GAIT TRAINING “TRUSTMOTION”

The complex with a training module designed for rehabilitation of patients with locomotor pathology through functional electrical stimulation (FES) and biofeedback (BFB).

 
 

The modification of the “Trust-M” complex is designed for walking training with the aim of recovery of the rhythm and the time structure of a pace cycle, lower limbs joint movements, correct automatism of muscle work and lower limbs support ability. Simultaneously with restorative exercises using BFG and FES methods it is possible to carry-out the analysis of movement biomechanics and EMG recording.

The walking simulator is included in the standard facilities of rehabilitation centers and departments for patients with somatic diseases, with the locomotor and the central and peripheral nervous system disorder. 

Application

Neurology – patients with ambulation disorder after previous stroke, cerebrospinal axis trauma, disseminated sclerosis, Parkinson’s disease, cerebral paralysis, poliomyelitis consequences, spinal osteochondrosis.

Traumatology – patients with vertebral column trauma, slowly fused fractures and pseudoarthrosis.

Orthopedics – patient rehabilitation after large joint endoproshesis replacement, scoliotic disease, walking with prostheses after amputation on the leg or hip level.

Exercise therapy – after long-term patient immobility, it helps to effectively learn walking skill maximally facilitating patient training.

Cardiology – rehabilitation of patients with old myocardial infarction, cardiac surgery.

Angiology – obliterating diseases of lower limb vessels.

 

Technical features

Multifunctional autonomous biomechanical sensors “Trust-M” are the basis of the complex.

The sensors allow performing segment motion recording synchronously with electromyography, estimating joint rotation, performing phase electric stimulation.

Together with PA “Biomekhanika-Neurocor” the complex provides simultaneous implementation of diagnostic and rehabilitation measures with the continuous monitoring of patient’s condition and the estimation of the treatment course.

Advantages

A distinctive feature of the complex is the adaptive FES which makes it possible simultaneously with walking training in the BFB mode to impact on a muscle in the phase of its physiological activity.

The specially designed BFB virtual environment “Fascinating Walk”implemented by means of a 3-D monitor or VR-helmet provides the effect of “physiological mirror”, evokes the sense of presence enhancing a patient’s motivation and training effect.

The “Trust-M” complex makes possible to perform the clinical analysis of gate recording time and spatial characteristics of a step, joint rotational movements, impact loads on lower limbs with simultaneous EMG recording. The recording of bioelectrical activity of muscle groups or separate muscles during an examined person movement allows determining the engagement of muscles in a motor action.

The complex consists of a simulator, PC operated race track (treadmill) which allows working in a low speed mode with smooth shifting from 0.1 km/h. Besides, the treadmill is equipped with an ergonomic, height-adjustable railing, emergency stop button and an access ramp for convenience of wheelchair patients. This is particularly important for disabled persons.

The mobile system for active unloading of a patient’s weight containing an independent power supply, the sensor of unloaded weight, a set of elastic suspensions of different size provides patient comfort and safety during training.

 

Main technical characteristics

 

Biomechanical sensors “Trust-M” with a phase myostimulation function

2-7 pcs

 Number of phase myostimulation channels

4-8 channels

Number of channels for sensor rotation parameters recording

6 channels

Rotation recording accuracy

At least 0.5 degrees

Number of channels for sensor tremor recording

3 channels

Number of channels for sensor EMG recording

1-2 channeld

Visualization and reconstruction of movements, stimulation phases and muscle work in the form of the “Skeleton in muscles” model.

Available

Race track simulator speed

0.1-10 rm/h

Maximum patient weight

150 kg

Virtual reality BFB system

3D with stereo effect (LCD display, projector, VR-helmet)

PC interface

Telemetry. USB

Time of autonomous work of “Trust-M” sensors

Up to 3 hours after one recharge in the “FES” mode. Up to 6 hours in the “Diagnostics” mode.

The modification of the “Trust-M” complex is designed for walking training with the aim of recovery of the rhythm and the time structure of a pace cycle, lower limbs joint movements, correct automatism of muscle work and lower limbs support ability. Simultaneously with restorative exercises using BFG and FES methods it is possible to carry-out the analysis of movement biomechanics and EMG recording.

The walking simulator is included in the standard facilities of rehabilitation centers and departments for patients with somatic diseases, with the locomotor and the central and peripheral nervous system disorder. The order of the Ministry of Health of the Russian Federation of 29.12.12.   #1705 n “On the Medical Rehabilitation Management”.

The walking simulator is a diagnostic and at the same time rehabilitation complex. The complex is widely used in any pathology accompanied by ambulation disorder enabling accurate diagnostics and gate recovery.

In neurology the complex is used in patients with ambulation disorder after previous stroke, cerebrospinal axis trauma, disseminated sclerosis, Parkinson’s disease, cerebral paralysis, poliomyelitis consequences, spinal osteochondrosis.

In traumatology – in patients with vertebral column trauma, slowly fused fractures and pseudoarthrosis.

In orthopedics – patient rehabilitation after large joint endoprosthesis replacement, scoliotic disease, walking with prostheses after amputation on the leg or hip level.

Exercise therapy – after a long-term patient immobility it helps to effectively learn walking skill maximally facilitating patient training.

Cardiology – rehabilitation of patients with old myocardial infarction, cardiac surgery.

Angiology – obliterating diseases of lower limb vessels.

It is notorious that accurate diagnosis is vitally important for correct treatment process. The estimate of the functional status of the locomotor system during different pathological conditions is a quite complicated procedure requiring a team approach. A physician on examination is able make only subjective estimate of patient’s walking and standing acts. This estimate depends on qualification and experience of a concrete physician.

 

Clinical biomechanics 

"Biomechanic Neurocor" Software

 

The walking simulator “Trust-M” thanks to the included biomechanical sensors makes possible to perform objective functional diagnostics of gate disorder as well as clinical analysis of movements. Time and spatial characteristics of a step, joint movements (flexion-extension, turning aside-turning in and rotation movements) or body segment movements, pelvis movements in 3 mutually perpendicular planes, impact loads on lower limbs are recorded.

Patient cyclic movements during walking are analyzed with subsequent semiautomatic arrangement of the step cycle phases which allows comparing results with the norm and evaluating asymmetries. The analysis results are represented in the form of goniogram graphic charts, angle table values, body skeleton design. All the data help a physician to perform a deep analysis of functional changes of the locomotor system, allow evaluating the treatment efficiency and the course of recovery processes.

 

EMG

In the “Trust-M” complex synchronously with movements biomechanics recording surface electromyography (SEMG) is used which allows recording and analyzing EMG activity of any surface muscles during a movement act.

SEMG main capabilities: 

EMG, "Biomechanic Neurocor" Software 

 

-  makes possible “to look” directly into a muscle;

- makes possible to measure muscle characteristics;

-  gives objective information when comparing prior and after treatment;

- documents treatment and training regimens;

- helps patients to “find” and train necessary muscles.

- helps to optimize sport activities;

- helps to determine muscle response in ergonomic studies.

EMG channels are integrated in the “Trust-M” sensor which significantly facilitates the study conducting for a patients and a physician. EMG recording allows evaluating the contractility of the studied muscles by different disorders of the locomotor system. The EMG data synchronized with a step cycle makes possible to determine the engagement of the studied muscles into a motor action which subsequently enables the correct adjustment of rehabilitation procedure by way of FES by acting on a muscle in the phase of its physiological activity. The obtained results are represented in the form of graphic charts of native, “enveloping” and averaged EMG. The data are synchronized with movement cycles which significantly facilitates the analysis of muscle activity phases. For illustration purposes the 3D body skeleton with muscles reconstruction function is available. The review of the performed study in a video format with synchronous animation of the skeleton model, graphical charts of goniograms and myograms is possible.

 

FES

Functional electric simulation as a trend of electrical muscle stimulation method emerged in early 60s. Its point is that electrical stimulation is used not as a recovery method of a separate organ-muscle but a recovery method of a complicated motor action. 

FES, Gate Training Device

The base of the FES method is the excitation of muscles by electrical impulses of special shape which are accurately synchronized with a performed movement and generated strictly in accordance with the phase of natural excitation and contraction of muscles. Abnormal engagements of muscles in a motor act is characteristic for a wide range of widespread diseases such as cerebral apoplexy consequences, infantile cerebral paralysis, peripheral and central paralyses and pareses of different origin. FES is the method which makes possible to reprogram the muscle activity phase.

The walking simulator Trust-M is equipped with sensors with adaptive functional electric stimulation which simultaneously with walking training in the BFB mode acts on the muscle in its physiological activity phase. In this case the functional state of the muscles is improved, incorrectly performed movements are corrected and gradually a correct movement pattern is developed.

The Trust-M sensor with a stimulation FES channel has compact size and small weight. The design provides its comfort fixing on patient’s body in the required segment. This fact significantly improves the sensor use ergonomics minimizing the number and the length of wires and not restricting a patient’s movements.

The Trust-M complex can be used for performing FES both independently, for example, when a patient is walking or performing special exercises, and as a part of task-specific simulators. In the capacity of simulators different types of active and passive simulators for lower and upper limbs and for the trunk can be used. The most popular simulators in rehabilitation institutions are such as the race track (treadmill forming part of the complex, the exercise bike for upper and lower limbs etc.

 

BFB-Training 

BFB, Gate Training Device

BFB or Biocontrol, Biofeedback is a method of teaching the voluntary regulation of different physiological functions and motor actions by means of their visual or sound real-time representation. In the BFB method so called “physiological mirror” principle is used, when by means of special hardware a patients gets direct information about different physiological functions. The forming of such a feedback channel allows a patient to learn both voluntary and involuntary regulation of the function i.e. without consciousness.

The walking training complex Trust-M allows performing effective BFB method rehabilitation in patients with the locomotor disorders. Specifically developed BFB virtual environment “Exciting walk”implemented by a 3D monitor or VR-helmet significantly increases a patient’s motivation; the training process becomes pleasant and interesting.

Virtual reality is used in rehabilitation for maximum realism providing the effect of a patient’s “diving” into the environment and for instant biofeedback eliminating the risk of attention distraction.

The virtual environment “Exciting walk” is represented by the landscape in which a patient travels training the speed and step frequency with the possibility to review his actions on a man-simulator from outside (from 3d person).

In this case all movements will be shown real time which provides the effect of “observation – imitation”. Today it is one of the most effective recovery methods after stroke since it enhances activity of mirror neurons, plasticity of brain and as a consequence-rehabilitation potential.

To perform BFB procedure in the Trust-M complex for walking training the following physiological parameters are used:

- movement kinematics;

- step parameters;

- rotation movements in joints;

- movement asymmetry;

- myoelectrical activity.

During BFB training visual real time simulation occurs as a result of which a sort of a walking pattern is created and patients imitating it can control the walk speed, keep step width and symmetry.

The use of EMG activity is one of the most effective methods of purposeful recovery of muscle activity by means of BFB which main task is the recovery of normal phase activity and the increase of the activity amplitude. For EMG activity analysis as a rule cyclic movements are recorded, most frequently – walking.

There are several variants of EMG training:

- bioelectrical muscle recovery in amplitude;

- recovery of muscle activity rhythm (bilateral technique);

- recovery of correct phase muscle activity;

- combined techniques.

 

Training module  

Training Module

The Trust-M Complex contains an adapted for serious patients race track (treadmill) with smooth speed adjustment – from 0.1 km/h which is particularly important for patients who cannot independently sit and walk. The track is PC operated and has training imbedded programs. Also the treadmill is equipped with a convenient telescopic railing adjustable according to a patient’s height. The running belt with a buffer coating reduces load on joints and enhances comfort.  An emergency stop button and an access ramp for wheelchair patients are provided.

The mobile system for active unloading of a patient’s weight “Biokinekt” was developed specifically for facilitating training procedures during rehabilitation of patients with the locomotor disorders. The system provides the compensation of patient’s weight and balance maintenance in the upright position protecting against fall. The function of vertical orientation from sedentary position is provided for wheelchair patients. The LCD screen on the control panel displays current operation modes, battery condition and unloaded weight. The built-in autonomous battery system allows using the simulator without 220V mains supply and continuing working after power cut.

 

 

 

 

 

 

 

Technical capabilities of the complex “Walking Simulator”

 

Characteristics of Treadmill Simulator

Power (minimum)

2.5 h.p.

Speed

0.1-10 km/h

Adjustable tilt

0-15 degrees

Emergency stop button

available

Security key

available

Moving belt size (minimum)

50x1540 mm

Running belt buffer

available

Height-adjustable side hand-rails

available

Access ramp for wheelchair patients

optional

Maximum patient weight

150 kg

Number of programs in autonomous mode

At least 6

PC control

Available, USB interface

Patient biofeedback system

available

Transport rollers

available

Weight unloading system characteristics

Maximum patient weight

Up to 150 kg

Dimensions

1400x1400x2400mm

Inside width

1050mm

Telescopic railing (optional)

500-1050

Motion range of lifting cable

Minimum 0-800 mm

Maximum lifting speed

Minimum 10mm

Lift speed mode

3 modes

Duty cycle, % or minutes

10 or 2/18

Autonomous work time during duty cycle

Minimum 3 h

Pitch of unloading weight adjustment

0.1 kg

Control unit

Electronic

LCD display

Graphic, displaying unloading weight, battery state of charge, simulator mode

Battery charging unit

220V, 50Hz

Battery supply

12V, 7Ah

PC connection (optional)

Bluetooth (to 100m)

Elastic suspension for patient weight unloading

3 sizes

Elastic suspension for fall arrest

1 size

 

Characteristics of biomechanical sensors

Dimensions

38x49x20mm

Sensor weight

Maximum 40g

Number of biomechanical sensors Trust-M

1-16 pcs

Accuracy of synchronization of sensors and recording channels

Minimum 0.1sec

Linear movement recording channels

In 3 mutually perpendicular planes

Rotation movement recording channels

In 3 mutually perpendicular planes

Tremor recording

available

Angular movement recording accuracy

Minimum 1 degree

Movement angle recording range

-180 to + 180 degrees

Angle speed and rotation movement recording range

2,000 degrees/sec

Linear acceleration recording range

2g,4g*,16g*

Sampling frequency of locomotion recording channels

Minimum 1,000Hz

Number of EMG channels

1-2*

Voltage range of EMG input signals

5-2,000µV

Noises fed to EMG input

Minimum 2 µV

In-phase rejection, EMG channel

Minimum 100 dB

Input impedance, EMG channel

Minimum 5MOhm

Sampling frequency of EMG recording channels

Minimum 2,000Hz

Bandwidth, EMG channel

0.05-500Hz

Telemetric control and data transfer channel

Bluetooth or WIFI, communication range to 80m

Number of FES channels

1-2*

Signal waveform, FES channel

Meander

Stimulation mode, FES channel

Monopolar, bipolar

Stimulating current impulse amplitude of FES channel

5-100mA

Stimulating current pulses amplitude pitch of FES channel

1mA

Stimulating current amplitude excursion from set value, FES channel

Maximum 10%

Frequency setting range of current pulse sequence in stimulation period, FES channel

40-100Hz

Stimulating current pulses frequency pitch of FES channel

1Hz

Stimulating current pulses length setup range, FES channel

2--200µs

FES procedure duration

To 20min

BFB(biofeedback) characteristics

Interactive virtual environment

“Forest Walk”

Virtual patient

View from 3d person

Symmetry of step parameters BFB

available

Amplitude and phase step parameters BFB

available

Joint flex angle BFB

available

Rotation movement speed BFB

available

EMG parameters BFB

available

Visualization of BFB content on patient’s LCD panel

available

Visualization of BFB content in VR-helmet

optional

Visualization of BFB content on the screen by means of projector

optional

3D stereo visualization mode support

available

FES program characteristics

Pre-programed methods

available

Capability of adjusting and editing methods by user

available

Adaptive algorithms for step cycle and phase determining

available

Smooth adjustment of stimulating action

available

Synchronization with biomechanical step parameters

available

Characteristics of diagnostic mode

Diagnostic of gate, recording and analysis of locomotion

available

EMG visualization

Up to 64 channels synchronous

Visualization of locomotion graphic charts

Up to 64 channels synchronous

Diagnostics and analysis of gate symmetry

available

Recording and analysis of phase EMG

available

Reconstruction of movements on 3D model “skeleton” for modifications with >5 biomechanical sensors

available

Reconstruction of movements on 3D model “skeleton with muscles” for modifications with >5 biomechanical sensors

available

Recording and analysis of tremor

available

Recording and analysis of cycling movements, step phases

available

Mode of averaging of cycling movement parameters

available

Patient data and recording data base management

available

Capability of comparing parameters with the norm

available

Supply package

Training Module Treadmill

1pcs

Patient weight unloading system

1pcs

Suspension for patient weight unloading

1-3

Fall arrest suspension

1*

Biomechanical sensors

2-16pcs

Charging device for biomechanical sensors

package

EMG electrodes

1 package

FES electrodes

1 package

Connection cables for electrodes

package

Interface cables

package

Fixing cuff package

package

Intel-based PC with professional graphic adapter, printer and peripherals

1pcs

Software “BiomechanicsTrust-M"”

1pcs

Software Patient Data Base

1pcs

Software BFB Game Applications

package

BFB LCD Panel

1pcs

BFB Panel LCD Stand

1pcs

System mini-cinema with projector and screen on rack

1pcs

VR-Helmet

optional

Mobile bogie for PC and peripheral mounting

optional

User’s manual

1pcs

Software maintenance guide

1pcs

FES guidelines

1pcs

Guidelines for gate clinical analysis

1pcs

Power supply

1pcs

Package

1pcs

*At the request of customers the technical capabilities and the supply package may be changed when it is possible.