Embed Size (px)
Citation preview
“These results suggest additive clinical-functional benefits may be achieved by incorporating mobile, intention-based robotic
technology into therapist supervised mobility training
for patients in the late-phase post stroke.”
AlterG® BIONIC LEG™ - CASE SERIES: UCSF
RESEARCH HIGHLIGHTS
In the UCSF study, therapy with the AlterG® Bionic Leg™ improved step length, ambulation speed, and endurance after plateau with conventional training.The AlterG Bionic Leg provides intention-based, patient-specific assistance during untethered, task-specific mobility training in the clinic.1 The Bionic Leg is the first wearable, mobile robotic exoskeleton for lower extremity physical therapy. With the help of a skilled clinician, the device may be programmed to optimize the patient’s level of participation by adjusting the amount of robotic assistance with concentric and eccentric knee extension. With the Bionic Leg, patients are able to practice overground gait, transfers, balance training, and reciprocal stair negotiation more effectively than previously.
Study Summary: Mobility Training Using a Bionic Knee Orthosis in Patients Chronic Post-Stroke: A Case Series
Byl, NN. Journal of Medical Case Reports 2012 (In Press)
A team from the University of California San Francisco (UCSF) Department of Physical Therapy recently investigated the use of the AlterG Bionic Leg for intention-based, task-oriented mobility training in individuals chronic post-stroke. Three subjects, ranging from 15 months to 10 years post-stroke, who had plateaued with conventional bodyweight-supported treadmill training (BSWTT) were enrolled. Each subject participated in a 4-week task-oriented therapy program using the Bionic Leg, approximately 1 hour per session 2 to 4 times per week. Gait characteristics, speed, endurance, and balance measures were assessed at baseline, immediately following the therapy program, and at one-month post-therapy. Two subjects did not receive additional therapy in the one-month interim period following the study.
Using the Bionic Leg, subjects were able to safely complete a regimen of task-specific mobility training with minimal assistance from a therapist. All participants achieved immediate post-training gains in gait speed (ten-meter walk test or 10MWT), walking endurance (six-minute walk test or 6MWT) and step-length compared to baseline. Two of the three subjects improved their functional ambulation category classification status during the study; the third, who entered the study as a community ambulator, improved to exit the study as an age-matched healthy adult. Mean improvements were maintained at one month post-training. In interviews conducted a year after training, subjects also reported continued gains in both mobility and participation in the community.2
Test units/Subject # Baseline Post-training %Diff 1-Month %Diff
10 MWT, m/s123
0.600.290.83
0.810.411.03
354824
0.950.451.14
585537
6 MWT, m123
17093271
207140300
225011
250123285
47325
Step length, m (affected limb)123*% Diff from baseline score
0.490.290.54
0.560.400.59
14389
0.590.390.60
203511 BYL,
Journal of Medical Case Reports 2012
10882 AGT Case Studies USF m1.0.indd 1 6/12/13 9:06 PM
“These results suggest additive clinical-functional benefits may be achieved by incorporating mobile, intention-based robotic
technology into therapist supervised mobility training
for patients in the late-phase post stroke.”
AlterG® BIONIC LEG™ - CASE SERIES: UCSF
RESEARCH HIGHLIGHTS
In the UCSF study, therapy with the AlterG® Bionic Leg™ improved step length, ambulation speed, and endurance after plateau with conventional training.The AlterG Bionic Leg provides intention-based, patient-specific assistance during untethered, task-specific mobility training in the clinic.1 The Bionic Leg is the first wearable, mobile robotic exoskeleton for lower extremity physical therapy. With the help of a skilled clinician, the device may be programmed to optimize the patient’s level of participation by adjusting the amount of robotic assistance with concentric and eccentric knee extension. With the Bionic Leg, patients are able to practice overground gait, transfers, balance training, and reciprocal stair negotiation more effectively than previously.
Study Summary: Mobility Training Using a Bionic Knee Orthosis in Patients Chronic Post-Stroke: A Case Series
Byl, NN. Journal of Medical Case Reports 2012 (In Press)
A team from the University of California San Francisco (UCSF) Department of Physical Therapy recently investigated the use of the AlterG Bionic Leg for intention-based, task-oriented mobility training in individuals chronic post-stroke. Three subjects, ranging from 15 months to 10 years post-stroke, who had plateaued with conventional bodyweight-supported treadmill training (BSWTT) were enrolled. Each subject participated in a 4-week task-oriented therapy program using the Bionic Leg, approximately 1 hour per session 2 to 4 times per week. Gait characteristics, speed, endurance, and balance measures were assessed at baseline, immediately following the therapy program, and at one-month post-therapy. Two subjects did not receive additional therapy in the one-month interim period following the study.
Using the Bionic Leg, subjects were able to safely complete a regimen of task-specific mobility training with minimal assistance from a therapist. All participants achieved immediate post-training gains in gait speed (ten-meter walk test or 10MWT), walking endurance (six-minute walk test or 6MWT) and step-length compared to baseline. Two of the three subjects improved their functional ambulation category classification status during the study; the third, who entered the study as a community ambulator, improved to exit the study as an age-matched healthy adult. Mean improvements were maintained at one month post-training. In interviews conducted a year after training, subjects also reported continued gains in both mobility and participation in the community.2
Test units/Subject # Baseline Post-training %Diff 1-Month %Diff
10 MWT, m/s123
0.600.290.83
0.810.411.03
354824
0.950.451.14
585537
6 MWT, m123
17093271
207140300
225011
250123285
47325
Step length, m (affected limb)123*% Diff from baseline score
0.490.290.54
0.560.400.59
14389
0.590.390.60
203511 BYL,
Journal of Medical Case Reports 2012
10882 AGT Case Studies USF m1.0.indd 1 6/12/13 9:06 PM
With the AlterG® Bionic Leg™, therapists are able focus on strategies designedto to enhance active motor learning and functional recovery of mobility.• Timing:
Beginning bedside during the first days post-stroke to promote weight bearing on the involved
limb with transfers, and standing with focus on restorative patterns of movement. Progress the
patient through the continuum of care to therapy in the home, conquering their own stairs.
• Motivation:
The Bionic Leg requires a therapist-adjustable level of patient effort before robotic assistance is
provided. As the patient progresses through therapy, assistance can be dialed back to optimize
paretic limb work. This encourages active participation from the patient towards restorative
training – not more compensatory mechanisms.
• Feedback:
Real-time feedback from the mechanical assistance and auditory cueing empowers the patient
and the therapist to recognize and correct movement patterns, practicing the task at hand
correctly and safely.
• Intensity and Repetition:
With use of the adjustable settings to match or challenge strength in the impaired limb, the
patient can safely be encouraged to work more intensely and independently than before. By
augmenting patient ability, reducing fear of falling, and therapist-injury risk, the Bionic Leg can
significantly increase the number of repetitions in a typical therapy session.
• Specificity and Salience:
With the device, patients can walk outside the clinic over varied terrain, practice getting in and
out of a real car, and negotiate curbs and steps as they will in the community. Reprogram patients’ expectations and movement
pathways simultaneously.
• Transfer of Knowledge:
By implementing “Parts to a Whole” treatments with the Bionic Leg, clinicians can break down tasks to core elements and
enhance learning. Utilizing the “carry-over” of training effects following Bionic Leg training3, clinicians are able to reinforce
learning by assigning exercises and task-specific activities for patients to work on outside of therapy.
AlterG, Inc. | 48438 Milmont Dr., Fremont, CA 94538 | 510-270-5900 | alterg.com
REFERENCES:1. Horst RW. A bio-robotic leg orthosis for rehabilitation and mobility enhancement. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:5030-5033.2. Byl, NN. Mobility Training Using a Bionic Knee Orthosis in Patients Chronic Post-Stroke: A Case Series. Journal of Medical Case Reports. In Press.3. Wong, CK. A wearable robotic knee orthosis for gait training: a case-series of hemiparetic stroke survivors. Prosthetics and Orthotics International. 2011; [Fill-In]: 1-8.
10882 AGT Case Studies USF m1.0.indd 2 6/12/13 9:06 PM
With the AlterG® Bionic Leg™, therapists are able focus on strategies designedto to enhance active motor learning and functional recovery of mobility.• Timing:
Beginning bedside during the first days post-stroke to promote weight bearing on the involved
limb with transfers, and standing with focus on restorative patterns of movement. Progress the
patient through the continuum of care to therapy in the home, conquering their own stairs.
• Motivation:
The Bionic Leg requires a therapist-adjustable level of patient effort before robotic assistance is
provided. As the patient progresses through therapy, assistance can be dialed back to optimize
paretic limb work. This encourages active participation from the patient towards restorative
training – not more compensatory mechanisms.
• Feedback:
Real-time feedback from the mechanical assistance and auditory cueing empowers the patient
and the therapist to recognize and correct movement patterns, practicing the task at hand
correctly and safely.
• Intensity and Repetition:
With use of the adjustable settings to match or challenge strength in the impaired limb, the
patient can safely be encouraged to work more intensely and independently than before. By
augmenting patient ability, reducing fear of falling, and therapist-injury risk, the Bionic Leg can
significantly increase the number of repetitions in a typical therapy session.
• Specificity and Salience:
With the device, patients can walk outside the clinic over varied terrain, practice getting in and
out of a real car, and negotiate curbs and steps as they will in the community. Reprogram patients’ expectations and movement
pathways simultaneously.
• Transfer of Knowledge:
By implementing “Parts to a Whole” treatments with the Bionic Leg, clinicians can break down tasks to core elements and
enhance learning. Utilizing the “carry-over” of training effects following Bionic Leg training3, clinicians are able to reinforce
learning by assigning exercises and task-specific activities for patients to work on outside of therapy.
AlterG, Inc. | 48438 Milmont Dr., Fremont, CA 94538 | 510-270-5900 | alterg.com
REFERENCES:1. Horst RW. A bio-robotic leg orthosis for rehabilitation and mobility enhancement. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:5030-5033.2. Byl, NN. Mobility Training Using a Bionic Knee Orthosis in Patients Chronic Post-Stroke: A Case Series. Journal of Medical Case Reports. In Press.3. Wong, CK. A wearable robotic knee orthosis for gait training: a case-series of hemiparetic stroke survivors. Prosthetics and Orthotics International. 2011; [Fill-In]: 1-8.
10882 AGT Case Studies USF m1.0.indd 2 6/12/13 9:06 PM
108550 V1 108550 V1
