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Theoretical schema combining patient’s level of ability defined by functional classification of ambulation (FAC) with best possible solution in terms of walking training and machine constriction.
Source publication
In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a...
Citations
... Therefore, it has been suggested as an "add on" treatment [82] and, rarely, as a substitution for conventional rehabilitation, either in the early phase or in chronic patients [83][84][85]. However, there is still controversy surrounding which different phases of stroke are the best window to start RAGT, how to perform the best rehab protocol, and whose patients may benefit from a specific robotic device [86][87][88]. The American Heart Association and the American Stroke Association have suggested that combined therapy of electro-medical devices and conventional therapy within the first three to six months of acute/subacute strokes is more effective than traditional therapy alone. ...
Spasticity is a very common sign in the neurological field. It can be defined as “a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes” associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life”. The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients’ performance and outcomes. The combined strategies might rise the toxin’s effect, lowering its dosages of botulinum and reducing side effects and costs.
... Серед методів фізичної терапії, що застосовують для відновлення ходьби, значне місце займає тренування на біговій доріжці з підтриманням ваги тіла, яке демонструє ефективність у покращенні контролю руху за рахунок імітації фізіологічного патерну кроку та зменшення осьового навантаження на нижні кінцівки [23,24]. Роботизовані ортези та інші індивідуальні технологічні вироби, які допомагають у відновленні фаз кроку, дають можливість пацієнтам, які втратили значну частину моторних функцій, знову вчитися ходити, стимулюючи нервово-м'язові зв'язки [25]. Функціональна електрична стимуляція також використовується як метод реабілітації для покращення рухових функцій під час пересування та вертикалізації, зокрема при швидкісному та координаційному контролі ходьби, що підтверджено численними дослідженнями [30]. ...
Резюме. Інсульт продовжує бути однією з найсерйозніших медичних проблем у нашійкраїні з реєстрацією понад 111 тис. нових випадків щорічно, що підкреслює її роль якпровідної причини високого рівня смертності та інвалідизації серед працездатної частининаселення. Мета. Вивчення зарубіжного досвіду ефективності використання різних алгорит-мів фізичної терапії при відновленні навичок ходьби у пацієнтів після гострого порушеннямозкового кровообігу. Методи. Аналіз наукової літератури та досвіду зарубіжних колег. Ре-зультати. Огляд наукових джерел виявив, що останнім часом відбувається переорієнтація встратегіях реабілітації пацієнтів після інсульту. Основним принципом у процесі відновленняцієї категорії пацієнтів є розгляд гострого порушення мозкового кровообігу як невідкладно-го стану, що потребує негайної реакції та інтенсивного реабілітаційного втручання. Фактичнідані, отримані з аналізу сучасної науково-методологічної літератури, свідчать про значніпереваги використання високоінтенсивних тренувань у ранньому періоді реабілітації порів-няно з традиційними методами відновлення. Використання високоінтенсивного тренуванняне тільки значно покращує моторні навички пацієнтів, включаючи відновлення фаз крокута патерну ходьби, а й скорочує тривалість госпіталізації, мінімізує ризик ускладнень, щопідвищує рівень якості їхнього життя. Враховуючи важливість своєчасного залучення осібдо процесу відновлення з використанням найефективніших науково обґрунтованих методів,можна стверджувати, що високоінтенсивне тренування є новаторською практикою, яка всеще знаходиться на етапі активного вивчення та адаптації як у світовій, так і в українськіймедичній спільноті. Незважаючи на попередні позитивні результати, подальші дослідженняє ключовими для повного розуміння безпеки та ефективності таких тренувань для різнихкатегорій пацієнтів.Ключові слова: фізична терапія, інсульт, високоінтенсивне тренування, ходьба.
... This is based on the notion of "neuroplasticity," wherein the death of one area in a neural network is compensated by alternative pathways generated by repeated exercises involving the affected limbs (Bogue 2018). Despite lagging in the speed of deployment behind surgical robots (Morone et al. 2017(Morone et al. : 1308, the utilization of robots is increasing in rehabilitation, aided particularly by the developments in artificial intelligence. The hype generated by these robots, often through images of patients with limb paralysis being overjoyed at walking with exoskeletons, is not generally translated into long-term clinical outcomes discernibly better than conventional human-based therapies (Iosa et al. 2012). ...
... The success of Intuitive Surgical's "da Vinci" system, a package of robots used for laparoscopic surgeries (Ma 2018: 9), has boosted the interest of engineers and practitioners in the direction of surgeries (Dupont et al. 2021: 4−10). Rehabilitation robotics, meanwhile, has not been so successful (Morone et al. 2017(Morone et al. : 1308, forcing researchers to move their attention to such new modalities as soft robotics or the application of bio-friendly materials, and to a brain-computer interface in which tendon-based signals are used to actuate limb joints (Dupont et al. 2021: 7-10;Wang et al. 2010: 2-7). ...
... Exoskeletons (EXOs) are wearable devices that augment the physical capabilities of their wearers using mechanical (passive) or electromechanical (active) actuation and an external structure [27][28][29][30]. Within the past decade, EXOs have risen as promising interventions to improve human performance and safety in the military [31], healthcare [32,33], and industry [34]. These devices are often categorized based on the body region they support, with common types being those supporting the upper body (back, shoulder, arm, wrist) or lower body (knee, ankle) regions. ...
Monitoring physical demands during task execution with exoskeletons can be instrumental in understanding their suitability for industrial tasks. This study aimed at developing a fatigue level prediction model for Back-Support Industrial Exoskeletons (BSIEs) using wearable sensors. Fourteen participants performed a set of intermittent trunk-flexion task cycles consisting of static, sustained, and dynamic activities, until they reached medium-high fatigue levels, while wearing BSIEs. Three classification algorithms, Support Vector Machine (SVM), Random Forest (RF), and XGBoost (XGB), were implemented to predict perceived fatigue level in the back and leg regions using features from four wearable wireless Electromyography (EMG) sensors with integrated Inertial Measurement Units (IMUs). We examined the best grouping and sensor combinations by comparing prediction performance. The findings showed best performance in binary classification of leg and back fatigue with 95% (2 EMG + IMU sensors) and 82% (single IMU sensor) accuracy, respectively. Tertiary classification for back and leg fatigue level prediction required four sensor setups with both EMG and IMU measures to perform at 79% and 67% accuracy, respectively. The efforts presented in our article demonstrate the feasibility of an accessible fatigue level detection system, which can be beneficial for objective fatigue assessment, design selection, and implementation of BSIEs in real-world scenarios.
... Recently, various types of gait robots have been used to assist individuals with hemiparesis during gait training. Robot-assisted gait training (RAGT) can provide intensive, repetitive, and task-oriented training for individuals with hemiparetic stroke who have difficulty walking independently, by partially or fully supporting their body weight and movements using a robot control mechanism [8]. A systematic review showed that a higher percentage of individuals with hemiparetic stroke within 3 months of stroke onset achieved gait independence by combining RAGT with conventional training [9]. ...
... Additionally, the study population consisted of individuals with subacute stroke. Stroke rehabilitation is recommended to include early repetitive training [38] and RAGT has the potential to provide intensive and highly repetitive training [8]. Therefore, future studies should examine the effects of RAGT on improving gait independence in individuals with early post-onset stroke. ...
Background
Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.
Methods
An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.
Results
A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914–18.995], p = 0.065, HR 4.443 [95%CI 0.973–20.279], p = 0.054, respectively).
Conclusions
The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.
Trial registration
This study was registered with the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCT 042180078) on March 3, 2019.
... Robot-based neurorehabilitation is a rapidly growing field that uses robots to treat neurological injuries [5]. Systematic reviews have indicated that robot-assisted rehabilitation has more positive outcomes for stroke patients in improving walking and motor recovery than conventional training [6,7]. ...
... Robot-assisted training may be more beneficial than conventional training in improving balance in persons with stroke because it enables higher-intensity training, especially for most disabled patients [5]. Additionally, it may be beneficial for early retraining after stroke, when there is maximum plasticity and potential for recovery [37]. ...
The objective of this study was to evaluate the effectiveness of robot-assisted lower-limb rehabilitation on balance in stroke patients and to explore the covariates associated with these effects.
A systematic literature search was carried out in four databases (MEDLINE (Ovid), CINAHL, PsycINFO, and ERIC) for studies published from inception to 25 th of March 2022. Studies on robot-assisted lower-limb rehabilitation with a randomized controlled trial (RCT) design, participants with stroke, a comparison group with conventional training, and balance-related outcomes were included. Studies were assessed for Cochrane Risk of Bias 2 and quality of evidence. Meta-analysis and meta-regression were performed.
A total of 48 (RCT) with 1472 participants were included. The overall risk of bias in the included studies was unclear (n = 32), high (n = 15) or low (n = 1). Compared to conventional rehabilitation, robot-assisted lower-limb rehabilitation interventions were more effective for balance improvement (Hedges’ g = 0.25, 95% CI: 0.10 0.41). In meta-regression, a relationship between the training effect was observed with the time since stroke, explaining 56% of the variance ( p = 0.001), and with the ankle robots, explaining 16% of the variance ( p = 0.048). No serious adverse events related to robot-assisted training were reported.
Robot-assisted lower-limb rehabilitation may improve balance more than conventional training in people with stroke, especially in the acute stage. Robot-assisted lower-limb rehabilitation seems to be a safe rehabilitation method for patients with stroke. To strengthen the evidence, more high-quality RCTs with adequate sample sizes are needed.
... Although robotic rehabilitation satisfaction is quite satisfactory with a rate of 95% in patients with SCI, as technology advances, the functions of patients with SCI will increase with exoskeleton type robotic devices [17,18]. Most of the robots commercialized today are based on the basic idea that walking is an automatic subcortical ability [19]. However, this needs to be reconsidered in the near future from neuromechanical perspectives, and physiatrists need to determine appropriate treatment methods for the appropriate patient. ...
This study aimed to understand the needs and expectations of individuals with disabilities caused by spinal cord injuries who require long-term rehabilitation from a rehabilitation hospital.
The cross-sectional clinical study was conducted, which included individuals over the age of 18 with spinal cord injuries who had previously been hospitalized in a rehabilitation hospital. The 16-question survey, titled "What should a rehabilitation hospital be like according to patients with spinal cord injuries," was applied to individuals hospitalized in the inpatient service of Çam Sakura City Hospital. It was also given to spinal cord injured people reached through social media. The participants' demographic data was recorded, and the survey was completed by 120 participants, comprising 70 males and 50 females. The mean age was 37.47 ± 11.63 years, with 79 participants being married and 41 being single. Twenty-five participants had graduated from at least one university. The time since the spinal cord injury was less than two years for 20 individuals and more than two years for 100 individuals.
The results showed that robotic rehabilitation and psychological support were the most requested rehabilitation elements, while interest in sexual rehabilitation was less than other rehabilitation elements. Furthermore, in the correlation analysis, elderly participants indicated that there should be more specialized services and outpatient clinics.
This study highlights the importance of considering the needs and wishes of patients when planning and operating a rehabilitation center. The study clarifies that patients' needs for specialized services and robotic rehabilitation were striking. Additionally, the significance and necessity of sexual rehabilitation should be conveyed to patients.
... • Cost: robot-aided rehabilitation systems are expensive [88]. ...
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterized by airflow limitation and respiratory symptoms such as shortness of breath, chronic cough, and sputum production. The relationship between COPD and gait disturbance is orchestrated by a complex interplay of factors. Airflow obstruction, the hallmark of COPD, imposes a strain on the respiratory system, leading to breathlessness and fatigue. This relentless struggle for breath forces individuals with COPD to curtail their walking pace, where they adopt a shortened stride and reduced step height. Furthermore, the chronic inflammation associated with COPD infiltrates skeletal muscles, leading to muscle weakness and decreased muscle mass. This insidious process further impairs gait, diminishing the ability to generate the necessary force for efficient ambulation. This chapter will explore the connection between COPD and gait disturbance, examining the underlying mechanisms, prevalence, impact, and management strategies to prevent fall-related injuries and improve the well-being of individuals affected by this challenging combination.
... The prognosis of patients with stroke in terms of walking ability may be improved further through robotic rehabilitation (Baronchelli et al., 2021;Calafiore et al., 2022). On the other hand, it is far from established and recommended when, how and for whom to use a particular device (Morone et al., 2017). A previous study suggested that patients with stroke who are pain-free, have good communication, and visual-spatial function are more suitable for walking training with HAL (Chihara et al., 2016). ...
... In facts, during clinical practice, as clear characteristics of patients are unknown, it is difficult to identify which patients should receive gait training with HAL; some patients even fail to exhibit sufficient therapeutic response for robot-assisted gait training. A systematic review of current guidelines on robotic-assisted gait rehabilitation after stroke states that future guidelines should focus on identifying the characteristics of patients who may better benefit from a specific robotic device (Morone et al., 2017). In addition, a systematic review of effects of gait training with HAL reported no strong evidence supporting the effectiveness of HAL in improving the walking ability owing to differing patient characteristics (Taki et al., 2022). ...
Robot-assisted gait training is effective for walking independence in stroke rehabilitation, the hybrid assistive limb (HAL) is an example. However, gait training with HAL may not be effective for everyone, and it is not clear who is not expected to benefit. Therefore, we aimed to identify the characteristics of stroke patients who have difficulty gaining benefits from gait training with HAL. We conducted a single-institutional retrospective cohort study. The participants were 82 stroke patients who had received gait training with HAL during hospitalization. The dependent variable was the functional ambulation category (FAC) that a measure of gait independence in stroke patients, and five independent [age, National Institutes of Health Stroke Scale, Brunnstrom recovery stage (BRS), days from stroke onset, and functional independence measure total score (cognitive items)] variables were selected from previous studies and analyzed by logistic regression analysis. We evaluated the validity of logistic regression analysis by using several indicators, such as the area under the curve (AUC), and a confusion matrix. Age, days from stroke onset to HAL initiation, and BRS were identified as factors that significantly influenced walking independence through gait training with HAL. The AUC was 0.86. Furthermore, after building a confusion matrix, the calculated binary accuracy, sensitivity (recall), and specificity were 0.80, 0.80, and 0.81, respectively, indicated high accuracy. Our findings confirmed that older age, greater degree of paralysis, and delayed initiation of HAL-assisted training after stroke onset were associated with increased likelihood of walking dependence upon hospital discharge.
... Exoskeleton robots have emerged as indispensable tools in active rehabilitation training for individuals with lower-limb motor dysfunctions, spinal cord injuries, and developmental disabilities [1]- [3]. These robotic devices offer a unique fusion of user engagement and physical activity, presenting promising alternatives to traditional rehabilitation exercises [4], [5]. By enabling human-like control, exoskeleton robots strive to accurately recognize human motion intentions in real- Proposed KINETIQA Model Architecture for Precise Knee Joint Angle Prediction. ...
