Introdução: A distrofia muscular de Duchenne (DMD) é causada pela deleção ou deficiência do gene que codifica a proteína distrofina. Com a evolução da doença, ocorre um grande comprometimento na marcha com consequente perda da capacidade de deambulação, fato que causa grande impacto na qualidade de vida dos pacientes e de seus cuidadores. Recomendações para uso noturno da órtese suropodálica, também chamada AFO (Ankle-Foot Orthosis), já estão bem estabelecidos na literatura científica, porém o uso durante a deambulação ainda é incipiente. Recentemente, o uso da AFO articulada diurna foi avaliado e indicado como importante aliado no tratamento da reabilitação desses pacientes, capaz de minimizar as compensações características da doença e prolongar a marcha. Ainda assim, questões como o tempo recomendado para uso diário e efeitos do uso do dispositivo, a médio e longo prazo, aguardam investigações mais precisas . Objetivo: Identificar as adaptações cinemáticas e cinéticas da marcha de pacientes com DMD que fizeram uso da órtese tipo AFO articulada diurna durante dois períodos de três meses, pelo uso progressivo e livre, respectivamente. Método: A amostra foi composta por 8 pacientes deambuladores diagnosticados com DMD, de 6 a 10 anos de idade. As avaliações foram compostas por testes de força, medida da amplitude de movimento, teste de caminhada dos 10 metros, testes funcionais cronometrados, aplicação da escala de Medida da Função Motora (MFM) e análise cinética e cinemática da marcha, com órtese (CO) e sem órtese (SO). Cada voluntário participou de 4 avaliações ao longo de um período de 6 meses e fez um auto-relato do número de quedas. No período entre 1ª avaliação (AV1) e a 2ª avaliação (AV2) o paciente fez uso diurno da órtese durante 2 horas/dia que foi incrementado para 4 horas/dia (2º mês) e 6 horas/dia (3º mês), momento que foi realizada a 3ª avaliação (AV3). Entre o 3º e 6º mês, o voluntário ficou livre para usar, ou não, a AFO diurna. Ao final desse período, foi realizada a 4ª avaliação (AV4). Para análise dos dados, foi utilizado o teste de regressão linear com efeitos mistos (efeitos aleatórios e fixos) obtidas com o auxílio do Software SAS® 9.3. Os dados obtidos em nosso estudo foram comparados com dados normativos da literatura. Para os dados cinemáticos e cinéticos da marcha foram obtidas as médias, de 3 avaliações, dos picos máximos e mínimos dos parâmetros de cada fase da marcha (apoio e balanço) para cada paciente com e sem órtese. Posteriormente, foram calculadas as médias e os intervalos de confiança de cada grupo, com e sem órtese. Resultados: Os testes cronometrados demonstraram redução do tempo de subida de 4 degraus, sem órtese, quando comparados os tempos de execução na AV1 em relação à AV3 e na AV1 em relação à AV4 (p<0.05). A análise comparativa das médias de força muscular indicou que houve aumento significativo da força de flexores de joelho da AV3 para AV4, dos extensores de joelho da AV1 para AV3 e dos dorsiflexores da AV1 para AV3 e da AV1 para AV4 (p<0,05). A análise dos parâmetros espaço-temporais indicou diminuição da largura da passada (p<0.05) quando comparada a AV1 em relação à AV4 na situação sem órtese (AV1 vs AV4). Quando comparamos dados do grupo CO em relação ao grupo SO, pode ser observado que o grupo CO apresentou maior tempo do ciclo da marcha na AV1 (p<0.01), maior tempo de duplo apoio na AV1 (p<0.01), na AV2 (p<0.01) e na AV3 (p=0.02). Nas avaliações cinética e cinemática, a análise comparativa entre as condições com e sem órtese, na fase de apoio da marcha, indicou redução significativa dos seguintes 11 parâmetros, para condição CO: amplitude de abdução e adução (p=0.0002) e absorção de potência de quadril (p<0.0001), geração de potência de potência de tornozelo (p<0.0001). Outros parâmetros apresentaram aumento significativo na condição CO quando comparado à condição SO, fase de apoio: máximo momento extensor (p<0.0001) e geração de potência (p=0.0035) de quadril, máximo momento flexor (p<0.0001) e amplitud e de geração e absorção de potência (p<0.0001) de joelho, máximo ângulo de dorsiflexão (p<0.0001), máximo momento flexor plantar (p<0.0001) e absorção de potência (p<0.0001) de tornozelo. Na fase de balanço houve redução significativa para máximo momento extensor (p<0.0001) e geração de potência (p<0.0001) de quadril. Nesta mesma fase foi observado aumento significativo para máximo ângulo de flexão (p<0.0001) do joelho, máximo ângulo de dorsiflexão (p<0.0001), máximo momento flexor plantar (p<0.0001) e amplitude de momento dorsiflexor e flexor plantar (p<0.0001) do tornozelo. Foi observado ainda, na fase de balanço da marcha, aumento significativo na geração de potência de tornozelo (p=0.0251) nas AV1, AV3 e AV4, na condição CO quando comparada à condição SO. O efeito de interação das fases de apoio e balanço também indicou que a condição SO apresentou máximo ângulo de inclinação pélvica superior quando comparado à condição CO, nas AV2 (p=0.0011), AV3 (p=0.0024) e AV4 (p=0.0191). Conclusão: O uso diurno e progressivo da órtese AFO articulada, em situação de carga, provoca alterações biomecânicas positivas na marcha de pacientes com DMD que repercutem minimizando o número de quedas e favorecendo a funcionalidade geral das crianças . / Introduction: Duchenne Muscular Dystrophy (DMD) is caused by deletion or deficiency in the gene that encodes the protein dystrophin. The clinical evolution of this disease includes significant gait impairment with consequent loss of walking ability, and this fact causes negative impact on the quality of life of the affected ones and their caregivers. It has already been well established that there are beneficial effects of nocturnal use of Ankle Foot Orthosis (AFO), nevertheless, the discussion about the daytime use of articulated AFO is rare. Recently, the daytime use of AFO was evaluated and indicated as an important ally in the treatment of these patients, capable of minimizing the biomechanical compensations and prolonging gait cycle. Even so, some issues such as the recommended time and effects for daily use, in the medium and long term, await more precise investigation. Objective: To identify the effects of daytime use of articulated AFO on spatiotemporal, kinematic and kinetic gait parameters of DMD patients, during two periods of three months, by progressive and free use, respectively. Methods: Eight walking patients diagnosed with DMD between the ages of 6 and 10 years old were evaluated. The data were obtained according to the isometric muscle strength, joint range of motion, timed functional score, the Motor Function Measure (MFM) scale and gait analysis parameters, with (CO) and without (SO) AFO. Four evaluations were carried out over a period of six months and each volunteer self-reported your number of falls. During the first (AV1) and second (AV2) evaluation, patients u sed the daytime orthosis during two hours per day. This time was increased to four hours per day in the second month and six hours per day in the third month, then when the third (AV3) evaluation was conducted. Between third and sixth month, the use of the orthosis was optional. By the end of month six, the fourth (AV4) evaluation was conducted. The data were analyzed using the mixed linear regression model (Random and Fixed Effects) through the Software SAS® 9.3. The results obtained in the present study are compared with literature data. The means of 3 evaluations for the spatiotemporal, kinematic and kinetic gait data were obtained, for the maximum and minimum peaks of the parameters of each phases in a gait cycle (stance and swing) for each patient with and without orthosis. In the end, the means and the confidence interval were calculated for each group, with and without AFO. Results: The timed tests showed a reduction in time for climbing 4 steps without AFO, when compared the AV1 and AV3 runtime in relation to AV1 and AV4 runtime (p<0.05). The comparation of muscle strength showed a significant increase in knee flexor strength from AV3 to AV4, knee extensors from AV1 to AV3 and dorsiflexors from AV1 to AV3 and from AV1 to AV4 (p<0.05). The analysis of s patiotemporal parameters indicates a decrease in the width stride (p<0.05) between AV1 and AV4 without orthosis (AV1 vs AV4). When comparing CO with SO, CO group presented longer gait cycle in AV1 (p<0.01), longer double support phase in AV1 (p<0.01), AV2 (p<0.01) and AV3 (p=0.02). In the kinetic and kinematic evaluations, the comparative analysis between the conditions with and without orthosis in the gait stance phase indicated a significant reduction of the following parameters for the CO condition: adduction-abduction range of motion (p = 0.0002) and hip power absorption (p<0.0001) and ankle power generation (p <0.0001). Other parameters showed a significant increase in the CO condition when compared to the SO in stance phase: peak extensor moment (p<0.0001) and hip power 14 generation (p=0.0035), peak flexor moment (p<0.0001) and power generation and absorption range of motion (p<0.0001), peak dorsiflexion angle (p<0.0001), peak plantar-flexor (p<0.0001) and ankle power absorption (p<0.0001). In the swing phase, a significant reduction in the extension angle (p<0.0001) and hip power generating (p<0.0001). Also in swing phase, a significant increase for peak knee flexion (p<0.0001), peak dorsiflexion range of motion (p<0.0001), peak plantar flexor moment (p<0.0001) and ankle joint dorsiflexor and plantar-flexor range of motion (p<0.0001) were observed. Besides this, in the gait swing phase was observed significant increase in ankle power generation (p=0.0251) in AV1, AV3 and AV4 in the condition CO when compared to the SO condition. The interaction effect of stance and swing phases also indicated that the SO condition presented higher pelvic tilt angle when compared to the CO condition, in AV2 (p=0.0011), AV3 (p=0.0024) and AV4 (p=0.0191). Conclusion: Thus, the progressive use of Articulated Ankle Foot Orthosis (AFO) in loading response phase can change the gait pattern of patients with Duchenne muscular dystrophy. This result turn to positivity when the temporal, kinematic and kinetic gait parameters are evaluated.

Orientador: João Maurício Rosário / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica / Made available in DSpace on 2018-08-25T20:31:34Z (GMT). No. of bitstreams: 1 Kuteken_RenatoSuekichi_M.pdf: 4564566 bytes, checksum: 3e020109dd07850f4dc6d80cbf4e64b9 (MD5) Previous issue date: 2014 / Resumo: O treinamento de marcha suspensa sobre esteira ergométrica vem sendo aplicado com sucesso em pacientes que perderam os movimentos dos membros inferiores, proporcionando uma reabilitação eficaz, com fortalecimento muscular e redução de atrofias. Além do treino de marcha, exoesqueletos também vem sendo utilizados na recuperação funcional, monitorando e atuando sobre o corpo do paciente. Este trabalho propõe a integração entre um exoesqueleto e uma esteira ergométrica no treinamento de marcha com suspensão de peso através de um sinal de acionamento para a esteira que compense os movimentos das pernas e mantenha fixa a posição do centro de massa do corpo. Este sinal de referência é elaborado a partir de valores angulares obtidos do sensoriamento das juntas do exoesqueleto, aplicados ao modelo cinemático da perna. O desenvolvimento do projeto se deu em duas plataformas, com o uso do Arduino para a aquisição da implementação física e do MATLAB para o desenvolvimento em software / Abstract: The body weight supported gait training on treadmill has been successfully applied on patients who lost their lower limbs movements, providing an efficient rehabilitation, with muscle strengthening and reduction of the atrophy. Besides gait training, exoskeletons have also been used on functional rehabilitation, monitoring and actuating on the patient¿s body. This work proposes the integration between an exoskeleton and a treadmill on the weight supported gait training through a driving signal for the treadmill that compensates the movements of the legs and hold still the position of the center of mass of the body. This reference signal is elaborated making use of angular values obtained from joint sensors on the exoskeleton, applied to the kinematic model of the leg. The development of the project occurred in two platforms, with the use of Arduino to acquisition on the physical implementation and MATLAB to software development / Mestrado / Mecanica dos Sólidos e Projeto Mecanico / Mestre em Engenharia Mecânica

Le développement des orthèses est souvent basé sur l’expertise empirique des entreprises. Il en résulte parfois des dispositifs mal adaptés. Pour cette raison, une structuration du processus de conception des orthèses doit être conduite.Cette thèse a comme objectif de développer une méthode structurée de conception d’orthèses avec mécanisme.Une définition des typologies d’orthèses est établie en fonction de l’existence d’un mécanisme. Cette typologie est le point de départ d’une décomposition du cycle d’utilisation de l’orthèse en situations de vie et moments significatifs.La méthode proposée permet la recherche des mécanismes dans une base de données de mobilités ; l’adéquation entre concepts, contraintes de déplacement et contraintes dimensionnelles, l’adaptation de confort, la définition du blocage, la définition final de l’OAM et la qualification de la conception.La méthode est appliquée au développement d’un corset de traitement de la camptocormie, pathologie posturale caractérisée par l’antéro-flexion progressive du tronc.Une orthèse posturale, corset de distraction thoraco-pelvienne antérieur, développée par la société Lagarrigue S.A. est actuellement prescrite. Pour prouver l’utilité du port du corset, une caractérisation cinématique du mouvement et de l’activité musculaire du patient camptocormique sans et avec corset est déroulée pour recueillir des informations nécessaires au processus de conception d’une orthèse innovante.L’application de cette méthode permet le développement de deux prototypes fonctionnels de corset pour traiter la camptocormie en intégrant des informations biomécaniques du patient et les limitations techniques de l’entreprise. / Orthosis development is often based on the empirical expertise of the manufacturers. This can sometimes result in poorly adapted devices. For this reason, some structure needs to be created for the orthosis design process.The purpose of this thesis is to develop a structured design method for orthoses with a mechanism.A typology of orthoses is established according to whether or not a mechanism is present. This typology is the starting point for producing a breakdown of the cycle of orthosis use in life situations and at significant moments.The method described here includes searching a mobility database for mechanisms; ensuring compatibility between concepts, displacement and dimensional constraints, making suitable adaptations for a comfortable fit, defining the blocking, preparing the final definition of the orthosis with mechanism and approving the design.The method is applied to the development of a corset for treating camptocormia, a postural illness identified by the gradual forward flexion of the trunk.A postural orthosis, a thoraco-pelvic anterior distraction corset developed by Lagarrigue S.A., is currently prescribed. To prove the utility of wearing the corset, a kinematic characterisation of the movement and muscle activity of the camptocormic patient is carried out both with and without the corset to collect the information needed for the design process of an innovative orthosis.Using this method two functional corset prototypes were developed to treat camptocormia, incorporating the patient’s biomechanical information and the manufacturer’s technical limitations.

As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.

abstract: The human ankle is a critical joint required for mobility and stability of the body during static and dynamic activity. The absence of necessary torque output by the ankle due to neurological disorder or near-fatal injury can severely restrict locomotion and cause an inability to perform daily tasks. Physical Human-Robot Interaction (pHRI) has explored the potential of controlled actuators to positively impact human joints and partly restoring the required torque and stability at the joint to perform a task. However, a trade-off between agility and stability of the control technique of these devices can reduce the complete utilization of the performance to create a desirable impact on human joints. This research focuses on two control techniques of an Active Ankle Foot Orthosis (AFO) namely, Variable Stiffness (VS) and Variable Damping (VD) controllers to modulate ankle during walking. The VS controller is active during the stance phase and is used to restore the ankle trajectory of healthy participants that has been altered by adding a dead-weight of 2 Kgs. The VD controller is active during the terminal stance and early-swing phase and provides augmentative force during push-off that results in increased propulsion and stabilizes the ankle based on user-intuitions. Both controllers have a positive impact on Medial Gastrocnemius (GAS) muscle and Soleus (SOL) muscle which are powerful plantar - flexors critical to propulsion and kinematic properties during walking. The VS controller has recorded an 8.18% decrease in GAS and an 9.63 % decrease in SOL muscle activity during the stance phase amongst participants while decreasing mean ankle position error by 22.28 % and peak ankle position error by 17.43%. The VD controller demonstrated a 7.59 % decrease in GAS muscle and a 10.15 % decrease in SOL muscle activity during push-off amongst the participants while increasing the range-of-motion (ROM) by 7.84 %. Comprehensively, the study has shown a positive impact on ankle trajectory and the corresponding muscle effort at respective stages of the controller activity. / Dissertation/Thesis / Masters Thesis Mechanical Engineering 2020

abstract: According to the Center for Disease Control and Prevention report around 29,668 United States residents aged greater than 65 years had died as a result of a fall in 2016. Other injuries like wrist fractures, hip fractures, and head injuries occur as a result of a fall. Certain groups of people are more prone to experience falls than others, one of which being individuals with stroke. The two most common issues with individuals with strokes are ankle weakness and foot drop, both of which contribute to falls. To mitigate this issue, the most popular clinical remedy given to these users is thermoplastic Ankle Foot Orthosis. These AFO's help improving gait velocity, stride length, and cadence. However, studies have shown that a continuous restraint on the ankle harms the compensatory stepping response and forward propulsion. It has been shown in previous studies that compensatory stepping and forward propulsion are crucial for the user's ability to recover from postural perturbations. Hence, there is a need for active devices that can supply a plantarflexion during the push-off and dorsiflexion during the swing phase of gait. Although advancements in the orthotic research have shown major improvements in supporting the ankle joint for rehabilitation, there is a lack of available active devices that can help impaired users in daily activities. In this study, our primary focus is to build an unobtrusive, cost-effective, and easy to wear active device for gait rehabilitation and fall prevention in individuals who are at risk. The device will be using a double-acting cylinder that can be easily incorporated into the user's footwear using a novel custom-designed powered ankle brace. The device will use Inertial Measurement Units to measure kinematic parameters of the lower body and a custom control algorithm to actuate the device based on the measurements. The study can be used to advance the field of gait assistance, rehabilitation, and potentially fall prevention of individuals with lower-limb impairments through the use of Active Ankle Foot Orthosis. / Dissertation/Thesis / Masters Thesis Electrical Engineering 2020

No description available.

Traditionally, the mechanical testing of ankle-foot orthoses (AFOs) has been performed with simple limb surrogates, typically with a single axis ankle joint and rigid foot and shank components. Since many current AFO designs allow 3D motion, a surrogate lower limb (SLL) that provides anatomically similar motion in all planes is needed to enable realistic load testing and cyclic testing in a controlled manner. The aim of this thesis was to design, fabricate and test a novel SLL that provides anatomically realistic 3D foot motion, based on a consensus of the passive lower limb range of motion (RoM) found in the literature. The SLL design was inspired by the Rizzoli model, sectioning the lower limb into five segments (shank, hindfoot, midfoot, forefoot, toes). Ball and socket joints were used for the shank-hindfoot, hindfoot-midfoot, and midfoot-forefoot. Forefoot-toes used a hinge-type joint. 3D printed flexible thermoplastic polyurethane (TPU) snap-fit connectors connected the 3D printed nylon foot blocks. A threaded ball stud connected the shank shaft and hindfoot. This shank shaft was surrounded by a 3D printed polylactic acid (PLA) shank cover. The foot was cast in silicone rubber to emulate soft tissue, with a PLA custom mould based on a Össur prosthetic foot cover model. The SLL was successfully designed for easy fabrication using readily available techniques, materials, and components. Only the metal shaft required additional machining. 3D printed components used an affordable 3D printer (Artillery Sidewinder X1), and readily available nylon, PLA, and TPU. Using motion capture testing, SLL foot rotation angles were found to be within standard deviation of mean foot passive rotation angle ranges found in the literature, showing that most joints were within 5° of target maximum rotation angles. With load testing, the SLL was shown to survive static loads representing 1.5 times body weight for a 100 kg individuals and cyclic loads representing normal gait loading for 500,000 cycles.

No description available.

This paper presents a novel approach to the design of a motorized rehabilitation device – active elbow orthosis (AEO) – inspired by the principles of robotic exoskeletons. The device is currently designed for the elbow joint, but can be easily modified for other joints as well. AEO determines the motion activity of the patient using a strain gauge and utilizes this measurement to control the actuator that drives the forearm part of the orthosis. Patient activity level is related to a free arm measurement obtained via a calibration procedure prior to the exercise. A high-level control module offers several types of exercises mimicking the physiotherapist. The device was successfully verified by tests on a number of patients, resulting in extended range of elbow-joint motion.