Discussion
There were few significant differences in knee extensor and knee flexor muscle activity during walking with robotic assistance. Significant differences in muscle activity across condition only occurred in muscles targeted for intervention (knee extensor, VL), with an increase in muscle activity during the EXO condition, a positive result for an extensor muscle. Although some undesirable increases in MH flexor muscle activity were seen in the linear envelopes, they did not present significant changes the statistical analysis on the group level. Muscle activity did not change significantly across visits with the exoskeleton.
On average, cortical activity did not differ in the presence of robotic knee extension assistance, supporting
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Future work in this area will focus on the use of EEG with exoskeleton assistance to maximize cortical activity during gait rehabilitation. The next step for the exoskeleton is use over extended periods of time, outside of the clinical environment, to determine if maintained muscle activity and improved kinematics translate to effects in normal walking.
Acknowledgements
Supported by the Intramural Research Program at the National Institutes of Health Clinical Center (protocol #13-CC-0210) and the NIBIB Biomedical Engineering Summer Internship Program.
References
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The cerebral activity is more important for an exercise which implicates legs than for an
Occupational Therapy is a growing field; one that is constantly changing as technology becomes more advanced. There are different techniques and methods used in this field, as well as the field of physical therapy, in order assist in client advancement and growth. The traditional method being discussed is Proprioceptive Neuromuscular Facilitation also known as PNF and the contemporary technique is Kinesio Taping. These techniques and methods came about for the same purpose, and that is to ultimately help both the Practitioners and of course clients they work with.
The article “Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a Theoretical Framework for Crouch Gait” by Allison Arnold, Frank Anderson, Marcus Pandy, and Scott Delp investigates the biomechanics of normal gait in hopes to uncover ideas to help determine treatments for crouch gait. Crouch gait is a bothersome abnormality that affects the gait pattern of people who suffer from the condition of cerebral palsy. It’s characterized by excessive flexion of the hips and knees during standing and excessive use of metabolic energy to complete a single gait cycle. Currently, the treatments for this condition are limited and have unpredictable outcomes due to the unknown biomechanical causes of the excessive flexion in crouch gait. These treatments include surgical lengthening of hamstrings, ankle-foot orthoses, and intense stretching regimens, with patients experiencing results ranging from no improvement in their symptoms to dramatic improvements. The vast array of results from treatments are due to the little understanding medical professionals have of not only abnormal gait patterns (such as crouch gait) but of normal gait as well (Arnold, Anderson, Pandy, and Delp, 2005). Despite the article’s title relating to crouch gait, the purpose of the study conducted was to examine and quantify the accelerations of normal hip and knee movements that were induced by specific muscles during the single limb stance phase and to rank these
According to Beek, Peper, and Stegeman (1995), “the motor control theories provide an explanation on how the nervous system will solve the degrees of freedom problem and serve to direct movement command.” The following theories are the generalized motor program theory and the dynamical systems theory. The GMP theory “proposes that the movement plan is retrieved from memory within the central nervous system and neural instructions are sent down to the effectors via the efferent pathways.” The dynamical systems approach on the other hand, “does not propose a hierarchical control, but suggests that movements emerge through self-organization of the interaction of the body and environment.” It can be said that everybody’s “bodily movements occur in the context of the everyday functioning of people while realizing specific task goals.” As a general, yet acquired rule, “such movements involve the participation of multiple joints and limbs.” Moreover, when in action, these body parts are “coordinated and are brought into proper relation to one another as well as to the surrounding layout of surface.” The coordination of these body parts may “look relatively simple, as in picking up an object, or relatively complicated, as in juggling, performing an attacking forehand drive in table tennis or playing the drums.” To the psychomotor scientist or researcher, however, “all coordination is complex in that he or she is confronted with the challenge to explain
Certain functional abilities such as walking need some amount of dorsiflexion, minimum of 10 degrees of dorsiflexion (mecagni et al). With the ageing ankle dorsiflexion range of motion is reduced Chesworth et al, 1992). Decreased ankle range of motion alters movement patterns declining the balance of these patients (Elin et al, 2011) (Mecagni et al). Furthermore, decreases in postural control may result from the use of motions at the hip or trunk that are required to compensate for restrictions in motion at the ankle (Mecagni et al).
Constraint Induced Movement Therapy (CIMT) is a treatment approach that has been found to be effective in unilateral (hemiplegic) spastic cerebral palsy. It involves constraint of the less impaired upper extremity and repetitive practice of the affected arm and hand. Casts, splints, and slings are used to restrain the unaffected arm while the individual is encouraged to use the impaired arm. The individual performs motor activities repetitively for up to 6 hours a day for 2 to 4 weeks. In order to perform more complex functional motor acts, the task is broken down into smaller movements and rewarded at each step of the
Our meta-analysis revealed that premotor reaction times are indeed faster in SCM+ than in SCM- trials. The estimated magnitude of this effect across the studies may be long enough to entertain the possibility that motor programs are triggered via a pathway that bypasses some cortical areas of the brain [1, 23], but not fast enough to completely rule out cortical involvement [11]. Although, the meta-analysis showed that the effect associated with SCM activity is robust across studies, the heterogeneity test approached significance and depended on the correlation coefficient chosen for the studies for which data was not available: an increase in the correlation coefficient from 0.5 to 0.56 resulted in a statistically significant
A research was conducted to study the effect of knee flexion contracture towards the mechanical overloading in both limbs. A total of ten healthy old women were recruited for this research. Knee brace was used to simulate an unilateral knee flexion contractures with 0, 15 and 30 degree. The experiments were conducted on the left and right side of the leg respectively during level walking, with and without the simulation. The walking velocity (m/s), change in knee flexion angle, net knee extension moment, net knee adduction moment and external knee forces for every condition during the stance phase were evaluated. From the experiment, it was noticed that the mean walking velocity of the participants decreases as the simulated contracture
The significant improvement in post-treatment mean values of all measured variables in the three groups may attribute to motor learning effect as multiple repetitions of movement with intensive training required for new motor skill acquisition and inducing long-term brain plasticity. Sensorimotor stimulation is needed to induce this plasticity that is intensive, highly repetitive and rewarded. The neural plasticity and motor function retraining using multiple repetitions of movement are essential to regain function
According to another study, rTMS could reduce motor improvement in SCI. It is possible that motor score improvement and amelioration of spasticity with rTMS in SCI can be induced through enhancement of descending corticospinal projection and reduction in corticospinal inhibition [11].
For the walking rehabilitation and gait training of stroke patients, body weight supported treadmill walking training is widely used in clinics as a physically active rehabilitation technique (Miller, Quinn, Seddon. 2002). Stroke patients have very distinctive walking patterns exhibiting long gait cycles, low walking speeds, alterations in stride length between the affected side and the unaffected side step length, short stance phases and long swing phases on the affected side (Finch, Barbeau, Arsenault, 1991). Parameters surrounding BWSTT suggest the amount support of used is dependent on the ability of the patient to carry body weight on the affected leg during single limb stance, maintaining proper trunk and limb alignment (Hesse, 2008).
An examination of a person’s gait would reveal that the body is in a constant state of imbalance with each step taken. The body counteracts and maintains postural control and balance during these perturbations by regulating the integrated relationship between center of mass (COM) and base of support (BOS); and we use observe the effects of this relationship with use of the motion analysis system. Therefore, the purpose of this lab is to examine the relationship between COM and BOS during walking. I hypothesized that of the three walking task, (normal walking, walking along a tape line, and walking while balancing a book on your head), that walking while balancing a book upon your head would have the greatest amount of COM sway
The goals of a device assistive to the rehabilitation process are to improve independent mobility, reduce disability, delay functional decline, decrease the burden of care and provide assessment tools for the medical community. Patients using assistive devices have reported improved confidence and feeling of safety resulting in increased activity levels and independence. Assistive devices such as canes, crutches, and walkers can be used to increase a patient's base of support, improve balance and increase activity and independence. Walkers are an important assistive device for people with difficulty of walking unassisted, helping them maintain mobility and continue an active lifestyle. An inactive lifestyle can lead to weakened motor skills,
This report highlights the benefits and innovative of exoskeleton to the Singapore Polytechnic (SP) Learning and Sharing Festival Organising Committee. It also suggested improvements and other way of usages that can be used for future advancement according to expert and feedback from users.
In the process of estimating movement and correcting motion, researchers realigned all images to the 4th frame of the first functional run and used AFNI to correct for movement, obtaining 2 sets of movement parameters. The analysis used low pass filtering to transform images into stereotaxic space; it excluded the first three scans and erroneous scans. The researchers used a linear model with correlated errors to analyze the fMRI data, a baseline to compare BOLD response, and the minimum from Bonferroni correction and random field theory to threshold t statistic images. All analyses were based on the random effects model.