What the fuck is your stroke hospital going to do with this? NOTHING?
Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?
Activity-based training with the Myosuit: a safety and feasibility study across diverse gait disorders
Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 135 (2020)
Abstract
Background
Physical activity is a recommended part of treatment for numerous neurological and neuromuscular disorders. Yet, many individuals with limited mobility are not able to meet the recommended activity levels. Lightweight, wearable robots like the Myosuit promise to facilitate functional ambulation and thereby physical activity. However, there is limited evidence of the safety and feasibility of training with such devices.
Methods
Twelve participants with diverse motor disorders and the ability to walk for at least 10 m were enrolled in this uncontrolled case series study. The study protocol included five training sessions with a net training time of 45 min each. Primary outcomes were the feasibility of engaging in training with the Myosuit, the occurrence of adverse events, and participant retention. As secondary outcomes, we analyzed the walking speed using the 10-m Walk Test (10MWT) and for three participants, walking endurance using the 2-min Walk Tests.
Results
Eight out of 12 participants completed the entire study protocol. Three participants withdrew from the study or were excluded for reasons unrelated to the study. One participant withdrew because of an unsafe feeling when walking with the Myosuit. No adverse events occurred during the study period for any of the participants and all scheduled trainings were completed. For five out of the eight participants that completed the full study, the walking speed when using the Myosuit was higher than to their baseline walking speed.
Conclusions
Activity-based training with the Myosuit appears to be safe, feasible, and well-tolerated by individuals with diverse motor disorders.
Background
Physical inactivity has been identified as the fourth leading risk factor for global mortality, only surpassed by hypertension, tobacco use, and hyperglycemia. To contain the risks associated with physical inactivity, the World Health Organization recommends that all adults engage in moderate intensity physical activity for at least 150 min each week [1].
Physical activity is also a recommended part of treatment for stroke patients [2], and for patients with incomplete spinal cord injury (SCI) [3], inherited neuropathies such Charcot–Marie–Tooth disease [4], heart failure [5], or chronic obstructive pulmonary disease [6]. These wide-ranging recommendations reflect the consistent association between increased physical activity and improved health-related quality of life (e.g. [7,8,9].).
In spite of the evident health benefits of physical activity, a large proportion of elderly individuals and individuals with limited mobility do not meet the recommended dose of physical activity in their daily lives [10]. In many of these cases, neurological, neuromuscular, or cardiovascular deficits prevent individuals from reaching moderate intensity levels during exercise. In some cases, they prohibit any voluntary exercise altogether.
To address this problem, various technological solutions like full-leg, rigid exoskeletons have been developed to assist overground mobility (e.g. [11,12,13,14].). The safety and feasibility of gait training with mobile exoskeletons has been evaluated in several longitudinal training studies for individuals with spinal cord injury [15,16,17] and hemiparesis following stroke [18, 19]. Rigid exoskeletons largely substitute the ambulatory function of severely affected or completely paralyzed individuals and enable them to walk. Electric motors are used to provide large assistive torques to the users’ leg joints via rigid linkages. This allows exoskeletons to support the majority of the users’ weight and advance the users’ legs without a major voluntary contribution from the leg muscles.
The typically large masses of mobile rigid exoskeletons increase limb inertia and thereby hinder walking at higher speeds. The highest walking speed achieved in previous training studies [15,16,17,18,19] was 0.67 m/s, while most speeds were as low as 0.1 m/s to 0.4 m/s. This is well below the speeds required to support individuals with residual mobility during moderate intensity exercise.
To assist this more capable section of the population, more lightweight wearable robots (also known as “exosuits”, “exomuscles” or “dermoskeletons”) have been proposed [20,21,22,23,24]. Unlike exoskeletons that act on all leg joints, these devices allow for—and require—the active participation of the user, and can (partially) assist walking over a larger range of speeds [20, 25]. Thereby, such wearable robots can provide assistance as needed for functional ambulation [25] while simultaneously modulating the cardiovascular load of their users according to exercise recommendations. For example, a soft robotic exosuit unilaterally acting on one ankle joint was shown to reduce the energy expenditure and interlimb asymmetry of individuals with hemiparesis following a stroke during walking at 0.5 to 1.3 m/s [20]. In previous work from our group, we demonstrated that a soft wearable robot actively supporting hip and knee extension, the Myosuit, enabled an individual with incomplete SCI to walk substantially faster when assisted [25]. More recently, we showed that this functional improvement also translates to an increase in exercise intensity and a momentary reduction of the energetic cost of transport [26]. In larger longitudinal studies, training with wearable robots acting on the hip joint was shown to result in an intrinsic reduction of the cost of transport for elderly individuals [23] and individuals following stroke [24].
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