scholarly journals Improved Physiological Gait in Acute and Chronic SCI Patients After Training With Wearable Cyborg Hybrid Assistive Limb

2021 ◽  
Vol 15 ◽  
Author(s):  
Alexis Brinkemper ◽  
Mirko Aach ◽  
Dennis Grasmücke ◽  
Birger Jettkant ◽  
Thomas Rosteius ◽  
...  
Keyword(s):  
Gait Cycle ◽  
Walk Test ◽  
Scientific Publications ◽  
Timed Up And Go ◽  
Functional Parameters ◽  
Cord Injury ◽  
Gait Phase ◽  
Robotic Devices ◽  
Hybrid Assistive Limb ◽  
10 Meter Walk Test

In recent years robotic devices became part of rehabilitation offers for patients suffering from Spinal Cord Injury (SCI) and other diseases. Most scientific publications about such devices focus on functional outcome. The aim of this study was to verify whether an improvement in physiological gait can be demonstrated in addition to the functional parameters after treatment with neurological controlled HAL® Robot Suit. Fifteen subjects with acute (<12 months since injury, n = 5) or chronic (>12 months since injury, n = 10) incomplete paraplegia (AIS B, n = 0/AIS C, n = 2/AIS D, n = 8) or complete paraplegia (AIS A, n = 5) with zones of partial preservation participated. Subjects underwent a body weight supported treadmill training for five times a week over 12 weeks using HAL®. At baseline and at the end of the study a gait analysis was performed and additional functional parameters such as 10-Meter-Walk-Test, Timed-Up-and-Go-Test, 6-Minutes-Walk-Test, and WISCI II score were collected. Results were evaluated for whole group and individually for acute and chronic subgroups. All functional parameters improved. Differences were also found in physiological parameters such as phases of gait cycle and accompanied by significant improvement in all spatiotemporal and gait phase parameters. The presented study shows signs that an improvement in physiological gait can be achieved in addition to improved functional parameters in patients with SCI after completing 12-week training with HAL®.Trial Registration: DRKS, DRKS00020805. Registered 12 February 2020—Retrospectively registered, https://www.drks.de/DRKS00020805.

scholarly journals Аналіз наявних інструментів оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона

2021 ◽  
pp. 84-91
Author(s):  
В. Брушко ◽  
Р. Баннікова ◽  
А. Ковельська
Keyword(s):  
Dual Task ◽  
Berg Balance Scale ◽  
Walk Test ◽  
Walk Distance ◽  
Timed Up And Go ◽  
Sf 36 ◽  
Minute Walk Distance ◽  
Minute Walk ◽  
Disease Questionnaire ◽  
10 Meter Walk Test

Резюме. Правильний і обґрунтований вибір інструментальних методів оцінювання функціо-нального стану пацієнта є обов’язковою умовою адекватної фізичної терапії. Особливе місце цей аспект займає в системі нейрореабілітації пацієнтів з хворобою Паркінсона в Україні, оскільки на сьогодні кількість осіб, що потребують систематичної фізичної терапії, сягає 23 900 тис. Наростаюча маніфестація моторних і немоторних симптомів при хворобі Паркін-сона, від яких часто вирішальною мірою залежить тяжкість стану пацієнта, негативно впливає на якість його життя. Наявні функціональні порушення, які є самостійними проявами хвороби Паркінсона, вимагають специфічного підходу до комплексного інструментального досліджен-ня цих порушень для визначення диференційно-діагностичних критеріїв та оцінювання впливу фізіотерапевтичного втручання. Мета. Проаналізувати наявні інструменти оцінювання впливу фізичної терапії на осіб з хворобою Паркінсона. Методи. Теоретичний аналіз та узагальнення зарубіжних даних спеціальної науково-методичної літератури з питань застосування інстру-ментів оцінювання при хворобі Паркінсона та їх інформативності і надійності у фізичній терапії. Результати. Представлені дані свідчать, що ефективність запроваджених заходів фізичної терапії при хворобі Паркінсона залежить від правильно підібраних інструментів оцінювання, які дозволяють оцінити моторні і немоторні проблеми через призму життєдіяльності і якості життя пацієнта. Основним інструментом оцінювання для вирішення цього питання вважаєть-ся Уніфікована рейтингова шкала хвороби Паркінсона MDS-UPDRS, яка дозволяє об’єктивно оцінити моторні і немоторні аспекти життя пацієнта і його рухову активність. Оскільки наявні моторні й аксіальні рухові порушення негативно впливають на повсякденну функціональну активність пацієнта, для верифікації цих порушень пропонують використовувати тест для оці-нювання часу підйому і ходьби (Timed Up and Go (TUG)); тест з подвійним завданням (Dual-Task TUG (TUG-DT)) та шкалу рівноваги Берга (Berg Balance Scale (BBS)). Але виходячи з того, що ці тести недостатньо чутливі до невеликих змін у рухливості при хворобі Паркінсона, особливо на середніх і пізніх стадіях захворювання, їх доцільно поєднувати з одним із кількісних тестів для оцінювання ходьби: 10-метровим тестом ходьби (10 Meter Walk Test (10MW)) та 6-хвилинним тестом ходьби (Six Minute Walk Distance (6MWT)). Поняття «життєдіяльність» включає в себе не тільки переміщення, її оцінювання має бути доповнено аналізом ступеня впливу наявних по-рушень на повсякденну діяльність, тобто на якість життя пацієнта. Найбільш інформативними інструментами для проведення цього аналізу є універсальні і специфічні при хворобі Паркінсо-на опитувальники з метою оцінювання стану здоров’я SF-36, EuroQOL (EQ-5D) і PDQ-39 (The Parkinson’s Disease Questionnaire). Результати аналізу та узагальнення даних науково-мето-дичної літератури дають підставу встановити, що маніфестація порушень та їх варіабельність при хворобі Паркінсона стають серйозною проблемою у досягненні кінцевого результату за-проваджених заходів фізичної терапії на всіх стадіях захворювання. Використання в комплексі стандартної експертно-реабілітаційної діагностики спеціальних інструментів оцінювання дозволяє об’єктивізувати оцінювання клінічної інформації та стимулює розроблення особисто-орієнтованих реабілітаційних стратегій із застосуванням заходів фізичної терапії, спрямованих на покращення якості життя пацієнтів з хворобою Паркінсона. Ключові слова: хвороба Паркінсона, фізична терапія, якість життя, інструменти оцінювання, достовірність, надійність, валідність.

scholarly journals Mechanics and energetics of walking and running up and downhill: A joint-level perspective to guide design of lower-limb exoskeletons

2020 ◽  
Author(s):  
Richard W. Nuckols ◽  
Kota Z. Takahashi ◽  
Dominic J. Farris ◽  
Sarai Mizrachi ◽  
Raziel Riemer ◽  
...  
Keyword(s):  
Lower Limb ◽  
Gait Cycle ◽  
Human Locomotion ◽  
Mechanical Power ◽  
Joint Mechanics ◽  
Wearable Robot ◽  
Lower Limb Exoskeleton ◽  
Surface Gradient ◽  
Gait Phase ◽  
Robotic Devices

AbstractLower-limb wearable robotic devices can provide effective assistance to both clinical and healthy populations; however, how assistance should be applied in different gait conditions and environments is still unclear. We suggest a biologically-inspired approach derived from knowledge of human locomotion mechanics and energetics to establish a ‘roadmap’ for wearable robot design. In this study, we characterize the changes in joint mechanics during both walking and running across a range of incline/decline grades and then provide an analysis that informs the development of lower-limb exoskeletons capable of operating across a range of mechanical demands. Eight subjects (6M,2F) completed five walking (1.25 m -1) trials at −15%, −10%, 0%, 10%, and 15% grade and five running (2.25 m s-1) trials at −10%, −5%, 0%, 5%, and 10% grade on a treadmill. We calculated time-varying joint moment and power output for the ankle, knee, and hip. For each gait, we examined how individual limb-joints contributed to total limb positive, negative and net power across grades. For both walking and running, changes in grade caused a redistribution of joint mechanical power generation and absorption. From level to incline walking, the ankle’s contribution to limb positive power decreased from 44% on the level to 28% at 15% uphill grade (p < 0.0001) while the hip’s contribution increased from 27% to 52% (p < 0.0001). In running, regardless of the surface gradient, the ankle was consistently the dominant source of lower-limb positive mechanical power (47-55%). In the context of our results, we outline three distinct use-modes that could be emphasized in future lower-limb exoskeleton designs 1) Energy injection: adding positive work into the gait cycle, 2) Energy extraction: removing negative work from the gait cycle, and 3) Energy transfer: extracting energy in one gait phase and then injecting it in another phase (i.e., regenerative braking).

scholarly journals Walking Ability Outcome Measures in Individuals with Spinal Cord Injury: A Systematic Review

2021 ◽  
Vol 18 (18) ◽  
pp. 9517
Author(s):  
Isabel Sinovas-Alonso ◽  
Ángel Gil-Agudo ◽  
Roberto Cano-de-la-Cuerda ◽  
Antonio J. del-Ama
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Berg Balance Scale ◽  
Walking Ability ◽  
Walk Test ◽  
Timed Up And Go ◽  
Cord Injury ◽  
Profile Score

Walking function recovery in spinal cord injury (SCI) is tackled through several therapeutic approaches in which precise evaluation is essential. A systematic review was performed to provide an updated qualitative review of walking ability outcome measures in SCI and to analyze their psychometric properties. PubMed, Cochrane, and PEDro databases were consulted until 1 April 2020. Seventeen articles written in English were included. Five of them studied the walking index for SCI, four studied the 10 meter walk test, and two studied the six-minute walk test, the timed Up and go test, and the Berg balance scale. The rest of the articles studied the following metrics: gait profile score, spinal cord injury functional ambulation profile, five times sit-to-stand test, spinal cord injury functional ambulation inventory, spinal cord independence measure (indoors and outdoors mobility items), locomotor stages in spinal cord injury, community balance and mobility scale, and activity-based balance level evaluation scale. The choice of a single or a set of metrics should be determined by the clinician. Based on the results obtained in this review, a combination of outcome measures is proposed to assess walking ability. Future work is required to integrate a more realistic environment for walking assessment.

scholarly journals Functional Outcome of Neurologic-Controlled HAL-Exoskeletal Neurorehabilitation in Chronic Spinal Cord Injury: A Pilot With One Year Treatment and Variable Treatment Frequency

2017 ◽  
Vol 7 (8) ◽  
pp. 735-743 ◽  
Author(s):  
Oliver Jansen ◽  
Thomas A. Schildhauer ◽  
Renate C. Meindl ◽  
Martin Tegenthoff ◽  
Peter Schwenkreis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Training Session ◽  
Treadmill Walking ◽  
Functional Mobility ◽  
Training Period ◽  
Walk Test ◽  
Timed Up And Go ◽  
Treatment Frequency ◽  
Training Frequency ◽  
Cord Injury

Study Design: Longitudinal prospective study. Objectives: Whether 1-year HAL-BWSTT of chronic spinal cord injured patients can improve independent ambulated mobility further as a function of training frequency, after an initial 3-month training period. Methods: Eight patients with chronic SCI were enrolled. They initially received full standard physical therapy and neurorehabilitation in the acute/subacute posttrauma phase. During this trial, all patients first underwent a daily (5 per week) HAL-BWSTT for 12 weeks. Subsequently, these patients performed a 40-week HAL-BWSTT with a training session frequency of either 1 or 3 to 5 sessions per week. The patients’ functional status including HAL-associated treadmill-walking time, -distance, and -speed with additional analysis of gait pattern, and their independent (without wearing the robot suit) functional mobility improvements, were assessed using the 10-Meter-Walk Test (10MWT), Timed-Up-and-Go Test (TUG) and 6-Minute-Walk Test (6MinWT) on admission, at 6 weeks, 12 weeks, and 1 year after enrollment. The data were analyzed separately for the 2 training frequency subgroups after the initial 12-week training period, which was identical in both groups. Results: During the 1-year follow-up, HAL-associated walking parameters and independent functional improvements were maintained in all the patients. This result held irrespective of the training frequency. Conclusions: Long-term 1-year maintenance of HAL-associated treadmill walking parameters and of improved independent walking abilities after initial 12 weeks of daily HAL-BWSTT is possible and depends mainly on the patients’ ambulatory status accomplished after initial training period. Subsequent regular weekly training, but not higher frequency training, seems to be sufficient to preserve the improvements accomplished.

scholarly journals Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level

2017 ◽  
Vol 42 (5) ◽  
pp. E15 ◽  
Author(s):  
Dennis Grasmücke ◽  
Amrei Zieriacks ◽  
Oliver Jansen ◽  
Christian Fisahn ◽  
Matthias Sczesny-Kaiser ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Behavior ◽  
Treadmill Training ◽  
Walk Test ◽  
Chronic Spinal Cord Injury ◽  
Training Tool ◽  
Cord Injury ◽  
Lesion Level ◽  
Hybrid Assistive Limb

ObjectiveAge and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool.MethodsFifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (< 50 or ≥ 50 years), independent of lesion level, and also into 4 homogeneous groups according to lesion level. The subgroups were as follows: Subgroup 1, tetraplegic iSCI (n = 13) (C2–8, AIS C [n = 8] and AIS D [n = 5]); Subgroup 2, paraplegic iSCI with spastic motor behavior (n = 15) (T2–12, AIS C [n = 8] and AIS D [n = 7]); Subgroup 3, paraplegic cSCI with complete motor paraplegia and absence of spastic motor behavior (n = 18) (T11–L4 [AIS A], and ZPP from L-3 to S-1); and Subgroup 4, paraplegic iSCI with absence of spastic motor behavior (n = 9) (T12–L3, AIS C [n = 8] and AIS D [n = 1]). The training paradigm consisted of 12 weeks of HAL-assisted treadmill training (5 times/week). Baseline status was documented prior to intervention by using the AIS grade, Walking Index for SCI II (WISCI II) score, the 10-meter walk test (10MWT), and the 6-minute walk test (6MinWT). Training effects were assessed after 6 and 12 weeks of therapy, without HAL assistance.ResultsOverall, a time reduction of 47% in the 10MWT, self-selected speed (10MWTsss) (< 50 years = 56% vs ≥ 50 years = 37%) and an increase of 50% in the 6MinWT were documented. The WISCI II scores showed a mean gain of 1.69 levels. At the end of the study, 24 of 55 patients (43.6%) were less dependent on walking aids. Age had a nonsignificant negative influence on the 10MWTsss. Despite a few nonsignificant subgroup differences, participants improved across all tests. Namely, patients with iSCI who had spastic motor behavior improved to a nonsignificant, lesser extent in the 6MinWT.ConclusionsThe HAL-assisted treadmill training leads to functional improvements in chronic iSCI or cSCI, both in and out of the exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (≥ 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements.Clinical trial registration no.: DRKS00010250 (https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do)

scholarly journals Potential Benefits of a Selective Region High-frequency Diathermy with Therapeutic Exercises on Older Persons with Degenerative Knee Osteoarthritis

2020 ◽  
Author(s):  
SinHo Ha ◽  
GyuChang Lee
Keyword(s):  
Knee Osteoarthritis ◽  
High Frequency ◽  
Training Session ◽  
The Elderly ◽  
Trigger Points ◽  
Walk Test ◽  
Timed Up And Go ◽  
Therapeutic Exercises ◽  
Potential Benefits ◽  
10 Meter Walk Test

Abstract Background: Musculoskeletal degenerative diseases, such as osteoporosis, knee osteoarthritis and spondylolysis often occur in the elderly. The purpose of this case study was to investigate selective region high-frequency diathermy at trigger points with therapeutic exercises on pain, dysfunction, balance and gait in older patients with degenerative knee osteoarthritis.Methods. The patient who participated in this study was a 71-year-old woman, who had been diagnosed with moderate osteoarthritis with a Kellgren & Lawrence grading scale grade II. The treatment consisted of selective region high-frequency diathermy at trigger points, with hip and knee strengthening and stretching therapeutic exercises. Both treatments were applied simultaneously. The participant was given assessments before and after every training session using the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Timed Up and Go test (TUG) and the 10 Meter Walk Test (10MWT). The participant was assessed a total of 19 times and treatment was performed 18 times for a total of 30 minutes each. Results. Consecutively, VAS decreased to 3 points, and the Western Ontario and McMaster Universities Arthritis Index decreased to 53 points. In addition, the Timed Up and Go test decreased to 3.25 s and the 10 Meter Walk Test decreased to 1.14 s.Conclusion. The results of this study suggest that selective region high-frequency diathermy at trigger points with therapeutic exercises may be an effective treatment to decrease pain, improve functional status, balance and gait in patients with degenerative knee osteoarthritis. The selective region high-frequency diathermy with therapeutic exercises may be feasible and provide potential benefits for rehabilitation of degenerative knee osteoarthritis.

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