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Moeller T, Moehler F, Krell-Roesch J, Dežman M, Marquardt C, Asfour T, Stein T, Woll A. Use of Lower Limb Exoskeletons as an Assessment Tool for Human Motor Performance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3032. [PMID: 36991743 PMCID: PMC10057915 DOI: 10.3390/s23063032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
Exoskeletons are a promising tool to support individuals with a decreased level of motor performance. Due to their built-in sensors, exoskeletons offer the possibility of continuously recording and assessing user data, for example, related to motor performance. The aim of this article is to provide an overview of studies that rely on using exoskeletons to measure motor performance. Therefore, we conducted a systematic literature review, following the PRISMA Statement guidelines. A total of 49 studies using lower limb exoskeletons for the assessment of human motor performance were included. Of these, 19 studies were validity studies, and six were reliability studies. We found 33 different exoskeletons; seven can be considered stationary, and 26 were mobile exoskeletons. The majority of the studies measured parameters such as range of motion, muscle strength, gait parameters, spasticity, and proprioception. We conclude that exoskeletons can be used to measure a wide range of motor performance parameters through built-in sensors, and seem to be more objective and specific than manual test procedures. However, since these parameters are usually estimated from built-in sensor data, the quality and specificity of an exoskeleton to assess certain motor performance parameters must be examined before an exoskeleton can be used, for example, in a research or clinical setting.
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Affiliation(s)
- Tobias Moeller
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Felix Moehler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Miha Dežman
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Charlotte Marquardt
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Tamim Asfour
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Thorsten Stein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
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Vastano R, Costantini M, Alexander WH, Widerstrom-Noga E. Multisensory integration in humans with spinal cord injury. Sci Rep 2022; 12:22156. [PMID: 36550184 PMCID: PMC9780239 DOI: 10.1038/s41598-022-26678-x] [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: 09/07/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Although multisensory integration (MSI) has been extensively studied, the underlying mechanisms remain a topic of ongoing debate. Here we investigate these mechanisms by comparing MSI in healthy controls to a clinical population with spinal cord injury (SCI). Deafferentation following SCI induces sensorimotor impairment, which may alter the ability to synthesize cross-modal information. We applied mathematical and computational modeling to reaction time data recorded in response to temporally congruent cross-modal stimuli. We found that MSI in both SCI and healthy controls is best explained by cross-modal perceptual competition, highlighting a common competition mechanism. Relative to controls, MSI impairments in SCI participants were better explained by reduced stimulus salience leading to increased cross-modal competition. By combining traditional analyses with model-based approaches, we examine how MSI is realized during normal function, and how it is compromised in a clinical population. Our findings support future investigations identifying and rehabilitating MSI deficits in clinical disorders.
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Affiliation(s)
- Roberta Vastano
- grid.26790.3a0000 0004 1936 8606Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, FL 33136 USA
| | - Marcello Costantini
- grid.412451.70000 0001 2181 4941Department of Psychological, Health and Territorial Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy ,grid.412451.70000 0001 2181 4941Institute for Advanced Biomedical Technologies, ITAB, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - William H. Alexander
- grid.255951.fCenter for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, USA ,grid.255951.fDepartment of Psychology, Florida Atlantic University, Boca Raton, USA ,grid.255951.fThe Brain Institute, Florida Atlantic University, Boca Raton, USA
| | - Eva Widerstrom-Noga
- grid.26790.3a0000 0004 1936 8606Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, FL 33136 USA
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Shao X, Wang Z, Luan L, Sheng Y, Yu R, Pranata A, Adams R, Zhang A, Han J. Impaired ankle inversion proprioception during walking is associated with fear of falling in older adults. Front Aging Neurosci 2022; 14:946509. [PMID: 36247986 PMCID: PMC9563849 DOI: 10.3389/fnagi.2022.946509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ankle proprioception plays a critical role in lower limb movement control. However, the relationship between ankle proprioception and fear of falling (FOF) in older people is still unclear. Objective (1) This study aims to develop a new device for measuring ankle inversion proprioceptive discrimination sensitivity during walking, i.e., the Ankle Inversion Discrimination Apparatus–Walking (AIDAW), and assess the test–retest reliability of the AIDAW in both young and older adults; (2) to evaluate the discriminant validity of the measure by comparing ankle proprioception during walking between the two groups; and (3) to explore convergent validity by determining to what extent the AIDAW proprioceptive scores correlate with Fall Efficacy Scale-International (FES-I) scores. Materials and methods The AIDAW was purpose-built to test ankle inversion proprioceptive discrimination sensitivity during walking. The area under the receiver operating curve (AUC) was calculated as the proprioceptive discrimination score. In total, 54 adults volunteered. Test–retest reliability was evaluated in 12 young and 12 older adults, and another 15 young and 15 older adults completed the comparison study. FOF was assessed by using the FES-I. Results The test–retest reliability intraclass correlation coefficient ICC (3,1) value for the whole group was 0.76 (95% CI: 0.52–0.89). The ICC values of the young and older groups were 0.81 (95% CI: 0.46–0.94) and 0.71 (95% CI: 0.26–0.91), respectively. The Minimal Detectable Change with 90% confidence (MDC90) values for the young and older groups were 0.03 and 0.11, respectively. There was a significant difference between the AIDAW proprioceptive sensitivity scores for the young and older groups (0.78 ± 0.04 vs. 0.72 ± 0.08, F = 5.06, p = 0.033). Spearman’s correlation analysis showed that the FES-I scores were significantly and negatively correlated with the AIDAW scores (rho = −0.61, p = 0.015), with higher FOF associated with worse ankle proprioception. Conclusion The AIDAW is a reliable and valid device for measuring ankle proprioception during walking in both young and older adults. Ankle inversion proprioceptive discrimination sensitivity during walking was found to be impaired in the elderly compared to young adults. This impairment was found to be strongly associated with FOF, suggesting that assessment and intervention for ankle proprioception in this population are needed to reduce the risk of falls.
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Affiliation(s)
- Xuerong Shao
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zheng Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yilan Sheng
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Ruoni Yu
- School of Medicine, Jinhua Polytechnic, Jinhua, China
| | - Adrian Pranata
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Roger Adams
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Anren Zhang
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Anren Zhang,
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
- Jia Han,
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Alteration of ankle proprioceptive threshold during gait in the presence of acute experimental pain. PLoS One 2022; 17:e0263161. [PMID: 35078205 PMCID: PMC8789182 DOI: 10.1371/journal.pone.0263161] [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: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Human gait requires complex somatosensory processing of various inputs such as proprioception. Proprioception can be altered in the presence of pain. This has been shown mostly during controlled tasks, thereby limiting the influence of external perturbations. While controlling the environment is sometimes warranted, it limits the ecological validity of the data. Using robotic orthoses to apply perturbations during movements seems a promising tool to functionally assess proprioception, where the complex somatosensory processing required in real-life situations is at play. The main objective of this study was to compare the proprioceptive threshold of healthy participants during gait in the presence and absence of an acute experimental pain. METHODS 36 healthy participants walked on a treadmill while wearing a robotized ankle-foot orthosis (rAFO) around their right ankle. The rAFO applied torque perturbations of graded magnitudes during the swing phase of gait. Participants had to report the presence/absence of such perturbations, as a measure of proprioceptive threshold. Following initial assessment, they were randomly assigned to one of three experimental groups: Control (no stimulation), Painless (non-nociceptive stimulation) and Painful (nociceptive stimulation). Electrodes placed on the right lateral malleolus delivered an electrical stimulation during the second assessment for Painless and Painful groups. A Kruskal-Wallis was used to compare the percentage of change of the three groups between the two assessments. RESULTS A 31.80±32.94% increase in proprioceptive threshold, representing an increase of 1.3±1.2 Nm in the detection threshold, was observed for the Painful group only (p<0.005), with an effect size of 1.6. CONCLUSION Findings show that the presence of pain at the ankle can alter participants' proprioceptive threshold during gait. Clinical assessment of proprioception should therefore carefully consider the presence of pain when evaluating a patient's performance using clinical proprioceptive test and consider the negative effect of pain on proprioceptive threshold for test interpretation.
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Dambreville C, Pairot de Fontenay B, Blanchette AK, Roy JS, Mercier C, Bouyer L. Ankle proprioception during gait in individuals with incomplete spinal cord injury. Physiol Rep 2019; 7:e14328. [PMID: 31883208 PMCID: PMC6934873 DOI: 10.14814/phy2.14328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Proprioception is known to be affected after a spinal cord injury (SCI). However, it is currently assessed during simple tasks that do not reflect activities of daily living. To better understand how proprioception affects movement, assessing it during a functional sensorimotor task such as walking is therefore of primary importance. Therefore, the objectives of this study were as follows: (a) measure the protocol reliability of a new robotic test in nondisabled controls; (b) evaluate the effect nonlesion-related factors such as sex, age, pain, and gait speed on ankle proprioception; and (c) assess ankle proprioception during walking in individuals with SCI. METHODS In the current study, ankle proprioception was assessed during gait in individuals with an incomplete spinal cord injury (iSCI; n = 15) using an electrohydraulic robotized ankle-foot orthosis (rAFO). Ankle proprioceptive threshold was quantified as the participants' ability to detect torque perturbations of varied amplitude applied during swing by the rAFO. In addition, test-retest reliability and the potential effect of nonlesion-related factors (sex, age, pain, and gait speed) were evaluated in nondisabled (ND; n = 65) participants. RESULTS During gait, individuals with iSCI had a 53% poorer proprioceptive threshold than ND controls (p < .05). Test-retest reliability was good (ICC = 0.78), and only gait speed affected proprioceptive threshold (p = .018). CONCLUSION This study is the first to show that ankle proprioception assessed during gait is impaired in individuals with an iSCI. The developed test can now be used to better characterize proprioception in population with other neurological conditions and has potential to maximize functional recovery during gait training in those populations.
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Affiliation(s)
- Charline Dambreville
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada
| | - Benoit Pairot de Fontenay
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada
| | - Andreanne K Blanchette
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
| | - Jean-Sebastien Roy
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
| | - Laurent Bouyer
- Centre for Interdisciplinary Research in Rehabilitation And Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
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