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Buttery C, Birns J, Gibson J, Jones GD. Use of the Rehabilitation Treatment Specification System (RTSS) in the management of nitrous oxide (N 2O)-induced spinal cord injury. BMJ Case Rep 2023; 16:16/2/e252529. [PMID: 36750296 PMCID: PMC9906271 DOI: 10.1136/bcr-2022-252529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Nitrous oxide (N2O) is an inhaled anaesthetic gas and a popular intoxicant. Excessive recreational use can cause spinal cord myelopathy. Previous studies have discussed the medical management. However, none have specified the sensorimotor rehabilitation management. This case report documents the investigations, physical rehabilitation and functional outcomes in two cases of N2O-associated myelopathy. Both presented with lower limb strength and sensorimotor integration impairments resulting in ataxic ambulation. Dorsal column signal abnormality was observed on T2-weighted MRI in one case. Myelopathy was diagnosed based on clinical presentation and both were treated with vitamin B12 Rehabilitation was conceived and specified using the Rehabilitation Treatment Specification System (RTSS). Both cases achieved independent indoor gait on hospital discharge, and full function at 9 months in one case. Appropriate and timely medical management and reasoned rehabilitation provided excellent functional outcomes for N2O-related myelopathy. By using the RTSS, reasoned rehabilitation efficacy can be tested in the future.
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Affiliation(s)
- Charlotte Buttery
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Physiotherapy Department, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Jonathan Birns
- Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jamie Gibson
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Workforce Transformation, Health Education England (HEE), Leeds, UK
| | - Gareth David Jones
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK .,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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2
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Sánchez-Manchola M, Arciniegas-Mayag L, Múnera M, Bourgain M, Provot T, Cifuentes CA. Effects of stance control via hidden Markov model-based gait phase detection on healthy users of an active hip-knee exoskeleton. Front Bioeng Biotechnol 2023; 11:1021525. [PMID: 37101752 PMCID: PMC10123285 DOI: 10.3389/fbioe.2023.1021525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/14/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction: In the past years, robotic lower-limb exoskeletons have become a powerful tool to help clinicians improve the rehabilitation process of patients who have suffered from neurological disorders, such as stroke, by applying intensive and repetitive training. However, active subject participation is considered to be an important feature to promote neuroplasticity during gait training. To this end, the present study presents the performance assessment of the AGoRA exoskeleton, a stance-controlled wearable device designed to assist overground walking by unilaterally actuating the knee and hip joints. Methods: The exoskeleton's control approach relies on an admittance controller, that varies the system impedance according to the gait phase detected through an adaptive method based on a hidden Markov model. This strategy seeks to comply with the assistance-as-needed rationale, i.e., an assistive device should only intervene when the patient is in need by applying Human-Robot interaction (HRI). As a proof of concept of such a control strategy, a pilot study comparing three experimental conditions (i.e., unassisted, transparent mode, and stance control mode) was carried out to evaluate the exoskeleton's short-term effects on the overground gait pattern of healthy subjects. Gait spatiotemporal parameters and lower-limb kinematics were captured using a 3D-motion analysis system Vicon during the walking trials. Results and Discussion: By having found only significant differences between the actuated conditions and the unassisted condition in terms of gait velocity (ρ = 0.048) and knee flexion (ρ ≤ 0.001), the performance of the AGoRA exoskeleton seems to be comparable to those identified in previous studies found in the literature. This outcome also suggests that future efforts should focus on the improvement of the fastening system in pursuit of kinematic compatibility and enhanced compliance.
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Affiliation(s)
- Miguel Sánchez-Manchola
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Luis Arciniegas-Mayag
- LabTel, Electrical Engineering Department at Federal University of Espírito Santo, Vitória, Brazil
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
| | - Maxime Bourgain
- EPF Graduate School of Engineering, Cachan, France
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Thomas Provot
- EPF Graduate School of Engineering, Cachan, France
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Carlos A. Cifuentes
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
- School of Engineering, Science and Technology, Universidad Del Rosario, Bogotá, Colombia
- *Correspondence: Carlos A. Cifuentes ,
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Knee Exoskeletons Design Approaches to Boost Strength Capability: A Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11219990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are different devices to increase the strength capacity of people with walking problems. These devices can be classified into exoskeletons, orthotics, and braces. This review aims to identify the state of the art in the design of these medical devices, based on an analysis of patents and literature. However, there are some difficulties in processing the records due to the lack of filters and standardization in the names, generating discrepancies between the search engines, among others. Concerning the patents, 74 patents were analyzed using search engines such as Google Patents, Derwent, The Lens, Patentscope, and Espacenet over the past ten years. A bibliometric analysis was performed using 63 scientific reports from Web of Science and The Lens in the same period for scientific communications. The results show a trend to use the mechanical design of exoskeletons based on articulated rigid structures and elements that provide force to move the structure. These are generally two types: (a) elastic elements and (b) electromechanical elements. The United States accounts for 32% of the technological patents reviewed. The results suggest that the use of exoskeletons or orthoses customized to the users’ needs will continue to increase over the years due to the worldwide growth in disability, particularly related to mobility difficulties and technologies related to the combined use of springs and actuators.
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Hsiao HY, Gray VL, Borrelli J, Rogers MW. Biomechanical control of paretic lower limb during imposed weight transfer in individuals post-stroke. J Neuroeng Rehabil 2020; 17:140. [PMID: 33109225 PMCID: PMC7590464 DOI: 10.1186/s12984-020-00768-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Stroke is a leading cause of disability with associated hemiparesis resulting in difficulty bearing and transferring weight on to the paretic limb. Difficulties in weight bearing and weight transfer may result in impaired mobility and balance, increased fall risk, and decreased community engagement. Despite considerable efforts aimed at improving weight transfer after stroke, impairments in its neuromotor and biomechanical control remain poorly understood. In the present study, a novel experimental paradigm was used to characterize differences in weight transfer biomechanics in individuals with chronic stroke versus able-bodied controls Methods Fifteen participants with stroke and fifteen age-matched able-bodied controls participated in the study. Participants stood with one foot on each of two custom built platforms. One of the platforms dropped 4.3 cm vertically to induce lateral weight transfer and weight bearing. Trials involving a drop of the platform beneath the paretic lower extremity (non-dominant limb for control) were included in the analyses. Paretic lower extremity joint kinematics, vertical ground reaction forces, and center of pressure velocity were measured. All participants completed the clinical Step Test and Four-Square Step Test. Results Reduced paretic ankle, knee, and hip joint angular displacement and velocity, delayed ankle and knee inter-joint timing, increased downward displacement of center of mass, and increased center of pressure (COP) velocity stabilization time were exhibited in the stroke group compared to the control group. In addition, paretic COP velocity stabilization time during induced weight transfer predicted Four-Square Step Test scores in individuals post-stroke. Conclusions The induced weight transfer approach identified stroke-related abnormalities in the control of weight transfer towards the paretic limb side compared to controls. Decreased joint flexion of the paretic ankle and knee, altered inter-joint timing, and increased COP stabilization times may reflect difficulties in neuromuscular control during weight transfer following stroke. Future work will investigate the potential of improving functional weight transfer through induced weight transfer training exercise.
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Affiliation(s)
- Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA. .,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Borrelli
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Shideler BL, Bulea TC, Chen J, Stanley CJ, Gravunder AJ, Damiano DL. Toward a hybrid exoskeleton for crouch gait in children with cerebral palsy: neuromuscular electrical stimulation for improved knee extension. J Neuroeng Rehabil 2020; 17:121. [PMID: 32883297 PMCID: PMC7469320 DOI: 10.1186/s12984-020-00738-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neuromuscular Electrical Stimulation (NMES) has been utilized for many years in cerebral palsy (CP) with limited success despite its inherent potential for improving muscle size and/or strength, inhibiting or reducing spasticity, and enhancing motor performance during functional activities such as gait. While surface NMES has been shown to successfully improve foot drop in CP and stroke, correction of more complex gait abnormalities in CP such as flexed knee (crouch) gait remains challenging due to the level of stimulation needed for the quadriceps muscles that must be balanced with patient tolerability and the ability to deliver NMES assistance at precise times within a gait cycle. METHODS This paper outlines the design and evaluation of a custom, noninvasive NMES system that can trigger and adjust electrical stimulation in real-time. Further, this study demonstrates feasibility of one possible application for this digitally-controlled NMES system as a component of a pediatric robotic exoskeleton to provide on-demand stimulation to leg muscles within specific phases of the gait cycle for those with CP and other neurological disorders who still have lower limb sensation and volitional control. A graphical user interface was developed to digitally set stimulation parameters (amplitude, pulse width, and frequency), timing, and intensity during walking. Benchtop testing characterized system delay and power output. System performance was investigated during a single session that consisted of four overground walking conditions in a 15-year-old male with bilateral spastic CP, GMFCS Level III: (1) his current Ankle-Foot Orthosis (AFO); (2) unassisted Exoskeleton; (3) NMES of the vastus lateralis; and (4) NMES of the vastus lateralis and rectus femoris. We hypothesized in this participant with crouch gait that NMES triggered with low latency to knee extensor muscles during stance would have a modest but positive effect on knee extension during stance. RESULTS The system delivers four channels of NMES with average delays of 16.5 ± 13.5 ms. Walking results show NMES to the vastus lateralis and rectus femoris during stance immediately improved mean peak knee extension during mid-stance (p = 0.003*) and total knee excursion (p = 0.009*) in the more affected leg. The electrical design, microcontroller software and graphical user interface developed here are included as open source material to facilitate additional research into digitally-controlled surface stimulation ( github.com/NIHFAB/NMES ). CONCLUSIONS The custom, digitally-controlled NMES system can reliably trigger electrical stimulation with low latency. Precisely timed delivery of electrical stimulation to the quadriceps is a promising treatment for crouch. Our ultimate goal is to synchronize NMES with robotic knee extension assistance to create a hybrid NMES-exoskeleton device for gait rehabilitation in children with flexed knee gait from CP as well as from other pediatric disorders. TRIAL REGISTRATION clinicaltrials.gov, ID: NCT01961557 . Registered 11 October 2013; Last Updated 27 January 2020.
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Affiliation(s)
- Blynn L Shideler
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA
| | - Thomas C Bulea
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA
| | - Ji Chen
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA
| | - Christopher J Stanley
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA
| | - Andrew J Gravunder
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA
| | - Diane L Damiano
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Functional & Applied Biomechanics Section, Bldg 10 CRC Rm 1-1469, 10 Center Dr. MSC 1604, Bethesda, MD, 20892-1604, USA.
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Bong JH, Jung S, Park N, Kim SJ, Park S. Development of a Novel Robotic Rehabilitation System With Muscle-to-Muscle Interface. Front Neurorobot 2020; 14:3. [PMID: 32132916 PMCID: PMC7040493 DOI: 10.3389/fnbot.2020.00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/14/2020] [Indexed: 11/24/2022] Open
Abstract
In this study, we developed a novel robotic system with a muscle-to-muscle interface to enhance rehabilitation of post-stroke patients. The developed robotic rehabilitation system was designed to provide patients with stage appropriate physical rehabilitation exercise and muscular stimulation. Unlike the position-based control of conventional bimanual robotic therapies, the developed system stimulates the activities of the target muscles, as well as the joint movements of the paretic limb. The robot-assisted motion and the electrical stimulation on the muscles of the paretic side are controlled by on-line comparison of the motion and the muscle activities between the paretic and unaffected sides. With the developed system, the rehabilitation exercise can be customized and modulated depending on the patient’s stage of motor recovery after stroke. The system can be operated in three different modes allowing both passive and active exercises. The effectiveness of the developed system was verified with healthy human subjects, where the subjects were paired to serve as the unaffected side and the paretic side of a hemiplegic patient.
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Affiliation(s)
- Jae Hwan Bong
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Suhun Jung
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
| | - Namji Park
- School of Dentistry, Seoul National University, Seoul, South Korea
| | - Seung-Jong Kim
- College of Medicine, Korea University, Seoul, South Korea
| | - Shinsuk Park
- Department of Mechanical Engineering, Korea University, Seoul, South Korea
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Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2018. [DOI: 10.1007/s41315-017-0042-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Chang SR, Nandor MJ, Li L, Kobetic R, Foglyano KM, Schnellenberger JR, Audu ML, Pinault G, Quinn RD, Triolo RJ. A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia. J Neuroeng Rehabil 2017; 14:48. [PMID: 28558835 PMCID: PMC5450339 DOI: 10.1186/s12984-017-0258-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional neuromuscular stimulation, lower limb orthosis, powered lower limb exoskeleton, and hybrid neuroprosthesis (HNP) technologies can restore stepping in individuals with paraplegia due to spinal cord injury (SCI). However, a self-contained muscle-driven controllable exoskeleton approach based on an implanted neural stimulator to restore walking has not been previously demonstrated, which could potentially result in system use outside the laboratory and viable for long term use or clinical testing. In this work, we designed and evaluated an untethered muscle-driven controllable exoskeleton to restore stepping in three individuals with paralysis from SCI. METHODS The self-contained HNP combined neural stimulation to activate the paralyzed muscles and generate joint torques for limb movements with a controllable lower limb exoskeleton to stabilize and support the user. An onboard controller processed exoskeleton sensor signals, determined appropriate exoskeletal constraints and stimulation commands for a finite state machine (FSM), and transmitted data over Bluetooth to an off-board computer for real-time monitoring and data recording. The FSM coordinated stimulation and exoskeletal constraints to enable functions, selected with a wireless finger switch user interface, for standing up, standing, stepping, or sitting down. In the stepping function, the FSM used a sensor-based gait event detector to determine transitions between gait phases of double stance, early swing, late swing, and weight acceptance. RESULTS The HNP restored stepping in three individuals with motor complete paralysis due to SCI. The controller appropriately coordinated stimulation and exoskeletal constraints using the sensor-based FSM for subjects with different stimulation systems. The average range of motion at hip and knee joints during walking were 8.5°-20.8° and 14.0°-43.6°, respectively. Walking speeds varied from 0.03 to 0.06 m/s, and cadences from 10 to 20 steps/min. CONCLUSIONS A self-contained muscle-driven exoskeleton was a feasible intervention to restore stepping in individuals with paraplegia due to SCI. The untethered hybrid system was capable of adjusting to different individuals' needs to appropriately coordinate exoskeletal constraints with muscle activation using a sensor-driven FSM for stepping. Further improvements for out-of-the-laboratory use should include implantation of plantar flexor muscles to improve walking speed and power assist as needed at the hips and knees to maintain walking as muscles fatigue.
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Affiliation(s)
- Sarah R Chang
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA. .,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Mark J Nandor
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lu Li
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rudi Kobetic
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Kevin M Foglyano
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - John R Schnellenberger
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Musa L Audu
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Gilles Pinault
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA
| | - Roger D Quinn
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ronald J Triolo
- Department of Veterans Affairs, Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, 151AW/APT, Cleveland, OH, 44106, USA.,Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Orthopaedics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
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Holinski BJ, Mazurek KA, Everaert DG, Toossi A, Lucas-Osma AM, Troyk P, Etienne-Cummings R, Stein RB, Mushahwar VK. Intraspinal microstimulation produces over-ground walking in anesthetized cats. J Neural Eng 2016; 13:056016. [PMID: 27619069 DOI: 10.1088/1741-2560/13/5/056016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Spinal cord injury causes a drastic loss of motor, sensory and autonomic function. The goal of this project was to investigate the use of intraspinal microstimulation (ISMS) for producing long distances of walking over ground. ISMS is an electrical stimulation method developed for restoring motor function by activating spinal networks below the level of an injury. It produces movements of the legs by stimulating the ventral horn of the lumbar enlargement using fine penetrating electrodes (≤50 μm diameter). APPROACH In each of five adult cats (4.2-5.5 kg), ISMS was applied through 16 electrodes implanted with tips targeting lamina IX in the ventral horn bilaterally. A desktop system implemented a physiologically-based control strategy that delivered different stimulation patterns through groups of electrodes to evoke walking movements with appropriate limb kinematics and forces corresponding to swing and stance. Each cat walked over an instrumented 2.9 m walkway and limb kinematics and forces were recorded. MAIN RESULTS Both propulsive and supportive forces were required for over-ground walking. Cumulative walking distances ranging from 609 to 835 m (longest tested) were achieved in three animals. In these three cats, the mean peak supportive force was 3.5 ± 0.6 N corresponding to full-weight-support of the hind legs, while the angular range of the hip, knee, and ankle joints were 23.1 ± 2.0°, 29.1 ± 0.2°, and 60.3 ± 5.2°, respectively. To further demonstrate the viability of ISMS for future clinical use, a prototype implantable module was successfully implemented in a subset of trials and produced comparable walking performance. SIGNIFICANCE By activating inherent locomotor networks within the lumbosacral spinal cord, ISMS was capable of producing bilaterally coordinated and functional over-ground walking with current amplitudes <100 μA. These exciting results suggest that ISMS may be an effective intervention for restoring functional walking after spinal cord injury.
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Affiliation(s)
- B J Holinski
- Department of Biomedical Engineering, University of Alberta, Alberta, Canada. Project SMART (Alberta Innovates-Health Solutions Interdisciplinary Team in Smart Neural Prostheses), Canada
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10
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Bulea TC, Kobetic R, Audu ML, Schnellenberger JR, Pinault G, Triolo RJ. Forward stair descent with hybrid neuroprosthesis after paralysis: Single case study demonstrating feasibility. ACTA ACUST UNITED AC 2015; 51:1077-94. [PMID: 25437932 DOI: 10.1682/jrrd.2013.12.0257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/30/2014] [Indexed: 11/05/2022]
Abstract
The ability to negotiate stairs is important for community access and independent mobility but requires more effort and strength than level walking. For this reason, previous attempts to utilize functional neuromuscular stimulation (FNS) to restore stair navigation after spinal cord injury (SCI) have had limited success and are not readily generalizable. Stair descent is particularly challenging because it requires energy absorption via eccentric muscle contractions, a task not easily accomplished with FNS. This article presents the design and initial testing of a hybrid neuroprosthesis with a variable impedance knee mechanism (VIKM-HNP) for stair descent. Using a 16-channel percutaneous FNS system, a muscle activation pattern was synthesized to descend stairs with the VIKM-HNP in a step-by-step fashion. A finite state control system was implemented to deactivate knee extensor stimulation and utilize the VIKM-HNP to absorb energy and regulate descent speed. Feasibility testing was performed on one individual with complete thoracic-level SCI. Stair descent was achieved with maximum upper-limb forces of less than 45% body weight compared with previously reported value of 70% with FNS only. The experiments also provided insight into design requirements for future hybrid systems for stair navigation, the implications of which are discussed.
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Affiliation(s)
- Thomas C Bulea
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
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Chang SR, Kobetic R, Audu ML, Quinn RD, Triolo RJ. Powered Lower-Limb Exoskeletons to Restore Gait for Individuals with Paraplegia - a Review. CASE ORTHOPAEDIC JOURNAL 2015; 12:75-80. [PMID: 28004009 PMCID: PMC5166705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Individuals with paraplegia due to spinal cord injury rank restoration of walking high on the list of priorities to improving their quality of life. Powered lower-limb exoskeleton technology provides the ability to restore standing up, sitting down, and walking movements for individuals with paraplegia. The robotic exoskeletons generally have electrical motors located at the hip and knee joint centers, which move the wearers' lower limbs through the appropriate range of motion for gait according to control systems using either trajectory control or impedance control. Users of exoskeletons are able to walk at average gait speeds of 0.26 m/s and distances ranging between 121-171 m. However, the achieved gait speeds and distances fall short of those required for full community ambulation (0.8 m/s and at least 230 m), restricting use of the devices to limited community use with stand-by assist or supervised rehabilitation settings. Improvement in the gait speed and distance may be achievable by combining a specially designed powered exoskeleton with neuromuscular stimulation technologies resulting in a hybrid system that fully engages the user and achieves the necessary requirements to ambulate in the community environment with benefits of muscle contraction.
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Affiliation(s)
- Sarah R Chang
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Department of Biomedical Engineering, Case Western Reserve University
| | - Rudi Kobetic
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
| | - Musa L Audu
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
| | - Roger D Quinn
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Departments of Mechanical Engineering and Aerospace Engineering, Case Western Reserve University
| | - Ronald J Triolo
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Department of Biomedical Engineering, Case Western Reserve University; Department of Orthopaedics, Case Western Reserve University
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