The pictures show a Balance Master for testing your balance.
I was tested in one of these 4 weeks post-stroke. The force plates I was standing on could move side to side, front to back and tilt in various directions, all the while the three sides; front of you and each side were moving around. You were strapped into a harness to catch you when you fall. After it was all done my PT ran my scores thru the universe of results and at that time my age of 50 results were better than the average 50 year old male. I just told him I would really have enjoyed that testing challenge when I was healthy. It's like kneeling on a yoga ball for balance practice. This was all absolutely necessary for keeping upright in a squirrely whitewater canoe. My favorite was a Mad River Outrage. Ok, feeling sorry for myself again.
But is it better than this other spring loaded one? Your doctor has some comparisons to do.
This was known about 5 years ago,did your doctor bring one in to help stroke patients recover? OR IS THAT NOT HIS/HER JOB?
Spring-based wearable device could help those with certain neurological conditions walk again December 2015
Or maybe this Levitation brace from December 2015 also.
World’s first ‘bionic knee brace’ returns energy to your joints to boost leg strength
The latest here, why was this research done?
The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 42 (2021)
Abstract
Background
Compared with traditional physical therapy for stroke patients, lower extremity exoskeletons can provide patients with greater endurance and more repeatable and controllable training, which can reduce the therapeutic burden of the therapist. However, most exoskeletons are expensive, heavy or require active power to be operated. Therefore, a lighter, easy to wear, easy to operate, low-cost technology for stroke rehabilitation would be a welcome opportunity for stroke survivors, caregivers and clinicians. One such device is the Kickstart Walk Assist system and the purpose of this study was to determine feasibility of using this unpowered exoskeleton device in a sample of stroke survivors.
Methods
Thirty stroke survivors were enrolled in the study and experienced walking with the Kickstart exoskeleton device that provided spring-loaded assistance during gait. After 5 days of wearing the exoskeleton, participants were evaluated in the two states of wearing and not wearing the exoskeleton. Outcome measures included: (a) spatio-temporal gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire.
Results
In comparison to not wearing the device, when participants wore the Kickstart walking system, weight bearing asymmetry was reduced. The time spent on the 10-m walk test was also reduced, but there was no difference in the timed-up-and-go test (TUGT). Gait analysis data showed reduction in step time and double support time. Stroke survivors were positive about the Kickstart walking system’s ability to improve their balance, speed and gait. In addition, their confidence level and willingness to use the device was also positive.
Conclusions
These findings show the feasibility of using the Kickstart walking system for improving walking performance in stroke survivors. Our future goal is to perform a longer duration study with more comprehensive pre- and post-testing in a larger sample of stroke survivors.
Trial registration Chinese Clinical Trial Registry, ChiCTR2000032665. Registered 5 May 2020—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=53288
Background
Nearly one-third of strokes occur in people over the age of 65, and most stroke survivors have associated ambulation problems [1, 2]. In this population, the reduction in muscle mass and muscle strength frequently reduces their daily activities, confines them to bed, and reduces the ability to move, thus accelerating the degradation of the neuromuscular system. Stroke can lead to major impairments related to functional mobility [3,4,5] that consequently impacts independence and reduces the quality of life. Conventional gait therapy for stroke survivors, that is provided by therapists, can improve gait speed and endurance [6], especially when performed in the sub-acute stage [7]. However, it is demanding and exhausting for therapists and outcomes depend on the skill of the therapist which may vary a lot depending on experience and expertise. Devices that reduce this burden like the body weight support system or robot-assisted gait training devices like the Lokomat have other issues such as being too expensive and bulky, and may require superior technical skills to operate and therefore may not suitable for wide usage [8]. Therefore, in recent years, light and easy-to-operate exoskeletons have become popular which can help stroke survivors who are unable to stand independently to regain their ability to stand and walk [9].
Exoskeletons have been in development since at least the 1890′s [10]. In the past several decades, many universities, research institutions and companies have made great progress in developing exoskeleton-assisted rehabilitation devices [11, 12]. Based on power source types, exoskeletons can be categorized as active (powered by the external sources) or passive (self-powered through elastic components) [13,14,15]. Currently, several lower extremity exoskeletons are in the market that can assist with gait training in stroke survivors, including treadmill-based Lokomat [16], LokoHelp [17] and ReoAmbulator [18], and wearable systems such as Ekso GT [19], HAL-5 [20] and ReWalk [21]. They are mainly used for elderly people or patients who have lost walking ability due to stroke or spinal cord injury, so that they can walk, sit up, and climb stairs, thus reducing the burden on the caregiver and improving the quality of life of the patients [22].
Exoskeletal devices target characteristic deficiencies observed after a stroke—insufficient forward propulsion, reduced range of motion, hyper-reflexia which lead to compensatory strategies such as hip hiking, circumductory gait and elevated metabolic cost [23,24,25,26,27]. Compared with traditional physical therapy, lower extremity exoskeletons can provide patients with more repeatable and controllable training, which can reduce the treatment burden of the therapist, so that the therapist can pay attention to other aspects of the patient’s treatment [28].
Based on a Cochrane review of electromechanical and robotic-assisted training for walking after stroke [29], an analysis of 36 different research studies that involved over 1400 participants, it was shown that the use of such devices in combination with physical therapy can improve walking after stroke. These devices were shown to be safe and acceptable to most participants. It was noted that the improvement was greatest for those who were not ambulatory. Additionally, best results were obtained for treatment in the acute/sub-acute phase within 3 months of the stroke episode. It is important to note that a reason for the Cochrane review of this field was to determine the justification for large equipment and human resource costs that are needed to implement electromechanical-assisted gait devices.
Although in the past 20 years, research and development of robotic exoskeletons has grown rapidly, and many robotic-assisted systems have been successfully used in scientific research and clinical applications, the adoption rate remains very low. According to a survey of 1326 rehabilitation therapists in the US, about 2% of them used some robot-assisted devices for upper and lower movement rehabilitation [30]. Primary barriers to adoption include the lack of scientific evidence of effectiveness, high economic costs and low user-friendliness, which greatly limit clinical usage of robotic exoskeletons [31, 32]. While active devices, like Lokomat, provide several functional benefits to a variety of patient populations, these are only available to well-funded clinical facilities and research settings. Moreover, it is unrealistic for patients to use an active device by themselves because of its size, weight, cost, and complexity of use. Therefore, there is a significant need for lighter-weight, easy to wear, user-friendly, and low-cost technologies for walking training in stroke survivors.
The Kickstart® Walk Assist system is such a rehabilitation device that consists of a belt, an external support structure and an Exotendon (Fig. 1). The effect of the Exotendon is similar to an artificial tendon, which stores energy during the stance phase and releases it during the swing phase of the gait cycle. The Exotendon mechanism is inspired by the anatomical features of the hind limbs of the horse: in the hind limbs of the horse, several long tendons span multiple joints, and during the stance phase, the tendons stretch and store energy, and this stored energy is then used to initiate gait swing and consequently, reduce muscle exertion [33, 34]. Compared to other robotic lower extremity exoskeleton systems, the Kickstart walking system is lighter in weight, easier to wear and take off, and is inexpensive. In a series of case studies (2 stroke survivors and one spinal cord injury patient), it was shown that the Kickstart walking system could increase wearers' walking speed and endurance [35]. Unlike more tightly controlled exoskeletal systems like the Lokomat, the lightweight, spring-loaded Kickstart walking system could allow easier interaction with the environment that would be more explorative.
The figure shows the setup for the weight bearing squat test in the a upright position and b The squatting position with the exoskeleton device attached unilaterally. c Shows a non-study participant walking with exoskeletal assistance on a set of force platforms in the gait lab that has motion capture cameras on the walls. d Shows the dial sticker that was attached to the hip piece to note the movement of the ratchet for tightening the exotendon cable
The purpose of this study was to determine the feasibility of using the Kickstart walking system in a sample of stroke survivors who were in the subacute and chronic stages of the disease and attending an inpatient rehabilitation center. Study participants were tested for several measures with/without the device after experiencing walking with the exoskeleton over a period of 5 days. Outcome measures included: (a) gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire. Results from this study will help us to explore if the technology can offer a new option for encouraging the recovery of walking ability of stroke patients, optimizing the rehabilitation treatment strategy, and providing some reference for subsequent related research.
No comments:
Post a Comment