D2.1 Requirements and Specification - CORBYS

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D2.1 Requirements and Specification professional user (therapist) is optimizing the patient´s gait with his/her manual techniques, the system is “learning” the optimal gait applicable for this individual patient (=”teaching mode”). The data relevant for the support given by the robotic system are transferred to the system. The sensors used as a diagnostic tool on the treadmill will not be the same as in the robotic system. Clinical, informal, formal and apparative diagnostic procedures and Specific and goal orientated treatment Reassessment of achieved goals setting new goals Figure 6: usual workflow in a rehabilitation unit - The patient is performing overground walking with the system on his own, but under supervision of a therapist. The system is optimising his gait and measuring the efforts, energy and result. This increases the treatment time without therapist and increases the time for reciprocal repetitive training - The therapist is evaluating the parameters measured by the system and reevaluates the gait on the treadmill, again optimising the gait and by this changing the walking parameters of the system. Alternatively the system itself corrects the gait with its cognitive structure by approximating the patients gait to normal gait pattern or to the therapist assisted, learned gait pattern“. As a result, the gait rehabilitation robot system could allow more independence from the need to have therapist supervision at all time. The therapist may supervise more than one patient at the same time more than one robot system. The patients will have more repeatative training time, which leads to a more affective rehabilitation outcome. However, the role of therapist cannot completely be replaced by the technology. The gait rehabilitation robot system should interact with the patient at following different levels: Level 1: co-operation of the powered orthosis and mobile platform with the user on the level of basic overground walking: walking along the straight line at a constant speed. This level would cover the “gentle” alteration of the existing walking patterns: symmetry, weight-bearing capabilities, “normalisation” of kinematic and kinetic patterns in all three joints of lower extremity in all three planes of motion, balance control (COP vs. COM control). This level is not concerned with “cognitive” issues as this should be 12 Clinical, (Re)Integration into patient´s environment
D2.1 Requirements and Specification automated movement. This level, however, should allow incorporation of “targeted walking” input that can be determined by a CORBYS professional user. For example, first the existing patterns like toe walking, crouch, stiff-knee, knee hyperextension, Trendelenburg etc. would be identified and appropriate changes in the desired kinematic and kinetic patterns would be made. The iterative nature of walking should be exploited in the design of a suitable control of powered orthosis and mobile platform. An important aspect of Level 1 operating mode would be training of isolated components of skills required in walking such as proper weight transfer training (starting from appropriate placement of the leg in swing onto the ground, followed by weight transfer during double stance and concluded by adequate control of trunk in the frontal plane during the single stance). Level 2: starting/stopping the walking, changing the speed of walking, turning during walking – change of walking direction. This level would be heavily concerned with cognitive interaction between the man and machine. A very motivating treatment modality would be avoiding the obstacles on the route that would represent a purposeful journey for a patient (going from the therapy session to their room for example). Level 3: the pathologic gait pattern of the patient is corrected by the gait rehabilitation robot system itself in an autonomous mode by comparing the measured joint angles, torques, velocities etc with a normal gait pattern or the CORBYS professional user assisted/corrected gait pattern and correcting false movements of the patient. 4.3 Requirements for demonstrator I REQUIREMENTS FOR THE FIRST DEMONSTRATOR MANDATORY DESIRABLE, OPTIONAL 1. Inclusion criteria to use the CORBYS gait rehabilitation system All symptoms leading to disturbed gait: - weakness of legs - increased tonus (spasticity) of legs - lack of coordination of legs - involuntary movement of legs - sensoric disorders of legs: disturbed afferences - Contractures < 30° in ankle, knee and hip - weakness of legs and trunk - lack of coordination of legs and trunk - involuntary movement of and trunk - in this case, the system must also support the trunk, which is unstable 2. Exclusion criteria for use of the CORBYS gait rehabilitation system - blindness - cognitive impairments to use the system - no arm or hand function - massive, suddenly outbreaking dynamic spasticity, ballistic movement disorder - grand mal epilepsy with frequent seizures 3. Informal diagnostic measurements by the robot system - degree of passive movement in hip, knee and ankle joint - analysis of balance problems (analysis for fixed contractures) - measurement of fatigue / tiredness: Measure cycle - resistance to a passive movement (analysis for dynamic time contractures) Co-ordination will find out mistakes and abnormalities and thus allow to identify tiredness as Within a gait cycle the following parameters should betired patient will increase mistakes and this can be measured detected by co-ordination feedback - torque (= voluntary muscle strength) in hip, knees and ankle joints both sides 13
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D2.1 Requirements and Specification - CORBYS

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