1
|
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.
Collapse
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.
| |
Collapse
|
2
|
He Y, Xu Y, Hai M, Feng Y, Liu P, Chen Z, Duan W. Exoskeleton-Assisted Rehabilitation and Neuroplasticity in Spinal Cord Injury. World Neurosurg 2024; 185:45-54. [PMID: 38320651 DOI: 10.1016/j.wneu.2024.01.167] [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: 10/23/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
Spinal cord injury (SCI) results in neurological deficits below the level of injury, causing motor dysfunction and various severe multisystem complications. Rehabilitative training plays a crucial role in the recovery of individuals with SCI, and exoskeleton serves as an emerging and promising tool for rehabilitation, especially in promoting neuroplasticity and alleviating SCI-related complications. This article reviews the classifications and research progresses of medical exoskeletons designed for SCI patients and describes their performances in practical application separately. Meanwhile, we discuss their mechanisms for enhancing neuroplasticity and functional remodeling, as well as their palliative impacts on secondary complications. The potential trends in exoskeleton design are raised according to current progress and requirements on SCI rehabilitation.
Collapse
Affiliation(s)
- Yana He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Yuxuan Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Minghang Hai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Yang Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Penghao Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute(CHINA-INI), Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute(CHINA-INI), Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute(CHINA-INI), Beijing, China.
| |
Collapse
|
3
|
Nguyen CM, Uy J, Serrada I, Hordacre B. Quantifying patient experiences with therapeutic neurorehabilitation technologies: a scoping review. Disabil Rehabil 2024; 46:1662-1672. [PMID: 37132669 DOI: 10.1080/09638288.2023.2201514] [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: 12/02/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Neurorehabilitation technologies are a novel approach to providing rehabilitation for patients with neurological conditions. There is a need to explore patient experiences. This study aimed; 1) To identify available questionnaires that assess patients' experiences with neurorehabilitation technologies, and 2) where reported, to document the psychometric properties of the identified questionnaires. MATERIALS AND METHODS Four databases were searched (Medline, Embase, Emcare and PsycInfo). The inclusion criteria were all types of primary data collection that included neurological patients of all ages who had experienced therapy with neurorehabilitation technologies and completed questionnaires to assess these experiences. RESULTS Eighty-eight publications were included. Fifteen different questionnaires along with many self-developed scales were identified. These were categorised as; 1) self-developed tools, 2) specific questionnaire for a particular technology, and 3) generic questionnaires originally developed for a different purpose. The questionnaires were used to assess various technologies, including virtual reality, robotics, and gaming systems. Most studies did not report any psychometric properties. CONCLUSION Many tools have been used to evaluate patient experiences, but few were specifically developed for neurorehabilitation technologies and psychometric data was limited. A preliminary recommendation would be use of the User Satisfaction Evaluation Questionnaire to evaluate patient experience with virtual reality systems.
Collapse
Affiliation(s)
- Chi Mai Nguyen
- University of South Australia, Allied Health and Human Performance, Adelaide, Australia
| | - Jeric Uy
- University of South Australia, Allied Health and Human Performance, Adelaide, Australia
| | - Ines Serrada
- University of South Australia, Allied Health and Human Performance, Adelaide, Australia
| | - Brenton Hordacre
- University of South Australia, Innovation, Implementation and Clinical Translation (IIMPACT), Health Allied Health and Human Performance, Adelaide, Australia
| |
Collapse
|
4
|
Vincent C, Dumont FS, Rogers M, Hu T, Bass A, Aubertin-Leheudre M, Karelis AD, Morin SN, McKerral M, Duclos C, Gagnon DH. Perspectives of wheelchair users with chronic spinal cord injury following a walking program using a wearable robotic exoskeleton. Disabil Rehabil 2024:1-9. [PMID: 38357879 DOI: 10.1080/09638288.2024.2317994] [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: 05/26/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To examine the perspectives of wheelchair users with spinal cord injury (WUSCI) regarding their participation in a 16-week walking program using a wearable robotic exoskeleton (WRE); and explore concerns and expectations regarding potential use of this device and intervention in the context of a home or community-based adapted physical activity program. METHOD Semi-structured interviews were conducted using a narrative research, 3 weeks post-intervention. Thematic analysis resulted in 6 themes and 21 subthemes. RESULTS Seven men and 4 women aged between 32 and 72 years were interviewed; 8 of them had a complete SCI. After the walking program, WUSCI reported positive psychological aspects (having fun and motivation) and experiencing improvements in physical aspects (strength, endurance, balance and flexibility, blood circulation and intestinal transit). The structural aspects of the WRE device were acceptable in a lab with research personnel (appearance, size, weight, and comfort). Participants had concerns about safety on uneven surfaces, and possibility of falling. They expressed the desire to use the WRE for more life habits than just walking. CONCLUSION This is the first study in which WUSCI report that the WRE should be implemented in initial rehabilitation. Lack of availability for community use after rehabilitation remains a concern.
Collapse
Affiliation(s)
- Claude Vincent
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
| | - Frédéric S Dumont
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
| | - Manon Rogers
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
| | - Tiffany Hu
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
| | - Alec Bass
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | | | - Antony D Karelis
- Department of Exercise Science, Université du Québec à Montréal, Montréal, Canada
| | | | - Michelle McKerral
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montréal, Canada
| | - Cyril Duclos
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR) of Greater Montreal, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| |
Collapse
|
5
|
Hu X, Lu J, Wang Y, Pang R, Liu J, Gou X, Bai X, Zhang A, Cheng H, Wang Q, Chang Y, Yin J, Chang C, Xiao H, Wang W. Effects of a lower limb walking exoskeleton on quality of life and activities of daily living in patients with complete spinal cord injury: A randomized controlled trial. Technol Health Care 2024; 32:243-253. [PMID: 37483030 DOI: 10.3233/thc-220871] [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: 07/25/2023]
Abstract
BACKGROUND In recent years, lower limb walking exoskeletons have been widely used in the study of spinal cord injury (SCI). OBJECTIVE To explore the effect of a lower limb walking exoskeleton on quality of life and functional independence in patients with motor complete SCI. METHODS This was a multi-center, single blind, randomized controlled trial. A total of 16 SCI patients were randomly assigned to either the exoskeleton-assisted walking (EAW) group (n= 8) or the conventional group (n= 8). Both groups received conventional rehabilitation training, including aerobic exercise and strength training. The EAW group additionally conducted the exoskeleton-assisted walking training using an AIDER powered robotic exoskeleton for 40-50 minutes, 5 times/week for 8 weeks. World Health Organization quality of life-BREF (WHOQOL-BREF) and the Spinal Cord Independence Measure III (SCIM-III) were used for assessment before and after training. RESULTS There was an increasing tendency of scores in the psychological health, physical health, and social relationships domain of WHOQOL-BREF in the EAW group after the intervention compared with the pre-intervention period, but there was no significant difference (P> 0.05). SCIM-III scores increased in both groups compared to pre-training, with only the conventional group showing a significant difference after 8 weeks of training (P< 0.05). CONCLUSION A lower limb walking exoskeleton may have potential benefits for quality of life and activities of daily living in patients with motor complete SCI.
Collapse
Affiliation(s)
- Xiaomin Hu
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Jiachun Lu
- The Eighth People's Hospital of Chengdu, Chengdu, Sichuan, China
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Yunyun Wang
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Rizhao Pang
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Jiancheng Liu
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Xiang Gou
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Xingang Bai
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Anren Zhang
- Department of Rehabilitation, Shanghai Fourth People's Hospital, Shanghai, China
| | - Hong Cheng
- University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Qian Wang
- Chengdu Gulian Jinchen Rehabilitation Hospital, Chengdu, Sichuan, China
| | - Youjun Chang
- Sichuan Rehabilitation Hospital, Chengdu, Sichuan, China
| | - Jie Yin
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Cong Chang
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| | - Hua Xiao
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Wenchun Wang
- Department of Rehabilitation Medicine, The Western Theater General Hospital, Chengdu, China
| |
Collapse
|
6
|
Cumplido-Trasmonte C, Molina-Rueda F, Puyuelo-Quintana G, Plaza-Flores A, Hernández-Melero M, Barquín-Santos E, Destarac-Eguizabal MA, García-Armada E. Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review. J Neuroeng Rehabil 2023; 20:47. [PMID: 37072823 PMCID: PMC10111693 DOI: 10.1186/s12984-023-01161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons. METHODS A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons. RESULTS Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists. CONCLUSION Users' satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users' point of view are ease of adjustment, size and weight, and ease of use.
Collapse
Affiliation(s)
- C Cumplido-Trasmonte
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda- Arganda del Rey, Madrid, 28500, Spain.
- International Doctoral School, Rey Juan Carlos University, Madrid, 28922, Spain.
| | - F Molina-Rueda
- Department of Physical Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Madrid, Spain
| | - G Puyuelo-Quintana
- International Doctoral School, Rey Juan Carlos University, Madrid, 28922, Spain
- Marsi Bionics S.L., Madrid, Spain
| | - A Plaza-Flores
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda- Arganda del Rey, Madrid, 28500, Spain
- Marsi Bionics S.L., Madrid, Spain
- Polytechnic University of Madrid, Madrid, Spain
| | - M Hernández-Melero
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda- Arganda del Rey, Madrid, 28500, Spain
| | | | | | - E García-Armada
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda- Arganda del Rey, Madrid, 28500, Spain.
| |
Collapse
|
7
|
Chandran VD, Nam S, Hexner D, Bauman WA, Pal S. Comparison of the dynamics of exoskeletal-assisted and unassisted locomotion in an FDA-approved lower extremity device: Controlled experiments and development of a subject-specific virtual simulator. PLoS One 2023; 18:e0270078. [PMID: 36763637 PMCID: PMC9916583 DOI: 10.1371/journal.pone.0270078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
Robotic exoskeletons have considerable, but largely untapped, potential to restore mobility in individuals with neurological disorders, and other conditions that result in partial or complete immobilization. The growing demand for these devices necessitates the development of technology to characterize the human-robot system during exoskeletal-assisted locomotion (EAL) and accelerate robot design refinements. The goal of this study was to combine controlled experiments with computational modeling to build a virtual simulator of EAL. The first objective was to acquire a minimum empirical dataset comprising human-robot kinematics, ground reaction forces, and electromyography during exoskeletal-assisted and unassisted locomotion from an able-bodied participant. The second objective was to quantify the dynamics of the human-robot system using a subject-specific virtual simulator reproducing EAL compared to the dynamics of normal gait. We trained an able-bodied participant to ambulate independently in a Food and Drug Administration-approved exoskeleton, the ReWalk P6.0 (ReWalk Robotics, Yoknaem, Israel). We analyzed the motion of the participant during exoskeletal-assisted and unassisted walking, sit-to-stand, and stand-to-sit maneuvers, with simultaneous measurements of (i) three-dimensional marker trajectories, (ii) ground reaction forces, (iii) electromyography, and (iv) exoskeleton encoder data. We created a virtual simulator in OpenSim, comprising a whole-body musculoskeletal model and a full-scale exoskeleton model, to determine the joint kinematics and moments during exoskeletal-assisted and unassisted maneuvers. Mean peak knee flexion angles of the human subject during exoskeletal-assisted walking were 50.1° ± 0.6° (left) and 52.6° ± 0.7° (right), compared to 68.6° ± 0.3° (left) and 70.7° ± 1.1° (right) during unassisted walking. Mean peak knee extension moments during exoskeletal-assisted walking were 0.10 ± 0.10 Nm/kg (left) and 0.22 ± 0.11 Nm/kg (right), compared to 0.64 ± 0.07 Nm/kg (left) and 0.73 ± 0.10 Nm/kg (right) during unassisted walking. This work provides a foundation for parametric studies to characterize the effects of human and robot design variables, and predictive modeling to optimize human-robot interaction during EAL.
Collapse
Affiliation(s)
- Vishnu D. Chandran
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, United States of America
| | - Sanghyun Nam
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, United States of America
| | | | - William A. Bauman
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States of America
- Department of Medicine and Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Saikat Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, United States of America
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, Newark, New Jersey, United States of America
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Duddy D, Doherty R, Connolly J, Loughrey J, Condell J, Hassan D, Faulkner M. The Cardiorespiratory Demands of Treadmill Walking with and without the Use of Ekso GT™ within Able-Bodied Participants: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6176. [PMID: 35627714 PMCID: PMC9141321 DOI: 10.3390/ijerph19106176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 12/07/2022]
Abstract
Individuals with neurological impairments tend to lead a predominantly sedentary lifestyle due to impaired gait function and mobility. This may be detrimental to health by negatively impacting cardiorespiratory fitness and muscular strength, and increasing the risk of developing secondary health problems. Powered exoskeletons are assistive devices that may aid neurologically impaired individuals in achieving the World Health Organisation's (WHO) physical activity (PA) guidelines for health. Increased PA should elicit a sufficient cardiorespiratory stimulus to provide health benefits to exoskeleton users. This study examined the cardiorespiratory demands of treadmill walking with and without the Ekso GT™ among able-bodied participants. The Ekso GT™ is a powered exoskeleton that enables individuals with neurological impairments to walk by supporting full body mass with motors attached at the hip and knee joints to generate steps. This feasibility study consisted of one group of healthy able-bodied individuals (n = 8). Participants completed two 12 min treadmill walking assessments, one with and one without the Ekso GT™ at the same fixed speed. Throughout each walking bout, various cardiorespiratory parameters, namely, volume of oxygen per kilogram (kg) of body mass (V˙O2·kg-1), volume of carbon dioxide per kg of body mass (V˙CO2·kg-1), respiratory exchange ratio (RER), ventilation (V˙E), heart rate (HR), and rate of perceived exertion (RPE), were recorded. Treadmill walking with Ekso GT™ elevated all recorded measurements to a significantly greater level (p ≤ 0.05) (except RER at 1 km·h-1; p = 0.230) than treadmill walking without the Ekso GT™ did at the same fixed speed. An increased cardiorespiratory response was recorded during treadmill walking with the exoskeleton. Exoskeleton walking may, therefore, be an effective method to increase PA levels and provide sufficient stimulus in accordance with the PA guidelines to promote cardiorespiratory fitness and subsequently enhance overall health.
Collapse
Affiliation(s)
- Damien Duddy
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - Rónán Doherty
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| | - James Connolly
- Department of Computing, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland;
| | | | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, Ulster University Magee, Londonderry BT48 7JL, UK;
| | - David Hassan
- Sport and Exercise Sciences Research Institute, Ulster University Jordanstown, Newtownabbey BT37 0QB, UK;
| | - Maria Faulkner
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland; (R.D.); (M.F.)
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Tamburella F, Lorusso M, Tramontano M, Fadlun S, Masciullo M, Scivoletto G. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. J Neuroeng Rehabil 2022; 19:27. [PMID: 35292044 PMCID: PMC8922901 DOI: 10.1186/s12984-022-01003-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/14/2022] [Indexed: 12/12/2022] Open
Abstract
Overground powered lower limb exoskeletons (EXOs) have proven to be valid devices in gait rehabilitation in individuals with spinal cord injury (SCI). Although several articles have reported the effects of EXOs in these individuals, the few reviews available focused on specific domains, mainly walking. The aim of this systematic review is to provide a general overview of the effects of commercial EXOs (i.e. not EXOs used in military and industry applications) for medical purposes in individuals with SCI. This systematic review was conducted following the PRISMA guidelines and it referred to MED-LINE, EMBASE, SCOPUS, Web of Science and Cochrane library databases. The studies included were Randomized Clinical Trials (RCTs) and non-RCT based on EXOs intervention on individuals with SCI. Out of 1296 studies screened, 41 met inclusion criteria. Among all the EXO studies, the Ekso device was the most discussed, followed by ReWalk, Indego, HAL and Rex devices. Since 14 different domains were considered, the outcome measures were heterogeneous. The most investigated domain was walking, followed by cardiorespiratory/metabolic responses, spasticity, balance, quality of life, human–robot interaction, robot data, bowel functionality, strength, daily living activity, neurophysiology, sensory function, bladder functionality and body composition/bone density domains. There were no reports of negative effects due to EXOs trainings and most of the significant positive effects were noted in the walking domain for Ekso, ReWalk, HAL and Indego devices. Ekso studies reported significant effects due to training in almost all domains, while this was not the case with the Rex device. Not a single study carried out on sensory functions or bladder functionality reached significance for any EXO. It is not possible to draw general conclusions about the effects of EXOs usage due to the lack of high-quality studies as addressed by the Downs and Black tool, the heterogeneity of the outcome measures, of the protocols and of the SCI epidemiological/neurological features. However, the strengths and weaknesses of EXOs are starting to be defined, even considering the different types of adverse events that EXO training brought about. EXO training showed to bring significant improvements over time, but whether its effectiveness is greater or less than conventional therapy or other treatments is still mostly unknown. High-quality RCTs are necessary to better define the pros and cons of the EXOs available today. Studies of this kind could help clinicians to better choose the appropriate training for individuals with SCI.
Collapse
Affiliation(s)
- Federica Tamburella
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy.
| | - Matteo Lorusso
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Marco Tramontano
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Silvia Fadlun
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Marcella Masciullo
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| | - Giorgio Scivoletto
- I.R.C.C.S. Santa Lucia Foundation (FSL), Via Ardeatina, 306, 00179, Rome, Italy
| |
Collapse
|
12
|
Yip CCH, Lam CY, Cheung KMC, Wong YW, Koljonen PA. Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury—A Scoping Review. Front Neurol 2022; 13:792295. [PMID: 35359657 PMCID: PMC8960715 DOI: 10.3389/fneur.2022.792295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.
Collapse
Affiliation(s)
- Christopher C. H. Yip
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chor-Yin Lam
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yat Wa Wong
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Kowloon, Hong Kong SAR, China
| | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Maclehose Medical Rehabilitation Centre, Hong Kong West Cluster, Hospital Authority, Kowloon, Hong Kong SAR, China
- *Correspondence: Paul A. Koljonen
| |
Collapse
|
13
|
Forte G, Leemhuis E, Favieri F, Casagrande M, Giannini AM, De Gennaro L, Pazzaglia M. Exoskeletons for Mobility after Spinal Cord Injury: A Personalized Embodied Approach. J Pers Med 2022; 12:jpm12030380. [PMID: 35330380 PMCID: PMC8954494 DOI: 10.3390/jpm12030380] [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: 01/05/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Endowed with inherent flexibility, wearable robotic technologies are powerful devices that are known to extend bodily functionality to assist people with spinal cord injuries (SCIs). However, rather than considering the specific psychological and other physiological needs of their users, these devices are specifically designed to compensate for motor impairment. This could partially explain why they still cannot be adopted as an everyday solution, as only a small number of patients use lower-limb exoskeletons. It remains uncertain how these devices can be appropriately embedded in mental representations of the body. From this perspective, we aimed to highlight the homeostatic role of autonomic and interoceptive signals and their possible integration in a personalized experience of exoskeleton overground walking. To ensure personalized user-centered robotic technologies, optimal robotic devices should be designed and adjusted according to the patient's condition. We discuss how embodied approaches could emerge as a means of overcoming the hesitancy toward wearable robots.
Collapse
Affiliation(s)
- Giuseppe Forte
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Erik Leemhuis
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Rome “Sapienza”, Via Degli Apuli 1, 00185 Rome, Italy;
| | - Anna Maria Giannini
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
| | - Luigi De Gennaro
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| |
Collapse
|
14
|
Chang CH, Casas J, Brose SW, Duenas VH. Closed-Loop Torque and Kinematic Control of a Hybrid Lower-Limb Exoskeleton for Treadmill Walking. Front Robot AI 2022; 8:702860. [PMID: 35127833 PMCID: PMC8811381 DOI: 10.3389/frobt.2021.702860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Restoring and improving the ability to walk is a top priority for individuals with movement impairments due to neurological injuries. Powered exoskeletons coupled with functional electrical stimulation (FES), called hybrid exoskeletons, exploit the benefits of activating muscles and robotic assistance for locomotion. In this paper, a cable-driven lower-limb exoskeleton is integrated with FES for treadmill walking at a constant speed. A nonlinear robust controller is used to activate the quadriceps and hamstrings muscle groups via FES to achieve kinematic tracking about the knee joint. Moreover, electric motors adjust the knee joint stiffness throughout the gait cycle using an integral torque feedback controller. For the hip joint, a robust sliding-mode controller is developed to achieve kinematic tracking using electric motors. The human-exoskeleton dynamic model is derived using Lagrangian dynamics and incorporates phase-dependent switching to capture the effects of transitioning from the stance to the swing phase, and vice versa. Moreover, low-level control input switching is used to activate individual muscles and motors to achieve flexion and extension about the hip and knee joints. A Lyapunov-based stability analysis is developed to ensure exponential tracking of the kinematic and torque closed-loop error systems, while guaranteeing that the control input signals remain bounded. The developed controllers were tested in real-time walking experiments on a treadmill in three able-bodied individuals at two gait speeds. The experimental results demonstrate the feasibility of coupling a cable-driven exoskeleton with FES for treadmill walking using a switching-based control strategy and exploiting both kinematic and force feedback.
Collapse
Affiliation(s)
- Chen-Hao Chang
- Department of Mechanical and Aerospace Engineering, Syracuse University, Syracuse, NY, United States
| | - Jonathan Casas
- Department of Mechanical and Aerospace Engineering, Syracuse University, Syracuse, NY, United States
| | - Steven W. Brose
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, United States
- Spinal Cord Injury and Disabilities Service, Syracuse VA Medical Center, Syracuse, NY, United States
| | - Victor H. Duenas
- Department of Mechanical and Aerospace Engineering, Syracuse University, Syracuse, NY, United States
| |
Collapse
|
15
|
Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
Collapse
Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
16
|
Xiang XN, Zong HY, Ou Y, Yu X, Cheng H, Du CP, He HC. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. J Neuroeng Rehabil 2021; 18:86. [PMID: 34030720 PMCID: PMC8146689 DOI: 10.1186/s12984-021-00880-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Exoskeleton-assisted walking (EAW) is expected to improve the gait of spinal cord injury (SCI) individuals. However, few studies reported the changes of pulmonary function (PF) parameters after EAW trainings. Hence, we aimed to explore the effect of EAW on PF parameters, 6-min walk test (6MWT) and lower extremity motor score (LEMS) in individuals with SCI and to compare those with conventional trainings. METHODS In this prospective, single-center, single-blinded randomized controlled pilot study, 18 SCI participants were randomized into the EAW group (n = 9) and conventional group (n = 9) and received 16 sessions of 50-60 min training (4 days/week, 4 weeks). Pulmonary function parameters consisting of the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), peak expiratory flow, and maximal voluntary ventilation, 6MWT with assisted devices and LEMS were reported pre- and post-training. RESULTS Values of FVC (p = 0.041), predicted FVC% (p = 0.012) and FEV1 (p = 0.013) were significantly greater in EAW group (FVC: 3.8 ± 1.1 L; FVC% pred = 94.1 ± 24.5%; FEV1: 3.5 ± 1.0 L) compared with conventional group (FVC: 2.8 ± 0.8 L; FVC% pred = 65.4 ± 17.6%; FEV1: 2.4 ± 0.6 L) after training. Participants in EAW group completed 6MWT with median 17.3 m while wearing the exoskeleton. There was no difference in LEMS and no adverse event. CONCLUSIONS The current results suggest that EAW has potential benefits to facilitate PF parameters among individuals with lower thoracic neurological level of SCI compared with conventional trainings. Additionally, robotic exoskeleton helped walking. TRIAL REGISTRATION Registered on 22 May 2020 at Chinese Clinical Trial Registry (ChiCTR2000033166). http://www.chictr.org.cn/edit.aspx?pid=53920&htm=4 .
Collapse
Affiliation(s)
- Xiao-Na Xiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hui-Yan Zong
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Ou
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Yu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Cheng
- University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, People's Republic of China
| | - Chun-Ping Du
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Hong-Chen He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| |
Collapse
|
17
|
Evans RW, Shackleton CL, West S, Derman W, Laurie Rauch HG, Baalbergen E, Albertus Y. Robotic Locomotor Training Leads to Cardiovascular Changes in Individuals With Incomplete Spinal Cord Injury Over a 24-Week Rehabilitation Period: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2021; 102:1447-1456. [PMID: 33839105 DOI: 10.1016/j.apmr.2021.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the effect of robotic locomotor training (RLT) and activity-based training (ABT) on cardiovascular indices during various physiological positions in individuals with spinal cord injury. DESIGN Randomized controlled pilot study. SETTING Private practice: Therapy & Beyond Centre - Walking with Brandon Foundation, Sports Science Institute of South Africa, Cape Town, South Africa. PARTICIPANTS Participants with chronic traumatic motor incomplete tetraplegia (N=16) who resided in the Western Cape, South Africa. INTERVENTION Robotic locomotor training (Ekso GT) and activity-based training over a 24-week intervention. MAIN OUTCOME MEASURES Brachial and ankle blood pressure, heart rate, heart rate variability, and cardiovascular efficiency during 4 physiological positions. RESULTS No differences between groups or over time were evident in resting systolic and diastolic blood pressure, ankle systolic pressure, ankle brachial pressure index, and heart rate variability. Standing heart rate at 24 weeks was significantly higher in the ABT group (95.58±12.61 beats/min) compared with the RLT group (75.14±14.96 beats/min) (P=.05). In the RLT group, no significant changes in heart rate variability (standard deviation R-R interval and root mean square of successive differences) was found between the standing and 6-minute walk test physiological positions throughout the intervention. Cardiovascular efficiency in the RLT group during the 6-minute walk test improved from 11.1±2.6 at baseline to 7.5±2.8 beats per meter walked at 6 weeks and was maintained from 6 to 24 weeks. CONCLUSIONS Large effect sizes and significant differences between groups found in this pilot study support the clinical effectiveness of RLT and ABT for changing cardiovascular indices as early as 6 weeks and up to 24 weeks of rehabilitation. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress. Based on heart rate variability metrics, the stimulus of standing has comparable effects to RLT on the parasympathetic nervous system. Cardiovascular efficiency of exoskeleton walking improved, particularly over the first 6 weeks. Both the RLT and ABT interventions were limited in their effect on brachial and ankle blood pressure. A randomized controlled trial with a larger sample size is warranted to further examine these findings.
Collapse
Affiliation(s)
- Robert W Evans
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Claire L Shackleton
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town; IOC Research Centre, South Africa
| | - H G Laurie Rauch
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Ed Baalbergen
- Rehabilitation Unit, Life Vincent Pallotti Hospital, Cape Town, South Africa
| | - Yumna Albertus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town.
| |
Collapse
|
18
|
Monardo G, Pavese C, Giorgi I, Godi M, Colombo R. Evaluation of Patient Motivation and Satisfaction During Technology-Assisted Rehabilitation: An Experiential Review. Games Health J 2021; 10:13-27. [DOI: 10.1089/g4h.2020.0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Giulia Monardo
- Service of Psychology and Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Chiara Pavese
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ines Giorgi
- Service of Psychology and Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation and Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Roberto Colombo
- Service of Bioengineering, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| |
Collapse
|
19
|
van Dijsseldonk RB, van Nes IJW, Geurts ACH, Keijsers NLW. Exoskeleton home and community use in people with complete spinal cord injury. Sci Rep 2020; 10:15600. [PMID: 32973244 PMCID: PMC7515902 DOI: 10.1038/s41598-020-72397-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022] Open
Abstract
A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1-15]) out of 16 ([12-21]) days, in which participants took a median of 3,226 ([330-28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5-95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.
Collapse
Affiliation(s)
- Rosanne B van Dijsseldonk
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Ilse J W van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
20
|
Waerling RD, Kjaer TW. A systematic review of impairment focussed technology in neurology. Disabil Rehabil Assist Technol 2020; 17:234-247. [DOI: 10.1080/17483107.2020.1776776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Troels Wesenberg Kjaer
- University of Copenhagen, Denmark
- Department of Neurology, Zealand University Hospital, Denmark
| |
Collapse
|
21
|
Design and verification of a human-robot interaction system for upper limb exoskeleton rehabilitation. Med Eng Phys 2020; 79:19-25. [PMID: 32205023 DOI: 10.1016/j.medengphy.2020.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/19/2020] [Accepted: 01/26/2020] [Indexed: 11/22/2022]
Abstract
This paper presents the design of a motion intent recognition system, based on an altitude signal sensor, to improve the human-robot interaction performance of upper limb exoskeleton robots during rehabilitation training. A modified adaptive Kalman filter combined with clipping filtering is proposed for the control system to mitigate the noise and time delay of the collected signal. The clipping filtering method was used to filter the accidental error and avoid the safety problem caused by a mistrigger. A modified adaptive Kalman filter was used to account for the sudden change of the motion state during rehabilitation training. The results show that the intent recognition system designed herein can accurately recognize the human-robot interaction information, and estimate the intent of human motion in time. Therefore, it can be concluded that the designed system effectively follows the predicted motion intent with the proposed method, which is a significant improvement for human-robot interaction control of upper limb extremity rehabilitation robots.
Collapse
|
22
|
Pinto D, Garnier M, Barbas J, Chang SH, Charlifue S, Field-Fote E, Furbish C, Tefertiller C, Mummidisetty CK, Taylor H, Jayaraman A, Heinemann AW. Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems. J Neuroeng Rehabil 2020; 17:4. [PMID: 31924224 PMCID: PMC6954546 DOI: 10.1186/s12984-019-0639-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. METHODS A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. RESULTS Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226-397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to $4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. CONCLUSIONS Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions.
Collapse
Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- Department of Medical and Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA.
| | | | - Jason Barbas
- Shirley Ryan Ability Lab, Chicago, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Shuo-Hsiu Chang
- Department of Physical Medicine and Rehabilitation McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Susan Charlifue
- SCI Research, Craig Hospital, Englewood, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, USA
| | - Edelle Field-Fote
- Spinal Cord Injury Research at the Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Catherine Furbish
- Spinal Cord Injury Research at the Shepherd Center, Atlanta, Georgia
| | | | - Chaithanya K Mummidisetty
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Chicago, USA
- Office of Translational Research, Shirley Ryan Ability Lab, Chicago, USA
| | - Heather Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Herman, Houston, USA
- Pediatrics and Physical Medicine and Rehabilitation McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - Arun Jayaraman
- Office of Translational Research, Shirley Ryan Ability Lab, Chicago, USA
- Northwestern University, Evanston, USA
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Department of PM&R, Feinberg School of Medicine, Northwestern University, Evanston, USA
| |
Collapse
|
23
|
Exoskeleton for Gait Rehabilitation: Effects of Assistance, Mechanical Structure, and Walking Aids on Muscle Activations. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9142868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several exoskeletons have been developed and increasingly used in clinical settings for training and assisting locomotion. These devices allow people with severe motor deficits to regain mobility and sustain intense and repetitive gait training. However, three factors might affect normal muscle activations during walking: the assistive forces that are provided during walking, the crutches or walker that are always used in combination with the device, and the mechanical structure of the device itself. To investigate these effects, we evaluated eight healthy volunteers walking with the Ekso, which is a battery-powered, wearable exoskeleton. They walked supported by either crutches or a walker under five different assistance modalities: bilateral maximum assistance, no assistance, bilateral adaptive assistance, and unilateral adaptive assistance on each leg. Participants also walked overground without the exoskeleton. Surface electromyography was recorded bilaterally, and the statistical parametric mapping approach and muscle synergies analysis were used to investigate differences in muscular activity across different walking conditions. The lower limb muscle activations while walking with the Ekso were not influenced by the use of crutches or walker aids. Compared to normal walking without robotic assistance, the Ekso reduced the amplitude of activation for the distal lower limb muscles while changing the timing for the others. This depended mainly on the structure of the device, and not on the type or level of assistance. In fact, the presence of assistance did not change the timing of the muscle activations, but instead mainly had the effect of increasing the level of activation of the proximal lower limb muscles. Surprisingly, we found no significant changes in the adaptive control with respect to a maximal fixed assistance that did not account for subjects’ performance. These are important effects to take into careful considerations in clinics where these devices are used for gait rehabilitation in people with neurological diseases.
Collapse
|