Lower Limb Disability Research Articles

ABLE: A Standing Style Transfer System for Persons with Lower Limb Disability

Research in Medical & Engineering Sciences ABLE: A Standing Style Transfer System for Persons with Lower Limb Disability Yoshikazu Mori1*, Ken Maejima2 and Masato Yukishita3 1Domain of Mechanical Systems Engineering, Japan 2Nakayama Corp. Ltd, Japan 3PHC Holdings Corp, Japan *Corresponding author: Yoshikazu Mori, Domain of Mechanical Systems Engineering, Ibaraki University, Japan Submission: June 26, 2019Published: July 02, 2019 DOI: 10.31031/RMES.2019.07.000674 ISSN: 2576-8816Volume7 Issue5

Hedonic Adaptation to Treatment: Evidence from a Medical Intervention

We investigate whether changes in life circumstances lead to long-lasting changes in subjective well-being using a medical intervention that provided orthotic equipment to Ugandan adults with lower limb disabilities. The intervention had a positive effect on mobility and physical health, and treated patients reported a significant improvement in life satisfaction in the first few months after the treatment. However, the effect on subjective well-being was not prolonged. After one year, life satisfaction returned to the pre-treatment levels. The evidence of adaptation is also supported by evidence of changes in patients’ reference levels, in the form of aspirations measured as both the level of income considered sufficient to live well, and the minimum income to make ends meet.

Investigation of gait cycle deviation over surface irregularities utilizing muscle activities.

Human beings regularly walk over even and uneven surfaces during their daily activities. A human being with lower limb disability needs an exoskeleton to walk independently. However, walking surface irregularities increase the risk of falling of exoskeleton users. This falling tendency can be minimized by balancing the exoskeleton on irregular surface profiles against the gait cycle variation. Gait variation is studied using quality EMG signals obtained from the gastrocnemius and hamstring muscle activity during uneven surface walking. The present study compares the activity of hamstring and gastrocnemius muscles during walking on a treadmill, utilizing both even and uneven planes. Integrated electromyography signals from eight healthy male subjects are collected while walking on a treadmill, even and uneven planes. Muscle activity variation on these planes is studied using two-way ANOVA with replications. The results show that hamstring muscle activity registers a sound variation in swing phase but has no variation in stance phase over all three planes, whereas gastrocnemius muscle activity changes between swing and stance phases over even and uneven planes during forward walking. The results illustrate that the gait cycle variation depends on surface irregularities which indicates the importance of surface consideration.

The Future of Mobility

A highly prestigious design competition has the potential to revolutionise the lives of those suffering from lower limb disability.

A compact wrist rehabilitation robot with accurate force/stiffness control and misalignment adaptation

Robots have been demonstrated to assist the rehabilitation of patients with upper or lower limb disabilities. To make exoskeleton robots more friendly and accessible to patients, they need to be lightweight and compact without major performance tradeoffs. Existing upper-limb exoskeleton robots focus on the assistance of the coarse-motion of the upper arm while the fine-motion rehabilitation of the forearm is often ignored. This paper presents a wrist robot with three degrees-of-freedom. Using a geared bearing, slider crank mechanisms, and a spherical mechanism, this robot can provide the complete motion assistance for the forearm. The optimized robot dimensions allow large torque and rotation output while the motors are placed parallel to the forearm. Thus lightweight, compactness, and better inertia properties can be achieved. Linear and rotary series elastic actuators (SEAs) with high torque-to-weight ratios are proposed to accurately measure and control the interaction force and impedance between the robot and the wrist. The resulting 1.5-kg robot can be used alone or easily in combination with other robots to provide various robot-aided upper limb rehabilitation.

Test-retest reliability of a maximal arm cycle exercise test for younger individuals with traumatic lower limb amputations

Study design: Cross-sectional study design.Background: Cardiopulmonary exercise testing (CPET) using the upper-body is an alternative to standardised CPET. A variety of test protocols has been developed for CPET performed on an arm crank for individuals with lower limb disabilities. However, no test protocol specifically designed to evaluate exercise capacity in younger adults with lower limb amputees is available.Objective: To determine test–retest reliability of VO2peak, watts, test time and max heart rate for an upper-body CPET.Methods: Males with unilateral lower limb amputation at crus-level or above, aged 18–40 years, without comorbidities preventing arm cycling were eligible. Participants completed three maximal tests with a minimum of two days between tests and maximum 14 days between the first and third test.Results: Eight participants volunteered to participate and were tested three times. Excellent and acceptable ICC values were found for power in Watts (ICC = 0.73) and test time (ICC = 0.74). Good but non-acceptable test–retest reliability was found for VO2peak (ICC = 0.51) and max heart rate (ICC = 0.64) for all three test sessions.Conclusions: Upper-body CPET shows acceptable test–retest reliability for Watts and test time in younger adult lower limb amputees, but non-acceptable reliability for VO2peak and heart rate.

Prognostic factors of disability in relapsing remitting multiple sclerosis

Background: The clinical manifestation of multiple sclerosis (MS) is highly variable. Factors influencing phenotypic heterogeneity are not well known since most studies have relied on the Expanded Disability Status Scale which has modest inter/intra-rater reliability. We therefore sought to investigate other reliable and valid measures of impairment. Methods: We constructed a retrospective cohort of 2083 relapsing remitting MS patients using electronic health records to identify prognostic factors of Timed 25-Foot Walk (lower limb disability), Performance Scales Sum (perceived global disability), and Patient Health Questionnaire 9 (a depression tool). Patients had a clinical visit between 1/1/2008 and 5/29/2012, and at least one additional visit within approximately 3 years; the cohort consisted of 16,538 visits. The outcomes and predictors were extracted from the records. Longitudinal models were conducted, and sex- and race-specific differences were explored. Results: Walking speeds were slower in females, black patients, ever smokers, and Medicaid/Medicare beneficiaries. Higher body mass index (BMI), older age, longer disease duration, lower median income, and higher depression scores also predicted slower walking speeds. Older age, higher BMI, lower median income, higher depression scores, ever smokers and Medicaid/Medicare beneficiaries were associated with higher global disability. Those who were of younger age, higher BMI, lower median income, ever smoked, and on Medicaid had higher depressive scores. The effect of age and BMI on depressive scores were restricted to female and white patients, respectively. Conclusion: We identified multiple longitudinal predictors of disability in relapsing remitting patients. Modifiable factors (including smoking and BMI) and adverse socioeconomic conditions were independently, and negatively associated with walking speed, global disability, and depression.

Design and Feasibility Study of a Leg-exoskeleton Assistive Wheelchair Robot with Tests on Gluteus Medius Muscles.

The muscles of the lower limbs directly influence leg motion, therefore, lower limb muscle exercise is important for persons living with lower limb disabilities. This paper presents a medical assistive robot with leg exoskeletons for locomotion and leg muscle exercises. It also presents a novel pedal-cycling actuation method with a crank-rocker mechanism. The mechanism is driven by a single motor with a mechanical structure that ensures user safety. A control system is designed based on a master-slave control with sensor fusion method. Here, the intended motion of the user is detected by pedal-based force sensors and is then used in combination with joystick movements as control signals for leg-exoskeleton and wheelchair motions. Experimental data is presented and then analyzed to determine robotic motion characteristics as well as the assistance efficiency with attached electromyogram (EMG) sensors. A typical muscle EMG signal analysis shows that the exercise efficiency for EMG activated amplitudes of the gluteus medius muscles approximates a walking at speed of 3 m/s when cycling at different speeds (i.e., from 16 to 80 r/min) in a wheelchair. As such, the present wheelchair robot is a good candidate for enabling effective gluteus medius muscle exercises for persons living with gluteus medius muscle disabilities.

Acupuncture Enhances Communication between Cortices with Damaged White Matters in Poststroke Motor Impairment.

Stroke is a leading cause of motor disability. Acupuncture is an effective therapeutic strategy for poststroke motor impairment. However, its mechanism is still elusive. Twenty-two stroke patients having a right-hemispheric subcortical infarct and 22 matched healthy controls were recruited to undergo diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) scanning. The resting-state fMRI was implemented before and after needling at GB34 (Yanglingquan). The stroke patients presented a substantially reduced fractional anisotropy value in the right superior longitudinal fasciculus (SLF), corticospinal tract, and corpus callosum. The structural integrity of the frontoparietal part of the SLF (SLF-FP) correlated with the motor scores of lower limbs in stroke patients. This corticocortical association bundle originated from the premotor cortex (PM) and the adjacent supplementary motor area (SMA), known as secondary motor areas, and terminated in the supramarginal gyrus (SMG). After acupuncture intervention, the corresponding functional connectivity between the PM/SMA and SMG was enhanced in stroke patients compared with healthy controls. These findings suggested that the integrity of the SLF is a potential neuroimaging biomarker for motor disability of lower limbs following a stroke. Acupuncture could increase the communication between the cortices connected by the impaired white matter tracts, implying the neural mechanism underlying the acupuncture intervention.

Research Progress of Lower Limb Rehabilitation Robots in Mainland China

The number of people with lower limb disabilities caused by stroke, traffic accidents and work-related injuries is increasing sharply every year in mainland China, and the corresponding number of rehabilitation therapists is obviously insufficient. To solve this problem, domestic large hospitals have introduced advanced lower limb rehabilitation robots from abroad. However, such robots are expensive and the number of them cannot meet the needs of patients. As a result, many universities and colleges in mainland China have launched research on this issue. This paper collects and collates the research literature, gives the mature and typical structure and control system design scheme in mainland China, and lists some representative research results. Finally, the rehabilitation effect of these lower limb rehabilitation robots is evaluated.

Entropy-Based Surface Electromyogram Feature Extraction for Knee Osteoarthritis Classification

Knee osteoarthritis (KOA) is one of the major causes of lower limb disability. This study aims to develop a computer-based approach to discriminate KOA individuals from controls by using entropy-based features, and therefore to provide an auxiliary, quantitative tool for KOA diagnosis. The surface EMG (sEMG) data were collected from the vastus lateralis, vastus medialis, biceps femoris, and semitendinosus when KOA participants and controls were walking barefoot on ground at a self-paced speed. We employed and compared three different entropy measures, including 1) approximate entropy, 2) sample entropy, 3) fuzzy entropy, for extracting KOA-related features from the sEMG signals for classification. The differences between the KOA group and healthy controls are primarily shown in the fuzzy entropy features extracted from the vastus medialis and biceps femoris muscle pair. Among all tested measures, the fuzzy entropy yielded the best performance in distinguishing KOA patients from controls, with 92% of accuracy, 91.43% of sensitivity and 93.33% of specificity. The results indicate that the fuzzy entropy method is applicable for extracting KOA-related features from sEMG, which can be developed as a sensitive metric for computer-assist diagnosis of knee osteoarthritis.

Biomedical Variables and Adaptation to Disease and Health-Related Quality of Life in Polish Patients with MS.

The aim of this research was to assess the level of adaptation to multiple sclerosis (Sclerosis multiplex; MS) and health-related quality of life (HRQoL) of the study population as well as to determine the relationship between biomedical factors related to the course of multiple sclerosis, adaptation to the disease, and HRQoL. Analysis of medical records, clinical and psychological interviews, the Extended Disability Status Scale (EDSS), Guy’s Neurological Disability Scale (GNDS), the Acceptance of Illness Scale (AIS), and the Multiple Sclerosis Impact Scale 29 (MSIS-29) were collected from 137 patients with MS. It was found that there was a relation between motor impairment, neurological disability, adaptation to illness, and HRQoL; it was also found that there were negative correlations between adaptation to illness and the severity of lower-limb disability, fatigue, mood disorders, other problems related to MS, and upper-limb disability. Of all the symptoms, lower-limb disability, fatigue, and mood disorders had the strongest relation with adaptation. All of the analysed symptoms were found to correlate with HRQoL. Of all the symptoms, HRQoL was most affected by lower- and upper-limb disability, fatigue, other MS problems, and mood disorders.

Design and Performance Evaluation of a Wearable Sensing System for Lower-Limb Exoskeleton.

Because the target users of the assistive-type lower extremity exoskeletons (ASLEEs) are those who suffer from lower limb disabilities, customized gait is adopted for the control of ASLEEs. However, the customized gait is unable to provide stable motion for variable terrain, for example, flat, uphill, downhill, and soft ground. The purpose of this paper is to realize gait detection and environment feature recognition for AIDER by developing a novel wearable sensing system. The wearable sensing system employs 7 force sensors as a sensing matrix to achieve high accuracy of ground reaction force detection. There is one more IMU sensor that is integrated into the structure to detect the angular velocity. By fusing force and angular velocity data, four typical terrain features can be recognized successfully, and the recognition rate can reach up to 93%.

Cycling with/without functional electrical stimulation improves lower limbs disability in patients post-stroke: A systematic review with meta-analysis

Cycling with or without functional electrical stimulation (FES) is an effective way to rehabilitate patients with lower limb disability. The purpose of this systematic review and meta-analysis was to quantify the effectiveness of different protocols of cycling with/without FES on lower limbs after stroke. The following databases were searched: PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index of Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness, by means of words relevant to randomized and stroke, cycling and lower limbs disability. Randomized-controlled trials from 1990 to July 2017 were included following predetermined search and selection criteria. Data extraction was performed using a predetermined data collection form. A total of 15 trials satisfied eligibility criteria for this review. Cycling had a positive effect on 6 meter walking test performance [30.4 s; −1.9 to 62.6 (standardized mean difference; 95% confidence interval)] compared with no or placebo intervention (control). Cycling had a positive effect on walking speed (0.10 m/s; 0.1–0.2), based on the results of 10 meter walking test, compared with control. Cycling had a positive effect on balance based on Berg score (0.25; −0.44 to 0.94) compared with control. Cycling with FES had a positive effect on balance (1.95; 1.33–2.52) compared with cycling alone. Although cycling alone has a positive effect on walking ability, walking speed, and balance the effects are small and variable. In terms of balance, positive effects substantially smaller when compared with concurrent effect of FES with cycling with low evidence. It appears that cycling with or without functional electrical stimulation has positive effects on walking ability walking speed and balance, but further research is needed to confirm the clinical utility of these modalities for stroke patients.

Analysis and construction of a prosthetic foot

The assistive devices for people with disabilities are configured as a set of mechanical, electromechanical, orthotic and prosthetic parts designed to assist in the rehabilitation process of patients who suffered amputation of their lower limbs, whether the injury generates The implementation of a transtibial or transfemoral prosthesis these elements must be performed with proper analysis of pre-amputation, amputation and post amputation in order to achieve specific objectives for each patient, achieving the best possible treatment. It is important to ensure that in the treatment of lower limb disability by amputation, the best decisions are generated for the patient, with the objective of bringing the patient closer to a normal gait pattern. Considering these characteristics it will be possible to elaborate a prosthetic element that meets the physical and personal characteristics of the patient such as activity level, age, weight ... etc. Taking into account each of these variables we have decided to analyze in depth a crucial element in the implementation of lower limb prosthesis such as the foot, which we carry from a phase of analysis, design, to implementation in carbon fiber where we currently perform tests with our patients under study.

Standing automatic stabilization control for people with disability in lower limbs

Standing automatic stabilization control for people with disability in lower limbs

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AT A TERTIARY ORTHOPEDIC TRAUMA CENTER.

ABSTRACTObjective:To evaluate the profile of patients with osteoporotic fractures treated at a tertiary orthopedic hospital. Methods:Using questionnaires, 70 patients with osteoporotic fractures (OF) were compared with 50 outpatients with multiple osteoarthritis (OA) followed through an outpatient clinic. Results:The OF group was older (p <0.001), less heavy (p=0.003), had lower BMI (p=0.006), was more likely to be white (p=0.011), was less likely to be married (p=0.008), and had previous falls, previous fractures, old fractures (>1 year), falls in the last 12 months, fractures due to falls, and needed more assistance (p<0.05). They also had lower Lawton & Brody Instrumental Activities of Daily Living scores (p <0.05) and reported less lower limb disability, foot pathology, muscle weakness, hypothyroidism, and vitamin D intake than patients in the OA group. White race, previous falls, and previous fractures increase the risk of osteoporotic fractures by 10.5, 11.4, and 4.1 times, respectively. The chance of fracture dropped 29% for each one-unit increase in Lawton & Brody IADL score. Married participants had fewer fractures than participants with other marital status. Conclusion:Together, race, marital status, previous falls, foot pathologies, previous fractures, and IADL scores define the profile of patients with osteoporotic fractures. Level of Evidence III; Case control study.

Impact of rear wheel axle position on upper limb kinematics and electromyography during manual wheelchair use

Manual wheelchair propulsion is an important form of mobility for people with lower limb disabilities. Changes in the wheelchair configuration can affect, range of motion (ROM) of the upper limb joints, muscle actions and system stability. The purpose of this study is to investigate the impact of adjusting wheelchair configurations on upper body joints kinematics and muscle recruitment for able-bodied non experienced manual wheelchair users through applying a marker-based 3D motion analysis technique. Ten healthy male subjects were characterised for three wheelchair configurations, set by adjusting the horizontal axle position of both rear wheels by (3 cm) and (6 cm) posteriorly from the original position set by the manufacturer. Selected 3D kinematic and surface electromyography (sEMG) parameters of the upper body joints and shoulder muscles were measured in the Cardiff University Motion Analysis Laboratory. During the propulsion trials, trunk flexion/extension, lateral bending and axial rotation were evaluated within the average range of (7.50°±1.4°), (5.91°±1.23°) and (7.01°±3.91°), respectively. Dominant shoulder abduction/adduction, flexion/extension and internal/external rotation were evaluated within the average range of (24.63°±6.38°), (17.31°±4.27°) and (40.02°±12.35°), respectively. Dominant elbow pronation/supination and flexion/extension were evaluated within the range of (15.49°±7.70°) and (34.37°±8.38°), respectively. Dominant wrist radial/ulnar deviation and flexion/ extension were evaluated within the average range of (29.82°±8.97°) and (53.59°±9.65°), respectively. With normalising the muscle EMG to the percentage of MVC activity, posterior deltoid had the highest average EMG muscle activity (11.43 ± 5.33) during the propulsion trials and at the three wheel adjustments relative to the other dominant shoulder muscles. Other average muscles activities were evaluated as (6.99 ± 2.37) for upper trapezius, (6.89 ± 2.51) for triceps brachii, (5.39 ± 2.95) for anterior deltoid, (3.26 ± 1.00) for biceps brachii and (3.14 ± 1.26) for pectoralis major as the lowest average activity. The findings of this study indicate that changing rear wheel axle position posteriorly is correlated with increasing the kinematic ROMs of the trunk and dominant upper limb and the sEMG activities of the muscles predominantly involved with the recovery phase of propulsion which could be linked with higher risks of musculoskeletal disorders. This knowledge may help professionals when designing and prescribing wheelchairs that are more proper to users’ functional characteristics, accordingly profiting them improved quality of life.

The Effect of Sling Exercise Therapy with Vibration Balls on Upper Limb Muscle Activity for Paraplegia-Spinal Cord Injury

Objective: The purpose of the present study is to investigate the effect of a muscle activity by applying the complex exercise method of sling in accordance with the provision of various vibration intensities for paraplegia-spinal cord injury. Method: The subjects of the study were 15 men in their 40s and 50s with lower limb disabilities and low potential risk, who were randomly divided into a sling exercise group (SG n=4), a sling with low frequency vibration group (SLVG n=4), a sling with mid-frequency vibration group (SMVG n=4), and a sling with high frequency group (SHVG n=4) in accordance with the provision of slings and vibration stimuli. The vibratory intensity provided was divided into low frequency (30 Hz), mid-frequency (50 Hz), and high frequency (70 Hz). The anterior deltoid (AD), the posterior deltoid (PD), the pectoralis major (PM), the upper trapezius (UT), the latissimus dorsi (LD), and the multifidus (MF) were measured to compare and analyze muscle activity. Results: The closed kinetic chain (CKC) exercise to the shoulder joint showed higher muscle activity in most muscles for the SMVG, and statistically significant differences in the anterior deltoid (AD), the pectoralis major (PM), and the multifidus (MF) in particular. Conclusion: The intermediate frequency (50 Hz) string vibration was the effective vibration stimuli for Closed kinetic chain (CKC) exercises.

Motion Control of Cycling Wheelchair With Continuously Variable Transmission and Clutch

The cycling wheelchair, which is pedaled like a bicycle, is an effective device for improving its user's activities of daily living. It is commercially available in Japan, and is currently being used by hospitals and rehabilitation facilities. However, many patients, particularly those with lower-limb disabilities, would like to use it both indoors and outdoors. Indoor use requires relatively slow forward and backward movement combined with a small turning radius, all of which increase maneuverability in confined spaces. In contrast, outdoor use requires the cycling wheelchair to move faster with bicycle-like mobility and a freewheel mechanism for comfortable driving, although the latter precludes pedaling backward. In addition, the user would like to ascend slopes easily and descend them safely. Hence, the cycling wheelchair requires a transmission system that can change the gear ratio based on the environment, and an automatic braking system. In this letter, we discuss in more detail the assistive functions required of the cycling wheelchair, and we realize them by developing a new cycling wheelchair with a continuously variable transmission and clutch. In addition, we conduct experiments to illustrate the validity of the proposed cycling wheelchair and its control method.