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Accurately estimating knee joint angle during walking from surface electromyography (sEMG) signals can enable more natural control of wearable robotics like exoskeletons. However, challenges exist due to variability across individuals and sessions. This study evaluates an attention-based deep recurrent neural network combining gated recurrent units (GRUs) and an attention mechanism (AM) for knee angle estimation. Three experiments were conducted. First, the GRU-AM model was tested on four healthy adolescents, demonstrating improved estimation compared to GRU alone. A sensitivity analysis revealed that the key contributing muscles were the knee flexor and extensors, highlighting the ability of the AM to focus on the most salient inputs. Second, transfer learning was shown by pretraining the model on an open source dataset before additional training and testing on the four adolescents. Third, the model was progressively adapted over three sessions for one child with cerebral palsy (CP). The GRU-AM model demonstrated robust knee angle estimation across participants with healthy participants (mean RMSE 7 degrees) and participants with CP (RMSE 37 degrees). Further, estimation accuracy improved by 14 degrees on average across successive sessions of walking in the child with CP. These results demonstrate the feasibility of using attention-based deep networks for joint angle estimation in adolescents and clinical populations and support their further development for deployment in wearable robotics.
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Parálisis Cerebral , Electromiografía , Articulación de la Rodilla , Redes Neurales de la Computación , Caminata , Humanos , Parálisis Cerebral/fisiopatología , Electromiografía/métodos , Caminata/fisiología , Adolescente , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Masculino , Femenino , Niño , Estudios de Factibilidad , Fenómenos Biomecánicos/fisiología , Músculo Esquelético/fisiopatología , Músculo Esquelético/fisiología , Rodilla/fisiopatología , Rodilla/fisiología , Dispositivos Electrónicos Vestibles , Rango del Movimiento Articular/fisiologíaRESUMEN
BACKGROUND: Mirror therapy (MT) has been used for functional recovery of the affected hand by providing the mirrored image of the unaffected hand movement, which induces neural activation of the cortical hemisphere contralateral to the affected hand. Recently, many wearable robots assisting the movement of the hand have been developed, and several studies have proposed robotic mirror therapy (RMT) that uses a robot to provide mirrored movements of the unaffected hand to the affected hand with the robot controlled by measuring electromyography or posture of the unaffected hand. In some cases of RMT a mirror is placed to allow the person to observe only the unaffected hand but in others users simply observe the robotically assisted hand performing the mirrored movements, as was the case in this study. There have been limited evaluations of the cortical activity during RMT compared to MT and robotic therapy (RT) providing passive movements despite the difference in the modality of sensory feedback and the involvement of motor intention, respectively. METHODS: This paper analyzes bilateral motor cortex activation in nine healthy subjects and five chronic stroke survivors during a pinching task performed in MT, RT, and RMT conditions using functional near infrared spectroscopy (fNIRS). In the MT condition, the person moved the unaffected hand and observed it in a mirror while the affected hand remained still. In RT condition passive movements were provided to the affected hand with a cable-driven soft robotic glove, while, in RMT condition, the posture of the unaffected hand was measured by a sensing glove and the soft robotic glove mirrored its movement on the affected hand. RESULTS: For both groups, the RMT condition showed the greatest mean cortical activation on the motor cortex contralateral to the affected (non-dominant for the healthy group) hand compared to other conditions. Individual results indicate that RMT induces similar or greater neural activation on the motor cortex compared to MT and RT conditions. The interhemispheric activations of both groups were balanced in RMT condition. In MT condition, significantly greater activation was shown on the hemisphere ipsilateral to the affected (dominant for the healthy group) hand for both subject groups, while the contralateral side showed significantly greater activation for the healthy group in RT condition. CONCLUSION: The experimental results indicate that combining visual feedback, somatosensory feedback, and motor intention are important for greater stimulation on the contralateral motor cortex of the affected hand. RMT that includes these factors is hypothesized to achieve a more effective functional rehabilitation due to greater and more balanced cortical activation.
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Corteza Motora , Procedimientos Quirúrgicos Robotizados , Robótica , Retroalimentación Sensorial/fisiología , Lateralidad Funcional/fisiología , Mano/fisiología , Humanos , Corteza Motora/fisiología , Movimiento/fisiologíaRESUMEN
State-of-the-art exoskeletons are typically limited by low control bandwidth and small range stiffness of actuators which are based on high gear ratios and elastic components (e.g., series elastic actuators). Furthermore, most exoskeletons are based on discrete gait phase detection and/or discrete stiffness control resulting in discontinuous torque profiles. To fill these two gaps, we developed a portable lightweight knee exoskeleton using quasi-direct drive (QDD) actuation that provides 14 Nm torque (36.8% biological joint moment for overground walking). This paper presents 1) stiffness modeling of torque-controlled QDD exoskeletons and 2) stiffness-based continuous torque controller that estimates knee joint moment in real-time. Experimental tests found the exoskeleton had high bandwidth of stiffness control (16 Hz under 100 Nm/rad) and high torque tracking accuracy with 0.34 Nm Root Mean Square (RMS) error (6.22%) across 0-350 Nm/rad large range stiffness. The continuous controller was able to estimate knee moments accurately and smoothly for three walking speeds and their transitions. Experimental results with 8 able-bodied subjects demonstrated that our exoskeleton was able to reduce the muscle activities of all 8 measured knee and ankle muscles by 8.60%-15.22% relative to unpowered condition, and two knee flexors and one ankle plantar flexor by 1.92%-10.24% relative to baseline (no exoskeleton) condition.
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BACKGROUND: Neuromuscular Electrical Stimulation (NMES) has been utilized for many years in cerebral palsy (CP) with limited success despite its inherent potential for improving muscle size and/or strength, inhibiting or reducing spasticity, and enhancing motor performance during functional activities such as gait. While surface NMES has been shown to successfully improve foot drop in CP and stroke, correction of more complex gait abnormalities in CP such as flexed knee (crouch) gait remains challenging due to the level of stimulation needed for the quadriceps muscles that must be balanced with patient tolerability and the ability to deliver NMES assistance at precise times within a gait cycle. METHODS: This paper outlines the design and evaluation of a custom, noninvasive NMES system that can trigger and adjust electrical stimulation in real-time. Further, this study demonstrates feasibility of one possible application for this digitally-controlled NMES system as a component of a pediatric robotic exoskeleton to provide on-demand stimulation to leg muscles within specific phases of the gait cycle for those with CP and other neurological disorders who still have lower limb sensation and volitional control. A graphical user interface was developed to digitally set stimulation parameters (amplitude, pulse width, and frequency), timing, and intensity during walking. Benchtop testing characterized system delay and power output. System performance was investigated during a single session that consisted of four overground walking conditions in a 15-year-old male with bilateral spastic CP, GMFCS Level III: (1) his current Ankle-Foot Orthosis (AFO); (2) unassisted Exoskeleton; (3) NMES of the vastus lateralis; and (4) NMES of the vastus lateralis and rectus femoris. We hypothesized in this participant with crouch gait that NMES triggered with low latency to knee extensor muscles during stance would have a modest but positive effect on knee extension during stance. RESULTS: The system delivers four channels of NMES with average delays of 16.5 ± 13.5 ms. Walking results show NMES to the vastus lateralis and rectus femoris during stance immediately improved mean peak knee extension during mid-stance (p = 0.003*) and total knee excursion (p = 0.009*) in the more affected leg. The electrical design, microcontroller software and graphical user interface developed here are included as open source material to facilitate additional research into digitally-controlled surface stimulation ( github.com/NIHFAB/NMES ). CONCLUSIONS: The custom, digitally-controlled NMES system can reliably trigger electrical stimulation with low latency. Precisely timed delivery of electrical stimulation to the quadriceps is a promising treatment for crouch. Our ultimate goal is to synchronize NMES with robotic knee extension assistance to create a hybrid NMES-exoskeleton device for gait rehabilitation in children with flexed knee gait from CP as well as from other pediatric disorders. TRIAL REGISTRATION: clinicaltrials.gov, ID: NCT01961557 . Registered 11 October 2013; Last Updated 27 January 2020.
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Parálisis Cerebral/rehabilitación , Terapia por Estimulación Eléctrica/instrumentación , Dispositivo Exoesqueleto , Trastornos Neurológicos de la Marcha/rehabilitación , Diseño de Prótesis , Adolescente , Parálisis Cerebral/complicaciones , Trastornos Neurológicos de la Marcha/etiología , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Espasticidad Muscular/fisiopatologíaRESUMEN
Individuals with neuromuscular disorders display a combination of motor control deficits and lower limb weakness contributing to knee extension deficiency characterized by exaggerated stance phase knee flexion. There is a lack of evidence for long-term improvement of knee extension deficiency with currently available clinical treatment programs. Our previous work testing a wearable robotic exoskeleton with precisely timed assistive torque applied at the knee showed immediate increases in knee extension during walking for children with cerebral palsy, which continued to improve over an acute practice period. When we applied interleaved assistance and resistance to knee extension, we observed improvements in knee extension and increased muscle activation indicating the potential for muscle strengthening when used over time. There is a need for additional, high-quality trials to assess the impact of dosage, intensity and volume of training necessary to see persistent improvement in lower limb function for these patient populations. This randomized crossover study (ClinicalTrials.gov: NCT05726591) was designed to determine whether 12 weeks of overground gait training with a robotic exoskeleton outside of the clinical setting, following an initial in clinic accommodation period, has a beneficial effect on walking ability, muscle activity and overall motor function. Participants will be randomized to either complete the exoskeleton intervention or continue their standard therapy for 12 weeks first, followed by a crossover to the other study component. The primary outcome measure is change in peak knee extension angle during walking; secondary outcome measures include gait speed, strength, and validated clinical scales of motor function and mobility. Assessments will be completed before and after the intervention and at 6 weeks post-intervention, and safety and compliance will be monitored throughout. We hypothesize that the 12-week exoskeleton intervention outside the clinical setting will show greater improvements in study outcome measures than the standard therapy.
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Estudios Cruzados , Dispositivo Exoesqueleto , Marcha , Humanos , Niño , Marcha/fisiología , Masculino , Femenino , Adolescente , Trastornos del Movimiento/rehabilitación , Trastornos del Movimiento/fisiopatología , Trastornos del Movimiento/terapia , Parálisis Cerebral/rehabilitación , Parálisis Cerebral/fisiopatología , Caminata/fisiología , Terapia por Ejercicio/métodos , Terapia por Ejercicio/instrumentación , Robótica/instrumentación , Fuerza Muscular/fisiologíaRESUMEN
A host of medical conditions, including amputations, diabetes, stroke, and genetic disease, result in loss of touch sensation. Because most types of sensory loss have no pharmacological treatment or rehabilitative therapy, we propose a haptic sensory prosthesis that provides substitutive feedback. The wrist and forearm are compelling locations for feedback due to available skin area and not occluding the hands, but have reduced mechanoreceptor density compared to the fingertips. Focusing on localized pressure as the feedback modality, we hypothesize that we can improve on prior devices by invoking a wider range of stimulus intensity using multiple points of pressure to evoke spatial summation, which is the cumulative perceptual experience from multiple points of stimuli. We conducted a preliminary perceptual test to investigate this idea and found that just noticeable difference is reduced with two points of pressure compared to one, motivating future work using spatial summation in sensory prostheses.
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BACKGROUND: Functional neuromuscular stimulation (FNS) restores walking function after paralysis from spinal cord injury via electrical activation of muscles in a coordinated fashion. Combining FNS with a controllable orthosis to create a hybrid neuroprosthesis (HNP) has the potential to extend walking distance and time by mechanically locking the knee joint during stance to allow knee extensor muscle to rest with stimulation turned off. Recent efforts have focused on creating advanced HNPs which couple joint motion (e.g., hip and knee or knee and ankle) to improve joint coordination during swing phase while maintaining a stiff-leg during stance phase. METHODS: The goal of this study was to investigate the effects of incorporating stance controlled knee flexion during loading response and pre-swing phases on restored gait. Knee control in the HNP was achieved by a specially designed variable impedance knee mechanism (VIKM). One subject with a T7 level spinal cord injury was enrolled and served as his own control in examining two techniques to restore level over-ground walking: FNS-only (which retained a stiff knee during stance) and VIKM-HNP (which allowed controlled knee motion during stance). The stimulation pattern driving the walking motion remained the same for both techniques; the only difference was that knee extensor stimulation was constant during stance with FNS-only and modulated together with the VIKM to control knee motion during stance with VIKM-HNP. RESULTS: Stance phase knee angle was more natural during VIKM-HNP gait while knee hyperextension persisted during stiff-legged FNS-only walking. During loading response phase, vertical ground reaction force was less impulsive and instantaneous gait speed was increased with VIKM-HNP, suggesting that knee flexion assisted in weight transfer to the leading limb. Enhanced knee flexion during pre-swing phase also aided flexion during swing, especially when response to stimulation was compromised. CONCLUSIONS: These results show the potential advantages of incorporating stance controlled knee flexion into a hybrid neuroprosthesis for walking. The addition of such control to FNS driven walking could also enable non-level walking tasks such as uneven terrain, slope navigation and stair descent where controlled knee flexion during weight bearing is critical.
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Articulación de la Rodilla/fisiología , Prótesis Neurales , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Fenómenos Biomecánicos , Humanos , Masculino , Persona de Mediana Edad , Parálisis/etiología , Parálisis/rehabilitación , Diseño de Prótesis , Traumatismos de la Médula Espinal/complicacionesRESUMEN
Accurate prediction of joint angle during walking from surface electromyography (sEMG) offers the potential to infer movement intention and therefore represents a potentially useful approach for adaptive control of wearable robotics. Here, we present the use of a recurrent neural network (RNN) with gated recurrent units (GRUs) and an attention mechanism to estimate knee angle during overground walking from sEMG and its initial offline validation in healthy adolescents. Our results show that the attention mechanism improved estimation accuracy by focusing on the most relevant parts of the input dataset within each time window, particularly muscles active during knee excursion. Sensitivity analysis revealed knee extensor and flexor muscles to be most salient in accurately estimating joint angle. Additionally, we demonstrate the ability of the GRU-RNN approach to accurately estimate knee angle during overground walking in a child with cerebral palsy (CP) in the presence of exoskeleton knee extension assistance. Collectively, our findings establish the initial feasibility of using this approach to estimate user movement from sEMG, which is particularly important for developing robotic exoskeletons for children with neuromuscular disorders such as CP.
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Parálisis Cerebral , Marcha , Niño , Adolescente , Humanos , Marcha/fisiología , Fenómenos Biomecánicos , Caminata/fisiología , Músculo Esquelético , Electromiografía , Redes Neurales de la ComputaciónRESUMEN
BACKGROUND: Reaching is a fundamental motor skill often impaired in cerebral palsy (CP). Studies on manual function, intervention, and underlying brain mechanisms largely focus on unilateral CP. This first electroencephalography (EEG) evaluation of reaching exclusively in bilateral CP aims to quantify and relate brain activation patterns to bimanual deficits in this population. METHODS: A total of 15 children with bilateral CP (13.4 ± 2.9 years) and 13 with typical development (TD: 14.3 ± 2.4 years) performed 45 reaches per hand while recording motion capture and EEG data. The Box and Blocks test was administered bilaterally. Cortical sources were identified using independent component analysis and clustered using k-means. Alpha (8-12 Hz) and beta (13-30 Hz) band event-related desynchronization (ERD) values were compared across groups and hands within clusters, between dominant and non-dominant sensorimotor clusters, and related to reach kinematics and the Box and Block test. RESULTS: The group with CP demonstrated bimanual motor deficits with slower reaches, lower Box and Blocks scores, and stronger hand preference than in TD. Beta ERD, representing motor execution, was notably higher in the dominant sensorimotor cluster in CP compared to TD. Both groups demonstrated more contralateral than ipsilateral activity in both hands and clusters, with CP showing a less lateralized (more bilateral) alpha response. Higher brain activation was generally related to better function. CONCLUSION: Bimanual deficits in bilateral CP and related EEG differences warrant more clinical and research attention particularly earlier in life when greater potential for neural and functional recovery exists.
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Parálisis Cerebral , Humanos , Niño , Encéfalo , Electroencefalografía , Extremidad Superior , ManoRESUMEN
OBJECTIVE: Few studies focus on upper limbs in bilateral cerebral palsy (CP) despite potential bimanual deficits. Electroencephalography (EEG) was utilized to investigate brain mechanisms underlying upper limb tasks in bilateral CP and typical development (TD) and relationships to function. METHODS: 26 (14 CP; 12 TD) completed the Box and Blocks Test and transport task with paper, sponge or mixed blocks, while recording EEG and motion data. RESULTS: Group effects for path time, path length and Box and Blocks Test revealed bimanual deficits. Four sensorimotor-related EEG clusters were identified. Group effects were found in premotor and dominant motor clusters with greater beta event-related desynchronization (ERD) in CP. Hand and hand by group effects were found in the dominant motor cluster, showing greater ERD with the more affected hand in CP. Condition effects were prominent in the posterior parietal cluster with higher ERD reflecting greater difficulty in force modulation. CONCLUSIONS: Higher brain activation associated with greater bimanual deficits is similar to our lower limb findings but contrasts studies in TD or unilateral CP linking higher ERD to greater proficiency. SIGNIFICANCE: Bilateral CP shows overreliance on the dominant hemisphere with the less functional hand and higher brain activity presumably related to excessive intracortical connectivity.
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Parálisis Cerebral , Humanos , Parálisis Cerebral/diagnóstico , Encéfalo , Extremidad Superior , Electroencefalografía , Mano , Movimiento/fisiologíaRESUMEN
We propose a sensory substitution device that communicates one-degree-of-freedom proprioceptive feedback via deep pressure stimulation on the arm. The design is motivated by the need for a feedback modality detectable by individuals with a genetic condition known as PIEZO2 loss of function, which is characterized by absence of both proprioception and sense of light touch. We created a wearable and programmable prototype that applies up to 15 N of deep pressure stimulation to the forearm and includes an embedded force sensor. We conducted a study to evaluate the ability of participants without sensory impairment to control the position of a virtual arm to match a target angle communicated by deep pressure stimulation. A participant-specific calibration resulted in an average minimum detectable force of 0.41 N and maximum comfortable force of 6.42 N. We found that, after training, participants were able to significantly reduce angle error using the deep pressure haptic feedback compared to without it. Angle error increased only slightly with force, indicating that this sensory substitution method is a promising approach for individuals with PIEZO2 loss of function and other forms of sensory loss.
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Despite external environmental changes in walking, such as manipulating gait speed, previous studies have shown that the underlying muscle synergy structures (synergy weights or vectors) rarely vary. The purpose of this study is to examine if external environmental changes to the walking task influence muscle synergies in children with cerebral palsy (CP) and/or typical development (TD). To identify muscle synergies, we extracted muscle synergies from eight children with CP and eight age-matched TD in three treadmill walking conditions, e.g., baseline (adjusted to individual comfortable walking speed), variable speed (VS), or restricted foot width (RW). Then, we grouped similar muscle synergies using k-mean clustering and discriminant analyses from all datasets of individual synergy structures. Proportion tests exhibited six clusters of muscle synergies predominantly arising from children with CP and four clusters from children with TD. Also, the proportion of muscle synergies was significantly different in four of the CP-preferred clusters across conditions. Specifically, the proportion of the baseline condition was significantly different from VS and RW conditions in one and two clusters, respectively. The proportion was significantly different between VS and RW conditions in four clusters. Cadence and step lengths differed across conditions but not groups which makes the group differences in proportion even more notable. In contrast, step width, while significantly lower in CP, did not differ across conditions. Our findings demonstrate that muscle synergies in children with CP are more sensitive to changes in the external walking environment than in typically developing children.
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Brain computer interface (BCI) systems were initially developed to replace lost function; however, they are being increasingly utilized in rehabilitation to restore motor functioning after brain injury. In such BCI-mediated neurofeedback training (BCI-NFT), the brain-state associated with movement attempt or intention is used to activate an external device which assists the movement while providing sensory feedback to enhance neuroplasticity. A critical element in the success of BCI-NFT is accurate timing of the feedback within the active period of the brain state. The overarching goal of this work was to develop a reliable deep learning model that can predict motion before its onset, and thereby deliver the sensory stimuli in a timely manner for BCI-NFT applications. To this end, the main objective of the current study was to design and evaluate a Multi-layer Perceptron Neural Network (MLP-NN). Movement-related cortical potentials (MRCP) during planning and execution of ankle dorsiflexion was used to train the model to classify dorsiflexion planning vs. rest. The accuracy and reliability of the model was evaluated offline using data from eight healthy individuals (age: 26.3 ± 7.6 years). First, we evaluated three different epoching strategies for defining our 2 classes, to identify the one which best discriminated rest from dorsiflexion. The best model accuracy for predicting ankle dorsiflexion from EEG before movement execution was 84.7%. Second, the effect of various spatial filters on the model accuracy was evaluated, demonstrating that the spatial filtering had minimal effect on model accuracy and reliability.
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Interfaces Cerebro-Computador , Neurorretroalimentación , Adolescente , Adulto , Tobillo , Electroencefalografía , Humanos , Movimiento/fisiología , Redes Neurales de la Computación , Neurorretroalimentación/fisiología , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Strength and selective motor control are primary determinants of pathological gait in children with cerebral palsy (CP) and other neuromotor disorders. Emerging evidence suggests robotic application of task-specific resistance to functional movements may provide the opportunity to strengthen muscles and improve neuromuscular function during walking in children with CP. Such a strategy could be most beneficial to children who are more severely affected by the pathology but their ability to overcome such resistance and maintain functional ambulation remains unclear. The goal of this study was to design, validate and evaluate initial feasibility and effects of a novel exoskeleton strategy that provides interleaved assistance and resistance to knee extension during overground walking. One participant with CP (GMFCS III) was recruited and completed ten total visits, nine walking with the exoskeleton. Our results validated the controller's ability to parse the gait cycle into five discrete phases (mean accuracy 91%) and provide knee extension assistance during stance and resistance during swing. Following acclimation to the interleaved strategy, peak knee extension was significantly improved in both the left (mean 7.9 deg) and right (15.2 deg) limbs when walking with the exoskeleton. Knee extensor EMG during late swing phase increased to 2.7 (left leg) and 1.7 (right leg) times the activation level during baseline exoskeleton walking without resistance. These results indicate that this interleaved strategy warrants further investigation in a longitudinal intervention study, particularly in individuals who may be more severely affected such that they are unable to ambulate overground using an exoskeleton training strategy that only deploys targeted resistance to limb motion.
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Introduction: Instrumented gait mat systems have been regarded as one of the gold standard methods for measuring spatiotemporal gait parameters. However, their portable walkways confine walking to a restricted area and limit the number of gait cycles collected. Wearable inertial sensors are a potential alternative that allow more natural walking behavior and have fewer space restrictions. The objective of this pilot study was to establish the concurrent validity of body-worn sensors against the portable walkway system in older children. Methods: Twenty-one participants (10 males) 7-17 years old performed 2-min walk tests at a self-selected and fast pace in a 25-m-long hallway, while wearing three inertial sensors. Data collection were synchronized between devices and the portions of the walk when subjects passed on the walkway were used to compare gait speed, stride length, gait cycle duration, cadence, and double support time. Regression models and Bland-Altman analysis were completed to determine agreement between systems for the selected gait parameters. Results: Gait speed, cadence, gait cycle duration, and stride length as measured by inertial sensors demonstrated strong agreement overall. Double support time was found to have lower validity due to a combined bias of age, height, weight, and walking pace. Conclusion: These results support the validity of wearable inertial sensors in measuring gait speed, cadence, gait cycle duration, and stride length in children 7 years old and above during a 2-min walking test. Future studies are warranted with a broader age range to thoroughly represent the pediatric population.
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OBJECTIVES: To examine the effect of muscle fiber recruitment patterns on muscle oxygen utilization during treadmill walking in a group of individuals who have incomplete spinal cord injury. METHODS: 5 participants with motor incomplete spinal cord injury (Age; 42.2 ± 18.8 years, Male; n = 4) completed an over ground locomotor training program. Muscle utilization/oxygenation and activation of the medial gastrocnemius were measured by near infrared spectroscopy and surface electromyography pre- and post-over ground locomotor training during two separate treadmill walking bouts at self-selected speeds. Outcomes were changes in deoxygenation hemoglobin/myoglobin concentrations, and the change in median power of the power spectrum of the electromyography after training. RESULTS: A significant increase in median power of the power spectrum of the electromyography signal was observed during both bouts of treadmill walking, 6-minute walking bout and longer fatiguing bout (49% p = 0.047 and 48% p = 0.035, respectively) post-over ground locomotor training. There was no significant change in muscle utilization/oxygenation post-over ground locomotor training. There was no significant effect of median power of the power spectrum on deoxygenation hemoglobin/myoglobin during either of the walking bouts. CONCLUSIONS: The main finding of the current study was that median power of the power spectrum significantly increased following 12 weeks of over ground locomotor training, with no significant change in deoxygenation hemoglobin/myoglobin. The recruitment of more and/or larger motor units was seen in conjunction with no changes in muscle oxygen utilization for the same walking task.Implications for RehabilitationThe reduction of skeletal muscle innervation in Spinal Cord Injury may adversely affect the orderly recruitment of motor units, which could in turn blunt the oxidative metabolic response during physical activity.Over-ground locomotor could be a useful tool in the rehabilitative process following an incomplete spinal cord injury.
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Traumatismos de la Médula Espinal , Adulto , Electromiografía , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético , Modalidades de Fisioterapia , Caminata/fisiología , Adulto JovenRESUMEN
Grip myotonia and weakness are attractive treatment response biomarkers in clinical trials of myotonic dystrophy type 1 (DM1). There is a need to develop simple, patient-friendly and reproducible methods of quantifying grip myotonia in multisite trial settings. We designed a HandClench Relaxometer (HCR) that measures grip myotonia and strength. In contrast with the existing quantitative myometry (QMA) setup, the HCR is portable, economical, can be used with any laptop and generates automated command prompts. We demonstrate the feasibility and reliability of HCR device in twenty DM1 individuals and ten age-matched controls; patients returned for follow up within two months. The device showed excellent day to day reproducibility (ICC >0.80) in patients. The HCR device detected myotonia in milder muscle disease and measured longer myotonia duration than QMA indicating enhanced sensitivity for quantifying myotonia in DM1. The reaction time to the relax but not squeeze command was delayed and showed warm up similar to myotonia in DM1. HCR outcomes were correlated with key pinch strength, hand dexterity test, and fat replacement in the MRI of the long finger flexor muscles. Use of the HCR is warranted for grip myotonia and strength measurements in longitudinal observational and interventional studies of DM1.
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Miotonía , Distrofia Miotónica , Electromiografía , Fuerza de la Mano/fisiología , Humanos , Lactante , Miotonía/diagnóstico , Distrofia Miotónica/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
Children with cerebral palsy typically exhibit reduced complexity of muscle coordination patterns during walking; however, the specific patterns that characterize their gait abnormalities are still not well documented. This study aimed to identify the specific repertoire of muscle coordination patterns in children with CP during walking compared to same-aged peers without CP and their relationships to gait performance. To identify muscle coordination patterns, we extracted muscle synergies from 10 children with CP and 10 age-matched typically developing children (TD). K-mean clustering and discriminant analyses of all extracted synergies were used to group similar synergies. Then, weight-averaged z-scores were quantified for each cluster to determine their group-specific level. In this cohort, 10 of the 17 distinct clusters were largely CP-specific while six clusters were seen mainly in TD, and one was non-specific. CP-specific clusters generally showed merging of two TD synergies, excessive antagonist co-activation, decreased muscle activation compared to TD, and complex or atypical pattern. Significant correlations were found between weight-averaged z-scores and step length asymmetry, cadence asymmetry, self-selected treadmill speed and AP-COM displacement of the pelvis such that greater CP-specificity of muscle synergies was related to poorer performance, thus indicating that CP-specific synergies can influence motor dysfunction.
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Background: Rehabilitation in cerebral palsy (CP) seeks to harness neuroplasticity to improve movement, including walking, yet cortical activation underlying gait is not well understood. Methods: We used electroencephalography (EEG) to compare motor related cortical activity, measured by mu rhythm, during quiet standing and treadmill walking in 10 children with unilateral CP and 10 age- and sex-matched children with typical development (TD). Peak mu band frequency, mu rhythm desynchronization (MRD), and gait related intra- and inter-hemispheric coherence were examined. Results: MRD during walking was observed bilaterally over motor cortex in both cohorts but peak mu band frequency showing MRD was significantly lower in CP compared to TD. Coherence during quiet standing between motor and frontal regions was significantly higher in the non-dominant compared to dominant hemisphere in CP with no hemispheric differences in TD. Conclusions: EEG-based measures should be further investigated as clinical biomarkers for atypical motor development and to assess rehabilitation effectiveness.
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Ondas Encefálicas , Parálisis Cerebral/fisiopatología , Marcha , Niño , Femenino , Humanos , Masculino , Posición de PieRESUMEN
Gait training via a wearable device in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton (P.REX) with a microcontroller based multi-layered closed loop control system to provide individualized control capability. Exoskeleton performance was evaluated through benchtop and human subject testing. Step response tests show the averaged 90% rise was 26 ± 0.2 ms for 5 Nm, 22 ± 0.2 ms for 10 Nm, 32 ± 0.4 ms for 15 Nm. Torque bandwidth of P.REX was 12 Hz and output impedance was less than 1.8 Nm with control on (Zero mode). Three different control strategies can be deployed to apply assistance to knee extension: state-based assistance, impedance-based trajectory tracking, and real-time adaptive control. One participant with typical development (TD) and one participant with crouch gait from CP were recruited to evaluate P.REX in overground walking tests. Data from the participant with TD were used to validate control system performance. Kinematic and kinetic data were collected by motion capture and compared to exoskeleton on-board sensors to evaluate control system performance with results demonstrating that the control system functioned as intended. The data from the participant with CP are part of a larger ongoing study. Results for this participant compare walking with P.REX in two control modes: a state-based approach that provided constant knee extension assistance during early stance, mid-stance and late swing (Est+Mst+Lsw mode) and an Adaptive mode providing knee extension assistance proportional to estimated knee moment during stance. Both were well tolerated and significantly improved knee extension compared to walking without extension assistance (Zero mode). There was less reduction in gait speed during use of the adaptive controller, suggesting that it may be more intuitive than state-based constant assistance for this individual. Future work will investigate the effects of exoskeleton assistance during overground gait training in children with neurological disorders and will aim to identify the optimal individualized control strategy for exoskeleton prescription.