Abstract
Background: Robotic devices have been used to rehabilitate walking function after stroke. Although results suggest that post-stroke patients benefit from this non-conventional therapy, there is no agreement on the optimal robot-assisted approaches to promote neurorecovery. Here we present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control.Method: Ten healthy individuals and a post-stroke patient participated in the study and were enrolled in a pilot intervention protocol that involved performance of ankle movements following different trajectories via video game visual feedback. The system autonomously modulated task difficulty according to the performance to increase the challenge. We hypothesized that motor learning throughout training sessions would lead to increased corticospinal excitability of dorsi-plantarflexor muscles. Transcranial Magnetic Stimulation was used to assess the effects on corticospinal excitability.Results: Improvements have been observed on task performance and motor outcomes in both healthy individuals and post-stroke patient case study. Tibialis Anterior corticospinal excitability increased significantly after the training; however no significant changes were observed on Soleus corticospinal excitability. Clinical scales showed functional improvements in the stroke patient.Discussion and Significance: Our findings both in neurophysiological and performance assessment suggest improved motor learning. Some limitations of the study include treatment duration and intensity, as well as the non-significant changes in corticospinal excitability obtained for Soleus. Nonetheless, results suggest that this robotic training framework is a potentially interesting approach that can be explored for gait rehabilitation in post-stroke patients.
Highlights
Stroke affects each year around 13.7 million people worldwide, is the second leading cause of disability and may result in a series of motor impairments including gait abnormalities (Barroso et al, 2017; World Stroke Organization, 2018)
We aimed at exploring the validity of combining the robotic ankle exoskeleton with a video game designed to promote motor learning in a therapy protocol involving autonomously customized control
We found a significant increase in Tibialis Anterior (TAnt) Motor Evoked Potentials (MEPs) peak-topeak amplitude, supporting the hypothesis that an increase in performance has a relationship with corticospinal excitability
Summary
Stroke affects each year around 13.7 million people worldwide, is the second leading cause of disability and may result in a series of motor impairments including gait abnormalities (Barroso et al, 2017; World Stroke Organization, 2018). A possible shortcoming of robotic guidance is that this approach might as well reduce patients’ effort, and the possible benefits of the therapy (Rowe et al, 2017) In this vein, Goodman et al (2014) designed a video game that decreased the level of assistance delivered to the ankle joint by the robot if the performance (assessed as a function of the smoothness of trajectories) increased. Other strategies involve adding resistance to make the task more challenging when the performance of the user improves, which can potentially increase engagement in the task (Ren et al, 2011) These two opposite strategies found evidence of enhanced motor learning markers, there is still no consensus regarding the effects of using either type of robotic guidance. We present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control
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