Josep Medina

Gait Training in Human Spinal Cord Injury Using Electromechanical Systems: Effect of Device Type and Patient Characteristics

OBJECTIVEnTo report the clinical improvements in spinal cord injury (SCI) patients associated with intensive gait training using electromechanical systems according to patient characteristics.nnnDESIGNnProspective longitudinal study.nnnSETTINGnInpatient SCI rehabilitation center.nnnPARTICIPANTSnAdults with SCI (n=130).nnnINTERVENTIONnPatients received locomotor training with 2 different electromechanical devices, 5 days per week for 8 weeks.nnnMAIN OUTCOME MEASURESnLower-extremity motor score, Walking Index for Spinal Cord Injury, and 10-meter walking test data were collected at the baseline, midpoint, and end of the program. Patients were stratified according to the American Spinal Injury Association (ASIA) category, time since injury, and injury etiology. A subgroup of traumatic ASIA grade C and D patients were compared with data obtained from the European Multicenter Study about Human Spinal Cord Injury (EM-SCI).nnnRESULTSnOne hundred and five patients completed the program. Significant gains in lower-limb motor function and gait were observed for both types of electromechanical device systems, to a similar degree. The greatest rate of improvement was shown in the motor incomplete SCI patients, and for patients <6 months postinjury. The positive response associated with training was not affected by injury etiology, age, sex, or lesion level. The trajectory of improvement was significantly enhanced relative to patients receiving the conventional standard of care without electromechanical systems (EM-SCI).nnnCONCLUSIONSnThe use of electromechanical systems for intensive gait training in SCI is associated with a marked improvement in lower-limb motor function and gait across a diverse range of patients and is most evident in motor incomplete patients, and for patients who begin the regimen early in the recovery process.

Decrease of spasticity with muscle vibration in patients with spinal cord injury

OBJECTIVEnSpasticity is common after spinal cord injury (SCI). Exaggerated tendon jerks, clonus, and spasms are key features of spasticity that result from hyperexcitability of the stretch reflex circuit. Here we studied the effects of vibration on the rectus femoris muscle (RF) on clinical and electrophysiological measures of spasticity in the leg.nnnMETHODSnNineteen SCI patients with spasticity and nine healthy subjects were studied at baseline and under stimulation (vibration at 50 Hz during 10 min on the thigh). Neurophysiological studies included evaluation of the soleus T wave and Hmax/Mmax ratio. Clinical measurements of spasticity were the score in the Modified Ashworth Scale (MAS), range of motion (ROM), and duration and frequency of clonus.nnnRESULTSnPatients with incomplete SCI (iSCI) presented higher number of cycles and longer duration of clonus than patients with complete SCI (cSCI). The Hmax/Mmax ratio and T wave amplitude at baseline were significantly larger in iSCI patients than in cSCI or healthy subjects. During vibration, we found a significant reduction of MAS and duration of clonus, and an increase in ROM, in all patients as a group. The Hmax/Mmax ratio and the T wave amplitude decreased significantly in both, patients and controls.nnnCONCLUSIONSnProlonged vibration on proximal lower extremity muscles decreased limb spasticity in patients with spinal cord injury, regardless of whether the lesion is complete or incomplete.nnnSIGNIFICANCEnMuscle vibration may be useful for physical therapy, by facilitating passive and active movements of the extremities in spastic SCI patients.

Hybrid EEG/EOG-based brain/neural hand exoskeleton restores fully independent daily living activities after quadriplegia

A noninvasive, hybrid brain/neural hand exoskeleton restored intuitive control of grasping motion, restoring independent activities to quadriplegics. Direct brain control of advanced robotic systems promises substantial improvements in health care, for example, to restore intuitive control of hand movements required for activities of daily living in quadriplegics, like holding a cup and drinking, eating with cutlery, or manipulating different objects. However, such integrated, brain- or neural-controlled robotic systems have yet to enter broader clinical use or daily life environments. We demonstrate full restoration of independent daily living activities, such as eating and drinking, in an everyday life scenario across six paraplegic individuals (five males, 30 ± 14 years) who used a noninvasive, hybrid brain/neural hand exoskeleton (B/NHE) to open and close their paralyzed hand. The results broadly suggest that brain/neural-assistive technology can restore autonomy and independence in quadriplegic individuals’ everyday life.

Usability test of a hand exoskeleton for activities of daily living: an example of user-centered design

Abstract Purpose: (1) To assess a robotic device (Handexos) during the design process with regard to usability, end user satisfaction and safety, (2) to determine whether Handexos can improve the activities of daily living (ADLs) of spinal cord injury (SCI) patients and stroke patients with upper-limb dysfunction. Methods: During a 2-year development stage of the device, a total of 37 participants (aged 22–68), 28 clinicians (experts) and nine patients with SCI or stroke (end users) were included in a user-centered design process featuring usability tests. They performed five grasps wearing the device. The assessments were obtained at the end of the session by filling out a questionnaire and making suggestions. Results: The experts’ opinion was that the modified device was an improvement over the preliminary version, although this was not reflected in the scores. Whereas end user scores for comfort, grasp, performance and safety were above the sufficiency threshold, the scores for year 2 were lower than those for year 1. Conclusions: The findings demonstrate that although Handexos meets the initial functional requirements and underlines the potential for assisting SCI and post-stroke subjects in ADLs, several aspects such as mechanical complexity and low adaptability to different hand sizes need to be further addressed. Implications for Rehabilitation Wearable robotics devices could improve the activities of daily living in patients with spinal cord injury or stroke. They could be a tool for rehabilitation of the upper limb. Further usability tests to improve this type of tools are recommended.

Dysfunctional Profile for Patients in Physical Neurorehabilitation of Upper Limb

This paper proposes a first approach to Objective Motor Assessment (OMA) methodology. Also, it introduces the Dysfunctional profile (DP) concept. DP consists of a data matrix characterizing the Upper Limb (UL) physical alterations of a patient with Acquired Brain Injury (ABI) during the rehabilitation process. This research is based on the comparison methology of UL movement between subjects with ABI and healthy subjects as part of OMA. The purpose of this comparison is to classify subjects according to their motor control and subsequently issue a functional assessment of the movement. For this purpose Artificial Neural Networks (ANN) have been used to classify patients. Different network structures are tested. The obtained classification accuracy was 95.65%. This result allows the use of ANNs as a viable option for dysfunctional assessment. This work can be considered a pilot study for further research to corroborate these results.

P22.10 Motor and gait improvement in incomplete spinal cord injury with high-frequency repetitive transcranial magnetic stimulation

shortening of PT and MT with no changes in emCT between 90 and 150 seconds in test with respect to control trials. The differences became again non significant at the interval of 300 seconds. Conclusions: Our study indicates that the neural drive used to execute a patterned ballistic voluntary movement is influenced by the preceding activity of the motor system. The history of the recent motor activity should be specifically considered in those circumstances in which previous local fatigue cannot be avoided.