JNER at 15 years: analysis of the state of neuroengineering and rehabilitation.

On JNER's 15th anniversary, this editorial analyzes the state of the field of neuroengineering and rehabilitation. I first discuss some ways that the nature of neurorehabilitation research has evolved in the past 15 years based on my perspective as editor-in-chief of JNER and a researcher in the field. I highlight increasing reliance on advanced technologies, improved rigor and openness of research, and three, related, new paradigms - wearable devices, the Cybathlon competition, and human augmentation studies - indicators that neurorehabilitation is squarely in the age of wearability. Then, I briefly speculate on how the field might make progress going forward, highlighting the need for new models of training and learning driven by big data, better personalization and targeting, and an increase in the quantity and quality of usability and uptake studies to improve translation

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI

Robotic Rehabilitation Devices of Human Extremities: Design Concepts and Functional Particularities

International audienceAll over the world, several dozen million people suffer from the effects of post-polio, multiple sclerosis, spinal cord injury, cerebral palsy, etc. and could benefit from the advances in robotic devices for rehabilitation. Thus, for modern society, an important and vital problem of designing systems for rehabilitation of human physical working ability appears. The temporary or permanent loss of human motor functions can be compensated by means of various rehabilitation devices. They can be simple mechanical systems for orthoses, which duplicate the functions of human extremities supplying with rigidity and bearing capacity or more complex mechatronic rehabilitation devices with higher level of control. We attempt to cover all of the major developments in these areas, focusing particularly on the development of the different concepts and their functional characteristics. The robotic devices with several structures are classified, taking into account the actuation systems, the neuromuscular stimulations, and the structural schemes. It is showed that the problems concerning the design of rehabilitation devices are complex and involve many questions in the sphere of biomedicine, mechanics, robot technology, electromechanics and optimal control. This paper provides a design overview of hardware, actuation, sensory, and control systems for most of the devices that have been described in the literature, and it ends with a discussion of the major advances that have been made and should be yet overcome

Hybrid Neuroprosthesis for Lower Limbs

Assistive technologies have been proposed for the locomotion of people with spinal cord injury (SCI). One of them is the neuroprosthesis that arouses the interest of developers and health professionals bearing in mind the beneficial effects promoted in people with SCI. Thus, the first session of this chapter presents the principles of human motility and the impact that spinal cord injury causes on a person’s mobility. The second session presents functional electrical stimulation as a solution for the immobility of paralyzed muscles. It explains the working principles of constituent modules and main stimulatory parameters. The third session introduces the concepts and characteristics of neural prosthesis hybridization. The last two sessions present and discuss examples of hybrid neuroprostheses. Such systems employ hybrid assistive lower limb strategies to evoke functional movements in people with SCI, associating the motor effects of active and/or passive orthoses to a functional electrical stimulation (FES) system. Examples of typical applications of FES in rehabilitation are discussed

A Novel User-Controlled Assisted Standing Control System for a Hybrid Neuroprosthesis

Spinal cord injury (SCI) is a serious condition with 17,000 new cases each year and an estimated total of 282,000 people in the United States who have SCI. Some people with SCI who have paraplegia suffer from paralysis, muscle spasticity, bone changes, chronic pain and other problems. Active orthoses such as the ReWalk, EXPOS, and Ekso have improved the quality of life of people with SCI. The hybrid neuroprosthesis is an active orthosis that uses functional electrical stimulation (FES) at the quadriceps and has two main purposes: restoring mobility in people with SCI and providing physical therapy for the user outside of a clinical setting. To mobilize people with SCI, the neuroprosthesis must provide assisted movement for a sitting to standing motion. A standing control system developed by the Pitt Neuromuscular Control and Robotics Laboratory (NCRL) before this proposed system did not give enough control of the movement to the user and FES alone did not provide enough torque at the knees for standing. The NCRL neuroprosthesis was modified to include a harmonic gearmotor at the knees, a thumb joystick for user control, and a force sensing walker. A control system using a finite state machine (FSM) was designed to perform hybrid standing in the neuroprosthesis. The FSM is divided into 3 states and uses 5 separate controllers: a tracking controller for forward leaning during sitting, a tracking controller to synchronize the knees, a tracking controller to lock the knees during standing, a hip tracking controller, and openloop FES. Four experiments were performed on subjects to analyze control performance, power usage, and energy consumption during motors only and hybrid standing. A subject with SCI successfully performed several trials of hybrid standing. The controllers performed sufficiently accurately, and several minor control problems were fixed. The highest average energy consumption at the knee motors was 88.4 joules during experiment 1. The hybrid standing experiment demonstrated a modest energy reduction of 15% in a subject with SCI. The hybrid standing demonstrated a high energy reduction of 74% in the right knee in experiment 2, through hybrid actuation and a slower standing speed

Optimizing User Integration for Individualized Rehabilitation

User integration with assistive devices or rehabilitation protocols to improve movement function is a key principle to consider for developers to truly optimize performance gains. Better integration may entail customizing operation of devices and training programs according to several user characteristics during execution of functional tasks. These characteristics may be physical dimensions, residual capabilities, restored sensory feedback, cognitive perception, or stereotypical actions

Use of Exoskeletons in the Treatment and Rehabilitation of Paraplegia Patients

This chapter presents a review that includes five robotic exoskeletons used in the rehabilitation of paraplegic patients, highlighting the qualities of each one and offering the doctor and the rehabilitator a tool to select the exoskeleton that is most appropriate to the needs of their patient and a more satisfying and integral therapy. A systematic search was carried out in different platforms of scientific interest, the publications that met the inclusion criteria were selected. The information collected was classified and synthesized, resulting in a review that covers the five most relevant exoskeletons for the rehabilitation of paraplegic patients. Concluding with a tool that helps the therapist select the most appropriate exoskeleton for each patient

Feasibility of Rehabilitation Training With a Newly Developed Wearable Robot for Patients With Limited Mobility

ObjectiveTo investigate the feasibility of rehabilitation training with a new wearable robot.DesignBefore-after clinical intervention.SettingUniversity hospital and private rehabilitation facilities.ParticipantsA convenience sample of patients (N=38) with limited mobility. The underlying diseases were stroke (n=12), spinal cord injuries (n=8), musculoskeletal diseases (n=4), and other diseases (n=14).InterventionsThe patients received 90-minute training with a wearable robot twice per week for 8 weeks (16 sessions).Main Outcome MeasuresFunctional ambulation was assessed with the 10-m walk test (10MWT) and the Timed Up & Go (TUG) test, and balance ability was assessed with the Berg Balance Scale (BBS). Both assessments were performed at baseline and after rehabilitation.ResultsThirty-two patients completed 16 sessions of training with the wearable robot. The results of the 10MWT included significant improvements in gait speed, number of steps, and cadence. Although improvements were observed, as measured with the TUG test and BBS, the results were not statistically significant. No serious adverse events were observed during the training.ConclusionsEight weeks of rehabilitative training with the wearable robot (16 sessions of 90min) could be performed safely and effectively, even many years after the subjects received their diagnosis

Brain-controlled cycling system for rehabilitation following paraplegia with delay-time prediction

Objective: Robotic rehabilitation systems have been investigated to assist with motor dysfunction recovery in patients with lower-extremity paralysis caused by central nervous system lesions. These systems are intended to provide appropriate sensory feedback associated with locomotion. Appropriate feedback is thought to cause synchronous neuron firing, resulting in the recovery of function. Approach: In this study, we designed and evaluated an ergometric cycling wheelchair, with a brain-machine interface (BMI), that can force the legs to move by including normal stepping speeds and quick responses. Experiments were conducted in five healthy subjects and one patient with spinal cord injury (SCI), who experienced the complete paralysis of the lower limbs. Event-related desynchronization (ERD) in the β band (18‐28 Hz) was used to detect lower-limb motor images. Main results: An ergometer-based BMI system was able to safely and easily force patients to perform leg movements, at a rate of approximately 1.6 seconds/step (19 rpm), with an online accuracy rate of 73.1% for the SCI participant. Mean detection time from the cue to pedaling onset was 0.83±0.31 s Significance: This system can easily and safely maintain a normal walking speed during the experiment and be designed to accommodate the expected delay between the intentional onset and physical movement, to achieve rehabilitation effects for each participant. Similar BMI systems, implemented with rehabilitation systems, may be applicable to a wide range of patients