Simulation of a control method for active kinesiotherapy with an upper extremity rehabilitation exoskeleton without force sensor

Exoskeleton-aided active rehabilitation is a process that requires sensing and acting upon the motion intentions of the user. Typically, force sensors are used for this. However, they increase the weight and cost of these wearable devices. This paper presents the methodology for detecting users' intentions only with encoders integrated with the drives. It is unique compared to other algorithms, as enables active kinesiotherapy while adding no sensory systems. The method is based on comparing the measured motion with the one computed with the idealised model of the multibody system. The investigation assesses the method's performance and its robustness to model and measurement inaccuracies, as well as patients' unintended motions. Moreover, the PID parameters are selected to provide the optimal regulation based on the dynamics requirements. The research proves the presented concept of the control approach. For all the tests with the final settings, the system reacts to a change in the user's intention below one second and minimises the changes in proportion between the system's acceleration and the generated user's joint torque. The results are comparable to those obtained by EMG-based systems and significantly better than low-cost force sensors.

Active pelvic movements on a Swiss ball reduced labour duration, pain, fatigue and anxiety in parturient women: a randomised trial

QUESTION

How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes?

METHOD

A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS

Two-hundred parturient women.

INTERVENTION

The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower.

OUTCOME MEASURES

The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes.

RESULTS

The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear.

CONCLUSION

Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect.

REGISTRATION

NCT04124835.

Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps

BACKGROUND

Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS.

OBJECTIVE

To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS.

METHODS

A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted.

RESULTS

4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years.

CONCLUSION

Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.

Ludic Table: a comparative study between playful rehabilitation and kinesiotherapy in restricting upper limb movements in individuals with stroke

Stroke is a neurological syndrome resulting from the sudden interruption of blood flow. Among the symptoms/consequences of the stroke are muscle weakness in the lower and/or upper limbs, decreased sensitivity, altered fine motor skills, proprioception, and reflections. The treatment for the motor consequences is orthopedic management, in which the physiotherapist assists the individual in repetitive range of motion exercises, which can be demotivating during the treatment. The Ludic Table (LT), on the other hand, incorporates playfulness into therapy, making it a motivating tool. This research describes the comparative study between kinesiotherapy techniques and exercises using the LT, applied to the development of upper limb movements. For this, fourteen volunteers were divided into groups, submitted to interventions according to the techniques, and evaluated using systems such as goniometry, HAQ-DI, GMFM-88, and neurofunctional assessment. In general, it can be stated that regardless of the intervention, the individuals obtained gain in movements (minimum average of 7 degrees) and that the use of the LT allows the development of the angular amplitude and the reduction of the effects of spasticity. The individuals submitted to the intervention through the LT obtained the development of a greater number of articular movements of the shoulder and elbow.

Pemphigus foliaceus patients (Fogo Selvagem) treated with kinesiotherapy presented lower levels of proinflammatory cytokines

Fogo Selvagem (FS) is a rare autoimmune disease characterized by acantholysis and inflammation of the epidermis. It was evidenced in this disease the increase of proinflammatory cytokines levels which can be influenced by physical activities. Kinesiotherapy, as physiotherapeutic interventions, was associated improvement levels of the quality of live, mainly the pain. Understanding the impact of such methodology in immunology of the FS, may constitute an alternative and effective approach. We compare the levels of serum cytokines and chemokines between nine patients with FS submitted to kinesiotherapy for 12 weeks and ten patients not submitted to kinesiotherapy. The kinesiotherapy was composed by self-stretching followed by a resistance training for upper and lower limbs. The protocol was carried out in three sections of eight to ten repetitions with 70% of the maximum load measured by test maximum of ten repetitions. After strengthening period patients performed a passive stretching. The training sessions lasted 50 min and were performed 3 times a week at least 12 weeks. Cytokines and chemokines were assessed in plasma using enzyme-linked immunosorbent assay and/or cytometric bead array. Patients with FS were being kinesiotherapy presented minors levels of interferon-γ, interleukin (IL)-17, IL-22, and IL-15 when compared to those not submitted to kinesiotherapy. No differences were observed for the detection of the chemokines chemokine ligand (CCL)-2, CCL-3, CCL-5, CCL-11, C-X-C motif chemokine 8 (CXCL-8), and CXCL-10. These results suggest that kinesiotherapy had a positive impact on inflammatory markers that are associated with disease worsening in FS.