Abstract
BackgroundFunctional training is becoming the state-of-the-art therapy approach for rehabilitation of individuals after stroke and spinal cord injury. Robot-aided treadmill training reduces personnel effort, especially when treating severely affected patients. Improving rehabilitation robots towards more patient-cooperative behavior may further increase the effects of robot-aided training. This pilot study aims at investigating the feasibility of applying patient-cooperative robot-aided gait rehabilitation to stroke and incomplete spinal cord injury during a therapy period of four weeks. Short-term effects within one training session as well as the effects of the training on walking function are evaluated.MethodsTwo individuals with chronic incomplete spinal cord injury and two with chronic stroke trained with the Lokomat gait rehabilitation robot which was operated in a new, patient-cooperative mode for a period of four weeks with four training sessions of 45 min per week. At baseline, after two and after four weeks, walking function was assessed with the ten meter walking test. Additionally, muscle activity of the major leg muscles, heart rate and the Borg scale were measured under different walking conditions including a non-cooperative position control mode to investigate the short-term effects of patient-cooperative versus non-cooperative robot-aided gait training.ResultsPatient-cooperative robot-aided gait training was tolerated well by all subjects and performed without difficulties. The subjects trained more actively and with more physiological muscle activity than in a non-cooperative position-control mode. One subject showed a significant and relevant increase of gait speed after the therapy, the three remaining subjects did not show significant changes.ConclusionsPatient-cooperative robot-aided gait training is feasible in clinical practice and overcomes the main points of criticism against robot-aided gait training: It enables patients to train in an active, variable and more natural way. The limited number of subjects in this pilot trial does not permit valid conclusions on the effect of patient-cooperative robot-aided gait training on walking function. A large, possibly multi-center randomized controlled clinical trial is required to shed more light on this question.
Highlights
Functional training is becoming the state-of-the-art therapy approach for rehabilitation of individuals after stroke and spinal cord injury
For the Lokomat, studies with stronger focus on nonambulatory subjects found advantages of robot-aided gait training over manually assisted gait training [29,30,31,32], while studies focusing on ambulatory subjects found manually assisted gait training to be more effective [33,34]. These results suggest that currently, robot-aided treadmill training is most effective for severely affected, nonambulatory patients, whereas it may not be ideal for more advanced, ambulatory patients
We have previously investigated the immediate effects of the Path Control strategy versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury
Summary
Functional training is becoming the state-of-the-art therapy approach for rehabilitation of individuals after stroke and spinal cord injury. Patients with motor dysfunction due to lesions of their central nervous system (CNS) typically undergo physical and occupational therapy for rehabilitation In the past, this therapy mainly consisted of stretching, bracing and sufficiently encouraged to use them. This therapy mainly consisted of stretching, bracing and sufficiently encouraged to use them This (psychological) state would be unfavorable in the perspective of neural plasticity, as the CNS is not driven to reorganize itself in support of the affected limbs. Body-weight supported treadmill training In the light of neural plasticity and basic principles of motor learning it seems apparent that rehabilitation training should be task specific, i.e. if the aim is to relearn walking, one should practice walking. This common-sense argument for task specificity has been demonstrated to be valid by a large body of research, e.g. [8,9,10,11,12]
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