Robot-assisted Treadmill Training Research Articles

Perspective of robotic-assisted treadmill training effect in children with cerebral palsy on motor functions and gait

Perspective of robotic-assisted treadmill training effect in children with cerebral palsy on motor functions and gait

A randomized, cross-over trial comparing the effect of innovative robotic gait training and functional clinical therapy in children with cerebral palsy; a protocol to test feasibility.

Robotic gait training is relatively new in the world of pediatric rehabilitation. Preliminary feasibility studies and case reports include stationary robot-assisted treadmill training. Mobile robotic gait trainers hold greater promise for intensive practice-based therapy within hospitals, schools, rehabilitation centers, and at-home therapy as they enable participation and social integration while practicing high-quality gait patterns. This paper (clinical trials registry number: NCT05378243) provides a detailed description of a mixed-method cross-over trial design with a broad set of outcome measures. Ultimately the goal is to establish the feasibility of this design which includes the collection of qualitative data regarding patient, family, and therapist experience and quantitative data regarding gait efficiency and quality, impact on tone, individualized goal achievement and bone strength.

Clinical Benefit of Rehabilitation Training in Spinal Cord Injury: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.

Therapeutic effects of rehabilitation training methods on spinal cord injury: a meta-analysis

BackgroundSpinal cord injury (SCI) is a lesion of neural elements of spinal cord. Frequently, there is motor incomplete injury and locomotor disability. Robot assisted locomotor training, functional electrical stimulation (FES) devices, and repetitive transcranial magnetic stimulation (rTMS) devices are commonly used to improve motor control and gait of patients with SCI. The efficacies of different interventions for SCI have not been reported comprehensively, and a full comparison of these strategies may benefit clinicians who apply these techniques in the rehabilitation of patients with SCI. This study aimed to comprehensively evaluate the efficacies of different interventions for SCI. MethodsWe did a systematic review and meta-analysis by searching for publications using PubMed, Embase, the Cochrane Database, the database of the US National Institutes of Health, and the WHO International Clinical Trials Registry Platform on Dec 30, 2018. Randomised controlled trials and controlled trials that compared interventions with usual care or a no exercise control, and that were published in English, were selected for our meta-analysis. The primary outcomes included functional independence (assessed using the functional independence measure, SCI independence measure, American Spinal Injury Association [ASIA] upper extremity motor score [UEMS] or lower extremity motor score [LEMS], and other hand function tests), walking speed (10 m walking test [10MWT]) and walking distance (6 min walking test [6MWT]), walking capacity (walking index for spinal cord injuries version II [WISCI II]), spasticity (modified Ashworth scale [MAS]), and quality of life of patients with SCI. The secondary outcomes included patient dropout and adverse events during intervention. Weighted mean differences and 95% CIs were used to measure intervention efficacy, and the OR was used for analysis of adverse events. Physiotherapy Evidence Database (PEDro) scale scores were used for quality assessment of the included studies. Meta-analysis was performed using Revman 5.0 software. FindingsOur initial search yielded 1410, 1643, and 452 English articles reporting the effectiveness of rTMS or FES, exercise or training, and robot assisted locomotor treadmill training on functional recovery after SCI. Of these articles, 27 randomised controlled trials and three controlled trials, including 1020 patients with SCI, were included for meta-analysis. Four articles were available for evaluating rTMS versus control (81 participants), six for FES (174 participants), nine for massed practice or treadmill training (218 participants), and 11 for robot assisted treadmill training (547 participants). rTMS improved walking speed (mean absolute difference [MD] 0·09, 95% CI 0·01–0·16, p=0·03, 10MWT) and lower extremity motor function (4·41, 1·55–7·27, p=0·003, ASIA LEMS) compared with control (sham rTMS plus gait training), but not spasticity and walking index. FES significantly increased upper extremity independence (2·92, 0·37–5·48, p=0·03) compared with control (conventional occupational therapy [COT] or resistance and aerobic training), but not upper extremity or lower extremity function and quality of life. Activity-based therapy (massed practice and treadmill training) showed no benefit to nerve injury and functional rehabilitation compared with control (no intervention, overground mobility therapy, self-regulated exercises, or conventional rehabilitation program), whereas robot assisted treadmill training significantly improved ASIA LEMS scores (5·00, 3·44–6·56, p<0·00001) and lower extremity independence (3·73, 2·53–4·92, p<0·00001) compared with control interventions (no intervention, cycling and walking), but not walking capacity (10MWT and 6MWT). No difference was seen in the incidence of adverse events in pairwise comparison of robot assisted treadmill training with control and activity-based therapy with control. InterpretationrTMS, FES, and robot assisted treadmill training are effective in rehabilitating patients with SCI. The efficacies of rTMS and robot assisted treadmill training were relatively consistent among articles. The combination of rTMS and robot assisted treadmill training was effective in the rehabilitation of patients with SCI. FundingNone.

Impact of feedback display during robotic-assisted treadmill training on cardiorespiratory properties in persons with spinal cord injury: a pilot study

Impact of feedback display during robotic-assisted treadmill training on cardiorespiratory properties in persons with spinal cord injury: a pilot study

Plasticity and alterations of trunk motor cortex following spinal cord injury and non-stepping robot and treadmill training

Spinal cord injury (SCI) induces significant reorganization in the sensorimotor cortex. Trunk motor control is crucial for postural stability and propulsion after low thoracic SCI and several rehabilitative strategies are aimed at trunk stability and control. However little is known about the effect of SCI and rehabilitation training on trunk motor representations and their plasticity in the cortex. Here, we used intracortical microstimulation to examine the motor cortex representations of the trunk in relation to other representations in three groups of chronic adult complete low thoracic SCI rats: chronic untrained, treadmill trained (but ‘non-stepping’) and robot assisted treadmill trained (but ‘non-stepping’) and compared with a group of normal rats. Our results demonstrate extensive and significant reorganization of the trunk motor cortex after chronic adult SCI which includes (1) expansion and rostral displacement of trunk motor representations in the cortex, with the greatest significant increase observed for rostral (to injury) trunk, and slight but significant increase of motor representation for caudal (to injury) trunk at low thoracic levels in all spinalized rats; (2) significant changes in coactivation and the synergy representation (or map overlap) between different trunk muscles and between trunk and forelimb. No significant differences were observed between the groups of transected rats for the majority of the comparisons. However, (3) the treadmill and robot-treadmill trained groups of rats showed a further small but significant rostral migration of the trunk representations, beyond the shift caused by transection alone. We conclude that SCI induces a significant reorganization of the trunk motor cortex, which is not qualitatively altered by non-stepping treadmill training or non-stepping robot assisted treadmill training, but is shifted further from normal topography by the training. This shift may potentially make subsequent rehabilitation with stepping longer or less successful.

Combination of Robot-Assisted and Conventional Body-Weight–Supported Treadmill Training Improves Gait in Persons With Multiple Sclerosis

The majority of persons with multiple sclerosis (MS) experience problems with gait, which they characterize as highly disabling impairments that adversely impact their quality of life. Thus, it is crucial to develop effective therapies to improve mobility for these individuals. The purpose of this study was to determine whether combination gait training, using robot-assisted treadmill training followed by conventional body-weight-supported treadmill training within the same session, improved gait and balance in individuals with MS. This study tested combination gait training in 7 persons with MS. The participants were randomized into the immediate therapy group (IT group) or the delayed therapy group (DT group). In phase I of the trial, the IT group received treatment while the DT group served as a concurrent comparison group. In phase II of the trial, the DT group received treatment identical to the treatment received by the IT group in phase I. Outcome measures included the 6-Minute Walk Test (6MWT), the Timed 25-Foot Walk Test, velocity, cadence, and the Functional Reach Test (FRT). Nonparametric statistical techniques were used for analysis. Combination gait training resulted in significantly greater improvements in the 6MWT for the IT group (median change = +59 m) compared with Phase I DT group (median change = -8 m) (P = 0.08) and FRT (median change = +3.3 cm in IT vs -0.8 cm in the DT group phase I; P = 0.03). Significant overall pre-post improvements following combination gait training were found in 6MWT (+32 m; P = 0.02) and FRT (+3.3 cm; P = 0.06) for IT and Phase II DT groups combined. Combination of robot with body-weight-supported treadmill training gait training is feasible and improved 6MWT and FRT distances in persons with MS.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A62) for more insights from the authors.

Gait analysis in children with hemiplegia and robotic assisted treadmill training

Introduction: Duchenne walking pattern is a common sequelae in various gait disorders and also found in cerebral palsy. Hip abductor weakness may result in pelvic obliquity and may be compensated by lateral shift of the trunk (trunk obliquity) to the ipsilateral side to maintain gait stability [1]. A reduction of abduction moment in Perthes patients with Duchenne gait was reported [2]. However, investigations addressing pelvis and trunk in frontal plane in CP patients are rare leaving unconsciousness on how to interpret these parameters.We investigated the correlation between hip abductor strength and frontal plane kinematics in CP patients. Furthermore hip abductionmoment in these patientswas evaluated. Patients/materials andmethods: 653 ambulatory (GMFCS I-II) patients (1306 limbs) with diplegic CP (mean age: 16 years) and 25 healthy controls were selected from our gait lab database, who underwent a standardized three-dimensional gait analysis and a clinical examination including hip abductor strength testing (MRCscale) between 1996 and 2012 and included in the study. Exclusion criteriawere previous orthopedic surgery on the lower extremities. Selected frontal plane kinematic and kinetic parameters were statistically analyzed using unpaired t-tests and were correlated with hip abductor strength (MRC). Results: With weaker hip abductors significant more trunk obliquity, less pelvic obliquity and significant less abductionmomentwas found (t-test: significant difference to the next higher MRC level). The results are summarized in Table 1 and Fig. 1.

Modulation ability of automatic postural response in individuals with spastic diplegic cerebral palsy

Introduction: Clinical gait analysis (CGA) was conducted on an 8-year old female patient with spastic right hemiplegia (cerebral palsy, CP). The main problem of the patient is extremely tight Achilles tendon. Achilles tendon lengthening was done in early childhood, with no positive results. In addition, pre-fasciotomy leg length discrepancy was 2.5 cm, resulting with posture problems. CGA was conducted pre-operatively, one month, four months and eight months following fasciotomy. The first two analyses were made barefoot, the last analysis was done with footwear, with correction for leg length discrepancy. After the surgery, the patient received three intensive rehabilitation periods, each lasted two weeks. In addition she had 20 robot-assisted treadmill training sessions and home exercises. The aim of this paper is to describe the changes of gait pattern over time after plantarflexors fasciotomy of hemiplegic patient. Patients/materials and methods: 3D Vicon Gait Analysis System (8 Vicon MX-T20 cameras, two Basler cameras) and two AMTI dynamographic platforms were used to capture the data. Markers were placed according to Davis model. Before the gait analysis physiotherapeutic assessmentwas carried out. All assessments and gait data collection was carried out within one day by two physiotherapists. Data was capturedwith Vicon Nexus 1.7.1 software and presented for interpretationwith Vicon Polygon 3.5.1 software. For interpretation three good gait trials were selected. Results: Before the surgery, there was a severe plantarflexion (over 25◦) at initial contact on the right side. Plantarflexion lasted throughout the whole gait cycle, with no active dorsiflexion in swing phase. Push-off values for the right ankle were close to zero. Onemonth post-op analysis showed great improvement of ankle dorsi-plantarflexionmovement. Initial contactwas stillmade with ankle in plantarflexion, but the range was less than 10◦. The graph has moved close to zero-line, with drop-foot in the swing phase. The pattern on ankle power graph is close to normal, but values are minimal. 8-month post-op analysis showed improvement from mid-stance to toe-off; the patient has achieved 2nd and 3rd rocker. Initial contact is still made with ankle in plantarflexion and drop-foot continues because there is no active dorsiflexion. Pushoff values on the ankle power graph have increased up to about 1/3 of estimated values. Discussion and conclusions: The fasciotomy has been effective for improving the gait pattern of hemiplegic patient. Position of the right foot improved greatly. There was a great difference in the ankle joint position at the initial contact pre and post-op, but almost no change occurred during 1-month and 8-month followup studies due to no active dorsiflexion. Furthermore, drop-foot in the swing phase retained. Because of no further improvement in swing-phase and initial contact, AFO was recommended to support the dorsiflexion of right ankle. The push-off values increased constantly. The fasciotomy showed good results in improving gait pattern an CGA is a good tool to describe and evaluate the efficacy of chosen intervention.

Improvement of hemiplegic patient's gait pattern over 8-month period after plantarflexors fasciotomy: A case study

Introduction: Clinical gait analysis (CGA) was conducted on an 8-year old female patient with spastic right hemiplegia (cerebral palsy, CP). The main problem of the patient is extremely tight Achilles tendon. Achilles tendon lengthening was done in early childhood, with no positive results. In addition, pre-fasciotomy leg length discrepancy was 2.5 cm, resulting with posture problems. CGA was conducted pre-operatively, one month, four months and eight months following fasciotomy. The first two analyses were made barefoot, the last analysis was done with footwear, with correction for leg length discrepancy. After the surgery, the patient received three intensive rehabilitation periods, each lasted two weeks. In addition she had 20 robot-assisted treadmill training sessions and home exercises. The aim of this paper is to describe the changes of gait pattern over time after plantarflexors fasciotomy of hemiplegic patient. Patients/materials and methods: 3D Vicon Gait Analysis System (8 Vicon MX-T20 cameras, two Basler cameras) and two AMTI dynamographic platforms were used to capture the data. Markers were placed according to Davis model. Before the gait analysis physiotherapeutic assessmentwas carried out. All assessments and gait data collection was carried out within one day by two physiotherapists. Data was capturedwith Vicon Nexus 1.7.1 software and presented for interpretationwith Vicon Polygon 3.5.1 software. For interpretation three good gait trials were selected. Results: Before the surgery, there was a severe plantarflexion (over 25◦) at initial contact on the right side. Plantarflexion lasted throughout the whole gait cycle, with no active dorsiflexion in swing phase. Push-off values for the right ankle were close to zero. Onemonth post-op analysis showed great improvement of ankle dorsi-plantarflexionmovement. Initial contactwas stillmade with ankle in plantarflexion, but the range was less than 10◦. The graph has moved close to zero-line, with drop-foot in the swing phase. The pattern on ankle power graph is close to normal, but values are minimal. 8-month post-op analysis showed improvement from mid-stance to toe-off; the patient has achieved 2nd and 3rd rocker. Initial contact is still made with ankle in plantarflexion and drop-foot continues because there is no active dorsiflexion. Pushoff values on the ankle power graph have increased up to about 1/3 of estimated values. Discussion and conclusions: The fasciotomy has been effective for improving the gait pattern of hemiplegic patient. Position of the right foot improved greatly. There was a great difference in the ankle joint position at the initial contact pre and post-op, but almost no change occurred during 1-month and 8-month followup studies due to no active dorsiflexion. Furthermore, drop-foot in the swing phase retained. Because of no further improvement in swing-phase and initial contact, AFO was recommended to support the dorsiflexion of right ankle. The push-off values increased constantly. The fasciotomy showed good results in improving gait pattern an CGA is a good tool to describe and evaluate the efficacy of chosen intervention.

Effect of Robot-Assisted Treadmill Training on Motor Functions Depending on Severity of Impairment in Patients with Bilateral Spastic Cerebral Palsy

Objective: To assess impact of RATT (robot-assisted treadmill training) on motor function in patients with cerebral palsy depending on the severity of motor impairment. Design: Uncontrolled prospective pilot study with pre-post treatment outcome comparison according to severity of motor impairment. Setting: Outpatient Rehabilitation Centre. Participants: Fifty-one patients aged 4 - 27 years with bilateral spastic cerebral palsy. Interventions: Patients were divided into two groups according to severity of motor impairment determined by the Gross Motor Function Classification Scale (GMFCS). All 51 participants underwent 20 RATT sessions over a 5-6 week period in an outpatient approach using the Lokomat® driven gait orthosis (DGO). Outcome Measures: Dimension A(lying, rolling), B(sitting), C(crawling, kneeling), D (standing) and E(walking, running, jumping) within the Gross Motor Function Measure (GMFM-88), 6-minute walking test, 10-meter walk test, Functional Ambulation Categories (FAC). Results: Patients demonstrated statistically significant improvements in all GMFM-88 dimensions. Improvements in GMFM A, B and C were significantly larger in the more severely affected cohort (GMFCS III, IV) compared to the mildly affected cohort (GMFCS I, II). In contrast, GMFM D and E improvements were greater in the mildly affected cohort, but not statistically significant. Mean (SD) maximum gait speed of 0.75 (0.48) to 0.89 (0.52) m/s; mean (SD) 6 Min WT of 154 (103.21) to 191.21 (114.55) m; as well as the mean (SD) FAC of 1.44 (1.22) to 1.89 (1.33) showed a statistically significant level of improvement (p= .000). Conclusion: RATT is a promising treatment option in ambulatory and non-ambulatory patients with cerebral palsy. The severity of motor impairment affects the amount of improvement that can be achieved. Keywords: Robot-assisted treadmill training, cerebral palsy, gross motor function measure, impairment, neurodevelopmental concept. Read more →

A Randomized Comparative Study of Manually Assisted Versus Robotic-Assisted Body Weight Supported Treadmill Training in Persons With a Traumatic Brain Injury

(1) To compare the effects of robotic-assisted treadmill training (RATT) and manually assisted treadmill training (MATT) in participants with traumatic brain injury (TBI) and (2) to determine the potential impact on the symmetry of temporal walking parameters, 6-minute walk test, and the mobility domain of the Stroke Impact Scale, version 3.0 (SIS). Randomized prospective study. A total of 16 participants with TBI and a baseline over ground walking self-selected velocity (SSV) of ≥0.2 m/s to 0.6 m/s randomly assigned to either the RATT or MATT group. Gait training for 45 minutes, 3 times a week with either RATT or MATT for a total of 18 training sessions. Primary: Overground walking SSV, maximal velocity. Secondary: Spatiotemporal symmetry, 6-minute walk test, and SIS. Between-group differences were not statistically significant for any measure. However, from pretraining to post-training, the average SSV increased by 49.8% for the RATT group (P = .01) and by 31% for MATT group (P = .06). The average maximal velocity increased by 14.9% for the RATT group (P = .06) and by 30.8% for the MATT group (P = .01). Less staffing and effort was needed for RATT in this study. Step-length asymmetry ratio improved during SSV by 33.1% for the RATT group (P = .01) and by 9.1% for the MATT group (P = .73). The distance walked increased by 11.7% for the robotic group (P = .21) and by 19.3% for manual group (P = .03). A statistically significant improvement in the mobility domain of the SIS was found for both groups (P ≤ .03). The results of this study demonstrate greater improvement in symmetry of gait (step length) for RATT and no significant differences between RATT and MATT with regard to improvement in gait velocity, endurance, and SIS. Our study provides evidence that participants with a chronic TBI can experience improvements in gait parameters with gait training with either MATT or RATT.

Long-term effect of robot-assisted treadmill walking reduces freezing of gait in Parkinson’s disease patients: a pilot study

Freezing of gait (FOG) is a common and disabling symptom in patients with advanced Parkinson’s disease (PD). Treatment options are often limited, since dopaminergic medication can either alleviate or aggravate FOG, and deep brain stimulation does not seem to suppress FOG as well as other PD symptoms [5]. In the last decade, physiotherapeutic studies moved into the focus of research. Two case studies found that repetitive robot-assisted treadmill training reduces FOG [4, 10], and in a randomized controlled trial robot-assisted gait training was superior to conventional physiotherapy on general walking performance in PD patients [6]. However, long-term effects of this potentially new training method are unknown so far. Based on previous studies, we hypothesised that robot-assisted treadmill training specifically reduces FOG by either increasing step length and/or decreasing step length variation, and that, similar to other physiotherapeutic training methods, this therapeutic effect declines over time after cessation of training. Three PD patients diagnosed according to the UK PDS Brain Bank Criteria with severe FOG participated in the study. All patients gave informed consent before study participation. The study was approved by the local ethics committee. Patients were trained by an experienced physiotherapist (FC) specialized in neurological rehabilitation. All patients received 10–12 training sessions of 30 min on a robot-assisted treadmill (Lokomat , Hocoma, Switzerland) in their regular medication ON. Robot-assisted treadmill walking includes treadmill walking combined with a certain degree of body weight support through assistance of mechanically driven robotic orthosis. A robotic exoskeleton attached to the patients’ legs shifts them passively through a stereotyped gait cycle over a treadmill with variable amounts of assistance. Walking parameters such as gait speed, leg movement assistance and body weight support can be adjusted individually. All patients received a piloting training session before the actual training started. We intended to use the same walking parameters for all three patients. All three patients reported comfortable training with a gait velocity of 1.5 km/h, fully assisted leg movements and a body weight support of 70 %. In the training session, body weight support was initially set at 100 % and was then gradually reduced to 70 % to familiarize patients with the walking device. Range of motion at the hip joint was set at 45 ; all other settings were kept according to the manufacturer’s specifications. On some occasions, training sessions had to be terminated due to exhaustion shortly before 30 min were Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6703-3) contains supplementary material, which is available to authorized users.

Treadmill training stimulates brain-derived neurotrophic factor mRNA expression in motor neurons of the lumbar spinal cord in spinally transected rats

Brain-derived neurotrophic factor (BDNF) induces plasticity within the lumbar spinal circuits thereby improving locomotor recovery in spinal cord-injured animals. We examined whether lumbar spinal cord motor neurons and other ventral horn cells of spinally transected (ST) rats were stimulated to produce BDNF mRNA in response to treadmill training. Rats received complete spinal cord transections as neonates (n=20) and one month later, received four weeks of either a low (100 steps/training session; n=10) or high (1000 steps/training session; n=10) amount of robotic-assisted treadmill training. Using combined non-radioactive in situ hybridization and immunohistochemical techniques, we found BDNF mRNA expression in heat shock protein 27-labeled motor neurons and in non-motor neuron cells was greater after 1000 steps/training session compared to the 100 steps/training session and was similar to BDNF mRNA labeling in untrained Intact rats. In addition, there were significantly more motor neurons that contained BDNF mRNA labeling within processes in the ST rats that received the higher amount of treadmill training. These findings suggested that motor neurons and other ventral horn cells in ST rats synthesized BDNF in response to treadmill training. The findings support a mechanism by which postsynaptic release of BDNF from motor neurons contributed to synaptic plasticity.

Stride length analysis and therapeutic effect of robot-assisted treadmill training in Parkinsonian patients with freezing of gait

Stride length analysis and therapeutic effect of robot-assisted treadmill training in Parkinsonian patients with freezing of gait

Treadmill Training in Multiple Sclerosis: Can Body Weight Support or Robot Assistance Provide Added Value? A Systematic Review

Purpose. This systematic review critically analyzes the literature on the effectiveness of treadmill training (TT), body-weight-supported TT (BWSTT), and robot-assisted TT (RATT) in persons with multiple sclerosis (MS), with focus on gait-related outcome measurements. Method. Electronic databases (Pubmed, Pedro, Web of Science, and Cochrane Library) and reference lists of articles and narrative reviews were searched. Pre-, quasi- and true-experimental studies were included if adult persons with MS were involved in TT, BWSTT, or RATT intervention studies published before 2012. Descriptive analysis was performed and two researchers scored the methodological quality of the studies. Results. 5 true- and 3 preexperimental studies (mean quality score: 66%) have been included. In total 161 persons with MS were involved (TT, BWSTT, or RATT, 6–42 sessions; 2–5x/week; 3–21 weeks). Significant improvements in walking speed and endurance were reported. Furthermore, improvements of step length, double-support time, and Expanded Disability Status Scale were found. Conclusions. There is a limited number of published papers related to TT in persons with MS, concluding that TT, BWSTT, and RATT improve the walking speed and endurance. However, it is not clear what type of TT is most effective. RCTs with larger but more homogeneous populations are needed.

Robot-assisted walking vs overground walking in stroke patients: An evaluation of muscle activity

There is increasing evidence that robot-assisted treadmill training might be useful for gait rehabilitation after stroke. The aim of this study was to evaluate the muscle activity of stroke patients during robot-assisted walking and overground walking, and of a group of able-bodied subjects during overground walking. Case-control observational study. Ten stroke subjects and 10 able-bodied control subjects. Electromyography measurements of 7 lower-limb muscles were made in 3 trials: robotic walking, in which stroke subjects walked in a robot-assisted gait orthosis; overground walking for the same group of stroke subjects; and overground walking for control subjects. Trials were compared with respect to electromyography amplitude of selected leg muscles. Higher muscle activity during overground walking compared with robotic walking was found in several muscles during several phases of the gait cycle. A significant trial × leg interaction revealed smaller differences in muscle activity between the paretic and non-paretic leg during robotic walking compared with overground walking. Furthermore, the muscle activity pattern was not significantly different between control walking and robotic walking, while it was different between control walking and overground walking. Despite lower muscle activity, robot-assisted treadmill training may elicit a more symmetrical pattern of leg muscle activity, which approaches that of able-bodied individuals.

Poster 82 Robot-Assisted Treadmill Training during Rehabilitation of Stroke Patients

Poster 82 Robot-Assisted Treadmill Training during Rehabilitation of Stroke Patients

Is the Gross Motor Function Measure (GMFM 66) a sensitive tool to represent the therapeutic improvement after robotic assisted treadmill training? A controlled study about the therapeutic effect of Lokomat® therapy

Is the Gross Motor Function Measure (GMFM 66) a sensitive tool to represent the therapeutic improvement after robotic assisted treadmill training? A controlled study about the therapeutic effect of Lokomat® therapy

Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation

Robot-assisted treadmill training is an established intervention used to improve walking ability in patients with neurological disorders. Although it has been shown that attention to the task is a key factor for successful rehabilitation, the psychological state of patients during robot-assisted gait therapy is often neglected. We presented 17 nondisabled subjects and 10 patients with neurological disorders a virtual-reality task with varying difficulty levels to induce feelings of being bored, excited, and overstressed. We developed an approach to automatically estimate and classify a patient's psychological state, i.e., his or her mental engagement, in real time during gait training. We used psychophysiological measurements to obtain an objective measure of the current psychological state. Automatic classification was performed by a neural network. We found that heart rate, skin conductance responses, and skin temperature can be used as markers for psychological states in the presence of physical effort induced by walking. The classifier achieved a classification error of 1.4% for nondisabled subjects and 2.1% for patients with neurological disorders. Using our new method, we processed the psychological state data in real time. Our method is a first step toward real-time auto-adaptive gait training with potential to improve rehabilitation results by optimally challenging patients at all times during exercise.