Walking is the most basic and essential part of the activities of daily living. To enable the elderly and non-ambulatory gait-impaired patients, the repetitive practice of this task, a novel gait training robot(GTR) w...Walking is the most basic and essential part of the activities of daily living. To enable the elderly and non-ambulatory gait-impaired patients, the repetitive practice of this task, a novel gait training robot(GTR) was designed followed the end-effector principle, and an active partial body weight support(PBWS) system was introduced to facilitate successful gait training. For successful establishment of a walking gait on the GTR with PBWS, the motion laws of the GTR were planned to enable the phase distribution relationships of the cycle step, and the center of gravity(COG) trajectory of the human body during gait training on the GTR was measured. A coordinated control strategy was proposed based on the impedance control principle. A robotic prototype was developed as a platform for evaluating the design concepts and control strategies. Preliminary gait training with a healthy subject was implemented by the robotic-assisted gait training system and the experimental results are encouraging.展开更多
BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBP...BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.展开更多
Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-B...Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.展开更多
基金Project(61175128) supported by the National Natural Science Foundation of ChinaProject(2008AA040203) supported by the National High Technology Research and Development Program of China
文摘Walking is the most basic and essential part of the activities of daily living. To enable the elderly and non-ambulatory gait-impaired patients, the repetitive practice of this task, a novel gait training robot(GTR) was designed followed the end-effector principle, and an active partial body weight support(PBWS) system was introduced to facilitate successful gait training. For successful establishment of a walking gait on the GTR with PBWS, the motion laws of the GTR were planned to enable the phase distribution relationships of the cycle step, and the center of gravity(COG) trajectory of the human body during gait training on the GTR was measured. A coordinated control strategy was proposed based on the impedance control principle. A robotic prototype was developed as a platform for evaluating the design concepts and control strategies. Preliminary gait training with a healthy subject was implemented by the robotic-assisted gait training system and the experimental results are encouraging.
基金the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University(No.KY01-2018-10-18).
文摘BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.
基金supported by the Uehara Memorial foundation,Japan Science and Technology Agency,No.05-001-0002Japan Agency for Medical Research and Development,No.19bk0104017h00029(both to MN)。
文摘Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.