Design and Simulation Analysis of a Robot-Assisted Gait Trainer with the PBWS System

In response to the ever-increasing demand of lower limb rehabilitation, this paper presents a novel robot-assisted gait trainer (RGT) to assist the elderly and the pediatric patients with neurological impairments in the lower limb rehabilitation training (LLRT). The RGT provides three active degrees of freedom (DoF) to both legs that are used to implement the gait cycle in such a way that the natural gait is not significantly affected. The robot consists of (i) the partial body weight support (PBWS) system to assist patients in sit-to-stand transfer via the precision linear rail system and (ii) the bipedal end-effector (BE) to control the motions of lower limbs via two mechanical arms. The robot stands out for multiple modes of training and optimized functional design to improve the quality of life for those patients. To analyze the performance of the RGT, the kinematic and static models are established in this paper. After that, the reachable workspace and motion trajectory are analyzed to cover the motion requirements and implement natural gait cycle. The preliminary results demonstrate the usability of the robot.

Short Term Effects of Rhythmic Auditory Stimulation with Body Weight Supported Treadmill Training on Gait and Balance in Individuals with Incomplete Spinal Cord Injury

Background: Rhythmic auditory stimulation and body weight supported treadmill training both are standardized gait rehabilitation techniques. However there is limited literature evaluating the effect of rhythmic auditory stimulation and its combination with gait training in spinal cord injury. Aim of this study is to determine the short term effectiveness of rhythmic auditory stimulation with body weight supported treadmill training on gait and balance in individuals with incomplete Spinal Cord Injury. Method: A randomized control study design. 8 subjects with incomplete spinal cord injury who met the inclusion criteria were randomly allocated into two groups: Experimental and Control. Subjects in experimental group were given body weight supported treadmill training with rhythmic auditory stimulation. Subjects in Control Group were given Body weight supported treadmill training alone. Both the groups received conventional rehabilitation as well. Both groups received training for 30 minutes, five times a week for two weeks (10 sessions). Outcome Measures: Gait parameters i.e. cadence, velocity, step length were measured using the Biodex Gait Trainer 2TM, level of walking performance measured using Walking Index for Spinal Cord Injury II, and balance was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Results: No significant improvement was found on gait parameters i.e. cadence, velocity, step length which were measured using the Gait Trainer, level of walking performance measured using WISCI II, and balance which was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Conclusion: Rhythmic auditory stimulation didn’t have any positive effect on gait training in incomplete spinal cord injured patients. Further studies are warranted to explore the entrainment effects of rhythmic auditory stimulation in spinal cord injured individuals on gait rehabilitation. Keywords: Rhythmic Auditory Stimulation (RAS), Body Weight Supported Treadmill Training (BWSTT), Metronome, Incomplete spinal cord injury, Biodex Gait Trainer 2.0, Prokin 252N

HYBRID: Ambulatory Robotic Gait Trainer with Movement Induction and Partial Weight Support

Robotic exoskeletons that induce leg movement have proven effective for lower body rehabilitation, but current solutions offer limited gait patterns, lack stabilization, and do not properly stimulate the proprioceptive and balance systems (since the patient remains in place). Partial body weight support (PBWS) systems unload part of the patient’s body weight during rehabilitation, improving the locomotive capabilities and minimizing the muscular effort. HYBRID is a complete system that combines a 6DoF lower body exoskeleton (H1) with a PBWS system (REMOVI) to produce a solution apt for clinical practice that offers improves on existing devices, moves with the patient, offers a gait cycle extracted from the kinematic analysis of healthy users, records the session data, and can easily transfer the patient from a wheelchair to standing position. This system was developed with input from therapists, and its response times have been measured to ensure it works swiftly and without a perceptible delay.

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion

Background and Objectives: Gait training with body weight-support has been shown to improve the walking speed of individuals with movement disorders. The AccesSportAmerica Gait Trainer is a low-cost, pre-market gait rehabilitation device that alters the stride characteristics of participants walking on a standard treadmill. The purpose of this study was to examine the biomechanical outcomes that training on this device has for people with brain injuries that affect motor functioning. It was hypothesized that there would be an increase in walking speed post-intervention, and that there would be an increase in step length and joint range-of-motion. Materials and Methods: An intervention study was conducted with 11 people with ambulatory difficulty caused by post-stroke hemiparesis (n = 7), traumatic brain injury (n = 3), and cerebral palsy (n = 1). The average time using the AccesSportAmerica Gait Trainer was 34.5 (SD = 6.0) minutes per session for 36.9 (SD = 21.8) sessions. Gait speed, step length and time, and joint flexion were measured during the 10 Meter Walk Test. Results: From pre- to post-intervention, there was a mean increase in walking speed of 0.19 m/s (SD = 0.06, p = 0.016, d = 0.40) and a decrease in step time of both affected and unaffected legs (affected: p = 0.011, d = 0.37; unaffected: p = 0.004, d = 0.67). There was no significant change in stride length or joint angles. Conclusions: The AccesSportAmerica Gait Trainer has the potential to improve the walking speed of people with ambulatory difficulty.

Treatment of Aggression in an Adult With Intellectual Disability and Physical Impairment Through Function-Based Ambulatory Support

We report the case of a man who had intellectual disability and physical impairment, required assistance from care-providers when ambulating, and demonstrated aggression during transitions between locations. Results of a functional analysis suggested that aggression was negatively reinforced by termination of transition-assisted guidance from care-providers. Intervention evaluation found that aggression during transitions was eliminated by providing the man with ambulatory support through a gait-trainer device that removed the need for care-provider assistance. The case study supports and extends previous research on the analysis and treatment of problem behaviors occurring during environmental transitions.

Kesahihan dan Keandalan Uji Jalan Enam Menit pada Lintasan 15 Meter

Walk test is a test that often used because walking is a basic activity. There are time-based walk tests and some are based on track length. A 6-minute walk test is a time-based walk test with a distance trevaled as a result. A 6-minute walk test is frequently used as functional clinical capacity trial. This test is performed on a straight track. The length of the track varies from 10-meters to 85-meters. This study examined the reliability and validity of a 6-minute walk test on a 15-meter track. The 15-meter track with markers every 3-meters, 30-centimeters wide to the right and left from the center line. The subject went straight as close to the center line as possible. When the subject arrived at both ends, the subject rotated with the three step method. The study compared the 6-minute walk test on the 15-meter track with three-step rotating method with on Biodex® gait trainer gold-standard. This study involved subjects as many as 123 healthy Indonesians adults (58 men, 65 women), and obtained Cronbach alpha of 0.999 and Pearson correlation value of 0.998. This shows that the results of the 15-meter trajectory test have validity and precision values which are as good as the 6-minute walk test without spinning. Abstark Uji jalan merupakan uji yang sering dipakai karena berjalan merupakan aktivitas dasar. Uji jalan ada yang berbasis waktu dan berbasis panjang lintasan. Uji jalan enam menit merupakan uji berbasis waktu dengan jarak tempuh sebagai hasil keluarannya. Uji jalan 6 menit merupakan uji klinis kapasitas fungsional yang sering dipergunakan. Uji ini dilakukan pada lintasan lurus. Panjang lintasan bervariasi dari 10 meter hingga 60 meter.. Penelitian ini meneliti keterandalan dan kesahihan uji jalan enam menit pada lintasan 15 meter. Lintasan sepanjang 15 meter dengan marka setiap tiga meter, lebar lintasan 30 sentimeter ke kanan dan ke kiri dari garis tengah. Subyek berjalan lurus sedekat mungkin dengan garis tengah lintasan. Ketika subyek tiba pada ke dua ujung , berbalik arah dengan metoda tiga langkah. Penelitian ini membandingkan uji jalan 6 menit pada lintasan 15 meter dengan metoda berputar pada ke dua ujungnya dengan baku emas uji jalan 6 menit pada Biodex®gait trainer. Melibatkan subyek 123 orang Indonesia dewasa sehat (58 laki-laki), didapatkan Cronbach alfa 0,999 dengan nilai korelasi r= 0,998. Hal ini memiliki arti bahwa hasil lintasan 15 meter memiliki kesahihan dan nilai ketepatan yang sama baiknya dengan uji jalan 6 menit.

Parametric dynamic analysis of walking within a cable-based gait trainer

SUMMARYIn this paper, a parametric analysis of the inverse dynamics of an upright partially unloaded walking is performed. This motion is produced through a gait-training machine emulating the over-ground walking using a body weight support mechanism and a cable-driven robot. The input motion is the kinematics of a normal gait, and the ultimate output result is the required tensions to be generated by the cable robot in order to drive the lower limb. The dynamic analysis is carried out based on the Newton–Euler approach. A Matlab Simscape model is also built to validate the analytical results. The obtained dynamic model is used to investigate the effect of the variation of the gait simulation parameters on the actuation wrench and the cable tensions. The obtained results could be used to determine the optimal design of the gait trainer actuators and they are useful in estimating optimal gait training parameters.