Movement goals encoded within the cortex and muscle synergies to reduce redundancy pre and post-stroke. The relevance for gait rehabilitation and the prescription of walking-aids. A literature review and scholarly discussion

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

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Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00815-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Antonio Rodríguez-Fernández ◽

Joan Lobo-Prat ◽

Josep M. Font-Llagunes

Keyword(s):

Systematic Review ◽

Clinical Efficacy ◽

Lower Limb ◽

Gait Training ◽

Health Conditions ◽

Current Evidence ◽

Clinical Aspects ◽

Gait Rehabilitation ◽

Comprehensive Overview ◽

Walking Aids

AbstractGait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

10.21203/rs.3.rs-40114/v2 ◽

2020 ◽

Author(s):

Antonio Rodríguez-Fernández ◽

Joan Lobo-Prat ◽

Josep M. Font-Llagunes

Keyword(s):

Systematic Review ◽

Clinical Efficacy ◽

Lower Limb ◽

Gait Training ◽

Health Conditions ◽

Current Evidence ◽

Clinical Aspects ◽

Gait Rehabilitation ◽

Comprehensive Overview ◽

Walking Aids

Abstract Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: A pilot study

Neurorehabilitation ◽

10.3233/nre-131035 ◽

2014 ◽

Vol 34 (2) ◽

pp. 267-276 ◽

Cited By ~ 16

Author(s):

Ruth Dickstein ◽

Sandra Levy ◽

Sara Shefi ◽

Sarit Holtzman ◽

Sara Peleg ◽

...

Keyword(s):

Pilot Study ◽

Motor Imagery ◽

Gait Rehabilitation ◽

Group Practice ◽

Post Stroke ◽

Imagery Group

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Assessment of an Assistive Control Approach Applied in an Active Knee Orthosis Plus Walker for Post-Stroke Gait Rehabilitation

Sensors ◽

10.3390/s20092452 ◽

2020 ◽

Vol 20 (9) ◽

pp. 2452

Author(s):

Ana Cecilia Villa-Parra ◽

Jessica Lima ◽

Denis Delisle-Rodriguez ◽

Laura Vargas-Valencia ◽

Anselmo Frizera-Neto ◽

...

Keyword(s):

Healthy Subjects ◽

Muscle Activation ◽

Inertial Sensors ◽

Lower Limbs ◽

Trunk Muscles ◽

Control Group ◽

Gait Rehabilitation ◽

Control Approach ◽

Post Stroke ◽

Knee Orthosis

The goal of this study is the assessment of an assistive control approach applied to an active knee orthosis plus a walker for gait rehabilitation. The study evaluates post-stroke patients and healthy subjects (control group) in terms of kinematics, kinetics, and muscle activity. Muscle and gait information of interest were acquired from their lower limbs and trunk, and a comparison was conducted between patients and control group. Signals from plantar pressure, gait phase, and knee angle and torque were acquired during gait, which allowed us to verify that the stance control strategy proposed here was efficient at improving the patients’ gaits (comparing their results to the control group), without the necessity of imposing a fixed knee trajectory. An innovative evaluation of trunk muscles related to the maintenance of dynamic postural equilibrium during gait assisted by our active knee orthosis plus walker was also conducted through inertial sensors. An increase in gait cycle (stance phase) was also observed when comparing the results of this study to our previous work. Regarding the kinematics, the maximum knee torque was lower for patients when compared to the control group, which implies that our orthosis did not demand from the patients a knee torque greater than that for healthy subjects. Through surface electromyography (sEMG) analysis, a significant reduction in trunk muscle activation and fatigability, before and during the use of our orthosis by patients, was also observed. This suggest that our orthosis, together with the assistive control approach proposed here, is promising and could be considered to complement post-stroke patient gait rehabilitation.

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Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00750-x ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Julie Vaughan-Graham ◽

Dina Brooks ◽

Lowell Rose ◽

Goldie Nejat ◽

Jose Pons ◽

...

Keyword(s):

Lower Limb ◽

Stakeholder Participation ◽

Patient Characteristics ◽

Evidence Base ◽

End Users ◽

Gait Rehabilitation ◽

Walking Ability ◽

Locomotor Training ◽

Post Stroke ◽

Single Use

Abstract Background Wearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton. Methods We used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton. Results Five persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use. Conclusions This study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.

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