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Lin CW, Shieh JY, Tsui PH, Chen CL, Lu CH, Hung YH, Lee HY, Weng WC, Gau SSF. Acoustic radiation force impulse shear wave elastography quantifies upper limb muscle in patients with Duchenne muscular dystrophy. ULTRASONICS SONOCHEMISTRY 2023; 101:106661. [PMID: 37924615 PMCID: PMC10641721 DOI: 10.1016/j.ultsonch.2023.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
We investigated whether the upper limb muscle stiffness quantified by the acoustic radiation force impulse shear wave elastography (ARFI/SWE) is a potential biomarker for age-related muscle alteration and functional decline in patients with Duchenne muscular dystrophy (DMD). 37 patients with DMD and 30 typically developing controls (TDC) were grouped by age (3-8, 9-11, and 12-18 years). ARFI/SWE measured the biceps and deltoid muscle's shear wave velocities (SWVs). Performance of Upper Limb Module (PUL 1.2 module) assessed muscle function in DMD patients. Mann Whitney test compared muscle SWVs between DMD and TDC, stratified by three age groups. We used analysis of variance with Bonferroni correction to compare muscle SWVs between DMD and TDC and correlated muscle SWVs with PUL results in the DMD group. Results showed that the SWVs of biceps differentiated DMD patients from TDC across age groups. Younger DMD patients (3-8 years) exhibited higher SWVs (p = 0.013), but older DMD patients (12-18 years) showed lower SWVS (p = 0.028) than same-aged TDC. DMD patients had decreasing biceps SWVs with age (p < 0.001), with no such age effect in TDC. The SWVs of deltoid and biceps positively correlated with PUL scores (r = 0.527 ∼ 0.897, P < 0.05) and negatively correlated with PUL timed measures (r = -0.425 ∼ -0.542, P < 0.05) in DMD patients. Our findings suggest that ARFI/SWE quantifying the SWVs in upper limb muscle could be a potential biomarker to differentiate DMD from TDC across ages and that DMD patients showed age-related muscle alteration and limb functional decline.
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Affiliation(s)
- Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.1, Chang-Te St., Taipei 10048, Taipei, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Dist, Tao-Yuan City 33302, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Chun-Hao Lu
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Dist, Tao-Yuan City 33302, Taiwan
| | - Yi-Hsuan Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Hsiao-Yuan Lee
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Rd., Zhubei City, Hsinchu County 302, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan 10002, Taiwan; Department of Pediatric Neurology, National Taiwan University Children's Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan 10002, Taiwan.
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.1, Chang-Te St., Taipei 10048, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, and College of Medicine, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University, No.1 Jen Ai road section 1, Taipei 100 Taiwan.
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Khantan M, Avery M, Aung PT, Zarin RM, Hammelef E, Shawki N, Serruya MD, Napoli A. The NuroSleeve, a user-centered 3D printed hybrid orthosis for individuals with upper extremity impairment. J Neuroeng Rehabil 2023; 20:103. [PMID: 37542335 PMCID: PMC10403889 DOI: 10.1186/s12984-023-01228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis. METHODS This study introduces the design, implementation, and clinical evaluation of the NuroSleeve, a user-centered hybrid device that incorporates a lightweight, easy to don and doff 3D-printed motorized UE orthosis and a functional electrical stimulation (FES) component. Our primary goals are to develop a customized hybrid device that individuals with UE neuromuscular impairment can use to perform ADLs and to evaluate the benefits of incorporating the device into occupational therapy sessions. The trial is designed as a prospective, open-label, single-cohort feasibility study of eight-week sessions combined with at-home use of the device and implements an iterative device design process where feedback from participants and therapists informs design improvement cycles. RESULTS All participants learned how to independently don, doff, and use the NuroSleeve in ADLs, both in clinical therapy and in their home environments. All participants showed improvements in their Canadian Occupational Performance Measure (COPM), which was the primary clinical trial outcome measure. Furthermore, participants and therapists provided valuable feedback to guide further development. CONCLUSIONS Our results from non-clinical testing and clinical evaluation demonstrate that the NuroSleeve has met feasibility and safety goals and effectively improved independent voluntary function during ADLs. The study's encouraging preliminary findings indicate that the NuroSleeve has met its technical and clinical objectives while improving upon the limitations of the existing UE orthoses owing to its personalized and flexible approach to hardware and firmware design. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04798378, https://clinicaltrials.gov/ct2/show/NCT04798378 , date of registration: March 15, 2021.
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Affiliation(s)
- Mehdi Khantan
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Department of Electrical and Computer Engineering, Temple University, Philadelphia, PA, 19121, USA
| | | | - Phyo Thuta Aung
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Rachel M Zarin
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Emma Hammelef
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Nabila Shawki
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mijail Demian Serruya
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Alessandro Napoli
- Raphael Center for Neurorestoration, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
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Naarding KJ, Janssen MMHP, Boon RD, Bank PJM, Matthew RP, Kurillo G, Han JJ, Verschuuren JJGM, de Groot IJM, van der Holst M, Kan HE, Niks EH. The Black Box of Technological Outcome Measures: An Example in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2022; 9:555-569. [PMID: 35723109 PMCID: PMC9398077 DOI: 10.3233/jnd-210767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Outcome measures for non-ambulant Duchenne muscular dystrophy (DMD) patients are limited, with only the Performance of the Upper Limb (PUL) approved as endpoint for clinical trials. Objective: We assessed four outcome measures based on devices developed for the gaming industry, aiming to overcome disadvantages of observer-dependency and motivation. Methods: Twenty-two non-ambulant DMD patients (range 8.6–24.1 years) and 14 healthy controls (HC; range 9.5–25.4 years) were studied at baseline and 16 patients at 12 months using Leap Motion to quantify wrist/hand active range of motion (aROM) and a Kinect sensor for reached volume with Ability Captured Through Interactive Video Evaluation (ACTIVE), Functional Workspace (FWS) summed distance to seven upper extremity body points, and trunk compensation (KinectTC). PUL 2.0 was performed in patients only. A stepwise approach assessed quality control, construct validity, reliability, concurrent validity, longitudinal change and patient perception. Results: Leap Motion aROM distinguished patients and HCs for supination, radial deviation and wrist flexion (range p = 0.006 to <0.001). Reliability was low and the manufacturer’s hand model did not match the sensor’s depth images. ACTIVE differed between patients and HCs (p < 0.001), correlated with PUL (rho = 0.76), and decreased over time (p = 0.030) with a standardized response mean (SRM) of –0.61. It was appraised as fun on a 10-point numeric rating scale (median 9/10). PUL decreased over time (p < 0.001) with an SRM of –1.28, and was appraised as fun (median 7/10). FWS summed distance distinguished patients and HCs (p < 0.001), but reliability in patients was insufficient. KinectTC differed between patients and HCs (p < 0.01), but correlated insufficiently with PUL (rho = –0.69). Conclusions: Only ACTIVE qualified as potential outcome measure in non-ambulant DMD patients, although the SRM was below the commonly used threshold of 0.8. Lack of insight in technological constraints due to intellectual property and software updates made the technology behind these outcome measures a kind of black box that could jeopardize long-term use in clinical development.
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Affiliation(s)
- Karin J Naarding
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
| | - Mariska M H P Janssen
- Duchenne CenterNetherlands.,Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben D Boon
- C.J. Gorter Center for High Field MRI, Dept. of Radiology, LUMC, Leiden, Zuid-Holland, Netherlands
| | - Paulina J M Bank
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands
| | - Robert P Matthew
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, CA, USA
| | - Gregorij Kurillo
- Department of Orthopaedic Surgery, University of California at San Francisco, SanFrancisco, CA, USA
| | - Jay J Han
- Department of Physical Medicine & Rehabilitation, UC Irvine School of Medicine, Irvine, CA, USA
| | - Jan J G M Verschuuren
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
| | - Imelda J M de Groot
- Duchenne CenterNetherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Menno van der Holst
- Duchenne CenterNetherlands.,Department of Orthopedics, Rehabilitation and Physiotherapy, Leiden University Medical Center, Leiden, Netherlands
| | - Hermien E Kan
- Duchenne CenterNetherlands.,C.J. Gorter Center for High Field MRI, Dept. of Radiology, LUMC, Leiden, Zuid-Holland, Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
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Tolchin DW. Rehabilitation in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Janssen MMHP, Horstik J, Klap P, de Groot IJM. Feasibility and effectiveness of a novel dynamic arm support in persons with spinal muscular atrophy and duchenne muscular dystrophy. J Neuroeng Rehabil 2021; 18:84. [PMID: 34020668 PMCID: PMC8139063 DOI: 10.1186/s12984-021-00868-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background Neuromuscular disorders (NMD) commonly affect the upper extremity. Due to muscle weakness, performance of daily activities becomes increasingly difficult, which leads to reduced independence and quality of life. In order to support the performance of upper extremity tasks, dynamic arm supports may be used. The Yumen Arm is a novel dynamic arm support specially developed for people with NMD. The aim of this study is to evaluate the feasibility and effectiveness of the Yumen Arm in persons with Duchenne Muscular Dystrophy (DMD) and persons with Spinal Muscular Atrophy (SMA). Methods Three persons with DMD and three persons with SMA participated in this study. All participants conducted a set of measures with and without the Yumen Arm. Outcome measures were: active range of motion of the arm and trunk (i.e. Reachable Workspace, Functional Workspace, and trunk movement), fatigue (OMNI-RPE), Performance of Upper Limb (PUL) scale and some additional activities of daily living. User experiences were collected using a questionnaire. Results The Yumen Arm could be used by all participants. Results showed a median increase in active range of motion (4% relative surface area), and a median increase of function ability (>11% PUL score) when using the Yumen Arm. In addition, three out of four (data from 2 participants was missing) participants indicated that activity performance was less fatiguing when using the Yumen Arm. Four out of five (data from 1 participant was missing) participants indicated that they would like to use the Yumen Arm in their daily lives. Conclusion This study is one of the first studies describing a range of objective measures to examine the effectiveness of a dynamic arm support. Based on these measurements we can conclude that the Yumen Arm effectively improves arm function in NMD patients, however the effectiveness varies a lot between individual subjects. We provided detailed recommendations for the improvement of the Yumen Arm, and possible also for the development of other dynamic arm supports. This study showed a lot of variability between individual subjects, which emphasizes the importance of tuning dynamic arm supports based on individual user characteristics, such as scoliosis, functional capacity and muscle strength. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00868-6.
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Affiliation(s)
- Mariska M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands.
| | | | | | - Imelda J M de Groot
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands
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Longatelli V, Antonietti A, Biffi E, Diella E, D'Angelo MG, Rossini M, Molteni F, Bocciolone M, Pedrocchi A, Gandolla M. User-centred assistive SystEm for arm Functions in neUromuscuLar subjects (USEFUL): a randomized controlled study. J Neuroeng Rehabil 2021; 18:4. [PMID: 33407580 PMCID: PMC7789525 DOI: 10.1186/s12984-020-00794-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background Upper limb assistive devices can compensate for muscular weakness and empower the user in the execution of daily activities. Multiple devices have been recently proposed but there is still a lack in the scientific comparison of their efficacy. Methods We conducted a cross-over multi-centric randomized controlled trial to assess the functional improvement at the upper limb level of two arms supports on 36 patients with muscular dystrophy. Participants tested a passive device (i.e., Wrex by Jaeco) and a semi-active solution for gravity compensation (i.e., Armon Ayura). We evaluated devices’ effectiveness with an externally-assessed scale (i.e., Performance of the Upper Limb-PUL-module), a self-perceived scale (i.e., Abilhand questionnaire), and a usability scale (i.e., System Usability Scale). Friedman’s test was used to assess significant functional gain for PUL module and Abilhand questionnaire. Moreover, PUL changes were compared by means of the Friedman’s test. Results Most of the patients improved upper limb function with the use of arm supports (median PUL scores increase of 1–3 points). However, the effectiveness of each device was related to the level of residual ability of the end-user. Slightly impaired patients maintained the same independence without and with assistive devices, even if they reported reduced muscular fatigue for both devices. Moderately impaired patients enhanced their arm functionality with both devices, and they obtained higher improvements with the semi-active one (median PUL scores increase of 9 points). Finally, severely impaired subjects benefited only from the semi-active device (median PUL scores increase of 12 points). Inadequate strength was recognized as a barrier to passive devices. The usability, measured by the System Usability Scale, was evaluated by end-users “good” (70/100 points) for the passive, and “excellent” (80/100 points) for the semi-active device. Conclusions This study demonstrated that assistive devices can improve the quality of life of people suffering from muscular dystrophy. The use of passive devices, despite being low cost and easy to use, shows limitations in the efficacy of the assistance to daily tasks, limiting the assistance to a predefined horizontal plane. The addition of one active degree of freedom improves efficacy and usability especially for medium to severe patients. Further investigations are needed to increase the evidence on the effect of arm supports on quality of life and diseases’ progression in subjects with degenerative disorders. Trial registration clinicaltrials.gov, NCT03127241, Registered 25th April 2017. The clinical trial was also registered as a post-market study at the Italian Ministry of Health.
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Affiliation(s)
- Valeria Longatelli
- NeuroEngineering And medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, 20133, Milan, Italy
| | - Alberto Antonietti
- NeuroEngineering And medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, 20133, Milan, Italy
| | - Emilia Biffi
- Scientific Institute IRCCS E. Medea, Via Don Luigi Monza 20, 23842, Bosisio Parini, Italy
| | - Eleonora Diella
- Scientific Institute IRCCS E. Medea, Via Don Luigi Monza 20, 23842, Bosisio Parini, Italy
| | - Maria Grazia D'Angelo
- Scientific Institute IRCCS E. Medea, Via Don Luigi Monza 20, 23842, Bosisio Parini, Italy
| | - Mauro Rossini
- Valduce Hospital, Villa Beretta Rehabilitation Center, Via Nazario Sauro 17, 23845, Costa Masnaga, Italy
| | - Franco Molteni
- Valduce Hospital, Villa Beretta Rehabilitation Center, Via Nazario Sauro 17, 23845, Costa Masnaga, Italy
| | - Marco Bocciolone
- Department of Mechanical Engineering, Politecnico di Milano, Via Giuseppe La Masa 1, 20156, Milan, Italy
| | - Alessandra Pedrocchi
- NeuroEngineering And medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, 20133, Milan, Italy
| | - Marta Gandolla
- NeuroEngineering And medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, 20133, Milan, Italy. .,Department of Mechanical Engineering, Politecnico di Milano, Via Giuseppe La Masa 1, 20156, Milan, Italy.
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Essers JMN, Murgia A, Peters AA, Janssen MMHP, Meijer K. Recommendations for studies on dynamic arm support devices in people with neuromuscular disorders: a scoping review with expert-based discussion. Disabil Rehabil Assist Technol 2020; 17:487-500. [PMID: 32981390 DOI: 10.1080/17483107.2020.1806937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Neuromuscular disorders are characterised by muscle weakness that limits upper extremity mobility, but can be alleviated with dynamic arm support devices. Current research highlights the importance and difficulties of evidence-based recommendations for device development. We aim to provide research recommendations primarily concerning upper extremity body functions, and secondarily activity and participation, environmental and personal factors. METHODS Evidence was synthesised from literature, ongoing studies, and expert opinions and tabulated within a framework based on a combination of the International Classification of Functioning, Disability and Health (ICF) model and contextual constructs. RESULTS Current literature mostly investigated the motor capacity of muscle function, joint mobility, and upper body functionality, and a few studies also addressed the impact on activity and participation. In addition, experts considered knowledge on device utilisation in the daily environment and characterising the beneficiaries better as important. Knowledge gaps showed that ICF model components and contextual constructs should be better integrated and more actively included in future research. CONCLUSIONS It is recommended to, first, integrate multiple ICF model components and contextual constructs within one study design. Second, include the influence of environmental and personal factors when developing and deploying a device. Third, include short-term and long-term measurements to monitor adaptations over time. Finally, include user satisfaction as guidance to evaluate the device effectiveness.IMPLICATIONS ON REHABILITATIONSynthesized evidence will support future research and development of dynamic arm supports.Tabulated evidence stresses the importance of integrating ICF model components and contextual constructs to fill the knowledge gaps.Presented knowledge gaps and proposed steps guide the set up of future studies on dynamic arm supports.
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Affiliation(s)
- J M N Essers
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A Murgia
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A A Peters
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Meijer
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Simpson C, Huerta B, Sketch S, Lansberg M, Hawkes E, Okamura A. Upper Extremity Exomuscle for Shoulder Abduction Support. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2020.3012471] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Castro MN, Rahman T, Nicholson KF, Rasmussen J, Bai S, Andersen MS. A Case Study on Designing a Passive Feeding-Assistive Orthosis for Arthrogryposis. J Med Device 2020. [DOI: 10.1115/1.4047462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Passive arm-assistive devices play an important role in the rehabilitation of patients with neuromuscular disorders or injuries by overcoming their motor deficit. Routine human activities such as feeding are not possible without the aid provided by one of these devices or by a caregiver. In this study, a body-powered assistive device was designed for feeding purposes using a compact spherical scissors mechanism and zero-free-length (ZFL) springs (rubber bands) to leverage the patient's residual biceps and healthy triceps function. This partially balanced and lightweight orthosis was also projected to accommodate the spring attachment points closer to the elbow joint center. The performance of the prototype was evaluated on a young adult with bilateral amyoplasia of the biceps due to arthrogryposis who could not initially reach the superior anterior aspect of the close-to-torso region of the reachable three-dimensional (3D) workspace (RWS). That was accomplished by measuring the anatomical RWS of the patient before and while wearing the device. The results show that the patient, with the assistance provided by the device, was able to attain positions in the frontal close-to-torso region of the body that included reaching her mouth, thus enabling independent feeding.
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Affiliation(s)
- Miguel Nobre Castro
- Department of Materials and Production, Aalborg University, Aalborg DK-9220, Denmark
| | - Tariq Rahman
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - Kristen Faith Nicholson
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, Aalborg 9220, Denmark
| | - Shaoping Bai
- Department of Materials and Production, Aalborg University, Aalborg 9220, Denmark
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Gasperina SD, Gfoehler M, Puchinger M, Braghin F, Pedrocchi A, Gandolla M, Manti A, Aquilante L, Longatelli V, D'Angelo MG, Molteni F, Biffi E, Rossini M. Upper-limb actuated exoskeleton for muscular dystrophy patients: preliminary results .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4431-4435. [PMID: 31946849 DOI: 10.1109/embc.2019.8857725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Being able to perform a lost movement is an important experience towards increased independence and self-esteem, particularly for neuromuscular patients, who see their muscles weaken day after day. In this pilot study, preliminary results on the testing of a motorized upper-limb exoskeleton for muscular dystrophy patients are presented. The mechatronic system is a five Degrees of Freedom exoskeleton, which acts at shoulder, elbow, and wrist levels. It is designed to help severely impaired people to regain independence during daily-life activities. While wearing the exoskeleton, the user has the direct control of the system by actively piloting the position of end-effector by means of joystick or vocal control. The usability of the system and a quantitative assessment of arm functionality with and without the exoskeleton are evaluated on five muscular dystrophy patients. According to the objective functional benefit evaluation performed through the PUL scale, all participants strongly increased their range of motion and they were able to perform activities that were not possible without the exoskeleton, such as such as feeding, playing activities at the table, combing hair or using a keyboard. As for the evaluation of self-perceived functional benefit, four patients reflected the effective measured functional improvement. System usability has been evaluated to be good.
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Gandolla M, Antonietti A, Longatelli V, Pedrocchi A. The Effectiveness of Wearable Upper Limb Assistive Devices in Degenerative Neuromuscular Diseases: A Systematic Review and Meta-Analysis. Front Bioeng Biotechnol 2020; 7:450. [PMID: 32039171 PMCID: PMC6992540 DOI: 10.3389/fbioe.2019.00450] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background: This systematic review summarizes the current evidence about the effectiveness of wearable assistive technologies for upper limbs support during activities of daily living for individuals with neuromuscular diseases. Methods: Fourteen studies have been included in the meta-analysis, involving 184 participants. All included studies compared patients ability to perform functional tasks with and without assistive devices. Results: An overall effect size of 1.06 (95% CI = 0.76-1.36, p < 0.00001) was obtained, demonstrating that upper limbs assistive devices significantly improve the performance in activities of daily living in people with neuromuscular diseases. A significant interaction between studies evaluating functional improvement with externally-assessed outcome measures or self-perceived outcome measures has been detected. In particular, the effect size of the sub-group considering self-perceived scales was 1.38 (95% CI = 1.08-1.68), while the effect size of the other group was 0.77 (95% CI = 0.41-1.11), meaning that patients' perceived functional gain is often higher than the functional gain detectable through clinical scales. Conclusion: Overall, the quality of the evidence ranged from low to moderate, due to low number of studies and participants, limitations in the selection of participants and in the blindness of outcome assessors, and risk of publication bias. Significance: A large magnitude effect and a clear dose-response gradient were found, therefore, a strong recommendation, in favor of the use of assistive devices could be suggested.
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Affiliation(s)
- Marta Gandolla
- Nearlab@Lecco, Polo Territoriale di Lecco, Politecnico di Milano, Lecco, Italy
| | - Alberto Antonietti
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Valeria Longatelli
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandra Pedrocchi
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Janssen MMHP, Lobo-Prat J, Bergsma A, Vroom E. 2nd Workshop on upper-extremity assistive technology for people with Duchenne: Effectiveness and usability of arm supports Irvine, USA, 22nd-23rd January 2018. Neuromuscul Disord 2019; 29:651-656. [PMID: 31443952 DOI: 10.1016/j.nmd.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Mariska M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, Postbox 9101, 6500 HB Nijmegen, the Netherlands; Flextension Foundation, the Netherlands.
| | - Joan Lobo-Prat
- Department of Mechanical and Aerospace Engineering, University of California Irvine, USA; Flextension Foundation, the Netherlands
| | - Arjen Bergsma
- Department of Biomechanical Engineering, University of Twente, the Netherlands; Flextension Foundation, the Netherlands
| | - Elizabeth Vroom
- Duchenne Parent Project, the Netherlands; World Duchenne Organization, the Netherlands
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13
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Perry JC, Rathod A. Energy Density and Hysteresis Comparison in Natural Rubber Tube Springs for Wearable Exoskeleton Applications. IEEE Int Conf Rehabil Robot 2019; 2019:21-27. [PMID: 31374601 PMCID: PMC10751862 DOI: 10.1109/icorr.2019.8779400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Wearable exoskeletons show promise as a means for compensating lost function as well as for providing optimal assistance for maximal therapeutic benefit during everyday tasks. Development of lightweight spring systems for efficient storage and return are proposed as a key component in the successful deployment of wearable exoskeletons for individuals with neurological deficits. Both spring steel and natural rubber are common materials used in energy storage, but have not been directly compared by metrics such as energy storage density, energy storage efficiency, and hysteresis. In this work, we perform cyclic loading tests on spring steel extension springs of varying wire diameter and natural rubber tubing of varying wall thicknesses. We then use measured load-extension profiles to illustrate and compute metrics to better quantify the energy storing capabilities of each material and their appropriateness for use as energy storing and returning components in wearable robotic applications. Results show that natural rubber has a higher capacity for energy storage per unit weight in comparison to steel springs. Hysteresis is also higher in natural rubber and can be dramatically reduced by applying adequate pre-strain at levels greater than the anticipated strain during use.
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A Systematic Review on Existing Measures for the Subjective Assessment of Rehabilitation and Assistive Robot Devices. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2016:1048964. [PMID: 27196802 PMCID: PMC5058569 DOI: 10.1155/2016/1048964] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
The objective of the current study is to identify and classify outcome measures currently used for the assessment of rehabilitation or assistive robot devices. We conducted a systematic review of the literature using PubMed, MEDLINE, CIRRIE, and Scopus databases for studies that assessed rehabilitation or assistive robot devices from 1980 through January 2016. In all, 31 articles met all inclusion criteria. Tailor-made questionnaires were the most commonly used tool at 66.7%, while the great majority (93.9%) of the studies used nonvalidated instruments. The study reveals the absence of a standard scale which makes it difficult to compare the results from different researchers. There is a great need, therefore, for a valid and reliable instrument to be available for use by the intended end users for the subjective assessment of robot devices. The study concludes by identifying two scales that have been validated in general assistive technology devices and could support the scope of subjective assessment in rehabilitation or assistive robots (however, with limited coverage) and a new one called PYTHEIA, recently published. The latter intends to close the gap and help researchers and developers to evaluate, assess, and produce products that satisfy the real needs of the end users.
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15
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Mahmood MN, Peeters LHC, Paalman M, Verkerke GJ, Kingma I, van Dieën JH. Development and evaluation of a passive trunk support system for Duchenne muscular dystrophy patients. J Neuroeng Rehabil 2018. [PMID: 29540235 PMCID: PMC5853074 DOI: 10.1186/s12984-018-0353-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Patients with Duchenne muscular dystrophy gradually lose the ability to use different muscles of their body. Consequently, they lose the ability to stabilize their trunk against gravity. This hinders them to effectively perform different daily activities. In this paper, we describe the design, realization and evaluation of a trunk orthosis for these patients that should allow them to move their trunk and maintain stability. Method This study aimed to primarily assess the effectiveness of the trunk support system in terms of unloading of trunk muscles, so only healthy participants were recruited for this phase of the study. Measurements were done on 10 healthy participants (23.4±2.07 [M±SD] years old, average body weight 68.42±24.22 [M±SD] kg). The experiment comprised maintaining a constant trunk posture in three different device conditions (control without orthosis and two conditions with different configurations of the orthosis), at four different flexion angles (10°, 20°, 30°, 40°) for each device condition and for two load conditions (with and without stretching the arms). Electromyography (EMG) signals from the trunk muscles were measured to estimate activation levels of the trunk muscles (iliocostalis, longissimus, external oblique and rectus abdominis) and a motion capture system was used to record the movement of the participants during the experiment. Results Wearing the orthosis caused reductions in longissimus and iliocostalis activity. The average muscle activity level was 5%–10% of maximum voluntary contraction in the unsupported conditions for those particular muscles. This level was reduced to 3%–9% of maximal voluntary contraction for the supported conditions. No effect on external oblique and rectus abdominis activity was observed. Moreover, no pain or discomfort was reported by any of the participants during the experiment. The results from the current experiment also suggests the necessity of lumber stabilizing systems while using trunk orthosis. Conclusion The developed orthosis reduces trunk muscle activation level and provides a solid step for further development of support systems for Duchenne muscular dystrophy patients. Trial registration The current study was approved by the medical ethics committee Arnhem-Nijmegen (study number: NL53143.091.15), The Netherlands.
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Affiliation(s)
| | - Laura H C Peeters
- Dept of Rahabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Micha Paalman
- Dept of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gijsbertus J Verkerke
- Dept of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,dept of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Idsart Kingma
- Dept of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Jaap H van Dieën
- Dept of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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16
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Bergsma A, Lobo-Prat J, Vroom E, Furlong P, Herder JL. 1st Workshop on Upper-Extremity Assistive Technology for People with Duchenne: State of the art, emerging avenues, and challenges: April 27th 2015, London, United Kingdom. Neuromuscul Disord 2016; 26:386-93. [PMID: 27133663 DOI: 10.1016/j.nmd.2016.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/05/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Arjen Bergsma
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, The Netherlands; Department of Biomechanical Engineering, University of Twente, The Netherlands; Flextension Foundation, The Netherlands.
| | - Joan Lobo-Prat
- Department of Biomechanical Engineering, University of Twente, The Netherlands
| | - Elizabeth Vroom
- Duchenne Parent Project, The Netherlands; United Parent Project Muscular Dystrophy
| | - Pat Furlong
- United Parent Project Muscular Dystrophy; Parent Project Muscular Dystrophy, USA
| | - Just L Herder
- Department of Biomechanical Engineering, University of Twente, The Netherlands; Flextension Foundation, The Netherlands; Department of Precision and Microsystems Engineering, Delft University of Technology, The Netherlands
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17
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Kooren PN, Dunning AG, Janssen MMHP, Lobo-Prat J, Koopman BFJM, Paalman MI, de Groot IJM, Herder JL. Erratum to: Design and pilot validation of A-gear: a novel wearable dynamic arm support. J Neuroeng Rehabil 2015; 12:111. [PMID: 26637230 PMCID: PMC4670545 DOI: 10.1186/s12984-015-0106-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Peter N Kooren
- Department of Physics and Medical Technology, VU Medical Center, Amsterdam, The Netherlands.
| | - Alje G Dunning
- Department of Precision & Microsystems Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mariska M H P Janssen
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joan Lobo-Prat
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Bart F J M Koopman
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Micha I Paalman
- Department of Physics and Medical Technology, VU Medical Center, Amsterdam, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Just L Herder
- Department of Precision & Microsystems Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Mechanical Automation, University of Twente, Enschede, The Netherlands
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