detection of gait events, via a learning algorithm that analyzes patient movement and offers electrical stimulation precisely when needed during the gait cycle.

Additional features, according to a media release from Valencia, Calif-based Bioness, include adaptive motion detection and onboard controls that eliminate dependence on foot sensors or remote controls; multi-channel stimulation, which enables clinicians to adjust dorsiflexion and inversion/eversion with a novel new electrode options; and myBioness, a new mobile iOS application designed to empower home users to extend rehabilitative gains through setting goals and tracking recovery progress.

“Today’s value-based healthcare model demands that rehabilitative professionals keep patients motivated through superior, more personalized care,” says Todd Cushman, president and CEO of Bioness, in the release. “With the introduction of the L300 Go, clinicians now have access to technological innovations that keep patients engaged during the recovery process while improving mobility in the clinic and community.”

Current users of the L300 Foot Drop System and the L300 Plus System will be eligible for a Customer Loyalty Upgrade Program, which is designed to make the L300 Go more accessible for users in the clinic and community.

[Source(s): Bioness, PR Newswire]

Source: Bioness Begins Shipping L300 Go Systems for Foot Drop – Rehab Managment

, , , ,

Leave a comment

[ARTICLE] Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study – Full Text

Abstract

Objective: To investigate the feasibility and effectiveness of virtual reality training for improving balance and/or gait during inpatient rehabilitation of patients within 12 weeks after stroke.

Methods: Sixteen patients within 12 weeks after stroke and dependent gait as categorised with a Functional Ambulation Category score of 2 or 3 were included in this longitudinal pilot study. Participants received eight 30-min sessions of virtual reality training during four weeks as part of the regular inpatient rehabilitation program. Feasibility was assessed using compliance with the training, adverse events, experiences of the participants and the physiotherapists; and effectiveness with the Berg Balance Scale, centre of pressure velocity, Functional Ambulation Category and 10-meter walking test.

Results: Participants positively evaluated the intervention and enjoyed the training sessions. Also, physiotherapists observed the training as feasible and beneficial for improving balance or gait. Compliance with the training was 88% and no serious adverse events occurred. The Berg Balance Scale, anterior-posterior centre of pressure velocity, Functional Ambulation Category and 10-meter walking test showed significant improvement after four weeks of training (p<0.05).

Conclusion: This study demonstrates that virtual reality training in patients early after stroke is feasible and may be effective in improving balance and/or gait ability.

Introduction

Balance and gait recovery are considered as key aspects in stroke rehabilitation [13]. To date, physiotherapy and occupational therapy focus on high intensity, repetitive and task-specific practice, which are important principles of motor learning, to elicit improvements in the early rehabilitation phase [1,4,5]. In addition to high intensity, repetitive and task-specific training, variability in practice is important for motor learning. Also, cognitive involvement, functional relevance and the presence of feedback enhance learning [5]. In current physiotherapy or occupational therapy it is difficult to meet all of these above-mentioned training characteristics as therapy may be tedious and resource-intensive [69]. In addition, the frequency and intensity of current therapies have been indicated as insufficient to achieve maximum recovery in the early phase of rehabilitation [8,10]. There is need for engaging, motivating and varied therapy that achieves maximal recovery [11].

In recent years, virtual reality (VR) is introduced in the field of balance and gait rehabilitation after stroke [12]. Since VR training is characterised by individualised, high intensity training in a variety of virtual environments with a high amount of real-time feedback [1315] it might be valuable in stroke rehabilitation. This is confirmed by recent studies [12,1518]. However, almost all studies on the effect of VR on balance and/or gait ability were conducted in the chronic phase after brain injury [9,12,16,17,1923]. Because of the potential relevant characteristics of VR for motor learning and neuroplasticity [14], VR may be of even more added value during the earlier rehabilitation phase. Three studies [2426] that investigated the effect of VR in this time period after stroke indicated a positive effect of commercially available VR systems (Nintendo Wii Fit or IREX) on balance and/or gait recovery. However, the results of these studies cannot be generalised to the whole population of patients with stroke because included participants had a relatively high functional level regarding balance and gait at the start of the VR intervention. A lack of studies including patients with lower functional status after stroke might be caused by the idea that the feasibility of using advanced VR technology may be restricted because of visual, cognitive and/or endurance impairments. These impairments are more often present in the more impaired patients early after stroke [2729]. Because of the expected promising effects of VR training for the recovery of balance and gait in patients with low functional level early after stroke, it is important to investigate the feasibility of this innovative form of training and to determine whether the above-mentioned impairments interfere with the use of VR training early after stroke.

Therefore, the aim of the present study was to investigate the feasibility and effectiveness of VR training for improving balance and/or gait during the inpatient rehabilitation of patients with stroke. The specific research questions were:

• What is the feasibility, from the perspective of patients and physiotherapists, of VR training aimed to improve balance and gait ability?

• What is the effectiveness of VR training, embedded within an inpatient rehabilitation program, on balance and gait ability in people with impaired balance and dependent gait within 12 weeks after stroke?

Methods

Study design

This longitudinal pilot study involved two assessments, one before and one after a four-week VR training intervention, performed within the inpatient rehabilitation program of patients with stroke at (Revant Rehabilitation Centres, Breda, the Netherlands).

Participants

Patients with stroke who were following an inpatient rehabilitation program with a treatment goal to improve balance and/or gait. They received balance and/or gait training with VR as part of their regular rehabilitation program. Besides the VR training, the regular rehabilitation program could include therapy given by a physiotherapist, occupational therapist, speech therapist, psychomotor therapist, psychologist and social worker, depending on the goals of the patient with stroke. Inclusion criteria consisted of hemiplegia resulting from a stroke, a time since stroke of less than 12 weeks, a Berg Balance Scale (BBS) score of at least 20, i.e. the minimum level of balance deemed safe for balance interventions [30], and a Functional Ambulation Category (FAC) score of 2 or 3 out of 5 [31]. Exclusion criteria were patients with stroke with terminal diseases, lower-limb impairments not related to stroke, severe cognitive impairments, severe types of expressive or receptive aphasia, visual impairments, age over 80 years and experiencing epileptic seizures. All participants provided written consent to use data obtained during the rehabilitation program for research, and anonymity was assured. The study procedures follow the principles of the Declaration of Helsinki.

VR training intervention

The intervention consisted of balance and gait training using the recently developed treadmill based Gait Real-time Analysis Interactive Lab (GRAIL, Motekforce Link, Amsterdam, The Netherlands). The GRAIL comprises a dual-belt treadmill with force platform, a motion-capture system (Vicon, Oxford, UK) and speed-matched virtual environments projected on a 180° semi-cylindrical screen (Figure 1) [32].

[…]

Continue —> Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study | Open Access Journals

, , , ,

Leave a comment

[WEB SITE] Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

Source: Bioness Announces Commercial Availability of the L300 Go™ System to Healthcare Professionals

, , , , , ,

Leave a comment

[WEB SITE] SaeboStep Details 

Anatomy of the SaeboStep

 

 

Key ingredients.

Lift Strong durable spectra cord easily slips onto included eyelet attachments and lifts the foot quickly and easily.

Adjust The revolutionary BOA dial technology allows individuals to quickly customize the lift angle required for safe foot clearance during walking.

Secure Hook and loop velcro strapping system and nylon buckle secures the device to the ankle.

Release Conveniently release tension as needed with the simple to use dial technology.

Source: SaeboStep Details | Saebo

,

Leave a comment

[REVIEW] INFLUENCE OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ON SPASTICITY, BALANCE, AND WALKING SPEED IN STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS – Full Text PDF

Objective: To evaluate the influence of transcutaneous electrical nerve stimulation in patients with stroke through a systematic review and meta-analysis.

Methods: PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials assessing the effect of transcutaneous electrical nerve stimulation vs placebo transcutaneous electrical nerve stimulation on stroke were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was modified Ashworth scale (MAS). Meta-analysis was performed using the random-effect model.

Results: Seven randomized controlled trials were included in the meta-analysis. Compared with placebo transcutaneous electrical nerve stimulation, transcutaneous electrical nerve stimulation supplementation significantly reduced MAS (standard mean difference (SMD) = –0.71; 95% confidence interval (95% CI) = –1.11 to –0.30; p =0.0006), improved static balance with open eyes (SMD = –1.26; 95% CI = –1.83
to –0.69; p<0.0001) and closed eyes (SMD = –1.74; 95% CI = –2.36 to –1.12; p < 0.00001), and increased walking speed (SMD = 0.44; 95% CI = 0.05 to 0.84; p = 0.03), but did not improve results on the Timed Up and Go Test (SMD = –0.60; 95% CI=–1.22 to 0.03; p = 0.06).

Conclusion: Transcutaneous electrical nerve stimulation is associated with significantly reduced spasticity, increased static balance and walking speed, but has no influence on dynamic balance.

Download Full Text PDF

 

, , , , ,

Leave a comment

[ARTICLE] Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients – Full Text PDF

Abstract.

[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients.

[Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion.

[Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group.

[Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.

INTRODUCTION
Patients with stroke show various muscle abnormalities, including a combination of denervation, disuse, remodeling, and spasticity1). These reduce their balance ability and lead to gait disorders2). Abnormal gaits cause flexion and extension synergy patterns due to compensatory actions of muscles, etc., on the unaffected side, impairment of proprioceptive sensibility, and abnormal coordination of stiffened muscles of the lower limb3). As a substitute of stair climbing exercise, inclined treadmill walking training, which is aimed at improving these gait disorders, is being considered as an essential means for indoor and outdoor movements of the disabled, the elderly, or pregnant women who are unable to use stairs4). However, Rhea et al.5) stated that treadmill walking training, compared with walking on flat ground, is characterized by a shorter step length. Oh, Kim, and Woo6) argued that treadmill walking training has negative effects on gait asymmetry. Sensory elements play an important part in compensating for these weaknesses7), and rhythmic auditory stimulation (RAS) can be used as a complementing intervention8). In this intervention, the external auditory sense of rhythms generates rhythmic and more symmetrical alternate movements in the lower limbs of stroke patients who show gait asymmetry6, 9). Existing studies have not shown consistent results regarding the effects of treadmill walking training on the gait of stroke patients. In particular, with regard to balance and gait, which are essential for the activity and participation of stroke patients, there are no systematic studies showing the effects of inclined treadmill walking training with RAS thus far.[…]

Full Text PDF

, , , ,

Leave a comment

[BLOG POST] Brain-Computer Interface & Virtual Avatar Offers New Hope to Patients with Gait Disabilities – Neuroscience News

Summary: Coupling a non invasive brain computer interface with a virtual walking avatar may help those with gait disorders to regain control of their movements, a new study reports. Source: University of Houston.Researchers from the University of Houston have shown for the first time that the use of a brain-computer interface augmented with a virtual walking avatar can control gait, suggesting the protocol may help patients recover the ability to walk after stroke, some spinal cord injuries and certain other gait disabilities.

Researchers said the work, done at the University’s Noninvasive Brain-Machine Interface System Laboratory, is the first to demonstrate that a brain-computer interface can promote and enhance cortical involvement during walking. The study, funded by the National Institute of Neurological Disease and Stroke, was published this week in Scientific Reports.

 

a woman

Researchers already knew electroencephalogram (EEG) readings of brain activity can distinguish whether a subject is standing still or walking. But they hadn’t previously known if a brain-computer interface was practical for helping to promote the ability to walk, or what parts of the brain are relevant to determining gait. NeuroscienceNews.com image is adapted from the U of H video.

Jose Luis Contreras-Vidal, Cullen professor of electrical and computer engineering at UH and senior author of the paper, said the data will be made available to other researchers. While similar work has been done in other primates, this is the first to involve humans, he said. Contreras-Vidal is also site director of the BRAIN Center (Building Reliable Advances and Innovation in Neurotechnology), a National Science Foundation Industry/University Cooperative Research Center.

Contreras-Vidal and researchers with his lab use non-invasive brain monitoring to determine what parts of the brain are involved in an activity, using that information to create an algorithm, or a brain-machine interface, which can translate the subject’s intentions into action.

In addition to Contreras-Vidal, researchers on the project are first author Trieu Phat Luu, a research fellow in neural engineering at UH; Sho Nakagome and Yongtian He, graduate students in the UH Department of Electrical and Computer Engineering.

“Voluntary control of movements is crucial for motor learning and physical rehabilitation,” they wrote. “Our results suggest the possible benefits of using a closed-loop EEG-based BCI-VR (brain-computer interface-virtual reality) system in inducing voluntary control of human gait.”

Researchers already knew electroencephalogram (EEG) readings of brain activity can distinguish whether a subject is standing still or walking. But they hadn’t previously known if a brain-computer interface was practical for helping to promote the ability to walk, or what parts of the brain are relevant to determining gait.

In this case, they collected data from eight healthy subjects, all of whom participated in three trials involving walking on a treadmill while watching an avatar displayed on a monitor. The volunteers were fitted with a 64-channel headset and motion sensors at the hip, knee and ankle joint.

The avatar first was activated by the motion sensors, allowing its movement to precisely mimic that of the test subject. In later tests, the avatar was controlled by the brain-computer interface, meaning the subject controlled the avatar with his or her brain.

The avatar perfectly mimicked the subject’s movements when relying upon the sensors, but the match was less precise when the brain-computer interface was used.

Contreras-Vidal said that’s to be expected, noting that other studies have shown some initial decoding errors as the subject learns to use the interface. “It’s like learning to use a new tool or sport,” he said. “You have to understand how the tool works. The brain needs time to learn that.”

The researchers reported increased activity in the posterior parietal cortex and the inferior parietal lobe, along with increased involvement of the anterior cingulate cortex, which is involved in motor learning and error monitoring.

The next step is to use the protocol with patients, the subject of He’s Ph.D. dissertation.

“The appeal of brain-machine interface is that it places the user at the center of the therapy,” Contreras-Vidal said. “They have to be engaged, because they are in control.”

Source: Brain-Computer Interface & Virtual Avatar Offers New Hope to Patients with Gait Disabilities – Neuroscience News

 

, , , , , , , , , , ,

Leave a comment

%d bloggers like this: