Parameter analysis and selection for human gait characterization using a low cost vision system

This paper presents a low cost system for human gait analysis. Two opposite-faced web cameras are used to acquire images of the walking of a person carrying a set of passive marks, where the color is chosen to contrast with the ambient dominant color. It is also used a treadmill with passive marks, where the user walks at different speeds. The acquired trajectories of the marks are used to determine body joint angles and other 3D crossed angles, obtained by both opposite sides from video images processing. With this low cost measurement system the analysis and reconstruction of human gait can be done with a mean error of 2 degrees, becoming a good alternative to more expensive systems to be used in human gait characterization. The system can be used to detect human gait pathologies and to accomplish physical rehabilitation.

This paper presents an indirect user interface solution for an active walking aid using visual image sensing. The aim of the design is to track the movement of the human feet in order to obtain command signals for driving an active walker to be seen as a robotic rollator. The human gait becomes the input device by which the user controls the actuators of the robotic rollator. Computer vision techniques are used to track the user's feet as end effectors during human gait. A camera is mounted on the frame of the rollator and captures video images of the user's feet. The kinematics of the feet are measured in two dimensions to obtain the position and orientation of the user's body. The measured motion parameters of the feet are relayed to the desired position and orientation of the rollator. The robotic rollator is to be used as a rehabilitation tool during everyday walking and gait training.

Robotic-assisted rehabilitation is currently being applied to improve the effectiveness of human gait rehabilitation and recover the mobility and strength after a stroke or spinal cord injury; a robotic assistant can allow the active participation of the patient and the supervision of the collected data and decrease the labor required from therapists during the patient’s training exercises. The goal of gait rehabilitation with robotic-based assistance is to restore motor function by using diverse control strategies, taking account of the physical interaction with the lower limbs of the patient. Over the last few years, researchers have extracted useful information from the patient’s biological signals that can effectively reflect movement intention and muscle activation. One way to evaluate progress in rehabilitation is through isokinetic prototype tests that describe the dynamic characteristics of an isokinetic leg extension device for rehabilitation and control action. These tests use an isokinetic system to assess muscle strength and performance in a patient during isometric or isokinetic contraction. An experimental prototype shown in the following work allows the device’s performance to be evaluated in a controlled environment before the patient’s use. New features provide a control system that can be teleoperated for distributed structures, enabling the remote operation and management of the device. In order to achieve physical recovery from musculoskeletal injuries in the lower limbs and the reintegration of the affected subject into society as an independent and autonomous individual in their daily activities, a control model that introduces a medical isokinetic rehabilitation protocol is presented, in which the element that carries out such protocol consists of a magnetic particle brake whose control action is strongly influenced by the dynamics of the system when in contact with the end user—specifically, the patient’s legs in the stretch from the knee to the ankle. The results of these tests are valuable for health professionals seeking to measure their patient’s progress during the rehabilitation process and determine when it is safe and appropriate to advance in their treatment.

Purpose Evidence for health-related effects of German medical rehabilitation programs for back pain is inconclusive. This cohort study aimed to examine the effectiveness of medical rehabilitation in residents with back pain (German Clinical Trial Register: DRKS00011554). Material and methods A sample of 45 000 people aged 45–59 years was randomly drawn from two pension agencies. We used propensity score matching to compare persons with back pain who completed a medical rehabilitation program with similar untreated subjects. Questionnaire data were assessed in 2017 and 2019, and linked with administrative data. The primary outcome was pain disability. Results In total, 6610 persons with back pain were considered for matching and we finally compared 200 persons treated in a medical rehabilitation program with 200 untreated subjects. Pain disability was reported more favorable in the control group without medical rehabilitation compared to the intervention group (difference = 4.2; 95% CI −0.8–9.2), as well as other secondary outcomes. Conclusions At first glance, the findings suggest that medical rehabilitation was ineffective in improving health, pain and work ability among employed persons with back pain, but we found plausible explanations indicating that the estimated effects in favor of the untreated subjects are methodologically induced. IMPLICATIONS FOR REHABILITATION Propensity score matching can be used to assess the effects of multimodal interventions in persons with back pain in routine care. Inappropriate recruitment of controls may underestimate treatment effects. When using observational data and propensity score matching to analyze the effectiveness of medical rehabilitation, baseline survey should be conducted directly before the start of rehabilitation to identify comparable controls.

This book presents the development of a new multimodal human-robot interface for testing and validating control strategies applied to robotic walkers for assisting human mobility and gait rehabilitation. The aim is to achieve a closer interaction between the robotic device and the individual, empowering the rehabilitation potential of such devices in clinical applications. A new multimodal human-robot interface for testing and validating control strategies applied to robotic walkers for assisting human mobility and gait rehabilitation is presented. Trends and opportunities for future advances in the field of assistive locomotion via the development of hybrid solutions based on the combination of smart walkers and biomechatronic exoskeletons are also discussed.

Control strategies for effective robot assisted gait rehabilitation: The state of art and future prospects

In order to determine the possibility of using a rehabilitation profile to assess the effectiveness of rehabilitation and develop a methodology for quantifying the effectiveness of rehabilitation measures in the short term in inpatients of the State Institution "Ukrainian State Research Institute of Medical and Social Disability of the Ministry of Health of Ukraine" we created a rehabilitation profile of the patient based on the principles of the International Classification of Functioning, Disability and Health (ICF). There were analyzed rehabilitation profiles of 522 patients with therapeutic pathology, musculoskeletal system diseases, and eye diseases. Rehabilitation of patients was comprehensive, with the use of methods of medical, psychological, and physical rehabilitation. The severity of dysfunctions was assessed by a quantitative scale from 0 to 4 points, where "0" – no issues, and "4" – extremely serious issue. The evaluation was performed twice by members of the multidisciplinary team: at the initial examination of the patient and at the discharge from the clinic. The statistical method and the method of expert evaluations were used to process the research results. The licensed software MS Excel for Windows was used. The study found that the proposed method of assessing the effectiveness of short-term rehabilitation is accurate and objective, it considers the initial functional status of the patient and allows to assess the quality and effectiveness of rehabilitation measures at the patient level and at the institution. Its implementation will provide a unified approach to the provision of rehabilitation services and draw conclusions about the effectiveness of rehabilitation activities of the medical institution differentially, considering the type of pathology, leading limitations of life, severity of disorders, age of patients.

BackgroundWe have developed a wearable rehabilitation robot, “curara®,” and examined its immediate effect in patients with spinocerebellar degeneration and stroke, but its rehabilitative effect has not been clarified. The purpose of this study was to examine the effect of this device on gait training in stroke patients.MethodsForty stroke patients were enrolled in this study. The participants were divided randomly into two groups (groups A and B). The participants assigned to group A received RAGT with curara® type 4, whereas those in group B received conventional therapist-assisted gait training. The clinical trial period was 15 days. The participants performed 10 sessions of gait training (5 times per week) each lasting 30 ± 5 min per day. The 10-m walking time (10mWT), and 6-minute walking distance (6MWD) were evaluated as the main outcomes. Timed up and go and Berg Balance Scale (BBS) were also examined. Gait parameters (stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance/swing phases, minimum/maximum knee joint angle, and minimum/maximum hip joint angle) were measured using a RehaGait®. The items other than BBS were measured on days 0, 7, and 14, whereas BBS was measured on days 0 and 14. The improvement rate was calculated as the difference of values between days 14 and 0 divided by the value on day 0. The improvement rates of the 10mWT and 6MWD were set as the main outcomes.ResultsThe data of 35 participants were analyzed. There was no significant difference in the main outcomes between both groups at the end of gait training. As for intragroup changes, gait speed, stride length, stride duration, and cadence were improved significantly between days 0 and 14 in each group. When examining the interaction effect between the day of measurement and group, stride duration (p = 0.006) and cadence (p = 0.012) were more significantly improved in group A than in group B.ConclusionsThis novel wearable powered robot may have the potential to improve gait speed of individuals in stroke rehabilitation.Trial registrationJapan Registry of Clinical Trials (jRCTs032180163). Registered on February 22, 2019; https://jrct.niph.go.jp/en-latest-detail/jRCTs032180163.UMIN Clinical Trials Registry (UMIN000034237)Registered on September 22, 2018; https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000038939.

BACKGROUND: In medical rehabilitation of patients with polyposis rhinosinusitis, aimed at solving the urgent strategic task of public health care to achieve and maintain an optimal level of functioning of persons suffering from partial disability through the development of effective methods of restoration of impaired functions and prevention of complications, there is a need to adequately assess the effectiveness of the measures taken. In this regard, it should be noted that the International Classification of Functioning, Disability and Health (ICF) serves as the gold standard for assessing the patient's quality of life and the effectiveness of rehabilitation measures. The category of human functioning acts as a system-forming basis and starting point of the patient's rehabilitation process in the ICF. In practice, the ICF is based on the biopsychosocial model of health (disease) assessment, which considers psychological and social factors of health (disease) and biological disorders in close interrelated unity. AIM: To evaluate the effectiveness of complex medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis using dynamic changes in the main domains of the ICF. MATERIALS AND METHODS: The study was performed with 89 patients with polyposis rhinosinusitis associated with atopic dermatitis. All patients were divided into 4 groups by simple fixed randomisation. The first group (control, n=22) received only basic therapy, including endonasal application of nasonex 2 doses 2 times a day, daily twice daily washing of the nasal mucosa, as well as the use of desensitising (antihistamines, topical glucocorticoids and moisturising and emollient agents) and detoxifying agents. Patients in the second group (comparison group 1, n=22) were additionally subcutaneously administered dupilumab at a dose of 300 mcg once a fortnight. In the third group (comparison group 2, n=23) against the background of dupilumab administration the combined effect of alternating magnetic field and low-intensity laser radiation of red spectrum was performed. Patients of the fourth group (the main group, n=22) received a course of phototherapy in addition to the scope of treatment of patients of the third group. The results of medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis were evaluated according to the dynamics of specialised categories of ICF, which most accurately characterise the patient's condition from the perspective of the biopsychosocial model of the disease. RESULTS: Changes in the estimated parameters of ICF at comparable initial values had different character and were determined by the scheme of medical rehabilitation. Minimal changes were recorded in the control group. The use of dupilumab was accompanied by positive dynamics of the parameters after 1 month with a significant increase in the shifts after 6 months, indicating the recovery of a number of mental and physical functions, as well as the ICF categories characterising the organism structures, activity and participation of the patient. Supplementation of biological therapy with course magnetolaser influence was accompanied by an increase in positive changes, which were confirmed in 6 months after rehabilitation. The maximum dynamics of the considered ICF categories was noted in the 4th group, where dupilumab administration was supplemented with complex use of therapeutic physical factors. CONCLUSION: The obtained results prove the high informativeness of the system approach realised with the help of ICF in assessing the effectiveness of medical rehabilitation measures. The comparative evaluation of rehabilitation results convincingly showed the advantages of the complex programme including dupilumab target therapy in combination with physiotherapeutic effects.

INTRODUCTION. In recent years, magnetic resonance imaging (MRI) has been increasingly used to diagnose early osteoarthritis (OA). Taking into account the fact that nowadays pharmacological agents are not effective enough and often lead to allergization of the body, there is a need to search for new non-drug methods of treatment of patients with knee joint OA that have proven effectiveness. AIM. To analyze scientific evidence on the use of MRI as an objective method of assessing the effectiveness of medical rehabilitation of patients with knee OA. MATERIALS AND METHODS. We searched for publications in the PEDro and PubMed for the period from 2000 to March 2023. Suitable articles were to reflect the use of MRI as a criterion for the effectiveness of medical rehabilitation in patients with OA of the knee joint. RESULTS AND DISCUSSION. As a result of a search in electronic resources, the largest number of works on the subject under study was found in PubMed. According to the literature quantitative analysis, 7256 works were identified, which reflect the use of MRI in medical rehabilitation. The publications in which the effectiveness of medical rehabilitation of patients with knee OA was evaluated by researchers using MRI accounted for 2.5 % of the total number. Most of the publications were in international databases, while they were practically absent in the Russian ones. CONCLUSION. Despite the scarce research on the matter, we can distinguish the following rehabilitation medicine methods with a proven effect on the ligamentous apparatus, cartilage and soft tissues of the knee joint in patients with OA, according to MRI data: shockwave therapy, physical therapy and ultrasound therapy. However, the need for further scientific research in this direction is obvious.

This paper deal with the modification of a gait training system. This system is designed to produce artificially similar the effects to gait training in a swimming pool. The weight of the patient is supported by a slinging system, while the patient walks on force plates placed on a round track. The slinging force is controlled by the data collected from the force plates. The purpose of the system is to control the slinging force to maintain the most effective load on the patient's lower extremity during training, and to adapt the slinging force to the patient's recovery. To achieve this purpose, the load meter on the force plate is designed to enhance the measurement performance. Tests revealed that dynamic response improved with the new design. Furthermore, the human interface also improved by mounting a display that projects the patient's foot by means of a movie camera. The patient's gait posture can be significantly improved by adapting this method.

Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.

The investigation of the neural correlates of human gait, as measured by means of non-invasive electroencephalography (EEG), is of central importance for the understanding of human gait and for novel developments in gait rehabilitation. Particularly, gait-event-related brain potentials (gERPs) may provide information about the functional role of cortical brain regions in human gait control. The purpose of this paper is to explore possible experimental and technical solutions for time-sensitive analysis of human gait ERPs during spontaneous and instructed treadmill walking. A solution (hardware/software) for synchronous recording of gait and EEG data was developed, tested and piloted. The solution consists of a custom-made USB synchronization interface, a time-synchronization module, and a data-merging module, allowing the temporal synchronization of recording devices, time-sensitive extraction of gait markers for the analysis of gERPs, and the training of artificial neural networks. In the present manuscript, the hardware and software components were tested with the following devices: A treadmill with an integrated pressure plate for gait analysis (zebris FDM-T) and an Acticap non-wireless 32-channel EEG system (Brain Products GmbH). The usability and validity of the developed solution was investigated in a pilot study (n = 3 healthy participants, n = 3 females, mean age = 22.75 years). The recorded continuous EEG data were segmented into epochs according to the detected gait markers for the analysis of gERPs. Finally, the EEG epochs were used to train a deep learning artificial neural network as classifier of gait phases. The results obtained in this pilot study, although preliminary, support the feasibility of the solution for the application of gait-related EEG analysis.

IntroductionElectromechanically-assisted gait training has been introduced in stroke rehabilitation as a means to enable gait training with a large number of reproducible and symmetrical task repetitions, i.e. steps. However, few studies have evaluated its impact on gait pattern functions. This study includes persons with no independent ambulation function at the start of a 4-week neurorehabilitation period in the sub-acute phase after stroke. The primary aim of the study was to evaluate whether the addition of electromechanically-assisted gait training to conventional training resulted in better gait pattern function than conventional training alone. The secondary aim was to identify correlations between overall gait quality and standardized clinical assessments.Participants and methodsSeventeen patients with no independent ambulation function who participated in a Prospective Randomized Open Blinded End-point study in the sub-acute phase after stroke were randomized into two groups; one group (n = 7) to undergo conventional training only (CONV group) and the other group (n = 10) to undergo conventional training with additional electromechanically-assisted gait training (HAL group). All patients were assessed with 3D gait analysis and clinical assessments after the 4-week intervention period. Overall gait quality as per the Gait Profile Score (GPS), as well as kinematic, and kinetic and other spatiotemporal metrics were collected and compared between intervention groups. Correlations between biomechanical and clinical outcomes were evaluated.ResultsBoth the CONV and HAL groups exhibited similar gait patterns with no significant differences between groups in any kinematic, kinetic parameters or other spatiotemporal metrics. The GPS for the paretic limb had a median (IQR) of 12.9° (7.8°) and 13.4° (4.3°) for the CONV and HAL groups, respectively (p = 0.887). Overall gait quality was correlated with independence in walking, walking speed, movement function and balance. We found no added benefit in gait pattern function from the electromechanically-assisted gait training compared to the conventional training alone.DiscussionThis finding raises new questions about how to best design effective and optimal post-stroke rehabilitation programs in patients with moderate to severe gait impairments to achieve both independent walking and optimal gait pattern function, and about which patients should be in focus in further studies on the efficacy of electromechanically-assisted gait training.Clinical trial registrationThe study was retrospectively registered at ClinicalTrials.gov, identifier (NCT02410915) on April 2015.

The restoration of healthy locomotion (gait) after stroke, traumatic brain injury, and spinal cord injury, is a major task in neurological rehabilitation. The rehabilitation process is labor intensive. Patient evaluation is often subjective, foiling determination of precise rehabilitation goals and assessment of treatment effects. To date it is the experienced clinician who continues to perform functional gait assessment and training in the absence of virtually any technological assistance. This paper introduces an algorithm capable of identifying human gait patterns. The fuzzy inferential reasoning uses typical joint angle trajectories to identify varying gait patterns. The algorithm will, thus, offer doctors, therapists, and patients a significant tool to assess the efficacy and outcomes of medical rehabilitation therapies and practices.