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Article ; Online: Oxygen Uptake During Exoskeletal-Assisted Walking in Persons With Paraplegia.

Knezevic, Steven / Asselin, Pierre K / Cirnigliaro, Christopher M / Kornfeld, Stephen / Emmons, Racine R / Spungen, Ann M

Archives of physical medicine and rehabilitation

2020 Volume 102, Issue 2, Page(s) 185–195

Abstract: Objective: To determine the cardiometabolic demands associated with exoskeletal-assisted walking (EAW) in persons with paraplegia. This study will further examine if training in the device for 60 sessions modifies cost of transport (CT).: Design: ... ...

Abstract	Objective: To determine the cardiometabolic demands associated with exoskeletal-assisted walking (EAW) in persons with paraplegia. This study will further examine if training in the device for 60 sessions modifies cost of transport (CT). Design: Prospective cohort study. Measurements over the course of a 60-session training program, approximately 20 sessions apart. Setting: James J. Peters Bronx Veterans Affairs Medical Center, Center for the Medical Consequences of Spinal Cord Injury Research Center. Participants: The participants' demographics (N=5) were 37-61 years old, body mass index (calculated as weight in kilograms divided by height in meters squared) of 22.7-28.6, level of injury from T1-T11, and 2-14 years since injury. Interventions: Powered EAW. Main outcome measures: Oxygen consumption per unit time (V˙O Results: With training: EAW velocity significantly improved (Pre: 51±51m; 0.14±0.14m/s vs Post: 99±42m; 0.28±0.12m/s, P=.023), RPE significantly decreased (Pre: 13±6 vs Post: 7±4, P=.001), V˙O Conclusions: The current study suggests that EAW training improves oxygen uptake efficiency and walking velocities, with a lower perception of exertion.
MeSH term(s)	Adult ; Exoskeleton Device ; Female ; Humans ; Male ; Middle Aged ; Oxygen Consumption/physiology ; Paraplegia/physiopathology ; Paraplegia/therapy ; Prospective Studies ; Walking/physiology
Language	English
Publishing date	2020-11-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2020.08.025
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Article ; Online: Estimation of Physical Activity Intensity in Spinal Cord Injury Using a Wrist-Worn ActiGraph Monitor.

Veerubhotla, Akhila / Hong, EunKyoung / Knezevic, Steven / Spungen, Ann / Ding, Dan

Archives of physical medicine and rehabilitation

2020 Volume 101, Issue 9, Page(s) 1563–1569

Abstract: Objectives: To derive accelerometer count thresholds for classifying time spent in sedentary, light intensity, and moderate-to-vigorous physical activity (MVPA) in manual wheelchair users (MWUs) with spinal cord injury (SCI).: Design: Participants ... ...

Abstract	Objectives: To derive accelerometer count thresholds for classifying time spent in sedentary, light intensity, and moderate-to-vigorous physical activity (MVPA) in manual wheelchair users (MWUs) with spinal cord injury (SCI). Design: Participants completed 18 activities of daily living and exercises for 10 minutes each with a 3-minute break between activities while wearing a COSMED K4b2 portable metabolic cart and an ActiGraph activity monitor on the dominant wrist. A linear regression was computed between the wrist acceleration vector magnitude and SCI metabolic equivalent of task (MET) for 80% of the participants to obtain thresholds for classifying different activity intensities, and the obtained thresholds were tested for accuracy on the remaining 20% of participants. This cross-validation process was iterated for 1000 times to evaluate the stability of the thresholds on data corresponding to different proportions of sedentary, light intensity, and MVPA. MET values of 1.5 or lower were classified as sedentary behavior, MET values between 1.5 and 3 were classified as light intensity, and MET values of 3 or higher were classified as MVPA. The final thresholds were then validated on an out-of-sample independent dataset. Participants: MWUs (N=17) with SCI in the out-of-sample validation data set. Interventions: Not applicable. Setting: Research lab, community MAIN OUTCOME MEASURES: Accelerometer thresholds to classify sedentary, light intensity, and MVPA were obtained and their accuracy tested using cross-validation and an out-of-sample dataset. Results: The threshold between sedentary and light intensity was 2057 counts-per-minute, and the threshold between light intensity and MVPA was 11,551 counts per minute. Based on the out-of-sample validation, the obtained thresholds had an overall accuracy of 85.6%, with a sensitivity and specificity of 95.3% and 97.4% for sedentary behavior, 87.8% and 84.5% for light intensity, 68.5% and 96.3% for MVPA, respectively. Conclusion: Accelerometer-based thresholds can be used to accurately identify sedentary behavior. However, thresholds may not provide accurate estimations of MVPA throughout the day when participants engage in more resistance-based activities.
MeSH term(s)	Actigraphy/instrumentation ; Activities of Daily Living ; Adult ; Exercise/physiology ; Female ; Humans ; Male ; Middle Aged ; Sedentary Behavior ; Sensitivity and Specificity ; Spinal Cord Injuries/rehabilitation ; Wheelchairs ; Wrist
Language	English
Publishing date	2020-06-02
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2020.05.014
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Article ; Online: Exoskeletal-assisted walking may improve seated balance in persons with chronic spinal cord injury: a pilot study.

Tsai, Chung-Ying / Asselin, Pierre K / Hong, Eunkyoung / Knezevic, Steven / Kornfeld, Stephen D / Harel, Noam Y / Spungen, Ann M

Spinal cord series and cases

2021 Volume 7, Issue 1, Page(s) 20

Abstract: Study design: Pre-post intervention.: Objective: To explore the potential effect of exoskeletal-assisted walking (EAW) on seated balance for persons with chronic motor complete spinal cord injury (SCI).: Setting: A SCI research center.: Methods!# ...

Abstract	Study design: Pre-post intervention. Objective: To explore the potential effect of exoskeletal-assisted walking (EAW) on seated balance for persons with chronic motor complete spinal cord injury (SCI). Setting: A SCI research center. Methods: Eight participants who were over 18 years of age with chronic SCI and used a wheelchair for mobility were enrolled. Seven able-bodied participants were used for normal seated balance comparative values. Participants with chronic SCI received supervised EAW training using a powered exoskeleton (ReWalk Results: After EAW training, seated balance significantly improved in total-direction EPE and MXE (P < 0.01 and P < 0.017 respectively). The results of MFRT and sub-scales of physical functioning and role limitations due to physical health improved after EAW training but were not statistically significant. Conclusions: EAW training may have the potential to improve seated balance for persons with chronic motor complete SCI. Due to the limitations of the study, such as small sample size and lack of a control group, further studies are needed to clarify the effect of improving seated balance through EAW training.
MeSH term(s)	Adolescent ; Adult ; Exoskeleton Device ; Humans ; Pilot Projects ; Postural Balance ; Spinal Cord Injuries ; Walking
Language	English
Publishing date	2021-03-12
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	2058-6124
ISSN (online)	2058-6124
DOI	10.1038/s41394-021-00384-8
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Article ; Online: Predicting physical activity intensity using raw accelerometer signals in manual wheelchair users with spinal cord injury.

Shwetar, Yousif / Huang, Zijian / Veerubhotla, Akhila / Knezevic, Steven / Hong, EunKyoung / Spungen, Ann M / Ding, Dan

Spinal cord

2021 Volume 60, Issue 2, Page(s) 149–156

Abstract: Study design: Cross-sectional validation study.: Objectives: The performance of previously published physical activity (PA) intensity cutoff thresholds based on proprietary ActiGraph counts for manual wheelchair users (MWUs) with spinal cord injury ( ... ...

Abstract	Study design: Cross-sectional validation study. Objectives: The performance of previously published physical activity (PA) intensity cutoff thresholds based on proprietary ActiGraph counts for manual wheelchair users (MWUs) with spinal cord injury (SCI) was initially evaluated using an out-of-sample dataset of 60 individuals with SCI. Two types of PA intensity classification models based on raw accelerometer signals were developed and evaluated. Setting: Research institutions in Pittsburgh PA, Birmingham AL, and Bronx NY. Methods: Data were collected from 60 MWUs with SCI who followed a structured activity protocol while wearing an ActiGraph activity monitor on their dominant wrist and portable metabolic cart which measured criterion PA intensity. Data was used to assess published models as well as develop and assess custom models using recall, specificity, precision, as well as normalized Mathew's correlation coefficient (nMCC). Results: All the models performed well for predicting sedentary vs non-sedentary activity, yielding an nMCC of 0.87-0.90. However, all models demonstrated inadequate performance for predicting moderate to vigorous PA (MVPA) with an nMCC of 0.76-0.82. Conclusions: The mean absolute deviation (MAD) cutoff threshold yielded the best performance for predicting sedentary vs non-sedentary PA and may be used for tracking daily sedentary activity. None of the models displayed strong performance for MVPA vs non-MVPA. Future studies should investigate combining physiological measures with accelerometry to yield better prediction accuracies for MVPA.
MeSH term(s)	Accelerometry/methods ; Cross-Sectional Studies ; Exercise/physiology ; Humans ; Spinal Cord Injuries/diagnosis ; Wheelchairs
Language	English
Publishing date	2021-11-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1316161-1
ISSN	1476-5624 ; 1362-4393
ISSN (online)	1476-5624
ISSN	1362-4393
DOI	10.1038/s41393-021-00728-z
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Article ; Online: Effect of Exoskeletal-Assisted Walking on Soft Tissue Body Composition in Persons With Spinal Cord Injury.

Asselin, Pierre / Cirnigliaro, Christopher M / Kornfeld, Stephen / Knezevic, Steven / Lackow, Rachel / Elliott, Michael / Bauman, William A / Spungen, Ann M

Archives of physical medicine and rehabilitation

2020 Volume 102, Issue 2, Page(s) 196–202

Abstract: Objective: To determine the effect of overground walking using a powered exoskeleton on soft tissue body composition in persons with spinal cord injury (SCI).: Design: A prospective, single group observational pilot study.: Setting: Medical center. ...

Abstract	Objective: To determine the effect of overground walking using a powered exoskeleton on soft tissue body composition in persons with spinal cord injury (SCI). Design: A prospective, single group observational pilot study. Setting: Medical center. Participants: Persons (N=8) with chronic (>6mo) SCI between 18 and 65 years old who weighed less than 100 kg. Interventions: Overground ambulation training using a powered exoskeleton (ReWalk) for 40 sessions, with each session lasting up to 2 hours, with participants training 3 times per week. Main outcome measure(s): Dual-energy x-ray absorptiometry (DXA) was used to measure lean mass (LM) and fat mass (FM) from the whole body, arms, legs and trunk. DXA was also used to assess visceral adipose tissue (VAT). Walking performance was measured by 6-minute walk test. Results: Participants significantly lost total body FM (-1.8±1.2kg, P=.004) with the loss of adiposity distributed over several regional sites. Six of the 8 participants lost VAT, with the average loss in VAT trending toward significance (-0.141kg, P=.06). LM for the group was not significantly changed. Conclusions: Sustained and weekly use of powered exoskeletons in persons with SCI has the potential to reduce FM with inferred improvements in health.
MeSH term(s)	Absorptiometry, Photon ; Adolescent ; Adult ; Aged ; Body Composition ; Exoskeleton Device ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Spinal Cord Injuries/physiopathology ; Spinal Cord Injuries/rehabilitation ; Walk Test ; Walking/physiology
Language	English
Publishing date	2020-11-07
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2020.07.018
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Article ; Online: Control of Glyphosate-Resistant Common Waterhemp (Amaranthus rudis) in Glufosinate-Resistant Soybean

Jhala, Amit J. / Sandell, Lowell D. / Sarangi, Debalin / Kruger, Greg R. / Knezevic, Steven Z.

Weed technology. 2017 Jan., v. 31, no. 1, p. 32-45

2017 , Page(s) 32–45

Abstract: Glyphosate-resistant (GR) common waterhemp has become a significant problem weed in Nebraska and several Midwestern states. Several populations of GR common waterhemp are also resistant to acetolactate synthase (ALS)-inhibiting herbicides, making them ... ...

Abstract	Glyphosate-resistant (GR) common waterhemp has become a significant problem weed in Nebraska and several Midwestern states. Several populations of GR common waterhemp are also resistant to acetolactate synthase (ALS)-inhibiting herbicides, making them difficult to control with POST herbicides in GR soybean. Glufosinate-resistant (GFR) soybean is an alternate system for controlling GR common waterhemp, justifying the need for evaluating glufosinate-based herbicide programs. The objectives of this study were to compare POST-only herbicide programs (including one-pass and two-pass POST programs) with PRE followed by (fb) POST herbicide programs for control of GR common waterhemp in GFR soybean and their effect on common waterhemp density, biomass, and soybean yield. Field experiments were conducted in 2013 and 2014 near Fremont, NE in a grower's field infested with GR common waterhemp. Glufosinate applied early- and late-POST provided 76% control of GR common waterhemp at 14 d after late-POST (DALPOST) compared with 93% control with a PRE fb POST program when averaged across treatments. The PRE application of chlorimuron plus thifensulfuron plus flumioxazin, S-metolachlor plus fomesafen or metribuzin, saflufenacil plus dimethenamid-P fb glufosinate provided ≥95% control of common waterhemp throughout the growing season, reduced common waterhemp density to ≤2.0 plants m⁻², caused ≥94% biomass reduction, and led to 1,984 to 2,210 kg ha⁻¹ soybean yield. Averaged across treatments, the PRE fb POST program provided 82% common waterhemp control at soybean harvest, reduced density to 23 plants m⁻² at 14 DALPOST, and caused 86% biomass reduction and 1,803 kg ha⁻¹ soybean yield compared with 77% control, 99 plants m⁻², 53% biomass reduction, and 1,190 kg ha⁻¹ yield with POST-only program. It is concluded that PRE fb POST programs with multiple effective modes of action are available for control of GR common waterhemp in GFR soybean. Nomenclature: Acetochlor; alachlor; cloransulam; chlorimuron; dimethenamid; flumioxazin; fomesafen; glufosinate; glyphosate; imazethapyr; metribuzin; saflufenacil; S-metolachlor; sulfentrazone; thifensulfuron; common waterhemp, Amaranthus rudis Sauer; soybean, Glycine max (L.) Merr.
Keywords	Amaranthus tuberculatus ; Glycine max ; acetochlor ; acetolactate synthase ; alachlor ; biomass ; chlorimuron ; cloransulam ; crop yield ; dimethenamid ; field experimentation ; flumioxazin ; fomesafen ; glufosinate ; glyphosate ; growing season ; herbicide resistance ; imazethapyr ; mechanism of action ; metolachlor ; metribuzin ; saflufenacil ; soybeans ; sulfentrazone ; thifensulfuron ; Nebraska
Language	English
Dates of publication	2017-01
Size	p. 32-45
Publishing place	Cambridge University Press
Document type	Article ; Online
ZDB-ID	743243-4
ISSN	1550-2740 ; 0890-037X
ISSN (online)	1550-2740
ISSN	0890-037X
Database	NAL-Catalogue (AGRICOLA)

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Article: Training persons with spinal cord injury to ambulate using a powered exoskeleton

Asselin, Pierre K / Avedissian, Manuel / Knezevic, Steven / Kornfeld, Stephen / Spungen, Ann M

Journal of visualized experiments. 2016 June 16, , no. 112

2016

Abstract: Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an ... ...

Abstract	Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.
Keywords	animal injuries ; arms (limbs) ; bone density ; clinical examination ; education programs ; exoskeleton ; hips ; learning ; people ; proprioception ; risk ; risk reduction ; screening ; spinal cord
Language	English
Dates of publication	2016-0616
Size	p. e54071.
Publishing place	Journal of Visualized Experiments
Document type	Article
ZDB-ID	2259946-0
ISSN	1940-087X
ISSN	1940-087X
DOI	10.3791/54071
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton.

Asselin, Pierre K / Avedissian, Manuel / Knezevic, Steven / Kornfeld, Stephen / Spungen, Ann M

Journal of visualized experiments : JoVE

2016 , Issue 112

Abstract	Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.
MeSH term(s)	Humans ; Knee Joint ; Posture ; Range of Motion, Articular ; Spinal Cord Injuries ; Walking
Language	English
Publishing date	2016-06-16
Publishing country	United States
Document type	Journal Article
ISSN	1940-087X
ISSN (online)	1940-087X
DOI	10.3791/54071
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Article ; Online: Mobility Skills With Exoskeletal-Assisted Walking in Persons With SCI: Results From a Three Center Randomized Clinical Trial.

Hong, EunKyoung / Gorman, Peter H / Forrest, Gail F / Asselin, Pierre K / Knezevic, Steven / Scott, William / Wojciehowski, Sandra Buffy / Kornfeld, Stephen / Spungen, Ann M

Frontiers in robotics and AI

2020 Volume 7, Page(s) 93

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-08-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781824-X
ISSN	2296-9144 ; 2296-9144
ISSN (online)	2296-9144
ISSN	2296-9144
DOI	10.3389/frobt.2020.00093
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Article ; Online: Dynamic Margins of Stability During Robot-Assisted Walking in Able-Bodied Individuals: A Preliminary Study.

Ramanujam, Arvind / Momeni, Kamyar / Ravi, Manikandan / Augustine, Jonathan / Garbarini, Erica / Barrance, Peter / Spungen, Ann M / Asselin, Pierre / Knezevic, Steven / Forrest, Gail F

Frontiers in robotics and AI

2020 Volume 7, Page(s) 574365

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2020-12-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781824-X
ISSN	2296-9144 ; 2296-9144
ISSN (online)	2296-9144
ISSN	2296-9144
DOI	10.3389/frobt.2020.574365
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