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Dalal KK, Joshua AM, Nayak A, Mithra P, Misri Z, Unnikrishnan B. Effectiveness of prowling with proprioceptive training on knee hyperextension among stroke subjects using videographic observation- a randomised controlled trial. Gait Posture 2018; 61:232-237. [PMID: 29413790 DOI: 10.1016/j.gaitpost.2018.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 12/20/2017] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Knee hyperextension is seen in 40-68% of ambulating hemiparetics. If left untreated it may lead to laxity of posterior structures of knee resulting in early degeneration of knee leading to pain, reduced independence in activities of daily living (ADL), deformities and instability. In this study we hypothesize walking with bent knee attitude (prowling) along with proprioceptive training may help to reduce knee hyperextension during the stance phase of gait cycle. OBJECTIVE To test the efficacy of prowling along with proprioceptive training on knee hyperextension range, dorsiflexion range and spatio temporal parameters of gait using Wisconsin gait scale (WGS) as compared to routine physiotherapy. METHOD 32 subjects were randomized into 2 groups- experimental and control groups. Both the groups were given routine physiotherapy. Experimental group received an additional treatment consisting of prowling along with proprioceptive training. Knee hyperextension and ankle dorsiflexion ranges were videotaped and analysed using Kinovea software, and for spatio-temporal gait parameters WGS was used. RESULTS In our study, the experimental group showed significant improvement over the control group with regards to knee hyperextension, dorsiflexion range and WGS score. Pre post intervention analysis, within the group, for time taken to cover the distance revealed significant improvement, however between group analysis did not reveal any significant difference. CONCLUSION Prowling along with proprioceptive training is effective in reducing knee hyperextension, increasing dorsiflexion range and improving spatio-temporal gait parameters.
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Affiliation(s)
- Khushboo K Dalal
- Department of Physiotherapy, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India.
| | - Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India.
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India.
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India.
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India.
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152
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Kamono A, Ogihara N. Weight-shift ability significantly correlates with walking velocity in post-acute stroke patients. Proc Inst Mech Eng H 2018; 232:361-370. [DOI: 10.1177/0954411918757814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ability to shift weight toward the paretic leg has been considered an essential ability to restore independent walking for post-acute stroke patients. However, few data are available regarding the relationship between the weight-shift ability and gait performance. No clear mechanism has been provided as to why and how the weight-shift ability improves walking performance in stroke patients. We therefore investigated changes in the weight-shift ability and kinematic and kinetic parameters of walking gait in post-stroke patients during rehabilitation. Eight male inpatients undergoing rehabilitation for moderate hemiplegia participated in this study. Measurements were taken every 4 weeks from when the participants were able to walk at least 10 m until they were discharged from the hospital. Our results demonstrated a significant overall correlation between the weight-shift ability and walking velocity, indicating that the improvement in the weight-shift ability toward the paretic leg by lateral tilting of the thorax is fundamentally important to improve walking velocity. We also found that the upward impulse and vertical ground reaction force exerted by the paretic leg were significantly correlated with the walking velocity to cope with the downward impulse due to gravity and to allow sufficient time to swing the non-paretic leg forward during walking. Therefore, improvement in the weight-shift ability is crucial for restoration of walking velocity. We believe that weight-shift training for the paretic leg while instructing the patients to laterally tilt the thorax should be advocated as an effective protocol during rehabilitation of post-acute stroke inpatients.
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Affiliation(s)
- Arinori Kamono
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan
- Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Naomichi Ogihara
- Faculty of Science and Technology, Keio University, Yokohama, Japan
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153
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Li M, Xu G, Xie J, Chen C. A review: Motor rehabilitation after stroke with control based on human intent. Proc Inst Mech Eng H 2018; 232:344-360. [PMID: 29409401 DOI: 10.1177/0954411918755828] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Strokes are a leading cause of acquired disability worldwide, and there is a significant need for novel interventions and further research to facilitate functional motor recovery in stroke patients. This article reviews motor rehabilitation methods for stroke survivors with a focus on rehabilitation controlled by human motor intent. The review begins with the neurodevelopmental principles of motor rehabilitation that provide the neuroscientific basis for intuitively controlled rehabilitation, followed by a review of methods allowing human motor intent detection, biofeedback approaches, and quantitative motor rehabilitation assessment. Challenges for future advances in motor rehabilitation after stroke using intuitively controlled approaches are addressed.
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Affiliation(s)
- Min Li
- 1 School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Guanghua Xu
- 1 School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Jun Xie
- 1 School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Chaoyang Chen
- 2 Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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154
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Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4085298. [PMID: 29546057 PMCID: PMC5818914 DOI: 10.1155/2018/4085298] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/12/2017] [Accepted: 12/25/2017] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy (p < 0.05). Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient's functional level and onset time of stroke.
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155
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Katsuhira J, Yamamoto S, Machida N, Ohmura Y, Fuchi M, Ohta M, Ibayashi S, Yozu A, Matsudaira K. Immediate synergistic effect of a trunk orthosis with joints providing resistive force and an ankle-foot orthosis on hemiplegic gait. Clin Interv Aging 2018; 13:211-220. [PMID: 29440881 PMCID: PMC5804285 DOI: 10.2147/cia.s146881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The synergistic effects of a trunk orthosis and an ankle-foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke. Methods Twenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Results When compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase. Conclusion The TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment.
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Affiliation(s)
- Junji Katsuhira
- Department of Prosthetics and Orthotics and Assistive Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata.,Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
| | - Sumiko Yamamoto
- Graduate School of International University of Health and Welfare, Tokyo
| | - Nodoka Machida
- International University of Health and Welfare, School of Health Sciences at Narita, Department of Physical Therapy, Chiba
| | - Yuji Ohmura
- International University of Health and Welfare, School of Health Sciences at Odawara, Department of Physical Therapy, Kanagawa
| | - Masako Fuchi
- Department of Occupational Therapy, Kyusyu Nutrition Welfare University, Fukuoka
| | | | | | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
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156
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Khan RA, Naseer N, Qureshi NK, Noori FM, Nazeer H, Khan MU. fNIRS-based Neurorobotic Interface for gait rehabilitation. J Neuroeng Rehabil 2018; 15:7. [PMID: 29402310 PMCID: PMC5800280 DOI: 10.1186/s12984-018-0346-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this paper, a novel functional near-infrared spectroscopy (fNIRS)-based brain-computer interface (BCI) framework for control of prosthetic legs and rehabilitation of patients suffering from locomotive disorders is presented. METHODS fNIRS signals are used to initiate and stop the gait cycle, while a nonlinear proportional derivative computed torque controller (PD-CTC) with gravity compensation is used to control the torques of hip and knee joints for minimization of position error. In the present study, the brain signals of walking intention and rest tasks were acquired from the left hemisphere's primary motor cortex for nine subjects. Thereafter, for removal of motion artifacts and physiological noises, the performances of six different filters (i.e. Kalman, Wiener, Gaussian, hemodynamic response filter (hrf), Band-pass, finite impulse response) were evaluated. Then, six different features were extracted from oxygenated hemoglobin signals, and their different combinations were used for classification. Also, the classification performances of five different classifiers (i.e. k-Nearest Neighbour, quadratic discriminant analysis, linear discriminant analysis (LDA), Naïve Bayes, support vector machine (SVM)) were tested. RESULTS The classification accuracies obtained from SVM using the hrf were significantly higher (p < 0.01) than those of the other classifier/ filter combinations. Those accuracies were 77.5, 72.5, 68.3, 74.2, 73.3, 80.8, 65, 76.7, and 86.7% for the nine subjects, respectively. CONCLUSION The control commands generated using the classifiers initiated and stopped the gait cycle of the prosthetic leg, the knee and hip torques of which were controlled using the PD-CTC to minimize the position error. The proposed scheme can be effectively used for neurofeedback training and rehabilitation of lower-limb amputees and paralyzed patients.
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Affiliation(s)
- Rayyan Azam Khan
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Noman Naseer
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Nauman Khalid Qureshi
- Department of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Farzan Majeed Noori
- Department of Electrical and Computer Engineering, Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
| | - Hammad Nazeer
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
| | - Muhammad Umer Khan
- Department of Mechatronics Engineering, Air University, Islamabad, Pakistan
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157
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Martinez A, Lawson B, Goldfarb M. A Controller for Guiding Leg Movement During Overground Walking With a Lower Limb Exoskeleton. IEEE T ROBOT 2018. [DOI: 10.1109/tro.2017.2768035] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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158
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Irimia DC, Cho W, Ortner R, Allison BZ, Ignat BE, Edlinger G, Guger C. Brain-Computer Interfaces With Multi-Sensory Feedback for Stroke Rehabilitation: A Case Study. Artif Organs 2018; 41:E178-E184. [PMID: 29148137 DOI: 10.1111/aor.13054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Conventional therapies do not provide paralyzed patients with closed-loop sensorimotor integration for motor rehabilitation. This work presents the recoveriX system, a hardware and software platform that combines a motor imagery (MI)-based brain-computer interface (BCI), functional electrical stimulation (FES), and visual feedback technologies for a complete sensorimotor closed-loop therapy system for poststroke rehabilitation. The proposed system was tested on two chronic stroke patients in a clinical environment. The patients were instructed to imagine the movement of either the left or right hand in random order. During these two MI tasks, two types of feedback were provided: a bar extending to the left or right side of a monitor as visual feedback and passive hand opening stimulated from FES as proprioceptive feedback. Both types of feedback relied on the BCI classification result achieved using common spatial patterns and a linear discriminant analysis classifier. After 10 sessions of recoveriX training, one patient partially regained control of wrist extension in her paretic wrist and the other patient increased the range of middle finger movement by 1 cm. A controlled group study is planned with a new version of the recoveriX system, which will have several improvements.
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Affiliation(s)
- Danut C Irimia
- Guger Technologies OG, Graz, Austria.,"Gheorghe Asachi" Technical University of Iasi, Iasi, Romania
| | - Woosang Cho
- g.tec medical engineering GmbH, Schiedlberg, Austria
| | - Rupert Ortner
- g.tec medical engineering GmbH, Schiedlberg, Austria
| | | | - Bogdan E Ignat
- "Grigore T. Popa" Medicine and Pharmacy University of Iasi, Iasi, Romania.,Rehabilitation Hospital of Iasi, Iasi, Romania
| | | | - Christoph Guger
- Guger Technologies OG, Graz, Austria.,g.tec medical engineering GmbH, Schiedlberg, Austria
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159
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Tieri G, Morone G, Paolucci S, Iosa M. Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies. Expert Rev Med Devices 2018; 15:107-117. [DOI: 10.1080/17434440.2018.1425613] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Gaetano Tieri
- SCNLab, Fondazione Santa Lucia IRCCS, Rome, Italy
- University of Rome Unitelma Sapienza, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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160
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Rajasekaran V, López-Larraz E, Trincado-Alonso F, Aranda J, Montesano L, Del-Ama AJ, Pons JL. Volition-adaptive control for gait training using wearable exoskeleton: preliminary tests with incomplete spinal cord injury individuals. J Neuroeng Rehabil 2018; 15:4. [PMID: 29298691 PMCID: PMC5751847 DOI: 10.1186/s12984-017-0345-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gait training for individuals with neurological disorders is challenging in providing the suitable assistance and more adaptive behaviour towards user needs. The user specific adaptation can be defined based on the user interaction with the orthosis and by monitoring the user intentions. In this paper, an adaptive control model, commanded by the user intention, is evaluated using a lower limb exoskeleton with incomplete spinal cord injury individuals (SCI). METHODS A user intention based adaptive control model has been developed and evaluated with 4 incomplete SCI individuals across 3 sessions of training per individual. The adaptive control model modifies the joint impedance properties of the exoskeleton as a function of the human-orthosis interaction torques and the joint trajectory evolution along the gait sequence, in real time. The volitional input of the user is identified by monitoring the neural signals, pertaining to the user's motor activity. These volitional inputs are used as a trigger to initiate the gait movement, allowing the user to control the initialization of the exoskeleton movement, independently. A Finite-state machine based control model is used in this set-up which helps in combining the volitional orders with the gait adaptation. RESULTS The exoskeleton demonstrated an adaptive assistance depending on the patients' performance without guiding them to follow an imposed trajectory. The exoskeleton initiated the trajectory based on the user intention command received from the brain machine interface, demonstrating it as a reliable trigger. The exoskeleton maintained the equilibrium by providing suitable assistance throughout the experiments. A progressive change in the maximum flexion of the knee joint was observed at the end of each session which shows improvement in the patient performance. Results of the adaptive impedance were evaluated by comparing with the application of a constant impedance value. Participants reported that the movement of the exoskeleton was flexible and the walking patterns were similar to their own distinct patterns. CONCLUSIONS This study demonstrates that user specific adaptive control can be applied on a wearable robot based on the human-orthosis interaction torques and modifying the joints' impedance properties. The patients perceived no external or impulsive force and felt comfortable with the assistance provided by the exoskeleton. The main goal of such a user dependent control is to assist the patients' needs and adapt to their characteristics, thus maximizing their engagement in the therapy and avoiding slacking. In addition, the initiation directly controlled by the brain allows synchronizing the user's intention with the afferent stimulus provided by the movement of the exoskeleton, which maximizes the potentiality of the system in neuro-rehabilitative therapies.
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Affiliation(s)
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | | | - Joan Aranda
- Departamento de Automatic e Control, Universitat Politécnica de Catalunya, Barcelona-Tech, Barcelona, Spain
| | - Luis Montesano
- Departamento de Informatica e Ingenería de Sistemas and, Instituto de Investigacion en Ingeneria de Aragon (I3A), University of Zaragoza, Zaragoza, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids unit, National Hospital for Spinal cord injury, Toledo, Spain
| | - Jose L Pons
- Neural Rehabilitation group, Spanish National Research Council (CSIC), Cajal Institute, Madrid, Spain
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161
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Schalk G, Allison BZ. Noninvasive Brain–Computer Interfaces. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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162
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Deng W, Papavasileiou I, Qiao Z, Zhang W, Lam KY, Han S. Advances in Automation Technologies for Lower Extremity Neurorehabilitation: A Review and Future Challenges. IEEE Rev Biomed Eng 2018; 11:289-305. [DOI: 10.1109/rbme.2018.2830805] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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163
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Liu D, Chen W, Chavarriaga R, Pei Z, Millán JDR. Decoding of Self-paced Lower-Limb Movement Intention: A Case Study on the Influence Factors. Front Hum Neurosci 2017; 11:560. [PMID: 29218004 PMCID: PMC5703734 DOI: 10.3389/fnhum.2017.00560] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022] Open
Abstract
Brain-machine interfaces (BMIs) have been applied as new rehabilitation tools for motor disabled individuals. Active involvement of cerebral activity has been shown to enhance neuroplasticity and thus to restore mobility. Various studies have focused on the detection of upper-limb movement intention, while the fewer study has investigated the lower-limb movement intention decoding. This study presents a BMI to decode the self-paced lower-limb movement intention, with 10 healthy subjects participating in the experiment. We varied four influence factors including the movement type (dorsiflexion or plantar flexion), the limb side (left or right leg), the processing method (time-series analysis based on MRCP, i.e., movement-related cortical potential or frequency-domain estimation based on SMR, i.e., sensory motor rhythm) and the frequency band (e.g., delta, theta, mu, beta and MRCP band at [0.1 1] Hz), to estimate both single-trial and sample-based performance. Feature analysis was then conducted to show the discriminant power (DP) and brain modulations. The average detection latency was -0.334 ± 0.216 s in single-trial basis across all conditions. An average area under the curve (AUC) of 91.0 ± 3.5% and 68.2 ± 4.6% was obtained for the MRCP-based and SMR-based method in the classification, respectively. The best performance was yielded from plantar flexion with left leg using time-series analysis on the MRCP band. The feature analysis indicated a cross-subject consistency of DP with the MRCP-based method and subject-specific variance of DP with the SMR-based method. The results presented here might be further exploited in a rehabilitation scenario. The comprehensive factor analysis might be used to shed light on the design of an effective brain switch to trigger external robotic devices.
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Affiliation(s)
- Dong Liu
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China.,Defitech Chair in Brain-Machine Interface, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Weihai Chen
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Ricardo Chavarriaga
- Defitech Chair in Brain-Machine Interface, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Zhongcai Pei
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - José Del R Millán
- Defitech Chair in Brain-Machine Interface, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
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164
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Slow Versus Fast Robot-Assisted Locomotor Training After Severe Stroke: A Randomized Controlled Trial. Am J Phys Med Rehabil 2017; 96:S165-S170. [PMID: 28796648 DOI: 10.1097/phm.0000000000000810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Robot-assisted locomotor training on a bodyweight-supported treadmill is a rehabilitation intervention that compels repetitive practice of gait movements. Standard treadmill speed may elicit rhythmic movements generated primarily by spinal circuits. Slower-than-standard treadmill speed may elicit discrete movements, which are more complex than rhythmic movements and involve cortical areas. OBJECTIVE Compare effects of fast (i.e., rhythmic) versus slow (i.e., discrete) robot-assisted locomotor training on a bodyweight-supported treadmill in subjects with chronic, severe gait deficit after stroke. METHODS Subjects (N = 18) were randomized to receive 30 sessions (5 d/wk) of either fast or slow robot-assisted locomotor training on a bodyweight-supported treadmill in an inpatient setting. Functional ambulation category, time up and go, 6-min walk test, 10-m walk test, Berg Balance Scale, and Fugl-Meyer Assessment were administered at baseline and postintervention. RESULTS The slow group had statistically significant improvement on functional ambulation category (first quartile-third quartile, P = 0.004), 6-min walk test (95% confidence interval [CI] = 1.8 to 49.0, P = 0.040), Berg Balance Scale (95% CI = 7.4 to 14.8, P < 0.0001), time up and go (95% CI = -79.1 to 5.0, P < 0.0030), and Fugl-Meyer Assessment (95% CI = 24.1 to 45.1, P < 0.0001). The fast group had statistically significant improvement on Berg Balance Scale (95% CI = 1.5 to 10.5, P = 0.02). CONCLUSIONS In initial stages of robot-assisted locomotor training on a bodyweight-supported treadmill after severe stroke, slow training targeting discrete movement may yield greater benefit than fast training.
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165
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Guo G, Guffey K, Chen W, Pergami P. Classification of Normal and Pathological Gait in Young Children Based on Foot Pressure Data. Neuroinformatics 2017; 15:13-24. [PMID: 27585914 DOI: 10.1007/s12021-016-9313-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human gait recognition, an active research topic in computer vision, is generally based on data obtained from images/videos. We applied computer vision technology to classify pathology-related changes in gait in young children using a foot-pressure database collected using the GAITRite walkway system. As foot positioning changes with children's development, we also investigated the possibility of age estimation based on this data. Our results demonstrate that the data collected by the GAITRite system can be used for normal/pathological gait classification. Combining age information and normal/pathological gait classification increases the accuracy of the classifier. This novel approach could support the development of an accurate, real-time, and economic measure of gait abnormalities in children, able to provide important feedback to clinicians regarding the effect of rehabilitation interventions, and to support targeted treatment modifications.
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Affiliation(s)
- Guodong Guo
- Beijing Advanced Innovation Center for Imaging Technology, Beijing, 100048, People's Republic of China. .,College of Information Engineering, Capital Normal University, Beijing, 100048, China. .,Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA.
| | - Keegan Guffey
- Child Neurology, Department of Pediatrics, West Virginia University, Morgantown, WV, 26506, USA
| | - Wenbin Chen
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV, 26506, USA
| | - Paola Pergami
- Neurology, Neurocritical care Children's National Medical Center, 111 Michigan Avenue, Washington, DC, USA
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166
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Effectiveness of the conductive educational approach added to conventional physiotherapy in the improvement of gait parameters of poststroke patients: randomized-controlled pilot study. Int J Rehabil Res 2017; 40:366-369. [PMID: 28885236 DOI: 10.1097/mrr.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our objective was to assess the benefits of the conductive education (CE) approach added to conventional physiotherapy in gait functions of poststroke, hemiparetic patients. A randomized-controlled trial was designed in a rehabilitation clinic. Late and chronic poststroke patients with gait disturbances (n=17, median age: 55 years, range: 41-72 years) were enrolled in the study. All patients received conventional physiotherapy. However, patients of only one group took part in therapy on the basis of the CE approach. The gait parameters, semiobjective outcome measures, functional independence measure, and International Classification of Functioning, Disability and Health domains were collected. The effectiveness of the CE approach was underlined by those outcome measures that were only significant (P≤0.05) in the conductive group: functional independence measure motor subscale; maintaining body position and walking long distances; and muscle strength in some muscle groups. The results suggest that CE could have an additive effect on gait improvement of stroke patients.
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167
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Sun R, Wong WW, Wang J, Tong RKY. Changes in Electroencephalography Complexity using a Brain Computer Interface-Motor Observation Training in Chronic Stroke Patients: A Fuzzy Approximate Entropy Analysis. Front Hum Neurosci 2017; 11:444. [PMID: 28928649 PMCID: PMC5591875 DOI: 10.3389/fnhum.2017.00444] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022] Open
Abstract
Entropy-based algorithms have been suggested as robust estimators of electroencephalography (EEG) predictability or regularity. This study aimed to examine possible disturbances in EEG complexity as a means to elucidate the pathophysiological mechanisms in chronic stroke, before and after a brain computer interface (BCI)-motor observation intervention. Eleven chronic stroke subjects and nine unimpaired subjects were recruited to examine the differences in their EEG complexity. The BCI-motor observation intervention was designed to promote functional recovery of the hand in stroke subjects. Fuzzy approximate entropy (fApEn), a novel entropy-based algorithm designed to evaluate complexity in physiological systems, was applied to assess the EEG signals acquired from unimpaired subjects and stroke subjects, both before and after training. The results showed that stroke subjects had significantly lower EEG fApEn than unimpaired subjects (p < 0.05) in the motor cortex area of the brain (C3, C4, FC3, FC4, CP3, and CP4) in both hemispheres before training. After training, motor function of the paretic upper limb, assessed by the Fugl-Meyer Assessment-Upper Limb (FMA-UL), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT) improved significantly (p < 0.05). Furthermore, the EEG fApEn in stroke subjects increased considerably in the central area of the contralesional hemisphere after training (p < 0.05). A significant correlation was noted between clinical scales (FMA-UL, ARAT, and WMFT) and EEG fApEn in C3/C4 in the contralesional hemisphere (p < 0.05). This finding suggests that the increase in EEG fApEn could be an estimator of the variance in upper limb motor function improvement. In summary, fApEn can be used to identify abnormal EEG complexity in chronic stroke, when used with BCI-motor observation training. Moreover, these findings based on the fApEn of EEG signals also expand the existing interpretation of training-induced functional improvement in stroke subjects. The entropy-based analysis might serve as a novel approach to understanding the abnormal cortical dynamics of stroke and the neurological changes induced by rehabilitation training.
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Affiliation(s)
- Rui Sun
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
| | - Wan-Wa Wong
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
| | - Jing Wang
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong.,School of Mechanical Engineering, Xi'an Jiaotong UniversityXi'an, China
| | - Raymond Kai-Yu Tong
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
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168
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Chung SH, Choi T, Hwang Y, Kim H, Kim SJ, Chun MH, Lee JM. Walking speed intention model using soleus electromyogram signal of nondisabled and post-stroke hemiparetic patients. IEEE Int Conf Rehabil Robot 2017; 2017:308-313. [PMID: 28813837 DOI: 10.1109/icorr.2017.8009265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is well known that the activation of plantar flexors have a strong influence on the walking speed. If the gait speed can be predicted using this relationship, a post-stroke hemiparetic patient could control a gait rehabilitation robot according to his or her gait intention, and the robotic gait rehabilitation effect could be further improved. To find out this relationship, 9 nondisabled subjects and 4 chronic post-stroke hemiparetic subjects performed overground level walking at a comfortable pace, a slow pace, a fast pace, and an increasing pace with electromyogram sensors attached on plantar flexors. Soleus among plantar flexors showed the most stable relationship with walking speed. The relationship between maximum activation level of soleus electromyogram during stance phase before toe-off and walking speed during swing phase after the same toe-off was modeled by a polynomial regression model. The model outputs were then compared to the measured walking speeds using coefficients of determination (R2). The average R2 values are 0.594 and 0.692 for 1st· and 2nd order models respectively in the nondisabled subjects. The average R2 values are 0.598 and 0.623 for the unaffected side and 0.388 and 0.394 for the affected side in the chronic subjects. The results show the feasibility of applying the soleus-walking speed relationship to control the robot gait speed at will. A walking speed estimation method is proposed using only a walking step in real time.
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169
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Lahiff CA, Ramakrishnan T, Reed K. Knee orthosis with variable stiffness and damping that simulates hemiparetic gait. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2218-2221. [PMID: 28268771 DOI: 10.1109/embc.2016.7591170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Individuals with unilateral stroke have neuromuscular weakness or paralysis on one side of the body caused by some muscles disengaging and others overexciting. Hyperextension of the knee joint and complete lack of plantar flexion of the ankle joint are common symptoms of stroke. This paper focuses on the creation and implementation of a small, lightweight, and adjustable orthotic device to be positioned around the knee of an able-bodied person to simulate hemiparetic gait. Force and range of motion data from able-bodied subjects fitted with the orthosis, inducing hemiparetic gait, was collected using the Computer Assisted Rehabilitation ENvironment (CAREN) system. The four parameters that the design focused on are damping, catch, hysteresis, and stiffness. The main goal of the project was to discern whether this device could be utilized as a viable research instrument to simulate hemiparetic gait. It was hypothesized that the device has the potential to be utilized in the future as a rehabilitation device for people with stroke since it has been designed to induce larger knee flexion as an after effect. A comparison between how the dominant leg was affected by the orthosis and how the non-dominant leg was affected was investigated as well. The results show that the device affected the velocities, knee angles, and force profiles of the subject's gait.
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170
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Dierick F, Dehas M, Isambert JL, Injeyan S, Bouché AF, Bleyenheuft Y, Portnoy S. Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy? PLoS One 2017; 12:e0178636. [PMID: 28575054 PMCID: PMC5456343 DOI: 10.1371/journal.pone.0178636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing. OBJECTIVE This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks' intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat. METHODS Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests. RESULTS Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively), Postural Assessment Scale for Stroke (P<0.001 and P = 0.003), 6 Minutes Walk Test (P = 0.003 and P = 0.015) and 10-Meter Walk Test (P = 0.001 and P = 0.024). Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81) and medium (dz = 0.66) effect sizes, respectively. CONCLUSION Overall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.
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Affiliation(s)
- Frédéric Dierick
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Faculty of Motor Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- * E-mail:
| | - Mélanie Dehas
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
| | | | - Soizic Injeyan
- « Le Normandy » Rehabilitation Center, Granville, France
| | - Anne-France Bouché
- Forme & Fonctionnement Humain Research Unit, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, Montignies sur Sambre, Belgium
- Rehabilitation Unit, « Le Richemont », Bioul, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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171
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Morone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, Iosa M. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatr Dis Treat 2017; 13:1303-1311. [PMID: 28553117 PMCID: PMC5440028 DOI: 10.2147/ndt.s114102] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented.
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Affiliation(s)
- Giovanni Morone
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | | | - Marco Iosa
- Private Inpatient Unit
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
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172
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He Y, Eguren D, Luu TP, Contreras-Vidal JL. Risk management and regulations for lower limb medical exoskeletons: a review. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:89-107. [PMID: 28533700 PMCID: PMC5431736 DOI: 10.2147/mder.s107134] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Gait disability is a major health care problem worldwide. Powered exoskeletons have recently emerged as devices that can enable users with gait disabilities to ambulate in an upright posture, and potentially bring other clinical benefits. In 2014, the US Food and Drug Administration approved marketing of the ReWalk™ Personal Exoskeleton as a class II medical device with special controls. Since then, Indego™ and Ekso™ have also received regulatory approval. With similar trends worldwide, this industry is likely to grow rapidly. On the other hand, the regulatory science of powered exoskeletons is still developing. The type and extent of probable risks of these devices are yet to be understood, and industry standards are yet to be developed. To address this gap, Manufacturer and User Facility Device Experience, Clinicaltrials.gov, and PubMed databases were searched for reports of adverse events and inclusion and exclusion criteria involving the use of lower limb powered exoskeletons. Current inclusion and exclusion criteria, which can determine probable risks, were found to be diverse. Reported adverse events and identified risks of current devices are also wide-ranging. In light of these findings, current regulations, standards, and regulatory procedures for medical device applications in the USA, Europe, and Japan were also compared. There is a need to raise awareness of probable risks associated with the use of powered exoskeletons and to develop adequate countermeasures, standards, and regulations for these human-machine systems. With appropriate risk mitigation strategies, adequate standards, comprehensive reporting of adverse events, and regulatory oversight, powered exoskeletons may one day allow individuals with gait disabilities to safely and independently ambulate.
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Affiliation(s)
- Yongtian He
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - David Eguren
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - Trieu Phat Luu
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
| | - Jose L Contreras-Vidal
- Laboratory for Noninvasive, Brain-Machine Interface Systems, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA
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173
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Tamburella F, Moreno JC, Iosa M, Pisotta I, Cincotti F, Mattia D, Pons JL, Molinari M. Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis: a pilot study. Top Stroke Rehabil 2017; 24:447-456. [PMID: 28460597 DOI: 10.1080/10749357.2017.1318340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spasticity is a motor disorder that is commonly treated manually by a physical therapist (PhT) stretching the muscles. Recent data on learning have demonstrated the importance of human-to-human interaction in improving rehabilitation: cooperative motor behavior engages specific areas of the motor system compared with execution of a task alone. OBJECTIVES We hypothesize that PhT-guided therapy that involves active collaboration with the patient (Pt) through shared biomechanical visual biofeedback (vBFB) positively impacts learning and performance by the Pt during ankle spasticity treatment. A sensorized ankle foot orthosis (AFO) was developed to provide online quantitative data of joint range of motion (ROM), angular velocity, and electromyographic activity to the PhT and Pt during the treatment of ankle spasticity. METHODS Randomized controlled clinical trial. Ten subacute stroke inpatients, randomized into experimental (EXP) and control (CTRL) groups, underwent six weeks of daily treatment. The EXP group was treated with an active AFO, and the CTRL group was given an inactive AFO. Spasticity, ankle ROM, ankle active and passive joint speed, and coactivation index (CI) were assessed at enrollment and after 15-30 sessions. RESULTS Spasticity and CI (p < 0.005) decreased significantly after training only in the EXP group, in association with a significant rise in active joint speed and active ROM (p < 0.05). Improvements in spasticity (p < 0.05), active joint speed (p < 0.001), and CI (p < 0.001) after treatment differed between the EXP and CTRL groups. CONCLUSIONS PhT-Pt sharing of exercise information, provided by joint sensorization and vBFB, improved the efficacy of the conventional approach for treating ankle spasticity in subacute stroke Pts.
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Affiliation(s)
- Federica Tamburella
- a SPInal REhabilitation Lab and Laboratory (SPIRE Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy.,b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
| | - Juan C Moreno
- c Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group , Madrid , Spain
| | - Marco Iosa
- d Clinical Laboratory of Experimental Neurorehabilitation , IRCCS S. Lucia Foundation , Rome , Italy
| | - Iolanda Pisotta
- b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
| | - Febo Cincotti
- e Department of Computer, Control and Management Engineering , Sapienza University of Rome , Rome , Italy.,f Neuroelectrical Imaging and BCI Lab , IRCCS S. Lucia Foundation , Rome , Italy
| | - Donatella Mattia
- f Neuroelectrical Imaging and BCI Lab , IRCCS S. Lucia Foundation , Rome , Italy
| | - José L Pons
- c Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group , Madrid , Spain
| | - Marco Molinari
- b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
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174
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Fujii K, Abe T, Kubota S, Marushima A, Kawamoto H, Ueno T, Matsushita A, Nakai K, Saotome K, Kadone H, Endo A, Haginoya A, Hada Y, Matsumura A, Sankai Y, Yamazaki M. The voluntary driven exoskeleton Hybrid Assistive Limb (HAL) for postoperative training of thoracic ossification of the posterior longitudinal ligament: a case report. J Spinal Cord Med 2017; 40:361-367. [PMID: 26856189 PMCID: PMC5472024 DOI: 10.1080/10790268.2016.1142056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT The hybrid assistive limb (HAL) is a wearable robot suit that assists in voluntary control of knee and hip joint motion by detecting bioelectric signals on the surface of the skin with high sensitivity. HAL has been reported to be effective for functional recovery in motor impairments. However, few reports have revealed the utility of HAL for patients who have undergone surgery for thoracic ossification of the posterior longitudinal ligament (thoracic OPLL). Herein, we present a postoperative thoracic OPLL patient who showed remarkable functional recovery after training with HAL. FINDINGS A 63-year-old woman, who could not walk due to muscle weakness before surgery, underwent posterior decompression and fusion. Paralysis was re-aggravated after the initial postoperative rising. We diagnosed that paralysis was due to residual compression from the anterior lesion and microinstability after posterior fixation, and prescribed bed rest for a further 3 weeks. The incomplete paralysis gradually recovered, and walking training with HAL was started on postoperative day 44 in addition to standard physical therapy. The patient underwent 10 sessions of HAL training until discharge on postoperative day 73. Results of a 10-m walk test were assessed after every session, and the patient's speed and cadence markedly improved. At discharge, the patient could walk with 2 crutches and no assistance. Furthermore, no adverse events associated with HAL training occurred. CONCLUSION HAL training for postoperative thoracic OPLL patients may enhance improvement in walking ability, even if severe impairment of ambulation and muscle weakness exist preoperatively.
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Affiliation(s)
- Kengo Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan,Correspondence to: Kengo Fujii, University of Tsukuba, Department of Orthopaedic Surgery, 1-1-1 Tennodai, Tsukuba-city, 305-8575 Ibaraki, Japan.
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan,Center for Innovating Medicine and Engineering, University of Tsukuba, Tsukuba City, Japan
| | - Hiroaki Kawamoto
- Information and Systems, Faculty of Engineering, University of Tsukuba, Tsukuba City, Japan,Cybernic Research Center, University of Tsukuba, Tsukuba City, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation, University of Tsukuba, Tsukuba City, Japan
| | - Akira Matsushita
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan,Cybernic Research Center, University of Tsukuba, Tsukuba City, Japan
| | - Kei Nakai
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Kosaku Saotome
- Cybernic Research Center, University of Tsukuba, Tsukuba City, Japan
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering, University of Tsukuba, Tsukuba City, Japan
| | - Ayumu Endo
- Department of Rehabilitation, University of Tsukuba, Tsukuba City, Japan
| | - Ayumu Haginoya
- Department of Rehabilitation, University of Tsukuba, Tsukuba City, Japan
| | - Yasushi Hada
- Department of Rehabilitation, University of Tsukuba, Tsukuba City, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Yoshiyuki Sankai
- Information and Systems, Faculty of Engineering, University of Tsukuba, Tsukuba City, Japan,Cybernic Research Center, University of Tsukuba, Tsukuba City, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan,Center for Innovating Medicine and Engineering, University of Tsukuba, Tsukuba City, Japan
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175
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Koseoglu BF, Dogan A, Tatli HU, Sezgin Ozcan D, Polat CS. Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients? Complement Ther Clin Pract 2017; 27:46-51. [PMID: 28438279 DOI: 10.1016/j.ctcp.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the effects of the kinesio tape application to the tibialis anterior on rehabilitation outcomes of the stroke patients. DESIGN AND SETTING Twenty patients with stroke were allocated into two groups: the first group of ten patients was assigned to receive kinesio tape in addition to the conventional rehabilitation program while a second group of 10 patients was assigned to receive a conventional rehabilitation program only. MAIN OUTCOME MEASURES The clinical variables and health-related quality of life (HRQoL) were evaluated at baseline and at the end of the forth week. RESULTS The present study showed that kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL and gait compared to the control group and baseline. CONCLUSIONS The results of this study suggest that kinesio tape can be used as an ankle training method.
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Affiliation(s)
- Belma Fusun Koseoglu
- Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey.
| | - Asuman Dogan
- Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hilmi Umut Tatli
- Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Didem Sezgin Ozcan
- Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Cemile Sevgi Polat
- Ministry of Health, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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176
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Ramírez-Fernández C, Morán AL, García-Canseco E, Gómez-Montalvo JR. Evaluation Results of an Ontology-based Design Model of Virtual Environments for Upper Limb Motor Rehabilitation of Stroke Patients. Methods Inf Med 2017; 56:145-155. [PMID: 28220927 DOI: 10.3414/me16-02-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/30/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES 1) To enhance the content of an ontology for designing virtual environments (VEs) for upper limb motor rehabilitation of stroke patients according to the suggestions and comments of rehabilitation specialists and software developers, 2) to characterize the perceived importance level of the ontology, 3) to determine the perceived usefulness of the ontology, and 4) to identify the safety characteristics of the ontology for VEs design according to the rehabilitation specialists. METHODS Using two semi-structured Web questionnaires, we asked six rehabilitation specialists and six software developers to provide us with their perception regarding the level of importance and the usability of the ontology. From their responses we have identified themes related to perceived and required safety characteristics of the ontology. RESULTS Significant differences in the importance level were obtained for the Stroke Disability, VE Configuration, Outcome Measures, and Safety Calibration classes, which were perceived as highly important by rehabilitation specialists. Regarding usability, the ontology was perceived by both groups with high usefulness, ease of use, learnability and intention of use. Concerning the thematic analysis of recommendations, eight topics for safety characteristics of the ontology were identified: adjustment of therapy strategies; selection and delimitation of movements; selection and proper calibration of the interaction device; proper selection of measuring instruments; gradual modification of the difficulty of the exercise; adaptability and variability of therapy exercises; feedback according to the capabilities of the patient; and real-time support for exercise training. CONCLUSIONS The rehabilitation specialists and software developers confirmed the importance of the information contained in the ontology regarding motor rehabilitation of the upper limb. Their recommendations highlight the safety features and the advantages of the ontology as a guide for the effective design of VEs.
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Affiliation(s)
- Cristina Ramírez-Fernández
- Cristina Ramírez-Fernández, Facultad de Ciencias, Universidad Autónoma de Baja California, Carretera Tijuana-Ensenada, 22860, Mexico, E-mail:
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177
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Ibáñez J, Monge-Pereira E, Molina-Rueda F, Serrano JI, Del Castillo MD, Cuesta-Gómez A, Carratalá-Tejada M, Cano-de-la-Cuerda R, Alguacil-Diego IM, Miangolarra-Page JC, Pons JL. Low Latency Estimation of Motor Intentions to Assist Reaching Movements along Multiple Sessions in Chronic Stroke Patients: A Feasibility Study. Front Neurosci 2017; 11:126. [PMID: 28367109 PMCID: PMC5355476 DOI: 10.3389/fnins.2017.00126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background: The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke. Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention. Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol. Conclusions: According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits.
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Affiliation(s)
- Jaime Ibáñez
- Neural Rehabilitation Group, Spanish National Research Council, Cajal InstituteMadrid, Spain; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College LondonLondon, UK
| | - Esther Monge-Pereira
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Francisco Molina-Rueda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - J I Serrano
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Universidad Politécnica de Madrid (UPM), Spanish National Research Council Madrid, Spain
| | - Maria D Del Castillo
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Universidad Politécnica de Madrid (UPM), Spanish National Research Council Madrid, Spain
| | - Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - María Carratalá-Tejada
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Isabel M Alguacil-Diego
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Juan C Miangolarra-Page
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University Madrid, Spain
| | - Jose L Pons
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute Madrid, Spain
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178
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Alia C, Spalletti C, Lai S, Panarese A, Lamola G, Bertolucci F, Vallone F, Di Garbo A, Chisari C, Micera S, Caleo M. Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation. Front Cell Neurosci 2017; 11:76. [PMID: 28360842 PMCID: PMC5352696 DOI: 10.3389/fncel.2017.00076] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/03/2017] [Indexed: 12/21/2022] Open
Abstract
Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration.
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Affiliation(s)
- Claudia Alia
- CNR Neuroscience Institute, National Research Council (CNR)Pisa, Italy; Laboratory of Biology, Scuola Normale SuperiorePisa, Italy
| | | | - Stefano Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna Pontedera, Italy
| | - Alessandro Panarese
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna Pontedera, Italy
| | - Giuseppe Lamola
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Federica Bertolucci
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Fabio Vallone
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'AnnaPontedera, Italy; CNR Biophysics Institute, National Research Council (CNR)Pisa, Italy; Neural Computation Laboratory, Center for Neuroscience and Cognitive Systems @UniTn, Italian institute of Technology (IIT)Rovereto, Italy
| | - Angelo Di Garbo
- CNR Biophysics Institute, National Research Council (CNR) Pisa, Italy
| | - Carmelo Chisari
- Department of Neuroscience, Unit of Neurorehabilitation-University Hospital of Pisa Pisa, Italy
| | - Silvestro Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'AnnaPontedera, Italy; Ecole Polytechnique Federale de Lausanne (EPFL), Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, Center for Neuroprosthetics and Institute of BioengineeringLausanne, Switzerland
| | - Matteo Caleo
- CNR Neuroscience Institute, National Research Council (CNR) Pisa, Italy
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179
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Sburlea AI, Montesano L, Minguez J. Advantages of EEG phase patterns for the detection of gait intention in healthy and stroke subjects. J Neural Eng 2017; 14:036004. [PMID: 28291737 DOI: 10.1088/1741-2552/aa5f2f] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE One use of EEG-based brain-computer interfaces (BCIs) in rehabilitation is the detection of movement intention. In this paper we investigate for the first time the instantaneous phase of movement related cortical potential (MRCP) and its application to the detection of gait intention. APPROACH We demonstrate the utility of MRCP phase in two independent datasets, in which 10 healthy subjects and 9 chronic stroke patients executed a self-initiated gait task in three sessions. Phase features were compared to more conventional amplitude and power features. MAIN RESULTS The neurophysiology analysis showed that phase features have higher signal-to-noise ratio than the other features. Also, BCI detectors of gait intention based on phase, amplitude, and their combination were evaluated under three conditions: session-specific calibration, intersession transfer, and intersubject transfer. Results show that the phase based detector is the most accurate for session-specific calibration (movement intention was correctly detected in 66.5% of trials in healthy subjects, and in 63.3% in stroke patients). However, in intersession and intersubject transfer, the detector that combines amplitude and phase features is the most accurate one and the only that retains its accuracy (62.5% in healthy subjects and 59% in stroke patients) w.r.t. session-specific calibration. SIGNIFICANCE MRCP phase features improve the detection of gait intention and could be used in practice to remove time-consuming BCI recalibration.
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Affiliation(s)
- Andreea Ioana Sburlea
- University of Zaragoza (DIIS), Instituto de investigación en ingeniería de Aragón (I3A), Zaragoza, Spain. Bit&Brain Technologies S.L., Paseo Sagasta 19, 50001, Zaragoza, Spain
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180
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Siqueira-Batista R, Souza CR, Maia PM, Siqueira SL. ROBOTIC SURGERY: BIOETHICAL ASPECTS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:287-290. [PMID: 28076489 PMCID: PMC5225874 DOI: 10.1590/0102-6720201600040018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
Abstract
Introduction The use of robots in surgery has been increasingly common today, allowing the emergence of numerous bioethical issues in this area. Objective To present review of the ethical aspects of robot use in surgery. Method Search in Pubmed, SciELO and Lilacs crossing the headings "bioethics", "surgery", "ethics", "laparoscopy" and "robotic". Results Of the citations obtained, were selected 17 articles, which were used for the preparation of the article. It contains brief presentation on robotics, its inclusion in health and bioethical aspects, and the use of robots in surgery. Conclusion Robotic surgery is a reality today in many hospitals, which makes essential bioethical reflection on the relationship between health professionals, automata and patients.
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Affiliation(s)
- Rodrigo Siqueira-Batista
- Postgraduate Program in Bioethics, Applied Ethics and Public Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ; Brazil.,Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, MG; Brazil.,Nucleus of Medical Sciences Studies, Dynamics Faculty of Piranga Valley, Ponte Nova, MG, Brazil
| | - Camila Ribeiro Souza
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, MG; Brazil
| | - Polyana Mendes Maia
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, MG; Brazil
| | - Sávio Lana Siqueira
- Nucleus of Medical Sciences Studies, Dynamics Faculty of Piranga Valley, Ponte Nova, MG, Brazil
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181
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Ciou SH, Hwang YS, Chen CC, Luh JJ, Chen SC, Chen YL. Football APP based on smart phone with FES in drop foot rehabilitation. Technol Health Care 2017; 25:541-555. [PMID: 28211830 DOI: 10.3233/thc-160730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical stimulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. OBJECTIVE A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that is more convenient and interesting. METHODS An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES stimulation for inadequate ankle efforts. RESULTS After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. CONCLUSIONS Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation.
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Affiliation(s)
- Shih-Hsiang Ciou
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Yuh-Shyan Hwang
- Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan.,Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chih-Chen Chen
- Department of Management Information Systems, Hwa Hsia University of Technology, Taipei, Taiwan.,Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Jer-Junn Luh
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine & Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Yu-Luen Chen
- Department of Digital Technology Design, National Taipei University of Education, Taipei, Taiwan
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182
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractRecent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.
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183
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Skidmore J, Artemiadis P. Unilateral changes in walking surface compliance evoke dorsiflexion in paretic leg of impaired walkers. J Rehabil Assist Technol Eng 2017; 4:2055668317738469. [PMID: 31186942 PMCID: PMC6453080 DOI: 10.1177/2055668317738469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Gait impairments due to stroke impact millions of individuals throughout the world. Despite the growing interest in automating gait therapy with robotic devices, there is no clear evidence that robot-assisted gait therapy is superior to traditional treadmill-based therapy. METHODS This work investigates the effect of perturbations to the compliance of the walking surface on the paretic leg of impaired walkers. Using a novel robotic device, the variable stiffness treadmill, we apply perturbations to the compliance of the walking surface underneath the non-paretic leg of two hemi-paretic walkers and analyze the kinematic and neuromuscular response of the contralateral (paretic) leg with motion capture and surface electromyography systems. RESULTS We present results of evoked muscle activity (predominately tibialis anterior) and increased dorsiflexion in the paretic leg during the swing phase of gait at stiffness values of 60 kN/m and less for all subjects. CONCLUSIONS This work provides evidence for the first time of reducing the drop-foot effect in the impaired leg of hemiparetic walkers in response to unilateral perturbations to the compliance of the treadmill platform, thus providing direction for targeted robot-assisted gait rehabilitation.
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Affiliation(s)
- Jeffrey Skidmore
- Mechanical and Aerospace Engineering, Arizona State
University, Tempe, AZ, USA
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184
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Neuroplasticity-Based Technologies and Interventions for Restoring Motor Functions in Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 958:171-185. [PMID: 28093714 DOI: 10.1007/978-3-319-47861-6_11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Motor impairments are very common in multiple sclerosis (MS), leading to a reduced Quality of Life and active participation. In the past decades, new insights into the functional reorganization processes that occur after a brain injury have been introduced. Specifically, the motor practice seems to be determinant to induce neuroplastic changes and motor recovery. More recently, these findings have been extended to multiple sclerosis, in particular, it has been hypothesized that disease progression, functional reorganization and disability are mutually related. For this reason, neuroplasticity-based technologies and interventions have been rapidly introduced in MS rehabilitation. Constraint-induced movement therapy (CIMT), robotics and virtual reality training are new rehabilitative interventions that deliver an intensive e task-specific practice, which are two critical factors associated with functional improvements and cortical reorganization. Another promising strategy for enhancing neuroplastic changes is non-invasive brain stimulation that can be used with a priming effect on motor training. The aims of this chapter are to review the evidence of neuroplastic changes in multiple sclerosis and to present technologies and interventions that have been tested in clinical trials.
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185
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Monge-Pereira E, Molina-Rueda F, Rivas-Montero F, Ibáñez J, Serrano J, Alguacil-Diego I, Miangolarra-Page J. Electroencephalography as a post-stroke assessment method: An updated review. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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186
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Swinnen E, Lefeber N, Willaert W, De Neef F, Bruyndonckx L, Spooren A, Michielsen M, Ramon T, Kerckhofs E. Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists. Top Stroke Rehabil 2016; 24:299-308. [PMID: 27996894 DOI: 10.1080/10749357.2016.1266750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients' and therapists' perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. OBJECTIVES This study aimed to examine stroke patients' motivation and expectations of RAGT, and therapists' expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. METHODS A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal-Wallis tests were conducted. RESULTS In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. CONCLUSIONS Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.
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Affiliation(s)
- Eva Swinnen
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nina Lefeber
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ward Willaert
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Fallon De Neef
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lyn Bruyndonckx
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Annemie Spooren
- d Centre of Expertise - Care in Innovation , PXL University College , Hasselt , Belgium.,e Faculty of Medicine and Life Sciences, REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute , Hasselt University , Hasselt , Belgium
| | - Marc Michielsen
- f St. Ursula Rehabilitation Centre , Jessa Hospital , Herk-de-Stad , Belgium
| | - Tine Ramon
- g AZ Delta Hospital , Roeselare , Belgium
| | - Eric Kerckhofs
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
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187
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Meyer AJ, Eskinazi I, Jackson JN, Rao AV, Patten C, Fregly BJ. Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions. Front Bioeng Biotechnol 2016; 4:77. [PMID: 27790612 PMCID: PMC5061852 DOI: 10.3389/fbioe.2016.00077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/21/2016] [Indexed: 12/18/2022] Open
Abstract
Researchers have explored a variety of neurorehabilitation approaches to restore normal walking function following a stroke. However, there is currently no objective means for prescribing and implementing treatments that are likely to maximize recovery of walking function for any particular patient. As a first step toward optimizing neurorehabilitation effectiveness, this study develops and evaluates a patient-specific synergy-controlled neuromusculoskeletal simulation framework that can predict walking motions for an individual post-stroke. The main question we addressed was whether driving a subject-specific neuromusculoskeletal model with muscle synergy controls (5 per leg) facilitates generation of accurate walking predictions compared to a model driven by muscle activation controls (35 per leg) or joint torque controls (5 per leg). To explore this question, we developed a subject-specific neuromusculoskeletal model of a single high-functioning hemiparetic subject using instrumented treadmill walking data collected at the subject's self-selected speed of 0.5 m/s. The model included subject-specific representations of lower-body kinematic structure, foot-ground contact behavior, electromyography-driven muscle force generation, and neural control limitations and remaining capabilities. Using direct collocation optimal control and the subject-specific model, we evaluated the ability of the three control approaches to predict the subject's walking kinematics and kinetics at two speeds (0.5 and 0.8 m/s) for which experimental data were available from the subject. We also evaluated whether synergy controls could predict a physically realistic gait period at one speed (1.1 m/s) for which no experimental data were available. All three control approaches predicted the subject's walking kinematics and kinetics (including ground reaction forces) well for the model calibration speed of 0.5 m/s. However, only activation and synergy controls could predict the subject's walking kinematics and kinetics well for the faster non-calibration speed of 0.8 m/s, with synergy controls predicting the new gait period the most accurately. When used to predict how the subject would walk at 1.1 m/s, synergy controls predicted a gait period close to that estimated from the linear relationship between gait speed and stride length. These findings suggest that our neuromusculoskeletal simulation framework may be able to bridge the gap between patient-specific muscle synergy information and resulting functional capabilities and limitations.
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Affiliation(s)
- Andrew J Meyer
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Ilan Eskinazi
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Jennifer N Jackson
- Department of Biomedical Engineering, University of Florida , Gainesville, FL , USA
| | - Anil V Rao
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Carolynn Patten
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Neural Control of Movement Lab, Malcom-Randall VA Medical Center, Gainesville, FL, USA
| | - Benjamin J Fregly
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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188
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Chaudhary U, Birbaumer N, Ramos-Murguialday A. Brain-computer interfaces for communication and rehabilitation. Nat Rev Neurol 2016; 12:513-25. [PMID: 27539560 DOI: 10.1038/nrneurol.2016.113] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brain-computer interfaces (BCIs) use brain activity to control external devices, thereby enabling severely disabled patients to interact with the environment. A variety of invasive and noninvasive techniques for controlling BCIs have been explored, most notably EEG, and more recently, near-infrared spectroscopy. Assistive BCIs are designed to enable paralyzed patients to communicate or control external robotic devices, such as prosthetics; rehabilitative BCIs are designed to facilitate recovery of neural function. In this Review, we provide an overview of the development of BCIs and the current technology available before discussing experimental and clinical studies of BCIs. We first consider the use of BCIs for communication in patients who are paralyzed, particularly those with locked-in syndrome or complete locked-in syndrome as a result of amyotrophic lateral sclerosis. We then discuss the use of BCIs for motor rehabilitation after severe stroke and spinal cord injury. We also describe the possible neurophysiological and learning mechanisms that underlie the clinical efficacy of BCIs.
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Affiliation(s)
- Ujwal Chaudhary
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Silcherstrasse 5, 72076 Tübingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Silcherstrasse 5, 72076 Tübingen, Germany.,Wyss-Center for Bio- and Neuro-Engineering, Chenin de Mines 9, Ch 1202, Geneva, Switzerland
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Silcherstrasse 5, 72076 Tübingen, Germany.,TECNALIA, Health Department, Neural Engineering Laboratory, San Sebastian, Paseo Mikeletegi 1, 20009 San Sebastian, Spain
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189
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Chaudhary U, Birbaumer N, Ramos-Murguialday A. Brain-computer interfaces in the completely locked-in state and chronic stroke. PROGRESS IN BRAIN RESEARCH 2016; 228:131-61. [PMID: 27590968 DOI: 10.1016/bs.pbr.2016.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brain-computer interfaces (BCIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this chapter, we discuss the historical perspective of development of BCIs and the current advances of noninvasive BCIs for communication in patients with amyotrophic lateral sclerosis and for restoration of motor impairment after severe stroke. Distinct techniques have been explored to control a BCI in patient population especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS) because of their noninvasive nature and low cost. Previous studies demonstrated successful communication of patients with locked-in state (LIS) using EEG- and invasive electrocorticography-BCI and intracortical recordings when patients still showed residual eye control, but not with patients with complete LIS (ie, complete paralysis). Recently, a NIRS-BCI and classical conditioning procedure was introduced, allowing communication in patients in the complete locked-in state (CLIS). In severe chronic stroke without residual hand function first results indicate a possible superior motor rehabilitation to available treatment using BCI training. Here we present an overview of the available studies and recent results, which open new doors for communication, in the completely paralyzed and rehabilitation in severely affected stroke patients. We also reflect on and describe possible neuronal and learning mechanisms responsible for BCI control and perspective for future BMI research for communication in CLIS and stroke motor recovery.
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Affiliation(s)
- U Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.
| | - N Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; Wyss-Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - A Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany; TECNALIA, San Sebastian, Spain.
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191
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Chung GY, Choi GS, Shin KY, Park JS. Gait changes after using a temporomandibular joint exerciser in patients who underwent lower limb joint surgery. J Phys Ther Sci 2016; 28:1584-7. [PMID: 27313377 PMCID: PMC4905916 DOI: 10.1589/jpts.28.1584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/03/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The improvements in gait of the patients with lower limb disease who used a temporomandibular joint (TMJ) exerciser were verified. [Subjects and Methods] Eleven subjects were included. Their mean age was 53.2 years. The lower limb joint angles before and after using the TMJ exerciser were measured using a gait analyzer. Before the gait experiment, the TMJ exerciser setting process and one-leg stance balance test (OLST) were repeated until the balance maintenance time improved. [Results] Because of the OLST, the mean change in the body center point after the subjects used the exerciser improved from 5.76 mm to 4.20 mm. When the TMJ exerciser was used, the joint angle range of the subjects approached that of the normal individuals. [Conclusion] According to the gait experiments, the angles of the subjects' hips, knees, and ankle joints approached to those of the normal individuals after the subjects used the TMJ exerciser; however, the results did not completely match. The changes in the hip, knee, and ankle joint angles were statistically significant, which confirm the usefulness of the TMJ exerciser.
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Affiliation(s)
| | | | - Ki-Young Shin
- Department of Energy and Power Conversion Engineering, University of Science and Technology, Republic of Korea
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Riccio A, Pichiorri F, Schettini F, Toppi J, Risetti M, Formisano R, Molinari M, Astolfi L, Cincotti F, Mattia D. Interfacing brain with computer to improve communication and rehabilitation after brain damage. PROGRESS IN BRAIN RESEARCH 2016; 228:357-87. [PMID: 27590975 DOI: 10.1016/bs.pbr.2016.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Communication and control of the external environment can be provided via brain-computer interfaces (BCIs) to replace a lost function in persons with severe diseases and little or no chance of recovery of motor abilities (ie, amyotrophic lateral sclerosis, brainstem stroke). BCIs allow to intentionally modulate brain activity, to train specific brain functions, and to control prosthetic devices, and thus, this technology can also improve the outcome of rehabilitation programs in persons who have suffered from a central nervous system injury (ie, stroke leading to motor or cognitive impairment). Overall, the BCI researcher is challenged to interact with people with severe disabilities and professionals in the field of neurorehabilitation. This implies a deep understanding of the disabled condition on the one hand, and it requires extensive knowledge on the physiology and function of the human brain on the other. For these reasons, a multidisciplinary approach and the continuous involvement of BCI users in the design, development, and testing of new systems are desirable. In this chapter, we will focus on noninvasive EEG-based systems and their clinical applications, highlighting crucial issues to foster BCI translation outside laboratories to eventually become a technology usable in real-life realm.
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Affiliation(s)
- A Riccio
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - F Pichiorri
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - F Schettini
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - J Toppi
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - M Risetti
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - R Formisano
- Post-Coma Unit, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - M Molinari
- Spinal Cord Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - L Astolfi
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - F Cincotti
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - D Mattia
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy.
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193
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Cho W, Sabathiel N, Ortner R, Lechner A, Irimia DC, Allison BZ, Edlinger G, Guger C. Paired Associative Stimulation Using Brain-Computer Interfaces for Stroke Rehabilitation: A Pilot Study. Eur J Transl Myol 2016; 26:6132. [PMID: 27990240 PMCID: PMC5128973 DOI: 10.4081/ejtm.2016.6132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Conventional therapies do not provide paralyzed patients with closed-loop sensorimotor integration for motor rehabilitation. Paired associative stimulation (PAS) uses brain-computer interface (BCI) technology to monitor patients’ movement imagery in real-time, and utilizes the information to control functional electrical stimulation (FES) and bar feedback for complete sensorimotor closed loop. To realize this approach, we introduce the recoveriX system, a hardware and software platform for PAS. After 10 sessions of recoveriX training, one stroke patient partially regained control of dorsiflexion in her paretic wrist. A controlled group study is planned with a new version of the recoveriX system, which will use a new FES system and an avatar instead of bar feedback.
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Affiliation(s)
- Woosang Cho
- g.tec medical engineering GmbH , Schiedlberg, Austria
| | | | - Rupert Ortner
- g.tec medical engineering GmbH , Schiedlberg, Austria
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194
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Severens M, Perusquia-Hernandez M, Nienhuis B, Farquhar J, Duysens J. Using Actual and Imagined Walking Related Desynchronization Features in a BCI. IEEE Trans Neural Syst Rehabil Eng 2016; 23:877-86. [PMID: 26353236 DOI: 10.1109/tnsre.2014.2371391] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recently, brain-computer interface (BCI) research has extended to investigate its possible use in motor rehabilitation. Most of these investigations have focused on the upper body. Only few studies consider gait because of the difficulty of recording EEG during gross movements. However, for stroke patients the rehabilitation of gait is of crucial importance. Therefore, this study investigates if a BCI can be based on walking related desynchronization features. Furthermore, the influence of complexity of the walking movements on the classification performance is investigated. Two BCI experiments were conducted in which healthy subjects performed a cued walking task, a more complex walking task (backward or adaptive walking), and imagination of the same tasks. EEG data during these tasks was classified into walking and no-walking. The results from both experiments show that despite the automaticity of walking and recording difficulties, brain signals related to walking could be classified rapidly and reliably. Classification performance was higher for actual walking movements than for imagined walking movements. There was no significant increase in classification performance for both the backward and adaptive walking tasks compared with the cued walking tasks. These results are promising for developing a BCI for the rehabilitation of gait.
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195
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Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial. J Neuroeng Rehabil 2016; 13:47. [PMID: 27225043 PMCID: PMC4880987 DOI: 10.1186/s12984-016-0155-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke. METHODS Forty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months. RESULTS Treatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 ± 27.6 % vs. 48.1 ± 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home. CONCLUSIONS A robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community. TRIAL REGISTRATION This study was registered on anzctr.org.au (July 1, 2015; ACTRN12615000681550 ).
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196
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Youssofzadeh V, Zanotto D, Wong-Lin K, Agrawal SK, Prasad G. Directed Functional Connectivity in Fronto-Centroparietal Circuit Correlates With Motor Adaptation in Gait Training. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1265-1275. [PMID: 27071181 DOI: 10.1109/tnsre.2016.2551642] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lower-extremity robotic exoskeletons are used in gait rehabilitation to achieve functional motor recovery. To date, little is known about how gait training and post-training are characterized in brain signals and their causal connectivity. In this work, we used time-domain partial Granger causality (PGC) analysis to elucidate the directed functional connectivity of electroencephalogram (EEG) signals of healthy adults in robot-assisted gait training (RAGT). Our results confirm the presence of EEG rhythms and corticomuscular relationships during standing and walking using spectral and coherence analyses. The PGC analysis revealed enhanced connectivity close to sensorimotor areas ( C3 and CP3 ) during standing, whereas additional connectivities involve the centroparietal ( CP z) and frontal ( F z ) areas during walking with respect to standing. In addition, significant fronto-centroparietal causal effects were found during both training and post-training. Strong correlations were also found between kinematic errors and fronto-centroparietal connectivity during training and post-training. This study suggests fronto-centroparietal connectivity as a potential neuromarker for motor learning and adaptation in RAGT.
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197
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Sallés L, Gironès X, Martín-Casas P, Lafuente JV. A neurocognitive approach to recovery of movement following stroke. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2015.1111579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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198
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Miltner WHR. Plasticity and Reorganization in the Rehabilitation of Stroke. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. This paper outlines some actual developments in the behavioral treatment and rehabilitation of stroke and other brain injuries in post-acute and chronic conditions of brain lesion. It points to a number of processes that demonstrate the enormous plasticity and reorganization capacity of the human brain following brain lesion. It also highlights a series of behavioral and neuroscientific studies that indicate that successful behavioral rehabilitation is paralleled by plastic changes of brain structures and by cortical reorganization and that the amount of such plastic changes is obviously significantly determining the overall outcome of rehabilitation.
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Affiliation(s)
- Wolfgang H. R. Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
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199
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Skidmore J, Artemiadis P. On the effect of walking surface stiffness on inter-limb coordination in human walking: toward bilaterally informed robotic gait rehabilitation. J Neuroeng Rehabil 2016; 13:32. [PMID: 27004528 PMCID: PMC4802589 DOI: 10.1186/s12984-016-0140-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/16/2016] [Indexed: 11/12/2022] Open
Abstract
Background Robotic devices have been utilized in gait rehabilitation but have only produced moderate results when compared to conventional physiotherapy. Because bipedal walking requires neural coupling and dynamic interactions between the legs, a fundamental understanding of the sensorimotor mechanisms of inter-leg coordination during walking, which are not well understood but are systematically explored in this study, is needed to inform robotic interventions in gait therapy. Methods In this study we investigate mechanisms of inter-leg coordination by utilizing novel sensory perturbations created by real-time control of floor stiffness on a split-belt treadmill. We systematically alter the unilateral magnitude of the walking surface stiffness and the timing of these perturbations within the stance phase of the gait cycle, along with the level of body-weight support, while recording the kinematic and muscular response of the uperturbed leg. This provides new insight into the role of walking surface stiffness in inter-leg coordination during human walking. Both paired and unpaired unadjusted t-tests at the 95 % confidence level are used in the approriate scernario to determine statistical significance of the results. Results We present results of increased hip, knee, and ankle flexion, as well as increased tibialis anterior and soleus activation, in the unperturbed leg of healthy subjects that is repeatable and scalable with walking surface stiffness. The observed response was not impacted by the level of body-weight support provided, which suggests that walking surface stiffness is a unique stimulus in gait. In addition, we show that the activation of the tibialis anterior and soleus muscles is altered by the timing of the perturbations within the gait cycle. Conclusions This paper characterizes the contralateral leg’s response to ipsilateral manipulations of the walking surface and establishes the importance of walking surface stiffness in inter-leg coordination during human walking.
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Affiliation(s)
- Jeffrey Skidmore
- Department of Mechanical and Aerospace Engineering, Arizona State University, 501 E. Tyler Mall, Tempe, USA
| | - Panagiotis Artemiadis
- Department of Mechanical and Aerospace Engineering, Arizona State University, 501 E. Tyler Mall, Tempe, USA.
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200
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Moro SB, Carrieri M, Avola D, Brigadoi S, Lancia S, Petracca A, Spezialetti M, Ferrari M, Placidi G, Quaresima V. A novel semi-immersive virtual reality visuo-motor task activates ventrolateral prefrontal cortex: a functional near-infrared spectroscopy study. J Neural Eng 2016; 13:036002. [PMID: 27001948 DOI: 10.1088/1741-2560/13/3/036002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In the last few years, the interest in applying virtual reality systems for neurorehabilitation is increasing. Their compatibility with neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), allows for the investigation of brain reorganization with multimodal stimulation and real-time control of the changes occurring in brain activity. The present study was aimed at testing a novel semi-immersive visuo-motor task (VMT), which has the features of being adopted in the field of neurorehabilitation of the upper limb motor function. APPROACH A virtual environment was simulated through a three-dimensional hand-sensing device (the LEAP Motion Controller), and the concomitant VMT-related prefrontal cortex (PFC) response was monitored non-invasively by fNIRS. Upon the VMT, performed at three different levels of difficulty, it was hypothesized that the PFC would be activated with an expected greater level of activation in the ventrolateral PFC (VLPFC), given its involvement in the motor action planning and in the allocation of the attentional resources to generate goals from current contexts. Twenty-one subjects were asked to move their right hand/forearm with the purpose of guiding a virtual sphere over a virtual path. A twenty-channel fNIRS system was employed for measuring changes in PFC oxygenated-deoxygenated hemoglobin (O2Hb/HHb, respectively). MAIN RESULTS A VLPFC O2Hb increase and a concomitant HHb decrease were observed during the VMT performance, without any difference in relation to the task difficulty. SIGNIFICANCE The present study has revealed a particular involvement of the VLPFC in the execution of the novel proposed semi-immersive VMT adoptable in the neurorehabilitation field.
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Affiliation(s)
- Sara Basso Moro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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