Publication: Sistema robótico ambulatorio de rehabilitación de marcha. Solución integrada de inducción de movimientos y descarga parcial de peso del paciente
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2018-03
Defense date
2018-07-05
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Abstract
En esta tesis doctoral se presenta el diseño, el desarrollo y la validación de un dispositivo
robótico para el entrenamiento y la rehabilitación de la marcha de personas
con deficiencia motora. Se basa en la combinación de un exoesqueleto bilateral activo
de miembros inferiores y de una plataforma de descarga parcial de peso, regulable, que
proporciona una alta estabilidad y seguridad durante la marcha. Se ha diseñado para
proporcionar una marcha natural en un entorno real con una descarga adaptable, con
el objeto de potenciar las capacidades motoras residuales del paciente, así como evitar
o disminuir importantes problemas que aparecen por períodos largos de sedestación.
Inicialmente, se presenta la caracterización de la marcha humana a través de sus
parámetros espacio-temporales y cinemáticos, así como los sistemas empleados para
su caracterización. Se hace igualmente una revisión del estado del arte de los sistemas
tecnológicos de ayuda a la movilidad, proponiendo una clasificación en función de las capacidades
motoras del usuario. Se realiza un especial énfasis en los dispositivos vestibles
y en los entrenadores de marcha tanto en fase de investigación como comerciales.
A partir de este estudio, se detectan las carencias que se marcan como objetivos a
cumplir para el entrenador HYBRID, desarrollo central del trabajo realizado en esta tesis
doctoral, dentro del proyecto nacional DPI 2011-28160-C03. Se detalla el diseño mecánico
realizado, así como la integración hardware e implementación software de los subsistemas
y su integración conjunta para su correcto funcionamiento de manera integrada. El
sistema se diseña como una plataforma abierta que permite el procesamiento y el registro
de señales para la caracterización de la marcha.
El sistema ha sido validado con personas sanas como paso previo a la validación clínica.
Esta se ha centrado en asegurar la estabilidad y seguridad del dispositivo, caracterizar
la marcha desarrollada, comprobar la correcta inducción del movimiento sobre las extremidades
inferiores del usuario, caracterizar las fuerzas de suspensión y determinar el
grado de acoplamiento entre el sistema y el usuario.
Finalmente, se ha validado el sistema con pacientes con lesión medular de distinto
grado de afección y capacidades de locomoción. Se ha valorado el impacto metabólico en
términos respiratorios, cardíacos y energéticos; además de los parámetros de la marcha
desarrollada y las fuerzas de suspensión. Los resultados obtenidos tanto de las escalas
objetivas empleadas como de las valoraciones subjetivas de los pacientes se han considerado
satisfactorios en un buen grado y se presentan en la memoria, constatando el
potencial del dispositivo como herramienta fiable para el entrenamiento de la marcha de
personas con un alto grado de discapacidad motora.
In this PhD thesis, the design, development and validation of a robotic device for the training and rehabilitation of people with motor deficits is presented. This robotic device is based on the combination of a powered bilateral lower limb exoskeleton and an adjustable partial body weight support platform, that gives high stability and safety during walking. It has been designed to provide natural gait in real environments with an adaptive support, focused on enhancing the residual motor abilities of the patient as well as avoiding or diminishing the numerous and important problems that appear after long periods of sitting. Initially, human gait characterization is presented through its spatio-temporal and kinematic parameters as well as the systems used for it. A review of the state-of-theart of the mobility devices is presented, proposing a classification based on the user's residual motor abilities. Special emphasis is placed on wearable devices and gait trainers in both the research field and the market. From this study, the identified shortcomings are proposed as the objectives to be achieved for the HYBRID gait trainer, framework of development of this PhD Thesis, within the national project DPI 2011-28160-C03. In this sense, the mechanical design, hardware integration, software implementation and integration of the subsystems is presented. The system is designed as an open platform that allows the integration of new functionalities, as well as the processing and recording of sensor signals for the gait characterization. The system has been validated with healthy people as a first step to the clinical validation with people with motor disabilities, people with spinal cord injury in this case. This first validation has been focused on ensuring the stability and safety of the device, the analysis of the gait developed with the HYBRID system, the validation of the induced movement of the lower limb in the user, the characterization of the unloading forces and the assessment of the degree of coupling between the system and the user. Finally, the system has been validated with spinal cord injured patients with different levels of motor disability. The metabolic impact in respiratory, cardiac and energetic terms has been evaluated; in addition to the characterization of the gait parameters and the unloading forces. The results obtained from the clinical scales and user experience evaluation, presented in this PhD thesis, have been considered satisfactory, confirming the potential of the device as a reliable tool for gait training of people with a high degree of motor disability.
In this PhD thesis, the design, development and validation of a robotic device for the training and rehabilitation of people with motor deficits is presented. This robotic device is based on the combination of a powered bilateral lower limb exoskeleton and an adjustable partial body weight support platform, that gives high stability and safety during walking. It has been designed to provide natural gait in real environments with an adaptive support, focused on enhancing the residual motor abilities of the patient as well as avoiding or diminishing the numerous and important problems that appear after long periods of sitting. Initially, human gait characterization is presented through its spatio-temporal and kinematic parameters as well as the systems used for it. A review of the state-of-theart of the mobility devices is presented, proposing a classification based on the user's residual motor abilities. Special emphasis is placed on wearable devices and gait trainers in both the research field and the market. From this study, the identified shortcomings are proposed as the objectives to be achieved for the HYBRID gait trainer, framework of development of this PhD Thesis, within the national project DPI 2011-28160-C03. In this sense, the mechanical design, hardware integration, software implementation and integration of the subsystems is presented. The system is designed as an open platform that allows the integration of new functionalities, as well as the processing and recording of sensor signals for the gait characterization. The system has been validated with healthy people as a first step to the clinical validation with people with motor disabilities, people with spinal cord injury in this case. This first validation has been focused on ensuring the stability and safety of the device, the analysis of the gait developed with the HYBRID system, the validation of the induced movement of the lower limb in the user, the characterization of the unloading forces and the assessment of the degree of coupling between the system and the user. Finally, the system has been validated with spinal cord injured patients with different levels of motor disability. The metabolic impact in respiratory, cardiac and energetic terms has been evaluated; in addition to the characterization of the gait parameters and the unloading forces. The results obtained from the clinical scales and user experience evaluation, presented in this PhD thesis, have been considered satisfactory, confirming the potential of the device as a reliable tool for gait training of people with a high degree of motor disability.
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Keywords
Biomecánica, Discapacidad física, Exoesqueletos robóticos, Robótica médica, Robots asistenciales