Gait Training Research Articles

People with spinal cord injury or stroke are able to reach moderate-to-vigorous intensity while exercising on an end-effector robot assisted gait trainer: A pilot study.

Background: Spinal cord injury and stroke are neurological disorders that lead to aerobic deconditioning and increased likelihood of cardiovascular disease. Sessions of at least 20minutes of moderate-to-vigorous intensity exercise is recommended but decreased mobility limits engagement in such exercise. The aim of the study was to assess whether individuals can achieve exercise recommendations with the assistance of an end-effector robot assisted gait trainer (E-RAGT). Methods: We conducted an observational study during which participants were required to complete one exercise session on an E-RAGT. Heart rate, dyspnea, lower limb fatigue and enjoyment were monitored. Based on current guidelines, participants were considered to have reached exercise recommendations if they reached prespecified intensity thresholds for at least 20minutes. Results: Five people with spinal cord injury and ten people with stroke agreed to participate. Every participant was able to reach moderate-to-vigorous exercise intensity and 3 out of 5 participants with spinal cord injury and 4 out of 10 participants with stroke were able to maintain this intensity for at least 20minutes. Overall, participants rated their session as very enjoyable with a median score of 4 out of 5 on a Likert Scale (IQR 3 to 4). Discussion: Individuals with spinal cord injury or stroke who use an E-RAGT can reach moderate-to-vigorous exercise intensity, but not all are able to maintain this intensity of exercise according to disease-specific recommendations. Future research should explore the effectiveness of a training program using an E-RAGT.

Cognitive representation of gait: differences in memory structures between individuals after total knee arthroplasty and total hip arthroplasty.

The objective was to examine differences in the gait-specific cognitive representation structures between individuals after total knee- (TKA) and after total hip-joint arthroplasty (THA). The cognitive representation structure was compared between three groups: 1. three months after TKA (n = 12), 2. three months after THA (n = 12), and 3. healthy control group (CG) (n = 12) using the structural dimensional analysis of mental representation (SDA-M). Additionally, perceived joint function was rated by either the KOOS, JR. or HOOS, JR. Mean distribution of perceived joint function was not significantly different between the TKA (60.35 ± 11.2) and THA group (68.01 ± 13.8) (t = - 1.425; p = .173). In the cognitive representation structure, the THA group exhibited functional differences from the TKA group and control group, both of which showed a functional structure. Three months after hip joint replacement the gait-specific cognitive representation structure seems to reflect joint function-specific deviations. Therefore, focussing on functional recovery of cognitive gait representation may facilitate gait rehabilitation in individuals after hip replacement.

Robotic Technology Enabled Gait Training Methods: A Boon for Gait Rehabilitation in Incomplete Tetraplegia

Robotic Technology Enabled Gait Training Methods: A Boon for Gait Rehabilitation in Incomplete Tetraplegia

Treatment for Lateropulsion in Standard Clinical Practice: A Multicenter Randomized Controlled Trial

Background Post-stroke lateropulsion with pusher syndrome (LP) severely impacts postural control and daily activities. In Japan, while a knee-ankle-foot orthosis (KAFO) is recommended for LP treatment, a gait exercise assist robot (GEAR) is also used. Objective We investigated the effectiveness of gait training using a GEAR and KAFO in improving LP. Methods Thirty-six stroke patients with LP were randomly assigned to GEAR or KAFO groups, and received 50-min daily sessions for 2 weeks. Both the GEAR group, using robot assistance, and the KAFO group, with therapist assistance, engaged in gait training with a goal of 30 min per session. Primary outcomes were changes in Burke Lateropulsion Scale (BLS) and Scale for Contraversive Pushing (SCP) scores. Results Seventeen participants in each group completed their respective interventions. Both groups showed marked improvements in BLS and SCP scores (all p < 0.001). Although the GEAR group achieved greater walking distances and step counts ( p < 0.01 each), overall BLS and SCP improvements did not significantly differ between the groups ( p = 0.51 and 0.84, respectively). Both interventions demonstrated comparable LP improvement to previous studies. Conclusions We found no significant difference in the treatment effects between the two interventions, indicating both to be effective.

Acute intermittent hypoxia in spinal cord injury gait rehabilitation: a systematic review of randomized trials.

Gait impairments are one of the popular consequences of spinal cord injury (SCI). Acute intermittent hypoxia (AIH) is an innovative treatment that has recently been used to enhance motor function in patients with neurological conditions. This review aims to examine the effects of AIH on gait post-SCI, verify who most likely would benefit from the treatment, and recognize the best treatment protocol, if possible. The search was conducted in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases from inception to October 2024. This review included randomized trials involving individuals with SCI who received AIH, alone or in combination with other interventions, compared with active or passive comparators, and evaluated at least one outcome related to gait ability. The quality of the included studies was measured using the "Physiotherapy Evidence Database (PEDro)". Nine studies met the eligibility criteria. In total, 158 individuals with SCI (mean age 44.45 years; 86% male) were involved in this analysis. The included studies' PEDro scores ranged from 5 to 10, with a median of 8. The main findings showed that AIH improves gait speed, walking endurance, dynamic balance, and plantar flexor strength in individuals with SCI. AIH is a safe intervention for individuals with SCI. This review underscores the potential benefits of AIH for improving gait abilities in SCI with motor-incomplete injuries (ASIA grades C and D) at cervical, thoracic, and lumbar levels. Further studies are recommended to verify our findings.

Evaluation of the Effectiveness of Lokomat® Robot-assisted Gait Training in Children with Cerebral Palsy: A Systematic Review

Evaluation of the Effectiveness of Lokomat^® Robot-assisted Gait Training in Children with Cerebral Palsy: A Systematic Review

Gait Training with Virtual Reality-Based Real-Time Feedback for Chronic Post-Stroke Patients: A Pilot Study.

Virtual reality-based training has been widely used for post-stroke patients due to its positive effects on functional aspects by promoting brain plasticity. This study aimed to investigate the effectiveness of gait training with virtual reality-based real-time feedback on motor function, balance, and spatiotemporal gait parameters in post-stroke patients. Fifteen patients (n = 15) with chronic stroke were randomly assigned to either the virtual reality-based real-time feedback with treadmill gait training (experimental group n = 8) or the treadmill gait training (control group n = 7). For the experimental group that participated, a treadmill, an Oculus Rift VR device, and smart insoles were used for gait training with VR-based real-time feedback. Regarding gait training with VR-based real-time feedback, the patient wore an Oculus Rift and performed gait training on a treadmill for 30 min a day, three times a week, for 5 weeks. The control group participated in treadmill gait training for 30 min a day, three times a week, for 5 weeks. Motor function was measured using the Fugl-Meyer assessment. Balance was measured using the timed up and go test and Berg balance scale. Gait performance was measured using an Optogait. The normality test was performed using the Shapiro-Wilk test, the Wilcoxon signed-rank test was used for the within-group comparison, and the Mann-Whitney U test was used for the between-group comparison. In the group analyses, both groups showed significant improvements in motor function balance and gait ability. According to the pre- and post-treatment results, greater improvement in the Fugl-Meyer assessment (experimental group: 4.75 vs. control group: 1.57) was observed in the experimental group compared with the control group (p < 0.05). In balance ability, greater improvement in the timed up and go test (experimental group: -3.10 vs. control group: -1.12) and Berg balance scale (experimental group: 3.00 vs. control group: 1.71) (p < 0.05). In the spatiotemporal gait parameters, greater improvement in affected step length (5.35 vs. 2.01), stride length (3.86 vs. 1.75), affected single support (2.61 vs. 1.22), and cadence (0.07 vs. 0.02) was observed in the experimental group compared with the control group (p < 0.05). This study suggested the positive effects of the virtual reality-based real-time feedback with treadmill gait training on motor function, balance, and gait performance.

Is the subischial socket better than others in subjects with transfemoral amputation? A systematic review of randomized and controlled clinical trials.

Rehabilitation is often complex for persons with transfemoral amputation, and poor socket fit is one of the main factors affecting gait re-education, rehabilitation, and quality of life. The present study systematically reviewed the literature to test whether the subischial socket provides better outcomes in comfort, quality of life, and mobility than other transfemoral sockets. Systematic review and meta-analysis. We searched MEDLINE, Physical Therapy Evidence Database Scale, Epistemonikos, Cochrane, BIREME, Web of Science, and Scopus from inception to January 2024 to identify randomized and controlled trials. Two authors independently screened records and assessed the risk of bias. We performed a narrative synthesis of the evidence and used the standardized mean difference and mean difference for meta-analyses and the Grading of Recommendations, Assessment, Development, and Evaluation approach for recommendations. We identified 7 randomized and controlled clinical trials. Five studies compared the subischial socket with the ischial containment socket (IC), 1 study compared the IC with the Marlo anatomical socket, and 1 study compared the IC with the quadrilateral. Very low certainty showed a difference in comfort (1 study: mean difference = 1.4 [95% CI 0.61, 2.19]), but no in quality of life (2 studies: standardized mean difference = 1.28 (95% CI -1.04, 3.59), and mobility (2 studies: mean difference = 0.11 (95% CI -1.08, 1.29). We observed differences between the subischial socket and the IC in comfort but not in quality of life, mobility, and stability. Furthermore, we found a very low certainty that the subischial socket provides better outcomes than the IC in comfort, quality of life, and mobility.

Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds

BackgroundTreadmill-based gait training is part of rehabilitation programs focused on walking abilities. The use of handrails embedded in treadmill systems is debated, and current literature only explores the issue from a behavioral perspective.MethodsWe examined the cortical correlates of treadmill walking in healthy participants using functional near-infrared spectroscopy. We investigated whether the utilization of treadmill handrails at varying walking speeds could affect cortical activation associated with the task, and we evaluated potential differences in task-based functional connectivity across the various walking conditions.ResultsSignificant differences in cortical activation were found between the two walking speeds (3 and 5 km/h) in the unsupported condition; these differences were reduced when using the handrails. Specifically, cortical activation was significantly higher when the participants swung their arms freely while walking at a speed of 5 compared to 3 km/h in several Brodmann’s Areas (BA): left BA10, BA3 and BA39, and right BA10, BA9, BA8, BA3, and BA40. No significant differences were found when participants were holding onto the handrails. A significant difference was found in the left BA40 between the two speeds, regardless of whether the participants were holding onto the handrails. Furthermore, at the higher speed and without the use of handrails, a wider pattern of task-based functional connectivity was observed, with significantly stronger connectivity between the left BA10 and BA40.ConclusionsWe suggest that speed and handrails use play a role in walking cortical activity patterns, therefore they are key ingredients to take into account when planning a rehabilitation program.

Bilateral hip exoskeleton assistance enables faster walking in individuals with chronic stroke-related gait impairments

Millions of individuals surviving a stroke have lifelong gait impairments that reduce their personal independence and quality of life. Reduced walking speed is one of the major problems limiting community mobility and reintegration. Previous studies have shown positive effect of robot-assisted gait training utilizing hip exoskeletons for individuals with gait impairments due to a stroke, leading to increased walking speed in post-treatment compared to pre-treatment assessments. However, no evidence emerged of a significant increasing in walking speed attributable to device usage compared to walking without the device. In this pilot investigation, we observed that hip flexion/extension assistance delivered by a portable bilateral powered hip exoskeleton increased overground self-selected walking speed by 20.2 ± 5.0% on average among six chronic post-stroke survivors. When comparing walking with and without the hip exoskeleton within the same experimental session, the observed speed increment resulted in statistically and clinically meaningful improvement (0.14 ± 0.03 m/s > minimal clinically important difference, p = 0.015). The increased walking speed was the result of a higher self-selected cadence and longer step length both on the paretic and nonparetic limbs. By facilitating gait, a bilateral hip exoskeleton could be a viable technology for extending locomotor mobility and facilitating gait training of individuals affected by post-stroke hemiparesis.

Unveiling the Underlying Motor Control Mechanism of Arm-trunk-leg Coordinated Humanoid Exoskeletal Interlimb Locomotor Robotic Neurorehabilitation

Background Arm-leg coordinated humanoid exoskeletal robots offer a solution to the ‘unnatural’ gait patterns seen in current leg-only exoskeletons, but their neuromechanical control mechanisms require further exploration. Objective This study investigates the neuromechanical properties and modulation of cervical and lumbar central pattern generators (CPGs) across different gait training conditions. Methods Eleven healthy adults (mean age: 25.27 ± 1.95 years; 5 females, 6 males) participated in gait analysis involving kinematics, kinetics, and electromyography during treadmill-based arm-leg interlimb coordination (TIT), robot-assisted arm-leg coordination (RIT), and robot-assisted leg-only coordination (RLT). Results Trunk counterrotation and shoulder, hip, and knee kinematics in RIT closely resembled those in TIT (5–10% variance) but significantly differed from RLT (30–40% variance). Electromyography revealed normalized reciprocal activation between the anterior and posterior deltoids (r = -0.48), tibialis anterior, and gastrocnemius (r = -0.68) during RIT, while RLT showed altered agonist-antagonist co-activation (r = 0.84). Conclusions These findings highlight the importance of cervical and lumbar CPG interaction in natural locomotion, suggesting that arm-leg coordinated exoskeletons could improve neurorehabilitation for individuals recovering from stroke or spinal cord injury.

EFICÁCIA DAS INTERVENÇÕES FISIOTERAPÊUTICAS NA REABILITAÇÃO DE PACIENTES PÓS-AVC EM AMBIENTE HOSPITALAR: UMA REVISÃO DE PRÁTICAS E RESULTADOS

The Cerebrovascular Accident (CVA) is one of the leading causes of disability and mortality worldwide, affecting millions of people annually and generating significant economic and social costs. The sequelae of a stroke, such as the loss of motor, cognitive, and emotional skills, compromise the patient's quality of life and functional independence. In this context, physiotherapy plays a crucial role in recovery, with techniques such as muscle strengthening, stretching, gait training, and sensory stimulation being essential to restore motor function and prevent complications such as muscle atrophy, pain, fatigue, and falls. Furthermore, intensive physiotherapy contributes to neuroplasticity by promoting brain reorganization and the formation of new neuronal connections. The application of these specific interventions, based on scientific evidence, is essential for improving rehabilitation outcomes and aiding in the recovery of lost functions, providing greater autonomy, well-being, confidence, functionality, and quality of life for post-stroke patients.

The Feasibility of non-motorized Treadmill Training on Lower Extremity Muscle Strength, Balance, and Gait in Patients with Stroke: A Pilot Study

Background Non-motorized treadmills have been used for health improvement in healthy individuals and for enhancing physical fitness in athletes. However, there is a lack of research focusing on their use with patients with stroke. Objective This study aims to assess the impact of non-motorized treadmill training on lower limb strength, balance, and gait in patients with stroke, and compare it with flat ground walking training. Methods The participants included 22 patients with stroke, divided into two groups: non-motorized treadmill training group ( n = 11) and flat ground walking training group ( n = 11). All participants underwent 20 training sessions, 30 min each, five times a week for four weeks. Outcome measures included the digital dynamometer, Medical Research Council scale (MRC), Berg Balance Scale (BBS), Four Square Step Test (FSST), 6-Minute Walk Test (6MWT), and GAITRite. Results The non-motorized treadmill training group showed significant improvements compared to the flat ground walking group in hip abductor and extensor muscle strength, knee flexor and extensor muscle strength, MRC, BBS, FSST, 6MW and gait parameters ( p &lt; 0.05). Conclusions Non-motorized treadmill training may be considered an effective gait rehabilitation method in clinical settings for patients experiencing stroke with reduced lower limb strength, balance, and walking ability.

ROBOT-ASSISTED GAIT TRAINING IN PATIENTS WITH PARKINSON DISEASE

Background: Gait impairment is one of the most disabling symptoms of Parkinson’s disease (PD), significantly affecting mobility and quality of life. Parkinsonian gait abnormalities, including freezing and festinating gait, arise from basal ganglia dysfunction due to the degeneration of dopaminergic neurons, leading to reduced neuronal connections and impaired motor regulation. While pharmacological interventions targeting dopaminergic circuits are effective for some motor symptoms, gait impairments remain largely unresponsive to drug therapy, necessitating alternative management strategies. Body: Recent advancements in neuro-rehabilitation have introduced interventions such as visual rehabilitation, tai chi, dance and music therapy, and robot-assisted gait training (RAGT). Among these, RAGT has emerged as a superior therapeutic approach due to its ability to promote neuroplasticity through task-specific, repetitive, and intensive training. By enhancing neuronal connectivity, RAGT addresses the underlying mechanisms of gait impairment in PD. The reviewed literature supports RAGT as an effective tool for improving gait mechanics, including stride length, gait speed, and overall mobility, making it a promising addition to rehabilitation protocols for PD. Conclusion: This review underscores the potential of RAGT as a transformative intervention for managing gait impairments in Parkinson’s disease. By promoting neuroplasticity and addressing the limitations of pharmacological treatments, RAGT offers a viable solution for enhancing mobility and quality of life in PD patients. Future research should focus on optimizing RAGT protocols and exploring its long-term efficacy.

A novel gait quality measure for characterizing pathological gait based on Hidden Markov Models.

This study addresses the characterization of normal gait and pathological deviations caused by neurological diseases. We focus on the angular knee kinematics in the sagittal plane and we propose to exploit Hidden Markov Models to build a statistical model of normal gait. Such model provides a log-likelihood score that quantifies gait quality. Hence allowing to assess deviations of pathological cycles from normal gait. Our approach allows a refined characterization of motor impairments of three different patients' groups. In particular, it detects the affected lower limb in Hemiparetic patients. Comparatively to the Gait Variable Score and a Dynamic Time Warping-based metric, our results show that our statistical method is more effective for finely quantifying pathological deviations. Finally, we show the potential use of our methodology to assess therapeutic impacts during gait rehabilitation, which represents a promising avenue for improving patient care.

Striatal-cortical dysconnectivity underlies somatosensory deficits in Parkinson's disease: Insights from rhythmic auditory-motor training.

Evidence indicates that neurodegenerative diseases spread through distinct brain networks. For Parkinson's disease (PD), somatosensory abnormalities may accompany motor dysfunction in early disease stages when dopaminergic degeneration is limited to the basal ganglia. It remains unclear whether, based on the network-spread account, these abnormalities emanated from aberrant functional connectivity with the basal ganglia, and whether interventions normalizing this connectivity could reverse these abnormalities. Here, we employed functional MRI to record brain responses to tactile stimuli in patients with idiopathic PD and healthy controls before and after three-week rhythmic auditory stimulation-assisted gait (RASg) training. Consistent with the presence of striatal degeneration, patients showed right posterior putamen (pPut) hypoactivation when detecting tactile stimuli of their left leg. They also exhibited reduced functional connectivity from the right pPut to the right parietal somatosensory region (inferior parietal lobule, IPL), whose hypoactivation reflected patients' impaired tactile detectability. Importantly, this dysconnectivity predicted right IPL hypoactivation, indicating that pPut-IPL dysconnectivity underlay patients' impaired tactile detectability. Intriguingly, RASg training normalized patients' tactile detectability, which was mirrored by normalization of right IPL activation and pPut-IPL connectivity. Training-induced changes in pPut-IPL connectivity predicted changes in IPL activation during tactile detection, reinforcing the role of pPut-IPL connectivity in patients' tactile detectability. These findings suggest that somatosensory abnormalities in PD may arise from the spread of striatal pathology to relevant cortical regions. Rhythmic auditory-motor training acts to recover striatal connectivity, improving PD patients' somatosensory deficits.

A Faster Walking Speed Is Important for Improving Biomechanical Function and Walking Performance in Stroke Survivors.

This study compares joint kinematics and kinetics of young stroke survivors who walk <0.79m/s (slow) or >0.80m/s (fast) with reference to a healthy able-bodied group and provides clinical recommendations for guiding the gait rehabilitation of stroke survivors. Twenty-two young stroke survivors (18-55y) were recruited from 6 hospital sites in the United Kingdom. Stroke participants were classified by walking speed as slow (<0.79) or fast (>0.80m/s), and joint kinematics and kinetics at the pelvis, hip, knee, and ankle were measured during walking on level ground at self-selected speed. Ten walking biomechanical parameters correlated to walking speed (ρ ≥ .550). Stroke survivors in the slow group walked with significantly greater range of sagittal plane pelvic motion (P < .009), reduced range of hip adduction and abduction (P < .011), and smaller peak hip extension angle (P < .011) and hip flexion moment (P < .029) for the paretic limb. For the nonparetic limb, a significantly reduced hip flexion moment (P < .040) was observed compared with the fast group and control. We are the first to report how biomechanical function during walking is compromised in young stroke survivors classified by walking speed as slow (<0.79m/s) or fast (>0.80m/s) and propose that these biomechanical parameters be used to inform rehabilitation programs to improve walking for stroke survivors.

Coordinated human-exoskeleton locomotion emerges from regulating virtual energy.

Lower-limb exoskeletons have demonstrated great potential for gait rehabilitation in individuals with motor impairments; however, maintaining human-exoskeleton coordination remains a challenge. The coordination problem, referred to as any mismatch or asynchrony between the user's intended trajectories and exoskeleton desired trajectories, leads to sub-optimal gait performance, particularly for individuals with residual motor ability. Here, we investigate the virtual energy regulator (VER)'s ability to generate coordinated locomotion in lower limb exoskeleton. Contribution: (1) In this paper, we experimented VER on a group of nine healthy individuals at different speeds (0.6m/s - 0.85m/s) to study the resultant gait coordination and naturalness on a large group of users. (2) The resultant assisted gait is compared to the natural and passive (zero-torque exoskeleton) walking conditions in terms of muscle activities, kinematic, spatiotemporal and kinetic measures, and questionnaires. (3) Moreover, we presented the VER's convergence proof considering the user contribution to the gait and introduced a metric to measure the user's contribution to gait. (4) We also compared VER performance with the phase-based path controller in terms of muscle effort reduction and joint kinematics using three able-bodied individuals. Results: (1) The results from the VER demonstrate the emergence of natural, coordinated locomotion, resulting in an average muscle effort reduction ranging from 13.1% to 17.7% at different speeds compared to passive walking. (2) The results from VER revealed improvements in all indicators towards natural gait when compared to walking with a zero-torque exoskeleton, for instance, an enhancement in average knee extension ranging from 3.9 to 4.1 degrees. All indicators suggest that the VER preserves natural gait variability and user engagement in locomotion control. (3) Using VER also yields in 13.9%, 15.1%, and 7.0% average muscle effort reduction when compared to the phase-based path controller. (4) Finally, using our proposed metric, we demonstrated that the resultant locomotion limit cycle is a linear combination of human-intended limit cycle and the VER's limit cycle. These findings may have implications for understanding how the central nervous system controls our locomotion.

Randomized Controlled Trial: Preliminary Investigation of the Impact of High-Intensity Treadmill Gait Training on Recovery Among Persons with Traumatic Brain Injury

Randomized Controlled Trial: Preliminary Investigation of the Impact of High-Intensity Treadmill Gait Training on Recovery Among Persons with Traumatic Brain Injury

Cardiac Function and Fatigue During Exoskeleton-Assisted Sit-to-Stand Maneuver and Walking in People with Stroke with Moderate to Severe Gait Disability: A Pilot Cross-Sectional Study.

Wearable powered exoskeletons could be used to provide robotic-assisted gait training (RAGT) in people with stroke (PwST) and walking disability. The study aims to compare the differences in cardiac function, fatigue, and workload during activities of daily living (ADLs), while wearing an exoskeleton. Five PwST were recruited in this pilot cross-sectional study. We observed three experimental conditions: walking without and with the UAN.GO exoskeleton and walking with the UAN.GO combined with the OPTIGO walker. Each condition included five trials related to ADLs such as sitting and walking. No statistically significant difference was found between heart rate and R-R of ECG data while comparing all the observed conditions during each respective trial. The NASA Task Load Index did not show significant differences across all trials, except for a significant difference between Condition 2 and Condition 3 in Trial 4 (p = 0.043). However, walking and sit-to-stand tasks seem to be more challenging according to the NASA-TLX. Only one participant scored over 70 points on the System Usability Scale. The TSQ-WT scores for conditions 2 and 3 were 62 (56.5-72.5) and 70 (66.5-75) points, respectively. This study suggests that UAN.GO exoskeleton could be used for RAGT in PwST with disability without compromising cardiovascular function.