Abstract
BackgroundThe Andago is a rehabilitation robot that allows training walking over-ground while providing bodyweight unloading (BWU). We investigated the practicability, acceptability, and appropriateness of the device in children with gait impairments undergoing neurorehabilitation. Concerning appropriateness, we investigated whether (i) stride-to-stride variability of the stride time and inter-joint coordination was higher when walking over-ground in Andago versus treadmill walking, and (ii) activation of antigravity leg muscles decreased with higher levels of BWU.MethodsEighteen children and adolescents with gait impairments participated in three sessions. Practicability was assessed by determining the time needed to get a patient in and out of Andago, the accuracy of the BWU system, and other aspects. Acceptability was assessed by patients responding to questions, while six therapists filled out the System Usability Scale. To determine appropriateness, the participants were equipped with surface electromyography (sEMG) electrodes, electrogoniometers and accelerometers. Various parameters were compared between walking over-ground and on a treadmill, and between walking with three different levels of BWU (median: 20%, 35% and 50% of the bodyweight) over-ground.ResultsPracticability: the average time needed to get in and out of Andago amounted to 60 s and 16 s, respectively. The BWU system seemed accurate, especially at higher levels. We experienced no technical difficulties and Andago prevented 12 falls. However, participants had difficulties walking through a door without bumping into it. Acceptability: after the second session, nine participants felt safer walking in Andago compared to normal walking, 15 preferred walking in Andago compared to treadmill walking, and all wanted to train again with Andago. Therapists rated the usability of the Andago as excellent. Appropriateness: stride-to-stride variability of stride duration and inter-joint coordination was higher in Andago compared to treadmill walking. sEMG activity was not largely influenced by the levels of BWU investigated in this study, except for a reduced M. Gluteus Medius activity at the highest level of BWU tested.ConclusionsThe Andago is a practical and well-accepted device to train walking over-ground with BWU in children and adolescents with gait impairments safely. The system allows individual stride-to-stride variability of temporospatial gait parameters without affecting antigravity muscle activity strongly.Trial registration: ClinicalTrials.gov Identifier: NCT03787199.
Highlights
The Andago is a rehabilitation robot that allows training walking over-ground while providing body‐ weight unloading (BWU)
Participants Twenty participants were recruited, but data were obtained from 18 children (ID17 walked too fast to walk in the Andago, and ID04 was not compliant enough and stopped after the first session)
Pie-charts showing the number of participants who a felt safer walking in Andago compared to normal walking, b preferred to train with Andago compared to treadmill walking, and c would like to train again with Andago. d Individual patient responses, whether it was cool training in Andago
Summary
The Andago is a rehabilitation robot that allows training walking over-ground while providing body‐ weight unloading (BWU). Acceptability, and appropriateness of the device in chil‐ dren with gait impairments undergoing neurorehabilitation. Concerning appropriateness, we investigated whether (i) stride-to-stride variability of the stride time and inter-joint coordination was higher when walking over-ground in Andago versus treadmill walking, and (ii) activation of antigravity leg muscles decreased with higher levels of BWU. Independent mobility, though, is important for the developing child as it allows exploring its surroundings and enhance socioemotional expression and interaction with the caregivers and other family members [1]. Improving gait is an important rehabilitation goal for the patient and his/her social environment. For this reason, rehabilitative interventions often focus on (re-)learning to walk. Depending on the severity of the patient’s impairments, physical support needs to be adjusted, for example, by having one or two physio therapists keeping the patient upright while assisting leg movements and preventing falls, perhaps in combination with the use of walking-aids like parallel bars or walkers
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