Gait Training System Research Articles

Effects of virtual reality with robot training on the gait of subacute stroke patients

Ambulation is always one of the most significant issues for post-stroke patients as well as a formidable challenge. There was few study, to our best knowledge, focusing on the kinetic and kinematic changes resulting from training using robotic devices with virtual reality (VR) for subacute stroke patients. Thus, we analyzed the gait parameters of these patients at 1week and 3 weeks after they suffered the disease. Twenty patients were included in this single blind randomized control study. Patients were randomized to either a VR with robot group ( n = 10) or non-VR group ( n = 10). The training was performed on a robotic gait-training system with situational interaction. Subjects in VR group were trained 5 times a week for two weeks for approximately 30 minutes every time. Others were trained by traditional therapies. After the two-week training, the step time of patients in VR group significantly decreased (from 0.88 ± 0.29 to 0.77 ± 0.16), while the stride length average (from 0.72 ± 0.26 to 0.81 ± 0.25), step length average (from 0.36 ± 0.12 to 0.42 ± 0.10) and walking speed average (from 0.49 ± 0.25 to 0.59 ± 0.23) significantly increased ( P < 0.05). Subjects in VR group demonstrated an obviously larger improvement in the maximum hip moment and minimum ankle moment ( P = 0.028 and P = 0.040, respectively) compared with those in non-VR group. VR training with robot system could also be applied, as traditional therapy, in rehabilitation process of subacute stroke patients, especially in the improvement of step length and walking speed.

Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia.

The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Structural analysis of a rehabilitative training system based on a ceiling rail for safety of hemiplegia patients.

The body-weight support (BWS) function, which helps to decrease load stresses on a user, is an effective tool for gait and balance rehabilitation training for elderly people with weakened lower-extremity muscular strength, hemiplegic patients, etc. This study conducts structural analysis to secure user safety in order to develop a rail-type gait and balance rehabilitation training system (RRTS). The RRTS comprises a rail, trolley, and brain-machine interface. The rail (platform) is connected to the ceiling structure, bearing the loads of the RRTS and of the user and allowing locomobility. The trolley consists of a smart drive unit (SDU) that assists the user with forward and backward mobility and a body-weight support (BWS) unit that helps the user to control his/her body-weight load, depending on the severity of his/her hemiplegia. The brain-machine interface estimates and measures on a real-time basis the body-weight (load) of the user and the intended direction of his/her movement. Considering the weight of the system and the user, the mechanical safety performance of the system frame under an applied 250-kg static load is verified through structural analysis using ABAQUS (6.14-3) software. The maximum stresses applied on the rail and trolley under the given gravity load of 250 kg, respectively, are 18.52 MPa and 48.44 MPa. The respective safety factors are computed to be 7.83 and 5.26, confirming the RRTS’s mechanical safety. An RRTS with verified structural safety could be utilized for gait movement and balance rehabilitation and training for patients with hemiplegia.

Development of Movable Gait Training System with Body Weight Support

Development of Movable Gait Training System with Body Weight Support

A novel Robotic Gait Training System (RGTS) may facilitate functional recovery after stroke: A feasibility and safety study.

Robot-assisted gait training has been introduced as a practical treatment adjunctive to traditional stroke rehabilitation to provide high-intensity repetitive training. The design of robots is usually based on either the end-effector and exoskeleton method. The novel Robot Gait Training System (RGTS), a hybrid mixed type of end-effector and exoskeleton, tries to combine advantages from both methods. This preliminary study was conducted to report whether this novel system is feasible and safe when applied to non-ambulatory subacute patients with stroke. Six patients with stroke participated in this study and received 15 daily RGTS sessions. The outcome measures included the lower extremity subscale of the Fugl-Meyer Assessment (FMA-LE), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), and Barthel Index (BI). These measurements were performed at the pretest and posttest. The RGTS demonstrated significant after-before changes in the FMA-LE, PASS, BBS and BI (p < 0.05), which indicated improvements substantially across the neurological status, balance, and activities of daily living after intervention. This study demonstrated that the novel RGTS designed was practical, safe, and suitable to use in substantial leg dysfunction with stroke.

Configurable, wearable sensing and vibrotactile feedback system for real-time postural balance and gait training: proof-of-concept

BackgroundPostural balance and gait training is important for treating persons with functional impairments, however current systems are generally not portable and are unable to train different types of movements.MethodsThis paper describes a proof-of-concept design of a configurable, wearable sensing and feedback system for real-time postural balance and gait training targeted for home-based treatments and other portable usage. Sensing and vibrotactile feedback are performed via eight distributed, wireless nodes or “Dots” (size: 22.5 × 20.5 × 15.0 mm, weight: 12.0 g) that can each be configured for sensing and/or feedback according to movement training requirements. In the first experiment, four healthy older adults were trained to reduce medial-lateral (M/L) trunk tilt while performing balance exercises. When trunk tilt deviated too far from vertical (estimated via a sensing Dot on the lower spine), vibrotactile feedback (via feedback Dots placed on the left and right sides of the lower torso) cued participants to move away from the vibration and back toward the vertical no feedback zone to correct their posture. A second experiment was conducted with the same wearable system to train six healthy older adults to alter their foot progression angle in real-time by internally or externally rotating their feet while walking. Foot progression angle was estimated via a sensing Dot adhered to the dorsal side of the foot, and vibrotactile feedback was provided via feedback Dots placed on the medial and lateral sides of the mid-shank cued participants to internally or externally rotate their foot away from vibration.ResultsIn the first experiment, the wearable system enabled participants to significantly reduce trunk tilt and increase the amount of time inside the no feedback zone. In the second experiment, all participants were able to adopt new gait patterns of internal and external foot rotation within two minutes of real-time training with the wearable system.ConclusionThese results suggest that the configurable, wearable sensing and feedback system is portable and effective for different types of real-time human movement training and thus may be suitable for home-based or clinic-based rehabilitation applications.

CONCURRENT VALIDITY AND TEST-RETEST RELIABILITY OF THE WALKBOT-K SYSTEM FOR ROBOTIC GAIT TRAINING

While the Walkbot-K robotic-assisted gait training systems have rapidly gained widespread acceptance for pediatric locomotor training in children with cerebral palsy, the validity and reliability for the Walkbot-K system have not been well established. The aim of this study is to investigate the validity and test-retest reliability of the innovative exoskeletal Walkbot-K system which is designed to help the active development and learning of fundamental locomotor skills in children with locomotor impairments. The electrogoniometer was used concurrently to compare the sagittal kinematic angular displacement data with that of the Walkbot-K system as a reference standard measure. Neuromechanical data obtained from kinematic measurement produced an excellent validity ([Formula: see text]). The test-retest reliability for kinematic knee angle data showed a remarkable consistency ([Formula: see text]). This study provides the first compelling evidence of the children’s robotic gait-assisted Walkbot-K system’s validity and reliability, indicating that the system is a highly valid and reliable robotic-assisted gait training system to evaluate and treat locomotor dysfunction.

레일형 보행보조기구의 방향전환을 위한 턴 롤러 시스템 개발

It is needed to use the gait training system for the rehabilitation of the disabled and old people. In this study, a gait training system of turn roller type is proposed for the purpose of helping the rehabilitation. A driving mechanism with the turn roller is designed by using the RecurDyn which is the dynamic analysis program. RecurDyn is used to analyze the dynamic behavior of the gait training system. The static load analysis is carried out to investigate the safety of this system. From the operating test of this system, it is noted that the driving error is little and the load capacity is 130 kgf.

Design and Analysis of a Cable-Driven Articulated Rehabilitation System for Gait Training

Assisted motor therapies play a critical role in enhancing functional musculoskeletal recovery and neurological rehabilitation. Our long-term goal is to assist and automate the performance of repetitive motor-therapy of the human lower limbs. Hence, in this paper, we examine the viability of a light-weight and reconfigurable hybrid (articulated-multibody and cable) robotic system for assisting lower-extremity rehabilitation and analyze its performance. A hybrid cable-actuated articulated-multibody system is formed when multiple cables are attached from a ground-frame to various locations on an articulated-linkage-based orthosis. Our efforts initially focus on developing an analysis and simulation framework for the kinematics and dynamics of the cable-driven lower limb orthosis. A Monte Carlo approach is employed to select configuration parameters including cuff sizes, cuff locations, and the position of fixed winches. The desired motions for the rehabilitative exercises are prescribed based upon motion patterns from a normative subject cohort. We examine the viability of using two controllers—a joint-space feedback-linearized PD controller and a task-space force-control strategy—to realize trajectory- and path-tracking of the desired motions within a simulation environment. In particular, we examine performance in terms of (i) coordinated control of the redundant system; (ii) reducing internal stresses within the lower-extremity joints; and (iii) continued satisfaction of the unilateral cable-tension constraints throughout the workspace.

Gait Training System Using a Walking Treadmill and Pedal Stepping for Patients with a Left-Right Difference in Leg Strength

Gait Training System Using a Walking Treadmill and Pedal Stepping for Patients with a Left-Right Difference in Leg Strength

Master–Slave-Type Gait Training System for Hip Movement Disorders

Master–Slave-Type Gait Training System for Hip Movement Disorders

Modification of the ICARE System for Pediatric Therapy

Effective gait therapy is critical to children who have difficulty walking due to developmental, neurologic, or orthopedic conditions. Current gait training technologies can be cost prohibitive and often do not address the needs of children of varying sizes. In addition, clinicians often need to provide significant physical assistance to children with profound weakness. Based on the success of an elliptical-based adult-sized intelligently controlled assistive rehabilitation elliptical (ICARE) system for gait training, a modified technology was proposed to address the needs of younger/smaller children. The new design relied on a screw-and-slider joint to adjust the effective length of the crank link in the elliptical mechanism, reducing the step length and stride height simultaneously. The new trajectories of the foot pedal were normalized against stride length and showed nearly identical trajectories between pediatric strides and adult strides. Simulation results and human usability studies verified that the design was feasible.

Coordinated control strategy for robotic-assisted gait training with partial body weight support

Walking is the most basic and essential part of the activities of daily living. To enable the elderly and non-ambulatory gait-impaired patients, the repetitive practice of this task, a novel gait training robot (GTR) was designed followed the end-effector principle, and an active partial body weight support (PBWS) system was introduced to facilitate successful gait training. For successful establishment of a walking gait on the GTR with PBWS, the motion laws of the GTR were planned to enable the phase distribution relationships of the cycle step, and the center of gravity (COG) trajectory of the human body during gait training on the GTR was measured. A coordinated control strategy was proposed based on the impedance control principle. A robotic prototype was developed as a platform for evaluating the design concepts and control strategies. Preliminary gait training with a healthy subject was implemented by the robotic-assisted gait training system and the experimental results are encouraging.

A robotic gait training system integrating split-belt treadmill, footprint sensing and synchronous EEG recording for neuro-motor recovery.

This paper presents a robotic gait training system for neuro-motor rehabilitation of hemiplegic stroke survivors. The system is composed of a treadmill consisting of two separated belts, footprint array sensor attached below each belt for gait data acquisition, and an electroencephalography (EEG) device for monitoring brain activities during gait training. The split belt treadmill allow physical therapists to set different treadmill belt velocities to modify physical workload of the patients during walking, thus being able to better improve the symmetry of gait phases between affected and unaffected (sound) legs in comparison with conventional treadmills where there is only one single belt. In contrast to in-shoe pressure sensors, the under-belt footprint sensor array designed in this study not only reduces the preparation complexity of gait training but also collects more gait data for motion analysis. Recorded EEG is segmented synchronously with gait-related events. The processed EEG data can be used for monitoring brain-activities during gait training, providing a neurological approach for motion assessment. One subject with simulated stroke using an ankle-foot orthosis participated in this study. Preliminary results indicate the feasibility of the proposed system to improve gait function and monitor neuro-motor recovery.

Correlation between plantar pressure and walking ability in hemiplegic stroke survivors

Objective To explore the correlation between plantar pressure and walking function in hemiplegic stroke patients. Methods Thirty hemiplegic patients with stroke (a hemiplegic group) and thirty age-matched healthy persons (a control group) were recruited. Gait and balance function training and assessment system (model: AL-600) were used to quantify the walking velocity, peak plantar pressure at heel-strike and push-off periods and displacement of center of pressure (DCOP) of all subjects during walking. The asymmetry of gait was calculated. Two independent sample t-test were used to compare the walking velocity, peak plantar pressure and DCOP for the two groups. Pearson correlation coefficients were applied to analyze the correlation between the walking velocity and peak plantar pressure and DCOP. Results The walking velocity, the peak plantar pressure at heel-strike and push-off periods and DCOP of the hemiplegic group were significantly lower than the control group. In the hemiplegic group, the asymmetry of peak plantar pressure and DCOPx significantly increased, while that of DCOPy became bigger without significant difference. Moreover, the walking capacity of the hemiplegic group was positively correlated with the peak plantar pressure and DCOP. Conclusion Among hemiplegic stroke patients, both the peak plantar pressure at heel-strike and push-off periods lower in a way. Their capacity of weight transfer decreases, which is closely related to their walking velocity. Key words: Stroke; Hemiplegia; Gait disorders, Neurologic; Plantar pressure; Walking capacity

2G12 ヒト歩行時の左右対称性を考慮したマスタースレーブ型歩行訓練支援装置の開発(GS9-1:人間支援(1))

2G12 ヒト歩行時の左右対称性を考慮したマスタースレーブ型歩行訓練支援装置の開発(GS9-1:人間支援(1))

1D11 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 免荷装置の開発と評価(OS6:医療機器・再生医療製品のレギュラトリーサイエンス)

1D11 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 免荷装置の開発と評価(OS6:医療機器・再生医療製品のレギュラトリーサイエンス)

2G16 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 短下肢装具部の開発(GS9-1:人間支援(1))

2G16 空気圧人工筋を用いた免荷式歩行訓練システムの開発 : 短下肢装具部の開発(GS9-1:人間支援(1))

2A2-I06 上肢と下肢の協調運動を促す歩行訓練システムの開発 : 踵接地に基づいた肩水平面回旋動作の制御手法の構築

2A2-I06 上肢と下肢の協調運動を促す歩行訓練システムの開発 : 踵接地に基づいた肩水平面回旋動作の制御手法の構築

A Wearable System for Gait Training in Subjects with Parkinson’s Disease

In this paper, a system for gait training and rehabilitation for Parkinson's disease (PD) patients in a daily life setting is presented. It is based on a wearable architecture aimed at the provision of real-time auditory feedback. Recent studies have, in fact, shown that PD patients can receive benefit from a motor therapy based on auditory cueing and feedback, as happens in traditional rehabilitation contexts with verbal instructions given by clinical operators. To this extent, a system based on a wireless body sensor network and a smartphone has been developed. The system enables real-time extraction of gait spatio-temporal features and their comparison with a patient's reference walking parameters captured in the lab under clinical operator supervision. Feedback is returned to the user in form of vocal messages, encouraging the user to keep her/his walking behavior or to correct it. This paper describes the overall concept, the proposed usage scenario and the parameters estimated for the gait analysis. It also presents, in detail, the hardware-software architecture of the system and the evaluation of system reliability by testing it on a few subjects.