Lower Extremity Rehabilitation Research Articles

Research on the Design of Lower Extremity Rehabilitation Assistive Devices Based on User Experience

With the aggravation of social aging, patients with lower extremity movement disorders are also increasing year by year. The elderly with lower extremity movement disorders have their own characteristics in physiology, psychology and behavior. Firstly, this paper analyzes the research and development status of lower extremity rehabilitation assistive devices by data analysis and induction. Secondly, the physiological, behavioral and psychological characteristics of the elderly were analyzed through interviews and observation to understand the use of lower extremity assistive devices, and in-depth analysis was made on user needs and product pain points. Based on this analysis, this paper puts forward the design principles and elements based on the theoretical basis of user experience elements, increases the humanized design of lower extremity rehabilitation assistive devices, improves the safety and interest of products, and enhances user experience.

Lower Extremity Osseointegration Postoperative Rehabilitation Protocols: A Scoping Review.

Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation. Two differently phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either "osseointegration" or "osseointegrated" or "bone anchored prosthesis" AND [last name]. Second, replacing author name with "physical therapy" or "rehabilitation." Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar's "Cited by" feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation. All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether 1 or 2 surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility. All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation. This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation.

A Systematic Review of Worldwide Female Enrollment in Randomized Controlled Trials of Post-Stroke Lower Extremity Rehabilitation

Abstract This review systematically examined the reporting of sex and female participation in post-stroke lower extremity (LE) motor rehabilitation randomized controlled trials (RCTs) over time and identified differences in female participation across RCTs conducted in low-and-middle-income countries (LMICs), high-income-countries (HICs), and HIC-regions. Systematic searches were conducted of MEDLINE, Embase, CINAHL and PsycINFO from 1970 to May 2022. RCTs in English were included if they examined post-stroke LE motor rehabilitation interventions in adults diagnosed with stroke. A total of 1,285 RCTs were analyzed; 4.5% of RCTs did not report sex, and the overall female participation was 39.4%. The percentage of female participants did not significantly differ between HICs and LMICs. Within HICs, the percentage of female participants was significantly higher in European RCTs than RCTs in Asia & Oceania (P = 0.008). No significant changes in female participation were found for any of the countries or regions over the last two decades. Female participation was significantly higher in RCTs conducted in the acute phase compared to those in the chronic phase (p < 0.001). More research is needed to understand the reasons behind female under-enrollment and further efforts are required to ensure adequate enrollment of males and females.

A robot-based hybrid lower limb system for Assist-As-Needed rehabilitation of stroke patients: Technical evaluation and clinical feasibility

Background:Although early rehabilitation is important following a stroke, severely affected patients have limited options for intensive rehabilitation as they are often bedridden. To create a system for early rehabilitation of lower extremities in these patients, we combined the robotic manipulator ROBERT® with electromyography (EMG)-triggered functional electrical stimulation (FES) and developed a novel user-driven Assist-As-Needed (AAN) control. The method is based on a state machine able to detect user movement capability, assessed by the presence of an EMG-trigger and the movement velocity, and provide different levels of assistance as required by the patient (no support, FES only, and simultaneous FES and mechanical assistance). Methods:To technically validate the system, we tested 10 able-bodied participants who were instructed to perform specific behaviors to test the system states while conducting knee extension and ankle dorsal flexion exercises. The system was also tested on two stroke patients to establish its clinical feasibility. Results:The technical validation showed that the state machine correctly detected the participants’ behavior and activated the target AAN state in more than 96% of the exercise repetitions. The clinical feasibility test showed that the system successfully recognized the patients’ movement capacity and activated assistive states according to their needs providing the minimal level of support required to exercise successfully. Conclusions:The system was technically validated and preliminarily proved clinically feasible. The present study shows that the novel system can be used to deliver exercises with a high number of repetitions while engaging the participants’ residual capabilities through the AAN strategy.

The Human–Machine Interaction Methods and Strategies for Upper and Lower Extremity Rehabilitation Robots: A Review

The Human–Machine Interaction Methods and Strategies for Upper and Lower Extremity Rehabilitation Robots: A Review

Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke

Purpose Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.

The effect of virtual reality applications on treatment outcomes in lower extremity rehabilitation: a systematic review

The effect of virtual reality applications on treatment outcomes in lower extremity rehabilitation: a systematic review

The effect of the Lokomat® robotic-orthosis system on lower extremity rehabilitation in patients with stroke: a systematic review and meta-analysis.

The Lokomat® is a device utilized for gait training in post-stroke patients. Through a systematic review, the objective was to determine whether robot-assisted gait training with the Lokomat® is more effective in enhancing lower extremity rehabilitation in patients with stroke in comparison to conventional physical therapy (CPT). In this study, a systematic search was conducted in various databases, including CINAHL, MEDLINE, PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Physiotherapy Evidence Database (PEDro), as well as bibliographies of previous meta-analyses, to identify all randomized controlled trials that investigated the use of Lokomat® devices in adult stroke patients. The study aimed to derive pooled estimates of standardized mean differences for six outcomes, namely, Fugl-Meyer Assessment lower-extremity subscale (FMA-LE), Berg Balance Scale (BBS), gait speed, functional ambulation category scale (FAC), timed up and go (TUG), and functional independence measure (FIM), through random effects meta-analyses. The review analyzed 21 studies with a total of 709 participants and found that the use of Lokomat® in stroke patients resulted in favorable outcomes for the recovery of balance as measured by the BBS (mean difference = 2.71, 95% CI 1.39 to 4.03; p < 0.0001). However, the FAC showed that Lokomat® was less effective than the CPT group (mean difference = -0.28, 95% CI -0.45 to 0.11, P = 0.001). There were no significant differences in FMA-LE (mean difference = 1.27, 95% CI -0.88 to 3.42, P = 0.25), gait speed (mean difference = 0.02, 95% CI -0.03 to 0.07, P = 0.44), TUG (mean difference = -0.12, 95% CI -0.71 to 0.46, P = 0.68), or FIM (mean difference = 2.12, 95% CI -2.92 to 7.16, P = 0.41) between the Lokomat® and CPT groups for stroke patients. Our results indicate that, with the exception of more notable improvements in balance, robot-assisted gait training utilizing the Lokomat® was not superior to CPT based on the current literature. Considering its ability to reduce therapists' work intensity and burden, the way in which Lokomat® is applied should be strengthened, or future randomized controlled trial studies should use more sensitive assessment criteria.

Investigating the Telerehabilitation With Aims to Improve Lower Extremity Recovery Poststroke Program: A Feasibility Study.

The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke program (TRAIL), in individuals with stroke. A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19years or older, had a stroke within 18months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4weeks that were 60 to 90minutes, with a trained physical therapist in a ≤2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed "Up & Go" test, the virtual Fugl-Meyer Lower Extremity Assessment, the 30-Second Sit-to-Stand Test, the Functional Reach, the Tandem Stand, the Activities-Specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale. Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in Timed "Up & Go" test (Cohen d= 0.57); Fugl-Meyer Lower Extremity Assessment (d= 0.76); 30-Second Sit-to-Stand Test (d= 0.89); and Goal Attainment Scale (d= 0.95). The delivery of TRAIL, a lower extremity stroke rehabilitation program using videoconferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment. Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community postdischarge or during global disruptions, such as Coronavirus Disease 2019 (COVID-19). Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.

A DMP-Based Motion Generation Scheme for Robotic Mirror Therapy

Hemiparesis has become prevalent in recent years, and robot-assisted rehabilitation provides great therapeutic potential. Robotic mirror therapy is a promising approach for hemiplegic patients by transmitting the motion of the healthy limb (HL) to the impaired limb (IL), where the wearable robot assists the IL to mimic the HL's action to stimulate the active participation of the injured muscles. However, complete replication of the HL's movement trajectory without considering the IL's muscle strength is not satisfactory for rehabilitation. In this article, a motion generation scheme is proposed for robotic mirror therapy. The robot's movement trajectory is modeled with dynamic movement primitive (DMP), and the physical human–robot interaction is formulated as an impedance model and coupled with the DMP model. The subject's muscle strength is evaluated with skin surface electromyography signals and transferred to the robot's joint stiffness. In order to adapt the human–robot coupled DMP model parameters to varying subject performance, a reinforcement learning algorithm is designed to optimize the robot's movement trajectory and stiffness profile, where the training safety and rehabilitation improvement are both guaranteed. The proposed method is validated using a lower extremity rehabilitation robot, and experimental results demonstrate its feasibility and superiority.

A rehabilitation robot control framework with adaptation of training tasks and robotic assistance.

Robot-assisted rehabilitation has exhibited great potential to enhance the motor function of physically and neurologically impaired patients. State-of-the-art control strategies usually allow the rehabilitation robot to track the training task trajectory along with the impaired limb, and the robotic motion can be regulated through physical human-robot interaction for comfortable support and appropriate assistance level. However, it is hardly possible, especially for patients with severe motor disabilities, to continuously exert force to guide the robot to complete the prescribed training task. Conversely, reduced task difficulty cannot facilitate stimulating patients' potential movement capabilities. Moreover, challenging more difficult tasks with minimal robotic assistance is usually ignored when subjects show improved performance. In this paper, a control framework is proposed to simultaneously adjust both the training task and robotic assistance according to the subjects' performance, which can be estimated from the users' electromyography signals. Concretely, a trajectory deformation algorithm is developed to generate smooth and compliant task motion while responding to pHRI. An assist-as-needed (ANN) controller along with a feedback gain modification algorithm is designed to promote patients' active participation according to individual performance variance on completing the training task. The proposed control framework is validated using a lower extremity rehabilitation robot through experiments. The experimental results demonstrate that the control scheme can optimize the robotic assistance to complete the subject-adaptation training task with high efficiency.

An analysis of gait capture and simulation techniques for lower limb exoskeleton robots for stroke rehabilitation

Lower extremity rehabilitation-assisted exoskeleton robots bring together multiple disciplines such as biomechanics, control engineering, robotics, and computer science. The main role of lower extremity rehabilitation exoskeleton robots is to help patients and rehabilitators to maintain or restore the mobility of lower extremities, therefore, proper research and discussion of human gait analysis is the basis for establishing and improving such exoskeleton robots. To analyse and evaluate the positive effects of modern technology on stroke patients, the development of human gait capture and simulation technologies will be mainly summarized, the latest human gait capture and simulation technologies will be classified and evaluated. And through a comprehensive review and analysis of research advances in these areas, the usefulness of lower extremity rehabilitation-assisted exoskeleton robots for stroke populations is evaluated. This paper is informative in studying the usefulness of a lower limb exoskeleton robot combined with gait capture and simulation technology for rehabilitation training of stroke patients.

Modeling and control of the linear actuator for the lower limb rehabilitation device

In recent years, the number of stroke patients has increased, which has led to an increased need for motor rehabilitation exercises. The application of automation devices in the rehabilitation of patients is becoming increasingly developed. These devices help reduce the patient training time and workload. Each type of equipment uses different actuators such as electric motors, pneumatic cylinders, and hydraulic cylinders. Different from previous studies, in this paper, a research model of lower extremity rehabilitation devices using a simple actuator which is a linear actuator is presented. The main contribution of this study is that a dynamic model of the linear actuator associated with the action dynamics of the lower extremities of the studied model with three degrees of freedom was established. A mathematical model for this actuator is also presented, simulating the response of the mechanism using the MATLAB/Simulink software. A lower extremity rehabilitation device using a linear actuator was manufactured and tested. The test results for 10 volunteers show that the actuator works and causes miniature angle errors. This experiment demonstrates that the linear actuator can be used in stroke patient rehabilitation equipment and contributes to the diversification of the mechanism in automation equipment.

TeleRehabilitation with Aims to Improve Lower extremity recovery in community-dwelling individuals who have had a stroke: protocol for a multisite, parallel group, assessor-blinded, randomised attention-controlled trial

IntroductionTelerehabilitation is an accessible service delivery model that may support innovative lower extremity rehabilitation programmes that extend the stroke recovery continuum into the community. Unfortunately, there is limited evidence on...

Visual Feedback and Guided Balance Training in the Immersive Virtual Reality Environment for Lower Extremity Rehabilitation

Visual Feedback and Guided Balance Training in the Immersive Virtual Reality Environment for Lower Extremity Rehabilitation

Learning robotic motion with mirror therapy framework for hemiparesis rehabilitation

The number of hemiplegic patients has rapidly increased in recent years, and intelligent robots have high rehabilitation potential. Robotic mirror therapy (RMT) is a promising therapeutic measure for hemiparesis by voluntarily transferring the motion of the healthy limb (HL) to the impaired limb (IL), in which a robot interacts with and assists the IL to mimic the action of the HL to stimulate the active participation of the injured muscles. Nonetheless, complete replication of the HL movement trajectory to the robot without considering the IL muscle strength cannot ensure safety or facilitate rehabilitation. In this study, a learning-based robotic motion generation scheme was developed for RMT. The robot movement trajectories were modeled with dynamic movement primitives (DMPs), and the physical human-robot interaction was formulated as an impedance model coupled with the DMP model. To adapt the robotic motion to different pilots, reinforcement learning was used to optimize the coupled DMP model parameters. The reinforcement learning approach was implemented based on policy improvement and the path integral (PI2) algorithm, and the cost function was designed to simultaneously ensure training safety and enhance muscle strength. The proposed method was validated using a lower-extremity rehabilitation robot with magnetorheological actuators, and the experimental results demonstrated the feasibility and superiority.

Combined robot motor assistance with neural circuit-based virtual reality (NeuCir-VR) lower extremity rehabilitation training in patients after stroke: a study protocol for a single-centre randomised controlled trial

IntroductionImproving lower extremity motor function is the focus and difficulty of post-stroke rehabilitation treatment. More recently, robot-assisted and virtual reality (VR) training are commonly used in post-stroke rehabilitation and are...

Fuzzy radial-based impedance controller design for lower limb exoskeleton robot

AbstractThe lower extremity rehabilitation exoskeleton is mainly used to help patients with movement disorders complete rehabilitation training. For the human-machine interaction problem of the lower limb rehabilitation exoskeleton, a fuzzy radial-based impedance (RBF-FVI) controller is proposed in this study. A six degree of freedom (DOF) lower extremity rehabilitation exoskeleton was developed, and the human-machine coupling dynamics model was established. To realize the compliance control of the human-machine coupling system, a novel RBF-FVI controller is designed, which includes an inner-loop fuzzy position control module and an outer-loop impedance control module. The inner-loop fuzzy position control module is mainly used to achieve the tracking control of the desired training trajectory and position adjustment amount. The outer-loop impedance control module regulates the impedance parameters and compensates for the uncertainty terms. The superiority of the proposed controller in trajectory following is verified through simulation and comparison tests. The hardware test of the human-machine coupling system was carried out, and the test results showed that the subject and the exoskeleton system could realize a coordinated and smooth movement.

Electromyography-controlled lower extremity exoskeleton to provide wearers flexibility in walking

Objective:In recent years, there have been significant developments in lower extremity robotic exoskeletons intended for gait rehabilitation. However, wearers may not be sufficiently motivated to participate in traditional rehabilitation robot training as the training pattern is usually predefined and rigid. Enabling wearers to actively control the exoskeleton to assist them in walking may improve rehabilitation treatments. Methods:This paper presents an electromyography (EMG)-based gait pattern adaptation method that allows subjects to control the exoskeleton via EMG signals of thigh muscles (quadriceps femoris and hamstrings muscles). Six healthy subjects participated in the initial experiment on a treadmill based lower extremity rehabilitation robot system. In a single walking routine, six widely used adaptation gait patterns were tested. Results:The results indicate that all of the subjects were able to change the gait pattern of the exoskeleton and achieved the adaptation goals stably within average 16 strides by generating EMG signals. The muscle activation during the adaptation condition is significantly higher than that in fixed normal walking condition (p<0.05). The subjects gave positive evaluation on the designed system. Conclusion:With this method, the subjects were involved in the control loop and actively participated in the training. Significance:The proposed EMG-based two-layer admittance control algorithm is novel, which enabled subjects to adjust gait trajectories continuously and smoothly.

Gluteus Medius Activity With Resistance Band Biking: A Pilot Study

PURPOSE: Compare surface electromyography (EMGs) of the gluteus medius (GMed) during the following conditions: while stationary biking with and without a hip abduction resistance band and while performing 5 standard hip strengthening exercises. METHODS: Eleven healthy adult volunteers (27 ± 5 yrs, 7F) were included in this IRB approved study. EMGs of right GMed (1000 Hz) were collected in randomized order for 30 seconds of biking with and without resistance (Band vs no-Band conditions) and for 15 seconds of five standard hip strengthening exercises: 1) Right hip IR with hip ABD (0° extension); 2) Side plank with ipsilateral (right) hip ABD; 3) Side plank with contralateral (left) hip ABD; 4) Single leg squat; 5) Front plank with left hip extensions. EMG linear envelope was normalized to max voluntary isometric contraction (MVIC) and averaged across cycles. Peak amplitude and integrated EMG (iEMG) were compared across conditions with paired t-tests (p ≤ 0.05). RESULTS: Normalized peak amplitude and iEMG were significantly higher for the Band compared to the No Band condition (p < 0.001, p = 0.001, respectively). The average increase of 13 ± 9% of MVIC in peak amplitude represented an increase of 111%. Peak amplitude in the four exercises targeting hip ABD (1-4) was significantly (p < 0.01) higher than the banded condition (range increase: 48-100% of MVIC), while peak was lower during front plank. The increase in iEMG with the Band compared to no-band was on average 135%. CONCLUSIONS: Banded biking elicits greater GMed activity in comparison to non-banded biking, but lower than most of the hip strengthening exercises. The addition of a low-cost resistance band to an exercise that is often a part of standard rehab protocol provides an intermediate step in the activation of the hip abductors, before progressing to more demanding activities. This study provides therapists with a better understanding of the progression of exercise and hip abductor muscle recruitment with a goal to further accelerate lower extremity rehabilitation protocols. The inclusion of only healthy subjects is a first step before we study pre-post and non-operative patients.