Powered Exoskeletons for Walking Assistance in Persons with Central Nervous System Injuries: A Narrative Review

Esquenazi, Alberto; Talaty, Mukul; Jayaraman, Arun

doi:10.1016/j.pmrj.2016.07.534

Cited by 141 publications

(81 citation statements)

References 46 publications

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“…Reviews about robotic rehabilitation for gait recovery in stroke patients mainly involved static exoskeletons [22]; reviews about wearable powered exoskeletons are few, with small populations, and are mainly technical, scoping, or narrative [23,24].…”

Section: Resultsmentioning

confidence: 99%

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Molteni

Gasperini

Cannaviello

et al. 2018

PM&R

196

143

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Recovery of upper and lower limbs function is essential to reach independence in daily activities in patients with upper motor neuron syndrome (UMNS). Rehabilitation can provide a guide for motor recovery influencing the neurobiology of neuronal plasticity providing controlled, repetitive, and variable patterns. Increasing therapy dosage, intensity, number of repetition, execution of task‐oriented exercises, and combining top‐down and bottom‐up approaches can promote plasticity and functional recovery. Robotic exoskeletons for upper and lower limbs, based on the principle of motor learning, have been introduced in neurorehabilitation. In this narrative review, we provide an overview of literature published on exoskeleton devices for upper and lower limb rehabilitation in patients with UMNS; we summarized the available current research evidence and outlined the new challenges that neurorehabilitation and bioengineering will have to face in the upcoming years. Robotic treatment should be considered a rehabilitation tool useful to generate a more complex, controlled multisensory stimulation of the patient and useful to modify the plasticity of neural connections through the experience of movement. Efficacy and efficiency of robotic treatment should be defined starting from intensity, complexity, and specificity of the robotic exercise, that are related to human‐robot interaction in terms of motion, emotion, motivation, meaning of the task, feedback from the exoskeleton, and fine motion assistance. Duration of a single session, global period of the treatment, and the timing for beginning of robotic treatment are still open questions. There is the need to evaluate and individualize the treatment according to patient's characteristics. Robotic devices for upper and lower limbs open a window to define therapeutic modalities as possible beneficial drug, able to boost biological, neurobiological, and epigenetic changes in central nervous system. We need to implement large and innovative research programs to answer these issues in the near future.

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Section: Resultsmentioning

confidence: 99%

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Molteni

Gasperini

Cannaviello

et al. 2018

PM&R

196

143

View full text Add to dashboard Cite

show abstract

“…However, they remain as the less desirable options due to the lack of upright bipedal walking. It has been suggested that standing itself has physical and psychological benefits that are not replicated by wheelchairs (Esquenazi et al 2017). …”

Section: Non-orthotic Robot-based Hybrid Systemsmentioning

confidence: 99%

Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies

Anaya

Thangavel

Huang

2018

Int J Intell Robot Appl

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Gait disorders in neurologically disabled people can be treated by various techniques available today which include passive orthoses, functional electrical stimulation (FES) and robot assisted gait training devices (RAGT). However, each system has its own drawback. For example, gait rehabilitation with orthosis is physically taxing for the patient with no significant functional improvement. FES uses muscle powers as physiological actuators to promote balance and improve gait but leads to fatigue, along with poor control of joint trajectories. RAGT devices including powered exoskeletons, gait rehabilitation systems employing programmable footplates and mobile training platforms, have shown significant advantages but the devices are not yet mature due to numerous drawbacks associated with physical and cognitive interaction, energy-management and portability issues. The combination of FES technology and RAGT devices, often named hybrid FES-robot technologies, has arisen as a promising approach to aid in gait restoration. This work reports a comprehensive review on the hybrid FES-robot technologies over the last decades, focusing on different mechanical structures, actuator designs, sensing technologies, and control approaches. The hybrid robotic structures are classified into two categories: (i) orthotic-based hybrid systems, where (a) FES is used to stimulate the muscles and produce joint torque while the robotic system acts as energy dissipating device, and (b) FES and robotic systems are both torque-generating devices; and (ii) non-orthotic based hybrid systems. The review compiles a variety of sources and illustrates the technology's most important challenges in the fields of hybrid rehabilitation robotics which may contribute towards further development of hybrid robot systems.

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“…Es por ello que en los últimos años han surgido exoesqueletos y sistemas robóticos que pretenden rehabilitar a pacientes con marcha hemiparética. Debido a la naturaleza de esta patología, podemos encontrar tanto dispositivos bilaterales para terapia sobre suelo [11], como por ejemplo Ekso [12], Exo-H2 [13] o Hal-3 [14], o dispositivos montados sobre cinta rodante tales como Lokomat [15] o Lopes [16]; así como sistemas unilaterales [17] o monoarticulares [18], [19].…”

Section: Introductionunclassified

Diseño de una órtesis activa de rodilla para la evaluación de algoritmos de asistencia robótica en sujetos hemiparéticos

Millán¹,

Hidalgo²,

Lima³

2020

Actas De Las XXXIX Jornadas De Automática, Badajoz, 5-7 De Septiembre De 2018

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Campo Real Km 0.200 Arganda del Rey (Madrid), julio.lora@csic.es ResumenUna de las principales consecuencias del Ictus es la hemiparesia, enfermedad en la cual los pacientes pierden movilidad en las extremidades de un lado del cuerpo. A pesar de que existen multitud de sistemas de rehabilitación para estos pacientes, muchos de ellos siguen necesitando de dispositivos asistenciales para realizar distintas tareas en su vida diaria. En este documento presentamos el diseño de una órtesis activa de rodilla para el desarrollo y evaluación de algoritmos de asistencia robótica en estos pacientes. Concretamente, el prototipo presentado está completamente definido en cuanto a sensores y actuadores, así como los controladores de bajo nivel. Los controladores que se han implementado varían en el nivel de asistencia que aportan al usuario y han sido testeados en una prueba de concepto con un sujeto sano. Los resultados obtenidos con los distintos controles señalan que el prototipo aquí presentado puede ser utilizado como base para el desarrollo y evaluación de algoritmos más complejos de coordinación y asistencia.Palabras Clave: Órtesis activa de rodilla, exoesqueleto robótico monoarticular, controladores de bajo nivel, control de impedancia, hemiparesia. INTRODUCCIÓNCerca de 16 millones de personas al año sufren Ictus por primera vez, siendo la marcha hemiparética una de sus principales consecuencias [1]. Esta marcha se caracteriza por ser más lenta e ineficiente que la marcha de una persona sana [2], y a pesar de la rehabilitación, la mayoría de los supervivientes de Ictus mantienen déficits neuromotores que les impiden andar con normalidad [3]. Ejemplos típicos de trastornos neuromotores en pacientes hemiparéticos son debilidad muscular y espasticidad [4], coordinación motora deteriorada [5], y rangos de movimiento de dorso-flexión en tobillo y flexión en rodilla reducidos. Estos trastornos conllevan una disminución de la velocidad de la marcha y la aparición de mecanismos de compensación [6], así como el aumento del riesgo de caídas y un aumento del consumo metabólico [7]. Incluso aquellos pacientes capaces de alcanzar velocidades cercanas a la normalidad continúan manifestando ciertas secuelas que les suponen una disminución de su calidad de vida [8], [9]. Como respuesta a la demanda de equipos de rehabilitación que surge para paliar los hándicaps sufridos por estos pacientes, la rehabilitación robótica se postula como una alternativa a tener en cuenta frente a las terapias convencionales [10]. Es por ello que en los últimos años han surgido exoesqueletos y sistemas robóticos que pretenden rehabilitar a pacientes con marcha hemiparética. Debido a la naturaleza de esta patología, podemos encontrar tanto dispositivos bilaterales para terapia sobre suelo [11], como por ejemplo Ekso [12], Exo-H2 [13] o Hal-3 [14], o dispositivos montados sobre cinta rodante tales como Lokomat [15] o Lopes [16]; así como sistemas unilaterales [17] o monoarticulares [18], [19]. Si bien estos dispositivos han demostrado grandes beneficios para ...

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Powered Exoskeletons for Walking Assistance in Persons with Central Nervous System Injuries: A Narrative Review

Cited by 141 publications

References 46 publications

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Exoskeleton and End‐Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review

Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies

Diseño de una órtesis activa de rodilla para la evaluación de algoritmos de asistencia robótica en sujetos hemiparéticos

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