Posts Tagged gait

[WEB SITE] New technology is helping patients to get moving again – News

A ground-breaking ’bicycle’ which simulates muscle movements is helping a range of patients with long-term mobility problems caused by head or spinal injuries, stroke or MS. Julie Blackburn watched a demonstration.

One morning in April last year Jason Moffatt from Peel woke up with a headache.

And not just any normal headache, as he recalls: ’I don’t usually do headaches and this one was the worst: it felt like my head was about to explode out of the top.’

He put up with it for a while then decided it ’might be worth popping into the A&E’. It was lucky he did because an examination and subsequent scan revealed dried blood on his brain. He had suffered a bleed.

Jason was flown off the island to Walton Hospital in Liverpool for an operation but during surgery he suffered a stroke which left him paralysed down the left side of his body.

’I then spent three months in Liverpool, learning to walk again and do everyday tasks,’ he says.

While there, Jason realised that strokes do not just happen to older people, but to plenty of younger ones too.

Back on the island his rehabilitation programme has included sessions on a Functional Electrical Stimulation (FES) bicycle.

FES is a technique that uses low energy electrical pulses and has been found to be effective in restoring voluntary functions.

These pulses artificially generate body movements in specific muscle groups through electrodes placed on the patient’s body.

Jason’s physiotherapist is Christine Wright, from the Community Adult Therapy Services team. She specialises in helping patients with long-term neurological conditions and she demonstrated how the machine works.

Once the electrodes are positioned on the muscle groups which Jason needs to get working, he sits in a chair which is attached to the machine with his legs strapped onto the ’pedals’.

His session starts with a warm-up of around one and a half minutes before the resistance increases and he is working hard, concentrating on putting in more effort on his left leg.

Having started his treatments with around 10 to 15 minutes on the bike, Jason has now built up to 30 minutes in each session.

’I’ll be sweating at the end of this,’ he says.

As she keeps an eye on his progress, Christine explains: ’Although it’s a bike, the pattern of movement is simulating walking: each turn of the bike gives Jason a step.

’Numbers of repetitions lead to changes in the brain and the development of new neural pathways.

’The bike also strengthens the muscles so that, when those connections in the brain reform, those muscles are there, ready to be used.’

It has probably served Jason well that he was a keen cyclist before he became ill, having done the End2End mountain bike race, as well as the Parish Walk to Peel and the End to End walk.

He knows that he is also fortunate to have the use of the FES bicycle. When he was doing rehab in Liverpool, at a large, dedicated 30-bed rehab centre there, they didn’t have one: ’It was basically just a gym,’ he recalls. This is true of most rehab units where FES simulators are not part of the standard kit.

’We’re incredibly lucky to have this,’ Christine says.

This machine was purchased for the Community Physiotherapy Department two years ago with £11,695 provided by the Henry Bloom Noble Healthcare Trust.

The Trust’s main remit is to provide equipment over and above what the DHSC in the island would be able to buy.

It has been a great success for Christine and the other physiotherapists, Graihagh Betteridge and Rosie Callow, who are also trained to use the machine.

As well as working on patients’ lower limbs, the simulator can be detached from the bicycle element and used as a portable machine.

It can then be taken to people’s homes and used to help them regain shoulder and arm movement.

At the moment the department has to ration the machine’s use.

They take around 25 to 30 patients at a time, usually for a six-eight week course, with a session once a week on the bike.

They have a waiting list, both with new patients and patients who have had a course already and need further treatment. Because of this the Henry Bloom Noble Healthcare Trust has agreed to purchase a second bicycle so more patients will have the chance to use one.

Chairman of the Trust, Terry Groves, said: ’Jason’s story, and many others, have shown the value of this FES bicycle in managing differing conditions and rehabilitation.

’Recognising the continuing donations made to our Healthcare Trust we are delighted to fund the acquisition of this second FES bicycle from our funds so that continuing strides in this important area of aftercare can be made.’

Jason himself is delighted with the progress he has made using the bicycle: ’I can see an improvement. I can walk further and with a better balance,’ he says.

His aim now is to get back on his (real) bike.

Christine smiles when he says this. ’You will do it,’ she assures him.

via New technology is helping patients to get moving again | News |

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[WEB SITE] Staying One Step Ahead – Rehab Managment

Staying One Step Ahead

photo caption: Patient walks with an AFO which supports his ankle. While the loss of muscles in his lower leg will be permanent, the orthosis will stabilize the foot and aid in walking.

by Polly Swingle, PT, GCS, CEEAA, and Brian Paulson, CPO

Foot drop is a potentially painful—and even disabling—condition where an individual has difficulty raising (or a complete inability to raise) the front of the foot. Foot drop—also referred to as dropped foot or drop foot—is caused by a damage or impairment to the muscles and nerves responsible for lifting the foot. The resulting weakness or paralysis leads to characteristic symptoms that most obviously manifest in an altered gait. Because individuals suffering from foot drop cannot properly lift their foot, they may drag their toes on the ground while walking. To avoid this potentially painful and dangerous impairment (which can damage the foot and increase the risk of falling), foot drop patients may utilize a “steppage gait,” a common compensation tactic where they lift their knee(s) higher in a marching-style walk or swing their leg(s) outward.

Causes of Foot Drop

It is important to understand foot drop is not a disease; it is a symptom. There are several types of damage or diseases that can weaken nerves and/or muscles and lead to foot drop, but the three most common are an injury to the peroneal nerve that controls the muscles responsible for lifting the foot; muscular compromise due to a disorder such as amyotrophic lateral sclerosis (ALS) or muscular dystrophy; and neurological conditions such as multiple sclerosis (MS) or stroke.

Patient has a diagnosis of Cauda Equina injury due to a lumbar discectomy that had complications, and resulted in loss of his distal muscles controlling the ankle. The intervention for this injury is physical therapy for strengthening the intact muscle above the ankle, as well as balance activities and a solid AFO.

Treatment Options

There are four basic categories of treatment options for foot drop. Because successfully treating foot drop almost always depends on addressing/correcting the underlying cause of the condition, the best course of treatment and therapeutic care can vary significantly from one patient to the next.

Treatment options include the following:

Surgical intervention

Surgical treatment options can be effective for foot drop patients whose condition has been caused by physical damage to nerves or muscles. A herniated disc, tumor, or other spinal condition that has damaged or pinched a nerve can often be addressed surgically. Damaged muscles or tendons in the leg or foot can also be repaired in surgery. Patients suffering from persistent or chronic foot drop that is resistant to treatment may benefit from surgical intervention that fuses the bones of the ankle or foot, or even surgery that transplants and/or reconfigures tendon and muscle.

Functional electrical stimulation (FES)

In cases where peroneal nerve damage or impairment is causing foot drop, functional electrical stimulation (FES) can be an effective form of treatment. Therapeutic FES treatment in conjunction with physical therapy can help stimulate damaged nerves and muscles and promote motor recovery.

FES treatment uses sophisticated equipment to deliver targeted pulses of electrical current that evoke muscle contraction and activity. This can improve muscle functionality, enhance blood flow and range of motion, reverse muscle atrophy, and—in some cases—help foot drop sufferers regain some or all of their ability to lift their foot/feet and walk normally. Portable FES devices designed specifically for foot drop patients are also available. These systems deliver low-level FES impulses targeting the peroneal nerve, allowing wearers to achieve improved foot dorsiflexion and walk more naturally—with improved speed, stability, and confidence. These two-part systems use a specialized sensor to monitor the motion and position of the leg, in conjunction with a stimulator that delivers the electrical impulse and stimulates the peroneal nerve.

Physical therapy

Physical therapy is an important and often effective treatment option for foot drop that can be used alone or in conjunction with another treatment. The overall goal of any therapeutic or rehabilitation program for foot drop is to strengthen the muscles in the foot, ankle, and lower leg, enhance joint function and range of motion, prevent stiffness, minimize the chances of re-injury, improve balance and stability, and ultimately achieve improved mobility and regain a normal gait.

While the specific details of a therapy program for foot drop symptoms may vary from patient to patient, strength and balance training, stretching, and range of motion exercises are standard. Exercises include stretching with towels or exercise bands, seated or standing lifts, ankle dorsiflexion and plantar flexion exercises (pulling the foot toward you and pushing it away from you) with resistance from exercise bands, and even picking up small objects with your toes.

Foot drop patients should participate in a personalized therapeutic program under the guidance of a physical therapist with demonstrated experience working with foot drop patients. While in-office visits and therapy sessions are critical, most programs also include a home component with a series of exercises that the patient can perform independently.

External support and bracing

After determining the root cause for the foot drop and beginning a therapy program that incorporates the many facets of therapeutic care, including strength training, range-of-motion stretches, balance training, etc, the next step involves orthotic treatment to improve function and safety while reducing the risk of joint damage until the patient has fully recovered. An ankle-foot orthosis (AFO) can help to stabilize the affected foot and help foot drop patients maintain a normal foot position.

It is highly advisable that doctors and therapists who frequently see patients with foot drop take the time to establish a good working relationship with an orthotist. That relationship is the key to ensuring a collaborative, multidisciplinary approach where the patient, the therapist, and the orthotist are all on the same page.

Patient Safety

The highest priority of orthotic care is patient safety. Safety can be greatly improved by use of an AFO by restricting or reducing plantar flexion during swing phase of gait, and thereby reducing the risk of a fall due to catching the toes on the ground. Without the use of an AFO, many gait deviations are utilized to clear the foot during swing phase, including circumduction, hip hiking, and contralateral vaulting. These deviations increase the energy expenditure of the gait and can create muscle imbalances that often lead to further issues and complications.

Early Intervention

Early orthotic intervention is also beneficial for reducing the risk of joint contractures in patients with increased tone, such as a post-CVA foot drop with resulting equinovarus foot position. The AFO can properly position the foot in the coronal and sagittal plane to help maintain functional joint range of motion.

Innovations and Options

Revolutionary changes have taken place in the orthotic industry in the past 20 years. New lightweight materials have been introduced that are not only supportive, but can also provide energy storage and return to assist with push-off at terminal stance for patients with weak calf muscles.

When determining what kind of orthosis would provide the optimal treatment for a foot drop patient, one concept should always be remembered: joint motion should be permitted in an orthosis when sufficient muscle control and strength are present to move the joint normally through the available range. What this means is that, while support is crucial, “overbracing” a patient can create many negative consequences; some of which include muscular atrophy, dependence on the orthosis, and replacing one gait deviation with another by taking away the essential three rockers of gait. It is essential that when a patient has sufficient strength to control the ankle joint in a certain motion, that the orthotic allows them to do so.

One example of overbracing would be putting a patient with a flaccid foot drop (weak dorsiflexors) but strong plantar flexors into a solid ankle AFO. This AFO solution would prevent them from using their calf musculature at terminal stance for push-off. It also would prevent anterior tibial translation during the second rocker of gait, creating an unsmooth rigid transition through mid-stance. That could subsequently lead to genu recurvatum by restricting dorsiflexion of the ankle. A more appropriate AFO selection may be something with flexibility that has enough plantar flexion resistance to improve clearance of the foot during swing phase, but also lets the patient use their own musculature for other motions that they can control appropriately.

Manufacturers provide plentiful options to the physical therapy market for off-the-shelf and custom AFOs. Rockaway, NJ-headquartered Allard USA offers AFOs designed especially for foot drop that provide mild, moderate, and maximum stability. The company’s ToeOFF is a carbon composite dynamic response floor reaction AFO designed to keep the foot up during swing phase and provide a soft heel strike in addition to stability in stand and good toe-off. The company also offers the ToeOFF and the BlueROCKER as custom AFOs when more specific needs must be met, such as fit issues related to unique leg shapes, alignment issues, or calf atrophy/hypertrophy. Another manufacturer, DJO Global, Dallas, offers a line of AFOs including the lightweight Posterior Leaf Splint AFO, designed to provide utility for mild to moderate foot drop needs. Cascade Dafo Inc, Ferndale, Wash, offers a versatile line of pediatric dynamic AFOs that are available as customized products and feature colors and design elements that will appeal to children.

Ongoing Consultation

As recovery progresses, the orthotist should be consulted on a regular basis so that the AFO can be changed or modified throughout each stage of rehabilitation. As the patient’s condition changes, the therapeutic remedies (from exercises to AFO solutions) should change with them. The ultimate goal is to eventually eliminate the need for the brace entirely, because full function has been regained. In the meantime, the proper orthosis can be very beneficial in improving function and safety until independence is possible without it. RM

Polly Swingle, PT, GCS, CEEAA, is co-founder and lead physical therapist of The Recovery Project, which provides progressive, effective, evidence-based neuro rehab therapies that improve the quality of life and functionality of patients with spinal cord, neurological, and traumatic brain injuries at its three Michigan-based locations.

Brian Paulson, CPO, is a clinical manager for Wright and Filippis, a Michigan-based provider of prosthetics, orthotics, custom mobility products, and accessibility solutions with over 70 years of experience. For more information, contact


via Staying One Step Ahead – Rehab Managment

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[ARTICLE] Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke – Full Text



Wearable activity monitors that track step count can increase the wearer’s physical activity and motivation but are infrequently designed for the slower gait speed and compensatory patterns after stroke. New and available technology may allow for the design of stroke-specific wearable monitoring devices, capable of detecting more than just step counts, which may enhance how rehabilitation is delivered. The objective of this study was to identify important considerations in the development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke.


A qualitative research design with focus groups was used to collect data. Five focus groups were conducted, audio recorded, and transcribed verbatim. Data were analyzed using content analysis to generate overarching categories representing the stakeholder considerations for the development of stroke-specific wearable monitor technology for the lower extremity.


A total of 17 physical therapists took part in four focus group discussions and three individuals with stroke participated in the fifth focus group. Our analysis identified four main categories for consideration: 1) ‘Variability’ described the heterogeneity of patient presentation, therapy approaches, and therapeutic goals that are taken into account for stroke rehabilitation; 2) ‘Context of use’ described the different settings and purposes for which stakeholders could foresee employing stroke-specific wearable technology; 3) ‘Crucial design features’ identified the measures, functions, and device characteristics that should be considered for incorporation into prospective technology to enhance uptake; and 4) ‘Barriers to adopting technology’ highlighted challenges, including personal attitudes and design flaws, that may limit the integration of current and future wearable monitoring technology into clinical practice.


The findings from this qualitative study suggest that the development of stroke-specific lower extremity wearable monitoring technology is viewed positively by physical therapists and individuals with stroke. While a single, specific device or function may not accommodate all the variable needs of therapists and their clients, it was agreed that wearable monitoring technology could enhance how physical therapists assess and treat their clients. Future wearable devices should be developed in consideration of the highlighted design features and potential barriers for uptake.


Individuals with stroke commonly face mobility limitations, beginning at stroke onset [1] and continuing past discharge into the community [2], and demonstrate a range of gait deviations due to altered motor control and resulting compensatory movement patterns [3]. Improving walking quality and quantity is a major focus of therapy [4], as doing so can improve mobility, fitness, quality of life, and prevent secondary complications [56]. One avenue to target walking for individuals with stroke may be to utilize wearable monitoring technology, as previous research has shown that application of an activity monitor can improve user self-efficacy and physical activity levels in various patient populations including older adults, breast cancer survivors, and those with chronic obstructive pulmonary disease [7,8,9,10,11]. Additionally, wearable monitors have been increasingly utilized by therapists and researchers to assess various outcomes relating to exercise and physical activity, [1213] within therapy and between visits, to ensure exercise targets are met [14].

The majority of currently available wearable monitoring technology has not been developed specifically for stroke-related impairments and movement patterns. For example, consumer activity monitors are often limited by a minimum walking speed or movement amplitude in order to provide accurate and reliable feedback [1516]. Research efforts have attempted to adapt available wearable monitoring technology to meet the needs of individuals with stroke with increasing accuracy, from simple solutions such as wearing hip-situated fitness trackers at the ankle [1718], to developing software algorithms to analyze captured data to recognize movements patterns specific to stroke [19,20,21]. The advances in wearable monitoring have reached a point at which designing stroke-specific wearable monitoring technology is a realistic priority to assess outcome and enhance rehabilitation interventions [22].

Much of the efforts to design stroke-specific wearable monitoring technology has so far focused on the hemiparetic upper limb [23,24,25,26]. This is unsurprising, as many individuals with stroke report long-term upper limb deficits or disability [27], and upper limb recovery has been identified as a top research priority from the perspective of individuals with stroke and their health professionals [28]. Conversely, limited efforts have been made in applying sensing technology to design stroke-specific wearable monitors for the hemiparetic lower limb. Research has shown that accelerometry can be reliable and valid in measuring physical activity after stroke [29], and new technologies to quantify foot pressure, leg motion, and muscle activity are being shown to be applicable to stroke [3031]. Thus, there is a gap in wearable monitoring technology for individuals with stroke, between what can be designed to improve rehabilitation of the lower extremity and what is currently available.

In order to develop devices that fill this niche, it is important to involve end-users in the development process from the onset to ensure initial efforts are relevant to the individuals who will ultimately use them, [3233] which inevitably are individuals with stroke and their physical therapists. This user-centered design approach is optimal for identifying relevant factors and technical aspects that should inform design choices [3233]. Thus, the objective of the current study was to identify important considerations in the future development of stroke-specific lower extremity wearable monitoring technology for rehabilitation, from the perspective of physical therapists and individuals with stroke.[…]


Continue —->  Perspectives on the prospective development of stroke-specific lower extremity wearable monitoring technology: a qualitative focus group study with physical therapists and individuals with stroke | Journal of NeuroEngineering and Rehabilitation | Full Text


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[Abstract] An investigation into the validity and reliability of mHealth devices for counting steps in chronic stroke survivors

To investigate the validity and test–retest reliability of mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra) to estimate the number of steps in individuals after chronic stroke and to compare whether the measurement of the number of steps is affected by their location on the body (paretic and non-paretic side).

Observational study with repeated measures.

Fifty-five community-dwelling individuals with chronic stroke.

The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra), and compared against criterion-standard measure during the Two-Minute Walk Test using habitual speed.

Our sample was 54.5% men, mean age of 62.5 years (SD 14.9) with a chronicity after stroke of 66.8 months (SD 55.9). There was a statistically significant association between the actual number of steps and those estimated by the Google Fit, STEPZ Iphone and Android applications, Pacer iphone and Android, and Fitbit Ultra (0.30 ⩽ r ⩾ 0.80). The Pacer iphone application demonstrated the highest reliability coefficient (ICC(2,1) = 0.80; P < 0.001). There were no statistically significant differences in device measurements that depended on body location.

mHealth devices (Pacer–iphone, Fitbit Ultra, Google Fit, and Pacer–Android) are valid and reliable for step counting in chronic stroke survivors. Body location (paretic or non-paretic side) does not affect validity or reliability of the step count metric.


via An investigation into the validity and reliability of mHealth devices for counting steps in chronic stroke survivors – Pollyana Helena Vieira Costa, Thainá Paula Dias de Jesus, Carolee Winstein, Camila Torriani-Pasin, Janaine Cunha Polese, 2020

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[WEB PAGE] Post Acute Medical Expands Exoskeleton Rehab with New EksoNR Devices

Post Acute Medical Expands Exoskeleton Rehab with New EksoNR Devices


Post Acute Medical LLC, a system of inpatient rehabilitation hospitals, has acquired three additional EksoNR devices from Ekso Bionics to expand the availability of exoskeleton-assisted rehabilitation to seven of its facilities.

The new EksoNR devices will be placed in Kyle and Clear Lake, Texas and Tulsa, Oklahoma. Exoskeleton-assisted rehabilitation is now available at five PAM locations in Texas. The device is designed to help patients stand and walk during rehabilitation after a stroke or spinal cord injury.

“Using EksoNR exoskeletons to help our stroke and spinal cord injury patients learn to walk again has been transformative,” says Anthony Misitano, PAM’s President and Chief Executive Officer, in a media release.

“The technology has been an integral part of our patients’ recovery and our physical therapists are eager to integrate it into their care of more patients. We are pleased to respond to the needs of our patients and providers with three additional EksoNR devices.”

PAM provides inpatient rehabilitation services in 12 states through 41 inpatient rehabilitation hospitals and long-term acute care hospitals, as well as more than 32 outpatient physical therapy locations, per the release.

“We are excited to see the growth of exoskeleton-assisted rehabilitation in systems like PAM,” Jack Peurach, Chief Executive Officer and President of Ekso Bionics, comments in the release.

“Using our exoskeleton devices in rehabilitation can provide better patient outcomes by helping patients walk farther and faster, and have better balance outside of the device. We are thrilled that PAM is embracing our technology and making it available to more of their patients.”

Developed for neurorehabilitation, EksoNR is an intuitive exoskeleton device that empowers patients recovering from stroke or spinal cord injury to learn to walk again with a more natural gait.

[Source(s): Ekso Bionics Holdings Inc, Globe Newswire]


via Post Acute Medical Expands Exoskeleton Rehab with New EksoNR Devices – Rehab Managment

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[VIDEO] Indego Therapy Exoskeleton

Indego Therapy Exoskeleton

A new video has been released to showcase the Indego Therapy exoskeleton.  It’s worth 14 minutes of your time.

Indego Exoskeleton – Advanced Opportunities for Therapy

These three institutions can offer trials of the Indego Personal unit and therapy sessions with the Therapy product.
– More Rehab (Sheffield/Doncaster)
– The Royal Buckinghamshire Hospital (Aylesbury)
– The Wellington Hospital (London)

The real power offered by the Indego for Therapy is it’s ability to really fine tune the support provided to a user. It’s easy to argue that if an exoskeleton does all the work it is not likely to be beneficial to the user who has potential for functional recovery. The Indego’s outstanding ability to provide adjustable support to the user means that it is truly restorative technology.  It’s the combination of hardware and software that makes the difference.  To take advantage of neuralplasticity it is important that fine control of the gait pattern is achieved – otherwise all that happens is a reinforcement of poor performance.

This video unpicks the details of exactly what the Indego Therapy unit can do.

What’s the difference between the Therapy and Personal models?
The Therapy unit has an adjustable thigh and pelvis sections to allow easy adjustment in the clinic for users with different statures.  The Personal unit functions in an identical manner but the fact that it is intended for one user means that the adjustment features are not needed. It is therefore lighter. Some 12 kg for the Personal Indego and 17 kg for the Therapy product

See Video

via Rehab News from Anatomical Concepts (UK) Ltd – – Gmail

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[WEB PAGE] Dutch ‘walking-bike’ helps disabled people gain mobility, sit tall

Dutch 'walking-bike' helps disabled people gain mobility, sit tall

File photo Image Credit:

Lindsey Main from Massachusetts was an active woman who enjoyed yoga, running and walking her dog, until she suffered a stroke in January 2018 and lost mobility. While starting the long, slow process of exercise and rehabilitation she spotted actress Selma Blair announcing on Instagram she had the nervous system-damaging disease multiple sclerosis.The 47-year-old star of films including “Cruel Intentions” and “The Sweetest Thing” posted images of herself using an Alinker mobility bike. The two began private messaging and Blair bought the Main one of the bikes. Main says it has changed her life. Now she can walk her dog again, go to the shops and dance on it.

“I think movement actually is the best medicine. It’s like that saying: ‘If you don’t use it, you lose it’,” Main said. The bike was created by Dutch designer and humanitarian Barbara Alink, who made it initially as a mobility device for her aging mother to use without the stigma attached to mobility walkers and scooters.

A successful crowdfunding campaign in 2014 brought about a launch in the Dutch market and a North America launch followed in 2016. Now the bike, which costs $1,977.00 ships worldwide. “The Alinker is for everybody who identifies as an active person and happens to have a diagnosis,” said Alink.

“The feedback that I’m getting from people is that their life has changed, they can go out again, they have agency back,” she added. The Alinker has three wheels and riders support themselves on a saddle and move their legs to push it forward. It has brakes and the high saddle means users can sit almost at standing height and speak to others at their eye level.

It is used by people with Parkinson’s, arthritis, cerebral palsy, spinal cord injuries, muscular dystrophy, and peripheral neuropathy along with those recovering from strokes and surgery. “Isolation is a bigger disease or a bigger burden on people than the actual symptoms of the disease itself,” said Alink.

“So with the Alinker, being engaged in life again because you can go out… your radius expands again,” she added. Alinker is not classed as a medical device, so many insurance companies do not fund its purchase, leaving people to rely on crowdfunding or using the company’s rent-to-own scheme.

At its factory in Taipei in Taiwan, the company is working on prototypes for smaller Alinkers for children.

(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)

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via Dutch ‘walking-bike’ helps disabled people gain mobility, sit tall

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[THESIS] Multi-sensors for realization of home tele-rehabilitation


Research in assistive healthcare, in particular home rehabilitation, has spawn huge potential owing to the recent advancement of internet-of-things technology and the wearable hardware, Inertial Measurement Unit (IMU) in wearable sensors and smartphones become a affordable for community usage. However, using low cost IMU sensors or smartphones face certain challenges, such as accurate orientation estimation for lower-limb motion tracking, which is usually less of a problem in specialized motion tracking sensor devices. To address these issues, the candidate has made three main contributions: a new and better orientation estimation algorithm which combines quaternion-based Kalman filter with corrector estimates using gradient descent (KFGD), an auto-detector of post-filtered lower-limb orientation signal oscillation and the machine-learning based state identification of rehabilitation exercise. Firstly, obtaining accurate orientation readings with noise-prone IMU and post-processing drift is a key challenge in motion tracking research. It is the result of accumulated errors over the integration of the gyroscope signal to calculate the angular displacement, in other words, the orientation of the limb, in the motion tracking application. Thus, the candidate proposes two sensor fusion algorithms: the complementary filter feedback (CFF) and the quaternion-based Kalman filter with corrector estimates using gradient descent (KFGD). The complementary filter feedback (CFF) focuses on the components’ performance of high-pass filter (from angular velocity) and low-pass filter (from fusion of gravity and earth magnetic field). These components contribute to the estimated orientation while the proposed feedback loop can correct the drift. KFGD is later introduced to further improve the limitation of the low-pass filter and the fixed fusion threshold of the CFF. Gradient descent method and quaternion-based Kalman Filter are chosen for their progressive features. The performance was evaluated on the case study of early stage rehabilitation exercises, namely, leg extension and sit-to-stand. The result shows that CFF is capable of fast motion tracking and confirms that the feedback loop is capable of correcting errors caused by integration of gyroscope data. KFGD outperforms the state-of-the-art Madgwick algorithm and is recommended for obtaining accurate orientation readings using motion sensors. Secondly, upon observing the characteristics of the post-filtered orientation signals of the lower-limb, a noticeable artifact in the output signal that it would oscillate from positive to negative and vice versa. To address the oscillations in the signals of both motion capture and inertial measurement sensors, the candidate applied machine learning algorithms and compared them with the rule-based approach. Machine learning methods, such as Logistic Regression, Support Vector Machine and Multilayer perceptron, were adopted in order to automatically detect the oscillation. The results showed that machine learning methods are able to learn the oscillation patterns in wearable sensor data and identify the tendency of fluctuation thereby allowing the errors to be filtered out more efficiently than rule-based method. Lastly, in order to realize meaningful home rehabilitation, there is a need for informative feedback or intervention in parallel with the exercise monitoring. The study aims to use the collected data and the understanding of wearable signal to simulate the high-level observations by the physiotherapist towards the patients and provide informative feedback during exercising at home. Therefore, the candidate proposes the study on machine-learning based state identification of rehabilitation exercise by using wearable sensors on the lower limbs. The informative feedback and quality assessment could be obtained by selectively segmenting the exercise into four states: rest, raise, hold and drop. The segmentation potentially increases the frequency of detection resulting in almost real-time feedback. In addition, identifying the abnormal sequences against the correct pattern in the respective state results in more specific and informative feedback. In this work, the candidate analyses the impact and derives valuable insights of the extracted sensor signals in relation to the predicted. As a result, the predictive model yields up to 95.89% (SVM) and 94.04% (SVM) accuracy for binary and multi-label pattern recognition respectively. The experiment and recommended framework show the efficiency and potential of using signal data as features in motion-based exercise pattern recognition. The work presented in this thesis demonstrates the realization of home rehabilitation from the hardware-level to the simulation of user intervention. The methodologies exploit the a ordable hardware to correctly track the limb motion while the motion signal prediction model and analysis boost the potential of intervention strategy for the user’s home exercise feedback.

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via Multi-sensors for realization of home tele-rehabilitation | DR-NTU

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[VIDEO] Using the SaeboStep and the SaeboStim Go – YouTube

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence.

In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products.

At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued.

Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began.

Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence.

Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.

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[Abstract] The Effect of IoT-based Upper and Lower Extremity Rehabilitation Medical Device Training on Gait in Chronic Stroke Survivor : A Case Study

Purpose: For stroke survivors, abnormal gait patterns lead to a significant risk of falls. We have recently developed an IoT-based Upper and Lower Extremity Rehabilitation Medical Device (RoBoGat) that enables continuous passive motion (CPM) training, squat training (ST), and gait training (GT). The purpose of this study was to test the effectiveness of RoBoGat on gait in a chronic stroke survivor.

Methods: In this study, an individual with right-side chronic hemiparesis post-stroke participated. The participant underwent 14 days of RoBoGat training that involved continuous passive motion training, squat training, and gait training. During the training, knee and hip joint angles were adjusted within the range where the subject felt no pain. We assessed gait, timed up and go test, and visual analog scale at baseline and after first and final interventions.

Results: After the intervention, positive changes were observed such as stride, gait velocity, and loading phase. Improvements were also observed in timed up and go tests. However, there was no significant change in VAS, which assessed pain in training and daily life.

Conclusion: The main finding of this case-control study is that robot-based upper and lower extremity training may be a feasible approach in the neurorehabilitation field. It can be concluded that repetitive and continuous robot rehabilitation exercises have a positive effect on improving the physical function of chronic stroke survivors.


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