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Jose L Pons - One of the best experts on this subject based on the ideXlab platform.
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the h2 Robotic Exoskeleton for gait rehabilitation after stroke early findings from a clinical study
Journal of Neuroengineering and Rehabilitation, 2015Co-Authors: Magdo Bortole, Jose L Pons, Juan Moreno, Anusha Venkatakrishnan, Fangshi Zhu, Gerard E Francisco, Jose L ContrerasvidalAbstract:Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered Robotics Exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb Robotic Exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the Exoskeleton. A Likert scale was used to measure patient’s perception about the easy of use of the device. Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients. The developed Exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means to optimize a rehabilitation treatment that can be customized for individuals. Trial registration: This study was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/show/NCT02114450 ).
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A Robotic Exoskeleton for overground gait rehabilitation
Proceedings - IEEE International Conference on Robotics and Automation, 2013Co-Authors: Magdo Bortole, Antonio J. Del-ama, Eduardo Rocon, Fernando Brunetti, Juan C. M-moreno, Jose L PonsAbstract:Every year, stroke significantly affects thousands of individuals who require rehabilitation to regain lost movements and return to a normal life. Exoskeletons are becoming a very powerful tool to help therapists in this rehabilitation process. This work presents a Robotic Exoskeleton designed to assist overground gait training for stroke survivors with deficits in gait coordination despite conventional rehabilitation. The device is a bilateral Exoskeleton with six degrees of freedom and is designed to implement two control strategies. An adaptive trajectory control has been developed to guide the patient's limb within a desired path, allowing a deviation based on torque of interaction between the user and the Exoskeleton. An admittance control strategy allows the Robotic platform to capture the user's movements during assistive training and to replicate it during active training. Experimental results show that the Exoskeleton can adapt a pre-recorded gait pattern for the gait pattern of a specific user. Future investigations will evaluate the device in the rehabilitation of patients who have suffered from stroke and make a comparative analysis of the effectiveness of different Robotic therapies.
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design and validation of a rehabilitation Robotic Exoskeleton for tremor assessment and suppression
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2007Co-Authors: Eduardo Rocon, A F Ruiz, J M Beldalois, Mario Manto, Juan Moreno, Jose L PonsAbstract:Exoskeletons are mechatronic systems worn by a person in such a way that the physical interface permits a direct transfer of mechanical power and exchange of information. Upper limb Robotic Exoskeletons may be helpful for people with disabilities and/or limb weakness or injury. Tremor is the most common movement disorder in neurological practice. In addition to medication, rehabilitation programs, and deep brain stimulation, biomechanical loading has appeared as a potential tremor suppression alternative. This paper introduces the Robotic Exoskeleton called WOTAS (wearable orthosis for tremor assessment and suppression) that provides a means of testing and validating nongrounded control strategies for orthotic tremor suppression. This paper describes in detail the general concept for WOTAS, outlining the special features of the design and selection of system components. Two control strategies developed for tremor suppression with Exoskeletons are described. These two strategies are based on biomechanical loading and notch Altering the tremor through the application of internal forces. Results from experiments using these two strategies on patients with tremor are summarized. Finally, results from clinical trials are presented, which indicate the feasibility of ambulatory mechanical
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on the use of an active wearable Exoskeleton for tremor suppression via biomechanical loading
International Conference on Robotics and Automation, 2006Co-Authors: Eduardo Rocon, Jose L Pons, A F Ruiz, J M Beldalois, F Brunetti, Javier SanchezlacuestaAbstract:Biomechanical loading, in particular, viscous loading of the upper limb has been proposed in the literature as a means for suppressing pathologic tremor. It is expected that an improvement on manipulative function can be obtained by reducing the tremorous motion associated to some neurological disorders. This article presents two non-grounded control strategies to suppress tremor by means of a orthotic (wearable) Exoskeleton. These two strategies are based on biomechanical loading and notch filtering of tremor via internal forces. Both controls strategies are evaluated and validated on the Robotic Exoskeleton called WOTAS (wearable orthosis for tremor assessment and suppression). At the end, results obtained in the pre-clinical trials and conclusions of this study are presented
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rehabilitation Robotics a wearable exo skeleton for tremor assessment and suppression
International Conference on Robotics and Automation, 2005Co-Authors: Eduardo Rocon, Jose L Pons, A F Ruiz, J M Beldalois, Javier SanchezlacuestaAbstract:There is a need for wearable powered upper limb Exoskeletons able to apply forces to the upper limb for use by people with disabilities and/or limb weakness or injury. The Robotic Exoskeleton called WOTAS (Wearable Orthosis for Tremor Assessment and Suppression) presented in this paper will provide a means of testing non-grounded control strategies in order to help these people. For instance, biomechanical loading, in particular, viscous loading of the upper limb has been proposed in the literature as a means for suppressing pathologic tremor. This article describes in detail the general concept for WOTAS, outlining the special features of the design and selection of system components.
Arun Jayaraman - One of the best experts on this subject based on the ideXlab platform.
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WITHDRAWN: Immediate Adaptations to Poststroke Walking Performance Using a Wearable Robotic Exoskeleton.
Archives of physical medicine and rehabilitation, 2019Co-Authors: Arun Jayaraman, Megan K. O'brien, Sangeetha Madhavan, Kiyoshi Oikawa, Yosuke Endo, Shailesh S. Kantak, James Stinear, T. George Hornby, William Z. RymerAbstract:Abstract Objective To examine the immediate effects of a hip-assistive wearable Robotic Exoskeleton on clinical walking performance, walking energetics, gait kinematics, and corticomotor excitability in individuals with stroke. Design Randomized cross-over trial. Setting Research laboratory of a rehabilitation hospital. Participants Individuals (N=12; 4 female and 8 male; mean age [y] ± SD, 57.8±7.2) with chronic hemiparetic stroke. Interventions Honda’s Stride Management Assist (SMA) Exoskeleton, which provides torque-based flexion and extension assistance at the hip joints during walking. Main Outcome Measures The primary outcome measure was change in self-selected walking speed with the device off vs with the device on. Secondary outcome measures included changes in clinical endurance, energy expenditure, kinematics, and corticomotor excitability of lower limb muscles. Results In a single session using the device, participants exhibited adaptations over most outcome measures. Self-selected walking speed and peak treadmill speed increased, while oxygen consumption rate decreased during over-ground and treadmill endurance tests. More symmetric walking patterns were observed during treadmill walking. Changes in corticomotor excitability were highly variable among participants, with a nonsignificant increase in excitability for the paretic rectus femoris. Conclusions The SMA hip Exoskeleton causes immediate positive adaptations in walking performance in individuals with stroke when the device is in use.
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withdrawn immediate adaptations to poststroke walking performance using a wearable Robotic Exoskeleton
Archives of Physical Medicine and Rehabilitation, 2019Co-Authors: Arun Jayaraman, Sangeetha Madhavan, Kiyoshi Oikawa, Yosuke Endo, Shailesh S. Kantak, James Stinear, Megan K ObrienAbstract:Abstract Objective To examine the immediate effects of a hip-assistive wearable Robotic Exoskeleton on clinical walking performance, walking energetics, gait kinematics, and corticomotor excitability in individuals with stroke. Design Randomized cross-over trial. Setting Research laboratory of a rehabilitation hospital. Participants Twelve individuals (4F/8M, mean age 57.8±7.2) with chronic hemiparetic stroke. Interventions Honda’s Stride Management Assist (SMA) Exoskeleton, which provides torque-based flexion and extension assistance at the hip joints during walking. Main Outcome Measures The primary outcome measure was change in self-selected walking speed with the device off vs. with the device on. Secondary outcome measures included changes in clinical endurance, energy expenditure, kinematics, and corticomotor excitability of lower limb muscles. Results In a single session using the device, participants exhibited adaptations over most outcome measures. Self-selected walking speed and peak treadmill speed increased, while oxygen consumption rate decreased during overground and treadmill endurance tests. More symmetric walking patterns were observed during treadmill walking. Changes in corticomotor excitability were highly variable among participants, with a non-significant increase in excitability for the paretic rectus femoris. Conclusions The SMA hip Exoskeleton causes immediate positive adaptations in walking performance in individuals with stroke when the device is in use.
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experience of Robotic Exoskeleton use at four spinal cord injury model systems centers
Journal of Neurologic Physical Therapy, 2018Co-Authors: Allen W Heinemann, Daniel Pinto, Shuohsiu Chang, Susan Charlifue, Arun Jayaraman, Chaithanya K Mummidisetty, Jamal Spraggins, Candy Tefertiller, Heather B Taylor, Argyrios StampasAbstract:Background and purpose Refinement of Robotic Exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using Robotic Exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of Exoskeleton benefits and risks and developments that would enhance utility. Methods We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. Results Thirty clinicians participated in focus groups. They reported using Exoskeletons primarily in outpatient and wellness settings; 1 center used Exoskeletons during inpatient rehabilitation. A typical episode of outpatient Exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to Exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. Discussion and conclusions Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates Robotic Exoskeletons into physical therapy services. There is currently little evidence to guide integration of Exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231).
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accelerometry enabled measurement of walking performance with a Robotic Exoskeleton a pilot study
Journal of Neuroengineering and Rehabilitation, 2016Co-Authors: Arun Jayaraman, William Z. Rymer, Luca Lonini, Nicholas Shawen, Kathleen Scanlan, Konrad P KordingAbstract:Clinical scores for evaluating walking skills with lower limb Exoskeletons are often based on a single variable, such as distance walked or speed, even in cases where a host of features are measured. We investigated how to combine multiple features such that the resulting score has high discriminatory power, in particular with few patients. A new score is introduced that allows quantifying the walking ability of patients with spinal cord injury when using a powered Exoskeleton. Four spinal cord injury patients were trained to walk over ground with the ReWalk™ Exoskeleton. Body accelerations during use of the device were recorded by a wearable accelerometer and 4 features to evaluate walking skills were computed. The new score is the Gaussian naive Bayes surprise, which evaluates patients relative to the features’ distribution measured in 7 expert users of the ReWalk™. We compared our score based on all the features with a standard outcome measure, which is based on number of steps only. All 4 patients improved over the course of training, as their scores trended towards the expert users’ scores. The combined score (Gaussian naive surprise) was considerably more discriminative than the one using only walked distance (steps). At the end of training, 3 out of 4 patients were significantly different from the experts, according to the combined score (p < .001, Wilcoxon Signed-Rank Test). In contrast, all but one patient were scored as experts when number of steps was the only feature. Integrating multiple features could provide a more robust metric to measure patients’ skills while they learn to walk with a Robotic Exoskeleton. Testing this approach with other features and more subjects remains as future work.
Eduardo Rocon - One of the best experts on this subject based on the ideXlab platform.
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A Robotic Exoskeleton for overground gait rehabilitation
Proceedings - IEEE International Conference on Robotics and Automation, 2013Co-Authors: Magdo Bortole, Antonio J. Del-ama, Eduardo Rocon, Fernando Brunetti, Juan C. M-moreno, Jose L PonsAbstract:Every year, stroke significantly affects thousands of individuals who require rehabilitation to regain lost movements and return to a normal life. Exoskeletons are becoming a very powerful tool to help therapists in this rehabilitation process. This work presents a Robotic Exoskeleton designed to assist overground gait training for stroke survivors with deficits in gait coordination despite conventional rehabilitation. The device is a bilateral Exoskeleton with six degrees of freedom and is designed to implement two control strategies. An adaptive trajectory control has been developed to guide the patient's limb within a desired path, allowing a deviation based on torque of interaction between the user and the Exoskeleton. An admittance control strategy allows the Robotic platform to capture the user's movements during assistive training and to replicate it during active training. Experimental results show that the Exoskeleton can adapt a pre-recorded gait pattern for the gait pattern of a specific user. Future investigations will evaluate the device in the rehabilitation of patients who have suffered from stroke and make a comparative analysis of the effectiveness of different Robotic therapies.
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design and validation of a rehabilitation Robotic Exoskeleton for tremor assessment and suppression
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2007Co-Authors: Eduardo Rocon, A F Ruiz, J M Beldalois, Mario Manto, Juan Moreno, Jose L PonsAbstract:Exoskeletons are mechatronic systems worn by a person in such a way that the physical interface permits a direct transfer of mechanical power and exchange of information. Upper limb Robotic Exoskeletons may be helpful for people with disabilities and/or limb weakness or injury. Tremor is the most common movement disorder in neurological practice. In addition to medication, rehabilitation programs, and deep brain stimulation, biomechanical loading has appeared as a potential tremor suppression alternative. This paper introduces the Robotic Exoskeleton called WOTAS (wearable orthosis for tremor assessment and suppression) that provides a means of testing and validating nongrounded control strategies for orthotic tremor suppression. This paper describes in detail the general concept for WOTAS, outlining the special features of the design and selection of system components. Two control strategies developed for tremor suppression with Exoskeletons are described. These two strategies are based on biomechanical loading and notch Altering the tremor through the application of internal forces. Results from experiments using these two strategies on patients with tremor are summarized. Finally, results from clinical trials are presented, which indicate the feasibility of ambulatory mechanical
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on the use of an active wearable Exoskeleton for tremor suppression via biomechanical loading
International Conference on Robotics and Automation, 2006Co-Authors: Eduardo Rocon, Jose L Pons, A F Ruiz, J M Beldalois, F Brunetti, Javier SanchezlacuestaAbstract:Biomechanical loading, in particular, viscous loading of the upper limb has been proposed in the literature as a means for suppressing pathologic tremor. It is expected that an improvement on manipulative function can be obtained by reducing the tremorous motion associated to some neurological disorders. This article presents two non-grounded control strategies to suppress tremor by means of a orthotic (wearable) Exoskeleton. These two strategies are based on biomechanical loading and notch filtering of tremor via internal forces. Both controls strategies are evaluated and validated on the Robotic Exoskeleton called WOTAS (wearable orthosis for tremor assessment and suppression). At the end, results obtained in the pre-clinical trials and conclusions of this study are presented
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rehabilitation Robotics a wearable exo skeleton for tremor assessment and suppression
International Conference on Robotics and Automation, 2005Co-Authors: Eduardo Rocon, Jose L Pons, A F Ruiz, J M Beldalois, Javier SanchezlacuestaAbstract:There is a need for wearable powered upper limb Exoskeletons able to apply forces to the upper limb for use by people with disabilities and/or limb weakness or injury. The Robotic Exoskeleton called WOTAS (Wearable Orthosis for Tremor Assessment and Suppression) presented in this paper will provide a means of testing non-grounded control strategies in order to help these people. For instance, biomechanical loading, in particular, viscous loading of the upper limb has been proposed in the literature as a means for suppressing pathologic tremor. This article describes in detail the general concept for WOTAS, outlining the special features of the design and selection of system components.
Dany H Gagnon - One of the best experts on this subject based on the ideXlab platform.
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effects of an overground walking program with a Robotic Exoskeleton on long term manual wheelchair users with a chronic spinal cord injury protocol for a self controlled interventional study
JMIR Research Protocols, 2020Co-Authors: Alec Bass, Cyril Duclos, Antony D Karelis, Mylene Aubertinleheudre, Claude Vincent, Suzanne N Morin, Michelle Mckerral, Dany H GagnonAbstract:Background In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity-typically linked to this mode of mobility-contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable Robotic Exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective This study's overall goals are as follows: (1) to determine the effects of a 16-week wearable Robotic Exoskeleton-assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable Robotic Exoskeleton-assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users' satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results This study is currently underway with active recruitment in Montreal, Quebec, Canada. Results are expected in the spring of 2021. Conclusions The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable Robotic Exoskeleton-assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable Robotic Exoskeletons during initial rehabilitation following a spinal cord injury. Trial registration ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752. International registered report identifier (irrid) DERR1-10.2196/19251.
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effects of Robotic Exoskeleton control options on lower limb muscle synergies during overground walking an exploratory study among able bodied adults
Neurophysiologie Clinique-clinical Neurophysiology, 2020Co-Authors: Manuel J Escalona, Cyril Duclos, Daniel Bourbonnais, Damien Le Flem, Michel Goyette, Dany H GagnonAbstract:Summary Background The effects of lower limb (L/L) control options, developed for overground walking with a wearable Robotic Exoskeleton (WRE), on the neuromotor control of L/L muscles [i.e., muscle synergies (MSs)] during walking remain uncertain. Objective To gain initial insights regarding the effects of different control options on the number of MSs at the L/L and on their muscle weighting within each MS when walking with a WRE. Methods Twenty able-bodied adults walked overground without and with the WRE set at two control options with a predetermined foot pathway imposed by the WRE, and at three other control options with free L/L kinematics in the sagittal plane. Surface electromyography of eight right L/L muscles was recorded. MSs were extracted using a non-negative matrix factorisation algorithm. Cosine similarity and correlation coefficients characterised similarities between the MSs characteristics. Results Freely moving the L/L in the sagittal plane (i.e., non-trajectory controlled options) during WRE walking best duplicated typical MSs extracted when walking without WRE. Conversely, WRE walking while fully controlling the L/L trajectory presented the lowest correlations to all MSs extracted when walking without WRE, especially during early swing and L/L deceleration. Conclusion Neuromotor control of L/L muscles is affected by the selected control option during WRE walking, particularly when a predetermined foot pathway is imposed. Significance This exploratory study represents the first step in informing the decision-making process regarding the use of different L/L control options when using WRE and calls for further research among adults with sensorimotor impairments.
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cardiorespiratory demand and rate of perceived exertion during overground walking with a Robotic Exoskeleton in long term manual wheelchair users with chronic spinal cord injury a cross sectional study
Annals of Physical and Rehabilitation Medicine, 2018Co-Authors: Maria Jose Escalona, M. Vermette, Cyril Duclos, Rachel Brosseau, Alain S Comtois, Mylene Aubertinleheudre, Dany H GagnonAbstract:Abstract Background Many wheelchair users adopt a sedentary lifestyle, which results in progressive physical deconditioning with increased risk of musculoskeletal, cardiovascular and endocrine/metabolic morbidity and mortality. Engaging in a walking program with an overground Robotic Exoskeleton may be an effective strategy for mitigating these potential negative health consequences and optimizing fitness in this population. However, additional research is warranted to inform the development of adapted physical activity programs incorporating this technology. Objectives To determine cardiorespiratory demands during sitting, standing and overground walking with a Robotic Exoskeleton and to verify whether such overground walking results in at least moderate-intensity physical exercise. Methods We enrolled 13 long-term wheelchair users with complete motor spinal cord injury in a walking program with an overground Robotic Exoskeleton. Cardiorespiratory measures and rate of perceived exertion (RPE) were recorded by using a portable gas analyzer system during sitting, standing and four 10 m walking tasks with the Robotic Exoskeleton. Each participant also performed an arm crank ergometer test to determine maximal cardiorespiratory ability (i.e., peak heart rate and O 2 uptake [HR peak , VO 2peak ]). Results Cardiorespiratory measures increased by a range of 9%–35% from sitting to standing and further increased by 22%–52% from standing to walking with the Robotic Exoskeleton. During walking, median oxygen cost (O 2Walking ), relative HR (%HR peak ), relative O 2 consumption (%VO 2peak ) and respiratory exchange ratio (RER) reached 0.29 mL/kg/m, 82.9%, 41.8% and 0.9, respectively, whereas median RPE reached 3.2/10. O 2Walking was moderately influenced by total number of sessions and steps taken with the Robotic Exoskeleton since the start of the walking program. Conclusion Overground walking with the Robotic Exoskeleton over a short distance allowed wheelchair users to achieve a moderate-intensity level of exercise. Hence, an overground locomotor training program with a Robotic Exoskeleton may have cardiorespiratory health benefits in the population studied.
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Locomotor training using an overground Robotic Exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, per
Journal of NeuroEngineering and Rehabilitation, 2018Co-Authors: Dany H Gagnon, Lívia P. Carvalho, M. Vermette, Maria Jose Escalona, Cyril Duclos, Antony D Karelis, Mylène Aubertin-leheudreAbstract:For individuals who sustain a complete motor spinal cord injury (SCI) and rely on a wheelchair as their primary mode of locomotion, overground Robotic Exoskeletons represent a promising solution to stand and walk again. Although overground Robotic Exoskeletons have gained tremendous attention over the past decade and are now being transferred from laboratories to clinical settings, their effects remain unclear given the paucity of scientific evidence and the absence of large-scale clinical trials. This study aims to examine the feasibility of a locomotor training program with an overground Robotic Exoskeleton in terms of recruitment, attendance, and drop-out rates as well as walking performance, learnability, and safety. Individuals with a SCI were invited to participate in a 6 to 8-week locomotor training program with a Robotic Exoskeleton encompassing 18 sessions. Selected participants underwent a comprehensive screening process and completed two familiarization sessions with the Robotic Exoskeleton. The outcome measures were the rate of recruitment of potential participants, the rate of attendance at training sessions, the rate of drop-outs, the ability to walk with the Exoskeleton, and its progression over the program as well as the adverse events. Out of 49 individuals who expressed their interest in participating in the study, only 14 initiated the program (recruitment rate = 28.6%). Of these, 13 individuals completed the program (drop-out rate = 7.1%) and attended 17.6 ± 1.1 sessions (attendance rate = 97.9%). Their greatest standing time, walking time, and number of steps taken during a session were 64.5 ± 10.2 min, 47.2 ± 11.3 min, and 1843 ± 577 steps, respectively. During the training program, these last three parameters increased by 45.3%, 102.1%, and 248.7%, respectively. At the end of the program, when walking with the Exoskeleton, most participants required one therapist (85.7%), needed stand-by or contact-guard assistance (57.1%), used forearm crutches (71.4%), and reached a walking speed of 0.25 ± 0.05 m/s. Five participants reported training-related pain or stiffness in the upper extremities during the program. One participant sustained bilateral calcaneal fractures and stopped the program. This study confirms that larger clinical trials investigating the effects of a locomotor training program with an overground Robotic Exoskeleton are feasible and relatively safe in individuals with complete motor SCI. Moreover, to optimize the recruitment rate and safety in future trials, this study now highlights the need of developing pre-training rehabilitation programs to increase passive lower extremity range of motion and standing tolerance. This study also calls for the development of clinical practice guidelines targeting fragility fracture risk assessment linked to the use of overground Robotic Exoskeletons.
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effect on body composition and bone mineral density of walking with a Robotic Exoskeleton in adults with chronic spinal cord injury
Journal of Rehabilitation Medicine, 2017Co-Authors: Antony D Karelis, Dany H Gagnon, Livia Pinheiro Carvalho, Manuel Jose Escalona Castillo, Mylene AubertinleheudreAbstract:OBJECTIVE To examine the effect on body composition and bone mineral density of locomotor training using a Robotic Exoskeleton in individuals with spinal cord injury. STUDY DESIGN Interventional study. SUBJECTS/METHODS Five adults with a non-progressive traumatic complete sensorimotor spinal cord injury who were using a wheelchair as a primary mode of mobility. Participants performed a personalized 6-week progressive locomotor training programme using a Robotic Exoskeleton 3 times/week for up to 60 min. Body composition measures were determined using dual energy X-ray absorptiometry and peripheral quantitative computed tomography. RESULTS A significant increase in leg and appendicular lean body mass and a decrease in total, leg and appendicular fat mass was observed after the intervention. Furthermore, the calf muscle cross-sectional area increased significantly after the intervention. Finally, although not statistically significant, there was an increase of 14.5% in bone mineral density of the tibia, which may be clinically significant. A decrease of > 5 % was also noted for subcutaneous adipose tissue and intramuscular adipose tissue. CONCLUSION Locomotor training using a Robotic Exoskeleton appears to be associated with improvements in body composition and, potentially, bone health.
James Stinear - One of the best experts on this subject based on the ideXlab platform.
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WITHDRAWN: Immediate Adaptations to Poststroke Walking Performance Using a Wearable Robotic Exoskeleton.
Archives of physical medicine and rehabilitation, 2019Co-Authors: Arun Jayaraman, Megan K. O'brien, Sangeetha Madhavan, Kiyoshi Oikawa, Yosuke Endo, Shailesh S. Kantak, James Stinear, T. George Hornby, William Z. RymerAbstract:Abstract Objective To examine the immediate effects of a hip-assistive wearable Robotic Exoskeleton on clinical walking performance, walking energetics, gait kinematics, and corticomotor excitability in individuals with stroke. Design Randomized cross-over trial. Setting Research laboratory of a rehabilitation hospital. Participants Individuals (N=12; 4 female and 8 male; mean age [y] ± SD, 57.8±7.2) with chronic hemiparetic stroke. Interventions Honda’s Stride Management Assist (SMA) Exoskeleton, which provides torque-based flexion and extension assistance at the hip joints during walking. Main Outcome Measures The primary outcome measure was change in self-selected walking speed with the device off vs with the device on. Secondary outcome measures included changes in clinical endurance, energy expenditure, kinematics, and corticomotor excitability of lower limb muscles. Results In a single session using the device, participants exhibited adaptations over most outcome measures. Self-selected walking speed and peak treadmill speed increased, while oxygen consumption rate decreased during over-ground and treadmill endurance tests. More symmetric walking patterns were observed during treadmill walking. Changes in corticomotor excitability were highly variable among participants, with a nonsignificant increase in excitability for the paretic rectus femoris. Conclusions The SMA hip Exoskeleton causes immediate positive adaptations in walking performance in individuals with stroke when the device is in use.
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withdrawn immediate adaptations to poststroke walking performance using a wearable Robotic Exoskeleton
Archives of Physical Medicine and Rehabilitation, 2019Co-Authors: Arun Jayaraman, Sangeetha Madhavan, Kiyoshi Oikawa, Yosuke Endo, Shailesh S. Kantak, James Stinear, Megan K ObrienAbstract:Abstract Objective To examine the immediate effects of a hip-assistive wearable Robotic Exoskeleton on clinical walking performance, walking energetics, gait kinematics, and corticomotor excitability in individuals with stroke. Design Randomized cross-over trial. Setting Research laboratory of a rehabilitation hospital. Participants Twelve individuals (4F/8M, mean age 57.8±7.2) with chronic hemiparetic stroke. Interventions Honda’s Stride Management Assist (SMA) Exoskeleton, which provides torque-based flexion and extension assistance at the hip joints during walking. Main Outcome Measures The primary outcome measure was change in self-selected walking speed with the device off vs. with the device on. Secondary outcome measures included changes in clinical endurance, energy expenditure, kinematics, and corticomotor excitability of lower limb muscles. Results In a single session using the device, participants exhibited adaptations over most outcome measures. Self-selected walking speed and peak treadmill speed increased, while oxygen consumption rate decreased during overground and treadmill endurance tests. More symmetric walking patterns were observed during treadmill walking. Changes in corticomotor excitability were highly variable among participants, with a non-significant increase in excitability for the paretic rectus femoris. Conclusions The SMA hip Exoskeleton causes immediate positive adaptations in walking performance in individuals with stroke when the device is in use.
