Posts Tagged gait

[WEB SITE] Achieve Dramatic Foot-Drop Relief with X-Strap Systems

X-Strap Systems offers unique proven products for foot drop relief. Products provide full-time comfort, normal ankle joint mobility, and normal gait. Products include the Dorsi-Strap, Dorsi-Strap PRO, and Dorsi-Lite Foot Splint.

Each foot drop product is easy on and off, ultra-low profile, lightweight, durable, washable, and latex free. No Rx needed. No fitting requirements. 30-day refund warranty. Shipped worldwide within 24 hours.

Dorsi-Lite can be used with or without shoes, during day or night, and in dry or wet conditions. No oversized shoes are needed. Treats plantar fasciitis, Achilles tendonitis, heel spurs and shin splints.

Dorsi-Strap is available in Standard and heavy-duty PRO models. Nothing is placed into the shoe or under the foot, so no oversize shoes are needed. The units offer quick adjustment and can be easily transferred or removed from the shoe. Available in White, Black, or Tan/Brown to match a wide array of shoe colors.

Guaranteed results!

via Achieve Dramatic Foot-Drop Relief with X-Strap Systems | Lower Extremity Review Magazine

, , , ,

Leave a comment

[Abstract] Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke

Introduction. Physiological responses are rarely considered during walking after stroke and if considered, only during a short period (3-6 minutes). The aims of this study were to examine physiological responses during 30-minute robot-assisted and body weight–supported treadmill and overground walking and compare intensities with exercise guidelines.

Methods. A total of 14 ambulatory stroke survivors (age: 61 ± 9 years; time after stroke: 2.8 ± 2.8 months) participated in 3 separate randomized walking trials. Patients walked overground, on a treadmill, and in the Lokomat (60% robotic guidance) for 30 minutes at matched speeds (2.0 ± 0.5 km/h) and matched levels of body weight support (BWS; 41% ± 16%). Breath-by-breath gas analysis, heart rate, and perceived exertion were assessed continuously.

Results. Net oxygen consumption, net carbon dioxide production, net heart rate, and net minute ventilation were about half as high during robot-assisted gait as during body weight–supported treadmill and overground walking (P < .05). Net minute ventilation, net breathing frequency, and net perceived exertion significantly increased between 6 and 30 minutes (respectively, 1.8 L/min, 2 breaths/min, and 3.8 units). During Lokomat walking, exercise intensity was significantly below exercise recommendations; during body weight–supported overground and treadmill walking, minimum thresholds were reached (except for percentage of heart rate reserve during treadmill walking).

Conclusion. In ambulatory stroke survivors, the oxygen and cardiorespiratory demand during robot-assisted gait at constant workload are considerably lower than during overground and treadmill walking at matched speeds and levels of body weight support. Future studies should examine how robotic devices can be Future studies should examine how robotic devices can be exploited to induce aerobic exercise.

 

via Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke – Nina Lefeber, Emma De Keersmaecker, Stieven Henderix, Marc Michielsen, Eric Kerckhofs, Eva Swinnen, 2018

, , , , , , ,

Leave a comment

[ARTICLE] Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury : A qualitative study – Full Text

Abstract

Objectives

It is well known that physical activity levels for persons after stroke or acquired brain injuries do not reach existing recommendations. Walking training is highly important since the ability to walk is considered to be a meaningful occupation for most people, and is often reduced after a brain injury. This suggests a need to innovate stroke rehabilitation, so that forms of walking training that are user-friendly and enjoyable can be provided.

Method

An interview study was carried out with persons after stroke (n = 8), or acquired brain injury (n = 2) at a rehabilitation unit at Sahlgrenska University Hospital. We used a semi-structured interview guide to investigate experiences and thoughts about walking on a treadmill with non-immersive virtual reality feedback. The contents were analyzed through an inductive approach, using qualitative content analysis.

Results

The virtual reality experience was perceived as enjoyable, exciting, and challenging. Participants stressed that the visual and auditory feedback increased their motivation to walk on a treadmill. However, for some participants, the virtual reality experience was too challenging, and extreme tiredness or fatigue were reported after the walking session.

Conclusions

Participants’ thoughts and experiences indicated that the Virtual Reality walking system could serve as a complement to more traditional forms of walking training. Early after a brain injury, virtual reality could be a way to train the ability to handle individually adapted multisensory input while walking. Obvious benefits were that participants perceived it as engaging and exciting.

Introduction

In general, physical activity levels in rehabilitation units are low [] and do not reach the recommendations for persons with stroke or acquired brain injury (ABI) []. There are also indications that the intensity of physiotherapy sessions after stroke is mostly at low levels []. Several barriers may contribute to inactivity, such as neurological deficits, cognitive impairment, environmental factors, and lack of motivation [].

A dose-response effect on exercise outcome after stroke has been shown, and training should be highly repetitive and task oriented []. Walking training is important and considered to be a meaningful occupation for most people. To increase walking exercise intensity, treadmill walking has been proposed as a means of task-oriented training that gives the opportunity for many repetitions, and has shown to promote a more normal walking pattern []. Walking on a moving surface like a treadmill is more demanding than walking on the ground in terms of sensory processing, postural control and movement coordination. From a motivational perspective, treadmill walking may be perceived as boring the long run.

Training of goal-specific activities with a high number of repetitions may be offered using virtual reality (VR) applications, which have been introduced in neurological rehabilitation []. Training using VR has also been suggested to enhance neuroplasticity after stroke [] by means of offering multisensory stimulation at a high intensity. VR comprises computer-based real-time simulation of an environment with user interaction [] visually displayed on a screen or through head-mounted devices. Differences in technology and visual presentations in 2D or 3D enable varying types of feedback, levels of immersion and sense of presence in the virtual environment []. VR feedback can be mediated through vision, hearing, touch, movement, or smell. The technique provides performance feedback–both directly experienced and objectively quantified, and may thereby increase exercise motivation, and improve motor performance [].

Following stroke, VR training has been mostly described for the upper limb but also for the lower limb; balance and walking as well as for perceptual/cognitive skills []. VR has shown a potential for positive effects on walking and balance abilities, although the number of studies are low and the evidence for its superiority to other methods is low [].

Although few adverse events from VR training have been described, some participants have reported headache or dizziness [] and knowledge is lacking regarding how persons affected by brain injuries perceive the exposure of multisensory input, during a complex activity such as treadmill walking with VR. The potential effects on motivation and participant experience of VR are scarcely investigated [] and mostly focused on upper limb activities and games []. Based on this, we wanted to investigate patients’ overall experiences of a VR concept in walking training.

The aim of the present study was to explore the experiences of VR in addition to walking on a treadmill in persons with stroke or acquired brain injuries. Participants’ overall experiences and suggestions for development of the exercise method were areas of interest.[…]

 

Continue —>  Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury – A qualitative study

, , , , , , ,

Leave a comment

[ARTICLE] Sensory retraining of the leg after stroke: systematic review and meta-analysis – Full Text

This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke.

Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched.

All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets.

The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I2 = 59.05%). Gait SES, mainly of gait velocity, was not significant.

This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.

 

Somatosensory impairment is common after stroke, occurring in up to 89% of stroke survivors.1Proprioception and tactile somatosensation are more impaired in the leg than in the arm post stroke,2 with the frequency increasing with increasing level of weakness and stroke severity.2,3 Leg somatosensory impairment also has a significant impact on independence in daily activities3 and activity participation in stroke survivors,4 as well as predicts longer hospital stays and lower frequency of home discharges.5

Leg somatosensory impairment negatively influences balance and gait. Post-stroke plantar tactile deficits correlate with lower balance scores and greater postural sway in standing.6 Tactile and proprioceptive feedback provide critical information about weight borne through the limb.7 Accordingly, tactile and proprioceptive somatosensory deficits may hinder paretic limb load detection ability, potentially leading to reduced weight-bearing and contributing to balance impairment and falls post stroke.8 Indeed, stroke survivors with somatosensory impairment have a higher falls incidence compared to those without somatosensory impairment.3 In addition to reduced balance, impaired load detection may also contribute to gait asymmetry, particularly in the push-off phase.8 In addition, leg proprioception influences variance in stride length, gait velocity,9 and walking endurance in stroke survivors.10 In fact, leg somatosensory impairment has been shown to be the third most important independent factor for reduced gait velocity in stroke survivors.11

Two systematic reviews have previously investigated the effects of interventions for retraining somatosensory function after stroke.12,13 In the first review, published more than a decade ago, only four of the 14 included studies targeted the leg,12 while the second only included studies of the arm.13 Nevertheless, both reviews reported that there were insufficient data to determine the effectiveness of these interventions. A third systematic review evaluating the effectiveness of proprioceptive training14 only included 16 studies with stroke-specific populations, of which only two specifically addressed the leg. From these three reviews, the effects of interventions for post-stroke leg somatosensory impairment remain unclear. In addition, the first review12 was critiqued for including studies with participants without somatosensory impairment, and that did not report somatosensory outcomes.15 Therefore, a targeted systematic review, addressing the limitations of previous reviews, is required to elucidate the effects of interventions for post-stroke leg somatosensory impairment.

It is of interest to clinicians and researchers to evaluate the effects of leg somatosensory retraining on factors that may ultimately influence activity and participation, as this could change practice. Therefore, this systematic review aimed to examine the effects of post-stroke leg somatosensory retraining on somatosensory impairment, balance, gait, motor impairment, and leg function.[…]

 

Continue —> Sensory retraining of the leg after stroke: systematic review and meta-analysis – Fenny SF Chia, Suzanne Kuys, Nancy Low Choy, 2019

, , , , , ,

Leave a comment

[ARTICLE] Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot – Full Text

Abstract

Background

Central drop foot is a common problem in patients with stroke or multiple sclerosis (MS). For decades, it has been treated with orthotic devices, keeping the ankle in a fixed position. It has been shown recently that semi-implantable functional electrical stimulation (siFES) of the peroneal nerve can lead to a greater gait velocity increase than orthotic devices immediately after being switched on. Little is known, however, about long-term outcomes over 12 months, and the relationship between quality of life (QoL) and gait speed using siFES has never been reported applying a validated tool. We provide here a report of short (3 months) and long-term (12 months) outcomes for gait speed and QoL.

Methods

Forty-five consecutive patients (91% chronic stroke, 9% MS) with central drop foot received siFES (Actigait®). A 10 m walking test was carried out on day 1 of stimulation (T1), in stimulation ON and OFF conditions, and repeated after 3 (T2) and 12 (T3) months. A 36-item Short Form questionnaire was applied at all three time points.

Results

We found a main effect of stimulation on both maximum (p < 0.001) and comfortable gait velocity (p < 0.001) and a main effect of time (p = 0.015) only on maximum gait velocity. There were no significant interactions. Mean maximum gait velocity across the three assessment time points was 0.13 m/s greater with stimulation ON than OFF, and mean comfortable gait velocity was 0.083 m/s faster with stimulation ON than OFF. The increase in maximum gait velocity over time was 0.096 m/s, with post hoc testing revealing a significant increase from T1 to T2 (p = 0.012), which was maintained but not significantly further increased at T3. QoL scores showed a main effect of time (p < 0.001), with post hoc testing revealing an increase from T1 to T2 (p < 0.001), which was maintained at T3 (p < 0.001). Finally, overall absolute QoL scores correlated with the absolute maximum and comfortable gait speeds at T2 and T3, and the increase in overall QoL scores correlated with the increase in comfortable gait velocity from T1 to T3. Pain was reduced at T2 (p < 0.001) and was independent of gait speed but correlated with overall QoL (p < 0.001).

Conclusions

Peroneal siFES increased maximal and comfortable gait velocity and QoL, with the greatest increase in both over the first three months, which was maintained at one year, suggesting that 3 months is an adequate follow-up time. Pain after 3 months correlated with QoL and was independent of gait velocity, suggesting pain as an independent outcome measure in siFES for drop foot.

 

Introduction

Drop foot is a common symptom in patients suffering from first motor neuron lesions, such as due to stroke and multiple sclerosis (MS). It is characterized by impaired lifting of the forefoot from the ground during the swing phase of walking and by a lack of stability during the early stance phase. Drop foot results in an altered gait pattern [3] and increased risk of falls [8]. Application of an ankle foot orthosis (AFO) is the traditional approach to improving gait pattern and reducing falls. However, it is not well-tolerated in all patients [10]. In recent years, gait improvement has been achieved using functional electrical stimulation (FES) [110162325], which combines the orthotic benefits of an AFO with a more physiological approach that involves muscle contraction and the related sensory feedback [1025]. Transcutaneous FES (tcFES) of the peroneal nerve has been associated with significantly reduced falls compared to intensive physiotherapy [7]. Indeed, 69% of the falls in this FES group occurred when the system was not used. Moreover, a systematic review of FES in MS patients indicates increased gait speed using FES [19]. Semi-implantable FES (siFES) of the peroneal nerve has been found to increase gait speed and improve gait patterns compared with a baseline without stimulation [61017], compared to orthotic devices [123], and also compared to tcFES [17]. The findings of a systematic review, including predominantly chronic stroke patients, however, did not suggest a difference between tcFES and siFES in terms of walking speed [13]. An implantable stimulator does, however, offer the advantage of avoiding the need for daily optimization of stimulator location [28] and potential skin lesions associated with surface stimulation electrodes. Moreover, the possibility of using a 4-channel implantable system, with independent control of each channel, means that the volume of tissue activated within the nerve can be individually selected, in order to optimize dorsiflexion of the foot while avoiding stimulation of the sensory fascicles of the common peroneal nerve [10]. Here we retrospectively hypothesised that increases in gait speed are associated with improvements in quality of life (QoL). Furthermore, we assumed pain scores had improved under therapy and expected them to be related to the overall QoL, and we hypothesised that increased gait velocity would have resulted in improvement of both physical and emotional subscores of the QoL. To address these hypotheses, we evaluated improvement in gait velocity in the largest cohort of patients to date, with stimulation ON and OFF, at three time points over 1 year, to assess the short- and long-term effects of siFES, examining correlation between gait speed and QoL, as well as between changes in these factors, over a year of continuous treatment.

Most studies of implantable systems for stroke to date cover observation periods of 3 to 6 months post-surgery and suggest siFES provides a promising approach to managing drop foot. An increase in gait velocity and endurance, as well as an improvement in QoL, was observed 3–6 weeks post-operatively in a cohort of 27 patients receiving siFES [17]. Trials applying tcFES, which has been available since the early seventies [27], have tended to employ standardized and stratified re-examination, with early and long-term follow-up periods, such as 6 and 12 weeks [16], 3 and 12 months [25], and 24 days and 3 years [28]. A recent long-term multi-centre study applying siFES reported an improved gait pattern in a cohort of 10 stroke patients 6 months following siFES activation and in a separate cohort of 12 stroke patients 1 year after activation [1]. Their findings suggested greater knee stability, ankle plantarflexion power, and propulsion than that provided by an AFO. Here, we examined both the short- and long-term effects of using multichannel peroneal siFES in the largest patient group thus far reported, including both stroke and MS patients. The independent association between slow gait velocity and an increased risk of falls [8] renders gait velocity a valid surrogate parameter for the orthotic functionality of devices aiming to improve the limitations of drop foot. We aimed to investigate whether gait velocity improvements translate into QoL changes. Long-term follow-up (one year or longer) has been reported for large cohorts (more than 20 patients) using tcFES [2528], and for a smaller cohort (N = 12) using siFES [1]. Long-term follow-up in a large cohort of patients receiving siFES and evaluating QoL has not yet been reported. The particular strengths of the current study are the large cohort, the inclusion of short- and long-term follow-up, and the evaluation of QoL and its correlation with gait speed.[…]

 

Continue —>  Long-term outcomes of semi-implantable functional electrical stimulation for central drop foot | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1Gait speed (m/s) in relation to duration of therapy with stimulation ON and OFF. a. Maximum gait velocity. Main effect of stimulation and time. Post hoc testing: significant difference from day 1 to month 3 (*). b. Comfortable gait velocity. Main effect of stimulation only. Error bars = standard error of the mean

, , , , ,

Leave a comment

[Abstract] Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized control trial.

Abstract

BACKGROUND:
Patients with stroke generally have diminished balance and gait. Mobilization with movement (MWM) can be used with manual force applied by a therapist to enhance talus gliding movement. Furthermore, the weight-bearing position during the lunge may enhance the stretch force.

OBJECTIVES:
This study aimed to compare the effects of a 4-week program of MWM training with those of static muscle stretching (SMS). Ankle dorsiflexion passive range of motion (DF-PROM), static balance ability (SBA), the Berg balance scale (BBS), and gait parameters (gait speed and cadence) were measured in patients with chronic stroke.

METHODS:
Twenty patients with chronic stroke participated in this study. Participants were randomized to either the MWM (n = 10) or the SMS (n = 10) group. Patients in both groups underwent standard rehabilitation therapy for 30 min per session. In addition, MWM and SMS techniques were performed three times per week for 4 weeks. Ankle DF-PROM, SBA, BBS score, and gait parameters were measured after 4 weeks of training.

RESULTS:
After 4 weeks of training, the MWM group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, SBA, BBS, and cadence showed greater improvement in the MWM group compared to the SMS group (p < 0.05).

CONCLUSIONS:
This study demonstrated that MWM training, combined with standard rehabilitation, improved ankle DF-PROM, SBA, BBS scores, and gait speed and cadence. Thus, MWM may be an effective treatment for patients with chronic stroke.

via Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized control… – PubMed – NCBI

, , , , , , , , ,

Leave a comment

[Abstract] Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis.

Abstract

BACKGROUND:

and purpose: The benefits of Kinesio taping (KT) in post-stroke rehabilitation have not been determined. This study aimed to evaluate its effects on lower-extremity rehabilitation in patients after a stroke.

METHODS:

A literature search was performed using EBSCOhost, Embase, Physiotherapy Evidence Database (PEDro), PubMed, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang Data through June 2018. Randomized controlled trials (RCTs) on the use of KT during lower-extremity, post-stroke rehabilitation were selected. Meta-analysis was conducted.

RESULTS:

A total of 14 RCTs of low to moderate quality were reviewed and included 783 participants. Results indicated that KT significantly improved patients’ lower extremity spasticity, motor function, balance, ambulation, gait parameters, and daily activities, with few adverse effects.

CONCLUSION:

KT may have positive effects on lower-extremity, post-stroke rehabilitation. Due to the limited number and quality of the research, additional studies are needed to identify KT benefits.

via Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis. – PubMed – NCBI

, , , , , , ,

Leave a comment

[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

IMAGE

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.”

###

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

 

, , , , , , , , , ,

Leave a comment

[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

, , , , , ,

Leave a comment

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

Published on 

MotusNova

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

, , , , , , , , , , ,

Leave a comment

%d bloggers like this: