A mechanized gait trainer for restoring gait in nonambulatory subjects

OBJECTIVE: To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. PATIENTS: Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. INTERVENTION: Four weeks of training, five times a week, each session 20 minutes long. MAIN OUTCOME MEASURES: Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. RESULTS: Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. CONCLUSION: The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.     

应用自控机动步态训练机提高脑卒中偏瘫患者行走能力

脑卒中患者的步态康复治疗是神经康复的关键,减重支持的踏车训练可以重复进行复杂步态的练习,有效地恢复急慢性截瘫患者的走路能力。踏车运动最大的不便是训练时需要两个治疗师在旁协助。一个治疗师坐在瘫侧帮助促进瘫侧下肢摆动,确定足跟先着地,防止膝过伸,保证两腿站立时间与步长对称;另一治疗师站在两人身后,促进重心转移至负重腿上,保证躯干直立。因此设计了两种机动步态训练机,这种机器模拟上肢康复训练可以在不需要治疗师过多协助,患者可以自主进行类似步态训练的重复训练机,对此做一介绍。     

Robotic gait trainer in water: Development of an underwater gait-training orthosis

Purpose.?To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method.?The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results.?The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion.?Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

Robotic gait trainer in water: development of an underwater gait-training orthosis

Purpose. To develop a robotic gait trainer that can be used in water (RGTW) and achieve repetitive physiological gait patterns to improve the movement dysfunctions.

Method. The RGTW is a hip-knee-ankle-foot orthosis with pneumatic actuators; the control software was developed on the basis of the angular motions of the hip and knee joint of a healthy subject as he walked in water. Three-dimensional motions and electromyographic (EMG) activities were recorded in nine healthy subjects to evaluate the efficacy of using the RGTW while walking on a treadmill in water.

Results. The device could preserve the angular displacement patterns of the hip and knee and foot trajectories under all experimental conditions. The tibialis anterior EMG activities in the late swing phase and the biceps femoris throughout the stance phase were reduced whose joint torques were assisted by the RGTW while walking on a treadmill in water.

Conclusion. Using the RGTW could expect not only the effect of the hydrotherapy but also the standard treadmill gait training, in particular, and may be particularly effective for treating individuals with hip joint movement dysfunction.     

Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke

[Purpose] The purpose of this study was to confirm the effects of both conventional overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS) on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke. [Subjects and Methods] Thirty stroke patients were alternately assigned to one of two treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional ambulation classification on the affected side improved significantly in the CGT and GTBWS groups. Walking speed also improved significantly in both groups. [Conclusion] These results suggest that the GTBWS in company with CGT may be, in part, an effective method of gait training for restoring gait ability in patients after a stroke.Key words: Gait training, Spatiotemporal gait parameters, Stroke patients     

Evaluation of the effectiveness of a novel gait trainer in increasing the functionality of individuals with motor impairment: A case series

Regaining the ability to independently ambulate following a physical disability can increase functional ability and participation of patients in daily life. Gait trainers are assistive devices that enable body support and provide safety during gait. However, most conventional gait trainers are pre-configured to a constant position, therefore not suitable for practicing sit-to-stand function, and require assistance from a caregiver in order to mount the device from a sitting position. We therefore evaluated the effectiveness of a dynamically-adjusting gait trainer, designed to provide independence and safety during gait and various activities, in both lab setting and at home in four subjects (one female, three males, ages 32–79 years) with limited ambulation. Spatiotemporal parameters and gait symmetry were recorded, as well as activity levels, actual use of device, and satisfaction. Although gait parameters and physical activity levels were not notably improved, and in one case were worsened, three subjects reported positive experience with the gait trainer. The new gait trainer may have advantages in supporting users with limited mobility during walking and various functions and decrease the risk for falls. A longer practice time and individual fitting process are recommended for better accommodation to the new possibilities.     

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation

BACKGROUND AND PURPOSE: This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke. CASE DESCRIPTION: Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation. OUTCOMES: By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures. DISCUSSION: This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.     

Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: a randomized controlled trial

OBJECTIVE: To compare the therapeutic effects of conventional gait training (CGT), gait training using an electromechanical gait trainer (EGT), and gait training using an electromechanical gait trainer with functional electric stimulation (EGT-FES) in people with subacute stroke. DESIGN: Nonblinded randomized controlled trial. SETTING: Rehabilitation hospital for adults. PARTICIPANTS: Fifty patients were recruited within 6 weeks after stroke onset; 46 of these completed the 4-week training period. INTERVENTION: Participants were randomly assigned to 1 of 3 gait intervention groups: CGT, EGT, or EGT-FES. The experimental intervention was a 20-minute session per day, 5 days a week (weekdays) for 4 weeks. In addition, all participants received their 40-minute sessions of regular physical therapy every weekday as part of their treatment by the hospital. MAIN OUTCOME MEASURES: Five-meter walking speed test, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), Motricity Index leg subscale, FIM instrument score, and Barthel Index. RESULTS: The EGT and EGT-FES groups had statistically significantly more improvement than the CGT group in the 5-m walking speed test (CGT vs EGT, P=.011; CGT vs EGT-FES, P=.001), Motricity Index (CGT vs EGT-FES, P=.011), EMS (CGT vs EGT, P=.006; CGT vs EGT-FES, P=.009), and FAC (CGT vs EGT, P=.005; CGT vs EGT-FES, P=.002) after the 4 weeks of training. No statistically significant differences were found between the EGT and EGT-FES groups in all outcome measures. CONCLUSIONS: In this sample with subacute stroke, participants who trained on the electromechanical gait trainer with body-weight support, with or without FES, had a faster gait, better mobility, and improvement in functional ambulation than participants who underwent conventional gait training. Future studies with assessor blinding and larger sample sizes are warranted.     

结构性速度依赖性平板训练对脑卒中偏瘫患者步行功能的影响

目的比较结构性速度依赖性平板训练、减重平板步行训练和常规步行训练对脑卒中偏瘫患者步行功能的影响.方法将恢复步行能力的脑卒中偏瘫患者45例随机分为结构性速度依赖性组(15例)、减重组(15例)和常规组(15例).在治疗开始和治疗结束时对3组患者进行步行功能性分级和最大步行速度评定.结果经过4周治疗后,3组患者步行功能较治疗前均明显改善(P＜0.001),但结构性速度依赖性训练组较减重步行训练组和常规步行训练组的步行功能的改善更为明显(P＜0.001).结论对于恢复脑卒中偏瘫患者的步行能力,结构性速度依赖性训练较减重步行训练和常规步行训练更为有效.     

步行矫形器在截瘫患者步行能力恢复中的作用

目的通过观察4例完全性截瘫患者配戴步行矫形器(Walkabout)行走功能恢复情况,探讨Walkabout在截瘫患者恢复中的应用价值。方法选择4例典型T10～L1节段完全性脊髓损伤患者,经过转移平衡训练后,装配步行矫形器,再进行步行训练。结果病例1～4佩戴Walkabout及进行功能训练后分别达到:用双肘拐5min步行20m,用助步器233s行走20m,达到功能性步行;用助步器148s行走20m,达到功能性步行;用助步器步行20m,耗时250s;用双走拐步行20m,耗时176s。4例完全性损伤患者均达到功能性步行。结论步行矫形器能帮助T10以下完全性截瘫患者完成功能性步行。     

A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery

Purpose

Smaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors.

Methods

Face and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario.

Results

The trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill.

Conclusion

The developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.

     

Head position trainer application for research and clinical use

The head position trainer (HPT) is a frequently used biofeedback device for improving the head control of cerebral palsied children. When the HPT is used as a training or evaluative device, questions may arise regarding the consistency and accuracy of positioning it on the head and the position of the trainee's head. This article describes a technique for positioning and orienting the head and the HPT to one another and to common axes. With the subject in a supine position on a specially designed platform, the long axes of the zygomatic arch and the control box of the HPT were oriented vertically. The headband of the HPT then was tightened about the midforehead and the occipital areas. Reference marks were made on the forehead and the HPT was removed. After the subject assumed the sitting position, the HPT was reapplied using the forehead reference marks and the occipital areas as guides. Test-retest procedures were conducted using different therapists to apply the HPT to healthy and to handicapped subjects. The criterion score was the degrees difference between the long axes of the HPT control box and the zygomatic arch, an angle that would be 0 degree if the two long axes were parallel. No significant differences were observed between Trials 1 and 2, and the correlation coefficient between the two trials was statistically significant (p less than .02) in all situations. The HPT referencing platform can be constructed at minimal expense, and the technique of HPT application is relatively quick and reliable, and it produces minimal stress in handicapped subjects.     

An innovative trainer for surgical procedures using animal organs

Since 1990, almost 3000 surgeons have absolved the training course for minimally invasive surgery in our training center. A phantom trainer using animal organs has been used as a training device. Based on this experience, we have developed an innovative trainer for surgical procedures using animal organs. The form of this trainer was copied from a human body with gas insufflation; abdominal organs from the slaughterhouse can be integrated into this trainer. Surgeons can repeat operations such as laparoscopic cholecystectomy, appendectomy, fundoplication, colon resection and transanal endoscopic microsurgery in a realistic way and acquire a training effect in a short time.     

A robotic wheelchair trainer: design overview and a feasibility study

Background  

Experiencing independent mobility is important for children with a severe movement disability, but learning to drive a powered wheelchair can be labor intensive, requiring hand-over-hand assistance from a skilled therapist.     

An innovative trainer for surgical procedures using animal organs.

Since 1990, almost 3000 surgeons have absolved the training course for minimally invasive surgery in our training center. A phantom trainer using animal organs has been used as a training device. Based on this experience, we have developed an innovative trainer for surgical procedures using animal organs. The form of this trainer was copied from a human body with gas insufflation; abdominal organs from the slaughterhouse can be integrated into this trainer. Surgeons can repeat operations such as laparoscopic cholecystectomy, appendectomy, fundoplication, colon resection and transanal endoscopic microsurgery in a realistic way and acquire a training effect in a short time.     

膝关节康复训练器的研制及应用

目的 研制膝关节康复训练器并评价其应用效果。方法 研制膝关节康复训练器。选取2018年1月—10月70例接受膝关节置换术治疗的患者分为试验组和对照组,每组各35例,试验组采用自制膝关节康复训练器进行功能锻炼,对照组采用常规功能锻炼方法进行锻炼。使用膝关节功能量表分别于术后拔除引流管当天、首次下地和出院时对两组膝关节功能进行评估,比较首次下地时两组的行走距离。结果 两组膝关节功能量表评分在术后拔除引流管当天、首次下地和出院时3个时间点比较,差异均具有统计学意义（P<0.05）;其中疼痛程度、活动度在3个时间点比较,试验组均优于对照组（P<0.05）。两组首次下地时行走距离比较,试验组30（30,40） m,对照组10（10,15） m,差异具有统计学意义（P<0.05）。结论 膝关节康复训练器可改善膝关节置换术后患者的膝关节功能、增加首次下地行走距离,提升患者功能锻炼的效果。