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

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Clara Beatriz Sanz-Morère ◽  
Elena Martini ◽  
Barbara Meoni ◽  
Gabriele Arnetoli ◽  
Antonella Giffone ◽  
...  
Keyword(s):  
Pilot Study ◽  
Training Program ◽  
Gait Training ◽  
Rehabilitation Program ◽  
Gait Rehabilitation ◽  
Metabolic Efficiency ◽  
Cost Of Transport ◽  
Before And After ◽  
Locomotion Pattern ◽  
Spatio Temporal

Abstract 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.

scholarly journals Stroke Gait Rehabilitation: A Comparison of End-Effector, Overground Exoskeleton, and Conventional Gait Training

2019 ◽  
Vol 9 (13) ◽  
pp. 2627 ◽  
Author(s):  
Michela Goffredo ◽  
Chiara Iacovelli ◽  
Emanuele Russo ◽  
Sanaz Pournajaf ◽  
Chiara Di Blasi ◽  
...  
Keyword(s):  
Stroke Rehabilitation ◽  
Gait Training ◽  
Gait Rehabilitation ◽  
Positive Outcomes ◽  
Robot Assisted ◽  
End Effector ◽  
Gait Parameters ◽  
Significant Difference ◽  
Spatio Temporal ◽  
Clinically Significant

Gait recovery is one of the main goals of post-stroke rehabilitation and Robot-Assisted Gait Training (RAGT) has shown positive outcomes. However, there is a lack of studies in the literature comparing the effects of different devices. This paper aims to study the effects, in terms of clinical and gait outcomes, of treadmill-based and overground RAGT, compared to conventional gait training in stroke subjects. The results showed a significant improvement of clinical outcomes in both robotic treatments and in conventional therapy. The performance of locomotor tasks was clinically significant in the robotic groups only. The spatio-temporal gait parameters did not reveal any significant difference. Results suggest future multicentre studies on a larger number of subjects.

scholarly journals A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia

2016 ◽  
Vol 14 (1) ◽  
Author(s):  
Susan T. Tran ◽  
Staci Thomas ◽  
Christopher DiCesare ◽  
Megan Pfeiffer ◽  
Soumitri Sil ◽  
...  
Keyword(s):  
Pilot Study ◽  
Training Program ◽  
Juvenile Fibromyalgia ◽  
Biomechanical Assessment ◽  
Before And After

Effects of residential exercise training on heart rate recovery in coronary artery patients

2007 ◽  
Vol 292 (1) ◽  
pp. H510-H515 ◽  
Author(s):  
Jacopo M. Legramante ◽  
Ferdinando Iellamo ◽  
Michele Massaro ◽  
Sergio Sacco ◽  
Alberto Galante
Keyword(s):  
Heart Rate ◽  
Coronary Artery ◽  
Exercise Training ◽  
Training Program ◽  
Exercise Test ◽  
Heart Rate Recovery ◽  
Rehabilitation Program ◽  
Cycle Ergometer ◽  
Ergometer Exercise ◽  
Before And After

The aims of the present study are twofold: 1) to investigate whether heart rate recovery (HRR) after a cycle ergometry test is affected by exercise training and 2) to test the ability of HRR to replicate the baroreflex sensitivity (BRS) changes that occur in response to an exercise training program in coronary artery patients. We randomized 82 coronary artery patients undergoing a residential cardiac rehabilitation program to an exercise training group (TR; n = 43) and an untrained group (UTR; n = 39). All of the patients underwent an exercise test before and after the rehabilitation program. HRR was recorded at the end of the 1st and 2nd min after exercise. BRS was determined at rest before and after treatment. HRR after the 2nd min was significantly improved in TR patients (−21.4 ± 0.9 beats/min) compared with UTR patients (−17.8 ± 1.2 beats/min) at the end of the training program. Improvement in HRR paralleled that in BRS in TR patients (from 3.2 ± 0.3 to 5.3 ± 0.8 ms/mmHg; P < 0.001), whereas no significant change was evident in UTR patients (from 3.5 ± 0 to 4.0 ± 0.4 ms/mmHg; P = 0.230). Our data show that HRR in the 2nd min after the cessation of a cycle ergometer exercise test increased in coronary artery patients after an exercise training period. This result confirms the positive effect induced by exercise training on HRR and extends the conclusions of previous studies to different modalities of exercise (i.e., cycle ergometer). HRR might provide an additional simple marker of the effectiveness of physical training programs in cardiac patients.

scholarly journals Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

2021 ◽  
Vol 9 ◽  
Author(s):  
Brian Horsak ◽  
Mark Simonlehner ◽  
Lucas Schöffer ◽  
Bernhard Dumphart ◽  
Arian Jalaeefar ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Real World ◽  
Gait Training ◽  
Gait Rehabilitation ◽  
Overground Walking ◽  
Convenience Sample ◽  
Single Measure ◽  
The Real ◽  
Temporal Parameters ◽  
Spatio Temporal

Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab−), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (−0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab−. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.

scholarly journals Effectiveness of exercise training program on postural control and quality of life in middle-aged men with unilateral lower limb amputation

2021 ◽  
Vol 13 (2) ◽  
pp. 29-35
Author(s):  
Masoud Kashfi ◽  
◽  
Iman Khakroo Abkenar ◽  
Ali Fakourian ◽  
Giovanni Lombardi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Exercise Training ◽  
Postural Control ◽  
Training Program ◽  
Lower Limb ◽  
Rehabilitation Program ◽  
Limb Amputation ◽  
Exercise Training Program ◽  
Before And After

This study aimed to investigate whether the exercise-based amputee rehabilitation program improves postural control and quality of life in people with unilateral transtibial amputation (TTA). Twenty middle-aged men (48.4±3.8 y) with lower limb amputation, in a randomized-controlled longitudinal design, volunteered to participate in the study and were divided into experimental (EXP, n=10) and control (CON, n=10) groups. Before and after 8 weeks of the exercise training program, postural control performance, using one-leg standing (OLS) and Y-balance tests, was measured. The quality of life was also assessed before and after 8 weeks training period using standard questionnaires. Group x time interactions were observed for the EXP group in OLS and Y-balance tests and quality of life scores in comparison to pre- training values and the CON group (p<0.05). People with unilateral TTA who received exercise-based amputee rehabilitation program demonstrated significant improvement in balance performance with significant effects on quality of life.

Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: A pilot study

Lung Cancer ◽  
2006 ◽  
Vol 52 (2) ◽  
pp. 257-260 ◽  
Author(s):  
Martijn A. Spruit ◽  
Paul P. Janssen ◽  
Sonja C.P. Willemsen ◽  
Monique M.H. Hochstenbag ◽  
Emiel F.M. Wouters
Keyword(s):  
Lung Cancer ◽  
Pilot Study ◽  
Cancer Patients ◽  
Exercise Capacity ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Lung Cancer Patients ◽  
Before And After

A pilot study on the effect of ulipristal acetate on myoma angiogenesis, measured by 2D ultrasound and VEGF serum levels

2020 ◽  
pp. 19-29
Author(s):  
Patricia Diaz Ortega ◽  
Manuel García Manero
Keyword(s):  
Pilot Study ◽  
Power Doppler ◽  
Uterine Fibroids ◽  
Premenopausal Women ◽  
Serum Levels ◽  
Ulipristal Acetate ◽  
Before And After ◽  
Angiogenesis Process ◽  
2D Ultrasound ◽  
Average Size

Introduction: Symptomatic uterine fibroids can cause symptoms that can be disabling. There are many treatments, including ulipristal acetate, whose role in reducing symptoms and decreasing the size of the fibroid is well known. With this preliminary study, we also try to evaluate the correlation between myoma vascularization measured by ultrasound (Power Doppler 2D) and serum VEGF levels, before and after treatment with ulipristal acetate; in patients diagnosed with symptomatic uterine fibroids. Materials and Methods: A preliminary, prospective observational pilot study was designed. Twenty-four premenopausal women, diagnosed with symptomatic uterine fibroids, were included and all of them completed the study. Four cycles of ulipristal acetate were administered according to the dose and indications specified in the data sheet. In order to assess the influence of this treatment on the angiogenesis process of the fibroids, measurements of VEGF serum levels were made and their vascularization was assessed by means of 2D power doppler ultrasound; at the beginning and the end of treatment. In addition, several determinations of the same parameters were made throughout the successive visits. Endpoints were defined as the decrease in VEGF levels from previous levels, the decrease in myoma vascularization on ultrasound, and the reduction in myoma size. Result: 24 patients who met the inclusion criteria were enrolled (n=24). The average size of myomas was reduced from 45,08 ? 24,02mm to 29?16,96mm after treatment. The average VEGF serum level significantly decreased after the first treatment cycle (from 147,17 ? 153,51 pg/ml to 102,04 ? 186,08pg/ml). Vascularization of myomas after treatment with ulipristal acetate was analyzed, and a significantly decrease was achieved in 83,3% of cases. Conclusion: There is a correlation between myoma vascularization and treatment with Ulipristal acetate. SPRMs may provide effective treatment for women with symptomatic fibroids by two ways: supports selective progesterone receptor modulators and reduced angiogenesis. Keywords: Angiogenesis; Ulipristal Acetate; Uterine fibroids; VEGF

Evaluation of a New Field Epidemiology Training Program Intermediate Course to Strengthen Public Health Workforce Capacity in Tanzania

2021 ◽  
pp. 003335492097466
Author(s):  
Kate Wilson ◽  
Amir Juya ◽  
Ahmed Abade ◽  
Senga Sembuche ◽  
Devotha Leonard ◽  
...  
Keyword(s):  
Public Health ◽  
Training Program ◽  
Health Workforce ◽  
Outcome Evaluation ◽  
Exit Interviews ◽  
Field Epidemiology ◽  
Health Threats ◽  
Before And After ◽  
Workforce Capacity ◽  
Field Epidemiology Training Program

Objectives Sub-Saharan Africa faces a shortage of skilled epidemiologists to prevent, detect, and respond to health threats. Tanzania has implemented one of the first Centers for Disease Control and Prevention Field Epidemiology Training Program (FETP) Intermediate courses in Africa. This course aims to strengthen health workforce capacity in surveillance system assessment, outbreak investigation, and evaluation, prioritizing HIV control. We conducted an outcome evaluation of this new course. Methods We used a pre/post evaluation design using data from 4 cohorts of trainees who took the FETP Intermediate course from 2017 to 2020. We conducted knowledge assessments before and after each cohort and combined those results. Outcomes included knowledge and self-rated competency and trends in integrated disease surveillance and response (IDSR) data. We collected data through tests, field assignments, exit interviews, and data audits. We compared the mean change in pre-/posttest scores using linear regression and 95% CIs. We used content analysis to summarize exit interviews. Results Fifty-three FETP trainees from 10 regions enrolled in the FETP Intermediate course, and 52 (99.0%) completed the course. We found substantial increases in mean knowledge (44.0 to 68.0 points) and self-rated competency (4.14 to 4.43) scores before and after the course. Trainees evaluated 52 surveillance systems and 52 district HIV care programs, and 39 (75.0%) trainees participated in outbreak investigations. From before to after cohort 1, timeliness and completeness of IDSR reports increased from 4.2% to 52.1% and from 27.4% to 76.5%, respectively. Course strengths were quality of instruction, individualized mentoring, and practical skills gained. Challenges were mentor availability, limited time for data analysis practice, and balancing work and field assignments. Conclusions The Tanzania FETP Intermediate course substantially improved trainee knowledge and helped to improve local data quality and reporting. This course is a promising model to strengthen subnational capacity to prevent, detect, and respond to public health threats in Africa.

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