To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients ... more To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Motion analysis laboratory of a rehabilitation centre. Fourteen chronic, nonambulatory hemiparetic patients. Complex gait analysis while training on the gait trainer and while walking on the treadmill. Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking (p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer (p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing (p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device. The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.
In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-b... more In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement.
A system for clinical analysis of sit-to-stand transfer using two force plates is presented. Dist... more A system for clinical analysis of sit-to-stand transfer using two force plates is presented. Distinct time-events and phases are estimated. Illustrative parameters are also determined, such as the distribution of the vertical ground reaction forces, displacement of the center of gravity in the sagittal and frontal planes, and a comparison of the displacement of the center of gravity and the center of pressure. These parameters indicate a symmetrical raising while keeping the middle of the body. Future applications include the validation of therapy, biofeedback and the control of closed-loop FES.
In 15 healthy and 20 hemiparetic persons we studied standing-up by two force-plates. Phases befor... more In 15 healthy and 20 hemiparetic persons we studied standing-up by two force-plates. Phases before and after the seat-off, force distribution and centre of gravity displacement were assessed. The patients rose significantly slower. The force ratios after seat-off differed significantly between the groups (0.88 vs 0.68). Left/right hemiparetic patients put more weight on the affected limb in 18%/11% of the trials before seat-off, with its insufficient use after it mainly in the left patients. At seat-off, projection of the centre of gravity fell within the support area in hemiparetic patients, and 3 cm behind it in healthy subjects. With larger lateral displacement of the centre of gravity in the hemiparetic group, left hemiparetic patients mostly shifted their weight to the non-affected side and right hemiparetic patients to both sides. Weight distribution and mediolateral displacement of the centre of gravity in the left and right hemiparetic patients were considered.
... Functional electrical stimulation and treadmill training with partial body weight support thr... more ... Functional electrical stimulation and treadmill training with partial body weight support through suspension by a parachute harness were combined for gait restoration in 11 chronic non-ambulatory hemiparetic patients. Individually ...
This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a ... more This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a functional electrical stimulation (FES) program for restoration of the ability to stand and walk. Four tetraplegic patients reached a mean FES-assisted standing duration of 6.8 min after 6 weeks. After 1 year three patients had stopped FES-assisted standing due to orthostatic problems and only used the system for cyclic stimulation of quadriceps muscles while lying down. Ten paraplegic patients had a mean standing duration of 22.6 min. The gait velocity (gait distance) of seven patients ranged from 2.9 to 24.2 m/min (from 4 to 335 m) in seven patients. Due to flexor spasm in two and unrealistic expectations in seven cases, four patients stopped the program and five only practiced FES-assisted standing. One patient continued FES walking after 1 year. Three patients with an incomplete cervical lesion who had been able to walk a short distance before treatment achieved constant improvement their gait ability. Their gait velocity/walking distance without FES improved for a mean of +33.3%/+163.8%, after 6 weeks. Assuming that FES is used according to the level of impairment, the results favor broader application of the method in the rehabilitation of patients with spinal cord injuries.
To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients ... more To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Motion analysis laboratory of a rehabilitation centre. Fourteen chronic, nonambulatory hemiparetic patients. Complex gait analysis while training on the gait trainer and while walking on the treadmill. Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking (p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer (p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing (p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device. The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.
In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-b... more In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement.
A system for clinical analysis of sit-to-stand transfer using two force plates is presented. Dist... more A system for clinical analysis of sit-to-stand transfer using two force plates is presented. Distinct time-events and phases are estimated. Illustrative parameters are also determined, such as the distribution of the vertical ground reaction forces, displacement of the center of gravity in the sagittal and frontal planes, and a comparison of the displacement of the center of gravity and the center of pressure. These parameters indicate a symmetrical raising while keeping the middle of the body. Future applications include the validation of therapy, biofeedback and the control of closed-loop FES.
In 15 healthy and 20 hemiparetic persons we studied standing-up by two force-plates. Phases befor... more In 15 healthy and 20 hemiparetic persons we studied standing-up by two force-plates. Phases before and after the seat-off, force distribution and centre of gravity displacement were assessed. The patients rose significantly slower. The force ratios after seat-off differed significantly between the groups (0.88 vs 0.68). Left/right hemiparetic patients put more weight on the affected limb in 18%/11% of the trials before seat-off, with its insufficient use after it mainly in the left patients. At seat-off, projection of the centre of gravity fell within the support area in hemiparetic patients, and 3 cm behind it in healthy subjects. With larger lateral displacement of the centre of gravity in the hemiparetic group, left hemiparetic patients mostly shifted their weight to the non-affected side and right hemiparetic patients to both sides. Weight distribution and mediolateral displacement of the centre of gravity in the left and right hemiparetic patients were considered.
... Functional electrical stimulation and treadmill training with partial body weight support thr... more ... Functional electrical stimulation and treadmill training with partial body weight support through suspension by a parachute harness were combined for gait restoration in 11 chronic non-ambulatory hemiparetic patients. Individually ...
This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a ... more This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a functional electrical stimulation (FES) program for restoration of the ability to stand and walk. Four tetraplegic patients reached a mean FES-assisted standing duration of 6.8 min after 6 weeks. After 1 year three patients had stopped FES-assisted standing due to orthostatic problems and only used the system for cyclic stimulation of quadriceps muscles while lying down. Ten paraplegic patients had a mean standing duration of 22.6 min. The gait velocity (gait distance) of seven patients ranged from 2.9 to 24.2 m/min (from 4 to 335 m) in seven patients. Due to flexor spasm in two and unrealistic expectations in seven cases, four patients stopped the program and five only practiced FES-assisted standing. One patient continued FES walking after 1 year. Three patients with an incomplete cervical lesion who had been able to walk a short distance before treatment achieved constant improvement their gait ability. Their gait velocity/walking distance without FES improved for a mean of +33.3%/+163.8%, after 6 weeks. Assuming that FES is used according to the level of impairment, the results favor broader application of the method in the rehabilitation of patients with spinal cord injuries.
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Papers by Stefan Hesse