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Author for Correspondence Abstract- This paper presents a novel, smart and portable
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Active Knee Rehabilitation Orthotic Device (AKROD)
designed to train stroke patients to correct knee hyperextension
during stance and stiff-legged gait (defined as reduced knee
flexion during swing). The knee brace provides variable
damping controlled in ways that foster motor recovery in
stroke patients. A resistive, variable damper, electro-
rheological fluid (ERF) based component is used to facilitate
knee flexion during stance by providing resistance to knee
buckling. Furthermore, the knee brace is used to assist in knee
control during swing, i.e. to allow patients to achieve adequate
knee flexion for toe clearance and adequate knee extension in
preparation to heel strike. The detailed design of AKROD, the
first prototype built, closed loop control results and initial
human testing are presented here.6217
Index Terms - Electro-Rheological Fluids, Rehabilitation
Robotics
I. INTRODUCTION
Stroke is a leading cause of permanent disability in the
Unites States. According to the National Stroke Association,
each year about 730,300 people suffer a stroke, and
approximately two-thirds of these inpiduals survive and
require rehabilitation [1]. Approximately 80% of stroke
survivors present an early motor deficit, with 50% having
chronic deficits. Impairments such as spasticity, muscle
weakness, loss of range of motion, and impaired force
generation create deficits in motor control that affect the
stroke survivor's capacity for independent living. Robotic
and mechatronic technologies that can be integrated into
portable devices and can be used by patients in the home
setting are particularly attractive in the above-discussed
context because they have the potential of providing tools to
facilitate functional recovery, reducing cost of treatment and
providing patients with adequate level of independence.
Many ambulatory stroke survivors have substantial
alterations of their gait patterns as a result of the hemiparesis.
Compromised motor control and force generation frequently
lead to limited knee flexion and stiff-legged gait, defined as
limited knee flexion during swing and typically associated
with limited hip flexion and limited or absent ankle
dorsiflexion. These gait patterns cause substantial reduction
in gait velocity and efficiency, and can increase the
likelihood of falls. In some patients, knee hyperextension
develops as a mechanism to increase stability during stance.
Unfortunately, knee hyperextension can cause pain, and is
believed to lead to premature degenerative joint disease of
the knee in these inpiduals. Conventional treatments
largely focus on the use of ankle-foot orthoses (AFO) to
provide ankle stability and correct knee gait abnormalities.
Little emphasis is generally aimed at addressing knee
movement abnormalities via a knee orthosis. This is
because currently available knee orthoses are bulky and
rather make it difficult to achieve functional use of the knee.
The development of an intelligent, actuated knee orthosis
has the potential to address these issues. Two objectives
could be pursued with the proposed AKROD: (1) enhancing
gait retraining, and (2) improving orthotic intervention in the
home and community settings.
For many patients, a programmable actuated knee
orthosis could guide and facilitate the recovery of a more
efficient and clinically desirable gait pattern via retraining
sessions. Current clinical practice is generally restricted to
brief periods of less than 1 hour of gait training and
provided a few times per week. In between these sessions,
patients continue to walk using their typical gait pattern, andreinforce compensatory patterns of gait. Lower-extremity