Traumatic spinal cord injuries are frequent and hardly repairable incidents associated with significant socioeconomic burdens, both at the individual and community levels. In this regard, early mobilization by the bedside cyclo-ergometer is one of the activity-based therapies that may promote neuroplasticity in spinal cord injured patients (BM). However, the literature review reveals the poor ability of circular cyclic movement to reproduce natural gait for which recovery is a critical need for BM. This contradicts the principle of task specificity in activity-based therapies. Although alternative movements exist, the literature lacks information on the best movement that reproduces natural gait in supine posture. Similarly, the influence of posture and training mode on similarity to natural gait is not sufficiently studied. Therefore, the main objective of this project was to better understand the best movement and posture configuration that promotes neuroplasticity in BM early mobilization. To address this objective, first, a technical specification for an early mobilization device for BM is developed. Then, a comparative study was conducted including 14 healthy adults (including 8 women) between gait and three movements: circular, elliptical and step, in two postures: supine and standing and two training modes (except for the step). For each participant, dominant leg kinematics were acquired by the OptiTrack optic system, and ground and pedal reaction forces were acquired by wireless F-Scan force insoles. For each of the motion modalities seven parameters were then calculated in comparison to natural gait. Statistical analysis of the dependent parameters as a function of the factors studied used generalized linear mixed models (GLMM) and pairwise comparisons. The results of this research project confirm the low biomechanical similarity between natural gait and circular movement in both postures. The best movement that reproduces natural gait in supine posture is the step, followed by the elliptical. Switching to a standing posture significantly favours kinematic and kinetic similarity. Also, the passive mode does not significantly influence similarity, but it significantly reduces maximal training reaction forces. These results demonstrate the relevance of substituting circular cyclic movement with step motion in the context of BM early mobilization. This suggests the design of a step-ergometer device as an interesting target for future work. In addition, the device design should promote standing posture and active mode as much as possible. That said, comparing the effectiveness of early mobilization with a stepergometer vs a cyclo-ergometer on natural gait recovery is potential horizon to explore.
| Date | 5 May 2023 |
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| Original language | French |
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| Awarding Institution | - École de technologie supérieure
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| Supervisor | Yvan Petit (Supervisor) & Jean Marc Mac-Thiong (Co-supervisor) |
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Chammakhi, H. (Author),
Petit (Supervisor) & Mac-Thiong (Co-supervisor),
5 May 2023Student thesis: Master's thesis › Master in Engineering: Mechanical Engineering