Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors.
Margaux B Linde, Andrew R Thoreson, Cesar Lopez and 8 others
PMID 36188812WHAT IT FOUND
Force sensors at the knee tracked when and how long clinicians assisted treadmill stepping, but not how hard they pushed.
In two people with complete spinal cord injury, knee contact time was shorter during body-weight-supported training with hands-on cueing and epidural stimulation.
Key findings
01During validation, the sensors captured only 52 of 120 loads, none of the 40 high-level loads, and read lower than the load cell for force, with a correlation of 0.77.
02For participant 1, clinician force duration at the knee was below 1 second in nearly all month 18 trials, with many at 0 seconds.
03For participant 2, assistance duration decreased on the left leg with epidural stimulation, but the right leg remained variable and often required support.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only two participants were studied, and they received many components at once: epidural stimulation, body-weight-supported treadmill training, body-weight support, treadmill speed, verbal cueing, parallel bars, and months of prior training. The study cannot separate the effect of any one component. The sensors were not reliable for force magnitude. In validation, only 52 of 120 loads stayed within range, and none of the 40 high-level loads registered. The validation used an artificial leg and a soft pad that may not match human knee tissue. Participant sessions had missing trials, unavailable data, and sensor integrity problems, so comparisons across timepoints are uneven. The study defined independence only as minimal to no clinician force at the front of the knee during stance, not swing phase or overall walking independence. The paper did not report randomisation or a control group for the participant stepping sessions, and the participant results are descriptive.
Declared interests
The authors declared no commercial or financial relationships that could be construed as a conflict of interest. Funding was reported from the Jack Jablonski Bel13ve in Miracles Foundation, Mayo Clinic Rehabilitation Medicine Research Center, Mayo Clinic Transform the Practice, Craig H. Neilsen Foundation, Regenerative Medicine Minnesota, Mayo Clinic Center for Regenerative Medicine, and Mayo Clinic Graduate School of Biomedical Sciences.
The easy way to misread this
Do not read this as proof that epidural stimulation makes people with spinal cord injury walk independently. The study had only two participants, and they received months of training, body-weight-supported treadmill stepping, stimulation, hands-on cueing, body-weight support, speed settings, and parallel bars together. It also does not show that the sensors can measure force strength reliably.