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Moeller T, Moehler F, Krell-Roesch J, Dežman M, Marquardt C, Asfour T, Stein T, Woll A. Use of Lower Limb Exoskeletons as an Assessment Tool for Human Motor Performance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3032. [PMID: 36991743 PMCID: PMC10057915 DOI: 10.3390/s23063032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
Exoskeletons are a promising tool to support individuals with a decreased level of motor performance. Due to their built-in sensors, exoskeletons offer the possibility of continuously recording and assessing user data, for example, related to motor performance. The aim of this article is to provide an overview of studies that rely on using exoskeletons to measure motor performance. Therefore, we conducted a systematic literature review, following the PRISMA Statement guidelines. A total of 49 studies using lower limb exoskeletons for the assessment of human motor performance were included. Of these, 19 studies were validity studies, and six were reliability studies. We found 33 different exoskeletons; seven can be considered stationary, and 26 were mobile exoskeletons. The majority of the studies measured parameters such as range of motion, muscle strength, gait parameters, spasticity, and proprioception. We conclude that exoskeletons can be used to measure a wide range of motor performance parameters through built-in sensors, and seem to be more objective and specific than manual test procedures. However, since these parameters are usually estimated from built-in sensor data, the quality and specificity of an exoskeleton to assess certain motor performance parameters must be examined before an exoskeleton can be used, for example, in a research or clinical setting.
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Affiliation(s)
- Tobias Moeller
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Felix Moehler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Miha Dežman
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Charlotte Marquardt
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Tamim Asfour
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Thorsten Stein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
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Li G, Su Q, Xi W, Song Z, Bao R, Du Z. Dynamic analysis and design of a multipurpose lower limb exoskeleton for rehabilitation. INT J ADV ROBOT SYST 2022. [DOI: 10.1177/17298806221135140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To solve some defects of exoskeleton robot at present, this article establishes the dynamic model of human lower limb. The torque curves for hip joint and knee joint are obtained. A dynamics simulation is conducted in ADAMS which will guide the selection of motors and reducers for exoskeleton joints. Three structural design projects for leg and an integrated joint with the function of force perception are proposed. Then a lightweight exoskeleton is put forward and a kinematics simulation of man–machine coupling system is carried out in ADAMS. This article sets up a 24-V low-voltage control electrical system and a rehabilitation training expert system. Some performance tests and clinical experiments are carried out by an experimental prototype. The results show that the joints have sufficient driving torque. Leg structure has large adjustment range and self-locking function. The exoskeleton has lightweight and does not interfere with human body during movement. The expert system has a friendly operation interface and abundant functions. Clinical experimental results show that lower limb exoskeleton has good rehabilitation effect for some diseases.
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Affiliation(s)
- Gang Li
- SIASUN Robot & Automation Co. Ltd, Shenyang, China
| | - Qiying Su
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | - Wenqiu Xi
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Renren Bao
- SIASUN Robot & Automation Co. Ltd, Shenyang, China
| | - Zhenjun Du
- SIASUN Robot & Automation Co. Ltd, Shenyang, China
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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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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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Olthof NA, Coppieters MW, Moseley GL, Sterling M, Chippindall DJ, Harvie DS. Modernising tactile acuity assessment; clinimetrics of semi-automated tests and effects of age, sex and anthropometry on performance. PeerJ 2021; 9:e12192. [PMID: 35070517 PMCID: PMC8759376 DOI: 10.7717/peerj.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Reduced tactile acuity has been observed in several chronic pain conditions and has been proposed as a clinical indicator of somatosensory impairments related to the condition. As some interventions targeting these impairments have resulted in pain reduction, assessing tactile acuity may have significant clinical potential. While two-point discrimination threshold (TPDT) is a popular method of assessing tactile acuity, large measurement error has been observed (impeding responsiveness) and its validity has been questioned. The recently developed semi-automated ‘imprint Tactile Acuity Device’ (iTAD) may improve tactile acuity assessment, but clinimetric properties of its scores (accuracy score, response time and rate correct score) need further examination. Aims Experiment 1: To determine inter-rater reliability and measurement error of TPDT and iTAD assessments. Experiment 2: To determine internal consistencies and floor or ceiling effects of iTAD scores, and investigate effects of age, sex, and anthropometry on performance. Methods Experiment 1: To assess inter-rater reliability (ICC(2,1)) and measurement error (coefficient of variation (CoV)), three assessors each performed TPDT and iTAD assessments at the neck in forty healthy participants. Experiment 2: To assess internal consistency (ICC(2,k)) and floor or ceiling effects (skewness z-scores), one hundred healthy participants performed the iTAD’s localisation and orientation tests. Balanced for sex, participants were equally divided over five age brackets (18–30, 31–40, 41–50, 51–60 and 61–70). Age, sex, body mass index (BMI) and neck surface area were assessed to examine their direct (using multiple linear regression analysis) and indirect (using sequential mediation analysis) relationship with iTAD scores. Results Mean ICC(2,1) was moderate for TPDT (0.70) and moderate-to-good for the various iTAD scores (0.65–0.86). The CoV was 25.3% for TPDT and ranged from 6.1% to 16.5% for iTAD scores. Internal consistency was high for both iTAD accuracy scores (ICC(2,6) = 0.84; ICC(2,4) = 0.86). No overt floor or ceiling effects were detected (all skewness z-scores < 3.29). Accuracy scores were only directly related to age (decreasing with increasing age) and sex (higher for men). Discussion Although reliability was similar, iTAD scores demonstrated less measurement error than TPDT indicating a potential for better responsiveness to treatment effects. Further, unlike previously reported for TPDT, iTAD scores appeared independent of anthropometry, which simplifies interpretation. Additionally, the iTAD assesses multiple aspects of tactile processing which may provide a more comprehensive evaluation of tactile acuity. Taken together, the iTAD shows promise in measuring tactile acuity, but patient studies are needed to verify clinical relevance.
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Affiliation(s)
- Nick A. Olthof
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, QLD, Australia
| | - Dylan J. Chippindall
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Daniel S. Harvie
- School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA, Australia
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Ren H, Shang W, Li N, Wu X. A fast parameterized gait planning method for a lower-limb exoskeleton robot. INT J ADV ROBOT SYST 2020. [DOI: 10.1177/1729881419893221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In order to meet requirements of diverse activities of exoskeleton robot in practical application, a dynamic motion planning system is proposed using a fast parameterized gait planning method in this article. This method can plan the required gait data by adaptively adjusting very few parameters according to different application requirements. The inverted pendulum model is used to ensure the sagittal stability of the robot in the planning process. And this article specifies the end location of robot and iterates the associated joint angles by inverse kinematics. The gait trajectories generated by the proposed method are applied to the lightweight lower-limb exoskeleton robot. The results demonstrate that the trajectories of gait can be online generated smoothly and correctly, meanwhile every variable step can be satisfied as expected.
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Affiliation(s)
- Hao Ren
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wanfeng Shang
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Lab of Robotics and Intelligent System, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Niannian Li
- Otolaryngology Research Institute, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xinyu Wu
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Lab of Robotics and Intelligent System, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Qaiser T, Eginyan G, Chan F, Lam T. The sensorimotor effects of a lower limb proprioception training intervention in individuals with a spinal cord injury. J Neurophysiol 2019; 122:2364-2371. [DOI: 10.1152/jn.00842.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Proprioception is critical for movement control. After a spinal cord injury (SCI), individuals not only experience paralysis but may also experience proprioceptive deficits, further confounding motor recovery. The objective of this study was to test the effects of a robotic-based proprioception training protocol on lower limb proprioceptive sense in people with incomplete SCI. A secondary objective was to assess whether the effects of training transferred to a precision stepping task in people with motor-incomplete SCI. Participants with chronic incomplete SCI and able-bodied controls underwent a 2-day proprioceptive training protocol using the Lokomat robotic exoskeleton. The training involved positioning the test leg to various positions and participants were asked to report whether they felt their heel position (end-point position) was higher or lower compared with a reference position. Feedback was provided after each trial to help participants learn strategies that could help them discern different positions of their foot. Changes in end-point position as well as knee joint position sense were assessed pre- and posttraining. We also assessed the effects of proprioception training on the performance of a precision stepping task in people with motor-incomplete SCI. Following training, there were significant improvements in end-point and knee joint position sense in both groups. The magnitude of improvement was related to pretraining (baseline) proprioceptive sense, indicating that those who initially had better lower limb position sense showed greater changes. Participants also showed improvements in performance of a precision stepping task. NEW & NOTEWORTHY We show that it is possible to alter proprioceptive sense in people with incomplete SCI using a passive proprioception training protocol combined with feedback. Improvements in proprioceptive sense transferred from end-point to joint position sense and also to an untrained precision stepping task.
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Affiliation(s)
- Taha Qaiser
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Franco Chan
- International Collaboration on Repair Discoveries, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Négyesi J, Galamb K, Szilágyi B, Nagatomi R, Hortobágyi T, Tihanyi J. Age-specific modifications in healthy adults' knee joint position sense. Somatosens Mot Res 2019; 36:262-269. [PMID: 31691599 DOI: 10.1080/08990220.2019.1684888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aim: Right-handed young adults perform target-matching tasks more accurately with the non-dominant (ND) compared to the dominant (D) limb, but it is unclear if age affects this disparity. We determined if age affects target-matching asymmetry in right-side dominant healthy adults. Method: Young (n = 12, age: 23.6 y, 6 females) and older (n = 12; age: 75.1 y, 7 females) adults performed a passive joint position-matching task with the D and ND leg in a randomized order. Result: Age affected absolute, constant, and variable knee JPS errors but, contrary to expectations, it did not affect target-matching asymmetries between the D and ND knees. However, older participants tended to underestimate while young subjects overestimated the target angles. Moreover, older as compared to young subjects performed the target-matching task with higher variability. Conclusion: Altogether, age seems to affect passive knee target-matching behaviour in right-side dominant healthy adults. The present data indicate that healthy aging produces age-specific modifications in passive joint position sense.
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Affiliation(s)
- János Négyesi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kata Galamb
- Department of Movement, Human and Health Sciences, University of Rome, Rome, Italy
| | - Borbála Szilágyi
- Department of Biomechanics, Kinesiology and Informatics, University of Physical Education, Budapest, Hungary
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Biomedical Engineering for Health & Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - József Tihanyi
- Department of Biomechanics, Kinesiology and Informatics, University of Physical Education, Budapest, Hungary
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Chisholm AE, Qaiser T, Williams AMM, Eginyan G, Lam T. Acquisition of a precision walking skill and the impact of proprioceptive deficits in people with motor-incomplete spinal cord injury. J Neurophysiol 2019; 121:1078-1084. [PMID: 30726165 DOI: 10.1152/jn.00432.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Many people with motor-incomplete spinal cord injury (m-iSCI) experience difficulty navigating obstacles, such as curbs and stairs. The ability to relearn walking skills may be limited by proprioceptive deficits. The purpose of this study was to determine the capacity of participants to acquire a precision walking skill, and to evaluate the influence of proprioceptive deficits on the skill acquisition in individuals with m-iSCI. Sixteen individuals with m-iSCI and eight controls performed a precision walking task that required matching their foot height to a target during the swing phase. Proprioceptive deficits were quantified at the hip and knee for joint position and movement detection sense. Participants completed 600 steps of training with visual feedback. Pretraining and posttraining tests were conducted without visual feedback, along with a transfer test with an ankle weight. Posttraining and transfer tests were repeated 1 day later. Participants returned to the laboratory 1 wk later to repeat the training. Performance was calculated as the vertical distance between the target and actual foot height for each step. The posttraining and transfer performances were similar between groups. However, participants with m-iSCI had a slower rate of acquisition to achieve a similar performance level compared with controls. Acquisition rate and posttraining performance of the precision walking task were related to lower limb joint position sense among SCI participants. Although they can achieve a similar level of performance in a precision walking task, proprioceptive deficits impair the rate of learning among individuals with m-iSCI compared with able-bodied controls. NEW & NOTEWORTHY People with motor-incomplete spinal cord injuries are able to achieve the same level of performance accuracy on a precision walking task as able-bodied controls; however, the rate of learning is slower, indicating that more practice is required to stabilize performance. Our findings also show a relationship between impaired sensory function and reduced accuracy when performing a precision walking task after spinal cord injury.
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Affiliation(s)
- Amanda E Chisholm
- School of Kinesiology, University of British Columbia Vancouver, British Columbia Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver Costal Health Research Institute , Vancouver, British Columbia , Canada
| | - Taha Qaiser
- School of Kinesiology, University of British Columbia Vancouver, British Columbia Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver Costal Health Research Institute , Vancouver, British Columbia , Canada
| | - Alison M M Williams
- School of Kinesiology, University of British Columbia Vancouver, British Columbia Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver Costal Health Research Institute , Vancouver, British Columbia , Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia Vancouver, British Columbia Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver Costal Health Research Institute , Vancouver, British Columbia , Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia Vancouver, British Columbia Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver Costal Health Research Institute , Vancouver, British Columbia , Canada
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Ballardini G, Carlini G, Giannoni P, Scheidt RA, Nisky I, Casadio M. Tactile-STAR: A Novel Tactile STimulator And Recorder System for Evaluating and Improving Tactile Perception. Front Neurorobot 2018; 12:12. [PMID: 29681809 PMCID: PMC5897626 DOI: 10.3389/fnbot.2018.00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Many neurological diseases impair the motor and somatosensory systems. While several different technologies are used in clinical practice to assess and improve motor functions, somatosensation is evaluated subjectively with qualitative clinical scales. Treatment of somatosensory deficits has received limited attention. To bridge the gap between the assessment and training of motor vs. somatosensory abilities, we designed, developed, and tested a novel, low-cost, two-component (bimanual) mechatronic system targeting tactile somatosensation: the Tactile-STAR-a tactile stimulator and recorder. The stimulator is an actuated pantograph structure driven by two servomotors, with an end-effector covered by a rubber material that can apply two different types of skin stimulation: brush and stretch. The stimulator has a modular design, and can be used to test the tactile perception in different parts of the body such as the hand, arm, leg, big toe, etc. The recorder is a passive pantograph that can measure hand motion using two potentiometers. The recorder can serve multiple purposes: participants can move its handle to match the direction and amplitude of the tactile stimulator, or they can use it as a master manipulator to control the tactile stimulator as a slave. Our ultimate goal is to assess and affect tactile acuity and somatosensory deficits. To demonstrate the feasibility of our novel system, we tested the Tactile-STAR with 16 healthy individuals and with three stroke survivors using the skin-brush stimulation. We verified that the system enables the mapping of tactile perception on the hand in both populations. We also tested the extent to which 30 min of training in healthy individuals led to an improvement of tactile perception. The results provide a first demonstration of the ability of this new system to characterize tactile perception in healthy individuals, as well as a quantification of the magnitude and pattern of tactile impairment in a small cohort of stroke survivors. The finding that short-term training with Tactile-STAR can improve the acuity of tactile perception in healthy individuals suggests that Tactile-STAR may have utility as a therapeutic intervention for somatosensory deficits.
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Affiliation(s)
- Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Giorgio Carlini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Psiche Giannoni
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Robert A. Scheidt
- Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Civil, Mechanical and Manufacturing Innovation, National Science Foundation, Alexandria, VA, United States
| | - Ilana Nisky
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beersheba, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
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11
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Rajasekaran V, López-Larraz E, Trincado-Alonso F, Aranda J, Montesano L, Del-Ama AJ, Pons JL. Volition-adaptive control for gait training using wearable exoskeleton: preliminary tests with incomplete spinal cord injury individuals. J Neuroeng Rehabil 2018; 15:4. [PMID: 29298691 PMCID: PMC5751847 DOI: 10.1186/s12984-017-0345-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gait training for individuals with neurological disorders is challenging in providing the suitable assistance and more adaptive behaviour towards user needs. The user specific adaptation can be defined based on the user interaction with the orthosis and by monitoring the user intentions. In this paper, an adaptive control model, commanded by the user intention, is evaluated using a lower limb exoskeleton with incomplete spinal cord injury individuals (SCI). METHODS A user intention based adaptive control model has been developed and evaluated with 4 incomplete SCI individuals across 3 sessions of training per individual. The adaptive control model modifies the joint impedance properties of the exoskeleton as a function of the human-orthosis interaction torques and the joint trajectory evolution along the gait sequence, in real time. The volitional input of the user is identified by monitoring the neural signals, pertaining to the user's motor activity. These volitional inputs are used as a trigger to initiate the gait movement, allowing the user to control the initialization of the exoskeleton movement, independently. A Finite-state machine based control model is used in this set-up which helps in combining the volitional orders with the gait adaptation. RESULTS The exoskeleton demonstrated an adaptive assistance depending on the patients' performance without guiding them to follow an imposed trajectory. The exoskeleton initiated the trajectory based on the user intention command received from the brain machine interface, demonstrating it as a reliable trigger. The exoskeleton maintained the equilibrium by providing suitable assistance throughout the experiments. A progressive change in the maximum flexion of the knee joint was observed at the end of each session which shows improvement in the patient performance. Results of the adaptive impedance were evaluated by comparing with the application of a constant impedance value. Participants reported that the movement of the exoskeleton was flexible and the walking patterns were similar to their own distinct patterns. CONCLUSIONS This study demonstrates that user specific adaptive control can be applied on a wearable robot based on the human-orthosis interaction torques and modifying the joints' impedance properties. The patients perceived no external or impulsive force and felt comfortable with the assistance provided by the exoskeleton. The main goal of such a user dependent control is to assist the patients' needs and adapt to their characteristics, thus maximizing their engagement in the therapy and avoiding slacking. In addition, the initiation directly controlled by the brain allows synchronizing the user's intention with the afferent stimulus provided by the movement of the exoskeleton, which maximizes the potentiality of the system in neuro-rehabilitative therapies.
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Affiliation(s)
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | | | - Joan Aranda
- Departamento de Automatic e Control, Universitat Politécnica de Catalunya, Barcelona-Tech, Barcelona, Spain
| | - Luis Montesano
- Departamento de Informatica e Ingenería de Sistemas and, Instituto de Investigacion en Ingeneria de Aragon (I3A), University of Zaragoza, Zaragoza, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids unit, National Hospital for Spinal cord injury, Toledo, Spain
| | - Jose L Pons
- Neural Rehabilitation group, Spanish National Research Council (CSIC), Cajal Institute, Madrid, Spain
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Marini F, Contu S, Antuvan CW, Morasso P, Masia L. The Influence of External Forces on Wrist Proprioception. Front Hum Neurosci 2017; 11:440. [PMID: 28912703 PMCID: PMC5583607 DOI: 10.3389/fnhum.2017.00440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/16/2017] [Indexed: 11/13/2022] Open
Abstract
Proprioception combines information from cutaneous, joint, tendon, and muscle receptors for maintaining a reliable internal body image. However, it is still a matter of debate, in both neurophysiology and psychology, to what extent such body image is modified or distorted by a changing haptic environment. In particular, what is worth investigating is the contribution of external forces on our perception of body and joint configuration. The proprioceptive acuity of fifteen young participants was tested with a Joint Position Matching (JPM) task, performed with the dominant wrist under five different external forces, in order to understand to what extent they affect proprioceptive acuity. Results show that accuracy and precision in target matching do not change in a significant manner as a function of the loading condition, suggesting that the multi-sensory integration process is indeed capable of discriminating different sub-modalities of proprioception, namely the joint position sense and the sense of force. Furthermore, results indicate a preference for target undershooting when movements are performed in a viscous or high resistive force field, rather than passive or null fields in which subjects did not show any predominance for under/over estimation of their position.
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Affiliation(s)
- Francesca Marini
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di TecnologiaGenova, Italy
| | - Sara Contu
- School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore
| | - Chris W Antuvan
- School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore
| | - Pietro Morasso
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di TecnologiaGenova, Italy
| | - Lorenzo Masia
- School of Mechanical and Aerospace Engineering, Nanyang Technological UniversitySingapore, Singapore
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Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, Dettori JR, Schildhauer TA. The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review. Global Spine J 2016; 6:822-841. [PMID: 27853668 PMCID: PMC5110426 DOI: 10.1055/s-0036-1593805] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023] Open
Abstract
Study Design Systematic review. Clinical Questions (1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury? Methods PubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury. Results No comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure-Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton. Conclusion There is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs. There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury. Trials comparing later-generation exoskeletons are needed.
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Affiliation(s)
- Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States,Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany,Address for correspondence Christian Fisahn, MD Swedish Neuroscience Institute, Swedish Medical Center550 17th Avenue, Seattle, WA 98122United States
| | - Mirko Aach
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Oliver Jansen
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marc Moisi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States
| | - Angeli Mayadev
- Multiple Sclerosis Center, Swedish Medical Center, Seattle, Washington, United States
| | | | | | - Thomas A. Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Malik RN, Cote R, Lam T. Sensorimotor integration of vision and proprioception for obstacle crossing in ambulatory individuals with spinal cord injury. J Neurophysiol 2016; 117:36-46. [PMID: 27733593 DOI: 10.1152/jn.00169.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/03/2016] [Indexed: 01/02/2023] Open
Abstract
Skilled walking, such as obstacle crossing, is an essential component of functional mobility. Sensorimotor integration of visual and proprioceptive inputs is important for successful obstacle crossing. The objective of this study was to understand how proprioceptive deficits affect obstacle-crossing strategies when controlling for variations in motor deficits in ambulatory individuals with spinal cord injury (SCI). Fifteen ambulatory individuals with SCI and 15 able-bodied controls were asked to step over an obstacle scaled to their motor abilities under full and obstructed vision conditions. An eye tracker was used to determine gaze behaviour and motion capture analysis was used to determine toe kinematics relative to the obstacle. Combined, bilateral hip and knee proprioceptive sense (joint position sense and movement detection sense) was assessed using the Lokomat and customized software controls. Combined, bilateral hip and knee proprioceptive sense in subjects with SCI varied and was significantly different from able-bodied subjects. Subjects with greater proprioceptive deficits stepped higher over the obstacle with their lead and trail limbs in the obstructed vision condition compared with full vision. Subjects with SCI also glanced at the obstacle more frequently and with longer fixation times compared with controls, but this was not related to proprioceptive sense. This study indicates that ambulatory individuals with SCI rely more heavily on vision to cross obstacles and show impairments in key gait parameters required for successful obstacle crossing. Our data suggest that proprioceptive deficits need to be considered in rehabilitation programs aimed at improving functional mobility in ambulatory individuals with SCI. NEW & NOTEWORTHY This work is unique since it examines the contribution of combined, bilateral hip and knee proprioceptive sense on the recovery of skilled walking function, in addition to characterizing gaze behavior during a skilled walking task in people with motor-incomplete spinal cord injury.
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Affiliation(s)
- Raza Naseem Malik
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Cote
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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Marini F, Squeri V, Morasso P, Konczak J, Masia L. Robot-Aided Mapping of Wrist Proprioceptive Acuity across a 3D Workspace. PLoS One 2016; 11:e0161155. [PMID: 27536882 PMCID: PMC4990409 DOI: 10.1371/journal.pone.0161155] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Proprioceptive signals from peripheral mechanoreceptors form the basis for bodily perception and are known to be essential for motor control. However we still have an incomplete understanding of how proprioception differs between joints, whether it differs among the various degrees-of-freedom (DoFs) within a particular joint, and how such differences affect motor control and learning. We here introduce a robot-aided method to objectively measure proprioceptive function: specifically, we systematically mapped wrist proprioceptive acuity across the three DoFs of the wrist/hand complex with the aim to characterize the wrist position sense. Thirty healthy young adults performed an ipsilateral active joint position matching task with their dominant wrist using a haptic robotic exoskeleton. Our results indicate that the active wrist position sense acuity is anisotropic across the joint, with the abduction/adduction DoF having the highest acuity (the error of acuity for flexion/extension is 4.64 ± 0.24°; abduction/adduction: 3.68 ± 0.32°; supination/pronation: 5.15 ± 0.37°) and they also revealed that proprioceptive acuity decreases for smaller joint displacements. We believe this knowledge is imperative in a clinical scenario when assessing proprioceptive deficits and for understanding how such sensory deficits relate to observable motor impairments.
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Affiliation(s)
- Francesca Marini
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Valentina Squeri
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Pietro Morasso
- Motor Learning and Robotic Rehabilitation Laboratory, Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology and Center for Clinical Movement Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lorenzo Masia
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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Maggioni S, Melendez-Calderon A, van Asseldonk E, Klamroth-Marganska V, Lünenburger L, Riener R, van der Kooij H. Robot-aided assessment of lower extremity functions: a review. J Neuroeng Rehabil 2016; 13:72. [PMID: 27485106 PMCID: PMC4969661 DOI: 10.1186/s12984-016-0180-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/21/2016] [Indexed: 01/01/2023] Open
Abstract
The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.
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Affiliation(s)
- Serena Maggioni
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland.
- Hocoma AG, Volketswil, Switzerland.
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland.
| | - Alejandro Melendez-Calderon
- Hocoma AG, Volketswil, Switzerland
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edwin van Asseldonk
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | | | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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The relationship between lower limb proprioceptive sense and locomotor skill acquisition. Exp Brain Res 2016; 234:3185-3192. [PMID: 27380635 DOI: 10.1007/s00221-016-4716-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/27/2016] [Indexed: 01/01/2023]
Abstract
Sensorimotor integration is essential for controlling movement and acquiring new motor tasks in humans. The aim of this project was to understand how lower limb proprioceptive sense contributes to the acquisition of a skilled walking task. We assessed lower limb joint position and movement detection sense in healthy human subjects using the Lokomat robotic exoskeleton. Subjects walked on a treadmill to practice a skilled motor task (200 trials) requiring them to match their foot height during the swing phase to the height of a virtual obstacle displayed on a monitor in front of them. Subjects were given visual feedback on their error relative to the obstacle height after it was crossed. Lower limb joint position sense was related to the final performance error, but not the learning rate of the skilled walking task. The findings from this study support the role of lower limb proprioceptive sense on locomotor skill performance in healthy adult subjects.
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Chamorro-Moriana G, Sevillano JL, Ridao-Fernández C. A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity. SENSORS 2016; 16:s16060925. [PMID: 27338396 PMCID: PMC4934350 DOI: 10.3390/s16060925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 12/26/2022]
Abstract
Frequently, patients who suffer injuries in some lower member require forearm crutches in order to partially unload weight-bearing. These lesions cause pain in lower limb unloading and their progression should be controlled objectively to avoid significant errors in accuracy and, consequently, complications and after effects in lesions. The design of a new and feasible tool that allows us to control and improve the accuracy of loads exerted on crutches during aided gait is necessary, so as to unburden the lower limbs. In this paper, we describe such a system based on a force sensor, which we have named the GCH System 2.0. Furthermore, we determine the validity and reliability of measurements obtained using this tool via a comparison with the validated AMTI (Advanced Mechanical Technology, Inc., Watertown, MA, USA) OR6-7-2000 Platform. An intra-class correlation coefficient demonstrated excellent agreement between the AMTI Platform and the GCH System. A regression line to determine the predictive ability of the GCH system towards the AMTI Platform was found, which obtained a precision of 99.3%. A detailed statistical analysis is presented for all the measurements and also segregated for several requested loads on the crutches (10%, 25% and 50% of body weight). Our results show that our system, designed for assessing loads exerted by patients on forearm crutches during assisted gait, provides valid and reliable measurements of loads.
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Affiliation(s)
| | - José Luis Sevillano
- Department of Computer Technology and Architecture, University of Seville, Sevilla 41012, Spain.
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The Three Laws of Neurorobotics: A Review on What Neurorehabilitation Robots Should Do for Patients and Clinicians. J Med Biol Eng 2016; 36:1-11. [PMID: 27069459 PMCID: PMC4791450 DOI: 10.1007/s40846-016-0115-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 01/10/2023]
Abstract
Most studies and reviews on robots for neurorehabilitation focus on their effectiveness. These studies often report inconsistent results. This and many other reasons limit the credit given to these robots by therapists and patients. Further, neurorehabilitation is often still based on therapists' expertise, with competition among different schools of thought, generating substantial uncertainty about what exactly a neurorehabilitation robot should do. Little attention has been given to ethics. This review adopts a new approach, inspired by Asimov's three laws of robotics and based on the most recent studies in neurorobotics, for proposing new guidelines for designing and using robots for neurorehabilitation. We propose three laws of neurorobotics based on the ethical need for safe and effective robots, the redefinition of their role as therapist helpers, and the need for clear and transparent human-machine interfaces. These laws may allow engineers and clinicians to work closely together on a new generation of neurorobots.
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Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci 2016; 37:503-14. [PMID: 26781943 DOI: 10.1007/s10072-016-2474-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/18/2022]
Abstract
Gait abnormalities following neurological disorders are often disabling, negatively affecting patients' quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one's ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson's disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.
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Chisholm AE, Domingo A, Jeyasurya J, Lam T. Quantification of Lower Extremity Kinesthesia Deficits Using a Robotic Exoskeleton in People With a Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:199-208. [PMID: 26089310 DOI: 10.1177/1545968315591703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Our ability to sense movement is essential for motor control; however, the impact of kinesthesia deficits on functional recovery is not well monitored in the spinal cord injury (SCI) population. One problem is the lack of accurate and reliable tools to measure kinesthesia. OBJECTIVE The purpose of this study was to establish the validity and reliability of a quantitative robotic assessment tool to measure lower limb kinesthesia in people with SCI. METHODS Seventeen individuals with an incomplete SCI and 17 age-matched controls completed 2 robotic-based assessments of lower limb kinesthesia sense, separated by at least 1 week. The Lokomat, a lower limb robotic exoskeleton, was used to quantify the movement detection score bilaterally for the hip and knee joints. Four passive movement speeds (0.5, 1.0, 2.0, and 4.0 deg/s) were applied in both flexion and extension directions. Participants responded via pressing a joystick button when movement was felt. RESULTS The movement detection score was significantly greater in people with SCI compared with the control group, particularly at the slowest movement speed. The difference between groups was more pronounced among those classified as ASIA (American Spinal Injury Association) Impairment Scale B. Our measure showed high test-retest reliability and good internal consistency for the hip and knee joints. CONCLUSIONS Our findings demonstrated that lower limb kinesthesia deficits are common in the SCI population and highlighted the importance of valid and reliable tools to monitor sensory function. Future studies need to examine changes in sensory function in response to therapy.
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Affiliation(s)
- Amanda E Chisholm
- University of British Columbia, Vancouver, British Columbia, Canada Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Antoinette Domingo
- University of British Columbia, Vancouver, British Columbia, Canada Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeswin Jeyasurya
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- University of British Columbia, Vancouver, British Columbia, Canada Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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