Biomedical Engineering and Bioengineering Commons^™

The Value Of High Intensity Locomotor Training Applied To Patients With Acute-Onset Neurologic Injury, Meghan Fahey, Gabrielle Brazg, Christopher E. Henderson, Abby Plawecki, Emily H. Lucas, Darcy S. Reisman, Brian D. Schmit, T. George Hornby

Biomedical Engineering Faculty Research and Publications

The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can …

Task-Specific Versus Impairment-Based Training On Locomotor Performance In Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study, Jennifer K. Lotter, Christopher E. Henderson, Abby Plawecki, Molly E. Holthus, Emily H. Lucas, Marzieh M. Ardestani, Brian Schmit, George Hornby

Biomedical Engineering Faculty Research and Publications

Background. Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective. The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific versus impairment-based interventions on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI >1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 …

Promoting Global Clinical Care And Research For Children With Orthopaedic Disabilities Through Motion Analysis Technology, Jacob R. Rammer, Joycie Eulah Abiera, Monica Arroyo, Luis Fernando Caicedo, Karl Canseco, Christopher Constantino, Filipe Haces Garcia, Jorge Gomez, Nikhil T. Kurapati, Mariano Gonzalez Lugo, Terence Miller, Wilfredo Agredo Rodriguez, Carlo Emmanuel Sumpaico, Gerald F. Harris

Biomedical Engineering Faculty Research and Publications

Human motion analysis is a tool used to understand orthopaedic disabilities in children and to plan and monitor treatment strategies. It enables clinicians to quantitatively describe rehabilitative progress, plan surgeries, and conduct research. While this technology is prevalent in major academic medical centers, access is lacking in many regions throughout the world. This paper presents a novel approach to offer more accessible technology at greatly reduced cost. Current applications are underway in the Philippines, Mexico, and Colombia. Through international partnerships, improvements in clinical care, medical education, and research have been observed.

Robotic Resistance Treadmill Training Improves Locomotor Function In Children With Cerebral Palsy: A Randomized Controlled Pilot Study, Ming Wu, Janis Kim, Deborah J. Gaebler-Spira, Brian D. Schmit, Pooja Arora

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training as compared with applying controlled assistance forces in children with cerebral palsy (CP).

Design

Randomized controlled study.

Setting

Research unit of a rehabilitation hospital.

Participants

Children with spastic CP (N=23; mean age, 10.6y; range, 6–14y; Gross Motor Function Classification System levels, I–IV).

Interventions

Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 …

Engineering Synthetic Feedback To Promote Recovery Of Self-Feeding Skills In People With Sensory Deficits Due To Stroke, Alexis Krueger

Master's Theses (2009 -)

Kinesthesia refers to sensations of limb position and movement, and deficits of upper limb kinesthetic feedback are common after stroke, impairing stroke survivors’ ability to perform the fundamental reaching and stabilization behaviors needed for daily functions like self-feeding. I attempt to mitigate the negative impact of post-stroke kinesthesia deficits by evaluating the utility of vibrotactile sensory substitution to restore closed-loop kinesthetic feedback of the upper limb. As a first step, this study evaluated performance in healthy individuals during fundamental reaching, stabilization, and tracking behaviors while using supplemental vibrotactile feedback encoding either limb state information or goal-aware error information. First, I …

Evaluation Of An Actuated Wrist Orthosis For Use In Assistive Upper Extremity Rehabilitation, Devon Holley

Master's Theses (2009 -)

Cerebral palsy (CP) is a neurological condition caused by damage to motor control centers of the brain. This leads to physical and cognitive deficiencies that can reduce an individual’s quality of life. Specifically, motor deficiencies of the upper extremity can make it difficult for an individual to complete everyday tasks, including eating, drinking, getting dressed, or combing their hair. Physical therapy, involving repetitive tasks, has been shown to be effective in training normal motion of the limb by invoking the neuroplasticity of the brain and its ability to adapt in order to facilitate motor learning. Creating a device for use …

Structural-Functional Brain Connectivity Underlying Integrative Sensorimotor Function After Stroke, Benjamin Thomas Kalinosky

Dissertations (1934 -)

In this dissertation research project, we demonstrated the relationship between the structural and functional connections across the brain in stroke survivors. We used this information to predict arm function in stroke survivors, suggesting that the tools developed through this research will be useful for prescribing individualized rehabilitation strategies in people after stroke. Current clinical methods for rehabilitating sensorimotor function after stroke are not based on the locus of injury in the brain. Instead, therapies are generalized, treating symptoms such as weakness and spasticity. This results in outcomes that are highly variable, with severity of impairment immediately following stroke as the …

Increased Lower Limb Spasticity But Not Strength Or Function Following A Single-Dose Serotonin Reuptake Inhibitor In Chronic Stroke, Krishnaj Gourab, Brian D. Schmit, T. George Hornby

Biomedical Engineering Faculty Research and Publications

Objective: To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke.

Design: Double-blind, randomized, placebo-controlled crossover trial.

Setting: Outpatient research setting.

Participants: Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of >1 year duration who completed all assessments.

Interventions: Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions.

Main Outcome Measures: Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s–120°/s) plantarflexor stretch reflexes under …

A Novel Fmri Paradigm Suggests That Pedaling-Related Brain Activation Is Altered After Stroke, Nutta-On Promjunyakul, Brian D. Schmit, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

The purpose of this study was to examine the feasibility of using functional magnetic resonance imaging (fMRI) to measure pedaling-related brain activation in individuals with stroke and age-matched controls. We also sought to identify stroke-related changes in brain activation associated with pedaling. Fourteen stroke and 12 control subjects were asked to pedal a custom, MRI-compatible device during fMRI. Subjects also performed lower limb tapping to localize brain regions involved in lower limb movement. All stroke and control subjects were able to pedal while positioned for fMRI. Two control subjects were withdrawn due to claustrophobia, and one control data set was …

Robotic Resistance/Assistance Training Improves Locomotor Function In Individuals Poststroke: A Randomized Controlled Study, Ming Wu, Jill M. Landry, Janis Kim, Brian D. Schmit, Sheng-Che Yen, Jillian Macdonald

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals poststroke.

Design

Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.

Setting

Research units of rehabilitation hospitals.

Participants

Patients (N=30) with chronic stroke.

Intervention

Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. …

Dynamic Balance Control During Treadmill Walking In Chronic Stroke Survivors, Eric Richard Walker

Dissertations (1934 -)

Maintaining dynamic balance is an important component of walking function that is likely impaired in chronic stroke survivors, evidenced by an increased prevalence of falls. Dynamic balance control requires maintaining the center of mass (COM) within the base of support during movement. During walking, dynamic balance control is achieved largely by modifying foot placement to adjust the base of support. However, chronic stroke survivors have difficulty with both precision control of foot placement, as well as reduced control of COM movement. The objective of this dissertation was to characterize dynamic balance control strategies during walking in chronic stroke survivors. Additionally, …

Robotic Resistance Treadmill Training Improves Locomotor Function In Human Spinal Cord Injury: A Pilot Study, Ming Wu, Jill M. Landry, Brian Schmit, T. George Hornby, Sheng-Che Yen

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI).

Design

Repeated assessment of the same patients with crossover design.

Setting

Research units of rehabilitation hospitals in Chicago.

Participants

Patients with chronic incomplete SCI (N=10) were recruited to participate in this study.

Interventions

Subjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by …

The Dominant Role Of The Hip In Multijoint Reflex Responses In Human Spinal Cord Injury, Tanya Onushko

Dissertations (1934 -)

Following a spinal cord injury (SCI), people often experience exaggerated reflexes, such that mild provocations can cause prolonged and uncontrolled muscle activity throughout the entire leg. These reflexes can be problematic and are known to interfere with functional tasks, such as transferring to and from a wheelchair, and they may interfere with locomotor function by prolonging muscle activity and/or inappropriately activating muscles during attempts to walk. While these multijoint reflexes have been shown to originate from several afferent cues, hip afferent input is a particularly potent sensory signal that readily triggers multijoint reflexes. The overall objective of this dissertation was …

Design And Validation Of An Mr Conditional Upper Extremity Evaluation System To Study Brain Activation Patterns After Stroke, Rubing Xu

Master's Theses (2009 -)

Stroke is the third leading cause of death and second most frequent cause of disability in the United States. Stroke rehabilitation methods have been developed to induce the cortical reorganization and motor-relearning that leads to stroke recovery. In this thesis, we designed and developed an MR conditional upper extremity reach and grasp movement evaluation system for the stroke survivors to study their kinematic performances in reach and grasp movement and the relationship between kinematic metrics and the recovery level measured by clinical assessment methods. We also applied the system into the functional MRI experiments to identify the ability to study …

Parallel Facilitatory Reflex Pathways From The Foot And Hip To Flexors And Extensors In The Injured Human Spinal Cord, Maria Knikou, Elizabeth Kay, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

Spinal integration of sensory signals associated with hip position, muscle loading, and cutaneous sensation of the foot contributes to movement regulation. The exact interactive effects of these sensory signals under controlled dynamic conditions are unknown. The purpose of the present study was to establish the effects of combined plantar cutaneous afferent excitation and hip movement on the Hoffmann (H) and flexion reflexes in people with a spinal cord injury (SCI). The flexion and H-reflexes were elicited through stimulation of the right sural (at non-nociceptive levels) and posterior tibial nerves respectively. Reflex responses were recorded from the ipsilateral tibialis anterior (TA) …

Pre- And Post-Alpha Motoneuronal Control Of The Soleus H-Reflex During Sinusoidal Hip Movements In Human Spinal Cord Injury, Maria Knikou, Debjani Chaudhuri, Elizabeth Kay, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

The aim of this study was to establish the contribution of hip-mediated sensory feedback to spinal interneuronal circuits during dynamic conditions in people with incomplete spinal cord injury (SCI). Specifically, we investigated the effects of synergistic and antagonistic group I afferents on the soleus H-reflex during imposed sinusoidal hip movements. The soleus H-reflex was conditioned by stimulating the common peroneal nerve (CPN) at short (2, 3, and 4 ms) and long (80, 100, and 120 ms) conditioning test (C-T) intervals to assess the reciprocal and pre-synaptic inhibition of the soleus H-reflex, respectively. The soleus H-reflex was also conditioned by medial …

Motivating Rehabilitation By Distorting Reality, James L. Patton, Yejun Wei, Chris Scharver, Robert V. Kenyon, Robert A. Scheidt

Biomedical Engineering Faculty Research and Publications

We have found, through a series of recent experiments, encouraging evidence that the neuro-motor system is motivated to change motor patterns when exposed to visuo-motor tasks. We have also shown that the learning of these tasks can be heightened with forces and/or visual distortions that appropriately manipulate the error. This process does not require intense concentration and it is often considered a game. We describe the next generation of robotic large-workspace, three dimensional haptics/graphics systems for rehabilitation

A Physiologically Based Clinical Measure For Spastic Reflexes In Spinal Cord Injury, Ela N. Benz, T. George Hornby, Rita K. Bode, Robert A. Scheidt, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

Objective: To test the validity of the Spinal Cord Assessment Tool for Spastic reflexes (SCATS), a clinical tool intended to rate spastic motor behavior after spinal cord injury (SCI).

Design: By using correlational analyses, the SCATS was validated using concurrent measurements of kinematics and electromyograms and traditional assessments of spasms and spastic hypertonia.

Setting: Research laboratory (kinematics and electromyography) and outpatient medical clinic (traditional measures of spastic hypertonia).

Participants: Eleven people with SCI were used for kinematic and electromyographic measurements. Seventeen people with SCI were used for comparison with other clinical scales.

Interventions: Not applicable. …

Computerized Biofeedback Knee Goniometer: Acceptance And Effect On Exercise Behavior In Post-Total Knee Arthroplasty Rehabilitation, Todd A. Kuiken, Hagay Amir, Robert A. Scheidt

Biomedical Engineering Faculty Research and Publications

Objective

To assess device accuracy, patient acceptance, and effect of a computerized biofeedback knee goniometer (CBG), on patients’ compliance with active range of motion (AROM) exercises after total knee arthroplasty (TKA).

Design

Two-stage study: measurement validation on asymptomatic controls and an unblinded, multiple crossover trial.

Setting

Inpatient rehabilitation.

Participants

Asymptomatic controls (n=14) and post-TKA inpatients (n=11).

Interventions

For measurement validation, CBG-angle measurements were compared with manual, clinician-obtained angles. To assess motivational effect, the CBG was worn after TKA; on alternating days, it either monitored AROM silently (no feedback) or provided audiovisual feedback about reaching preset range of motion (ROM) goals …

A Rehabilitation Engineering Course For Biomedical Engineers, M. Barbara Silver-Thorn

Biomedical Engineering Faculty Research and Publications

This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses …