Effects of Supporting System on Walking based on Mutual Entrainment in Poststroke Hemiplegia

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1 Effects of Supporting System on Walking based on Mutual Entrainment in Poststroke Hemiplegia Ikki Ishizawa In this study, to evaluate the effectiveness of the Walk-Mate system, which is based on mutual-entrainment dynamics, we measured the symmetry and the stability of the walking in poststroke patients with hemiplegia by using kinematic analysis and time-series analysis. The effect of Walk-Mate was compared with rhythmic auditory stimulation. The symmetry of gait was improved by the both methods, however, the stability of the gait was only improved by the Walk-Mate. These results indicate that the interactive system Walk-Mate is useful for the walking rehabilitation in poststroke. Key Words: Walk-Mate, gait disorder hemiplegia mutual adaptation, co-creation system 1. 1) 3) 4) - Walk-Mate Walk-Mate PC 5) Walk-Mate 6), 7) RAS (Rhythmic Auditory Stimulation) Thaut RAS 8) Prassas Matthew 9), 1) 1/f 1/f 11) 12) RAS Walk-Mate Walk-Mate Walk-Mate RAS 6) Walk-Mate RAS 13) Walk-Mate RAS Walk-Mate 7) Walk-Mate

2 Table 1 Subject characteristics Age Gender Handedness Paretic side Pathomechanism Territory Complicating disease Br.Stage Subject A 78 M R L Infarction Temporal lobe Left hemispatial neglect V Subject B 59 M R L Infarction Corona radiata - IV Subject C 74 M R L Infarction Watershed - IV-V Subject D 48 M R L Infarction Corona radiata - IV Subject E 72 M R L Hemorrhage Thalamus Left hemispatial neglect V Subject F 28 M L L Hemorrhage Putamen - V Subject G 58 M R R Hemorrhage Thalamus Aphagia IV Br.Stage:lower-limb Brunnstrom Stage Walk-Mate RAS Walk-Mate, 2. 2 RAS Walk-Mate PC 3 m 3 Table 1 7 (28-78 ) Brunnstrom stage IV V 2. 3 Walk-Mate Walk- Mate RAS RAS 18sec 6sec ( 12sec Walk-Mate RAS Walk-Mate RAS ) 2. 4 Walk-Mate RAS PC (Panasonic CF-W5AWDBJR) Walk-Mate RAS (Victor HP-RX5) Walk-Mate Walk-Mate Fig. 1a Walk-Mate Fig. 1b (module) (module) 5) Fig. 1 Foot Sensor Step sound Head Phone Step timing Human Walker θ m θ h Module Phase control ωm, i+1 Module Mutual-entrainment Virtual Robot Walking Robot φ hm, i Walk-Mate system a:human-robot interaction,b:dual dynamics model 14) φ d

3 Walk-Mate 15), 16) (1),(2) θ m = ω m + K m sin(θ h θ m ) (1) θ h = ω h + K h sin(θ m θ h ) (2) (1) (2) ω m ω h θ m θ h K m K h (3) ω m,i+1 = ω m,i 2ε(φ d φ hm,i ) (3) φ hm,i = θ h θ m φ hm,i i φ hm,i φ d (3) ω m,i+1 Walk-Mate Fig. 1 Fig. 2 PC ( S19M1F WM19M1F) PC Transmitters Receiver PC Head Phone Foot sensor Fig. 2 Experimental system Walk-Mate RAS(Rhythmic Auditory Stimulation) RAS Walk-Mate RAS (1) K m = ω m ω m Fig. 3a T LR T RL Fig. 3b (Paretic side) T LR (None-Paretic side) T RL 17) Walk- Mate Fig. 3c

Virtual Robot Right Step φ = +β d TLR TLR TLR TRL TRL TRL Hemiplegia gait pattern and phase control a:normal subject b:left hemiplegia patient c:phase control for improving symmetry t t t PC 2. 5.

4 Human Left Step c ) Fig. 3 Human Right Step Human Left Step ( Paretic Side ) Human Right Step ( None-Paretic Side ) Human Left Step ( Paretic Side ) Virtual Robot Left Step φ = α d Human Right Step ( None-Paretic Side ) Virtual Robot Right Step φ = +β d TLR TLR TLR TRL TRL TRL Hemiplegia gait pattern and phase control a:normal subject b:left hemiplegia patient c:phase control for improving symmetry t t t PC ) Fig. 4b ANA- LOG DEVICE ADXL22E) L3 PC 3. T LR T RL.2rad +.2rad RAS T LR T RL Fig. 4a OT1BP-G (22g/cm 2 ) 19) Fig. 4a Fig. 4 Transmitter Foot sensor Transmitter Foot sensor Gait analysis system a:foot sensors b:waist sensor Accelerometer Walk-Mate RAS Fig. 5 Fig. 5a LHC(Left Heel Contact: Left Stance Phase Y U L Y D L RHC(Right Heel Contact: Right Stance Phase Y U R Y D R Fig. 5b Y U L Y D L Y U R Y D R LHC Y U L

5 Y D L Y U R Y D R (4) Y U L Y U L + Y D L.5 Y sym L Y sym R (5) Y sym L = Y U L/(Y U L + Y D L).5 (4) Y sym R = Y U R /(Y U R + Y D R ).5 (5) Fig. 6 θ hl θ hr (6)(7) φ l,j = θ hl (t l,j ) θ ml (t l,j ) (6) φ r,j = θ hr (t r,j ) θ mr (t r,j ) (7) φ l,j φ r,j j t l,j t r,j j (θ hl = θ hr = ) θ hl (t) θ hr (t) t θ ml (t) θ mr (t) t Fig. 6 3 LHC ( Left Heel Contact ) RHC ( Right Heel Contact ) Normal 2 1 YUL Left Stance Phase Right Stance Phase Time [sec] 3 LHC ( Left Heel Contact ) Left-Hemiplegia 2 RHC ( Right Heel Contact ) 1 YUL Left Stance Phase Right Stance Phase Time [sec] Fig. 7 Fig. 7a Fig. 7b (8)(9) P dsd L, P dsd R φ l,j φ r,j N j v u P dsd L = t 1 NX `φl,j φ l 2 (8) N v u P dsd R = t 1 N Fig. 6 Phase Difference [rad] Phase Difference [rad] Fig. 7 φ l, j j=1 NX `φr,j φ r 2 j=1 θ ml θ hl = ( Heel contact ) Human Phase Oscillator Virtual robot Phase Oscillator Phase difference between human and robot π Left Phase Difference Right Phase Difference -π Steps [step] π Stable Unstable Left Phase Difference Right Phase Difference -π Steps [step] Temporal development of phase difference a:stable b:unstable (9) Fig. 5 Temporal development of gait trajectory a:normal subject b:left-hemiplegia patient

6 Table 2 t-test of symmetry Y sym during Walk-Mate trial Y sym during RAS trial Single-walk Walk-Mate p Effect Improvement Single-walk RAS p Effect Improvement Subject A L ** L R ** R * Subject B L ** L * R ** R Subject C L ** L R ** R Subject D L ** L ** -.28 R ** R ** -.24 Subject E L ** L R R Subject F L ** -.17 L R ** -.18 R Subject G L * L ** R R : p <.5 : p <.1 (t-test) ++ significant improvement + improvement tendency :siginificant decline :decline tendency LHC RHC YUL Single-walk LHC RHC YUL Single-walk Time [sec] Time [sec] LHC RHC YUL Walk-Mate LHC RHC YUL RAS Time [msec].4.3 ** Left Right Time [sec].4.3 p =.61 Left Right.2.2 Ysym.1 Ysym Single-walk Walk-Mate ** Single-walk Walk-Mate Single-walk RAS * Single-walk RAS Fig. 8 Symmetry of gait trajectory (SubjectA) a:temporal development of gait trajectory b:t-test of Y sym ( : p <.5 : p <.1) Fig. 9 Symmetry of gait trajectory (SubjectA) a:temporal development of gait trajectory b:t-test of Y sym ( : p <.5 : p <.1) Walk-Mate RAS SubjectA Fig. 8a Walk-Mate Y U L Y D L Y U R Y D R Walk-Mate Y U L Y D L Y U R Y D R Walk-Mate Y sym t Fig. 8b Walk-Mate

7 -.1 Fig t n.1 e m e v r o.5 p im m y. s Y n a e -.5 m Paretic side p =.91 None-paretic side p =.237 Walk-Mate RAS Walk-Mate RAS Wilcoxon signed-rank test of mean Y sym improvement : p <.5 : p <.1 (N=7) Walk-Mate Fig. 9a RAS RAS Y U L Y D L Y U R Y D R Fig. 9b RAS Table 2 Walk-Mate RAS Y sym L Y sym L R Y sym R Improvement Walk-Mate RAS Y sym Y sym Walk-Mate RAS Y sym Walk-Mate SubjectA B C D SubjectE SubjectF G SubjectF SubjectG RAS SubjectA B SubjectC SubjectE SubjectD F G Fig. 1 Walk-Mate RAS Improvement Wilcoxon Walk-Mate RAS Table 3 F-test of stability Walk-Mate RAS p Stability Subject A L ** W > R R ** W > R Subject B L ** W > R R ** W > R Subject C L ** W > R R ** W > R Subject D L ** W > R R ** W > R Subject E L ** W > R R ** W > R Subject F L ** W > R R ** W > R Subject G L ** W > R Phase Difference [rad] Phase Difference [rad] Fig. 11 PdSd R ** W > R : p <.5 : p <.1 (F-test) W > R Walk-Mate is more stable than RAS W < R RAS is more stable than Walk-Mate π Left Phase Difference Right Phase Difference -π Steps [step] π Left Phase Difference Right Phase Difference -π Steps [step] ** Left ** Walk-Mate Walk-Mate RAS Walk-Mate RAS RAS Right Stability of phase difference (SubjectA) a:temporal development of phase difference b:f-test of P dsd ( : p <.5 : p <.1) 4. 2 Walk-Mate Fig. 11a SubjectA Walk-Mate RAS Walk-Mate RAS

8 d S d P 1. n a e m.5 Fig. 12 Paretic side * * None-paretic side Walk-Mate RAS Walk-Mate RAS Wilcoxon signed-rank test of mean P dsd : p <.5 : p <.1 (N=7) Walk-Mate RAS P dsd F Fig. 11b Walk-Mate RAS Walk-Mate RAS Table 3 Walk-Mate RAS P dsd L P dsd L R P dsd R F Walk-Mate RAS P dsd RAS Walk-Mate Fig. 12 Walk-Mate RAS P dsd Wilcoxon 5%( p =.18 p =.18) RAS Walk-Mate 5. Walk-Mate RAS 5. 1 Walk-Mate RAS Fig. 5b 17), 2) Walk-Mate RAS 4. 1 Walk-Mate RAS RAS Walk-Mate Constraint-Induced movement therapy:ci 18), 21), 22) Walk-Mate RAS Walk-Mate RAS Walk-Mate RAS CI RAS RAS RAS 23)

9 RAS Walk-Mate Walk-Mate Walk-Mate Walk-Mate SubjectA E G Walk- Mate RAS P dsd Table 1 SubjectA SubjectE 24) 25) SubjectA E P dsd SujbectG 5. 3 RAS Walk-Mate RAS Walk-Mate Walk-Mate RAS Walk-Mate RAS 5. 4 Walk-Mate Walk-Mate 26) HRI(Human- Robot Interaction) HAI(Human-Agent Interaction) 27) 28) 6. RAS Walk-Mate Walk-Mate RAS Walk-Mate Walk-Mate RAS Walk-Mate. Walk-Mate.. 1 ( 339/397), NTT (2) 2,, 25-6, 31/317 (1997) 3,, 9-5, 637/647 (1997) 4,, 62/74, (21) 5,, -,, 371, 187/196 (21) 6, Walk-Mate,, 39, 74/81 (23) 7,,, Walk-Mate,, 42-5, 567/576 (26) 8 M.H.Thaut, G.C.McIntosh, R.R.Rice Rhythmic facili-

10 tation of gait training in hemiparetic stroke rehabilitation, Journal of the Neurological Sciences, 151, 27/212 (1997) 9 S.Prassas, M.H.Thaut, G.McIntosh, R.Rice Effect of auditory rhythmic cuing on gait kinematic parameters of stroke patients, Gait & Posture, 6, 218/223 (1997) 1 M.P.Ford, R.C.Wagenaar, K.M.Newell The effects of auditory rhythms and instruction on walking patterns in individuals post stroke, Gait & Posture, 26, 15/155 (27) 11,,,, 41, 866/875 (25) 12,,,,, Dynamics&Design Conference, 26, 345/345-5 (26) 13 T.Muto, B.Herzberger, J.Hermsdörfer, Y.Miyake, E. Pöppel Interactive gait training device walk-mate for hemiparetic stroke rehabilitation, Proceedings of the 27 IEEE/RSJ International Conference on Intelligent Robots and Systems, 2268/2274 (27) 14 Y.Miyake Interpersonal Synchronization of Body Motion and the Walk-Mate Walking Support Robot, IEEE Transaction on Robotics (in press) 15 Y.Kobayashi and Y.Miyake:New ensemble system based on mutual entrainment,proc. of 22 IEEE International Conference on Systems, Man and Cybernetics(SMC22),Hammamett,Tunisia,MPIJI, 1/6(22) 16 Y.Kuramoto:Chemical oscillation, waves and turbulence, Springer-Verlag(1984) 17, 3, 63/615, (25) 18 E.Taub, N.E.Miller, T.A.Novack, E.W.3rd.Cook, W.C. Fleming, C.S.Nepomuceno, J.S.Connell, J.E.Crago Technique to improve chronic motor deficit after stroke, Archives of physical medicine and rehabilitation, 74, 347/354(1993) 19,,,, 27, 921/926 (27) 2, 15/2, (1995) 21 R.Hakim, S.Kelly,M.Grant-Beuttler, B.Healy, J. Krempasky, S.Moore A modified constraint-induced therapy (mcit) program for the upper extremity of a person with chronic stroke, Physiotherapy theory and practice,21-4,243/256(25) 22,,,,, Modified constraint induced movement therapy,, 34, 34/4(27) 23,, 24, 1132/1136 (24) 24, 21/26, (26) 25, ( ),, 38, 16/18(21) 26 Walk-Mate,, 24-6, 7/77 (26) 27 Kozima Infanoid: A Babybot that Explores the Social Environment, K. Dautenhahn, A. H. Bond, L. Canamero and B. Edmonds(eds.), Socially Intelligent Agents: Creating Relationships with Computers and Robots, 157/164,Amsterdam: Kluwer Academic Publishers(22) 28,,,,, 42-6, 1348/1358(21)

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