Physical therapy is targeted and adjusted over time for the rehabilitation of locomotor function in acute spinal cord injury interventions in physical and sports therapy

Franz, Martina; Richner, Lea; Wirz, Markus; Reumont, Anne von; Bergner, Ulla; Herzog, Tanja; Popp, Werner; Bach, Kathrin; Weidner, Norbert; Curt, Armin

doi:10.1038/s41393-017-0007-5

Cited by 24 publications

(16 citation statements)

References 24 publications

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“…However, when examining individual stages of the in-patient rehabilitation, at stage VA as well as at A III, no equivalence could be shown. In the latter stage, patients showed a higher VEL during the week than on the weekends, which might be due to the integration of sports activities into their therapy schedule, as already shown for ambulatory SCI patients (51). The result found for the stage VA is based on only a limited number of observations as most of these patients do not wheel actively, and thus has to be taken with care.…”

Section: Discussionmentioning

confidence: 52%

Reliability of Wearable-Sensor-Derived Measures of Physical Activity in Wheelchair-Dependent Spinal Cord Injured Patients

et al. 2018

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Physical activity (PA) has been shown to have a positive influence on functional recovery in patients after a spinal cord injury (SCI). Hence, it can act as a confounder in clinical intervention studies. Wearable sensors are used to quantify PA in various neurological conditions. However, there is a lack of knowledge about the inter-day reliability of PA measures. The objective of this study was to investigate the single-day reliability of various PA measures in patients with a SCI and to propose recommendations on how many days of PA measurements are required to obtain reliable results. For this, PA of 63 wheelchair-dependent patients with a SCI were measured using wearable sensors. Patients of all age ranges (49.3 ± 16.6 years) and levels of injury (from C1 to L2, ASIA A-D) were included for this study and assessed at three to four different time periods during inpatient rehabilitation (2 weeks, 1 month, 3 months, and if applicable 6 months after injury) and after in-patient rehabilitation in their home-environment (at least 6 months after injury). The metrics of interest were total activity counts, PA intensity levels, metrics of wheeling quantity and metrics of movement quality. Activity counts showed consistently high single-day reliabilities, while measures of PA intensity levels considerably varied depending on the rehabilitation progress. Single-day reliabilities of metrics of movement quantity decreased with rehabilitation progress, while metrics of movement quality increased. To achieve a mean reliability of 0.8, we found that three continuous recording days are required for out-patients, and 2 days for in-patients. Furthermore, the results show similar weekday and weekend wheeling activity for in- and out-patients. To our knowledge, this is the first study to investigate the reliability of an extended set of sensor-based measures of PA in both acute and chronic wheelchair-dependent SCI patients. The results provide recommendations for sensor-based assessments of PA in clinical SCI studies.

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Section: Discussionmentioning

confidence: 52%

Reliability of Wearable-Sensor-Derived Measures of Physical Activity in Wheelchair-Dependent Spinal Cord Injured Patients

et al. 2018

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“…An important goal of rehabilitation following spinal cord injury (SCI) is to improve the voluntary strength of muscles directly affected by the injury [ 1 – 3 ]. SCI results in complete or partial disruption of descending motor pathways resulting in paralysis or weakness, respectively [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial

et al. 2020

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Study design A multi-centred, single-blinded randomised controlled trial. Objectives To determine the effect of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury (SCI). Settings Seven hospitals in Australia and Asia. Methods One hundred and twenty people with recent SCI undergoing inpatient rehabilitation were randomised to either a Treatment or Control Group. One major muscle group from an upper or lower limb was selected if the muscle had grade 1 or grade 2 strength on a standard six-point manual muscle test. Participants allocated to the Treatment Group performed 10,000 isolated contractions of the selected muscle group, as well as usual care in 48 sessions over 8 weeks. Participants allocated to the Control Group received usual care alone. Participants were assessed at baseline and 8 weeks by a blinded assessor. The primary outcome was voluntary muscle strength on a 13-point manual muscle test. There were three secondary outcomes capturing therapists' and participants' perceptions of strength and function. Results The mean between-group difference of voluntary strength at 8 weeks was 0.4/13 points (95% confidence interval −0.5 to 1.4) in favour of the Treatment Group. There were no notable between-group differences on any secondary outcome. Conclusion Ten thousand isolated contractions of very weak muscles in people with SCI over 8 weeks has either no or a very small effect on voluntary strength.

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“…In recent years, the demands for exoskeleton as a rehabilitation device have been increased, because of the growing population of elderly people and brain injuries such as stroke and Spinal Cord Injury (SCI) [1]- [3]. Therefore, development of the exoskeleton has been focused in assisting patients who lost their muscle stamina to recover their mobility function [4]- [6]. Lower Limb Exoskeleton (LLE) is a type of rehabilitation wearable robots, which is worn in parallel with patients' lower limb.…”

Section: Introductionmentioning

confidence: 99%

Initialized Model Reference Adaptive Control for Lower Limb Exoskeleton

2019

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In this paper, a Proportional-Integral-Derivative (PID) controller tuning scheme by Initialized Model Reference Adaptive Control (IMRAC) for a Lower Limb Exoskeleton (LLE) is presented. Mathematical expression of the LLE structure is determined using Lagrangian and Kirchoff's equations. The transfer function of the structure based on the physical features of the links, and actuators is established under Range of Motion (RoM) condition. The PID controller of the LLE is tuned in a closed-loop control system using Ziegler-Nichols (Z-N) for initializing parameters of IMRAC. Adjustment mechanism is a gradient based method for real-time adaptation of tuned PID controller. A Lyapunov function has been applied to confirm the stability of IMRAC. The proposed IMRAC shows faster convergence in comparison with conventional non-initialized model reference adaptive control. It can be ascertained the proposed tuning scheme is applicable for real-time tuning of PID controller of LLE.

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Physical therapy is targeted and adjusted over time for the rehabilitation of locomotor function in acute spinal cord injury interventions in physical and sports therapy

Cited by 24 publications

References 24 publications

Reliability of Wearable-Sensor-Derived Measures of Physical Activity in Wheelchair-Dependent Spinal Cord Injured Patients

Reliability of Wearable-Sensor-Derived Measures of Physical Activity in Wheelchair-Dependent Spinal Cord Injured Patients

The effects of 10,000 voluntary contractions over 8 weeks on the strength of very weak muscles in people with spinal cord injury: a randomised controlled trial

Initialized Model Reference Adaptive Control for Lower Limb Exoskeleton

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