211 research outputs found
Design and Evaluation of the LOPES Exoskeleton Robot for Interactive Gait Rehabilitation
This paper introduces a newly developed gait rehabilitation device. The device, called LOPES, combines a freely translatable and 2-D-actuated pelvis segment with a leg exoskeleton containing three actuated rotational joints: two at the hip and one at the knee. The joints are impedance controlled to allow bidirectional mechanical interaction between the robot and the training subject. Evaluation measurements show that the device allows both a "pa- tient-in-charge" and "robot-in-charge" mode, in which the robot is controlled either to follow or to guide a patient, respectively. Electromyography (EMG) measurements (one subject) on eight important leg muscles, show that free walking in the device strongly resembles free treadmill walking; an indication that the device can offer task-specific gait training. The possibilities and limitations to using the device as gait measurement tool are also shown at the moment position measurements are not accurate enough for inverse-dynamical gait analysis
Applications of EMG in Clinical and Sports Medicine
This second of two volumes on EMG (Electromyography) covers a wide range of clinical applications, as a complement to the methods discussed in volume 1. Topics range from gait and vibration analysis, through posture and falls prevention, to biofeedback in the treatment of neurologic swallowing impairment. The volume includes sections on back care, sports and performance medicine, gynecology/urology and orofacial function. Authors describe the procedures for their experimental studies with detailed and clear illustrations and references to the literature. The limitations of SEMG measures and methods for careful analysis are discussed. This broad compilation of articles discussing the use of EMG in both clinical and research applications demonstrates the utility of the method as a tool in a wide variety of disciplines and clinical fields
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Trunk Rehabilitation Using Cable-Driven Robotic Systems
Upper body control is required to complete many daily tasks. One needs to stabilize the head and trunk over the pelvis, as one shifts the center of mass to interact with the world. While healthy individuals can perform activities that require leaning, reaching, and grasping readily, those with neurological and musculoskeletal disorders present with control deficits. These deficits can lead to difficulty in shifting the body center of mass away from the stable midline, leading to functional limitations and a decline in the quality of activity. Often these patient groups use canes, walkers, and wheelchairs for support, leading to occasional strapping or joint locking of the body for trunk stabilization.
Current rehabilitation strategies focus on isolated components of stability. This includes strengthening, isometric exercises, hand-eye coordination tasks, isolated movement, and proprioceptive training. Although all these components are evidence based and directly correlate to better stability, motor learning theories such as those by Nikolai Bernstein, suggest that task and context specific training can lead to better outcomes. In specific, based on our experimentation, we believe functional postural exploration, while encompassing aspects of strengthening, hand-eye coordination, and proprioceptive feedback can provide better results.
In this work, we present two novel cable robotic platforms for seated and standing posture training. The Trunk Support Trainer (TruST) is a platform for seated posture rehabilitation that provides controlled external wrench on the human trunk in any direction in real-time. The Stand Trainer is a platform for standing posture rehabilitation that can control the trunk, pelvis, and knees, simultaneously. The system works through the use of novel force-field algorithms that are modular and user-specific. The control uses an assist-as-needed strategy to apply forces on the user during regions of postural instability. The device also allows perturbations for postural reactive training.
We have conducted several studies using healthy adult populations and pilot studies on patient groups including cerebral palsy, cerebellar ataxia, and spinal cord injury. We propose new training methods that incorporate motor learning theory and objective interventions for improving posture control. We identify novel methods to characterize posture in form of the “8-point star test”. This is to assess the postural workspace. We also demonstrate novel methods for functional training of posture and balance.
Our results show that training with our robotic platforms can change the trunk kinematics. Specifically, healthy adults are able to translate the trunk further and rotate the trunk more anteriorly in the seated position. In the standing position, they can alter their reach strategy to maintain the upper trunk more vertically while reaching. Similarly, Cerebral Palsy patients improve their trunk translations, reaching workspace, and maintain a more vertical posture after training, in the seated position. Our results also showed that an Ataxia patient was able to improve their reaching workspace and trunk translations in the standing position. Finally, our results show that the robotic platforms can successfully reduce trunk and pelvis sway in spinal cord injury patients. The results of the pilot studies suggest that training with our robotic platforms and methods is beneficial in improving trunk control
Robotic biofeedback for post-stroke gait rehabilitation: a scoping review
This review aims to recommend directions for future research on robotic biofeedback towards prompt post-stroke gait rehabilitation by investigating the technical and clinical specifications of biofeedback systems (BSs), including the complementary use with assistive devices and/or physiotherapist-oriented cues. A literature search was conducted from January 2019 to September 2022 on Cochrane, Embase, PubMed, PEDro, Scopus, and Web of Science databases. Data regarding technical (sensors, biofeedback parameters, actuators, control strategies, assistive devices, physiotherapist-oriented cues) and clinical (participants’ characteristics, protocols, outcome measures, BSs’ effects) specifications of BSs were extracted from the relevant studies. A total of 31 studies were reviewed, which included 660 stroke survivors. Most studies reported visual biofeedback driven according to the comparison between real-time kinetic or spatiotemporal data from wearable sensors and a threshold. Most studies achieved statistically significant improvements on sensor-based and clinical outcomes between at least two evaluation time points. Future research should study the effectiveness of using multiple wearable sensors and actuators to provide personalized biofeedback to users with multiple sensorimotor deficits. There is space to explore BSs complementing different assistive devices and physiotherapist-oriented cues according to their needs. There is a lack of randomized-controlled studies to explore post-stroke stage, mental and sensory effects of BSs.This work has been supported in part by the FEDER Funds through the COMPETE 2020—Programa Operacional Competitividade e Internacionalização (POCI) and P2020 with the Reference Project SmartOs Grant POCI-01-0247-FEDER-039868, and by FCT national funds, under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, under scholarship reference 2020.05709.BD, and under Stimulus of Scientific Employment with the grant 2020.03393.CEECIND
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