Lower Extremity Rehabilitation Research Articles

Design of the Lower Extremity Rehabilitation Robot Communication System

According to this analysis, we designed a scenario on lower extremity rehabilitation robot communication system based on CAN bus and efficiently solved the problems of low signal processing, computing power and data transfer rate ability for the traditional means of communication of RS232 and RS485.The research deals with the characteristics of communication systems and topological structure, and specifically, with CAN bus protocol design and hardware and software implementation aspects of Communication System designing for some robot sensor.

Constraint-induced movement therapy promotes brain functional reorganization in stroke patients with hemiplegia.

Stroke patients with hemiplegia exhibit flexor spasms in the upper limb and extensor spasms in the lower limb, and their movement patterns vary greatly. Constraint-induced movement therapy is an upper limb rehabilitation technique used in stroke patients with hemiplegia; however, studies of lower extremity rehabilitation are scarce. In this study, stroke patients with lower limb hemiplegia underwent conventional Bobath therapy for 4 weeks as baseline treatment, followed by constraint-induced movement therapy for an additional 4 weeks. The 10-m maximum walking speed and Berg balance scale scores significantly improved following treatment, and lower extremity motor function also improved. The results of functional MRI showed that constraint-induced movement therapy alleviates the reduction in cerebral functional activation in patients, which indicates activation of functional brain regions and a significant increase in cerebral blood perfusion. These results demonstrate that constraint-induced movement therapy promotes brain functional reorganization in stroke patients with lower limb hemiplegia.

Design of the Lower Extremity Rehabilitation Robot Communication System

According to this analysis, we designed a scenario on lower extremity rehabilitation robot communication system based on CAN bus and efficiently solved the problems of low signal processing, computing power and data transfer rate ability for the traditional means of communication of RS232 and RS485.The research deals with the characteristics of communication systems and topological structure, and specifically, with CAN bus protocol design and hardware and software implementation aspects of Communication System designing for some robot sensor.

Design of a Rehabilitation Device Based on a Mechanical Link System

Realizing an ideal impedance control system in lower extremity rehabilitation systems is challenged by mechanical impedance of robot hardware. Although many researchers in Robotics and Control Systems have studied to reduce the mechanical impedance of actuators, they have not been able to eliminate the inertia of robot hardware. This paper introduces an alternative design using mechanical links. The mechanical links are driven by one actuator without any complicated servo systems. The design parameters were optimized by simulation studies for the link system to generate the normal walking motion. The device is connected to a human using elastic components, and therefore, the inertia of the link system is not directly imposed on the user. The human legs are guided to follow the motion of the link system by an assistive force generated by the elastic components.

Comparison of elliptical training, stationary cycling, treadmill walking and overground walking. Electromyographic patterns

The most common functional motor goal of lower extremity rehabilitation is to improve walking ability. For reasons of feasibility, safety or intensity, devices are frequently used to facilitate or augment gait training. The objective of this study was to compare the muscle activity patterns of the rectus femoris and semitendinosus muscles during four conditions: overground walking, treadmill walking, stationary cycling, and elliptical training. Ten healthy adults (six male, four female; mean age 22.7±2.9 years, range 20–29) participated and surface electromyographic data were recorded. Linear envelope curves were generated and time normalized from 0 to 100% cycle. The mean plus three standard deviations from a static trial was used as the threshold for muscle activity. Repeated measures analysis of variance procedures were used to detect differences between conditions. Elliptical training demonstrated greater rectus femoris activity and greater rectus femoris/semitendinosus coactivation than all other conditions. Consistent with previous work, treadmill walking demonstrated greater rectus femoris activity than overground walking. Minimal differences in semitendinosus activation were observed between conditions, limited to lower peak activity during cycling compared to treadmill walking. These results provide normative values for rectus femoris and semitendinosus activation for different locomotor training methods and may assist in selecting the most appropriate training device for specific patients. Clinicians and researchers should also consider the kinematic and kinetic differences between tasks, which cannot necessarily be inferred from muscle activation patterns.

Efficacy of retrowalking on strength and balance in patients with hamstring strain

BackgroundHamstring muscle strain is one of the most common injuries in sports. Retrowalking on treadmill is a common tool for lower extremity rehabilitation in the clinical settings. However, minimal clinical...

Rehabilitation Following a Minimally Invasive Procedure for the Repair of a Combined Anterior Cruciate and Posterior Cruciate Ligament Partial Rupture in a 15-Year-Old Athlete

Case report. The healing response procedure is a minimally invasive arthroscopic surgical technique used to stimulate healing in the treatment of partial cruciate ligament tears. The purpose of this report is to provide information on the surgical procedure, the postoperative rehabilitation, and the overall functional results in a patient who underwent such a procedure. A 15-year-old male, who sustained a partial tear of both the anterior cruciate and posterior cruciate ligament while playing football, underwent arthroscopic surgical management utilizing a healing response technique. Precautions concerning range of motion and resisted activities were followed postoperatively to protect the healing cruciate ligaments. The postoperative protocol consisted of 3 phases, culminating in return-to-sport training. Treatment incorporated cardiovascular, proprioceptive, strength, power, plyometric, and sport-specific activities. Treatment was progressed based on specific criteria emphasizing proper movement patterns and eccentric control during functional activities. The patient attended 31 physical therapy sessions over 17 weeks. Strength improved from 3/5 to 5/5, knee range of motion returned to normal, Lower Extremity Functional Scale scores improved from 21/80 to 80/80, and successful outcomes on functional return-to-sport testing allowed the patient to return to competitive athletics. Primary repair of cruciate ligament tears has yielded poor results, and partial cruciate ligament tears may not require complete surgical reconstruction. The healing response technique offers a possible solution for the treatment of partial cruciate ligament tears. A criterion-based postoperative protocol was derived based on current evidence regarding rehabilitation following cruciate ligament reconstruction and evidence regarding lower extremity rehabilitation principles and injury prevention. Therapy, level 4.

Comparison of Lower Extremity Kinematics and Hip Muscle Activation During Rehabilitation Tasks Between Sexes

Closed kinetic chain exercises are an integral part of rehabilitation programs after lower extremity injury. Sex differences in lower extremity kinematics have been reported during landing and cutting; however, less is known about sex differences in movement patterns and activation of the hip musculature during common lower extremity rehabilitation exercises. To determine whether lower extremity kinematics and muscle activation levels differ between sexes during closed kinetic chain rehabilitation exercises. Cross-sectional with 1 between-subjects factor (sex) and 1 within-subjects factor (exercise). Research laboratory. Participants included 21 women (age = 23 +/- 5.8 years, height = 167.6 +/- 5.1 cm, mass = 63.7 +/- 5.9 kg) and 21 men (age = 23 +/- 4.0 years, height = 181.4 +/- 7.4 cm, mass = 85.6 +/- 16.5 kg). In 1 testing session, participants performed 3 trials each of single-leg squat, lunge, and step-up-and-over exercises. We recorded the peak joint angles (degrees) of knee flexion and valgus and hip flexion, extension, adduction, and external rotation for each exercise. We also recorded the electromyographic activity of the gluteus maximus, rectus femoris, adductor longus, and bilateral gluteus medius muscles for the concentric and eccentric phases of each exercise. Peak knee flexion angles were smaller and peak hip extension angles were larger for women than for men across all tasks. Peak hip flexion angles during the single-leg squat were smaller for women than for men. Mean root-mean-square amplitudes for the gluteus maximus and rectus femoris muscles in both the concentric and eccentric phases of the 3 exercises were greater for women than for men. Sex differences were observed in sagittal-plane movement patterns during the rehabilitation exercises. Because of the sex differences observed in our study, future researchers need to compare the findings for injured participants by sex to garner a better representation of altered kinematic angles and muscle activation levels due to injury.

The Architectural Design of the Gluteal Muscle Group: Implications for Movement and Rehabilitation

The organization of fibers within a muscle (architecture) defines the performance capacity of that muscle. In the current commentary, basic architectural terms are reviewed in the context of the major hip muscles and then specific illustrative examples relevant to lower extremity rehabilitation are presented. These data demonstrate the architectural and functional specialization of the hip muscles, and highlight the importance of muscle physiology and joint mechanics when evaluating and treating musculoskeletal disorders.

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: A single-blind, randomised, controlled trial

Objective. In this study, the effectiveness of neuromuscular electrical stimulation (NMES) was evaluated in lower extremity rehabilitation in patients with chronic stroke.Method. The study enrolled 40 patients with chronic stroke. Twenty patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received NMES treatment for hemiplegic foot dorsiflexor muscles for 4 weeks, 5 days a week. The sessions were performed as one session per day and added to a total of 20 sessions. Clinical parameters were evaluated before and after the treatment.Results. Pre-treatment and post-treatment evaluations showed a significant increase in ankle dorsiflexion and a significant decrease in the level of spasticity in the treatment group (p < 0.05); however, there were no significant differences in the control group between the pre-treatment and post-treatment measures. Although Brunnstrom Stage, Rivermead leg and trunk score and Functional Independence Measurement motor subscore showed a significant improvement in pre- and post-treatment comparisons for both groups, the treatment group's scores were significantly higher than the control group (p < 0.05). Functional Ambulation Categories showed a significant improvement in both groups following the treatment; however, there was no significant difference between the two groups (p > 0.05).Conclusions. Use of NMES in hemiplegic foot dorsiflexion can contribute to the clinical improvement of patients when used in combination with rehabilitation programs.

A benchmarked automated progress measurement system for haptic motor rehabilitation

As Haptic devices become more affordable and economical, research in Haptic-based virtual rehabilitation systems is gaining more interest. In addition to the benefits provided by virtual rehabilitation, Haptics offer force and tactile feedback which can be crucial for much upper and lower extremity rehabilitation. In this paper, we present such a system that provides a rich media environment for motor rehabilitation of stroke patients. The system can be used by Occupational Therapists (OTs) to measure and monitor the progress of rehab patients. This is an expanded version of a paper presented at the 3rd IEEE International Workshop on Medical Measurements and Applications, 9 10 May 2008, Ottawa, ON, Canada.

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: A single-blind, randomised, controlled trial

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: A single-blind, randomised, controlled trial

Standardized voluntary force measurement in a lower extremity rehabilitation robot

BackgroundIsometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD) because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO) Lokomat. To evaluate the capabilities of this new measurement method, inter- and intra-rater reliability were assessed.MethodsReliability was assessed in subjects with and without NMD. Subjects were tested twice on the same day by two different therapists to test inter-rater reliability and on two separate days by the same therapist to test intra-rater reliability.ResultsResults showed fair to good reliability for the new measurement method to assess isometric muscle force of lower extremities. In subjects without NMD, intraclass correlation coefficients (ICC) for inter-rater reliability ranged from 0.72 to 0.97 and intra-rater reliability from 0.71 to 0.90. In subjects with NMD, ICC ranged from 0.66 to 0.97 for inter-rater and from 0.50 to 0.96 for intra-rater reliability.ConclusionInter- and intra- rater reliability of an assessment method for measuring maximal voluntary isometric muscle force of lower extremities was demonstrated. We suggest that this method is a valuable tool for documentation and controlling of the rehabilitation process in patients using a DGO.

A Biomechanical Investigation of A Single-Limb Squat: Implications for Lower Extremity Rehabilitation Exercise

Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60 degrees of knee flexion while performing a single-limb squat at different decline angles. Participants acted as their own controls in a repeated-measures design. We recruited 10 participants who had no pain, injury, or neurologic disorder. Participants performed single-limb squats at different decline angles. Angle-specific knee and ankle moments were calculated at 60 degrees of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60 degrees of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P = .001), but EMG activity in the gastrocnemius increased between 16 degrees and 24 degrees (P = .018). As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24 degrees decline angle compared with the 16 degrees decline angle. This indicates that decline squats at an angle greater than 16 degrees may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.

Electromyographic Analysis of Hip Rehabilitation Exercises in a Group of Healthy Subjects

Single-occasion, repeated-measures design. To determine the magnitude of hip abductor muscle activation during 6 rehabilitation exercises. Many researchers have reported that hip strengthening, especially of the hip abductors, is an important component of a lower extremity rehabilitation program. Clinicians employ non-weight-bearing and weight-bearing exercise to strengthen the hip musculature; however, researchers have not examined relative differences in muscle activation during commonly used exercises. Information regarding these differences may provide clinicians with a scientific rationale needed for exercise prescription. Sixteen healthy subjects (mean +/- SD age, 27 +/- 5 years; range, 18-42 years; mean +/- SD height, 1.7 +/- 0.2 m; mean +/- SD body mass, 76 +/- 15 kg) volunteered for this study. Bipolar surface electrodes were applied to the right gluteus medius muscle. We measured muscle activation as subjects performed 3 non-weight-bearing (sidelying right hip abduction and standing right hip abduction with the hip at 0 degrees and 20 degrees of flexion) and 3 weight-bearing (left-sided pelvic drop and weight-bearing left hip abduction with the hips at 0 degrees and 20 degrees of flexion) exercises. Data were expressed as a percent of maximum voluntary isometric contraction of the right gluteus medius. Differences in muscle activation across exercises were determined using a 1-way analysis of variance with repeated measures, followed by a sequentially rejective Bonferroni post hoc analysis to identify differences between exercises. The weight-bearing exercises demonstrated significantly greater EMG amplitudes (P<.001) than all non-weight-bearing exercises except non-weight-bearing sidelying hip abduction. The weight-bearing exercises and non-weight-bearing sidelying hip abduction exercise resulted in greater muscle activation because of the greater external torque applied to the hip abductor musculature. Although the non-weight-bearing standing hip abduction exercises required the least activation, they may benefit patients who cannot safely perform the weight-bearing or sidelying hip abduction exercises. Clinicians may use results from this study when designing hip rehabilitation programs.

Upper and lower extremity robotic devices for rehabilitation and for studying motor control.

The successful motor rehabilitation of stroke, traumatic brain-injured and spinal cord-injured patients requires an intensive and task-specific therapy approach. Budget constraints limit a hand-to-hand therapy approach, so that intelligent machines may offer a solution to promote motor recovery and obtain a better understanding of motor control. This new field of automated or robot-assisted motor rehabilitation has emerged since the 1990s. This article will present clinically viable devices for upper and lower extremity rehabilitation. The MIT-Manus and the Mirror-Image Motion Enabler robot, which enable unrestricted unilateral or bilateral shoulder and elbow movement, consistently proved superior on the motor impairment level. The ARM guide, which assisted reaching in a straight-line trajectory, and the Bi-Manu-Track, which enabled the bilateral practice of a forearm and wrist movement, are currently being tested. For gait rehabilitation after stroke, the electromechanical gait trainer, GT I, has proved effective compared with treadmill training with body weight support. The Lokomat, consisting of a treadmill and a powered exoskeleton, lessened the therapeutic effort compared with manually assisted treadmill training in spinal cord-injured patients. Future developments will see more degrees of freedom, improved man-machine interaction and the implementation of virtual reality. Technical possibilities are one aspect, but multi-centre trials and a consideration of the unsubstantiated fears among therapists of being replaced by machines will decide on the successful implementation of this most promising field to the benefit of patients.

Effect of Duration of Upper- and Lower-Extremity Rehabilitation Sessions and Walking Speed on Recovery of Interlimb Coordination in Hemiplegic Gait

The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger mean CRP for both limb pairs, with increased stability and asymmetry of walking, indicating that walking speed influences interlimb coordination in hemiplegic gait.

Design and implementation of a neuromuscular training program following anterior cruciate ligament reconstruction.

Neuromuscular training programs are increasingly integrated into clinical practice for lower extremity rehabilitation. A few rehabilitation programs have been evaluated for patients with anterior cruciate ligament (ACL) deficiency and for injury prevention, but there is limited scientific evidence of the effect of neuromuscular training following ACL reconstruction. Therefore, a neuromuscular training program was developed for patients after ACL reconstruction. The objective of the neuromuscular training was to improve the ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, and to relearn movement patterns and skills necessary during activities of daily living and sports activities. The main areas considered when designing the postoperative rehabilitation program after ACL reconstruction were: ACL graft healing and ACL strain values during exercises, proprioception and neuromuscular control, and clinical studies on the effect of neuromuscular training programs. The rehabilitation program consists of balance exercises, dynamic joint stability exercises, jump training/plyometric exercises, agility drills, and sport-specific exercise. The patients exercise 3 times a week for 6 months. The scientific and clinical evidence for the rehabilitation program are described and the main exercises in the program are outlined.

Lower Extremity Applications of Functional Neuromuscular Stimulation After Spinal Cord Injury

This paper reviews the therapeutic and neuroprosthetic applications of functional neuromuscular stimulation (FNS), also known as functional electrical stimulation (FES), for lower extremity rehabilitation after spinal cord injury and summarizes the important clinical and technical issues involved in its use. The therapeutic effects of electrical stimulation on disuse atrophy, muscle strength and endurance, cardiopulmonary status, and tissue viability in terms of risk of pressure sore development are summarized. Neuroprosthetic uses of surface and implanted technologies for standing, ambulation, and personal mobility are also described. Health and functional benefits, contraindications, and other clinical considerations are discussed, along with the potential of the technology to be an important component in the overall rehabilitation of persons with spinal cord injuries.

Scientific Rationale and Physiological Basis for the Use of Closed Kinetic Chain Exercise in the Lower Extremity

Closed kinetic chain exercise is a common component of lower extremity rehabilitation. It has virtually replaced open kinetic chain exercise in the treatment of some conditions. In this paper, anatomy and physiology as they relate to closed chain exercise are examined to elucidate its unique contributions to rehabilitation. Claims made about the specificity, functionality, and safety of closed kinetic chain exercise are discussed. Muscle action, the stretch–shortening cycle, joint position sense, and clinical cases are used to illustrate the distinct role of closed kinetic chain exercise in rehabilitation.