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A Passive Mechanical Add-on for Treadmill Exercise (P-MATE) in Stroke Rehabilitation

Irene L. Y. Beck, Belle C. Hopmans, Bram Haanen, Levi Kieft, Heike Vallery, Laura Marchal-Crespo, Katherine L. Poggensee

TL;DR

This paper tackles the challenge of delivering high-dose gait rehabilitation for stroke patients with affordable, easily deployable technology. It introduces P-MATE, a passive end-effector add-on that uses elastic tendons and pulleys to link paretic and non-paretic legs on a treadmill, eliminating the need for actuators. Through simulation-guided pulley optimization and a feasibility study with unimpaired participants and a therapist, the authors demonstrate the device's potential and uncover user-interface differences, setup times, and safety considerations. The findings suggest P-MATE can enable accessible gait therapy with acceptable usability, while pointing to necessary refinements for personalized tuning and robust clinical evaluation.

Abstract

Robotic rehabilitation can deliver high-dose gait therapy and improve motor function after a stroke. However, for many devices, high costs and lengthy setup times limit clinical adoption. Thus, we designed, built, and evaluated the Passive Mechanical Add-on for Treadmill Exercise (P-MATE), a low-cost passive end-effector add-on for treadmills that couples the movement of the paretic and non-paretic legs via a reciprocating system of elastic cables and pulleys. Two human-device mechanical interfaces were designed to attach the elastic cables to the user. The P-MATE and two interface prototypes were tested with a physical therapist and eight unimpaired participants. Biomechanical data, including kinematics and interaction forces, were collected alongside standardized questionnaires to assess usability and user experience. Both interfaces were quick and easy to attach, though user experience differed, highlighting the need for personalization. We also identified areas for future improvement, including pretension adjustments, tendon derailing prevention, and understanding long-term impacts on user gait. Our preliminary findings underline the potential of the P-MATE to provide effective, accessible, and sustainable stroke gait rehabilitation.

A Passive Mechanical Add-on for Treadmill Exercise (P-MATE) in Stroke Rehabilitation

TL;DR

This paper tackles the challenge of delivering high-dose gait rehabilitation for stroke patients with affordable, easily deployable technology. It introduces P-MATE, a passive end-effector add-on that uses elastic tendons and pulleys to link paretic and non-paretic legs on a treadmill, eliminating the need for actuators. Through simulation-guided pulley optimization and a feasibility study with unimpaired participants and a therapist, the authors demonstrate the device's potential and uncover user-interface differences, setup times, and safety considerations. The findings suggest P-MATE can enable accessible gait therapy with acceptable usability, while pointing to necessary refinements for personalized tuning and robust clinical evaluation.

Abstract

Robotic rehabilitation can deliver high-dose gait therapy and improve motor function after a stroke. However, for many devices, high costs and lengthy setup times limit clinical adoption. Thus, we designed, built, and evaluated the Passive Mechanical Add-on for Treadmill Exercise (P-MATE), a low-cost passive end-effector add-on for treadmills that couples the movement of the paretic and non-paretic legs via a reciprocating system of elastic cables and pulleys. Two human-device mechanical interfaces were designed to attach the elastic cables to the user. The P-MATE and two interface prototypes were tested with a physical therapist and eight unimpaired participants. Biomechanical data, including kinematics and interaction forces, were collected alongside standardized questionnaires to assess usability and user experience. Both interfaces were quick and easy to attach, though user experience differed, highlighting the need for personalization. We also identified areas for future improvement, including pretension adjustments, tendon derailing prevention, and understanding long-term impacts on user gait. Our preliminary findings underline the potential of the P-MATE to provide effective, accessible, and sustainable stroke gait rehabilitation.
Paper Structure (16 sections, 4 figures, 3 tables)

This paper contains 16 sections, 4 figures, 3 tables.

Table of Contents

  1. Introduction
  2. Design
  3. System Overview
  4. Pulley Location Optimization
  5. Mechanical Design
  6. Frame
  7. Pulleys
  8. Elastic tendons
  9. Safety harness
  10. Human-device interface
  11. Experiment
  12. Experimental Protocol
  13. Outcome metrics
  14. Experimental Results
  15. Discussion
  16. ...and 1 more sections

Figures (4)

  • Figure 1: The mechanical design of the P-MATE. A: An overview of all parts of the system with the 1) frame, 2) six pulleys, 3) two anterior and two posterior elastic tendons, 4) body weight support, 5) anterior and posterior load sensors, and 6) human-device interface. The two prototypes of the interface are highlighted in B: the cuff around the shank and C: the bandage around the foot.
  • Figure 2: The optimization setup with the eight parameters to determine optimal pulley location.
  • Figure 3: Donning and doffing time of both prototypes. A: Donning (solid) and doffing (dashed) by the experimenter over time for the cuff (blue diamond) and bandage (red circle) prototype. Donning (B) and doffing (C) of the two prototypes by the participants and therapist (orange star) are also shown.
  • Figure 4: Results of the questionnaires for the cuff (blue diamond) and bandage (red circle) prototypes. Therapist scores are shown as orange stars. The System Usability Scale (SUS) (A) is ranked on a scale from 0 to 100, and the User Experience Questionnaire (UEQ) (B), Acceptance Questionnaire on Usability (ASU) (C) and Satisfaction (ASS) (D) on a scale from -2 to 2.