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Khan AS, Livingstone DC, Hurd CL, Duchcherer J, Misiaszek JE, Gorassini MA, Manns PJ, Yang JF. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity. J Neuroeng Rehabil 2019; 16:145. [PMID: 31752911 PMCID: PMC6868817 DOI: 10.1186/s12984-019-0585-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment. Methods Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2–3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts. Results Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28–0.60 m/s, and distances of 0.74–1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments. Conclusion For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries. Trial registration NCT02322125 Registered 22 December 2014. Electronic supplementary material The online version of this article (10.1186/s12984-019-0585-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Atif S Khan
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Donna C Livingstone
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Caitlin L Hurd
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - John E Misiaszek
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Monica A Gorassini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia J Manns
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jaynie F Yang
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada. .,Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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A Wearable Body Controlling Device for Application of Functional Electrical Stimulation. SENSORS 2018; 18:s18041251. [PMID: 29670039 PMCID: PMC5948602 DOI: 10.3390/s18041251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
In this research, we describe a new balancing device used to stabilize the rear quarters of a patient dog with spinal cord injuries. Our approach uses inertial measurement sensing and direct leg actuation to lay a foundation for eventual muscle control by means of direct functional electrical stimulation (FES). During this phase of development, we designed and built a mechanical test-bed to develop the control and stimulation algorithms before we use the device on our animal subjects. We designed the bionic test-bed to mimic the typical walking gait of a dog and use it to develop and test the functionality of the balancing device for stabilization of patient dogs with hindquarter paralysis. We present analysis for various muscle stimulation and balancing strategies, and our device can be used by veterinarians to tailor the stimulation strength and temporal distribution for any individual patient dog. We develop stabilizing muscle stimulation strategies using the robotic test-bed to enhance walking stability. We present experimental results using the bionic test-bed to demonstrate that the balancing device can provide an effective sensing strategy and deliver the required motion control commands for stabilizing an actual dog with a spinal cord injury.
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The effect of 'Sensor Lock', a knee–ankle–foot orthosis with an electromechanical stance control knee joint, on walking parameters and gait symmetry of subjects with quadriceps weakness: a pilot study. Spinal Cord Ser Cases 2017. [DOI: 10.1038/scsandc.2017.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Arazpour M, Ahmadi Bani M, Baniasad M, Samadian M, Golchin N. Design, construction, and evaluation of "sensor lock": an electromechanical stance control knee joint. Disabil Rehabil Assist Technol 2017; 13:226-233. [PMID: 28350511 DOI: 10.1080/17483107.2017.1306591] [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: 10/19/2022]
Abstract
BACKGROUND AND AIM Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost. METHOD Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system. RESULTS For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users. CONCLUSIONS The feasibility of this new knee joint with AB people was demonstrated. Implications for rehabilitation Stance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking. Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially. The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated.
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Affiliation(s)
- Mokhtar Arazpour
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,c Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Science , Tehran , Islamic Republic of Iran
| | - Monireh Ahmadi Bani
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mina Baniasad
- d Mechanical Engineering Department , Sharif University of Technology , Tehran , Iran
| | - Mohammad Samadian
- e Department of Neurosurgery , Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Navid Golchin
- f Department of Neurosurgery , Firuzgar Hospital, Iran University of Medical Sciences , Tehran , Iran
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Mojaver A, Arazpour M, Aminian G, Ahmadi Bani M, Bahramizadeh M, Sharifi G, Sherafatvaziri A. The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study. Disabil Rehabil Assist Technol 2016; 12:747-751. [DOI: 10.1080/17483107.2016.1260654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ali Mojaver
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Student Research Commute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Holinski BJ, Mazurek KA, Everaert DG, Toossi A, Lucas-Osma AM, Troyk P, Etienne-Cummings R, Stein RB, Mushahwar VK. Intraspinal microstimulation produces over-ground walking in anesthetized cats. J Neural Eng 2016; 13:056016. [PMID: 27619069 DOI: 10.1088/1741-2560/13/5/056016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Spinal cord injury causes a drastic loss of motor, sensory and autonomic function. The goal of this project was to investigate the use of intraspinal microstimulation (ISMS) for producing long distances of walking over ground. ISMS is an electrical stimulation method developed for restoring motor function by activating spinal networks below the level of an injury. It produces movements of the legs by stimulating the ventral horn of the lumbar enlargement using fine penetrating electrodes (≤50 μm diameter). APPROACH In each of five adult cats (4.2-5.5 kg), ISMS was applied through 16 electrodes implanted with tips targeting lamina IX in the ventral horn bilaterally. A desktop system implemented a physiologically-based control strategy that delivered different stimulation patterns through groups of electrodes to evoke walking movements with appropriate limb kinematics and forces corresponding to swing and stance. Each cat walked over an instrumented 2.9 m walkway and limb kinematics and forces were recorded. MAIN RESULTS Both propulsive and supportive forces were required for over-ground walking. Cumulative walking distances ranging from 609 to 835 m (longest tested) were achieved in three animals. In these three cats, the mean peak supportive force was 3.5 ± 0.6 N corresponding to full-weight-support of the hind legs, while the angular range of the hip, knee, and ankle joints were 23.1 ± 2.0°, 29.1 ± 0.2°, and 60.3 ± 5.2°, respectively. To further demonstrate the viability of ISMS for future clinical use, a prototype implantable module was successfully implemented in a subset of trials and produced comparable walking performance. SIGNIFICANCE By activating inherent locomotor networks within the lumbosacral spinal cord, ISMS was capable of producing bilaterally coordinated and functional over-ground walking with current amplitudes <100 μA. These exciting results suggest that ISMS may be an effective intervention for restoring functional walking after spinal cord injury.
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Affiliation(s)
- B J Holinski
- Department of Biomedical Engineering, University of Alberta, Alberta, Canada. Project SMART (Alberta Innovates-Health Solutions Interdisciplinary Team in Smart Neural Prostheses), Canada
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Shamaei K, Napolitano PC, Dollar AM. Design and functional evaluation of a quasi-passive compliant stance control knee-ankle-foot orthosis. IEEE Trans Neural Syst Rehabil Eng 2014; 22:258-68. [PMID: 24608684 DOI: 10.1109/tnsre.2014.2305664] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper, we present the mechanical design, control algorithm, and functional evaluation of a quasi-passive compliant stance control knee-ankle-foot orthosis. The orthosis implements a spring in parallel with the knee joint during the stance phase of the gait and allows free rotation during the swing phase. The design is inspired by the moment-angle analysis of the knee joint revealing that the knee function approximates that of a linear torsional spring in the stance phase of the gait. Our orthosis aims to restore the natural function of a knee that is impaired by injury, stroke, post-polio, multiple sclerosis, spinal cord injury, patellofemoral pain syndrome, osteoarthritis, and others. Compared with state-of-the-art stance control orthoses, which rigidly lock the knee during the stance phase, the described orthosis intends to provide the natural shock absorption function of the knee in order to reduce compensatory movements both in the affected and unaffected limbs. Preliminary testing on three unimpaired subjects showed that compliant support of the knee provided by the orthosis explained here results in higher gait speed as well as more natural kinematic profiles for the lower extremities when compared with rigid support of the knee provided by an advanced commercial stance control orthosis.
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Holinski BJ, Everaert DG, Mushahwar VK, Stein RB. Real-time control of walking using recordings from dorsal root ganglia. J Neural Eng 2013; 10:056008. [PMID: 23928579 DOI: 10.1088/1741-2560/10/5/056008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of this study was to decode sensory information from the dorsal root ganglia (DRG) in real time, and to use this information to adapt the control of unilateral stepping with a state-based control algorithm consisting of both feed-forward and feedback components. APPROACH In five anesthetized cats, hind limb stepping on a walkway or treadmill was produced by patterned electrical stimulation of the spinal cord through implanted microwire arrays, while neuronal activity was recorded from the DRG. Different parameters, including distance and tilt of the vector between hip and limb endpoint, integrated gyroscope and ground reaction force were modelled from recorded neural firing rates. These models were then used for closed-loop feedback. MAIN RESULTS Overall, firing-rate-based predictions of kinematic sensors (limb endpoint, integrated gyroscope) were the most accurate with variance accounted for >60% on average. Force prediction had the lowest prediction accuracy (48 ± 13%) but produced the greatest percentage of successful rule activations (96.3%) for stepping under closed-loop feedback control. The prediction of all sensor modalities degraded over time, with the exception of tilt. SIGNIFICANCE Sensory feedback from moving limbs would be a desirable component of any neuroprosthetic device designed to restore walking in people after a spinal cord injury. This study provides a proof-of-principle that real-time feedback from the DRG is possible and could form part of a fully implantable neuroprosthetic device with further development.
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Affiliation(s)
- B J Holinski
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Hamzaid NA, Davis G. Health and Fitness Benefits of Functional Electrical Stimulation-Evoked Leg Exercise for Spinal Cord–Injured Individuals. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1404-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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