Bioinspired robotic rehabilitation tool for lower limb motor learning after stroke

Mención Internacional en el título de doctorEsta tesis doctoral presenta, tras repasar la marcha humana, las principales patologíıas y condiciones que la afectan, y los distintos enfoques de rehabilitación con la correspondiente implicación neurofisiológica, el camino de investigación que desemboca en la herramienta robótica de rehabilitación y las terapias que se han desarrollado en el marco de los proyectos europeos BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills y HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients, y probado bajo el paraguas del proyecto europeo ASTONISH: Advancing Smart Optical Imaging and Sensing for Health y el proyecto nacional ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This doctoral thesis presents, after reviewing human gait, the main pathologies and conditions that affect it, and the different rehabilitation approaches with the corresponding neurophysiological implications, the research journey that leads to the development of the rehabilitation robotic tool, and the therapies that have been designed, within the framework of the European projects BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills and HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients and tested under the umbrella of the European project ASTONISH: Advancing Smart Optical Imaging and Sensing for Health and the national project ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This work has been carried out at the Neural Rehabilitation Group (NRG), Cajal Institute, Spanish National Research Council (CSIC). The research presented in this thesis has been funded by the Commission of the European Union under the BioMot project - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (Grant Agreement number IFP7-ICT - 611695); under HANK Project - European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients (Grant Agreements number H2020-EU.2. - PRIORITY ’Industrial leadership’ and H2020-EU.3. - PRIORITY ’Societal challenges’ - 699796); also under the ASTONISH Project - Advancing Smart Optical Imaging and Sensing for Health (Grant Agreement number H2020-EU.2.1.1.7. - ECSEL - 692470); with financial support of Spanish Ministry of Economy and Competitiveness (MINECO) under the ASSOCIATE project - A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury (Grant Agreement number 799158449-58449-45-514); and with grant RYC-2014-16613, also by Spanish Ministry of Economy and Competitiveness.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: Fernando Javier Brunetti Fernández.- Secretario: Dorin Sabin Copaci.- Vocal: Antonio Olivier

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Bioinspired robotic rehabilitation tool for lower limb motor learning after stroke

Mención Internacional en el título de doctorEsta tesis doctoral presenta, tras repasar la marcha humana, las principales patologíıas y condiciones que la afectan, y los distintos enfoques de rehabilitación con la correspondiente implicación neurofisiológica, el camino de investigación que desemboca en la herramienta robótica de rehabilitación y las terapias que se han desarrollado en el marco de los proyectos europeos BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills y HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients, y probado bajo el paraguas del proyecto europeo ASTONISH: Advancing Smart Optical Imaging and Sensing for Health y el proyecto nacional ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This doctoral thesis presents, after reviewing human gait, the main pathologies and conditions that affect it, and the different rehabilitation approaches with the corresponding neurophysiological implications, the research journey that leads to the development of the rehabilitation robotic tool, and the therapies that have been designed, within the framework of the European projects BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills and HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients and tested under the umbrella of the European project ASTONISH: Advancing Smart Optical Imaging and Sensing for Health and the national project ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This work has been carried out at the Neural Rehabilitation Group (NRG), Cajal Institute, Spanish National Research Council (CSIC). The research presented in this thesis has been funded by the Commission of the European Union under the BioMot project - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (Grant Agreement number IFP7-ICT - 611695); under HANK Project - European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients (Grant Agreements number H2020-EU.2. - PRIORITY ’Industrial leadership’ and H2020-EU.3. - PRIORITY ’Societal challenges’ - 699796); also under the ASTONISH Project - Advancing Smart Optical Imaging and Sensing for Health (Grant Agreement number H2020-EU.2.1.1.7. - ECSEL - 692470); with financial support of Spanish Ministry of Economy and Competitiveness (MINECO) under the ASSOCIATE project - A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury (Grant Agreement number 799158449-58449-45-514); and with grant RYC-2014-16613, also by Spanish Ministry of Economy and Competitiveness.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: Fernando Javier Brunetti Fernández.- Secretario: Dorin Sabin Copaci.- Vocal: Antonio Olivier

Tacit adaptability on submaximal force control for ankle robotic training

Trabajo presentado en 2019 Wearable Robotics Association Conference (WearRAcon) in Scottsdale, AZ, EE.UU., el 26 Marzo de 2019.This study is part of our research on the use of a submaximal force generation task for early rehabilitation of ankle joint movements after stroke. We present the evaluation of metrics related to force generation and position control, and their relationship with submaximal force generation control learning, as well as their attainability for robot-mediated treatment after a cerebrovascular accident. In experiments with a group of healthy individuals we have found a decrease in the error and increase in the score of our proposed biofeedback game. We concluded that the proposed protocol and the rehabilitation robotic tool are able to promote motor learning in healthy individuals

Quantifying the Impact of a Lower Limb Exoskeleton on Whole-Body Manipulation Tasks. Methodological Approach and First Results

In recent years, back-support exoskeletons have been postulated as a competitive solution to reduce mechanical loading during lifting tasks, contributing to the prevention of low back pain. However, little research involving lower body exoskeletons has been done on this matter. The present study evaluates the impact of the H2 robotic exoskeleton on whole-body manipulation tasks, through a standardized experimental protocol and a set of objective metrics. Wearing the exoskeleton allowed the subject to perform the tasks successfully, occasionally showing magnified range of movement values at certain joints. In addition, its use reduced back mechanical loading of loaded-box lifts. However, the device also had a non-desirable impact on functional performance, increasing postural instability, slowing down tasks completion, and diminishing movement smoothness.The work presented in this paper was supported by the European Union’s Horizon 2020 research and innovation program under grant agreement No 779963—EUROBENCH. The authors would like to acknowledge the support of Technaid S.L. for unconditionally providing the exoskeleton for this research

Transcranial Magnetic Stimulation Following a Paired Associative Stimulation Protocol Based on a Video Game Neuromodulates Cortical Excitability and Motor Behavior

Transcranial Magnetic Stimulation (TMS) can be used to modulate cortico-spinal excitability following a paired associative stimulation (PAS) protocol. Movement-related cortical stimulation (MRCS) is a PAS protocol based on the synchronization of a single-pulse TMS with a movement task. However, plasticity and motor performance potentiation due to MRCS has been related exclusively to single-movement tasks. In order to unveil the effects of an MRCS protocol in complex movements, we applied PAS synchronized with a movement-related dynamic task (MRDT) with a customized video game. In 22 healthy subjects, we measured the reaction time (RT), trajectory error (TE), and the number of collected and avoided items when playing the custom video game to evaluate the task motor performance. Moreover, we assessed the recruitment curve of Motor Evoked Potentials (MEPs) with five different intensities to evaluate the motor corticospinal excitability. MEPs were recorded in Abductor Pollicis Brevis (APB) and Abductor Digiti Minimi (ADM), before, right after, and 30 min after the PAS intervention, in an active versus sham experimental design. The MRCS PAS intervention resulted in RT reduction, and motor corticospinal excitability was modulated, reflected as significant MEP amplitude change at 110% RMT intensity in ADM and at 130% RMT intensity in APB. RTs and ADM MEP amplitudes correlated positively in specific time and intensity assessments. We conclude that the proposed PAS protocol facilitated RT performance in a complex task. This phenomenon might be useful to develop neurorehabilitation strategies with complex movements, similar to activities of daily living.This research was funded by the European social fund through the Youth Employment Operational Program and the Youth Employment Initiative of the Comunidad de Madrid, within the framework of order 2811/2016 and by the Consejo Superior de Investigaciones Científicas, PIE 2018, 201850E062. The APC was funded by Shirley Ryan Ability Lab’s internal funding

Diseño de una órtesis motorizada de tobillo para rehabilitación de ictus con un enfoque TOP-DOWN

En la actualidad, la rehabilitación de pacientes que han sufrido un episodio de ictus tiene un enfoque BOTTOM-UP, o de abajo hacia arriba, que se basa en la asunción de que el movimiento pasivo de las articulaciones de los miembros afectados del paciente es beneficiosa para la recuperación del mismo. Se presenta en este trabajo una herramienta para evaluar el enfoque contrario, TOP-DOWN o de arriba hacia abajo, donde se pretende demostrar que la terapia recompensando al paciente cuando se detecta que está activamente intentando mover sus miembros paralizados es beneficiosa para su recuperación. Además, esta herramienta pretende ser una ayuda y no un sustituto del fisioterapeuta, permitiendo además tener medidas objetivables del estado de recuperación del sujeto patológico.Este estudio se ha realizado con financiación de la Comisión Europea, dentro del Séptimo Programa Marco, bajo contrato FP7-ICT-2009-247935: BETTER BNCI-driven Robotic Physical Therapies in Stroke Rehabilitation of Gait Disorders. También con subvención del Ministerio de Economía y Competitividad, plan CONSOLIDER INGENIO, proyecto HYPER (Hybrid NeuroProsthetic and NeuroRobotic Devices for Functional Compensation and Rehabilitation of Motor Disorders, CSD2009-00067).Peer reviewe

Plataforma Robótica con Paradigma Visual para Inducir Aprendizaje Motor en Sujetos Sanos

Proyectos recientes destacan cómo el aprendizaje motor y un nivel alto de atención puede mejorar la producción de fuerza submáxima durante la rehabilitación de ictus. Este estudio se centra en la evaluación de métricas detalladas de producción de fuerza y control de posición en sujetos sanos, y su correlación con la producción de fuerza submáxima en una tarea de rehabilitación consistente en mantener la posición del tobillo ante perturbaciones realizadas por una ortesis motorizada de tobillo, con un control de par cero y una interfaz visual. Se pide al sujeto que siga las trayectorias de la interfaz visual, mientras que el robot perturba el movimiento. El objetivo del ejercicio es mejorar el control motor, aprendiendo a controlar la posición del tobillo para seguir la trayectoria compensando las perturbaciones, bajo tres posibles paradigmas de entrenamiento: 1) par fijo; 2) aumento progresivo del par, y 3) par modulado basándose en la puntuación en la tarea. Todos los paradigmas de entrenamiento condujeron a una mejora en la puntuación comparando el rendimiento antes y después del entrenamiento, por lo que concluimos que esta plataforma induce aprendizaje en sujetos sanos.Esta investigación ha sido financiada por la Comisión de la Unión Europea bajo el proyecto BioMot - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (acuerdo de subvención número IFP7-ICT- 2013-10-611695), y parcialmente apoyado con la subvención RYC-2014-16613 por el Ministerio de Economía y Competitividad.Peer reviewe

HYBRID: Ambulatory Robotic Gait Trainer with Movement Induction and Partial Weight Support

Robotic exoskeletons that induce leg movement have proven effective for lower body rehabilitation, but current solutions offer limited gait patterns, lack stabilization, and do not properly stimulate the proprioceptive and balance systems (since the patient remains in place). Partial body weight support (PBWS) systems unload part of the patient&rsquo;s body weight during rehabilitation, improving the locomotive capabilities and minimizing the muscular effort. HYBRID is a complete system that combines a 6DoF lower body exoskeleton (H1) with a PBWS system (REMOVI) to produce a solution apt for clinical practice that offers improves on existing devices, moves with the patient, offers a gait cycle extracted from the kinematic analysis of healthy users, records the session data, and can easily transfer the patient from a wheelchair to standing position. This system was developed with input from therapists, and its response times have been measured to ensure it works swiftly and without a perceptible delay