Tag Archives: rehabilitation

A Second Chance: Robotic Exoskeletons May Be the Future of Mobility for Patients with Spinal Cord Injuries

No one ever imagines themselves getting seriously injured. Accidents do happen though, like car crashes and unexpected sports injuries. These events can drastically change a person’s life, leaving them unable to perform simple daily tasks without assistance, such as walking. One injury that can radically impact a person’s life is a spinal cord injury. There are approximately a quarter of a million people in the United States with spinal cord injuries, and that number grows by 12,500 each year.

The spine is the center of support in the body. It adds structure and facilitates movement. Its other extremely important job is to protect the spinal cord, which is a column of nerves that runs down the length of the neck and back. The spinal cord is part of the nervous system, and it acts as a messenger, taking orders from the brain and relaying these messages to the rest of the body, telling the muscles what to do. If the spinal cord is injured, the messages can’t be delivered properly. This often results in a loss of mobility.

Diagram of the central and peripheral nervous system showing how the spinal cord connects the brain to nerves that run throughout the body
From OpenStax Anatomy and Physiology on Wikimedia Commons

Most people don’t think about the mechanics involved in the simple act of walking. However, in order to walk, various joints such as the hip, knee, and ankle need to work together, rotating and bearing loads to allow for movement. When your foot hits the ground, the ground imparts a force through the foot which is translated up through the lower extremities to the spine. When a spinal cord injury occurs, the brain is unable to communicate with our muscles which inhibits this load bearing and the resulting movement.

Studies have shown that powered exoskeletons have numerous benefits for patients with spinal cord injuries to help with walking and mobility. These powered exoskeletons are built in various ways to bear loads and encourage movement, and a review of different exoskeletons, along with other rehabilitation devices, discusses differences in design and control of the systems. For example, to allow for control of movement, one exoskeleton was built with motors located at the joints while another was designed with a braking system at the joints.

Photo of the Indego powered exoskeleton
Indego Exoskeleton – From Indego.com

One study researched mobility outcomes for patients with injuries that varied in severity and location on the spine. Some patients were paraplegic, which means their lower extremities were paralyzed, and some patients were tetraplegic/quadriplegic, which means the paralysis affected both their lower and upper extremities. Also, some patients had complete spinal cord injuries, which means all feeling was lost below the injury, while others had incomplete spinal cord injuries, which means they had some feeling and some ability to control movement below the injury. This study showed that powered exoskeletons, specifically the Indego exoskeleton, could help a patient move in both indoor and outdoor settings, and there is potential for patients with paraplegia caused by injuries to the lower spine to use this device to allow greater ease of mobility in public spaces. For patients with more severe injuries, such as those with quadriplegia, the powered exoskeleton allowed for slower movement with supervision and occasional assistance from a therapist. These patients also needed assistance with putting on and removing the device. Therefore, the powered exoskeleton won’t help patients with more severe injuries move on their own in public settings, but it was excellent for exercise and rehabilitation.

These exoskeletons are also proven to be safe and feasible. Patients with complete spinal cord injuries did not report discomfort or injury, and they were able to use a powered exoskeleton more easily than previous rehabilitation technology.

Powered exoskeletons may be the future of movement for those who thought they would never walk again. This further reading contains examples of paraplegics who walked using a powered exoskeleton. Another man even walked marathons using one of these devices:

From Freethink on YouTube

There are limitations on these devices, but the robotics field is swiftly evolving, and the technology is giving patients something they never thought they would have: a second chance.

Soft Robotics: Humanizing the Mechanical

Cassie the robot, created by Dr. Mikhail Jones at Oregon State University
Cassie the Robot, developed by Mikhail Jones, Faculty Research Assistant in Mechanical Engineering at Oregon State University.

In media and science-fiction, robots have stereotypically, and perhaps somewhat unfairly, been depicted as mechanical, stiff assemblies of moving joints and complicated circuitry. While this still holds true for many robots designed today, whether for industry or research, the past few years have seen a growing interest in soft robotics in academia, industry, and popular culture. As the name implies, many research groups have begun investing in constructing robots from compliant, softer materials.

Stickybot, a gecko-inspired robot.
Stickybot, a biomimetic robot.

Inspired by the way organisms in nature survive and adapt to their surroundings (formally known as biomimicry), the advantages of soft robotic components lie in their flexibility, sensitivity, and malleability – delicate tasks or interactions involving other people would be better accomplished by robots made of compliant materials rather than one that could potentially cause harm to the object or person. To that end, many of the applications of soft robotic research have already seen results in the medical industry, from invasive surgery to assistive exosuits. By taking inspiration from biological creatures or mechanisms, softer materials like rubbers and plastics can be actuated to accomplish tasks conventional, “hard” robots could struggle with.

Animation of pneumatic muscle.
Animation of pneumatic air muscle used as robotic actuators.

The most common method of moving these robotic parts is with changes in internal pressure. By creating a “hard”, skeletal frame, and surrounding it with soft, sealed membranes, changes in pressure allow the designer to control its components precisely. By decreasing the pressure and creating a vacuum, the robotic section would shrink or crumple, and increasing it would do the opposite. Researchers at Harvard developed “artificial muscles” by taking this concept a step further; using origami, they were able to design soft robotic mechanisms that could orient themselves into tunable positions as the pressure was changed inside the membrane (as a side note, origami is used in a surprising number of research fields, one of the most famous being satellite deployment). Compared to the challenge of precisely controlling prismatic (sliding) joints and servos in conventional robotics, the compliance of the materials used allow for finer control and smaller ranges of applied forces that are better suited for precise tasks.

Animation of a person demonstrating the Miura fold on a piece of paper
The Miura fold pictured here is often used to deploy large surfaces while minimizing volume, such as for satellites.

Another significant advantage of soft robots over their stiff counterparts is their adaptability to environmental conditions. Generally speaking, robots do not do well in water (or lava, for that matter), but it would have little effect on robots covered in a sealed, pressurized “skin”. This is what inspired NASA in 2015 to fund research into soft robots that could explore the oceans of one of Jupiter’s moons, Europa.  Similarly, a light-activated underwater robotic manta ray was designed at a centimeter scale to study the effect of environmental cues on controllable robots.

Schematic and pictures of soft robot design.
A soft-legged robot with walking capabilities.

While research in soft robotics is still relatively new, it has the potential to significantly affect the role of robots in our daily lives. As a softer, safer, and more environmentally robust alternative to “hard” robots, wearable robotic devices, exploratory robotic fish, and personal medical attendants could soon become commonplace for the general public.

Continue reading Soft Robotics: Humanizing the Mechanical

Medical Marvel: Robotic exoskeletons enable those with spinal cord injury to walk again

Claire Lomas surrounded by supporters as she walks the 2012 London Marathon
Lulu Kyriacou [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]
A fall off of her horse in 2007 caused Claire Lomas to lose all function in her legs. In 2012, she completed the London Marathon, all 26.2 miles. Robotic exoskeletons can literally get people back on their feet shortly after a spinal cord injury occurs, but how exactly do these medical devices not only supplement but restore human performance? What does the future look like for robotic exoskeletons and those with paralysis?

There are approximately 300,000 people living with SCI in the United States, with 17,700 affected annually. So what exactly is a spinal cord injury? A spinal cord injury occurs when trauma, disease, or compression due to tumors causes damage to your spinal cord, which is responsible for your body’s motor functions (voluntary muscle movements), sensory functions (what you feel, such as temperature, pressure and pain), and autonomous functions (your heart beat, body temperature regulation, or digestion). Injuries are classified as complete or incomplete, with complete corresponding to a total loss of function or sensory feedback in areas of the body which are lower than the injury level.

Image showing the area of injury corresponding to the resulting level of paralysis
http://www.living-with-attendant-care.info/Content/Spinal_Cord_Injury_c_Understanding_spinal_cord_injury.html

Studies have shown that people with spinal cord injury, specifically individuals with paraplegia-paralysis who retain function of their upper limbs, prioritize walking as the main function they wish to regain. Robotic exoskeletons, which operate in collaboration with the user to reinforce and retrain certain functions, may be the answer to this pressing need. An exoskeleton  facilitates untethered step repetitions and evenly redistributes the user’s weight to his or her core, minimizing stress on the user’s back, neck, and shoulder muscles. One study testing the exoskeleton from Ekso Bionics also showed an improvement in unassisted balance, since the device only initiates the next step if the user properly shifts his or her weight. Though primarily used for gait or mobility training in rehabilitation facilities, these devices are on their way to becoming everyday mobility aids for people with paralysis.

Rehabilitation for spinal cord injuries is long and tedious. Robotic exoskeletons enable patients to begin rehabilitation early after injury, which helps to prevent joint contracture (which is a limit in a joint’s range of motion, preserve muscle memory and strength, retain bone density, and ensure proper functioning of the digestive and respiratory systems). Humans are meant to be vertical and active, so just the act of standing reduces spasticity (perpetual muscle contraction) and pain, decreases the risk of pressure ulcers or osteoporosis from sitting or laying down for extended periods, and improves bowel and bladder functioning. Moreover, the ability to stand at eye-level and walk again reduces instances of depression.

Despite all of these benefits, current models aren’t perfect yet. The energy demand to operate the devices and consequential fatigue of the user limits long-term use, which restricts use outside of therapy. When people hear exoskeleton, images of Marvel’s Iron Man or soldiers carrying heavy packs come to mind. The advance of robotic exoskeletons may expand their use beyond rehabilitation facilities, allowing them to become integrated into everyday life.

Biomechanics: a Key Factor in Rehabilitation of Neurological Diseases

In the rapidly evolving modern world, technological advancements are allowing for more effective research and treatment of diseases, disorders, and injuries sustained by humans.  One of the foremost areas of current research in the biomechanics field is that of its role in treatment and rehabilitation of neurological disorders such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS).  According to the United Nations, as many as 1 billion people in the world live with neurological disorders.  This post will focus mainly on how biomechanics can aid in the treatment and rehabilitation of ALS and MS.  ALS is a fatal disease that causes degeneration of motor neurons leading to muscle atrophy and loss of motor skills.  MS is a nonfatal disease in which the body’s immune system attacks its central nervous system which can cause pain in movement and loss of motor function.  ALS and MS have no known cures; therefore, it is necessary that steps be taken in order to counteract the disabling symptoms of the diseases.  For ALS, rehabilitation can help to sustain motor function thus leading to an enhanced quality of life and perhaps a longer life expectancy.  For MS, rehabilitation can potentially allow for patients to regain motor function in areas where it may have been lost.

diagram showing example of how whole body function is determined by function of much smaller tissues
photo from Kulig & Burnfield, The role of biomechanics in orthopedic and neurological rehabilitation (2008)

 

Biomechanical research has led to breakthroughs in terms of understanding the root cause and resulting difficulties of movement caused by diseases such as MS and ALS.  Many people living with MS and ALS face challenges walking due to muscle weakness and the inability to balance.  Thanks to clinical gait studies, the abnormalities of the stride of people with MS and ALS can be thoroughly analyzed by comparison to the average stride of a human.  The root of these abnormalities can be discovered and addressed through rehabilitation exercises or biomechanical technology such as braces or implants that deliver medicine to muscles.

 

 

gait study participant equipped with surface electrodes, footswitches, and passive reflective markers walking on force plate sensors
photo from Kulig & Burnfield, The role of biomechanics in orthopedic and neurological rehabilitation (2008)

 

An article by Kornelia Kulig and Judith Marie Burnfield explains how clinical gait studies are performed using footswitches, passive reflective markers, force plates, and electrodes to record data on stride characteristics, full body kinematics, ground reaction forces, and muscle activity.  Footswitches enable initial detection of irregularities.  The kinematic data recorded by the passive reflective markers can then trace the irregularity to the source of the issue.  Ground reaction forces signify stress levels placed on various joints. Electrodes assist in distinguishing between movements that are a direct result of disability versus movements that are performed in order to make up for the lack of muscle function.

Clinical gait studies are just one example of how biomechanics research can improve rehabilitation techniques for those with neurological disorders.  Any basic muscular function lost to a neurological disorder (such as hand/grip function) is theoretically able to be treated through proper biomechanical research and rehabilitation.  It is a truly exciting prospect that diseases that were once permanently disabling are now becoming more and more treatable with the goal of a permanent cure in mind.

For additional information on the topic of neurological rehabilitation, visit this Wikipedia article.

 

Walk [Under] Water: The Benefits of Underwater Running

Just because you can’t walk on water doesn’t mean you shouldn’t run under it!

Aqua-jogging. Hydro-running. Water-treadmills. Have you ever heard some combination of these terms and wondered what the hype is?

Running underwater offers benefits for people throughout their fitness journey. Underwater running has proven useful for a variety of focuses, including recovery after injury, cross training, and even improved gait. This article includes a video showing a Runner’s World coach tries out a Hydrotrack and discusses some of the benefits!

So, why does it work?

Three basic water properties: hydrostatic pressure, buoyancy, and viscosity.

Hydrostatic pressure is the force that the water exerts on a submerged point. Hydrostatic pressure acts all around the point. However, since hydrostatic pressure is proportional to the weight of liquid above the point, it increases with increased water depth. This means that your feet would experience greater hydrostatic pressures than your knees. While running, this pressure helps support your body and decrease impact forces. In addition to helping prevent injuries through a decreased risk of falling, it also helps decrease swelling and promote cardiovascular health. This article talks about the specifics of pressure with swelling and the cardiovascular system.

Diagram showing hydrostatic forces. Magnitude of the hydrostatic force is larger as it goes deeper below the surface.
Hydrostatic pressure acts on all sides of a point. The pressure increases with depth. Created in Microsoft PowerPoint.

Buoyancy is the hydrostatic force applied to an object with volume (rather than just a point). Since they are at the same depth, all the horizontal forces cancel out. Since the bottom of the object is deeper than the top, the net buoyant force on the object pushes up. The difference between the buoyant force and the weight of the object submerged determines if the object will rise, sink, or stay in place. Thus, the more submerged a person is, the more of their weight is supported. This research article explains how this support can help make gait analysis more effective to further prevent injury. When water reaches the person’s navel, 50% of their weight is supported. This weight bearing capability of water decreases forces on joints and can even help improve range of motion. This allows physical therapy to begin sooner and, overall, take less time out of the patient’s normal routine. This allows shorter rehabilitation times without sacrificing quality of care or recovery.

 

Diagrams showing how the hydrostatic force varies around the submerged object due to depth. The side forces cancel out at equal depth leaving a net buoyant force acting upward against the downward force of the object weight.
Buoyant forces cancel out on the sides leading to the second image showing the net buoyant force and the weight of the object. Created in Microsoft PowerPoint.

Viscosity is a fluid property that affects the resistance that an object encounters during motion. In the case of underwater running, viscosity explains why you move significantly slower in water than on land. It also can offer resistance up to 15 times the amount of resistance on land. Forcing your limbs through the water strengthens muscles that are not typically used out of the water and even burns more calories!

As noted above, viscosity can help strengthen muscles as shown in this study on deep water running (DWR) in a community of elderly women shows how viscosity affects overall strength training. It showed that the women who participated in DWR increased their muscle strength (measured through power) and performed better in various tests, including ones that involved sitting down and getting up. The study showed that deep water running helped to mitigate some of the negative muscular effects of aging.

Overall, running underwater offers some great benefits. The basic properties of water (hydrostatic pressure, buoyancy, and viscosity) provide scientific background for why hydro-running provides benefits for all.