Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study.

Introduction: Tuning the control parameters is one of the main challenges in robotic gait therapy. Control strategies that vary the control parameters based on the user's performance are still scarce and do not exploit the potential of using spatiotemporal metrics. The goal of this study was to validate the feasibility of using shank-worn Inertial Measurement Units (IMUs) for clinical gait analysis after stroke and evaluate their preliminary applicability in designing an automatic and adaptive controller for a knee exoskeleton (ABLE-KS). Methods: First, we estimated the temporal (i.e., stride time, stance, and swing duration) and spatial (i.e., stride length, maximum vertical displacement, foot clearance, and circumduction) metrics in six post-stroke participants while walking on a treadmill and overground and compared these estimates with data from an optical motion tracking system. Next, we analyzed the relationships between the IMU-estimated metrics and an exoskeleton control parameter related to the peak knee flexion torque. Finally, we trained two machine learning algorithms, i.e., linear regression and neural network, to model the relationship between the exoskeleton torque and maximum vertical displacement, which was the metric that showed the strongest correlations with the data from the optical system [r = 0.84; ICC(A,1) = 0.73; ICC(C,1) = 0.81] and peak knee flexion torque (r = 0.957). Results: Offline validation of both neural network and linear regression models showed good predictions (R2 = 0.70-0.80; MAE = 0.48-0.58 Nm) of the peak torque based on the maximum vertical displacement metric for the participants with better gait function, i.e., gait speed > 0.7 m/s. For the participants with worse gait function, both models failed to provide good predictions (R2 = 0.00-0.19; MAE = 1.15-1.29 Nm) of the peak torque despite having a moderate-to-strong correlation between the spatiotemporal metric and control parameter. Discussion: Our preliminary results indicate that the stride-by-stride estimations of shank-worn IMUs show potential to design automatic and adaptive exoskeleton control strategies for people with moderate impairments in gait function due to stroke.

Adapted Assistance and Resistance Training With a Knee Exoskeleton After Stroke.

Studies on robotic interventions for gait rehabilitation after stroke require: (i) rigorous performance evidence; (ii) systematic procedures to tune the control parameters; and (iii) combination of control modes. In this study, we investigated how stroke individuals responded to training for two weeks with a knee exoskeleton (ABLE-KS) using both Assistance and Resistance training modes together with auditory feedback to train peak knee flexion angle. During the training, the torque provided by the ABLE-KS and the biofeedback were systematically adapted based on the subject's performance and perceived exertion level. We carried out a comprehensive experimental analysis that evaluated a wide range of biomechanical metrics, together with usability and users' perception metrics. We found significant improvements in peak knee flexion ( p = 0.0016 ), minimum knee angle during stance ( p = 0.0053 ), paretic single support time ( p = 0.0087 ) and gait endurance ( p = 0.022 ) when walking without the exoskeleton after the two weeks of training. Participants significantly ( ) improved the knee angle during the stance and swing phases when walking with the exoskeleton powered in the high Assistance mode in comparison to the No Exo and the Unpowered conditions. No clinically relevant differences were found between Assistance and Resistance training sessions. Participants improved their performance with the exoskeleton (24-55 %) for the peak knee flexion angle throughout the training sessions. Moreover, participants showed a high level of acceptability of the ABLE-KS (QUEST 2.0 score: 4.5 ± 0.3 out of 5). Our preliminary findings suggest that the proposed training approach can produce similar or larger improvements in post-stroke individuals than other studies with knee exoskeletons that used higher training intensities.

Comparing walking with knee-ankle-foot orthoses and a knee-powered exoskeleton after spinal cord injury: a randomized, crossover clinical trial.

Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee-powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses, which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compensatory movements (38% reduction of circumduction, 25% increase of step length, 29% improvement in weight shifting). However, participants did not exhibit significantly better results in walking performance for the standard clinical tests (Timed Up and Go, 10-m Walk Test, and 6-min Walk Test), nor significant reductions in energy consumption. These results suggest that providing powered assistance only on the knee joints is not enough to significantly reduce the energy consumption required by people with SCI to walk compared to passive orthoses. Active assistance on the hip or ankle joints seems necessary to achieve this outcome.

Oxygen Uptake Slow Component and the Efficiency of Resistance Exercises.

ABSTRACT: Garnacho-Castaño, MV, Albesa-Albiol, L, Serra-Payá, N, Gomis Bataller, M, Pleguezuelos Cobo, E, Guirao Cano, L, Guodemar-Pérez, J, Carbonell, T, Domínguez, R, and Maté-Muñoz, JL. Oxygen uptake slow component and the efficiency of resistance exercises. J Strength Cond Res 35(4): 1014-1022, 2021-This study aimed to evaluate oxygen uptake slow component (V̇o2sc) and mechanical economy/efficiency in half squat (HS) exercise during constant-load tests conducted at lactate threshold (LT) intensity. Nineteen healthy young men completed 3 HS exercise tests separated by 48-hour rest periods: 1 repetition maximum (1RM), incremental-load HS test to establish the %1RM corresponding to the LT, and constant-load HS test at the LT. During the last test, cardiorespiratory, lactate, and mechanical responses were monitored. Fatigue in the lower limbs was assessed before and after the constant-load test using a countermovement jump test. A slight and sustained increase of the V̇o2sc and energy expended (EE) was observed (p < 0.001). In blood lactate, no differences were observed between set 3 to set 21 (p > 0.05). A slight and sustained decrease of half squat efficiency and gross mechanical efficiency (GME) was detected (p < 0.001). Significant inverse correlations were observed between V̇o2 and GME (r = -0.93, p < 0.001). Inverse correlations were detected between EE and GME (r = -0.94, p < 0.001). Significant losses were observed in jump height ability and in mean power output (p < 0.001) in response to the constant-load HS test. In conclusion, V̇o2sc and EE tended to rise slowly during constant-load HS exercise testing. This slight increase was associated with lowered efficiency throughout constant-load test and a decrease in jump capacity after testing. These findings would allow to elucidate the underlying fatigue mechanisms produced by resistance exercises in a constant-load test at LT intensity.

Ventilatory efficiency during constant-load test at lactate threshold intensity: Endurance versus resistance exercises.

There is a lack of evidence about the ventilatory efficiency in resistance exercises despite the key role played in endurance exercises. This study aimed to compare the cardiorespiratory, metabolic responses and ventilatory efficiency between half-squat (HS) and cycle ergometer exercises during a constant-load test at the lactate threshold (LT) intensity. Eighteen healthy male participants were randomly assigned in a crossover design to carry out HS or cycle ergometer tests. For the three HS tests, a one repetition maximum (1RM) test was performed first to determine the load (kg) corresponding to the 1RM percentages. In the second test, the incremental HS exercise was carried out to establish the load (kg) at the LT intensity. Finally, a constant-load HS test was performed at the LT intensity. The first cycle ergometer test was incremental loading to determine the intensity in watts corresponding to the LT, followed by a constant-load test at the LT intensity. A recovery time of 48 hours between each test was established. During both constant-load test, cardiorespiratory and metabolic responses were monitored. A significant exercise mode x time interaction effect was only detected in oxygen uptake (VO2), heart rate, and blood lactate (p < 0.001). No differences were found between the two types of exercise in ventilatory efficiency (p >0.05). Ventilation (VE) and carbon dioxide were highly correlated (p <0.001) in the cycle ergometer (r = 0.892) and HS (r = 0.915) exercises. In the VO2 efficiency slope (OUES), similarly significant and high correlations (p <0.001) were found between VO2 and log10 VE in the cycle ergometer (r = 0.875) and in the HS (r = 0.853) exercise. Although the cardioventilatory responses were greater in the cycle ergometer test as compared to HS exercise, ventilatory efficiency was very similar between the two exercise modalities in a predominantly aerobic metabolism.

The Slow Component of Oxygen Uptake and Efficiency in Resistance Exercises: A Comparison With Endurance Exercises.

INTRODUCTION: There is a lack of information regarding the slow component of oxygen uptake (VO2sc) and efficiency/economy in resistance exercises despite the crucial role played in endurance performance. PURPOSE: this study aimed to compare the VO2sc, efficiency/economy, metabolic, cardiorespiratory responses, rating of perceived effort and mechanical fatigue between cycling and half-squat (HS) exercises during a constant-load test at lactate threshold (LT1) intensity. METHODS: Twenty-one healthy men were randomly assigned in a crossover design to perform cycle-ergometer or HS tests. The order of the two cycle ergometer tests was an incremental test for determining load-intensity in watts (W) at LT1, followed by a constant-load test at the LT1 intensity. For the three HS tests, the order was a 1RM test to determine the load (kg) corresponding to the 1RM percentages to be used during the second test, incremental HS exercise to establish the load (kg) at the LT1 intensity, and finally, a constant-load HS test at the LT1 intensity. A rest period of 48 h between each test was established. During the HS and cycle-ergometer constant-load tests, cardiorespiratory and metabolic responses were recorded. Lower limbs fatigue was determined by a jump test before and after the constant-load tests. RESULTS: A significant exercise mode × time interaction effect was detected in VO2, heart rate, energy expenditure (EE), gross efficiency (GE), and economy (p < 0.05). A significant and sustained VO2 raise was confirmed in HS exercise (p < 0.05) and a steady-state VO2 was revealed in cycle-ergometer. A higher GE and economy were obtained in HS test than in cycle-ergometer exercise (p < 0.001). In both exercises, a non-significant decrease was observed in GE and economy (p > 0.05). Lower limbs fatigue was only detected after constant-load HS test. CONCLUSION: Although the VO2, heart rate and EE responses were higher in cycling exercise, the constant-load HS test induced a greater VO2sc and EE raise than the cycling test in a predominantly aerobic metabolism. These results could explain a decrease observed in jump performance only after HS test. GE and economy could benefit from the eccentric phase of the HS exercise.

Effect of a distal weight-bearing implant on visual analog scale scores in 23 transfemoral amputees.

The objective of this interrupted time series clinical trial was to evaluate the effect of a distal weight-bearing implant on well-being in patients with transfemoral amputations using the visual analog scale (VAS). A total of 29 patients from five hospitals with previous transfemoral amputations were surgically implanted with an osseoanchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using the VAS. The Wilcoxon test was used to evaluate the differences between variables. VAS mean scores improved significantly after intervention. Significant and clinically meaningful improvements in the VAS score suggest overall improvement in well-being for patients after receiving a distal weight-bearing implant.

The anterior mini-open approach for femeroacetabular impingement: Gait and functional assessment at one year post-surgery.

OBJECTIVE: This study aimed to evaluate the outcome of the anterior mini-open approach of the hip for femoroacetabular impingement (FAI) at one year post-surgery by use of questionnaires, functional capacity tests and biomechanical studies. DESIGN: This is a case series prospective study. A total of 14 patients diagnosed of FAI were included. Patients were classified according to Tönnis scale. Hip joint mobility, Faber distance, pain levels (assessed on a visual analogic scale [VAS]), 6-minute walking test (6MWT), Timed up & go test (TUGT), Stairs climbing test, Lequesne functional index, and gait analysis were assessed prior to and 12 months after surgery. RESULTS: Pain significantly improved following surgery. An improvement of 80% or more was found in 6 patients (42.85% of cases). Improvements were also seen in time support of the affected limb and in the braking force of the contralateral limb, although these are not clinically significant. No statistically significant changes were seen in functional capacity tests. At 12 months after surgery, meralgia paraesthetica presented in 3 patients (21.4%), and a total hip arthroplasty was performed in 1 patient. CONCLUSIONS: There was significant reduction in pain intensity 12 months following mini-open approach for FAI compared to preoperatively. Improvement in gait analysis and functional capacity was also seen, although not statistically significant.

Alteraciones del control postural en fases iniciales del latigazo cervical / Postural control disorders in initial phases of whiplash

Fundamentos y objetivo: El vértigo de intensidad variable es un síntoma frecuente en pacientes que han presentado un síndrome del latigazo cervical (SLC) y que presentan alteraciones del equilibrio bien documentadas. El objetivo del estudio fue evidenciar alteraciones del control postural en las fases precoces del SLC tras el accidente. Pacientes y método: Se incluyó a 99 mujeres; 54 habían presentado un SLC en las 2 semanas previas, mientras que 45 voluntarias sanas formaron el grupo control. En ambos grupos se realizó una posturografía estática sobre una plataforma de fuerza y se estudió en 4 fases secuenciales la prueba de Romberg para valorar el área de barrido (AB) como variable dependiente. Para evaluar el dolor y la funcionalidad cervical se usaron la escala analógica visual (EVA) y el Northwick Park Neck Pain Questionnaire (NPH). Resultados: El AB aumentó de forma significativa en cada una de las fases consecutivas en ambos grupos. Las diferencias de las medias del área de barrido fueron estadísticamente significativas en todas las fases del Romberg (p=0,009 a p=0,000). No se evidenció correlación entre el AB y el dolor o la funcionalidad cervical. Existió una correlación positiva con el AB en Romberg gomaespuma ojos cerrados y el tiempo de incapacidad laboral temporal (r=0,414; p=0,009). Conclusiones: Los pacientes diagnosticados de un SLC reciente muestran alteración del control postural valorado mediante posturografía estática secuencial, lo que sugiere que la alteración del equilibrio no es sólo consecuencia de la evolución tardía del SLC, por lo que debería promoverse la instauración temprana de un plan terapéutico específico si el paciente refiriera vértigos y/o síntomas relacionados (AU)

Background and objective: Dizziness of variable intensity is a frequent complaint in patients who suffered whiplash and largely documented balance disturbances. The objective of the study was to identify balance disorders in early stage of whiplash after road traffic accidents. Patients and method: Ninety nine women were included in the study. Fifty four women had suffered whiplash within two weeks and 45 were included in a healthy control group. Static posturography on a force platform was carried out in all study participants, by means of the Romberg test in four sequential phases, using the postural sway area (SA) as a dependent variable. Visual Analogic Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPH) were used to evaluate pain and function. Results: Postural sway area increased significantly in each of the consecutive phases in both groups. The differences of the means of the postural sway area were statistically significant in all Romberg phases (p=.009 to P=.000). No correlation was found between SA and VAS or NPH scores. There was a positive correlation between the postural sway area standing on a thick foam cushion placed over the plate with closed eyes and the number of days of transitory incapacity (r=0.414; P=.009). Conclusions: Patients with recent whiplash show a postural control disturbance revealed trough a sequential static posturography analysis. This suggests that the balance disorder is not only a consequence of late whiplash syndrome evolution. Therefore, we should promote early instauration of a specific therapeutic approach if and when the patient refers dizziness and related symptoms (AU)

[Postural control disorders in initial phases of whiplash]. / Alteraciones del control postural en fases iniciales del latigazo cervical.

BACKGROUND AND OBJECTIVE: Dizziness of variable intensity is a frequent complaint in patients who suffered whiplash and largely documented balance disturbances. The objective of the study was to identify balance disorders in early stage of whiplash after road traffic accidents. PATIENTS AND METHOD: Ninety nine women were included in the study. Fifty four women had suffered whiplash within two weeks and 45 were included in a healthy control group. Static posturography on a force platform was carried out in all study participants, by means of the Romberg test in four sequential phases, using the postural sway area (SA) as a dependent variable. Visual Analogic Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPH) were used to evaluate pain and function. RESULTS: Postural sway area increased significantly in each of the consecutive phases in both groups. The differences of the means of the postural sway area were statistically significant in all Romberg phases (p=.009 to P=.000). No correlation was found between SA and VAS or NPH scores. There was a positive correlation between the postural sway area standing on a thick foam cushion placed over the plate with closed eyes and the number of days of transitory incapacity (r=0.414; P=.009). CONCLUSIONS: Patients with recent whiplash show a postural control disturbance revealed trough a sequential static posturography analysis. This suggests that the balance disorder is not only a consequence of late whiplash syndrome evolution. Therefore, we should promote early instauration of a specific therapeutic approach if and when the patient refers dizziness and related symptoms.