Gait Training, Analysis and Rehabilitation
Gait Training, Analysis and Rehabilitation devices are used for Gait Analysis, Training and Rehabilitation of the persons with Neuro-Muscular disorders and injuries, Post-Surgery, Stroke, Patients fitted with artificial limbs, performance/strength enhancement. Following products are available.
MotekForcelink Rehabilitation and Analysis Systems
MotekForceLink products are used for clinical analysis and training as well as Research. The many available application options make the products suitable for research and clinical treatment in neurology, rehabilitation medicine, orthopedics, physical therapy, sports, and psychology.
What is CAREN?
The Computer Assissted Rehabiliation ENvironment (CAREN) is a versatile, multi sensory system for clinical analysis, rehabilitation, evaluation and registration of the human balance system. The use of virtual reality enables researchers to assess the subject’s behavior and includes sensory inputs like visual, auditory, vestibular and tactile.
World's most advanced Biomechanical Lab
The functionality of the CAREN system is unique in the world and is being used by some of the best and most advanced clinical and research facilities. Our client base includes: Cleveland Clinic, Massachusetts Institute of Technology, Brooke Army Medical Center and many others.
Broad Range of Functionality
The CAREN can be used in many different types of research and clinical paradigms, patient populations and fields of interest.
Custom Design that fits your needs
The CAREN system can be tailor-made for each client with options to extend the virtual reality projection, kinetic and kinematic add-ons, wireless EMG and other device integration using our D-Flow software. We also offer the CAREN in three typical setups ranging from a balance orientated setup with flat screen projection to a full dome with dual belt treadmill.
In this video you can see how the CAREN is used at the Military Rehabilitation Center in Doorn.
Gait Lab of the Future
GRAIL is a total package solution for gait analysis and gait training. GRAIL empowers user friendly assessments and exercises, in challenging conditions, to improve (pathological) gait patterns. Real-time feedback in GRAIL enable analysis and training during the same session.
Why Choose GRAIL
GRAIL facilitates the analysis and training of impaired walking in patients with neurological and neuromuscular problems, orthopedic patients, and the elderly. The rich, immersive Virtual Reality environments combined with existing scientifically proven clinical protocols offer a faster and better rehabilitation process. All this functionality requires less than 1/3 of the lab space of a traditional gait lab, with a 100% utilization rate because of the extensive training options.
The GRAIL Way
Conventional gait analysis is, although scientifically proven to be effective,
time consuming, complex, and expensive, which means that most labs limit their service to a small number of patients. The GRAIL’s fully instrumented dual-belt treadmill allows you to measure and analyse hundreds of steps in just a few minutes. The treadmill’s self-paced mode enables the patient to initiate gait and walk at a self selected pace, while the treadmill and the VR environment run in perfect synchronization to create a natural optical flow. Because of these unique features patients walking on a GRAIL show a natural variance in gait that is also seen in walking over ground. (Krogt et al, 2014; Gates et al., 2012).
How GRAIL Works
Synchronized VR environments, projected on a semi-cylindrical screen, immerse the patient in virtual worlds and natural walking environments.
GRAIL combines a fully instrumented treadmill with a self-paced option, an integrated motion capture system, 3 video cameras, and an EMG system. All the components are integrated and synchronized via the D-Flow software making the information available in real-time for the calculation of all gait parameters. Simulate walking uphill & downhill, combined with visual stimuli, to challenge patients while measuring gait behavior to perform a ‘functional gait analysis’.
Functional Gait Analysis
The GRAIL’s unique combination of real-time data processing, treadmill perturbations and virtual reality allows you to challenge the patient with mechanical, visual and cognitive dual-tasks in a safe, controlled environment. Measuring the changes in gait pattern during these situations allows for the identification and quantification of pathology specific compensation strategies or determining the dynamic stability. Once the gait analysis is completed, a training session can be initiated to improve the impaired gait functionality right away.
The Gait Offline Analysis Tool (GOAT) offers intuitive data analysis and
Modular Treadmill System
The M-Gait is modular, enabling various system enhancements to improve the functionality of your set-up. A 3D instrumented treadmill can be upgraded with pitch and/or sway, motion capture, Virtual Reality, Body Weight Support and many other features.
What is the Basic Setup?
The M-Gait Basic Setup contains a 3D instrumented treadmill that measures
ground reaction forces, center-of-pressure, and spatio-temporal parameters. Left and right belt speed can be controlled separately, allowing a split belt walking protocol and advanced gait research applications mimicking tripping or slipping, provoked by sudden belt stops or accelerations.
The M-Gait is controlled by the D-Flow software which provides real-time system control and a application development environment using visual programming. Different modules can be added to the D-Flow software to extend the functionality.
System Enhancements Improve Functionality
Various system enhancements are possible, which increase both the clinical and the research possibilities of your M-Gait. See below for the available addons, please contact us for more detailed specifications.
Pitch and Sway
Add dynamic pitch and sway to enhance your M-Gait. The flexible D-Flow software platform can be configured to control fast pitch and sway of the walking surface. Treadmill perturbations can be used to study pathology specific responses, allowing for a more functional gait analysis.
Virtual Reality Environment
Create a high-end Virtual Reality Environment with a large flat screen projection or a truly immersive experience with the 180 degree projection screen and the surround sound audio system. Enhance even further with a 3D stereoscopic projection.
Enhance your clinical gait analysis and research options by adding a 3D
motion capture system to your M-Gait system. The flexible D-Flow software platform can be configured to work with motion capture data acquisition and synchronize real-time processing, in combination with any parameter in your set-up.
Body Weight Support
Add a Body Weight Support (BWS) to your system in order to enhance your M-Gait’s functionality. The BWS is designed to facilitate functional gait training of patients with gait impairments by enabling vertical unloading during walking on a treadmill.
Various other sensors and systems can be integrated, for example the Human Body Model, Electromyography, Video cameras, Accelerometers and many others. Contact us for more details.
Your Customized Solution?
Feel free to contact us for a customized solution. We are experienced both in integrating hardware components as well as in the clinical and research application of the technology.
The D-Flow software is a visual programming tool designed for the development of interactive and immersive virtual reality applications, for the purpose of clinical research and rehabilitation. The D-Flow software system allows an operator to define feedback strategies through a flexible and extensible application development framework, based on visual programming.
D-Flow is based on the concept of modules: manageable components with a specific functionality, which can be combined to create complex, interactive virtual reality applications. There are various types of modules present in the D-Flow software system. Some modules directly control specific hardware devices, such as a treadmill or a motion base. Other hardware modules provide access to real-time data streams from live input devices or control the virtual environment.
The D-Flow software platform has integrated many different hardware devices, ranging from infra-red motion capture cameras, 6-degree of freedom platforms and dual belt treadmills to inertia sensors and haptic devices. Many of the MotekforceLink products are powered by the D-Flow software, like CAREN, GRAIL, and M-Gait.
Key to the D-Flow software is that the subject is regarded as an integral part of a real-time feedback loop, in which multi-sensory input devices measure the behavior of the subject, while output devices return motorsensory, visual and auditory feedback to the subject.
The D-Flow software system allows an operator to define feedback strategies through a flexible and extensible application development framework, based on visual programming.
Fast Feedback Loop
Balancing a small stick in the palm of your hand requires the brain to interpret the movement of the stick, choose a counter movement and execute this movement before the stick reaches a critical point. The video on the right shows just how we are able to perform this task using the D-Flow software, motion capture and a motion base. For more information on D-flow please contact us.
Human Body Model
What is the Human Body Model?
The Human Body Model (HBM) is a computer model of the complete human body, including all joints representing a total of 46 kinematic degrees of freedom. The HBM is used to calculate and visualizes joint rotations, joint moments and muscle forces for real-time and off-line analysis.
Real-Time Movement Analysis
Biomechanical analysis of movement has an important role in clinical management of many neurological and orthopedic conditions, but also for sports purposes. HBM facilitates movement analysis in real-time, by providing immediate feedback to both the therapist and the patient.
With HBM clinicians, physical or exercise therapists directly benefit from realtime and off-line visualization of specific motion variables. Additional information about internal forces and moments which are otherwise fundamentally invisible can be analyzed.
The Human Body Model is based on “van den Bogert et al. (2013) A real-time system for biomechanical analysis of human movement and muscle function” as published in Medical & Biological Engineering & Computing.
LEADING INNOVATION IN ROBOTIC REHABILITATION by Heaxel
What is icone
icone is the first cost-effective plug-and-play robotic platform for upper limb neuro-rehabilitation, cleared for out-of-hospital use.
icone is thus the ideal medical robotic system for chronic patients, allowing long term, intensive and engaging therapeutic sessions via exergames (exercises performed through video games). It is designed for post-acute & chronic post-stroke patients with needs for upper limb rehabilitation:
it is a unique, portable, all-in-one, plug-and-play, cloud-connected, compact rehabilitation robot certified also for non-hospital use and for use by non-clinicians.
icone delivers accessible high-quality therapy in four programmable modalities and it delivers relevant, quantitative patient performance feedback while minimizing operating and maintenance costs.
icone replicates the widest studied robotic rehabilitation protocols, delivering high quality haptic feedback while performing both kinematic and dynamic measures of patient’s movements.
Thanks to icone high-quality therapy can be brought closer to the patient - even at home - and for long periods of time so that therapy can be sustainably delivered throughout patient’s recovery.
The system proves to maintain high therapeutic standards while maximizing financial reward for rehabilitation centers and reducing costs for patients.
icone is different to the, less engaging, current standard of care which is non easily scalable, expensive and normally delivered for short periods of time after Patient’s acute phase.
It is also different to the comparable high quality robots that are less affordable, hardly accessible and often not approved for the use outside the hospital.
Adaptive mode: icone assists the patient’s movement by automatically adapting assistance (i.e. the time allotted to complete the movement and the rigidity of the haptic tunnel), in real-time, on the basis of the patient’s performance. In this way, the robot automatically selects the best therapy for the single patient.
Passive mode: icone does not assist nor opposes to the patient’s movement: this mode is also called «transparent mode».
All in one
The ICone is the only all-in-one and plug-and-play medical system supporting rehabilitation professionals in providing intensive treatments for neurological patients, even after hospital discharge.
Through interactive and engaging games, designed according to the latest scientific evidences about neuroplasticity stimulation, the ICone promotes active motor planning and generates adaptive force fields to provide assistance as needed.
Treatments are provided in the form of interactive games, which can be easily tailored on the patient needs using the touch interface. The therapy can be objectively assessed and the data collected in real-time can be remotely accessed.
The ICone is the perfect partner of rehabilitation professionals, wherever the patient is. ICone is the ideal solution for hospitals and clinics, as well as community centers, rehabilitation clinics, physiotherapy centers and gyms.
The therapy is customized for the specific patient by the rehabilitation specialist (therapist or doctor), by selecting:
-The patient scenario (football game, bowling, curling or galaxy);
-The number of repetitions ( the number of reaching movements to perform);
-The modality of robot-patient interaction
Feeling the Patients: the haptic tunnel
icone assesses, in real time, patient’s movement quality and provides force feedback accordingly to correct the movement, as a therapist would do by accompanying the patient’s hand:
-if the patient stays on the trajectory, the robot is transparent and the end-effect or can be moved very easily (haptic tunnel);
- if the patient deviates too much from the right trajectory, the robot will gently push back the patient, correcting the movement:
- The higher the deviation, the higher the correcting force.
- The entity of the correcting force can be increased by the therapy
- The entity of deviation allowed, defined by width and resistance of the haptic tunnel, can be modified by the therapy manager - so that «staying on the trajectory» might be easier or more challeng ing for the patient.
Patient-Robot Interaction Modalities
Assistive mode: icone assists the patient, just in case he/she is not able to start the movement within the maximum time allotted to initiate the movement, and he/she moves too slowly with respect to the ideal trajectory.
The degree of assistance (i.e. the assistive force exerted by the robot) is selectable by the therapy manager (1: minimum resistance; 10: maximum resistance). Both the maximum time to start the movement and the maximum time to complete the movement can be selected by the therapy manager.
Resistive mode: icone opposes to the patient’s movement, challenging his/her with a more difficult environment, in a sort of «arm wrestling» exercise.
The intensity of resistance (i.e. the opposing force exerted by the robot) is selectable by the therapy manager (1: minimum resistance; 10: maximum resistance). This mode is for patients who are more advanced in the recovery process and need to improve their strength.
• selectable interaction modalities: passive, active, assist-as-needed
• Active workspace: Φ 330 mm
• Reachable workspace: 400 x 440 mm
User defined features
• Target arm (left, right)
• Type of patient-robot interaction: assistive, resistive, adaptive, transparent.
• Interactive exergame scenarios
• Width of haptic tunnel (0 ÷ 30 mm)
• Tunnel resistance (50-350 N/m)
• Resistance level (0.5 ÷ 20 Ns/m)
• Number of repetitions per session (1 ÷ 1200)
• Time allotted for motion initiation (1.0÷ 10 s)
• Tolerance on hand position error (0.5 ÷ 25 mm)
• Maximum speed (200 ÷ 800 mm/s)
• Damping level (0.5 - 20.0 Ns/m)
• Time allotted to reach the target (2-25 s)
• Integrated 15.6’ multitouch screen
• Bluetooth connection for keyboard and mouse
• Medical grade ergonomic artificial leather handle
• Integrated arm support
On-board sensory system
• Force resolution: better than 0.2N
• Position resolution: better than 0.1 mm
• Max output force: 45 N
• Force resolution: 1.1% FS
• Max end-effector speed: 0.8 m/s
• Redundant sensors with automatic check of data
• Overload protection
• Automatic speed limitation
• Damping virtual edges
Icone was developed based on the widest robot protocol studied for upper limb rehabilitation –
MIT-MANUS, now called InMotion ARM.
Both the American Heart Association and the Department of Defense (Veteran Affairs) cite the
InMotion robots (now the MIT-Manus is called InMotion ARM and is from bioniks labs), see here
- VA REFERENCE: Dept. of Veterans Affairs and Dept. of Defense, Management of Stroke
Rehabilitation Working Group. "VA/DoD Clinical Practice Guideline for the Management of Stroke
Rehabilitation, Guideline Summary." Washington, D.C.: Government Printing Office, October (2010)
Vers. 2.0, p. 37 URL: http://www.healthquality.va.gov.
- AHA REFERENCE: Miller, E.L., et al., on behalf of the American Heart Association Council on
Cardiovascular Nursing and the Stroke Council, "Comprehensive Overview of Nursing and
Interdisciplinary Rehabilitation Care of the Stroke Patient:
A Scientific Statement From the American Heart Association," Stroke, 41:2402-2448, (2010)
Find below a partial list of the articles published on the MIT-Manus. We collected these references
from our Medical Science Liaison with the expectation to be used for business clarifications and to
be presented to decision makers. For this reason, we selected a few articles whose title is selfexplanatory,
and added a few comments (bold).
· Volpe, B.T., et al., "Intensive Sensorimotor arm training mediated by therapist or robot
improves hemiparesis in patients with chronic stroke," Neurorehabilitation and Neural
Repair 22:3:305-310 (2008)
· Electromechanical and Robot-Assisted ARM training for improving general activities of daily
leaving, arm function, and arm muscle strength after stroke." The cochrane Collaboration,
The Cochrane Library , 2012 issue 6
· Norouzi-Gheidari, N, et al., "Effects of Robot-Assisted Therapy on Stroke Rehabilitation in
Upper Limbs: Systematic Review and Meta-Analysis of the Literature," VA Journal of
Rehabilitation Research and Development, 49 (4) 479-496 (2012)
· Dipietro L, Krebs H.I, Volpe B.T, Stein J, Bever , S.TMernoff, Fasoli S.E, Hogan N "Learning, not
Adaptation, Characterizes Stroke Motor Recovery: Evidence from Kinematic Changes Induced
by Robot-Assisted Therapy in Trained and Untrained Task in the Same Workspace" IEEE Trans
Neural Syst Rehabil Eng. 2012 Jan;20(1):48-57. Epub 2011 Dec 16 --> this means with
the robot you really stimulate neuroplasticity and you are LEARNING, not just automatically
adapting to a new task. This means: 1) you will retain progress and 2) you will be able to
apply learned skills to other (new) tasks.
· Volpe, B.T., et al., "Robot Training Enhanced Motor Outcome in Patients with Stroke
maintained over 3 years, Neurology 534874-1876 (1999)
· Lo, A.C., et al., "Robot Assisted Therapy for Long-Term Upper-Limb Impairment After
Stroke, New England Journal of Medicine, 362(19):1772-83.
· Kwakkel, G., et al., "Effects of Robot-assisted therapy on upper limb recovery after stroke: A
Systematic Review, Neurorehabilitation and Neural Repair 22:2:111-121 (2008)
· MacClellan, L.R., et al., "Robotic Upper Extremity Neuro-Rehabilitation in Chronic Stroke
Patients, VA Journal of Rehabilitation Research and Development 42(6)717-722 (2005)
· Fasoli, S.D., et al., "Does Shorter-Rehabilitation Limit Potential Recovery Poststroke
- Neurorehabilitation & Neural Repair. 18 2:88-94 (2004) ---> Short answer: yes. Longer
rehabilitation with the robot leads to better motor outcomes.
· Ferraro, M., et al., "Robot Aided Sensorimotor Arm Training Improves Outcome in Patients
with Chronic Stroke, Neurology. 61:1604-1607 (2003)
Khymeia's VR based Neuro Rehabilitation Systems
The research activities of the Department of Cognitive Science at MIT Massachusetts Institute of Technology in Boston have shown that, through rehabilitation in a virtual environment, the central nervous system receives feedback signals increased (augmented feedback) which, during the execution of voluntary movements even if altered by the disease, induces profound changes in cortical and subcortical synaptic and cellular level that are responsible for the restoration of motor activity even in patients who, for example, have had extensive head injuries and strokes.
The virtual environment is developed from the operational protocol resulting from a treatment method in neuromotor virtual environment, developed at the Department of Cognitive Sciences at MIT, Massachusetts Institute of Technology in Boston, using the most advanced knowledge of neurophysiological processes of motion learning and memorization processes.
What is VRRS?
VRRS is conceived to put the patient in a situation to generate the augmented feedback towards his central nervous system (augmented feedback) through exercises performed in a virtual environment which help to develop knowledge of results of the movements (knowledge of results) and knowledge of the quality of the movements (knowledge of performance). The VRRS method is based on information for the central nervous system such as the evidence of results "knowledge of results" and "knowledge of performance." This way the central nervous system can activate a physiological key learning mechanism called "reinforcement learning" which implies an increase of the specific information of a movement to produce an effective improvement of performance quality. The patient treated with the VRRS method does not split his attention between his gesture and the one performed by the therapist in different times and places of work, thus avoiding to make translations or rotations in the central nervous system to take the same point of view of the movement execution.
THE VIRTUAL REALITY MOST ADVANCED AND CLINICALLY TESTED SYSTEM FOR NEUROLOGICAL, COGNITIVE, SPEECH THERAPY, CARDIO RESPIRATORY, POSTURAL, ELDERLY AND MUSCULOSKELETAL TELE/REHABILITATION
The scientific paradigms underlying the system are in particular those of the augmented feedback and the motor imagination, principles upon which it is based the established experience of motor learning promotion by the central nervous system. TECHNOLOGY PRINCIPLES VERSATILITY VRRS is a central hub for connecting multiple devices such as treadmill, augmented reality devices technologies, balance stabilometric and proprioceptive platforms, devices for fine hand rehabilitation and others, representing the output in virtual reality mode with the appropriate work settings combined with specific sets of report. EASINESS VRRS is exceptionally easy to use; endowed with a touch screen monitor and the smart “Interactive Touch Explorer System”, it allows the therapist to an immediate and intuitive management of all its functionalities. INNOVATION VRRS represents the world’s most advanced rehabilitation technology in the virtual reality environment; VRRS is clinically adopted on daily bases also in the most advanced Rehabilitation Centers even for remote and home telerehabilitation mode.
VRRS is a central hub for connecting multiple devices such as treadmill, augmented reality devices technologies, balance stabilometric and proprioceptive platforms, devices for fine hand rehabilitation and others, representing the output in virtual reality mode with the appropriate work settings combined with specific sets of report.
VRRS is exceptionally easy to use; endowed with a touch screen monitor and the smart “Interactive Touch Explorer System”, it allows the therapist to an immediate and intuitive management of all its functionalities.
VRRS represents the world’s most advanced rehabilitation technology in the virtual reality environment; VRRS is clinically adopted on daily bases also in the most advanced Rehabilitation Centers even for remote and home telerehabilitation mode.
THE VRRS METHOD
The rehabilitation effectiveness of the VRRS system has been verified by numerous facilities.
international scientific publications (including the COCHRANE REVIEW), is the result of many years of development and clinical testing by international prestigious centers of excellence. Technically, VRRS generates a feeble magnetic field area wherein are recognized in real time the position as well as the inclination of small 3D wireless sensors with 6 degrees of freedom, completely harmless. The sensors are applied to the affected part of the patient or to daily living items, reproducing with extreme precision the patient’s movements into virtual reality scenarios. The patient is asked to emulate in real time the “ideal” movement previously recorded. Sensors can play individual segments as well as the whole body of the patient, allowing to face the most complex rehabilitation fields such as step, walking, balance and compensation. Each operation is carried out with extraordinary ease thanks to the "Smart Touch Explorer System” that allows to manage tasks with immediacy and intuitiveness.
Our client base includes: Cleveland Clinic, Massachusetts Institute of Technology, Brooke Army Medical Center and many others.
VRRS platform integrates an exclusive large library of clinically validated exercises divided into specific modules, including "Neuromotor"; "Cognitive"; "Speech Therapy"; "Postural and Balance"; "Head and Cervical"; "Orthopedic"; "Cardiorespiratory". Each module includes specific additional hardware, such as Posturographic and Proprioceptive platforms, Handbox, Grasp Sensor.
All activities are automatically recorded by the system, thus generating a complete and objective reporting system that, very easily, can be consulted by the therapist at any time, with the opportunity to view a real "replay" of the exercises up to more sophisticated analysis in graphical and numerical modes. This is both, a powerful tool of analysis and evaluation, and an exceptional system of objective monitoring of the patient's progress.
DESIGNING BRAND NEW EXERCISES
The VRRS has a large number of clinically validated exercises, set up for the different diseases, from basic scenarios to those more "environmentally" and complex. However, VRRS allows therapists to create with extraordinary simplicity from scratch brand new exercises, fitting to the specific needs of each patient.
TELEREHABILITATION AND TELEMEDICINE
The VRRS Tele Rehabilitation integrates all the modules, and allows to implement the remote rehabilitation and medicine, representing a genuine clinical and technological innovation. The therapist is able to take full control of the system remotely and to interact in real time with the patient via the integrated two-way video conference. The patient can also work offline, performing activities prescribed by the therapist remotely via a dedicated web interface. Specific scientific studies have shown equal rehabilitation effectiveness of the VRRS TR compared to same treatment in hospital.
The platform VRRS-TR allows to implement even remote telemedicine and teleconsultation. The physician interacts in real time with the patient and in real time can upload data even of the cardiorespiratory matter.
The exercises for Neurological rehabilitation include available scenarios ranging from the most simple “reaching” activities to those complex and ecological ones, fitting many diseases. The exercises are organized by segment and by body area: --Upper limb, left and right;
--Leg, left and right;
This module requires the magnetic kinematic tracking system. The specific activity for fine hand rehabilitation requires the VRRS HANDBOX System.
The exercises for Cognitive rehabilitation are organized by cognitive
-- Spatial orientation;
-- Time orientation;
The module provides interaction through touchscreen or via the special sensor VRRS GRASP.
Speech Therapy Rehabilitation
The exercises for Speech Therapy rehabilitation are organized by domain of
-- Written denomination;
-- Exercises of respiratory education.
The module provides a wide activity based on videoconference with the therapist.
The module provides interaction through touchscreen or via the special sensor VRRS GRASP.
The exercises for the Orthopedic rehabilitation are organized by
This module requires the magnetic kinematic tracking system.
For some activities, it is required the VRRS Stabilometric Balance.
The Stabilometric and Proprioceptive exercises are organized by
-- Posturographic assesment;
-- Exercises of reaching;
-- Exercises of tracking;
-- Exercises of weight shift;
-- Exercises of weight balance.
The module requires the Stabilometric Balance and the Proprioceptive Balance.
The activities for the Cervical Rachis rehabilitation include:
-- Exercises of tracking;
-- Exercises of reaching;
-- Exercises of trajectory tracking.
This module requires the magnetic kinematic tracking system;
Cardiorespiratory Rehabilitation and Monitoring
The activities for Cardiorespiratory rehabilitation include:
-- Remote monitoring about pressure, respiratory rate, heart-rate,
-- Spirometry evaluation;
-- Biofeedback exercises for monitoring the respiratory rate and inhalation and exhalation phases.
This module requires the spirometer and the Khymeia dedicated monitor cardiorespiratory monitor.