Abstract
BackgroundLocomat is a robotic exoskeleton providing guidance force and bodyweight support to facilitate intensive walking training for people with stroke. Although the Locomat has been reported to be effective in improving walking performance, the effects of training parameters on the neuromuscular control remain unclear. This study aimed to compare the muscle activities between Locomat walking and treadmill walking at a normal speed, as well as to investigate the effects of varying bodyweight support and guidance force on muscle activation patterns during Locomat walking in people with stroke.MethodsA cross-sectional study design was employed. Participants first performed an unrestrained walking on a treadmill and then walked in the Locomat with different levels of bodyweight support (30% or 50%) and guidance force (40% or 70%) at the same speed (1.2 m/s). Surface electromyography (sEMG) of seven muscles of the affected leg was recorded. The sEMG envelope was time-normalised and averaged over gait cycles. Mean sEMG amplitude was then calculated by normalising the sEMG amplitude with respect to the peak amplitude during treadmill walking for statistical analysis. A series of Non-parametric test and post hoc analysis were performed with a significance level of 0.05.ResultsFourteen participants with stroke were recruited at the Yangzhi Affiliated Rehabilitation Hospital of Tongji University (female n = 1; mean age 46.1 ± 11.1 years). Only the mean sEMG amplitude of vastus medialis oblique during Locomat walking (50% bodyweight support and 70% guidance force) was significantly lower than that during treadmill walking. Reducing both bodyweight and guidance increased muscle activity of gluteus medius and tibialis anterior. Activity of vastus medialis oblique muscle increased as bodyweight support reduced, while that of rectus femoris increased as guidance force decreased.ConclusionsThe effects of Locomat on reducing muscle activity in people with stroke were minimized when walking at a normal speed. Reducing bodyweight support and guidance force increased the activity of specific muscles during Locomat walking. Effects of bodyweight support, guidance force and speed should be taken into account when developing individualized Locomat training protocols for clients with stroke.
Highlights
Gait disturbance is one of the major consequences associated with stroke
The present study found that the application of bodyweight support (BWS) and guidance force (GF) during Locomat walking only reduced the muscle activity in vastus medialis oblique (VMO) compared to unrestrained treadmill walking in people with stroke when a normal speed was selected
The results of this study showed that reducing BWS and GF led to increased muscle activities in gluteus medius (GM), VMO rectus femoris (RF) and tibialis anterior (TA)
Summary
Gait disturbance is one of the major consequences associated with stroke. Due to the impaired supraspinal control, the gait pattern post stroke is characterized as muscle weakness, spasticity, abnormal muscular amplitude and asymmetrical temporal ordering of muscle activity [1, 2]. Various robot-assisted gait trainers, like Locomat, G-EO system Evolution and Gait Trainer, have been designed and implemented in gait rehabilitation for stroke patients [9,10,11,12,13,14,15] These gait trainers enable a repetitive walking training with predefined normal gait pattern and largely reduce the physical demand of therapists [16]. Those robot-assisted gait trainers, like Locomat (Hocoma, Switzerland), can provide a range of adjustable functions, including bodyweight support (BWS), guidance force (GF) and walking speed, allowing clinicians to develop an individualised training protocol that best fits patient’s ability level [17, 18]. This study aimed to compare the muscle activities between Locomat walking and treadmill walking at a normal speed, as well as to investigate the effects of varying bodyweight support and guidance force on muscle activation patterns during Locomat walking in people with stroke
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