RESUMO
This work presents a means to automatically synchronize two promising gait training technologies to address gait deficits in stroke survivors: functional electrical stimulation using intramuscular electrodes (FES-IM) and the Lokomat robotic gait orthosis. A system of hardware and software was developed to achieve the automatic synchronization. A series of bench tests were performed to verify the feasibility and reliability of automatic synchronization. The bench tests showed that automatic synchronization of FES-IM to the Lokomat gait cycle was feasible and reliable. Automatic synchronization was more consistent than manually triggered stimulation (10-fold smaller standard deviation of latency), and produced no early or missed stimulations across 634 strides. Automatic synchronization had greater accuracy than manually triggered stimulation, producing stimulation timed to an accuracy of 2.5% of one gait cycle duration (heel strike to heel strike = 100).
Assuntos
Terapia por Estimulação Elétrica/instrumentação , Teste de Esforço/instrumentação , Transtornos Neurológicos da Marcha/reabilitação , Modalidades de Fisioterapia/instrumentação , Robótica/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Teste de Esforço/métodos , Estudos de Viabilidade , Retroalimentação , Humanos , Robótica/métodos , Integração de SistemasRESUMO
After stroke rehabilitation, many survivors of stroke exhibit persistent gait deficits. In previous work, we demonstrated significant gains in gait kinematics for survivors of chronic stroke using multichannel functional electrical stimulation with intramuscular electrodes (FES-IM). For this study, we tested the feasibility of combining FES-IM and gait robot technologies for treating persistent gait deficits after stroke. Six subjects, >or= 6 months after stroke, received 30-minute intervention sessions of combined FES-IM and gait robotics 4 days a week for 12 weeks. Feasibility was assessed according to three factors: (1) performance of the interface of the two technologies during intervention sessions, (2) clinicians' success in using two technologies simultaneously, and (3) subject satisfaction. FES-IM system hardware and software design features combined with the gait robot technology proved feasible to use. Each technology alone provided unique advantages and disadvantages of gait practice characteristics. Because of the unique advantages and disadvantages of each technology, gait deficits need to be accurately identified and a judicious treatment plan properly targeted before FES-IM, a gait robot, or both combined are selected.
Assuntos
Estimulação Elétrica/métodos , Transtornos Neurológicos da Marcha/reabilitação , Robótica , Reabilitação do Acidente Vascular Cerebral , Idoso , Estimulação Elétrica/instrumentação , Estudos de Viabilidade , Transtornos Neurológicos da Marcha/etiologia , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicaçõesRESUMO
Twelve moderately to severely involved chronic stroke survivors (>12 mo) were randomized to one of two treatments: robotics and motor learning (ROB-ML) or functional neuromuscular stimulation and motor learning (FNS-ML). Treatment was 5 h/d, 5 d/wk for 12 wk. ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow (S/E) training. FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation (surface electrodes) for wrist and hand (W/H) flexors/extensors. The primary outcome measure was the functional measure Arm Motor Ability Test (AMAT). Secondary measures were AMAT-S/E and AMAT-W/H, Fugl-Meyer (FM) upper-limb coordination, and the motor control measures of target accuracy (TA) and smoothness of movement (SM). ROB-ML produced significant gains in AMAT, AMAT-S/E, FM upper-limb coordination, TA, and SM. FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination.
