Abstract
Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients. Neuroprosthetic technology can contribute to increase the efficacy of a training paradigm in the promotion of a locomotor pattern. Robotic exoskeletons can be used to manage the unavoidable loss of performance of artificially driven muscles. Hybrid exoskeletons blend complementary robotic and neuro-prosthetic technologies. The aim of this pilot study was to determine the effects of hybrid gait training in three case studies with persons with incomplete spinal cord injury (iSCI) in terms of locomotion performance during assisted gait, patient-robot adaptations, impact on ambulation and assessment of lower limb muscle strength and spasticity. Participants with iSCI received interventions with a hybrid bilateral exoskeleton for 4 days. Assessment of gait function revealed that patients improved the 6 min and 10 m walking tests after the intervention, and further improvements were observed 1 week after the intervention. Muscle examination revealed improvements in knee and hip sagittal muscle balance scores and decreased score in ankle extensor balance. It is concluded that improvements in biomechanical function of the knee joint after the tested overground hybrid gait trainer are coherent with improvements in gait performance.
Highlights
Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients
We report the effects of hybrid gait training in three cases of persons with incomplete spinal cord injury (iSCI) in terms of locomotion performance during assisted gait with and without electrical muscle stimulation (EMS), patient-robot adaptations, impact on ambulation and assessment of lower limb muscle strength and spasticity
The purpose of this study was the assessment of the effects of the overground gait therapy by means of overground exoskeletons with neuro-prosthetic control
Summary
Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients. With training functional movements under close physiological conditions, sensory inputs and central neuronal circuits become activated, with important spinal cord regeneration effects. Such training paradigm of stepping that relies on the entrainment of control of movement by driving the limbs through trajectories can be implemented with wearable actuated exoskeletons. The importance of the EMS-induced gait training approach emerges from the demonstrated benefits it provides to the patient, mainly related to muscle strength and cardiorespiratory fitness (Creasey et al, 2004; Nightingale et al, 2007; Graupe et al, 2008; Lam et al, 2010)
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