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van Nes IJ, van Dijsseldonk RB, van Herpen FH, Rijken H, Geurts AC, Keijsers NL. Improvement of quality of life after 2-month exoskeleton training in patients with chronic spinal cord injury. J Spinal Cord Med 2024; 47:354-360. [PMID: 35377297 PMCID: PMC11044750 DOI: 10.1080/10790268.2022.2052502] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine changes in quality of life (QoL) after an eight-week period of robotic exoskeleton training in a homogeneous group of patients with chronic complete spinal cord injury (SCI). DESIGN Prospective single-group pre-post study. SETTING Rehabilitation center. PARTICIPANTS Patients with a chronic (>6 months) motor complete SCI (T1-L1). INTERVENTION Twenty-four training sessions with the ReWalk exoskeleton over an eight-week period. MAIN OUTCOME MEASURE QoL, assessed with the sum score of the Short Form-36 with Walk Wheel modification (SF-36ww). Secondary outcome measures were the eight SF-36ww subdomains, satisfaction with bladder and bowel management, lower extremity joint passive range of motion (pROM), and lower extremity spasticity. RESULTS Twenty-one participants completed the training. QoL significantly improved after the training period (average SF-36 sum score 621 ± 90) compared to baseline (571 ± 133) (t(20)=-2.5, P=.02). Improvements were seen on the SF-36ww subdomains for pain (P=.003), social functioning (P=.03), mental health (P=.02), and general health perception (P=.01). Satisfaction with bladder management (range 1-5) improved from median 3 at baseline to 4 after exoskeleton training (P=0.01). No changes in satisfaction with bowel management (P=.11), pROM (hip-extension (P=.49), knee-extension (P=.36), ankle dorsiflexion (P=.69)), or spasticity (P=.94) were found. CONCLUSION Even in patients with chronic motor complete SCI and a relatively high level of QoL at baseline, a short-term exoskeleton training improved their QoL, pain and satisfaction with bladder management; findings that warrant further controlled studies in this specific SCI population.
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Affiliation(s)
- Ilse J.W. van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Rosanne B. van Dijsseldonk
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H.M. van Herpen
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Hennie Rijken
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C.H. Geurts
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Noël L.W. Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pan YT, Kang I, Joh J, Kim P, Herrin KR, Kesar TM, Sawicki GS, Young AJ. Effects of Bilateral Assistance for Hemiparetic Gait Post-Stroke Using a Powered Hip Exoskeleton. Ann Biomed Eng 2023; 51:410-21. [PMID: 35963920 DOI: 10.1007/s10439-022-03041-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/28/2022] [Indexed: 01/26/2023]
Abstract
Hemiparetic gait due to stroke is characterized by an asymmetric gait due to weakness in the paretic lower limb. These inter-limb asymmetries increase the biomechanical demand and reduce walking speed, leading to reduced community mobility and quality of life. With recent progress in the field of wearable technologies, powered exoskeletons have shown great promise as a potential solution for improving gait post-stroke. While previous studies have adopted different exoskeleton control methodologies for restoring gait post-stroke, the results are highly variable due to limited understanding of the biomechanical effect of exoskeletons on hemiparetic gait. In this study, we investigated the effect of different hip exoskeleton assistance strategies on gait function and gait biomechanics of individuals post-stroke. We found that, compared to walking without a device, powered assistance from hip exoskeletons improved stroke participants' self-selected overground walking speed by 17.6 ± 2.5% and 11.1 ± 2.7% with a bilateral and unilateral assistance strategy, respectively (p < 0.05). Furthermore, both bilateral and unilateral assistance strategies significantly increased the paretic and non-paretic step length (p < 0.05). Our findings suggest that powered assistance from hip exoskeletons is an effective means to increase walking speed post-stroke and tuning the balance of assistance between non-paretic and paretic limbs (i.e., a bilateral strategy) may be most effective to maximize performance gains.
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Vouga T, Fasola J, Baud R, Manzoori AR, Pache J, Bouri M. TWIICE One powered exoskeleton: effect of design improvements on usability in daily life as measured by the performance in the CYBATHLON race. J Neuroeng Rehabil 2022; 19:63. [PMID: 35761399 PMCID: PMC9238043 DOI: 10.1186/s12984-022-01028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/17/2022] [Indexed: 08/30/2023] Open
Abstract
Background Spinal cord injury leading to paraplegia affects the mobility and physiological well-being of one in a thousand people. Powered exoskeletons can temporarily restore the ability to walk. Their relevance in daily life is still limited because of low performance beyond ground that is even. CYBATHLON is an international competition promoting improvements in assistive technology. In this article, we present the latest design and results of testing of TWIICE One version 2018, one of the competing devices in the 2020 race. Methods A person with a motor-complete spinal cord injury at thoracic level T10 participated as race pilot. Training ahead of the race took place over one week at a rate of 2 h per day. The time to perform each of the seven tasks of the competition was recorded together with the number of repetitions. Performance is compared over the training period and against the 2016 race results. Results Progression was observed in all tasks and accounted for by both user training and technology improvements. Final competition rank was second out of seven participating teams, with a record time of 4′40". This represents an average improvement of 40% with respect to comparable obstacles of the 2016 race, explaining the two ranks of improvement since then. Conclusion These results help understand which features had a positive impact on the real-life performance of the device. Understanding how design affects performance is key information to create devices that really improve the life of people living with paraplegia.
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Affiliation(s)
| | | | | | | | | | - Mohamed Bouri
- Biorobotics Laboratory (BioRob), EPFL, Lausanne, Switzerland.,Translational Neural Engineering Laboratory (TNE), EPFL, Campus Biotech, Geneva, Switzerland
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Molazadeh V, Zhang Q, Bao X, Sharma N. An Iterative Learning Controller for a Switched Cooperative Allocation Strategy during Sit-to-Stand Tasks with a Hybrid Exoskeleton. IEEE Trans Control Syst Technol 2022; 30:1021-1036. [PMID: 36249864 PMCID: PMC9560042 DOI: 10.1109/tcst.2021.3089885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A hybrid exoskeleton that combines functional electrical stimulation (FES) and a powered exoskeleton is an emerging technology for assisting people with mobility disorders. The cooperative use of FES and the exoskeleton allows active muscle contractions via FES while robustifying torque generation to reduce FES-induced muscle fatigue. In this paper, a switched distribution of allocation ratios between FES and electric motors in a closed-loop adaptive control design is explored for the first time. The new controller uses an iterative learning neural network (NN)-based control law to compensate for structured and unstructured parametric uncertainties in the hybrid exoskeleton model. A discrete Lyapunov-like stability analysis that uses a common energy function proves asymptotic stability for the switched system with iterative learning update laws. Five human participants, including a person with complete spinal cord injury, performed sit-to-stand tasks with the new controller. The experimental results showed that the synthesized controller, in a few iterations, reduced the root mean square error between desired positions and actual positions of the knee and hip joints by 46.20% and 53.34%, respectively. The sit-to-stand experimental results also show that the proposed NN-based iterative learning control (NNILC) approach can recover the asymptotically trajectory tracking performance despite the switching of allocation levels between FES and electric motor. Compared to a proportional-derivative controller and traditional iterative learning control, the findings showed that the new controller can potentially simplify the clinical implementation of the hybrid exoskeleton with minimal parameters tuning.
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Affiliation(s)
- Vahidreza Molazadeh
- Department of Mechanical Engineering and Materials Science at University of Pittsburgh, Pittsburgh, PA, USA
| | - Qiang Zhang
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina Chapel-Hill, Raleigh, NC, USA
| | - Xuefeng Bao
- Department of Biomedical Engineering at Case Western Reserve University, Cleveland, OH, USA
| | - Nitin Sharma
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina Chapel-Hill, Raleigh, NC, USA
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Nedergård H, Arumugam A, Sandlund M, Bråndal A, Häger CK. Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2021; 18:64. [PMID: 33863345 PMCID: PMC8052671 DOI: 10.1186/s12984-021-00857-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone. METHODS Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2-3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest. RESULTS Thirteen studies including a total of 412 individuals (mean age: 52-69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all. CONCLUSION There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.
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Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Bråndal
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Khan AS, Livingstone DC, Hurd CL, Duchcherer J, Misiaszek JE, Gorassini MA, Manns PJ, Yang JF. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity. J Neuroeng Rehabil 2019; 16:145. [PMID: 31752911 PMCID: PMC6868817 DOI: 10.1186/s12984-019-0585-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment. Methods Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2–3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts. Results Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28–0.60 m/s, and distances of 0.74–1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments. Conclusion For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries. Trial registration NCT02322125 Registered 22 December 2014. Electronic supplementary material The online version of this article (10.1186/s12984-019-0585-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Atif S Khan
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Donna C Livingstone
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Caitlin L Hurd
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - John E Misiaszek
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Monica A Gorassini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia J Manns
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jaynie F Yang
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada. .,Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Russell Esposito E, Schmidtbauer KA, Wilken JM. Experimental comparisons of passive and powered ankle-foot orthoses in individuals with limb reconstruction. J Neuroeng Rehabil 2018; 15:111. [PMID: 30463576 PMCID: PMC6249722 DOI: 10.1186/s12984-018-0455-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFO) are commonly prescribed to provide functional assistance for patients with lower limb injuries or weakness. Their passive mechanical elements can provide some energy return to improve walking ability, but cannot restore plantar flexor push-off. Powered AFOs provide an assistive torque about the ankle to address the limitations of passive devices, but current designs have yet to be implemented on a large scale clinically. PURPOSE To compare passive AFOs to a new untethered, powered AFO design in a clinical population with lower limb reconstruction. METHODS A crossover study design, conducted on three individuals with lower limb reconstruction, compared gait mechanics at a standardized speed (based on leg length) in 4 AFO conditions: 1. None (shoes only), 2. Blue Rocker (BR, Allard, USA), 3. Intrepid Dynamic Exoskeletal Orthosis (IDEO), and 4. PowerFoot Orthosis (PFO BionX Medical Technologies, Inc.). The PFO was a custom, battery-powered device whose damping and power were capable to being tuned to meet patient needs. Subjects performed biomechanical gait analysis and metabolic testing at slow, moderate and fast speeds. Dependent variables included total limb power (calculated using a unified deformable segment model), mechanical work, mechanical efficiency, ankle motion, net metabolic cost across three speeds, and performance measures were calculated. Effect sizes (d) were calculated and d > 0.80 denoted a large effect. RESULTS Net positive work (d > 1.17) and efficiency (d > 1.43) were greatest in the PFO. There were large effects for between limb differences in positive work for all conditions except the PFO (d = 0.75). The PFO normalized efficiency between the affected and unaffected limbs (d = 0.50), whereas efficiency was less on the affected limb for all other conditions (d > 1.69). Metabolic rate was not consistently lowest in any one AFO condition across speeds. Despite some positive results of the PFO, patient preferred their daily use AFO (2 IDEO, 1 BR). All participants indicated that mass and size were concerns with using the PFO. CONCLUSIONS A novel PFO resulted in more biomimetic mechanical work and efficiency than commercially-available and custom passive AFO models. Although the powered AFO provided some biomechanical benefits, further improvements are warranted to improve patient satisfaction.
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Affiliation(s)
- Elizabeth Russell Esposito
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft, Sam Houston, TX, USA.,Extremity Trauma and Amputation Center of Excellence, JBSA Ft, Sam Houston, TX, USA.,Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Kelly A Schmidtbauer
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft, Sam Houston, TX, USA. .,Extremity Trauma and Amputation Center of Excellence, JBSA Ft, Sam Houston, TX, USA. .,Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA.
| | - Jason M Wilken
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft, Sam Houston, TX, USA.,Extremity Trauma and Amputation Center of Excellence, JBSA Ft, Sam Houston, TX, USA.,University of Iowa, Iowa City, IA, USA
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Schrade SO, Dätwyler K, Stücheli M, Studer K, Türk DA, Meboldt M, Gassert R, Lambercy O. Development of VariLeg, an exoskeleton with variable stiffness actuation: first results and user evaluation from the CYBATHLON 2016. J Neuroeng Rehabil 2018. [PMID: 29534730 PMCID: PMC5851253 DOI: 10.1186/s12984-018-0360-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Powered exoskeletons are a promising approach to restore the ability to walk after spinal cord injury (SCI). However, current exoskeletons remain limited in their walking speed and ability to support tasks of daily living, such as stair climbing or overcoming ramps. Moreover, training progress for such advanced mobility tasks is rarely reported in literature. The work presented here aims to demonstrate the basic functionality of the VariLeg exoskeleton and its ability to enable people with motor complete SCI to perform mobility tasks of daily life. METHODS VariLeg is a novel powered lower limb exoskeleton that enables adjustments to the compliance in the leg, with the objective of improving the robustness of walking on uneven terrain. This is achieved by an actuation system with variable mechanical stiffness in the knee joint, which was validated through test bench experiments. The feasibility and usability of the exoskeleton was tested with two paraplegic users with motor complete thoracic lesions at Th4 and Th12. The users trained three times a week, in 60 min sessions over four months with the aim of participating in the CYBATHLON 2016 competition, which served as a field test for the usability of the exoskeleton. The progress on basic walking skills and on advanced mobility tasks such as incline walking and stair climbing is reported. Within this first study, the exoskeleton was used with a constant knee stiffness. RESULTS Test bench evaluation of the variable stiffness actuation system demonstrate that the stiffness could be rendered with an error lower than 30 Nm/rad. During training with the exoskeleton, both users acquired proficient skills in basic balancing, walking and slalom walking. In advanced mobility tasks, such as climbing ramps and stairs, only basic (needing support) to intermediate (able to perform task independently in 25% of the attempts) skill levels were achieved. After 4 months of training, one user competed at the CYBATHLON 2016 and was able to perform 3 (stand-sit-stand, slalom and tilted path) out of 6 obstacles of the track. No adverse events occurred during the training or the competition. CONCLUSION Demonstration of the applicability to restore ambulation for people with motor complete SCI was achieved. The CYBATHLON highlighted the importance of training and gaining experience in piloting an exoskeleton, which were just as important as the technical realization of the robot.
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Affiliation(s)
- Stefan O Schrade
- Product Development Group Zurich, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland.
| | - Katrin Dätwyler
- Rehabilitation Engineering Laboratory, ETH Zurich, Lengghalde 5, Zurich, 8092, Switzerland
| | - Marius Stücheli
- Rehabilitation Engineering Laboratory, ETH Zurich, Lengghalde 5, Zurich, 8092, Switzerland
| | - Kathrin Studer
- Product Development Group Zurich, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Daniel-Alexander Türk
- Rehabilitation Engineering Laboratory, ETH Zurich, Lengghalde 5, Zurich, 8092, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Roger Gassert
- Product Development Group Zurich, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, ETH Zurich, Lengghalde 5, Zurich, 8092, Switzerland
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