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Lora-Millan JS, Sanchez-Cuesta FJ, Romero JP, Moreno JC, Rocon E. Robotic exoskeleton embodiment in post-stroke hemiparetic patients: an experimental study about the integration of the assistance provided by the REFLEX knee exoskeleton. Sci Rep 2023; 13:22908. [PMID: 38129592 PMCID: PMC10739721 DOI: 10.1038/s41598-023-50387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Hemiparetic gait is the most common motor-disorder after stroke and, in spite of rehabilitation efforts, it is persistent in 50% of community dwelling stroke-survivors. Robotic exoskeletons have been proposed as assistive devices to support impaired joints. An example of these devices is the REFLEX knee exoskeleton, which assists the gait of hemiparetic subjects and whose action seems to be properly embodied by stroke survivors, who were able to adapt the motion of their non-assisted limbs and, therefore, reduce their compensation mechanisms. This paper presents an experimental validation carried out to deepen into the effects of REFLEX's assistance in hemiparetic subjects. Special attention was paid to the effect produced in the muscular activity as a metric to evaluate the embodiment of this technology. Significant differences were obtained at the subject level due to the assistance; however, the high dispersion of the measured outcomes avoided extracting global effects at the group level. These results highlight the need of individually tailoring the action of the robot to the individual needs of each patient to maximize the beneficial outcomes. Extra research effort should be done to elucidate the neural mechanisms involved in the embodiment of external devices by stroke survivors.
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Affiliation(s)
| | - Francisco José Sanchez-Cuesta
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Spanish National Research Council (CSIC), Madrid, Spain
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Chen YN, Wu YN, Yang BS. The neuromuscular control for lower limb exoskeleton- a 50-year perspective. J Biomech 2023; 158:111738. [PMID: 37562276 DOI: 10.1016/j.jbiomech.2023.111738] [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: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Historically, impaired lower limb function has resulted in heavy health burden and large economic loss in society. Although experts from various fields have put large amounts of effort into overcoming this challenge, there is still not a single standard treatment that can completely restore the lost limb function. During the past half century, with the advancing understanding of human biomechanics and engineering technologies, exoskeletons have achieved certain degrees of success in assisting and rehabilitating patients with loss of limb function, and therefore has been spotlighted in both the medical and engineering fields. In this article, we review the development milestones of lower limb exoskeletons as well as the neuromuscular interactions between the device and wearer throughout the past 50 years. Fifty years ago, the lower-limb exoskeletons just started to be devised. We review several prototypes and present their designs in terms of structure, sensor and control systems. Subsequently, we introduce the development milestones of modern lower limb exoskeletons and discuss the pros and cons of these differentiated devices. In addition, we summarize current important neuromuscular control systems and sensors; and discuss current evidence demonstrating how the exoskeletons may affect neuromuscular control of wearers. In conclusion, based on our review, we point out the possible future direction of combining multiple current technologies to build lower limb exoskeletons that can serve multiple aims.
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Affiliation(s)
- Yu-Ning Chen
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, MA, USA; The New England Robotics Validation and Experimentation Center, University of Massachusetts Lowell, MA, USA
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Mechanical and Mechatronics Systems Research Laboratories, Industrial Technology Research Institute, Taiwan; Taiwanese Society of Biomechanics, Taiwan.
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Karunakaran KK, Pamula SD, Bach CP, Legelen E, Saleh S, Nolan KJ. Lower extremity robotic exoskeleton devices for overground ambulation recovery in acquired brain injury-A review. Front Neurorobot 2023; 17:1014616. [PMID: 37304666 PMCID: PMC10249611 DOI: 10.3389/fnbot.2023.1014616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/27/2023] [Indexed: 06/13/2023] Open
Abstract
Acquired brain injury (ABI) is a leading cause of ambulation deficits in the United States every year. ABI (stroke, traumatic brain injury and cerebral palsy) results in ambulation deficits with residual gait and balance deviations persisting even after 1 year. Current research is focused on evaluating the effect of robotic exoskeleton devices (RD) for overground gait and balance training. In order to understand the device effectiveness on neuroplasticity, it is important to understand RD effectiveness in the context of both downstream (functional, biomechanical and physiological) and upstream (cortical) metrics. The review identifies gaps in research areas and suggests recommendations for future research. We carefully delineate between the preliminary studies and randomized clinical trials in the interpretation of existing evidence. We present a comprehensive review of the clinical and pre-clinical research that evaluated therapeutic effects of RDs using various domains, diagnosis and stage of recovery.
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Affiliation(s)
- Kiran K. Karunakaran
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Research Staff Children's Specialized Hospital New Brunswick, New Brunswick, NJ, United States
| | - Sai D. Pamula
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Caitlyn P. Bach
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Eliana Legelen
- Department of Psychology, Montclair State University, Montclair, NJ, United States
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
| | - Karen J. Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Research Staff Children's Specialized Hospital New Brunswick, New Brunswick, NJ, United States
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de Miguel-Fernández J, Lobo-Prat J, Prinsen E, Font-Llagunes JM, Marchal-Crespo L. Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness. J Neuroeng Rehabil 2023; 20:23. [PMID: 36805777 PMCID: PMC9938998 DOI: 10.1186/s12984-023-01144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes. METHODS Four databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. RESULTS (1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke. CONCLUSIONS Despite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
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Affiliation(s)
- Jesús de Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Erik Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH Enschede, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Laura Marchal-Crespo
- Cognitive Robotics Department, Delft University of Technology, Mekelweg 2, 2628 Delft, Netherlands
- Motor Learning and Neurorehabilitation Lab, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Xiong Q, Wan J, Jiang S, Liu Y. Age-related differences in gait symmetry obtained from kinematic synergies and muscle synergies of lower limbs during childhood. Biomed Eng Online 2022; 21:61. [PMID: 36058910 PMCID: PMC9442939 DOI: 10.1186/s12938-022-01034-2] [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: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
The age-related changes of gait symmetry in healthy children concerning individual joint and muscle activation data have previously been widely studied. Extending beyond individual joints or muscles, identifying age-related changes in the coordination of multiple joints or muscles (i.e., muscle synergies and kinematic synergies) could capture more closely the underlying mechanisms responsible for gait symmetry development. To evaluate the effect of age on the symmetry of the coordination of multiple joints or muscles during childhood, we measured gait symmetry by kinematic and EMG data in 39 healthy children from 2 years old to 14 years old, divided into three equal age groups: preschool children (G1; 2.0-5.9 years), children (G2; 6.0-9.9 years), pubertal children (G3; 10.0-13.9 years). Participants walked barefoot at a self-selected walking speed during three-dimensional gait analysis (3DGA). Kinematic synergies and muscle synergies were extracted with principal component analysis (PCA) and non-negative matrix factorization (NNMF), respectively. The synergies extracted from the left and right sides were compared with each other to obtain a symmetry value. Statistical analysis was performed to examine intergroup differences. The results showed that the effect of age was significant on the symmetry values extracted by kinematic synergies, while older children exhibited higher kinematic synergy symmetry values compared to the younger group. However, no significant age-related changes in symmetry values of muscle synergy were observed. It is suggested that kinematic synergy of lower joints can be asymmetric at the onset of independent walking and showed improving symmetry with increasing age, whereas the age-related effect on the symmetry of muscle synergies was not demonstrated. These data provide an age-related framework and normative dataset to distinguish age-related differences from pathology in children with neuromotor disorders.
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Affiliation(s)
- Qiliang Xiong
- Key Laboratory of Nondestructive Testing, Ministry of Education, Nanchang Hangkong University, Nanchang, Jiangxi, China. .,Department of Biomedical Engineering, Nanchang Hangkong University, Nanchang, Jiangxi, China.
| | - Jinliang Wan
- Key Laboratory of Nondestructive Testing, Ministry of Education, Nanchang Hangkong University, Nanchang, Jiangxi, China
| | - Shaofeng Jiang
- Key Laboratory of Nondestructive Testing, Ministry of Education, Nanchang Hangkong University, Nanchang, Jiangxi, China.,Department of Biomedical Engineering, Nanchang Hangkong University, Nanchang, Jiangxi, China
| | - Yuan Liu
- Department of Rehabilitation, Children's Hospital of Chongqing Medical University, Chongqing, China
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Lora-Millan JS, Moreno JC, Rocon E. Coordination Between Partial Robotic Exoskeletons and Human Gait: A Comprehensive Review on Control Strategies. Front Bioeng Biotechnol 2022; 10:842294. [PMID: 35694226 PMCID: PMC9174608 DOI: 10.3389/fbioe.2022.842294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Lower-limb robotic exoskeletons have become powerful tools to assist or rehabilitate the gait of subjects with impaired walking, even when they are designed to act only partially over the locomotor system, as in the case of unilateral or single-joint exoskeletons. These partial exoskeletons require a proper method to synchronize their assistive actions and ensure correct inter-joint coordination with the user’s gait. This review analyzes the state of the art of control strategies to coordinate the assistance provided by these partial devices with the actual gait of the wearers. We have analyzed and classified the different approaches independently of the hardware implementation, describing their basis and principles. We have also reviewed the experimental validations of these devices for impaired and unimpaired walking subjects to provide the reader with a clear view of their technology readiness level. Eventually, the current state of the art and necessary future steps in the field are summarized and discussed.
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Affiliation(s)
- Julio S. Lora-Millan
- Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas-Universidad Politécnica de Madrid, CSIC-UPM, Madrid, Spain
- Electronic Technology Department, Universidad Rey Juan Carlos, Madrid, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - E. Rocon
- Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas-Universidad Politécnica de Madrid, CSIC-UPM, Madrid, Spain
- *Correspondence: E. Rocon,
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Afzal T, Zhu F, Tseng SC, Lincoln JA, Francisco GE, Su H, Chang SH. Evaluation of Muscle Synergy during Exoskeleton-assisted Walking in Persons with Multiple Sclerosis. IEEE Trans Biomed Eng 2022; 69:3265-3274. [PMID: 35412969 DOI: 10.1109/tbme.2022.3166705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Gait deficit after multiple sclerosis (MS) can be characterized by altered muscle activation patterns. There is preliminary evidence of improved walking with a lower limb exoskeleton in persons with MS. However, the effects of exoskeleton-assisted walking on neuromuscular modifications are relatively unclear. The objective of this study was to investigate the muscle synergies, their activation patterns and the differences in neural strategies during walking with (EXO) and without (No-EXO) an exoskeleton. METHODS Ten subjects with MS performed walking during EXO and No-EXO conditions. Electromyography signals from seven leg muscles were recorded. Muscle synergies and the activation profiles were extracted using non-negative matrix factorization. RESULTS The stance phase duration was significantly shorter during EXO compared to the No-EXO condition (p<0.05). Moreover, typically 3-5 modules were extracted in each condition. The module-1 (comprising Vastus Medialis and Rectus Femoris muscles), module-2 (comprising Soleus and Medial Gastrocnemius muscles), module-3 (Tibialis Anterior muscle) and module-4 (comprising Biceps Femoris and Semitendinosus muscles) were comparable between conditions. During EXO condition, Semitendinosus and Vastus Medialis emerged in module-5 in 7/10 subjects. Compared to No-EXO, average activation amplitude was significantly reduced corresponding to module-2 during the stance phase and module-3 during the swing phase during EXO. CONCLUSION Exoskeleton-assistance does not alter the existing synergy modules, but could induce a new module to emerge, and alters the control of these modules, i.e., modifies the neural commands indicated by the reduced amplitude of the activation profiles.
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Modification of Hand Muscular Synergies in Stroke Patients after Robot-Aided Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are still being studied. Recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns, but the muscular patterns of the hand have not completely investigated, although the hand represents a paramount tool for performing activities of daily living (ADLs) and stroke can significantly alter the mobilization of this part of the body. In this context, this study aims at investigating hand muscular synergies in chronic stroke patients and evaluating some possible benefits in the robot-aided rehabilitation treatment of the hand in these subjects. Seven chronic stroke patients with mild-to-moderate impairment (FM>30) were involved in this study. They received a 5-week robot-aided rehabilitation treatment with the Gloreha hand exoskeleton, and muscle synergies of both the healthy and injured hand were evaluated at the beginning and at the end of the treatment. The performed analysis showed a very high degree of similarity of the involved synergies between the healthy and the injured limb both before and after the rehabilitation treatment (mean similarity index values: H-BR: 0.88±0.03, H-AR: 0.94±0.03, BR-AR: 0.89±0.05). The increasing similarity is regarded as an effect of the robot-aided rehabilitation treatment and future activities will be performed to increase the population involved in the study.
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Merged swing-muscle synergies and their relation to walking characteristics in subacute post-stroke patients: An observational study. PLoS One 2022; 17:e0263613. [PMID: 35120178 PMCID: PMC8815905 DOI: 10.1371/journal.pone.0263613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
In post-stroke patients, muscle synergy (the coordination of motor modules during walking) is impaired. In some patients, the muscle synergy termed module 1 (hip/knee extensors) is merged with module 2 (ankle plantar flexors), and in other cases, module 1 is merged with module 4 (knee flexors). However, post-stroke individuals with a merging pattern of module 3 (hip flexor and ankle dorsiflexor) and module 4, which is the swing-muscle synergy, have not been reported. This study aimed to determine the muscle-synergy merging subtypes of post-stroke during comfortable walking speed (cws). We also examined the effect of experimental lower-limb angle modulation on the muscle synergy patterns of walking in each subtype. Forty-one participants were assessed under three conditions: cws, long stepping on the paretic side (p-long), and long stepping on the non-paretic side (np-long). Lower-limb flexion and extension angles and the electromyogram were measured during walking. Subtype classification was based on the merging pattern of the muscle synergies, and we examined the effect of different lower-limb angles on the muscle synergies. We identified three merging subtypes: module 1 with module 2 (subtype 1), module 1 with module 4 (subtype 2), and module 3 with module 4 (subtype 3). In the cws condition, the lower-limb flexion angle was reduced in subtype 3, and the lower-limb extension angle was decreased in subtype 1. A more complex muscle synergy was observed only in subtype 3 in the p-long condition versus cws (p = 0.036). This subtype classification of walking impairments based on the merging pattern of the muscle synergies could be useful for the selection of a rehabilitation strategy according to the individual’s particular neurological condition. Rehabilitation with increased lower-limb flexion may be effective for the training of patients with merging of modules 3 and 4 in comfortable walking.
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Suzuki H, Imajo Y, Funaba M, Nishida N, Sakamoto T, Sakai T. Current Concepts of Neural Stem/Progenitor Cell Therapy for Chronic Spinal Cord Injury. Front Cell Neurosci 2022; 15:794692. [PMID: 35185471 PMCID: PMC8850278 DOI: 10.3389/fncel.2021.794692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic spinal cord injury (SCI) is a devastating condition that results in major neurological deficits and social burden. It continues to be managed symptomatically, and no real therapeutic strategies have been devised for its treatment. Neural stem/neural progenitor cells (NSCs/NPCs) being used for the treatment of chronic SCI in experimental SCI models can not only replace the lost cells and remyelinate axons in the injury site but also support their growth and provide neuroprotective factors. Currently, several clinical studies using NSCs/NPCs are underway worldwide. NSCs/NPCs also have the potential to differentiate into all three neuroglial lineages to regenerate neural circuits, demyelinate denuded axons, and provide trophic support to endogenous cells. This article explains the challenging pathophysiology of chronic SCI and discusses key NSC/NPC-based techniques having the greatest potential for translation over the next decade.
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Mizuta N, Hasui N, Nishi Y, Higa Y, Matsunaga A, Deguchi J, Yamamoto Y, Nakatani T, Taguchi J, Morioka S. Association between temporal asymmetry and muscle synergy during walking with rhythmic auditory cueing in stroke survivors living with impairments. Arch Rehabil Res Clin Transl 2022; 4:100187. [PMID: 35756980 PMCID: PMC9214337 DOI: 10.1016/j.arrct.2022.100187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We examined the effect of temporal gait asymmetry on muscle synergy post stroke. In our design, the temporal asymmetry during gait was experimentally modulated. The temporal asymmetry was modulated using rhythmic auditory cueing. Rhythmic auditory cueing with gait immediately improved temporal asymmetry and muscle synergy deficits. The temporal asymmetry affected muscle synergy more than kinematics.
Objective To examine the relationship between temporal asymmetry and complexity of muscle synergy during walking using rhythmic auditory cueing (RAC) and the factors related to changes in muscle synergy during walking with RAC in survivors of stroke. Design Cross-sectional study. Setting Wards at 2 medical corporation hospitals. Participants Forty survivors of stroke (N=40; mean age, 70.4±10.3 years; time since stroke, 72.2±32.3 days) who could walk without physical assistance. Interventions Not applicable. Main Outcome Measures The participants were assessed in a random block design under 2 conditions: comfortable walking speed (CWS) and walking with RAC. Single-leg support time, kinematics, and electromyograms were measured. Factors related to the complexity of muscle synergy (variance accounted for by 1 synergy [VAF1]) between the walking conditions were examined using hierarchical multiple regression analysis. Results In the RAC condition, lower limb flexion and knee flexion angles, single-leg support time on the paretic side, and the symmetry index of single-leg support time were increased compared with those in the CWS condition. VAF1 was decreased in the RAC condition (73.9±0.15) compared with that in the CWS condition (76.9±0.13, P=.002). Hierarchical multiple regression analysis revealed that the change in VAF1 was explained by change in single-leg support time (R2=0.43, P=.002). Conclusions The RAC condition demonstrated a more complex representation of muscle synergy than the CWS condition; the change in single-leg support time on the paretic side related to the changes in muscle synergy more than changes in lower limb angle. These findings can help in the walking-training concept to improve muscle synergy deficits in survivors of stroke.
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Affiliation(s)
- Naomichi Mizuta
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
- Corresponding author Naomichi Mizuta, PT, PhD, Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Yasutaka Higa
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Ayaka Matsunaga
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Junji Deguchi
- Department of Rehabilitation, Nakazuyagi Hospital (HIMAWARIKAI Medical Corporation), Tokushima, Japan
| | - Yasutada Yamamoto
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Okawara H, Tashiro S, Sawada T, Sugai K, Matsubayashi K, Kawakami M, Nori S, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M. Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study. Neural Regen Res 2022; 17:427-432. [PMID: 34269219 PMCID: PMC8463976 DOI: 10.4103/1673-5374.317983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Body weight-supported treadmill training with the voluntary driven exoskeleton (VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level (six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral (right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee (IRB No. 20150355-3) on September 26, 2017.
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Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Sugai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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13
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Hong YNG, Ballekere AN, Fregly BJ, Roh J. Are muscle synergies useful for stroke rehabilitation? CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021. [DOI: 10.1016/j.cobme.2021.100315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Infarinato F, Romano P, Goffredo M, Ottaviani M, Galafate D, Gison A, Petruccelli S, Pournajaf S, Franceschini M. Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke. Brain Sci 2021; 11:brainsci11040448. [PMID: 33915808 PMCID: PMC8066552 DOI: 10.3390/brainsci11040448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. Methods: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. Conclusions: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. Results: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects’ characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns.
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Affiliation(s)
- Francesco Infarinato
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Paola Romano
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Correspondence: ; Tel.: +39-0652252319
| | - Marco Ottaviani
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Daniele Galafate
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Annalisa Gison
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Simone Petruccelli
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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15
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Ezaki S, Kadone H, Kubota S, Abe T, Shimizu Y, Tan CK, Miura K, Hada Y, Sankai Y, Koda M, Suzuki K, Yamazaki M. Analysis of Gait Motion Changes by Intervention Using Robot Suit Hybrid Assistive Limb (HAL) in Myelopathy Patients After Decompression Surgery for Ossification of Posterior Longitudinal Ligament. Front Neurorobot 2021; 15:650118. [PMID: 33867965 PMCID: PMC8044802 DOI: 10.3389/fnbot.2021.650118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostonic condition in which the posterior longitudinal ligament becomes thick and loses its flexibility, resulting in ectopic ossification and severe neurologic deficit (Matsunaga and Sakou, 2012). It commonly presents with myelopathy and radiculopathy and with myelopathy progression motor disorders and balance disorders can appear. Even after appropriate surgical decompression, some motor impairments often remain. The Hybrid Assistive Limb (HAL) is a wearable powered suit designed to assist and support the user's voluntary control of hip and knee joint motion by detecting bioelectric signals from the skin surface and force/pressure sensors in the shoes during movement. In the current study, the HAL intervention was applied to 15 patients diagnosed with OPLL who presented with myelopathy after decompression surgery (6 acute and 9 chronic stage). Following the HAL intervention, there were significant improvements in gait speed, cadence, stride length, in both acute and chronic groups. Joint angle analysis of the lower limbs showed that range of motion (ROM) of hip and knee joints in acute group, and also ROM of hip joint and toe-lift during swing in chronic group increased significantly. ROM of knee joint became closer to healthy gait in both groups. Electromyography analysis showed that hamstrings activity in the late swing phase increased significantly for acute patients. Immidiate effect from HAL session was also observed. EMG of vastus medialis were decreased except chronic 7th session and EMG of gastrocnemius were decreased except acute 7th session, which suggests the patients were learning to walk with lesser knee-hypertension during the sessions. After all, double knee action appeared in both acute and chronic groups after the HAL intervention, rather than knee hyper-extension which is a common gait impairment in OPLL. We consider that these improvements lead to a smoother and healthier gait motion.
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Affiliation(s)
- Seioh Ezaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chun Kwang Tan
- Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
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16
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Ueno T, Marushima A, Kawamoto H, Shimizu Y, Watanabe H, Kadone H, Hiruta K, Yamauchi S, Endo A, Hada Y, Tsurushima H, Ishikawa E, Matsumaru Y, Sankai Y, Yamazaki M, Matsumura A. Staged treatment protocol for gait with hybrid assistive limb in the acute phase of patients with stroke. Assist Technol 2021; 34:437-443. [PMID: 33465002 DOI: 10.1080/10400435.2020.1862361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Hybrid Assistive Limb (HAL) is a wearable human assistant cyborg-type robot that helps lower-leg movement based on bioelectrical signals detected from the voluntary movement of the person wearing it. In this study, we developed a novel staged HAL treatment protocol for patients with acute stroke. The Regain Program for Gait with HAL (RPG-HAL) was formulated in four steps, based on the severity of limb paralysis. Twenty-one patients with acute stroke received a combination treatment of RPG-HAL and conventional rehabilitation. The feasibility and safety of RPG-HAL were evaluated based on changes in physical function and activities of daily living (ADL). RPG-HAL yielded improvement in gait speed, cadence, step length, and functional ambulation category (FAC). The effect size was >0.8 in all measurements. FAC (1.90) and Barthel Index (BI) (1.92) exhibited the highest scores. Twelve out of 14 patients with FAC 0 before RPG-HAL reached the upper FAC. Thus, earlier intervention using RPG-HAL as improving physical function, ADL, and gait ability in patients with stroke.
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Affiliation(s)
- Tomoyuki Ueno
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kayo Hiruta
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shunsuke Yamauchi
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ayumu Endo
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideo Tsurushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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17
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Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J Neuroeng Rehabil 2021; 18:22. [PMID: 33526065 PMCID: PMC7852187 DOI: 10.1186/s12984-021-00815-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023] Open
Abstract
Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.
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Affiliation(s)
- Antonio Rodríguez-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
| | - Joan Lobo-Prat
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain.,Institut de Robòtica i Informàtica Industrial, CSIC-UPC, Llorens i Artigas 4-6, 08028, Barcelona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain
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18
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Watanabe H, Tsurushima H, Yanagi H. Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study. J Phys Ther Sci 2021; 33:168-174. [PMID: 33642694 PMCID: PMC7897533 DOI: 10.1589/jpts.33.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/25/2020] [Indexed: 12/04/2022] Open
Abstract
[Purpose] In stroke rehabilitation, gait assessment measures the maximal walking speed and six-minute walking distance, both of which have not been thoroughly investigated as determinants of walking ability. Here, we assessed the methods for evaluating these gait parameters using clinical data on hybrid assistive limb treatment compared with conventional training. [Participants and Methods] In total, 20 stroke patients (hybrid assistive limb group, n=9; conventional group, n=11) participated in this randomized controlled trial. For 12 sessions (three times per week in 4 weeks), the hybrid assistive limb and conventional groups performed gait treatment with hybrid assistive limb and conventional gait training, respectively. Short physical performance battery and walking ability (maximal walking speed and six-minute walking distance) were evaluated pre- and post-intervention. Subsequently, the patients were divided further into two groups: low- and high-balance score groups. [Results] Maximum walking speed and six-minute walking distance were significantly associated, with a positive relationship observed post-intervention. The high-balance score group showed a significant improvement in the six-minute walking distance compared to the low-balance score group. However, no significant improvement in maximum walking speed was observed between both groups. [Conclusion] Due to its sensitivity in detecting differences in balance, six-minute walking distance may be a useful assessment parameter for stroke rehabilitation, particularly in the recovery of physiological walking ability.
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Affiliation(s)
- Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideo Tsurushima
- Department of Neurosurgery, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hisako Yanagi
- Department of Medical Science and Welfare, Faculty of
Medicine, University of Tsukuba, Japan
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19
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Hessel AL, Raiteri BJ, Marsh MJ, Hahn D. Rightward shift of optimal fascicle length with decreasing voluntary activity level in the soleus and lateral gastrocnemius muscles. J Exp Biol 2021; 224:jeb235614. [PMID: 33257433 DOI: 10.1242/jeb.235614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Much of our understanding of in vivo skeletal muscle properties is based on studies performed under maximal activation, which is problematic because muscles are rarely activated maximally during movements such as walking. Currently, force-length properties of the human triceps surae at submaximal voluntary muscle activity levels are not characterized. We therefore evaluated plantar flexor torque- and force-ankle angle, and torque- and force-fascicle length properties of the soleus and lateral gastrocnemius muscles during voluntary contractions at three activity levels: 100, 30 and 22% of maximal voluntary contraction. Soleus activity levels were controlled by participants via real-time electromyography feedback and contractions were performed at ankle angles ranging from 10 deg plantar flexion to 35 deg dorsiflexion. Using dynamometry and ultrasound imaging, torque-fascicle length curves of the soleus and lateral gastrocnemius muscles were constructed. The results indicate that small muscle activity reductions shift the torque- and force-angle, and torque- and force-fascicle length curves of these muscles to more dorsiflexed ankle angles and longer fascicle lengths (from 3 to 20% optimal fascicle length, depending on ankle angle). The shift in the torque- and force-fascicle length curves during submaximal voluntary contraction have potential implications for human locomotion (e.g. walking) as the operating range of fascicles shifts to the ascending limb, where muscle force capacity is reduced by at least 15%. These data demonstrate the need to match activity levels during construction of the torque- and force-fascicle length curves to activity levels achieved during movement to better characterize the lengths that muscles operate at relative to their optimum during a specific task.
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Affiliation(s)
- Anthony L Hessel
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
- Institute for Physiology II, University of Muenster, 48149 Muenster, Germany
| | - Brent J Raiteri
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
| | - Michael J Marsh
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
| | - Daniel Hahn
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, 4072 Australia
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20
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Plaza A, Hernandez M, Puyuelo G, Garces E, Garcia E. Wearable rehabilitation exoskeletons of the lower limb: analysis of versatility and adaptability. Disabil Rehabil Assist Technol 2020; 18:392-406. [PMID: 33332159 DOI: 10.1080/17483107.2020.1858976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse the versatility and adaptability of commercially available exoskeletons for mobility assistance and their adaptation to diverse pathologies through a review of clinical trials in robotic lower limb training. DATA SOURCES A computer-aided search in bibliographic databases (PubMed and Web of Science) of clinical trials published up to September 2020 was done. METHODS To be selected for detailed review, clinical trials had to meet the following criteria: (1) a protocol was designed and approved, (2) participants were people with pathologies, and (3) the trials were not a single case study. Clinical trial data were collected, extracted, and analysed, considering: objectives, trial participants, number of sessions, pathologies involved, and conclusions. RESULTS The search resulted in 312 potentially relevant studies of seven commercial exoskeletons, of which 135 passed the preliminary screening; and 69 studies were finally selected. Of the 69 clinical trials included in the review about 50% involved Spinal Cord Injury participants, while roughly 25% focussed on stroke and two trials corresponded to patients with both disorders. The rest were composed of neurological diseases and trauma disorders. CONCLUSIONS The use of a single wearable robot for different medical conditions in various diseases is a challenge. Based on this comparative, the properties of the exoskeletons that improve the working ability with different pathologies and patient conditions have been evaluated. Suggestions were made for developing a new lower-limb exoskeleton based on various modules with a distributed control system to improve versatility in wearable technology for different gait pattern progression.Implications for rehabilitationWearable robotic exoskeletons for gait assistance have been analysed from the perspective of adaptation to different diseases.This paper emphasizes the importance of personalized therapies and adaptive assistive technology.Suggestions were made for a new modular exoskeleton capable of addressing the issue of low versatility characterizing currently wearable assistive technology.
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Affiliation(s)
- Alberto Plaza
- Marsi Bionics S.L, Madrid, Spain.,Centro de Automática y Robótica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Mar Hernandez
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
| | - Gonzalo Puyuelo
- Marsi Bionics S.L, Madrid, Spain.,Escuela de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Elena Garcia
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), Madrid, Spain
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21
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Nunes PF, Ostan I, Siqueira AAG. Evaluation of Motor Primitive-Based Adaptive Control for Lower Limb Exoskeletons. Front Robot AI 2020; 7:575217. [PMID: 33501336 PMCID: PMC7805746 DOI: 10.3389/frobt.2020.575217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
In order to assist after-stroke individuals to rehabilitate their movements, research centers have developed lower limbs exoskeletons and control strategies for them. Robot-assisted therapy can help not only by providing support, accuracy, and precision while performing exercises, but also by being able to adapt to different patient needs, according to their impairments. As a consequence, different control strategies have been employed and evaluated, although with limited effectiveness. This work presents a bio-inspired controller, based on the concept of motor primitives. The proposed approach was evaluated on a lower limbs exoskeleton, in which the knee joint was driven by a series elastic actuator. First, to extract the motor primitives, the user torques were estimated by means of a generalized momentum-based disturbance observer combined with an extended Kalman filter. These data were provided to the control algorithm, which, at every swing phase, assisted the subject to perform the desired movement, based on the analysis of his previous step. Tests are performed in order to evaluate the controller performance for a subject walking actively, passively, and at a combination of these two conditions. Results suggest that the robot assistance is capable of compensating the motor primitive weight deficiency when the subject exerts less torque than expected. Furthermore, though only the knee joint was actuated, the motor primitive weights with respect to the hip joint were influenced by the robot torque applied at the knee. The robot also generated torque to compensate for eventual asynchronous movements of the subject, and adapted to a change in the gait characteristics within three to four steps.
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Affiliation(s)
- Polyana F. Nunes
- Rehabilitation Robotics Laboratory, Department of Mechanical Engineering, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
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22
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Goffredo M, Infarinato F, Pournajaf S, Romano P, Ottaviani M, Pellicciari L, Galafate D, Gabbani D, Gison A, Franceschini M. Barriers to sEMG Assessment During Overground Robot-Assisted Gait Training in Subacute Stroke Patients. Front Neurol 2020; 11:564067. [PMID: 33193001 PMCID: PMC7604287 DOI: 10.3389/fneur.2020.564067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The limitation to the use of ElectroMyoGraphy (sEMG) in rehabilitation services is in contrast with its potential diagnostic capacity for rational planning and monitoring of the rehabilitation treatments, especially the overground Robot-Assisted Gait Training (o-RAGT). Objective: To assess the barriers to the implementation of a sEMG-based assessment protocol in a clinical context for evaluating the effects of o-RAGT in subacute stroke patients. Methods: An observational study was conducted in a rehabilitation hospital. The primary outcome was the success rate of the implementation of the sEMG-based assessment. The number of dropouts and the motivations have been registered. A detailed report on difficulties in implementing the sEMG protocol has been edited for each patient. The educational level and the working status of the staff have been registered. Each member of staff completed a brief survey indicating their level of knowledge of sEMG, using a five-point Likert scale. Results: The sEMG protocol was carried out by a multidisciplinary team composed of Physical Therapists (PTs) and Biomedical Engineers (BEs). Indeed, the educational level and the expertise of the members of staff influenced the fulfillment of the implementation of the study. The PTs involved in the study did not receive any formal education on sEMG during their course of study. The low success rate (22.7%) of the protocol was caused by several factors which could be grouped in: patient-related barriers; cultural barriers; technical barriers; and administrative barriers. Conclusions: Since a series of barriers limited the use of sEMG in the clinical rehabilitative environment, concrete actions are needed for disseminating sEMG in rehabilitation services. The sEMG assessment should be included in health systems regulations and specific education should be part of the rehabilitation professionals' curriculum. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03395717.
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Affiliation(s)
- Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Francesco Infarinato
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Paola Romano
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Ottaviani
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Leonardo Pellicciari
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Daniele Galafate
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Debora Gabbani
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Annalisa Gison
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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23
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Klochkov AS, Zimin AA, Khizhnikova AE, Suponeva NA, Piradov MA. Effect of robot-assisted gait training on biomechanics of ankle joint in patients with post-stroke hemiparesis. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The key factor promoting post-stroke gait disturbances is motor impairment of the ankle joint (AJ) which results in pathological synergies. Robotic devices used for gait training are equipped with hip and knee joint actuators. However, there is no consensus in the literature on their effect on AJ movements. The aim of this study was to investigate the effect of robot-assisted gait training on AJ movements in patients with post-stroke paresis. The study recruited 22 hemispheric stroke survivors. They motor function was assessed using clinical scales and motion capture analysis. All patients received 11 robot-assisted gait training session. After rehabilitation, the total score on the Fugl-Meyer Assessment scale increased from 146.5 to 152 points (p < 0.05); for the lower limb, the score increased from 18 to 20.5 points (p < 0.05). The muscle tone of ankle extensors decreased from 2.5 to 2.0 points on the modified Ashworth scale (p < 0.05). The duration of the stance phase increased from 28.0 to 33.5% relative to the total gait cycle (GC). The main difference in the GC structure before and after rehabilitation is the presence of 3 GC parts instead of 5, suggesting consolidation of patients’ goniograms at 1-61% of GC. Comparison of joint angles before and after rehabilitation revealed that only the interquartile ranges (IR) were different (р < 0.05). The authors conclude that robot-assisted training with knee and hip joint actuators indirectly affects the kinematic parameters of AJ by promoting a shift towards the average gait kinematics.
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Affiliation(s)
- AS Klochkov
- Research Center of Neurology, Moscow, Russia
| | - AA Zimin
- Research Center of Neurology, Moscow, Russia
| | | | - NA Suponeva
- Research Center of Neurology, Moscow, Russia
| | - MA Piradov
- Research Center of Neurology, Moscow, Russia
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24
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Rinaldi L, Yeung LF, Lam PCH, Pang MYC, Tong RKY, Cheung VCK. Adapting to the Mechanical Properties and Active Force of an Exoskeleton by Altering Muscle Synergies in Chronic Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2203-2213. [DOI: 10.1109/tnsre.2020.3017128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Tan CK, Kadone H, Watanabe H, Marushima A, Hada Y, Yamazaki M, Sankai Y, Matsumura A, Suzuki K. Differences in Muscle Synergy Symmetry Between Subacute Post-stroke Patients With Bioelectrically-Controlled Exoskeleton Gait Training and Conventional Gait Training. Front Bioeng Biotechnol 2020; 8:770. [PMID: 32850696 PMCID: PMC7403486 DOI: 10.3389/fbioe.2020.00770] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022] Open
Abstract
Understanding the reorganization of the central nervous system after stroke is an important endeavor in order to design new therapies in gait training for stroke patients. Current clinical evaluation scores and gait velocity are insufficient to describe the state of the nervous system, and one aspect where this is lacking is in the quantification of gait symmetry. Previous studies have pointed out that spatiotemporal gait asymmetries are commonly observed in stroke patients with hemiparesis. Such asymmetries are known to cause long-term complications like joint pain and deformation. Recent studies also indicate that spatiotemporal measures showed that gait symmetry worsens after discharge from therapy. This study shows that muscle synergy analysis can be used to quantify gait symmetry and compliment clinical measures. Surface EMG was collected from lower limb muscles of subacute post-stroke patients (with an onset of around 14 days) from two groups, one undergoing robotic-assisted therapy (known as HAL group) and the other undergoing conventional therapy (known as Control group). Muscle synergies from the paretic and non-paretic limb were extracted with Non-Negative Matrix Factorization (NNMF) and compared with each other to obtain a gait symmetry index over therapy sessions. Gait events were tracked with motion tracking (for the HAL group) or foot pressure sensors (for the conventional therapy group). Patients from both groups were assessed over a 3-weeks long gait training program. Results indicated that there were no differences in muscle synergy symmetry for both groups of patients. However, the timing of muscle synergies were observed to be symmetrical in the HAL group, but not for the Control group. Intergroup comparisons of symmetry in muscle synergies and their timings were not significantly different. This could be due to a large variability in recovery in the Control group. Finally, stance time ratio was not observed to improve in both groups after their respective therapies. Interestingly, FIM and FMA scores of both groups were observed to improve after their respective therapies. Analysis of muscle coordination could reveal mechanisms of gait symmetry which could otherwise be difficult to observe with clinical scores.
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Affiliation(s)
- Chun Kwang Tan
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
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26
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Gurve D, Delisle-Rodriguez D, Romero-Laiseca M, Cardoso V, Loterio F, Bastos T, Krishnan S. Subject-specific EEG channel selection using non-negative matrix factorization for lower-limb motor imagery recognition. J Neural Eng 2020; 17:026029. [PMID: 31614343 DOI: 10.1088/1741-2552/ab4dba] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to propose and validate a subject-specific approach to recognize two different cognitive neural states (relax and pedaling motor imagery (MI)) by selecting the relevant electroencephalogram (EEG) channels. The main aims of the proposed work are: (i) to reduce the computational complexity of the BCI systems during MI detection by selecting the relevant EEG channels, (ii) to reduce the amount of data overfitting that may arise due to unnecessary channels and redundant features, and (iii) to reduce the classification time for real-time BCI applications. APPROACH The proposed method selects subject-specific EEG channels and features based on their MI. In this work, we make use of non-negative matrix factorization to extract the weight of the EEG channels based on their contribution to MI detection. Further, the neighborhood component analysis is used for subject-specific feature selection. MAIN RESULTS We executed the experiments using EEG signals recorded for MI where ten healthy subjects performed MI movement of the lower limb to generate motor commands. An average accuracy of 96.66%, average true positive rate (TPR) of 97.77%, average false positives rate of 4.44%, and average Kappa of 93.33% were obtained. The proposed subject-specific EEG channel selection based MI recognition system provides 13.20% improvement in detection accuracy, and 27% improvement in Kappa value with less number of EEG channels compared to the results obtained using all EEG channels. SIGNIFICANCE The proposed subject-specific BCI system has been found significantly advantageous compared to the typical approach of using a fixed channel configuration. This work shows that fewer EEG channels not only reduce computational complexity and processing time (two times faster) but also improve the MI detection performance. The proposed method selects EEG locations related to the foot movement, which may be relevant for neuro-rehabilitation using lower-limb movements that may provide a real-time and more natural interface between patient and robotic device.
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Affiliation(s)
- Dharmendra Gurve
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada. Author to whom any correspondence should be addressed
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27
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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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28
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Ambrosini E, Parati M, Peri E, De Marchis C, Nava C, Pedrocchi A, Ferriero G, Ferrante S. Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study. J Neuroeng Rehabil 2020; 17:35. [PMID: 32106874 PMCID: PMC7047376 DOI: 10.1186/s12984-020-00662-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Muscle synergies analysis can provide a deep understanding of motor impairment after stroke and of changes after rehabilitation. In this study, the neuro-mechanical analysis of leg cycling was used to longitudinally investigate the motor recovery process coupled with cycling training augmented by Functional Electrical Stimulation (FES) in subacute stroke survivors. Methods Subjects with ischemic subacute stroke participated in a 3-week training of FES-cycling with visual biofeedback plus usual care. Participants were evaluated before and after the intervention through clinical scales, gait spatio-temporal parameters derived from an instrumented mat, and a voluntary pedaling test. Biomechanical metrics (work produced by the two legs, mechanical effectiveness and symmetry indexes) and bilateral electromyography from 9 leg muscles were acquired during the voluntary pedaling test. To extract muscles synergies, the Weighted Nonnegative Matrix Factorization algorithm was applied to the normalized EMG envelopes. Synergy complexity was measured by the number of synergies required to explain more than 90% of the total variance of the normalized EMG envelopes and variance accounted for by one synergy. Regardless the inter-subject differences in the number of extracted synergies, 4 synergies were extracted from each patient and the cosine-similarity between patients and healthy weight vectors was computed. Results Nine patients (median age of 75 years and median time post-stroke of 2 weeks) were recruited. Significant improvements in terms of clinical scales, gait parameters and work produced by the affected leg were obtained after training. Synergy complexity well correlated to the level of motor impairment at baseline, but it did not change after training. We found a significant improvement in the similarity of the synergy responsible of the knee flexion during the pulling phase of the pedaling cycle, which was the mostly compromised at baseline. This improvement may indicate the re-learning of a more physiological motor strategy. Conclusions Our findings support the use of the neuro-mechanical analysis of cycling as a method to assess motor recovery after stroke, mainly in an early phase, when gait evaluation is not yet possible. The improvement in the modular coordination of pedaling correlated with the improvement in motor functions and walking ability achieved at the end of the intervention support the role of FES-cycling in enhancing motor re-learning after stroke but need to be confirmed in a controlled study with a larger sample size. Trial registration ClinicalTrial.gov, NCT02439515. Registered on May 8, 2015, .
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Affiliation(s)
- Emilia Ambrosini
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Monica Parati
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy.
| | - Elisabetta Peri
- Department of Electrical Engineering, Laboratory of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Claudia Nava
- Istituti Clinici Scientifici Maugeri, IRCSS, Lissone, Italy
| | - Alessandra Pedrocchi
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | | | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
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29
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Watanabe H, Marushima A, Kadone H, Ueno T, Shimizu Y, Kubota S, Hino T, Sato M, Ito Y, Hayakawa M, Tsurushima H, Takada T, Tsukada A, Fujimori H, Sato N, Maruo K, Kawamoto H, Hada Y, Yamazaki M, Sankai Y, Ishikawa E, Matsumaru Y, Matsumura A. Effects of Gait Treatment With a Single-Leg Hybrid Assistive Limb System After Acute Stroke: A Non-randomized Clinical Trial. Front Neurosci 2020; 13:1389. [PMID: 32038125 PMCID: PMC6987474 DOI: 10.3389/fnins.2019.01389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
We hypothesized that a single-leg version of the Hybrid Assistive Limb (HAL) system could improve the gait and physical function of patients with hemiparesis following a stroke. In this pilot study, we therefore compared the efficacy of HAL-based gait training with that of conventional gait training (CGT) in patients with acute stroke. Patients admitted to the participating university hospital were assigned to the HAL group, whereas those admitted to outside teaching hospitals under the same rehabilitation program who did not use the HAL were assigned to the control group. Over 3 weeks, all participants completed nine 20 min sessions of gait training, using either HAL (i.e., the single-leg version of HAL on the paretic side) or conventional methods (i.e., walking aids and gait orthoses). Outcome measures were evaluated before and after the nine training sessions. The Functional Ambulation Category (FAC) was the primary outcome measure, but the following secondary outcome measures were also assessed: National Institutes of Health Stroke Scale, Fugl-Meyer Assessment (Lower Extremity), comfortable walking speed, step length, cadence, 6-min walk distance, Barthel Index, and Functional Independence Measure. In total, 22 post-stroke participants completed the clinical trial: 12 in the HAL group and 10 in the CGT group. No serious adverse events occurred in either group. The HAL group showed significant improvement in FAC after nine sessions when compared with the CGT group (P = 0.014). However, secondary outcomes did not differ significantly between the groups. Our results demonstrate that HAL-based gait therapy may improve independent walking in patients with acute stroke hemiplegia who are dependent on ambulatory assistance. A larger-scale randomized controlled trial is needed to clarify the effectiveness of single-leg HAL therapy. Clinical Trial Registration: UMIN Clinical Trials Registry, identifier UMIN000022410.
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Affiliation(s)
- Hiroki Watanabe
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tenyu Hino
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mikito Hayakawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideo Tsurushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoya Takada
- Department of Neurosurgery, Kennan Hospital, Tsuchiura, Japan
| | - Atsuro Tsukada
- Department of Neurosurgery, Kennan Hospital, Tsuchiura, Japan
| | | | - Naoaki Sato
- Department of Neurosurgery, Kobari General Hospital, Noda, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Kawamoto
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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30
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Ichimura D, Yamazaki T. A Pathological Condition Affects Motor Modules in a Bipedal Locomotion Model. Front Neurorobot 2019; 13:79. [PMID: 31616276 PMCID: PMC6763684 DOI: 10.3389/fnbot.2019.00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022] Open
Abstract
Bipedal locomotion is a basic motor activity that requires simultaneous control of multiple muscles. Physiological experiments suggest that the nervous system controls bipedal locomotion efficiently by using motor modules of synergistic muscle activations. If these modules were merged, abnormal locomotion patterns would be realized as observed in patients with neural impairments such as chronic stroke. However, sub-acute patients have been reported not to show such merged motor modules. Therefore, in this study, we examined what conditions in the nervous system merges motor modules. we built a two-dimensional bipedal locomotion model that included a musculoskeletal model with 7 segments and 18 muscles, a neural system with a hierarchical central pattern generator (CPG), and various feedback inputs from reflex organs. The CPG generated synergistic muscle activations comprising 5 motor modules to produce locomotion phases. Our model succeeded to acquire stable locomotion by using the motor modules and reflexes. Next, we examined how a pathological condition altered motor modules. Specifically, we weakened neural inputs to muscles on one leg to simulate a stroke condition. Immediately after the simulated stroke, the model did not walk. Then, internal parameters were modified to recover stable locomotion. We refitted either (a) reflex parameters or (b) CPG parameters to compensate the locomotion by adapting (a) reflexes or (b) the controller. Stable locomotion was recovered in both conditions. However the motor modules were merged only in (b). These results suggest that light or sub-acute stroke patients, who can compensate stable locomotion by just adapting reflexes, would not show merge of motor modules, whereas severe or chronic patients, who needed to adapt the controller for compensation, would show the merge, as consistent with experimental findings.
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Affiliation(s)
- Daisuke Ichimura
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan.,Heisei Ougi Hospital, Tokyo, Japan
| | - Tadashi Yamazaki
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
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31
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Delisle-Rodriguez D, Cardoso V, Gurve D, Loterio F, Alejandra Romero-Laiseca M, Krishnan S, Bastos-Filho T. System based on subject-specific bands to recognize pedaling motor imagery: towards a BCI for lower-limb rehabilitation. J Neural Eng 2019; 16:056005. [DOI: 10.1088/1741-2552/ab08c8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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32
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Shimizu Y, Kadone H, Kubota S, Ueno T, Sankai Y, Hada Y, Yamazaki M. Voluntary Elbow Extension-Flexion Using Single Joint Hybrid Assistive Limb (HAL) for Patients of Spastic Cerebral Palsy: Two Cases Report. Front Neurol 2019; 10:2. [PMID: 30723447 PMCID: PMC6349701 DOI: 10.3389/fneur.2019.00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/03/2019] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) patients with spastic diplegia struggle to perform activities of daily life (ADL) using their upper arms. The single-joint-type Hybrid Assistive limb (HAL) for upper limbs is a new portable robot that can provide elbow motion support in accordance with bioelectric activation of patient's biceps and triceps brachii muscles. The purpose of this study is to assess the feasibility and efficacy of the use of HAL for CP patients. Two patients were enrolled in this study. (Case 1: a 19-years-old male, at the Gross Motor Function Classification System (GMFCS) level IV, Case 2: a 17-years-old male at GMFCS level III). Both these patients experienced difficulty in voluntary elbow extension in ADLs. The HAL intervention (eight sessions; voluntary extension-flexion training of the elbow with HAL and clinical evaluation) was conducted for both sides in Case 1 and for the right side in Case 2. Clinical assessments were conducted as follows: Surface electromyography was used to evaluate the muscle activities of the biceps, triceps brachii, trapezius, and pectoralis major during elbow extension-flexion. The voluntary extension-flexion angles of the elbow, the coactivation index of the biceps and triceps brachii muscles, synergy analysis, and the Action Research Arm Test (ARAT) scores were assessed before and after the HAL sessions; the FIM score was evaluated before and after the entire intervention. In Case 1, the voluntary extension angle tended to increase after the HAL sessions. In both cases, the ARAT scores improved after the sessions. The FIM scores improved after HAL intervention. The voluntary extension-flexion of the elbow using the HAL may be a feasible option for rehabilitation of CP patients.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Puentes S, Kadone H, Watanabe H, Ueno T, Yamazaki M, Sankai Y, Marushima A, Suzuki K. Reshaping of Bilateral Gait Coordination in Hemiparetic Stroke Patients After Early Robotic Intervention. Front Neurosci 2018; 12:719. [PMID: 30356738 PMCID: PMC6189332 DOI: 10.3389/fnins.2018.00719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/19/2018] [Indexed: 01/04/2023] Open
Abstract
Hemiparetic gait is a common condition after stroke which alters importantly the quality of life of stroke survivors. In recent years, several robotic interventions have been developed to support and enhance rehabilitation strategies for such population. The Hybrid Assistive Limb® (HAL) robot suit is a unique device able to collect in real time bioelectric signals from the patient to support and enhance voluntary gait. HAL has been used before in early stages of stroke showing gait improvement after the intervention. However, evaluation of the coordination of gait has not been done yet. Coordination is a key factor for an adequate gait performance; consequently, its changes may be closely related to gait recovery. In this study, we used planar covariation to evaluate coordination changes in hemiparetic stroke patients after early HAL intervention. Before starting, impaired intersegmental coordination for the paretic and non-paretic side was evident. HAL intervention was able to induce recovery of the covariation loop shape and deviation from the covariation plane improving intersegmental coordination. Also, there was a tendency of recovery for movement range evidenced by comparison of peak elevation angles of each limb segment of the patients before and after HAL intervention, and also when compared to healthy volunteers. Our results suggest that early HAL intervention contributed to the improvement of gait coordination in hemiparetic stroke patients by reinforcing central pattern generators and therefore reshaping their gait pattern. Trial registration: UMIN000022410 2016/05/23.
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Affiliation(s)
- Sandra Puentes
- Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hiroki Watanabe
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
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