[Abstract] Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis

Abstract

Purpose

There is limited evidence of gait training using newly developed exoskeletal lower limb robot called Hybrid Assistive Limb (HAL) on the function and ability to perform ADL in stroke patients. In clinical settings, we frequently find it challenging to conduct a randomized controlled trial; thus, a large-scale observational study using propensity score analysis methods is a feasible alternative. The present study aimed to determine whether exoskeletal lower limb robot training improved the ability to perform ADL in stroke patients.

Materials and methods

Acute stroke patients who were admitted to our facility from April 2016 to March 2017 were evaluated in the conventional rehabilitation period (CRP) and those admitted from April 2017 to June 2019 were evaluated in the HAL rehabilitation period (HRP). We started a new gait rehabilitation program using HAL at the midpoint of these two periods. The functional outcomes or ADL ability outcomes of the patients in the CRP and the subsequent HRP were compared using propensity score matched analyses.

Results

Propensity score matching analysis was performed for 108 stroke patients (63 from the CRP and 45 from the HRP), and 36 pairs were matched. The ADL ability, defined by the FIM scores and FIM score change, was significantly higher in patients admitted during the HRP. In addition, more stroke patients obtained practical walking ability during hospitalization in the HRP.

Conclusion

Gait training using HAL affects the ADL ability and obtaining of practical walking ability of stroke patients.

via Effects of Exoskeletal Lower Limb Robot Training on the Activities of Daily Living in Stroke Patients: Retrospective Pre-Post Comparison Using Propensity Score Matched Analysis – ScienceDirect

[ARTICLE] DEVELOPMENT OF A REHABILITATIVE EXOSKELETAL ARM – Full Text HTML/PDF

 

ABSTRACT

Reduced motor capacity of the upper extremities is a common

result of strokes, spinal cord injuries, accidental injuries, and

neurodegenerative diseases. Sensorimotor recovery can be

attained through gradual and repetitive exercises. In recent

years, robot-assisted rehabilitation has been shown to improve

treatment outcomes in these cases. This paper aims to discuss a

potential method of rehabilitation through the use of a robotic

exoskeletal device that is designed to conform to the shape of

an arm. Three different program methods were developed as

modes of exercise and therapy to achieve passive exercise,

assisted motions, and resistive-active exercise.

INTRODUCTION

Reduced motor capacity of the upper extremities is a

common result of strokes, spinal cord injuries, accidental

injuries, and neurodegenerative diseases. Sensorimotor

recovery can be attained through gradual and repetitive

exercises [3-5]. In recent years, robot-assisted rehabilitation has

been shown to improve treatment outcomes in these cases [6-

10].

Current exoskeleton rehabilitative devices have multiple

advantages over traditionally manual techniques, including [2]:

 Data tracking for performance feedback

 The ability to apply controlled forces at each joint as

well as magnitude adjustment of such forces based on

patient needs

 They can be adjusted for multiple limb sizes to fit

different patients

 They can replicate the majority of the patients upper

limb healthy workspace, using multiple degrees of

freedom.

This device contains additional advantages over current

devices. First of all it will be portable. It is going to address a

very specific task, which makes it more user friendly, and last

but not least it has a simple and cost effective design.

This bicep & tricep therapeutic device will have three

modes of operation: passive, assisted motions, and resistive-

active. A linear actuator provides the necessary movement of

the exoskeleton and a pair of force sensors tracks the response

of the patient to the therapeutic session. The passive mode is

for patients that have complete muscle atrophy. In this mode

the actuator does all the work to emotionally stimulate the

patient. The assisted motions mode offers the patient force

amplification. This mode allows patients with weak upper

limbs to perform everyday life tasks such as lifting, pushing,

pulling, etc. In this mode, the speed of the actuator is directly

proportional to the force applied by the user. If the patient

applies a higher force, the actuator moves faster, and vice versa.

In the resistive-active mode, the user must apply a load on the

load sensor that surpasses a certain threshold. When the robot

detects this, it moves the actuator at a speed that creates

resistance for the user. In this mode, if the load applied by the

user falls below the threshold, the actuator stops.

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[ARTICLE] Exoskeleton Robots for Rehabilitation of the Upper Limb – Full Text PDF

Abstract

The number of cerebrovascular and neuromuscular diseases are increasing in parallel with the rising avarage age of world’s population.

Usage of the rehabilitation robots for physiotherapy of patiens who have lost their limb motor functions, gains importance. The usage of these robots provides treatment for more patients, shortens the time period of treatment and provides doing the excersises accurately and repeatable.

Disuse of the upper limbs adversely affect the human life because this upper limbs are commonly used in daily life. Exoskeletal robot manipulators are one of the important application area of BIOMECHATRONICS.

In this study exoskeleton robots for upper limb rehabilitation available in the literature were examined and compared.

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