Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

Robotic design and modelling of medical lower extremity exoskeletons

This study aims to explain the development of the robotic Lower Extremity Exoskeleton (LEE) systems between 1960 and 2019 in chronological order. The scans performed in the exoskeleton system’s design have shown that a modeling program, such as AnyBody, and OpenSim, should be used first to observe the design and software animation, followed by the mechanical development of the system using sensors and motors. Also, the use of OpenSim and AnyBody musculoskeletal system software has been proven to play an essential role in designing the human-exoskeleton by eliminating the high costs and risks of the mechanical designs. Furthermore, these modeling systems can enable rapid optimization of the LEE design by detecting the forces and torques falling on the human muscles

Dynamics analysis and simulation verification of a novel knee joint exoskeleton

A novel knee joint exoskeleton, is designed in this paper, including the mechanical structure and hydraulic damper. To determine the spring parameters of knee joint exoskeleton and verify its effectiveness, we conduct the following studies. Firstly, forward kinematics analysis of the swing phase is obtained and Lagrange dynamics analysis is carried out. Secondly, the 3D model of exoskeleton is set up and ADAMS simulation is conducted. Then the spring parameters of knee joint exoskeleton are selected, including the spring force, the spring stiffness coefficient and the spring expansion, according to the simulation results. Finally, there are three sets of moments on the non-wearable side, the moments resulted from ADAMS simulations, the moments from the CGA (Clinical gait analysis) and the moments calculated from the Lagrange equation are compared, results show they are in good agreement. The effectiveness of the ADAMS simulation proves that the parameters of the hydraulic damper can meet the actual requirements. The simulation analysis of the exoskeleton provides important parameters for the manufacture and it also provides theoretical basis for the later control theory

Gait quality is improved by locomotor training in individuals with SCI regardless of training approach

<p>Abstract</p> <p>Background</p> <p>While various body weight supported locomotor training (BWSLT) approaches are reported in the literature for individuals with spinal cord injury (SCI), none have evaluated outcomes in terms of gait quality. The purpose of this study was to compare changes in measures of gait quality associated with four different BWSLT approaches in individuals with chronic motor-incomplete SCI, and to identify how gait parameters differed from those of non-disabled (ND) individuals.</p> <p>Methods</p> <p>Data were analyzed from 51 subjects with SCI who had been randomized into one of four BWSLT groups: treadmill with manual assistance (TM), treadmill with electrical stimulation (TS), overground with electrical stimulation (OG), treadmill with locomotor robot (LR). Subjects with SCI performed a 10-meter kinematic walk test before and after 12 weeks of training. Ten ND subjects performed the test under three conditions: walking at preferred speed, at speed comparable to subjects with SCI, and with a walker at comparable speed. Six kinematic gait quality parameters were calculated including: cadence, step length, stride length, symmetry index, intralimb coordination, and timing of knee extension.</p> <p>Results</p> <p>In subjects with SCI, all training approaches were associated with improvements in gait quality. After training, subjects with SCI walked at higher cadence and had longer step and stride lengths. No significant differences were found among training groups, however there was an interaction effect indicating that step and stride length improved least in the LR group. Compared to when walking at preferred speed, gait quality of ND subjects was significantly different when walking at speeds comparable to those of the subjects with SCI (both with and without a walker). Post training, gait quality measures of subjects with SCI were more similar to those of ND subjects.</p> <p>Conclusion</p> <p>BWSLT leads to improvements in gait quality (values closer to ND subjects) regardless of training approach. We hypothesize that the smaller changes in the LR group were due to the passive settings used for the robotic device. Compared to walking at preferred speed, gait quality values of ND individuals walking at a slower speed and while using a walker were more similar to those of individuals with SCI.</p

Design Principles for FES Concept Development

© Cranfield University 2013. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright owner.A variety of pathologies can cause injury to the spinal cord and hinder movement. A range of equipment is available to help spinal injury sufferers move their affected limbs. One method of rehabilitation is functional electrical stimulation (FES). FES is a technique where small electrical currents are applied to the surface of the user’s legs to stimulate the muscles. Studies have demonstrated the benefits of using this method and it has also been incorporated into a number of devices. The aim of the project was to produce a number of designs for a new device that uses FES technology. The project was completed in conjunction with an industrial partner. A review of the literature and consultation with industrial experts suggested a number of ways current devices could be improved. These included encouraging the user to lean forwards while walking and powering the device using a more ergonomic method. A group of designers were used to produce designs that allowed the user to walk with a more natural gait and avoided cumbersome power packs. The most effective of these designs were combined to form one design that solved both problems. A 3-dimensional model of this design was simulated using computer-aided design software. Groups of engineers, scientists and consumers were also invited to provide input on how a new device should function. Each of these groups provided a design that reflected their specific needs, depending on their experience with similar technology. Low level prototypes were produced of these designs. A group of designers were also used to design concepts for a functional electrical stimulation device based on an introduction given by industry experts. Each of the designs was presented to experienced professionals to obtain feedback. A set of guidelines were also produced during the project that instructed how to create the designs

THE DEVELOPMENT OF A ROBOTIC TRAINER FOR THE CORRECTION OF ABNORMAL HUMAN GAIT

In this study, we developed a robotic gait trainer which induces the gait training based on predefined continuous proper lower extremity joint movements for the paralysis. AC servo motors and linear actuators were used to control hip and knee joints of patients and the weight support system was used to support the patient's weight during the gait training. We also implemented a GUI program to set the gait training pattern with several training parameters and to confirm states of patients and the system through the visual feedback. The effectiveness of the gait trainer will be determined by the long-term clinical experiments in the future. We expect that the developed robotic gait trainer could be applied very practically to recover gait abilities for persons with gait disorder

Therapeutic Potential of Haptic TheraDrive: An Affordable Robot/Computer System for Motivating Stroke Rehabilitation

There is a need for increased opportunities for effective neurorehabilitation services for stroke survivors outside the hospital environment. Efforts to develop low-cost robot/computer therapy solutions able to be deployed in home and community rehabilitation settings have been growing. Our long-term goal is to develop a very low-cost system for stroke rehabilitation that can use commercial gaming technology and support rehabilitation with stroke survivors at all functioning levels. This paper reports the results of experiments comparing the old and new TheraDrive systems in terms of ability to assist/resist subjects and the root-mean-square (RMS) trajectory tracking error. Data demonstrate that the new system, in comparison to the original TheraDrive, produces a larger change in normalized trajectory tracking error when assistance/resistance is added to exercises and has the potential to support stroke survivors at all functioning levels

The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: a systematic review

Context: Robotic assisted gait training (RAGT) technology can be used as a rehabilitation tool or as an assistive device for spinal cord injured (SCI) individuals. Its impact on upright stepping characteristics of SCI individuals using treadmill or overground robotic exoskeleton systems has yet to be established.Objective: To systematically review the literature and identify if overground or treadmill based RAGT use in SCI individuals elicited differences in temporal-spatial characteristics and functional outcome measures.Methods:A systematic search of the literature investigating overground and treadmill RAGT in SCIs was undertaken excluding case-studies and case-series. Studies were included if the primary outcomes were temporal-spatial gait parameters. Study inclusion and methodological quality were assessed and determined independently by two reviewers. Methodological quality was assessed using a validated scoring system for randomized and non-randomized trials.Results: Twelve studies met all inclusion criteria. Participant numbers ranged from 5-130 with injury levels from C2 to T12, American Spinal Injuries Association A-D. Three studies used overground RAGT systems and the remaining nine focused on treadmill based RAGT systems. Primary outcome measures were walking speed and walking distance. The use of treadmill or overground based RAGT did not result in an increase in walking speed beyond that of conventional gait training and no studies reviewed enabled a large enough improvement to facilitate community ambulation.Conclusion: The use of RAGT in SCI individuals has the potential to benefit upright locomotion of SCI individuals. Its use should not replace other therapies but be incorporated into a multi-modality rehabilitation approach

Mechatronic Design of a Lower Limb Exoskeleton

This chapter presents a lower limb exoskeleton mechatronic design. The design aims to be used as a walking support device focused on patients who suffer of partial lower body paralysis due to spine injuries or caused by a stroke. First, the mechanical design is presented and the results are validated through dynamical simulations performed in Autodesk Inventor and MATLAB. Second, a communication network design is proposed in order to establish a secure and fast data link between sensors, actuators, and microprocessors. Finally, patient‐exoskeleton system interaction is presented and detailed. Movement generation is performed by means of digital signal processing techniques applied to electromyography (EMG) and electrocardiography (EEG) signals. Such interaction system design is tested and evaluated in MATLAB whose results are presented and explained. A proposal of real‐time supervisory control is also presented as a part of the integration of every component of the exoskeleton