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Jiang X, Li J, Zhu Z, Liu X, Yuan Y, Chou C, Yan S, Dai C, Jia F. MovePort: Multimodal Dataset of EMG, IMU, MoCap, and Insole Pressure for Analyzing Abnormal Movements and Postures in Rehabilitation Training. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2633-2643. [PMID: 39024074 DOI: 10.1109/tnsre.2024.3429637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
In most real world rehabilitation training, patients are trained to regain motion capabilities with the aid of functional/epidural electrical stimulation (FES/EES), under the support of gravity-assist systems to prevent falls. However, the lack of motion analysis dataset designed specifically for rehabilitation-related applications largely limits the conduct of pilot research. We provide an open access dataset, consisting of multimodal data collected via 16 electromyography (EMG) sensors, 6 inertial measurement unit (IMU) sensors, and 230 insole pressure sensors (IPS) per foot, together with a 26-sensor motion capture system, under different MOVEments and POstures for Rehabilitation Training (MovePort). Data were collected under diverse experimental paradigms. Twenty four participants first imitated multiple normal and abnormal body postures including (1) normal standing still, (2) leaning forward, (3) leaning back, and (4) half-squat, which in practical applications, can be detected as feedback to tune the parameters of FES/EES and gravity-assist systems to keep patients in a target body posture. Data under imitated abnormal gaits, e.g., (1) with legs raised higher under excessive electrical stimulation, and (2) with dragging legs under insufficient stimulation, were also collected. Data under normal gaits with low, medium and high speeds are also included. Pathological gait data from a subject with spastic paraplegia further increases the clinical value of our dataset. We also provide source codes to perform both intra- and inter-participant motion analyses of our dataset. We expect our dataset can provide a unique platform to promote collaboration among neurorehabilitation engineers.
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Milekovic T, Moraud EM, Macellari N, Moerman C, Raschellà F, Sun S, Perich MG, Varescon C, Demesmaeker R, Bruel A, Bole-Feysot LN, Schiavone G, Pirondini E, YunLong C, Hao L, Galvez A, Hernandez-Charpak SD, Dumont G, Ravier J, Le Goff-Mignardot CG, Mignardot JB, Carparelli G, Harte C, Hankov N, Aureli V, Watrin A, Lambert H, Borton D, Laurens J, Vollenweider I, Borgognon S, Bourre F, Goillandeau M, Ko WKD, Petit L, Li Q, Buschman R, Buse N, Yaroshinsky M, Ledoux JB, Becce F, Jimenez MC, Bally JF, Denison T, Guehl D, Ijspeert A, Capogrosso M, Squair JW, Asboth L, Starr PA, Wang DD, Lacour SP, Micera S, Qin C, Bloch J, Bezard E, Courtine G. A spinal cord neuroprosthesis for locomotor deficits due to Parkinson's disease. Nat Med 2023; 29:2854-2865. [PMID: 37932548 DOI: 10.1038/s41591-023-02584-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/08/2023] [Indexed: 11/08/2023]
Abstract
People with late-stage Parkinson's disease (PD) often suffer from debilitating locomotor deficits that are resistant to currently available therapies. To alleviate these deficits, we developed a neuroprosthesis operating in closed loop that targets the dorsal root entry zones innervating lumbosacral segments to reproduce the natural spatiotemporal activation of the lumbosacral spinal cord during walking. We first developed this neuroprosthesis in a non-human primate model that replicates locomotor deficits due to PD. This neuroprosthesis not only alleviated locomotor deficits but also restored skilled walking in this model. We then implanted the neuroprosthesis in a 62-year-old male with a 30-year history of PD who presented with severe gait impairments and frequent falls that were medically refractory to currently available therapies. We found that the neuroprosthesis interacted synergistically with deep brain stimulation of the subthalamic nucleus and dopaminergic replacement therapies to alleviate asymmetry and promote longer steps, improve balance and reduce freezing of gait. This neuroprosthesis opens new perspectives to reduce the severity of locomotor deficits in people with PD.
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Affiliation(s)
- Tomislav Milekovic
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Nicolo Macellari
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Charlotte Moerman
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Flavio Raschellà
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Shiqi Sun
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Camille Varescon
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Robin Demesmaeker
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Alice Bruel
- Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Léa N Bole-Feysot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Giuseppe Schiavone
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Laboratory for Soft Bioelectronic Interfaces (LSBI), NeuroX Institute, EPFL, Lausanne, Switzerland
| | - Elvira Pirondini
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheng YunLong
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Li Hao
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Andrea Galvez
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Sergio Daniel Hernandez-Charpak
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Gregory Dumont
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Jimmy Ravier
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Camille G Le Goff-Mignardot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Jean-Baptiste Mignardot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Gaia Carparelli
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Cathal Harte
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Nicolas Hankov
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Viviana Aureli
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | | | | | - David Borton
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- School of Engineering, Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Jean Laurens
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Isabelle Vollenweider
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Simon Borgognon
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - François Bourre
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Michel Goillandeau
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Wai Kin D Ko
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Laurent Petit
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Qin Li
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | | | | | - Maria Yaroshinsky
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, CHUV/UNIL, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, CHUV/UNIL, Lausanne, Switzerland
| | | | - Julien F Bally
- Department of Neurology, CHUV/UNIL, Lausanne, Switzerland
| | | | - Dominique Guehl
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Auke Ijspeert
- Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Marco Capogrosso
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Squair
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Leonie Asboth
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Stéphanie P Lacour
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
- Laboratory for Soft Bioelectronic Interfaces (LSBI), NeuroX Institute, EPFL, Lausanne, Switzerland
| | - Silvestro Micera
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
- Department of Excellence in Robotics and AI, Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chuan Qin
- China Academy of Medical Sciences, Beijing, China
| | - Jocelyne Bloch
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
- Department of Neurosurgery, CHUV, Lausanne, Switzerland.
| | - Erwan Bezard
- Motac Neuroscience, UK-M15 6WE, Manchester, UK.
- China Academy of Medical Sciences, Beijing, China.
- Institute of Laboratory Animal Sciences, Beijing, China.
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
| | - G Courtine
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
- Department of Neurosurgery, CHUV, Lausanne, Switzerland.
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Li G, Li Z, Su CY, Xu T. Active Human-Following Control of an Exoskeleton Robot With Body Weight Support. IEEE TRANSACTIONS ON CYBERNETICS 2023; 53:7367-7379. [PMID: 37030717 DOI: 10.1109/tcyb.2023.3253181] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This article presents an active human-following control of the lower limb exoskeleton for gait training. First, to improve safety, considering the human balance, the OpenPose-based visual feedback is used to estimate the individual's pose, then, the active human-following algorithm is proposed for the exoskeleton robot to achieve the body weight support and active human-following. Second, taking the human's intention and voluntary efforts into account, we develop a long short-term memory (LSTM) network to extract surface electromyography (sEMG) to build the estimation model of joints' angles, that is, the multichannel sEMG signals can be correlated with flexion/extension (FE) joints' angles of the human lower limb. Finally, to make the robot motion adapt to the locomotion of subjects under uncertain nonlinear dynamics, an adaptive control strategy is designed to drive the exoskeleton robot to track the desired locomotion trajectories stably. To verify the effectiveness of the proposed control framework, several recruited subjects participated in the experiments. Experimental results show that the proposed joints' angles estimation model based on the LSTM network has a higher estimation accuracy and predicted performance compared with the existing deep neural network, and good simultaneous locomotion tracking performance is achieved by the designed control strategy, which indicates that the proposed control can assist subjects to perform gait training effectively.
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Takai A, Teramae T, Noda T, Ishihara K, Furukawa JI, Fujimoto H, Hatakenaka M, Fujita N, Jino A, Hiramatsu Y, Miyai I, Morimoto J. Development of split-force-controlled body weight support (SF-BWS) robot for gait rehabilitation. Front Hum Neurosci 2023; 17:1197380. [PMID: 37497041 PMCID: PMC10366359 DOI: 10.3389/fnhum.2023.1197380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023] Open
Abstract
This study introduces a body-weight-support (BWS) robot actuated by two pneumatic artificial muscles (PAMs). Conventional BWS devices typically use springs or a single actuator, whereas our robot has a split force-controlled BWS (SF-BWS), in which two force-controlled actuators independently support the left and right sides of the user's body. To reduce the experience of weight, vertical unweighting support forces are transferred directly to the user's left and right hips through a newly designed harness with an open space around the shoulder and upper chest area to allow freedom of movement. A motion capture evaluation with three healthy participants confirmed that the proposed harness does not impede upper-body motion during laterally identical force-controlled partial BWS walking, which is quantitatively similar to natural walking. To evaluate our SF-BWS robot, we performed a force-tracking and split-force control task using different simulated load weight setups (40, 50, and 60 kg masses). The split-force control task, providing independent force references to each PAM and conducted with a 60 kg mass and a test bench, demonstrates that our SF-BWS robot is capable of shifting human body weight in the mediolateral direction. The SF-BWS robot successfully controlled the two PAMs to generate the desired vertical support forces.
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Affiliation(s)
- Asuka Takai
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Graduate School of Engineering Division of Mechanical Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Tatsuya Teramae
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Tomoyuki Noda
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Koji Ishihara
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
| | - Jun-ichiro Furukawa
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Man-Machine Collaboration Research Team, Guardian Robot Project, RIKEN, Kyoto, Japan
| | - Hiroaki Fujimoto
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Megumi Hatakenaka
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Nobukazu Fujita
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Akihiro Jino
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Yuichi Hiramatsu
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Ichiro Miyai
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka, Japan
| | - Jun Morimoto
- Department of Brain Robot Interface, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan
- Man-Machine Collaboration Research Team, Guardian Robot Project, RIKEN, Kyoto, Japan
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
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5
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Kathe C, Skinnider MA, Hutson TH, Regazzi N, Gautier M, Demesmaeker R, Komi S, Ceto S, James ND, Cho N, Baud L, Galan K, Matson KJE, Rowald A, Kim K, Wang R, Minassian K, Prior JO, Asboth L, Barraud Q, Lacour SP, Levine AJ, Wagner F, Bloch J, Squair JW, Courtine G. The neurons that restore walking after paralysis. Nature 2022; 611:540-547. [DOI: 10.1038/s41586-022-05385-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/23/2022] [Indexed: 11/10/2022]
Abstract
AbstractA spinal cord injury interrupts pathways from the brain and brainstem that project to the lumbar spinal cord, leading to paralysis. Here we show that spatiotemporal epidural electrical stimulation (EES) of the lumbar spinal cord1–3 applied during neurorehabilitation4,5 (EESREHAB) restored walking in nine individuals with chronic spinal cord injury. This recovery involved a reduction in neuronal activity in the lumbar spinal cord of humans during walking. We hypothesized that this unexpected reduction reflects activity-dependent selection of specific neuronal subpopulations that become essential for a patient to walk after spinal cord injury. To identify these putative neurons, we modelled the technological and therapeutic features underlying EESREHAB in mice. We applied single-nucleus RNA sequencing6–9 and spatial transcriptomics10,11 to the spinal cords of these mice to chart a spatially resolved molecular atlas of recovery from paralysis. We then employed cell type12,13 and spatial prioritization to identify the neurons involved in the recovery of walking. A single population of excitatory interneurons nested within intermediate laminae emerged. Although these neurons are not required for walking before spinal cord injury, we demonstrate that they are essential for the recovery of walking with EES following spinal cord injury. Augmenting the activity of these neurons phenocopied the recovery of walking enabled by EESREHAB, whereas ablating them prevented the recovery of walking that occurs spontaneously after moderate spinal cord injury. We thus identified a recovery-organizing neuronal subpopulation that is necessary and sufficient to regain walking after paralysis. Moreover, our methodology establishes a framework for using molecular cartography to identify the neurons that produce complex behaviours.
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6
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Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis. Nat Med 2022; 28:260-271. [PMID: 35132264 DOI: 10.1038/s41591-021-01663-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022]
Abstract
Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.
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7
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Hachmann JT, Yousak A, Wallner JJ, Gad PN, Edgerton VR, Gorgey AS. Epidural spinal cord stimulation as an intervention for motor recovery after motor complete spinal cord injury. J Neurophysiol 2021; 126:1843-1859. [PMID: 34669485 DOI: 10.1152/jn.00020.2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/12/2021] [Indexed: 12/19/2022] Open
Abstract
Spinal cord injury (SCI) commonly results in permanent loss of motor, sensory, and autonomic function. Recent clinical studies have shown that epidural spinal cord stimulation may provide a beneficial adjunct for restoring lower extremity and other neurological functions. Herein, we review the recent clinical advances of lumbosacral epidural stimulation for restoration of sensorimotor function in individuals with motor complete SCI and we discuss the putative neural pathways involved in this promising neurorehabilitative approach. We focus on three main sections: review recent clinical results for locomotor restoration in complete SCI; discuss the contemporary understanding of electrical neuromodulation and signal transduction pathways involved in spinal locomotor networks; and review current challenges of motor system modulation and future directions toward integrative neurorestoration. The current understanding is that initial depolarization occurs at the level of large diameter dorsal root proprioceptive afferents that when integrated with interneuronal and latent residual supraspinal translesional connections can recruit locomotor centers and augment downstream motor units. Spinal epidural stimulation can initiate excitability changes in spinal networks and supraspinal networks. Different stimulation parameters can facilitate standing or stepping, and it may also have potential for augmenting myriad other sensorimotor and autonomic functions. More comprehensive investigation of the mechanisms that mediate the transformation of dysfunctional spinal networks to higher functional states with a greater focus on integrated systems-based control system may reveal the key mechanisms underlying neurological augmentation and motor restoration after severe paralysis.
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Affiliation(s)
- Jan T Hachmann
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Andrew Yousak
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, Virginia
| | - Josephine J Wallner
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, Virginia
| | - Parag N Gad
- Department of Neurobiology, University of California, Los Angeles, California
| | - V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, California
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació Badalona, Barcelona, Spain
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, Virginia
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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8
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Plooij M, Apte S, Keller U, Baines P, Sterke B, Asboth L, Courtine G, von Zitzewitz J, Vallery H. Neglected physical human-robot interaction may explain variable outcomes in gait neurorehabilitation research. Sci Robot 2021; 6:eabf1888. [PMID: 34550719 DOI: 10.1126/scirobotics.abf1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- M Plooij
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Demcon Advanced Mechatronics, Delfttechpark 23, Delft, Netherlands.,Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands
| | - S Apte
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - U Keller
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
| | - P Baines
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
| | - B Sterke
- Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
| | - L Asboth
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - G Courtine
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - J von Zitzewitz
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - H Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
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Hagio S, Nakazato M, Kouzaki M. Modulation of spatial and temporal modules in lower limb muscle activations during walking with simulated reduced gravity. Sci Rep 2021; 11:14749. [PMID: 34285306 PMCID: PMC8292403 DOI: 10.1038/s41598-021-94201-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Gravity plays a crucial role in shaping patterned locomotor output to maintain dynamic stability during locomotion. The present study aimed to clarify the gravity-dependent regulation of modules that organize multiple muscle activities during walking in humans. Participants walked on a treadmill at seven speeds (1-6 km h-1 and a subject- and gravity-specific speed determined by the Froude number (Fr) corresponding to 0.25) while their body weight was partially supported by a lift to simulate walking with five levels of gravity conditions from 0.07 to 1 g. Modules, i.e., muscle-weighting vectors (spatial modules) and phase-dependent activation coefficients (temporal modules), were extracted from 12 lower-limb electromyographic (EMG) activities in each gravity (Fr ~ 0.25) using nonnegative matrix factorization. Additionally, a tensor decomposition model was fit to the EMG data to quantify variables depending on the gravity conditions and walking speed with prescribed spatial and temporal modules. The results demonstrated that muscle activity could be explained by four modules from 1 to 0.16 g and three modules at 0.07 g, and the modules were shared for both spatial and temporal components among the gravity conditions. The task-dependent variables of the modules acting on the supporting phase linearly decreased with decreasing gravity, whereas that of the module contributing to activation prior to foot contact showed nonlinear U-shaped modulation. Moreover, the profiles of the gravity-dependent modulation changed as a function of walking speed. In conclusion, reduced gravity walking was achieved by regulating the contribution of prescribed spatial and temporal coordination in muscle activities.
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Affiliation(s)
- Shota Hagio
- Laboratory of Neurophysiology, Graduate School of Human and Environmental Studies, Kyoto University, Yoshida-nihonmatsu-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
- Unit of Synergetic Studies for Space, Kyoto University, Kyoto, 606-8502, Japan.
| | - Makoto Nakazato
- Laboratory of Neurophysiology, Graduate School of Human and Environmental Studies, Kyoto University, Yoshida-nihonmatsu-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Motoki Kouzaki
- Laboratory of Neurophysiology, Graduate School of Human and Environmental Studies, Kyoto University, Yoshida-nihonmatsu-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Unit of Synergetic Studies for Space, Kyoto University, Kyoto, 606-8502, Japan
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10
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Bonizzato M, Martinez M. An intracortical neuroprosthesis immediately alleviates walking deficits and improves recovery of leg control after spinal cord injury. Sci Transl Med 2021; 13:13/586/eabb4422. [PMID: 33762436 DOI: 10.1126/scitranslmed.abb4422] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 01/09/2021] [Indexed: 12/18/2022]
Abstract
Most rehabilitation interventions after spinal cord injury (SCI) only target the sublesional spinal networks, peripheral nerves, and muscles. However, mammalian locomotion is not a mere act of rhythmic pattern generation. Recovery of cortical control is essential for voluntary movement and modulation of gait. We developed an intracortical neuroprosthetic intervention to SCI, with the goal to condition cortical locomotor control. Neurostimulation delivered in phase coherence with ongoing locomotion immediately alleviated primary SCI deficits, such as leg dragging, in rats with incomplete SCI. Cortical neurostimulation achieved high fidelity and markedly proportional online control of leg trajectories in both healthy and SCI rats. Long-term neuroprosthetic training lastingly improved cortical control of locomotion, whereas short training held transient improvements. We performed longitudinal awake cortical motor mapping, unveiling that recovery of cortico-spinal transmission tightly parallels return of locomotor function in rats. These results advocate directly targeting the motor cortex in clinical neuroprosthetic approaches.
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Affiliation(s)
- Marco Bonizzato
- Department of Neurosciences and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montréal, Québec H3T 1N8, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec H4J 1C5, Canada
| | - Marina Martinez
- Department of Neurosciences and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montréal, Québec H3T 1N8, Canada. .,CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec H4J 1C5, Canada
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11
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Srivastava E, Singh A, Kumar A. Spinal cord regeneration: A brief overview of the present scenario and a sneak peek into the future. Biotechnol J 2021; 16:e2100167. [PMID: 34080314 DOI: 10.1002/biot.202100167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 01/01/2023]
Abstract
The central nervous system (CNS) portrays appreciable complexity in developing from a neural tube to controlling major functions of the body and orchestrated co-ordination in maintaining its homeostasis. Any insult or pathology to such an organized tissue leads to a plethora of events ranging from local hypoxia, ischemia, oxidative stress to reactive gliosis and scarring. Despite unravelling the pathophysiology of spinal cord injury (SCI) and linked cellular and molecular mechanism, the over exhaustive inflammatory response at the site of injury, limited intrinsic regeneration capability of CNS, and the dual role of glial scar halts the expected accomplishment. The review discusses major current treatment approaches for traumatic SCI, addressing their limitation and scope for further development in the field under three main categories- neuroprotection, neuro-regeneration, and neuroplasticity. We further propose that a multi-disciplinary combinatorial treatment approach exploring any two or all three heads simultaneously might alleviate the inhibitory milieu and ameliorate functional recovery.
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Affiliation(s)
- Ekta Srivastava
- Biomaterial and Tissue Engineering Group, Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India
| | - Anamika Singh
- Biomaterial and Tissue Engineering Group, Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India
| | - Ashok Kumar
- Biomaterial and Tissue Engineering Group, Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India.,Centre for Environmental Science and Engineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India.,Centre for Nanosciences, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India.,The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India
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12
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Leme B, Hirokawa M, Kadone H, Suzuki K. A Socially Assistive Mobile Platform for Weight-Support in Gait Training. Int J Soc Robot 2021. [DOI: 10.1007/s12369-019-00550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Aguirre-Ollinger G, Yu H. Omnidirectional Platforms for Gait Training: Admittance-Shaping Control for Enhanced Mobility. J INTELL ROBOT SYST 2021. [DOI: 10.1007/s10846-021-01335-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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14
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Yao Q, Guan J, Ma L, Cheng L, Duan F, Xu F, Zhao W, Duan W, Wu H, Chen Z, Jian F. Wireless Epidural Electrical Stimulation in Combination With Serotonin Agonists Improves Intraspinal Metabolism in Spinal Cord Injury Rats. Neuromodulation 2020; 24:416-426. [PMID: 33377590 DOI: 10.1111/ner.13344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The combination of epidural electrical stimulation (EES) and serotonin agonists (5-HTA) effectively restores rhythmic lower-limb movements and improves intraspinal hemodynamics after spinal cord injury (SCI). Nonetheless, whether EES + 5-HTA improves intraspinal metabolism remains unclear. The present study aimed to evaluate the effects of EES + 5-HTA on intraspinal metabolism in SCI rats. MATERIALS AND METHODS Wireless EES (WEES) implantation with complete T8 transection was performed in SCI rats. Electrodes were placed at the T12 and L2 vertebral levels. After rest for a week, the SCI rats received 11 weeks of WEES + 5-HTA treatment and treadmill training. WEES was switched off after each daily training. Locomotor function was evaluated by motion capture at week 12. Positron emission tomography-computed tomography was conducted to evaluate basal metabolism when WEES was switched off and assess task metabolism when WEES was switched on. RESULTS With locomotor recovery after training for 11 weeks, WEES + 5-HTA conjointly improved basal metabolism (vs. each intervention alone; p < 0.05) and linearly modulated task metabolism in a frequency-dependent manner (R2 = 0.8901). Furthermore, 60 Hz of WEES was identified as the threshold for the extensive activation of the spinal cord's task metabolism below the transection plane (p < 0.05). CONCLUSIONS WEES + 5-HTA could conjointly restore basal metabolism to a healthy level and modulate task metabolism by adjusting the stimulation frequency.
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Affiliation(s)
- Qingyu Yao
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longbing Ma
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei Cheng
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Duan
- College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Fu Xu
- School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Wang Zhao
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Wanru Duan
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
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15
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Simpson C, Huerta B, Sketch S, Lansberg M, Hawkes E, Okamura A. Upper Extremity Exomuscle for Shoulder Abduction Support. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3012471] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Lemus D, Berry A, Jabeen S, Jayaraman C, Hohl K, van der Helm FCT, Jayaraman A, Vallery H. Controller synthesis and clinical exploration of wearable gyroscopic actuators to support human balance. Sci Rep 2020; 10:10412. [PMID: 32591577 PMCID: PMC7320159 DOI: 10.1038/s41598-020-66760-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Gyroscopic actuators are appealing for wearable applications due to their ability to provide overground balance support without obstructing the legs. Multiple wearable robots using this actuation principle have been proposed, but none has yet been evaluated with humans. Here we use the GyBAR, a backpack-like prototype portable robot, to investigate the hypothesis that the balance of both healthy and chronic stroke subjects can be augmented through moments applied to the upper body. We quantified balance performance in terms of each participant's ability to walk or remain standing on a narrow support surface oriented to challenge stability in either the frontal or the sagittal plane. By comparing candidate balance controllers, it was found that effective assistance did not require regulation to a reference posture. A rotational viscous field increased the distance healthy participants could walk along a 30mm-wide beam by a factor of 2.0, compared to when the GyBAR was worn but inactive. The same controller enabled individuals with chronic stroke to remain standing for a factor of 2.5 longer on a narrow block. Due to its wearability and versatility of control, the GyBAR could enable new therapy interventions for training and rehabilitation.
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Affiliation(s)
- Daniel Lemus
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Andrew Berry
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Chandrasekaran Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Frans C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands.
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17
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Apte S, Plooij M, Vallery H. Simulation of human gait with body weight support: benchmarking models and unloading strategies. J Neuroeng Rehabil 2020; 17:81. [PMID: 32586398 PMCID: PMC7318415 DOI: 10.1186/s12984-020-00697-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 05/21/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Gait training with partial body weight support (BWS) has become an established rehabilitation technique. Besides passive unloading mechanisms such as springs or counterweights, also active systems that allow rendering constant or modulated vertical forces have been proposed. However, only pilot studies have been conducted to compare different unloading or modulation strategies, and conducting experimental studies is costly and time-consuming. Simulation models that predict the influence of unloading force on human walking may help select the most promising candidates for further evaluation. However, the reliability of simulation results depends on the chosen gait model. The purpose of this paper is two-fold: First, using human experimental data, we evaluate the accuracy of some of the most prevalent walking models in replicating human walking under the influence of Constant-Force BWS: The Simplest Walking model (SW), the Spring-Loaded Inverted Pendulum model (SLIP) and the Muscle-Reflex (MR) gait model. Second, three realizations of BWS, based on Constant-Force (CF), Counterweight (CW) and Tuned-Spring (TS) approaches, are compared to each other in terms of their influence on gait parameters. METHODS We conducted simulations in Matlab/Simulink to model the behaviour of each gait model under all three BWS conditions. Nine simulations were undertaken in total and gait parameter response was analysed in each case. Root mean square error (mrmse) w.r.t human data was used to compare the accuracy of gait models. The metrics of interest were spatiotemporal parameters and the vertical ground reaction forces. To scrutinize the BWS strategies, loss of dynamic similarity was calculated in terms of root mean square difference in gait dynamics (Δgd) with respect to the reference gait under zero unloading. The gait dynamics were characterized by a dimensionless number Modela-w. RESULTS SLIP model showed the lowest mrmse for 6 out of 8 gait parameters and for 1 other, the mrmse value were comparable to the MR model; SW model had the highest mrmse. Out of three BWS strategies, Tuned-Spring strategies led to the lowest Δgd values. CONCLUSIONS The results of this work demonstrate the usefulness of gait models for BWS simulation and suggest the SLIP model to be more suitable for BWS simulations than the Simplest Walker and the Muscle-reflex models. Further, the Tuned-Spring approach appears to cause less distortions to the gait pattern than the more established Counterweight and Constant-Force approaches and merits experimental verification.
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Affiliation(s)
- Salil Apte
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, 2628 CD Netherlands
- Laboratory of Movement Analysis and Measurement (LMAM), École Polytechnique Fédérale de Lausanne, Station 9, Lausanne, CH-1015 Switzerland
| | - Michiel Plooij
- Motek Medical BV, Hogehilweg 18C, Amsterdam, 1101 CD Netherlands
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, Delft, 2628 CD Netherlands
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18
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Song Z, Chen W, Wang W, Zhang G. Dynamic Modeling and Simulation of a Body Weight Support System. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:2802574. [PMID: 32104557 PMCID: PMC7038437 DOI: 10.1155/2020/2802574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
Abstract
This paper proposes a body weight support (BWS) system with a series elastic actuator (SEA) to facilitate walking assistance and motor relearning during gait rehabilitation. This system comprises the following: a mobile platform that ensures movement of the system on the ground, a BWS mechanism with an SEA that is capable of providing the desired unloading force, and a pelvic brace to smooth the pelvis motions. The control of the body weight support is realized by an active weight-offload method, and a dynamic model of the BWS system with offload mass of a human is conducted to simulate the control process and optimize the parameters. Preliminary results demonstrate that the BWS system can provide the desired support force and vertical motion of the pelvis.
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Affiliation(s)
- Zhendong Song
- Shen Zhen Polytechnic, 4089 Shahe West Road, Shenzhen 518055, China
| | - Wei Chen
- Shen Zhen Polytechnic, 4089 Shahe West Road, Shenzhen 518055, China
| | - Wenbing Wang
- Shen Zhen Polytechnic, 4089 Shahe West Road, Shenzhen 518055, China
| | - Guoqing Zhang
- People's Hospital of Gaoxin, 768 Fudong Road, Weifang 261205, China
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19
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Bannwart M, Rohland E, Easthope CA, Rauter G, Bolliger M. Robotic body weight support enables safe stair negotiation in compliance with basic locomotor principles. J Neuroeng Rehabil 2019; 16:157. [PMID: 31870393 PMCID: PMC6929285 DOI: 10.1186/s12984-019-0631-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/11/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND After a neurological injury, mobility focused rehabilitation programs intensively train walking on treadmills or overground. However, after discharge, quite a few patients are not able to independently negotiate stairs, a real-world task with high physical and psychological demands and a high injury risk. To decrease fall risk and improve patients' capacity to navigate typical environments, early stair negotiation training can help restore competence and confidence in safe stair negotiation. One way to enable early training in a safe and permissive environment is to unload the patient with a body weight support system. We here investigated if unloaded stair negotiation complies with basic locomotor principles, in terms of enabling performance of a physiological movement pattern with minimal compensation. METHODS Seventeen able-bodied participants were unloaded with 0-50% bodyweight during self-paced ascent and descent of a 4-tread staircase. Spatio-temporal parameters, joint ranges of motion, ground reaction forces and myoelectric activity in the main lower limb muscles of participants were compared between unloading levels. Likelihood ratio tests of separated linear mixed models of the investigated outcomes assessed if unloading affects the parameters in general. Subsequent post-hoc testing revealed which levels of unloading differed from unsupported stair negotiation. RESULTS Unloading affected walking velocity, joint ranges of motion, vertical ground reaction force parameters and myoelectric activity in all investigated muscles for stair ascent and descent while step width and single support duration were only affected during ascent. A reduction with increasing levels of body weight support was seen in walking velocity (0.07-0.12 m/s), ranges of motion of the knee and hip (2-10°), vertical ground reaction force peaks (10-70%) and myoelectric activity (17-70%). An increase with unloading was only seen during ascent for ankle range of motion and tibialis anterior activity at substantial unloading. CONCLUSIONS Body weight support facilitates stair negotiation by providing safety and support against gravity. Although unloading effects are present in most parameters, up to 30% body weight support these changes are small, and no dysfunctional patterns are introduced. Body weight support therefore fulfills all the necessary requirements for early stair negotiation training.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - E. Rohland
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Lab, Department of Biomedical Engineering, University Basel, Gewerbestrasse 14, CH-4123 Basel, Allschwil Switzerland
| | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
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20
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Neuromechanical adjustments when walking with an aiding or hindering horizontal force. Eur J Appl Physiol 2019; 120:91-106. [DOI: 10.1007/s00421-019-04251-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 02/02/2023]
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21
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Jackson RW, Collins SH. Heuristic-Based Ankle Exoskeleton Control for Co-Adaptive Assistance of Human Locomotion. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2059-2069. [DOI: 10.1109/tnsre.2019.2936383] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Kim J, Oh S, Kim J, Kim J. A two-wire body weight support system for interactive treadmill. IEEE Int Conf Rehabil Robot 2019; 2019:349-354. [PMID: 31374654 DOI: 10.1109/icorr.2019.8779549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Body weight support (BWS) system is widely used for patients to help their gait training. However, that existing systems require large workspace and elastic component in actuation makes the systems inappropriate for wide clinical use. The interactive treadmill was reported to be cost/space effectively simulate overground walking, but there was no suitable BWS system for the treadmill. We proposed a new concept of body weight support system for interactive treadmill. For wide clinical use, we applied a two-wire driven mechanism with simple actuator and a custom pelvic-type harness. With three healthy subjects, the performance of the proposed BWS system on unloading force control was evaluated, and the result showed that the feasibility of the proposed BWS system.
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23
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Cho N, Squair JW, Bloch J, Courtine G. Neurorestorative interventions involving bioelectronic implants after spinal cord injury. Bioelectron Med 2019; 5:10. [PMID: 32232100 PMCID: PMC7098222 DOI: 10.1186/s42234-019-0027-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization. However, recent advances in bioelectronic medicine are changing this landscape. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.
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Affiliation(s)
- Newton Cho
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,2Department of Neurosurgery, University of Toronto, Toronto, Ontario Canada
| | - Jordan W Squair
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,3Cumming School of Medicine, University of Calgary, Calgary, Canada.,4MD/PhD Training Program, University of British Columbia, Vancouver, Canada
| | - Jocelyne Bloch
- 5Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,6Defitech Center for Interventional Neurotherapies, EPFL / CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- École polytechnique fédérale de Lausanne (EPFL), Campus Biotech, Center for Neuroprosthetics and Brain Mind Institute, 1202 Genève, Switzerland.,5Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,6Defitech Center for Interventional Neurotherapies, EPFL / CHUV, Lausanne, Switzerland
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24
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Calvert JS, Grahn PJ, Zhao KD, Lee KH. Emergence of Epidural Electrical Stimulation to Facilitate Sensorimotor Network Functionality After Spinal Cord Injury. Neuromodulation 2019; 22:244-252. [PMID: 30840354 DOI: 10.1111/ner.12938] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). METHODS This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. RESULTS Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. CONCLUSIONS EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
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Affiliation(s)
| | - Peter J Grahn
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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25
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Formento E, Minassian K, Wagner F, Mignardot JB, Le Goff-Mignardot CG, Rowald A, Bloch J, Micera S, Capogrosso M, Courtine G. Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury. Nat Neurosci 2018; 21:1728-1741. [PMID: 30382196 PMCID: PMC6268129 DOI: 10.1038/s41593-018-0262-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.
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Affiliation(s)
- Emanuele Formento
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Karen Minassian
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Fabien Wagner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jean Baptiste Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Camille G Le Goff-Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Andreas Rowald
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Jocelyne Bloch
- Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Neural Engineering Area, Institute of Biorobotics, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Capogrosso
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Gregoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
- Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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Easthope CS, Traini LR, Awai L, Franz M, Rauter G, Curt A, Bolliger M. Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading. J Neuroeng Rehabil 2018; 15:102. [PMID: 30419945 PMCID: PMC6233558 DOI: 10.1186/s12984-018-0436-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/15/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Body weight support (BWS) is often provided to incomplete spinal cord injury (iSCI) patients during rehabilitation to enable gait training before full weight-bearing is recovered. Emerging robotic devices enable BWS during overground walking, increasing task-specificity of the locomotor training. However, in contrast to a treadmill setting, there is little information on how unloading is integrated into overground locomotion. We investigated the effect of a transparent multi-directional BWS system on overground walking patterns at different levels of unloading in individuals with chronic iSCI (CiSCI) compared to controls. METHODS Kinematics of 12 CiSCI were analyzed at six different BWS levels from 0 to 50% body weight unloading during overground walking at 2kmh- 1 and compared to speed-matched controls. RESULTS In controls, temporal parameters, single joint trajectories, and intralimb coordination responded proportionally to the level of unloading, while spatial parameters remained unaffected. In CiSCI, unloading induced similar changes in temporal parameters. CiSCI, however, did not adapt their intralimb coordination or single joint trajectories to the level of unloading. CONCLUSIONS The findings revealed that continuous, dynamic unloading during overground walking results in subtle and proportional gait adjustments corresponding to changes in body load. CiSCI demonstrated diminished responses in specific domains of gait, indicating that their altered neural processing impeded the adjustment to environmental constraints. CiSCI retain their movement patterns under overground unloading, indicating that this is a viable locomotor therapy tool that may also offer a potential window on the diminished neural control of intralimb coordination.
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Affiliation(s)
| | - Luca Renato Traini
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Martina Franz
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Georg Rauter
- BIROMED-Lab, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland
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27
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Tran AP, Warren PM, Silver J. The Biology of Regeneration Failure and Success After Spinal Cord Injury. Physiol Rev 2018. [PMID: 29513146 DOI: 10.1152/physrev.00017.2017] [Citation(s) in RCA: 513] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since no approved therapies to restore mobility and sensation following spinal cord injury (SCI) currently exist, a better understanding of the cellular and molecular mechanisms following SCI that compromise regeneration or neuroplasticity is needed to develop new strategies to promote axonal regrowth and restore function. Physical trauma to the spinal cord results in vascular disruption that, in turn, causes blood-spinal cord barrier rupture leading to hemorrhage and ischemia, followed by rampant local cell death. As subsequent edema and inflammation occur, neuronal and glial necrosis and apoptosis spread well beyond the initial site of impact, ultimately resolving into a cavity surrounded by glial/fibrotic scarring. The glial scar, which stabilizes the spread of secondary injury, also acts as a chronic, physical, and chemo-entrapping barrier that prevents axonal regeneration. Understanding the formative events in glial scarring helps guide strategies towards the development of potential therapies to enhance axon regeneration and functional recovery at both acute and chronic stages following SCI. This review will also discuss the perineuronal net and how chondroitin sulfate proteoglycans (CSPGs) deposited in both the glial scar and net impede axonal outgrowth at the level of the growth cone. We will end the review with a summary of current CSPG-targeting strategies that help to foster axonal regeneration, neuroplasticity/sprouting, and functional recovery following SCI.
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Affiliation(s)
- Amanda Phuong Tran
- Department of Neurosciences, Case Western Reserve University , Cleveland, Ohio ; and School of Biomedical Sciences, University of Leeds , Leeds , United Kingdom
| | - Philippa Mary Warren
- Department of Neurosciences, Case Western Reserve University , Cleveland, Ohio ; and School of Biomedical Sciences, University of Leeds , Leeds , United Kingdom
| | - Jerry Silver
- Department of Neurosciences, Case Western Reserve University , Cleveland, Ohio ; and School of Biomedical Sciences, University of Leeds , Leeds , United Kingdom
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28
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Targeted neurotechnology restores walking in humans with spinal cord injury. Nature 2018; 563:65-71. [DOI: 10.1038/s41586-018-0649-2] [Citation(s) in RCA: 469] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
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Brain-controlled modulation of spinal circuits improves recovery from spinal cord injury. Nat Commun 2018; 9:3015. [PMID: 30068906 PMCID: PMC6070513 DOI: 10.1038/s41467-018-05282-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 06/22/2018] [Indexed: 01/07/2023] Open
Abstract
The delivery of brain-controlled neuromodulation therapies during motor rehabilitation may augment recovery from neurological disorders. To test this hypothesis, we conceived a brain-controlled neuromodulation therapy that combines the technical and practical features necessary to be deployed daily during gait rehabilitation. Rats received a severe spinal cord contusion that led to leg paralysis. We engineered a proportional brain-spine interface whereby cortical ensemble activity constantly determines the amplitude of spinal cord stimulation protocols promoting leg flexion during swing. After minimal calibration time and without prior training, this neural bypass enables paralyzed rats to walk overground and adjust foot clearance in order to climb a staircase. Compared to continuous spinal cord stimulation, brain-controlled stimulation accelerates and enhances the long-term recovery of locomotion. These results demonstrate the relevance of brain-controlled neuromodulation therapies to augment recovery from motor disorders, establishing important proofs-of-concept that warrant clinical studies.
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30
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Plooij M, Keller U, Sterke B, Komi S, Vallery H, von Zitzewitz J. Design of RYSEN: An Intrinsically Safe and Low-Power Three-Dimensional Overground Body Weight Support. IEEE Robot Autom Lett 2018. [DOI: 10.1109/lra.2018.2812913] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Cortico-reticulo-spinal circuit reorganization enables functional recovery after severe spinal cord contusion. Nat Neurosci 2018; 21:576-588. [PMID: 29556028 DOI: 10.1038/s41593-018-0093-5] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022]
Abstract
Severe spinal cord contusions interrupt nearly all brain projections to lumbar circuits producing leg movement. Failure of these projections to reorganize leads to permanent paralysis. Here we modeled these injuries in rodents. A severe contusion abolished all motor cortex projections below injury. However, the motor cortex immediately regained adaptive control over the paralyzed legs during electrochemical neuromodulation of lumbar circuits. Glutamatergic reticulospinal neurons with residual projections below the injury relayed the cortical command downstream. Gravity-assisted rehabilitation enabled by the neuromodulation therapy reinforced these reticulospinal projections, rerouting cortical information through this pathway. This circuit reorganization mediated a motor cortex-dependent recovery of natural walking and swimming without requiring neuromodulation. Cortico-reticulo-spinal circuit reorganization may also improve recovery in humans.
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32
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Huang H, Sharma HS, Chen L, Otom A, Al Zoubi ZM, Saberi H, Muresanu DF, He X. Review of clinical neurorestorative strategies for spinal cord injury: Exploring history and latest progresses. JOURNAL OF NEURORESTORATOLOGY 2018. [DOI: 10.26599/jnr.2018.9040013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Clinical neurorestorative therapies recently made great progress for patients with spinal cord injury (SCI). This paper systemically reviews historical perspectives, recent advancements and achievements in SCI through key neurorestorative strategies. In this study, a search was performed in the PubMed, Scopus, and Scholar Google search engines using the keywords “neurorestorative strategies”, “spinal cord injury”, “cell therapy”, “neuromodulation”, and “nerve bridges”. Clinical studies published in the English language were included. It is paramount for academic community involved in this field to take the initiative of a multicenter randomized, double-blind, and placebo-control clinical study with high level of evidence-based treatments for most SCI neurorestorative strategies in patient management. It is of utmost need to establish standard therapeutic methods for patients with SCI as early as possible.
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Huang H, Skaper S, Mao G, Saberi H, Feng S, Jeon SR, Chen L, Dimitrijevic M. 2017 Yearbook of Neurorestoratology. JOURNAL OF NEURORESTORATOLOGY 2018. [DOI: 10.26599/jnr.2018.9040001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In 2016 we published the first Yearbook of Neurorestoratology, which summarized pathogenesis in nervous system disease and damage, as well as neurorestorative mechanisms and neurorestorative therapeutic results. Given the progress and achievements occurring in 2017, we have put together those major progresses as the “2017 Yearbook of Neurorestoratology”, which can help readers to easily follow the latest developments in Neurorestoratology.
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Lacquaniti F, Ivanenko YP, Sylos-Labini F, La Scaleia V, La Scaleia B, Willems PA, Zago M. Human Locomotion in Hypogravity: From Basic Research to Clinical Applications. Front Physiol 2017; 8:893. [PMID: 29163225 PMCID: PMC5682019 DOI: 10.3389/fphys.2017.00893] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/24/2017] [Indexed: 01/07/2023] Open
Abstract
We have considerable knowledge about the mechanisms underlying compensation of Earth gravity during locomotion, a knowledge obtained from physiological, biomechanical, modeling, developmental, comparative, and paleoanthropological studies. By contrast, we know much less about locomotion and movement in general under sustained hypogravity. This lack of information poses a serious problem for human space exploration. In a near future humans will walk again on the Moon and for the first time on Mars. It would be important to predict how they will move around, since we know that locomotion and mobility in general may be jeopardized in hypogravity, especially when landing after a prolonged weightlessness of the space flight. The combination of muscle weakness, of wearing a cumbersome spacesuit, and of maladaptive patterns of locomotion in hypogravity significantly increase the risk of falls and injuries. Much of what we currently know about locomotion in hypogravity derives from the video archives of the Apollo missions on the Moon, the experiments performed with parabolic flight or with body weight support on Earth, and the theoretical models. These are the topics of our review, along with the issue of the application of simulated hypogravity in rehabilitation to help patients with deambulation problems. We consider several issues that are common to the field of space science and clinical rehabilitation: the general principles governing locomotion in hypogravity, the methods used to reduce gravity effects on locomotion, the extent to which the resulting behavior is comparable across different methods, the important non-linearities of several locomotor parameters as a function of the gravity reduction, the need to use multiple methods to obtain reliable results, and the need to tailor the methods individually based on the physiology and medical history of each person.
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Affiliation(s)
- Francesco Lacquaniti
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Center of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Yury P. Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesca Sylos-Labini
- Center of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Valentina La Scaleia
- Center of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Barbara La Scaleia
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Patrick A. Willems
- Laboratory of Biomechanics and Physiology of Locomotion, Institute of NeuroScience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Myrka Zago
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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