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Nepomuceno P, Souza WH, Pakosh M, Musselman KE, Craven BC. Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters. J Neuroeng Rehabil 2024; 21:73. [PMID: 38705999 PMCID: PMC11070073 DOI: 10.1186/s12984-024-01365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established. OBJECTIVE This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure. RESULTS Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions). CONCLUSION This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.
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Affiliation(s)
- Patrik Nepomuceno
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wagner H Souza
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Tao G, Yang S, Xu J, Wang L, Yang B. Global research trends and hotspots of artificial intelligence research in spinal cord neural injury and restoration-a bibliometrics and visualization analysis. Front Neurol 2024; 15:1361235. [PMID: 38628700 PMCID: PMC11018935 DOI: 10.3389/fneur.2024.1361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Artificial intelligence (AI) technology has made breakthroughs in spinal cord neural injury and restoration in recent years. It has a positive impact on clinical treatment. This study explores AI research's progress and hotspots in spinal cord neural injury and restoration. It also analyzes research shortcomings related to this area and proposes potential solutions. Methods We used CiteSpace 6.1.R6 and VOSviewer 1.6.19 to research WOS articles on AI research in spinal cord neural injury and restoration. Results A total of 1,502 articles were screened, in which the United States dominated; Kadone, Hideki (13 articles, University of Tsukuba, JAPAN) was the author with the highest number of publications; ARCH PHYS MED REHAB (IF = 4.3) was the most cited journal, and topics included molecular biology, immunology, neurology, sports, among other related areas. Conclusion We pinpointed three research hotspots for AI research in spinal cord neural injury and restoration: (1) intelligent robots and limb exoskeletons to assist rehabilitation training; (2) brain-computer interfaces; and (3) neuromodulation and noninvasive electrical stimulation. In addition, many new hotspots were discussed: (1) starting with image segmentation models based on convolutional neural networks; (2) the use of AI to fabricate polymeric biomaterials to provide the microenvironment required for neural stem cell-derived neural network tissues; (3) AI survival prediction tools, and transcription factor regulatory networks in the field of genetics were discussed. Although AI research in spinal cord neural injury and restoration has many benefits, the technology has several limitations (data and ethical issues). The data-gathering problem should be addressed in future research, which requires a significant sample of quality clinical data to build valid AI models. At the same time, research on genomics and other mechanisms in this field is fragile. In the future, machine learning techniques, such as AI survival prediction tools and transcription factor regulatory networks, can be utilized for studies related to the up-regulation of regeneration-related genes and the production of structural proteins for axonal growth.
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Affiliation(s)
- Guangyi Tao
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Shun Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junjie Xu
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Linzi Wang
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bin Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Arroyo-Fernández R, Menchero-Sánchez R, Pozuelo-Carrascosa DP, Romay-Barrero H, Fernández-Maestra A, Martínez-Galán I. Effectiveness of Body Weight-Supported Gait Training on Gait and Balance for Motor-Incomplete Spinal Cord Injuries: A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:1105. [PMID: 38398415 PMCID: PMC10888564 DOI: 10.3390/jcm13041105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE This review aims to analyse the effectiveness of body weight-supported gait training for improving gait and balance in patients with motor-incomplete spinal cord injuries. METHOD Relevant articles were systematically searched in electronic databases to identify randomised controlled trials of body weight-supported gait training (either with methods of robotic, manual, and functional electrical stimulation assistance) versus conventional physical therapy or no intervention. Subjects were >16 years-old with motor-incomplete spinal cord injury (AIS C or D). Primary outcomes were gait-related parameters (functionality, endurance, and speed) and balance. Quality of life was included as a secondary outcome. Articles were selected up to 31 December 2023. RESULTS Fifteen studies met the inclusion criteria (n = 673). Nine studies used robotic assistance, four trials performed manual assistance, one study functional electrical stimulation assistance, and one trial performed the intervention without guidance. Robot-assisted body weight-supported gait training improved walking functionality (SMD = 1.74, CI 95%: 1.09 to 2.39), walking endurance (MD = 26.59 m, CI 95% = 22.87 to 30.31), and balance (SMD = 0.63, CI 95% = 0.24 to 1.02). CONCLUSIONS Body weight-supported gait training is not superior to conventional physiotherapy in gait and balance training in patients with motor-incomplete spinal cord injury. However, body weight-supported gait training with robotic assistance does improve walking functionality, walking endurance, and balance, but not walking speed.
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Affiliation(s)
- Rubén Arroyo-Fernández
- Faculty of Physical Therapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain
- Water and Health Research Group (GIAS), University of Castilla-La Mancha, 45004 Toledo, Spain
- Department of Physical Medicine and Rehabilitation, Hospital General Universitario Nuestra Señora del Prado, 45600 Talavera de la Reina, Spain
| | - Raquel Menchero-Sánchez
- Faculty of Physical Therapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain
- Water and Health Research Group (GIAS), University of Castilla-La Mancha, 45004 Toledo, Spain
| | | | - Helena Romay-Barrero
- Faculty of Physical Therapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain
- Water and Health Research Group (GIAS), University of Castilla-La Mancha, 45004 Toledo, Spain
| | - Araceli Fernández-Maestra
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, 45004 Toledo, Spain
| | - Inés Martínez-Galán
- Faculty of Physical Therapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain
- Water and Health Research Group (GIAS), University of Castilla-La Mancha, 45004 Toledo, Spain
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Wan C, Huang S, Wang X, Ge P, Wang Z, Zhang Y, Li Y, Su B. Effects of robot-assisted gait training on cardiopulmonary function and lower extremity strength in individuals with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2024; 47:6-14. [PMID: 36972206 PMCID: PMC10795646 DOI: 10.1080/10790268.2023.2188392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
CONTEXT Robot-assisted gait training (RAGT) has been increasingly adopted in many rehabilitation facilities for walking function and activity in individuals with spinal cord injury (SCI). However, the effectiveness of RAGT on lower extremity strength and cardiopulmonary function, especially static pulmonary function, have not been clearly outlined. OBJECTIVE Determine the effect of RAGT on cardiopulmonary function and lower extremity strength in SCI survivors. METHODS Eight databases were systematically searched for randomized controlled trials comparing RAGT with conventional physical therapy or other non-robotic therapies for survivors with SCI. Study selection required lower extremity strength decline after SCI at baseline. The overall effects of RAGT were calculated using a meta-analytic method. Begg's test was used to assess the risk of publication bias. RESULTS The pooled analysis demonstrated that RAGT may have a positive effect for individuals with SCI on lower extremity strength enhancing (n = 408; standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.14-1.48) and cardiopulmonary endurance(n = 104; standardized mean difference [SMD] = 2.24; 95% confidence interval [CI] = 0.28-4.19). However, no significant effect was established on static pulmonary function. No publication bias was observed according to the Begg's test. CONCLUSIONS RAGT may be a useful technique for improving lower limb strength and cardiovascular endurance in SCI survivors. The usefulness of RAGT in enhancing static pulmonary function was not demonstrated by the study. However, these results should be interpreted with caution, given the low number of selected studies and subjects. Clinical studies with large sample sizes will be necessary in the future.
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Affiliation(s)
- Chunli Wan
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Sisi Huang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Xue Wang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Panli Ge
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Zhixiang Wang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yuting Zhang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yongqiang Li
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Bin Su
- Wuxi Central Rehabilitation Hospital/Wuxi Mental Health Center, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214151, China
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He LW, Guo XJ, Zhao C, Rao JS. Rehabilitation Training after Spinal Cord Injury Affects Brain Structure and Function: From Mechanisms to Methods. Biomedicines 2023; 12:41. [PMID: 38255148 PMCID: PMC10813763 DOI: 10.3390/biomedicines12010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Spinal cord injury (SCI) is a serious neurological insult that disrupts the ascending and descending neural pathways between the peripheral nerves and the brain, leading to not only functional deficits in the injured area and below the level of the lesion but also morphological, structural, and functional reorganization of the brain. These changes introduce new challenges and uncertainties into the treatment of SCI. Rehabilitation training, a clinical intervention designed to promote functional recovery after spinal cord and brain injuries, has been reported to promote activation and functional reorganization of the cerebral cortex through multiple physiological mechanisms. In this review, we evaluate the potential mechanisms of exercise that affect the brain structure and function, as well as the rehabilitation training process for the brain after SCI. Additionally, we compare and discuss the principles, effects, and future directions of several rehabilitation training methods that facilitate cerebral cortex activation and recovery after SCI. Understanding the regulatory role of rehabilitation training at the supraspinal center is of great significance for clinicians to develop SCI treatment strategies and optimize rehabilitation plans.
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Affiliation(s)
- Le-Wei He
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
| | - Xiao-Jun Guo
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing 100068, China
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; (L.-W.H.); (X.-J.G.)
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Aach M, Schildhauer TA, Zieriacks A, Jansen O, Weßling M, Brinkemper A, Grasmücke D. Feasibility, safety, and functional outcomes using the neurological controlled Hybrid Assistive Limb exoskeleton (HAL®) following acute incomplete and complete spinal cord injury - Results of 50 patients. J Spinal Cord Med 2023; 46:574-581. [PMID: 37083596 PMCID: PMC10274525 DOI: 10.1080/10790268.2023.2200362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Recent studies reveal that Hybrid Assistive Limb (HAL®) locomotion training in paraplegic patients suffering from chronic spinal cord injury (SCI) induces improvements in functional and ambulatory mobility. The purpose of this study was to determine the safety, feasibility, and functional effectiveness of HAL® locomotion training in the initial rehabilitation of acute SCI patients. This clinical trial represents the first systematic intervention worldwide for acute SCI patients using a neurologically controlled exoskeleton. DESIGN Single center, prospective study. SETTING BG University Hospital Bergmannsheil, Bochum, Germany. PARTICIPANTS Fifty acute SCI patients (14 women, 36 men). INTERVENTIONS All participants received a daily (5 times/week) HAL® exoskeleton supported training for 12 weeks (mean amount of training sessions 60.4 ± 30.08). OUTCOME MEASURES Functional outcome for overground walking was monitored using the 10-m-walk test (10 MWT) combined with the WISCI II score, 6-minute-walk test (6 MWT) and the timed-up and go test (TUG test). Treadmill-related parameters (speed, distance and walking time) and the Lower Extremity Motor Score (LEMS) were recorded separately. RESULTS Significant improvements were observed for HAL®-associated (walking time, distance and speed) and for functional outcomes (10 MWT, 6 MWT and TUG-test). WISCI-II-Score and the LEMS increased significantly compared with the status prior to training. CONCLUSION HAL® locomotion training is feasible and safe in the rehabilitation of acute SCI patients. The HAL® exoskeleton enables the patient to perform effective treadmill training and leads to improvements in functional and ambulatory mobility. However, spontaneous recovery vs training-related effects remain unclear and findings should not be extrapolated beyond the acute in-patient rehabilitation setting.Trial registration: German Clinical Trials Register identifier: DRKS00010250..
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Affiliation(s)
- Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Amrei Zieriacks
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Martin Weßling
- Department of Tumor- and Revision Surgery, Orthopaedic Hospital Volmarstein, Wetter, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Dennis Grasmücke
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
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Tarnacka B, Korczyński B, Frasuńska J. Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure. Diagnostics (Basel) 2023; 13:diagnostics13111966. [PMID: 37296818 DOI: 10.3390/diagnostics13111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.
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Affiliation(s)
- Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
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La Rosa G, Avola M, Di Gregorio T, Calabrò RS, Onesta MP. Gait Recovery in Spinal Cord Injury: A Systematic Review with Metanalysis Involving New Rehabilitative Technologies. Brain Sci 2023; 13:brainsci13050703. [PMID: 37239175 DOI: 10.3390/brainsci13050703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Gait recovery is a fundamental goal in patients with spinal cord injury to attain greater autonomy and quality of life. Robotics is becoming a valid tool in improving motor, balance, and gait function in this patient population. Moreover, other innovative approaches are leading to promising results. The aim of this study was to investigate new rehabilitative methods for gait recovery in people who have suffered spinal cord injuries. A systematic review of the last 10 years of the literature was performed in three databases (PubMed, PEDro, andCochrane). We followed this PICO of the review: P: adults with non-progressive spinal cord injury; I: new rehabilitative methods; C: new methods vs. conventional methods; and O: improvement of gait parameters. When feasible, a comparison through ES forest plots was performed. A total of 18 RCTs of the 599 results obtained were included. The studies investigated robotic rehabilitation (n = 10), intermittent hypoxia (N = 3) and external stimulation (N = 5). Six studies of the first group (robotic rehabilitation) were compared using a forest plot for 10MWT, LEMS, WISCI-II, and SCIM-3. The other clinical trials were analyzed through a narrative review of the results. We found weak evidence for the claim that robotic devices lead to better outcomes in gait independence compared to conventional rehabilitation methods. External stimulation and intermittent hypoxia seem to improve gait parameters associated with other rehabilitation methods. Research investigating the role of innovative technologies in improving gait and balance is needed since walking ability is a fundamental issue in patients with SCI.
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Affiliation(s)
| | - Marianna Avola
- Consorzio Siciliano di Riabilitazione, 95100 Catania, Italy
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Gil-Agudo Á, Megía-García Á, Pons JL, Sinovas-Alonso I, Comino-Suárez N, Lozano-Berrio V, Del-Ama AJ. Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial. J Neuroeng Rehabil 2023; 20:36. [PMID: 36964574 PMCID: PMC10039497 DOI: 10.1186/s12984-023-01158-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In recent years, ambulatory lower limb exoskeletons are being gradually introduced into the clinical practice to complement walking rehabilitation programs. However, the clinical evidence of the outcomes attained with these devices is still limited and nonconclusive. Furthermore, the user-to-robot adaptation mechanisms responsible for functional improvement are still not adequately unveiled. This study aimed to (1) assess the safety and feasibility of using the HANK exoskeleton for walking rehabilitation, and (2) investigate the effects on walking function after a training program with it. METHODS A randomized controlled trial was conducted including a cohort of 23 patients with less than 1 year since injury, neurological level of injury (C2-L4) and severity (American Spinal Cord Injury Association Impairment Scale [AIS] C or D). The intervention was comprised of 15 one-hour gait training sessions with lower limb exoskeleton HANK. Safety was assessed through monitoring of adverse events, and pain and fatigue through a Visual Analogue Scale. LEMS, WISCI-II, and SCIM-III scales were assessed, along with the 10MWT, 6MWT, and the TUG walking tests (see text for acronyms). RESULTS No major adverse events were reported. Participants in the intervention group (IG) reported 1.8 cm (SD 1.0) for pain and 3.8 (SD 1.7) for fatigue using the VAS. Statistically significant differences were observed for the WISCI-II for both the "group" factor (F = 16.75, p < 0.001) and "group-time" interactions (F = 8.87; p < 0.01). A post-hoc analysis revealed a statistically significant increase of 3.54 points (SD 2.65, p < 0.0001) after intervention for the IG but not in the CG (0.7 points, SD 1.49, p = 0.285). No statistical differences were observed between groups for the remaining variables. CONCLUSIONS The use of HANK exoskeleton in clinical settings is safe and well-tolerated by the patients. Patients receiving treatment with the exoskeleton improved their walking independence as measured by the WISCI-II after the treatment.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain.
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain.
| | - Álvaro Megía-García
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - José Luis Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Natalia Comino-Suárez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Rey Juan Carlos University, Electronic Technology Area, Móstoles, Spain
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Li R, Ding M, Wang J, Pan H, Sun X, Huang L, Fu C, He C, Wei Q. Effectiveness of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for incomplete spinal cord injury: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:312-329. [PMID: 36373899 DOI: 10.1177/02692155221133474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for people with incomplete spinal cord injury. METHODS PubMed, Embase, Web of Science, PEDro, CENTRAL and CINAHL were searched from inception until September 4, 2022. Randomized controlled trials that evaluated the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury were selected. Mean differences (MD) with 95% confidence interval (CI) were calculated. The methodological quality was evaluated by the Cochrane Risk of Bias 2.0 tool. Subgroup analyses were conducted according to the time since injury. RESULTS In total 19 studies involving 770 patients were eligible for analysis. Individuals with acute incomplete spinal cord injury in robotic-assisted gait training groups showed significantly greater improvements in 6-minute walking test (MD 53.32; 95% CI 33.49 to 73.15; P < 0.001), lower extremity motor scale (MD 5.22; 95% CI 3.63 to 6.80; P < 0.001) and walking index for spinal cord injury II (MD 3.18; 95% CI 1.34 to 5.02; P < 0.001). Robotic-assisted gait training improved peak oxygen consumption to a greater degree for chronic incomplete spinal cord injury patients (MD 4.90; 95% CI 0.96 to 8.84; P = 0.01). CONCLUSION Robot-assisted gait training may be a feasible and effective intervention in terms of cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Mingfu Ding
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jiao Wang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Hongxia Pan
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Liyi Huang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- National Clinical Research Center for Geriatrics, 34753West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
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11
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Robot-Assisted Gait Training with Trexo Home: Users, Usage and Initial Impacts. CHILDREN 2023; 10:children10030437. [PMID: 36979997 PMCID: PMC10047646 DOI: 10.3390/children10030437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
Robotic gait training has the potential to improve secondary health conditions for people with severe neurological impairment. The purpose of this study was to describe who is using the Trexo robotic gait trainer, how much training is achieved in the home and community, and what impacts are observed after the initial month of use. In this prospective observational single-cohort study, parent-reported questionnaires were collected pre- and post-training. Of the 70 participants, the median age was 7 years (range 2 to 24), 83% had CP, and 95% did not walk for mobility. Users trained 2–5 times/week. After the initial month, families reported a significant reduction in sleep disturbance (p = 0.0066). Changes in bowel function, positive affect, and physical activity were not statistically significant. These findings suggest that families with children who have significant mobility impairments can use a robotic gait trainer frequently in a community setting and that sleep significantly improves within the first month of use. This intervention holds promise as a novel strategy to impact multi-modal impairments for this population. Future work should include an experimental study design over a longer training period to begin to understand the relationship between training volume and its full potential.
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12
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Zanatta F, Farhane-Medina NZ, Adorni R, Steca P, Giardini A, D'Addario M, Pierobon A. Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients. Health Qual Life Outcomes 2023; 21:18. [PMID: 36810124 PMCID: PMC9942343 DOI: 10.1186/s12955-023-02097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases. METHODS A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized. RESULTS The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables. CONCLUSIONS Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.
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Affiliation(s)
- Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Naima Z Farhane-Medina
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Department of Psychology, University of Córdoba, Córdoba, Spain
| | - Roberta Adorni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | - Patrizia Steca
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marco D'Addario
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonia Pierobon
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Italy
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13
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den Brave M, Beaudart C, de Noordhout BM, Gillot V, Kaux JF. Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis. Clin Rehabil 2023; 37:876-890. [PMID: 36683416 DOI: 10.1177/02692155231152567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Robot-assisted gait training (RAGT) is often used as a rehabilitation tool for neurological impairments. The purpose of this study is to investigate the effects of rehabilitation with robotic devices on quality of life and depression. DATA SOURCES Two electronic databases (MEDLINE and Scopus) were searched for studies from inception up to December 2022. REVIEW METHODS Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses, studying each one's mental and physical health and depression. Random effect meta-analyses were run using standardized mean difference and 95% confidence interval (CI). RESULTS A total of 853 studies were identified from the literature search. 31 studies (17 RCTs and 14 non-RCTs) including 1151 subjects met the inclusion criteria. 31 studies were selected for the systematic review and 27 studies for the meta-analysis. The outcome measure of mental health significantly improved in favor of the RAGT group in RCTs and non-RCTs (adjusted Hedges'g 0.72, 95% CI: 0.34-1.10, adjusted Hedges g = 0.80, 95% CI 0.21-1.39, respectively). We observed a significant effect of RAGT on physical health in RCTs and non-RCTs (adjusted Hedges'g 0.58, 95% CI 0.28, 0.88, adjusted Hedges g = 0.73, 95% CI 0.12, 1.33). After realizing a sensitivity analysis in RCTs, a positive impact on depression is observed (Hedges' g of -0.66, 95% CI -1.08 to -0.24). CONCLUSION This study suggests that RAGT could improve the quality of life of patients with neurological impairments. A positive impact on depression is also observed in the short term. Further studies are needed to differentiate grounded and overgrounded exoskeletons as well as RCT comparing overground exoskeletons with a control group.
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Affiliation(s)
- Meike den Brave
- Department of Physical and Rehabilitation Medicine, 26658University of Liège, Liège, Belgium
| | - Charlotte Beaudart
- Department of Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
| | | | | | - Jean-Francois Kaux
- Department of Rehabilitation and Sports Sciences, 26658University of Liège, Liège, Belgium.,Department of Physical Medicine and Sports Traumatology, SportS2, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
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14
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Masengo G, Zhang X, Dong R, Alhassan AB, Hamza K, Mudaheranwa E. Lower limb exoskeleton robot and its cooperative control: A review, trends, and challenges for future research. Front Neurorobot 2023; 16:913748. [PMID: 36714152 PMCID: PMC9875327 DOI: 10.3389/fnbot.2022.913748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Effective control of an exoskeleton robot (ER) using a human-robot interface is crucial for assessing the robot's movements and the force they produce to generate efficient control signals. Interestingly, certain surveys were done to show off cutting-edge exoskeleton robots. The review papers that were previously published have not thoroughly examined the control strategy, which is a crucial component of automating exoskeleton systems. As a result, this review focuses on examining the most recent developments and problems associated with exoskeleton control systems, particularly during the last few years (2017-2022). In addition, the trends and challenges of cooperative control, particularly multi-information fusion, are discussed.
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Affiliation(s)
- Gilbert Masengo
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China,Shaanxi Key Laboratory of Intelligent Robot, Xi'an Jiaotong University, Xi'an, China,Department of Mechanical Engineering, Rwanda Polytechnic/Integrated Polytechnic Regional College (IPRC) Karongi, Kigali, Rwanda,*Correspondence: Gilbert Masengo ✉
| | - Xiaodong Zhang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China,Shaanxi Key Laboratory of Intelligent Robot, Xi'an Jiaotong University, Xi'an, China
| | - Runlin Dong
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China,Shaanxi Key Laboratory of Intelligent Robot, Xi'an Jiaotong University, Xi'an, China
| | - Ahmad B. Alhassan
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China,Shaanxi Key Laboratory of Intelligent Robot, Xi'an Jiaotong University, Xi'an, China
| | - Khaled Hamza
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China,Shaanxi Key Laboratory of Intelligent Robot, Xi'an Jiaotong University, Xi'an, China
| | - Emmanuel Mudaheranwa
- Department of Mechanical Engineering, Rwanda Polytechnic/Integrated Polytechnic Regional College (IPRC) Karongi, Kigali, Rwanda,Department of Engineering, Cardiff University, Cardiff, United Kingdom
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15
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Zanatta F, Steca P, Fundarò C, Giardini A, Felicetti G, Panigazzi M, Arbasi G, Grilli C, D’Addario M, Pierobon A. Biopsychosocial effects and experience of use of robotic and virtual reality devices in neuromotor rehabilitation: A study protocol. PLoS One 2023; 18:e0282925. [PMID: 36897863 PMCID: PMC10004562 DOI: 10.1371/journal.pone.0282925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Robot-assisted therapy (RAT) and virtual reality (VR)-based neuromotor rehabilitation have shown promising evidence in terms of patient's neuromotor recovery, so far. However, still little is known on the perceived experience of use of robotic and VR devices and the related psychosocial impact. The present study outlines a study protocol aiming to investigate the biopsychosocial effects and the experience of use of robotic and non-immersive VR devices in patients undergoing neuromotor rehabilitation. METHODS Adopting a prospective, two-arm, non-randomized study design, patients with different neuromotor diseases (i.e., acquired brain injury, Parkinson's Disease, and total knee/hip arthroplasty) undergoing rehabilitation will be included. In a real-world clinical setting, short- (4 weeks) and long-term (6 months) changes in multiple patient's health domains will be investigated, including the functional status (i.e., motor functioning, ADLs, risk of falls), cognitive functioning (i.e., attention and executive functions), physical and mental health-related quality of life (HRQoL), and the psychological status (i.e., anxiety and depression, quality of life satisfaction). At post-intervention, the overall rehabilitation experience, the psychosocial impact of the robotic and VR devices will be assessed, and technology perceived usability and experience of use will be evaluated through a mixed-methods approach, including both patients' and physiotherapists' perspectives. Repeated measures within-between interaction effects will be estimated, and association analyses will be performed to explore the inter-relationships among the variables investigated. Data collection is currently ongoing. IMPLICATIONS The biopsychosocial framework adopted will contribute to expanding the perspective on patient's recovery within the technology-based rehabilitation field beyond motor improvement. Moreover, the investigation of devices experience of use and usability will provide further insight into technology deployment in neuromotor rehabilitation programs, thereby maximising therapy engagement and effectiveness. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05399043.
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Affiliation(s)
- Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Patrizia Steca
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Cira Fundarò
- Istituti Clinici Scientifici Maugeri IRCCS, Neurophysiopathology Unit of Montescano Institute, Montescano, Italy
- * E-mail:
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Information Technology Department of Pavia Institute, Pavia, Italy
| | - Guido Felicetti
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Montescano Institute, Montescano, Italy
| | - Monica Panigazzi
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational Physiatry and Ergonomics Unit of Montescano Institute, Montescano, Italy
| | - Giovanni Arbasi
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Montescano Institute, Montescano, Italy
| | - Cesare Grilli
- Istituti Clinici Scientifici Maugeri IRCCS, Occupational Physiatry and Ergonomics Unit of Montescano Institute, Montescano, Italy
| | - Marco D’Addario
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, Montescano, Italy
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16
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Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bizzarrini E. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review. NeuroRehabilitation 2022; 51:609-647. [PMID: 36502343 DOI: 10.3233/nre-220061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. RESULTS Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
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Affiliation(s)
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Simona Maria Carmignano
- Rehabilitation Therapeutic Center (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Isabella Companini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - David Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Emiliana Bizzarrini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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17
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Yang FA, Chen SC, Chiu JF, Shih YC, Liou TH, Escorpizo R, Chen HC. Body weight-supported gait training for patients with spinal cord injury: a network meta-analysis of randomised controlled trials. Sci Rep 2022; 12:19262. [PMID: 36357483 PMCID: PMC9649733 DOI: 10.1038/s41598-022-23873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Different body weight-supported gait-training strategies are available for improving ambulation in individuals with spinal cord injury (SCI). These include body weight-supported overground training (BWSOGT), body weight-supported treadmill training (BWSTT), and robot-assisted gait training (RAGT). We conducted a network meta-analysis of randomised controlled trials (RCTs) to assess the effect and priority of each training protocol. We searched the PubMed, Cochrane Library, Scopus, and Embase databases from inception to 6 August 2022. The eligibility criteria were as follows: (1) being RCTs, (2) recruiting participants with SCI diagnosis and requiring gait training, (3) comparing different body weight-supported gait training strategies, and (4) involving ambulatory assessments. We conducted a network meta-analysis to compare different training strategies using the standard mean difference and its 95% credible interval. To rank the efficacy of training strategies, we used the P score as an indicator. Inconsistency in network meta-analysis was evaluated using loop-specific heterogeneity. We included 15 RCTs in this analysis. RAGT was had significantly more favourable performance than had the control intervention. The ranking probabilities indicated that the most effective approach was RAGT, followed by BWSOGT, BWSTT, and the control intervention. No significant inconsistency was noted between the results of the direct and indirect comparisons.
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Affiliation(s)
- Fu-An Yang
- grid.412896.00000 0000 9337 0481School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ching Chen
- Taiwan Society of Neurorehabilitation, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jing-Fang Chiu
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
| | - Ya-Chu Shih
- grid.412896.00000 0000 9337 0481School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
| | - Reuben Escorpizo
- grid.59062.380000 0004 1936 7689Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT USA ,grid.419770.cSwiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Taiwan Society of Neurorehabilitation, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
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18
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The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications. Medicina (B Aires) 2022; 58:medicina58101447. [PMID: 36295607 PMCID: PMC9611825 DOI: 10.3390/medicina58101447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injuries (SCIs) have major consequences on the patient’s health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient’s independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.
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Meng G, Ma X, Chen P, Xu S, Li M, Zhao Y, Jin A, Liu X. Effect of early integrated robot-assisted gait training on motor and balance in patients with acute ischemic stroke: a single-blinded randomized controlled trial. Ther Adv Neurol Disord 2022; 15:17562864221123195. [PMID: 36147622 PMCID: PMC9486263 DOI: 10.1177/17562864221123195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Gait disruption is a common poststroke problem. Robot-assisted gait training
(RAGT) might improve motor function, balance, and activities of daily
living. Objective: We compared the clinical effectiveness of early integrated RAGT using the
Walkbot robotic gym with an intensity-matched enhanced lower limb therapy
(ELLT) program and with conventional rehabilitation therapy (CRT) in
patients with acute ischemic stroke. Methods: A total of 192 patients with acute ischemic stroke were randomly assigned
(1:1:1) to receive RAGT, ELLT, or CRT. All three groups received 45 min of
training daily, 3 days a week, for 4 weeks consecutively. Before and after
the 4-week treatment, the patients were assessed based on a 6-minute walking
test (6MWT), functional ambulation classification (FAC), timed up and go
(TUG) test, dual-task walking (DTW) test, Tinetti’s test, Barthel’s index
(BI), stroke-specific quality of life (SS-QOL) scale, and gait analysis
parameters. Results: After the 4-week intervention, the results of the 6MWT, FAC, TUG, DTW,
Tinetti’s test, BI, SS-QOL, and gait in the three groups significantly
improved. Compared with ELLT and CRT groups, participants in the RAGT group
had a better performance in 6MWT (199.11 ± 60.72 versus
182.47 ± 59.72 versus 173.69 ± 40.58,
p = 0.035), FAC (4.10 ± 0.91 versus
3.69 ± 0.88 versus 3.58 ± 0.81,
p = 0.044), DTW (10.29 ± 2.38 versus
12.92 ± 2.64 versus 13.89 ± 2.62,
p = 0.031), SS-QOL (184.46 ± 20.53 versus
165.39 ± 20.49 versus 150.72 ± 20.59,
p = 0.012), velocity (0.66 ± 0.22 versus
0.55 ± 0.23 versus 0.51 ± 0.20,
p = 0.008), cycle duration (1.38 ± 0.40
versus 1.50 ± 0.38 versus 1.61 ± 0.30,
p = 0.040), and swing phase symmetry ratio (SPSR,
1.10 ± 0.33 versus 1.21 ± 0.22 versus
1.48 ± 0.25, p = 0.021). The TUG, Tinetti’s test, BI, and
RMT results were similar, however. Conclusion: In the acute stroke phase, early integrated RAGT showed greater performance
in gait rehabilitation than CRT and ELLT. Registration: ChiCTR1900026225
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Affiliation(s)
- Guilin Meng
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoye Ma
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pengfei Chen
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaofang Xu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingliang Li
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yichen Zhao
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aiping Jin
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
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Ma T, Zhang Q, Zhou T, Zhang Y, He Y, Li S, Liu Q. Effects of robotic-assisted gait training on motor function and walking ability in children with thoracolumbar incomplete spinal cord injury. NeuroRehabilitation 2022; 51:499-508. [DOI: 10.3233/nre-220124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI.
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Affiliation(s)
- Tingting Ma
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qi Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Tiantian Zhou
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yanqing Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yan He
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Sijia Li
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qianjin Liu
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
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21
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Guo Y, Yang J, Liu Y, Chen X, Yang GZ. Detection and assessment of Parkinson's disease based on gait analysis: A survey. Front Aging Neurosci 2022; 14:916971. [PMID: 35992585 PMCID: PMC9382193 DOI: 10.3389/fnagi.2022.916971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.
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Affiliation(s)
- Yao Guo
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxin Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Yuxuan Liu
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Chen
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, China
| | - Guang-Zhong Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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22
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Rehabilitation Program for Gait Training Using UAN.GO, a Powered Exoskeleton: A Case Report. Neurol Int 2022; 14:536-546. [PMID: 35736624 PMCID: PMC9227123 DOI: 10.3390/neurolint14020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Spinal cord injury is characterized by the interruption of neural pathways of the spinal cord, with alteration of sensory, motor, and autonomic functions. Robotic-assisted gait training offers many possibilities, including the capability to reach a physiological gait pattern. Methods: A training protocol with UAN.GO®, an active lower limb exoskeleton, was developed. A participant having D10 complete SCI was recruited for this study. The training protocol was composed by 13 sessions, lasting 1.5 h each. The effectiveness of the protocol was evaluated through the mobility performance during the 6 MWT, the level of exertion perceived administrating Borg RPE at the end of each 6 MWT. Furthermore, time and effort required by the participant to earn a higher level of skills were considered. Results: A significant improvement was registered in the six MWT (t0 = 45.64 m t1 = 84.87 m). Data referring to the mean level of exertion remained stable. The patient successfully achieved a higher level of independence and functional mobility with the exoskeleton. Discussion: The findings from this preliminary study suggest that UAN.GO can be a valid tool for walking rehabilitation of spinal cord injury patients, allowing the achievement of greater mobility performances.
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Tamburella F, Lorusso M, Tramontano M, Fadlun S, Masciullo M, Scivoletto G. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. J Neuroeng Rehabil 2022; 19:27. [PMID: 35292044 PMCID: PMC8922901 DOI: 10.1186/s12984-022-01003-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Overground powered lower limb exoskeletons (EXOs) have proven to be valid devices in gait rehabilitation in individuals with spinal cord injury (SCI). Although several articles have reported the effects of EXOs in these individuals, the few reviews available focused on specific domains, mainly walking. The aim of this systematic review is to provide a general overview of the effects of commercial EXOs (i.e. not EXOs used in military and industry applications) for medical purposes in individuals with SCI. This systematic review was conducted following the PRISMA guidelines and it referred to MED-LINE, EMBASE, SCOPUS, Web of Science and Cochrane library databases. The studies included were Randomized Clinical Trials (RCTs) and non-RCT based on EXOs intervention on individuals with SCI. Out of 1296 studies screened, 41 met inclusion criteria. Among all the EXO studies, the Ekso device was the most discussed, followed by ReWalk, Indego, HAL and Rex devices. Since 14 different domains were considered, the outcome measures were heterogeneous. The most investigated domain was walking, followed by cardiorespiratory/metabolic responses, spasticity, balance, quality of life, human–robot interaction, robot data, bowel functionality, strength, daily living activity, neurophysiology, sensory function, bladder functionality and body composition/bone density domains. There were no reports of negative effects due to EXOs trainings and most of the significant positive effects were noted in the walking domain for Ekso, ReWalk, HAL and Indego devices. Ekso studies reported significant effects due to training in almost all domains, while this was not the case with the Rex device. Not a single study carried out on sensory functions or bladder functionality reached significance for any EXO. It is not possible to draw general conclusions about the effects of EXOs usage due to the lack of high-quality studies as addressed by the Downs and Black tool, the heterogeneity of the outcome measures, of the protocols and of the SCI epidemiological/neurological features. However, the strengths and weaknesses of EXOs are starting to be defined, even considering the different types of adverse events that EXO training brought about. EXO training showed to bring significant improvements over time, but whether its effectiveness is greater or less than conventional therapy or other treatments is still mostly unknown. High-quality RCTs are necessary to better define the pros and cons of the EXOs available today. Studies of this kind could help clinicians to better choose the appropriate training for individuals with SCI.
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Affiliation(s)
- Federica Tamburella
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy.
| | - Matteo Lorusso
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Marco Tramontano
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Silvia Fadlun
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Marcella Masciullo
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Giorgio Scivoletto
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
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Stampas A, Hook M, Korupolu R, Jethani L, Kaner MT, Pemberton E, Li S, Francisco GE. Evidence of treating spasticity before it develops: a systematic review of spasticity outcomes in acute spinal cord injury interventional trials. Ther Adv Neurol Disord 2022; 15:17562864211070657. [PMID: 35198042 PMCID: PMC8859674 DOI: 10.1177/17562864211070657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 12/09/2022] Open
Abstract
Introduction: Spasticity is a common consequence of spinal cord injury (SCI), estimated to affect up to 93% of people living with SCI in the community. Problematic spasticity affects around 35% people with SCI spasticity. The early period after injury is believed to be the most opportune time for neural plasticity after SCI. We hypothesize that clinical interventions in the early period could reduce the incidence of spasticity. To address this, we evaluated the spasticity outcomes of clinical trials with interventions early after SCI.Methods: We performed a systematic review of the literature between January 2000 and May 2021 to identify control trials, in humans and animals, that were performed early after SCI that included measures of spasticity in accordance with PRISMA guidelines.Results: Our search yielded 1,463 records of which we reviewed 852 abstracts and included 8 human trial peer-reviewed publications and 9 animal studies. The 9 animal trials largely supported the hypothesis that early intervention can reduce spasticity, including evidence from electrophysiological, behavioral, and histologic measures. Of the 8 human trials, only one study measured spasticity as a primary outcome with a sample size sufficient to test the hypothesis. In this study, neuromodulation of the spinal cord using electric stimulation of the common peroneal nerve reduced spasticity in the lower extremities compared to controls.Conclusion: Given the prevalence of problematic spasticity, there is surprisingly little research being performed in the early period of SCI that includes spasticity measures, and even fewer studies that directly address spasticity. More research on the potential for early interventions to mitigate spasticity is needed.
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Affiliation(s)
| | | | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lavina Jethani
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mahmut T. Kaner
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Erinn Pemberton
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
| | - Gerard E. Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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Inoue J, Kimura R, Shimada Y, Saito K, Kudo D, Hatakeyama K, Watanabe M, Maeda K, Iwami T, Matsunaga T, Miyakoshi N. Development of a Gait Rehabilitation Robot Using an Exoskeleton and Functional Electrical Stimulation: Validation in a Pseudo-paraplegic Model. Prog Rehabil Med 2022; 7:20220001. [PMID: 35118211 PMCID: PMC8784275 DOI: 10.2490/prm.20220001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We have developed a robot for gait rehabilitation of paraplegics for use in combination
with functional electrical stimulation (FES). The purpose of this study was to verify
whether the robot-derived torque can be reduced by using FES in a healthy-person
pseudo-paraplegic model. Methods: Nine healthy participants (22–36 years old) participated in this study. The robot
exoskeleton was designed based on the hip–knee–ankle–foot orthosis for paraplegia.
Participants walked on a treadmill using a rehabilitation lift to support their weight.
The bilateral quadriceps femoris and hamstrings were stimulated using FES. The
participants walked both with and without FES, and two walking speeds, 0.8 and 1.2 km/h,
were used. Participants walked for 1 min in each of the four conditions: (a) 0.8 km/h
without FES, (b) 0.8 km/h with FES, (c) 1.2 km/h without FES, and (d) 1.2 km/h with FES.
The required robot torques in these conditions were compared for each hip and knee
joint. The maximum torque was compared using one-way analysis of variance to determine
whether there was a difference in the amount of assist torque for each gait cycle. Results: Walking with the exoskeleton robot in combination with FES significantly reduced the
torque in hip and knee joints, except for the right hip during extension. Conclusions: In the healthy-participant pseudo-paraplegic model, walking with FES showed a reduction
in the robot-derived torque at both the hip and knee joints. Our rehabilitation robot
combined with FES has the potential to assist paraplegics with various degrees of muscle
weakness and thereby provide effective rehabilitation.
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Affiliation(s)
- Junichi Inoue
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Motoyuki Watanabe
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Kai Maeda
- Department of Systems Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, Akita, Japan
| | - Takehiro Iwami
- Department of Systems Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, Akita, Japan
| | - Toshiki Matsunaga
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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27
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Xu F, Qiu J, Yuan W, Cheng H. A Novel Balance Control Strategy Based on Enhanced Stability Pyramid Index and Dynamic Movement Primitives for a Lower Limb Human-Exoskeleton System. Front Neurorobot 2021; 15:751642. [PMID: 34899229 PMCID: PMC8656433 DOI: 10.3389/fnbot.2021.751642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/07/2021] [Indexed: 12/04/2022] Open
Abstract
The lower limb exoskeleton is playing an increasing role in enabling individuals with spinal cord injury (SCI) to stand upright, walk, turn, and so on. Hence, it is essential to maintain the balance of the human-exoskeleton system during movements. However, the balance of the human-exoskeleton system is challenging to maintain. There are no effective balance control strategies because most of them can only be used in a specific movement like walking or standing. Hence, the primary aim of the current study is to propose a balance control strategy to improve the balance of the human-exoskeleton system in dynamic movements. This study proposes a new safety index named Enhanced Stability Pyramid Index (ESPI), and a new balance control strategy is based on the ESPI and the Dynamic Movement Primitives (DMPs). To incorporate dynamic information of the system, the ESPI employs eXtrapolated Center of Mass (XCoM) instead of the center of mass (CoM). Meanwhile, Time-to-Contact (TTC), the urgency of safety, is used as an automatic weight assignment factor of ESPI instead of the traditional manual one. Then, the balance control strategy utilizing DMPs to generate the gait trajectory according to the scalar and vector values of the ESPI is proposed. Finally, the walking simulation in Gazebo and the experiments of the human-exoskeleton system verify the effectiveness of the index and balance control strategy.
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Affiliation(s)
- Fashu Xu
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Machine Intelligence Institute, School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Engineering Research Center of Human Robot Hybrid Intelligent Technologies and Systems, Ministry of Education, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Qiu
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Machine Intelligence Institute, School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Engineering Research Center of Human Robot Hybrid Intelligent Technologies and Systems, Ministry of Education, University of Electronic Science and Technology of China, Chengdu, China.,Buffalo Robot Technology (Chengdu) Co., Ltd., Chengdu, China
| | - Wenbo Yuan
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Machine Intelligence Institute, School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Engineering Research Center of Human Robot Hybrid Intelligent Technologies and Systems, Ministry of Education, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Cheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Machine Intelligence Institute, School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Engineering Research Center of Human Robot Hybrid Intelligent Technologies and Systems, Ministry of Education, University of Electronic Science and Technology of China, Chengdu, China
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Bae YH, Chang WH, Fong SSM. Different Effects of Robot-Assisted Gait and Independent Over-Ground Gait on Foot Plantar Pressure in Incomplete Spinal Cord Injury: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212072. [PMID: 34831823 PMCID: PMC8624494 DOI: 10.3390/ijerph182212072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022]
Abstract
Background: There is insufficient evidence to establish the optimal treatment protocol for robot-assisted gait training. Objective: This study aimed to analyze the effects of robot-assisted gait and independent over-ground gait on foot pressure and to determine an effective training protocol for improvement of gait pattern in patients with incomplete spinal cord injury due to industrial accidents. Methods: Four patients with incomplete spinal cord injury due to an industrial accident who had gait disturbance underwent measurement of peak foot pressure and stance phase duration using a foot pressure analysis system with robot-assisted gait and independent over-ground gait. Results: The robot-assisted gait condition has lower peak foot pressure and shorter stance phase duration than the independent over-ground gait. Conclusions: In this study, robot-assisted gait was found to limit gait pattern improvement in patients with gait disturbance caused by incomplete spinal cord injury due to industrial accidents. Therefore, future research will be conducted to determine the optimal protocol for robot-assisted gait training for gait pattern improvement.
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Affiliation(s)
- Young-Hyeon Bae
- Korea National Rehabilitation Center, Department of Healthcare and Public Health, Rehabilitation Research Institute, Seoul 01022, Korea
- Correspondence:
| | - Won Hyuk Chang
- Center for Prevention and Rehabilitation, Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Shirley S. M. Fong
- Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong-Kong 999077, China;
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29
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Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
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Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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30
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The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort. Life (Basel) 2021; 11:life11060548. [PMID: 34208009 PMCID: PMC8230650 DOI: 10.3390/life11060548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/05/2023] Open
Abstract
Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.
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31
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Rodríguez-Costa I, De la Cruz-López I, Fernández-Zárate I, Maldonado-Bascón S, Lafuente-Arroyo S, Nunez-Nagy S. Benefits of a Low-Cost Walking Device in Children with Cerebral Palsy: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062808. [PMID: 33801985 PMCID: PMC7998765 DOI: 10.3390/ijerph18062808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/03/2022]
Abstract
Children with Cerebral Palsy (CP) participate less regularly in physical and social activities. Support walkers allow mobility for infants who need aid. The aim of this study is to explore the benefits of a low-cost walking device in children with CP. A qualitative study using semi-structured, face-to-face interviews was conducted. Eight participants (two parents, two educational professionals, and four physical therapists) who live or work with children with CP that use a low-cost walking device were questioned to examine the benefits of the practice. Thematic analysis denoted three key factors about the benefits: emotional welfare, physical wellbeing, and social enjoyment. To conclude, the use of a support walker in children with CP makes them feel happier, improves their self-confidence and autonomy, and promotes participation.
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Affiliation(s)
- Isabel Rodríguez-Costa
- Department of Physical Therapy, University of Alcalá, 28807 Alcalá de Henares, Spain; (I.D.l.C.-L.); (I.F.-Z.); (S.N.-N.)
- Correspondence: ; Tel.: +34-918-852-586
| | - Irene De la Cruz-López
- Department of Physical Therapy, University of Alcalá, 28807 Alcalá de Henares, Spain; (I.D.l.C.-L.); (I.F.-Z.); (S.N.-N.)
| | - Ignacio Fernández-Zárate
- Department of Physical Therapy, University of Alcalá, 28807 Alcalá de Henares, Spain; (I.D.l.C.-L.); (I.F.-Z.); (S.N.-N.)
| | - Saturnino Maldonado-Bascón
- Department of Signal Theory and Communications, University of Alcalá, 28807 Alcalá de Henares, Spain; (S.M.-B.); (S.L.-A.)
| | - Sergio Lafuente-Arroyo
- Department of Signal Theory and Communications, University of Alcalá, 28807 Alcalá de Henares, Spain; (S.M.-B.); (S.L.-A.)
| | - Susana Nunez-Nagy
- Department of Physical Therapy, University of Alcalá, 28807 Alcalá de Henares, Spain; (I.D.l.C.-L.); (I.F.-Z.); (S.N.-N.)
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32
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Robotic Rehabilitation in Spinal Cord Injury: A Pilot Study on End-Effectors and Neurophysiological Outcomes. Ann Biomed Eng 2020; 49:732-745. [PMID: 32918105 DOI: 10.1007/s10439-020-02611-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022]
Abstract
Robot-aided gait training (RAGT) has been implemented to provide patients with spinal cord injury (SCI) with a physiological limb activation during gait, cognitive engagement, and an appropriate stimulation of peripheral receptors, which are essential to entrain neuroplasticity mechanisms supporting functional recovery. We aimed at assessing whether RAGT by means of an end-effector device equipped with body weight support could improve functional ambulation in patients with subacute, motor incomplete SCI. In this pilot study, 15 patients were provided with six RAGT sessions per week for eight consecutive weeks. The outcome measures were muscle strength, ambulation, going upstairs, and disease burden. Furthermore, we estimated the activation patterns of lower limb muscles during RAGT by means of surface electromyography and the resting state networks' functional connectivity (RSN-FC) before and after RAGT. Patients achieved a clinically significant improvement in the clinical outcome measures substantially up to six months post-treatment. These data were paralleled by an improvement in the stair-climbing cycle and a potentiating of frequency-specific and area-specific RSN-FC patterns. Therefore, RAGT, by means of an end-effector device equipped with body weight support, is promising in improving gait in patients with subacute, motor incomplete SCI, and it could produce additive benefit for the neuromuscular reeducation to gait in SCI when combined with conventional physiotherapy.
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33
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Moore SA, Tipold A, Olby NJ, Stein V, Granger N. Current Approaches to the Management of Acute Thoracolumbar Disc Extrusion in Dogs. Front Vet Sci 2020; 7:610. [PMID: 33117847 PMCID: PMC7521156 DOI: 10.3389/fvets.2020.00610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Intervertebral disc extrusion (IVDE) is one of the most common neurologic problems encountered in veterinary clinical practice. The purpose of this manuscript is to provide an overview of the literature related to treatment of acute canine thoracolumbar IVDE to help construct a framework for standard care of acute canine thoracolumbar IVDE where sufficient evidence exists and to highlight opportunities for future prospective veterinary clinical research useful to strengthen care recommendations in areas where evidence is low or non-existent. While there exist a number of gaps in the veterinary literature with respect to standards of care for dogs with acute thoracolumbar IVDE, recommendations for standard care can be made in some areas, particularly with respect to surgical decompression where the currently available evidence supports that surgery should be recommended for dogs with nonambulatory paraparesis or worse. While additional information is needed about the influence on timing of decompression on outcome in dogs that are deep pain negative for longer than 48 h duration, there is no evidence to support treatment of the 48 h time point as a cut off beyond which it becomes impossible for dogs to achieve locomotor recovery. Surgical decompression is best accomplished by either hemilaminectomy or mini-hemilaminectomy and fenestration of, at a minimum, the acutely ruptured disc. Adjacent discs easily accessed by way of the same approach should be considered for fenestration given the evidence that this substantially reduces future herniation at fenestrated sites. Currently available neuroprotective strategies such as high does MPSS and PEG are not recommended due to lack of demonstrated treatment effect in randomized controlled trials, although the role of anti-inflammatory steroids as a protective strategy against progressive myelomalacia and the question of whether anti-inflammatory steroids or NSAIDs provide superior medical therapy require further evaluation.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
| | - Andrea Tipold
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Veronica Stein
- Division of Clinical Neurology, Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hatfield, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
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