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Smart ArM: a customizable and versatile robotic arm prosthesis platform for Cybathlon and research. 智能机械臂:用于电子竞技和研究的可定制多功能机械臂假肢平台。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-05 DOI: 10.1186/s12984-024-01423-9
Sébastien Mick, Charlotte Marchand, Étienne de Montalivet, Florian Richer, Mathilde Legrand, Alexandre Peudpièce, Laurent Fabre, Christophe Huchet, Nathanaël Jarrassé

Background: In the last decade, notable progress in mechatronics paved the way for a new generation of arm prostheses, expanding motor capabilities thanks to their multiple active joints. Yet, the design of control schemes for these advanced devices still poses a challenge, especially with the limited availability of command signals for higher levels of arm impairment. When addressing this challenge, current commercial devices lack versatility and customizing options to be employed as test-beds for developing novel control schemes. As a consequence, researchers resort to using lab-specific experimental apparatuses on which to deploy their innovations, such as virtual reality setups or mock prosthetic devices worn by unimpaired participants.

Methods: To meet this need for a test-bed, we developed the Smart Arm platform, a human-like, multi-articulated robotic arm that can be worn as a trans-humeral arm prosthesis. The design process followed three principles: provide a reprogrammable embedded system allowing in-depth customization of control schemes, favor easy-to-buy parts rather than custom-made components, and guarantee compatibility with industrial standards in prosthetics.

Results: The Smart ArM platform includes motorized elbow and wrist joints while being compatible with commercial prosthetic hands. Its software and electronic architecture can be easily adapted to build devices with a wide variety of sensors and actuators. This platform was employed in several experiments studying arm prosthesis control and sensory feedback. We also report our participation in Cybathlon, where our pilot with forearm agenesia successfully drives the Smart Arm prosthesis to perform activities of daily living requiring both strength and dexterity.

Conclusion: These application scenarios illustrate the versatility and adaptability of the proposed platform, for research purposes as well as outside the lab. The Smart Arm platform offers a test-bed for experimenting with prosthetic control laws and command signals, suitable for running tests in lifelike settings where impaired participants wear it as a prosthetic device. In this way, we aim at bridging a critical gap in the field of upper limb prosthetics: the need for realistic, ecological test conditions to assess the actual benefit of a technological innovation for the end-users.

背景:在过去十年中,机电一体化领域取得了显著进展,为新一代假肢铺平了道路,这些假肢的多个活动关节扩大了运动能力。然而,为这些先进设备设计控制方案仍然是一项挑战,尤其是在手臂损伤程度较高的情况下,指令信号的可用性有限。在应对这一挑战时,目前的商用设备缺乏多功能性和定制选项,无法用作开发新型控制方案的试验台。因此,研究人员不得不使用实验室专用的实验装置来部署他们的创新成果,例如虚拟现实装置或由无障碍参与者佩戴的模拟假肢装置:为了满足对试验平台的需求,我们开发了智能手臂平台,这是一个仿人的多关节机器人手臂,可作为跨肱骨假肢佩戴。设计过程遵循三个原则:提供一个可重新编程的嵌入式系统,允许对控制方案进行深度定制;采用易于购买的部件而不是定制部件;保证与假肢工业标准兼容:智能 ArM 平台包括电动肘关节和腕关节,同时与商用假手兼容。它的软件和电子结构可以轻松地进行调整,以构建带有各种传感器和致动器的设备。该平台被用于多项研究假肢控制和感觉反馈的实验中。我们还报告了我们参加 Cybathlon 的情况,在这项比赛中,我们的前臂失能症试验人员成功驱动智能手臂假肢完成了需要力量和灵活性的日常生活活动:这些应用场景说明了拟议平台的多功能性和适应性,既可用于研究目的,也可用于实验室之外。智能臂平台为假肢控制法则和指令信号的实验提供了一个测试平台,适合在逼真的环境中进行测试,让受损的参与者将其作为假肢设备佩戴。通过这种方式,我们的目标是弥补上肢假肢领域的一个关键缺口:即需要真实的生态测试条件来评估技术创新对最终用户的实际益处。
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引用次数: 0
Estimating highest capacity propulsion performance using backward-directed force during walking evaluation for individuals with acquired brain injury. 在对后天性脑损伤患者进行步行评估时,利用向后定向力估算最高推进能力。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-05 DOI: 10.1186/s12984-024-01428-4
Kelli LaCroix, Lauren Horelka, Clif Hung, David A Brown

There are over 5.3 million Americans who face acquired brain injury (ABI)-related disability as well as almost 800,000 who suffer from stroke each year. To improve mobility and quality of life, rehabilitation professionals often focus on walking recovery soon after hospital discharge for ABI. Reduced propulsion capacity (force output of the lower limbs to counteract ground reaction forces) negatively impacts walking ability and complicates recovery during rehabilitation for brain injured people. We describe a method, using backward-directed resistance (BDR) in a robotic-based treadmill device, to allow measurement of maximum walking propulsion force (MWPF) that is not otherwise possible during overground walking assessment. Our objective was to test the construct validity of a maximum walking propulsion force (MWPF) measure that reflects a person's propulsive strength against applied BDR, while walking on a robotic treadmill-based device for participants with acquired brain injury (ABI). Our study enrolled 14 participants with ABI at an in inpatient rehabilitation in Galveston, TX from 8/1/21 - 4/31/22. The range of weight-adjusted MWPF was 2.6-27.1% body weight (%BW), mean 16.5 ± 8.4%BW, reflecting a wide range of propulsive force capability. The strongest correlation with overground tests was between the 6-minute walk test (6-MWT) distance and the MWPF values (r = 0.83, p < 0.001) with moderate correlations between the 10-meter walk tests at comfortable (CWS) and fast speeds (FWS). The Five Times Sit-to-Stand (used as a standard clinical measure of functional lower extremity strength) and MWPF tests were poorly correlated (r = 0.26, p = 0.4). Forward model selection included 6-MWT distance, age, and overground CWS as significant partial predictors of MWPF. We conclude that this novel MWPF measure is a valid representation of maximum propulsive force effort during walking for people post-ABI. Additional research could help determine the impact of interventions designed to increase propulsive force generation during rehabilitation training to improve overground walking performance.

每年有超过 530 万美国人面临与后天性脑损伤(ABI)相关的残疾,还有近 80 万人罹患中风。为了提高行动能力和生活质量,康复专业人员通常会在后天性脑损伤患者出院后不久重点关注步行恢复。推进能力(下肢抵消地面反作用力的力量输出)的降低会对行走能力产生负面影响,并使脑损伤患者在康复期间的恢复变得更加复杂。我们介绍了一种在基于机器人的跑步机设备中使用后向阻力(BDR)来测量最大行走推进力(MWPF)的方法,这种方法在地面行走评估中是不可能实现的。我们的目标是测试最大行走推进力(MWPF)测量的构造有效性,该测量反映了后天性脑损伤(ABI)患者在基于机器人跑步机的设备上行走时,人在施加 BDR 时的推进力。我们的研究从 21 年 1 月 8 日至 22 年 4 月 31 日在德克萨斯州加尔维斯顿的一家住院康复中心招募了 14 名后天性脑损伤患者。体重调整后的 MWPF 范围为 2.6-27.1% 体重(%BW),平均值为 16.5 ± 8.4%BW,反映了广泛的推进力能力。与地面测试相关性最强的是 6 分钟步行测试(6-MWT)距离和 MWPF 值(r = 0.83,p<0.05)。
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引用次数: 0
Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson's disease: a randomized, four-arm controlled trial. 双侧重复经颅磁刺激和脑电图引导的神经反馈对帕金森病的临床和神经生理学影响:随机四臂对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-05 DOI: 10.1186/s12984-024-01427-5
Juan Pablo Romero, Marcos Moreno-Verdú, Aida Arroyo-Ferrer, J Ignacio Serrano, Jaime Herreros-Rodríguez, Juan García-Caldentey, Eduardo Rocon de Lima, María Dolores Del Castillo

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson's disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD.

Methods: A randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models.

Results: Forty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1-3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found.

Conclusions: The combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels.

Trial registration: NCT04017481.

背景:重复经颅磁刺激(rTMS)和脑电图引导的神经反馈技术可减轻帕金森病(PD)患者的运动症状。然而,两者结合的效果尚不清楚。我们的目标是确定单独或联合使用经颅磁刺激和脑电图引导的神经反馈技术与不采取任何干预措施相比,对帕金森病患者的运动和非运动症状以及神经电生理指标的直接和短期影响:进行了一项随机、单盲对照试验,共分为四组。A组在初级运动皮层接受8次双侧高频(10赫兹)经频磁刺激治疗;B组接受8次30分钟的脑电图引导神经反馈治疗,重点是减少双侧阿尔法和贝塔带的平均值;C组接受A和B的组合治疗;D组不接受任何治疗。主要结果指标是干预后和两周后的 UPDRS-III。次要结果是功能活动度、稳定性极限、抑郁、与健康相关的生活质量和皮质沉默期。治疗效果通过纵向协方差混合效应模型分析得出:40名帕金森病患者(27名男性,年龄=63±8.26岁,基线UPDRS-III=15.63±6.99分,H&Y=1-3)接受了治疗。C组对运动症状、健康相关生活质量和皮质沉默期的影响最大,其次是A组和B组;A-C组与D组在功能活动性或稳定性限制方面的差异微乎其微:结论:经频磁刺激与脑电图引导的神经反馈相结合可减轻整体运动症状并提高生活质量,但这并不反映在功能活动度、姿势稳定性或抑郁程度的变化上:试验注册:NCT04017481。
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引用次数: 0
Perturbation-based estimation of within-stride cycle metabolic cost 基于扰动的步内循环代谢成本估算
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-01 DOI: 10.1186/s12984-024-01424-8
Alex C. Dzewaltowski, Prokopios Antonellis, Arash Mohammadzadeh Gonabadi, Seungmoon Song, Philippe Malcolm
Metabolic cost greatly impacts trade-offs within a variety of human movements. Standard respiratory measurements only obtain the mean cost of a movement cycle, preventing understanding of the contributions of different phases in, for example, walking. We present a method that estimates the within-stride cost of walking by leveraging measurements under different force perturbations. The method reproduces time series with greater consistency (r = 0.55 and 0.80 in two datasets) than previous model-based estimations (r = 0.29). This perturbation-based method reveals how the cost of push-off (10%) is much smaller than would be expected from positive mechanical work (~ 70%). This work elucidates the costliest phases during walking, offering new targets for assistive devices and rehabilitation strategies.
代谢成本在很大程度上影响着各种人体运动的权衡。标准的呼吸测量只能获得运动周期的平均成本,因此无法了解步行等运动中不同阶段的成本。我们提出了一种方法,通过利用不同力量扰动下的测量结果来估算步行的步内成本。与之前基于模型的估算(r = 0.29)相比,该方法能以更高的一致性(两个数据集的 r = 0.55 和 0.80)再现时间序列。这种基于扰动的方法揭示了推离成本(10%)远小于正机械功的预期成本(约 70%)。这项研究阐明了行走过程中成本最高的阶段,为辅助设备和康复策略提供了新的目标。
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引用次数: 0
Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial 双重干预(运动和虚拟现实认知)对轻度认知障碍患者认知能力的影响:单盲随机对照试验
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-01 DOI: 10.1186/s12984-024-01422-w
Jorge Buele, Fátima Avilés-Castillo, Carolina de Valle Soto, José Varela-Aldás, Guillermo Palacios-Navarro
The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant. To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI. Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions). Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level. The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements. ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .
轻度认知功能障碍(MCI)病例的增加凸显了寻找有效方法来延缓病情发展的紧迫性。鉴于目前的药物疗法对预防或治疗这种退化的早期阶段效果有限,非药物疗法就显得尤为重要。目的是评估基于沉浸式虚拟现实(VR)模拟日常生活活动(ADL)的认知运动干预对 MCI 患者认知功能的有效性及其对抑郁和从事此类活动能力的影响。34 名患有 MCI 的老年人(男性、女性)被随机分配到实验组(n = 17;75.41 ± 5.76)或对照组(n = 17;77.35 ± 6.75)。两组均接受运动训练,包括有氧、平衡和阻力活动。随后,实验组接受了基于 VR 的认知训练,而对照组则接受了传统的认知训练。在进行为期 6 周的干预(共 12 次,每次 40 分钟)之前和之后,使用西班牙语版本的蒙特利尔认知评估(MoCA-S)、老年抑郁简易量表(SGDS-S)和日常生活工具活动(IADL-S)对认知功能、抑郁和日常生活活动能力进行了评估。组间比较并未发现认知功能或老年抑郁方面的显著差异。两组在认知功能和老年抑郁方面的组内效应都很明显(P < 0.001),效应大小较大。在评估 ADL 的表现时,两组在统计学上都没有明显改善(对照组,p = 0.28;实验组,p = 0.46)。实验组的完成率(82.35%)高于对照组(70.59%)。同样,实验组的参与者在应用中达到的难度级别更高,完成每个级别任务所需的时间更短。实验表明,在基于沉浸式 VR 的认知任务之前进行运动训练的双重干预是一种有益的非药物策略,可改善 MCI 患者的认知功能并减少抑郁。同样,对照组也从这种双重干预中获益,并取得了统计学意义上的显著改善。ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 。
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引用次数: 0
A usability study on the inGAIT-VSO: effects of a variable-stiffness ankle-foot orthosis on the walking performance of children with cerebral palsy inGAIT-VSO可用性研究:可变刚度踝足矫形器对脑瘫儿童行走表现的影响
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-01 DOI: 10.1186/s12984-024-01433-7
Luc van Noort, Nikko Van Crey, Elliott J. Rouse, Ignacio Martínez-Caballero, Edwin H. F. van Asseldonk, Cristina Bayón
Ankle-foot orthoses (AFOs) are commonly used by children with cerebral palsy (CP), but traditional solutions are unable to address the heterogeneity and evolving needs amongst children with CP. One key limitation lies in the inability of current passive devices to customize the torque–angle relationship, which is essential to adapt the support to the specific individual needs. Powered alternatives can provide customized behavior, but often face challenges with reliability, weight, and cost. Overall, clinicians find certain barriers that hinder their prescription. In recent work, the Variable Stiffness Orthosis (VSO) was developed, enabling stiffness customization without the need for motors or sophisticated control. This work evaluates a pediatric version of the VSO (inGAIT-VSO) by investigating its impact on the walking performance of children with CP and its potential to be used as a tool for assessing the effect of variable stiffness on pathological gait. Data was collected for three typical developing (TD) children and six pediatric participants with CP over two sessions involving walking/balance tasks and questionnaires. The sensors of the inGAIT-VSO provided useful information to assess the impact of the device. Increasing the stiffness of the inGAIT-VSO significantly reduced participants’ dorsiflexion and plantarflexion. Despite reduced range of motion, the peak restoring torque increased with stiffness. Overall the participants’ gait pattern was altered by reducing crouch gait, preventing drop-foot and supporting body weight. Participants with CP exhibited significantly lower (p < 0.05) physiological cost when walking with the inGAIT-VSO compared to normal condition (own AFO or shoes only). Generally, the device did not impair walking and balance of the participants compared to normal conditions. According to the questionnaire results, the inGAIT-VSO was easy to use and participants reported positive experiences. The inGAIT-VSO stiffnesses significantly affected participants’ plantarflexion and dorsiflexion and yielded objective data regarding walking performance in pathological gait (e.g. ankle angle, exerted torque and restored assistive energy). These effects were captured by the sensors integrated in the device without using external equipment. The inGAIT-VSO shows promise for customizing AFO stiffness and aiding clinicians in selecting a personalized stiffness based on objective metrics.
踝足矫形器(AFOs)是脑瘫(CP)患儿常用的矫形器,但传统的解决方案无法解决CP患儿的异质性和不断变化的需求。目前的被动式装置无法定制扭力-角度关系,而这是使支撑适应特定个体需求的关键所在。动力替代装置可以提供定制行为,但往往面临可靠性、重量和成本方面的挑战。总之,临床医生发现某些障碍阻碍了他们的处方。在最近的工作中,开发出了可变硬度矫形器(VSO),无需电机或复杂的控制就能实现硬度定制。本研究评估了儿童版可变僵硬矫形器(inGAIT-VSO),研究了其对脊柱侧弯症儿童行走表现的影响,以及将其用作评估可变僵硬度对病态步态影响的工具的潜力。我们收集了三位典型发育期(TD)儿童和六位患有脊髓灰质炎的儿科参与者的数据,包括行走/平衡任务和问卷调查两个部分。inGAIT-VSO的传感器为评估该设备的影响提供了有用的信息。增加 inGAIT-VSO 的硬度可显著减少参与者的背屈和跖屈。尽管活动范围缩小了,但峰值恢复扭矩却随着硬度的增加而增加。总体而言,参与者的步态通过减少蹲踞步态、防止垂足和支撑身体重量而发生了改变。与正常情况下(只穿自己的 AFO 或鞋)相比,CP 患者在使用 inGAIT-VSO 步行时的生理成本明显较低(p < 0.05)。总体而言,与正常情况相比,该装置不会影响参与者的行走和平衡。根据问卷调查的结果,inGAIT-VSO 易于使用,参与者的体验良好。inGAIT-VSO僵硬度对参与者的跖屈和背屈有明显影响,并产生了有关病理步态下行走表现的客观数据(如踝关节角度、施加的扭矩和恢复的辅助能量)。这些效果均由集成在设备中的传感器捕捉,无需使用外部设备。inGAIT-VSO显示出了定制AFO硬度和帮助临床医生根据客观指标选择个性化硬度的前景。
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引用次数: 0
Towards novel classification of infants' movement patterns supported by computerized video analysis. 在计算机视频分析的支持下,对婴儿的运动模式进行新的分类。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-07-31 DOI: 10.1186/s12984-024-01429-3
Iwona Doroniewicz, Daniel J Ledwoń, Monika Bugdol, Katarzyna Kieszczyńska, Alicja Affanasowicz, Dominika Latos, Małgorzata Matyja, Andrzej Myśliwiec

Background: Positional preferences, asymmetry of body position and movements potentially indicate abnormal clinical conditions in infants. However, a lack of standardized nomenclature hinders accurate assessment and documentation of these preferences over time. Video tools offer a safe and reproducible method to analyze and describe infant movement patterns, aiding in physiotherapy management and goal planning. The study aimed to develop an objective classification system for infant movement patterns with particular emphasis on the specific distribution of muscle tension, using methods of computer analysis of video recordings to enhance accuracy and reproducibility in assessments.

Methods: The study involved the recording of videos of 51 infants between 6 and 15 weeks of age, born at term, with an Apgar score of at least 8 points. Based on observations of a recording of infant spontaneous movements in the supine position, experts identified postural-motor patterns: symmetry and typical asymmetry linked to the asymmetrical tonic neck reflex. Deviations from the typical postural-motor system were indicated, and subcategories of atypical patterns were distinguished. A computer-based inference system was developed to automatically classify individual patterns.

Results: The following division of motor patterns was used: (1) normal patterns, including (a) typical (symmetrical, asymmetrical: variants 1 and 2); and (b) atypical (variants: 1 to 4), (2) positional preference, and (3) abnormal patterns. The proposed automatic classification method achieved an expert decision mapping accuracy of 84%. For atypical patterns, the high reproducibility of the system's results was confirmed. Lower reproducibility, not exceeding 70%, was achieved with typical patterns.

Conclusions: Based on the observation of infant spontaneous movements, it is possible to identify movement patterns divided into typical and atypical patterns. Computer-based analysis of infant movement patterns makes it possible to objectify and satisfactorily reproduce diagnostic decisions.

背景:体位偏好、体位和动作的不对称可能预示着婴儿的异常临床状况。然而,标准化术语的缺乏阻碍了对这些偏好的准确评估和长期记录。视频工具提供了一种安全、可重复的方法来分析和描述婴儿的运动模式,有助于物理治疗管理和目标规划。该研究旨在开发一套客观的婴儿运动模式分类系统,特别强调肌肉张力的具体分布,使用计算机分析视频记录的方法来提高评估的准确性和可重复性:这项研究包括录制 51 名 6 至 15 周大、足月出生、阿普加评分至少为 8 分的婴儿的视频。根据对婴儿仰卧位自发运动的观察记录,专家们确定了姿势运动模式:对称和典型的不对称,与不对称的颈部强直反射有关。专家们指出了典型姿势运动系统的偏差,并区分了非典型模式的子类别。我们还开发了一套基于计算机的推理系统,用于自动对各种模式进行分类:结果:对运动模式进行了如下划分:(1) 正常模式,包括(a) 典型模式(对称、不对称:变体 1 和 2);(b) 非典型模式(变体 1 至 4);(2) 位置偏好;(3) 异常模式。所提出的自动分类方法的专家决策映射准确率达到 84%。对于非典型模式,系统结果的高再现性得到了证实。典型模式的重现性较低,不超过 70%:结论:根据对婴儿自发运动的观察,可以将运动模式分为典型模式和非典型模式。基于计算机的婴儿运动模式分析使诊断结果客观化并令人满意地再现成为可能。
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引用次数: 0
Validation of IMU against optical reference and development of open-source pipeline: proof of concept case report in a participant with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant. 根据光学基准验证 IMU 并开发开源管道:在一名安装了经皮骨结合植入物的经股截肢患者身上进行的概念验证案例报告。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-07-31 DOI: 10.1186/s12984-024-01426-6
Kirstin Ahmed, Shayan Taheri, Ive Weygers, Max Ortiz-Catalan

Background: Systems that capture motion under laboratory conditions limit validity in real-world environments. Mobile motion capture solutions such as Inertial Measurement Units (IMUs) can progress our understanding of "real" human movement. IMU data must be validated in each application to interpret with clinical applicability; this is particularly true for diverse populations. Our IMU analysis method builds on the OpenSim IMU Inverse Kinematics toolkit integrating the Versatile Quaternion-based Filter and incorporates realistic constraints to the underlying biomechanical model. We validate our processing method against the reference standard optical motion capture in a case report with participants with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant (POI) and without amputation walking over level ground. We hypothesis that by using this novel pipeline, we can validate IMU motion capture data, to a clinically acceptable degree.

Results: Average RMSE (across all joints) between the two systems from the participant with a unilateral transfemoral amputation (TFA) on the amputated and the intact sides were 2.35° (IQR = 1.45°) and 3.59° (IQR = 2.00°) respectively. Equivalent results in the non-amputated participant were 2.26° (IQR = 1.08°). Joint level average RMSE between the two systems from the TFA ranged from 1.66° to 3.82° and from 1.21° to 5.46° in the non-amputated participant. In plane average RMSE between the two systems from the TFA ranged from 2.17° (coronal) to 3.91° (sagittal) and from 1.96° (transverse) to 2.32° (sagittal) in the non-amputated participant. Coefficients of Multiple Correlation (CMC) results between the two systems in the TFA ranged from 0.74 to > 0.99 and from 0.72 to > 0.99 in the non-amputated participant and resulted in 'excellent' similarity in each data set average, in every plane and at all joint levels. Normalized RMSE between the two systems from the TFA ranged from 3.40% (knee level) to 54.54% (pelvis level) and from 2.18% to 36.01% in the non-amputated participant.

Conclusions: We offer a modular processing pipeline that enables the addition of extra layers, facilitates changes to the underlying biomechanical model, and can accept raw IMU data from any vendor. We successfully validate the pipeline using data, for the first time, from a TFA participant using a POI and have proved our hypothesis.

背景:在实验室条件下捕捉运动的系统限制了其在真实世界环境中的有效性。惯性测量单元(IMU)等移动运动捕捉解决方案可以加深我们对 "真实 "人体运动的理解。IMU 数据必须在每个应用中进行验证,以解释其临床适用性;对于不同人群尤其如此。我们的 IMU 分析方法以 OpenSim IMU 逆运动学工具包为基础,集成了基于多用途四元数的滤波器,并将现实的约束条件纳入底层生物力学模型。我们在一份案例报告中验证了我们的处理方法是否符合光学运动捕捉的参考标准,该报告的参与者患有经股骨截肢,安装了经皮骨结合植入物(POI),而没有截肢,在平地上行走。我们假设,通过使用这种新型管道,我们可以在临床上可接受的程度上验证 IMU 运动捕捉数据:单侧经股动脉截肢(TFA)患者截肢侧和完好侧两个系统之间的平均均方根误差(跨所有关节)分别为 2.35°(IQR = 1.45°)和 3.59°(IQR = 2.00°)。未截肢受试者的同等结果为 2.26°(IQR = 1.08°)。在未截肢的受试者中,TFA 的两个系统之间的关节水平平均均方根误差介于 1.66° 至 3.82° 之间,而非截肢的受试者则介于 1.21° 至 5.46° 之间。在未截肢的受试者中,TFA 的两个系统之间的平面内平均均方根误差范围为 2.17°(冠状面)至 3.91°(矢状面),1.96°(横向)至 2.32°(矢状面)。在 TFA 中,两个系统之间的多重相关系数(CMC)从 0.74 到大于 0.99 不等,在非截肢受试者中,从 0.72 到大于 0.99 不等,在每个数据集的平均值、每个平面和所有关节水平上都具有 "极佳 "的相似性。来自 TFA 的两个系统之间的归一化均方根误差从 3.40%(膝关节水平)到 54.54%(骨盆水平)不等,在未截肢的受试者中则从 2.18% 到 36.01%不等:我们提供了一个模块化处理管道,可以添加额外的层,便于更改底层生物力学模型,并可接受来自任何供应商的原始 IMU 数据。我们首次使用一名使用 POI 的 TFA 参与者的数据成功验证了该管道,并证明了我们的假设。
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引用次数: 0
Safety & efficacy of a robotic hip exoskeleton on outpatient stroke rehabilitation. 机器人髋关节外骨骼在门诊中风康复治疗中的安全性和有效性。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-07-30 DOI: 10.1186/s12984-024-01421-x
Rebecca Macaluso, Matt Giffhorn, Sara Prokup, Brice Cleland, Jusuk Lee, Bokman Lim, Minhyung Lee, Hwang-Jae Lee, Sangeetha Madhavan, Arun Jayaraman

Objective: The objective of this study was to analyze the safety and efficacy of using a robotic hip exoskeleton designed by Samsung Electronics Co., Ltd., Korea, called the Gait Enhancing and Motivating System-Hip (GEMS-H), in assistance mode only with the poststroke population in an outpatient-rehabilitation setting.

Methods: Forty-one participants with an average age of 60 and average stroke latency of 6.5 years completed this prospective, single arm, interventional, longitudinal study during the COVID-19 pandemic. Significant modifications to the traditional outpatient clinical environment were made to adhere to organizational physical distancing policies as well as guidelines from the Centers for Disease Control. All participants received gait training with the GEMS-H in assistance mode for 18 training sessions over the course of 6-8 weeks. Performance-based and self-reported clinical outcomes were assessed at four time points: baseline, midpoint (after 9 training sessions), post (after 18 training sessions), and 1-month follow up. Daily step count was also collected throughout the duration of the study using an ankle-worn actigraphy device. Additionally, corticomotor excitability was measured at baseline and post for 4 bilateral lower limb muscles using transcranial magnetic stimulation.

Results: By the end of the training program, the primary outcome, walking speed, improved by 0.13 m/s (p < 0.001). Secondary outcomes of walking endurance, balance, and functional gait also improved as measured by the 6-Minute Walk Test (47 m, p < 0.001), Berg Balance Scale (2.93 points, p < 0.001), and Functional Gait Assessment (1.80 points, p < 0.001). Daily step count significantly improved with and average increase of 1,750 steps per day (p < 0.001). There was a 35% increase in detectable lower limb motor evoked potentials and a significant decrease in the active motor threshold in the medial gastrocnemius (-5.7, p < 0.05) after training with the device.

Conclusions: Gait training with the GEMS-H exoskeleton showed significant improvements in walking speed, walking endurance, and balance in persons with chronic stroke. Day-to-day activity also improved as evidenced by increased daily step count. Additionally, corticomotor excitability changes suggest that training with this device may help correct interhemispheric imbalance typically seen after stroke.

Trial registration: This study is registered with ClinicalTrials.gov (NCT04285060).

研究目的本研究的目的是分析韩国三星电子有限公司设计的步态增强和激励系统-髋关节(GEMS-H)机器人髋关节外骨骼在门诊康复环境中仅在辅助模式下对中风后人群使用的安全性和有效性:在 COVID-19 大流行期间,41 名平均年龄 60 岁、平均中风潜伏期 6.5 年的参与者完成了这项前瞻性、单臂、干预性纵向研究。对传统的门诊临床环境进行了重大调整,以遵守组织机构的物理距离政策以及美国疾病控制中心的指导方针。所有参与者都在 6-8 周内接受了 18 次 GEMS-H 辅助模式步态训练。在基线、中点(9 次训练后)、后期(18 次训练后)和 1 个月随访这四个时间点评估了基于表现和自我报告的临床结果。在整个研究过程中,还使用踝戴式运动计步器收集每日步数。此外,还使用经颅磁刺激法测量了基线和后期双侧下肢 4 块肌肉的皮质运动兴奋性:结果:训练计划结束时,主要结果--步行速度提高了 0.13 米/秒(p 结论:GEMS 系统的步态训练效果显著:使用 GEMS-H 外骨骼进行步态训练可显著提高慢性中风患者的行走速度、行走耐力和平衡能力。日常活动也有所改善,这体现在每日步数的增加上。此外,皮质运动神经兴奋性的变化表明,使用该装置进行训练可能有助于纠正中风后常见的大脑半球间失衡:本研究已在 ClinicalTrials.gov (NCT04285060) 注册。
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引用次数: 0
Customized passive-dynamic ankle-foot orthoses can improve walking economy and speed for many individuals post-stroke. 定制的被动动力踝足矫形器可以改善许多中风后患者的行走经济性和速度。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-07-29 DOI: 10.1186/s12984-024-01425-7
Jacob T Skigen, Corey A Koller, Luke Nigro, Darcy S Reisman, Zahra McKee, Shay R Pinhey, Adrienne Henderson, Jason M Wilken, Elisa S Arch

Background: Passive-dynamic ankle-foot orthoses (PD-AFOs) are often prescribed to address plantar flexor weakness during gait, which is commonly observed after stroke. However, limited evidence is available to inform the prescription guidelines of PD-AFO bending stiffness. This study assessed the extent to which PD-AFOs customized to match an individual's level of plantar flexor weakness influence walking function, as compared to No AFO and their standard of care (SOC) AFO.

Methods: Mechanical cost-of-transport, self-selected walking speed, and key biomechanical variables were measured while individuals greater than six months post-stroke walked with No AFO, with their SOC AFO, and with a stiffness-customized PD-AFO. Outcomes were compared across these conditions using a repeated measures ANOVA or Friedman test (depending on normality) for group-level analysis and simulation modeling analysis for individual-level analysis.

Results: Twenty participants completed study activities. Mechanical cost-of-transport and self-selected walking speed improved with the stiffness-customized PD-AFOs compared to No AFO and SOC AFO. However, this did not result in a consistent improvement in other biomechanical variables toward typical values. In line with the heterogeneous nature of the post-stroke population, the response to the PD-AFO was highly variable.

Conclusions: Stiffness-customized PD-AFOs can improve the mechanical cost-of-transport and self-selected walking speed in many individuals post-stroke, as compared to No AFO and participants' standard of care AFO. This work provides initial efficacy data for stiffness-customized PD-AFOs in individuals post-stroke and lays the foundation for future studies to enable consistently effective prescription of PD-AFOs for patients post-stroke in clinical practice.

Trial registration: NCT04619043.

背景:被动动态踝足矫形器(PD-AFO)通常用于解决中风后常见的步态时足底屈肌无力的问题。然而,用于指导 PD-AFO 弯曲硬度处方的证据有限。本研究评估了根据个人跖屈肌无力程度定制的 PD-AFO 与无 AFO 及其标准护理 (SOC) AFO 相比对步行功能的影响程度:方法:在中风后六个月以上的患者使用无AFO、标准护理AFO和硬度定制的PD-AFO行走时,对他们的行走机械成本、自选行走速度和关键生物力学变量进行了测量。使用重复测量方差分析或弗里德曼检验(取决于正态性)对不同条件下的结果进行比较,以进行群体层面的分析,并使用模拟建模分析进行个体层面的分析:结果:20 名参与者完成了研究活动。与无 AFO 和 SOC AFO 相比,根据刚度定制的 PD-AFO 改善了机械运动成本和自选步行速度。然而,这并没有导致其他生物力学变量向典型值的一致改善。与中风后人群的异质性相一致的是,PD-AFO 的反应也存在很大差异:与无AFO和参与者的标准护理AFO相比,根据硬度定制的PD-AFO可以改善许多中风后患者的机械运输成本和自选步行速度。这项研究提供了针对中风后患者的僵硬度定制PD-AFO的初步疗效数据,为今后的研究奠定了基础,以便在临床实践中为中风后患者持续有效地开具PD-AFO处方:试验注册:NCT04619043。
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引用次数: 0
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Journal of NeuroEngineering and Rehabilitation
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