Technical Brief

Design, Analysis, and Optimization of an Acute Stroke Gait Rehabilitation Device

[+] Author and Article Information
Kazuto Kora

Department of Mechanical Engineering,
The University of Auckland,
Private Bag 92019,
Auckland Mail Centre,
Auckland 1142, New Zealand
e-mail: kkor008@aucklanduni.ac.nz

James Stinear

Department of Exercise Sciences,
Faculty of Science,
The University of Auckland,
Private Bag 92019,
Auckland Mail Centre,
Auckland 1142, New Zealand
e-mail: j.stinear@auckland.ac.nz

Andrew McDaid

Department of Mechanical Engineering,
The University of Auckland,
Private Bag 92019,
Auckland Mail Centre,
Auckland 1142, New Zealand
e-mail: andrew.mcdaid@auckland.ac.nz

Manuscript received April 28, 2016; final manuscript received October 16, 2016; published online December 21, 2016. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 11(1), 014503 (Dec 21, 2016) (6 pages) Paper No: MED-16-1216; doi: 10.1115/1.4035127 History: Received April 28, 2016; Revised October 16, 2016

Stroke is one of the leading causes of adult physical disability, and rehabilitation and hospitalization costs for stroke are among the highest for all injuries. Current rehabilitation techniques are labor intensive and time consuming for therapists and difficult to perform effectively. Research suggests that starting rehabilitation during the acute or subacute stage of recovery results in better outcomes than therapy delivered in the chronic stage. To improve the gait rehabilitation process, robot-assisted gait rehabilitation has gained much interest over the past years. However, many robot-assisted rehabilitation devices have limitations; one of which is being bulky and complex to handle. Large and expensive devices that require special training to operate are less attractive to clinics and therapists, and ultimately less likely to be available to patients especially at the early stage of stroke. To address these limitations, this research proposes a new gait rehabilitation device called the linkage design gait trainer (LGT). The device is based on a walking frame design with a simple four-bar linkage “end-effector” mechanism to generate normal gait trajectories during general walking and exercise. The design of the four-bar linkage mechanism was optimized for a particular gait pattern. A prototype of the device was developed and tested. The kinematics of the device itself and gait kinematics with and without assistance from the device were recorded and analyzed using an optical motion capture system. The results show the linkage mechanism is able to guide the leg of the user during over ground walking. There were some differences in the hip (20.5 deg RMS) and knee (14.8 deg RMS) trajectory between the person walking with and without the device assistance. The study demonstrated the concept and feasibility of this novel gait training device.

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American Stroke Association, 2014, “ Patient Education Handout,” American Stroke Association, Dallas, TX.
Stroke Foundation of New Zealand, 2013, “ Life After Stroke,” 2nd ed., Stroke Foundation of New Zealand, Wellington, New Zealand.
Flansbjer, U.-B. , Holmbäck, A. M. , Downham, D. , Patten, C. , and Lexell, J. , 2005, “ Reliability of Gait Performance Tests in Men and Women With Hemiparesis After Stroke,” J. Rehabil. Med., 37(2), pp. 75–82. [CrossRef] [PubMed]
Preston, E. , Ada, L. , Dean, C. M. , Stanton, R. , and Waddington, G. , 2011, “ What is the Probability of Patients Who Are Nonambulatory After Stroke Regaining Independent Walking? A Systematic Review,” Int. J. Stroke, 6(6), pp. 531–540. [CrossRef] [PubMed]
Mehrholz, J. , Elsner, B. , Werner, C. , Kugler, J. , and Pohl, M. , 2013, “ Electromechanical-Assisted Training for Walking After Stroke,” Cochrane Database Syst. Rev., (7), Art. No. CD006185.
Fuzaro, A. C. , Guerreiro, C. T. , Galetti, F. C. , Jucá, R. B. V. M. , and de Araujo, J. E. , 2012, “ Modified Constraint-Induced Movement Therapy and Modified Forced-Use Therapy for Stroke Patients Are Both Effective to Promote Balance and Gait Improvements,” Braz. J. Phys. Ther., 16(2), pp. 157–165. [CrossRef]
Zipp, G. P. , and Winning, S. , 2012, “ Effects of Constraint-Induced Movement Therapy on Gait, Balance, and Functional Locomotor Mobility,” Pediatric Phys. Ther., 24(1), pp. 64–68. [CrossRef]
Jezernik, S. , Colombo, G. , and Morari, M. , 2004, “ Automatic Gait-Pattern Adaptation Algorithms for Rehabilitation With a 4-DOF Robotic Orthosis,” IEEE Trans. Rob. Autom., 20(3), pp. 574–582. [CrossRef]
Veneman, J. , Kruidhof, R. , Hekman, E. , Ekkelenkamp, R. , van Asseldonk, E. , and van der Kooij, H. , 2007, “ Design and Evaluation of the Lopes Exoskeleton Robot for Interactive Gait Rehabilitation,” IEEE Trans. Neural Syst. Rehabil. Eng., 15(3), pp. 379–386. [CrossRef] [PubMed]
West, R. , 2004, “ Powered Gait Orthosis and Method of Utilizing Same,” U.S. Patent 6,689,075. https://www.google.com/patents/US6689075
Yamawaki, K. , Ariyasu, R. , Kubota, S. , Kawamoto, H. , Nakata, Y. , Kamibayashi, K. , Sankai, Y. , Eguchi, K. , and Ochiai, N. , 2012, “ Application of Robot Suit Hal to Gait Rehabilitation of Stroke Patients: A Case Study,” Computers Helping People With Special Needs (Lecture Notes in Computer Science), K. Miesenberger , A. Karshmer , P. Penaz , and W. Zagler , eds., Vol. 7383, Springer Berlin Heidelberg, pp. 184–187.
Hesse, S. , and Uhlenbrock, D. , 2000, “ A Mechanized Gait Trainer for Restoration of Gait,” J. Rehabil. Res. Dev., 37(6), pp. 701–708. http://www.rehab.research.va.gov/jour/00/37/6/pdf/hesse.pdf [PubMed]
Hesse, S. , Sarkodie-Gyan, T. , and Uhlenbrock, D. , 1999, “ Development of an Advanced Mechanised Gait Trainer, Controlling Movement of the Centre of Mass, for Restoring Gait in Non-Ambulant Subjects-Weiterentwicklung Eines Mechanisierten Gangtrainers mit Steuerung des Massenschwerpunktes zur Gangrehabilitation Rollstuhlpflichtiger Patienten,” Biomedizinische Technik/Biomedical Engineering, 44(7–8), pp. 194–201. [CrossRef]
Freivogel, S. , Schmalohr, D. , and Mehrholz, J. , 2009, “ Improved Walking Ability and Reduced Therapeutic Stress With an Electromechanical Gait Device,” J. Rehabil. Med., 41(9), pp. 734–739. [CrossRef] [PubMed]
Schmidt, H. , Hesse, S. , Bernhardt, R. , and Krüger, J. , 2005, “ Hapticwalker—A Novel Haptic Foot Device,” ACM Trans. Appl. Percept., 2(2), pp. 166–180. [CrossRef]
Hesse, S. , Waldner, A. , and Tomelleri, C. , 2010, “ Research Innovative Gait Robot for the Repetitive Practice of Floor Walking and Stair Climbing Up and Down in Stroke Patients,” J. Neuroeng. Rehabil., 7(1), p. 30. [CrossRef] [PubMed]
Tomelleri, C. , Waldner, A. , Werner, C. , and Hesse, S. , 2011, “ Adaptive Locomotor Training on an End-Effector Gait Robot: Evaluation of the Ground Reaction Forces in Different Training Conditions,” 2011 IEEE International Conference on Rehabilitation Robotics (ICORR), Zurich, Switzerland, June 29–July 1, pp. 1–5.
Shyu, J. H. , Chen, C. K. , Yu, C. C. , and Luo, Y. J. , 2011, “ Research and Development of an Adjustable Elliptical Exerciser,” Advanced Design Technology (Advanced Materials Research), ADME 2011, Vol. 308, Trans Tech Publications, Pfaffikon, Switzerland, pp. 2078–2083.
Nelson, C. A. , Burnfield, J. M. , Shu, Y. , Buster, T. W. , Taylor, A. P. , and Graham, A. , 2011, “ Modified Elliptical Machine Motor-Drive Design for Assistive Gait Rehabilitation,” ASME J. Med. Devices, 5(2), p. 021001. [CrossRef]
Mehrholz, J. , and Pohl, M. , 2012, “ Electromechanical-Assisted Gait Training After Stroke: A Systematic Review Comparing End-Effector and Exoskeleton Devices,” J. Rehabil. Med., 44(3), pp. 193–199. [CrossRef] [PubMed]
Cheng, P.-Y. , and Lai, P.-Y. , 2013, “ Comparison of Exoskeleton Robots and End-Effector Robots on Training Methods and Gait Biomechanics,” Intelligent Robotics and Applications (Lecture Notes in Computer Science), J. Lee , M. Lee , H. Liu , and J.-H. Ryu , eds., Vol. 8102, Springer Berlin Heidelberg, pp. 258–266.
Hesse, S. , Schattat, N. , Mehrholz, J. , and Werner, C. , 2013, “ Evidence of End-Effector Based Gait Machines in Gait Rehabilitation After CNS Lesion,” NeuroRehabilitation, 33(1), pp. 77–84. [PubMed]
Dimyan, M. A. , and Cohen, L. G. , 2011, “ Neuroplasticity in the Context of Motor Rehabilitation After Stroke,” Nat. Rev. Neurol., 7(2), pp. 76–85. [CrossRef] [PubMed]
Langhorne, P. , and Pollock, A. , 2002, “ What are the Components of Effective Stroke Unit Care?,” Age Ageing, 31(5), pp. 365–371. [CrossRef] [PubMed]
Indredavik, B. , Bakke, F. , Slørdahl, S. , Rokseth, R. , and Håheim, L. , 1999, “ Treatment in a Combined Acute and Rehabilitation Stroke Unit Which Aspects are Most Important?,” Stroke, 30(5), pp. 917–923. [CrossRef] [PubMed]
Bernhardt, J. , Thuy, M. N. , Collier, J. M. , and Legg, L. A. , 2009, “ Very Early Versus Delayed Mobilisation After Stroke,” Cochrane Database Syst. Rev., (1), Art. No.: CD006187.
Cumming, T. B. , Collier, J. , Thrift, A. G. , and Bernhardt, J. , 2008, “ The Effect of Very Early Mobilization After Stroke on Psychological Well-Being,” Jof Rehabil. Med., 40(8), pp. 609–614. [CrossRef]
Stroke Foundation of New Zealand, and New Zealand Guidelines Group, 2010, “ New Zealand Clinical Guidelines for Stroke Management 2010,” Stroke Foundation of New Zealand, Wellington, New Zealand. http://www.stroke.org.nz/resources/NZClinicalGuidelinesStrokeManagement2010ActiveContents.pdf
Langhorne, P. , Stott, D. , Knight, A. , Bernhardt, J. , Barer, D. , and Watkins, C. , 2010, “ Very Early Rehabilitation or Intensive Telemetry After Stroke: A Pilot Randomised Trial,” Cerebrovasc. Dis., 29(4), pp. 352–360. [CrossRef] [PubMed]
Hornby, T. G. , Campbell, D. D. , Kahn, J. H. , Demott, T. , Moore, J. L. , and Roth, H. R. , 2008, “ Enhanced Gait-Related Improvements After Therapist—Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study,” Stroke, 39(6), pp. 1786–1792. [CrossRef] [PubMed]
United States Bureau of the Census, 1993, “ Statistical Abstract United States,” 113 ed., Vol. 8, United States Bureau of the Census, Washington, DC. http://www2.census.gov/library/publications/1993/compendia/statab/113ed/1993-01.pdf
Park, E. S. , Park, C. I. , and Kim, J. Y. , 2001, “ Comparison of Anterior and Posterior Walkers With Respect to Gait Parameters and Energy Expenditure of Children With Spastic Diplegic Cerebral Palsy,” Yonsei Med. J., 42(2), pp. 180–184. [CrossRef] [PubMed]
Bruggeman, H. , Zosh, W. , and Warren, W. , 2007, “ Optic Flow Drives Human Visuo-Locomotor Adaptation,” Current Biol., 17(23), pp. 2035–2040. [CrossRef]
Nelson, C. , Stolle, C. , Burnfield, J. , and Buster, T. , 2015, “ Synthesis of a Rehabilitation Mechanism Replicating Normal Gait,” 14th IFToMM World Congress, Taipei, Taiwan, Oct. 25–30, pp. 71–78.
Ji, Z. , and Manna, Y. , 2008, “ Synthesis of a Pattern Generation Mechanism for Gait Rehabilitation,”ASME J. Med. Dev., 2(3), p. 031004. [CrossRef]
Perry, J. , and Burnfield, M. B. , 2010, Gait Analysis: Normal and Pathological Function, 2nd ed., Slack Incorporated, Thorofare, NJ.
Ferrari, A. , Benedetti, M. G. , Pavan, E. , Frigo, C. , Bettinelli, D. , Rabuffetti, M. , Crenna, P. , and Leardini, A. , 2008, “ Quantitative Comparison of Five Current Protocols in Gait Analysis,” Gait Posture, 28(2), pp. 207–216. [CrossRef] [PubMed]


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Fig. 1

Schematic of first frame design: (a) 2D side view and (b) 3D view

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Fig. 2

Design parameters of a crank-rocker mechanism

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Fig. 3

Prototype of linkage design gait trainer (LGT)

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Fig. 4

Ankle trajectories

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Fig. 5

Simulation of hip and knee angles of the participant walking with 60% scaled step length (dotted line) against the normative gait pattern (solid line with one standard deviation in dashed lines)

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Fig. 6

Simulation of hip and knee angles the participant walking with 60% scaled step length (dotted line) against hip and knee angles of the participant walking without the LGT (solid line with one standard deviation in dashed line)

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Fig. 7

Simulation of hip and knee angles the participant walking with 60% scaled step length (dotted line) against hip and knee angles of the participant with the LGT (solid line with one standard deviation in dashed line)

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Fig. 8

Hip and knee angles of the participant with the LGT (solid line) against hip and knee angles of the participant walking without the LGT (dotted line). Dashed lines show 1SD from both results.



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