Published: 31 March 2016
Posts Tagged paraplegia
When there is a loss of muscular functioning in an area or sensory loss on area resulting usually from any damage to central nervous system, there is paralysis. Some of the probable causes of this dangerous condition are polio, stroke, excessive trauma or multiple sclerosis, etc. There may be complete paralysis or partial paralysis. It is mainly of two kinds, namely, paraplegia and quadriplegia. Paralysis is the consequence when the brain fails to send signals to various regions of the body. This may result from a variety of reasons. Stroke accounts for 30% of paralysis cases and is the major cause. However, one can choose paralysis treatment depending on the severity of the condition and the region which is paralyzed.
How is paralysis diagnosed?
On the event of any failure of muscular functioning or sensory loss on certain area, it is important to visit a medical practitioner immediately. To diagnose the condition, he prescribes a series of tests including CT Scan, MRI, X-Ray, Electromyography. If at all it is necessary, the patient may be suggested a neurologist. After paralysis is confirmed, the treatment begins. Certain types of paralysis may be cured and this mainly includes partial paralysis. You can ask the doctor whether the recovery is possible or not. No matter what the cause of the condition, the treatment procedure will be almost the same. Whatever treatment you choose for recovery, the treatment provider will try and restore brain and body connection. This is the only way to bring about recovery.
Some of the basic treatment options for paralysis
Wearable device running on electricity is the most basic treatment for paralysis. This wearable electronic device is also used for stroke treatment. It improves arm functioning and restores motion in the arms. When you wear this device, it delivers electrical current to activate the muscles of arms and legs. This technique of motion restoration is also termed as FES or Functional Electrical Stimulation. It can recover the feet or lower legs from paralysis. The use of FES along with specific exercises can bring about a relief.
Some of the best treatment options for paralysis
If anyone of your loved one is suffering from paralysis, read the following section to learn how to reduce the symptoms:
- Surgery can address physical barriers. It may be that there is an object fixed in the brain or spinal cord of the person. It needs to be got rid of. Through the surgery, certain portions of the spinal cord can also be fused together.
- Some paralysis medication may be used to reduce swelling, inflammation and infection on the area. If there is chronic pain, it may be addressed with medicines.
- Continuous monitoring of the person is mandatory to ensure that this condition does not get worse
- Psychotherapy can help a lot. Support groups may teach you how to cope with this critical situation.
- To restore muscular and nerve functioning, you may be asked to do certain exercises. Occupational therapy can also help a lot. Work on the injuries and practice them as much as possible. Physical therapy may reverse paralysis by rewiring the brain.
- Some people got great results from alternative treatments like chiropractic care, massage therapy and acupuncture treatment.
If there are breathing difficulties, problem in the bowel movement, take immediate treatment for them. Again, surgery is an effective sleep apnea treatment. Whether it is sleep apnea or paralysis, immediate medical attention is required.
[ARTICLE] Accelerometry-enabled measurement of walking performance with a robotic exoskeleton: a pilot study | Journal of NeuroEngineering and Rehabilitation – Full Text HTML
Clinical scores for evaluating walking skills with lower limb exoskeletons are often based on a single variable, such as distance walked or speed, even in cases where a host of features are measured. We investigated how to combine multiple features such that the resulting score has high discriminatory power, in particular with few patients. A new score is introduced that allows quantifying the walking ability of patients with spinal cord injury when using a powered exoskeleton.
Four spinal cord injury patients were trained to walk over ground with the ReWalk™ exoskeleton. Body accelerations during use of the device were recorded by a wearable accelerometer and 4 features to evaluate walking skills were computed. The new score is the Gaussian naïve Bayes surprise, which evaluates patients relative to the features’ distribution measured in 7 expert users of the ReWalk™. We compared our score based on all the features with a standard outcome measure, which is based on number of steps only.
All 4 patients improved over the course of training, as their scores trended towards the expert users’ scores. The combined score (Gaussian naïve surprise) was considerably more discriminative than the one using only walked distance (steps). At the end of training, 3 out of 4 patients were significantly different from the experts, according to the combined score (p < .001, Wilcoxon Signed-Rank Test). In contrast, all but one patient were scored as experts when number of steps was the only feature.
Integrating multiple features could provide a more robust metric to measure patients’ skills while they learn to walk with a robotic exoskeleton. Testing this approach with other features and more subjects remains as future work.
Clinical scores of walking ability are crucial in many areas of physical rehabilitation to assess the efficacy of a therapeutic intervention or an assistive device, as well as to discriminate the ability between different patients [1, 2]. One domain of interest is evaluating functional ambulation in individuals who suffered a spinal cord injury (SCI). Even though many outcome measures target the SCI population [3, 4], currently there exist no specific measures targeting the ability of a patient to use a lower limb robotic exoskeleton to walk overground and achieve functional ambulation.
Lower limb exoskeletons are bilateral powered orthoses designed to provide assistance for sit-to-stand and for walking and, in some cases, to assist lower extremity function in individuals with incomplete or complete SCI [5–8]. Currently, several exoskeletons are transitioning from purely research and rehabilitation devices to personal mobility systems that individuals with SCI could use to walk inside their home and in their communities [9, 10]. A paradigmatic case is the ReWalk™, which has been approved by the Food and Drug Administration to be sold to individuals with SCI as a take-home personal mobility device.
Quantitative clinical assessment of exoskeletons is fundamental to evaluate their safety and effectiveness when used by individuals with disabilities. Specifically, individuals with complete SCI, who aim at taking an exoskeleton home as a personal mobility device, require an intensive training protocol to become independent users. Such training is typically delivered in a clinical setting and therefore clinicians need a robust metric to evaluate if a patient has reached a level of ability and expertise to independently use the device at home and in the community. Obtaining a robust index of the patients’ walking skills with an exoskeleton could also be used to inform health insurance companies about the actual improvements in functional mobility for potential reimbursement. This point is crucial as the cost of these devices is extremely high and therefore any support funding has to be justified.
The primary clinical outcome measures currently used to assess functional ambulation with exoskeletons are the 6-Minute-Walk-Test (6MWT) and the Ten-Meter-Walk-Test (10mWT) [11, 12]. These two tests measure, respectively, the distance walked in six minutes and the time to walk over a distance of 10 m, while walking at a constant speed. Despite being validated in spinal cord injury populations , it is questionable whether these measures are sufficient to fully evaluate a patient skill and the device efficiency. Indeed, other studies have measured additional features to characterize walking skills with robotic exoskeletons.
Specifically, amongst the features quantified there are: the kinematics of the hip, knee and ankle joints in patients trained to use the ReWalk™ , as recorded via a motion capture system; the exertion level based on the heart rate normalized to the walking speed (i.e. physiological cost index)  and the oxygen uptake [16, 17]. Other metrics used include the variation in vertical and lateral amplitude of the head motion , ground reaction forces analysis  and the ability to maintain eye contact to assess cognitive effort . Even when multiple features were measured, each study reports the values of each feature individually to characterize functional ambulation with exoskeletons. Therefore it is unclear how each feature contributes to the overall expertise of a subject. Furthermore, some of the captured features require complex and expensive lab equipment, commonly seen only in large hospitals and university settings.
In the current study, we propose to combine multiple features of walking performance by estimating their probability distribution over a set of expert users who have been previously trained extensively to use the exoskeleton. New participants are then scored based on how well their features fit the experts’ probability distribution. Building on this principle, we define a new score to quantify walking ability with exoskeletons: the Gaussian Naïve Bayes surprise. The term surprise is derived from information theory and represents the amount of unexpected information provided by an event . We apply our score to quantify the walking skills of four individuals with complete SCI, as they are trained to use the ReWalk™ exoskeleton. Four features are computed from the trunk accelerations, which are recorded using a commercial wearable accelerometer while subjects perform a 6MWT with the exoskeleton. We estimate the parameters of the features probability distribution from seven expert subjects (1 SCI and 6 able-bodied) that received extensive prior training with the device, and compute the Gaussian naïve Bayes surprise of the four SCI participants with respect to the experts. The score based on all four features is compared with one based only on number of steps (an equivalent of distance walked), in terms of the separation between experts and patients that is yielded by the two indices.
The ReWalk™ exoskeleton
[WEB SITE] FDA approves Vanderbilt-designed Indego exoskeleton for clinical and personal use | Research News @ Vanderbilt | Vanderbilt University
by David Salisbury | Mar. 10, 2016
Segway with legs’ approved by FDA for use by people with paraplegia
The U.S. Food and Drug Administration (FDA) has given clearance to market and sell the powered lower-limb exoskeleton created by a team of Vanderbilt engineers and commercialized by the Parker Hannifin Corporation for both clinical and personal use in the United States.
“I’m really glad,” said H. Fort Flowers Professor of Mechanical Engineering Michael Goldfarb who developed the exoskeleton with a team of engineers and students in his Center for Intelligent Mechatronics. “It is particularly gratifying because it is the first thing that has come out of my lab that has become a product that people can purchase, which hopefully will make a significant improvement in their quality of life.”
Indego®, which allows people paralyzed below the waist to stand up and walk, is the result of an intensive, 10-year effort. The initial development was funded by a grant from the National Institute of Child Health and Human Development. In 2012 Parker, a global leader in motion and control technologies, purchased an exclusive license to market the design and has worked closely with Goldfarb’s group to develop a commercial version of the medical device.
“Parker has done an excellent job in running their leg of the relay race, bringing the exoskeleton to market in just three years,” said Goldfarb.
Until recently “wearable robots” like Indego were the stuff of science fiction. In the last 15 years, however, advances in robotics, microelectronics, battery and electric motor technologies have made it practical to develop them to aid people with stroke and spinal cord injuries. The device acts like an external skeleton. It straps in tightly around the torso. Rigid supports are strapped to the legs and extend from the hip to the knee and from the knee to the foot. The hip and knee joints are driven by computer-controlled electric motors powered by advanced batteries. Patients use the powered apparatus with walkers or forearm crutches to maintain their balance.
“You can think of our exoskeleton as a Segway with legs. If the person wearing it leans forward, he moves forward. If he leans back and holds that position for a few seconds, he sits down. When he is sitting down, if he leans forward and holds that position for a few seconds, then he stands up,” Goldfarb said.
Indego is the second exoskeleton to receive FDA certification for U.S. use. The first was a device produced by Rewalk Robotics Ltd. However, Indego’s clearance came after completion of the largest exoskeleton clinical trail conducted in the United States. According to the Parker news release, “Over the course of more than 1,200 individual sessions, study participants were able to use Indego to safely walk on a variety of indoor and outdoor surfaces and settings with no serious adverse events.”
One of Goldfarb’s design goals was to give users the maximum amount of personal freedom possible. One of his requirements, for example, was to allow the user to put the exoskeleton on and take it off while sitting in a wheelchair. As a result, the Indego is considerably lighter and less bulky than the other exoskeletons under development.
Indego also has two features that are specifically designed to aid in rehabilitation:
- The amount of robotic assistance adjusts automatically for users who have some muscle control in their legs. This allows them to use their own muscles while walking. When a user is totally paralyzed, the device does all the work. The other designs provide full power all of the time.
- It is the only wearable robot that incorporates a proven rehabilitation technology called functional electrical stimulation. FES applies small electrical pulses to paralyzed muscles, causing them to contract and relax. FES can improve strength in the legs of people with incomplete paraplegia. For complete paraplegics, FES can improve circulation, change bone density and reduce muscle atrophy.
The innovative nature of the Indego design led Popular Mechanics to name Goldfarb one of its “Ten Innovators Who Changed The World” in 2013.
Beginning this summer, Goldfarb will head a four-year U.S. Department of Defense-funded study of the tangible economic and rehabilitation benefits of exoskeletons for people with spinal cord injuries. This will be performed at three medical centers: James Haley Veteran’s Hospital in Tampa (the first VA center in the country to use Indego), the Mayo Clinic in Rochester, Minnesota and the Vanderbilt University Medical Center.
People who use wheelchairs regularly can develop serious problems with their urinary, respiratory, cardiovascular and digestive systems, as well as getting osteoporosis, pressure sores, blood clots and other afflictions associated with lack of mobility. The risk for developing these conditions can be reduced considerably by regularly standing, moving and exercising their lower limbs. The study, which will involve 24 participants, is designed to determine whether regular use of the Indego will also reduce these conditions.
Indego has been available in Europe since November, when it received the CE Mark, the European Union’s equivalent of FDA approval. The initial price is $80,000.
The next step is getting the device approved for health insurance reimbursement. This involves getting the Centers for Medicare and Medicaid Services (CMS) to approve a “rate code” for the exoskeleton: a numeric code that identifies the characteristics of patients who Medicare/Medicaid will reimburse for purchasing a given piece of medical equipment. Typically, the government will reimburse 80 percent of the cost of approved medical devices. In most cases private health insurance providers adopt the CMS code.
- Mar. 10, 2016: FDA Clears Parker’s Indego® Exoskeleton for Clinical, Personal Use
- Oct. 30, 2012: Advanced exoskeleton promises more independence for people with paraplegia
- Feb. 26, 2015: Paralyzed by accident, grad student engineers his future with exoskeleton
David Salisbury, (615) 322-NEWS
Not all exoskeletons need to give you superhuman strength. The exoskeleton startup company SuitX has developed an exoskeleton known as the Phoenix robotic system that was designed specifically to help people with paraplegia or other spinal cord injuries walk. It’s light, cheap, and feasible enough that it just might be practical.
Although SuitX also makes heavy-duty exoskeletons for industrial work environments, their Phoenix suit is designed to be as light and simple as possible. Most exoskeleton designs attempt to provide multiple benefits at once, such aid in lifting heavy objects, using tools with precision, and the ability to squat comfortably as if you were sitting on a chair. SuitX’s Phoenix keeps only the necessities for someone with hindered mobility to sit, stand, and walk.
The Phoenix has a motor on each hip but forgoes powered knee joints that are on many exoskeleton designs in favor of simple locking hinges around the knees. Using crutches to stabilize the system, the hip motors move each leg forward to allow paraplegics and people with other mobility ailments walk on level ground. It’s a new option for folks who would otherwise have no option beyond a wheelchair.
At 27 pounds, the Phoenix exoskeleton is one of the lightest on the market. The minimalist exoskeleton is expected to go on sale next month for a price of $40,000, relatively inexpensive for an exoskeleton suit. SuitX hopes to drive that price down even further by scaling up production in the coming years. And if it is a real, viable alternative to the wheelchair, you have to imagine there will be some demand.
[ARTICLE] The feasibility of a brain-computer interface functional electrical stimulation system for the restoration of overground walking after paraplegia – Full text HTML
Background: Direct brain control of overground walking in those with paraplegia due to spinal cord injury (SCI) has not been achieved. Invasive brain-computer interfaces (BCIs) may provide a permanent solution to this problem by directly linking the brain to lower extremity prostheses. To justify the pursuit of such invasive systems, the feasibility of BCI controlled overground walking should first be established in a noninvasive manner. To accomplish this goal, we developed an electroencephalogram (EEG)-based BCI to control a functional electrical stimulation (FES) system for overground walking and assessed its performance in an individual with paraplegia due to SCI.
Methods: An individual with SCI (T6 AIS B) was recruited for the study and was trained to operate an EEG-based BCI system using an attempted walking/idling control strategy. He also underwent muscle reconditioning to facilitate standing and overground walking with a commercial FES system. Subsequently, the BCI and FES systems were integrated and the participant engaged in several real-time walking tests using the BCI-FES system. This was done in both a suspended, off-the-ground condition, and an overground walking condition. BCI states, gyroscope, laser distance meter, and video recording data were used to assess the BCI performance.
Results: During the course of 19 weeks, the participant performed 30 real-time, BCI-FES controlled overground walking tests, and demonstrated the ability to purposefully operate the BCI-FES system by following verbal cues. Based on the comparison between the ground truth and decoded BCI states, he achieved information transfer rates >3 bit/s and correlations >0.9. No adverse events directly related to the study were observed.
Conclusion: This proof-of-concept study demonstrates for the first time that restoring brain-controlled overground walking after paraplegia due to SCI is feasible. Further studies are warranted to establish the generalizability of these results in a population of individuals with paraplegia due to SCI. If this noninvasive system is successfully tested in population studies, the pursuit of permanent, invasive BCI walking prostheses may be justified. In addition, a simplified version of the current system may be explored as a noninvasive neurorehabilitative therapy in those with incomplete motor SCI.