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Goo AC, Laubscher CA, Wajda DA, Sawicki JT. Preliminary Virtual Constraint-Based Control Evaluation on a Pediatric Lower-Limb Exoskeleton. Bioengineering (Basel) 2024; 11:590. [PMID: 38927826 PMCID: PMC11201092 DOI: 10.3390/bioengineering11060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Pediatric gait rehabilitation and guidance strategies using robotic exoskeletons require a controller that encourages user volitional control and participation while guiding the wearer towards a stable gait cycle. Virtual constraint-based controllers have created stable gait cycles in bipedal robotic systems and have seen recent use in assistive exoskeletons. This paper evaluates a virtual constraint-based controller for pediatric gait guidance through comparison with a traditional time-dependent position tracking controller on a newly developed exoskeleton system. Walking experiments were performed with a healthy child subject wearing the exoskeleton under proportional-derivative control, virtual constraint-based control, and while unpowered. The participant questionnaires assessed the perceived exertion and controller usability measures, while sensors provided kinematic, control torque, and muscle activation data. The virtual constraint-based controller resulted in a gait similar to the proportional-derivative controlled gait but reduced the variability in the gait kinematics by 36.72% and 16.28% relative to unassisted gait in the hips and knees, respectively. The virtual constraint-based controller also used 35.89% and 4.44% less rms torque per gait cycle in the hips and knees, respectively. The user feedback indicated that the virtual constraint-based controller was intuitive and easy to utilize relative to the proportional-derivative controller. These results indicate that virtual constraint-based control has favorable characteristics for robot-assisted gait guidance.
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Affiliation(s)
- Anthony C. Goo
- Center for Rotating Machinery Dynamics and Control (RoMaDyC), Washkewicz College of Engineering, Cleveland State University, Cleveland, OH 44115, USA;
| | - Curt A. Laubscher
- Department of Robotics, Michigan Engineering, University of Michigan Ann Arbor, Ann Arbor, MI 48109, USA;
| | - Douglas A. Wajda
- Department of Health Sciences and Human Performance, College of Health, Cleveland State University, Cleveland, OH 44115, USA;
| | - Jerzy T. Sawicki
- Center for Rotating Machinery Dynamics and Control (RoMaDyC), Washkewicz College of Engineering, Cleveland State University, Cleveland, OH 44115, USA;
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Nepomuceno P, Souza WH, Pakosh M, Musselman KE, Craven BC. Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters. J Neuroeng Rehabil 2024; 21:73. [PMID: 38705999 PMCID: PMC11070073 DOI: 10.1186/s12984-024-01365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established. OBJECTIVE This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure. RESULTS Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions). CONCLUSION This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.
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Affiliation(s)
- Patrik Nepomuceno
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wagner H Souza
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Lee DH, Woo BS, Park YH, Lee JH. General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:711. [PMID: 38792894 PMCID: PMC11123276 DOI: 10.3390/medicina60050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.
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Affiliation(s)
- Dae-Hwan Lee
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Bong-Sik Woo
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Yong-Hwa Park
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Jung-Ho Lee
- Department of Physical Therapy, University of Kyungdong, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gangwon-do, Republic of Korea
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Martinache F, Foudhaïli A, Vigué B. Early rehabilitation after spinal cord injury: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00294. [PMID: 38602049 DOI: 10.11124/jbies-22-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the timings and types of early rehabilitation after spinal cord injuries (SCI) that are documented in the literature, as well as identify possible research gaps in this field. INTRODUCTION Preclinical and clinical studies support the idea that early rehabilitation may be beneficial for patients with acute SCI. However, the timing and types of rehabilitation that should and could be used in the acute stage are still unclear. The first step towards such knowledge is to extensively review what is documented in the literature. INCLUSION CRITERIA This review will consider all papers focusing on early rehabilitation after SCI in adult humans or animals (<3 months post-SCI for humans and other primates and <3 weeks post-SCI for other animals). Interventions in the included papers must aim at sensorimotor or functional improvement and take place in a hospital or a rehabilitation center if they target human subjects. METHODS MEDLINE (PubMed), Scopus, Embase (Embase.com), PEDro, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PROSPERO, ClinicalTrials.gov, and gray literature sources will be searched for eligible articles. This review will include published and unpublished experimental and observational studies, research protocols, conference abstracts, systematic reviews, and guidelines. No language or date limits will be applied. Two independent reviewers will perform study selection and data extraction, and the results will be presented according to the SCI type and severity. REVIEW REGISTRATION Open Science Framework https://osf.io/q45er.
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Affiliation(s)
- Florence Martinache
- Université Paris-Saclay, CIAMS, 91405, Orsay, France
- Techno Concept, Manosque, France
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
| | - Adéla Foudhaïli
- Département de Médecine Physique et Réadaptation, AP-HP, CHU Lariboisiére, F-75010, Paris, France
- Université Paris Cité, Inserm, MASCOT, F-75010 Paris, France
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, F-75015 Paris, France
| | - Bernard Vigué
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
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Tao G, Yang S, Xu J, Wang L, Yang B. Global research trends and hotspots of artificial intelligence research in spinal cord neural injury and restoration-a bibliometrics and visualization analysis. Front Neurol 2024; 15:1361235. [PMID: 38628700 PMCID: PMC11018935 DOI: 10.3389/fneur.2024.1361235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Artificial intelligence (AI) technology has made breakthroughs in spinal cord neural injury and restoration in recent years. It has a positive impact on clinical treatment. This study explores AI research's progress and hotspots in spinal cord neural injury and restoration. It also analyzes research shortcomings related to this area and proposes potential solutions. Methods We used CiteSpace 6.1.R6 and VOSviewer 1.6.19 to research WOS articles on AI research in spinal cord neural injury and restoration. Results A total of 1,502 articles were screened, in which the United States dominated; Kadone, Hideki (13 articles, University of Tsukuba, JAPAN) was the author with the highest number of publications; ARCH PHYS MED REHAB (IF = 4.3) was the most cited journal, and topics included molecular biology, immunology, neurology, sports, among other related areas. Conclusion We pinpointed three research hotspots for AI research in spinal cord neural injury and restoration: (1) intelligent robots and limb exoskeletons to assist rehabilitation training; (2) brain-computer interfaces; and (3) neuromodulation and noninvasive electrical stimulation. In addition, many new hotspots were discussed: (1) starting with image segmentation models based on convolutional neural networks; (2) the use of AI to fabricate polymeric biomaterials to provide the microenvironment required for neural stem cell-derived neural network tissues; (3) AI survival prediction tools, and transcription factor regulatory networks in the field of genetics were discussed. Although AI research in spinal cord neural injury and restoration has many benefits, the technology has several limitations (data and ethical issues). The data-gathering problem should be addressed in future research, which requires a significant sample of quality clinical data to build valid AI models. At the same time, research on genomics and other mechanisms in this field is fragile. In the future, machine learning techniques, such as AI survival prediction tools and transcription factor regulatory networks, can be utilized for studies related to the up-regulation of regeneration-related genes and the production of structural proteins for axonal growth.
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Affiliation(s)
- Guangyi Tao
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Shun Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Junjie Xu
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Linzi Wang
- College of Orthopedics and Traumatology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bin Yang
- Department of Pain, Henan Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Tashiro S, Shibata S, Nagoshi N, Zhang L, Yamada S, Tsuji T, Nakamura M, Okano H. Do Pharmacological Treatments Act in Collaboration with Rehabilitation in Spinal Cord Injury Treatment? A Review of Preclinical Studies. Cells 2024; 13:412. [PMID: 38474376 DOI: 10.3390/cells13050412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Shinsuke Shibata
- Division of Microscopic Anatomy, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Liang Zhang
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Faculty of Medicine, Kyorin University, Tokyo 181-8611, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Hideyuki Okano
- Department of Physiology, School of Medicine, Keio University, Tokyo 160-8582, Japan
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Zhong J, He Y, Zhao Q, Luo H, Zhang Q, Tian Y, Liu Y, Yang C, Yin Y, Yu L, Pan L, Tan B. Low-Dose LPS Modulates Microglia/Macrophages Phenotypic Transformation to Amplify Rehabilitation Effects in Chronic Spinal Cord Injured (CSCI) Mice. Mol Neurobiol 2024:10.1007/s12035-024-03979-y. [PMID: 38311654 DOI: 10.1007/s12035-024-03979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024]
Abstract
Spinal cord injury (SCI) results in stalled motor function recovery under the chronic phase. One of the reasons due to the presence of ongoing inflammation. Therefore, regulating the status of immune cells may help reopen the window for neural repair, which represents a potential therapeutic target. In this study, we aimed to investigate whether this could be achieved in mice with cervical 5 crush CSCI (4 W) by utilizing a concentration of 0.5 mg/kg of lipopolysaccharide (LPS) to stimulate microglia/macrophages. Additionally, the mice underwent rehabilitation training for another 6 weeks. Our results showed that systemic injection of LPS enhanced the effects of forelimb rehabilitation training, as evaluated through single pellet grasping (SPG). Electrophysiological studies revealed the restoration of cortical drive to the injured side's forelimb muscles in the training combined with LPS group. Tract tracing studies demonstrated the reconstruction of cortical innervation to the cervical spinal cord. Furthermore, the levels of pro-inflammatory phenotype markers, such as inducible nitric oxide synthase (INOS) and CD68, decreased, while the expression of anti-inflammatory phenotype markers, including arginase 1 (ARG-1) and CD206, increased. Importantly, this phenotypic switch in microglia/macrophages was accompanied by an increase in phagocytic activity markers as indicated by BODIPY + IBA1 + staining. Collectively, our data suggests that low-dose LPS improves the effects of rehabilitation training by regulating the phenotypic transformation of microglia/macrophages in CSCI. This study provides a fresh perspective and intervention direction for the clinical treatment of chronic spinal cord injuries.
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Affiliation(s)
- Juan Zhong
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yingxi He
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Qin Zhao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Haodong Luo
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Qing Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yu Tian
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yuan Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Special War Wound, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Ce Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Special War Wound, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lu Pan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Huang L, Huang HL, Dang XW, Wang YJ. Effect of Body Weight Support Training on Lower Extremity Motor Function in Patients With Spinal Cord Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:149-157. [PMID: 37535636 DOI: 10.1097/phm.0000000000002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The aims of the study are to systematically evaluate the effect of body weight support training on lower extremity motor function(s) in patients with spinal cord injury and to compare the effect differences among three body weight support training methods. DESIGN PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, China Scientific Journal, and Wan Fang databases were searched until December 31, 2022. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and ADDIS 1.16.8. RESULTS Nineteen randomized controlled trials involving 864 patients were included. The meta-analysis showed that body weight support training could improve lower extremity motor scores according to the International Standards for Neurological Classification of Spinal Cord Injury standard (mean difference = 6.38, 95% confidence interval = 3.96-8.80, P < 0.05), walking speed (standard mean difference = 0.77, 95% confidence interval = 0.52-1.02, P < 0.05), and modified Barthel Index scores (mean difference = 9.85, 95% confidence interval = 8.39-11.30, P < 0.05). The network meta-analysis showed no significant difference among the three body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury. The best probability ranking of the body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury was robot-assisted gait training ( P = 0.60), followed by aquatic exercise ( P = 0.21) and body weight support training ( P = 0.19). CONCLUSIONS Body weight support training can improve lower extremity motor score in patients with spinal cord injury. No significant difference was observed among the three body weight support training methods, but robot-assisted gait training may produce the best effect.
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Affiliation(s)
- Lei Huang
- From the College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Changqing District, Jinan City, China
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Maggio MG, Bonanno M, Manuli A, Calabrò RS. Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway. Brain Sci 2024; 14:140. [PMID: 38391715 PMCID: PMC10886543 DOI: 10.3390/brainsci14020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Spinal cord injury (SCI) consists of damage to any segment of the spinal cord extending to potential harm to nerves in the cauda equina. Rehabilitative efforts for SCI can involve conventional physiotherapy, innovative technologies, as well as cognitive treatment and psychological support. The aim of this study is to evaluate the feasibility of a dedicated, multidisciplinary, and integrated intervention path for SCI, encompassing both conventional and technological interventions, while observing their impact on cognitive, motor, and behavioral outcomes and the overall quality of life for individuals with SCI. Forty-two patients with SCI were included in the analysis utilizing electronic recovery system data. The treatment regimen included multidisciplinary rehabilitation approaches, such as traditional physiotherapy sessions, speech therapy, psychological support, robotic devices, advanced cognitive rehabilitation, and other interventions. Pre-post comparisons showed a significant improvement in lower limb function (Fugl Meyer Assessment-FMA < 0.001), global cognitive functioning (Montreal Cognitive Assessment-MoCA p < 0.001), and perceived quality of life at both a physical and mental level (Short Form-12-SF-12 p < 0.001). Furthermore, we found a significant reduction in depressive state (Beck Depression Inventory-BDI p < 0.001). In addition, we assessed patient satisfaction using the Short Form of the Patient Satisfaction Questionnaire (PSQ), offering insights into the subjective evaluation of the intervention. In conclusion, this retrospective study provides positive results in terms of improvements in motor function, cognitive functions, and quality of life, highlighting the importance of exploring multidisciplinary approaches.
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Affiliation(s)
- Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Alfredo Manuli
- A.O.U. Policlinico "G. Martino", Via Consolare Valeria, 98124 Messina, Italy
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Gong T, Chen D, Wang G, Zhang W, Zhang J, Ouyang Z, Zhang F, Sun R, Ji JC, Chen W. Multimodal fusion and human-robot interaction control of an intelligent robot. Front Bioeng Biotechnol 2024; 11:1310247. [PMID: 38239918 PMCID: PMC10794586 DOI: 10.3389/fbioe.2023.1310247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction: Small-scaled robotic walkers play an increasingly important role in Activity of Daily Living (ADL) assistance in the face of ever-increasing rehab requirements and existing equipment drawbacks. This paper proposes a Rehabilitation Robotic Walker (RRW) for walking assistance and body weight support (BWS) during gait rehabilitation. Methods: The walker provides the patients with weight offloading and guiding force to mimic a series of the physiotherapist's (PT's) movements, and creates a natural, comfortable, and safe environment. This system consists of an omnidirectional mobile platform, a BWS mechanism, and a pelvic brace to smooth the motions of the pelvis. To recognize the human intentions, four force sensors, two joysticks, and one depth-sensing camera were used to monitor the human-machine information, and a multimodal fusion algorithm for intention recognition was proposed to improve the accuracy. Then the system obtained the heading angle E, the pelvic pose F, and the motion vector H via the camera, the force sensors, and the joysticks respectively, classified the intentions with feature extraction and information fusion, and finally outputted the motor speed control through the robot's kinematics. Results: To validate the validity of the algorithm above, a preliminary test with three volunteers was conducted to study the motion control. The results showed that the average error of the integral square error (ISE) was 2.90 and the minimum error was 1.96. Discussion: The results demonstrated the efficiency of the proposed method, and that the system is capable of providing walking assistance.
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Affiliation(s)
- Tao Gong
- Institute of Intelligent Manufacturing, Shenzhen Polytechnic University, Shenzhen, China
| | - Dan Chen
- Institute of Intelligent Manufacturing, Shenzhen Polytechnic University, Shenzhen, China
| | - Guangping Wang
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Weicai Zhang
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Junqi Zhang
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Zhongchuan Ouyang
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Fan Zhang
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Ruifeng Sun
- AVIC Changhe Aircraft Industry (Group) Corporation Ltd., Jingdezhen, China
| | - Jiancheng Charles Ji
- Institute of Intelligent Manufacturing, Shenzhen Polytechnic University, Shenzhen, China
| | - Wei Chen
- Institute of Intelligent Manufacturing, Shenzhen Polytechnic University, Shenzhen, China
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Wan C, Huang S, Wang X, Ge P, Wang Z, Zhang Y, Li Y, Su B. Effects of robot-assisted gait training on cardiopulmonary function and lower extremity strength in individuals with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2024; 47:6-14. [PMID: 36972206 PMCID: PMC10795646 DOI: 10.1080/10790268.2023.2188392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
CONTEXT Robot-assisted gait training (RAGT) has been increasingly adopted in many rehabilitation facilities for walking function and activity in individuals with spinal cord injury (SCI). However, the effectiveness of RAGT on lower extremity strength and cardiopulmonary function, especially static pulmonary function, have not been clearly outlined. OBJECTIVE Determine the effect of RAGT on cardiopulmonary function and lower extremity strength in SCI survivors. METHODS Eight databases were systematically searched for randomized controlled trials comparing RAGT with conventional physical therapy or other non-robotic therapies for survivors with SCI. Study selection required lower extremity strength decline after SCI at baseline. The overall effects of RAGT were calculated using a meta-analytic method. Begg's test was used to assess the risk of publication bias. RESULTS The pooled analysis demonstrated that RAGT may have a positive effect for individuals with SCI on lower extremity strength enhancing (n = 408; standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.14-1.48) and cardiopulmonary endurance(n = 104; standardized mean difference [SMD] = 2.24; 95% confidence interval [CI] = 0.28-4.19). However, no significant effect was established on static pulmonary function. No publication bias was observed according to the Begg's test. CONCLUSIONS RAGT may be a useful technique for improving lower limb strength and cardiovascular endurance in SCI survivors. The usefulness of RAGT in enhancing static pulmonary function was not demonstrated by the study. However, these results should be interpreted with caution, given the low number of selected studies and subjects. Clinical studies with large sample sizes will be necessary in the future.
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Affiliation(s)
- Chunli Wan
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Sisi Huang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Xue Wang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Panli Ge
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Zhixiang Wang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yuting Zhang
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yongqiang Li
- Department of rehabilitation medicine, The First Affiliated Hospital of Nanjing Medical University/School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Bin Su
- Wuxi Central Rehabilitation Hospital/Wuxi Mental Health Center, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, 214151, China
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Amatachaya S, Nithiatthawanon T, Amatachaya P, Thaweewannakij T. Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial. Disabil Rehabil 2023; 45:4431-4439. [PMID: 36472135 DOI: 10.1080/09638288.2022.2152502] [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: 05/16/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI). STUDY DESIGN Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797). METHODS Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter. RESULTS Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0-3.5s). CONCLUSIONS LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).
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Affiliation(s)
- Sugalya Amatachaya
- Faculty of Associated Medical Sciences, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Teerawat Nithiatthawanon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Physical Therapy, Division of Physical Therapy, Srinakharinwirot University (Ongkharak Campus), Nakhon-Nayok, Thailand
| | - Pipatana Amatachaya
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- Faculty of Associated Medical Sciences, School of Physical Therapy, Khon Kaen University, Khon Kaen, Thailand
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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Widuch-Spodyniuk A, Tarnacka B, Korczyński B, Wiśniowska J. Impact of Robotic-Assisted Gait Therapy on Depression and Anxiety Symptoms in Patients with Subacute Spinal Cord Injuries (SCIs)-A Prospective Clinical Study. J Clin Med 2023; 12:7153. [PMID: 38002765 PMCID: PMC10672092 DOI: 10.3390/jcm12227153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI. METHODS A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State-Trait Anxiety Inventory (STAI X-1). RESULTS SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p < 0.001, r = 0.43; STAI X-1: Z = -6.20, p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = -4.93; KPD: Z = -5.26; SR: Z = -3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = -4.01; KPD: Z = -3.65; SR: Z = -2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State-Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors. CONCLUSIONS Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT.
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Affiliation(s)
- Alicja Widuch-Spodyniuk
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Justyna Wiśniowska
- Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
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Yoshikawa K, Mutsuzaki H, Koseki K, Iwai K, Takeuchi R, Kohno Y. Gait training using a wearable robotic hip device for incomplete spinal cord injury: A preliminary study. J Spinal Cord Med 2023:1-13. [PMID: 37934493 DOI: 10.1080/10790268.2023.2273587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
CONTEXT/OBJECTIVE To explore changes in gait functions for patients with chronic spinal cord injury (SCI) before and after standard rehabilitation and rehabilitation with a wearable hip device, explore the utility of robot-assisted gait training (RAGT), and evaluate the safety and dose of RAGT. DESIGN Single-arm, open-label, observational study. SETTING A rehabilitation hospital. PARTICIPANTS Twelve patients with SCI. INTERVENTIONS Standard rehabilitation after admission in the first phase. RAGT for two weeks in the second phase. OUTCOME MEASURES Self-selected walking speed (SWS), step length, cadence, and the 6-minute walking distance were the primary outcomes. Walking Index for SCI score, lower extremity motor score, and spasticity were measured. Walking abilities were compared between the two periods using a generalized linear mixed model (GLMM). Correlations between assessments and changes in walking abilities during each period were analyzed. RESULTS After standard rehabilitation for 66.1 ± 36.9 days, a period of 17.6 ± 3.3 days of RAGT was safely performed. SWS increased during both periods. GLMM showed that the increase in cadence was influenced by standard rehabilitation, whereas the limited step length increase was influenced by RAGT. During RAGT, the increase in step length was related to an increase in hip flexor function. CONCLUSIONS Gait speed in patients with SCI increased after rehabilitation, including RAGT, in the short-term. This increase was associated with improved muscle function in hip flexion at the start of RAGT.Trial Registration: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR; UMIN000042025).
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
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Weerarathna IN, Raymond D, Luharia A. Human-Robot Collaboration for Healthcare: A Narrative Review. Cureus 2023; 15:e49210. [PMID: 38143700 PMCID: PMC10739095 DOI: 10.7759/cureus.49210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Robotic applications have often quickly transitioned from industrial to social. Because of this, robots can now engage with people in a natural way and blend in with their surroundings. Due to the lack of medical professionals, growing healthcare costs, and the exponential rise in the population of vulnerable groups like the ill, elderly, and children with developmental disabilities, the use of social robots in the healthcare system is expanding. As a result, social robots are employed in the medical field to entertain and educate hospitalized patients about health issues, as well as to assist the elderly and sick. They are also employed in the dispensing of medications, rehabilitation, and emotional and geriatric care. Thus, social robots raise the standard and effectiveness of medical care. This article explains how patients and healthcare professionals collaborate with robots in the healthcare industry. The objectives of this collaboration are to resolve moral and legal concerns, improve patient outcomes, and improve healthcare delivery. It has a broad range of uses, including telemedicine, rehabilitation, and robotic surgical support. Human-robot interaction is the term used to describe interactions between social robots and people. Many obstacles stand in the way of human-robot interaction in healthcare, including safety concerns, acceptability issues, appropriateness, usefulness, and the worry that robots may replace human carers. In the end, these difficulties result in a poor adoption rate for robotic technology. As a result, the applications and difficulties of human-robot interaction in healthcare are thoroughly evaluated in this research. This study also reviews future safety prospects from human-robot interaction in healthcare, as well as ethical and usability issues including privacy, trust, and safety, and our aims to provide a comprehensive overview of the use of robots in healthcare, including their applications, benefits, challenges, and prospects, to facilitate a deeper understanding of this evolving field.
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Affiliation(s)
- Induni N Weerarathna
- Biomedical Sciences, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - David Raymond
- Computer Science and Medical Engineering, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anurag Luharia
- Radiotherapy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cherni Y, Blache Y, Begon M, Ballaz L, Dal Maso F. Effect of Robotic-Assisted Gait at Different Levels of Guidance and Body Weight Support on Lower Limb Joint Kinematics and Coordination. SENSORS (BASEL, SWITZERLAND) 2023; 23:8800. [PMID: 37960500 PMCID: PMC10650199 DOI: 10.3390/s23218800] [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: 09/08/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
The Lokomat provides task-oriented therapy for patients with gait disorders. This robotic technology drives the lower limbs in the sagittal plane. However, normative gait also involves motions in the coronal and transverse planes. This study aimed to compare the Lokomat with Treadmill gait through three-dimensional (3D)-joint kinematics and inter-joint coordination. Lower limb kinematics was recorded in 18 healthy participants who walked at 3 km/h on a Treadmill or in a Lokomat with nine combinations of Guidance (30%, 50%, 70%) and bodyweight support (30%, 50%, 70%). Compared to the Treadmill, the Lokomat altered pelvic rotation, decreased pelvis obliquity and hip adduction, and increased ankle rotation. Moreover, the Lokomat resulted in significantly slower velocity at the hip, knee, and ankle flexion compared to the treadmill condition. Moderate to strong correlations were observed between the Treadmill and Lokomat conditions in terms of inter-joint coordination between hip-knee (r = 0.67-0.91), hip-ankle (r = 0.66-0.85), and knee-ankle (r = 0.90-0.95). This study showed that some gait determinants, such as pelvis obliquity, rotation, and hip adduction, are altered when walking with Lokomat in comparison to a Treadmill. Kinematic deviations induced by the Lokomat were most prominent at high levels of bodyweight support. Interestingly, different levels of Guidance did not affect gait kinematics. The present results can help therapists to adequately select settings during Lokomat therapy.
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Affiliation(s)
- Yosra Cherni
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
| | - Yoann Blache
- Centre de Recherche et d’Innovation Sur le Sport, Université de Lyon, 69007 Lyon, France
| | - Mickael Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
| | - Laurent Ballaz
- Centre de Recherche du CHU Ste Justine, Montréal, QC H3T 1C5, Canada
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 2C4, Canada
| | - Fabien Dal Maso
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des Sciences de l’Activité Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Centre Interdisciplinaire sur le Cerveau et l’Apprentissage, Université de Montréal, Montréal, QC H3C 3J7, Canada
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钟 旭, 张 弼, 李 纪, 张 亮, 元 香, 张 鹏, 赵 新. [Multi-modal synergistic quantitative analysis and rehabilitation assessment of lower limbs for exoskeleton]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:953-964. [PMID: 37879925 PMCID: PMC10600416 DOI: 10.7507/1001-5515.202212028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/24/2023] [Indexed: 10/27/2023]
Abstract
In response to the problem that the traditional lower limb rehabilitation scale assessment method is time-consuming and difficult to use in exoskeleton rehabilitation training, this paper proposes a quantitative assessment method for lower limb walking ability based on lower limb exoskeleton robot training with multimodal synergistic information fusion. The method significantly improves the efficiency and reliability of the rehabilitation assessment process by introducing quantitative synergistic indicators fusing electrophysiological and kinematic level information. First, electromyographic and kinematic data of the lower extremity were collected from subjects trained to walk wearing an exoskeleton. Then, based on muscle synergy theory, a synergistic quantification algorithm was used to construct synergistic index features of electromyography and kinematics. Finally, the electrophysiological and kinematic level information was fused to build a modal feature fusion model and output the lower limb motor function score. The experimental results showed that the correlation coefficients of the constructed synergistic features of electromyography and kinematics with the clinical scale were 0.799 and 0.825, respectively. The results of the fused synergistic features in the K-nearest neighbor (KNN) model yielded higher correlation coefficients ( r = 0.921, P < 0.01). This method can modify the rehabilitation training mode of the exoskeleton robot according to the assessment results, which provides a basis for the synchronized assessment-training mode of "human in the loop" and provides a potential method for remote rehabilitation training and assessment of the lower extremity.
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Affiliation(s)
- 旭 钟
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- 中国科学院 机器人与智能制造创新研究院(沈阳 110016)Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- 扬州大学附属医院 医学工程处(江苏扬州 225003)Medical Engineering Department, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225003, P. R. China
| | - 弼 张
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- 中国科学院 机器人与智能制造创新研究院(沈阳 110016)Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - 纪桅 李
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- 中国科学院 机器人与智能制造创新研究院(沈阳 110016)Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - 亮 张
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - 香南 元
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - 鹏 张
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - 新刚 赵
- 中国科学院 沈阳自动化研究所 机器人学国家重点实验室(沈阳 110016)State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- 中国科学院 机器人与智能制造创新研究院(沈阳 110016)Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang 110016, P. R. China
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Trzmiel T, Marchewka R, Pieczyńska A, Zasadzka E, Zubrycki I, Kozak D, Mikulski M, Poświata A, Tobis S, Hojan K. The Effect of Using a Rehabilitation Robot for Patients with Post-Coronavirus Disease (COVID-19) Fatigue Syndrome. SENSORS (BASEL, SWITZERLAND) 2023; 23:8120. [PMID: 37836950 PMCID: PMC10575211 DOI: 10.3390/s23198120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
The aim of this study was to compare the effectiveness of traditional neurological rehabilitation and neurological rehabilitation combined with a rehabilitation robot for patients with post-COVID-19 fatigue syndrome. Eighty-six participants transferred from intensive care units due to post-viral fatigue after COVID-19 were randomly divided into two groups: the intervention group and the control group. The control group received standard neurological rehabilitation for 120 min a day, while the intervention group received the same neurological rehabilitation for 75 min a day, complemented by 45 min of exercises on the rehabilitation robot. The Berg scale, Tinetti scale, six-minute walking test, isokinetic muscle force test, hand grip strength, Barthel Index, and Functional Independence Measure were used to measure the outcomes. Both groups improved similarly during the rehabilitation. Between groups, a comparison of before/after changes revealed that the intervention group improved better in terms of Functional Independence Measure (p = 0.015) and mean extensor strength (p = 0.023). The use of EMG-driven robots in the rehabilitation of post-COVID-19 fatigue syndrome patients was shown to be effective.
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Affiliation(s)
- Tomasz Trzmiel
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Renata Marchewka
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
| | - Anna Pieczyńska
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Ewa Zasadzka
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Igor Zubrycki
- Institute of Automatic Control, Lodz University of Technology, 90-537 Łódź, Poland;
| | - Dominika Kozak
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
- Department of Physiotherapy, University of Health Science, 85-067 Bydgoszcz, Poland
| | - Michał Mikulski
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
| | - Anna Poświata
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 61-866 Poznan, Poland
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19
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Wang L, Peng JL, Chen AL. Effect of robotic-assisted gait training on gait and motor function in spinal cord injury: a protocol of a systematic review with meta-analysis. BMJ Open 2023; 13:e070675. [PMID: 37739462 PMCID: PMC10533792 DOI: 10.1136/bmjopen-2022-070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Robotic-assisted gait training (RAGT) has been reported to be effective in rehabilitating patients with spinal cord injury (SCI). However, studies on RAGT showed different results due to a varied number of samples. Thus, summarising studies based on robotic-related factors is critical for the accurate estimation of the effects of RAGT on SCI. This work aims to search for strong evidence showing that using RAGT is effective in treating SCI and analyse the deficiencies of current studies. METHODS AND ANALYSIS The following publication databases were electronically searched in December 2022 without restrictions on publication year: MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Various combinations of keywords, including 'motor disorders', 'robotics', 'robotic-assisted gait training', 'Spinal Cord Injuries', 'SCI' and 'gait analysis' were used as search terms. All articles on randomised controlled trials (excluding retrospective trials) using RAGT to treat SCI that were published in English and Chinese and met the inclusion criteria were included. Outcomes included motor function, and gait parameters included those assessed by using the instrumented gait assessment, the Berg Balance Scale, the 10-m walk speed test, the 6-min walk endurance test, the functional ambulation category scale, the Walking index of SCI and the American Spinal Injury Association assessment scale. Research selection, data extraction and quality assessment were conducted independently by two reviewers to ensure that all relevant studies were free from personal bias. In addition, the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager V.5.3 software was used to produce deviation risk maps and perform paired meta-analyses. ETHICS AND DISSEMINATION Ethics approval is not required for systematic reviews and network meta-analyses. The results will be submitted to a peer-reviewed journal or presented at a conference. PROSPERO REGISTRATION NUMBER CRD42022319555.
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Affiliation(s)
- Lei Wang
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jin-Lin Peng
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ai-Lian Chen
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
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Song S, Fernandes NJ, Nordin AD. Characterizing Bodyweight-Supported Treadmill Walking on Land and Underwater Using Foot-Worn Inertial Measurement Units and Machine Learning for Gait Event Detection. SENSORS (BASEL, SWITZERLAND) 2023; 23:7945. [PMID: 37766002 PMCID: PMC10536282 DOI: 10.3390/s23187945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Gait rehabilitation commonly relies on bodyweight unloading mechanisms, such as overhead mechanical support and underwater buoyancy. Lightweight and wireless inertial measurement unit (IMU) sensors provide a cost-effective tool for quantifying body segment motions without the need for video recordings or ground reaction force measures. Identifying the instant when the foot contacts and leaves the ground from IMU data can be challenging, often requiring scrupulous parameter selection and researcher supervision. We aimed to assess the use of machine learning methods for gait event detection based on features from foot segment rotational velocity using foot-worn IMU sensors during bodyweight-supported treadmill walking on land and underwater. Twelve healthy subjects completed on-land treadmill walking with overhead mechanical bodyweight support, and three subjects completed underwater treadmill walking. We placed IMU sensors on the foot and recorded motion capture and ground reaction force data on land and recorded IMU sensor data from wireless foot pressure insoles underwater. To detect gait events based on IMU data features, we used random forest machine learning classification. We achieved high gait event detection accuracy (95-96%) during on-land bodyweight-supported treadmill walking across a range of gait speeds and bodyweight support levels. Due to biomechanical changes during underwater treadmill walking compared to on land, accurate underwater gait event detection required specific underwater training data. Using single-axis IMU data and machine learning classification, we were able to effectively identify gait events during bodyweight-supported treadmill walking on land and underwater. Robust and automated gait event detection methods can enable advances in gait rehabilitation.
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Affiliation(s)
- Seongmi Song
- Division of Kinesiology, Texas A&M University, College Station, TX 77843, USA;
| | - Nathaniel J. Fernandes
- Department of Computer Science & Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Andrew D. Nordin
- Division of Kinesiology, Texas A&M University, College Station, TX 77843, USA;
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
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21
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Tarnacka B, Korczyński B, Frasuńska J. Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure. Diagnostics (Basel) 2023; 13:diagnostics13111966. [PMID: 37296818 DOI: 10.3390/diagnostics13111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.
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Affiliation(s)
- Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
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Fabbri I, Betti F, Tedeschi R. Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review. eNeurologicalSci 2023; 31:100467. [PMID: 37304729 PMCID: PMC10248036 DOI: 10.1016/j.ensci.2023.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Background Spinal cord injury results in the interruption of neuronal conduction in the spinal cord, a condition that occurs in 0.1% of the world's population. This results in severe limitations in autonomy including locomotor function. Its recovery can be pursued through conventional isolated physiotherapeutic rehabilitation (overground walking training - OGT) or associated with Robot-assisted gait training - RAGT (e.g.: Lokomat ®). Aim The aim of this review is to compare the effectiveness of RAGT combined with conventional physiotherapy. Methods The databases consulted, from March 2022 to November 2022, were PubMed, PEDro, Cochrane Central Register of Controlled Trials (Cochrane Library) and CINAHL. RCT studies of people with incomplete spinal cord injuries treated with RAGT and/or OGT with the aim of improving walking were analysed. Results Among the 84 RCTs identified, 4 were included in the synthesis, with a total of 258 participants. The outcomes analysed concerned both locomotor function through lower limb muscle strength and the need for assistance in walking, using the WISCI-II scale and the LEMS. Robotic treatment stimulated the greatest improvements in the four studies; however, they were not always statistically significant. Conclusion A rehabilitation protocol combining RAGT with conventional physiotherapy is more effective than isolated OGT in improving ambulation in the subacute phase.
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Affiliation(s)
- Isabella Fabbri
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Betti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Physical Medicine and Rehabilitation, Ospedale Maggiore, Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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23
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Fallahi MS, Azadnajafabad S, Maroufi SF, Pour-Rashidi A, Khorasanizadeh M, Sattari SA, Faramarzi S, Slavin KV. Application of Vagus Nerve Stimulation in Spinal Cord Injury Rehabilitation. World Neurosurg 2023; 174:11-24. [PMID: 36858292 DOI: 10.1016/j.wneu.2023.02.101] [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: 01/22/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
Spinal cord injury (SCI) is a prevalent devastating condition causing significant morbidity and mortality, especially in developing countries. The pathophysiology of SCI involves ischemia, neuroinflammation, cell death, and scar formation. Due to the lack of definitive therapy for SCI, interventions mainly focus on rehabilitation to reduce deterioration and improve the patient's quality of life. Currently, rehabilitative exercises and neuromodulation methods such as functional electrical stimulation, epidural electrical stimulation, and transcutaneous electrical nerve stimulation are being tested in patients with SCI. Other spinal stimulation techniques are being developed and tested in animal models. However, often these methods require complex surgical procedures and solely focus on motor function. Vagus nerve stimulation (VNS) is currently used in patients with epilepsy, depression, and migraine and is being investigated for its application in other disorders. In animal models of SCI, VNS significantly improved locomotor function by ameliorating inflammation and improving plasticity, suggesting its use in human subjects. SCI patients also suffer from nonmotor complications, including pain, gastrointestinal dysfunction, cardiovascular disorders, and chronic conditions such as obesity and diabetes. VNS has shown promising results in alleviating these conditions in non-SCI patients, which makes it a possible therapeutic option in SCI patients.
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Affiliation(s)
- Mohammad Sadegh Fallahi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pour-Rashidi
- Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - MirHojjat Khorasanizadeh
- Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sina Faramarzi
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Walia S, Kumar P, Kataria C. Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis. Top Spinal Cord Inj Rehabil 2023; 29:56-83. [PMID: 37235196 PMCID: PMC10208260 DOI: 10.46292/sci21-00065] [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] [Indexed: 05/28/2023]
Abstract
Background Incomplete spinal cord injury (iSCI) often results in impaired balance leading to functional impairments. Recovery of standing balance ability is an important aim of rehabilitative programs. However, limited information is available on effective balance training protocols for individuals with iSCI. Objectives To assess the methodological quality and effectiveness of various rehabilitation interventions for improving standing balance in individuals with iSCI. Methods A systematic search was performed in SCOPUS, PEDro, PubMed, and Web of Science from inception until March 2021. Two independent reviewers screened articles for inclusion, extracted data, and evaluated methodological quality of the trials. PEDro Scale was used to assess the quality of randomized controlled trials (RCT) and crossover studies while pre-post trials were assessed using the modified Downs and Black tool. A meta-analysis was performed to quantitatively describe the results. The random effects model was applied to present the pooled effect. Results Ten RCTs with a total of 222 participants and 15 pre-post trials with 967 participants were analyzed. The mean PEDro score and modified Downs and Black score was 7/10 and 6/9, respectively. The pooled standardized mean difference (SMD) for controlled and uncontrolled trials of body weight-supported training (BWST) interventions was -0.26 (95% CI, -0.70 to 0.18; p = .25) and 0.46 (95% CI, 0.33 to 0.59; p < .001), respectively. The pooled effect size of -0.98 (95% CI, -1.93 to -0.03; p = .04) indicated significant improvements in balance after a combination of BWST and stimulation. Pre-post studies analyzing the effect of virtual reality (VR) training interventions on Berg Balance Scale (BBS) scores in individuals with iSCI reported a mean difference (MD) of 4.22 (95% CI, 1.78 to 6.66; p = .0007). Small effect sizes were seen in pre-post studies of VR+stimulation and aerobic exercise training interventions indicating no significant improvements after training on standing balance measures. Conclusion This study demonstrated weak evidence to support the use of BWST interventions for overground training for balance rehabilitation in individuals with iSCI. A combination of BWST with stimulation however showed promising results. There is a need for further RCTs in this field to generalize findings. Virtual reality-based balance training has shown significant improvement in standing balance post iSCI. However, these results are based on single group pre-post trials and lack appropriately powered RCTs involving a larger sample size to support this intervention. Given the importance of balance control underpinning all aspects of daily activities, there is a need for further well-designed and appropriately powered RCTs to evaluate specific features of training interventions to improve standing balance function in iSCI.
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Affiliation(s)
- Shefali Walia
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
- Indian Spinal Injuries Centre, New Delhi, India
| | - Pragya Kumar
- Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
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Park GM, Cho SH, Hong JT, Kim DH, Shin JC. Effects and Safety of Wearable Exoskeleton for Robot-Assisted Gait Training: A Retrospective Preliminary Study. J Pers Med 2023; 13:jpm13040676. [PMID: 37109062 PMCID: PMC10144215 DOI: 10.3390/jpm13040676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Wearable devices for robot-assisted gait training (RAGT) provide overground gait training for the rehabilitation of neurological injuries. We aimed to evaluate the effectiveness and safety of RAGT in patients with a neurologic deficit. METHODS Twenty-eight patients receiving more than ten sessions of overground RAGT using a joint-torque-assisting wearable exoskeletal robot were retrospectively analyzed in this study. Nineteen patients with brain injury, seven patients with spinal cord injury and two patients with peripheral nerve injury were included. Clinical outcomes, such as the Medical Research Council scale for muscle strength, Berg balance scale, functional ambulation category, trunk control tests, and Fugl-Meyer motor assessment of the lower extremities, were recorded before and after RAGT. Parameters for RAGT and adverse events were also recorded. RESULTS The Medical Research Council scale scores for muscle strength (36.6 to 37.8), Berg balance scale (24.9 to 32.2), and functional ambulation category (1.8 to 2.7) significantly improved after overground RAGT (p < 0.05). The familiarization process was completed within six sessions of RAGT. Only two mild adverse events were reported. CONCLUSIONS Overground RAGT using wearable devices can improve muscle strength, balance, and gait function. It is safe in patients with neurologic injury.
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Affiliation(s)
- Gwang-Min Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Su-Hyun Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jun-Taek Hong
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Dae-Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul 06355, Republic of Korea
| | - Ji-Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Yang S, Huang X, Zhou JM, Xue Q. Application of robotic lower limb orthosis for people with lower limb dysfunction. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:041501. [PMID: 38081284 DOI: 10.1063/5.0140319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 12/18/2023]
Abstract
Due to the aging of the population or diseases, the number of patients with lower limb disorders has increased, causing social concern. Scholars have designed and developed advanced robotic lower limb orthoses, which can guide patients to perform reasonable rehabilitation training with correct limb postures, enhance their daily life participation and quality of life, and help them recover quickly. In recent years, a large number of new and advanced orthopedic equipment have been developed, which require a systematic summary analysis and comparison. This article reviewed typical newly developed, robotic lower limb orthoses and their use effects, as well as the advanced theories and technologies for their applications, and systematically discussed the problems in the research, design, testing, use, and popularization of robotic lower limb orthoses, and predicted their development direction in the future research and design, to enhance the reliability, convenience, and protection functions of orthotic equipment, make its functions closer to life, and give full play to the initiative of patients in the process of rehabilitation training, and reduce costs. Robotic lower limb orthoses is poised for even greater success and development in the future.
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Affiliation(s)
- Shuo Yang
- Department of Mechanical Engineering, Tianjin Key Laboratory of Integrated Design and On-line Monitoring for Light Industry and Food Engineering Machinery and Equipment, Tianjin University of Science and Technology, Tianjin 300222, China
| | - Xin Huang
- Department of Mechanical Engineering, Tianjin Key Laboratory of Integrated Design and On-line Monitoring for Light Industry and Food Engineering Machinery and Equipment, Tianjin University of Science and Technology, Tianjin 300222, China
| | - Jin-Man Zhou
- Department of Mechanical Engineering, Tianjin Key Laboratory of Integrated Design and On-line Monitoring for Light Industry and Food Engineering Machinery and Equipment, Tianjin University of Science and Technology, Tianjin 300222, China
| | - Qiang Xue
- Department of Mechanical Engineering, Tianjin Key Laboratory of Integrated Design and On-line Monitoring for Light Industry and Food Engineering Machinery and Equipment, Tianjin University of Science and Technology, Tianjin 300222, China
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Chen J, Neo EJR, Tan YL. Complete spinal cord injury from postoperative seroma following scoliosis surgery: A case report with favorable ambulatory outcomes after comprehensive rehabilitation. J Spinal Cord Med 2023; 46:337-340. [PMID: 35981136 PMCID: PMC9987742 DOI: 10.1080/10790268.2022.2108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT Postoperative seroma is a known complication following spine deformity surgery. However, complete spinal cord injury (SCI) due to postoperative seroma is rare. Rehabilitation strategies and outcomes of SCI associated with postoperative seroma have been inadequately described. FINDINGS A 15-year-old female experienced inadvertent durotomy during pinal deformity correction surgery for idiopathic adolescent scoliosis. Despite immediate decompressive laminectomy, she developed complete loss of motor and sensory function with neurological level of injury at T10 immediately following the surgery. Urgent magnetic resonance imaging revealed cord compression due to seroma. Decompressive surgery was performed 48 h later and timely intensive rehabilitation was provided for 3 months, which included the use of robotic-assisted gait training (RAGT) to maximize neurological recovery. She demonstrated impressive improvement from grade A to D on the American Spinal Injury Association Impairment Scale and regained functional ambulation over the 3-month period. We describe a comprehensive rehabilitation program to manage SCI associated with postoperative seroma, entailing the use of a robotic gait device for locomotor training. The progression of the patient's neurological status and functional outcomes was documented accordingly. CONCLUSION/CLINICAL RELEVANCE Complete SCI due to seroma, a surgical complication of corrective scoliosis surgery, is rare. However, prompt postoperative examination should be performed routinely in anticipation of neurological deterioration. Early rehabilitation comprising of gait re-training and the use of RAGT might enhance the lower-limb motor strength and functional recovery.
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Affiliation(s)
- Jing Chen
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Yeow Leng Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
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Patathong T, Klaewkasikum K, Woratanarat P, Rattanasiri S, Anothaisintawee T, Woratanarat T, Thakkinstian A. The efficacy of gait rehabilitations for the treatment of incomplete spinal cord injury: a systematic review and network meta-analysis. J Orthop Surg Res 2023; 18:60. [PMID: 36683024 PMCID: PMC9869518 DOI: 10.1186/s13018-022-03459-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent pieces of evidence about the efficacy of gait rehabilitation for incomplete spinal cord injury remain unclear. We aimed to estimate the treatment effect and find the best gait rehabilitation to regain velocity, distance, and Walking Index Spinal Cord Injury (WISCI) among incomplete spinal cord injury patients. METHOD PubMed and Scopus databases were searched from inception to October 2022. Randomized controlled trials (RCTs) were included in comparison with any of the following: conventional physical therapy, treadmill, functional electrical stimulation and robotic-assisted gait training, and reported at least one outcome. Two reviewers independently selected the studies and extracted the data. Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. Network meta-analysis (NMA) was indirectly compared with all interventions and reported as pooled unstandardized mean difference (USMD) and 95% confidence interval (CI). Surface under the cumulative ranking curve (SUCRA) was calculated to identify the best intervention. RESULTS We included 17 RCTs (709 participants) with the mean age of 43.9 years. Acute-phase robotic-assisted gait training significantly improved the velocity (USMD 0.1 m/s, 95% CI 0.05, 0.14), distance (USMD 64.75 m, 95% CI 27.24, 102.27), and WISCI (USMD 3.28, 95% CI 0.12, 6.45) compared to conventional physical therapy. In NMA, functional electrical stimulation had the highest probability of being the best intervention for velocity (66.6%, SUCRA 82.1) and distance (39.7%, SUCRA 67.4), followed by treadmill, functional electrical stimulation plus treadmill, robotic-assisted gait training, and conventional physical therapy, respectively. CONCLUSION Functional electrical stimulation seems to be the best treatment to improve walking velocity and distance for incomplete spinal cord injury patients. However, a large-scale RCT is required to study the adverse events of these interventions. TRIAL REGISTRATION PROSPERO number CRD42019145797.
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Affiliation(s)
- Tanyaporn Patathong
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Krongkaew Klaewkasikum
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Patarawan Woratanarat
- grid.10223.320000 0004 1937 0490Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Payathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Sasivimol Rattanasiri
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Thunyarat Anothaisintawee
- grid.10223.320000 0004 1937 0490Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Thira Woratanarat
- grid.7922.e0000 0001 0244 7875Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Ammarin Thakkinstian
- grid.10223.320000 0004 1937 0490Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
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Chen JM, Li XL, Pan QH, Yang Y, Xu SM, Xu JW. Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis. J Neuroeng Rehabil 2023; 20:3. [PMID: 36635693 PMCID: PMC9837916 DOI: 10.1186/s12984-023-01129-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years, non-invasive brain stimulation (NIBS) has been used for motor function recovery. However, the effects of NIBS in populations with spinal cord injury (SCI) remain unclear. This study aims to conduct a meta-analysis of the existing evidence on the effects and safety of NIBS against sham groups for motor dysfunction after SCI to provide a reference for clinical decision-making. METHODS Two investigators systematically screened English articles from PubMed, MEDLINE, Embase, and Cochrane Library for prospective randomized controlled trials regarding the effects of NIBS in motor function recovery after SCI. Studies with at least three sessions of NIBS were included. We assessed the methodological quality of the selected studies using the evidence-based Cochrane Collaboration's tool. A meta-analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS A total of 14 randomized control trials involving 225 participants were included. Nine studies used repetitive transcranial magnetic stimulation (rTMS) and five studies used transcranial direct current stimulation (tDCS). The meta-analysis showed that NIBS could improve the lower extremity strength (SMD = 0.58, 95% CI = 0.02-1.14, P = 0.004), balance (SMD = 0.64, 95% CI = 0.05-1.24, P = 0.03), and decrease the spasticity (SMD = - 0.64, 95% CI = - 1.20 to - 0.03, P = 0.04). However, the motor ability of the upper extremity in the NIBS groups was not statistically significant compared with those in the control groups (upper-extremity strength: P = 0.97; function: P = 0.56; and spasticity: P = 0.12). The functional mobility in the NIBS groups did not reach statistical significance when compared with the sham NIBS groups (sham groups). Only one patient reported seizures that occurred during stimulation, and no other types of serious adverse events were reported. CONCLUSION NIBS appears to positively affect the motor function of the lower extremities in SCI patients, despite the marginal P-value and the high heterogeneity. Further high-quality clinical trials are needed to support or refute the use and optimize the stimulation parameters of NIBS in clinical practice.
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Affiliation(s)
- Jian-Min Chen
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China ,grid.412683.a0000 0004 1758 0400Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Lu Li
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Qin-He Pan
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Ye Yang
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sen-Ming Xu
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jian-Wen Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Jergova S, Dugan EA, Sagen J. Attenuation of SCI-Induced Hypersensitivity by Intensive Locomotor Training and Recombinant GABAergic Cells. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010084. [PMID: 36671656 PMCID: PMC9854592 DOI: 10.3390/bioengineering10010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
The underlying mechanisms of spinal cord injury (SCI)-induced chronic pain involve dysfunctional GABAergic signaling and enhanced NMDA signaling. Our previous studies showed that SCI hypersensitivity in rats can be attenuated by recombinant rat GABAergic cells releasing NMDA blocker serine-histogranin (SHG) and by intensive locomotor training (ILT). The current study combines these approaches and evaluates their analgesic effects on a model of SCI pain in rats. Cells were grafted into the spinal cord at 4 weeks post-SCI to target the chronic pain, and ILT was initiated 5 weeks post-SCI. The hypersensitivity was evaluated weekly, which was followed by histological and biochemical assays. Prolonged effects of the treatment were evaluated in subgroups of animals after we discontinued ILT. The results show attenuation of tactile, heat and cold hypersensitivity in all of the treated animals and reduced levels of proinflammatory cytokines IL1β and TNFα in the spinal tissue and CSF. Animals with recombinant grafts and ILT showed the preservation of analgesic effects even during sedentary periods when the ILT was discontinued. Retraining helped to re-establish the effect of long-term training in all of the groups, with the greatest impact being in animals with recombinant grafts. These findings suggest that intermittent training in combination with cell therapy might be an efficient approach to manage chronic pain in SCI patients.
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Shin JC, Jeon HR, Kim D, Min WK, Lee JS, Cho SI, Oh DS, Yoo J. Effects of end-effector robot-assisted gait training on gait ability, muscle strength, and balance in patients with spinal cord injury. NeuroRehabilitation 2023; 53:335-346. [PMID: 37638457 DOI: 10.3233/nre-230085] [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] [Indexed: 08/29/2023]
Abstract
BACKGROUND There is no randomized controlled study about the effects of end-effector robot-assisted gait training (RAGT) in patients with spinal cord injury (SCI). OBJECTIVE To examine the effects of end-effector RAGT on gait and balance abilities in SCI. METHODS Thirty-one patients were randomly assigned to the RAGT (Morning Walk®, Curexo, Seoul, South Korea) or conventional therapy (CT) group. Patients were assessed using the 10-meter walk test (10MWT), 6-minute walk test (6mWT), lower extremity motor score (LEMS) and proprioception, Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury-II (WISCI-II), and mobility category of Spinal Cord Independence Measure-III. RESULTS All clinical outcome measures significantly improved in both groups. The BBS and WISCI-II were significantly improved in the RAGT group compared to the CT group. In the RAGT group, pre-LEMS and pre-WISCI-II of the 10MWT improved group and pre-BBS of the 6mWT improved group were higher than those of the 10MWT non-improved and 6mWT non-improved group, respectively. CONCLUSION End-effector RAGT and CT in patients with incomplete SCI could lead to improvements in gait ability, lower extremity muscle strength, balance, proprioception, and mobility. Additionally, end-effector RAGT could improve balance and gait abilities substantially better than CT.
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Affiliation(s)
- Ji Cheol Shin
- Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Dahn Kim
- Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Kyu Min
- Rehabilitation Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - June Sung Lee
- Rehabilitation Center, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sung Il Cho
- Rehabilitation Center, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Da Som Oh
- Inje Industry, Academic Cooperation Foundation, Goyang, South Korea
| | - Jeehyun Yoo
- Department of Rehabilitation Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
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Ma B, Yang J, Wong FKY, Wong AKC, Ma T, Meng J, Zhao Y, Wang Y, Lu Q. Artificial intelligence in elderly healthcare: A scoping review. Ageing Res Rev 2023; 83:101808. [PMID: 36427766 DOI: 10.1016/j.arr.2022.101808] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022]
Abstract
The ageing population has led to a surge in the adoption of artificial intelligence (AI) technologies in elderly healthcare worldwide. However, in the advancement of AI technologies, there is currently a lack of clarity about the types and roles of AI technologies in elderly healthcare. This scoping review aimed to provide a comprehensive overview of AI technologies in elderly healthcare by exploring the types of AI technologies employed, and identifying their roles in elderly healthcare based on existing studies. A total of 10 databases were searched for this review, from January 1 2000 to July 31 2022. Based on the inclusion criteria, 105 studies were included. The AI devices utilized in elderly healthcare were summarised as robots, exoskeleton devices, intelligent homes, AI-enabled health smart applications and wearables, voice-activated devices, and virtual reality. Five roles of AI technologies were identified: rehabilitation therapists, emotional supporters, social facilitators, supervisors, and cognitive promoters. Results showed that the impact of AI technologies on elderly healthcare is promising and that AI technologies are capable of satisfying the unmet care needs of older adults and demonstrating great potential in its further development in this area. More well-designed randomised controlled trials are needed in the future to validate the roles of AI technologies in elderly healthcare.
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Affiliation(s)
- Bingxin Ma
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jin Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | | | | | - Tingting Ma
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jianan Meng
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China.
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China; School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China; National Institute of Health Data Science at Peking University, Beijing, China.
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin, China.
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Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bizzarrini E. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review. NeuroRehabilitation 2022; 51:609-647. [PMID: 36502343 DOI: 10.3233/nre-220061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. RESULTS Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
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Affiliation(s)
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Simona Maria Carmignano
- Rehabilitation Therapeutic Center (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Isabella Companini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - David Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Emiliana Bizzarrini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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Cherni Y, Tremblay A, Simon M, Bretheau F, Blanchette AK, Mercier C. Corticospinal Responses Following Gait-Specific Training in Stroke Survivors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15585. [PMID: 36497663 PMCID: PMC9737604 DOI: 10.3390/ijerph192315585] [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: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Corticospinal excitability is subject to alterations after stroke. While the reversal of these alterations has been proposed as an underlying mechanism for improved walking capacity after gait-specific training, this has not yet been clearly demonstrated. Therefore, the objective of this review is to evaluate the effect of gait-specific training on corticospinal excitability in stroke survivors. We conducted an electronic database search in four databases (i.e., Medline, Embase, CINAHL and Web of Science) in June 2022. Two authors screened in an independent way all the studies and selected those that investigated the effect of gait-specific training on variables such as motor-evoked potential amplitude, motor threshold, map size, latency, and corticospinal silent period in stroke survivors. Nineteen studies investigating the effect of gait-specific training on corticospinal excitability were included. Some studies showed an increased MEP amplitude (7/16 studies), a decreased latency (5/7studies), a decreased motor threshold (4/8 studies), an increased map size (2/3 studies) and a decreased cortical silent period (1/2 study) after gait-specific training. No change has been reported in terms of short interval intracortical inhibition after training. Five studies did not report any significant effect after gait-specific training on corticospinal excitability. The results of this systematic review suggest that gait-specific training modalities can drive neuroplastic adaptation among stroke survivors. However, given the methodological disparity of the included studies, additional clinical trials of better methodological quality are needed to establish conclusions. The results of this review can therefore be used to develop future studies to better understand the effects of gait-specific training on the central nervous system.
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Affiliation(s)
- Yosra Cherni
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
- TOPMED, Centre Collégial de Transfert de Technologie en Orthèses, Prothèses et Équipements Médicaux, Québec City, QC G1S 1C1, Canada
| | - Alexia Tremblay
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Margaux Simon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Floriane Bretheau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
| | - Andréanne K. Blanchette
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
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Yang FA, Chen SC, Chiu JF, Shih YC, Liou TH, Escorpizo R, Chen HC. Body weight-supported gait training for patients with spinal cord injury: a network meta-analysis of randomised controlled trials. Sci Rep 2022; 12:19262. [PMID: 36357483 PMCID: PMC9649733 DOI: 10.1038/s41598-022-23873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Different body weight-supported gait-training strategies are available for improving ambulation in individuals with spinal cord injury (SCI). These include body weight-supported overground training (BWSOGT), body weight-supported treadmill training (BWSTT), and robot-assisted gait training (RAGT). We conducted a network meta-analysis of randomised controlled trials (RCTs) to assess the effect and priority of each training protocol. We searched the PubMed, Cochrane Library, Scopus, and Embase databases from inception to 6 August 2022. The eligibility criteria were as follows: (1) being RCTs, (2) recruiting participants with SCI diagnosis and requiring gait training, (3) comparing different body weight-supported gait training strategies, and (4) involving ambulatory assessments. We conducted a network meta-analysis to compare different training strategies using the standard mean difference and its 95% credible interval. To rank the efficacy of training strategies, we used the P score as an indicator. Inconsistency in network meta-analysis was evaluated using loop-specific heterogeneity. We included 15 RCTs in this analysis. RAGT was had significantly more favourable performance than had the control intervention. The ranking probabilities indicated that the most effective approach was RAGT, followed by BWSOGT, BWSTT, and the control intervention. No significant inconsistency was noted between the results of the direct and indirect comparisons.
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Affiliation(s)
- Fu-An Yang
- grid.412896.00000 0000 9337 0481School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ching Chen
- Taiwan Society of Neurorehabilitation, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jing-Fang Chiu
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
| | - Ya-Chu Shih
- grid.412896.00000 0000 9337 0481School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
| | - Reuben Escorpizo
- grid.59062.380000 0004 1936 7689Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT USA ,grid.419770.cSwiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Taiwan Society of Neurorehabilitation, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongjheng Road, Zhonghe District, New Taipei City, 235 Taiwan
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Lorusso M, Tagliamonte NL, Tramontano M, Fresch A, Granelli G, Smania N, Tamburella F. Technology-assisted balance assessment and rehabilitation in individuals with spinal cord injury: A systematic review. NeuroRehabilitation 2022; 51:213-230. [DOI: 10.3233/nre-220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Balance is a crucial function of basic Activities of Daily Living (ADL) and is often considered the priority in Spinal Cord Injury (SCI) patients’ rehabilitation. Technological devices have been developed to support balance assessment and training, ensuring an earlier, intensive, and goal-oriented motor therapy. OBJECTIVE: The aim of this systematic review is to explore the technology-assisted strategies to assess and rehabilitate balance function in persons with SCI. METHODS: A systematic review was conducted in the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and Embase. Full reports on Randomized Clinical Trials (RCTs) of parallel-group or cross-over design and non-RCTs were included according to the following criteria: i) publication year from 1990 to 2021; ii) balance considered as a primary or secondary outcome; iii) population of individuals with SCI with age over 18 years old, regardless of traumatic or non-traumatic lesions, Time Since Injury, lesion level, Asia Impairment Scale score and gender. The methodological quality was determined for each included study according to the recognized Downs and Black (D&B) tool. RESULTS: Nineteen articles met the inclusion criteria and were included in the analysis. Four articles focused on balance assessment while 15 targeted rehabilitation interventions to improve balance by using Treadmill-Based Devices (TBD), OverGround Devices (OGD) and Tilt Table Devices (TTD). Statistically significant effects on balance can be found in TBD subcategory, in the hip-knee guidance subcategory of OGD and in the study of TTD category. CONCLUSION: Although different studies reported positive effects, improvements due to technology-assisted rehabilitation were not greater than those obtained by means of other rehabilitation therapies. The heterogeneity, low methodological quality, and the small number of the studies included do not allow general conclusions about the usefulness of technology-assisted balance assessment and training in individuals with SCI, even if significant improvements have been reported in some studies.
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Affiliation(s)
| | | | - Marco Tramontano
- IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Anna Fresch
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Giulia Granelli
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
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Gouveia D, Carvalho C, Cardoso A, Gamboa Ó, Almeida A, Ferreira A, Martins Â. Early Locomotor Training in Tetraplegic Post-Surgical Dogs with Cervical Intervertebral Disc Disease. Animals (Basel) 2022; 12:ani12182369. [PMID: 36139228 PMCID: PMC9495086 DOI: 10.3390/ani12182369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Locomotor training (LT) is task-specific repetitive training, with sensorimotor stimulation and intensive exercises that promote neuromuscular reorganization. This study aimed to observe if LT could be initiated safely in the first 3−15 days after surgery in tetraplegic C1−C5 IVDD—Hansen type I dogs. This prospective blinded clinical study was conducted at two rehabilitation centers in Portugal, with 114 grade 1 (MFS/OFS) dogs, divided by the presence of spinal hyperesthesia into the SHG (spinal hyperesthesia group) (n = 74) and the NSHG (non-spinal hyperesthesia group) (n = 40), evaluated in each time point for two weeks according to a neurorehabilitation checklist by three observers for inter-agreement relation. LT was safely applied with 62.3% of the OFS ≥ 11 within 15 days and of these, 32.4% achieved a OFS ≥ 13. There were no new cases of hyperesthesia in the NSHG and from the SHG all recovered. Comparing groups, a significant difference was observed in their ability to achieve ambulatory status (p < 0.001), between the presence of hyperesthesia and days until ambulation (p < 0.006) and in each time point (p < 0.001; R2 = 0.809). Early LT may be a safe treatment to be applied in the first 3 days on these dogs and spinal hyperesthesia should be important to the rehabilitation team. This study should be continued.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Correspondence:
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal
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Mah KM, Wu W, Al-Ali H, Sun Y, Han Q, Ding Y, Muñoz M, Xu XM, Lemmon VP, Bixby JL. Compounds co-targeting kinases in axon regulatory pathways promote regeneration and behavioral recovery after spinal cord injury in mice. Exp Neurol 2022; 355:114117. [PMID: 35588791 PMCID: PMC9443329 DOI: 10.1016/j.expneurol.2022.114117] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/21/2022]
Abstract
Recovery from spinal cord injury (SCI) and other central nervous system (CNS) trauma is hampered by limits on axonal regeneration in the CNS. Regeneration is restricted by the lack of neuron-intrinsic regenerative capacity and by the repressive microenvironment confronting damaged axons. To address this challenge, we have developed a therapeutic strategy that co-targets kinases involved in both extrinsic and intrinsic regulatory pathways. Prior work identified a kinase inhibitor (RO48) with advantageous polypharmacology (co-inhibition of targets including ROCK2 and S6K1), which promoted CNS axon growth in vitro and corticospinal tract (CST) sprouting in a mouse pyramidotomy model. We now show that RO48 promotes neurite growth from sensory neurons and a variety of CNS neurons in vitro, and promotes CST sprouting and/or regeneration in multiple mouse models of spinal cord injury. Notably, these in vivo effects of RO48 were seen in several independent experimental series performed in distinct laboratories at different times. Finally, in a cervical dorsal hemisection model, RO48 not only promoted growth of CST axons beyond the lesion, but also improved behavioral recovery in the rotarod, gridwalk, and pellet retrieval tasks. Our results provide strong evidence for RO48 as an effective compound to promote axon growth and regeneration. Further, they point to strategies for increasing robustness of interventions in pre-clinical models.
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Affiliation(s)
- Kar Men Mah
- The Miami Project to Cure Paralysis, Dept of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Wei Wu
- Department of Neurological Surgery, and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Hassan Al-Ali
- The Miami Project to Cure Paralysis, Dept of Neurological Surgery, University of Miami, Miami, FL, USA; Peggy and Harold Katz Family Drug Discovery Center, Dept of Medicine, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Yan Sun
- Department of Neurological Surgery, and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Qi Han
- Department of Neurological Surgery, and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ying Ding
- Department of Neurological Surgery, and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Melissa Muñoz
- The Miami Project to Cure Paralysis, Dept of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Xiao-Ming Xu
- Department of Neurological Surgery, and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Vance P Lemmon
- The Miami Project to Cure Paralysis, Dept of Neurological Surgery, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Institute for Data Science and Computing, University of Miami, Miami, FL, USA.
| | - John L Bixby
- The Miami Project to Cure Paralysis, Dept of Neurological Surgery, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Dept of Molecular and Cellular Pharmacology, University of Miami, Miami, FL, USA.
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Freyermuth-Trujillo X, Segura-Uribe JJ, Salgado-Ceballos H, Orozco-Barrios CE, Coyoy-Salgado A. Inflammation: A Target for Treatment in Spinal Cord Injury. Cells 2022; 11:cells11172692. [PMID: 36078099 PMCID: PMC9454769 DOI: 10.3390/cells11172692] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) is a significant cause of disability, and treatment alternatives that generate beneficial outcomes and have no side effects are urgently needed. SCI may be treatable if intervention is initiated promptly. Therefore, several treatment proposals are currently being evaluated. Inflammation is part of a complex physiological response to injury or harmful stimuli induced by mechanical, chemical, or immunological agents. Neuroinflammation is one of the principal secondary changes following SCI and plays a crucial role in modulating the pathological progression of acute and chronic SCI. This review describes the main inflammatory events occurring after SCI and discusses recently proposed potential treatments and therapeutic agents that regulate inflammation after insult in animal models.
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Affiliation(s)
- Ximena Freyermuth-Trujillo
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico
| | - Julia J. Segura-Uribe
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City CP 06720, Mexico
| | - Hermelinda Salgado-Ceballos
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
| | - Carlos E. Orozco-Barrios
- CONACyT-Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
| | - Angélica Coyoy-Salgado
- CONACyT-Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Dr. Bernardo Sepúlveda, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City CP 06720, Mexico
- Correspondence: ; Tel.: +52-55-2498-5223
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Zasadzka E, Tobis S, Trzmiel T, Marchewka R, Kozak D, Roksela A, Pieczyńska A, Hojan K. Application of an EMG-Rehabilitation Robot in Patients with Post-Coronavirus Fatigue Syndrome (COVID-19)-A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10398. [PMID: 36012033 PMCID: PMC9407702 DOI: 10.3390/ijerph191610398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 05/27/2023]
Abstract
This pilot study aimed to assess the safety and feasibility of an EMG-driven rehabilitation robot in patients with Post-Viral Fatigue (PVF) syndrome after COVID-19. The participants were randomly assigned to two groups (IG-intervention group and CG-control group) in an inpatient neurological rehabilitation unit. Both groups were assessed on admission and after six weeks of rehabilitation. Rehabilitation was carried out six days a week for six weeks. The patients in the IG performed additional training using an EMG rehabilitation robot. Muscle fatigue was assessed using an EMG rehabilitation robot; secondary outcomes were changes in hand grip strength, Fatigue Assessment Scale, and functional assessment scales (Functional Independence Measure, Barthel Index). Both groups improved in terms of the majority of measured parameters comparing pre- and post-intervention results, except muscle fatigue. Muscle fatigue scores presented non-significant improvement in the IG and non-significant deterioration in the CG. Using an EMG rehabilitation robot in patients with PVF can be feasible and safe. To ascertain the effectiveness of such interventions, more studies are needed, particularly involving a larger sample and also assessing the participants' cognitive performance.
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Affiliation(s)
- Ewa Zasadzka
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Tomasz Trzmiel
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Renata Marchewka
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
| | - Dominika Kozak
- Department of Physiotherapy, University of Health Science, 85-067 Bydgoszcz, Poland
- Egzotech sp. z o.o., 44-100 Gliwice, Poland
| | - Anna Roksela
- Egzotech sp. z o.o., 44-100 Gliwice, Poland
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Anna Pieczyńska
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 61-866 Poznan, Poland
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Ma T, Zhang Q, Zhou T, Zhang Y, He Y, Li S, Liu Q. Effects of robotic-assisted gait training on motor function and walking ability in children with thoracolumbar incomplete spinal cord injury. NeuroRehabilitation 2022; 51:499-508. [DOI: 10.3233/nre-220124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI.
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Affiliation(s)
- Tingting Ma
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qi Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Tiantian Zhou
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yanqing Zhang
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Yan He
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Sijia Li
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
| | - Qianjin Liu
- China Rehabilitation Research Center, Beijing Bo’ai Hospital, Capital Medical University School of Rehabilitation Medicine, Beijing, China
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Gao X, Gong Y, Zhang B, Hao D, He B, Yan L. Factors for Predicting Instant Neurological Recovery of Patients with Motor Complete Traumatic Spinal Cord Injury. J Clin Med 2022; 11:jcm11144086. [PMID: 35887845 PMCID: PMC9319428 DOI: 10.3390/jcm11144086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to analyze the factors affecting the instant recovery of neurological function in patients with motor complete traumatic spinal cord injury (TSCI) treated in hospital. Methods: A retrospective analysis of 1053 patients with TSCI classified according to the American Spinal Cord Injury Association (ASIA) as grades A and B at 59 tertiary hospitals from 1 January 2018 to 31 December 2018 was performed. All patients were classified into motor complete injury (ASIA A or B) and motor incomplete injury (ASIA C or D) groups, according to the ASIA upon discharge. The injury level, fracture segment, fracture type, ASIA score at admission and discharge, treatment protocol, and complications were recorded. Univariate and multivariate analyses were performed to evaluate the relationship between various factors and the recovery of neurological function. Results: The results of multiple logistic regression analysis revealed that the ASIA score on admission (p < 0.001, odds ratio (OR) = 5.722, 95% confidence interval (CI): 4.147−7.895), fracture or dislocation (p = 0.001, OR = 0.523, 95% CI: 0.357−0.767), treatment protocol (p < 0.001; OR = 2.664, 95% CI: 1.689−4.203), and inpatient rehabilitation (p < 0.001, OR = 2.089, 95% CI: 1.501−2.909) were independently associated with the recovery of neurological function. Conclusion: The recovery of neurological function is dependent on the ASIA score on admission, fracture or dislocation, treatment protocol, and inpatient rehabilitation.
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Affiliation(s)
- Xiangcheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Yining Gong
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Bo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Medical College, Yan’an University, Yan’an 716000, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China; (X.G.); (Y.G.); (B.Z.); (D.H.); (B.H.)
- Correspondence:
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Conner BC, Remec NM, Lerner ZF. Is robotic gait training effective for individuals with cerebral palsy? A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2022; 36:873-882. [PMID: 35331027 PMCID: PMC10035373 DOI: 10.1177/02692155221087084] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine if robotic gait training for individuals with cerebral palsy is more effective than the standard of care for improving function. METHOD PubMed, Embase, Scopus, and Cochrane databases were searched from 1980-January, 2022 for articles that investigated robotic gait training versus standard of care (i.e. physical therapy or standard gait training) for individuals with cerebral palsy. Articles were included if a randomized controlled trial design was used, and excluded if robotic gait training was combined with another neuromuscular intervention, such as functional electrical stimulation. A meta-analysis of outcomes measured in at least four studies was conducted. RESULTS Eight citations met all criteria for full-text review and inclusion in the meta-analysis. A total of 188 individuals with cerebral palsy, ages four to 35, and Gross Motor Function Classification System levels I-IV were studied. Level of evidence ranged from 2b-1b. All studies utilized a tethered, assistive device for robotic gait training. The overall effect was not significantly different between the robotic gait training and control interventions for six minute walk test performance (95% CI: -0.17, 0.73; P = 0.22), free walking speed (95% CI: -0.18, 0.57; P = 0.30), or Gross Motor Function Measures D (Standing) (95% CI: -0.29, 0.39; P = 0.77) and E (Walking, Running and Jumping) (95% CI: -0.11, 0.57; P = 0.19). CONCLUSION Tethered robotic devices that provide assistive gait training for individuals with cerebral palsy do not provide a greater benefit for improving mobility than the standard of care.
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Affiliation(s)
- Benjamin C. Conner
- College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, United States
- To whom correspondence should be addressed: Benjamin C Conner, College of Medicine – Phoenix, University of Arizona, 435 N 5th St, HSEB Rm B208, Phoenix, AZ 85004, USA, Phone: 717-514-2831, Fax: 928-523-2300,
| | | | - Zachary F. Lerner
- College of Medicine – Phoenix, University of Arizona, Phoenix, AZ, United States
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
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Hardware Development and Safety Control Strategy Design for a Mobile Rehabilitation Robot. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of bodyweight unloading force control on a treadmill with therapist manual assistance for gait training imposes constraints on natural walking. It influences the patient’s training effect for a full range of natural walks. This study presents a prototype and a safety controller for a mobile rehabilitation robot (MRR). The prototype integrates an autonomous mobile bodyweight support system (AMBSS) with a lower-limb exoskeleton system (LES) to simultaneously achieve natural over-ground gait training and motion relearning. Human-centered rehabilitation robots must guarantee the safety of patients in the presence of significant tracking errors. It is difficult for traditional stiff controllers to ensure safety and excellent tracking accuracy concurrently, because they cannot explicitly guarantee smooth, safe, and overdamped motions without overshoot. This paper integrated a linear extended state observer (LESO) into proxy-based sliding mode control (ILESO-PSMC) to overcome this problem. The LESO was used to observe the system’s unknown states and total disturbance simultaneously, ensuring that the “proxy” tracks the reference target accurately and avoids the unsafe control of the MRR. Based on the Lyapunov theorem to prove the closed-loop system stability, the proposed safety control strategy has three advantages: (1) it provides an accurate and safe control without worsening tracking performance during regular operation, (2) it guarantees safe recoveries and overdamped properties after abnormal events, and (3) it need not identify the system model and measure unknown system states as well as external disturbance, which is quite difficult for human–robot interaction (HRI) systems. The results demonstrate the feasibility of the proposed ILESO-PSMC for MRR. The experimental comparison also indicates better safety performance for the ILESO-PSMC than for the conventional proportional–integral–derivative (PID) control.
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Saotome K, Matsushita A, Eto F, Shimizu Y, Kubota S, Kadone H, Ikumi A, Marushima A, Masumoto T, Koda M, Takahashi H, Miura K, Matsumura A, Sankai Y, Yamazaki M. Functional magnetic resonance imaging of brain activity during hybrid assistive limb intervention in a chronic spinal cord injury patient with C4 quadriplegia. J Clin Neurosci 2022; 99:17-21. [DOI: 10.1016/j.jocn.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
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Xue X, Yang X, Deng Z, Tu H, Kong D, Li N, Xu F. Global Trends and Hotspots in Research on Rehabilitation Robots: A Bibliometric Analysis From 2010 to 2020. Front Public Health 2022; 9:806723. [PMID: 35087788 PMCID: PMC8788947 DOI: 10.3389/fpubh.2021.806723] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background: In recent years, with the development of medical science and artificial intelligence, research on rehabilitation robots has gained more and more attention, for nearly 10 years in the Web of Science database by journal of rehabilitation robot-related research literature analysis, to parse and track rehabilitation robot research hotspot and front, and provide some guidance for future research. Methods: This study employed computer retrieval of rehabilitation robot-related research published in the core data collection of the Web of Science database from 2010 to 2020, using CiteSpace 5.7 visualization software. The hotspots and frontiers of rehabilitation robot research are analyzed from the aspects of high-influence countries or regions, institutions, authors, high-frequency keywords, and emergent words. Results: A total of 3,194 articles were included. In recent years, the research on rehabilitation robots has been continuously hot, and the annual publication of relevant literature has shown a trend of steady growth. The United States ranked first with 819 papers, and China ranked second with 603 papers. Northwestern University ranked first with 161 publications. R. Riener, a professor at the University of Zurich, Switzerland, ranked as the first author with 48 articles. The Journal of Neural Engineering and Rehabilitation has the most published research, with 211 publications. In the past 10 years, research has focused on intelligent control, task analysis, and the learning, performance, and reliability of rehabilitation robots to realize the natural and precise interaction between humans and machines. Research on neural rehabilitation robots, brain–computer interface, virtual reality, flexible wearables, task analysis, and exoskeletons has attracted more and more attention. Conclusions: At present, the brain–computer interface, virtual reality, flexible wearables, task analysis, and exoskeleton rehabilitation robots are the research trends and hotspots. Future research should focus on the application of machine learning (ML), dimensionality reduction, and feature engineering technologies in the research and development of rehabilitation robots to improve the speed and accuracy of algorithms. To achieve wide application and commercialization, future rehabilitation robots should also develop toward mass production and low cost. We should pay attention to the functional needs of patients, strengthen multidisciplinary communication and cooperation, and promote rehabilitation robots to better serve the rehabilitation medical field.
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Affiliation(s)
- Xiali Xue
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Xinwei Yang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Zhongyi Deng
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Huan Tu
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Dezhi Kong
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Ning Li
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Fan Xu
- School of Public Health, Chengdu Medical College, Chengdu, China
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Zhang L, Lin F, Sun L, Chen C. Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis. Front Neurol 2022; 13:772660. [PMID: 35493806 PMCID: PMC9044921 DOI: 10.3389/fneur.2022.772660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveLokomat and wearable exoskeleton-assisted walking (EAW) have not been directly compared previously. To conduct a network meta-analysis of randomized and non-randomized controlled trials to assess locomotor abilities achieved with two different types of robotic-assisted gait training (RAGT) program in persons with spinal cord injury (SCI).MethodsThree electronic databases, namely, PubMed, Embase, and the Cochrane Library, were systematically searched for randomized and non-randomized controlled trials published before August 2021, which assessed locomotor abilities after RAGT.ResultsOf 319 studies identified for this review, 12 studies were eligible and included in our analysis. Studies from 2013 to 2021 were covered and contained 353 valid data points (N-353) on patients with SCI receiving wearable EWA and Lokomat training. In the case of wearable EAW, the 10-m walk test (10-MWT) distance and speed scores significantly increased [distance: 0.85 (95% CI = 0.35, 1.34); speed: −1.76 (95% CI = −2.79, −0.73)]. The 6-min walk test (6-MWT) distance [−1.39 (95% CI = −2.01, −0.77)] and the timed up and go (TUG) test significantly increased [(1.19 (95% CI = 0.74, 1.64)], but no significant difference was observed in the walking index for spinal cord injury (WISCI-II) [−0.33 (95% CI = −0.79, 0.13)]. Among the patients using Lokomat, the 10-MWT-distance score significantly increased [−0.08 (95% CI = −0.14, −0.03)] and a significant increase in the WISCI-II was found [1.77 (95% CI = 0.23, 3.31)]. The result of network meta-analysis showed that the probability of wearable EAW to rank first and that of Lokomat to rank second was 89 and 47%, respectively, in the 10-MWT speed score, while that of Lokomat to rank first and wearable EAW to rank second was 73 and 63% in the WISCI-II scores.ConclusionLokomat and wearable EAW had effects on the performance of locomotion abilities, namely, distance, speed, and function. Wearable EAW might lead to better outcomes in walking speed compared with that in the case of Lokomat.
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Affiliation(s)
- Lingjie Zhang
- School of Health, Fujian Medical University, Fuzhou, China
| | - Fabin Lin
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lei Sun
- School of Health, Fujian Medical University, Fuzhou, China
- Lei Sun
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
- *Correspondence: Chunmei Chen
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Marchesi G, De Luca A, Squeri V, De Michieli L, Vallone F, Pilotto A, Leo A, Casadio M, Canessa A. A Lifespan Approach to Balance in Static and Dynamic Conditions: The Effect of Age on Balance Abilities. Front Neurol 2022; 13:801142. [PMID: 35265025 PMCID: PMC8899125 DOI: 10.3389/fneur.2022.801142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Postural control is a complex sensorimotor skill that is fundamental to our daily life. The abilities to maintain and recover balance degrade with age. However, the time decay of balance performance with age is not well understood. In this study, we aim at quantifying the age-dependent changes in standing balance under static and dynamic conditions. We tested 272 healthy subjects with ages ranging from 20 to 90. Subjects maintained the upright posture while standing on the robotic platform hunova®. In the evaluation of static balance, subjects stood on the fixed platform both with eyes open (EO) and eyes closed (EC). In the dynamic condition, subjects stood with eyes open on the moving foot platform that provided three different perturbations: (i) an inclination proportional to the center of pressure displacements, (ii) a pre-defined predictable motion, and (iii) an unpredictable and unexpected tilt. During all these tests, hunova® measured the inclination of the platform and the displacement of the center of pressure, while the trunk movements were recorded with an accelerometer placed on the sternum. To quantify balance performance, we computed spatio-temporal parameters typically used in clinical environments from the acceleration measures: mean velocity, variability of trunk motion, and trunk sway area. All subjects successfully completed all the proposed exercises. Their motor performance in the dynamic balance tasks quadratically changed with age. Also, we found that the reliance on visual feedback is not age-dependent in static conditions. All subjects well-tolerated the proposed protocol independently of their age without experiencing fatigue as we chose the timing of the evaluations based on clinical needs and routines. Thus, this study is a starting point for the definition of robot-based assessment protocols aiming at detecting the onset of age-related standing balance deficits and allowing the planning of tailored rehabilitation protocols to prevent falls in older adults.
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Affiliation(s)
- Giorgia Marchesi
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | | | | | - Francesco Vallone
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alessandra Leo
- Unità Spinale Unipolare, Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maura Casadio
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Andrea Canessa
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Suzuki H, Imajo Y, Funaba M, Nishida N, Sakamoto T, Sakai T. Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury. Front Cell Neurosci 2022; 15:794692. [PMID: 35185471 PMCID: PMC8850278 DOI: 10.3389/fncel.2021.794692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic spinal cord injury (SCI) is a devastating condition that results in major neurological deficits and social burden. It continues to be managed symptomatically, and no real therapeutic strategies have been devised for its treatment. Neural stem/neural progenitor cells (NSCs/NPCs) being used for the treatment of chronic SCI in experimental SCI models can not only replace the lost cells and remyelinate axons in the injury site but also support their growth and provide neuroprotective factors. Currently, several clinical studies using NSCs/NPCs are underway worldwide. NSCs/NPCs also have the potential to differentiate into all three neuroglial lineages to regenerate neural circuits, demyelinate denuded axons, and provide trophic support to endogenous cells. This article explains the challenging pathophysiology of chronic SCI and discusses key NSC/NPC-based techniques having the greatest potential for translation over the next decade.
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Sasanuma N, Sota K, Uchiyama Y, Kodama N, Domen K. Identification of the Exercise Load When Using a Balance Exercise Assist Robot. Prog Rehabil Med 2022; 6:20210053. [PMID: 35083380 PMCID: PMC8702991 DOI: 10.2490/prm.20210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: The Balance Exercise Assist Robot (BEAR) is a boarding-type robot developed to improve
users’ balance performance. However, the exercise load experienced by users of the BEAR
remains unclear. Therefore, this study aimed to identify the exercise load of BEAR
users. Methods: Recruited healthy participants were fitted with an expiratory gas analyzer, and
instructed to control the avatar displayed on the computer monitor by shifting their
weight on the BEAR. Three types of activity (tennis, skiing, and rodeo) were prepared
for the BEAR, and the difficulty of each activity had 40 levels. Each balance exercise
for each level lasted for 90 s. The BEAR was administered at levels 1, 5, 10, and then
up to 40 in steps of 5 for each activity. The major parameters that were evaluated were
oxygen consumption (grossVO2, netVO2), metabolic equivalents
(METs), and heart rate (HR). Two-way analysis of variance with Tukey’s post hoc test was
applied to each level of each activity. Results: Fourteen healthy participants were recruited. For the rodeo activity, netVO2
and MET values were significantly higher than those for tennis and skiing at level 20
(tennis vs. skiing vs. rodeo: netVO2 114.0±59.7 vs. 160.6±71.1 vs.
205.6±82.9, METs 1.47±0.22 vs. 1.72±0.37 vs. 1.90±0.29) and higher. Furthermore,
comparisons within activity types showed that at level 40, netVO2 and MET
were significantly higher than for level 1. The exercise intensity was found to increase
along with the exercise level for all three activity types, with rodeo being the highest
at 2.74 METs. Conclusions: The current findings show that the BEAR can be used for balance practice without
generating excessive cardiopulmonary stress.
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Affiliation(s)
- Naoki Sasanuma
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Koichiro Sota
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
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