1
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Hui Z, Qi W, Zhang Y, Wang M, Zhang J, Li D, Zhu D. Efficacy of a Soft Robotic Exoskeleton to Improve Lower Limb Motor Function in Children with Spastic Cerebral Palsy: A Single-Blinded Randomized Controlled Trial. Brain Sci 2024; 14:425. [PMID: 38790405 PMCID: PMC11118818 DOI: 10.3390/brainsci14050425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE Soft robotic exoskeletons (SREs) are portable, lightweight assistive technology with therapeutic potential for improving lower limb motor function in children with cerebral palsy. To understand the effects of long-term SRE-assisted walking training on children with spastic cerebral palsy (SCP), we designed a study aiming to elucidate the effects of SRE-assisted walking training on lower limb motor function in this population. METHODS In this randomized, single-blinded (outcome assessor) controlled trial, forty children diagnosed with SCP were randomized into the routine rehabilitation (RR) group (N = 20) and the SRE group (N = 20) for comparison. The RR group received routine rehabilitation training, and the SRE group received routine rehabilitation training combined with SRE-assisted overground walking training. Assessments (without SRE) were conducted pre- and post-intervention (8 weeks after the intervention). The primary outcome measures included the 10 m walk test (10MWT) and the 6 min walk test (6MWT). Secondary outcome measures comprised the gross motor function measure-88, pediatric balance scale modified Ashworth scale, and physiological cost index. RESULTS Both groups showed significant improvements (p < 0.01) across all outcome measures after the 8-week intervention. Between-group comparisons using ANCOVA revealed that the SRE group demonstrated greater improvement in walking speed from the 10MWT (+6.78 m/min, 95% CI [5.74-7.83]; p < 0.001) and walking distance during the 6MWT (+34.42 m, 95% CI [28.84-39.99]; p < 0.001). The SRE group showed greater improvement in all secondary outcome measures (p < 0.001). CONCLUSIONS The study findings suggested that the integration of SRE-assisted overground walking training with routine rehabilitation more effectively enhances lower limb motor function in children with SCP compared to routine rehabilitation alone.
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Affiliation(s)
- Zhichong Hui
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Weihang Qi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Mingmei Wang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Jiamei Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Dong Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
| | - Dengna Zhu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; (Z.H.); (W.Q.); (Y.Z.); (M.W.); (J.Z.); (D.L.)
- Zhengzhou Key Laboratory of the Prevention and Cure of Cerebral Palsy Children, Zhengzhou 450052, China
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2
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Shin J, Yang S, Park C, Lee Y, You SJH. Comparative effects of passive and active mode robot-assisted gait training on brain and muscular activities in sub-acute and chronic stroke. NeuroRehabilitation 2022; 51:51-63. [PMID: 35311717 DOI: 10.3233/nre-210304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) was initially developed based on the passive controlled (PC) mode, where the target or ideal locomotor kinematic trajectory is predefined and a patient basically 'rides' the robot instead of actively participating in the actual locomotor relearning process. A new insightful contemporary neuroscience and mechatronic evidence suggest that robotic-based locomotor relearning can be best achieved through active interactive (AI) mode rather than PC mode. OBJECTIVE The purpose of this study was to compare the pattern of gait-related cortical activity, specifically gait event-related spectral perturbations (ERSPs), and muscle activity from the tibialis anterior (TA) and clinical functional tests in subacute and chronic stroke patients during robot-assisted gait training (RAGT) in passive controlled (PC) and active interactive (AI) modes. METHODS The present study involves a two-group pretest-posttest design in which two groups (i.e., PC-RAGT group and AI-RAGT group) of 14 stroke subjects were measured to assess changes in ERSPs, the muscle activation of TA, and the clinical functional tests, following 15- 18 sessions of intervention according to the protocol of each group. RESULTS Our preliminary results demonstrated that the power in the μ band (8- 12 Hz) was increased in the leg area of sensorimotor cortex (SMC) and supplementary motor area (SMA) at post-intervention as compared to pre-intervention in both groups. Such cortical neuroplasticity change was associated with TA muscle activity during gait and functional independence in functional ambulation category (FAC) and motor coordination in Fugl- Meyer Assessment for lower extremity (FMA-LE) test as well as spasticity in the modified Ashworth scale (MAS) measures. CONCLUSIONS We have first developed a novel neuroimaging experimental paradigm which distinguished gait event related cortical involvement between pre- and post-intervention with PC-RAGT and AI-RAGT in individuals with subacute and chronic hemiparetic stroke.
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Affiliation(s)
- Jiwon Shin
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Sejung Yang
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Yongseok Lee
- Myongji-Choonhey Rehabilitation Hospital, Seoul, Republic of Korea
| | - Sung Joshua H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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3
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Sarajchi M, Al-Hares MK, Sirlantzis K. Wearable Lower-Limb Exoskeleton for Children With Cerebral Palsy: A Systematic Review of Mechanical Design, Actuation Type, Control Strategy, and Clinical Evaluation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2695-2720. [PMID: 34910636 DOI: 10.1109/tnsre.2021.3136088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children with a neurological disorder such as cerebral palsy (CP) severely suffer from a reduced quality of life because of decreasing independence and mobility. Although there is no cure yet, a lower-limb exoskeleton (LLE) has considerable potential to help these children experience better mobility during overground walking. The research in wearable exoskeletons for children with CP is still at an early stage. This paper shows that the number of published papers on LLEs assisting children with CP has significantly increased in recent years; however, no research has been carried out to review these studies systematically. To fill up this research gap, a systematic review from a technical and clinical perspective has been conducted, based on the PRISMA guidelines, under three extended topics associated with "lower limb", "exoskeleton", and "cerebral palsy" in the databases Scopus and Web of Science. After applying several exclusion criteria, seventeen articles focused on fifteen LLEs were included for careful consideration. These studies address some consistent positive evidence on the efficacy of LLEs in improving gait patterns in children with CP. Statistical findings show that knee exoskeletons, brushless DC motors, the hierarchy control architecture, and CP children with spastic diplegia are, respectively, the most common mechanical design, actuator type, control strategy, and clinical characteristics for these LLEs. Clinical studies suggest ankle-foot orthosis as the primary medical solution for most CP gait patterns; nevertheless, only one motorized ankle exoskeleton has been developed. This paper shows that more research and contribution are needed to deal with open challenges in these LLEs.
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4
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Hussain F, Goecke R, Mohammadian M. Exoskeleton robots for lower limb assistance: A review of materials, actuation, and manufacturing methods. Proc Inst Mech Eng H 2021; 235:1375-1385. [PMID: 34254562 DOI: 10.1177/09544119211032010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The field of robot-assisted physical rehabilitation and robotics technology for providing support to the elderly population is rapidly evolving. Lower limb robot aided rehabilitation and assistive technology have been a focus for the engineering community during the last three decades as several robotic lower limb exoskeletons have been proposed in the literature as well as some being commercially available. Numerous manufacturing techniques and materials have been developed for lower limb exoskeletons during the last two decades, resulting in the design of a variety of robot exoskeletons for gait assistance for elderly and disabled people. One of the most important aspects of developing exoskeletons is the selection of the most appropriate proper material. The material selection strongly influences the overall weight and performance of the exoskeleton robot. The most suitable fabrication method for material is also an important parameter for the development of lower limb robot exoskeletons. In addition to the materials and manufacturing methods, the actuation method plays a vital role in the development of these robot exoskeletons. Even though various materials, manufacturing methods and actuators are reported in the literature for these lower limb robot exoskeletons, there are still avenues of improvement in these three domains. In this review, we have examined various lower limb robotic exoskeletons, concentrating on the three main aspects of material, manufacturing, and actuation. We have focused on the advantages and drawbacks of various materials and manufacturing practices as well as actuation methods. A discussion on future directions of research is provided for the engineering community covering the material, manufacturing and actuation methods.
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Affiliation(s)
- Fahad Hussain
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Roland Goecke
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Masoud Mohammadian
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
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Winter C, Kern F, Gall D, Latoschik ME, Pauli P, Käthner I. Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke. J Neuroeng Rehabil 2021; 18:68. [PMID: 33888148 PMCID: PMC8061882 DOI: 10.1186/s12984-021-00848-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background The rehabilitation of gait disorders in patients with multiple sclerosis (MS) and stroke is often based on conventional treadmill training. Virtual reality (VR)-based treadmill training can increase motivation and improve therapy outcomes. The present study evaluated an immersive virtual reality application (using a head-mounted display, HMD) for gait rehabilitation with patients to (1) demonstrate its feasibility and acceptance and to (2) compare its short-term effects to a semi-immersive presentation (using a monitor) and a conventional treadmill training without VR to assess the usability of both systems and estimate the effects on walking speed and motivation. Methods In a within-subjects study design, 36 healthy participants and 14 persons with MS or stroke participated in each of the three experimental conditions (VR via HMD, VR via monitor, treadmill training without VR). Results For both groups, the walking speed in the HMD condition was higher than in treadmill training without VR and in the monitor condition. Healthy participants reported a higher motivation after the HMD condition as compared with the other conditions. Importantly, no side effects in the sense of simulator sickness occurred and usability ratings were high. No increases in heart rate were observed following the VR conditions. Presence ratings were higher for the HMD condition compared with the monitor condition for both user groups. Most of the healthy study participants (89%) and patients (71%) preferred the HMD-based training among the three conditions and most patients could imagine using it more frequently. Conclusions For the first time, the present study evaluated the usability of an immersive VR system for gait rehabilitation in a direct comparison with a semi-immersive system and a conventional training without VR with healthy participants and patients. The study demonstrated the feasibility of combining a treadmill training with immersive VR. Due to its high usability and low side effects, it might be particularly suited for patients to improve training motivation and training outcome e. g. the walking speed compared with treadmill training using no or only semi-immersive VR. Immersive VR systems still require specific technical setup procedures. This should be taken into account for specific clinical use-cases during a cost–benefit assessment. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00848-w.
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Affiliation(s)
- Carla Winter
- Department of Psychology I, Biological Psychology, Clinical Psychology And Psychotherapy, University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.
| | - Florian Kern
- Human-Computer Interaction, University of Würzburg, Würzburg, Germany
| | - Dominik Gall
- Department of Psychology I, Biological Psychology, Clinical Psychology And Psychotherapy, University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.,Human-Computer Interaction, University of Würzburg, Würzburg, Germany
| | | | - Paul Pauli
- Department of Psychology I, Biological Psychology, Clinical Psychology And Psychotherapy, University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.,Center of Mental Health, Medical Faculty, University of Würzburg, Würzburg, Germany
| | - Ivo Käthner
- Department of Psychology I, Biological Psychology, Clinical Psychology And Psychotherapy, University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany
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6
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Bhardwaj S, Khan AA, Muzammil M. Lower limb rehabilitation robotics: The current understanding and technology. Work 2021; 69:775-793. [PMID: 34180443 DOI: 10.3233/wor-205012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With the increasing rate of ambulatory disabilities and rise in the elderly population, advance methods to deliver the rehabilitation and assistive services to patients have become important. Lower limb robotic therapeutic and assistive aids have been found to improve the rehabilitation outcome. OBJECTIVE The article aims to present the updated understanding in the field of lower limb rehabilitation robotics and identify future research avenues. METHODS Groups of keywords relating to assistive technology, rehabilitation robotics, and lower limb were combined and searched in EMBASE, IEEE Xplore Digital Library, Scopus, Web of Science and Google Scholar database. RESULTS Based on the literature collected from the databases we provide an overview of the understanding of robotics in rehabilitation and state of the art devices for lower limb rehabilitation. Technological advancements in rehabilitation robotic architecture (sensing, actuation and control) and biomechanical considerations in design have been discussed. Finally, a discussion on the major advances, research directions, and challenges is presented. CONCLUSIONS Although the use of robotics has shown a promising approach to rehabilitation and reducing the burden on caregivers, extensive and innovative research is still required in both cognitive and physical human-robot interaction to achieve treatment efficacy and efficiency.
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Affiliation(s)
- Siddharth Bhardwaj
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Abid Ali Khan
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Mohammad Muzammil
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
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7
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Yin G, Zhang X, Chen D, Li H, Chen J, Chen C, Lemos S. Processing Surface EMG Signals for Exoskeleton Motion Control. Front Neurorobot 2020; 14:40. [PMID: 32765250 PMCID: PMC7381241 DOI: 10.3389/fnbot.2020.00040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/26/2020] [Indexed: 01/30/2023] Open
Abstract
The surface electromyography (sEMG) signal has been used for volitional control of robotic assistive devices. There are still challenges in improving system performance accuracy and signal processing to remove systematic noise. This study presents procedures and a pilot validation of the EMG-driven speed-control of exoskeleton and integrated treadmill with a goal to provide better interaction between a user and the system. The gait cycle duration (GCD) was extracted from sEMG signals using the autocorrelation algorithm and Bayesian fusion algorithm. GCDs of various walking speeds were then programmed to control the motion speed of exoskeleton robotic system. The performance and efficiency of this sEMG-controlled robotic assistive ambulation system was tested and validated among 6 healthy volunteers. The results demonstrated that the autocorrelation algorithm extracted the GCD from individual muscle contraction. The GCDs of individual muscles had variability between different walking steps under a designated walking speed. Bayesian fusion algorithms processed the GCDs of multiple muscles yielding a final GCD with the least variance. The fused GCD effectively controlled the motion speeds of exoskeleton and treadmill. The higher amplitude of EMG signals with shorter GCD was found during a faster walking speed. The algorithms using fused GCDs and gait stride length yielded trajectory joint motion tracks in a shape of sine curve waveform. The joint angles of the exoskeleton measured by a decoder mounted on the hip turned out to be in sine waveforms. The hip joint motion track of the exoskeleton matched the angles projected by trajectory curve generated by computer algorithms based on the fused GCDs with high agreement. The EMG-driven speed-control provided the human-machine inter-limb coordination mechanisms for an intuitive speed control of the exoskeleton-treadmill system at the user's intents. Potentially the whole system can be used for gait rehabilitation of incomplete spinal cord hemispheric stroke patients as goal-directed and task-oriented training tool.
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Affiliation(s)
- Gui Yin
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Key Laboratory of Intelligent Robots, Xi’an Jiaotong University, Xi’an, China
| | - Xiaodong Zhang
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Key Laboratory of Intelligent Robots, Xi’an Jiaotong University, Xi’an, China
| | - Dawei Chen
- Robotic Rehabilitation Laboratory, Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States
| | - Hanzhe Li
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Key Laboratory of Intelligent Robots, Xi’an Jiaotong University, Xi’an, China
| | | | - Chaoyang Chen
- Robotic Rehabilitation Laboratory, Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States
- Department of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Orthopaedic Surgery and Sport Medicine, Detroit Medical Center, Detroit, MI, United States
| | - Stephen Lemos
- Department of Orthopaedic Surgery and Sport Medicine, Detroit Medical Center, Detroit, MI, United States
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8
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Cespedes N, Munera M, Gomez C, Cifuentes CA. Social Human-Robot Interaction for Gait Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1299-1307. [PMID: 32287000 DOI: 10.1109/tnsre.2020.2987428] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robot-assisted therapy for gait rehabilitation of patients with neurological disorders usually combines a body weight support system with a treadmill system. Lokomat is one of the most used devices for gait rehabilitation. This device allows therapists to focus on the patient and the therapy. However, this therapy session is based on multi-tasking processes, which are often difficult for a therapist to manage. In this work, a Socially Assistive Robot (SAR) was integrated into a neurorehabilitation program as a collaborator agent to promote patient engagement and performance during the therapy. This short-term study presents the effects comparing the social robot condition and control condition with a group of four neurological patients using repeated measurement design. As a remarkable result, patients improved thoracic 18.44% and cervical 32.23% posture on average with SAR assistance. This study demonstrated the feasibility of the integration of a social robot as a complement of gait rehabilitation programs.
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9
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Jamwal PK, Hussain S, Ghayesh MH. Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies. Proc Inst Mech Eng H 2020; 234:444-457. [PMID: 31916511 DOI: 10.1177/0954411919898293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The application of robotic devices in providing physiotherapies to post-stroke patients and people suffering from incomplete spinal cord injuries is rapidly expanding. It is crucial to provide valid rehabilitation for people who are experiencing abnormality in their gait performance; therefore, design and development of newer robotic devices for the purpose of facilitating patients' recovery is being actively researched. In order to advance the traditional gait treatment among patients, exoskeletons and orthoses were introduced over the last two decades. This article presents a thorough review of existing robotic gait rehabilitation devices. The latest advancements in the mechanical design, types of control and actuation are also covered. The study comprehends discussions on robotic rehabilitation devices developed both for the training on treadmill and over-ground training. The assist-as-needed strategy for the gait training is particularly emphasized while reviewing various control strategies applied to these robotic devices. This study further reviews experimental investigations and clinical assessments of different control strategies and mechanism designs of robotic gait rehabilitation devices using experimental and clinical trials.
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Affiliation(s)
- Prashant K Jamwal
- Department of Electrical and Computer Engineering, Nazarbayev University, Astana, Kazakhstan
| | - Shahid Hussain
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Mergen H Ghayesh
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
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10
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Abstract
SUMMARYThis paper deals with a continuous design task of a planar cable robot used in a gait training machine called the cable-driven legs trainer. The design of cable robots requires satisfying two constraints, that is, tensions in the cables must remain non-negative, and cable interferences should be avoided. The carried design approach is based on interval analysis, which is one of the most efficient methods to obtain certified results. The constraints of non-negative tensions and cable to end-effector interference are solved using interval analysis tools. By means of a dynamic simulation, the reached workspace and the produced wrenches of the cable robot are evaluated as a set of interval vectors. An optimization algorithm is then designed to optimize the cable robot structure for the gait training machine. The robot is designed to produce non-negative tensions in the cables and to avoid collision at all times within the desired workspace and under the required external loads.
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11
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Zheng QX, Ge L, Wang CC, Ma QS, Liao YT, Huang PP, Wang GD, Xie QL, Rask M. Robot-assisted therapy for balance function rehabilitation after stroke: A systematic review and meta-analysis. Int J Nurs Stud 2019; 95:7-18. [DOI: 10.1016/j.ijnurstu.2019.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
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12
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Boehm WL, Gruben KG. Development of KIINCE: A kinetic feedback-based robotic environment for study of neuromuscular coordination and rehabilitation of human standing and walking. J Rehabil Assist Technol Eng 2019; 5:2055668318793585. [PMID: 31191950 PMCID: PMC6453043 DOI: 10.1177/2055668318793585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The objective of this article is to introduce the robotic platform KIINCE and
its emphasis on the potential of kinetic objectives for studying and
training human walking and standing. The device is motivated by the need to
characterize and train lower limb muscle coordination to address balance
deficits in impaired walking and standing. Methods The device measures the forces between the user and his or her environment,
particularly the force of the ground on the feet (F) that
reflects lower limb joint torque coordination. In an environment that allows
for exploration of the user’s capabilities, various forms of real-time
feedback guide neural training to produce F appropriate for
remaining upright. Control of the foot plate motion is configurable and may
be user driven or prescribed. Design choices are motivated from theory of
motor control and learning as well as empirical observations of
F during walking and standing. Results Preliminary studies of impaired individuals demonstrate the feasibility and
potential utility of patient interaction with kinetic immersive interface
for neuromuscular coordination enhancement. Conclusion Applications include study and rehabilitation of standing and walking after
injury, amputation, and neurological insult, with an initial focus on stroke
discussed here.
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Affiliation(s)
- Wendy L Boehm
- Department of Biomedical Engineering, Northwestern University, Chicago, USA
| | - Kreg G Gruben
- Department of Kinesiology, University of Wisconsin, Madison, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, USA
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13
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van Kammen K, Boonstra AM, van der Woude LHV, Visscher C, Reinders-Messelink HA, den Otter R. Lokomat guided gait in hemiparetic stroke patients: the effects of training parameters on muscle activity and temporal symmetry. Disabil Rehabil 2019; 42:2977-2985. [DOI: 10.1080/09638288.2019.1579259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
| | - Anne M. Boonstra
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Chris Visscher
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Heleen A. Reinders-Messelink
- Rehabilitation Center “Revalidatie Friesland”, Beetsterzwaag, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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14
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Bingjing G, Jianhai H, Xiangpan L, Lin Y. Human–robot interactive control based on reinforcement learning for gait rehabilitation training robot. INT J ADV ROBOT SYST 2019. [DOI: 10.1177/1729881419839584] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A human–robot interactive control is proposed to govern the assistance provided by a lower limb exoskeleton robot to patients in the gait rehabilitation training. The rehabilitation training robot with two lower limb exoskeletons is driven by the pneumatic proportional servo system and has two rotational degrees of freedom of each lower limb. An adaptive admittance model is adopted considering its suitability for human–robot interaction. The adaptive law of the admittance parameters is designed with Sigmoid function and the reinforcement learning algorithm. Individualized admittance parameters suitable for patients are obtained by reinforcement learning. Experiments in passive and active rehabilitation training modes were carried out to verify the proposed control method. The passive rehabilitation training experimental results verify the effectiveness of the inner-loop position control strategy, which can meet the demands of gait tracking accuracy in rehabilitation training. The active rehabilitation training experimental results demonstrate that the personal adaption and active compliance are provided by the interactive controller in the robot-assistance for patients. The combined effects of flexibility of pneumatic actuators and compliance provided by the controller contribute to the training comfort, safety, and therapeutic outcome in the gait rehabilitation.
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Affiliation(s)
- Guo Bingjing
- School of Mechatronics Engineering, Henan University of Science and Technology, Luoyang, Henan, China
- Henan Provincial Key Laboratory of Robotics and Intelligent System, Luoyang, Henan, China
| | - Han Jianhai
- School of Mechatronics Engineering, Henan University of Science and Technology, Luoyang, Henan, China
- Henan Provincial Key Laboratory of Robotics and Intelligent System, Luoyang, Henan, China
- Collaborative Innovation Center of Machinery Equipment Advanced Manufacturing of Henan Province, Luoyang, Henan, China
| | - Li Xiangpan
- School of Mechatronics Engineering, Henan University of Science and Technology, Luoyang, Henan, China
- Henan Provincial Key Laboratory of Robotics and Intelligent System, Luoyang, Henan, China
| | - Yan Lin
- Wuhan COBOT Technology Co., Ltd., Wuhan, Hubei, China
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15
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A Therapist-Taught Robotic System for Assistance During Gait Therapy Targeting Foot Drop. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2018.2890674] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Aguirre-Güemez AV, Pérez-Sanpablo AI, Quinzaños-Fresnedo J, Pérez-Zavala R, Barrera-Ortiz A. Walking speed is not the best outcome to evaluate the effect of robotic assisted gait training in people with motor incomplete Spinal Cord Injury: A Systematic Review with meta-analysis. J Spinal Cord Med 2019; 42:142-154. [PMID: 29065788 PMCID: PMC6419626 DOI: 10.1080/10790268.2017.1390644] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
CONTEXT While there are previous systematic reviews on the effectiveness of the use of robotic-assisted gait training (RAGT) in people with spinal cord injuries (SCI), as this is a dynamic field, new studies have been produced that are now incorporated on this systematic review (SR) with meta-analysis, updating the available evidence on this area. OBJECTIVE To synthesise the available evidence on the use of RAGT, to improve gait, strength and functioning. METHODS SR and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions were implemented. Cochrane Injuries Group Specialized Register, PubMed, MEDLINE, EMBASE, CINAHL, ISIWeb of Science (SCIEXPANDED) databases were reviewed for the period 1990 to December 2016. Three researchers independently identified and categorized trials; 293 studies were identified, 273 eliminated; remaining 15 randomized clinical trials (RCT) and five SR. Six studies had available data for meta-analysis (222 participants). RESULTS The pooled mean demonstrated a beneficial effect of RAGT for WISCI, FIM-L and LEMS (3.01, 2.74 and 1.95 respectively), and no effect for speed. CONCLUSIONS The results show a positive effect in the use of RAGT. However, this should be taken carefully due to heterogeneity of the studies, small samples and identified limitations of some of the included trials. These results highlight the relevance of implementing a well-designed multicenter RCT powered enough to evaluate different RAGT approaches.
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Affiliation(s)
| | | | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Ramiro Pérez-Zavala
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Aída Barrera-Ortiz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
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Ayad S, Ayad M, Megueni A, Spaich EG, Struijk LNSA. Toward Standardizing the Classification of Robotic Gait Rehabilitation Systems. IEEE Rev Biomed Eng 2018; 12:138-153. [PMID: 30561350 DOI: 10.1109/rbme.2018.2886228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
With the existence of numerous rehabilitation systems, classification and comparison becomes difficult, especially due to the many factors involved. Moreover, most current reviews are descriptive and do not provide systematic methods for the visual comparison of systems. This review proposes a method for classifying systems and representing them graphically to easily visualize various characteristics of the different systems at the same time. This method could be an introduction for standardizing the evaluation of gait rehabilitation systems. It evaluates four main modules (body weight support, reciprocal stepping mechanism, pelvis mechanism, and environment module) of 27 different gait systems based on a set of characteristics. The combination of these modular evaluations provides a description of the system "in the space of rehabilitation." The evaluation of each robotic module, based on specific characteristics, showed diverse tendencies. While there is an augmented interest in developing more sophisticated reciprocal stepping mechanisms, few researchers are dedicated to enhance the properties of pelvis mechanisms.
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18
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Maggioni S, Reinert N, Lünenburger L, Melendez-Calderon A. An Adaptive and Hybrid End-Point/Joint Impedance Controller for Lower Limb Exoskeletons. Front Robot AI 2018; 5:104. [PMID: 33500983 PMCID: PMC7805861 DOI: 10.3389/frobt.2018.00104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Assist-as-needed (AAN) algorithms for the control of lower extremity rehabilitation robots can promote active participation of patients during training while adapting to their individual performances and impairments. The implementation of such controllers requires the adaptation of a control parameter (often the robot impedance) based on a performance (or error) metric. The choice of how an adaptive impedance controller is formulated implies different challenges and possibilities for controlling the patient's leg movement. In this paper, we analyze the characteristics and limitations of controllers defined in two commonly used formulations: joint and end-point space, exploring especially the implementation of an AAN algorithm. We propose then, as a proof-of-concept, an AAN impedance controller that combines the strengths of working in both spaces: a hybrid joint/end-point impedance controller. This approach gives the possibility to adapt the end-point stiffness in magnitude and direction in order to provide a support that targets the kinematic deviations of the end-point with the appropriate force vector. This controller was implemented on a two-link rehabilitation robot for gait training-the Lokomat®Pro V5 (Hocoma AG, Switzerland) and tested on 5 able-bodied subjects and 1 subject with Spinal Cord Injury. Our experiments show that the hybrid controller is a feasible approach for exoskeleton devices and that it could exploit the benefits of the end-point controller in shaping a desired end-point stiffness and those of the joint controller to promote the correct angular changes in the trajectories of the joints. The adaptation algorithm is able to adapt the end-point stiffness based on the subject's performance in different gait phases, i.e., the robot can render a higher stiffness selectively in the direction and gait phases where the subjects perform with larger kinematic errors. The proposed approach can potentially be generalized to other robotic applications for rehabilitation or assistive purposes.
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Affiliation(s)
- Serena Maggioni
- Department of Health Science and Technology, ETH Zürich, Zurich, Switzerland
- Hocoma AG, Volketswil, Switzerland
| | | | | | - Alejandro Melendez-Calderon
- Department of Health Science and Technology, ETH Zürich, Zurich, Switzerland
- Cereneo Advanced Rehabilitation Institute (CARINg), Vitznau, Switzerland
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
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19
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Bayón C, Martín-Lorenzo T, Moral-Saiz B, Ramírez Ó, Pérez-Somarriba Á, Lerma-Lara S, Martínez I, Rocon E. A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation. J Neuroeng Rehabil 2018; 15:69. [PMID: 30053857 PMCID: PMC6063005 DOI: 10.1186/s12984-018-0412-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to correctly implement robot-based treatments for gait rehabilitation. This contribution proposes an accurate robot-based training program for gait rehabilitation of pediatric population with Cerebral Palsy (CP). METHODS The program is focused on the achievement of some specifications defined by the International Classification of Functioning, Disability and Health framework, Children and Youth version (ICF-CY). It is framed on 16 non-consecutive sessions where motor control, strength and power exercises of lower limbs are performed in parallel with a postural control strategy. A clinical evaluation with four pediatric patients with CP using the CPWalker robotic platform is presented. RESULTS The preliminary evaluation with patients with CP shows improvements in several aspects as strength (74.03 ± 40.20%), mean velocity (21.46 ± 33.79%), step length (17.95 ± 20.45%) or gait performance (e.g. 66 ± 63.54% in Gross Motor Function Measure-88 items, E and D dimensions). CONCLUSIONS The improvements achieved in the short term show the importance of working strength and power functions meanwhile over-ground training with postural control. This research could serve as preliminary support for future clinical implementations in any robotic device. TRIAL REGISTRATION The study was carried out with the number R-0032/12 from Local Ethical Committee of the Hospital Infantil Niño Jesús. Public trial registered on March 23, 2017: ISRCTN18254257 .
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Affiliation(s)
- Cristina Bayón
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | - Teresa Martín-Lorenzo
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad Rey Juan Carlos, Madrid, Spain
| | - Beatriz Moral-Saiz
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad de La Salle, Madrid, Spain
| | - Óscar Ramírez
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | | | - Sergio Lerma-Lara
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad de La Salle, Madrid, Spain
| | | | - Eduardo Rocon
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain.
- Universidade Federal do Espírito Santo, Vitória, Brazil.
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20
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Weiland S, Smit IH, Reinders-Messelink H, van der Woude LHV, van Kammen K, den Otter R. The effect of asymmetric movement support on muscle activity during Lokomat guided gait in able-bodied individuals. PLoS One 2018; 13:e0198473. [PMID: 29864143 PMCID: PMC5986139 DOI: 10.1371/journal.pone.0198473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background To accommodate training for unilaterally affected patients (e.g. stroke), the Lokomat (a popular robotic exoskeleton-based gait trainer) provides the possibility to set the amount of movement guidance for each leg independently. Given the interlimb couplings, such asymmetrical settings may result in complex effects, in which ipsilateral activity co-depends on the amount of guidance offered to the contralateral leg. To test this idea, the effect of asymmetrical guidance on muscle activity was explored. Methods 15 healthy participants walked in the Lokomat at two speeds (1 and 2 km/h) and guidance levels (30% and 100%), during symmetrical (both legs receiving 30% or 100% guidance) and asymmetrical conditions (one leg receiving 30% and the other 100% guidance) resulting in eight unique conditions. Activity of the right leg was recorded from Erector Spinae, Gluteus Medius, Biceps Femoris, Semitendinosus, Vastus Medialis, Rectus Femoris, Medial Gastrocnemius and Tibialis Anterior. Statistical Parametric Mapping was used to assess whether ipsilateral muscle activity depended on guidance settings for the contralateral leg. Results Muscle output amplitude not only depended on ipsilateral guidance settings, but also on the amount of guidance provided to the contralateral leg. More specifically, when the contralateral leg received less guidance, ipsilateral activity of Gluteus Medius and Medial Gastrocnemius increased during stance. Conversely, when the contralateral leg received more guidance, ipsilateral muscle activity for these muscles decreased. These effects were specifically observed at 1 km/h, but not at 2 km/h. Conclusions This is the first study of asymmetrical guidance on muscle activity in the Lokomat, which shows that ipsilateral activity co-depends on the amount of contralateral guidance. In therapy, these properties may be exploited e.g. to promote active contributions by the more affected leg. Therefore, the present results urge further research on the use of asymmetrical guidance in patient groups targeted by Lokomat training.
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Affiliation(s)
- Sylvana Weiland
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
| | - Ineke H. Smit
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Heleen Reinders-Messelink
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
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21
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Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:7492024. [PMID: 29973978 PMCID: PMC6009012 DOI: 10.1155/2018/7492024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/22/2018] [Indexed: 11/18/2022]
Abstract
Robots were introduced in rehabilitation in the 90s to meet different needs, that is, reducing the physical effort of therapists. This work consists of a meta-analysis of robot-mediated lower limbs rehabilitation for stroke-affected patients; it aims at evaluating the effectiveness of the robotic approach through the use of wearable robots or operational machines with respect to the conventional approach (i.e., manual rehabilitation therapy). The primary assessed outcome is the patient's ability to recover walking independence, whereas the secondary outcome is the average walking speed. The therapy acceptability and the treatment costs are also assessed. The assessment shows that the robot-mediated therapy is more effective than the conventional one in reaching the primary outcome. As for the secondary outcome, there is no significant difference between the robotic (wearable robots or operational machines) and the conventional approach. Rehabilitation using wearable robots has a greater acceptability than the conventional one. This does not apply to operational machines. The cost of robotic treatment with wearable robots ranges from double to triple the cost of the conventional approach. On the contrary, rehabilitation using operational machines costs the same as the conventional treatment. Robotic rehabilitation based on operational machines is the most cost-effective approach.
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Zhao BL, Li WT, Zhou XH, Wu SQ, Cao HS, Bao ZR, An LB. Effective robotic assistive pattern of treadmill training for spinal cord injury in a rat model. Exp Ther Med 2018; 15:3283-3294. [PMID: 29545846 PMCID: PMC5840943 DOI: 10.3892/etm.2018.5822] [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] [Received: 09/28/2017] [Accepted: 01/24/2018] [Indexed: 01/18/2023] Open
Abstract
The purpose of the present study was to establish an effective robotic assistive stepping pattern of body-weight-supported treadmill training based on a rat spinal cord injury (SCI) model and assess the effect by comparing this with another frequently used assistive stepping pattern. The recorded stepping patterns of both hind limbs of trained intact rats were edited to establish a 30-sec playback normal rat stepping pattern (NRSP). Step features (step length, step height, step number and swing duration), BBB scores, latencies, and amplitudes of the transcranial electrical motor-evoked potentials (tceMEPs) and neurofilament 200 (NF200) expression in the spinal cord lesion area during and after 3 weeks of body-weight-supported treadmill training (BWSTT) were compared in rats with spinal contusion receiving NRSP assistance (NRSPA) and those that received manual assistance (MA). Hind limb stepping performance among rats receiving NRSPA during BWSTT was greater than that among rats receiving MA in terms of longer step length, taller step height, and longer swing duration. Furthermore a higher BBB score was also indicated. The rats in the NRSPA group achieved superior results in the tceMEPs assessment and greater NF200 expression in the spinal cord lesion area compared with the rats in the MA group. These findings suggest NRSPA was an effective assistive pattern of treadmill training compared with MA based on the rat SCI model and this approach could be used as a new platform for animal experiments for better understanding the mechanisms of SCI rehabilitation.
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Affiliation(s)
- Bo-Lun Zhao
- Department of Clinical Nursing, School of Nursing, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wen-Tao Li
- Department of Clinical Nursing, School of Nursing, Dalian University, Dalian, Liaoning 116622, P.R. China
| | - Xiao-Hua Zhou
- Department of Clinical Nursing, School of Nursing, Dalian University, Dalian, Liaoning 116622, P.R. China
| | - Su-Qian Wu
- Department of Clinical Nursing, School of Nursing, Dalian University, Dalian, Liaoning 116622, P.R. China
| | - Hong-Shi Cao
- Department of Clinical Nursing, School of Nursing, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhu-Ren Bao
- Department of Clinical Nursing, School of Nursing, Dalian University, Dalian, Liaoning 116622, P.R. China
| | - Li-Bin An
- Department of Clinical Nursing, School of Nursing, Jilin University, Changchun, Jilin 130021, P.R. China
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23
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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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Control design for a lower-limb paediatric therapy device using linear motor technology. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Li J, Chen D, Fan Y. An Open-Structure Treadmill Gait Trainer: From Research to Application. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9053630. [PMID: 29065662 PMCID: PMC5494776 DOI: 10.1155/2017/9053630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/26/2017] [Indexed: 11/17/2022]
Abstract
Lower limb rehabilitation robots are designed to enhance gait function in individuals with motor impairments. Although numerous rehabilitation robots have been developed, only few of these robots have been used in practical health care, particularly in China. The objective of this study is to construct a lower limb rehabilitation robot and bridge the gap between research and application. Open structure to facilitate practical application was created for the whole robot. Three typical movement patterns of a single leg were adopted in designing the exoskeletons, and force models for patient training were established and analyzed under three different conditions, respectively, and then a control system and security strategy were introduced. After establishing the robot, a preliminary experiment on the actual use of a prototype by patients was conducted to validate the functionality of the robot. The experiment showed that different patients and stages displayed different performances, and results on the trend variations across patients and across stages confirmed the validity of the robot and suggested that the design may lead to a system that could be successful in the treatment of patients with walking disorders in China. Furthermore, this study could provide a reference for a similar application design.
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Affiliation(s)
- Jian Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age and Disability and Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs and Engineering Research Center for Rehabilitation Aids of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
- Robotic Institute, Beihang University, Beijing 100191, China
| | - Diansheng Chen
- Robotic Institute, Beihang University, Beijing 100191, China
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age and Disability and Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs and Engineering Research Center for Rehabilitation Aids of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
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26
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Pan L, Song A, Xu G, Li H, Zeng H, Xu B. Safety Supervisory Strategy for an Upper-Limb Rehabilitation Robot Based on Impedance Control. INT J ADV ROBOT SYST 2017. [DOI: 10.5772/55094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lizheng Pan
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Aiguo Song
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Guozheng Xu
- College of Automation, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Huijun Li
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Hong Zeng
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Baoguo Xu
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
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27
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van Kammen K, Boonstra AM, van der Woude LHV, Reinders-Messelink HA, den Otter R. Differences in muscle activity and temporal step parameters between Lokomat guided walking and treadmill walking in post-stroke hemiparetic patients and healthy walkers. J Neuroeng Rehabil 2017; 14:32. [PMID: 28427422 PMCID: PMC5397709 DOI: 10.1186/s12984-017-0244-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/13/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Lokomat is a robotic exoskeleton that can be used to train gait function in hemiparetic stroke. To purposefully employ the Lokomat for training, it is important to understand (1) how Lokomat guided walking affects muscle activity following stroke and how these effects differ between patients and healthy walkers, (2) how abnormalities in the muscle activity of patients are modulated through Lokomat guided gait, and (3) how temporal step characteristics of patients were modulated during Lokomat guided walking. METHODS Ten hemiparetic stroke patients (>3 months post-stroke) and ten healthy age-matched controls walked on the treadmill and in the Lokomat (guidance force 50%, no bodyweight support) at matched speeds (0.56 m/s). Electromyography was used to record the activity of Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius and Tibialis Anterior, bilaterally in patients and of the dominant leg in healthy walkers. Pressure sensors placed in the footwear were used to determine relative durations of the first double support and the single support phases. RESULTS Overall, Lokomat guided walking was associated with a general lowering of muscle activity compared to treadmill walking, in patients as well as healthy walkers. The nature of these effects differed between groups for specific muscles, in that reductions in patients were larger if muscles were overly active during treadmill walking (unaffected Biceps Femoris and Gluteus Medius, affected Biceps Femoris and Vastus Lateralis), and smaller if activity was already abnormally low (affected Medial Gastrocnemius). Also, Lokomat guided walking was associated with a decrease in asymmetry in the relative duration of the single support phase. CONCLUSIONS In stroke patients, Lokomat guided walking results in a general reduction of muscle activity, that affects epochs of overactivity and epochs of reduced activity in a similar fashion. These findings should be taken into account when considering the clinical potential of the Lokomat training environment in stroke, and may inform further developments in the design of robotic gait trainers.
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Affiliation(s)
- Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, P.O. Box 196 21, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands. .,Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
| | - Anne M Boonstra
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
| | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, P.O. Box 196 21, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, P.O. Box 196 21, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Hussain S, Jamwal PK, Ghayesh MH. Effect of body weight support variation on muscle activities during robot assisted gait: a dynamic simulation study. Comput Methods Biomech Biomed Engin 2017; 20:626-635. [PMID: 28349768 DOI: 10.1080/10255842.2017.1282471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES While body weight support (BWS) intonation is vital during conventional gait training of neurologically challenged subjects, it is important to evaluate its effect during robot assisted gait training. In the present research we have studied the effect of BWS intonation on muscle activities during robotic gait training using dynamic simulations. METHODS Two dimensional (2-D) musculoskeletal model of human gait was developed conjointly with another 2-D model of a robotic orthosis capable of actuating hip, knee and ankle joints simultaneously. The musculoskeletal model consists of eight major muscle groups namely; soleus (SOL), gastrocnemius (GAS), tibialis anterior (TA), hamstrings (HAM), vasti (VAS), gluteus maximus (GLU), uniarticular hip flexors (iliopsoas, IP), and Rectus Femoris (RF). BWS was provided at levels of 0, 20, 40 and 60% during the simulations. In order to obtain a feasible set of muscle activities during subsequent gait cycles, an inverse dynamics algorithm along with a quadratic minimization algorithm was implemented. RESULTS The dynamic parameters of the robot assisted human gait such as joint angle trajectories, ground contact force (GCF), human limb joint torques and robot induced torques at different levels of BWS were derived. The patterns of muscle activities at variable BWS were derived and analysed. For most part of the gait cycle (GC) the muscle activation patterns are quite similar for all levels of BWS as is apparent from the mean of muscle activities for the complete GC. CONCLUSIONS Effect of BWS variation during robot assisted gait on muscle activities was studied by developing dynamic simulation. It is expected that the proposed dynamic simulation approach will provide important inferences and information about the muscle function variations consequent upon a change in BWS during robot assisted gait. This information shall be quite important while investigating the influence of BWS intonation on neuromuscular parameters of interest during robotic gait training.
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Affiliation(s)
- Shahid Hussain
- a School of Mechanical, Materials and Mechatronics Engineering , University of Wollongong , Wollongong , Australia
| | - Prashant K Jamwal
- b Department of Electrical and Electronics Engineering , Nazarbayev University , Astana , Kazakhstan
| | - Mergen H Ghayesh
- c School of Mechanical Engineering , University of Adelaide , Adelaide , Australia
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Ai Q, Ding B, Liu Q, Meng W. A Subject-Specific EMG-Driven Musculoskeletal Model for Applications in Lower-Limb Rehabilitation Robotics. INT J HUM ROBOT 2016. [DOI: 10.1142/s0219843616500055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Robotic devices have great potential in physical therapy owing to their repeatability, reliability and cost economy. However, there are great challenges to realize active control strategy, since the operator’s motion intention is uneasy to be recognized by robotics online. The purpose of this paper is to propose a subject-specific electromyography (EMG)-driven musculoskeletal model to estimate subject’s joint torque in real time, which can be used to detect his/her motion intention by forward dynamics, and then to explore its potential applications in rehabilitation robotics control. The musculoskeletal model uses muscle activation dynamics to extract muscle activation from raw EMG signals, a Hill-type muscle-tendon model to calculate muscle contraction force, and a proposed subject-specific musculoskeletal geometry model to calculate muscular moment arm. The parameters of muscle activation dynamics and muscle-tendon model are identified by off-line optimization methods in order to minimize the differences between the estimated muscular torques and the reference torques. Validation experiments were conducted on six healthy subjects to evaluate the proposed model. Experimental results demonstrated the model’s ability to predict knee joint torque with the coefficient of determination ([Formula: see text] value of [Formula: see text] and the normalized root-mean-square error (RMSE) of [Formula: see text].
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Affiliation(s)
- Qingsong Ai
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, P. R. China
| | - Bo Ding
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, P. R. China
| | - Quan Liu
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, P. R. China
| | - Wei Meng
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, P. R. China
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Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, Filoni S. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurol 2016; 16:12. [PMID: 26818847 PMCID: PMC4730780 DOI: 10.1186/s12883-016-0536-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury (SCI) is a severe neurological disorder associated not only with ongoing medical complications but also with a significant loss of mobility and participation. The introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. The aim of this preliminary report were to evaluate the efficacy, the feasibility and the changes in the mobility and in the de-adaptations of a new rehabilitative protocol for EKSO™ a robotic exoskeleton device in subjects with SCI disease with an impairment of lower limbs assessed by gait analysis and clinical outcomes. Method This is a pilot single case experimental A-B (pre-post) design study. Three cognitively intact voluntary participants with SCI and gait disorders were admitted. All subjects were submitted to a training program of robot walking sessions for 45 min daily over 20 sessions. The spatiotemporal parameters at the beginning (T0) and at the end of treatment (T1) were recorded. Other clinical assessments (6 min walking test and Timed Up and Go test) were acquired at T0 and T1. Results Robot training were feasible and acceptable and all participants completed the training sessions. All subjects showed improvements in gait spatiotemporal indexes (Mean velocity, Cadence, Step length and Step width) and in 6 min Walking Test (T0 versus T1). Conclusions Robot training is a feasible form of rehabilitation for people with SCI. Further investigation regarding long term effectiveness of robot training in time is necessary. Trial registration ClinicalTrials.gov NCT02065830.
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Affiliation(s)
- Patrizio Sale
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy.
| | | | - Michele Russo
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
| | - Stefano Masiero
- Department of Neuroscience, Rehabilitation Unit, University of Padua, Via Giustiniani 2, Padua, 35128, Italy
| | - Francesco Piccione
- Department of Neurorehabilitation, I.R.C.C.S. San Camillo Hospital, via Alberoni 70, 30126, Venice, Italy
| | - Rocco Salvatore Calabrò
- Neurobehavioral and Robotic Neurorehabilitation Laboratory Coordinator IRCCS Centro, Neurolesi "Bonino-Pulejo" Messina, Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, Foggia, Italy
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Kikuchi T, Sakai K, Ishiya K. Gait Analysis with Automatic Speed-Controlled Treadmill. JOURNAL OF ROBOTICS AND MECHATRONICS 2015. [DOI: 10.20965/jrm.2015.p0528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
<div class=""abs_img""> <img src=""[disp_template_path]/JRM/abst-image/00270005/09.jpg"" width=""300"" /> Automatic speed-controlled treadmill</div> Gait training is an important rehabilitation exercise that requires large space and support. To help it succeed, we developed an automatic speed-controlled treadmill with a sensor frame. A Microsoft Kinect sensor detects the user's legs, measuring step length and stride width. Leg information is used to control treadmill belt speed. Force sensors in the sensor frame measure support force and its center. Gait analysis using these values is discussed without including treadmill speed control. Subjects were healthy young males aged 22 to 23. Step length indicates the suitable belt speed for a subject. In experiments with automatic belt-speed control, the controller adjusts belt speed automatically based on how a user walks. </span>
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Trunk robot rehabilitation training with active stepping reorganizes and enriches trunk motor cortex representations in spinal transected rats. J Neurosci 2015; 35:7174-89. [PMID: 25948267 DOI: 10.1523/jneurosci.4366-14.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trunk motor control is crucial for postural stability and propulsion after low thoracic spinal cord injury (SCI) in animals and humans. Robotic rehabilitation aimed at trunk shows promise in SCI animal models and patients. However, little is known about the effect of SCI and robot rehabilitation of trunk on cortical motor representations. We previously showed reorganization of trunk motor cortex after adult SCI. Non-stepping training also exacerbated some SCI-driven plastic changes. Here we examine effects of robot rehabilitation that promotes recovery of hindlimb weight support functions on trunk motor cortex representations. Adult rats spinal transected as neonates (NTX rats) at the T9/10 level significantly improve function with our robot rehabilitation paradigm, whereas treadmill-only trained do not. We used intracortical microstimulation to map motor cortex in two NTX groups: (1) treadmill trained (control group); and (2) robot-assisted treadmill trained (improved function group). We found significant robot rehabilitation-driven changes in motor cortex: (1) caudal trunk motor areas expanded; (2) trunk coactivation at cortex sites increased; (3) richness of trunk cortex motor representations, as examined by cumulative entropy and mutual information for different trunk representations, increased; (4) trunk motor representations in the cortex moved toward more normal topography; and (5) trunk and forelimb motor representations that SCI-driven plasticity and compensations had caused to overlap were segregated. We conclude that effective robot rehabilitation training induces significant reorganization of trunk motor cortex and partially reverses some plastic changes that may be adaptive in non-stepping paraplegia after SCI.
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The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. J Neuroeng Rehabil 2015; 12:54. [PMID: 26076696 PMCID: PMC4469252 DOI: 10.1186/s12984-015-0048-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 06/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. METHODS H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the exoskeleton. A Likert scale was used to measure patient's perception about the easy of use of the device. RESULTS Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients. CONCLUSIONS The developed exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means to optimize a rehabilitation treatment that can be customized for individuals. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/show/NCT02114450 ).
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Swinnen E, Baeyens JP, Knaepen K, Michielsen M, Clijsen R, Beckwée D, Kerckhofs E. Robot-assisted walking with the Lokomat: the influence of different levels of guidance force on thorax and pelvis kinematics. Clin Biomech (Bristol, Avon) 2015; 30:254-9. [PMID: 25662678 DOI: 10.1016/j.clinbiomech.2015.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little attention has been devoted to the thorax and pelvis movements during gait. The aim of this study is to compare differences in the thorax and pelvis kinematics during unassisted walking on a treadmill and during walking with robot assistance (Lokomat-system (Hocoma, Volketswil, Switzerland)). METHODS 18 healthy persons walked on a treadmill with and without the Lokomat system at 2kmph. Three different conditions of guidance force (30%, 60% and 100%) were used during robot-assisted treadmill walking (30% body weight support). The maximal movement amplitudes of the thorax and pelvis were measured (Polhemus Liberty™ (Polhemus, Colchester, Vermont, USA) (240/16)). A repeated measurement ANOVA was conducted. FINDINGS Robot-assisted treadmill walking with different levels of guidance force showed significantly smaller maximal movement amplitudes for thorax and pelvis, compared to treadmill walking. Only the antero-posterior tilting of the pelvis was significantly increased during robot-assisted treadmill walking compared to treadmill walking. No significant changes of kinematic parameters were found between the different levels of guidance force. INTERPRETATION With regard to the thorax and pelvis movements, robot-assisted treadmill walking is significantly different compared to treadmill walking. It can be concluded that when using robot assistance, the thorax is stimulated in a different way than during walking without robot assistance, influencing the balance training during gait.
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Affiliation(s)
- Eva Swinnen
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE), Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Jean-Pierre Baeyens
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Biometry and Biomechanics (BIOM), Brussels, Belgium; University College Physiotherapy Thim van der Laan, Landquart, Switzerland
| | - Kristel Knaepen
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Menselijke Fysiologie (MFYS), Brussels, Belgium
| | - Marc Michielsen
- Jessa Hospital, Rehabilitation Center Sint-Ursula, Herk-de-Stad, Belgium
| | - Ron Clijsen
- University College Physiotherapy Thim van der Laan, Landquart, Switzerland
| | - David Beckwée
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE), Brussels, Belgium
| | - Eric Kerckhofs
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE), Brussels, Belgium; Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
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Cao J, Xie SQ, Das R, Zhu GL. Control strategies for effective robot assisted gait rehabilitation: The state of art and future prospects. Med Eng Phys 2014; 36:1555-66. [DOI: 10.1016/j.medengphy.2014.08.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
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Oza CS, Giszter SF. Plasticity and alterations of trunk motor cortex following spinal cord injury and non-stepping robot and treadmill training. Exp Neurol 2014; 256:57-69. [PMID: 24704619 PMCID: PMC7222855 DOI: 10.1016/j.expneurol.2014.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/14/2014] [Accepted: 03/20/2014] [Indexed: 12/18/2022]
Abstract
Spinal cord injury (SCI) induces significant reorganization in the sensorimotor cortex. Trunk motor control is crucial for postural stability and propulsion after low thoracic SCI and several rehabilitative strategies are aimed at trunk stability and control. However little is known about the effect of SCI and rehabilitation training on trunk motor representations and their plasticity in the cortex. Here, we used intracortical microstimulation to examine the motor cortex representations of the trunk in relation to other representations in three groups of chronic adult complete low thoracic SCI rats: chronic untrained, treadmill trained (but 'non-stepping') and robot assisted treadmill trained (but 'non-stepping') and compared with a group of normal rats. Our results demonstrate extensive and significant reorganization of the trunk motor cortex after chronic adult SCI which includes (1) expansion and rostral displacement of trunk motor representations in the cortex, with the greatest significant increase observed for rostral (to injury) trunk, and slight but significant increase of motor representation for caudal (to injury) trunk at low thoracic levels in all spinalized rats; (2) significant changes in coactivation and the synergy representation (or map overlap) between different trunk muscles and between trunk and forelimb. No significant differences were observed between the groups of transected rats for the majority of the comparisons. However, (3) the treadmill and robot-treadmill trained groups of rats showed a further small but significant rostral migration of the trunk representations, beyond the shift caused by transection alone. We conclude that SCI induces a significant reorganization of the trunk motor cortex, which is not qualitatively altered by non-stepping treadmill training or non-stepping robot assisted treadmill training, but is shifted further from normal topography by the training. This shift may potentially make subsequent rehabilitation with stepping longer or less successful.
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Affiliation(s)
- Chintan S Oza
- School of Biomedical Engineering and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Simon F Giszter
- School of Biomedical Engineering and Health Systems, Drexel University, Philadelphia, PA, USA; Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA, USA.
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Liu Q, Liu D, Meng W, Zhou Z, Ai Q. Fuzzy Sliding Mode Control of a Multi-DOF Parallel Robot in Rehabilitation Environment. INT J HUM ROBOT 2014. [DOI: 10.1142/s0219843614500042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multi-degrees of freedom (DOF) parallel robot, due to its compact structure and high operation accuracy, is a promising candidate for medical rehabilitation devices. However, its controllability relating to the nonlinear characteristics challenges its interaction with human subjects during the rehabilitation process. In this paper, we investigated the control of a parallel robot system using fuzzy sliding mode control (FSMC) for constructing a simple controller in practical rehabilitation, where a fuzzy logic system was used as the additional compensator to the sliding mode controller (SMC) for performance enhancement and chattering elimination. The system stability is guaranteed by the Lyapunov stability theorem. Experiments were conducted on a lower limb rehabilitation robot, which was built based on kinematics and dynamics analysis of the 6-DOF Stewart platform. The experimental results showed that the position tracking precision of the proposed FSMC is sufficient in practical applications, while the velocity chattering had been effectively reduced in comparison with the conventional FSMC with parameters tuned by fuzzy systems.
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Affiliation(s)
- Quan Liu
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
- School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Dong Liu
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
- School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Wei Meng
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
- School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Zude Zhou
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
- School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Qingsong Ai
- Key Laboratory of Fiber Optic Sensing Technology and Information Processing, Ministry of Education, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
- School of Information Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
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Williams CK, Carnahan H. Motor learning perspectives on haptic training for the upper extremities. IEEE TRANSACTIONS ON HAPTICS 2014; 7:240-250. [PMID: 24968385 DOI: 10.1109/toh.2013.2297102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recent developments in neurorehabilitation have spawned numerous new robotic rehabilitation therapies. However, many of the concepts upon which these therapies are based are not fully understood and it may be necessary to explore some of the motor learning principles that apply to the use of haptics for motor learning in non-clinical scenarios/populations. We conducted a review of studies that utilized a haptic training paradigm teaching healthy participants to perform a motor skill involving the upper extremities. We discuss studies in the context of four important motor learning concepts: performance versus learning, feedback, observational learning, and functional task difficulty. Additionally, we note that the proliferation of research in haptic training has led to an extensive vocabulary of terms, some of which may be misnomers or redundant. We propose a classification of terms describing haptic training in an effort to provide clarity and further contextualize the studies. We believe that making connections to motor learning principles and clarifying meanings will facilitate a fuller understanding of the outcomes of studies in basic science research and allow for more directed applications of these training techniques to clinical populations.
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Schindelholz M, Stoller O, Hunt K. A software module for cardiovascular rehabilitation in robotics-assisted treadmill exercise. Biomed Signal Process Control 2014. [DOI: 10.1016/j.bspc.2012.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jamwal PK, Hussain S, Xie SQ. Review on design and control aspects of ankle rehabilitation robots. Disabil Rehabil Assist Technol 2013; 10:93-101. [DOI: 10.3109/17483107.2013.866986] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sheffler LR, Chae J. Technological advances in interventions to enhance poststroke gait. Phys Med Rehabil Clin N Am 2013; 24:305-23. [PMID: 23598265 DOI: 10.1016/j.pmr.2012.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neurologic rehabilitation interventions may be either therapeutic or compensatory. Included in this article are lower extremity functional electrical stimulation, body weight-supported treadmill training, and lower extremity robotic-assisted gait training. These poststroke gait training therapies are predicated on activity-dependent neuroplasticity. All three interventions have been trialed extensively in research and clinical settings to show a positive effect on various gait parameters and measures of walking performance. This article provides an overview of evidence-based research that supports the efficacy of these three interventions to improve gait, as well as providing perspective on future developments to enhance poststroke gait in neurologic rehabilitation.
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Affiliation(s)
- Lynne R Sheffler
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, OH 44109, USA.
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Moreno JC, Barroso F, Farina D, Gizzi L, Santos C, Molinari M, Pons JL. Effects of robotic guidance on the coordination of locomotion. J Neuroeng Rehabil 2013; 10:79. [PMID: 23870328 PMCID: PMC3724716 DOI: 10.1186/1743-0003-10-79] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 06/14/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional integration of motor activity patterns enables the production of coordinated movements, such as walking. The activation of muscles by weightened summation of activation signals has been demonstrated to represent the spatiotemporal components that determine motor behavior during walking. Exoskeleton robotic devices are now often used in the rehabilitation practice to assist physical therapy of individuals with neurological disorders. These devices are used to promote motor recovery by providing guidance force to the patients. The guidance should in principle lead to a muscle coordination similar to physiological human walking. However, the influence of robotic devices on locomotor patterns needs still to be characterized. The aim of this study was to analyze the effect of force guidance and gait speed on the modular organization of walking in a group of eight healthy subjects. METHOD A group of healthy subjects walked on a treadmill with and without robotic aiding at speeds of 1.5, 2.0 and 2.5 Km/h. The guidance force was varied between 20%, 40%, 70% and 100% level of assistance. EMG recordings were obtained from seven leg muscles of the dominant leg and kinematic and kinetic features of the knee and hip joints were extracted. RESULTS Four motor modules were sufficient to represent the variety of behavioral goals demanded during robotic guidance, with similar relationships between muscle patterns and biomechanical parameters across subjects, confirming that the low-dimensional and impulsive control of human walking is maintained using robotic force guidance. The conditions of guidance force and speed that maintained correct and incorrect (not natural) modular control were identified. CONCLUSION In neurologically intact subjects robotic-guided walking at various force guidance and speed levels does not alter the basic locomotor control and timing. This allows the design of robotic-aided rehabilitation strategies aimed at the modulation of motor modules, which are altered in stroke.
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Affiliation(s)
- Juan C Moreno
- Bioengineering Group, Spanish National Research Council, CSIC, Carretera Campo Real, Madrid, Spain.
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Hussain S, Xie SQ, Jamwal PK. Effect of Cadence Regulation on Muscle Activation Patterns During Robot-Assisted Gait: A Dynamic Simulation Study. IEEE J Biomed Health Inform 2013. [DOI: 10.1109/titb.2012.2226596] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Currently in neurorehabilitation robotic devices are mostly applied for rehabilitation of the motor functions of the lower and upper extremities. Even if in recent research autonomous and humanoid robots are being used for cognitive rehabilitation robot medicated therapy predominately supports relearning of motor functions for subjects suffering from stroke, spinal cord injury or other neurological conditions. This review paper provides a summary of the main features and applied methods, and presents some examples to outline the large diversity of currently used devices. Future challenges for rehabilitation robotics to reach full clinical acceptance are clear answers regarding the optimal dosage of movement therapy and right inclusion/exclusion criteria for specific treatments.
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Hussain S, Xie SQ, Jamwal PK, Parsons J. An intrinsically compliant robotic orthosis for treadmill training. Med Eng Phys 2012; 34:1448-53. [PMID: 22421099 DOI: 10.1016/j.medengphy.2012.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/29/2011] [Accepted: 02/07/2012] [Indexed: 11/19/2022]
Abstract
A new intrinsically compliant robotic orthosis powered by pneumatic muscle actuators (PMA) was developed for treadmill training of neurologically impaired subjects. The robotic orthosis has hip and knee sagittal plane rotations actuated by antagonistic configuration of PMA. The orthosis has passive mechanisms to allow vertical and lateral translations of the trunk and a passive hip abduction/adduction joint. A foot lifter having a passive spring mechanism was used to ensure sufficient foot clearance during swing phase. A trajectory tracking controller was implemented to evaluate the performance of the robotic orthosis on a healthy subject. The results show that the robotic orthosis is able to perform the treadmill training task by providing sufficient torques to achieve physiological gait patterns and a realistic stepping experience. The orthosis is a new addition to the rapidly advancing field of robotic orthoses for treadmill training.
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Affiliation(s)
- Shahid Hussain
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.
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