17 results on '"Krebs, Hermano"'
Search Results
2. Robotic Kinematic measures of the arm in chronic Stroke: part 2 – strong correlation with clinical outcome measures
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Moretti, Caio B., Hamilton, Taya, Edwards, Dylan J., Peltz, Avrielle Rykman, Chang, Johanna L., Cortes, Mar, Delbe, Alexandre C. B., Volpe, Bruce T., and Krebs, Hermano I.
- Published
- 2021
- Full Text
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3. Effects of supraspinal feedback on human gait: rhythmic auditory distortion
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Forner-Cordero, Arturo, Pinho, João Pedro, Umemura, Guilherme, Lourenço, João Carlos, Mezêncio, Bruno, Itiki, Cinthia, and Krebs, Hermano Igo
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- 2019
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4. Robotic Kinematic measures of the arm in chronic Stroke: part 1 – Motor Recovery patterns from tDCS preceding intensive training
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Massachusetts Institute of Technology. Department of Mechanical Engineering, Moretti, Caio B., Edwards, Dylan J., Hamilton, Taya, Cortes, Mar, Peltz, Avrielle R., Chang, Johanna L., Delbem, Alexandre C. B., Volpe, Bruce T., Krebs, Hermano I., Massachusetts Institute of Technology. Department of Mechanical Engineering, Moretti, Caio B., Edwards, Dylan J., Hamilton, Taya, Cortes, Mar, Peltz, Avrielle R., Chang, Johanna L., Delbem, Alexandre C. B., Volpe, Bruce T., and Krebs, Hermano I.
- Abstract
Background Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor’s motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups. Methods This 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up. Results No difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation. Conclusions Robotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor reco
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- 2022
5. Robotic Kinematic measures of the arm in chronic Stroke: part 2 – strong correlation with clinical outcome measures
- Author
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Moretti, Caio B., Hamilton, Taya, Edwards, Dylan J., Peltz, Avrielle R., Chang, Johanna L., Cortes, Mar, Delbe, Alexandre C. B., Volpe, Bruce T., Krebs, Hermano I., Moretti, Caio B., Hamilton, Taya, Edwards, Dylan J., Peltz, Avrielle R., Chang, Johanna L., Cortes, Mar, Delbe, Alexandre C. B., Volpe, Bruce T., and Krebs, Hermano I.
- Abstract
Background A detailed sensorimotor evaluation is essential in planning effective, individualized therapy post-stroke. Robotic kinematic assay may offer better accuracy and resolution to understand stroke recovery. Here we investigate the added value of distal wrist measurement to a proximal robotic kinematic assay to improve its correlation with clinical upper extremity measures in chronic stroke. Secondly, we compare linear and nonlinear regression models. Methods Data was sourced from a multicenter randomized controlled trial conducted from 2012 to 2016, investigating the combined effect of robotic therapy and transcranial direct current stimulation (tDCS). 24 kinematic metrics were derived from 4 shoulder-elbow tasks and 35 metrics from 3 wrist and forearm evaluation tasks. A correlation-based feature selection was performed, keeping only features substantially correlated with the target attribute (R > 0.5.) Nonlinear models took the form of a multilayer perceptron neural network: one hidden layer and one linear output. Results Shoulder-elbow metrics showed a significant correlation with the Fugl Meyer Assessment (upper extremity, FMA-UE), with a R = 0.82 (P < 0.001) for the linear model and R = 0.88 (P < 0.001) for the nonlinear model. Similarly, a high correlation was found for wrist kinematics and the FMA-UE (R = 0.91 (P < 0.001) and R = 0.92 (P < 0.001) for the linear and nonlinear model respectively). The combined analysis produced a correlation of R = 0.91 (P < 0.001) for the linear model and R = 0.91 (P < 0.001) for the nonlinear model. Conclusions Distal wrist kinematics were highly correlated to clinical outcomes, warranting future investigation to explore our nonlinear wrist model with acute or subacute stroke populations. Trial registration http://www.clinicaltrials.gov . Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers: NCT01726673 and NCT03562663 .
- Published
- 2022
6. Effects of supraspinal feedback on human gait: rhythmic auditory distortion
- Author
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Massachusetts Institute of Technology. Department of Mechanical Engineering, Forner-Cordero, Arturo, Pinho, João P, Umemura, Guilherme, Lourenço, João C, Mezêncio, Bruno, Itiki, Cinthia, Krebs, Hermano Igo, Massachusetts Institute of Technology. Department of Mechanical Engineering, Forner-Cordero, Arturo, Pinho, João P, Umemura, Guilherme, Lourenço, João C, Mezêncio, Bruno, Itiki, Cinthia, and Krebs, Hermano Igo
- Abstract
BACKGROUND: Different types of sound cues have been used to adapt the human gait rhythm. We investigated whether young healthy volunteers followed subliminal metronome rhythm changes during gait. METHODS: Twenty-two healthy adults walked at constant speed on a treadmill following a metronome sound cue (period 566 msec). The metronome rhythm was then either increased or decreased, without informing the subjects, at 1 msec increments or decrements to reach, respectively, a low (596 msec) or a high frequency (536 msec) plateaus. After 30 steps at one of these isochronous conditions, the rhythm returned to the original period with decrements or increments of 1 msec. Motion data were recorded with an optical measurement system to determine footfall. The relative phase between sound cue (stimulus) and foot contact (response) were compared. RESULTS: Gait was entrained to the rhythmic auditory stimulus and subjects subconsciously adapted the step time and length to maintain treadmill speed, while following the rhythm changes. In most cases there was a lead error: the foot contact occurred before the sound cue. The mean error or the absolute mean relative phase increased during the isochronous high (536 msec) or low frequencies (596 msec). CONCLUSION: These results showed that the gait period is strongly “entrained” with the first metronome rhythm while subjects still followed metronome changes with larger error. This suggests two processes: one slow-adapting, supraspinal oscillator with persistence that predicts the foot contact to occur ahead of the stimulus, and a second fast process linked to sensory inputs that adapts to the mismatch between peripheral sensory input (foot contact) and supraspinal sensory input (auditory rhythm)., Office of Naval Research Global (Grants ONR-G 62909131278 and 62909141246)
- Published
- 2020
7. MIT-Skywalker: considerations on the Design of a Body Weight Support System
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Massachusetts Institute of Technology. Department of Mechanical Engineering, Sales Goncalves, Rogerio, Krebs, Hermano Igo, Massachusetts Institute of Technology. Department of Mechanical Engineering, Sales Goncalves, Rogerio, and Krebs, Hermano Igo
- Abstract
Background To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury. Method Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support. Results The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant. Conclusion We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training.
- Published
- 2017
8. MIT-Skywalker: considerations on the Design of a Body Weight Support System.
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Sales Gonçalves, Rogério, Krebs, Hermano Igo, and Gonçalves, Rogério Sales
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BODY weight , *WALKING , *REHABILITATION , *TREADMILLS , *WALKING speed - Abstract
Background: To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury.Method: Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support.Results: The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant.Conclusion: We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training. [ABSTRACT FROM AUTHOR]- Published
- 2017
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9. Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial.
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Rodgers, Helen, Shaw, Lisa, Bosomworth, Helen, Aird, Lydia, Alvarado, Natasha, Andole, Sreeman, Cohen, David L., Dawson, Jesse, Eyre, Janet, Finch, Tracy, Ford, Gary A., Hislop, Jennifer, Steven Hogg, Howel, Denise, Hughes, Niall, Krebs, Hermano Igo, Price, Christopher, Rochester, Lynn, Stamp, Elaine, and Ternent, Laura
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STROKE treatment ,RANDOMIZED controlled trials ,ECONOMIC research ,ARM amputation ,QUALITY of life ,PHYSIOLOGY ,ARM innervation ,ROBOTICS ,NATIONAL health services ,EXERCISE therapy ,STROKE diagnosis ,COMPARATIVE studies ,CONVALESCENCE ,COST effectiveness ,FUNCTIONAL assessment ,EXPERIMENTAL design ,KINEMATICS ,RESEARCH methodology ,MEDICAL care costs ,MEDICAL cooperation ,RESEARCH protocols ,QUESTIONNAIRES ,RESEARCH ,STROKE ,TIME ,EVALUATION research ,TREATMENT effectiveness ,QUALITY-adjusted life years ,STATISTICAL models ,ECONOMICS - Abstract
Background: Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke.Methods/design: Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation.Setting: NHS stroke services.Participants: adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation. Randomisation groups: 1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks 2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks 3. Usual NHS care in accordance with local clinical practice Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment.Primary Outcome: upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation.Secondary Outcomes: upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months. Blinding: outcomes are undertaken by blinded assessors. Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes. Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial.Sample Size: allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0-7 must improve by 3 or more points; baseline ARAT 8-13 improve by 4 or more points; baseline ARAT 14-19 improve by 5 or more points; baseline ARAT 20-39 improve by 6 or more points.Discussion: The results from this trial will determine whether robot-assisted training improves upper limb function post stroke.Trial Registration: ISRCTN, identifier: ISRCTN69371850 . Registered 4 October 2013. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. Task-specific ankle robotics gait training after stroke: a randomized pilot study.
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Forrester, Larry W., Roy, Anindo, Hafer-Macko, Charlene, Krebs, Hermano I., and Macko, Richard F.
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MEDICAL robotics ,GAIT in humans ,HUMAN locomotion ,STROKE patients ,REHABILITATION ,THERAPEUTICS ,ROBOTICS equipment ,ANKLE ,COMPARATIVE studies ,EXERCISE therapy ,GAIT disorders ,HEMIPLEGIA ,RESEARCH methodology ,MEDICAL cooperation ,NEUROLOGICAL disorders ,RESEARCH ,RESEARCH funding ,ROBOTICS ,STROKE ,PILOT projects ,EVALUATION research ,RANDOMIZED controlled trials ,DISEASE complications ,EQUIPMENT & supplies - Abstract
Background: An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments.Findings: Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics.Conclusions: Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery.Clinical Trial Identifier: NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1. [ABSTRACT FROM AUTHOR]- Published
- 2016
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11. Movement-generated afference paired with transcranial magnetic stimulation: an associative stimulation paradigm.
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Edwards, Dylan J., Dipietro, Laura, Demirtas-Tatlidede, Asli, Medeiros, Ana H., Thickbroom, Gary W., Mastaglia, Francis L., Krebs, Hermano I., and Pascual-Leone, Alvaro
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TRANSCRANIAL magnetic stimulation ,PERIPHERAL nervous system ,SOMATOSENSORY cortex ,AUTOMOBILE engines ,CONTINUOUS passive motion therapy ,ANALYSIS of variance - Abstract
Background A peripheral nerve stimulus can enhance or suppress the evoked response to transcranial magnetic stimulation (TMS) depending on the latency of the preceding peripheral nerve stimulation (PNS) pulse. Similarly, somatosensory afference from the passively moving limb can transiently alter corticomotor excitability, in a phase-dependent manner. The repeated association of PNS with TMS is known to modulate corticomotor excitability; however, it is unknown whether repeated passive-movement associative stimulation (MAS) has similar effects. Methods In a proof-of-principal study, using a cross-over design, seven healthy subjects received in separate sessions: (1) TMS (120% of the resting motor threshold-RMT, optimal site for Flexor Carpi Radialis) with muscle at rest; (2) TMS paired with cyclic passive movement during extension cyclic passive movement (400 pairs, 1 Hz), with the intervention order randomly assigned. Normality was tested using the Kolmogorov-Smirnov test, then compared to pre-intervention baseline using repeated measures ANOVA with a Dunnet multiple comparisons test. Results MAS led to a progressive and significant decrease in the motor evoked potential (MEP) amplitude over the intervention (R
2 = 0.6665, P < 0.0001), which was not evident with TMS alone (R2 = 0.0068, P = 0.641). Post-intervention excitability reduction, only present with MAS intervention, remained for 20min (0-10min = 68.2 ± 4.9%, P < 0.05; 10-20min = 73.3 ± 9.7%, P < 0.05). Conclusion The association of somatosensory afference from the moving limb with TMS over primary motor cortex in healthy subjects can be used to modulate corticomotor excitability, and may have therapeutic implications. [ABSTRACT FROM AUTHOR]- Published
- 2014
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12. EMG-based pattern recognition approach in post stroke robot-aided rehabilitation: a feasibility study.
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Cesqui, Benedetta, Tropea, Peppino, Micera, Silvestro, and Krebs, Hermano Igo
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ELECTROMYOGRAPHY ,ROBOTICS ,MUSCLES ,AUTOMATION ,MACHINE theory - Abstract
Background: Several studies investigating the use of electromyographic (EMG) signals in robot-based stroke neurorehabilitation to enhance functional recovery. Here we explored whether a classical EMG-based patterns recognition approach could be employed to predict patients' intentions while attempting to generate goal-directed movements in the horizontal plane. Methods: Nine right-handed healthy subjects and seven right-handed stroke survivors performed reaching movements in the horizontal plane. EMG signals were recorded and used to identify the intended motion direction of the subjects. To this aim, a standard pattern recognition algorithm (i.e., Support Vector Machine, SVM) was used. Different tests were carried out to understand the role of the inter- and intra-subjects' variability in affecting classifier accuracy. Abnormal muscular spatial patterns generating misclassification were evaluated by means of an assessment index calculated from the results achieved with the PCA, i.e., the so-called Coefficient of Expressiveness (CoE). Results: Processing the EMG signals of the healthy subjects, in most of the cases we were able to build a static functional map of the EMG activation patterns for point-to-point reaching movements on the horizontal plane. On the contrary, when processing the EMG signals of the pathological subjects a good classification was not possible. In particular, patients' aimed movement direction was not predictable with sufficient accuracy either when using the general map extracted from data of normal subjects and when tuning the classifier on the EMG signals recorded from each patient. Conclusions: The experimental findings herein reported show that the use of EMG patterns recognition approach might not be practical to decode movement intention in subjects with neurological injury such as stroke. Rather than estimate motion from EMGs, future scenarios should encourage the utilization of these signals to detect and interpret the normal and abnormal muscle patterns and provide feedback on their correct recruitment. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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13. Effects of unilateral robotic limb loading on gain characteristics in subjects with chronic stroke.
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Khanna, Ira, Roy, Anindo, Rodgers, Mary M., Krebs, Hermano I., Macko, Richard M., and Forrester, Larry W.
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MOTOR ability ,ROBOTICS ,CEREBROVASCULAR disease ,GAIT disorders ,ANALYSIS of variance - Abstract
Background: Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern. The purpose of this study was to assess the effects of the added mass of one of these robots, the MIT's Anklebot, while unpowered, on gait of chronic stroke survivors during overground and treadmill walking. Methods: Nine chronic stroke survivors walked overground and on a treadmill with and without the anklebot mounted on the paretic leg. Gait parameters, interlimb symmetry, and joint kinematics were collected for the four conditions. Repeated-measures analysis of variance (ANOVA) tests were conducted to examine for possible differences across four conditions for the paretic and nonparetic leg. Results: The added inertia and friction of the unpowered anklebot had no statistically significant effect on spatiotemporal parameters of gait, including paretic and nonparetic step time and stance percentage, in both overground and treadmill conditions. Noteworthy, interlimb symmetry as characterized by relative stance duration was greater on the treadmill than overground regardless of loading conditions. The presence of the unpowered robot loading reduced the nonparetic knee peak flexion on the treadmill and paretic peak dorsiflexion overground (p < 0.05). Conclusions: Our results suggest that for these subjects the added inertia and friction of this backdriveable robot did not significantly alter their gait pattern. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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14. A working model of stroke recovery from rehabilitation robotics practitioners.
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Krebs, Hermano Igo, Volpe, Bruce, and Hogan, Neville
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CEREBROVASCULAR disease patient rehabilitation , *MOTOR ability , *MOTOR learning , *ROBOTICS , *PSYCHOLOGY of learning - Abstract
We reviewed some of our initial insights about the process of upper-limb behavioral recovery following stroke. Evidence to date indicates that intensity, task specificity, active engagement, and focusing training on motor coordination are key factors enabling efficacious recovery. On modeling, experience with over 400 stroke patients has suggested a working model of recovery similar to implicit motor learning. Ultimately, we plan to apply these insights in the development of customized training paradigms to enhance recovery. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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15. Rehabilitation robotics: pilot trial of a spatial extension for MIT-Manus.
- Author
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Krebs, Hermano I., Ferraro, Mark, Buerger, Stephen P., Newbery, Miranda J., Makiyama, Antonio, Sandmann, Michael, Lynch, Daniel, Volpe, Bruce T., and Hogan, Neville
- Subjects
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ROBOTS , *ROBOTICS , *CLINICAL trials , *MOTOR ability , *MUSCLES - Abstract
Background: Previous results with the planar robot MIT-MANUS demonstrated positive benefits in trials with over 250 stroke patients. Consistent with motor learning, the positive effects did not generalize to other muscle groups or limb segments. Therefore we are designing a new class of robots to exercise other muscle groups or limb segments. This paper presents basic engineering aspects of a novel robotic module that extends our approach to anti-gravity movements out of the horizontal plane and a pilot study with 10 outpatients. Patients were trained during the initial six-weeks with the planar module (i.e., performance-based training limited to horizontal movements with gravity compensation). This training was followed by six-weeks of robotic therapy that focused on performing vertical arm movements against gravity. The 12-week protocol includes three one-hour robot therapy sessions per week (total 36 robot treatment sessions). Results: Pilot study demonstrated that the protocol was safe and well tolerated with no patient presenting any adverse effect. Consistent with our past experience with persons with chronic strokes, there was a statistically significant reduction in tone measurement from admission to discharge of performance-based planar robot therapy and we have not observed increases in muscle tone or spasticity during the anti-gravity training protocol. Pilot results showed also a reduction in shoulder-elbow impairment following planar horizontal training. Furthermore, it suggested an additional reduction in shoulder-elbow impairment following the anti-gravity training. Conclusion: Our clinical experiments have focused on a fundamental question of whether task specific robotic training influences brain recovery. To date several studies demonstrate that in mature and damaged nervous systems, nurture indeed has an effect on nature. The improved recovery is most pronounced in the trained limb segments. We have now embarked on experiments that test whether we can continue to influence recovery, long after the acute insult, with a novel class of spatial robotic devices. This pilot results support the pursuit of further clinical trials to test efficacy and the pursuit of optimal therapy following brain injury. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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16. MIT-Skywalker: considerations on the Design of a Body Weight Support System.
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Gonçalves RS and Krebs HI
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- Adult, Bicycling, Biomechanical Phenomena, Body Weight, Female, Gait Disorders, Neurologic etiology, Healthy Volunteers, Humans, Male, Nervous System Diseases complications, Nervous System Diseases rehabilitation, Software, Walking, Walking Speed, Gait Disorders, Neurologic rehabilitation, Orthotic Devices, Robotics instrumentation, Robotics methods
- Abstract
Background: To provide body weight support during walking and balance training, one can employ two distinct embodiments: support through a harness hanging from an overhead system or support through a saddle/seat type. This paper presents a comparison of these two approaches. Ultimately, this comparison determined our selection of the body weight support system employed in the MIT-Skywalker, a robotic device developed for the rehabilitation/habilitation of gait and balance after a neurological injury., Method: Here we will summarize our results with eight healthy subjects walking on the treadmill without any support, with 30% unloading supported by a harness hanging from an overhead system, and with a saddle/seat-like support system. We compared the center of mass as well as vertical and mediolateral trunk displacements across different walking speeds and support., Results: The bicycle/saddle system had the highest values for the mediolateral inclination, while the overhead harness body weight support showed the lowest values at all speeds. The differences were statistically significant., Conclusion: We selected the bicycle/saddle system for the MIT-Skywalker. It allows faster don-and-doff, better centers the patient to the split treadmill, and allows all forms of training. The overhead harness body weight support might be adequate for rhythmic walking training but limits any potential for balance training.
- Published
- 2017
- Full Text
- View/download PDF
17. Reversal of TMS-induced motor twitch by training is associated with a reduction in excitability of the antagonist muscle.
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Giacobbe V, Volpe BT, Thickbroom GW, Fregni F, Pascual-Leone A, Krebs HI, and Edwards DJ
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- Adult, Electromyography, Evoked Potentials, Motor physiology, Female, Humans, Male, Muscle, Skeletal innervation, Wrist innervation, Wrist physiology, Young Adult, Learning physiology, Motor Cortex physiology, Movement physiology, Muscle Contraction physiology, Muscle, Skeletal physiology, Transcranial Magnetic Stimulation
- Abstract
Background: A single session of isolated repetitive movements of the thumb can alter the response to transcranial magnetic stimulation (TMS), such that the related muscle twitch measured post-training occurs in the trained direction. This response is attributed to transient excitability changes in primary motor cortex (M1) that form the early part of learning. We investigated; (1) whether this phenomenon might occur for movements at the wrist, and (2) how specific TMS activation patterns of opposing muscles underlie the practice-induced change in direction., Methods: We used single-pulse suprathreshold TMS over the M1 forearm area, to evoke wrist movements in 20 healthy subjects. We measured the preferential direction of the TMS-induced twitch in both the sagittal and coronal plane using an optical goniometer fixed to the dorsum of the wrist, and recorded electromyographic (EMG) activity from the flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles. Subjects performed gentle voluntary movements, in the direction opposite to the initial twitch for 5 minutes at 0.2 Hz. We collected motor evoked potentials (MEPs) elicited by TMS at baseline and for 10 minutes after training., Results: Repetitive motor training was sufficient for TMS to evoke movements in the practiced direction opposite to the original twitch. For most subjects the effect of the newly-acquired direction was retained for at least 10 minutes before reverting to the original. Importantly, the direction change of the movement was associated with a significant decrease in MEP amplitude of the antagonist to the trained muscle, rather than an increase in MEP amplitude of the trained muscle., Conclusions: These results demonstrate for the first time that a TMS-twitch direction change following a simple practice paradigm may result from reduced corticospinal drive to muscles antagonizing the trained direction. Such findings may have implications for training paradigms in neurorehabilitation.
- Published
- 2011
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