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The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury.

ABSTRACT: BACKGROUND:Powered exoskeleton can improve the mobility for people with movement deficits by providing mechanical support and facilitate the gait training. This pilot study evaluated the effect of gait training using a newly developed powered lower limb exoskeleton robot for individuals with complete spinal cord injury (SCI). METHODS:Two participants with a complete SCI were recruited for this clinical study. The powered exoskeleton gait training was 8 weeks, 1 h per session, and 2 sessions per week. The evaluation was performed before and after the training for (1) the time taken by the user to don and doff the powered exoskeleton independently, (2) the level of exertion perceived by participants while using the powered exoskeleton, and (3) the mobility performance included the timed up-and-go test, 10-m walk test, and 6-min walk test with the powered exoskeleton. The safety of the powered exoskeleton was evaluated on the basis of injury reports and the incidence of falls or imbalance while using the device. RESULTS:The results indicated that the participants were donning and doffing the powered lower limb exoskeleton robot independently with a lower level of exertion and walked faster and farther without any injury or fall incidence when using the powered exoskeleton than when using a knee-ankle-foot orthosis. Bone mineral densities was also increased after the gait training. No adverse effects, such as skin abrasions, or discomfort were reported while using the powered exoskeleton. CONCLUSIONS:The findings demonstrated that individuals with complete SCI used the powered lower limb exoskeleton robot independently without any assistance after 8 weeks of powered exoskeleton gait training. TRIAL REGISTRATION:Trial registration: National Taiwan University Hospital. TRIAL REGISTRATION NUMBER:201210051RIB . Name of registry: Hui-Fen Mao. URL of registry: Not available. Date of registration: December 12th, 2012. Date of enrolment of the first participant to the trial: January 3rd, 2013.

SUBMITTER: Wu CH

PROVIDER: S-EPMC5838988 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Walking rehabilitation processes include many repetitions of the same physical movements in order to replicate, as close as possible, the normal gait trajectories, and kinematics of all leg joints. In these conventional therapies, the therapist's ability to discover patient's limitations-and gradually reduce them-is key to the success of the therapy. Lower-limb robotic exoskeletons have strong deficiencies in this respect as compared to an experienced therapist. Most of the currently available robotic solutions are not able to properly adapt their trajectories to the biomechanical limitations of the patient. With this in mind, much research and development is still required in order to improve artificial human-like walking patterns sufficiently for valuable clinical use. The work herein reported develops and presents a method to acquire and saliently analyze subject-specific gait data while the subject dons a passive lower-limb exoskeleton. Furthermore, the method can generate adjustable, yet subject-specific, kinematic gait trajectories useful in programming controllers for future robotic rehabilitation protocols. A human-user study with ten healthy subjects provides the experimental setup to validate the proposed method. The experimental protocol consists in capturing kinematic data while subjects walk, with the donned H2 lower-limb exoskeleton, across three experimental conditions: walking with three different pre-determined step lengths marked on a lane. The captured ankle trajectories in the sagittal plane were found by normalizing all trials of each test from one heel strike to the next heel strike independent of the specific gait features of each individual. Prior literature suggests analyzing gait in phases. A preliminary data analysis, however, suggests that there exist six key events of the gait cycle, events that can adequately characterize gait for the purposes required of robotic rehabilitation including gait analysis and reference trajectory generation. Defining the ankle as an end effector and the hip as the origin of the coordinate frame and basing the linear regression calculations only on the six key events, i.e., Heel Strike, Toe Off, Pre-Swing, Initial Swing, Mid-Swing, and Terminal Swing, it is possible to generate a new calculated ankle trajectory with an arbitrary step length. The Leave-One-Out Cross Validation algorithm was used to estimate the fitting error of the calculated trajectory vs. the characteristic captured trajectory per subject, showing a fidelity average value of 95.2, 96.1, and 97.2%, respectively, for each step-length trial including all subjects. This research presents method to capture ankle trajectories from subjects and generate human-like ankle trajectories that could be scaled and computed on-line, could be adjusted to different gait scenarios, and could be used not only to generate reference trajectories for gait controllers, but also as an accurate and salient benchmark to test the human likeness of gait trajectories employed by existing robotic exoskeletal devices.

Project description:BackgroundCerebral palsy (CP) is a leading cause of childhood disability. The motor impairments of individuals with CP significantly affect the kinematics of an efficient gait pattern. Robotic therapies have become increasingly popular as an intervention to address this. Powered lower limb exoskeletons (PoLLE) are a novel form of robotic therapy that allow the individual to perform over-ground gait training and yet its effectiveness for CP is unknown.PurposeTo determine the effectiveness of PoLLE use on gait in individuals with CP.MethodA systematic search of eight electronic databases was conducted in March 2020. Studies included children (0-18 years) and or adults (18+ years) diagnosed with CP who used a PoLLE for gait training. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, with the methodology registered with PROSPERO (CRD42020177160). A modified version of the McMaster critical review form for quantitative studies was used to assess the methodological quality. Due to the heterogeneity of the included studies, a descriptive synthesis using the National Health & Medical Research Council (NHMRC) FORM framework was undertaken.ResultsOf the 2089 studies screened, ten case series and three case studies met the inclusion criteria highlighting the current evidence base is emerging and low level. A range of PoLLEs were investigated with effectiveness measured by using a number of outcome measures. Collectively, the body of evidence indicates there is some consistent positive evidence on the effectiveness of PoLLE in improving gait in individuals with CP, with minimal adverse effects. While this is a positive and encouraging finding for an emerging technology, methodological concerns also need to be acknowledged.ConclusionWith rapidly evolving technology, PoLLEs could play a transformative role in the lives of people impacted by CP. Ongoing research is required to further strengthen the evidence base and address current methodological concerns.

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The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury.

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