Volume 56, Issue 1 - Special Issue: Technically Assisted Rehabilitation

No abstract available

No abstract available

There is a need for effective stroke rehabilitation systems that can be used in undersupervised/unsupervised environments such as the home to assist in improving and/or sustaining functional outcomes. We determined the stability, accuracy and usability of an extremely low-cost mobile robot for use with a robot/computer motivating rehabilitation device, TheraDrive. The robot provided cues to discourage excessive trunk movements and to encourage arm movements. The mobile robot system was positively received by potential users, and it was accurate and stable over time. Feedback from users suggests that finding the optimal frequency and type of encouragement and corrective feedback given by the robot helper will be critical for long-term acceptance.

In incomplete spinal cord injured subjects, task-oriented training regimes are applied for enhancement of neuroplasticity to improve gait capacity. However, a sufficient training intensity can only be achieved during the inpatient phase, which is getting shorter and shorter due to economic restrictions. In the clinical environment, complex and expensive robotic devices have been introduced to maintain the duration and the intensity of the training, but up to now only a few exist for continuation of automated locomotion training at home. For continuation of the automated locomotion training at home prototypes of the compact, pneumatically driven orthosis MoreGait have been realized, which generate the key afferent stimuli for activation of the spinal gait pattern generator. Artificial pneumatic muscles with excellent weight-to-force ratio and safety characteristics have been integrated as joint actuators. Additionally, a Stimulative Shoe for generation of the appropriate foot loading pattern has been developed without the need for verticalization of the user. The first results of the pilot study in eight chronic incomplete spinal cord injured subjects indicate that the home-based therapy is safe and feasible. The therapy related improvements of the walking capacity are in the range of locomotion robots used in clinical settings.

Functional electrical stimulation leg cycle ergometry (FES-LCE), which is often used as exercise for people with spinal cord injury (SCI), has recently been applied in the motor rehabilitation of stroke patients. Recently completed studies show controversial results, but with a tendency to positive training effects. Current technology is identical to that used in FES-LCE for SCI, whereas the pathology of stroke differs strongly. Most stroke patients with hemiparesis are able to drive an ergometer independently. Depending on the degree of spasticity, the paretic leg will partially support or hinder movements. Electrical stimulation increases muscle force and endurance and both are prerequisites for restoring gait. However, the effect of FES-LCE on improving impaired motor coordination is unclear. To measure motor coordination during FES-LCE, an EMG-amplifier design has been investigated which suppresses stimulation artifacts and allows detection of volitional or reflex induced muscle activity. Direct measurement of EMG from stimulation electrodes between stimulation pulses is an important asset of this amplifier. Photo-MOS switches in front of the preamplifier are utilized to achieve this. The technology presented here can be used to monitor the effects of FES-LCE to adapt the stimulation strategy or to realize EMG-biofeedback training.

The loss of the grasp function in cervical spinal cord injured (SCI) patients leads to life-long dependency on caregivers and to a tremendous decrease of the quality of life. This article introduces the novel non-invasive modular hybrid neuro-orthosis OrthoJacket for the restoration of the restricted or completely lost hand and arm functions in high tetraplegic SCI individuals. The primary goal of the wearable orthosis is to improve the paralysed upper extremity function and, thus, to enhance a patient's independence in activities of daily living. The system combines the advantage of orthotics in mechanically stabilising joints together with the possibilities of functional electrical stimulation for activation of paralysed muscles. In patients with limited capacity, for force generation, flexible fluidic actuators are used to support the movement. Thus, the system is not only intended for functional restoration but also for training. Several sensor systems together with an intelligent signal processing allow for automatic adaptation to the anatomical and neurological individualities of SCI patients. The integration of novel user interfaces based on residual muscle activities and detection of movement intentions by real-time data mining methods will enable the user to autonomously control the system in a natural and cooperative way.

To restore walking after transfemoral amputation, various actuated exoprostheses have been developed, which control the knee torque actively or via variable damping. In both cases, an important issue is to find the appropriate control that enables user-dominated gait. Recently, we suggested a generic method to deduce intended motion of impaired or amputated limbs from residual human body motion. Based on interjoint coordination in physiological gait, statistical regression is used to estimate missing motion. In a pilot study, this complementary limb motion estimation (CLME) strategy is applied to control an active knee exoprosthesis. A motor-driven prosthetic knee with one degree of freedom has been realized, and one above-knee amputee has used it with CLME. Performed tasks are walking on a treadmill and alternating stair ascent and descent. The subject was able to walk on the treadmill at varying speeds, but needed assistance with the stairs, especially to descend. The promising results with CLME are compared with the subject's performance with her own prosthesis, the C-Leg from Otto Bock.

The purpose of this study was to present the amount and distribution of pressure, stress, and deformation energy when basal implants in the mandible are restored with a bridge which is loaded at two different stages of bone healing. The model geometry and material properties of the mandible were gained from CT scans of a human mandible. The material model used in this study defined bone as an inhomogeneous, linear elastic isotropic material. The masseter and temporal muscles were considered as rigid connections between the bones in typical positions and directions. The rotation axis was simulated in the temporomandibular joint. The loading force of 450 N was assumed to be in the middle between the left molar and left canine implant. In freshly operated bone, the total deformation energy is 30% higher than in healed bone, due to the defined energy absorbing soft bone areas. Approximately 90% of the deformation energy is absorbed by the bone, regardless of the healing state of the bone. The immediate rigid implant splinting distributes peak forces. To cope with these energies, the necessity of a reduction of total masticatory forces or the use of additional implants for force distribution should be considered individually.

The thermodilution method has been widely used to estimate cardiac output by injecting a cold solution into circulating blood. It is uncertain if radial heat transfer from the vascular/cardiac wall to circulating injectate can cause inaccurate results with this method. In this study, we have introduced a physical experimental model of the thermodilution method without recirculation of the cold solution. To test the accuracy of the thermodilution method, the experimental setup included an aluminum tube to allow radial heat transfer. Variations of the following parameters were conducted: (i) the real flow rate, (ii) the distance between injection point of cold solution and the temperature sensor, (iii) the volume of injectate, and (iv) the temperature of injectate. By following the above variations, we have calculated different correction factors eliminating the influence of radial heat transfer on the estimation of flow rate by the thermodilution method. The results indicate that changes in both injectate temperature and volume have no influence on the estimation of flow rates. The experimental variations, which can cause greater radial heat transfer, seem to be responsible for the result of the smaller estimation of the flow rate than the real value. These variations include (i) a decreased real flow rate and (ii) increased distances between the injection point of cold fluid and the thermosensor. Such an incorrect estimation could be eliminated by using correction factors. The correction factor seems to be a function of the area of the thermodilution curve, assuming no recirculation.

We present a setup to measure biometric data of the eye using Fourier domain interferometry. The measuring depth of a Fourier domain system is basically limited owing to the spectral resolution. Combining two spectral domain interferometers with different wavelength ranges creates two measurement sections and allows for a simultaneous biometric measurement in terms of corneal thickness, anterior chamber depth, and axial length. The necessary offset between both sections in the combined setup was calibrated with a known reference object. The setup was tested by measuring a self-constructed model eye. All biometric data of the model eye can be detected simultaneously. This system has a precision of 13 μm (standard deviation) and a trueness of 46 μm. The signal-to-noise ratio was 98 dB for the anterior part and 76 dB for the posterior part. In contrast to time domain interferometry, this setup does not need any mechanically moving parts. Owing to the short time frame of the biometric measurement, potential eye movements should have no influence on the result. In addition to the fast measurement, this setup provides the possibility to adjust the laser power of both sections independently. This could help in the case of dense cataract.