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Ambrosini E, Ferrante S, Schauer T, Ferrigno G, Molteni F, Pedrocchi A. An automatic identification procedure to promote the use of FES-cycling training for hemiparetic patients. JOURNAL OF HEALTHCARE ENGINEERING 2015; 5:275-91. [PMID: 25193368 DOI: 10.1260/2040-2295.5.3.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cycling induced by Functional Electrical Stimulation (FES) training currently requires a manual setting of different parameters, which is a time-consuming and scarcely repeatable procedure. We proposed an automatic procedure for setting session-specific parameters optimized for hemiparetic patients. This procedure consisted of the identification of the stimulation strategy as the angular ranges during which FES drove the motion, the comparison between the identified strategy and the physiological muscular activation strategy, and the setting of the pulse amplitude and duration of each stimulated muscle. Preliminary trials on 10 healthy volunteers helped define the procedure. Feasibility tests on 8 hemiparetic patients (5 stroke, 3 traumatic brain injury) were performed. The procedure maximized the motor output within the tolerance constraint, identified a biomimetic strategy in 6 patients, and always lasted less than 5 minutes. Its reasonable duration and automatic nature make the procedure usable at the beginning of every training session, potentially enhancing the performance of FES-cycling training.
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Affiliation(s)
- Emilia Ambrosini
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, NeuroEngineering and Medical Robotics Laboratory, Piazza Leonardo da Vinci 32, 20133, Milano, Italy Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Institute of Care and Research, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
| | - Simona Ferrante
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, NeuroEngineering and Medical Robotics Laboratory, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin, Einsteinufer 17, D-10587 Berlin, Germany
| | - Giancarlo Ferrigno
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, NeuroEngineering and Medical Robotics Laboratory, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Via Nazario Sauro 17, 23845 Costa Masnaga, Lecco, Italy
| | - Alessandra Pedrocchi
- NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, NeuroEngineering and Medical Robotics Laboratory, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
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Barbosa D, Santos CP, Martins M. The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review. J Stroke Cerebrovasc Dis 2014; 24:253-73. [PMID: 25444025 DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/29/2014] [Accepted: 09/06/2014] [Indexed: 01/27/2023] Open
Abstract
Stroke is a leading cause of long-term disabilities, such as hemiparesis, inability to walk without assistance, and dependence of others in the activities of daily living. Motor function rehabilitation after stroke demands for methods oriented to the recovery of the walking capacity. Because of the similarities with walking, cycling leg exercise may present a solution to this problem. The aim of this article is to review the state of the art applications of cycling leg exercise as a (1) motor function rehabilitation method and an (2) aerobic training method for stroke patients as well as the commonly used (3) assessment tools. The cycling characteristics and applications, the applied test protocols as well as the tools used to assess the state and the recovery of patients and types of cycling devices are presented. In addition, the potential benefits of the use of other therapies, like feedback, together with cycling are explored. The application of cycling leg exercise alone and combined with feedback in stroke rehabilitation approaches has shown promising results. Positive effects on motor abilities were found in subacute and chronic patients. However, larger and normalized studies and assessments are needed because there is a high heterogeneity in the patients' characteristics, protocols and metrics. This wil allow the comparison between different studies related with cycling.
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Affiliation(s)
- David Barbosa
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
| | - Cristina P Santos
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal.
| | - Maria Martins
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
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Wang Z, Wang L, Fan H, Jiang W, Wang S, Gu Z, Wang T. Adapted low intensity ergometer aerobic training for early and severely impaired stroke survivors: a pilot randomized controlled trial to explore its feasibility and efficacy. J Phys Ther Sci 2014; 26:1449-54. [PMID: 25276034 PMCID: PMC4175255 DOI: 10.1589/jpts.26.1449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To evaluate the feasibility and efficacy of adapted low intensity ergometer
aerobic training for early and severely impaired stroke survivors. [Subjects] The subjects
were forty-eight early stroke survivors. [Methods] Eligible subjects were recruited and
randomly assigned to an experimental group and a control group. Both groups participated
in comprehensive rehabilitation training. Low intensity aerobic training was only
performed by the experimental group. Outcome measures were the Fugl-Meyer motor score,
Barthel index, exercise test time, peak heart rate, plasma glucose level and serum lipid
profiles. [Results] Patients in the experimental group finished 88.6% of the total aerobic
training sessions prescribed. In compliant participants (adherence≥80%), aerobic training
significantly improved the Barthel index (from 40.1±21.1 to 79.2±14.2), Fugl-Meyer motor
score (from 26.4±19.4 to 45.4±12.7), exercise test time (from 12.2±3.62 min to
13.9±3.6 min), 2-hour glucose level (from 9.22±1.16 mmol/L to 7.21±1.36 mmol/L) and
homeostasis model of assessment for insulin resistence index (from 1.72±1.01 to
1.28±0.88). [Conclusion] Preliminary findings suggest that early and severely impaired
stroke patients may benefit from low intensity ergometer aerobic training.
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Affiliation(s)
- Zun Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Lei Wang
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Hongjuan Fan
- Rehabilitation Therapy Department, The Second Medical School of Nanjing University of Traditional Chinese Medicine, China
| | - Wenjun Jiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Jiangsu University, China
| | - Sheng Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Zhaohua Gu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
| | - Tong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, China
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Pedrocchi A, Ferrante S, Ambrosini E, Gandolla M, Casellato C, Schauer T, Klauer C, Pascual J, Vidaurre C, Gföhler M, Reichenfelser W, Karner J, Micera S, Crema A, Molteni F, Rossini M, Palumbo G, Guanziroli E, Jedlitschka A, Hack M, Bulgheroni M, d'Amico E, Schenk P, Zwicker S, Duschau-Wicke A, Miseikis J, Graber L, Ferrigno G. MUNDUS project: MUltimodal neuroprosthesis for daily upper limb support. J Neuroeng Rehabil 2013; 10:66. [PMID: 23822118 PMCID: PMC3733825 DOI: 10.1186/1743-0003-10-66] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user’s direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be adapted to the level of severity or to the progression of the disease allowing the user to voluntarily interact with the environment. MUNDUS target pathologies are high-level spinal cord injury (SCI) and neurodegenerative and genetic neuromuscular diseases, such as amyotrophic lateral sclerosis, Friedreich ataxia, and multiple sclerosis (MS). The system can be alternatively driven by residual voluntary muscular activation, head/eye motion, and brain signals. MUNDUS modularly combines an antigravity lightweight and non-cumbersome exoskeleton, closed-loop controlled Neuromuscular Electrical Stimulation for arm and hand motion, and potentially a motorized hand orthosis, for grasping interactive objects. Methods The definition of the requirements and of the interaction tasks were designed by a focus group with experts and a questionnaire with 36 potential end-users. Five end-users (3 SCI and 2 MS) tested the system in the configuration suitable to their specific level of impairment. They performed two exemplary tasks: reaching different points in the working volume and drinking. Three experts evaluated over a 3-level score (from 0, unsuccessful, to 2, completely functional) the execution of each assisted sub-action. Results The functionality of all modules has been successfully demonstrated. User’s intention was detected with a 100% success. Averaging all subjects and tasks, the minimum evaluation score obtained was 1.13 ± 0.99 for the release of the handle during the drinking task, whilst all the other sub-actions achieved a mean value above 1.6. All users, but one, subjectively perceived the usefulness of the assistance and could easily control the system. Donning time ranged from 6 to 65 minutes, scaled on the configuration complexity. Conclusions The MUNDUS platform provides functional assistance to daily life activities; the modules integration depends on the user’s need, the functionality of the system have been demonstrated for all the possible configurations, and preliminary assessment of usability and acceptance is promising.
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Casellato C, Pedrocchi A, Zorzi G, Vernisse L, Ferrigno G, Nardocci N. EMG-based visual-haptic biofeedback: a tool to improve motor control in children with primary dystonia. IEEE Trans Neural Syst Rehabil Eng 2012; 21:474-80. [PMID: 23060345 DOI: 10.1109/tnsre.2012.2222445] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New insights suggest that dystonic motor impairments could also involve a deficit of sensory processing. In this framework, biofeedback, making covert physiological processes more overt, could be useful. The present work proposes an innovative integrated setup which provides the user with an electromyogram (EMG)-based visual-haptic biofeedback during upper limb movements (spiral tracking tasks), to test if augmented sensory feedbacks can induce motor control improvement in patients with primary dystonia. The ad hoc developed real-time control algorithm synchronizes the haptic loop with the EMG reading; the brachioradialis EMG values were used to modify visual and haptic features of the interface: the higher was the EMG level, the higher was the virtual table friction and the background color proportionally moved from green to red. From recordings on dystonic and healthy subjects, statistical results showed that biofeedback has a significant impact, correlated with the local impairment, on the dystonic muscular control. These tests pointed out the effectiveness of biofeedback paradigms in gaining a better specific-muscle voluntary motor control. The flexible tool developed here shows promising prospects of clinical applications and sensorimotor rehabilitation.
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Affiliation(s)
- Claudia Casellato
- Bioengineering Department, Politecnico di Milano, 20133 Milano, Italy.
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Ambrosini E, Ferrante S, Ferrigno G, Molteni F, Pedrocchi A. Cycling Induced by Electrical Stimulation Improves Muscle Activation and Symmetry During Pedaling in Hemiparetic Patients. IEEE Trans Neural Syst Rehabil Eng 2012; 20:320-30. [DOI: 10.1109/tnsre.2012.2191574] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ferrante S, Ambrosini E, Ravelli P, Guanziroli E, Molteni F, Ferrigno G, Pedrocchi A. A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients. J Neuroeng Rehabil 2011; 8:47. [PMID: 21861930 PMCID: PMC3200991 DOI: 10.1186/1743-0003-8-47] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 08/24/2011] [Indexed: 11/24/2022] Open
Abstract
Background The restoration of walking ability is the main goal of post-stroke lower limb rehabilitation and different studies suggest that pedaling may have a positive effect on locomotion. The aim of this study was to explore the feasibility of a biofeedback pedaling treatment and its effects on cycling and walking ability in chronic stroke patients. A case series study was designed and participants were recruited based on a gait pattern classification of a population of 153 chronic stroke patients. Methods In order to optimize participants selection, a k-means cluster analysis was performed to subgroup homogenous gait patterns in terms of gait speed and symmetry. The training consisted of a 2-week treatment of 6 sessions. A visual biofeedback helped the subjects in maintaining a symmetrical contribution of the two legs during pedaling. Participants were assessed before, after training and at follow-up visits (one week after treatment). Outcome measures were the unbalance during a pedaling test, and the temporal, spatial, and symmetry parameters during gait analysis. Results and discussion Three clusters, mainly differing in terms of gait speed, were identified and participants, representative of each cluster, were selected. An intra-subject statistical analysis (ANOVA) showed that all patients significantly decreased the pedaling unbalance after treatment and maintained significant improvements with respect to baseline at follow-up. The 2-week treatment induced some modifications in the gait pattern of two patients: one, the most impaired, significantly improved mean velocity and increased gait symmetry; the other one reduced significantly the over-compensation of the healthy limb. No benefits were produced in the gait of the last subject who maintained her slow but almost symmetrical pattern. Thus, this study might suggest that the treatment can be beneficial for patients having a very asymmetrical and inefficient gait and for those that overuse the healthy leg. Conclusion The results demonstrated that the treatment is feasible and it might be effective in translating progresses from pedaling to locomotion. If these results are confirmed on a larger and controlled scale, the intervention, thanks to its safety and low price, could have a significant impact as a home- rehabilitation treatment for chronic stroke patients.
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Affiliation(s)
- Simona Ferrante
- NearLab, Bioengineering Department, Politecnico di Milano, Milano, Italy.
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Aliverti A, Frigo C, Andreoni G, Baroni G, Bonarini A, Cerveri P, Crivellini M, Dellaca R, Ferrigno G, Galli M, Pedrocchi A, Rodano R, Santambrogio GC, Tognola G, Pedotti A. Functional evaluation and rehabilitation engineering. IEEE Pulse 2011; 2:24-34. [PMID: 21642030 DOI: 10.1109/mpul.2011.941520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Life is complex and all about movement, which allows us to interact with the environment and communicate with each other. The human nervous system is capable of performing a simultaneous and integrated control of 100-150 mechanical degrees of freedom of movement in the body via tensions generated by about 700 muscles. In its widest context, movement is carried out by a sensory motor system comprising multiple sensors (visual,auditory, and proprioceptive),multiple actuators (muscles acting on the skeletal system),and an intermediary processor that can be summarized as a multiple-input–multiple-output nonlinear dynamic time-varying control system. This grand control system is capable of responding with remarkable accuracy,speed, appropriateness,versatility, and adaptability to a wide spectrum of continuous and discrete stimuli and conditions and is certainly orders of magnitude more complex and sophisticated than the most advanced robotic systems currently available. In the last decades,a great deal of research has been carried out in the fields of functional evaluation of human performance and rehabilitation engineering. These fields combine knowledge, concepts, and methods from across many disciplines (e.g., biomechanics,neuroscience, and physiology), with the aim of developing apparatuses and methods fort he measurement and analysis of complex sensory motor performance and the ultimate goal of enhancing the execution of different tasks in both healthy people and persons with reduced capabilities from different causes (injury, disease, amputation,and neural degeneration).
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Affiliation(s)
- Andrea Aliverti
- Dipartimento di Bioingegneria, Politecnico di Milano, Italy.
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Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling Induced by Electrical Stimulation Improves Motor Recovery in Postacute Hemiparetic Patients. Stroke 2011; 42:1068-73. [DOI: 10.1161/strokeaha.110.599068] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emilia Ambrosini
- From Politecnico di Milano (E.A., S.F., A.P., G.F.), Bioengineering Department, NearLab, Milan, Italy; Valduce Hospital (F.M.), Villa Beretta, Rehabilitation Center, Costa Masnaga, Lecco, Italy
| | - Simona Ferrante
- From Politecnico di Milano (E.A., S.F., A.P., G.F.), Bioengineering Department, NearLab, Milan, Italy; Valduce Hospital (F.M.), Villa Beretta, Rehabilitation Center, Costa Masnaga, Lecco, Italy
| | - Alessandra Pedrocchi
- From Politecnico di Milano (E.A., S.F., A.P., G.F.), Bioengineering Department, NearLab, Milan, Italy; Valduce Hospital (F.M.), Villa Beretta, Rehabilitation Center, Costa Masnaga, Lecco, Italy
| | - Giancarlo Ferrigno
- From Politecnico di Milano (E.A., S.F., A.P., G.F.), Bioengineering Department, NearLab, Milan, Italy; Valduce Hospital (F.M.), Villa Beretta, Rehabilitation Center, Costa Masnaga, Lecco, Italy
| | - Franco Molteni
- From Politecnico di Milano (E.A., S.F., A.P., G.F.), Bioengineering Department, NearLab, Milan, Italy; Valduce Hospital (F.M.), Villa Beretta, Rehabilitation Center, Costa Masnaga, Lecco, Italy
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Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Guanziroli E, Molteni F. A novel biofeedback cycling training to improve gait symmetry in stroke patients: a case series study. IEEE Int Conf Rehabil Robot 2011; 2011:5975495. [PMID: 22275692 DOI: 10.1109/icorr.2011.5975495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The restoration of walking ability is crucial for maximizing independent mobility among patients with stroke. Leg cycling is becoming an established intervention to supplement ambulation training for stroke patients with problems of unbalance and weakness. The aim of the study was to explore the feasibility of a biofeedback pedaling treatment and its effects on cycling and walking ability in chronic stroke patients. Three patients were included in the study. The training consisted of a 2-week treatment of 6 sessions, during which a visual biofeedback helped the participants in maintaining a symmetrical pedaling. Participants were assessed before, after training and at follow-up, by means of a pedaling test and gait analysis. Outcome measurements were the unbalance during pedaling, the temporal, spatial and symmetry parameters during walking. An intra-subject statistical analysis (ANOVA, p<;0.05) showed that all patients significantly decreased pedaling unbalance after treatment and maintained the improvements at follow-up. The training induced some gait pattern modifications in two patients: one significantly improved mean velocity and gait symmetry, while the other one reduced the compensation strategy of the healthy leg. The results demonstrated the feasibility of the treatment. If further trials on a larger and controlled scale confirmed the same results, this treatment, thanks to its safety and low price, could have a significant impact as a home-rehabilitation treatment.
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Affiliation(s)
- Emilia Ambrosini
- Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy
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