Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial.

BACKGROUND: In recent years, ambulatory lower limb exoskeletons are being gradually introduced into the clinical practice to complement walking rehabilitation programs. However, the clinical evidence of the outcomes attained with these devices is still limited and nonconclusive. Furthermore, the user-to-robot adaptation mechanisms responsible for functional improvement are still not adequately unveiled. This study aimed to (1) assess the safety and feasibility of using the HANK exoskeleton for walking rehabilitation, and (2) investigate the effects on walking function after a training program with it. METHODS: A randomized controlled trial was conducted including a cohort of 23 patients with less than 1 year since injury, neurological level of injury (C2-L4) and severity (American Spinal Cord Injury Association Impairment Scale [AIS] C or D). The intervention was comprised of 15 one-hour gait training sessions with lower limb exoskeleton HANK. Safety was assessed through monitoring of adverse events, and pain and fatigue through a Visual Analogue Scale. LEMS, WISCI-II, and SCIM-III scales were assessed, along with the 10MWT, 6MWT, and the TUG walking tests (see text for acronyms). RESULTS: No major adverse events were reported. Participants in the intervention group (IG) reported 1.8 cm (SD 1.0) for pain and 3.8 (SD 1.7) for fatigue using the VAS. Statistically significant differences were observed for the WISCI-II for both the "group" factor (F = 16.75, p < 0.001) and "group-time" interactions (F = 8.87; p < 0.01). A post-hoc analysis revealed a statistically significant increase of 3.54 points (SD 2.65, p < 0.0001) after intervention for the IG but not in the CG (0.7 points, SD 1.49, p = 0.285). No statistical differences were observed between groups for the remaining variables. CONCLUSIONS: The use of HANK exoskeleton in clinical settings is safe and well-tolerated by the patients. Patients receiving treatment with the exoskeleton improved their walking independence as measured by the WISCI-II after the treatment.

A Systematic Methodology to Analyze the Impact of Hand-Rim Wheelchair Propulsion on the Upper Limb.

Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m/s (3 km/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint.

Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study.

(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.

RehabHand: Oriented-tasks serious games for upper limb rehabilitation by using Leap Motion Controller and target population in spinal cord injury.

BACKGROUND: There is a growing interest in the use of technology in the field of neurorehabilitation in order to quantify and generate knowledge about sensorimotor disorders after neurological diseases, understanding that the technology has a high potential for its use as therapeutic tools. Taking into account that the rehabilitative process of motor disorders should extend beyond the inpatient condition, it's necessary to involve low-cost technology, in order to have technological solutions that can approach the outpatient period at home. OBJECTIVE: to present the virtual applications-based RehabHand prototype for the rehabilitation of manipulative skills of the upper limbs in patients with neurological conditions and to determine the target population with respect to spinal cord injured patients. METHODS: Seven virtual reality applications have been designed and developed with a therapeutic sense, manipulated by means of Leap Motion Controller. The target population was determined from a sample of 40 people, healthy and patients, analyzing hand movements and gestures. RESULTS: The hand movements and gestures were estimated with a fitting rate between the range 0.607-0.953, determining the target population by cervical levels and upper extremity motor score. CONCLUSIONS: Leap Motion is suitable for a determined sample of cervical patients with a rehabilitation purpose.

Application of a model to analyze shoulder biomechanics in adult patients with spinal cord injury when walking with crutches in two different gait patterns.

BACKGROUND: Specific biomechanical models have been developed to study gait using crutches. Clinical application of these models is needed in adult spinal cord injury (SCI) population walking with different patterns of gait with crutches to prevent overuse shoulder injuries. OBJECTIVE: To apply a biomechanical model in a clinical environment to analyze shoulder in adult SCI patients walking with two different patterns of gait with crutches: two point reciprocal gait (RG) and swing-through gait (SG). METHODS: Load cells were fixed to the distal ends and forearm cuffs of a pair of crutches. An active markers system was used for kinematics. Five cycles for each gait pattern were analyzed applying a biomechanical model of the upper limbs. Fifteen subjects with SCI were analyzed. RESULTS: The flexo-extension range of motion was significantly greater when using SG (p < 0.01). Similarly, the superior, posterior and medial forces were significantly stronger for SG in all 3 directions. Flexion, adduction and internal rotation torques were also greater in SG (p < 0.01). CONCLUSIONS: A biomechanical model was successfully applied to study shoulder biomechanics in adult patients with SCI walking with crutches in two different gait patterns. Greater loads exerted on the shoulder walking with SG were confirmed compared to RG.

Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial.

OBJECTIVES: To compare the benefits of a short-term occupational therapy intervention (OTI) when added to the conventional treatment model (CTM) in the functional recovery of patients admitted to an acute geriatric unit (AGU). STUDY DESIGN: Non-pharmacological randomized clinical trial. 400 patients were randomized to OTI (n = 198) or CTM (n = 202) group. Mean age 83.5. Interventions included needs assessment, iatrogenic prevention, retraining in activities of daily living, and instructions for caregivers in three groups of patients defined a priori (cardiopulmonary disease, stroke, other conditions) 5 days a week, 30-45 min a day. MAIN OUTCOME MEASURE: Recovery of ≥ 10 Barthel index points by discharge. Secondary outcome was the reduction in confusional episodes. RESULTS: The adjusted relative risk (RR) of functional recovery in the OTI group was 1.16 (95%CI 0.91-1.47). In participants with cardiopulmonary disease was 1.57 (95%CI 1.06-2.32), number needed to treat (NNT) 5. Participants with other conditions assigned to OTI had a reduction in acute confusional episodes; RR 0.48 (95% CI 0.26-0.87), NNT 7. CONCLUSIONS: Although overall there were no significant differences, patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU, may benefit from a short-term OTI.