Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients

<p>Abstract</p> <p>Background</p> <p>Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine.</p> <p>Methods</p> <p>The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks.</p> <p>Results</p> <p>The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability.</p> <p>Conclusions</p> <p>The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.</p

Patient-cooperative control increases active participation of individuals with SCI during robot-aided gait training

ABSTRACT: BACKGROUND: Manual body weight supported treadmill training and robot-aided treadmill training are frequently used techniques for the gait rehabilitation of individuals after stroke and spinal cord injury. Current evidence suggests that robot-aided gait training may be improved by making robotic behavior more patient-cooperative. In this study, we have investigated the immediate effects of patient-cooperative versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury (iSCI). METHODS: Eleven patients with iSCI participated in a single training session with the gait rehabilitation robot Lokomat. The patients were exposed to four different training modes in random order: During both non-cooperative position control and compliant impedance control, fixed timing of movements was provided. During two variants of the patient-cooperative path control approach, free timing of movements was enabled and the robot provided only spatial guidance. The two variants of the path control approach differed in the amount of additional support, which was either individually adjusted or exaggerated. Joint angles and torques of the robot as well as muscle activity and heart rate of the patients were recorded. Kinematic variability, interaction torques, heart rate and muscle activity were compared between the different conditions. RESULTS: Patients showed more spatial and temporal kinematic variability, reduced interaction torques, a higher increase of heart rate and more muscle activity in the patient-cooperative path control mode with individually adjusted support than in the non-cooperative position control mode. In the compliant impedance control mode, spatial kinematic variability was increased and interaction torques were reduced, but temporal kinematic variability, heart rate and muscle activity were not significantly higher than in the position control mode. CONCLUSIONS: Patient-cooperative robot-aided gait training with free timing of movements made individuals with iSCI participate more actively and with larger kinematic variability than non-cooperative, position-controlled robot-aided gait training

Muscle weakness and lack of reflex gain adaptation predominate during post-stroke posture control of the wrist

Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to wrist joint stiffness during an active posture task. Continuous random torque perturbations applied to the wrist joint by a haptic manipulator had to be resisted maximally. Reflex provoking conditions were applied i.e. additional viscous loads and reduced perturbation signal bandwidth. Linear system identification and neuromuscular modeling were used to separate joint stiffness into the intrinsic resistance of the muscles including co-contraction and the reflex mediated contribution. Compared to an age and sex matched control group, patients showed an overall 50% drop in intrinsic elasticity while their reflexive contribution did not respond to provoking conditions. Patients showed an increased mechanical stability compared to control subjects. Post stroke, we found active posture tasking to be dominated by: 1) muscle weakness and 2) lack of reflex adaptation. This adds to existing doubts on reflex blocking therapy as the sole paradigm to improve active task performance and draws attention to muscle strength and power recovery and the role of the inability to modulate reflexes in post stroke movement disorders.Mechanical, Maritime and Materials Engineerin

Robot-Aided Gait Training with LOPES (chapter 21)

Robot-aided gait training in stroke survivors and spinal cord injury patients has shown inconclusive effects on walking ability. It is widely acknowledged that the control and design of the robotic devices needs to be further optimized to be able to provide training that fits better into modern insights in neural plasticity, motor learning, and motor recovery and in doing so improves its effectiveness. We will go more deeply into the need and scientific background for improvements on active participation, task specificity, and the facilitation of different recovery mechanisms. Subsequently, we will discuss recent advances that have been made in the control and design of robotic devices to improve on these aspects. Hereby, we will focus on the robotic gait training device LOPES that has been developed within our group. We will discuss how its design and control approach should contribute to improvements on all of the aforementioned aspects. The feasibility of the chosen approach is demonstrated by experimental results in healthy subjects and chronic stroke survivors. Future clinical testing has to demonstrate whether the outcome of robot-aided gait training can indeed be improved by increasing its task specificity, by the active contribution of the patient, and by allowing different movement strategies

HAMK Kaupallisten tapahtumien liiketoimintamalli

Tämän opinnäytetyön toimeksiantajana toimii Hämeen ammattikorkeakoulun Työelämän lähipalvelut. Opinnäytetyön tavoitteena oli määritellä Työelämän lähipalveluiden kaupallisten tapahtumien liiketoimintamalli. Liiketoimintamallin tavoitteena on toimia kaupallisten tapahtumien tuotantoprosessin tukena. Liiketoimintamalli havainnollistetaan Business Model Canvas-työkalua hyväksi käyttäen. Työn teoriaosuus koostuu liiketoimintamallista, liiketoimintamallin rakentamisesta ja tapahtumatuotannosta. Liiketoimintamallin teoriaa avataan käyttäen Business Model Canvas-työkalun kokonaisuuksia hyväksi käyttäen. Työhön on tehty teemahaastattelu, jossa haastateltiin kolmea henkilöä jotka toimivat tapahtumatuotannon asiantuntijoina. Haastattelun avulla selvitettiin Työelämän lähipalveluiden kaupallisten tapahtumien nykytilannetta ja tulevaisuuden mahdollisuuksia. Haastattelun tulokset on huomioitu liiketoimintamallia rakentaessa. Opinnäytetyön tuloksena on syntynyt kaupallisten tapahtumien liiketoi-mintamalli. Liiketoimintamalli havainnollistaa kaupallisten tapahtumien asiakaskuntaa, myyntiä, tapahtumatuotantoa ja kustannustehokasta ajattelua. Opinnäytetyön loppuun on koottu kehitysehdotukset. Kehitysehdotuksissa käydään läpi kokonaisuuksia, jotka saattaisivat parantaa kaupallisten tapahtumien tuotantoprosessia.This thesis was commissioned by the Business Services of Häme Univer-sity of Applied Sciences. The subject of this thesis was to make a business model of the commercial events of the Business Services. The business model is made to be part of the commercial events’ production process. The business model is illustrated by using the Business Model Canvas tool. The theoretical part of the thesis deals with the parts of the business model, how to build a business model and the event production. The business model itself is opened by using the Business Model Canvas tool. The thesis uses a qualitative research method. The study was made by in-terviewing three professional event organizers. The point of the interview was to clarify the current status of the Business services’ commercial events and the possibilities of the future. The results of the interviews were used when creating the actual business model. As the result of this thesis, the business model was created for the Business Services. The business model elaborates customer markets, sales, event production and cost-efficiency approach of commercial events. The final part of the thesis compiles the development points, which could help the production process of the commercial events