Abstract
Robot-aided gait therapy offers a promising approach towards improving gait function in individuals with neurological disorders such as stroke or spinal cord injury. However, incorporation of appropriate control strategies is essential for actively engaging the patient in the therapeutic process. Although several control algorithms (such as assist-as-needed and error augmentation) have been proposed to improve active patient participation, we hypothesize that the therapeutic benefits of these control algorithms can be greatly enhanced if combined with a motor learning task to facilitate neural reorganization and motor recovery. Here, we describe an active robotic training approach (patient-cooperative robotic gait training combined with a motor learning task) using the Lokomat and pilot-tested whether this approach can enhance active patient participation during training. Six neurologically intact adults and three chronic stroke survivors participated in this pilot feasibility study. Participants walked in a Lokomat while simultaneously performing a foot target-tracking task that necessitated greater hip and knee flexion during the swing phase of the gait. We computed the changes in tracking error as a measure of motor performance and changes in muscle activation as a measure of active subject participation. Repeated practice of the motor-learning task resulted in significant reductions in target-tracking error in all subjects. Muscle activation was also significantly higher during active robotic training compared to simply walking in the robot. The data from stroke participants also showed a trend similar to neurologically intact participants. These findings provide a proof-of-concept demonstration that combining robotic gait training with a motor learning task enhances active participation.
Highlights
Physical therapy is an important component of recovery after a neurological injury, such as stroke or spinal cord injury [1]
The inclusion of a motor learning task in the current approach is based on a large body of evidence that suggests that the human brain has a remarkable ability to undergo structural and functional alterations in response to motor training and skill acquisition [7], [8], [9], [10]
Because neuroplasticity is critical for recovery after a neurological injury, it has been suggested that the same mechanisms underlying motor learning may contribute to motor recovery after injury [28], [29]
Summary
Physical therapy is an important component of recovery after a neurological injury, such as stroke or spinal cord injury [1]. With the growing aging population and associated ailments, there is a great demand for physical therapy services. Using robots to assist in providing therapy is a promising approach to meet this heightened demand [2]. There are several advantages in using robots to assist during therapy. The dosage of therapy, which is a strong determinant of neural plasticity and recovery, can be substantially increased. Therapy can be provided in diverse and novel dynamic environments, which may be critical for generalizing motor recovery to tasks other than those that are practiced. Patient performance and progression can be objectively monitored using sensors built into the robot
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