Apparatus and method for restoring voluntary control of locomotion in neuromotor impairments

Patent metadata

Field	Value
Publication number	US-9968406-B2
Application number	US-201314404853-A
Country	US
Kind code	B2
Filing date	May 29, 2013
Priority date	May 30, 2012
Publication date	May 15, 2018
Grant date	May 15, 2018

Abstract

It is disclosed an apparatus for restoring voluntary control of locomotion in a subject suffering from a neuromotor impairment comprising a multidirectional trunk support system and a device for epidural electrical stimulation. The robotic interface is capable of evaluating, enabling and training motor pattern generation and balance across a variety of natural walking behaviors in subjects with neuromotor impairments. Optionally, pharmacological cocktails can be administered to enhance rehabilitation results. It is also disclosed a method for the evaluation, enablement and training of a subject suffering from neuromotor impairments by combining robotically assisted evaluation tools with sophisticated neurobiomechanical and statistical analyzes. A method for the rehabilitation (by this term also comprising restoring voluntary control of locomotion) of a subject suffering from a neuromotor impairment in particular partial or total paralysis of limbs, is also disclosed.

First claim

The invention claimed is:

1. An apparatus for restoring voluntary control of locomotion in a subject suffering from a neuromotor impairment comprising a multidirectional trunk support system and a device for epidural electrical stimulation, wherein the device for epidural electrical stimulation is used to modulate spinal cord neurons to facilitate communication between a brain of the subject and a spinal cord of the subject, and wherein said multidirectional trunk support system comprises:
a. a robotic interface actuating an end effector in a plurality of degrees of freedom;
b. compliant elements integrated in or attached to said robotic interface to provide compliant/elastic or viscoelastic behavior at said end effector in said degrees of freedom;
c. sensors to measure movement of said end effector resulting exclusively from this compliance; or sensors to measure a force resulting from the movement of this compliance;
d. an interface to the subject using said apparatus to facilitate a transfer of an arbitrary wrench in said degrees of freedom to said subject.

2. The apparatus according to claim 1 , which provides support to said subject against gravity.

3. The apparatus according to claim 1 , wherein said multidirectional trunk support system further comprises:
i. a multidirectional elastic decoupling system having three motor-driven, actuated linear modules, along horizontal, orthogonal axes X and Y, a vertical axis Z of an X, Y, Z Cartesian frame and one motor-driven, actuated rotating module around said vertical axis Z, said axes defining four degrees of freedom; wherein said actuated linear modules are simultaneously decoupled through a suspension system with compliant elements directed in each of the four degrees of freedom;
ii. a passive parallel Delta kinematic system to prevent tilting.

4. The apparatus according to claim 1 , wherein said sensors are position sensors or force sensors.

5. The apparatus according to claim 3 , wherein a computer communicates with said modules and acquires information coming from said sensors, exchanging the information with a second computer running a user interface.

6. The apparatus according to claim 3 , wherein said motor-driven actuated modules provide a constant-force mode independently from each other.

7. The apparatus according to claim 3 , wherein said motor-driven, actuated linear modules along said horizontal, orthogonal axes X and Y, and said motor-driven actuated rotating module around said vertical axis Z provide a transparent mode and said motor-driven, actuated rotating module along said vertical axis Z provides a constant-force mode.

8. The apparatus of claim 1 in combination with a pharmaceutical composition comprising a combination of agonists to monoaminergic receptors, for use in restoring voluntary control of locomotion in a subject suffering from a neuromotor impairment.

9. The apparatus in combination with the pharmaceutical composition according to claim 8 , wherein said impairment is partial or total paralysis of limbs.

10. The apparatus in combination with the pharmaceutical composition according to claim 9 , wherein said impairment is selected from a group consisting of spinal cord injury and consequences of stroke.

11. A method for restoring voluntary control of locomotion in a subject suffering from a neuromotor impairment comprising:
a. using the apparatus of claim 1 ,
b. providing electrical stimulation,
c. optionally administering a pharmaceutical composition comprising a combination of agonists to monoaminergic receptors.

12. The method according to claim 11 , wherein said neuromotor impairment is partial or total paralysis of the limbs.

13. The method according to claim 11 , wherein said neuromotor impairment is selected from a group consisting of spinal cord injury and consequences of stroke.

14. The method according to claim 11 , wherein said combination is of agonists to serotoninergic, dopaminergic, and adrenergic receptors.

15. The method according to claim 14 , wherein said combination is of agonists of 5HT1A, 5HT2A/C, 5HT7, and DA1-like receptors.

16. A method for restoring voluntary control of locomotion in a subject suffering from a neuromotor impairment comprising:
a. providing said subject with a treadmill exercise,
b. using the apparatus of claim 1 ,
c. providing electrical stimulation,
d. optionally administering a pharmaceutical composition comprising a combination of agonists to monoaminergic receptors.

17. The method according to claim 16 , wherein said neuromotor impairment is partial or total paralysis of limbs.

18. The method according to claim 16 , wherein said neuromotor impairment is selected from a group consisting of spinal cord injury and consequences of stroke.

19. The method according to claim 16 , wherein said combination is of agonists to serotoninergic, dopaminergic, and adrenergic receptors.

20. The method according to claim 19 , wherein said combination is of agonists of 5HT1A, 5HT2A/C, 5HT7, and DA1-like receptors.

21. A method for operating the apparatus of claim 3 comprising the following steps:
a. an evaluating mode, wherein the apparatus provides support against gravity by means of the motor-driven, actuated rotating module along the vertical axis Z in a spring-like condition or in a reduced gravity condition;
b. an enabling mode, wherein the apparatus provides propulsive and/or postural assistance with a forward movement at constant speed by means of the motor-driven, actuated linear module along the horizontal axis X, while the motor-driven, actuated rotating module along the vertical axis Z provides constant-force vertical support as a percentage of a body weight, and the motor-driven, actuated linear module along the horizontal axis Y and the motor-driven, actuated rotating module around said vertical axis Z provide stiff support in lateral and rotary directions;
c. a training mode, wherein the apparatus provides postural support against gravity by means of the motor-driven, actuated rotating module along the vertical axis Z, the motor-driven, actuated linear module along the horizontal axis X is set transparent, the motor-driven, actuated rotating module around said vertical axis Z is set stiff or transparent, and the motor-driven, actuated linear module along the horizontal axis Y is set stiff or transparent.

22. The method according to claim 21 , wherein a principal component (PC) analysis is performed on gait cycles.

Assignees

• Ecole Polytechnique Fed Lausanne Epfl
• Ecole Polytechnique Fed Lausanne Epfl

Inventors

• Courtine Gregoire
• Micera Silvestro
• Von Zitzewitz Joachim

Classifications

• A61P25/02

  for peripheral neuropathies · CPC title

• A63B2022/0094

  for active rehabilitation, e.g. slow motion devices · CPC title

• A63B69/0064

  Attachments on the trainee preventing falling · CPC title

• A63B22/203

  in a horizontal plane · CPC title

• A63B22/0235

  driven by a motor · CPC title