Rehab tech:swinnen:bodyweight supported,robotic&VR
applications rehab
BRUBOTICS OVER 120 RESEARCHERS
Working across boundaries
- A joint initiative of 9 research groups of the VuB collaborating on topic of
Human-Centered Robotics
Fully-equipped movement analysis lab with EKSO NR system
Gait training/rehabilitation is different for different types of neurological patients and depends on the
severity of the disorder / limitations of the patients
For example:
- Parkinson gait training versus Stroke gait rehabilitation
- Multiple Sclerosis, Spinal Cord Injury, Cerebral Palsy,…
GAIT TRAINING
TYPES OF GAIT TRAINING
Overground training
- Kan met rollator gedaan worden
Overground training with body weight support
- P in system ermee wandelen
Overground training with robot-assistance (exoskeleton devices)
- Wandelen met exoskeleton
Treadmill training
- Soms makkelijker voor P
Treadmill training with body weight support
Treadmill training with robot-assistance (exoskeleton devices / end-effector devices)
CASUS
Mrs. De Vries is a 76-year-old retired woman who used to be a saleswoman. She is an active lady who
loves walking with her dog, visiting her friends and dancing with her husband. On Tuesday, September 5,
2019, Mrs. de Vries had agreed to meet a friend at 10 am. Her husband had left early that morning for the
local market. However, Mrs. de Vries did not show up and her friend became worried. During her lunch
break (around noon) her daughter went to see her mother and found her lying on the ground in the
kitchen. Around the same time, Mr. De Vries also returned home. Mrs De Vries lay unconscious on the
floor and there was an unpleasant smell in the kitchen. The daughter immediately called an ambulance,
after which Mrs. de Vries was taken to the nearest hospital. There she first went to the intensive care unit,
after which a surgical thrombectomy was performed (left cerebral artery area). Subsequently, Mrs. de
Vries was transferred to the stroke unit at the Neurology department.
- Ze was een actieve persoon
- We weten niet hoe lang ze er heeft gelegen -> time window?
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, Rehab tech:swinnen:bodyweight supported,robotic&VR
applications rehab
STATUS 5 DAYS POST STROKE
ROM: normal left and right
Muscle strength
- Right arm: proximal 2/5, distal 2/5
- Right leg: global 2/5
- Kracht R is afgenomen
Gait pattern: patient needs firm continuous support from therapist (FAC 1)
- FAC1= Veel assistentie nodig om gewoon te kunnen staan en een beetje te stappen
niet onafhankelijk
Motricity Index: Upper limb 39/100 ; Lower limb 37/100
Berg Balance Scale: 6/56
- Balans problemen
Trunk control test: 62/100
Barthel Index: 46/100 (ADL)
- Ze is niet afhankelijk maar ook niet volledig onafhankelijk
- Zelfzorg is mogelijk
- ADL problemenniet onafhankelijk
No spasticity
No sensory problems
Request for help: Mrs de Vries hopes that in the future she will no longer be dependent on others (for ADL
and hygiene)
Could body weight supported and/or robot-assisted gait training be useful for this patient?
- BWS kan ervoor zorgen dat ze recht kan staan en ze zich veilig voelt
- now in the acute phase? Eerst kracht opbouwen voordat we met BWST gaan beginnen
- later in the subacute or chronic phase?
HOW CAN WE INCREASE THE EFFECT OF NEUROREHABILITATION?
APPLIED TO GAIT TRAINING
kan allemaal bereikt worden met robotica
Task-specific training
- We need to walk
High intensity training with a high number of repetitions
- We have to train a lot, mainly everyday
Goal-oriented training
- Independent walking
Differences in suspension-system (1 point, 2 points,…)
- CASUS: first 2 (more support) and later 1 point (more rotations possible)
3 TOPICS
- 1point: important for rotations of shoulders and pelvis
BODY - WEIGHT
≠in stabiliteit
SUPPORT SYSTEMS
- ≠ in ROM(rotaties,..)
- 1 punt:
Rotatie ook mogelijk
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, Rehab tech:swinnen:bodyweight supported,robotic&VR
applications rehab
- 2punt:
Meer stabiliteit
Beperkter in bewegen
Differences in harness (sizes, straps,…)
- Pathologie afhankelijk
Differences in suspension type (static, passive, dynamic, …)
- Bij wandelen COM +/- altijd hetzelfde
System gaan hierbij helpen
1. EXAMPLES OF SYSTEMS
Biodex-system
- 1 suspension and not so heavy
- T kan gaan zitten
Zero G system
- System in the ceiling, without a frame
- Different exercises, very safe -> good system!
Andago-system
- Very expensive, not often used in practice
- Interesting: sensors in system and the systems follows the P without help of the T
- System volgt P tijdens wandelen
Litegait-system
2. BWS GAIT TRAINING
Advantages:
- ↓ compensatory strategies (↑ symmetry)
Meer functionelere gang
- ↑ walking speed, ↑ safety and ↓ fear / risk of falling
- Gait training even if the patient can no more/not yet walk
- Task-specific training with high number of repetitions (more steps)
Disadvantages:
- Labor intensive for therapist (amount of staff + low at the ground)
Therapist needs to assist the foot, knee or hip
- Sometimes not moveable
- BWS ⟩ 45 to 50% influence the walking pattern (toe-walking) and changes in thorax and pelvis
biomechanics
BWS= body weight system
Often a problem for the heel strike (sensitive information)
Less rotation between pelvis and thorax
studies
o Harness: ↓ vertical acceleration (Aaslund 2008)
o BWS: ↓ acceleration in 3 directions (Aaslund 2008), ↓ inter-segmental coordination thorax
pelvis (Pintér 2006), ↓ amplitude muscle activity (Finch 1991, Swinnen 2014)
Risico starten in hog level BWS
- P hangt gewoon in syst
Je wilt dat P wandelt met normale gang
Optimal setting? Often: 30 to 40% of the body weight at a low walking speed (0,1 tot 0,3 m/s) and
increase
gait speed, walking distance, duration, and reduce body weight support to 0%
3. EFFECTIVITY
3.1. STROKE
People after stroke who receive treadmill with or without BWS are not more likely to improve their ability
to walk independently compared with people after stroke not receiving treadmill training, but walking
speed and walking endurance may improve.
Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to
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