Single joint robotic orthoses for gait rehabilitation: An educational technical review

Hussain, Shahid; Jamwal, Prashant K.; Ghayesh, Mergen H.

doi:10.2340/16501977-2073

Cited by 16 publications

(10 citation statements)

References 57 publications

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“…Moreover, the device power provided can be tuned to target specific gait abnormalities in a controlled way, by implementing subject-dependent assist-as-needed paradigms. A recent trend in rehabilitation robotics has been the use of extremely light-weight single-joint exoskeletons for gait training [ 37 ], which, in contrast to treadmill-based gait assistive robots, enable training in everyday scenarios, such as in overground walking and stair negotiation. Among them, powered hip orthoses analogous to our exoskeleton seem to positively support the rehabilitation of stroke survivors and other fragile patients with limited movement abilities, by improving spatiotemporal gait symmetry, metabolic efficiency and kinematics quality [ 38 – 41 ].…”

Section: Introductionmentioning

confidence: 99%

Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study

Sanz-Morère

Martini

Meoni

et al. 2021

J NeuroEngineering Rehabil

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Background Transfemoral amputation is a serious intervention that alters the locomotion pattern, leading to secondary disorders and reduced quality of life. The outcomes of current gait rehabilitation for TFAs seem to be highly dependent on factors such as the duration and intensity of the treatment and the age or etiology of the patient. Although the use of robotic assistance for prosthetic gait rehabilitation has been limited, robotic technologies have demonstrated positive rehabilitative effects for other mobility disorders and may thus offer a promising solution for the restoration of healthy gait in TFAs. This study therefore explored the feasibility of using a bilateral powered hip orthosis (APO) to train the gait of community-ambulating TFAs and the effects on their walking abilities. Methods Seven participants (46–71 years old with different mobility levels) were included in the study and assigned to one of two groups (namely Symmetry and Speed groups) according to their prosthesis type, mobility level, and prior experience with the exoskeleton. Each participant engaged in a maximum of 12 sessions, divided into one Enrollment session, one Tuning session, two Assessment sessions (conducted before and after the training program), and eight Training sessions, each consisting of 20 minutes of robotically assisted overground walking combined with additional tasks. The two groups were assisted by different torque-phase profiles, aiming at improving symmetry for the Symmetry group and at maximizing the net power transferred by the APO for the Speed group. During the Assessment sessions, participants performed two 6-min walking tests (6mWTs), one with (Exo) and one without (NoExo) the exoskeleton, at either maximal (Symmetry group) or self-selected (Speed group) speed. Spatio-temporal gait parameters were recorded by commercial measurement equipment as well as by the APO sensors, and metabolic efficiency was estimated via the Cost of Transport (CoT). Additionally, kinetic and kinematic data were recorded before and after treatment in the NoExo condition. Results The one-month training protocol was found to be a feasible strategy to train TFAs, as all participants smoothly completed the clinical protocol with no relevant mechanical failures of the APO. The walking performance of participants improved after the training. During the 6mWT in NoExo, participants in the Symmetry and Speed groups respectively walked 17.4% and 11.7% farther and increased walking speed by 13.7% and 17.9%, with improved temporal and spatial symmetry for the former group and decreased energetic expenditure for the latter. Gait analysis showed that ankle power, step width, and hip kinematics were modified towards healthy reference levels in both groups. In the Exo condition metabolic efficiency was reduced by 3% for the Symmetry group and more than 20% for the Speed group. Conclusions This study presents the first pilot study to apply a wearable robotic orthosis (APO) to assist TFAs in an overground gait rehabilitation program. The proposed APO-assisted training program was demonstrated as a feasible strategy to train TFAs in a rehabilitation setting. Subjects improved their walking abilities, although further studies are required to evaluate the effectiveness of the APO compared to other gait interventions. Future protocols will include a lighter version of the APO along with optimized assistive strategies.

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Section: Introductionmentioning

confidence: 99%

Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study

Sanz-Morère

Martini

Meoni

et al. 2021

J NeuroEngineering Rehabil

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“…This article also provides a renewed version of the reviews made by Hussain et al 1,8 The platform-based robotic devices developed for gait rehabilitation 42–44 are not included in this review. The robotic orthoses developed for the rehabilitation of single joint 45,46 such as Massachusetts institute of technology’s (MIT) Anklebot 47 and KNEXO 48,49 are not discussed. The mobile robotic orthoses for providing assistance to elderly, 50 providing load carrying augmentation, 51 incorporating functional electrical stimulation 52,53 and brain computer interface (BCI) 54,55 are also excluded from this review.…”

Section: Introductionmentioning

confidence: 99%

Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies

Jamwal

Hussain

Ghayesh

2020

Proc Inst Mech Eng H

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The application of robotic devices in providing physiotherapies to post-stroke patients and people suffering from incomplete spinal cord injuries is rapidly expanding. It is crucial to provide valid rehabilitation for people who are experiencing abnormality in their gait performance; therefore, design and development of newer robotic devices for the purpose of facilitating patients’ recovery is being actively researched. In order to advance the traditional gait treatment among patients, exoskeletons and orthoses were introduced over the last two decades. This article presents a thorough review of existing robotic gait rehabilitation devices. The latest advancements in the mechanical design, types of control and actuation are also covered. The study comprehends discussions on robotic rehabilitation devices developed both for the training on treadmill and over-ground training. The assist-as-needed strategy for the gait training is particularly emphasized while reviewing various control strategies applied to these robotic devices. This study further reviews experimental investigations and clinical assessments of different control strategies and mechanism designs of robotic gait rehabilitation devices using experimental and clinical trials.

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“…Es por ello que en los últimos años han surgido exoesqueletos y sistemas robóticos que pretenden rehabilitar a pacientes con marcha hemiparética. Debido a la naturaleza de esta patología, podemos encontrar tanto dispositivos bilaterales para terapia sobre suelo [11], como por ejemplo Ekso [12], Exo-H2 [13] o Hal-3 [14], o dispositivos montados sobre cinta rodante tales como Lokomat [15] o Lopes [16]; así como sistemas unilaterales [17] o monoarticulares [18], [19].…”

Section: Introductionunclassified

“…Si bien estos exoesqueletos han demostrado buenos resultados en cuanto a la asistencia que aportan a los usuarios, la mayoría de estos dispositivos imponen el movimiento en lugar de coordinarse con el movimiento de la extremidad sana del usuario [19], [21]. Así mismo, existen estudios sobre aprendizaje motor que analizan como los usuarios se ven afectados por las perturbaciones introducidas por las órtesis activas [22], [23].…”

Section: Introductionunclassified

Diseño de una órtesis activa de rodilla para la evaluación de algoritmos de asistencia robótica en sujetos hemiparéticos

Millán¹,

Hidalgo²,

Lima³

2020

Actas De Las XXXIX Jornadas De Automática, Badajoz, 5-7 De Septiembre De 2018

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Campo Real Km 0.200 Arganda del Rey (Madrid), julio.lora@csic.es ResumenUna de las principales consecuencias del Ictus es la hemiparesia, enfermedad en la cual los pacientes pierden movilidad en las extremidades de un lado del cuerpo. A pesar de que existen multitud de sistemas de rehabilitación para estos pacientes, muchos de ellos siguen necesitando de dispositivos asistenciales para realizar distintas tareas en su vida diaria. En este documento presentamos el diseño de una órtesis activa de rodilla para el desarrollo y evaluación de algoritmos de asistencia robótica en estos pacientes. Concretamente, el prototipo presentado está completamente definido en cuanto a sensores y actuadores, así como los controladores de bajo nivel. Los controladores que se han implementado varían en el nivel de asistencia que aportan al usuario y han sido testeados en una prueba de concepto con un sujeto sano. Los resultados obtenidos con los distintos controles señalan que el prototipo aquí presentado puede ser utilizado como base para el desarrollo y evaluación de algoritmos más complejos de coordinación y asistencia.Palabras Clave: Órtesis activa de rodilla, exoesqueleto robótico monoarticular, controladores de bajo nivel, control de impedancia, hemiparesia. INTRODUCCIÓNCerca de 16 millones de personas al año sufren Ictus por primera vez, siendo la marcha hemiparética una de sus principales consecuencias [1]. Esta marcha se caracteriza por ser más lenta e ineficiente que la marcha de una persona sana [2], y a pesar de la rehabilitación, la mayoría de los supervivientes de Ictus mantienen déficits neuromotores que les impiden andar con normalidad [3]. Ejemplos típicos de trastornos neuromotores en pacientes hemiparéticos son debilidad muscular y espasticidad [4], coordinación motora deteriorada [5], y rangos de movimiento de dorso-flexión en tobillo y flexión en rodilla reducidos. Estos trastornos conllevan una disminución de la velocidad de la marcha y la aparición de mecanismos de compensación [6], así como el aumento del riesgo de caídas y un aumento del consumo metabólico [7]. Incluso aquellos pacientes capaces de alcanzar velocidades cercanas a la normalidad continúan manifestando ciertas secuelas que les suponen una disminución de su calidad de vida [8], [9]. Como respuesta a la demanda de equipos de rehabilitación que surge para paliar los hándicaps sufridos por estos pacientes, la rehabilitación robótica se postula como una alternativa a tener en cuenta frente a las terapias convencionales [10]. Es por ello que en los últimos años han surgido exoesqueletos y sistemas robóticos que pretenden rehabilitar a pacientes con marcha hemiparética. Debido a la naturaleza de esta patología, podemos encontrar tanto dispositivos bilaterales para terapia sobre suelo [11], como por ejemplo Ekso [12], Exo-H2 [13] o Hal-3 [14], o dispositivos montados sobre cinta rodante tales como Lokomat [15] o Lopes [16]; así como sistemas unilaterales [17] o monoarticulares [18], [19]. Si bien estos dispositivos han demostrado grandes beneficios para ...

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Single joint robotic orthoses for gait rehabilitation: An educational technical review

Cited by 16 publications

References 57 publications

Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study

Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study

Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies

Diseño de una órtesis activa de rodilla para la evaluación de algoritmos de asistencia robótica en sujetos hemiparéticos

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