Exoskeletons for Personal Use After Spinal Cord Injury

Before the development of robotic exoskeletons, mobility options beyond a wheelchair were very limited for most people lacking leg movement due to spinal cord injury (SCI). Over the years, robotic exoskeletons have become more widely available and now have the potential to be successfully used for personal use at home and in the community. However, it is important that users set realistic expectations. The features and capabilities of each robotic exoskeleton differ, and how exoskeletons are used may vary greatly between individuals. Robotic exoskeletons can allow individuals with SCI with varying levels of injury to safely and functionally walk for personal mobility or exercise. The following special communication will discuss important considerations surrounding exoskeleton use including feasibility, safety, cost, speed, and potential health benefits of using an exoskeleton for everyday life for people with SCI.     

长下肢矫形器在偏瘫康复中的应用

目的探讨穿戴长下肢矫形器对重度偏瘫患者下肢功能康复的特点。方法38例下肢严重瘫痪,康复治疗效果不佳的偏瘫患者,分为应用长下肢矫形器加康复训练(矫形器组)和单纯康复训练(对照组)两组。训练前和训练后1个月,分别采用Fugl-Meyer下肢运动功能评定量表、Berg平衡量表、Holden步行功能量表、改良的Barthel指数对患者的运动、平衡、行走和日常生活能力进行评价。结果1个月后,两组间除Fugl-Meyer下肢运动功能评定量表分无显著性差异(P>0.05)外,Berg平衡量表、Holden步行功能量表、改良的Barthel指数分均有显著性差异(P<0.01),矫形器组明明显优于对照组。结论对适宜应用长下肢矫形器的偏瘫患者,应该积极佩戴矫形器。     

不同时期应用足踝矫形器对脑卒中后异常步态的影响

目的:探讨采取不同时期应用足踝矫形器对脑卒中后异常步态的影响。方法:123例脑卒中患者随机分为两组,两组除均给予常规康复治疗外,治瘪组开展早期(即BrunnstromI、II期)佩戴足踝矫形器,对照组于BrunnstromlII期佩戴。结果:治疗组下肢功能恢复Fugl-Meyer评分优于对照组,差异具有统计学意义(P<0.05):两组治疗前后步行能力差异具有统计学意义(P<0.05),治疗组优于对照组:且治疗组患者步行速度优于对照组(P<0.05)。结论:选择BrunnstromI、II期佩戴足踝矫形器的治疗方法能明显提高下肢功能的恢复:疗效确切。     

Hip orthosis powered by pneumatic artificial muscle: voluntary activation in absence of myoelectrical signal

Abstract:  Powered orthosis is a special class of gait assist device that employs a mechanical or electromechanical actuator to enhance movement of hip, knee, or ankle articulations. Pneumatic artificial muscle (PAM) has been suggested as a pneumatic actuator because its performance is similar to biological muscle. The electromyography (EMG) signal interpretation is the most popular and simplest method to establish the patient voluntary control of the orthosis. However, this technique is not suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. For those cases, an alternative control strategy should be provided. The aim of the present study is to develop a gait assistance orthosis for lower limb powered by PAMs controlled by a voluntary activation method based on the angular behavior of hip joint. In the present study, an orthosis that has been molded in a patient was employed and, by taking her anthropometric parameters and movement constraints, the adaptation of the existing orthosis to the powered orthosis was planned. A control system was devised allowing voluntary control of a powered orthosis suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. A pilot clinical study was reported where a patient, victim of poliovirus, successfully tested a hip orthosis especially modified for the gait test evaluation in the parallel bar system. The hip orthosis design and the control circuitry parameters were able to be set to provide satisfactory and comfortable use of the orthosis during the gait cycle.     

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.     

寰枢椎结核的定性诊断和治疗选择

目的探讨寰枢椎结核定性诊断的方法和治疗方案的选择。方法1994年1月至2004年12月共收治寰枢椎结核患者22例,均获得组织学诊断。其中3例经口腔穿刺活检,17例行CT监测下经皮穿刺活检,2例采用术中冰冻切片获得病理诊断。手术治疗13例：其中在Halo-vest架固定下行前路经口腔病灶清除植骨1例,颈前路病灶清除植骨融合7例;前路病灶清除植骨融合加钛板内固定1例,后路寰枢椎间单纯植骨融合2例,颈后路枕枢钛板内固定加植骨融合术2例。保守治疗9例：8例行Halo-vest架固定,1例行枕颌牵引。所有病例均辅以抗痨治疗12～18个月。结果22例患者均获得随诊,随访18个月～7年,平均37个月。有脊髓压迫症状者完全恢复,X线片见植骨融合,CT片见病灶修复并有骨愈合,治疗效果满意。结论对于寰枢椎结核,穿刺活检能获得定性诊断。有无寒性脓肿、病理骨折、寰枢椎脱位及脊髓压迫是选择治疗方法的依据。     

脑卒中患者静态踝足矫形器选择效果的临床回顾性分析

目的：回顾性分析临床病历资料以了解静态踝足矫形器在脑卒中患者中的应用情况．为踝足矫形器的合理应用提供依据。方法：对2002年1月-2004年12月脑卒中住院患者的病历资料进行回顾性分析．将病程1—3个月的脑卒中患者按是否使用静踝足矫形器（AFO）分为观察组（穿戴AFO，41例）和对照组（未穿戴AFO，118例）。结果：①两组患者入院时的一般资料无明显差异，出院时两组患者下肢Brunnstrom分级均较入院时升高．但两组间无显著差异，出院时两组Barthel指数均较入院时明显提高，但观察组较对照组增加更显著（P〈0．05）：②观察组出院时独立步行患者的比例（65．8％）显著高于对照组（43．2％），不能步行的比例由入院时的56．2％降低到出院时的4．9％。而对照组出院时不能步行的比例仍高达22．1％，显著高于观察组。出院时10m一坐一站一走时间测定．观察组所需时间明显低于对照组（P〈0．05）。观察组下肢Brunnstrom3级以上者均可恢复不同程度的步行能力．而对照组下肢Brunnstrom3级以上者不能步行的比例达17．8％；③观察组住院天数明显短于对照组，医疗费用也低于对照组。结论：静态踝足矫形器早期应用有助于提高步行能力和日常生活能力。同时缩短康复时程和住院周期．降低医疗费用。     

Use of the ICF to investigate impairment,activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

Purpose: This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use. Method: Adults (n?=?157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS). Results: 41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p?=?0.005), higher physical functioning (p?=?0.005), lower role-limitations due to emotional problems (p?=?0.001) and lower levels of anxiety (p?=?0.003) compared to people not using AFOs as recommended. Conclusion: Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients’ psychological well-being to gain a better understanding of AFO use.

• Implications for Rehabilitation

• Participants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended.

• In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs.

• Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management.

     

矫形支具配合矫正体操对特发性脊柱侧弯的作用

目的:探讨脊柱矫形器配合矫正体操治疗特发性脊柱侧弯患者的疗效。方法:40例特发性脊柱侧弯患儿。均每天穿戴矫形支具时间23h并配合脊柱矫正体操练习,要求达到凸侧肌肉收缩,凹侧肌肉牵伸,每次30min,每天1-2次。穿戴期间定期X线片检查脊柱Cobb角。结果:1年后随访,40例患儿中33例能坚持穿戴矫形支具和进行矫正体操练习;胸椎、腰椎Cobb角与治疗前比较均降低(P<0.05)。单弧侧弯治疗的效果比双弧更明显(P<0.05)。结论:矫形支具配合矫正体操治疗能矫正脊柱侧弯畸形,是治疗特发性脊柱侧弯的一种有价值的方法。