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结合神经刺激与动力外骨骼膝关节以改善中风后的行走能力。

Combining neural stimulation and a powered exoskeletal knee to enhance walking after stroke.

作者信息

Fitzpatrick Marshaun N, Lombardo Lisa M, Hnat Sandra K, Becker Brian M, Selkirk Stephen M, Audu Musa L, Triolo Ronald J, Quinn Roger D, Makowski Nathaniel S

机构信息

Department of Mechanical and Aerospace Engineering, CWRU, Cleveland, OH, USA.

Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.

出版信息

J Rehabil Assist Technol Eng. 2025 Mar 24;12:20556683251329256. doi: 10.1177/20556683251329256. eCollection 2025 Jan-Dec.

DOI:10.1177/20556683251329256
PMID:40144145
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11938448/
Abstract

In this study, we developed a unilateral, hybrid exoskeleton designed to augment post-stroke mobility through integration of noninvasive neural stimulation and a motorized knee orthosis. We evaluated proof of concept for this hybrid exoskeleton in a stroke survivor by assessing whether: (1) the motor and transmission possess sufficient backdrivability to facilitate effective muscle-generated movements, (2) the motor can independently drive movement, and (3) the combined application of stimulation and motor generate kinematic improvements superior to either modality used in isolation. The device was evaluated on an ambulatory stroke survivor under four overground walking conditions: (1) without the device, (2) stimulation only while wearing the exoskeleton, (3) motor assistance only, and (4) hybrid stimulated and motorized assistance. A motion capture system was used to obtain lower limb joint angles to assess the differences in each walking condition. Changes towards neurotypical hip, knee and ankle angles were found between the gait with no device compared to the assistive conditions. Hip-knee cyclograms suggest hybrid assistance most resembled neurotypical gait. Individually, neural stimulation and motor assistance resulted in improved gait kinematics and hybrid assistance provided greater improvement than each form of individual assistance.

摘要

在本研究中，我们开发了一种单侧混合外骨骼，旨在通过整合无创神经刺激和电动膝关节矫形器来增强中风后的运动能力。我们通过评估以下方面，在一名中风幸存者身上验证了这种混合外骨骼的概念：(1) 电机和传动装置是否具有足够的反向驱动能力，以促进有效的肌肉运动；(2) 电机能否独立驱动运动；(3) 刺激和电机的联合应用是否能产生优于单独使用任何一种方式的运动学改善。该装置在一名能行走的中风幸存者身上，于四种地面行走条件下进行了评估：(1) 不使用该装置；(2) 仅在穿戴外骨骼时进行刺激；(3) 仅使用电机辅助；(4) 刺激和电机联合辅助。使用运动捕捉系统获取下肢关节角度，以评估每种行走条件下的差异。与无辅助条件的步态相比，发现神经典型的髋、膝和踝关节角度在有辅助条件下发生了变化。髋 - 膝循环图表明，混合辅助最接近神经典型步态。单独来看，神经刺激和电机辅助均改善了步态运动学，且混合辅助比每种单独的辅助方式提供了更大的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/ef21b4c4e30f/10.1177_20556683251329256-fig8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/2ac6c0bced87/10.1177_20556683251329256-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/8b432ca5a295/10.1177_20556683251329256-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/77cc075459dd/10.1177_20556683251329256-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/ffc8c8959892/10.1177_20556683251329256-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/641afce25db8/10.1177_20556683251329256-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/07f4ba6fb600/10.1177_20556683251329256-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/def6f2854041/10.1177_20556683251329256-fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/ef21b4c4e30f/10.1177_20556683251329256-fig8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/2ac6c0bced87/10.1177_20556683251329256-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/8b432ca5a295/10.1177_20556683251329256-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/77cc075459dd/10.1177_20556683251329256-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/ffc8c8959892/10.1177_20556683251329256-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/641afce25db8/10.1177_20556683251329256-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/07f4ba6fb600/10.1177_20556683251329256-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/def6f2854041/10.1177_20556683251329256-fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/355d/11938448/ef21b4c4e30f/10.1177_20556683251329256-fig8.jpg

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本文引用的文献

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Adapted Assistance and Resistance Training With a Knee Exoskeleton After Stroke.脑卒中后使用膝关节外骨骼进行适应性辅助和抗阻训练。
IEEE Trans Neural Syst Rehabil Eng. 2023;31:3265-3274. doi: 10.1109/TNSRE.2023.3303777. Epub 2023 Aug 18.
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Relevance of hazards in exoskeleton applications: a survey-based enquiry.外骨骼应用中的危险相关性：基于调查的探究。
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Modeling and Stiffness-based Continuous Torque Control of Lightweight Quasi-Direct-Drive Knee Exoskeletons for Versatile Walking Assistance.
用于多功能步行辅助的轻质准直接驱动膝关节外骨骼的建模与基于刚度的连续扭矩控制
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A Muscle-First, Electromechanical Hybrid Gait Restoration System in People With Spinal Cord Injury.一种针对脊髓损伤患者的以肌肉优先的机电混合步态恢复系统。
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