Effects Of Robotic Gait Training Research Articles

Effect of robotic gait training on muscle and bone characteristics in spinal cord transected rats.

Osteoporosis and loss of muscle mass are secondary issues with spinal cord injury. Robotic gait training has provided evidence of increasing bone density and muscle mass, but its effect on bone strength is undetermined. The purpose of this study was to determine the effect of a 6-week robotic locomotion training program on skeletal muscle mass and bone characteristics. Twelve female Sprague-Dawley rats received a mid-thoracic spinal cord transection at 5 days old and at 3 weeks old were assigned to a Control or Trained Group. The Trained Group performed 5-min sessions on the Rat Stepper 5 days a week for 6 weeks with 90% of body weight supported. At the end of the 6 weeks, body mass was obtained and right femurs and four lower extremity muscles were harvested. Femur bone mineral density was measured with DXA and mechanical characteristics of the femur were determined via 3-point bending testing. Independent t-tests, effects sizes and percent differences were computed between the two groups (p < 0.05). The Trained Group had significantly larger normalized femur mass (p = 0.007) and normalized soleus muscle mass (p = 0.033) when compared to the Control Group. There was a medium or large effect size with the Trained Groups' femurs having larger mass, bone mineral density, rupture loads, cortical wall thickness, shaft cross sectional area, soleus mass, normalized gastrocnemius mass, and smaller shaft inner diameters compared to the Control Group. These changes may contribute to decreasing osteoporosis and fracture risk in those with spinal cord injuries.

Effects of Robotic Gait Training with Lower Extremity Restraint on Static Balance, Lower Extremity Function, Gait Ability in Subacute Stroke Patients

Effects of Robotic Gait Training with Lower Extremity Restraint on Static Balance, Lower Extremity Function, Gait Ability in Subacute Stroke Patients

Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy

ObjectiveRobotic gait training presents a promising training modality. Nevertheless, evidence supporting the efficacy of such therapy in children with cerebral palsy remains insufficient. This study aimed to assess the effect of robotic gait training in children/adolescents with cerebral palsy. MethodsTwenty-four children/adolescents with bilateral cerebral palsy (12 female, 10.1 ± 3.1 years, Gross Motor Function Classification System II to IV) took part in this study. They received two 30−45 min sessions/week of Lokomat training for 12-weeks. Muscle strengths, 6-min walk exercise and gait parameters were evaluated pre- and post-training and at 6-months-follow-up. Training effect according to the level of impairment severity (moderate vs severe) was analyzed using a change from the baseline procedure. ResultsA significant increase in muscle strength was observed after training (p ≤ 0.01). Hip flexors and knee extensors strength changes were maintained or improved at follow-up (p < 0.05). Comfortable walking speed was significantly increased by +20% after training with a slight reduction at follow-up compared to post-training condition (−2.7%, p < 0.05). A significant step length increase was observed after training (14%, p ≤ 0.001). The distance covered in 6 min was higher in post-training (+24%, p ≤ 0.001) and maintained at follow-up compared to pre-training conditions. No significant changes in kinematic patterns were observed. The analysis by subgroup showed that both groups of children (with moderate and severe impairments) improved muscle strength and walking capacities after Lokomat training. ConclusionThe suggested Lokomat training induced improvement in walking capacity of children/adolescents with cerebral palsy whatever the level of severity. Hence, Lokomat training could be viewed as a valuable training modality in this population.

The Effect Of Robotic Gait Training On Spinal Cord Transected Rat Femurs

Robotic locomotor training has been shown to be effective for significantly improving body composition and making some moderate, but not significant, changes in bone mineral density in individuals with spinal cord injury (Karalis et al., 2017). The effect of the training on other important mechanical properties of bone is unknown. PURPOSE: To determine the effects of 8 weeks of robotic locomotor training on mechanical properties of rat bones. METHODS: Twelve female Sprague-Dawley rats received spinal cord transections at 5 days old. At 3 weeks old, half of them were randomly assigned to a Training group and half to a Control group. The Training group received 5 minutes of robotic gait training with 90% body support for 5 days a week for 8 weeks. The Control group received no exercise. At the conclusion of the 8 weeks, the animals were euthanized and the right femurs were harvested for testing. Anthropometric measures and 3-point bending tests using an Instron material testing system (Norwood, MA) were performed. Independent t-tests were used to determine differences between the two groups (p < 0.05). RESULTS: There was no difference in body mass between the two groups prior to group assignments, but after 6 weeks of training the Control group had greater mass (p = 0.035) and at the end of training this difference continued (mass = 210.3 ± 36.0 g vs. 166.7 ± 14.5 g; p = 0.012). The Control group’s femur mass was significantly larger (p = 0.041), but when considered as a percentage of body mass, the Training group’s femur mass was larger (p = 0.014). Peak load and rupture loads were not different between the two groups, but when normalized for body mass the Training group had larger load values than the Control group (59.0±2.7% and 53.3±12.1% for the Training and 52.4±2.0% and 41.6±8.7% for Control; p = 0.001 and p = 0.035, respectively). The deflection at rupture was greater for the Control group (0.75 ± 0.09 mm vs. 0.59 ± 0.14 mm; p = 0.025), as was the energy absorbed (57.0 ± 6.1 mJ vs. 39.6 ± 12.1 mJ; p = 0.009). There were some differences in midshaft diameters, but the cross-sectional areas were not different between the two groups. CONCLUSION: Rats who experienced training had stronger and more massive femurs than those who experienced no training. This work was supported by NSF 0850516.

Effects of robotic gait training after stroke: A meta-analysis.

Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09m/s, 95% confidence interval [CI] 0.03 to 0.15; p=0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p=0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p=0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke.

Spatiotemporal gait characteristic changes with gait training using the hybrid assistive limb for chronic stroke patients

BackgroundRobotic rehabilitation has been attracting attention as a means to carry out "intensive", "repetitive", "task-specific", gait training. The newly developed robotic device, the Hybrid Assistive Limb (HAL), is thought to have the possibility of having an excellent effect on gait speed improvement over the conventional automatic programed assist robot. The purpose of this study was to investigate the spatiotemporal characteristics related to gait speed improvement using the HAL in chronic stroke patients. Research questionTo investigate the effects of robotic gait training on gait speed and gait parameters. MethodsAn observational study with an intervention for single group was used. Intervention was conducted in University Hospital. Eleven chronic stroke patients were enrolled in this study. The patients performed 8 gait training sessions using the HAL, 2–5 sessions/week for 3 weeks. Gait speed, stride length, cadence, time of gait cycle (double-limb stance phases and single-limb stance phases) and time asymmetry index were measured before and after intervention. ResultsAfter intervention, gait speed, stride length, and cadence were significantly improved (Effect size = 0.39, 0.29, and 0.29), the affected initial double-limb stance phase was significantly shortened (from 15.8 ± 3.46%–13.3 ± 4.20%, p = .01), and the affected single-limb stance phase was significantly lengthened (from 21.8±7.02%–24.5±7.95%, p < .01). The time asymmetry index showed a tendency to improve after intervention (from 22.9±11.8–17.6±9.62, p = .06). There was a significant correlation between gait speed and the stride length increase rate (r = .72, p = .01). SignificanceThis study showed that increasing stride length with lengthening of the affected single-stance phase by gait training using the HAL improved gait speed in chronic stroke patients. However, the actual contributions on HAL cannot be separated from gait training because this study is an observational research without a control group.

Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial.

Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke. Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n = 10) or sham tDCS + cathodal tsDCS (group 2; n = 10) or tDCS + cathodal tsDCS (group 3; n = 10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment. Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P = 0.015; 2-week follow-up P = 0.001) and between group 3 and group 2 (post-treatment P = 0.010; 2-week follow-up P = .015). No difference was found between group 2 and group 1. Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke.

Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson's disease: A randomized controlled trial

BackgroundThere is a lack of evidence about the most effective strategy for training gait in mild to moderate Parkinson's disease. The aim of this study was to compare the effects of robotic gait training versus equal intensity treadmill training and conventional physiotherapy on walking ability in patients with mild to moderate Parkinson's disease. MethodsSixty patients with mild to moderate Parkinson's disease (Hoehn & Yahr stage 3) were randomly assigned into three groups. All patients received twelve, 45-min treatment sessions, three days a week, for four consecutive weeks. The Robotic Gait Training group (n = 20) underwent robot-assisted gait training. The Treadmill Training group (n = 20) performed equal intensity treadmill training without body-weight support. The Physical Therapy group (n = 20) underwent conventional gait therapy according to the proprioceptive neuromuscular facilitation concept. Patients were evaluated before, after and 3 months post-treatment. Primary outcomes were the following timed tasks: 10-m walking test, 6-min walking test. ResultsNo statistically significant difference was found on the primary outcome measures between the Robotic Gait Training group and the Treadmill Training group at the after treatment evaluation. A statistically significant improvement was found after treatment on the primary outcomes in favor of the Robotic Gait Training group and Treadmill Training group compared to the Physical Therapy group. Findings were confirmed at the 3-month follow-up evaluation. ConclusionsOur findings support the hypothesis that robotic gait training is not superior to equal intensity treadmill training for improving walking ability in patients with mild to moderate Parkinson's disease.

Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury

The objectives in this study were to investigate the effect of robot-assisted gait training on cardiorespiratory fitness in subjects with motor incomplete spinal cord injury and document the exercise intensity of robotic walking in comparison with the recommended guidelines. Ten patients followed a 24-session training program with a robotic gait orthosis in addition to physiotherapy sessions completed within 10 to 16 wk. Cardiorespiratory fitness was determined in a graded arm crank exercise test before and after the training program. To assess the intensity of robot-assisted walking, oxygen consumption (VO2) and heart rate (HR) were measured during a training session early in and at the end of the training program, and exercise intensity measures (percentage of VO2 reserve [%VO2R], percentage of HR reserve [%HRR], and metabolic equivalents [METs]) were calculated. Whereas no changes were found in peak VO2, the resting and submaximal HR at a constant work load were significantly lower after training. Most subjects exercised at low intensity (<30%VO2R, <30%HRR, <3.0 METs), and only two subjects exercised at moderate intensity (>3.0 METs). In spite of the low exercise intensity of the training program and no changes in peak VO2, robot-assisted gait training induced some improvement in cardiorespiratory fitness, as suggested by lower resting and submaximal HR values.

Robotic gait training in patients with impaired consciousness due to severe traumatic brain injury

Primary objective: This prospective controlled non-randomized study investigated the effects of robotic gait training on electroencephalographic (EEG) brain activity in patients with impaired consciousness due to severe traumatic brain injury (TBI).Methods: Twelve TBI patients and 14 healthy controls underwent a single training session on a computer-driven gait orthosis (Lokomat®). The sensory pathways were assessed using sensory evoked potentials (SEPs). The global delta-alpha EEG power ratio (DAR) and latency of the P300 component of the event-related potentials was assessed prior to and following a training session.Results: Baseline measurements showed impaired SEPs in the majority of patients and significantly larger DAR in patients compared to healthy controls. Robotic gait training resulted in a reduction of the DAR in healthy subjects but not in patients. No changes were observed in P300 latencies after training in either patients or healthy controls.Conclusion: The study showed that robotic gait training induced measurable changes in the EEG power spectrum in healthy individuals, while no changes were observed in patients with severe TBI. The absence of the EEG changes following training might be an indicator of the severity of brain dysfunction.