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Analysis of the Gait Characteristics and Usability after Wearable Exoskeleton Robot Gait Training in Incomplete Spinal Cord Injury Patients with Industrial Accidents: A Preliminary Study

  • Bae, Young-Hyeon (Rehabilitation Research Institute, National Rehabilitation Center) ;
  • Kim, Sung-Shin (Rehabilitation Research Institute, National Rehabilitation Center) ;
  • Lee, Anna (Rehabilitation Research Institute, National Rehabilitation Center) ;
  • Fong, Shirley S.M. (School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong)
  • 투고 : 2022.04.04
  • 심사 : 2022.06.28
  • 발행 : 2022.06.30

초록

Objective: The aim of this study was to investigate of the foot plantar pressure and usability after gait training using the ExoAtlet wearable exoskeleton robot in an incomplete spinal cord injury (SCI) patient. Design: A case study Methods: Six participants with an asymmetry in motor and sensory function completed the gait training using ExoAtlet wearable exoskeleton robot for 15 sessions, five per weeks, 3weeks. They were divided into two groups (low and high strength group) and group differences were evaluated about session at stating of gait, gait distance at final session and foot plantar pressures and useability after training. Results: Low strength group was faster than high strength group on adaptation of robot gait. And high strength group increased faster than low strength group on the gait distance during training. In standing and gait, weaker leg was higher than stronger leg on mean foot plantar pressure in low strength group. And stronger leg was higher than weaker leg on foot plantar pressure in high strength group. The length of the anterior-posterior trajectory of the center of pressure during gait was similar in low strength group, but different in high strength group. useability was positive about ExoAtlet wearable exoskeleton gait after training. Conclusions: ExoAtlet wearable exoskeleton robot gait training was positive about improving gait in all participants regardless of differences in severity of symptoms and gait abnormalities.

키워드

과제정보

This study was supported by the Research Program (NRCTR-IN22006) of the Korea National Rehabilitation Center, Ministry of Health and Welfare, Korea.

참고문헌

  1. Jayaraman, A., Gregory, C. M., Bowden, M., Stevens, J. E., Shah, P., Behrman, A. L., & Vandenborne, K. (2006). Lower extremity skeletal muscle function in persons with incomplete spinal cord injury. Spinal cord, 44(11), 680-687. https://doi.org/10.1038/sj.sc.3101892
  2. Kumprou, M., Amatachaya, P., Sooknuan, T., Thaweewannakij, T., & Amatachaya, S. (2018). Is walking symmetry important for ambulatory patients with spinal cord injury?. Disability and Rehabilitation, 40(7), 836-841. https://doi.org/10.1080/09638288.2016.1277398
  3. Kumprou, M., Amatachaya, P., Sooknuan, T., Thaweewannakij, T., Mato, L., & Amatachaya, S. (2017). Do ambulatory patients with spinal cord injury walk symmetrically?. Spinal Cord, 55(2), 204-207. https://doi.org/10.1038/sc.2016.149
  4. Perez-Sanpablo, A. I., Quinzanos-Fresnedo, J., Loera-Cruz, R., Quinones-Uriostegui, I., Rodriguez-Reyes, G., & Perez-Zavala, R. (2017). Validation of the instrumented evaluation of spatio-temporal gait parameters in patients with motor incomplete spinal cord injury. Spinal cord, 55(7), 699-704. https://doi.org/10.1038/sc.2017.4
  5. Yang JK, Ahn NE, Kim DH, Kim DY. Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients. Ann Rehabil Med2014;38:145-52. https://doi.org/10.5535/arm.2014.38.2.145
  6. Swinnen E, Duerinck S, Baeyens JP, Meeusen R, Kerckhofs E. Effectiveness of robot-assisted gait training in persons with spinal cord injury: a systematic review. J Rehabil Med2010;42:520-6. https://doi.org/10.2340/16501977-0538
  7. Schuck A, Labruyere R, Vallery H, Riener R, Duschau-Wicke A. Feasibility and effects of patient-cooperative robot-aided gait training applied in a 4-week pilot trial. J Neuroeng Rehabil 2012;9(1):1-14. https://doi.org/10.1186/1743-0003-9-1
  8. Lennon, O., Tonellato, M., Del Felice, A., Di Marco, R., Fingleton, C., Korik, A., ... & Coyle, D. (2020). A systematic review establishing the current state-of-the-art, the limitations, and the DESIRED checklist in studies of direct neural interfacing with robotic gait devices in stroke rehabilitation. Frontiers in Neuroscience, 14, 578. https://doi.org/10.3389/fnins.2020.00578
  9. Schwartz I, Meiner Z. Robotic-assisted gait training in neurological patients: who may benefit? Ann Biome Eng2015;43:1260-9. https://doi.org/10.1007/s10439-015-1283-x
  10. Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices (Auckl) 2016;9:455-66.
  11. Louie DR, Eng JJ, Lam T. Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study. J Neuroeng Rehabil2015;12:1-10. https://doi.org/10.1186/1743-0003-12-1
  12. He Y, Eguren D, Luu TP. Contreras-Vidal, J.L. Risk management and regulations for lower limb medical exoskeletons: a review. Med Devices (Auckl) 2017;10:89-107. https://doi.org/10.2147/MDER.S107134
  13. van Dijsseldonk RB, Rijken H, van Nes IJW, van de Meent H, Keijsers, NLW. A Framework for Measuring the Progress in Exoskeleton Skills in People with Complete Spinal Cord Injury.Front Neurosci 2017;11:699. https://doi.org/10.3389/fnins.2017.00699
  14. Jansen O, Schildhauer TA, Meindl RC, Tegenthoff M, Schwenkreis P, Sczesny-Kaiser M, Grasmucke D, Fisahn C, Aach M. Functional Outcome of Neurologic-Controlled HAL-Exoskeletal Neurorehabilitation in Chronic Spinal Cord Injury: A Pilot With One Year Treatment and Variable Treatment Frequency. Global Spine J 2017;7:735-43. https://doi.org/10.1177/2192568217713754
  15. Chisholm AE, Alamro RA, Williams AM, Lam T. Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report. J Neuroeng Rehabil 2017;14:27. https://doi.org/10.1186/s12984-017-0236-z
  16. Lonini L, Shawen N, Scanlan K, Rymer WZ, Kording KP, Jayaraman A. Accelerometry-enabled measurement of walking performance with a robotic exoskeleton: a pilot study. J Neuroeng Rehabil 2016;13:1-10. https://doi.org/10.1186/s12984-015-0109-2
  17. Yang A, Asselin P, Knezevic S, Kornfeld S, Spungen AM. Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015;21:100-9. https://doi.org/10.1310/sci2102-100
  18. Lajeunesse V, Vincent C, Routhier F, Careau E, Michaud F. Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury. Disabil Rehabil Assist Technol 2016;11:535-47. https://doi.org/10.3109/17483107.2015.1080766
  19. Asselin P, Knezevic S, Kornfeld S, Cirnigliaro C, Agranova-Breyter I, Bauman WA, Spungen AM. Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. J Rehabil Res Dev 2015;52:147-58. https://doi.org/10.1682/JRRD.2014.02.0060
  20. Esquenazi A, Talaty M, Packel A, Saulino M. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil 2012;91:911-21. https://doi.org/10.1097/PHM.0b013e318269d9a3
  21. Fineberg DB, Asselin P, Harel NY, Agranova-Breyter I, Kornfeld SD, Bauman WA, Spungen AM. Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia. J Spinal Cord Med 2013; 36:313-21. https://doi.org/10.1179/2045772313Y.0000000126
  22. Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi A. Safety and tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study. J Spinal Cord Med 2012;35:96-101. https://doi.org/10.1179/2045772312y.0000000003
  23. Herbison, G. J., Isaac, Z., Cohen, M. E., & Ditunno, J. F. (1996). Strength post-spinal cord injury: myometer vs manual muscle test. Spinal cord, 34(9), 543-548. https://doi.org/10.1038/sc.1996.98
  24. Marino, R. J., Jones, L., Kirshblum, S., Tal, J., & Dasgupta, A. (2008). Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injury. The journal of spinal cord medicine, 31(2), 166-170. https://doi.org/10.1080/10790268.2008.11760707
  25. Pais-Vieira, C., Allahdad, M., Neves-Amado, J., Perrotta, A., Morya, E., Moioli, R., ... & Pais-Vieira, M. (2020). Method for positioning and rehabilitation training with the ExoAtlet? powered exoskeleton. MethodsX, 7, 100849. https://doi.org/10.1016/j.mex.2020.100849
  26. Kotov SV, Lijdvoy VY, Sekirin AB, Petrushanskaya KA, Pismennaya EV. The efficacy of the exoskeleton ExoAtlet to restore walking in patients with multiple sclerosis. Zh Nevrol Psikhiatr im SS Korsakova 2017;117:41-7.
  27. Jung DY. The Effect of Protective Socks Combined with Functional Insole on Plantar Foot Pressure in Healthy Adults: A Pilot Study. korean soc phys med 2018;13:147-54. https://doi.org/10.13066/kspm.2018.13.1.147
  28. Fritz H, Patzer D, Galen SS. Robotic exoskeletons for reengaging in everyday activities: promises, pitfalls, and opportunities. Disabil Rehabil 2019;41(5):560-3. https://doi.org/10.1080/09638288.2017.1398786