Collaborative robotic biomechanical interactions and gait adjustments in young, non-impaired individuals

 I guess your doctor is going to have to extrapolate these healthy subject findings to stroke survivors. Is your doctor up to that task? 

Does your hospital even have KineAssist?  8 years to come to some minimum level of competency. If not there, have the board of directors fired. We can't let the dead wood in stroke stay around until it falls over.

• KineAssist (3 posts to October 2012)

 

Collaborative robotic biomechanical interactions and gait adjustments in young, non-impaired individuals

 Valdeci C. Dionisio
1*
and David A. Brown
2

Abstract

Background:
 Collaborative robots are used in rehabilitation and are designed to interact with the client so as to provide the ability to assist walking therapeutically. One such device is the KineAssist which was designed to interact, either in a self-driven mode (SDM) or in an assist mode (AM), with neurologically-impaired individuals while they are walking on a treadmill surface. To understand the level of transparency (i.e., interference with movement due to the mechanical interface) between human and robot, and to estimate and account for changes in the kinetics and kinematics of the gait pattern, we tested the KineAssist under conditions of self-drive and horizontal push assistance. The aims of this study were to compare the joint kinematics, forces and moments during walking at a fixed constant treadmill belt speed and constrained walking cadence, with and without therobotic device (OUT) and to compare the biomechanics of assistive and self-drive modes in the device.
Method:
 Twenty non-neurologically impaired adults participated in this study. We evaluated biomechanical parameters of walking at a fixed constant treadmill belt speed (1.0 m/s), with and without the robotic device in assistive mode. We also tested the self-drive condition, which enables the user to drive the speed and direction of a treadmill belt. Hip, knee and ankle angular displacements, ground reaction forces, hip, knee and ankle moments,and center of mass displacement were compared “in” vs “out” of the device. A repeated measures ANOVA test was applied with the three level factor of condition (OUT, AM, and SDM), and each participant was used as its own comparison.
Results:
 When comparing “in” and “out” of the device, we did not observe any interruptions and/or reversals of direction of the basic gait pattern trajectory, but there was increased ankle and hip angular excursions, verticalground reaction force and hip moments and reduced center of mass displacement during the “in device” condition. Comparing assistive vs self-drive mode in device, participants had greater flexed posture and accentuated hip moments and propulsive force, but reduced braking force.
Conclusions:
 Although the magnitudes and/or range of certain gait pattern components were altered by the device, we did not observe any interruption from the mechanical interface upon the advancement of the trajectories nor reversals in direction of movement which suggests that the KineAssist permits relative transparency(i.e.. lack of interference of movement by the device mechanism) to the individual’s gait pattern. However, there are interactive forces to take into account, which appear to be overcome by kinematic and kinetic adjustments.

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

Now you need to create a protocol out of this and deliver it to all 10 million yearly stroke survivors. Otherwise this will never get into common use. 

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

 Abstract

Background:
 Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”).
Methods:
 Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then,they were exposed to walking at increased speeds, on a treadmill and while in
 “push mode”
 in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance.We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length.
Results:
 Maximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground.Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence.
Conclusions:
 With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.

KineAssist: A Robotic Overground Gait and Balance Training Device

Did your stroke hospital do anything to follow the earlier research on this from October 2012? Or do they incompetently not even have an employee assigned to follow and  implement research into rehab protocols? You can blame the board of directors for not setting correct goals and objectives for the hospital.

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

The latest here:

KineAssist: A Robotic Overground Gait and Balance Training Device

 Michael Peshkin, David A. Brown, Julio J. Santos-Munné, Alex Makhlin,Ela Lewis, J. Edward Colgate, James Patton, Doug Schwandt  — Chicago PT LLC, Evanston IL

  Abstract

 — The KineAssist is a robotic device for gait and balance training. A user-needs analysis led us to focus on increasing the level of challenge to a patient's ability to maintain balance during gait training, and also on maintaining direct involvement of a physical therapist (rather than attempting robotic replacement.) The KineAssist provides partial body weight support and postural torques on the torso; allows many axes of motion of the trunk as well as of the pelvis; leaves the patient's legs accessible to a physical therapist during walking; servo-follows a patient's walking motions overground in forward, rotation, and sidestepping directions; and catches a patient who begins to fall. Design and development of the KineAssist proceeded more rapidly in the context of a small company than would have been possible in most research contexts. A prototype KineAssist has been constructed, and has received FDA approval and IRB clearance for initial human studies. We describe the KineAssist's motivation, design, and use.

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

See if your therapist can use this in your recovery. 
http://www.jneuroengrehab.com/content/9/1/80/abstract

Abstract (provisional)

Background

Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. "push mode").

Methods

Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then, they were exposed to walking at increased speeds, on a treadmill and while in "push mode" in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance. We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length.

Results

Maximum walking speed in the "push mode" was 13% higher than the maximum walking speed on the treadmill and both were higher ("push mode": 61%; treadmill: 40%) than the maximum walking speed overground. Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence.

Conclusions

With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.