El Hospital Nacional de Parapléjicos. Un centro que mira al futuro desde la excelencia clínica e investigadora

El Hospital Nacional de Parapléjicos de Toledo es un centro de referencia acreditado por el Sistema Nacional de Salud para el tratamiento de la persona con lesión medular compleja. Desde su apertura en 1974 aborda su actividad centrada en el paciente con un enfoque holístico y multidisciplinario. La ubicación del paciente como eje director justifica que no sólo se atienden los problemas sanitarios sino también los correspondientes a la repercusión personal y a su integración social. Dispone de una amplia cartera de servicios médico-quirúrgicos que dan cobertura a las posibles complicaciones de la lesión medular apostando por las últimas novedades tecnológicas. Como centro de excelencia, la investigación básica y clínica juegan un papel destacado en la configuración de su actividad. Asimismo, el centro también realiza una importante labor docente en Ciencias de la Salud tanto en el pregrado como postgrado.National Hospital for Paraplegics in Toledo is a reference centre accredited by the National Health System for the treatment of people with complex spinal cord injury. Since it was opened in 1974, its activity has focussed on the patient with a holistic and multidisciplinary approach. The location of the patient as the main focus justifies that not only health problems are attended to, but also those corresponding to personal aspects and social integration. It has a wide range of medical-surgical services that cover the possible complications of spinal cord injury, using the latest technological innovations. As a centre of excellence, basic and clinical research play an important role in the configuration of its activity. Likewise, the centre also carries out important teaching work in Health Sciences at both undergraduate and postgraduate levels

Objective metrics for functional evaluation of upper limb during the ADL of drinking: application in SCI

Three-dimensional kinematic analysis provides quantitative assessment of upper limb motion and is used as an outcome measure to evaluate movement disorders. The aim of the present study is to present a set of kinematic metrics for quantifying characteristics of movement performance and the functional status of the subject during the execution of the activity of daily living (ADL) of drinking from a glass. Then, the objective is to apply these metrics in healthy people and a population with cervical spinal cord injury (SCI), and to analyze the metrics ability to discriminate between healthy and pathologic people. 19 people participated in the study: 7 subjects with metameric level C6 tetraplegia, 4 subjects with metameric level C7 tetraplegia and 8 healthy subjects. The movement was recorded with a photogrammetry system. The ADL of drinking was divided into a series of clearly identifiable phases to facilitate analysis. Metrics describing the time of the reaching phase, the range of motion of the joints analyzed, and characteristics of movement performance such as the efficiency, accuracy and smoothness of the distal segment and inter-joint coordination were obtained. The performance of the drinking task was more variable in people with SCI compared to the control group in relation to the metrics measured. Reaching time was longer in SCI groups. The proposed metrics showed capability to discriminate between healthy and pathologic people. Relative deficits in efficiency were larger in SCI people than in controls. These metrics can provide useful information in a clinical setting about the quality of the movement performed by healthy and SCI people during functional activities

Desarrollo de sistemas modulares robóticos y neuroprotésicos personalizables para la asistencia de la marcha patológica a través del diseño centrado en el usuario: Proyecto TAILOR

Currently available wereable exoskeletons and neuroprosthetic gait assistive devices have controverted efficacy and low penetration into rehabilitation centers because they are generic solutions that do not consider the individual requirements and characteristics of each patient. TAILOR project proposes a new approach to the design of customizable neurorobotic systems, based on robotic exoskeletons (WR) and modular neuroprosthetics (NP) to provide subject-specific solutions. These two technologies are integrated with a closed loop hybrid controller. We are using a User-Centered Design approach for the design and development of these technologies to effectively introduce the requirements and needs of patients and clinical staff. Currently, we are making modifications to the WR to integrate it to the NP, which has already been developedPeer ReviewedObjectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (author's final draft

Benchmarking Bipedal Locomotion: A Unified Scheme for Humanoids, Wearable Robots, and Humans

In the field of robotics, there is a growing awareness of the importance of benchmarking [1], [2]. Benchmarking not only allows the assessment and comparison of the performance of different technologies but also defines and supports the standardization and regulation processes during their introduction to the market. Its importance has been recently emphasized by the adoption of the technology readiness levels (TRLs) in the Horizon 2020 information and communication technologies by the European Union as an important guideline to assess when a technology can shift from one TRL to the other. The objective of this article is to define the basis of a benchmarking scheme for the assessment of bipedal locomotion that could be applied and shared across different research communities.European Commission Seventh Framework Program, and COS

A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs

Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system

A data-globe and immersive virtual reality environment for upper limb rehabilitation after spinal cord injury

While a number of virtual data-gloves have been used in stroke, there is little evidence about their use in spinal cord injury (SCI). A pilot clinical experience with nine SCI subjects was performed comparing two groups: one carried out a virtual rehabilitation training based on the use of a data glove, CyberTouch combined with traditional rehabilitation, during 30 minutes a day twice a week along two weeks; while the other made only conventional rehabilitation. Furthermore, two functional indexes were developed in order to assess the patient’s performance of the sessions: normalized trajectory lengths and repeatability. While differences between groups were not statistically significant, the data-glove group seemed to obtain better results in the muscle balance and functional parameters, and in the dexterity, coordination and fine grip tests. Related to the indexes that we implemented, normalized trajectory lengths and repeatability, every patient showed an improvement in at least one of the indexes, either along Y-axis trajectory or Z-axis trajectory. This study might be a step in investigating new ways of treatments and objective measures in order to obtain more accurate data about the patient’s evolution, allowing the clinicians to develop rehabilitation treatments, adapted to the abilities and needs of the patients

Análisis biomecánico para confirmar el diagnóstico en neurorrehabilitación

[ES] En los pacientes con lesión medular cervical (LMC) se ve comprometida en mayor o menor medida la fuerza de las extremidades superiores, lo que se traduce en dependencia para las AVDs. Si la lesión es incompleta, puede preservarse la capacidad de marcha. En este contexto, resulta difícil realizar un diagnóstico clínico correcto y los equipos de fotogrametría constituyen una herramienta de gran valor para objetivar las secuelas motoras. El objetivo es presentar la metodología biomecánica de miembros superiores e inferiores aplicada a un caso de estudio. Se trata de un paciente varón de 61 años que padeció una LMC incompleta de etiología traumática que, previamente, había sufrido un TCE. Mediante fotogrametría se analizaron los recorridos articulares de la cadera, rodilla y tobillo durante los ciclos de la marcha y del hombro, codo y muñeca, así como una serie de índices cinemáticos descriptores del movimiento del miembro superior. Se obtuvo un patrón de marcha muy simétrico en ambos miembros inferiores. Sin embargo, la funcionalidad global y los índices de destreza en ambos miembros superiores presentaron una marcada asimetría entre ellos. Las herramientas biomecánicas evidencian aspectos del control motor no fácilmente visibles con los tests clínicos y que perfeccionan el diagnóstico de los casos complejos.[EN] In cervical spinal cord injured (SCI) patients, upper limbs strength is affected to a greater or lesser extent, producing dependence on the execution of ADLs. If the lesion is incomplete, the gait ability can be preserved. In this context, it is difficult to make a correct clinical diagnosis and the photogrammetry equipments constitute a tool of great value to determine with objectivity motor sequelae. The objective is to present the biomechanics methodology of upper and lower limbs applied to a case study. It is a 61- year-old male patient who suffered an incomplete SCI of traumatic etiology that had previously suffered a traumatic brain injury. Through photogrammetry, the range of motion of the hip, knee and ankle joints were analyzed during the cycles of the gait and the shoulder, elbow and wrist joints, as well as a series of kinematic indices describing the ability and dexterity of the upper limb movement. A very symmetrical gait pattern was obtained in both lower limbs. However, overall functionality and skill indices in both upper limbs present a high asymmetry between them. Biomechanical tools demonstrate aspects of motor control not easily visible with clinical tests and perfect diagnosis of complex casesDe Los Reyes Guzmán, A.; López-Dolado, E.; Pérez-Rizo, E.; Lozano-Berrio, V.; Gil-Agudo, A.; Del Ama Espinosa, A. (2019). Análisis biomecánico para confirmar el diagnóstico en neurorrehabilitación. En 11º Simposio CEA de Bioingeniería. Editorial Universitat Politècnica de València. 49-63. https://doi.org/10.4995/CEABioIng.2019.10045OCS496

Gait kinematic analysis in patients with a mild form of central cord syndrome

<p>Abstract</p> <p>Background</p> <p>Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed.</p> <p>Methods</p> <p>Twelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion - ROM) were compared between the two groups walking at similar speeds.</p> <p>Results</p> <p>The kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05).</p> <p>Conclusions</p> <p>The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.</p