P.I.G.R.O. Pneumatic Interactive Gait Rehabilitation Orthosis

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1 P.I.G.R.O. Pneumatic Interactive Gait Rehabilitation Orthosis Active exoskeleton for the neuro-rehabilitation of lower limbs Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli Politecnico di Torino - Department of Mechanical and Aerospace Engineering Corresponding author silvia.sirolli@polito.it

2 DEPENDENCE INSECURITY FATIGUE DEPRESSION ~1 million patients-year with clinical problems which affect the Motor Control!

Stroke is the first leading cause of disability in Italy (196.

3 Stroke is the first leading cause of disability in Italy ( patients every year) and the second leading cause in Europe. In the EU27 countries, the annual economic cost of stroke is an estimated 27 billion Stroke incidence is an increasing trend

TBI is the leading cause of disability in people under 40 years of age

over the last five years, threefold greater than the rate of increase

Every year, over 1,600,000 patients sustain a traumatic brain injury in

4 TBI is the leading cause of disability in people under 40 years of age Recent statistics show an increase of 21% in the incidence of TBIs, over the last five years, threefold greater than the rate of increase in population. Every year, over 1,600,000 patients sustain a traumatic brain injury in the EU: 75% of the victims are children and young adults. In the EU27 countries, the annual economic cost of TBI exceeds 100 billion

5 State of art limits: Heavy system Fixed stations Limits in rehabilitation training: Treadmill prevents a right perception of the body movement in the space Move few or single joints Not physiological gait pattern

6 After a brain injury, how can be possible to reconstruct the motor gait schemes? Thanks to BRAIN PLASTICITY the brain is able to change to recover/compensate lost functions The SENSORIMOTOR EXPERIENCES with FOCUSED ATTENTION and MOTOR IMAGERY can reshape the structure and functions of the undamaged parts of the brain.

7 MOTOR TRAINING COGNITIVE TRAINING Focused attention on the movement Passive movement with P.I.G.R.O. Mental practice exercises

8 Body Weight Support (BWS) Electric pelvic adjustment Pneumatic actuation Pressure and position sensors Real-time control Active ankle articulation Structure flexibility

9 What makes P.I.G.R.O. Unique? Complete actuation: Hips Knees Ankle Portable Mobility Adaptability of the structure Adjustable from 10%ile female to 95%ile male Compliance of the structure due to the pneumatic power Visual bio-feedback both helps and stimulates the patient through the rehabilitation process

11 Robotic system Company Complete lower limbs rehabilit. Treadmill optional Active rehabilit. Biofeedback Lightweigth Woodway LokoHelp Hocoma Lokomat Motorika Reo-Ambulator Polito PIGRO

Behavioral Evaluation with physiatric scales Improvement of the balance clinically measurable in both patients Improvement of the gait clinically

12 Behavioral Evaluation with physiatric scales Improvement of the balance clinically measurable in both patients Improvement of the gait clinically measurable in 1 patient fmri analysis with functional activations The combined training - motor and cognitive - changes the motor brain circuits of lower limbs

(M1) primary sensory area (S1) at the level of the foot cortical

13 After the training brain activations increase in: premotor areas (SMA and CMA) involved in planning movements primary motor area (M1) primary sensory area (S1) at the level of the foot cortical representation Sacco et al., 2011 Frontiers in Human Neuroscience

14 T0 T1 T2 Nonspecific daily activities TRAINING Physiatric evaluation nps evaluation 5 weeks 5 weeks Physiatric evaluation nps evaluation fmri pre-training Physiatric evaluation nps evaluation fmri post-training TRAINING: 60 minutes per session - 3 sessions per week - 5 weeks The typical session: proprioceptive part with focused attention on the position of the limb active part in which the patient himself reproduce the movement actively motor imagery exercises locking the machine in a defined position

15 Improvement of the balance in all patients Statistically significant differences in the Berg Balance Scale (BBS, balance and safety of the gait) and Tinetti Balance and Gait Scale (TBGS, balance and quality of the gait) Improvement 15% S NS Improvement 25% NS S

16 CUSTOMERS Medical and health services managers USERS Patients with clinical problems (hemiplegia,tetraparesis, hemiparesis and other outcomes of brain damage) Physiotherapists Doctors INFLUENCERS

Engineers PoliTo - DIMEAS Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli Neuro Psychologists UniTO Psychology Department Katiuscia Sacco Giuliano Geminiani

17 Engineers PoliTo - DIMEAS Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli Neuro Psychologists UniTO Psychology Department Katiuscia Sacco Giuliano Geminiani Elisabetta Geda Physiatrists & Physiotherapists Fossano Hospital Gianfranco Lamberti Matteo Siccardi Francesca Chiavarino Arianna Dalmasso Psychologists Centro Puzzle,Torino Marina Zettin Roberta Virgilio

18 Developing & Testing P.I.G.R.O. towards commercialization Network with companies and industry from ASIA HELP PATENT WO Active orthosis for the motion neurological rehabilitation of lower limbs, system comprising such sling and process for operating such system G.Belforte, G.Eula, S.Appendino, G.C.Geminiani, M.Zettin

19 P.I.G.R.O. Pneumatic Interactive Gait Rehabilitation Orthosis Active exoskeleton for the neuro-rehabilitation Thanks for your Attention Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli Politecnico di Torino - Department of Mechanical and Aerospace Engineering Corresponding author silvia.sirolli@polito.it

Vibramoov NEUROREHABILITATION OF THE LOCOMOTOR SYSTEM THROUGH FUNCTIONAL PROPRIOCEPTIVE STIMULATION

Vibramoov NEUROREHABILITATION OF THE LOCOMOTOR SYSTEM THROUGH FUNCTIONAL PROPRIOCEPTIVE STIMULATION Principe of action BRAIN ACTIVATION VIBRAMOOV REVOLUTIONIZES FUNCTIONAL MOVEMENT THERAPY One of the main