Image_1_G-Exos: A wearable gait exoskeleton for walk assistance.JPEG

Stroke is the second leading cause of death and one of the leading causes of disability in the world. According to the World Health Organization, 11 million people suffer a stroke yearly. The cost of the disease is exorbitant, and the most widely used treatment is conventional physiotherapy. Therefore, assistive technology emerges to optimize rehabilitation and functional capabilities, but cost, robustness, usability, and long-term results still restrict the technology selection. This work aimed to develop a low-cost ankle orthosis, the G-Exos, a wearable exoskeleton to increase motor capability by assisting dorsiflexion, plantarflexion, and ankle stability. A hybrid system provided near-natural gait movements using active, motor, and passive assistance, elastic band. The system was validated with 10 volunteers with foot drop: seven with stroke, two with incomplete spinal cord injury (SCI), and one with acute inflammatory transverse myelitis (ATM). The G-Exos showed assistive functionality for gait movement. A Friedman test showed a significant difference in dorsiflexion amplitude with the use of the G-Exos compared to gait without the use of the G-Exos [x2(3) = 98.56, p 2(3) = 36.12, p < 0.001]. The G-Exos is a robust, lightweight, and flexible assistive technology device to detect the gait phase accurately and provide better human-machine interaction. G-Exos training improved capability to deal with gait disorders, usability, and motor and functional recovery. Wearable assistive technologies lead to a better quality of life and contribute using in activities of daily living.</p

Image_2_G-Exos: A wearable gait exoskeleton for walk assistance.JPEG

Stroke is the second leading cause of death and one of the leading causes of disability in the world. According to the World Health Organization, 11 million people suffer a stroke yearly. The cost of the disease is exorbitant, and the most widely used treatment is conventional physiotherapy. Therefore, assistive technology emerges to optimize rehabilitation and functional capabilities, but cost, robustness, usability, and long-term results still restrict the technology selection. This work aimed to develop a low-cost ankle orthosis, the G-Exos, a wearable exoskeleton to increase motor capability by assisting dorsiflexion, plantarflexion, and ankle stability. A hybrid system provided near-natural gait movements using active, motor, and passive assistance, elastic band. The system was validated with 10 volunteers with foot drop: seven with stroke, two with incomplete spinal cord injury (SCI), and one with acute inflammatory transverse myelitis (ATM). The G-Exos showed assistive functionality for gait movement. A Friedman test showed a significant difference in dorsiflexion amplitude with the use of the G-Exos compared to gait without the use of the G-Exos [x2(3) = 98.56, p 2(3) = 36.12, p < 0.001]. The G-Exos is a robust, lightweight, and flexible assistive technology device to detect the gait phase accurately and provide better human-machine interaction. G-Exos training improved capability to deal with gait disorders, usability, and motor and functional recovery. Wearable assistive technologies lead to a better quality of life and contribute using in activities of daily living.</p

Additional file 1: Table S1. of Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review

Description of the robotic device(s) used as a tool for rehabilitation of individuals with SCI. (PDF 157 kb

Additional file 2: Table S2. of Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review

Studies that presented metabolic and cardiorespiratory parameters as outcome measures in individuals with SCI. (PDF 257 kb

Additional file 3: Table S3. of Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review

Studies that presented altered reflex behavior parameters as outcome measures in individuals with SCI. (PDF 345 kb

Quantification of Cxs protein levels in the hippocampus during acute and latent periods.

<p>(A–D) We observed stable steady levels of Cx36, Cx45, Cx43 protein levels during the acute period. (E–F) Similarly, analysis performed in the latent period showed steady state levels of Cx36 and Cx45 proteins. (G–H) In addition, we observed changes in both Cx43 total protein levels and Cx43 unphosphorylated form, which have higher levels in the latent group when compared to controls. Beta-actin (42 kDa) was used as internal control. Optical densities (OD) from acute (n = 7) and latent (n = 7) groups were normalized by OD from control (n = 7) group in three independent experiments. Bars represent standard errors of mean. * <i>P</i><0.01; **<i>P</i><0.001 in T-Test.</p

Effects of pharmacological blockade of GJ channels on epileptiform potentials during status epilepticus (SE).

<p>(A, B, C) Representative spectrograms of the raw ECoGs from Control CBX, SE and SE+CBX groups, showing the main frequencies, evidenced by the color intensity, which compose the signal during the 2-hour interval after injection of CBX or saline. Note the increase of ECoG power in the SE group (B) and the reduction of color intensity after CBX treatment (C), showing the decrease of power of all frequency bands, especially the beta frequency. Representative power spectra of SE+CBX group. (D, E) Power spectrum of basal and methyl-scopolamine periods shows similar frequency composition. (F) It is possible to observe that pilocarpine-induced SE enhanced the power of all frequency bands, especially at 12–35 Hz range. (G–K) CBX administration 30 minutes after SE establishment caused notable decrease of the power in the beta frequency oscillations observed in the following 2 hours. Since we found that the reduction of beta oscillations occurs during the evolution of SE (data not shown), we tested whether this reduction was significant when compared to the same periods of SE group. (L) We observed that the time period for reduction in the beta frequency range was significantly decreased in the animals that received CBX injection. Bars represent standard errors of mean. *<i>P</i><0.01 in T-Test.</p

Gene expression levels of Cxs in the rat hippocampus during acute and latent periods.

<p>(A) Cx36 gene expression remains stable throughout acute and latent periods. (B) On the other hand, we were not able to detect changes in Cx45 transcript levels in acute period, although increased expression was observed in the latent group. (C) Similar results were observed for Cx43 mRNA levels, since we were not able to detect significant differences in the acute group, but we found increased expression in the latent group when compared to controls. (D) Gene expression of cyclophilin A was used as internal control. Means from acute (n = 8) and latent (n = 8) groups were normalized based on control group (n = 8) expression levels. Bars represent standard errors of mean. *<i>P</i><0.001 <i>vs</i>. Control group in Tukey's HSD pairwise comparisons after one-way ANOVA.</p

Effects of pharmacological blockade of GJ channels on ECoG.

<p>Representative local field potentials of SE+CBX group. (A, B) It is possible to see that basal and methyl-scopolamine periods share similar electrical activity patterns. After pilocarpine injection, we observed increasing epileptiform potentials represented by isolated spikes (I, arrows), poly-spikes (J-a) and spike-wave complexes (J-b), culminating in SE establishment (C). CBX administration 30 minutes after SE establishment (D) was able to induce changes in the epileptiform potentials, which could be seen during the whole analyzed interval post-CBX injection (E–H). We found out that the time frame for occurrence of flat periods (K, arrows) from SE+CBX group was significantly shorter when compared to SE group (L). Bars represent standard errors of mean. *<i>P</i><0.01 in T-Test.</p

Cx36 expression in parvalbumin (PV)-positive interneurons into CA3.

<p>In order to quantify the amount of Cx36 (green) in PV-positive cells (red), we performed double-labeling experiments in coronal sections of rats from control, acute and latent groups counterstained with 4′,6-diamidino-2-phenylindole (DAPI, blue). (A–D) High magnification of the selected area highlighted in the control section (E) shows Cx36 (A), PV (B) and DAPI labeling (C). Colocalization of both proteins is evidenced in (D). (E, F, G) In representative images of CA3 area it is possible to visualize that Cx36 remains in PV-positive cells in acute (F) and latent (G) groups. The pixel intensity profile revealed intersection of the green and red signals, supporting the colocalization of both proteins. (H) Pixel intensity analysis showed no significant differences in Cx36 mean intensity in PV-positive cells between the groups. (I–K) Intensity correlation between green (Cx36) vs. red (PV) channels of representative images from control, acute and latent periods, respectively. (L) Quantitative analysis (n = 4 animals per group) revealed that Mander's colocalization coefficient did not change in acute and latent groups. Bars represent standard errors of mean. Scale bar: 50 µm.</p