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Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors
Background: Neuromodulation using epidural electrical stimulation (EES) has shown functional restoration in humans with chronic spinal cord injury (SCI). EES during body weight supported treadmill training (BWSTT) enhanced stepping performance in clinical trial participants with paraplegia. Unfortun...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9397738/ https://www.ncbi.nlm.nih.gov/pubmed/36188812 http://dx.doi.org/10.3389/fresc.2021.757828 |
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author | Linde, Margaux B. Thoreson, Andrew R. Lopez, Cesar Gill, Megan L. Veith, Daniel D. Hale, Rena F. Calvert, Jonathan S. Grahn, Peter J. Fautsch, Kalli J. Sayenko, Dimitry G. Zhao, Kristin D. |
author_facet | Linde, Margaux B. Thoreson, Andrew R. Lopez, Cesar Gill, Megan L. Veith, Daniel D. Hale, Rena F. Calvert, Jonathan S. Grahn, Peter J. Fautsch, Kalli J. Sayenko, Dimitry G. Zhao, Kristin D. |
author_sort | Linde, Margaux B. |
collection | PubMed |
description | Background: Neuromodulation using epidural electrical stimulation (EES) has shown functional restoration in humans with chronic spinal cord injury (SCI). EES during body weight supported treadmill training (BWSTT) enhanced stepping performance in clinical trial participants with paraplegia. Unfortunately, tools are lacking in availability to quantify clinician assistance during BWSTT with and without EES. Force sensitive resistors (FSRs) have previously quantified clinician assistance during static standing; however, dynamic tasks have not been addressed. Objective: To determine the validity of FSRs in measurements of force and duration to quantify clinician assistance and participant progression during BWSTT with EES in participants with SCI. Design: A feasibility study to determine the effectiveness of EES to restore function in individuals with SCI. Methods: Two male participants with chronic SCI were enrolled in a pilot phase clinical trial. Following implantation of an EES system in the lumbosacral spinal cord, both participants underwent 12 months of BWSTT with EES. At monthly intervals, FSRs were positioned on participants' knees to quantity forces applied by clinicians to achieve appropriate mechanics of stepping during BWSTT. The FSRs were validated on the benchtop using a leg model instrumented with a multiaxial load cell as the gold standard. The outcomes included clinician-applied force duration measured by FSR sensors and changes in applied forces indicating progression over the course of rehabilitation. Results: The force sensitive resistors validation revealed a proportional bias in their output. Loading required for maximal assist training exceeded the active range of the FSRs but were capable of capturing changes in clinician assist levels. The FSRs were also temporally responsive which increased utility for accurately assessing training contact time. The FSRs readings were able to capture independent stance for both participants by study end. There was minimal to no applied force bilaterally for participant 1 and unilaterally for participant 2. Conclusions: Clinician assistance applied at the knees as measured through FSRs during dynamic rehabilitation and EES (both on and off) effectively detected point of contact and duration of forces; however, it lacks accuracy of magnitude assessment. The reduced contact time measured through FSRs related to increased stance duration, which objectively identified independence in stepping during EES-enabled BWSTT following SCI. |
format | Online Article Text |
id | pubmed-9397738 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93977382022-09-29 Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors Linde, Margaux B. Thoreson, Andrew R. Lopez, Cesar Gill, Megan L. Veith, Daniel D. Hale, Rena F. Calvert, Jonathan S. Grahn, Peter J. Fautsch, Kalli J. Sayenko, Dimitry G. Zhao, Kristin D. Front Rehabil Sci Rehabilitation Sciences Background: Neuromodulation using epidural electrical stimulation (EES) has shown functional restoration in humans with chronic spinal cord injury (SCI). EES during body weight supported treadmill training (BWSTT) enhanced stepping performance in clinical trial participants with paraplegia. Unfortunately, tools are lacking in availability to quantify clinician assistance during BWSTT with and without EES. Force sensitive resistors (FSRs) have previously quantified clinician assistance during static standing; however, dynamic tasks have not been addressed. Objective: To determine the validity of FSRs in measurements of force and duration to quantify clinician assistance and participant progression during BWSTT with EES in participants with SCI. Design: A feasibility study to determine the effectiveness of EES to restore function in individuals with SCI. Methods: Two male participants with chronic SCI were enrolled in a pilot phase clinical trial. Following implantation of an EES system in the lumbosacral spinal cord, both participants underwent 12 months of BWSTT with EES. At monthly intervals, FSRs were positioned on participants' knees to quantity forces applied by clinicians to achieve appropriate mechanics of stepping during BWSTT. The FSRs were validated on the benchtop using a leg model instrumented with a multiaxial load cell as the gold standard. The outcomes included clinician-applied force duration measured by FSR sensors and changes in applied forces indicating progression over the course of rehabilitation. Results: The force sensitive resistors validation revealed a proportional bias in their output. Loading required for maximal assist training exceeded the active range of the FSRs but were capable of capturing changes in clinician assist levels. The FSRs were also temporally responsive which increased utility for accurately assessing training contact time. The FSRs readings were able to capture independent stance for both participants by study end. There was minimal to no applied force bilaterally for participant 1 and unilaterally for participant 2. Conclusions: Clinician assistance applied at the knees as measured through FSRs during dynamic rehabilitation and EES (both on and off) effectively detected point of contact and duration of forces; however, it lacks accuracy of magnitude assessment. The reduced contact time measured through FSRs related to increased stance duration, which objectively identified independence in stepping during EES-enabled BWSTT following SCI. Frontiers Media S.A. 2021-12-02 /pmc/articles/PMC9397738/ /pubmed/36188812 http://dx.doi.org/10.3389/fresc.2021.757828 Text en Copyright © 2021 Linde, Thoreson, Lopez, Gill, Veith, Hale, Calvert, Grahn, Fautsch, Sayenko and Zhao. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Rehabilitation Sciences Linde, Margaux B. Thoreson, Andrew R. Lopez, Cesar Gill, Megan L. Veith, Daniel D. Hale, Rena F. Calvert, Jonathan S. Grahn, Peter J. Fautsch, Kalli J. Sayenko, Dimitry G. Zhao, Kristin D. Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title | Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title_full | Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title_fullStr | Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title_full_unstemmed | Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title_short | Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors |
title_sort | quantitative assessment of clinician assistance during dynamic rehabilitation using force sensitive resistors |
topic | Rehabilitation Sciences |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9397738/ https://www.ncbi.nlm.nih.gov/pubmed/36188812 http://dx.doi.org/10.3389/fresc.2021.757828 |
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