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...

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Autores principales:	Margaux B. Linde, Andrew R. Thoreson, Cesar Lopez, Megan L. Gill, Daniel D. Veith, Rena F. Hale, Jonathan S. Calvert, Peter J. Grahn, Kalli J. Fautsch, Dimitry G. Sayenko, Kristin D. Zhao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	spinal cord injury paralysis neuromodulation force sensitive resistors locomotor training rehabilitation Other systems of medicine RZ201-999 Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/cfba3fb2cf6146cbbc26f1ed238d446c
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spelling	oai:doaj.org-article:cfba3fb2cf6146cbbc26f1ed238d446c2021-12-02T10:29:04ZQuantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors2673-686110.3389/fresc.2021.757828https://doaj.org/article/cfba3fb2cf6146cbbc26f1ed238d446c2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fresc.2021.757828/fullhttps://doaj.org/toc/2673-6861Background: 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.Margaux B. LindeAndrew R. ThoresonAndrew R. ThoresonCesar LopezMegan L. GillDaniel D. VeithRena F. HaleJonathan S. CalvertPeter J. GrahnPeter J. GrahnKalli J. FautschDimitry G. SayenkoKristin D. ZhaoKristin D. ZhaoFrontiers Media S.A.articlespinal cord injuryparalysisneuromodulationforce sensitive resistorslocomotor trainingrehabilitationOther systems of medicineRZ201-999Medical technologyR855-855.5ENFrontiers in Rehabilitation Sciences, Vol 2 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	spinal cord injury paralysis neuromodulation force sensitive resistors locomotor training rehabilitation Other systems of medicine RZ201-999 Medical technology R855-855.5
spellingShingle	spinal cord injury paralysis neuromodulation force sensitive resistors locomotor training rehabilitation Other systems of medicine RZ201-999 Medical technology R855-855.5 Margaux B. Linde Andrew R. Thoreson Andrew R. Thoreson Cesar Lopez Megan L. Gill Daniel D. Veith Rena F. Hale Jonathan S. Calvert Peter J. Grahn Peter J. Grahn Kalli J. Fautsch Dimitry G. Sayenko Kristin D. Zhao Kristin D. Zhao Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors
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	article
author	Margaux B. Linde Andrew R. Thoreson Andrew R. Thoreson Cesar Lopez Megan L. Gill Daniel D. Veith Rena F. Hale Jonathan S. Calvert Peter J. Grahn Peter J. Grahn Kalli J. Fautsch Dimitry G. Sayenko Kristin D. Zhao Kristin D. Zhao
author_facet	Margaux B. Linde Andrew R. Thoreson Andrew R. Thoreson Cesar Lopez Megan L. Gill Daniel D. Veith Rena F. Hale Jonathan S. Calvert Peter J. Grahn Peter J. Grahn Kalli J. Fautsch Dimitry G. Sayenko Kristin D. Zhao Kristin D. Zhao
author_sort	Margaux B. Linde
title	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_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_sort	quantitative assessment of clinician assistance during dynamic rehabilitation using force sensitive resistors
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/cfba3fb2cf6146cbbc26f1ed238d446c
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Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors

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