The Effect of Locomotor Assisted Therapy on Lower Extremity Motor Performance in Typically Developing Children and Children with Cerebral Palsy

Indiana University-Purdue University Indianapolis (IUPUI)Background: Ambulation is critical to a child’s participation, development of selfconcept, and quality of life. Children with cerebral palsy (CP) frequently exhibit limitation in walking proficiency which has been identified as the primary physical disability. Traditional rehabilitative treatment techniques to improve ambulation for children with CP reveal inconsistent results. Driven gait orthosis (DGO) training is a novel approach focusing on motor learning principles that foster cortical neural plasticity. Objective: The objectives are to determine if: (i) the lower extremity muscle activation patterns of children with CP are similar to age-matched TD children in overground (OG) walking, (ii) DGO training replicates muscle activation patterns in OG ambulation in TD children, (iii) the lower extremity muscle activation patterns in OG walking of children with CP are similar to their muscle activation patterns with DGO assistance, and (iv) DGO training promotes unimpaired muscle activation patterns in children with CP. Methods: Muscle activity patterns of the rectus femoris, semitendinosus, gluteus maximus and gluteus medius were recorded in the OG and DGO walking conditions of children with CP and age-matched TD. The gait cycles were identified and the data was averaged to produce final average gait cycle time normalized values. Results: In comparing the variability of the muscle activation patterns within the subject groups, CP DGO walking was considerably lower than CP OG. In comparing the muscle activation patterns in each condition, consistent differences (p < .05) were noted in terminal stance, pre-swing and initial swing phases of gait with the DGO condition consistently revealing greater muscle unit recruitment. Conclusion: The results indicate that training in the DGO provided the ability to practice with measurably repetitive movement as evidenced by decreased variability. Consistent differences were noted in muscle activation patterns in the terminal stance, pre-swing and initial swing phases of gait when most of these muscles are primarily inactive. The alteration in ground reaction force within the DGO environment may play a role in this variance. With the goal of normalizing gait, it is important that the effect of these parameters on ground reaction forces be considered in the use of DGO rehabilitation

A systematic review of study results reported for the evaluation of robotic rollators from the perspective of users

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: To evaluate the effectiveness and perception of robotic rollators (RRs) from the perspective of users. Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results. Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive. Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.Implications for Rehabilitation RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention. The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences. The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies. RRs seem generally to be perceived as positive by the users. There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices. Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs

Evaluation of a Soft Robotic Knee Exosuit for Assistance in Stair Ascent

abstract: Muscular weakness is a common manifestation for Stroke survivors and for patients with Anterior Cruciate Ligament reconstruction leading to reduced functional independence, especially mobility. Several rigid orthotic devices are being designed to assist mobility. However, limitations in majority of these devices are: 1) that they are constrained only to level walking applications, 2) are mostly bulky and rigid lacking user comfort. For these reasons, rehabilitation using soft-robotics can serve as a powerful modality in gait assistance and potentially accelerate functional recovery. The characteristics of soft robotic exosuit is that it’s more flexible, delivers high power to weight ratio, and conforms with the user’s body structure making it a suitable choice. This work explores the implementation of an existing soft robotic exosuit in assisting knee joint mechanism during stair ascent for patients with muscular weakness. The exosuit assists by compensating the lack of joint moment and minimizing the load on the affected limb. It consists of two I-cross-section soft pneumatic actuators encased within a sleeve along with insole sensor shoes and control electronics. The exosuit actuators were mechanically characterized at different angles, in accordance to knee flexion in stair gait, to enable the generation of the desired joint moments. A linear relation between the actuator stiffness and internal pressure as a function of the knee angle was obtained. Results from this characterization along with the insole sensor outputs were used to provide assistance to the knee joint. Analysis of stair gait with and without the exosuit ‘active’ was performed, using surface electromyography (sEMG) sensors, for two healthy participants at a slow walking speed. Preliminary user testing with the exosuit presented a promising 16% reduction in average muscular activity of Vastus Lateralis muscle and a 3.6% reduction on Gluteus Maximus muscle during the stance phase and unrestrained motion during the swing phase of ascent thereby demonstrating the applicability of the soft-inflatable exosuit in rehabilitation.Dissertation/ThesisMasters Thesis Biomedical Engineering 201

Evaluation studies of robotic rollators by the user perspective: A systematic review

Background: Robotic rollators enhance the basic functions of established devices by technically advanced physical, cognitive, or sensory support to increase autonomy in persons with severe impairment. In the evaluation of such Ambient Assisted Living solutions, both the technical and user perspectives are important to prove usability, effectiveness, and safety, and to ensure adequate device application.Objective: The aim of this systematic review is to summarize the methodology of studies evaluating robotic rollators with focus on the user perspective and to give recommendations for future evaluation studies.Methods: A systematic literature search up to December 31, 2014 was conducted based on the Cochrane Review methodology using the electronic databases PubMed and IEEE Xplore. Articles were selected according to the following inclusion criteria: Evaluation studies of robotic rollators documenting human-robot interaction, no case reports, published in English language.Results: Twenty-eight studies were identified that met the predefined inclusion criteria. Large heterogeneity in the definitions of the target user group, study populations, study designs, and assessment methods was found across the included studies. No generic methodology to evaluate robotic rollators could be identified. We found major methodological shortcomings related to insufficient sample descriptions and sample sizes, and lack of appropriate, standardized and validated assessment methods. Long-term use in habitual environment was also not evaluated.Conclusions: Apart from the heterogeneity, methodological deficits in most of the identified studies became apparent. Recommendations for future evaluation studies include: clear definition of target user group, adequate selection of subjects, inclusion of other assistive mobility devices for comparison, evaluation of the habitual use of advanced prototypes, adequate assessment strategy with established, standardized and validated methods, and statistical analysis of study results. Assessment strategies may additionally focus on specific functionalities of the robotic rollators allowing an individually tailored assessment of innovative features to document their added value

Handle Anywhere: A Mobile Robot Arm for Providing Bodily Support to Elderly Persons

Age-related loss of mobility and increased risk of falling remain important obstacles toward facilitating aging-in-place. Many elderly people lack the coordination and strength necessary to perform common movements around their home, such as getting out of bed or stepping into a bathtub. The traditional solution has been to install grab bars on various surfaces; however, these are often not placed in optimal locations due to feasibility constraints in room layout. In this paper, we present a mobile robot that provides an older adult with a handle anywhere in space - "handle anywhere". The robot consists of an omnidirectional mobile base attached to a repositionable handle. We analyze the postural changes in four activities of daily living and determine, in each, the body pose that requires the maximal muscle effort. Using a simple model of the human body, we develop a methodology to optimally place the handle to provide the maximum support for the elderly person at the point of most effort. Our model is validated with experimental trials. We discuss how the robotic device could be used to enhance patient mobility and reduce the incidence of falls.Comment: 8 pages, 10 figure

Visual cue training to improve walking and turning after stroke:a study protocol for a multi-centre, single blind randomised pilot trial

Visual information comprises one of the most salient sources of information used to control walking and the dependence on vision to maintain dynamic stability increases following a stroke. We hypothesize, therefore, that rehabilitation efforts incorporating visual cues may be effective in triggering recovery and adaptability of gait following stroke. This feasibility trial aims to estimate probable recruitment rate, effect size, treatment adherence and response to gait training with visual cues in contrast to conventional overground walking practice following stroke.Methods/design: A 3-arm, parallel group, multi-centre, single blind, randomised control feasibility trial will compare overground visual cue training (O-VCT), treadmill visual cue training (T-VCT), and usual care (UC). Participants (n = 60) will be randomly assigned to one of three treatments by a central randomisation centre using computer generated tables to allocate treatment groups. The research assessor will remain blind to allocation. Treatment, delivered by physiotherapists, will be twice weekly for 8 weeks at participating outpatient hospital sites for the O-VCT or UC and in a University setting for T-VCT participants.Individuals with gait impairment due to stroke, with restricted community ambulation (gait spee

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

歩行支援ロボットの制御のための人間の特徴推定

要約のみTohoku University平田泰久課