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Mobility restoration for paralysed persons

Objective

1. Stimulation of research into new technologies which are admitting of meaningful application for the benefit of the disabled users.
2. Multi-centre trials of existing devices and of new technologies, exchange of evaluation results among the Centres involved in order to improve their value and reliability.
3. Coordination of methodologies and protocols for technical, functional and clinical evaluation of mobility aids.
4. Dissemination of research and testing results to industries, research centres and rehabilitation Centres throughout Europe.
The major achievements of a European project to evaluate technical aids for paralysed people are as follows:
techniques and algorithms have been developed for investigation into human gait modelization and functional evaluation of walking recovery in paralysed patients;
creation of a European network for multicentre clincial trials of the assistive devices for restoration of walking in patients with high level spinal lesions, using the same methods and protocols for patient selection, training, device adaptation and patient assessment;
research into electrodes (surface and implantable) and stimulation patterns for functional electrical stimulation (FES), supported also by experiments on animals;
development of models for control strategies in walking by FES and their preliminary validation on patients;
investigation into the ergonomics of wheelchairs and into its influence on design parameters, construction aspects, prescription criteria and fitting processes;
study of technical testing techniques and methodologies and investigation into their comparability in view of promoting implementation of international standards;
development and validation of methodologies for consumer testing of wheelchairs;
identification of obstacles and solutions for wheelchairs testing information disclosure at European level so as to ensure coherence with either the International Organization for Standardization (ISO) standards or the European Handynet information system;
definition of a preliminary agreement among the 6 European wheelchair testing institutes to circulate the test reports, according to common guidelines;
promotion of an infrastructure for ensuring that the expertise of the testing centres be exploited in the framework of the CEN standardization activities.

More than 200 paraplegic patients in Europe are now using advanced mechanical orthoses which have been developed or tested in the framework of this project and almost 20 hybrid systems (mechanical orthose s and FES) in Europe have been fitted with surface or implanted electrodes. A better insight has been achieved into the benefits of either functional or therapeutic walking in paraplegics and a clinical network for walking restoration has been created, including 22 centres in 5 countries.
This Concerted Action is addressed towards paralysed persons, who represent a high percentage among the physically disabled persons, although many other groups of disabled could benefit from the results of this Action. Most of those persons are paralysed as a result of spinal injuries (paraplegics, quadriplegics), of cerebral palsy, of neuromuscular diseases.

Assistive technology for mobility restoration assumes great importance for the achievement of independence and better quality of life, for social integration, for access to job opportunities, school integration and social relationships.

This Concerted Action took great advantages from the previous Concerted Action Evaluation of Assistive Devices for Paralyzed Persons, which explored all the ranges of technical aids and was able to identify the necessary priorities and the available multidisciplinary competences, stimulating initiatives and research in this field. The MORE aimed at a deeper insight into a more restricted scope which was given higher priority, ie mobility restoration.

On the ground of:
- the present state of technology and of the market
- the priority needs of most paralysed persons in Europe
- the research activities currently in progress in Europe the following areas were addressed:

1. Walking Restoration in Paraplegics (WREP), including:
mechanical devices
functional electrical stimulation (with implanted or surface electrodes)
hybrid systems (combining mechanical devices and FES)
2. Technical Aids for Independent Mobility (TAIM), including:
wheelchairs (manual and electric wheelchairs)
cars (adaptation of cars, modifications of car controls, special cars).

Funding Scheme

CON - Coordination of research actions

Coordinator

Fondazione "Pro Juventute" Don Carlo Gnocchi
Address
Via Gozzadini 7
20148 Milano
Italy