Posts Tagged gait

[NEWS] Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk

Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk again and exhibit partial motor recovery

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IMAGE: THE NON-INVASIVE CLOSED-LOOP NEUROREHABILITATION PROTOCOL: I) EEG: ELECTROENCEPHALOGRAPHY, NON-INVASIVE BRAIN-RECORDING. II) BRAIN-MACHINE INTERFACE: REAL-TIME DECODING OF MOTOR INTENTIONS. III) THE LEFT OR RIGHT LEG MUSCLES ARE STIMULATED TO TRIGGER THE… view more 
CREDIT: WALK AGAIN PROJECT – ASSOCIAÇÃO ALBERTO SANTOS DUMONT PARA APOIO À PESQUISA

In another major clinical breakthrough of the Walk Again Project, a non-profit international consortium aimed at developing new neuro-rehabilitation protocols, technologies and therapies for spinal cord injury, two patients with paraplegia regained the ability to walk with minimal assistance, through the employment of a fully non-invasive brain-machine interface that does not require the use of any invasive spinal cord surgical procedure. The results of this study appeared on the May 1 issue of the journal Scientific Reports.

The two patients with paraplegia (AIS C) used their own brain activity to control the non-invasive delivery of electrical pulses to a total of 16 muscles (eight in each leg), allowing them to produce a more physiological walk than previously reported, requiring only a conventional walker and a body weight support system as assistive devices. Overall, the two patients were able to produce more than 4,500 steps using this new technology, which combines a non-invasive brain-machine interface, based on a 16-channel EEG, to control a multi-channel functional electrical stimulation system (FES), tailored to produce a much smoother gait pattern than the state of the art of this technique.

“What surprised us was that, in addition to allowing these patients to walk with little help, one of them displayed a clear motor improvement by practicing with this new approach. Patients required approximatively 25 sessions to master the training before they were able to walk using this apparatus,” said Solaiman Shokur one of the authors of the study.

The two patients that used this new rehabilitation approach had previously participated in the long-term neurorehabilitation study carried out using the Walk Again Project Neurorehabilitation (WANR) protocol. As reported in a recent publication from the same team (Shokur et al., PLoS One, Nov. 2018), all seven patients who participated in that protocol for a period of 28 months improved their clinical status, from complete paraplegia (AIS A or B, meaning no motor functions below the level of the injury, according to the ASIA classification) to partial paraplegia (AIS C, meaning partial recovery of sensory and motor function below the injury level). This significant neurological recovery included major clinical improvements in sensory discrimination (tactile, nociception, vibration, and pressure), voluntary motor control of abdomen and leg muscles, and important gains in autonomic control, such as bladder, bowel, and sexual functions.

“The last two studies published by the Walk Again Project clearly indicate that partial neurological and functional recovery can be induced in chronic spinal cord injury patients by combining multiple non-invasive technologies that are based around the concept of using a brain-machine interface to control different types of actuators, like virtual avatars, robotic walkers, or muscle stimulating devices, to allow the total involvement of patients in their own rehabilitation routine,” said Miguel Nicolelis, scientific director of the Walk Again Project and one of the authors of the study.

In a recent report by another group, one AIS C and two AIS D patients were able to walk thanks to the employment of an invasive method for spinal cord electrical stimulation, which required a spinal surgical procedure. In contrast, in the present study two AIS C patients – which originally were AIS A (see Supplemental Material below)- and a third AIS B subject, who recently achieved similar results, were able to regain a significant degree of autonomous walking without the need for such invasive treatments. Instead, these patients only received electrical stimulation patterns delivered to the skin surface of their legs, so that a total of eight muscles in each limb could be electrically stimulated in a physiologically accurate sequence. This was done in order to produce a smoother and more natural pattern of locomotion.

“Crucial for this implementation was the development of a closed-loop controller that allowed real-time correction of the patients’ walking pattern, taking into account muscle fatigue and external perturbations, in order to produce a predefined gait trajectory. Another major component of our approach was the use of a wearable haptic display to deliver tactile feedback to the patients´ forearms in order to provide them with a continuous source of proprioceptive feedback related to their walking,” said Solaiman Shokur.

To control the pattern of electrical muscle stimulation in each leg, these patients utilized an EEG-based brain-machine interface. In this setup, patients learned to alternate the generation of “stepping motor imagery” activity in their right and left motor cortices, in order to create alternated movements of their left and right legs.

According to the authors, the patients exhibited not only “less dependency on walking assistance, but also partial neurological recovery, with substantial rates of motor improvement in one of them.” The improvement in motor control in this last AIS C patient was 9 points in the lower extremity motor score (LEMS), which was comparable with that observed using invasive spinal cord stimulation.

Based on the results obtained over the past 5 years, the WAP now intends to combine all its neurorehabilitation tools into a single integrated, non-invasive platform to treat spinal cord injury patients. This platform will allow patients to begin training soon after the injury occurs. It will also allow the employment of a multi-dimensional integrated brain-machine interface capable of simultaneously controlling virtual and robotic actuators (like a lowerlimb exoskeleton), a multi-channel non-invasive electrical muscle stimulation system (like the FES used in the present study), and a novel non-invasive spinal cord stimulation approach. In this final configuration, this WAP platform will incorporate all these technologies together in order to maximize neurological and functional recovery in the shortest possible time, without the need of any invasive procedure.

According to Dr. Nicolelis, “there is no silver bullet to treat spinal cord injuries. More and more, it looks like we need to implement multiple techniques simultaneously to achieve the best neurorehabilitation results. In this context, it is also imperative to consider the occurrence of cortical plasticity as a major component in the planning of our rehabilitation approach.”

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The other authors of this paper are Aurelie Selfslagh, Debora S.F. Campos, Ana R. C. Donati, Sabrina Almeida, Seidi Y. Yamauti, Daniel B. Coelho and Mohamed Bouri. This project was developed through a collaboration between the Neurorehabilitation Laboratory of the Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), the headquarters of the Walk Again Project, the Biomechanics and Motor Control Laboratory at the Federal University of ABC (UFABC), and the Laboratory of Robotic System at the Swiss Institute of Technology of Lausanne (EPFL). It was funded by a grant from the Brazilian Financing Agency for Studies and Projects (FINEP) 01.12.0514.00, Ministry of Science, Technology, Innovation and Communications (MCTIC), to AASDAP.

Supplemental Material:

https://www.youtube.com/watch?v=AZbQeuJiSOI

Supporting Research Studies:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206464

https://www.nature.com/articles/s41598-019-43041-9

 

via Brain-controlled, non-invasive muscle stimulation allows chronic paraplegics to walk | EurekAlert! Science News

 

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[ARTICLE] Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles – Full Text

Abstract

Exoskeleton technology has made significant advances during the last decade, resulting in a considerable variety of solutions for gait assistance and rehabilitation. The mechanical design of these devices is a crucial aspect that affects the efficiency and effectiveness of their interaction with the user. Recent developments have pointed towards compliant mechanisms and structures, due to their promising potential in terms of adaptability, safety, efficiency, and comfort. However, there still remain challenges to be solved before compliant lower limb exoskeletons can be deployed in real scenarios. In this review, we analysed 52 lower limb wearable exoskeletons, focusing on three main aspects of compliance: actuation, structure, and interface attachment components. We highlighted the drawbacks and advantages of the different solutions, and suggested a number of promising research lines. We also created and made available a set of data sheets that contain the technical characteristics of the reviewed devices, with the aim of providing researchers and end-users with an updated overview on the existing solutions.

Background

Robotic wearable exoskeletons1 have potential impact in several application domains, like industry [1], space [2] and healthcare [3]. In the healthcare sector, this technology is expected to contribute by reducing the clinical costs associated with the assistance and rehabilitation of people with neurological and age-related disorders [3456]. Research in this area is clearly shifting toward the inclusion of compliant elements (i.e. actuators, structure2, etc.) as a way to overcome the main drawbacks of rigid exoskeletons, in terms of adaptability, comfort, safety and efficiency [7].

Currently, there is a large variety of designs of lower limb compliant exoskeletons aimed at gait rehabilitation or assistance. However, there is a lack of detailed information about the mechanical components of these devices, which has been largely overlooked by previous reviews (e.g. [789]). These variety and lack of information makes it difficult for developers to identify which design choices are most important for a specific application, user’s need or pathology. For this reason, we aimed to bring together available literature into a comprehensive review focused on existing lower limb wearable exoskeletons that contain compliant elements in their design.

In this work, we refer to ‘compliant exoskeleton’ as a system that includes compliant properties derived from non-rigid actuation system and/or structure. Our review focused on three particular aspects: the actuation technology, the structure of the exoskeleton and the interface attachment components3.

We have gathered the mechanical and actuation characteristics of 52 devices into standardized data sheets (available at Additional file 1), to facilitate the process of comparison of the different solutions under a unified and homogeneous perspective. We consider that such a comprehensive summary will be vital to researchers and developers in search for an updated design reference.

Methodology

We applied the following search query on the Scopus database: TITLE-ABS-KEY(“actuat*” AND (“complian*” OR “elastic*” OR “soft”) AND (“exoskeleton*” OR “rehabilitat*” OR “orthotic*” OR “orthos*” OR (“wearable” AND “robot*”)) OR “exosuit” OR “exo-suit”), which returned 1131 studies. We excluded: publications focusing on upper limb robots; non-actuated compliant exoskeletons; solutions where compliance was achieved through control; studies that did not report any mechanical information on the robot; and studies not related to either assistance or rehabilitation. The above process resulted in a total of 105 publications, which covered 52 different lower limb exoskeletons.

To simplify and structure the information, we classified the compliant exoskeletons according to the mechanical component that results in their intrinsic compliant performance: (i) exoskeletons with compliant actuators (i.e. series elastic, variable stiffness and pneumatic actuators) and rigid structure; (ii) exoskeletons with soft structure (soft exoskeletons4) and rigid actuators; (iii) exoskeletons with compliant actuators and soft structure. The review describes the different design choices of the exoskeletons, i.e. actuation system, structure and interfacing attachment components to connect the actuators with the human body.

A glossary with the most commonly used terms in this article has been added at the end of the document. Some definitions have been readapted from the literature.

Results

As shown in Fig. 1, 85% of the reviewed articles (corresponding to 44 exoskeletons) used compliant actuators and a rigid structure. Soft exoskeletons represent 11% of the reviewed articles (6 exoskeletons). Two exoskeletons (4%) belong to the intersection of previous groups, this is, exoskeletons integrating both soft structure and compliant actuation5. We refer to the latter as “fully compliant exoskeletons”.

Fig. 1
Fig. 1

Classification of the 52 lower limb exoskeletons according to their compliant mechanical component

 

Continue —>  Compliant lower limb exoskeletons: a comprehensive review on mechanical design principles | Journal of NeuroEngineering and Rehabilitation | Full Text

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[NEWS] Robotic Rehab Aims for the Home Market in Q3

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Motus Nova is expanding its list of partner hospitals and clinics using its FDA-approved robotic stroke therapy system. It also plans to introduce its system to the consumer market for home use in Q3 2019.

Twenty-five hospitals in the Atlanta area within Emory Healthcare, the Grady Health System, and the Wellstar Health System are now using the Motus Nova rehabilitation therapy system, which is designed to use Artificial Intelligence (AI) to accelerate recovery from neurological injuries such as strokes.

The system features a Hand Mentor and Foot Mentor, which are sleeve-like robots that fit over a stroke survivor’s impaired hand or foot. Equipped with an active-assist air muscle and a suite of sensors and accelerometers, they provide clinically appropriate assistance and resistance while individual’s perform the needed therapeutic exercises.

A touchscreen console provides goal-directed biofeedback through interactive games—which Motus Nova calls “theratainment”—that make the tedious process of neuro rehab engaging and fun.

“It’s a system that has proven to be a valuable partner to stroke therapy professionals, where it complements skilled clinical care by augmenting the repetitive rehabilitation requirements of stroke recovery and freeing the clinician to do more nuanced care and assessment,” says Nick Housley, director of clinical research for Atlanta-based Motus Nova, in a media release.

“And while we continue to fill orders for the system to support therapy in the clinic and hospital, we also are looking to use our system to fill the gap patients often experience in receiving the needed therapy once they go home.”

Clinical studies show that neuroplasticity begins after approximately many 10’s to 100’s of hours of active guided rehab. The healing process can take months or years, and sometimes the individuals might never fully recover. Yet the typical regimen for stroke survivors is only two to three hours of outpatient therapy per week for a period of three to four months.

“These constraints were instituted by the Centers for Medicare & Medicaid Services (CMS) in determining Medicare reimbursement without a full understanding of the appropriate dosing required for stroke recovery, and many private insurers have adopted the policy, as well,” states David Wu, Motus Nova’s CEO.

Motus Nova plans to offer a more practical model, the release continues.

“By making the system available for home use at a reasonable weekly rate as long as the patient needs it, the individual can perform therapy anytime,” Wu adds. “A higher dosage of therapy can be achieved without the inconvenience of scheduling appointments with therapists or traveling to and from a clinic, and without the high cost of going to an outpatient center every time the individual wants to do therapy.”

While the system gathers data about individual performance, AI tailors the regimen to maximize user gains, discover new approaches, minimize side effects and help the stroke survivor realize his or her full potential more quickly.

“By optimizing factors such as frequency, intensity, difficulty, encouragement, and motivation, the AI system builds a personalized medicine plan uniquely tailored to each individual user of the system,” Housley comments.

“Our system is durable, too, proven in clinical trials to deliver an engaging physical therapy experience over thousands of repetitions. We look forward to making it available on a much wider scale in the coming months.”

[Source(s): Motus Nova, PR Newswire]

 

via Robotic Rehab Aims for the Home Market in Q3 – Rehab Managment

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[ARTICLE] Whole-Body Vibration in Horizontal Direction for Stroke Rehabilitation: A Randomized Controlled Trial – Full Text

Abstract

Background

As most of the existing whole-body vibration (WBV) training programs provide vertical or rotatory vibration, studies on the effects of horizontal vibration have rarely been reported. The present study was conducted to investigate the effect of WBV in the horizontal direction on balance and gait ability in chronic stroke survivors.

Material/Methods

This study was designed as a randomized controlled trial. Twenty-one stroke survivors were randomly allocated into 2 groups (whole-body vibration group [n=9] and control group [n=12]). In the WBV group, WBV training in the horizontal direction was conducted for 6 weeks, and a conventional rehabilitation for 30 min, 3 days per week for a 6-week period, was conducted in both the WBV and control groups. Outcome variables included the static balance and gait ability measured before training and after 6 weeks.

Results

On comparing the outcome variables before and after training in the WBV group, significant differences were observed in the cadence and single support time of gait ability. However, there were no significant differences in other variables, including velocity, step length, stride length, and double support time. In addition, after training, no significant differences in all variables were observed between the 2 groups.

Conclusions

The results of this study suggest that WBV training in the horizontal direction has few positive effects on balance and gait function in chronic stroke survivors. However, further investigation is needed to confirm this.

Background

Stroke survivors suffer from central nervous system damage, with sensory and motor system damage, which leads to consequences such as decreased control of muscle tone, delay in muscle contraction, and absence of selective movement [1,2]. In addition, stroke survivors have unstable balance and poor gait ability, which naturally limits their activities of daily living and participation in the community, while losing independence [2,3]. Consequently, the first priority for stroke survivors is recovery of independent activities, and for this, the recovery of balance in a standing posture and gait abilities is essential.

For functional recovery of stroke survivors, various methods have been suggested [4], and whole-body vibration (WBV) is a relatively novel form of exercise intervention that could improve functional recovery [5]. WBV involves the use of a vibrating platform in a static position or while performing dynamic movements. In previous studies, it was suggested that WBV training could improve physical functions. Castrogiovanni et al. [6] reported that a multi-component training, including aerobic activity and other types of training (resistance and/or strength exercises), is the best kind of exercise for improving bone mass and bone metabolism in elderly people and especially in osteopenic and osteoporotic women. With regard to whole-body vibration training, studies have suggested that it could be a valid method. Pichler et al. [7] reported that mechanical stimulation such as treadmill and vibration stimulation training inhibits the activity of RANKL in osteoporosis. In addition, Musumeci et al. [8] suggested that, in certain diseases such as osteoporosis, mechanical stimulation including treadmill and vibration platform training could be a possible therapeutic treatment. Based on their results, they proposed the hypothesis that physical activity could also be used as a therapeutic treatment for cartilage diseases such as osteoarthritis. Van Nes et al. [9] introduced WBV as a means of somatic sensory stimulation for functional recovery of stroke survivors. They also reported that somatosensory stimulation through WBV can significantly improve muscle performance, balance, and daily activities. Balance, defined as the ability to maintain the center of pressure (COP) on the support surface in given circumstances, can be held through adjusted harmony of visual, vestibular, and somatic sensory system [10], and vibration stimulation is reported to cause small changes in the skeletal muscle length of the human body and affect the motor neurons to facilitate activation of the spinal reflexes through short spindle-motor neuron connections [11].

Balance is a major component required for controlling or maintaining the COP in mobility and locomotion in which the support surface changes [12]. The information on changes of the support surface along with the biomechanic information needed for movement control is passed on to the central nervous system by muscle spindles, Golgi tendon organs, and joint receptors in the proprioception sense; thus, they have a very important role in controlling balance [13,14]. In addition, Muller and Redfern [15] performed a comparative analysis of the latency of beginning muscle activity by measuring electromyogram (EMG) activation degree of muscle strength of the lower extremities caused by movement of the COP while the support surface moved back and forth. Consequently, the latency of activation of the tibialis anterior muscle was rapid on the support surface moving forward and that of the soleus muscle was rapid when moving backward. Given these reports, for recovery of balance ability, the horizontal vibration in all directions might be needed more than the vertical or rotatory vibration provided by the original WBV training. Additionally, our bodies maintain standing posture using ankle strategy, hip strategy, or both [16]. The ankle strategy, which is the postural control strategy that starts first in postural sway, enables immediate recovery of standing balance through ankle joint muscle contraction [16]. Horizontal vibration, therefore, may significantly activate not only stimulation of somatosensory, but also ankle strategy or hip strategy.

However, since most of the existing WBV training programs provide only vertical or rotatory vibrations, studies on effects of horizontal vibrations have been rarely reported. Accordingly, the present study examined the effects of horizontal WBV in an antero-posterior or medio-lateral direction on balance and gait abilities of stroke survivors.[…]

Continue —> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408868/#__sec6title

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Figure 2
Whole-body vibration in horizontal direction.

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[Abstract] Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis

This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.

Systematic review and meta-analysis of randomized controlled trials.

Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.

Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.

Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).

This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.

via Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis – Tzu-Hsuan Peng, Jun-Ding Zhu, Chih-Chi Chen, Ruei-Yi Tai, Chia-Yi Lee, Yu-Wei Hsieh, 2019

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[WEB SITE] Engineers Develop Ankle Exoskeleton Designed to Be Worn Under Clothes

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Mechanical engineers at Vanderbilt University have developed a lightweight, low-profile ankle exoskeleton that they suggest could be worn under clothes without restricting motion, and does not require additional components such as batteries or actuators carried on the back or waist.

It could be widely used among elderly people, those with impaired lower-leg muscle strength, and workers whose jobs require substantial walking or running, they note, in a study published recently in IEEE Transactions on Neural Systems & Rehabilitation Engineering.

The study builds on a successful and widely cited ankle exoskeleton concept from other researchers in 2015, according to a media release from Vanderbilt University.

“We’ve shown how an unpowered ankle exoskeleton could be redesigned to fit under clothing and inside/under shoes so it more seamlessly integrates into daily life,” says Matt Yandell, a mechanical engineering PhD student and lead author of the study, in the release.

The team invented an unpowered friction clutch mechanism that fits under the foot or shoe and is no thicker than a typical shoe insole. The complete device, which includes a soft shank sleeve and assistive spring, weighs just over 1 pound.

“Our design is lightweight, low profile, quiet, uses no motor or batteries, it is low cost to manufacture, and naturally adapts to different walking speeds to assist the ankle muscles,” states Karl Zelik, assistant professor of mechanical engineering and senior author on the study.

“It could also help reduce fatigue in occupations that involve lots of walking, such as postal and warehouse workers, and soldiers in the field,” he adds.

[Source(s): Vanderbilt University, Science Daily]

 

via Engineers Develop Ankle Exoskeleton Designed to Be Worn Under Clothes – Rehab Managment

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[Abstract] Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial

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BACKGROUND: When solely mirror therapy is applied for a long period of time, spatial perception and attention to the damaged side may decrease, and the effect of mirror therapy may be limited. To overcome this limitation, it has recently been suggested that the combination of mirror therapy with mirror treatment is effective.
AIM: The aim of this study was to investigate the effects of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors.
DESIGN: A randomized controlled trial.
SETTING: Rehabilitation center.
POPULATION: Thirty stroke survivors were randomly assigned to two groups: the experimental group (n = 15) and the control group (n = 15).
METHODS: Participants of the experimental group received afferent electrical stimulation with mirror therapy, and participants of the control group received sham afferent electrical stimulation with sham mirror therapy for 60 minutes per day, 5 days per week, for 4 weeks. Motor function was measured using a handheld dynamometer and the Modified Ashworth Scale, balance was measured using the Berg Balance Scale, and gait was assessed using the GAITRite at baseline and after 4 weeks.
RESULTS: The experimental group showed significant differences in muscle strength, Modified Ashworth Scale, and Berg Balance Scale results, and velocity, cadence, step length, stride length, and double support time of their gait (p <0.05) in the pre-post intervention comparison. Significant differences between the two groups in muscle strength, Berg Balance Scale, gait velocity, step length, and stride length (p <0.05) were found.
CONCLUSIONS: Mirror therapy with afferent electrical stimulation may effectively improve muscle strength and gait and balance abilities in hemiplegic stroke survivors.
CLINICAL REHABILITATION IMPACT: Afferent electrical stimulation combined with mirror therapy can be used as an effective intervention to improve lower limb motor function, balance, and gait in chronic stroke survivors in clinical settings.

via Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2019 Mar 22 – Minerva Medica – Journals

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[VIDEO] FES (Functional Electrical Stimulation) System by FES Center India – YouTube

Functional Electrical Stimulation (FES): Best and latest treatment for Neurological rehabilitation/ Physiotherapy

FES is a technique that utilizes patterned electrical stimulation of neural tissue with the purpose of restoring or enhancing a lost or diminished function. It produces contractions in paralysed muscles by the application of small pulses of electrical stimulation to nerves that supply the paralysed muscle. The stimulation is controlled in such a way that the movement produced provides useful function.

FES is used as a tool to assist walking and also as a means of practicing various functional movements for therapeutic benefit. FES may be used to replace the natural electrical signals from the brain, helping the weak or paralyzed limbs move again. With continued stimulation over time, the brain may even be able to recapture and relearn this movement without the stimulation.

Use of “FES (Functional Electrical Stimulation) System India” for treatment of Foot Drop due to Hemiplegia. FES is a novel device for treatment/ rehabilitation of Neurological diseases. FES System India has many applications like

  1. Sit to stand training
  2. Pre Gait Training
  3. Correction of Foot Drop,
  4. Correction of Circumductory Gait

  5. for Paraplegia (Incomplete SCI) using FES unit on both sides

  6. Shoulder subluxation and shoulder rehabilitation

  7. Hand Function (Grasp and release)

This novel treatment is useful for all type of UMN disorders like hemiplegia (Cerebro Vascular Accident, Head Injury, Traumatic Brain injury, Brain tumor ), multiple scerosis, cerebral palsy, incomplete paraplegia etc.

contact “FES Center India” to buy FES System.

mail: fescenterindia@gmail.com

For more details visit: http://www.fescenterindia.com

via FES (Functional Electrical Stimulation) System by FES Center India – YouTube

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[ARTICLE] Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial – Full Text

Abstract

Background

A recent study has demonstrated that a turning-based treadmill program yields greater improvements in gait speed and temporal symmetry than regular treadmill training in chronic stroke patients. However, it remains unknown how this novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in chronic stroke patients. The purpose of this study was to examine how a novel type of gait training, which is an unfamiliar but effective task for people with chronic stroke, enhances brain reorganization.

Methods

Subjects in the experimental and control groups received 30 min of turning-based treadmill training and regular treadmill training, respectively. Cortico-cortical connectivity and cortico-muscular connectivity during walking and gait performance were assessed before and after completing the 12-session training.

Results

Eighteen subjects (n = 9 per group) with a mean age of 52.5 ± 9.7 years and an overground walking speed of 0.61 ± 0.26 m/s consented and participated in this study. There were significant group by time interactions for gait speed, temporal gait symmetry, and cortico-cortical connectivity as well as cortico-muscular connectivity in walk-related frequency (24–40 Hz) over the frontal-central-parietal areas. Compared with the regular treadmill training, the turning-based treadmill training resulted in greater improvements in these measures. Moreover, the increases in cortico-cortical connectivity and cortico-muscular connectivity while walking were associated with improvements in temporal gait symmetry.

Conclusions

Our findings suggest this novel turning-based treadmill training is effective for enhancing brain functional reorganization underlying cortico-cortical and corticomuscular mechanisms and thus may result in gait improvement in people with chronic stroke.

Introduction

A recent study suggested that chronic stroke patients maintain the capacity to increase synchronization of neural activity between different brain regions as measured by EEG connectivity. These changes of functional connectivity in the motor cortex through neurofeedback correlate with improvements in motor performance [1]. Previously, we demonstrated that a novel specific training, the turning-based treadmill program, yielded greater improvements in gait speed and temporal symmetry than regular treadmill training for people with chronic stroke [2]. We presumed the turning-based treadmill training, which is a challenging and unfamiliar training task for chronic stroke patients, may facilitate brain reorganization and behavioral recovery [3]. Thus, we sought to understand how such novel gait training promotes brain reorganization in this study.

An EEG-based method has the advantage of real-time recording during walking due to the relative ease of data acquisition. As indicated by the authors of the first study to use an EEG signal recorded during walking, the power increases within numerous frequency bands (3–150 Hz) in the sensorimotor cortex and is more pronounced during the end of the stance phase of walking [4]. Source localization EEG analysis revealed the importance of the primary somatosensory, somatosensory association, primary motor and cingulate cortex in gait control [5]. Focal lesions due to stroke may not only affect the functional connectivity of cortical areas [6] but also impede the neural transmission of descending motor pathways [7]. Based on spectral analysis, the direct relationship of cortical activities with peripheral movements is still unknown. Accordingly, an analysis of EEG-EMG coherence recorded during treadmill walking was done by Petersen et al. [8], who demonstrated that cortical activity in the primary motor cortex within the gamma band (24–40 Hz) was transmitted via the corticospinal tract to the leg muscles during the swing phase of walking. In addition, a recent study confirmed the strong correlation between kinematic errors of the lower extremities and fronto-centroparietal connectivity during gait training and post-training in healthy subjects [9]. However, it remains unknown how novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in individuals with chronic stroke. Therefore, the aims of the current study were to explore the effects of the turning-based treadmill training, a novel gait training program, on cortico-cortical connectivity and corticomuscular connectivity and to investigate the relationship between connectivity changes and gait performance in chronic stroke patients.[…]

 

Continue —> Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial | Journal of NeuroEngineering and Rehabilitation | Full Text

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[NEWS] ReStore Gait Rehab Exo-Suit On Path for FDA 510(k) Nod, Company Notes

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ReWalk Robotics Ltd has submitted a 510(k) application to the US Food and Drug Administration (FDA) for the ReStore exo-suit for gait training during stroke rehabilitation—the next step in the commercialization process, according to the company.

Introduced in 2017, the ReStore soft garment-like exo-suit is designed to allow variability of movement in combination with active ankle assistance that adaptively synchronizes with the patient’s natural gait, to facilitate functional gait training activities. The device also provides therapists the ability to adjust and optimize a patient’s treatment using real-time analytics.

”This submission marks a significant milestone for robotic rehabilitation technologies and represents a clear, distinct evolution in powered rehabilitation solutions,” says Larry Jasinski, ReWalk CEO, in a media release from the Marlborough, Mass-based company.

“The ReStore is a versatile device which will provide high-level, reproducible care for a broad range of a clinic’s gait training clients, at a price point accessible to many more clinics than current technologies.”

The 510(k) submission follows the completion of a nationwide clinical study, with 44 patients enrolled across five leading rehabilitation centers in the United States:

  • The Shirley Ryan AbilityLab in Chicago
  • Spaulding Rehabilitation Hospital in Boston, in partnership with Boston University College of Health and Rehabilitation Sciences: Sargent College
  • MossRehab Stroke and Neurological Disease Center in Elkins Park, Pa
  • TIRR Memorial Hermann in Houston
  • Kessler Foundation in West Orange, NJ

“As part of the multi-site study of the ReStore exo-suit, we applied the device to a broad range of individuals with post-stroke gait dysfunctions. The device allowed the study participants to walk effectively and efficiently, and we are encouraged with the potential of this technology to interact with and enhance everyday clinical care” explains Arun Jayaraman, PT, PhD, who is director of the Max Nader Lab for Rehabilitation Technologies & Outcomes Research at Shirley Ryan AbilityLab and lead investigator for the ReStore clinical study.

Following CE submission in Q4 of 2018, ReWalk anticipates commercializing the ReStore device for use by stroke patients and rehab clinics in Europe in mid-2019. In the United States a  potential launch of the product could occur in late Q2 or Q3, pending clearance from the FDA, per the release.

[Source(s): ReWalk Robotics Ltd, PR Newswire]

 

via ReStore Gait Rehab Exo-Suit On Path for FDA 510(k) Nod, Company Notes – Rehab Managment

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