ARECENT U.S. National Academy of Engineering and Institute of Medicine study (Building a Better Delivery System: A New Engineering/Health Care Partnership, National Academy Press, 2005) advocated the applications of system engineering tools and information/communication technologies to improve the quality and productivity of the healthcare system. Mechatronics design principle provides a synergistic integration of information, computation, and electromechanical device and systems, which plays an important role in advancing healthcare at both the device and system levels.

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Цель исследования: создание комплексной программы восстановления ходьбы у больных с инсультом с использованием роботизированных механотренажеров. В исследование включены пациенты в остром периоде инсульта, неспособные к самостоятельной ходьбе (средний возраст 59±10,4 года); 53 больных в основной группе и 25 — в контрольной. Среднее время от начала заболевания до начала проведения занятий с использованием роботизированных механотренажеров составило 14±1,6 суток и определялось адекватностью функциональных проб. Программа реабилитации включала ежедневные 30-минутные занятия лечебной физкультурой. Больные основной группы, в отличие от контрольной, получали также 20-минутные тренировки на роботизированных механотренажерах Motomed Viva 2 и Gait Trainer 1 (GT1), cопровождавшиеся непрерывным мониторингом артериального давления и частоты сердечных сокращений. Количество занятий на GT1 составило от 5 до 12, в среднем 7±1 занятие. После проведенного комплексного восстановительного лечения у пациентов основной группы по сравнению с контрольной отмечена достоверно (р<0,01) лучшая динамика по шкалам устойчивости стояния, функциональных категорий ходьбы, Берга, Бартел; все пациенты этой группы стали способны ходить с опорой или полностью самостоятельно. В основной группе достоверно (р<0,05) уменьшилось число больных с нарушениями проприоцептивной чувствительности (с 37,7 до 9,4%) и атаксией в нижних конечностях (с 37 до 11,3%), в контрольной группе динамики по этим показателям не было. Сделан вывод, что комплексное использование рефлекторной кинезотерапии и роботизированной механотерапии у больных в остром периоде инсульта позволяет увеличить функциональную активность и повысить уровень самообслуживания уже к моменту выписки из стационара.

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With the growing aging population, there is an increasing demand and oppor-tunity to develop exoskeletons, which are typically designed for military or industrial use, to be used on a daily basis to provide power assistance. Such exoskeletons could be used by the physically impaired and injured, in addition to the elderly. This report describes the design of a power-assist exoskeleton specifically for the pronation and supination motion of the forearm. The exoskeleton is controlled by two push-button sensors to indicate the direction of rotation, which is controlled by the user at all times. As a safety precaution, visual feedback was implemented to confirm the user’s inputs were received by the exoskeleton and that the robot is actuating. A stepper motor, whose torque is transferred to the system using a bidirectional winch system, is used such that the exoskeleton is able to output such holding torques to lock the position of the arm. The mechanical structure is composed of various PVC and ABS coupling hubs, which form a stationary and rotating unit. The exoskeleton is fixed onto the user’s forearm through a blood pressure cuff, and torque is transferred from the motor to the user’s wrist through a custom-carved Styrofoam wrist cuff. From testing, the average running torque of the system ranged from 5.24 Nm to 9.17 Nm for motor speeds from 60 rpm to 45 rpm, respectively, which confirmed that decreasing motor speeds increased running torque. The amount of holding torque could not be quantified because the testing setup was unable to produce sufficient loads (>55Nm) to move the system out of its fixed position. However, when in “idle”, the system still produced a holding torque of 30 Nm, suggesting a significant source of torque transfer loss in the system. The exoskeleton was worn by a user and tested for comfort, usability and overall functionality. While there were a few sources of discomfort that were expected, the robot was able to actuate the proper motions for the user and provide powered assistance. Overall, the system was able to pronate, supinate and hold the user’s forearm as controlled, demonstrating that the exoskeleton successfully provided powered-assistance.

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A lower extremity exoskeleton includes: at least one power unit; two leg supports designed to rest on the ground; two knee joints configured to allow flexion and extension between respective shank and thigh links of the leg supports; an exoskeleton trunk rotatably connectable to the leg supports; and two hip actuators configured to create torques between the exoskeleton trunk and the leg supports. In use, the hip actuators create a torque to move the leg supports backward relative to the exoskeleton trunk during a stance phase, which pushes the exoskeleton trunk forward. A second torque may be used to move the leg supports forward relative to the exoskeleton trunk into a swing phase. Additionally, a swing torque may be generated during the swing phase to move the leg support forward relative to the exoskeleton trunk. This results in decreased oxygen consumption and heart rate of a user wearing the exoskeleton.

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An exoskeleton bracing system includes: a trunk support for affixing to the trunk of a disabled person and leg braces for connecting to the legs of the person, each leg brace including limb segment braces. Motorized joints are adapted to provide relative angular movement between the limb segment braces of the leg braces and between the leg braces and the trunk support. One or more ground force sensors are designed to sense ground force exerted on each of the leg braces. The system also includes a controller for receiving sensed signals from said one or more ground force sensors, with an algorithm for identifying a stance from the sensed signals and, based on the identified stance, actuating the motorized joints to perform an action relating to a mode of locomotion selected from a set of predefined actions corresponding to the identified stance.

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