Pub Date : 2024-08-05DOI: 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。
{"title":"Smart ArM: a customizable and versatile robotic arm prosthesis platform for Cybathlon and research.","authors":"Sébastien Mick, Charlotte Marchand, Étienne de Montalivet, Florian Richer, Mathilde Legrand, Alexandre Peudpièce, Laurent Fabre, Christophe Huchet, Nathanaël Jarrassé","doi":"10.1186/s12984-024-01423-9","DOIUrl":"10.1186/s12984-024-01423-9","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 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.
{"title":"Estimating highest capacity propulsion performance using backward-directed force during walking evaluation for individuals with acquired brain injury.","authors":"Kelli LaCroix, Lauren Horelka, Clif Hung, David A Brown","doi":"10.1186/s12984-024-01428-4","DOIUrl":"10.1186/s12984-024-01428-4","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 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.
{"title":"Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson's disease: a randomized, four-arm controlled trial.","authors":"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","doi":"10.1186/s12984-024-01427-5","DOIUrl":"10.1186/s12984-024-01427-5","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>NCT04017481.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 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。
{"title":"Perturbation-based estimation of within-stride cycle metabolic cost","authors":"Alex C. Dzewaltowski, Prokopios Antonellis, Arash Mohammadzadeh Gonabadi, Seungmoon Song, Philippe Malcolm","doi":"10.1186/s12984-024-01424-8","DOIUrl":"https://doi.org/10.1186/s12984-024-01424-8","url":null,"abstract":"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.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141870717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 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 .
{"title":"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","authors":"Jorge Buele, Fátima Avilés-Castillo, Carolina de Valle Soto, José Varela-Aldás, Guillermo Palacios-Navarro","doi":"10.1186/s12984-024-01422-w","DOIUrl":"https://doi.org/10.1186/s12984-024-01422-w","url":null,"abstract":"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 .","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141870718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 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.
{"title":"A usability study on the inGAIT-VSO: effects of a variable-stiffness ankle-foot orthosis on the walking performance of children with cerebral palsy","authors":"Luc van Noort, Nikko Van Crey, Elliott J. Rouse, Ignacio Martínez-Caballero, Edwin H. F. van Asseldonk, Cristina Bayón","doi":"10.1186/s12984-024-01433-7","DOIUrl":"https://doi.org/10.1186/s12984-024-01433-7","url":null,"abstract":"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.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141870716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 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.
{"title":"Towards novel classification of infants' movement patterns supported by computerized video analysis.","authors":"Iwona Doroniewicz, Daniel J Ledwoń, Monika Bugdol, Katarzyna Kieszczyńska, Alicja Affanasowicz, Dominika Latos, Małgorzata Matyja, Andrzej Myśliwiec","doi":"10.1186/s12984-024-01429-3","DOIUrl":"10.1186/s12984-024-01429-3","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 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.
{"title":"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.","authors":"Kirstin Ahmed, Shayan Taheri, Ive Weygers, Max Ortiz-Catalan","doi":"10.1186/s12984-024-01426-6","DOIUrl":"10.1186/s12984-024-01426-6","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 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).
{"title":"Safety & efficacy of a robotic hip exoskeleton on outpatient stroke rehabilitation.","authors":"Rebecca Macaluso, Matt Giffhorn, Sara Prokup, Brice Cleland, Jusuk Lee, Bokman Lim, Minhyung Lee, Hwang-Jae Lee, Sangeetha Madhavan, Arun Jayaraman","doi":"10.1186/s12984-024-01421-x","DOIUrl":"10.1186/s12984-024-01421-x","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>This study is registered with ClinicalTrials.gov (NCT04285060).</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 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。
{"title":"Customized passive-dynamic ankle-foot orthoses can improve walking economy and speed for many individuals post-stroke.","authors":"Jacob T Skigen, Corey A Koller, Luke Nigro, Darcy S Reisman, Zahra McKee, Shay R Pinhey, Adrienne Henderson, Jason M Wilken, Elisa S Arch","doi":"10.1186/s12984-024-01425-7","DOIUrl":"10.1186/s12984-024-01425-7","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>NCT04619043.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11285468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}