Active exoskeleton for the neuro-rehabilitation

of lower limbs

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

Politecnico di Torino - Department of Mechanical and Aerospace Engineering

Corresponding author e-mail: silvia.sirolli@polito.it

Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli

~1 million patients-year with clinical

problems which affect the Motor Control!

FATIGUE

INSECURITY

DEPRESSION

DEPENDENCE

Stroke is the first leading cause of disability

in Italy (196.000 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

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

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

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

The SENSORIMOTOR EXPERIENCES with FOCUSED ATTENTION

and MOTOR IMAGERY can reshape the structure and functions of the

undamaged parts of the brain.

Thanks to BRAIN PLASTICITY the brain is able to change to

recover/compensate lost functions

After a brain injury,

how can be possible to reconstruct the motor gait schemes?

Passive movement

with P.I.G.R.O.

MOTOR TRAINING

Focused attention on the

movement

Mental practice exercises

COGNITIVE TRAINING

Pneumatic actuation

Active ankle articulation

Body Weight Support (BWS)

Electric pelvic adjustment

Pressure and position sensors

Real-time control

Structure flexibility

What makes P.I.G.R.O. Unique?

Complete

actuation: • Hips

• Knees

• Ankle

Portable

Mobility

Adjustable from

10%ile female to

95%ile male

Adaptability of the structure

Compliance of the structure due to the pneumatic power

Visual bio-feedback both helps and stimulates the patient through the rehabilitation process

Robotic

system Company

Complete

lower

limbs

rehabilit.

Treadmill

optional

Active

rehabilit.

Biofeed-

back

Light-

weigth

Woodway

Hocoma

Motorika

Polito

Lokomat

LokoHelp

Reo-Ambulator

PIGRO

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

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

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

T0 T1 T2

Physiatric evaluation

nps evaluation

Physiatric evaluation

nps evaluation

fMRI pre-training

Physiatric evaluation

nps evaluation

fMRI post-training

TRAINING Nonspecific daily activities

5 weeks 5 weeks

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)

S

NS

S

NS

Improvement of the balance in all patients

Improvement

15%

Improvement

25%

Patients

with clinical problems

(hemiplegia,tetraparesis,

hemiparesis and other

outcomes of brain damage)

Physiotherapists

Medical and health

services managers

Doctors

INFLUENCERS

CUSTOMERS USERS

Psychologists Centro Puzzle,Torino

Marina Zettin

Roberta Virgilio

Physiatrists &

Physiotherapists

Fossano Hospital

Gianfranco Lamberti

Matteo Siccardi

Francesca Chiavarino

Arianna Dalmasso

Engineers

PoliTo - DIMEAS

Guido Belforte

Terenziano Raparelli

Gabriella Eula

Silvia Appendino

Silvia Sirolli

Neuro Psychologists

UniTO – Psychology

Department

Katiuscia Sacco

Giuliano Geminiani

Elisabetta Geda

PATENT WO 2013136351

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

HELP

Developing & Testing P.I.G.R.O.

towards commercialization

Network with companies and industry

from ASIA

Active exoskeleton for the neuro-rehabilitation

Thanks for your Attention

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

Politecnico di Torino - Department of Mechanical and Aerospace Engineering

Corresponding author e-mail: silvia.sirolli@polito.it

Guido Belforte Terenziano Raparelli Gabriella Eula Silvia Appendino Silvia Sirolli