Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Monday, February 26, 2018

GEMS: the Gait Enhancing Mobile Shoe

Interesting, video at link.  Does your therapy department even have a split belt treadmill? Or know about it?
Project Background
A Split-belt treadmill as part
of the USF CAREN system.

Walking requires precise coordination between the legs. This interlimb coordination is often impaired in individuals with central nervous system lesion, such as stroke, resulting in an asymmetric walking pattern and a slower walking velocity. Walking on a split-belt treadmill, which has two belts moving the legs at different speeds, has been shown to correct walking asymmetries in people with stroke. One distinct drawback is that learning on the treadmill does not transfer completely to walking over the ground. Although regular and more frequent training leads to greater rehabilitation, another drawback of a split-belt is that people cannot practice in their more natural everyday environment, such as at home. Walking on a treadmill is a stationary task, so the sensory information experienced while walking over ground, such as the optic/visual flow of motion, is not the same as that while walking on a treadmill. It has been hypothesized that the limited transfer to over-ground walking is due to the conflicting sensory experiences between the treadmill training environment and the over-ground environment. The perceptual change gives the individual cues that the new environment is not the same as that in which he was trained. Mimicking the effects of the split-belt treadmill while walking over ground can alleviate the dynamic and psychological differences of walking on a treadmill and, thus, increase the transfer of the new walking pattern from treadmill to over-ground walking.
Gait Enhancing Mobile Shoe (GEMS)
Our innovative Gait Enhancing Mobile Shoe (GEMS) can impose a motion to a foot that is capable of changing interlimb coordination and the resulting walking velocity while walking over ground. The GEMS creates a motion similar to that felt when walking on a split-belt treadmill, but while walking over ground where the sensory information of the real world task will be experienced. The objective of this proposed research and development is to validate the use of the GEMS for long-term correction of the wearer's gait. The GEMS design uses no external power since the shoe mechanically converts the wearer's downward and horizontal forces into a horizontal motion. This shoe design is completely mobile, which opens up the doors to enabling long-term continuous rehabilitation outside the rehabilitation clinic. We anticipate that both the longer use of the device and experiencing gait modifications in real world environments will aid in achieving better rehabilitation outcomes.

Several Gait Enhancing Mobile Shoe prototypes have been developed and tested. The first GEMS was passive and completely mechanical, but it had no control of the backward foot motion. Although it moved the wearer's foot backward, it did so in a jerky and fairly unpredictable motion comparable to sliding on ice or a slippery surface. The second GEMS provided a smooth motion by controlling the generated horizontal motion. However, because of the various motion controls, this version ended up being too high off the ground and too heavy for actual subject testing. The third and fourth prototypes built upon the third being purely passive and completely mechanical, while introducing a rotary damper to regulate the backward motion of the foot. The fifth (not shown here) is currently undergoing a clinical trial.

GEMS Testing
While the research and development of the Gait Enhancing Mobile Shoe is centered in the REED Lab at the University of South Florida, the GEMS project works in collaboration with Erin Vasudeven at the Moss Rehab Einstein rehabilitation facility in Philadelphia, PN. Moss Rehab allows more extensive and comprehensive testing of prototype devices.
Future Work
Asymmetric Passive Dynamic Walker

The GEMS design is always evolving. While there have been several prototypes, the design and manufacture of the GEMS is an ongoing process toward finding an optimum design that realistically can be comfortably and safely implemented by gait asymmetry patients for rehabilitation.

A Passive Dynamic Walker (PDW) Model has also implemented to help in the analysis and optimization of the GEMS. A PDW is a passive mechanical device that walks in a human-like manner down an incline by using only the force of gravity. Such virtual modeling is very useful and a crucial step in the design process of a physical GEMS prototype and the prediction of the body dynamics of a person using a GEMS.

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