scholarly journals Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation

2021 ◽  
Vol 15 ◽  
Author(s):  
Valeria Longatelli ◽  
Alessandra Pedrocchi ◽  
Eleonora Guanziroli ◽  
Franco Molteni ◽  
Marta Gandolla
Keyword(s):  
Muscle Activation ◽  
Gait Training ◽  
Gait Pattern ◽  
Rehabilitation Program ◽  
Lower Limbs ◽  
Control Group ◽  
Robotic Exoskeleton ◽  
Lower Limb Muscles ◽  
Subacute Stroke ◽  
Efficient Gait

The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been recruited and underwent either conventional gait training or experimental training, including overground gait training using a wearable powered exoskeleton alongside conventional therapy. Before and after the rehabilitation treatment, we assessed: (i) gait functionality by means of clinical scales combined to obtain a Capacity Score, and (ii) gait neuromuscular lower limbs pattern using superficial EMG signals. Both groups improved their ability to walk in terms of functional gait, as detected by the Capacity Score. However, only the group treated with the robotic exoskeleton regained a controlled rhythmic neuromuscular pattern in the proximal lower limb muscles, as observed by the muscular activation analysis. Coherence analysis suggested that the control group (CG) improvement was mediated mainly by spinal cord control, while experimental group improvements were mediated by cortical-driven control. In subacute stroke patients, we hypothesize that exoskeleton multijoint powered fine control overground gait training, alongside conventional care, may lead to a more fine-tuned and efficient gait pattern.

THE DEVELOPMENT OF AN EMG CONTROLLER-BASED ROBOTIC GAIT TRAINING SYSTEM AND ITS CLINICAL FEASIBILITY FOR SUBACUTE STROKE PATIENTS IN IMPROVING LOCOMOTIVE FUNCTION

2019 ◽  
Vol 19 (02) ◽  
pp. 1940018
Author(s):  
ANDY CHIEN ◽  
FU-HAN HSIEH ◽  
CHING HUANG ◽  
FEI-CHUN CHANG ◽  
NAI-HSIN MENG ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Gait Cycle ◽  
Gait Training ◽  
Gait Pattern ◽  
Rehabilitation Program ◽  
Training System ◽  
Stroke Patients ◽  
Robotic Training ◽  
Subacute Stroke ◽  
Robotic Gait

One-third of stroke survivors fail to regain independent ambulation and strokes have been identified as a significant source of long-term disability and a tremendous health burden. Robot-assisted gait rehabilitation is gaining traction and advocators for its inclusion as part of the routine post-stroke rehabilitation program are on the increase. However, despite the recent technological advances in the development and design of better robotics, the research evidence on the best model of robotic training remains sparse and unclear. It is therefore the aim of the current study to comparatively investigate the clinical feasibility and efficacy of a recently developed HIWIN Robotic Gait Training System (MRG-P100) combined with the use of a lab-developed MBS-E100 EMG system as a controller on facilitating the development of an appropriate gait pattern for motor impaired subacute stroke patients. The results indicated that due to the heterogeneity of stroke-induced changes in muscle characteristics, an “auto-fit” algorithm was required to allow constant monitoring and updating of the appropriate threshold based on EMG signals captured during previous gait cycle in order to determine the desired muscle activation threshold for the current gait cycle. Eighteen participants were tested using the new auto-fit algorithm and results demonstrated a significantly more fluent and physiologically appropriate gait pattern.

Bilateral Changes in Ground Reaction Forces in Patients with Unilateral Anterior Cruciate Ligament Deficiency During Stair Locomotion

2011 ◽  
Vol 27 (3) ◽  
pp. 437-445 ◽  
Author(s):  
H.-C. Lin ◽  
H.-C. Hsu ◽  
T.-W. Lu
Keyword(s):  
Cruciate Ligament ◽  
Ground Level ◽  
Rehabilitation Program ◽  
Lower Limbs ◽  
Control Group ◽  
Ground Reaction Forces ◽  
Acl Deficiency ◽  
Stair Ascent ◽  
Reaction Forces ◽  
Stair Locomotion

ABSTRACTStair locomotion is an important but challenging functional activity for people with lower limb pathology. This study aimed to investigate the bilateral changes in force-bearing on lower limbs during stair locomotion in patients with unilateral ACL deficiency. The ground reaction forces (GRF) were collected from three force platforms: One at ground level in front of a 5-step stair and two on the first two steps respectively. Parameters in vertical and anterior-posterior GRF were extracted and compared between the ACL-deficient (ACLD) and control groups. The ACLD group showed significantly slower stepping cadences in both stair ascent and stepping down to the ground (p < 0.05). The vertical GRF in the ACLD group demonstrated smaller peak forces but larger minimum forces between the two peaks than those in the control group during both stair ascent and descent. Significantly reduced anterior propulsive forces and push-off rates in the late stance were also found in both limbs of the ACLD group (p < 0.05). The slower cadences and reduced force-bearing on the affected limb suggested a protective strategy was adopted. However, the anterior loading parameters in the early stance on the unaffected limb demonstrated different adaptations with significantly larger magnitudes during stair ascent but reduced magnitudes during stair descent (p < 0.05). Similar results were also found in the weight- transferring strategies between legs in consecutive steps with a significantly larger percentage of lift-up forces but a smaller percentage of impact forces on the leading unaffected limb. The results of this study indicated a cautious force-bearing strategy and bilateral adaptation were apparent in the patients with unilateral ACL deficiency. This information may provide a safety guideline for the patients and be helpful for a better use of the stair tasks as part of a rehabilitation program.

Deficits in anticipatory inhibition of postural muscle activity associated with load release while standing in individuals with spastic diplegic cerebral palsy

2013 ◽  
Vol 109 (8) ◽  
pp. 1996-2006 ◽  
Author(s):  
Hidehito Tomita ◽  
Yoshiki Fukaya ◽  
Kenji Totsuka ◽  
Yuri Tsukahara
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Muscle Activity ◽  
Erector Spinae ◽  
Lower Limbs ◽  
Control Group ◽  
Lower Limb Muscles ◽  
Limb Muscles ◽  
Postural Muscle ◽  
Load Release

This study aimed to determine whether individuals with spastic diplegic cerebral palsy (SDCP) have deficits in anticipatory inhibition of postural muscle activity. Nine individuals with SDCP (SDCP group, 3 female and 6 male, 13–24 yr of age) and nine age- and sex-matched individuals without disability (control group) participated in this study. Participants stood on a force platform, which was used to measure the position of the center of pressure (CoP), while holding a light or heavy load in front of their bodies. They then released the load by abducting both shoulders. Surface electromyograms were recorded from the rectus abdominis, erector spinae (ES), rectus femoris (RF), medial hamstring (MH), tibialis anterior (TA), and gastrocnemius (GcM) muscles. In the control group, anticipatory inhibition before load release and load-related modulation of the inhibition were observed in all the dorsal muscles recorded (ES, MH, and GcM). In the SDCP group, similar results were obtained in the trunk muscle (ES) but not in the lower limb muscles (MH and GcM), although individual differences were seen, especially in MH. Anticipatory activation of the ventral lower limb muscles (RF and TA) and load-related modulation of the activation were observed in both participant groups. CoP path length during load release was longer in the SDCP group than in the control group. The present findings suggest that individuals with SDCP exhibit deficits in anticipatory inhibition of postural muscles at the dorsal part of the lower limbs, which is likely to result in a larger disturbance of postural equilibrium.

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

Sensors ◽  
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.

scholarly journals Robot-assisted gait training to reduce pusher behavior

Neurology ◽  
2018 ◽  
Vol 91 (14) ◽  
pp. e1319-e1327 ◽  
Author(s):  
Jeannine Bergmann ◽  
Carmen Krewer ◽  
Klaus Jahn ◽  
Friedemann Müller
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
Gait Training ◽  
Class Ii ◽  
Control Group ◽  
Robot Assisted ◽  
Post Intervention ◽  
Subacute Stroke ◽  
Post Test

ObjectiveTo determine the effects of 2 weeks of intensive robot-assisted gait training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT).MethodsIn a single-blind, randomized, controlled trial with 2 parallel arms, we compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT (control group). Patients with subacute stroke who had pusher behavior according to the Scale for Contraversive Pushing (SCP) were included. The primary research questions were whether changes in pusher behavior would differ between groups post intervention, and at a follow-up 2 weeks afterward (SCP and Burke Lateropulsion Scale, Class II evidence). Secondary outcomes included the Performance-Oriented Mobility Assessment, the Functional Ambulation Classification, and the Subjective Visual Vertical.ResultsThirty-eight patients were randomized. Thereof, 30 patients received the allocated intervention and were included in the analyses. RAGT led to a larger reduction of pusher behavior than nR-PT at post test (SCP: U = 69.00, r = −0.33, p = 0.037; Burke Lateropulsion Scale: U = 47.500, r = −0.50, p = 0.003) and at follow-up (SCP: U = 54.00, r = −0.44, p = 0.008). Pusher behavior had ceased in 6 of 15 participants in the intervention group and 1 of 15 participants in the control group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, no longer exhibited the behavior.ConclusionsTwo weeks of RAGT seems to persistently reduce pusher behavior, possibly by recalibrating the disturbed inner reference of verticality. The potential benefits of RAGT on pusher behavior and verticality perception require further investigation.Trial registrationGerman Clinical Trials Register (registration number: DRKS00003444).Classification of evidenceThis study provides Class II evidence that RAGT is beneficial to reduce pusher behavior in patients with stroke.

Comparing Neuroplasticity Changes between High and Low Frequency of Gait Training based on Electroencephalogram Signal Analysis among Subacute Stroke Individuals (Preprint)

2021 ◽  
Author(s):  
Fatimah Ahmedy ◽  
Natiara Mohamad Hashim ◽  
Herwansyah Lago ◽  
Leonard Protasius Plijoly ◽  
Ismail Ahmedy ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Low Frequency ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Controlled Study ◽  
Control Group ◽  
Eeg Signals ◽  
Post Intervention ◽  
National Medical ◽  
Subacute Stroke

BACKGROUND Walking recovery post-stroke can be slow and incomplete. Determining effective stroke rehabilitation frequency requires assessment of neuroplasticity changes. Neurobiological signals from electroencephalogram (EEG) can measure neuroplasticity through incremental changes of these signals after rehabilitation. However, changes seen with different frequency of rehabilitation require further investigation. It is hypothesised that the association between the incremental changes from EEG signals and the improved functional outcome measure scores are greater in higher rehabilitation frequency, implying enhanced neuroplasticity changes. OBJECTIVE The purpose of this study is to identify the changes in the neurobiological signals from EEG, to associate these with functional outcome measures scores, and to compare their associations in different therapy frequency for gait rehabilitation among subacute stroke individuals. METHODS A randomised, single-blinded controlled study among subacute stroke patients with two groups: interventional group (IG) and control group (CG). Each participant in IG and CG will receive three times a week (high frequency) and once a week (low frequency) therapy sessions respectively, for a total of 12 consecutive weeks. Each session will last for an hour with strengthening, balance and gait training. Main variables to be assessed are the 6-Minute Walk Test (6MWT), Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and brainwave pattern from EEG signals recordings in the form of delta to alpha ratio (DAR) and delta-plus-theta to alpha-plus-beta ratio (DTABR). These will be measured at pre-intervention (R0) and post-intervention (R1). RESULTS Key analyses are to determine the changes in 6MWT, MAS, BBS, MBI, DAR, and DTABR at R0 and R1 for CG and IG. The changes in the DAR and DTABR will be analysed for association with the changes in the 6MWT, MAS, BBS and MBI to measure neuroplasticity changes for both CG and IG. CONCLUSIONS These associations are expected to be positive in both groups, but the IG group would demonstrate higher correlation compared to the CG group, reflecting enhanced neuroplasticity changes and objective evalution on dose-response relationship. CLINICALTRIAL This study has received the ethics approval from National Medical Research Register of Malaysia, which is the formal and statutory body that governed all medical-related studies in Malaysia, with ID no. NMRR-19-3840-51591 (IIR).

scholarly journals Use of hippotherapy in gait training for hemiparetic post-stroke

2010 ◽  
Vol 68 (6) ◽  
pp. 908-913 ◽  
Author(s):  
Fernanda Beinotti ◽  
Nilzete Correia ◽  
Gustavo Christofoletti ◽  
Guilherme Borges
Keyword(s):  
Conventional Treatment ◽  
Motor Impairment ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Positive Influence ◽  
Lower Limbs ◽  
Control Group ◽  
Post Stroke ◽  
Group B ◽  
In The Beginning

OBJECTIVE: To evaluate the hippotherapy influence on gait training in post-stroke hemiparetic individuals. METHOD: The study was constituted of 20 individuals divided into two groups. Group A performed the conventional treatment while group B the conventional treatment along with hippotherapy during 16 weeks. The patients were evaluated by using the Functional Ambulation Category Scale, Fugl-Meyer Scale, only the lower limbs and balance sub items, Berg Balance Scale, and functional assessment of gait (cadence) in the beginning and end of the treatment. RESULTS: Significant improvements were observed in the experimental group including motor impairment in lower limbs (p=0.004), balance, over time (p=0.007) but a significant trend between groups (p=0.056). The gait independence, cadence and speed were not significantly in both groups (p=0.93, 0.69 and 0.44). CONCLUSION: Hippotherapy associated with conventional physical therapy demonstrates a positive influence in gait training, besides bringing the patients' gait standard closer to normality than the control group.

scholarly journals PRELIMINARY EVIDENCE OF EFFECTIVENESS OF TECAR IN LYMPHEDEMA

Lymphology ◽  
2019 ◽  
Vol 52 (1) ◽  
Author(s):  
N Cau ◽  
V Cimolin ◽  
V Aspesi ◽  
M Galli ◽  
F Postiglione ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lymphatic Drainage ◽  
Rehabilitation Program ◽  
Volume Reduction ◽  
Lower Limbs ◽  
Control Group ◽  
Morbidly Obese ◽  
Mobility Impairment ◽  
Timed Up And Go ◽  
Pressure Therapy

Lymphedema of the lower limbs often contributes to the mobility impairment of morbidly obese patients. Defining novel cost-effective protocols is important for reducing treatment costs. The study aimed to assess if Capacitive and Resistive Energy Transfer (TECAR) can reduce edema and the minimum number of sessions needed to observe volume reduction. Forty-eight severely obese subjects (age range: 46-78 years; BMI &gt;40 kg/m2) with bilateral lower limb lymphedema were divided into three groups undergoing either manual lymphatic drainage, pressure therapy, or TECAR, in addition to a multidisciplinary rehabilitation program. They were compared to a control group composed by 12 women (age: 67.4 ± 8.9 years, BMI: 44.6 ± 4.1 Kg/m2) undergoing only the rehabilitation program. A handheld laser scanner 3D system was used for volume measurements. In addition, patients were evaluated with a Timed Up and Go (TUG) test and pain/heaviness of the lower limbs with a Visual Analog Scale (VAS). A significant volume reduction was observed after 6 sessions of TECAR: specifically, in the whole limb (PRE: 9.7+2.8 dm3; POST: 9.4+2.8 dm3; p&lt;0.05) and in the thigh (PRE: 3.5+1.3 dm3; POST: 3.3+1.2 dm3; p&lt;0.05). The TUG and VAS for pain showed a significant improvement in all groups. Our preliminary results suggest that TECAR can provide a relatively early reduction of lower limb edema with improvement of patients' function and pain.

Analysis of the activation modalities of the lower limb muscles during walking

2020 ◽  
Vol 28 (5) ◽  
pp. 521-532 ◽  
Author(s):  
Wei Li ◽  
Zhongli Li ◽  
Shuyan Qie ◽  
Huaqing Yang ◽  
Xuemei Chen ◽  
...  
Keyword(s):  
Lower Limb ◽  
Muscle Activation ◽  
Gait Cycle ◽  
Lower Limbs ◽  
Medial Gastrocnemius ◽  
Peak Time ◽  
Lower Limb Muscles ◽  
Emg Signal ◽  
Limb Muscles ◽  
Activation Intervals

BACKGROUND: Walking is a basic human activity and many orthopedic diseases can manifest with gait abnormalities. However, the muscle activation intervals of lower limbs are not clear. OBJECTIVE: The aim of this study was to explore the contraction patterns of lower limb muscles by analyzing activation intervals using surface electromyography (SEMG) during walking. METHODS: Four muscles including the tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and rectus femoris (RF) of bilateral lower extremity of 92 healthy subjects were selected for SEMG measurements. The number of activations (activation intervals) and the point of the highest root mean square (RMS) EMG signal in the percentage of the gait cycle (GC) were used to analyze muscle activities. RESULTS: The majority of TA and RF showed two activation intervals and both gastrocnemius parts three activation intervals during walking. The point of the highest RMS EMG signal in the percentage of the GC for TA, LG, MG and RF are 5%, 41%, 40%, and 8%, respectively. The activation intervals were mostly affected by age, height, different genders and bilateral limbs. CONCLUSION: This study identified the different activation intervals (four for each muscle) and the proportion of healthy adults in which they occurred during the normal gait cycle. These different activation intervals provided a new insight to evaluate the function of nerves and muscles. In addition, the activation interval and RMS peak time proposed in this study can be used as new parameters for gait analysis.

scholarly journals Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

2021 ◽  
Vol 11 (1) ◽  
pp. 104
Author(s):  
Franco Molteni ◽  
Eleonora Guanziroli ◽  
Michela Goffredo ◽  
Rocco Calabrò ◽  
Sanaz Pournajaf ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Lower Limb ◽  
Controlled Trial ◽  
Gait Training ◽  
Control Group ◽  
Clinical Effects ◽  
Walking Test ◽  
Randomized Controlled ◽  
Subacute Stroke ◽  
Multicenter Randomized Controlled Trial

Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.

Sign in / Sign up

Export Citation Format

Share Document