Fraunhofer-Institut für Produktionsanlagen und Konstruktionstechnik IPK

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  • Publication
    Richtlinien für die Gestaltung von visuellem Biofeedback in der neurologischen Gangrehabilitation nach Schlaganfall
    ( 2010)
    Brüning, M.
    ;
    Hussein, S.
    ;
    Bardeleben, A.
    ;
    Schmidt, H.
    ;
    Krüger, J.
    ;
    Hesse, S.
  • Publication
    Visuelles Biofeedback für die gerätegestützte neurologische Gangrehabilitation nach Schlaganfall
    ( 2010)
    Brüning, M.
    ;
    Hussein, S.
    ;
    Bardeleben, A.
    ;
    Schmidt, H.
    ;
    Krüger, J.
    ;
    Hesse, S.
  • Publication
    Gait rehabilitation machines based on programmable footplates
    ( 2007)
    Schmidt, H.
    ;
    Werner, C.
    ;
    Bernhardt, R.
    ;
    Hesse, S.
    ;
    Krüger, J.
    Background: Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing. Results: With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e. g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations. Conclusion: Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients.
  • Publication
    A new mechanical arm trainer to intensify the upper limb rehabilitation of severely affected patients after stroke: Design, concept and first case series
    ( 2007)
    Hesse, S.
    ;
    Schmidt, H.
    ;
    Werner, C.
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    Rybski, C.
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    Puzich, U.
    ;
    Bardeleben, A.
    Description and case series on a new mechanical arm trainer with three degrees of freedom (DoF), the REHASLIDE (RS), for stroke rehabilitation are presented. Similar to a rolling pin, it consists of two handles at either side of a connecting rod, the handles are bilaterally moved forward and backward, sideways, and rotated, the base plate is inclinable. A computer mouse attached to the rod enables playing games offering computer-biofeedback. Two patients, 6 and 5 weeks after a first-time supratentorial stroke, suffering from a flaccid non-functional upper extremity have been studied. Interventions performed were additional 30 min of RS-training every workday for 6 weeks; one session included 400 repetitions evenly distributed between the forward backward movement and drawing a circle clock- and counter clockwise. Afterwards the patients could play games. Upper extremity portion of the Fugl-Meyer Motor Assessment Score (FM, 0-66), and muscle strength by a Medical Researc h Council (MRC) sum score (0-45), the FM assessment was blinded. In the 2 patients, the FM (0-66) improved from 7 to 37, and from 17 to 43, their initial (terminal) MRC sum scores were 6 (36) and 13 (31). With the REHA-Slide (RS), severely affected patients practiced a bilateral 3 DoF movement No conclusions can be drawn so far and a controlled clinical study must be the next step.
  • Publication
    Automatisierte motorische Rehabilitation nach Schlaganfall
    ( 2006)
    Hesse, S.
    ;
    Werner, C.
    ;
    Schmidt, H.
    ;
    Bardeleben, A.
    Der Artikel bietet einen Überblick über die junge Forschungsrichtung der automatisierten motorischen Rehabilitation nach Schlaganfall. Der Einsatz intelligenter Maschinen zielt auf eine Steigerung der Therapieintensität, eine Entlastung der Therapeuten und die Gewährung einer nachvollziehbaren und auf die individuellen Bedürfnisse abgestimmten Therapie. Beispiele im Bereich der oberen Extremität sind der "MIT-Manus" und der "MIME"-Roboter für eine ungehinderte Schulter-Ellenbogenbewegung in der Horizontalen, der "Bi-Manu-Track" für das bilaterale, passive und aktive Üben einer Unterarmdreh- und Handgelenkscharnierbewegung, und das "Nudelholz" für die Eigentherapie einer dreidimensionalen Bewegung in der Klinik oder zu Hause. In der Gangrehabilitation werden der "Lokomat®" als angetriebenes Exoskeleton in Verbindung mit dem Laufband sowie der elektromechanische Gangtrainer "GT I" als Modell mit angetriebenen Fußplatten verwandt. Klinische Studien zu den einzelnen Geräten werden mit aufgeführt.
  • Publication
    Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin
    ( 2006)
    Hesse, S.
    ;
    Schmidt, H.
    ;
    Werner, C.
    The group at Klinik Berlin/Charite University Hospital in Berlin, Germany, began studies to promote motor recovery after stroke in the early 1990s. Following the introduction of treadmill training with partial body-weight support, the group designed an electromechanical gait trainer, GT I, based on movable foot plates that relieve therapist effort (e.g., when assisting the movement of the paretic limbs) and intensify patient gait training (GT). Preliminary results of a recent multicenter trial of 155 acute stroke patients showed that the GT I effectively promotes gait ability and competence in activities of daily living. The experimental group received 20 min of GT and 25 min of physiotherapy (PT) and the control group received 45 min of PT every day for 4 weeks. The laboratory's next step was the HapticWalker, a robotic walking simulator with freely programmable foot plates so that patients can, for example, additionally train for stair climbing and perturbations. The foot plates can be operated in full guidance or compliance control modes, thus reducing foot support according to the patient's learning success. For the severely affected upper limb, the laboratory's computerized arm trainer, called the Bi-Manu-Track, enables bilateral practice of forearm pronation/supination and wrist flexion/extension. Compared with electrical stimulation of the paretic wrist extensors, acute stroke patients with severe arm paresis (n = 44) had significantly more upper-limb muscle strength and control at the end of the 6-week intervention period and at follow-up. The laboratory's most recent and cost-effective development, the Nudelholz, is a purely mechanical device that bilaterally trains the shoulder, elbow, and wrist joints. It is intended for home therapy.
  • Publication
    Automatisierte motorische Rehabilitation nach Schlaganfall
    ( 2003)
    Werner, C.
    ;
    Schmidt, H.
    ;
    Sorowka, D.
    ;
    Bardeleben, A.
    ;
    Hesse, S.
    Der Artikel bietet einen Überblick über die junge Forschungsrichtung der automatisierten motorischen Rehabilitation nach Schlaganfall. Der Einsatz intelligenter Maschinen zielt auf eine Steigerung der Therapieintensität, eine Entlastung der Therapeuten und die Gewährung einer nachvollziehbaren und auf die individuellen Bedürfnisse abgestimmten Therapie. Beispiele im Bereich der oberen Extremität sind der "MIT-Manus" und der "MIME"-Roboter für eine ungehinderte Schulter-Ellenbogen-Bewegung in der Horizontalen sowie der "Bi-Manu-Track" für das bilaterale, passive und aktive Üben einer Unterarmdreh- und Handgelenkscharnierbewegung. In der Gangrehabilitation werden der "Lokomat®" als angetriebenes Exoskeleton in Verbindung mit dem Laufband sowie der elektromechanische Gangtrainer "GT I" als Modell mit angetriebenen Fußplatten verwandt. Klinische Studien zu den einzelnen Geräten werden aufgeführt.
  • Publication
    Entwicklung eines robotergestützten Laufsimulators zur Gangrehabilitation
    ( 2003)
    Schmidt, H.
    ;
    Sorowka, D.
    ;
    Hesse, S.
    ;
    Bernhardt, R.
    Restoration of gait is a major concern of rehabilitation after stroke or spinal cord injury. Modern concepts of motor learning favour a task-specific repetitive approach, i.e. "whoever wants to learn to walk again must walk." However, the physical demands this places on the therapist, is a limiting factor in the clinical routine setting. This article describes a robotic walking simulator for gait training that enables wheelchair-bound subjects to freely carry out repetitive practicing of an individually adapted gait pattern under simulation of the manual guidance of an experienced therapist. The technical principle applied makes use of programmable footplates with permanent foot/machine contact in combination with compliance control. The solution chosen comprises a planar parallel-serial hybrid kinematic system with three degrees of freedom that moves the feet in the sagittal plane. Gait analysis while floor walking and stair climbing, clinical practicability and safety aspects were the basis for the design. A variable compliance control enables man-machine interaction. ranging from purely position controlled movement to full compliance during swing phase above a virtual ground profile. In full compliance mode the robotic walking simulator behaves like a haptic device. The concept presented offers new prospects for individualised gait rehabilitation.