A Powered Lower Limb Orthosis for Providing Legged Mobility in Paraplegic Individuals

Quintero, Hugo; Farris, Ryan J.; Hartigan, Clare; Clesson, Ismari; Goldfarb, Michael

doi:10.1310/sci1701-25

Cited by 68 publications

(33 citation statements)

References 18 publications

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“…Both [59] and [60] which focused on a novel approach to walking therapy were excluded. Another two studies [61,62] concerning the whole lower limb recovery but no ankle were excluded. Eventually, 29 papers that still met the inclusion criteria were selected for this systematic review [58,63-90].…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

Zhang

Davies

Xie

2013

J NeuroEngineering Rehabil

179

117

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ObjectiveThe aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries.MethodsThirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle*’, ‘robot*’, ‘rehabilitat*’ or ‘treat*’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation.ResultsTwenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II.ConclusionAll the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

Zhang

Davies

Xie

2013

J NeuroEngineering Rehabil

179

117

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“…Further, given the current gate-keeping model of primary care and the vulnerability of persons with SCI developing SHCs, it is critical for persons with SCI to feel validated and concerns heard [46]. The present study builds on previous work highlighting caregiving tensions between persons with SCI and care providers.…”

Section: Discussionmentioning

confidence: 97%

Secondary health conditions and spinal cord injury: an uphill battle in the journey of care

Guilcher¹,

Craven²,

Lemieux‐Charles³

et al. 2012

Disability and Rehabilitation

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PurposeTo understand the journey of care in the prevention and management of secondary health conditions (SHCs) following spinal cord injury (SCI).MethodThis was a case study design with ‘Ontario’ as the case. The Network Episode Model was used as the conceptual framework. Data sources included in depth interviews with persons with SCI, care providers, and policy and decision makers. Document analysis was also conducted on relevant materials and policies. Key informants were selected by purposeful sampling as well as snowball sampling to provide maximum variation. Data analysis was an iterative process and involved descriptive and interpretive analyses. A coding structure was developed based on the conceptual framework which allowed for free nodes when emerging ideas or themes were identified.ResultsTwenty-eight individuals were interviewed (14 persons with SCI and 14 persons representing care providers, community advocacy organization representatives, system service delivery administrators and policy-makers). A major over-arching domain that emerged from the data was the concept of ‘fighting’. Eleven themes were identified: at the micro-individual level: (i) social isolation and system abandonment, (ii) funding and equitable care, (iii) bounded freedom and self-management; at the meso care provider level: (iv) gender and caregiving strain, (v) help versus disempowerment, (vi) holistic care-thinking outside the box, (vii) poor communication and coordination of care; and at the macro health system level: (viii) fight for access and availability, (ix) models of care tensions, (x) private versus public tensions and (xi) rigid rules and policies.ConclusionsFindings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates. If we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level.Implications for RehabilitationSecondary health conditions are problematic for individuals with a spinal cord injury (SCI).This study aimed to understand the journey of care in the prevention and management of secondary health conditions (SHCs) following SCI.Findings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates.All stakeholders involved recognized the disparities in access to care and resources that exist within the system. We recommend that if we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level.

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“…This approach enables the user to autonomously perform the various tests described here without the assistance of an external operator. A more detailed description of the exoskeleton control architecture and user interface, which discusses more specifically the conditions required to move between activities, is given in [46]. Finally, note that the turning maneuver (performed twice in each TUG test and also in the 6 MWT) does not entail a separate control mode, but rather is performed in the standing activity mode, with the use of the stability aid, by incrementally twisting the upper body and turning in place.…”

Section: Comparative Assessment Of a Powered Lower Limb Exoskeletonmentioning

confidence: 99%

A Preliminary Assessment of Legged Mobility Provided by a Lower Limb Exoskeleton for Persons With Paraplegia

Farris

Quintero

Murray

et al. 2014

IEEE Trans. Neural Syst. Rehabil. Eng.

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178

122

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This paper presents an assessment of a lower limb exoskeleton for providing legged mobility to people with paraplegia. In particular, the paper presents a single-subject case study comparing legged locomotion using the exoskeleton to locomotion using knee–ankle–foot orthoses (KAFOs) on a subject with a T10 motor and sensory complete injury. The assessment utilizes three assessment instruments to characterize legged mobility, which are the timed up-and-go test, the Ten-Meter Walk Test (10 MWT), and the Six-Minute Walk Test (6 MWT), which collectively assess the subject’s ability to stand, walk, turn, and sit. The exertion associated with each assessment instrument was assessed using the Physiological Cost Index. Results indicate that the subject was able to perform the respective assessment instruments 25%, 70%, and 80% faster with the exoskeleton relative to the KAFOs for the timed up-and-go test, the 10 MWT, and the 6 MWT, respectively. Measurements of exertion indicate that the exoskeleton requires 1.6, 5.2, and 3.2 times less exertion than the KAFOs for each respective assessment instrument. The results indicate that the enhancement in speed and reduction in exertion are more significant during walking than during gait transitions.

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A Powered Lower Limb Orthosis for Providing Legged Mobility in Paraplegic Individuals

Cited by 68 publications

References 18 publications

Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

Secondary health conditions and spinal cord injury: an uphill battle in the journey of care

A Preliminary Assessment of Legged Mobility Provided by a Lower Limb Exoskeleton for Persons With Paraplegia

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