I-BaR: integrated balance rehabilitation framework

Neurological diseases are observed in approximately 1 billion people worldwide. A further increase is foreseen at the global level as a result of population growth and aging. Individuals with neurological disorders often experience cognitive, motor, sensory, and lower extremity dysfunctions. Thus, the possibility of falling and balance problems arise due to the postural control deficiencies that occur as a result of the deterioration in the integration of multi-sensory information. We propose a novel rehabilitation framework, Integrated Balance Rehabilitation (I-BaR), to improve the effectiveness of the rehabilitation with objective assessment, individualized therapy, convenience with different disability levels and adoption of assist-as-needed paradigm and, with integrated rehabilitation process as whole, that is, ankle-foot preparation, balance, and stepping phases, respectively. Integrated Balance Rehabilitation allows patients to improve their balance ability by providing multi-modal feedback: visual via utilization of virtual reality; vestibular via anteroposterior and mediolateral perturbations with the robotic platform; proprioceptive via haptic feedback.

Exploring the interplay between ankle muscle strength, postural control, and pain intensity in chronic ankle instability: A comprehensive analysis

Background

Chronic Ankle Instability (CAI) is a common musculoskeletal condition characterized by recurring ankle sprains and impaired postural control (PC). Understanding the relationship between ankle muscle strength, PC, and the role of pain is essential for effective management.

Objectives

This prospective cross sectional study aimed to 1. Compare ankle isometric muscle strength (IMS) and PC between CAI and asymptomatic sides. 2. Assess the correlations between ankle IMS and PC and explore the potential mediating effect of pain in individuals with CAI.

Methods

A total of 44 individuals with CAI, were enrolled in the study. Ankle IMS (dorsiflexors, plantar flexors, invertors, and evertors) was measured using a dynamometer, while PC was evaluated using sway parameters (anterior-posterior and medial-lateral sway, ellipse area). Pain levels were reported using a Visual Analog Scale.

Results

The CAI ankles exhibited significantly lower ankle IMS in all muscle groups compared to the asymptomatic ankles (p < 0.001). Additionally, the CAI side showed increased postural sway and a larger ellipse area (p < 0.001), indicating reduced PC. Negative correlations were observed between ankle IMS and PC parameters on the CAI side, with dorsiflexor strength showing correlations ranging from -0.423 to -0.387, plantar flexor strength ranging from -0.423 to -0.371, invertor strength ranging from -0.412 to -0.238, and evertor strength ranging from -0.451 to -0.365 (p < 0.001). Mediation analysis revealed that pain played a significant mediating role in connecting ankle IMS and PC parameters among individuals with CAI, with statistical significance (p < 0.05).

Conclusions

Individuals with CAI exhibit weaker ankle IMS and diminished PC in comparison to their healthy side. Moreover, pain was identified as a mediator in the relationship between ankle IMS and PC in CAI. These findings underscore the importance of addressing both ankle IMS and pain in the rehabilitation and management of CAI.

The-state-of-the-art of soft robotics to assist mobility: a review of physiotherapist and patient identified limitations of current lower-limb exoskeletons and the potential soft-robotic solutions

BACKGROUND

Soft, wearable, powered exoskeletons are novel devices that may assist rehabilitation, allowing users to walk further or carry out activities of daily living. However, soft robotic exoskeletons, and the more commonly used rigid exoskeletons, are not widely adopted clinically. The available evidence highlights a disconnect between the needs of exoskeleton users and the engineers designing devices. This review aimed to explore the literature on physiotherapist and patient perspectives of the longer-standing, and therefore greater evidenced, rigid exoskeleton limitations. It then offered potential solutions to these limitations, including soft robotics, from an engineering standpoint.

METHODS

A state-of-the-art review was carried out which included both qualitative and quantitative research papers regarding patient and/or physiotherapist perspectives of rigid exoskeletons. Papers were themed and themes formed the review's framework.

RESULTS

Six main themes regarding the limitations of soft exoskeletons were important to physiotherapists and patients: safety; a one-size-fits approach; ease of device use; weight and placement of device; cost of device; and, specific to patients only, appearance of the device. Potential soft-robotics solutions to address these limitations were offered, including compliant actuators, sensors, suit attachments fitting to user's body, and the use of control algorithms.

CONCLUSIONS

It is evident that current exoskeletons are not meeting the needs of their users. Solutions to the limitations offered may inform device development. However, the solutions are not infallible and thus further research and development is required.

Effects of stance control via hidden Markov model-based gait phase detection on healthy users of an active hip-knee exoskeleton

Introduction: In the past years, robotic lower-limb exoskeletons have become a powerful tool to help clinicians improve the rehabilitation process of patients who have suffered from neurological disorders, such as stroke, by applying intensive and repetitive training. However, active subject participation is considered to be an important feature to promote neuroplasticity during gait training. To this end, the present study presents the performance assessment of the AGoRA exoskeleton, a stance-controlled wearable device designed to assist overground walking by unilaterally actuating the knee and hip joints. Methods: The exoskeleton's control approach relies on an admittance controller, that varies the system impedance according to the gait phase detected through an adaptive method based on a hidden Markov model. This strategy seeks to comply with the assistance-as-needed rationale, i.e., an assistive device should only intervene when the patient is in need by applying Human-Robot interaction (HRI). As a proof of concept of such a control strategy, a pilot study comparing three experimental conditions (i.e., unassisted, transparent mode, and stance control mode) was carried out to evaluate the exoskeleton's short-term effects on the overground gait pattern of healthy subjects. Gait spatiotemporal parameters and lower-limb kinematics were captured using a 3D-motion analysis system Vicon during the walking trials. Results and Discussion: By having found only significant differences between the actuated conditions and the unassisted condition in terms of gait velocity (ρ = 0.048) and knee flexion (ρ ≤ 0.001), the performance of the AGoRA exoskeleton seems to be comparable to those identified in previous studies found in the literature. This outcome also suggests that future efforts should focus on the improvement of the fastening system in pursuit of kinematic compatibility and enhanced compliance.

Stretchable One-Dimensional Conductors for Wearable Applications

Continuous, one-dimensional (1D) stretchable conductors have attracted significant attention for the development of wearables and soft-matter electronics. Through the use of advanced spinning, printing, and textile technologies, 1D stretchable conductors in the forms of fibers, wires, and yarns can be designed and engineered to meet the demanding requirements for different wearable applications. Several crucial parameters, such as microarchitecture, conductivity, stretchability, and scalability, play essential roles in designing and developing wearable devices and intelligent textiles. Methodologies and fabrication processes have successfully realized 1D conductors that are highly conductive, strong, lightweight, stretchable, and conformable and can be readily integrated with common fabrics and soft matter. This review summarizes the latest advances in continuous, 1D stretchable conductors and emphasizes recent developments in materials, methodologies, fabrication processes, and strategies geared toward applications in electrical interconnects, mechanical sensors, actuators, and heaters. This review classifies 1D conductors into three categories on the basis of their electrical responses: (1) rigid 1D conductors, (2) piezoresistive 1D conductors, and (3) resistance-stable 1D conductors. This review also evaluates the present challenges in these areas and presents perspectives for improving the performance of stretchable 1D conductors for wearable textile and flexible electronic applications.

Review of ankle rehabilitation devices for treatment of equinus contracture

INTRODUCTION

Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery.

AREAS COVERED

This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market.

EXPERT OPINION

This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.

High-Dorsiflexion Assistive System for Passive Swing Phase Dorsiflexion Training and Preventing Compensatory Movements

Over the last few years, numerous robotic ankle-foot orthoses have been developed to help stroke patients optimize gait rehabilitation. In this paper, we present a study on the effects of assistance on dorsiflexion-restricted gait. Our high-dorsiflexion assistive system aims to provide full assistance to realize passive training of dorsiflexion during the swing phase and prevent compensatory movements. This system, which includes a McKibben-type artificial muscle and an air source, is lightweight and provides a high-dorsiflexion torque. The device could help boost overground gait rehabilitation in stroke patients. With this system, we conducted an experiment on five healthy participants whose dorsiflexion movements were restricted, and the extent of their compensatory movements differed. The results of the processed surface electromyography data differed significantly when dorsiflexion movement was assisted by our system. The spatial parameters also showed significantly improved compensatory movement inclination with sufficient assistance. These results indicate the potential of our system to assist in passive training of ankle dorsiflexion movements and to prevent incorrect gait in patients with low dorsiflexion abilities.

Control System Design of an Underactuated Dynamic Body Weight Support System Using Its Stability

This paper discusses the stability of systems controlling patient body weight support systems which are used in gait re-education. These devices belong to the class of underactuated mechanical systems. This is due to the application of elastic shock-absorbing connections between the active part of the system and the passive part which impacts the patient. The model takes into account properties of the system, such as inertia, attenuation and susceptibility to the elements. Stability is an essential property of the system due to human-device interaction. In order to demonstrate stability, Lyapunov's theory of stability, which is based on the model of system dynamics, was applied. The stability of the control system based on a model that requires knowledge of the structure and parameters of the equations of motion was demonstrated. Due to inaccuracies in the modeling of the rope (one of the basic elements of the device), an adaptive control system was introduced and its stability was also proved. The authors conducted simulation and experimental tests that illustrate the functionality of the analyzed control systems.

Tremor-Suppression Orthoses for the Upper Limb: Current Developments and Future Challenges

Introduction: Pathological tremor is the most common motor disorder in adults and characterized by involuntary, rhythmic muscular contraction leading to shaking movements in one or more parts of the body. Functional Electrical Stimulation (FES) and biomechanical loading using wearable orthoses have emerged as effective and non-invasive methods for tremor suppression. A variety of upper-limb orthoses for tremor suppression have been introduced; however, a systematic review of the mechanical design, algorithms for tremor extraction, and the experimental design is still missing.

Methods: To address this gap, we applied a standard systematic review methodology to conduct a literature search in the PubMed and PMC databases. Inclusion criteria and full-text access eligibility were used to filter the studies from the search results. Subsequently, we extracted relevant information, such as suppression mechanism, system weights, degrees of freedom (DOF), algorithms for tremor estimation, experimental settings, and the efficacy.

Results: The results show that the majority of tremor-suppression orthoses are active with 47% prevalence. Active orthoses are also the heaviest with an average weight of 561 ± 467 g, followed by semi-active 486 ± 395 g, and passive orthoses 191 ± 137 g. Most of the orthoses only support one DOF (54.5%). Two-DOF and three-DOF orthoses account for 33 and 18%, respectively. The average efficacy of tremor suppression using wearable orthoses is 83 ± 13%. Active orthoses are the most efficient with an average efficacy of 83 ± 8%, following by the semi-active 77 ± 19%, and passive orthoses 75 ± 12%. Among different experimental setups, bench testing shows the highest efficacy at 95 ± 5%, this value dropped to 86 ± 8% when evaluating with tremor-affected subjects. The majority of the orthoses (92%) measured voluntary and/or tremorous motions using biomechanical sensors (e.g., IMU, force sensor). Only one system was found to utilize EMG for tremor extraction.

Conclusions: Our review showed an improvement in efficacy of using robotic orthoses in tremor suppression. However, significant challenges for the translations of these systems into clinical or home use remain unsolved. Future challenges include improving the wearability of the orthoses (e.g., lightweight, aesthetic, and soft structure), and user control interfaces (i.e., neural machine interface). We also suggest addressing non-technical challenges (e.g., regulatory compliance, insurance reimbursement) to make the technology more accessible.

Estimation of the Continuous Walking Angle of Knee and Ankle (Talocrural Joint, Subtalar Joint) of a Lower-Limb Exoskeleton Robot Using a Neural Network

A lower-limb exoskeleton robot identifies the wearer's walking intention and assists the walking movement through mechanical force; thus, it is important to be able to identify the wearer's movement in real-time. Measurement of the angle of the knee and ankle can be difficult in the case of patients who cannot move the lower-limb joint properly. Therefore, in this study, the knee angle as well as the angles of the talocrural and subtalar joints of the ankle were estimated during walking by applying the neural network to two inertial measurement unit (IMU) sensors attached to the thigh and shank. First, for angle estimation, the gyroscope and accelerometer data of the IMU sensor were obtained while walking at a treadmill speed of 1 to 2.5 km/h while wearing an exoskeleton robot. The weights according to each walking speed were calculated using a neural network algorithm programmed in MATLAB software. Second, an appropriate weight was selected according to the walking speed through the IMU data, and the knee angle and the angles of the talocrural and subtalar joints of the ankle were estimated in real-time during walking through a feedforward neural network using the IMU data received in real-time. We confirmed that the angle estimation error was accurately estimated as 1.69° ± 1.43 (mean absolute error (MAE) ± standard deviation (SD)) for the knee joint, 1.29° ± 1.01 for the talocrural joint, and 0.82° ± 0.69 for the subtalar joint. Therefore, the proposed algorithm has potential for gait rehabilitation as it addresses the difficulty of estimating angles of lower extremity patients using torque and EMG sensors.

Characteristic Analysis and Design Optimization of Bubble Artificial Muscles

Soft robotics requires new actuators and artificial muscles that are lighter, less expensive, and more effective than current technologies. Recently developed bubble artificial muscles (BAMs) are lightweight, flexible, inexpensive, pneumatic actuators with the capability of being scalable, contracting at a low pressure, and generating sufficient tension and contraction for assisting human mobility. The BAMs are simply fabricated by using a commercial plastic tubing with retaining rings, forming a "bubble" shape and creating a series of contractile units to attain a desired stroke. They can deliver high contraction through optimization of actuator length and radius, or high tension by strengthening their materials to operate at high pressure. Here, we present a detailed analysis of BAMs, define a model for their actuation, and verify the model through a series of experiments with fabricated BAM actuators. In tests, a maximum contraction of 43.1% and a maximum stress of 0.894 MPa were achieved, corresponding to the BAM lifting a load 1000 times its own weight (5.39 g). The BAM model was built to predict experimental performance, for example, the relationship between tension and contraction at various applied pressures, and between contraction and pressure. Characteristic analysis and design optimization of the BAM are presented as an approach to design and manufacture the ideal "bubble" actuator at any required dimensions. A BAM orthosis is demonstrated as assisting a sit-to-stand transition on a leg mechanism, constructed to match the scale of a human's lower limb. Guidelines for further improvement of the BAM are also included.

Electro-pneumatic pumps for soft robotics

Soft robotics has applications in myriad fields from assistive wearables to autonomous exploration. Now, the portability and the performance of many devices are limited by their associated pneumatic energy source, requiring either large, heavy pressure vessels or noisy, inefficient air pumps. Here, we present a lightweight, flexible, electro-pneumatic pump (EPP), which can silently control volume and pressure, enabling portable, local energy provision for soft robots, overcoming the limitations of existing pneumatic power sources. The EPP is actuated using dielectric fluid-amplified electrostatic zipping, and the device presented here can exert pressures up to 2.34 kilopascals and deliver volumetric flow rates up to 161 milliliters per minute and under 0.5 watts of power, despite only having a thickness of 1.1 millimeters and weight of 5.3 grams. An EPP was able to drive a typical soft robotic actuator to achieve a maximum contraction change of 32.40% and actuation velocity of 54.43% per second. We highlight the versatility of this technology by presenting three EPP-driven embodiments: an antagonistic mechanism, an arm-flexing wearable robotic device, and a continuous-pumping system. This work shows the wide applicability of the EPP to enable advanced wearable assistive devices and lightweight, mobile, multifunctional robots.

Design of a 2DoF Ankle Exoskeleton with a Polycentric Structure and a Bi-Directional Tendon-Driven Actuator Controlled Using a PID Neural Network

Lower limb exoskeleton robots help with walking movements through mechanical force, by identifying the wearer’s walking intention. When the exoskeleton robot is lightweight and comfortable to wear, the stability of walking increases, and energy can be used efficiently. However, because it is difficult to implement the complex anatomical movements of the human body, most are designed simply. Due to this, misalignment between the human and robot movement causes the wearer to feel uncomfortable, and the stability of walking is reduced. In this paper, we developed a two degrees of freedom (2DoF) ankle exoskeleton robot with a subtalar joint and a talocrural joint, applying a four-bar linkage to realize the anatomical movement of a simple 1DoF structure mainly used for ankles. However, bidirectional tendon-driven actuators (BTDAs) do not consider the difference in a length change of both cables due to dorsiflexion (DF) and plantar flexion (PF) during walking, causing misalignment. To solve this problem, a BTDA was developed by considering the length change of both cables. Cable-driven actuators and exoskeleton robot systems create uncertainty. Accordingly, adaptive control was performed with a proportional-integral-differential neural network (PIDNN) controller to minimize system uncertainty.

Design and Control of a Polycentric Knee Exoskeleton Using an Electro-Hydraulic Actuator

An exoskeleton robot helps the wearer with mechanical forces by identifying the wearer's intentions and requires high energy efficiency, sufficient load capacity, and a comfortable fit. However, since it is difficult to implement complex anatomical movements of the human body, most exoskeleton robots are designed simply, unlike the anatomy of real humans. This forces the wearer to accept the robot's stiffness entirely, and to use energy inefficiently from the power source. In this paper, a simple 1 degree of freedom (DoF) structure, which was mainly used in the knees of exoskeleton robots, was designed with a polycentric (multi-axial) structure to minimize the misalignment between wearer and robot, so that torque transfer could be carried out efficiently. In addition, the overall robot system was constructed by using an electro-hydraulic actuator (EHA) to solve the problems of the energy inefficiency of conventional hydraulic actuators and the low load capacity of conventional electric actuators. After the configuration of the hardware system, the sliding mode controller was designed to address the EHA nonlinear models and the uncertainty of the plant design. This was configured as Simulink for the first verification, and the experiment was conducted by applying it to the actual model to demonstrate the performance of the sliding mode control. In this process, an optical rotary encoder was used as the main feedback sensor of the controller. The proposed polycentric knee exoskeleton robot system using the EHA was able to reach the desired target value well despite the presence of many model uncertainties.

Measurement and Analysis of Gait Pattern during Stair Walk for Improvement of Robotic Locomotion Rehabilitation System

Background

Robotic locomotion rehabilitation systems have been used for gait training in patients who have had a stroke. Most commercialized systems allow patients to perform simple exercises such as balancing or level walking, but an additional function such as stair-walk training is required to provide a wide range of recovery cycle rehabilitation. In this study, we analyzed stair-gait patterns and applied the result to a robotic rehabilitation system that can provide a vertical motion of footplates.

Methods

To obtain applicable data for the robotic system with vertically movable footplates, stair-walk action was measured using an optical marker-based motion capture system. The spatial position data of joints during stair walking was obtained from six healthy adults who participated in the experiment. The measured marker data were converted into joint kinematic data by using an algorithm that included resampling and normalization. The spatial position data are represented as angular trajectories and the relative displacement of each joint on the anatomical sagittal plane and movements of hip joints on the anatomical transverse plane.

Results

The average range of motion (ROM) of each joint was estimated as (−6.75°, 48.69°) at the hip, (8.20°, 93.78°) at the knee, and (−17.78°, 11.75°) at the ankle during ascent and as (6.41°, 31.67°) at the hip, (7.38°, 91.93°) at the knee, and (−24.89°, 24.18°) at the ankle during descent. Additionally, we attempted to create a more natural stair-gait pattern by analyzing the movement of the hip on the anatomical transverse plane. The hip movements were estimated to within ±1.57 cm and ±2.00 cm for hip translation and to within ±2.52° and ±2.70° for hip rotation during stair ascent and stair descent, respectively.

Conclusions

Based on the results, standard patterns of stair ascent and stair descent were derived and applied to a lower-limb rehabilitation robot with vertically movable footplates. The relative trajectory from the experiment ascertained that the function of stair walking in the robotic system properly worked within a normal ROM.

A Motion Control of Soft Gait Assistive Suit by Gait Phase Detection Using Pressure Information

Power assistive devices have been developed in recent years. To detect the wearer’s motion, conventional devices require users to wear sensors. However, wearing many sensors increases the wearing time, and usability of the device will become worse. We developed a soft gait assistive suit actuated by pneumatic artificial rubber muscles (PARMs) and proposed its control method. The proposed suit is easy to wear because the attachment unit does not have any electrical sensors that need to be attached to the trainee’s body. A target application is forward walking exercise on a treadmill. The control unit detects the pre-swing phase in the gait cycle using the pressure information in the calf back PARMs. After the detection, the suit assists the trainee’s leg motion. The assist force is generated by the controlled PARM pressure, and the pressure input time is changed appropriately considering the gait cycle time. We conducted walking experiments; (1) verifies the proposed control method works correctly, and (2) verifies whether the gait assistive suit is effective for decreasing muscular activity. Finally, we confirmed that the accurate phase detection can be achieved by using the proposed control method, and the suit can reduce muscular activity of the trainee’s leg.

Dynamic Modeling of McKibben Muscle Using Empirical Model and Particle Swarm Optimization Method

This paper explores empirical modeling of McKibben muscle in characterizing its hysteresis behavior and nonlinearities during quasi-static, quasi-rate, and historic dependencies. The unconventional materials-based actuating system called McKibben muscle has excellent properties of power-to-weight ratio, which could be used in rehabilitation orthosis application for condition monitoring, physical enhancement, and rehabilitation therapy. McKibben muscle is known to exhibit hysteresis behavior and it is rate-dependent (the level of hysteresis depends closely on rate of input excitation frequency). This behavior is undesirable and it must be considered in realizing high precision control application. In this paper, the nonlinearities of McKibben muscle is characterized using empirical modeling with multiple correction functions such as shape irregularity and slenderness. A particle swarm optimization (PSO) method is used to determine the best parametric values of the proposed empirical with modified dynamic friction model. The LabVIEW and MATLAB platforms are used for data analysis, modeling and simulation. The results confirm that this model able to significantly characterize the nonlinearities of McKibben muscle while considering all dependencies.

Optimizing Control of Passive Gait Training Exoskeleton Driven by Pneumatic Muscles Using Switch-Mode Firefly Algorithm

This paper presents a lower-limb exoskeleton that is actuated by pneumatic muscle actuators (PMAs). This exoskeleton system is composed of the mechanical structures, a treadmill, and a weight support system. With the cooperative work of the three parts, the system aims to assist either the elderly for muscle strengthening by conducting walking activities or the stroke patients during a rehabilitation training program. A mechanism is developed to separate the PMAs from the wearer’s legs to reduce the subject’s physical exertion. Furthermore, considering the difficulty in the modeling of proposed PMAs-driven exoskeleton, a safe and model-free control strategy called proxy-based sliding mode control (PSMC) is used to ensure proper control of the exoskeleton. However, the favorable performances are strongly dependent on the appropriate control parameters, which may be difficult to obtain with blind tuning. Therefore, we propose a global parameters optimization algorithm called switch-mode firefly algorithm (SMFA) to automatically calculate the pre-defined object function and attain the most applicable parameters. Experimental studies are conducted, and the results show the effectiveness of the proposed method.

Robotics for Lower Limb Rehabilitation

Improving walking function is a desirable outcome in rehabilitation and of high importance for social and vocational reintegration for persons with neurologic-related gait impairment. Robots for lower limb gait rehabilitation are designed principally to help automate repetitive labor-intensive training during neurorehabilitation. These include tethered exoskeletons, end-effector devices, untethered exoskeletons, and patient-guided suspension systems. This article reviews the first 3 categories and briefly mentions the fourth. Research is needed to further define the therapeutic applications of these devices. Additional technical improvements are expected regarding device size, controls, and battery life for untethered devices.

Toward Standardizing the Classification of Robotic Gait Rehabilitation Systems

With the existence of numerous rehabilitation systems, classification and comparison becomes difficult, especially due to the many factors involved. Moreover, most current reviews are descriptive and do not provide systematic methods for the visual comparison of systems. This review proposes a method for classifying systems and representing them graphically to easily visualize various characteristics of the different systems at the same time. This method could be an introduction for standardizing the evaluation of gait rehabilitation systems. It evaluates four main modules (body weight support, reciprocal stepping mechanism, pelvis mechanism, and environment module) of 27 different gait systems based on a set of characteristics. The combination of these modular evaluations provides a description of the system "in the space of rehabilitation." The evaluation of each robotic module, based on specific characteristics, showed diverse tendencies. While there is an augmented interest in developing more sophisticated reciprocal stepping mechanisms, few researchers are dedicated to enhance the properties of pelvis mechanisms.

Development and assessment of a novel ankle rehabilitation system for stroke survivors

Spasticity after stroke is a common occurrence and requires treatment with rehabilitative regimens (e.g., stretching exercise). Unfortunately, many challenges (e.g., cost, limited availability of physical therapists, limited access to clinical facilities, etc.) can restrict participation in these rehabilitation regimens. Assistive technologies using robotic systems have been developed to provide an alternative to assist with rehabilitative exercises. However, existing assistive technologies are rarely available in clinical settings due to technical limitations (e.g., size, weight, complexity, etc.). This paper describes the development of a novel ankle rehabilitation system, called Motorized Ankle Stretcher (MAS). A proof-of-concept experiment was conducted to assess the effects of ankle stretching exercises with the MAS in a laboratory setting. Six stroke survivors participated in the proof-of-concept experiment. The participants' ankle range of motion (ROM) and walking performance (i.e., walking speed, step length, and cadence) were evaluated before and after a small number of the ankle stretching exercises using the MAS (i.e., 20 trials total) in a single training session. The results show that the ankle ROM was significantly increased after the exercises across all participants. However, no significant differences in walking speed, step length, and cadence were observed between pre- and post-exercises. Our investigation is a first attempt at developing a relatively small size, weight, and easy-to-use ankle rehabilitation system for stroke survivors.

A review in gait rehabilitation devices and applied control techniques

PURPOSE

The aim of this review is to analyse the different existing technologies for gait rehabilitation, focusing mainly in robotic devices. Those robots help the patient to recover a lost function due to neurological gait disorders, accidents or after injury. Besides, they facilitate the identification of normal and abnormal features by registering muscle activity providing the doctor important data where he can observe the evolution of the patient.

METHOD

A deep literature review was realized using selected keywords considering not only the most common medical and engineering databases, but also other available sources that provide information on commercial and scientific gait rehabilitation devices. The founded literature for this review corresponds to control techniques for gait rehabilitation robots, since the early seventies to the present year.

RESULTS

Different control strategies for gait analysis in rehabilitation devices have been developed and implemented such as position control, force and impedance control, haptic simulation, and control of EMG signals. These control techniques are used to analyze the force of the patient during therapy, compensating it with the force generated by the mechanism in the rehabilitation device. It is observed that the largest number of studies reported, focuses on the impedance control technique. Leading to include new control techniques and validate them using the necessary protocols with ill patients, obtaining reliable results that allows a progressive and active rehabilitation.

CONCLUSIONS

With this exhaustive review, we can conclude that the degree of complexity of the rehabilitation device influences in short and long-term therapeutic results since the movements become more controlled. However, there is still a lot of work in the sense of motion control in order to perform trajectories that are more alike the natural movements of humans. There are many control techniques in other areas, which seek to improve the performance of the process. These techniques may possibly be applicable in gait rehabilitation devices, obtaining controllers that are more efficient and that adapts to different people and the necessities that entail every disease. Implications for Rehabilitation Rehabilitation helps people to improve the activities of their daily life, allowing them to observe their progress in the functional abilities as the months pass by with intensive and repetitive therapies. There is a mobility issue when the patient needs to move to the hospital or to the laboratory, which is not always feasible. For overcoming it, patients use the equipment at home to perform their daily therapy. However, they need the sufficient knowledge about its operation, also about the therapeutic movements, the therapy duration and the movement speed. Besides, is necessary to place the equipment in a proper and lively environment that helps to forget or reduce pain while the patient moves his joints progressively. The purpose of robotic rehabilitation devices is to generate repetitive and progressive movements, according to the motor disability. There are training trajectories to follow, which motivate patients to generate active movements. The benefits of robotic rehabilitation depend on the ability of each patient to adapt to the speed and load variations generated by the device, improving and reinforcing motor functions in therapy, especially in patients with advanced disabilities in early rehabilitation. Multi-joint rehabilitation devices are more effective than single-joint rehabilitation devices because they involve a higher number of muscles in the therapy. The greater the number of degrees of freedom (DoF) of the device, it cushions its effect in the patient because the inertia is reduced and higher torques are generated. The assistive technological devices allows to explore different rehabilitation techniques that motivate the patient in therapy, increasing appropriately the energy and pressure in the blood which is reflected in gradually recovering his ability to walk.

Knee Impedance Modulation to Control an Active Orthosis Using Insole Sensors

Robotic devices for rehabilitation and gait assistance have greatly advanced with the objective of improving both the mobility and quality of life of people with motion impairments. To encourage active participation of the user, the use of admittance control strategy is one of the most appropriate approaches, which requires methods for online adjustment of impedance components. Such approach is cited by the literature as a challenge to guaranteeing a suitable dynamic performance. This work proposes a method for online knee impedance modulation, which generates variable gains through the gait cycle according to the users' anthropometric data and gait sub-phases recognized with footswitch signals. This approach was evaluated in an active knee orthosis with three variable gain patterns to obtain a suitable condition to implement a stance controller: two different gain patterns to support the knee in stance phase, and a third pattern for gait without knee support. The knee angle and torque were measured during the experimental protocol to compare both temporospatial parameters and kinematics data with other studies of gait with knee exoskeletons. The users rated scores related to their satisfaction with both the device and controller through QUEST questionnaires. Experimental results showed that the admittance controller proposed here offered knee support in 50% of the gait cycle, and the walking speed was not significantly different between the three gain patterns (p = 0.067). A positive effect of the controller on users regarding safety during gait was found with a score of 4 in a scale of 5. Therefore, the approach demonstrates good performance to adjust impedance components providing knee support in stance phase.

Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now?

Gait abnormalities following neurological disorders are often disabling, negatively affecting patients' quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one's ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson's disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.