Diseño de integración de exoesqueleto de tobillo T-FLEX con estimulación eléctrica funcional en pacientes post ACV con disfunción de tobillo

Abstract

Stroke remains a major public health problem in many countries, affecting nearly 15 million people worldwide each year according to the World Health Organization [1]. Of this number, 5 million die and another 5 million have some type of disability resulting from stroke [2]. Although the medical care for the rehabilitation of stroke survivors is considerable and has increased over time, many patients continue to live with significant locomotor impairments. Mainly, the successful recovery of gait after stroke remains a challenge for patients and rehabilitation specialists. The lower limb rehabilitation processes are developed with the use of different techniques, including the use of robotic orthoses and functional electrical stimulation (FES) .However, rehabilitation with orthoses is physically exhausting for the patient, as well as the interaction physical and cognitive of it. On the other hand, FES leads to early fatigue of the muscles and has poor control of joint trajectories and difficulties in portability. For this reason, in this document the development of an investigation of the different active robotic ankle orthoses, functional electrical stimulation systems and hybrid exoskeletons that are currently developed is registered. Based on the literature, a comparison is made regarding their limitations and advantages as devices used independently and integrated as a hybrid exoskeleton. This study allows to have foundations and concrete bases to present the design of an integration of FES with the robotic exoskeleton (T-FLEX), which manages to overcome the limitations of both devices and potentiate their benefits to help in the restoration of gait. In addition to this, an analysis is carried out focused on two studies that were carried out previously, in which the design opportunities and deficiencies of the use of the developed systems were mainly found. The T-FLEX orthosis did not demonstrate statistically significant gait improvements, instead, it did demonstrate a decrease in speed and cadence. For the use of FES, no statistically significant values ​​were found in any of the parameters, however, if it could be observed that with the assistance of the device an improvement was achieved in the parameters of stride length, cadence and speed, compared to gait in the basal state. On the other hand, a comparison of independent samples is made between the percentage of difference in gait in basal and assisted state with each device. Where only a significant difference was found in cadence, this being a value that decreased with the use of T-FLEX and that increased with the use of a functional electrical stimulation device (H-GAIT). Finally, the design of the an experimental protocol for the evaluation of the ankle exoskeleton (T-FLEX) integrated with a Functional Electrical Stimulation system. With this protocol, it is expected to observe an improvement in gait propulsion and to validate the effect that the integrated systems have on the patient, in terms of kinematics with respect to the use of each system independently.