Upper-limb actuated exoskeleton for muscular dystrophy patients: preliminary results.

Being able to perform a lost movement is an important experience towards increased independence and self-esteem, particularly for neuromuscular patients, who see their muscles weaken day after day. In this pilot study, preliminary results on the testing of a motorized upper-limb exoskeleton for muscular dystrophy patients are presented. The mechatronic system is a five Degrees of Freedom exoskeleton, which acts at shoulder, elbow, and wrist levels. It is designed to help severely impaired people to regain independence during daily-life activities. While wearing the exoskeleton, the user has the direct control of the system by actively piloting the position of end-effector by means of joystick or vocal control. The usability of the system and a quantitative assessment of arm functionality with and without the exoskeleton are evaluated on five muscular dystrophy patients. According to the objective functional benefit evaluation performed through the PUL scale, all participants strongly increased their range of motion and they were able to perform activities that were not possible without the exoskeleton, such as such as feeding, playing activities at the table, combing hair or using a keyboard. As for the evaluation of self-perceived functional benefit, four patients reflected the effective measured functional improvement. System usability has been evaluated to be good.

The combined action of a passive exoskeleton and an EMG-controlled neuroprosthesis for upper limb stroke rehabilitation: First results of the RETRAINER project.

The combined use of Functional Electrical Stimulation (FES) and robotic technologies is advocated to improve rehabilitation outcomes after stroke. This work describes an arm rehabilitation system developed within the European project RETRAINER. The system consists of a passive 4-degrees-of-freedom exoskeleton equipped with springs to provide gravity compensation and electromagnetic brakes to hold target positions. FES is integrated in the system to provide additional support to the most impaired muscles. FES is triggered based on the volitional EMG signal of the same stimulated muscle; in order to encourage the active involvement of the patient the volitional EMG is also monitored throughout the task execution and based on it a happy or sad emoji is visualized at the end of each task. The control interface control of the system provides a GUI and multiple software tools to organize rehabilitation exercises and monitor rehabilitation progress. The functionality and the usability of the system was evaluated on four stroke patients. All patients were able to use the system and judged positively its wearability and the provided support. They were able to trigger the stimulation based on their residual muscle activity and provided different levels of active involvement in the exercise, in agreement with their level of impairment. A randomized controlled trial aimed at evaluating the effectiveness of the RETRAINER system to improve arm function after stroke is currently ongoing.

A preliminary model study of the equine back including activity of longissimus dorsi muscle.

REASONS FOR PERFORMING STUDY: Identifying the underlying problem of equine back pain and diseases of the spine are significant problems in veterinary orthopaedics. A study to validate a preliminary biomechanical model of the equine back based on CT images including longissimus dorsi (LD) muscle is therefore important. OBJECTIVES: Validation of the back model by comparing the shortening of LD muscles in the model with integrated EMG (IEMG) at stance during induced lateral flexion of the spine. METHODS: Longissimus dorsi muscle activity at stance has been used for validation. EMG electrodes were placed laterally at the level of T12, T16 and L3. Reflective markers have been attached on top of the spinous processes T5, T12, T16, L1 and the sacral bone (OS1, OS2) for motion tracking analysis. A virtual model of the equine's back (T1-S5) was built with inclusion of a simplified LD muscle by 2 separate contours left and right of the spine, starting at tuber coxae laterally and attaching to the spinous process T5 medially. Shortening of LD during induced lateral flexion caused by the kinematic data (input) was compared to the 3 EMG signals (T12, T16 and L3) on the active side via correlation. RESULTS: Pearson correlation coefficient between IEMG and shortening length of LD in the model was (mean ± s.d.) 0.95 ± 0.07 for the left side and 0.91 ± 0.07 for the right side of LD. CONCLUSIONS: Activity of the LD muscles is mainly responsible for stabilisation of the vertebral column with isometric muscle contraction against dynamic forces in walk and trot. This validation requires muscle shortening in the back, like induced lateral flexion at stance. The length of the shortening muscle model and the IEMG show a linear relationship. These findings will help to model the LD for forward simulations, e.g. from force to motion.