Papers by Sergio Lerma Lara
Design, Development, and Functional Validation of a 3D-printed Passive Upper Limb Exoskeleton
IEEE transactions on neural systems and rehabilitation engineering, 2024
Motor disability in children is evident in diagnoses such as cerebral palsy, muscular dystrophy, ... more Motor disability in children is evident in diagnoses such as cerebral palsy, muscular dystrophy, multiple sclerosis, or spinal muscular atrophy, among others, due to altered movement and postural patterns. This becomes more evident as the child grows and can be treated with physical therapy. The effectiveness of early interventions in facilitating an improvement in daily life activities varies depending on the child’s condition. In this context, the use of exoskeletons has emerged in recent years as a valuable resource for conducting more efficient therapy processes. This work describes the design (both structural and functional) and preliminary usability and functional validation of a 3D-printed passive upper limb exoskeleton. The goal is to provide clinicians with an efficient, low-cost device that is both easy to manufacture and assemble and, in a gamified environment, serves as an assistive device to physical therapy. The device features 5 degrees of freedom, enabling both a pro-gravity and an anti-gravity mode, controlled by a series of elastic bands. This gives rise to a dual operating mode, offering assistance or resistance to different arm, forearm, and shoulder-dependent movements. Usability validation conducted by exoskeleton users showed average results in all aspects rated above 3.8 out of 5, which implies levels of satisfaction between “quite satisfied” and “very satisfied”. The analysis of metrics recorded during therapy, such as the Hand Path Ratio and Success Rate (capturing user movements using an inertial sensor in the gamified environment), as well as the range of motion, reveals quantifiable improvements which can be attributed to the use of the exoskeleton: the Hand Path Ratio tended to approach 1 throughout sessions in almost all the users, the Success Rate remained stable (as users consistently were capable of completing the assigned tasks), and the range of motion showed that all patients achieved improvements of more than 10 degrees in some of the tested movements). These functional validation processes involved the participation of 7 children with varying levels of upper limb neuro-motor impairments.
Valoración de fuerza muscular bíceps braquial a través de dinamometría isotónica e isocinetica tras la aplicación de un estiramiento pasivo.(proyecto piloto
Utilidad asistencial de la investigación clínica de los trastornos de la marcha en PCI
Boletín informativo de la Asociación Española de Terapeutas formados en el Concepto Bobath ( AETB ), 2015
Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial
PubMed, Apr 1, 2015
Background: Three different types of manual therapy techniques for patients with neck pain and re... more Background: Three different types of manual therapy techniques for patients with neck pain and relationship with psychological factors has not been evaluated. Aim: To compare the effectiveness high velocity and low amplitude (HVLA) manipulation vs. posteroanterior mobilization (PA mob) vs. sustain appophyseal natural glide (SNAG) in the management of patients with neck pain and to evaluate the interaction with psychological factors. Study desing: Randomized clinical trial. Setting: Primary Health Care Center. Population: Patients with history of chronic neck pain over the last 3 months were recruited. Methods: Patients were randomly assigned to receive treatment with HVLA (N.=15), with PA mob (N.=16) or with SNAG (N.=17). One session was applied. Pain intensity of neck pain, pressure pain threshold over processus spinosus of C2 (PPT_C2) and cervical range of motion (CROM) were measured pre- and post-intervention. Pain catastrophizing, depression, anxiety and kinesiophobia were assessed in baseline. ANOVAs were performed, with main effects, two-way (treatment x time) and three-way interactions (treatment x psychological variable x time) were examined. Results: Fourthy-eight patients (mean±SD age, 36.5±8.7 years; 87.5% female). A significant interaction treatment x time was observed for VAS-rest in HVLA and AP mob groups (P<0.05). With more pain relief to HVLA and AP mob groups than SNAG groups but all groups improve the same in CROM. Also, a significant three-way treatment x anxiety x time interaction for VAS in Flexion/Extension was identified (P<0.01), and a trend toward significance was observed for the three way treatment x anxiety x time interaction, with respect to CROM in Lateral-Flexion movement (P<0.05). Conclusion: The results suggest that an HVLA and PA mob groups relieved pain at rest more than SNAG in patients with Neck pain. Among psychological factors, only trait anxiety seems interact with Manual therapy, mainly high anxiety conditions interact with the Mobilization and SNAG effects but under low anxiety conditions interact with the HVLA effects. Significant mean differences can be observed both in VAS in Flexion/Extension and in CROM in lateral-flexion movement when using mobilization under high anxiety conditions Clinical rehabilitation impact: The findings provide preliminary evidence to support that three different techniques have similar immediate effects over neck pain and while under high anxiety levels a better outcome is expected after mobilization intervention, under low anxiety levels a better prognosis is expected after manipulation and SNAG intervention.
Valoración de fuerza muscular biceps braquial a través de dinamometría isocinética tras la aplicación de un estiramiento pasivo (proyecto piloto)
Herramientas Biomecánicas Instrumentales en la Valoración del Deportista
Cirugía multinivel para las alteraciones de la deambulación en parálisis cerebral infantil: evaluación cuantitativa, funcional y de satisfacción de los resultados obtenidos
Trauma, 2013
Objective: To study the efficacy of orthopaedic surgery with bone correction guided by quantitati... more Objective: To study the efficacy of orthopaedic surgery with bone correction guided by quantitative motion analysis, for the treatment of gait disorders in cerebral palsy. Material and method: A retrospective study with 26 patients, aged between 8 and 17, and an average follow up of 16 months, was conducted. 60% of the patients were level III or IV. Surgery of the bone lever arm dysfunction was added to the to soft-tissue surgery when necessary. Gait cycle graphs, F.M.S. (Functional Mobility Scale), and a post-treatment satisfaction and gait functional questionnaire were used for proving differences. Results: Kinematic improvements were found in the gait cycle. Maximun values of extension in stance phase and dynamic range of motion of the knee were better, showing a significant statistically difference. The greater functional improvement was reached in the 50 meters distance. In other words, the patients were able to use the wheel-chair at school less, after this surgical treatment. Around 80% of the parents considered results as good or excellent. Conclusion: The bone and articular surgey in the single multilevel surgery showed its efficacy in the treatment of gait disorders in cerebral palsy.
Gait & Posture, Sep 1, 2015
Fig. 1. Left knee range of motion in function of knee flexion angle at initial contact and left i... more Fig. 1. Left knee range of motion in function of knee flexion angle at initial contact and left internal hip rotation. internal hip rotation in both sides, for instances, stable walking could not be generated. Results: Without introducing hip internal rotation, knee range of motion decreases (from 20 • to 8 • ) with the increase of knee flexion angle at initial contact. Maintaining a constant knee flexion angle at initial contact and varying internal hip rotation does not have a significant influence on 'stiff-knee' gait. In Fig. , a summary of the results for the left knee is presented. Results for the right knee are the same. Discussion: Despite the differences between simulated gait and patients' patterns, similarities have been found. This approach may lead to new applications of the simulation of human gait, in particular the simulation of pathological gait. Experiments on human based model are being conducted. It is the first time that the relationship between crouch gait severity and the development of knee stiffness is demonstrated in 3D.
Biomedical research and clinical practice, 2016
Cerebral Palsy (CP) is one of the most severe disabilities in childhood, and it demands important... more Cerebral Palsy (CP) is one of the most severe disabilities in childhood, and it demands important costs in health, education, and social services. CP is caused by damage to or abnormalities inside the developing brain that disrupt the brain's ability to control movement and maintain posture. Furthermore, CP is often associated with sensory deficits, cognition impairments, communication and motor disabilities, behavior issues, seizure disorder, pain, and secondary musculoskeletal problems. According to the literature, motor modules are peripheral measurements related to automatic motor control. There is a lack of evidence of change in motor modules in children with CP when different treatment approaches have been evaluated. Thus, new strategies are needed to improve motor control in this population. Robotic-based therapies are emerging as an effective intervention for gait rehabilitation in motor disorders such as stroke, spinal cord injury, and CP. There is vast clinical evidence that neural plasticity is the central core of motor recovery and development, and on-going studies suggest that robot-mediated intensive therapy could be beneficial for improved functional recovery. However, current robotic strategies are focused on the peripheral neural system (PNS) facilitating the performance of repetitive movements (a bottom-up approach). Since CP affects primarily brain structures, both the PNS and the central nervous system (CNS) should to be integrated in a physical and cognitive rehabilitation therapy (a top-down approach). This paper discusses perspectives of the top-down approach based on a novel robot-assisted rehabilitative system. Accordingly, the CPWalker robotic platform was developed to support novel therapies for CP rehabilitation. This robotic platform (Smart Walker + exoskeleton) is controlled by a multimodal interface enabling the interaction of CP infants with robot-based therapies. The aim of these therapies is to improve the physical skills of infants with CP using a top-down approach, in which motor related brain activity is used to drive robotic physical rehabilitation therapies. Our hypothesis is that the CPWalker concept will promote motor learning and this improvement will lead to significant improvements in automatic motor control.
Report on the frontal and transverse plane range of motion of the hip during the "en dehors pirouette" in pre-profesional dancers
acuerdo con el sistema internacional 10-20) usando electrodos de Ag/Cl (Acticap, Brain Products G... more acuerdo con el sistema internacional 10-20) usando electrodos de Ag/Cl (Acticap, Brain Products GmbH, Germany). La referencia se estableció con los parámetros de voltaje del lóbulo de la oreja del lado contralateral al miembro estimulado. AFz se utilizó como toma de tierra. La señal fue amplificada (gUSBamp, g.Tecgmbh, Austria) y registrada a 256 Hz. La señal registrada fue filtrada con un filtro de banda (1 Hz-30Hz) y se eliminaron los artefactos mediante un análisis ICA y un corrector de filtros MARA (3). La señal continua se registró por un periodo comprendido entre los 2 segundos previos a la estimulación y los 2 segundos posteriores a la estimulación. La PSD se estimó por cada banda de frecuencia de 1Hz entre 1Hz y 30Hz y se referenció a una ventana basal [-2000ms, inicio de estímulo].
Kronos: revista universitaria de la actividad física y el deporte, 2013
El aterrizaje de saltos es un gesto que en varios deportes se produce con mucha frecuencia y cuya... more El aterrizaje de saltos es un gesto que en varios deportes se produce con mucha frecuencia y cuya técnica a menudo no es dominada por los deportistas, siendo un mecanismo común de lesiones, de ahí la importancia de conocer las variables biomecánicas que intervienen en dicho gesto. Se evaluó en 16 sujetos, mediante plataforma dinamométrica y electromiografía de superficie (EMG), la fuerza de reacción vertical en múltiplos del peso corporal (BW) y la activación muscular en aterrizajes bipodales y monopodales de saltos en dirección frontal, de espalda y lateral. Los resultados obtenidos demostraron que: los ejercicios bipodales representan mayor BW que los monopodales; los ejercicios monopodales presentan mayor activación electromiográfica que los bipodales; el salto de frente y la caída lateral, muestran diferencias al comparar aterrizajes bipodales y monopodales; la caída de espalda y lateral, muestran diferencias al comparar aterrizajes bipodales. El presente trabajo permite aproximarnos a la especificidad del gesto deportivo y realiza aportaciones al conocimiento de la cinética del aterrizaje de saltos que permitan plantear estrategias de tratamiento, y recuperación de lesiones. Palabras clave: electromiografía (EMG), fuerza de reacción vertical, prevención de lesiones.
Actas de las XXXVII Jornadas de Automática 7, 8 y 9 de septiembre de 2016, Madrid, Feb 18, 2022
C0048 Assessment of passive medial gastrocnemius relative fascicle excursions in children with cerebral palsy
Background With growth, fascicle lengths increase through sarcomere addition to maintain force pr... more Background With growth, fascicle lengths increase through sarcomere addition to maintain force production capacity. However, children with cerebral palsy (CP) present a reduced number of in-series sarcomeres. Regarding fascicle lengths of the medial gastrocnemius (MG) in children with CP, some studies have shown smaller fascicle lengths than typically developing (TD) children, though others have shown no difference. Because fascicle length is in part responsible for contraction velocity and range of force generation, smaller fascicle lengths may imply reduced power. However, unlike TD children, in CP no fascicle length to muscle power correlation has been found, possibly due to the assumption that fascicle length represents sarcomere number. On the contrary, children with CP have shown little, over-stretched sarcomeres. Recently, relative fascicle excursion (RFE) as a measure of sarcomere excursion has been suggested. The latter study observed children with CP have larger MG RFE than TD, suggesting larger sarcomere excursions covering the descending limb of the sarcomere force-length curve. Consequently, we consider RFE instead of fascicle length should be used to predict power generation capacity. Therefore, the aim of this study was to define a protocol to assess RFE, and compare RFE data of a sample of children with CP to that reported in the literature. Methods Ultrasound images were taken from 22 children with spastic type CP (29 legs, 10.74±3.38 years) attending our laboratory for a gait analysis. MG architecture was assessed at rest (RJA) and maximum dorsiflexion (MDF). The probe was aligned with the fascicle plane over the mio-tendinous junction. The MG was followed with the probe from MTJ to mid-belly for fascicle length measurement. Fascicle length, absolute fascicle excursion (AFE), and RFE were measured. Results Intra-rater fascicle length reliability was high (ICC=0.885–0.891). RFE was (mean ±SE) 41.01%±3.27%. Similarly, a RFE of (mean ±1 SD) 43,30±14,84% has been previously observed. Greater RFE reported in the literature was possibly unrelated to differences in ankle ROM as no correlations were found between RFE and ankle ROM. Conclusions Muscle ultrasound is a readily available tool which can be used to measure spastic muscle structure to better understand function and treatment adaptations in children with CP. Through ultrasound, RFE can be accurately measured.
A la URJC, por guiarme desde mis primeros pasos en la formación universitaria hasta la lectura de... more A la URJC, por guiarme desde mis primeros pasos en la formación universitaria hasta la lectura de mi tesis doctoral. En todo este tiempo han sido muchos los compañeros de viaje. A todos ellos les debo parte de lo aprendido. Sería imposible no olvidar a algún compañero, espero que todos los que habéis participado en mi educación os sintáis parte definitiva de este interesante camino. La familia es el pilar de mi vida que ha soportado gran parte de las ausencias debidas a mi compromiso con los niños. Sois mi gran fortaleza y sin vuestro constante murmullo en mi corazón no sería capaz. Os lo debo todo y por eso quiero agradecer lo que sin pedir nada me regaláis a diario. Sara, amor, amor y amor. Eres el constante aliento que me da fuerza. Gracias por tu esfuerzo y tu incansable estímulo. Me das todo, todos los días. Yo siempre necesitaré más de ti. Te quiero. A mis hijas Adriana y Marta. El mayor de los regalos del cielo, sería imposible entender la mi vida sin vuestro ruido, vuestras risas y los brazos estirados pidiendo a papá un achuchón. Me hacéis el hombre más feliz del planeta. A mi madre, incansable y tierna como nadie. Me has dado más de lo que nadie puede desear. A mi padre, en tu constante silencio siempre he sentido comprensión. A mi hermano Pablo, que es el hombre mas dulce que conozco. Hemos compartido tanto que te pienso como un guardián de mi norte. En la vida son muchos los personajes que nos marcan, yo siento el deber de agradecer a los que por su cercanía y significado me han arropado y conducido. A D. Manuel Alende, maestro. Supiste despertar en mi el interés por las ciencias, la curiosidad y la pasión sin freno por el conocimiento. Sin duda, mi vocación docente nació en una de tus clases, gracias maestro. A Andrés, es imprescindible que el camino tenga Sentido. Gracias por tu constancia y por toda la Paz que nos transmites. Nacho, amigo, maestro, mentor y protector. Significas mucho en todos los sentidos. Eres actor de cambio en nuestro entorno. Gracias a ti, muchos hemos conseguido ver las diferencias que la Ciencia nos ofrece. Maribel, dejas huella por donde pasas. Tus palabras me han orientado para completar este proceso en esta Universidad, con estos directores. Gracias. A mis directores Tomás y Carlos, sin duda la mejor elección posible. Vuestro apoyo constante me ha ayudado y vuestra pasión por el conocimiento será siempre un ejemplo. Al Dr. Tomás Epeldegui, director de este trabajo. Jefe y referente. Tu apoyo y la exigencia hacen que viva enamorado del estudio. Al Prof. Dr. Carlos Goicoechea, director de este trabajo. Profesor, siempre serás la madurez académica deseada. Tus consejos me seguirán moldeando y dirigiendo en la búsqueda de la excelencia. A los que ya no están, pero siempre serán fuente de inspiración. Gracias por hacer realidad este sueño.
PeerJ
The purpose of this study is to present the development and analysis of the factorial structure a... more The purpose of this study is to present the development and analysis of the factorial structure and psychometric properties of a new self-administered questionnaire (Dizziness Fear-Avoidance Behaviours and Beliefs Inventory (D-FABBI)) designed to measure fear-avoidance behaviors and cognitions related to dizziness disability. A mixed-method design combining a qualitative study with an observational and cross-sectional study was employed to develop (content validity) and psychometrically validate (construct validity, reliability, and convergent/discriminant validity) a new instrument. A total of 198 patients with vestibular disorders (acute vestibular syndrome (AVS), 23.2%; chronic vestibular syndrome (CVS), 35.4%; and episodic vestibular syndrome (EVS) 41.4%) were recruited. Sociodemographic characteristics, the Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS) and D-FABBI were evaluated. The final version of the D-FABBI consists of 17 items dis...
Prescription of Therapeutic Exercise in Migraine. An Evidence-Based Clinical Practice Guideline of the Professional College of Physiotherapists of the Community of Madrid
The main objective of this clinical practice guideline is to provide a series of recommendations ... more The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and conditioning coaches, regarding exercise prescription for patients with migraine. This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exer...
Translational Biomedicine, 2016
This paper presents a systematic review of robotic devices and therapies for cerebral palsy (CP),... more This paper presents a systematic review of robotic devices and therapies for cerebral palsy (CP), trying to shed some light on the present literature on robot-based CP rehabilitation. Background: Recent publications have demonstrated that robot-assisted therapies may constitute an effective tool for the compensation and rehabilitation of the functional skills of people with CP. The most important robotic devices for lower and upper limb rehabilitation were selected, specifying the assisted therapies, experiments done with them, and their results in children with CP. Methods: Scientific articles were obtained by means of an extensive search in electronic databases, primarily PubMed and Scopus. Papers published from the year 2000 to 2015 were considered for inclusion. The search was performed by using the following keywords in combination: robot, Cerebral Palsy, children, and therapies. Moreover, some web pages about CP organizations were used to complete the review. There is still a lack of randomized clinical trials with a representative number of subjects, which makes it difficult to evaluate the impact of robot-based therapy, especially the long-term effects. The inclusion of cognitive aspects into the therapies and the design of virtual scenarios in combination with robotic devices provide promising results.
Surgeries
A retrospective study that aims to analyze the safety and efficacy of single-event multilevel sur... more A retrospective study that aims to analyze the safety and efficacy of single-event multilevel surgery (SEMLS) involving bifocal femoral osteotomy (BFO) performed in nine non-ambulatory children with neuromuscular diseases (NMD), with a median age of 12.86 years, to resolve both hip subluxation and ipsilateral knee flexion contracture that impaired standing, and to evaluate patient and caregiver satisfaction. Results: Median surgical time was 4 h 15 min (2 h 35 min–5 h 50 min). Hip flexion deformity improved by a median of 30° (15–35), while median improvement in knee flexion deformity was 30° (20–50). Only two patients could use a standing frame prior to surgery, although with increasing difficulty, while all children could use it following SEMLS. Mean follow-up was 27.47 months (24.33–46.9). Significant blood loss requiring transfusion was the only complication recorded (8/9). All caregivers reported slight, moderate, or significant improvement in all domains of the questionnaire, ...
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Papers by Sergio Lerma Lara