Renato Varoto

A Hybrid System for Upper Limb Movement Restoration in Quadriplegics

Generally, quadriplegic individuals have difficulties performing object manipulation. Toward satisfactory manipulation, reach and grasp movements must be performed with voluntary control, and for that, grasp force feedback is essential. A hybrid system aiming at partial upper limb sensory-motor restoration for quadriplegics was built. Such device is composed of an elbow dynamic orthosis that provides elbow flexion/extension (range was approximately from 20 degrees to 120 degrees , and average angular speed was approximately 15 degrees /s) with forearm support, a wrist static orthosis and neuromuscular electrical stimulation for grasping generation, and a glove with force sensors that allows grasping force feedback. The glove presents two user interface modes: visual by light emitting diodes or audio emitted by buzzer. Voice control of the entire system (elbow dynamic orthosis and electrical stimulator) is performed by the patient. The movements provided by the hybrid system, combined with the scapular and shoulder movements performed by the patient, can aid quadriplegic individuals in tasks that involve reach and grasp movements.

Relationship between function, strength and electromyography of upper extremities of persons with tetraplegia.

Study design:Cross-sectional.Objective:To analyze the relationships between functional tests, arm strength and root mean square of surface electromyography (EMG).Setting:Sao Paulo, Brazil.Methods:Twenty-four individuals with chronic tetraplegia participated. Upper extremity motor score (UEMS), functional independence measure (FIM) motor score, spinal cord independence measure III and capabilities of upper extremity (CUE) were performed. Muscle strength of the right elbow flexors–extensors was assessed using dynamometry and manual muscle test (MMT) and EMG of right biceps and triceps brachii were performed. Spearmans rank correlation coefficients and Mann–Whitneys U-test were used.Results:Functional tests and UEMS correlated strongly among them. UEMS highly correlated with triceps dynamometry and EMG. The dynamometry showed a very high correlation with MMT on the extensor group and a moderate correlation with flexor group. Triceps EMG showed moderate correlation with FIM and CUE. High correlations between triceps EMG and elbow extensors dynamometry and MMT were observed. A significant better performance on functional tests was observed on lower ASIA motor levels. The low-tetraplegia group showed a significant higher score on triceps EMG and dynamometry.Conclusion:Arm strength and EMG seem to be related to functional capabilities and independence in chronic tetraplegia.

Análise clinica da espasticidade em indivíduos com lesão medular

OBJECTIVE: To evaluate the effect of neuromuscular electrical stimulation on spasticity in patients with spinal cord injury. METHODS: The study included eleven subjects with spinal cord injuries (C4 to T5). The modified Ashworth scale and pendulum test, which is accomplished through the Pendular Test Device - PTD (equipment which has a quartz crystal transducer accelerometer and optic fiber flexible electrogoniometer measuring the tensions and angular displacements). Patients underwent neuromuscular electrical stimulation (NMES) to the quadriceps muscle from fibular nerve, and the tests were administered before and after therapy. RESULTS: The data show a decrease in spasticity after NMES, with features such as increasead variation between maximum and minimum peaks, i.e. increased amplitude of the curves. Furthermore, data from the subjective scale, and modified Ashworth scale after neuromuscular electrical stimulation also showed a reduction in the values of spasticity. CONCLUSION: The data suggest that NMES is effective in reducing spasticity immediately after completion. Level of Evidence II, Therapeutic Studies-Investigating the Results of Treatment.Objective To evaluate the effect of neuromuscular electrical stimulation on spasticity in patients with spinal cord injury. Methods The study included eleven subjects with spinal cord injuries (C4 to T5). The modified Ashworth scale and pendulum test, which is accomplished through the Pendular Test Device - PTD (equipment which has a quartz crystal transducer accelerometer and optic fiber flexible electrogoniometer measuring the tensions and angular displacements). Patients underwent neuromuscular electrical stimulation (NMES) to the quadriceps muscle from fibular nerve, and the tests were administered before and after therapy. Results The data show a decrease in spasticity after NMES, with features such as increased variation between maximum and minimum peaks, i.e. increased amplitude of the curves. Furthermore, data from the subjective scale, and modified Ashworth scale after neuromuscular electrical stimulation also showed a reduction in the values of spasticity. Conclusion The data suggest that NMES is effective in reducing spasticity immediately after completion. Level of Evidence II, Therapeutic Studies-Investigating the Results of Treatment.

Experiencing Functional Electrical Stimulation Roots on Education, and Clinical Developments in Paraplegia and Tetraplegia With Technological Innovation

Cybernetics-based concepts can allow for complete independence for paralyzed individuals, including sensory motor recovery. Spinal cord injuries are responsible for a huge stress on health and a financial burden to society. This article focuses on novel procedures such as functional diagnosis for paraplegics and tetraplegics, cybertherapies toward lessening comorbidities such as cardiovascular diseases, osteoporosis, etc., and the production of new technology for upper and lower limb control. Functional electrical stimulation reflects a unique opportunity for bipedal gait to be achieved by paraplegics and tetraplegics. Education and training of undergraduates and postgraduates in engineering and life sciences have also been a major aim of this work.

AVALIAÇÃO CINEMÁTICA DA TRANSFERÊNCIA DE PARAPLÉGICOS DA CADEIRA DE RODAS

Objective: To evaluate the transfer strategy of paraplegic subjects from their wheelchairs. Methods: Twelve thoracic spinal cord injured subjects participated in this study (T2 to T12). The subjects were able to independently transfer from a wheelchair to a one square meter (m2) platform, half a meter in height. Images of reflexive anatomic markers were captured by six ProReflex infrared cameras and processed using a QTRac Capture software. Kinematic parameters of the trunk, head, shoulders and elbows were evaluated. Results: The data analyzed compared the subjects’ preferential side for performing transfers, according to the functions performed by each body segment. Angular displacement of the head on sagittal plan (y-z), and the shoulders on the transversal plan (x-y), showed statistical differences (p<0.05). Conclusion: The data obtained on this study showed that there are differences in transfer strategies of paraplegic subjects to their preferential side, in comparison with the non-preferential side. Level of Evidence II, Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

A Low Cost Wireless System to Monitor Plantar Pressure using Insole Sensor: Feasibility Approach.

Plantar pressure analysis is an important strategy applied in clinical, orthopaedics, sports and rehabilitation studies. In this context, this work describes the development and application of wireless system to monitor plantar pressure. This system is composed by a data acquisition module based on low cost electronic instrumentation, high resolution insole flexible pressure sensor and Java application for data real-time visualization. To verify the feasibility and effectiveness of the system, workbench tests were realized and a healthy subject performed pilot trials based on static and dynamic activities on the biomechanics platform. According to the preliminary results, this system is effective to show the interaction between the foot and floor in static and dynamic conditions, presenting a measurement range of pressure of 0-300kPa and rapid response, among other features. Thus, this system is a feasible tool for quick and practical mapping of plantar

Can Simple Electronic Instrumentation Associated with Basic Training Help Users of Assistive Devices

Crutches are prescribed towards compensating lower limb overload and adding sensory information through upper limb. However, adequate loads are required to avoid upper limb lesions and further lower limb injuries. Therefore, this work describes the development and application of a biofeedback module for a Lofstrand crutch, based on a simple electronic instrumentation. The goal is to train the user to apply proper load on the crutch. Basic training was performed by healthy subjects before and after static and dynamic activities. Results showed the feasibility of the device and the effectiveness of the training to reach the target (load on the crutch of 20% of body weight).

Development and Application of a Portable Device for Cutaneous Thermal Sensitivity Assessment: Characterizing the Neuropathic Pain Following Spinal Cord Injury

Neuropathic pain is characterized to arise due to injury or dysfunction of Peripheral and Central Nervous Systems, without stimulation of nociceptors, being one of the major problems following spinal cord injury (SCI). It involves altered mechanisms of impulse transmission in somatosensory pathways, causing abnormal sensations. Quantitative and qualitative sensory tests, by the detection of tactile and thermal stimuli and McGill Pain Questionnaire, are methods used to characterize and study the neuropathic pain. Therefore, this work describes the development and application of a portable device for cutaneous thermal sensitivity assessment in spinal cord injured subjects (SCIS). Using method of levels, the assessment was applied in healthy subjects and SCIS with and without neuropathic pain. The thresholds determined for healthy subjects during thermal sensitivity assessment are consistent and other results provided by clinical trials are according to previous works, demonstrating the device feasibility as an auxiliary tool for neuropathic pain study.