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Gil-Castillo J, Barria P, Aguilar Cárdenas R, Baleta Abarza K, Andrade Gallardo A, Biskupovic Mancilla A, Azorín JM, Moreno JC. A Robot-Assisted Therapy to Increase Muscle Strength in Hemiplegic Gait Rehabilitation. Front Neurorobot 2022; 16:837494. [PMID: 35574230 PMCID: PMC9100587 DOI: 10.3389/fnbot.2022.837494] [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: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
This study examines the feasibility of using a robot-assisted therapy methodology based on the Bobath concept to perform exercises applied in conventional therapy for gait rehabilitation in stroke patients. The aim of the therapy is to improve postural control and movement through exercises based on repetitive active-assisted joint mobilization, which is expected to produce strength changes in the lower limbs. As therapy progresses, robotic assistance is gradually reduced and the patient's burden increases with the goal of achieving a certain degree of independence. The relationship between force and range of motion led to the analysis of both parameters of interest. The study included 23 volunteers who performed 24 sessions, 2 sessions per week for 12 weeks, each lasting about 1 h. The results showed a significant increase in hip abduction and knee flexion strength on both sides, although there was a general trend of increased strength in all joints. However, the range of motion at the hip and ankle joints was reduced. The usefulness of this platform for transferring exercises from conventional to robot-assisted therapies was demonstrated, as well as the benefits that can be obtained in muscle strength training. However, it is suggested to complement the applied therapy with exercises for the maintenance and improvement of the range of motion.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Patricio Barria
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
- Electrical Engineering Department, Universidad de Magallanes, Punta Arenas, Chile
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | | | - Karim Baleta Abarza
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade Gallardo
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | | | - José M. Azorín
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Juan C. Moreno
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Ezaki S, Kadone H, Kubota S, Abe T, Shimizu Y, Tan CK, Miura K, Hada Y, Sankai Y, Koda M, Suzuki K, Yamazaki M. Analysis of Gait Motion Changes by Intervention Using Robot Suit Hybrid Assistive Limb (HAL) in Myelopathy Patients After Decompression Surgery for Ossification of Posterior Longitudinal Ligament. Front Neurorobot 2021; 15:650118. [PMID: 33867965 PMCID: PMC8044802 DOI: 10.3389/fnbot.2021.650118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostonic condition in which the posterior longitudinal ligament becomes thick and loses its flexibility, resulting in ectopic ossification and severe neurologic deficit (Matsunaga and Sakou, 2012). It commonly presents with myelopathy and radiculopathy and with myelopathy progression motor disorders and balance disorders can appear. Even after appropriate surgical decompression, some motor impairments often remain. The Hybrid Assistive Limb (HAL) is a wearable powered suit designed to assist and support the user's voluntary control of hip and knee joint motion by detecting bioelectric signals from the skin surface and force/pressure sensors in the shoes during movement. In the current study, the HAL intervention was applied to 15 patients diagnosed with OPLL who presented with myelopathy after decompression surgery (6 acute and 9 chronic stage). Following the HAL intervention, there were significant improvements in gait speed, cadence, stride length, in both acute and chronic groups. Joint angle analysis of the lower limbs showed that range of motion (ROM) of hip and knee joints in acute group, and also ROM of hip joint and toe-lift during swing in chronic group increased significantly. ROM of knee joint became closer to healthy gait in both groups. Electromyography analysis showed that hamstrings activity in the late swing phase increased significantly for acute patients. Immidiate effect from HAL session was also observed. EMG of vastus medialis were decreased except chronic 7th session and EMG of gastrocnemius were decreased except acute 7th session, which suggests the patients were learning to walk with lesser knee-hypertension during the sessions. After all, double knee action appeared in both acute and chronic groups after the HAL intervention, rather than knee hyper-extension which is a common gait impairment in OPLL. We consider that these improvements lead to a smoother and healthier gait motion.
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Affiliation(s)
- Seioh Ezaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chun Kwang Tan
- Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
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Nilsson MY, Andersson S, Magnusson L, Hanson E. Ambient assisted living technology-mediated interventions for older people and their informal carers in the context of healthy ageing: A scoping review. Health Sci Rep 2021; 4:e225. [PMID: 33392394 PMCID: PMC7770427 DOI: 10.1002/hsr2.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS There is a growing demand for health and social care services to provide technology-mediated interventions that promote the health and well-being of older people with health or care needs and of their informal carers. The objectives of this study were to scope and review the nature and extent of prior intervention studies involving ambient assisted living technology-mediated interventions for older people and their informal carers, and how and in what ways (if any) the goals and aims of these interventions reflected the domains of the World Health Organization framework for healthy ageing. METHODS We conducted a scoping review. Data were collected between June and October 2018 with an updated search in October 2020. A total of 85 articles were eligible for inclusion. RESULTS Nine categories described the aims and content of the included studies. The healthy ageing domain "Ability to meet basic needs" was mirrored in four categories, whereas "Ability to contribute to society" was not addressed at all. CONCLUSION The ways in which domains of healthy ageing are mirrored suggest that there is an emphasis on individual factors and individual responsibility, and a lack of attention given to broader, environmental factors affecting healthy ageing. Only a few of the studies used a dyadic approach when assessing health outcomes concerning older people and their informal carers.
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Affiliation(s)
- Maria Y. Nilsson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Stefan Andersson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Lennart Magnusson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Elizabeth Hanson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
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Bhardwaj S, Khan AA, Muzammil M. Lower limb rehabilitation robotics: The current understanding and technology. Work 2021; 69:775-793. [PMID: 34180443 DOI: 10.3233/wor-205012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND With the increasing rate of ambulatory disabilities and rise in the elderly population, advance methods to deliver the rehabilitation and assistive services to patients have become important. Lower limb robotic therapeutic and assistive aids have been found to improve the rehabilitation outcome. OBJECTIVE The article aims to present the updated understanding in the field of lower limb rehabilitation robotics and identify future research avenues. METHODS Groups of keywords relating to assistive technology, rehabilitation robotics, and lower limb were combined and searched in EMBASE, IEEE Xplore Digital Library, Scopus, Web of Science and Google Scholar database. RESULTS Based on the literature collected from the databases we provide an overview of the understanding of robotics in rehabilitation and state of the art devices for lower limb rehabilitation. Technological advancements in rehabilitation robotic architecture (sensing, actuation and control) and biomechanical considerations in design have been discussed. Finally, a discussion on the major advances, research directions, and challenges is presented. CONCLUSIONS Although the use of robotics has shown a promising approach to rehabilitation and reducing the burden on caregivers, extensive and innovative research is still required in both cognitive and physical human-robot interaction to achieve treatment efficacy and efficiency.
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Affiliation(s)
- Siddharth Bhardwaj
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Abid Ali Khan
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
| | - Mohammad Muzammil
- Department of Mechanical Engineering, Aligarh Muslim University, Aligarh, UP, India
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Plaza A, Hernandez M, Puyuelo G, Garces E, Garcia E. Wearable rehabilitation exoskeletons of the lower limb: analysis of versatility and adaptability. Disabil Rehabil Assist Technol 2020; 18:392-406. [PMID: 33332159 DOI: 10.1080/17483107.2020.1858976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse the versatility and adaptability of commercially available exoskeletons for mobility assistance and their adaptation to diverse pathologies through a review of clinical trials in robotic lower limb training. DATA SOURCES A computer-aided search in bibliographic databases (PubMed and Web of Science) of clinical trials published up to September 2020 was done. METHODS To be selected for detailed review, clinical trials had to meet the following criteria: (1) a protocol was designed and approved, (2) participants were people with pathologies, and (3) the trials were not a single case study. Clinical trial data were collected, extracted, and analysed, considering: objectives, trial participants, number of sessions, pathologies involved, and conclusions. RESULTS The search resulted in 312 potentially relevant studies of seven commercial exoskeletons, of which 135 passed the preliminary screening; and 69 studies were finally selected. Of the 69 clinical trials included in the review about 50% involved Spinal Cord Injury participants, while roughly 25% focussed on stroke and two trials corresponded to patients with both disorders. The rest were composed of neurological diseases and trauma disorders. CONCLUSIONS The use of a single wearable robot for different medical conditions in various diseases is a challenge. Based on this comparative, the properties of the exoskeletons that improve the working ability with different pathologies and patient conditions have been evaluated. Suggestions were made for developing a new lower-limb exoskeleton based on various modules with a distributed control system to improve versatility in wearable technology for different gait pattern progression.Implications for rehabilitationWearable robotic exoskeletons for gait assistance have been analysed from the perspective of adaptation to different diseases.This paper emphasizes the importance of personalized therapies and adaptive assistive technology.Suggestions were made for a new modular exoskeleton capable of addressing the issue of low versatility characterizing currently wearable assistive technology.
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Affiliation(s)
- Alberto Plaza
- Marsi Bionics S.L, Madrid, Spain.,Centro de Automática y Robótica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Mar Hernandez
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Gonzalo Puyuelo
- Marsi Bionics S.L, Madrid, Spain.,Escuela de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Elena Garcia
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
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Rinaldi L, Yeung LF, Lam PCH, Pang MYC, Tong RKY, Cheung VCK. Adapting to the Mechanical Properties and Active Force of an Exoskeleton by Altering Muscle Synergies in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2203-2213. [DOI: 10.1109/tnsre.2020.3017128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Puentes S, Kadone H, Kubota S, Abe T, Shimizu Y, Marushima A, Sankai Y, Yamazaki M, Suzuki K. Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery. Front Neurosci 2018; 12:99. [PMID: 29551960 PMCID: PMC5840280 DOI: 10.3389/fnins.2018.00099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.
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Affiliation(s)
- Sandra Puentes
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
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Abstract
Purpose: (1) To determine the specific functional characteristics of individuals with neurological impairments that may predict successful use of Keeogo™ dermoskeleton and (2) to quantify the specific benefit Keeogo™ provides to a regular user of the device. Methods: Thirteen individuals (seven males; six females; 52 ± 4.6 years old) with mobility impairments due to neurological disease or injury were recruited. Berg Balance Sale (BBS) score and Timed Up and Go (TUG) performance were used to identify baseline characteristics in participants. The 6-min walk test (6MWT) and 25-foot walk test (25FWT) were performed with the participants wearing and not wearing the dermoskeleton; a successful user of Keeogo™ displayed a ≥ 5% improvement in walking performance while wearing the device. A chronic stroke survivor (hemiparesis on left side) completed the stair climb test (SCT) and the 30-second chair stand test (30CST) with and without Keeogo™. Muscle activity, kinetics and postural control were analyzed during the sit-to-stand (sitTS), and compared to an age- and sex-matched healthy control. Results: Successful users of Keeogo™ have a moderate level of functionality (BBS: 46-51 s and/or TUG: 8-12 s). Wearing Keeogo™ improved performance on the 30CST, SCT and improved motor control, postural control and movement kinetics during the sitTS task in a chronic stroke survivor with significant hemiparesis. Conclusion: This is the first study providing data to help to identify which individuals with neurological impairment might benefit from using Keeogo™ dermoskeleton, together with new information quantifying its functional benefit to the user. Implications for Rehabilitation Keeogo™ is a user-initiated dermoskeleton that has been designed to assist individuals with mobility impairments to participate more effectively in activities of daily living (ADLs). Moderately impaired individuals have the greatest potential to benefit from using the device. Benefits of wearing the device include improvements in walking speed and endurance, performance on ADLs, motor control, kinetics, and postural control.
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Affiliation(s)
- Jonathan C Mcleod
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
| | - Susie Jm Ward
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
| | - Audrey L Hicks
- a Department of Kinesiology, McMaster University , Hamilton , Ontario , Canada
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