Josep Medina

Institut Guttmann

Citation: García-Alén, L.; Kumru, H.; Castillo-Escario, Y.; Benito-Penalva, J.; Medina-Casanovas, J.; Gerasimenko, Y.P.; Edgerton, V.R.; García-Alías, G.; Vidal, J. Transcutaneous Cervical Spinal Cord Stimulation Combined with Robotic Exoskeleton Rehabilitation for the Upper Limbs in Subjects with Cervical SCI: Clinical Trial. Biomedicines 2023, 11...

Purpose: This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases. Methods: A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the qu...

Background: Understanding the links between gait disorders, impairments, and activity limitations is essential for correctly interpreting the instrumented gait analysis. We aimed to evaluate the relationships between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy, and find out whether spatiotempor...

Background Ground reaction forces are the gold standard for detecting gait events, but they are not always applicable in cerebral palsy. Ghoussayni's algorithm is an event detection method based on the sagittal plane velocity of heel and toe markers. We aimed to evaluate whether Ghoussayni's algorithm, using two different thresholds, was a valid ev...

Introduction: Maximal oxygen uptake (VO2) may be one of the most important variables in the study of the responses of people with spinal cord injury (SCI) and without SCI to physical exercise. The results achieved during its assessment serve as a diagnostic and health indicator in clinical settings. Objective: this study aimed to investigate the ph...

Background: Community mobility (CM) is considered a part of community reintegration that enhances Quality of Life (QoL). Achieving an appropriate gait speed is essential in attaining an independent outdoor ambulation and satisfactory CM. Objective: The aim of this study was to identify whether gait speed is a predictor of CM and QoL in patients wit...

Introduction: The amount of people who survive a stroke is increasing annually. Persons with stroke suffer neurological deficits and a physical deconditioning that compromise walking ability, basic activities of daily living and health-related quality of life (HRQoL). The aim of the study was to determine the effects of a 12-week multimodal low–mod...

Background: The increasing number of patients with acquired brain injury and the current subjectivity of the conventional upper extremity (UE) assessment tests require new objective assessment techniques. Objective: This research proposes a novel objective motor assessment (OMA) methodology based on the Fugl-Meyer assessment (FMA). The goals are...

The aim of this study was to determine the effectiveness of a 12-week multimodal exercise rehabilitation program on walking speed, walking ability and activities of daily living (ADLs) among people who had suffered a stroke. Thirty-one stroke survivors who had completed a conventional rehabilitation program voluntarily participated in the study. Tw...

Introducción: El aumento de la incidencia de ictus, ha hecho aumentar el número de enfermos crónicos con discapacidad. Ésta causa un gran impacto en la Calidad de Vida Relacionada con la Salud (CdVRS) de las personas afectadas. El uso de escalas de CdVRS es fundamental en la evaluación de la eficacia de las intervenciones terapéuticas teniendo en c...

Purpose: (1) To assess a robotic device (Handexos) during the design process with regard to usability, end user satisfaction and safety, (2) to determine whether Handexos can improve the activities of daily living (ADLs) of spinal cord injury (SCI) patients and stroke patients with upper-limb dysfunction. Methods: During a 2-year development sta...

Purpose: (1) To develop a smart jacket with sensors embedded in the sleeve that monitors the upper limb movement through a User Centered Design (UCD) process and (2) to assess by means of a Usability Test whether this tool can be used in upper limb rehabilitation of people with neurological diseases such as spinal cord injuries or strokes. Methods:...

Direct brain control of advanced robotic systems promises substantial improvements in health care, for example, to restore intuitive control of hand movements required for activities of daily living in quadriplegics, like holding a cup and drinking, eating with cutlery, or manipulating different objects. However, such integrated, brain- or neural-c...

This paper introduces a new approach for upper limb neurorehabilitation based on customized devices for monitoring and interacting with virtual environments. A proof-of-concept test involving eight patients at the Guttmann Neurorehabilitation Hospital shows patient's good acceptance and usability scores and demonstrates the technically feasibility...

Esta investigación propone la valoración objetiva del control motor de la extremidad superior (ES) de pacientes con Daño Cerebral Adquirido (DCA) en neurorrehabilitación funcional, basada en la automatización de las pruebas de la evaluación Fugl-Meyer (FM). El objetivo principal de este trabajo es calcular una medida objetiva, puntuando de forma au...

Introducció: El Pla de Salut de Catalunya considera prioritari afrontar el repte estructural de la cronicitat amb una estratègia de canvi integral en el model assistencial amb un enfocament poblacional, orientat a totes les persones, independentment de l'estat evolutiu de la seva malaltia. La reducció de la mortalitat per ictus ha suposat un augmen...

Resumen Esta investigación propone la valoración objetiva del control motor de la extremidad superior (ES) de pacientes con Daño Cerebral Adquirido (DCA) en neurorrehabilitación funcional, basada en la automatización de las pruebas de la evaluación Fugl-Meyer (FM). El objetivo principal de este trabajo es calcular una medida objetiva, puntuando de...

This paper proposes a first approach for the automation of the Fugl-Meyer assessment scale used in physical neurorehabilitation. The main goal of this research is to automatically estimate an objective measurement for five Fugl-Meyer scale items related to the assessment of the upper limb motion. An objective score has been calculated for 7 patient...

Introducción: El ictus puede causar déficits motores severos, generando una disminución progresiva de la condición física y un efecto discapacitante en la realización de las actividades básicas de la vida diaria (ABVD). La capacidad de caminar, es una de las prioridades en la rehabilitación de las personas que han sufrido un ictus y que, se ve limi...

Introducción: El ictus puede causar déficits motores severos, generando una disminución progresiva de la condición física y un efecto discapacitante en la realización de las actividades básicas de la vida diaria (ABVD). La capacidad de caminar, es una de las prioridades en la rehabilitación de las personas que han sufrido un ictus y que, se ve limi...

El presente trabajo propone la automatización de las pruebas de la evaluación Fugl-Meyer (FM) usada para valorar el movimiento de la extremidad superior (ES) de pacientes con Daño Cerebral Adquirido (DCA) en neurorrehabilitación funcional. El objetivo principal de este trabajo es investigar una medida objetiva, puntuando de forma automática cada pr...

Individuals with severe motor impairment can use event-related desynchronization (ERD) based BCIs as assistive technology. Auto-calibrating and adaptive ERD-based BCIs that users control with motor imagery tasks ("SMR-AdBCI") have proven effective for healthy users. We aim to find an improved configuration of such an adaptive ERD-based BCI for indi...

Co-adaptive training paradigms for event-related desynchronization (ERD) based brain-computer interfaces (BCI) have proven effective for healthy users. As of yet, it is not clear whether co-adaptive training paradigms can also benefit users with severe motor impairment. The primary goal of our paper was to evaluate a novel cue-guided, co-adaptive B...

During the last decade, many studies have been carried out to understand the effects of focal vibratory stimuli at various levels of the central nervous system and to study pathophysiological mechanisms of neurological disorders as well as the therapeutic effects of focal vibration in neurorehabilitation. This review aimed to describe the effects o...

Robotic devices are becoming a popular alternative to the traditional physical therapy as a mean to enhance functional recovery after stroke; they offer more intensive practice opportunities without increasing time spent on supervision by the treating therapist. An ideal behavior for these systems would consist in emulating real therapists by provi...

Co-adaptive training paradigms for event-related desynchronization (ERD) based brain-computer interfaces (BCI) have proven effective for system setup and training of healthy users. However, there is little evidence as to whether co-adaptive ERD based BCI training paradigms could also benefit severely disabled users, including persons with spinal co...

This research work proposes a simulation-based planification tool for the selection of the most suitable configuration parameters of an assistance-as-needed controlled upper limb neurorehabilitation orthosis. The selection of these parameters is performed by applying planification algorithms that analyze the results of a set of simulation batteries...

This paper proposes a first approach to Objective Motor Assessment (OMA) methodology. Also, it introduces the Dysfunctional profile (DP) concept. DP consists of a data matrix characterizing the Upper Limb (UL) physical alterations of a patient with Acquired Brain Injury (ABI) during the rehabilitation process. This research is based on the comparis...

Severely disabled individuals often suffer from high care-giver dependence and are at risk of social exclusion. The prototype developed in the EU Project BrainAble (http://www.brainable.org/) offers access to common smart-home devices and popular Internet services, using electroencephalography (EEG) and non-EEG inputs. Here we describe our user-cen...

Background: Clinical studies have shown that after incomplete spinal cord lesions at the thoracic level, patients can develop functional gait patterns through gait training. To date, however, training has been ineffective in producing gait in patients with clinically motor complete spinal cord lesions. Objective: Here we report a patient with ch...

Objective: To study the differences in respiratory responses to exercise in environmental conditions similar to the practice of winter sports among physically active and healthy men with and without spinal cord injury (SCI). Methods: 24 healthy, physically active volunteers, 12 with SCI and the other 12 without SCI. Each subject performed three max...

a b s t r a c t Objective: This research is focused in the creation and validation of a solution to the inverse kinematics problem for a 6 degrees of freedom human upper limb. This system is intended to work within a real-time dysfunctional motion prediction system that allows anticipatory actuation in physical Neurorehabil-itation under the assist...

A Brain-Computer Interface (BCI) can provide an additional option for a person to express himself/herself if he/she suffers a disorder like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury or other diseases affecting the motor pathway. For a P300 based BCI a matrix of randomly flashing characters is presented to th...

To assess the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremities motor score (LEMS) and gait in patients with motor incomplete spinal cord injury (SCI). The prospective longitudinal randomized, double-blind study assessed 17 SCI patients ASIA D. We assessed LEMS, modified Ashworth Scale (MAS), 10-m wal...

The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to pr...

To report the clinical improvements in spinal cord injury (SCI) patients associated with intensive gait training using electromechanical systems according to patient characteristics. Prospective longitudinal study. Inpatient SCI rehabilitation center. Adults with SCI (n=130). Patients received locomotor training with 2 different electromechanical d...

Objective: To assess the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremities muscle strength (LEMS) and gait in motor incomplete spinal cord injury (SCI) subjects. Design: Prospective longitudinal randomized, double blind study. Participants and Methods: Twelve SCI subjects (ASIA D) were studied. We ass...

A Brain-Computer Interface (BCI) provides a completely new output pathway and so an additional possible way a person can express himself if he/she suffers disorders like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury or other diseases which impair the function of the common output pathways which are responsible f...

Spasticity is common after spinal cord injury (SCI). Exaggerated tendon jerks, clonus, and spasms are key features of spasticity that result from hyperexcitability of the stretch reflex circuit. Here we studied the effects of vibration on the rectus femoris muscle (RF) on clinical and electrophysiological measures of spasticity in the leg. Nineteen...

Here an inertial sensor-based monitoring system for measuring and analyzing upper limb movements is presented. The final goal is the integration of this motion-tracking device within a portable rehabilitation system for brain injury patients. A set of four inertial sensors mounted on a special garment worn by the patient provides the quaternions re...

Prospective longitudinal study. The aim of this study was to examine the effects of transcranial magnetic stimulation (TMS) on the soleus H reflex in patients with spinal cord injury (SCI) before and after locomotion training. Neurorehabilitation hospital in Barcelona, Spain. H reflex was elicited in 29 incomplete patients with SCI at 20, 50 and 80...

Este estudio de investigación pretende analizar la evolución de la marcha en un paciente con lesión medular incompleta, tras ser sometido a un programa de entrenamiento de la marcha de forma asistida con soporte parcial del peso corporal con el sistema Lokomat®. Para ello se ha realizado una exploración física y funcional con las escalas de evaluac...

The prevalence of neurological disorders such as stroke, spinal cord injury and traumatic brain injury is increasing quickly in the industrialised societies. Although the benefit of the use of technology in rehabilitation and neurorehabilitation programs is proved, the presence of mechatronic systems is still very low. This paper proposes a new low...

Technology has big presence in our lives and we are surrounded by lot of peripheral devices supposed to make our daily life easier; TV, computer, cellular phone and internet for example. The way we interact with these devices is critical for making them accessible and useful. This article presents an alternative, universal, non invasive and wireles...

This article presents the use of accelerometer and gyroscope to track pitch and yaw head movements in static and dynamic references in order to control two degrees of freedom peripheral devices. The interface is expected to be a communication alternative for many users with mobility impairments in upper-extremities, enabling interaction with most o...

A global physical evaluation was performed in 21 males with spinal cord injury (SCI), at the beginning and at three and six months of omega-3 fatty acid (FA) supplementation. A significant increase in the proportion of eicosapentaenoic acid and docosahexanoic acid in plasma was observed in response to the supplementation (p<0.05). After six months...

Purpose To compare the response to physical exercise between subjects with spinal cord injury (SCI) and able-bodied (AB) subjects with the objective of developing a new formula for the indirect calculation of oxygen consumption (VO 2 ). Subjects 20 individuals with paraplegia below Th 6 and 22 AB subjects have participated in the study. Measures...

Study design: A prospective study during a diet modification. Objective: To observe the evolution of the plasma lipid profile in a group of spinal cord injury (SCI) patients given a supplement of a mixture of docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA). Setting: Department of Physiological Sciences II, Medical School of the Unive...

El Korfbal adaptado se inicia como un medio rehabilitador dentro del programa de Educación Física Terapéutica del Institut Guttmann, centro especializado en rehabilitación de personas con grandes discapacidades físicas (lesiones medulares y daño cerebral). El Korfbal se convierte en uno de los deportes que se utiliza para que las personas con disca...