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2.
PLoS One ; 15(2): e0228536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049971

RESUMO

Recent literature emphasizes the importance of comfort in the design of exosuits and other assistive devices that physically augment humans; however, there is little quantitative data to aid designers in determining what level of force makes users uncomfortable. To help close this knowledge gap, we characterized human comfort limits when applying forces to the shoulders, thigh and shank. Our objectives were: (i) characterize the comfort limits for multiple healthy participants, (ii) characterize comfort limits across days, and (iii) determine if comfort limits change when forces are applied at higher vs. lower rates. We performed an experiment (N = 10) to quantify maximum tolerable force pulling down on the shoulders, and axially along the thigh and shank; we termed this force the comfort limit. We applied a series of forces of increasing magnitude, using a robotic actuator, to soft sleeves around their thigh and shank, and to a harness on their shoulders. Participants were instructed to press an off-switch, immediately removing the force, when they felt uncomfortable such that they did not want to feel a higher level of force. On average, participants exhibited comfort limits of ~0.9-1.3 times body weight on each segment: 621±245 N (shoulders), 867±296 N (thigh), 702±220 N (shank), which were above force levels applied by exosuits in prior literature. However, individual participant comfort limits varied greatly (~250-1200 N). Average comfort limits increased over multiple days (p<3e-5), as users habituated, from ~550-700 N on the first day to ~650-950 N on the fourth. Specifically, comfort limits increased 20%, 35% and 22% for the shoulders, thigh and shank, respectively. Finally, participants generally tolerated higher force when it was applied more rapidly. These results provide initial benchmarks for exosuit designers and end-users, and pave the way for exploring comfort limits over larger time scales, within larger samples and in different populations.


Assuntos
Desenho de Equipamento , Exoesqueleto Energizado , Perna (Membro)/fisiologia , Mialgia/prevenção & controle , Conforto do Paciente , Pressão/efeitos adversos , Ombro/fisiologia , Adulto , Tornozelo/fisiologia , Fenômenos Biomecânicos , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Exoesqueleto Energizado/efeitos adversos , Feminino , Marcha/fisiologia , Humanos , Masculino , Mialgia/etiologia , Conforto do Paciente/métodos , Robótica/instrumentação , Robótica/métodos , Estresse Mecânico , Coxa da Perna/fisiologia , Adulto Jovem
3.
Arch Phys Med Rehabil ; 101(4): 607-612, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31891715

RESUMO

OBJECTIVE: To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR. DESIGN: A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only). SETTING: SCI AIR facility. PARTICIPANTS: Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex. INTERVENTION: EAW incorporated into SCI AIR. MAIN OUTCOME MEASURES: FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps. RESULTS: Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and FIM, P<.05). One adverse event (minor skin abrasion) occurred during 42 walking sessions. Participants on average achieved 31.5 minutes of up time and 18.2 minutes of walk time with 456 steps in one EAW session. CONCLUSIONS: Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.


Assuntos
Exoesqueleto Energizado , Traumatismos da Medula Espinal/reabilitação , Caminhada/fisiologia , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Projetos Piloto , Quadriplegia/fisiopatologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/fisiopatologia
4.
J Neuroeng Rehabil ; 17(1): 9, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992322

RESUMO

BACKGROUND: In clinical practice, therapists choose the amount of assistance for robot-assisted training. This can result in outcomes that are influenced by subjective decisions and tuning of training parameters can be time-consuming. Therefore, various algorithms to automatically tune the assistance have been developed. However, the assistance applied by these algorithms has not been directly compared to manually-tuned assistance yet. In this study, we focused on subtask-based assistance and compared automatically-tuned (AT) robotic assistance with manually-tuned (MT) robotic assistance. METHODS: Ten people with neurological disorders (six stroke, four spinal cord injury) walked in the LOPES II gait trainer with AT and MT assistance. In both cases, assistance was adjusted separately for various subtasks of walking (in this study defined as control of: weight shift, lateral foot placement, trailing and leading limb angle, prepositioning, stability during stance, foot clearance). For the MT approach, robotic assistance was tuned by an experienced therapist and for the AT approach an algorithm that adjusted the assistance based on performances for the different subtasks was used. Time needed to tune the assistance, assistance levels and deviations from reference trajectories were compared between both approaches. In addition, participants evaluated safety, comfort, effect and amount of assistance for the AT and MT approach. RESULTS: For the AT algorithm, stable assistance levels were reached quicker than for the MT approach. Considerable differences in the assistance per subtask provided by the two approaches were found. The amount of assistance was more often higher for the MT approach than for the AT approach. Despite this, the largest deviations from the reference trajectories were found for the MT algorithm. Participants did not clearly prefer one approach over the other regarding safety, comfort, effect and amount of assistance. CONCLUSION: Automatic tuning had the following advantages compared to manual tuning: quicker tuning of the assistance, lower assistance levels, separate tuning of each subtask and good performance for all subtasks. Future clinical trials need to show whether these apparent advantages result in better clinical outcomes.


Assuntos
Algoritmos , Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/reabilitação , Robótica/métodos , Traumatismos da Medula Espinal/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
BMC Neurol ; 20(1): 35, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992219

RESUMO

BACKGROUND: The ability to walk is commonly reported as a top rehabilitation priority for individuals after a stroke. However, not all individuals with stroke are able to practice walking, especially those who require more assistance from their therapist to do so. Powered robotic exoskeletons are a new generation of robotic-assisted gait training devices, designed to assist lower extremity movement to allow repetitious overground walking practice. To date, minimal research has been conducted on the use of an exoskeleton for gait rehabilitation after stroke. The following research protocol aims to evaluate the efficacy and acceptability, and thus adoptability, of an exoskeleton-based gait rehabilitation program for individuals with stroke. METHODS: This research protocol describes a prospective, multi-center, mixed-methods study comprised of a randomized controlled trial and a nested qualitative study. Forty adults with subacute stroke will be recruited from three inpatient rehabilitation hospitals and randomized to receive either the exoskeleton-based gait rehabilitation program or usual physical therapy care. The primary outcome measure is the Functional Ambulation Category at post-intervention, and secondary outcomes include motor recovery, functional mobility, cognitive, and quality-of-life measures. Outcome data will be collected at baseline, post-intervention, and at 6 months. The qualitative component will explore the experience and acceptability of using a powered robotic exoskeleton for stroke rehabilitation from the point of view of individuals with stroke and physical therapists. Semi-structured interviews will be conducted with participants who receive the exoskeleton intervention, and with the therapists who provide the intervention. Qualitative data will be analyzed using interpretive description. DISCUSSION: This study will be the first mixed-methods study examining the adoptability of exoskeleton-based rehabilitation for individuals with stroke. It will provide valuable information regarding the efficacy of exoskeleton-based training for walking recovery and will shed light on how physical therapists and patients with stroke perceive the device. The findings will help guide the integration of robotic exoskeletons into clinical practice. TRIAL REGISTRATION: NCT02995265 (clinicaltrials.gov), Registered 16 December 2016.


Assuntos
Exoesqueleto Energizado , Modalidades de Fisioterapia/instrumentação , Projetos de Pesquisa , Reabilitação do Acidente Vascular Cerebral/instrumentação , Adulto , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada
6.
Arch Phys Med Rehabil ; 101(2): 309-316, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31678222

RESUMO

OBJECTIVE: To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation with intensive conventional therapy for restoring arm function in survivors of subacute stroke. DESIGN: This was a single-blinded, randomized controlled trial. SETTING: Inpatient rehabilitation university hospital. PARTICIPANTS: Patients (N=40) diagnosed as having ischemic stroke (time since stroke <8wk) and upper limb impairment were enrolled. INTERVENTIONS: Participants randomized to the experimental group received 30 sessions (5 sessions/wk) of robot-assisted arm therapy and hand functional electrical stimulation (RAT+FES). Participants randomized to the control group received a time-matched intensive conventional therapy. MAIN OUTCOME MEASURES: The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity, and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment, and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline. RESULTS: Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30d post stroke) demonstrated the greatest clinical improvements. CONCLUSIONS: RAT+FES was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.


Assuntos
Braço/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Terapia por Exercício/métodos , Exoesqueleto Energizado , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Idoso , Potencial Evocado Motor , Feminino , Mãos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Método Simples-Cego
7.
Arch Phys Med Rehabil ; 101(1): 113-120, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31568761

RESUMO

OBJECTIVE: To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. DESIGN: Case series observational study. SETTING: A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. PARTICIPANTS: Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. INTERVENTIONS: Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. MAIN OUTCOME MEASURES: Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. RESULTS: No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] ± SD, 117.1±11.7) in session 25 compared to session 2 (mean [m] ± SD, 47.6±6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] ± SD, 0.40±0.04) in comparison to session 2 (mean [m/s] ± SD, 0.12±0.01). CONCLUSIONS: Exoskeletal-assisted walking in acute rehabilitation (<6mo) following SCI appears to be both safe and feasible.


Assuntos
Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Reabilitação Neurológica/instrumentação , Traumatismos da Medula Espinal/reabilitação , Adulto , Canadá , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Esforço Físico , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Teste de Caminhada , Caminhada/fisiologia , Velocidade de Caminhada
8.
Arch Phys Med Rehabil ; 101(1): 121-129, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31465760

RESUMO

OBJECTIVES: To (1) compare energy expenditure during seated rest, standing, and prolonged bionic ambulation or bipedal ambulation in participants with spinal cord injury (SCI) and noninjured controls, respectively, and (2) test effects on postbionic ambulation glycemia in SCI. DESIGN: Two independent group comparison of SCI and controls. SETTING: Academic Medical Center. PARTICIPANTS: Ten participants with chronic SCI (C7-T1, American Spinal Injury Association Impairment Scale A-C) and 10 controls (N=20). INTERVENTIONS: A commercial bionic exoskeleton. MAIN OUTCOME MEASURES: Absolute and relative (to peak) oxygen consumption, perceived exertion, carbohydrate/fat oxidation, energy expenditure, and postbionic ambulation plasma glucose/insulin. RESULTS: Average work intensity accompanying 45 minutes of outdoor bionic ambulation was <40% peak oxygen consumption, with negligible drift after reaching steady state. Rating of perceived exertion (RPE) did not differ between groups and reflected low exertion. Absolute energy costs for bionic ambulation and nonbionic ambulation were not different between groups despite a 565% higher ambulation velocity in controls and 3.3× higher kilocalorie per meter in SCI. Fuel partitioning was similar between groups and the same within groups for carbohydrate and fat oxidation. Nonsignificant (9%) lowering of the area under a glucose tolerance curve following bionic ambulation required 20% less insulin than at rest. CONCLUSION: Work intensity during prolonged bionic ambulation for this bionic exoskeleton is below a threshold for cardiorespiratory conditioning but above seated rest and passive standing. Bionic ambulation metabolism is consistent with low RPE and unchanged fuel partitioning from seated rest. Bionic ambulation did not promote beneficial effects on glycemia in well-conditioned, euglycemic participants. These findings may differ in less fit individuals with SCI or those with impaired glucose tolerance. Observed trends favoring this benefit suggest they are worthy of testing.


Assuntos
Glicemia/metabolismo , Exoesqueleto Energizado , Traumatismos da Medula Espinal/sangue , Caminhada/fisiologia , Adolescente , Adulto , Biônica , Estudos de Casos e Controles , Metabolismo Energético , Feminino , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Adulto Jovem
9.
Phys Med Rehabil Clin N Am ; 31(1): 117-129, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31760985

RESUMO

Smaller, smarter, more portable rehabilitation technology has the potential to improve the ability of individuals with cerebral palsy to perform activities and increase participation. Robotics and virtual reality may improve movement by maximizing exercise dose, providing feedback, and motivating users. Augmentative and alternative communication technology is facilitating communication. Robots can help with self-care and provide encouragement and instruction in rehabilitation programs. Mobile applications can provide education and resources. Conducting high-quality research to validate technological advances in our field has been a major focus of researchers and advocacy groups.


Assuntos
Paralisia Cerebral/reabilitação , Auxiliares de Comunicação para Pessoas com Deficiência , Exoesqueleto Energizado , Humanos , Aplicativos Móveis , Robótica , Realidade Virtual
10.
Sensors (Basel) ; 19(24)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31835546

RESUMO

The aim of this paper is to describe new methods for detecting the appearance of unexpected obstacles during normal gait from EEG signals, improving the accuracy and reducing the false positive rate obtained in previous studies. This way, an exoskeleton for rehabilitation or assistance of people with motor limitations commanded by a Brain-Machine Interface (BMI) could be stopped in case that an obstacle suddenly appears during walking. The EEG data of nine healthy subjects were collected during their normal gait while an obstacle appearance was simulated by the projection of a laser line in a random pattern. Different approaches were considered for selecting the parameters of the BMI: subsets of electrodes, time windows and classifier probabilities, which were based on a linear discriminant analysis (LDA). The pseudo-online results of the BMI for detecting the appearance of obstacles, with an average percentage of 63.9% of accuracy and 2.6 false positives per minute, showed a significant improvement over previous studies.


Assuntos
Eletroencefalografia/métodos , Marcha/fisiologia , Monitorização Fisiológica , Caminhada/fisiologia , Adulto , Algoritmos , Interfaces Cérebro-Computador , Eletrodos , Exoesqueleto Energizado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador
11.
12.
Sensors (Basel) ; 19(23)2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31795240

RESUMO

Teleception is defined as sensing that occurs remotely, with no physical contact with the object being sensed. To emulate innate control systems of the human body, a control system for a semi- or fully autonomous assistive device not only requires feedforward models of desired movement, but also the environmental or contextual awareness that could be provided by teleception. Several recent publications present teleception modalities integrated into control systems and provide preliminary results, for example, for performing hand grasp prediction or endpoint control of an arm assistive device; and gait segmentation, forward prediction of desired locomotion mode, and activity-specific control of a prosthetic leg or exoskeleton. Collectively, several different approaches to incorporating teleception have been used, including sensor fusion, geometric segmentation, and machine learning. In this paper, we summarize the recent and ongoing published work in this promising new area of research.


Assuntos
Técnicas Biossensoriais/métodos , Aprendizado de Máquina , Exoesqueleto Energizado , Humanos , Procedimentos Cirúrgicos Robóticos
13.
Medicine (Baltimore) ; 98(50): e18286, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852105

RESUMO

RATIONALE: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs). PATIENT CONCERNS: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. DIAGNOSIS: The patient was tetraplegia with incomplete SCI at C3-C4. INTERVENTIONS: The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes. OUTCOMES: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO2 tests. LESSIONS: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.


Assuntos
Vértebras Cervicais/lesões , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Extremidade Inferior/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/fisiopatologia
14.
Medicine (Baltimore) ; 98(46): e17582, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725606

RESUMO

RATIONALE: Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem neuromuscular disease characterized by myotonia and muscle weakness and wasting of distal and axial muscles. People with DM1, due to the disease progression, are often concerned about their ability to carry out and participate in the activities of daily living. Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy to face such difficulties. Aim of this case-study was to demonstrate the effects of a combined approach by using conventional plus robotic training in rare neuromuscular diseases, such as DM1. PATIENT CONCERNS: A 46-year-old woman came to our observation complaining of difficulty in opening fist after strong voluntary muscle contraction for about 20 years. Over the years, she referred swallowing difficulties for solid foods, balance impairment complicated by tendency to stumble and falls, fatigability, hand muscle weakness with difficulty to open bottles and lifting weights, and daytime sleepiness DIAGNOSIS:: Paraparesis in DM1. INTERVENTIONS: The patient underwent 2 different trainings. The first period of treatment was carried out by using conventional physiotherapy, 6 times a week (twice a day) for 4 weeks. Then, she underwent a two-month specific task-oriented robotic rehabilitation training for the gait impairment using an overground exoskeleton, namely Ekso-GT, combined to the conventional therapy. OUTCOMES: The patient, after the EKSO training, gained a significant improvement in walking, balance and lower limbs muscle strength, as per 10-meter walking test and Left Lower Limb Motricity Index. Neurophysiological data (electroencephalography and surface electromyography) were also collected to more objectively assess the functional outcomes. LESSONS: Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy. Emerging and advancing robotic technologies can enhance clinical therapeutic outcomes by allowing therapists to activate and/or modulate neural networks to maximize motor and functional recovery.


Assuntos
Exoesqueleto Energizado , Distrofia Miotônica/reabilitação , Plasticidade Neuronal , Modalidades de Fisioterapia , Treinamento de Resistência/métodos , Atividades Cotidianas , Terapia Combinada , Eletromiografia , Feminino , Humanos , Pessoa de Meia-Idade , Distrofia Miotônica/fisiopatologia , Resultado do Tratamento
15.
Sensors (Basel) ; 19(21)2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31684102

RESUMO

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


Assuntos
Peso Corporal , Exoesqueleto Energizado , Marcha/fisiologia , Movimento/fisiologia , Robótica , Humanos , Articulações/fisiologia , Amplitude de Movimento Articular , Interface Usuário-Computador
16.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 785-794, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631627

RESUMO

The purpose of this paper was to investigate the effects of wearable lower limb exoskeletons on the kinematics and kinetic parameters of the lower extremity joints and muscles during normal walking, aiming to provide scientific basis for optimizing its structural design and improving its system performance. We collected the walking data of subjects without lower limb exoskeleton and selected the joint angles in sagittal plane of human lower limbs as driving data for lower limb exoskeleton simulation analysis. Anybody (the human biomechanical analysis software) was used to establish the human body model (the human body model without lower limb exoskeleton) and the man-machine system model (the lower limb exoskeleton model). The kinematics parameters (joint force and joint moment) and muscle parameters (muscle strength, muscle activation, muscle contraction velocity and muscle length) under two situations were compared. The experimental result shows that walking gait after wearing the lower limb exoskeleton meets the normal gait, but there would be an occasional and sudden increase in muscle strength. The max activation level of main lower limb muscles were all not exceeding 1, in another word the muscles did not appear fatigue and injury. The highest increase activation level occurred in rectus femoris (0.456), and the lowest increase activation level occurred in semitendinosus (0.013), which means the lower limb exoskeletons could lead to the fatigue and injury of semitendinosus. The results of this study illustrate that to avoid the phenomenon of sudden increase of individual muscle force, the consistency between the length of body segment and the length of exoskeleton rod should be considered in the design of lower limb exoskeleton extremity.


Assuntos
Exoesqueleto Energizado , Marcha , Extremidade Inferior/fisiologia , Fenômenos Biomecânicos , Humanos
17.
Sensors (Basel) ; 19(21)2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31652753

RESUMO

This paper deals with the fractional order control for the complex systems, hand exoskeleton and sensors, that monitor and control the human behavior. The control laws based on physical significance variables, for fractional order models, with delays or without delays, are proposed and discussed. Lyapunov techniques and the methods that derive from Yakubovici-Kalman-Popov lemma are used and the frequency criterions that ensure asymptotic stability of the closed loop system are inferred. An observer control is proposed for the complex models, exoskeleton and sensors. The asymptotic stability of the system, exoskeleton hand-observer, is studied for sector control laws. Numerical simulations for an intelligent haptic robot-glove are presented. Several examples regarding these models, with delays or without delays, by using sector control laws or an observer control, are analyzed. The experimental platform is presented.


Assuntos
Mãos/fisiologia , Modelos Teóricos , Exoesqueleto Energizado , Humanos , Dispositivos Eletrônicos Vestíveis
18.
Stroke ; 50(12): 3545-3552, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31623545

RESUMO

Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter. Results- Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention (P<0.05). The net cardiopulmonary metabolic energy cost (mL·kg-1·min-1) was also reduced by 14.71% in the experimental group after the intervention (P<0.01). Significant group×time interactions were observed for all parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02843828.


Assuntos
Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/reabilitação , Paresia/reabilitação , Robótica , Reabilitação do Acidente Vascular Cerebral/instrumentação , Idoso , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Locomoção , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Projetos Piloto , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos
19.
Sensors (Basel) ; 19(20)2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31614811

RESUMO

While controlling a lower limb exoskeleton providing walking assistance to wearers, the walking terrain is an important factor that should be considered for meeting performance and safety requirements. Therefore, we developed a method to estimate the slope and elevation using the contact points between the limb exoskeleton and ground. We used the center of pressure as a contact point on the ground and calculated the location of the contact points on the walking terrain based on kinematic analysis of the exoskeleton. Then, a set of contact points collected from each step during walking was modeled as the plane that represents the surface of the walking terrain through the least-square method. Finally, by comparing the normal vectors of the modeled planes for each step, features of the walking terrain were estimated. We analyzed the estimation accuracy of the proposed method through experiments on level ground, stairs, and a ramp. Classification using the estimated features showed recognition accuracy higher than 95% for all experimental motions. The proposed method approximately analyzed the movement of the exoskeleton on various terrains even though no prior information on the walking terrain was provided. The method can enable exoskeleton systems to actively assist walking in various environments.


Assuntos
Exoesqueleto Energizado , Extremidade Inferior/fisiologia , Pressão , Fenômenos Biomecânicos , Calibragem , Pé/fisiologia , Humanos , Articulações/fisiologia , Modelos Teóricos , Amplitude de Movimento Articular , Caminhada/fisiologia
20.
Sensors (Basel) ; 19(20)2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31615048

RESUMO

In this paper, we present a knee exoskeleton. Due to the complicated structure of the knee, an exoskeleton can limit the wearer's movement (e.g., when completely sitting down). To prevent this, the proposed exoskeleton is designed to move the ankle part prismatically, so the movement of the wearer is not limited. In addition, the developed exoskeleton could be worn on only one leg, but in this case, it is difficult to detect the intention because the relative relationship information of the two legs is unknown. For this purpose, the length between the knee center of rotation and the ankle (LBKA) was measured and used for intention detection. Using a physical sensor-an encoder and an LBKA sensor, the success rate of intention detection was 82.1%. By additionally using an electromyogram (EMG) sensor, the success rate of intention detection was increased to 92%, and the intention detection was also 27.1 ms faster on average.


Assuntos
Eletromiografia , Exoesqueleto Energizado , Joelho/fisiologia , Perna (Membro)/fisiologia , Algoritmos , Entropia , Humanos , Joelho/anatomia & histologia , Movimento , Redes Neurais de Computação , Probabilidade , Amplitude de Movimento Articular , Caminhada
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