Lower Limb Disability Research Articles

Treatment of Partial-Thickness Rotator Cuff Tears with Bio-Inductive Collagen Implant for Paraplegic Tennis Player: A Case Report

In patient with lower limb disability, rotator cuff disorders are prevalent, with partial thickness tears occurring at nearly twice the rate of full thickness tears. For those with acromion spurs unresponsive to conservative treatment, rotator cuff repair via the take-down method poses a retear risk and requires extensive rehabilitation. Conversely, surgery utilizing bio-inductive collagen implants shows a lower retear risk and enables faster recovery, making it an appealing option for wheelchair athletes. Thus, the authors aim to present favorable outcomes from isolated bio-inductive collagen implant repair in a 45-year-old female wheelchair tennis player with a bursal side partial thickness tear, alongside a literature review.

A Machine Learning–Based Ergonomic Assessment of Wireless Hand Control System for Lower‐Limb Disabled Tractor Operators and Abled Female Agricultural Workers

ABSTRACTTractor being the most used power source for agricultural operations needs hand control (HC) and foot control (FC) to maneuver it. FCs restrict lower‐limb disabled agricultural workers from participating in tractor operation, and high requirement of actuation forces to operate FCs may create overexertion and early fatigue to female agricultural workers. Therefore, a sensor‐based HC system has been developed to assist them in tractor operation with minimal actuating force. This study focuses on ergonomic assessment of the HC system to assess the suitability for the abled and disabled agricultural workers, including physiological, psychophysical, and muscle fatigue parameters. Heart rate (HR) of abled male and female, and disabled male and female was observed in the range of 83–118, 85–117, 93–118, and 92–114 beats/min, respectively, during tractor operation. Energy expenditure rate (EER) during tractor operation with FCs (9.7–17.4 kJ/min) was observed higher than with the HC system (7.3–16.5 kJ/min). Body parts discomfort was observed highest for the right hand of all the subjects (4.9–5.3) and maximum overall discomfort was experienced by abled females during the operation with FCs (5.4) as they have to exert higher force. The root mean square (RMS) value of the electromyography signal obtained for extensor digitorum muscle was found to be higher for all the subjects and with both HC and FC (abled male, 17.37–40.43 µV; abled female, 14.76–45.29 µV; disabled male, 15.49–40.23 µV; disabled female, 30.32–54.29 µV) than other upper arm muscles middle deltoid, flexor carpi radialis, and brachioradialis. Muscle workload for all the selected muscles of all the subjects was observed within the recommended limit during the tractor operation with a developed HC system (< 30%). Categorization of overall discomfort rating (ODR) of the subjects using HR, EER, and RMS through machine learning algorithms such as k‐nearest neighbor (KNN), random forest classifier, and support vector machine predicted the ODR with accuracies in the range of 77%–83%. KNN algorithm was found to be most accurate with prediction accuracy of 83%. The developed HC system provides assistantship to the lower‐limb disabled agricultural workers (1%–100% disability of lower limbs) and allows female workers to operate the tractor with minimal physical exertion.

Prediction of abnormal gait behavior of lower limbs based on depth vision

Abstract As a kind of lower-limb motor assistance device, the intelligent walking aid robot plays an essential role in helping people with lower-limb diseases to carry out rehabilitation walking training. In order to enhance the safety performance of the lower-limb walking aid robot, this study proposes a deep vision-based abnormal lower-limb gait prediction model construction method for the problem of abnormal gait prediction of patients’ lower limbs. The point cloud depth vision technique is used to acquire lower-limb motion data, and a multi-posture angular prediction model is trained using long and short-term memory networks to build a model of the user’s lower-limb posture characteristics during normal walking as well as a real-time lower-limb motion prediction model. The experimental results indicate that the proposed lower-limb abnormal behavior prediction model is able to achieve a 97.4% prediction rate of abnormal lower-limb movements within 150 ms. Additionally, the model demonstrates strong generalization ability in practical applications. This paper proposes further ideas to enhance the safety performance of lower-limb rehabilitation robot use for patients with lower-limb disabilities.

Optimization of Joint Space Trajectories for Assistive Lower Limb Exoskeleton Robots: Real-Time and Flexible Gait Patterns

This research focuses on designing a real-time, flexible gait planner for lower limb exoskeleton robots to assist patients with lower limb disabilities. Given the dynamic nature of gait parameters, which vary according to ground conditions and user intent, the challenge lies in developing a gait planner capable of adapting to these changes in real-time. To avoid planning complications in the cartesian space and to comply with the speed constraints of joint motors, this paper proposes planning in joint space. Furthermore, the approach also considers the maximum speed capabilities of the joint motors, aiming to generate an executable gait pattern and simultaneously enhance the robot’s walking speed by determining the minimum time required for implementation. The introduced gait planner optimizes joint trajectories for minimal angular acceleration. To provide flexibility, generalized boundary conditions suitable for different scenarios are defined. The effectiveness of the proposed planner is validated through comprehensive performance analysis, simulations, and successful implementation trials on the Exoped® robot in various scenarios.

Psychosocial Correlates and Behavioral Response to a Carbon Fiber Orthosis and Intensive Rehabilitation Program

Introduction Carbon fiber custom dynamic orthoses (CDOs), a type of ankle-foot orthosis (AFO), have been shown to improve function and mobility. Psychosocial aspects of disability can influence outcomes in prosthetic and orthotic users, but their association with outcomes in CDO users is unknown. Objective The aim of this study was to examine the relationships between physical and psychosocial outcomes following an intensive rehabilitative program including a carbon fiber ankle-foot orthosis, and identify factors related to continued orthosis use. Study Design Retrospective cohort with long-term follow-up. Methods An online survey including questions about device behaviors, self-reported function, pain, global health, self-efficacy, pain interference, resilience, and kinesiophobia was completed by participants who received a custom carbon fiber ankle-foot orthosis and intensive training because of chronic neuromusculoskeletal lower-limb disability. Results The mean follow-up was 4.0 (±1.0) years. Sixty-three adult participants responded to the survey (21 women, 42 men; mean age, 41 ± 12 years). All psychosocial outcomes at follow-up were within “good” or “normal” limits (<1 SD from reference population mean) on average. Strong correlations were observed between self-reported physical function and psychosocial outcomes, and moderate correlations were observed among psychosocial outcomes, between baseline physical outcomes and psychosocial outcomes, and between long-term outcomes and psychosocial outcomes. Device continuation at long-term follow-up was 68%. Conclusions Four years after the intervention, respondents with chronic lower-limb disabilities reported scores that were comparable to normative values for kinesiophobia, health-related quality of life, self-efficacy for managing their condition, pain interference, and psychological resilience. Clinical Relevance Psychosocial variables can affect the outcomes with, and perception of, orthotic devices in individuals with lower-limb neuromusculoskeletal deficits. A goal-oriented care program with emphasis on technique training, postdelivery follow-up, and psychosocial status may help explain long-term outcomes with CDOs and continued device use.

Development of a Body Weight Support System Employing Model-Based System Engineering Methodology

Partial body weight support systems have proven to be a vital tool in performing physical therapy for patients with lower limb disabilities to improve gait. Developing this type of equipment requires rigorous design process that obtains a robust system, allowing physiotherapy exercises to be performed safely and efficiently. With this in mind, a “Model-Based Systems Engineering” design process using SysML improves communication between different areas, thereby increasing the synergy of interdisciplinary workgroups and positively impacting the development process of cyber-physical systems. The proposed development process presents a work sequence that defines a clear path in the design process, allowing traceability in the development phase. This also ensures the observability of elements related to a part that has suffered a failure. This methodology reduces the integration complexity between subsystems that compose the partial body weight support system because is possible to have a hierarchical and functional system vision at each design stage. The standard allowed requirements to be established graphically, making it possible to observe their system dependencies and who satisfied them. Consequently, the Partial Weight Support System was implemented through with a clear design route obtained by the MBSE methodology.

The Reliability and Validity of the OneStep Smartphone Application for Gait Analysis among Patients Undergoing Rehabilitation for Unilateral Lower Limb Disability.

An easy-to-use and reliable tool is essential for gait assessment of people with gait pathologies. This study aimed to assess the reliability and validity of the OneStep smartphone application compared to the C-Mill-VR+ treadmill (Motek, Nederlands), among patients undergoing rehabilitation for unilateral lower extremity disability. Spatiotemporal gait parameters were extracted from the treadmill and from two smartphones, one on each leg. Inter-device reliability was evaluated using Pearson correlation, intra-cluster correlation coefficient (ICC), and Cohen's d, comparing the application's readings from the two phones. Validity was assessed by comparing readings from each phone to the treadmill. Twenty-eight patients completed the study; the median age was 45.5 years, and 61% were males. The ICC between the phones showed a high correlation (r = 0.89-1) and good-to-excellent reliability (ICC range, 0.77-1) for all the gait parameters examined. The correlations between the phones and the treadmill were mostly above 0.8. The ICC between each phone and the treadmill demonstrated moderate-to-excellent validity for all the gait parameters (range, 0.58-1). Only 'step length of the impaired leg' showed poor-to-good validity (range, 0.37-0.84). Cohen's d effect size was small (d < 0.5) for all the parameters. The studied application demonstrated good reliability and validity for spatiotemporal gait assessment in patients with unilateral lower limb disability.

A Brain-Controlled and User-Centered Intelligent Wheelchair: A Feasibility Study.

Recently, due to physical aging, diseases, accidents, and other factors, the population with lower limb disabilities has been increasing, and there is consequently a growing demand for wheelchair products. Modern product design tends to be more intelligent and multi-functional than in the past, with the popularization of intelligent concepts. This supports the design of a new, fully functional, intelligent wheelchair that can assist people with lower limb disabilities in their day-to-day life. Based on the UCD (user-centered design) concept, this study focused on the needs of people with lower limb disabilities. Accordingly, the demand for different functions of intelligent wheelchair products was studied through a questionnaire survey, interview survey, literature review, expert consultation, etc., and the function and appearance of the intelligent wheelchair were then defined. A brain-machine interface system was developed for controlling the motion of the intelligent wheelchair, catering to the needs of disabled individuals. Furthermore, ergonomics theory was used as a guide to determine the size of the intelligent wheelchair seat, and eventually, a new intelligent wheelchair with the features of climbing stairs, posture adjustment, seat elevation, easy interaction, etc., was developed. This paper provides a reference for the design upgrade of the subsequently developed intelligent wheelchair products.

Investigation of the Effectiveness of the Robotic ReStore Soft Exoskeleton in the Development of Early Mobilization, Walking, and Coordination of Stroke Patients: A Randomized Clinical Trial

Medical robotics nowadays can prevent, treat, or alleviate numerous severe conditions, including the dire consequences of stroke. Our objective was to determine the effect of employing a robotic soft exoskeleton in therapy on the development of the early mobilization, gait, and coordination in stroke patients. The ReStore™ Soft Exo-Suit, a wearable exosuit developed by a leading company with exoskeleton technology, was utilized. It is a powered, lightweight device intended for use in stroke rehabilitation for people with lower limb disability. We performed a randomized clinical intervention, using a before–after trial design in a university hospital setting. A total of 48 patients with a history of stroke were included, of whom 39 were randomized and 30 completed the study. Interventions: Barthel Index and modified Rankin scale (mRS) patients were randomly assigned to a non-physical intervention control (n = 9 of 39 completed, 30 withdrew before baseline testing), or to a high-intensity agility program (15 sessions, 5 weeks, n = 30 completed). The main focus of assessment was on the Modified Rankin Scale. Additionally, we evaluated secondary factors including daily life functionality, five dimensions of health-related quality of life, the Beck depression inventory, the 6 min walk test (6MWT), the Berg Balance Scale (BBS), and static balance (center of pressure). The Robot-Assisted Gait Therapy (ROB/RAGT) program led to significant improvements across various measures, including a 37% improvement in Barthel Index scores, a 56% increase in 10 m walking speed, and a 68% improvement in 6 min walking distance, as well as notable enhancements in balance and stability. Additionally, the intervention group demonstrated significant gains in all these aspects compared to the control group. In conclusion, the use of robotic therapy can be beneficial in stroke rehabilitation. These devices support the restoration and improvement of movement in various ways and contribute to restoring balance and stability.

Skin wound healing in diabetic rat model using low-dose photodynamic therapy.

Chronic wound is one of the major challenges in medicine and imposes a heavy financial burden on the healthcare of different countries. Diabetic foot ulcers as one of the important examples for chronic wounds can lead to lower limb amputation, disability, and death in diabetics. In this regard, novel technology with low side effects got attention in recent years. Low-dose photodynamic therapy (LDPDT) is one of the noninvasive techniques that can be considered for wound healing in diabetic wounds. In this experiment, we aim to study the effect of LDPDT on diabetic rats' wound healing and compare it to healthy rats. In this in vitro experimental study, 32 male rats were used. Rats in both normal and diabetic (streptozotocin injection) groups after being wounded (two wounds [0.8×0.8cm]) on the back of each rat were randomly divided into four groups, including the control group (without treatment), radiation-only (660nm-1 J/cm2 ) group, 5-ALA-only (1µg/mL) group, and LDPDT-recipient group. The procedure has been done for 2days, and at the end of Days 3, 7, 14, and 21, the wound sample was sent to the histopathology laboratory, and the wound size and tissue indices in these groups were evaluated by histology and microscopy techniques. The impact of low concentrations of 5-ALA and low irradiation energy density in both normal and diabetic rats were positive, which accelerated the wound-healing process as seen in the histology study. In diabetic rats treated with only radiation and LDPDT, the process of epithelial regeneration, collagen production, reduction of mast cells, and production of follicles was more as compared to the normal group. The results suggest that LDPDT can have a positive impact on the diabetic rat model wound healing.

Methodology based on machine learning through neck motion and POF-based pressure sensors for wheelchair operation

Polymer Optical Fiber (POF)-based sensors have gained recognition in recent years for biomedical applications because of their low cost, physical properties, and feasibility. A novel methodology is proposed here for classifying neck movements using POF- based pressure sensors and machine learning algorithms. To address this, signal pre-processing, feature extraction, and selection methods are implemented, considering variance, root mean square, and Hjorth parameters. Linear Discriminant Analysis, Support Vector Machine, k-Nearest Neighbors (kNN), and Decision Tree (DT) were used for classification. A maximum accuracy of 0.91 was obtained with kNN and DT for recognizing four neck movements by using the best discriminant nine features. These findings indicate that the proposed methodology is suitable for neck-motion classification using POF-based pressure sensors. Future work will focus on the implementation of this strategy for the design of intelligent Human Machine Interfaces based on electric-powered wheelchairs, which would allow for more independence for people with upper- and lower-limb disabilities.

Classification Of Robots and Industrial and Medical Applications

In the last 100 years, robots have evolved from fantasy to reality. Their design, research, and manufacture require the combination of various subjects such as CS, EEE, ME, AI, and others. The main objective is to replace humans in performing heavy or impossible tasks. Robots are classified into different categories based on their era and usefulness. This thesis will analyze industrial robots in terms of their basic stress conditions and activity scope with four degrees of freedom for the normal robot arm. The system architecture, various field interactions, and structure of mechanical fingers for human-like robot arms will also be analyzed. Additionally, this paper will examine the usefulness of service industry robots and highlight the exoskeleton robot for medical treatment by analyzing the forces, torques, and displacements during the walking of patients with lower limb disabilities. The interaction force between humans and exoskeleton robots will be calculated and a model will be constructed. Finally, some difficulties and possible solutions will be presented.

Prevalence of lower limb pain and disability in football, hockey, and floorball players.

Currently there are not enough studies that compared frequent types of collective sports with regard to the prevalence of pain and disability of the lower limb. To determine the prevalence of lower limb pain and disability in team sports players. 388 athletes with average age 27.26 ± 4.69, from sports clubs at the national level were included in the study. The Oxford Hip Score was used to determine the prevalence of hip pain. The International Knee Documentation Committee was used to determine the prevalence of knee pain. The Foot and Ankle Disability Index was used to determine the prevalence of ankle pain. Hockey players had a prevalence of hip pain of 97.2% and a 14.3 times higher risk of developing hip pain compared with football and floorball players. Floorball players had a 81.9% prevalence of knee pain, with a 3.8 times higher the risk of knee pain compared with football and hockey. Floorball players had a 62.3% prevalence of ankle pain and a 1.8 times higher the risk of developing ankle pain compared with football and hockey players. The highest percentage of knee 81.9% and ankle 62.3% pain, as well as the greatest risk of pain, was found among floorball players. Hockey players had the highest prevalence (97.2%) and risk of developing hip pain.

Innovative Stress-responsive Liner Design for Lower Limb Disability

After lower limb amputation or disability, prosthetic limbs are essential for regaining mobility, but skin integrity often degrades due to mechanical stresses at the stump–prosthesis interface. In this study, the finite element method was utilized to predict the areas at the stump–prosthetic interface experiencing the highest levels and distributions of mechanical stresses. The empirical results of the finite element analysis (FEA) delineated the stress concentration sites. Consequently, we devised an innovative liner design tailored to these stress patterns, which was subsequently implemented. The simulation outcomes validated the effectiveness of the liner, demonstrating significant reductions in stress levels at the junction of the residual limb and the prosthetic socket. The results demonstrated that the designed liner was highly effective in reducing stress, particularly in three critical areas: the lateral area of the tibia head (LTH), the tibia end area (TE), and the fibular end (FE). Stress values at the LTH were reduced from 55 to 10 kPa, at the TE from 60 to 28 kPa, and at the FE from 72.3 to 14 kPa. In essence, this liner represents a bespoke intervention, with the FEA serving as a predictive tool that not only identifies critical stress points but also guides the design of personalized prosthetic liners. These findings will improve the structural and functional compatibility of the prosthesis, thereby enhancing wearer comfort and reducing the risk of skin-related complications for persons with disabilities.

Does Exercise Testing with Arm Crank Ergometer Substitute for Cycle Ergometer to Evaluate Exercise Capacity?

Using the upper limbs to test cardiopulmonary exercise can be a useful option in the case of individuals who are unable to pedal a bicycle due to lower limb injury or disability. We evaluated whether exercise testing with the upper limbs can be used equivalently to that of the lower limbs in assessing exercise capacity. Nine collegiate rowers and eight collegiate cyclists underwent incremental exercise testing with an arm crank ergometer (ACE) and cycle ergometer (CE). Heart rate (HR) and oxygen uptake (VO2) were monitored throughout the tests. Segmental muscle mass and flow-mediated dilation of brachial artery were measured to assess the training status of the upper limbs. The muscle mass of the brachium, upper limb, and trunk were greater in the rowers than in the cyclists (p &lt; 0.05). The correlations between HR and VO2 was significantly different depending on exercise modalities, ACE and CE, in both groups (p &lt; 0.001). The estimated maximal VO2 using the correlation formula and age-predicted maximal HR was significantly lower in the exercise testing group with ACE than in the group with CE in rowers and cyclists (41.7 ± 7.3 vs. 52.6 ± 8.6 mL/kg/min, p = 0.010 and 35.5 ± 14.2 vs. 50.4 ± 13.4 mL/kg/min, p = 0.011, respectively). The results suggested that exercise capacity assessed by exercise testing with ACE is underestimated, regardless of the training status of the upper limbs. Further research is needed to verify factors which affect the correlations between HR and VO2 during upper- and lower-limb exercise.

Experimental research progress in traditional Chinese medicine prevention and treatment of diabetic peripheral neuropathy based on autophagy

Diabetic peripheral neuropathy(DPN) is a chronic complication resulted from peripheral nerve injury in the late stage of diabetes. It involves a variety of pathological changes such as oxidative stress, endoplasmic reticulum stress, neuroinflammation, and apoptosis of Schwann cells(SCs). DPN is the main factor leading to lower limb disability or amputation in diabetic patients, with high incidence, long disease course, and poor prognosis. The modern medicine treatment of DPN mainly focuses on controlling blood glucose and improving microcirculation and nerve nutrition, which can only mitigate the clinical symptoms and not fundamentally reverse the pathological changes of peripheral nerves. Autophagy is a self-clearing mechanism that maintains cellular homeostasis by removing excess metabolites. Traditional Chinese medicine(TCM), featuring the holistic concept and syndrome differentiation, can treat chronic diseases in a multi-target, multi-pathway, and wide-range manner. Modern studies have shown that the occurrence and development of DPN are related to a variety of pathological changes, and autophagy is a key mechanism associated with DPN. The environment with persistent high glucose can lead to the inhibition or over-activation of peripheral nerve cells, which causes irreversible damage of nerve cells and the occurrence and development of DPN. Therefore, restoring autophagy balance and reducing nerve damage is one of the key ways to treat DPN. The recent studies have confirmed that some active ingredients in traditional Chinese medicines and TCM compound prescriptions can inhibit the oxidative stress, endoplasmic reticulum stress, mitochondrial damage, inflammation, and apoptosis of SCs in DPN by regulating the autophagy pathway, thus playing a role in the prevention and treatment of DPN. However, the systematic induction in this field remains to be carried out. This paper reviewed the relevant literature, explained the mechanism of TCM in the prevention and treatment of DPN by regulating autophagy, and summarized the potential targets of TCM in the treatment of DPN, with a view to providing new ideas for clinical research and drug development.

Hybrid Nursing Robot Based on Humanoid Pick-Up Action: Safe Transfers in Living Environments for Lower Limb Disabilities

This research paper outlines the development of a modular and adjustable transfer care robot aimed at enhancing safe and comfortable transfers for individuals with lower limb disabilities. To design this robot, we utilized a 3D motion capture system to analyze the movements of a person assisting another person and to determine the necessary range of motion and workspace for the robot. Based on this analysis, we developed a 3-UPS + UPR parallel spreader to transfer the person receiving care. We also conducted kinematic and dynamic analyses of the parallel spreader to validate its operational space and to obtain the force change curve for the drive. To evaluate the robot’s performance, we enlisted the help of ten volunteers with varying heights and weights. Our findings indicate that the pressure distribution during transfers remained largely consistent. Additionally, the surveys revealed that those receiving care perceived the robot as being capable of securely and comfortably transferring individuals between different assistive devices. This modular and adaptable transfer assistance robot presents a promising solution to the challenges encountered in caregiving.

Meta-Analysis of Different Mobility Devices for Rehabilitation of Persons with Disabilities

Loss of physical mobility poses significant challenges to full participation in daily activities and can even lead to complete limitations. In India alone, based on census data from 2011, there are over 5.5 million individuals with lower limb disabilities who rely on manually propelled wheelchairs for their mobility needs. While wheelchairs, crutches, and tricycles are commonly used mobility aids in India, this paper explores mobility technologies that have been conceptualized and developed in other parts of the world to assess their potential applicability in the Indian context.

The Role of Extraversion Personality on Posttraumatic Growth in Victims With Disabilities Due to Earthquakes

The Yogyakarta earthquake in 2006 left many problems, especially for those with disabilities the aftermath earthquake. Posttraumatic growth is an individual’s positive interpretation of negative experiences or feelings. The personality type that is often associated with stress, trauma, and growth events is the extraversion type. The extraversion personality dominates in dealing with traumatic events. This research aimed to find out the roles of extraversion in the posttraumatic growth of survivors with disabilities aftermath earthquake. The subjects were survivors of the Yogyakarta earthquake 2006 (N=51) that suffered upper and lower limbs disability in arms and feet and spinal cord disability. Data were collected using the posttraumatic growth scale and extraversion scale. This study’s data analysis method was simple regression. The results show that extraversion contributes to posttraumatic growth with disabilities aftermath earthquake.&#x0D; Keywords: Extraversion, Posttraumatic growth, Earthquakes

Design and Fabrication of a Lightweight and Wearable Semirigid Robotic Knee Chain Exoskeleton

Abstract With the population of people affected by lower limb disability and physical impairments continuing to grow, engineers in response have begun to develop exoskeletons designed to assist and rehabilitate those in need. While there have been great strides and advancements in the development of exoskeletons, many of them are still too cumbersome, heavy, and expensive for most people. The project described in this paper aims to design and manufacture a wearable robotic knee exoskeleton that helps solve some of the drawbacks that exoskeletons have today. The exoskeleton is designed with lightweight and durable three-dimensional (3D)-printed PETG, TPU, and PLA components combined with soft, flexible, and wearable materials to achieve improved human–robot interaction while providing support when bending and extending the knee joint. The three main assemblies designed in this project were a 3D-printed semirigid knee chain, a 3D-printed flexible shin brace, and a motor actuator assembly mounted on a carbon fiber back plate. The semirigid knee chain is actuated using a Bowden cable which allows the heavy motor to be relocated onto the user's back. solidworks topology optimization and finite element analysis (FEA) were used to reduce weight while keeping the overall strength of the chain and ensuring the safety factor of 2. The exoskeleton was observed to be able to withstand applied torques of up to 29 N·m during the walking functionality test. This exoskeleton is also designed to be integrated into a larger hip exoskeleton system.