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Castro P, Martí M, Oliván-Blázquez B, Boñar N, García V, Gascón-Santos S, Panzano A, Vela S, Tajadura S, Peña A, Tris-Ara MJ. Benefits of robotic gait assistance with ATLAS 2030 in children with cerebral palsy. Front Pediatr 2024; 12:1398044. [PMID: 39135857 PMCID: PMC11318455 DOI: 10.3389/fped.2024.1398044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024] Open
Abstract
Objective This study aims to assess the impact of integrating ATLAS 2030 into the conventional therapy regimen for children with Cerebral Palsy (CP) compared to conventional therapy alone regarding gross motor function, range of motion (ROM) and spasticity. Design A non-randomized controlled trial conducted in outpatient rehabilitation settings and special education schools, following the recommendations by the Consolidated Standards of Reporting Trials (CONSORT) statement. Participants Thirty children with CP divided into intervention and control groups. Intervention The intervention group received three months of therapy (twice per week) with the ATLAS 2030 device in addition to their standard therapy, while the control group underwent standard therapy alone. Main outcome measure Gross motor function assessed using the Gross Motor Function Measure of 88 items (GMFM-88). Secondary outcomes Spasticity, measured by the Modified Ashworth Scale (MAS), and ROM of the lower limbs. Results Statistically significant differences were observed between groups, in favour the intervention group, in both the GMFM-88 total score and dimension A, B and D. Similar findings were noted for spasticity and ROM, demonstrating significant improvements in the intervention group. Conclusion ATLAS 2030 proves to be a safe and valuable tool for the rehabilitation of children with CP, showing improvements in motor function, spasticity and ROM.
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Affiliation(s)
- Pilar Castro
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - María Martí
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | | | | | | | | | - Alicia Panzano
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Sara Vela
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Sara Tajadura
- Asociación Tutelar Aragonesa de Discapacidad Intelectual (ATADES), Zaragoza, Spain
| | - Ana Peña
- Department of Paediatric Rehabilitation, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María Josefa Tris-Ara
- Department of Paediatric Rehabilitation, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Wang D, Zhang T, Li Y, Liu J, Jia Y, Xiao N. Rehabilitation for spinal muscular atrophy patients in China: a national cross-sectional study. Orphanet J Rare Dis 2024; 19:279. [PMID: 39060931 PMCID: PMC11282710 DOI: 10.1186/s13023-024-03291-x] [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: 02/19/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The management of Spinal Muscular Atrophy (SMA) requires a multidisciplinary treatment approach, wherein rehabilitation constitutes an integral element. In this study, we examined the effects of rehabilitation among Chinese SMA patients and assessed the real-world efficacy of rehabilitation interventions. METHODS We conducted a cross-sectional online survey on SMA patients from June 9, 2023, to June 30, 2023, through the Meier Advocacy & Support Center using data from the Center's database and electronic questionnaires. The rehabilitation situation of the participants over the past 14 months were investigated. Logistic binary regression was used to analyze the relationship between Pediatric Quality of Life Inventory(PedsQL™) scores and rehabilitation. RESULT A total of 186 questionnaires were finally analyzed. Only 29 patients did not rehabilitated in the past 14 months. A significant correlation between age and type of rehabilitation, as well as between age and duration of rehabilitation. Patients receiving no rehabilitation or solely home-based rehabilitation exhibited a higher median age of 8.4 compared to those undergoing standard rehabilitation or a combination of standard and home-based rehabilitation, with a median age of 4.9 (z-score = -4.49, p-value < 0.001). In addition, long-term rehabilitation (OR = 0.314, 95%CI = 0.106-0.927, p = 0.04) were negatively correlated with lower PedsQL™ Neuromuscular Module scores, and PedsQL scores in the long-term rehabilitation group were higher than those in the short-term and no-rehabilitation groups (54.2 ± 15.1 vs. 45.9 ± 14.4 and 42.3 ± 14.3, p = 0.01), with the most significant difference observed in the physical function section (59.0 ± 15.8 vs. 46.8 ± 15.2 and 45.6 ± 15.9, p < 0.01). Mobility and exercise (OR = 0.26, 95%CI = 0.08-0.81, p = 0.02), as well as assistive technology (OR = 0.28, 95%CI = 0.10-0.82, p = 0.02), were independently associated with a lower score in a negative direction. CONCLUSION The study found that long-term rehabilitation was linked to higher PedsQL scores in SMA patients, highlighting the need for standardized rehabilitation programs to enhance function and quality of life.
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Affiliation(s)
- Duan Wang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China
| | - Ting Zhang
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China
| | - Yi Li
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China
| | - Jiayu Liu
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China
| | - Yongzhu Jia
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China
| | - Nong Xiao
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, China.
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冷 明, 彭 宏, 吴 至. [Recent research on home rehabilitation and nursing for spinal muscular atrophy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:420-424. [PMID: 38660908 PMCID: PMC11057298 DOI: 10.7499/j.issn.1008-8830.2310037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder. With the emergence of disease-modifying therapies, the prognosis of SMA has significantly improved, drawing increased attention to the importance of home rehabilitation and nursing management. Long-term, standardized home rehabilitation and nursing can delay the progression of SMA, enhance the psychological well-being, and improve the quality of life of both patients and caregivers. This article provides an overview of the goals of home rehabilitation, basic functional training methods, respiratory management, and nutritional management for SMA patients, as well as psychological health issues, emphasizing the significance of obtaining appropriate home rehabilitation and support during the care process.
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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.
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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.
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Cortés-Pérez I, González-González N, Peinado-Rubia AB, Nieto-Escamez FA, Obrero-Gaitán E, García-López H. Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:9910. [PMID: 36560281 PMCID: PMC9785795 DOI: 10.3390/s22249910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Motor, gait and balance disorders reduce functional capabilities for activities of daily living in children with cerebral palsy (CP). Robot-assisted gait therapy (RAGT) is being used to complement conventional therapy (CT) or treadmill therapy (TT) in CP rehabilitation. The aim of this systematic review is to assess the effect of RAGT on gait, balance and functional independence in CP children, in comparison to CT or TT. METHODS We have conducted a systematic review with meta-analysis. A search in PubMed Medline, Web of Science, Scopus, CINAHL, PEDro and SciELO has been conducted for articles published until October 2022. Controlled clinical trials (CCT), in which RAGT was compared to TT or CT and assessed gait speed, step and stride length, width step, walking distance, cadence, standing ability, walking, running and jumping ability, gross motor function and functional independence in children with CP, have been included. Methodological quality was assessed with the PEDro scale and the pooled effect was calculated with Cohen's Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI). RESULTS A total of 15 CCTs have been included, providing data from 413 participants, with an averaged methodological quality of 5.73 ± 1.1 points in PEDro. The main findings of this review are that RAGT shows better results than CT in the post-intervention assessment for gait speed (SMD 0.56; 95% CI 0.03 to 1.1), walking distance (SMD 2; 95% CI 0.36 to 3.65) and walking, running and jumping ability (SMD 0.63; 95% CI 0.12 to 1.14). CONCLUSIONS This study shows that the effect of RAGT is superior to CT on gait speed, walking distance and walking, running and jumping ability in post-intervention, although no differences were found between RAGT and TT or CT for the remaining variables.
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Affiliation(s)
- Irene Cortés-Pérez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Road Sacramento s/n, 04120 Almería, Spain
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaén, Spain
| | | | | | - Francisco Antonio Nieto-Escamez
- Department of Psychology, University of Almería, Road Sacramento s/n, La Cañada, 04120 Almería, Spain
- Center for Neuropsychological Assessment and Neurorehabilitation (CERNEP), University of Almería, Road Sacramento s/n, La Cañada, 04120 Almería, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Campus las Lagunillas, 23071 Jaén, Spain
| | - Héctor García-López
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Road Sacramento s/n, 04120 Almería, Spain
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Cumplido-Trasmonte C, Ramos-Rojas J, Delgado-Castillejo E, Garcés-Castellote E, Puyuelo-Quintana G, Destarac-Eguizabal MA, Barquín-Santos E, Plaza-Flores A, Hernández-Melero M, Gutiérrez-Ayala A, Martínez-Moreno M, García-Armada E. Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series. J Neuroeng Rehabil 2022; 19:75. [PMID: 35854321 PMCID: PMC9297544 DOI: 10.1186/s12984-022-01055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with spinal muscular atrophy (SMA) present muscle weakness and atrophy that results in a number of complications affecting their mobility, hindering their independence and the development of activities of daily living. Walking has well-recognized physiological and functional benefits. The ATLAS 2030 exoskeleton is a paediatric device that allows gait rehabilitation in children with either neurological or neuromuscular pathologies with gait disorders. The purpose is to assess the effects in range of motion (ROM) and maximal isometric strength in hips, knees and ankles of children with SMA type II after the use of ATLAS 2030 exoskeleton. METHODS Three children (mean age 5.7 ± 0.6) received nine sessions bi-weekly of 60 min with ATLAS 2030. ROM was assessed by goniometry and strength by hand-held dynamometer. All modes of use of the exoskeleton were tested: stand up and sit down, forward and backward walking, and gait in automatic and active-assisted modes. In addition, different activities were performed during the gait session. A descriptive analysis of all variables was carried out. RESULTS The average time of use was 53.5 ± 12.0 min in all sessions, and all participants were able to carry out all the proposed activities as well as to complete the study. Regarding isometric strength, all the measurements increased compared to the initial state, obtaining the greatest improvements for the hip flexors (60.2%) and extensors muscles (48.0%). The ROM increased 12.6% in hip and 34.1% in the ankle after the study, while knee ROM remained stable after the study. CONCLUSION Improvements were showed in ROM and maximal isometric strength in hips, knees and ankles after using ATLAS 2030 paediatric gait exoskeleton in all three children. This research could serve as a preliminary support for future clinical integration of ATLAS 2030 as a part of a long-term rehabilitation of children with SMA. TRIAL REGISTRATION The approval was obtained (reference 47/370329.9/19) by Comunidad de Madrid Regional Research Ethics Committee with Medical Products and the clinical trial has been registered on Clinical Trials.gov: NCT04837157.
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Affiliation(s)
- C Cumplido-Trasmonte
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain. .,International Doctoral School, Rey Juan Carlos University, Madrid, Spain.
| | - J Ramos-Rojas
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | - E Delgado-Castillejo
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | - E Garcés-Castellote
- Marsi Bionics S.L., Madrid, Spain.,Doctoral Program in Health Sciences, Alcalá de Henares University, Madrid, Spain
| | - G Puyuelo-Quintana
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain.,Marsi Bionics S.L., Madrid, Spain
| | | | | | - A Plaza-Flores
- Marsi Bionics S.L., Madrid, Spain.,Polytechnic University of Madrid, Madrid, Spain
| | - M Hernández-Melero
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | - A Gutiérrez-Ayala
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | | | - E García-Armada
- Centre for Automation and Robotics (CAR), Spanish National Research Council-Technical University of Madrid, Ctra. Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
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Delgado E, Cumplido C, Ramos J, Garcés E, Puyuelo G, Plaza A, Hernández M, Gutiérrez A, Taverner T, Destarac MA, Martínez M, García E. ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children With Cerebral Palsy. A Case Series Study. Front Pediatr 2021; 9:753226. [PMID: 34900862 PMCID: PMC8652111 DOI: 10.3389/fped.2021.753226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral Palsy (CP), the most common motor disability in childhood, affects individual's motor skills, movement and posture. This results in limited activity and a low social participation. The ATLAS2030 exoskeleton is a pediatric device that enables gait rehabilitation for children with neurological or neuromuscular pathologies with gait pathology. Purpose: To study changes in relation to range of motion (ROM), strength and spasticity in children with CP after using the ATLAS2030 gait exoskeleton. Methods and Participants: Three children (mean age 8.0 ± 2.0), two girls and one boy, two of them with GMFCS IV and one with GMFCS III, received robot-assisted gait training (RAGT) with ATLAS2030 for one month. Results: The average time of exoskeleton use was 54.7 ± 10.4 min in all sessions, and all participants were able to perform all exercises. The strength of all muscle groups was increased after the 10 sessions for the participants assessed and the limited ROM in the sagittal plane (hip and knee extension and ankle dorsiflexion) decreased after the use of the exoskeleton compared to the initial state. Spasticity was reduced at the end of the sessions after the use of the exoskeleton compared to their initial state. Conclusion: The ROM, spasticity and strength were improved after RAGT with ATLAS2030 exoskeleton in these children with CP. However, further studies with larger samples should be carried out to confirm our findings.
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Affiliation(s)
- Elena Delgado
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Carlos Cumplido
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Jaime Ramos
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Elena Garcés
- Marsi Bionics S.L., Madrid, Spain
- Doctoral Program in Health Sciences, Alcalá de Henares University, Madrid, Spain
| | - Gonzalo Puyuelo
- Marsi Bionics S.L., Madrid, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
| | - Alberto Plaza
- Marsi Bionics S.L., Madrid, Spain
- Polytechnic University of Madrid, Madrid, Spain
| | - Mar Hernández
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | - Alba Gutiérrez
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
| | | | | | | | - Elena García
- Centre for Automation and Robotics, Spanish National Research Council (CSIC-UPM), Madrid, Spain
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