- Modified V-Y Turndown Flap Augmentation for Quadriceps Tendon Rupture Following Total Knee Arthroplasty: A Retrospective Study. [Journal Article]
- JBJ Bone Joint Surg Am 2019 Jun 05; 101(11):1010-1015
- CONCLUSIONS: The modified V-Y quadriceps tendon turndown flap was a reliable alternative treatment for achieving restoration of the extensor mechanism after complete quadriceps tendon rupture following TKA.
- Safety and efficacy of robotic elbow training using the upper limb single-joint hybrid assistive limb combined with conventional rehabilitation for bilateral obstetric brachial plexus injury with co-contraction: a case report. [Case Reports]
- JPJ Phys Ther Sci 2019; 31(2):206-210
- [Purpose] Obstetric brachial plexus injuries are accompanied by co-contractions due to misdirection of regenerated nerve fibers. The result is inhibition of arm movement necessary for activities of d…
[Purpose] Obstetric brachial plexus injuries are accompanied by co-contractions due to misdirection of regenerated nerve fibers. The result is inhibition of arm movement necessary for activities of daily living. Rehabilitation is important to prevent joint contracture and muscle atrophy in such cases. A single-joint hybrid assistive limb is a new wearable robot that can assist in elbow joint motion by detecting muscle action potentials on the upper limb surface. Inhibiting co-contractions due to obstetric brachial plexus injuries with this device may help with performance of activities of daily living. This study aimed to evaluate the safety and efficacy of using a single-joint hybrid assistive limb combined with conventional rehabilitation in a patient with obstetric brachial plexus injuries. [Participant and Methods] A 40-year-old male with bilateral obstetric brachial plexus injuries and co-contractions of the biceps and deltoid underwent rehabilitation training using the single-joint hybrid assistive limb 3 times a week for 12 sessions (4 weeks) in both upper limbs. [Results] The patient completed all 12 sessions of training using the single-joint hybrid assistive limb with no adverse events. Improvements in flexion strength in the left elbow, active flexion range of motion in both elbows, and functional tests in the right arm were observed. [Conclusion] Elbow training using the newly developed single-joint hybrid assistive limb combined with conventional rehabilitation can be performed without severe adverse events and may improve muscle strength, range of motion, and arm functions in adults with obstetric brachial plexus injuries and bilateral co-contractions of the deltoid and biceps muscles.
- Effectiveness of an on-body lifting aid (HAL® for care support) to reduce lower back muscle activity during repetitive lifting tasks. [Clinical Trial]
- JCJ Clin Neurosci 2019; 63:249-255
- The Hybrid Assistive Limb Lumbar Type (HAL) is an active exoskeleton that provides motion according to the wearer's voluntary drive. It was developed to support back muscles during repetitive lifting…
The Hybrid Assistive Limb Lumbar Type (HAL) is an active exoskeleton that provides motion according to the wearer's voluntary drive. It was developed to support back muscles during repetitive lifting tasks. The purpose of this paper was to determine if the myoelectric activity of the back muscles is reduced or altered when using the HAL and to investigate a possible influence of its use on the cardiovascular system. Fourteen healthy young men without lower back pain underwent a freestyle, symmetrical-lifting protocol. Participants lifted a 17.05 kg handled-box for 10 min. with and without HAL support. Surface electromyography (sEMG) signals were recorded at thoracic (TES) and lumbar erector spinae (LES) and quadriceps femoris (QF). Heart rate was recorded from electrocardiogram. The subjects rated their level of physical exertion using the Borg Rating of Perceived Exertion (BORG) scale. Additionally they commented on sites of discomfort, perceptions of force, and loss of range of motion. The root mean square and integrated sEMG value was significantly reduced at the LES and TES. Heart rate variability output variables did not show any significant difference. The BORG-Scale showed no difference, with a mean score of 2.5. The HAL decreased the magnitude and onset of muscle activity and force in the lower back in a repetitive lifting task. Reduction of the muscle force and activity required during the lifting process is meaningful regarding lower back pain prevention, and the HAL may contribute to reducing the incidence of lower back pain in the working population.
- Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation. [Journal Article]
- JRJMIR Rehabil Assist Technol 2018 Mar 06; 5(1):e2
- CONCLUSIONS: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial.
- Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury. [Journal Article]
- FNFront Neurosci 2017; 11:649
- Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformitie…
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20-67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60-90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.
- Feasibility of using the RAPAEL Smart Glove in upper limb physical therapy for patients after stroke: A randomized controlled trial. [Randomized Controlled Trial]
- CPConf Proc IEEE Eng Med Biol Soc 2017; 2017:3856-3859
- We aim to assess the feasibility of using the RAPAEL Smart Glove as an assistive tool for therapists in clinical rehabilitation therapy settings and to investigate if it can be used to improve the mo…
We aim to assess the feasibility of using the RAPAEL Smart Glove as an assistive tool for therapists in clinical rehabilitation therapy settings and to investigate if it can be used to improve the motor recovery rate of stroke survivors. Our randomized controlled study involved 13 post-stroke inpatients. An experimental treatment consisted of one 30-minute game-assisted therapy and one 30-minute conventional therapy per day while the control treatment consisted of two 30-minute conventional therapies. Each therapy block consisted of 15 days over a period of 3 weeks. The measured outcomes were the scores on the Wolf Motor Function Test and the active range of motion for the forearm and the wrist. The mean Wolf Motor Function Test score for the group that received game therapies as well as conventional therapies was significantly higher than that for the group who received only conventional therapies. The results suggest that the motor recovery rate of the clinical rehabilitation therapies can be improved when wearable sensors and therapeutic games are used by therapists in their routine therapy practice.
- Design and characterization of low-cost fabric-based flat pneumatic actuators for soft assistive glove application. [Journal Article]
- IIIEEE Int Conf Rehabil Robot 2017; 2017:1465-1470
- We present the design of low-cost fabric-based Hat pneumatic actuators for soft assistive glove application. The soft assistive glove is designed to assist hand impaired patients in performing activi…
We present the design of low-cost fabric-based Hat pneumatic actuators for soft assistive glove application. The soft assistive glove is designed to assist hand impaired patients in performing activities of daily living and rehabilitation. The actuators consist of flexible materials such as fabric and latex bladder. Using zero volume actuation concept, the 2D configuration of the actuators simplifies the manufacturing process and allows the actuators to be more compact. The actuators achieve bi-directional flexion and extension motions. Compared to previously developed inflatable soft actuators, the actuators generate sufficient force and torque to assist in both finger flexion and extension at lower air pressure. Preliminary evaluation results show that the glove is able to provide both active finger flexion and extension assistance for activities of daily living and rehabilitative training.
- Case Report on the Use of a Custom Myoelectric Elbow-Wrist-Hand Orthosis for the Remediation of Upper Extremity Paresis and Loss of Function in Chronic Stroke. [Case Reports]
- MMMil Med 2017; 182(7):e1963-e1968
- CONCLUSIONS: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices.
- Physical functioning and activities of daily living in adults with amyoplasia, the most common form of arthrogryposis. A cross-sectional study. [Journal Article]
- DRDisabil Rehabil 2018; 40(23):2767-2779
- CONCLUSIONS: Adults with amyoplasia are heterogeneous regarding function. Independence in everyday life requires a combination of muscle strength to move against gravity, ability to passive joint motion, and use of compensatory strategies. Implications for rehabilitation The ability to joint motion in the upper extremities is essential for independency in activities of daily living, especially when the muscle strength is impaired. Training of muscle strength is recommended, whenever possible, as muscle strength to move against gravity makes the performing of everyday tasks easier. The use of compensatory techniques, adaptions to the environment and relevant, often custom made, assistive devices is required to perform activities of daily living. Living an active life with physical challenges like in amyoplasia requires flexible and individually adapted solutions.
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- Development of an MR-compatible hand exoskeleton that is capable of providing interactive robotic rehabilitation during fMRI imaging. [Journal Article]
- MBMed Biol Eng Comput 2018; 56(2):261-272
- Following advances in robotic rehabilitation, there have been many efforts to investigate the recovery process and effectiveness of robotic rehabilitation procedures through monitoring the activation…
Following advances in robotic rehabilitation, there have been many efforts to investigate the recovery process and effectiveness of robotic rehabilitation procedures through monitoring the activation status of the brain. This work presents the development of a two degree-of-freedom (DoF) magnetic resonance (MR)-compatible hand device that can perform robotic rehabilitation procedures inside an fMRI scanner. The device is capable of providing real-time monitoring of the joint angle, angular velocity, and joint force produced by the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of four fingers. For force measurement, a custom reflective optical force sensor was developed and characterized in terms of accuracy error, hysteresis, and repeatability in the MR environment. The proposed device consists of two non-magnetic ultrasonic motors to provide assistive and resistive forces to the MCP and PIP joints. With actuation and sensing capabilities, both non-voluntary-passive movements and active-voluntary movements can be implemented. The MR compatibility of the device was verified via the analysis of the signal-to-noise ratio (SNR) of MR images of phantoms. SNR drops of 0.25, 2.94, and 11.82% were observed when the device was present but not activated, when only the custom force sensor was activated, and when both the custom force sensor and actuators were activated, respectively.