Neuro-degenerative and vascular diseases: methodology for functional recovery

Posture refers to the position of the body in space that is expressed through the interaction of all the districts and systems such as the musculoskeletal system, the central and peripheral nervous system. Alterations in imbalances and associated diseases produce a structural and physiologic reorganization of the anatomical structures to improve postural dynamics. Generally, these changes can occur due to trauma or following the onset of neurodegenerative diseases or vascular problems that, in different ways, ranging to compromising the proper functioning of one of the components involved in postural processes. Currently postural diseases are treated by passive (brace and orthosis) and active (robotic device and traditional rehabilitation) methods according with the severity of imbalance (1). The aim of this study is to evaluate the effects of an innovative exoskeleton, called Human Body Posturizer (HBP), in rehabilitation of different neurodegenerative and vascular diseases. We recruited 37 subjects divided according to the pathology: 9 subjects with Parkinson’s disease, 14 with multiple sclerosis, 10 post-stroke patients and 4 with infantile cerebral palsy. Subjects underwent 4 weeks HBP treatment, consisting of 30 minutes, with different timing and duration of treatment depending on the specific pathology. The samples were analyzed by using of Electronic Baropodometer, Stabilometric Platform and Sensorizer FreeSense. Each subject was sampled before and after treatment and differences between pre and post treatment were subjected to statistical analysis. In all groups, we found significant differences in the comparison between the measurements performed before and after treatment with HBP. These changes have allowed to pointing out the improvement in the parameters analyzed in the post-treatment tests. Thus, as demonstrated by other studies (2), the use of HBP could represent an integrative therapy for different postural diseases and it can be inserted as a supportive therapy during the rehabilitation process in neurodegenerative and vascular diseases

New methodology for a correct gait

A proper biomechanics of the foot is fundamental for the maintenance of posture and for a symmetrical distribution of plantar pressures. It ‘been shown that high plantar pressures are greater risks of damage to be covered by the same foot that the anatomical structures involved in the above processes postural(1). Thus numerous studies have investigated the effectiveness of orthotics that, by increasing the contact surface between the foot and the ground, they were going to decrease the load associated with certain anatomical districts(2). The aim of our study was to evaluate, through static and dynamic baropodometry, the effectiveness of the regular gait, a new support that has the task of stabilizing the arch of the foot in static and to allow proper movement of the same. These subjects underwent rating scales and baropodometric examination before and after using the orthotics. It was carried out both the analysis monopodalic, for the evaluation of the effectiveness of the insole in the redistribution of pressures between different zones of a same foot, both the bipodalic for the evaluation of the symmetry in the distribution of the pressures between the different feet. The results obtained, subjected to statistical analysis for significance, show that the insole, to how it was designed, is able to restore a correct distribution of the parameters both in analysis monopodalic that bipodalic and both in static and dynamic conditions. These redistributions, in addition, also remain in the tests posttreatment without footwear, showing that the particular conformation of the plantar, with supports positioned in specific districts of the arch of the foot, is able to stimulate the proprioceptors present therein and therefore to enable a reorganization at the central level . This reorganization allows the subject treated with the regular gait to maintain the morphology and the smooth running of the propeller breech during movement not only while wearing the insole, but also after it has been remove

Plantar support for a correct gait

Postural adjustments to maintain static and dynamic balance depend on the relationship between sensory input organs and the environment. The study of foot posture assists in the evaluation of overall posture. The human foot is the basis of support and propulsion for gait and it provides support and flexibility for effective weight transfer (1). Foot posture involves the integration of sensory information from the periphery to the body, especially mechanoreceptors in the sole of the foot, related to gravitational acceleration, the environment and the position of the segments of the body. Numerous studies have investigated the effectiveness of orthotics that, by increasing the contact surface between the foot and the ground, were going to decrease the load associated with certain areas of plantar surface (2). The aim of our study was to evaluate the effects of innovative insoles, named Regular Gait (RG), on plantar pressures distribution during standing position and walking in healthy subjects; therefore, we investigated whether these effects are maintained after insole removing. 30 subjects were tested; these were free of foot diseases or damage to the anatomical structures involved in the processes above posture. These subjects underwent rating scales and static and dynamic baropodometric examination before and after using RG. The results obtained, subjected to statistical analysis for significance, show that the RG, for as we have designed, is able to restore a correct distribution of the parameters both in static and dynamic conditions. We have also shown that the best results were obtained only after a month of treatment with RG and that the results obtained persist even in the tests post-treatment without insoles. The fact we charged to the special geometry with which the insole is designed: its supports, that are located in specific regions of the plantar arch, go to stimulate the mechanoreceptors found there. In this way, through the streets proprioceptive, you can obtain a reorganization of the plantar stance even at the higher nervous centers level. This allowed the subjects treated to improve their posture both while walking and during the maintenance of the upright position. As far demonstrated , the RG seems to be a tool whose potential does not end in the modification of the plantar stance, but that influences a number of processes, by acting on the kinetic chains that originate from the foot

An 8-week rehabilitation training using the HBP exoskeleton improves cognitive brain functions in multiple sclerosis patients

It has been showed that a single application of the exoskeleton (HBP) in multiple sclerosis patients is able to improve mobility and ambulation. These effects have been associated with brain changes in high-level executive functions decisive for improving patients’ motor control [1]. We applied an 8-weeks rehabilitation protocol in 12 MS patients, half of them randomly assigned to a standard protocol (control group, CG) and the other half to a protocol based on the HBP use (experimental group, EG). Patients were evaluated before and after rehabilitation training using multiple neurological, physiotherapeutic and cognitive testing. During the cognitive task, high-resolution EEG was also recorded for ERP analysis. Results showed that both groups improved their performance in the Barthel, Rivermead, 2-WT, 25-FWT, Tinetti and BBS tests. Only in the EG, other positive treatment effects were observed as measured by the EDSS disability scale and the FSS. Accordingly, in cognitive testing, only the EG showed significant benefits in response time (RT) and accuracy. At brain level the EG showed enhancement in task-related preparatory activity in frontal and prefrontal cortices and stronger post-stimulus activity in the anterior Insula, whose activity is related to more efficient decision making. The CG didn’t show enhanced performance in the cognitive task but only large activity in visual areas, as observed in EG. Concluding, both rehabilitation protocols brought substantial neurophysiological benefits to MS patients, however, the HBP protocol was particularly effective, boosting cognitive functions in prefrontal and frontal brain areas, it allowed improvements in RT and accuracy. The integration of HBP with standard rehabilitation procedure may considerably reduce disability in MS patients