Robotic Gait Training Research Articles

Abstract TP116: Evaluation of the Clinical Efficacy of Rehabilitation Therapy Using the Complex Upper and Lower Limb Robot Gait Rehabilitation System (GTR-A) in Stroke Patient

Background and aims: Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients. Methods: This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week. Results: In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2). Conclusion: The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.

Augmented Effect of Combined Robotic Assisted Gait Training and Proprioceptive Neuromuscular Facilitation-irradiation Technique on Muscle Activation and Ankle Kinematics in Hemiparetic Gait: A Preliminary Study

Background Proprioceptive neuromuscular facilitation (PNF) alone has limited effectiveness in restoring gait, while robotic-assisted gait training (RAGT) improves motor relearning through repetitive, task-specific movements. Combining PNF with robotic gait training (PRGT) may enhance locomotor recovery by promoting proprioceptive awareness and muscle activation alongside repetitive gait retraining in stroke patients. Objective This study compares the immediate effects of PRGT and RAGT on ankle dorsiflexion and muscle activity in chronic hemiparetic stroke patients and healthy controls. Methods Thirty participants, including 15 stroke patients and 15 healthy controls, were randomly assigned to PRGT or RAGT for a single 30-min session. Muscle activity (pectoralis major, external oblique, internal oblique/transverse abdominis, rectus femoris, tibialis anterior) was measured using electromyography, while ankle dorsiflexion angle was assessed using a dual-axis inclinometer. Results PRGT significantly increased muscle activations compared to RAGT in stroke patients ( p < 0.05). Additionally, there was a significant difference in ankle dorsiflexion between RAGT and PRGT in both groups ( p < 0.05). Conclusion PRGT demonstrated superior immediate effects on muscle activation and ankle movement, suggesting that combining PNF with robotic-assisted gait training is beneficial for chronic stroke rehabilitation.

Cost effective clinical methods to evaluate the efficacy of gait training devices: A systematic review of randomized controlled trials

Abstract Aim: This systematic review was aimed at identifying cost-effective outcome assessment metrics to perform clinical trials for assessing the efficacy of novel, low-cost gait training devices. Materials and methods: The search was conducted by the investigators through electronic databases, namely SCOPUS (91), Web of Science (93), PubMed (141) and Cochrane Library (164), from origination to 31st March 2024. The study design was a PRISMA style systematic review of randomized controlled trials (RCTs) of robotic gait training devices (RGTDs) that treated stroke patients. Results: Based on our inclusion and exclusion criteria, 17 randomized controlled trials were studied to identify suitable outcome assessment measures. This involved 705 patients at different stages of stroke, who were treated with different intervention durations, devices, randomization and blinding methods. It was observed from the extensive clinical trials with the RGTDs that it was tested with a variety of assessment methods. Cost-effective outcome assessment measures that require commonly available materials are chosen and discussed in this review. It is identified that the most extensively used measures possess concurrent validity, sufficient inter-rater, intra-rater and test-retest reliability. Conclusion: Clinical trials with a sophisticated setup cannot be afforded by clinics in low-income countries. It is vital to identify assessment methods that require commonly available materials that do not incur huge material costs. The methods discussed in this review can be administered without special training. This can facilitate quantifying and comparing the efficacy of these devices through clinical trials and multi-centric investigations.

Effectiveness of various lower extremity rehabilitation techniques to improve quality of life in post-stroke patients

The ability to move the lower extremities in individuals who have suffered from a stroke presents significant challenges to daily mobility and function. We conducted a systematic evaluation to compare the effectiveness of physical rehabilitation following a stroke. We searched six databases (PubMed, Science Direct, Cochrane Library, Springer, Portal Garuda, and Nature Portfolio) for publications published before November 2023. The researchers recruited stroke patients and used a validated scale to assess lower extremity strength and walking capacity in post-stroke patients. We used the Joanna Briggs Institute Critical Appraisal Checklist to evaluate the quality of the papers that met the inclusion criteria. The PRISMA checklist was used to report the study. We identified nine relevant articles that discussed various rehabilitation methods for stroke patients with lower extremity impairment. We examined the specificity of these results using a statistical parameter. The findings were as follow: Biofeedback cycling (P < 0.001); Pelvic Stability Training (P < 0.05); Exoskeleton for post-stroke recovery of ambulation (ExStRA) (P < 0.05); Aerobic Cycling (P < 0.001); Somatosensory Training (P < 0.001), Lower-extremity constraint-induced movement therapy (P < 0.001), Motor imagery with circuit class therapy (P < 0.001), Robotic gait training (P < 0.05), and Early and Intensive (P < 0.001). Various rehabilitation methods discussed in the article demonstrate high effectiveness in improving lower extremity function. These methods include biofeedback cycling, aerobic cycling, somatosensory training, movement therapy, motor imagery combined with structured progressive circuit therapy classes, and early and intensive rehabilitation after ischemic stroke.

Early robotic gait training after stroke (ERA Stroke): study protocol for a randomized clinical trial

BackgroundWalking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation.MethodsThis prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis.DiscussionThis study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation.Trial registrationNCT06430632.

Dosing overground robotic gait training after spinal cord injury: a randomized clinical trial protocol

BackgroundRobotic exoskeletons have changed rehabilitation care available to people after spinal cord injury (SCI). Yet, the current evidence base is insufficient to identify the optimal dose and neurophysiological mechanism of robotic exoskeleton gait training (RGT) as an effective rehabilitation approach. This study will (1) examine whether the frequency of RGT after motor incomplete SCI impacts function and health outcomes, (2) analyze the neuroplastic effects of RGT dose, and (3) evaluate the safety, tolerability, and feasibility of delivering RGT.MethodsWe will enroll 144 participants with motor incomplete SCI admitted to inpatient rehabilitation within 6 months of SCI. Participants will be randomized based on injury severity and level into one of 3 RGT frequency groups (high, moderate, low) or none/usual care only. Participants will complete 24 RGT sessions and be assessed at admission and discharge to inpatient rehabilitation, post-RGT intervention, 1-month post-RGT, and 9-month post-SCI. Outcomes include Walking Index for Spinal Cord Injury-II, health outcomes (gait speed, Spinal Cord Independence Measure, pain, fatigue, spasticity, general health, quality of life, physical activity), and motor evoked potential amplitudes obtained using transcranial magnetic stimulation.DiscussionSuccessful completion of this study will provide an evidence-based intervention, specifically tailored to meet the unique needs of people with SCI, which supports walking recovery; maximizing health, function, and ultimately participation. The intervention will further support widespread clinical implementation of exoskeleton use during acute rehabilitation.Trial registrationClinicalTrials.gov NCT05218447. Registered on June 23, 2022.

Physical therapist burden delivering gait training for a patient with lateropulsion after stroke during inpatient rehabilitation: a single-case design

Background/Aims Gait training for patients with lateropulsion after stroke improves outcomes (eg reduced lateropulsion and improved function) but can be burdensome on the physical therapist. This study describes the physical therapist burden and performance of a patient with moderate lateropulsion during three gait training approaches during inpatient rehabilitation. Methods A physical therapist delivered gait training (one session each of overground robotic exoskeleton, overground supported walking, and body weight-supported treadmill training) for a patient with lateropulsion (scoring 8 out of 17 on the Burke Lateropulsion Scale). Outcomes were physiological burden (heart rate, metabolic equivalents, respiratory exchange ratio and energy expenditure), which were measured via a wearable metabolic system and perceptual burden (National Aeronautics and Space Administration Task Load Index) on the physical therapist. Patient performance (step count, time walking, time spent upright and time in moderate-to-vigorous intensity) was recorded. Results During overground robotic exoskeleton gait training, the physical therapist's physiological metrics included an average heart rate of 116 beats per minute (minimum–maximum: 98–127, time in moderate-to-vigorous intensity was 0%), average metabolic equivalents of 3.2 (minimum–maximum: 1.7–4.3), a respiratory exchange ratio of 0.79 (minimum–maximum: 0.70–0.93), an energy expenditure of 228 kcal/hour and a perceptual burden of 33.3. The patient walked 228 steps, spent 15.4 minutes upright, 8.7 minutes walking and achieved 0% in moderate-to-vigorous intensity. During overground supported walking, the physical therapist's metrics included an average heart rate of 145 beats per minute (minimum–maximum: 113–164, time in moderate-to-vigorous intensity was 87%), average metabolic equivalents of 4.7 (minimum–maximum: 2.7–6.0), a respiratory exchange ratio of 0.96 (minimum–maximum: 0.81–1.16), an energy expenditure of 343 kcal/hour and a perceptual burden of 60.8. The patient walked 588 steps, spent 19.6 minutes upright, 10.5 minutes walking and achieved 38% in moderate-to-vigorous intensity. During body weight-supported treadmill training, the physical therapist's metrics included an average heart rate of 112 beats per minute (minimum–maximum: 69–137, time in moderate-to-vigorous intensity was 34%), average metabolic equivalents of 3.9 (minimum–maximum: 3.2–4.4), a respiratory exchange ratio of 0.89 (minimum–maximum: 0.82–0.95), an energy expenditure of 281 kcal/hour and a perceptual burden of 32.5. The patient walked 682 steps, spent 16.0 minutes upright, 10.0 minutes walking and achieved 0% in moderate-to-vigorous intensity. Conclusions As concordance between physical therapist burden and patient gait performance was low in this study, future efforts to identify gait training approaches that minimise therapist burden while maximising outcomes for the patient with lateropulsion are necessary for the health of both. Implications for practice Physical therapists may consider advanced technology use such as overground robotic exoskeletons to reduce the burden during the provision of gait training for patients with lateropulsion. Gait training performance of patients with lateropulsion may vary across different gait training approaches with low correspondence to therapist burden.

Children With Cerebral Palsy Try a Wearable Robot for Gait Training

Children With Cerebral Palsy Try a Wearable Robot for Gait Training

Robotic exoskeleton-assisted gait training in patients with motor incomplete myelopathy

Objectives: To assess the effect of gait training with robotic exoskeleton-assisted rehabilitation systems on gait parameters, balance, and overall disability in motor incomplete myelopathy. Design: Prospective pre-post study. Setting: Neurological rehabilitation unit in a tertiary university teaching hospital. Participants: Thirty-four motor incomplete myelopathy patients [22 males, mean age 36.7 y (12.7)] were included in this prospective, pre-post study. Twenty-two had nontraumatic etiology, and 17 had tetraplegia. American Spinal Injury Association impairment scale suggested 23 as C and 11 as American Spinal Injury Association impairment scale-D. The mean duration of the lesion was 333 days. Intervention: Twenty-four sessions of robotic gait training (1-h session, 5–6 sessions/wk) for 4–6 weeks. Outcome measures: Gait speed was assessed using a 10-meter walk test (10MWT), endurance with a 2-minute walk test (2MWT) and 6-minute walk test (6MWT), walking ability by Walking Index in Spinal Cord Injury-walking index for spinal cord injury II, functionality using Spinal cord Independence Measure-SCIM III, and balance by Timed-up-and-go (TUG) test. Results: At baseline, 20 patients were nonwalkers-NWB, and 14 were walkers-WB. The walking index for spinal cord injury II and SCIM III suggested significant improvement in both groups by the end of the study (P<0.05). Among the WB group, 10MWT, 2MWT, and TUG showed significant improvement (P=0.004, 0.02, and 0.01, respectively) with training. Patients in NWB group were able to perform 10MWT, 2MWT, 6MWT, and TUG by the end of the study. Conclusions: Gait training with robotic exoskeleton-assisted rehabilitation systems can lead to a significant improvement in gait endurance, speed, balance, and functional outcomes in individuals with incomplete myelopathy. The effect is more pronounced among already ambulatory patients.

Comparing the effectiveness of robotic plantarflexion resistance and biofeedback between overground and treadmill walking

Individuals with diminished walking performance caused by neuromuscular impairments often lack plantar flexion muscle activity. Robotic devices have been developed to address these issues and increase walking performance. While these devices have shown promise in their ability to increase musculature engagement of the lower limbs when used on a treadmill, most have not been developed or validated for overground walking and community use. Overground walking may limit the effectiveness of robotic devices due to differences in gait characteristics between walking terrains and reduced user engagement. The purpose of this study was to validate our multimodal robotic gait training system for overground walking in individuals with neuromuscular gait impairments. This untethered wearable robotic device can provide an ankle resistive torque proportional to the users’ biological ankle torque. The device can also provide audio biofeedback based on users’ plantar pressure intending to increase ankle power and muscle activity of the plantar flexors. Seven individuals with cerebral palsy participated. Participants walked overground and on a treadmill with our robotic gait training system in a single testing session. Results showed all seven participants to increase peak plantar flexor muscle activity, 10.3% on average, when walking with the gait trainer overground compared to treadmill. When compared to typical baseline overground walking, overground gait trainer use caused individuals to have slightly less knee joint excursion (3°) and moderately more ankle joint excursion (7°). This work supports our vision of using the wearable robotic device as a gait aid and rehabilitation tool in the home and community settings.

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches.

Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.

Can Robotic Gait Training with End Effectors Improve Lower-Limb Functions in Patients Affected by Multiple Sclerosis? Results from a Retrospective Case-Control Study.

Background: Multiple sclerosis (MS) is characterized as a neurodegenerative condition possibly triggered by autoimmune mechanisms, impacting the entire central nervous system. In this context, neurorehabilitation plays a crucial role in every phase of the disease, aiming to restore and preserve motor functions in MS patients. In particular, robotic gait training (RGT) allows intensive, repetitive, and task-oriented training, which is pivotal in boosting neuroplastic processes. Thus, the primary aim of our study is to evaluate the effectiveness of innovative robotic gait training, using the G-EO system, on gait, functional abilities, and quality of life (QoL) in patients affected by MS. Secondly, we evaluated the effect of the robotic rehabilitation on lower-limb motor functioning, balance, sensation, and joint functioning. Methods: The study involved twenty MS patients, divided into two groups with comparable medical characteristics and rehabilitation training duration. The experimental group (EG) underwent robotic gait training with the G-EO system (n. 10), while the control group (CG) received traditional rehabilitation training (n. 10). Results: Both groups exhibited improvements in disability level (Functional Independence Measure), 10 m walking distance (10MWT), gait, and balance performance (Functional Ambulation Classification, Tinetti Scale). However, the EG demonstrated a more significant improvement. The G-EO system notably reduced spasticity in the lower limbs (Modified Ashworth Scale) exclusively in the EG. Discussion: This study suggests that the G-EO system could be a valuable tool for enhancing gait functions, including lower-limb movements, functional abilities, and QoL in individuals with MS.

Kinematic Performance of a Customizable Single Degree-of-Freedom Gait Trainer for Cost-Effective Therapy Aimed at Neuromuscular Impairments

Abstract A majority of robotic gait trainers to facilitate physical therapy for gait rehabilitation in humans are based on multidegree-of-freedom exoskeleton-based systems with sophisticated electro-mechanical hardware and software, and consequently remain inaccessible to vast sections of the populations around the world. This study seeks to advance the development of a single degree-of-freedom (DOF) gait trainer for gait therapy for individuals with neuromuscular impairments. The goal is to offer a cost-effective, accessible solution to cater to the global need for gait rehabilitation. We build upon the previous gait trainer design based on Jansen mechanism and provide an in-depth analysis and experimental validation of its kinematic performance. The device's performance is also tested and successfully demonstrated through trials involving two healthy individuals to examine its kinematic behavior under human-induced load conditions. The gait trainer demonstrates satisfactory performance under both no load conditions and a 2 kg load, exhibiting an area difference of 1% and 7%, respectively. However, when subjected to a 5 kg loading condition, a significant area difference of 27% is observed, primarily attributed to the cantilever loading at the driving shaft. A method to adjust link lengths based on specific human gait trajectories is proposed and validated. Additionally, a cost-effective tool for ankle trajectory measurement is introduced to establish a ground truth. The study demonstrates the potential of an affordable, single DOF gait trainer in facilitating high-volume therapy for those with walking disorders. This research represents a step toward making gait therapy more accessible worldwide.

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.

OVERGROUND ROBOTIC EXOSKELETON GAIT TRAINING INTENSITY IN PATIENTS WITH SCI

https://youtu.be/nreyPHEQASg BACKGROUND High-intensity gait training during inpatient rehabilitation (IPR) promotes functional recovery following spinal cord injury (SCI) and may be achieved with overground robotic exoskeleton gait training (OEGT). Due to neuromuscular and autonomic impairments associated with SCI, assessing intensity through heart rate response and perceived exertion during gait training may be inaccurate. Wearable metabolic systems (WMS) have been used to directly measure intensity using oxygen consumption (VO2) with SCI. However, the use of WMS to assess OEGT intensity during OEGT in IPR is unexplored. PURPOSE: To describe the use of WMS to measure physiological intensity of OEGT in patients with motor incomplete SCI during IPR. METHODS This observational study included adults aged 18 to 85 admitted to IPR with diagnosis of motor incomplete SCI who were eligible to initiate OEGT. OEGT intensity, duration, and step count were assessed during 1 OEGT session performed within 1 week of gait training initiation following IPR admission. Intensity was assessed by rate of perceived exertion (RPE) and VO2. VO2 was measured using a WMS worn during OEGT and expressed in metabolic equivalents (METs). Moderate and high intensity were defined as ≥ 3 and ≥ 6 METs, respectively, with 2.7 mL/min/kg of VO2 = 1 MET. RESULTS 4 participants [3 males; 1 non-Hispanic white, 2 Hispanic white, 1 Black] were aged 52±8.4 years with a body mass index of 28.4±3.2. Participants’ SCI characteristics were 3 diagnosed ASIA Impairment Scale (AIS) C, 1 AIS D; 2 tetraplegia and 2 paraplegia admitted within 30.5 [range=8-56] days after SCI. Duration of OEGT sessions (n=4) was 15:57 [range=10:23-19:43] minutes and participants completed 512 [287-761] steps. RPE was 4 [2-6], VO2 was 7.3 [3.05-15.6], and METs were 2.72 [1.1-5.8]. Three participants achieved ≥3 METs and ≥6 METs for 79-89.6% and 4.2-54.8% of the OEGT session, respectively. VO2 was highest in the AIS D participant. CONCLUSIONS WMS use was demonstrated to feasibly obtain intensity data of OEGT in adults with SCI during IPR. Future research should consider the utility of WMS to assess the capacity of OEGT to promote high-intensity gait training in this population during IPR.

From Paralysis to Progress: The role of Robotic Gait Training in Restoring Ambulation in Spinal Cord Injury Patients: A Review

From Paralysis to Progress: The role of Robotic Gait Training in Restoring Ambulation in Spinal Cord Injury Patients: A Review

Design and Validation of a Pancake Style Planetary Gearbox for an Eddy Current-Based Wearable Gait Training Robot.

Eddy current brakes have been recently used for functional resistance training in individuals with neurological and orthopaedic disorders. These devices consist of a gearbox, a conductive disc, and permanent magnets that can be moved relative to the disc to alter resistance. However, current devices use a commercial planetary gearbox with a tall profile that sticks out from the leg, which affects wearability. This is coupled with the large system inertia, which together impedes potential device transition to clinical and in-home use. In this study, we developed a low-profile, pancake-style planetary gearbox that greatly reduces the protrusion of the device from the leg. We performed a design analysis and optimization to minimize the thickness and inertia of the device while ensuring that it could withstand the maximum expected torque (50 Nm). We then performed human subjects experiments to examine the effectiveness of our new design for functional resistance training. The results indicated that all leg muscles showed a significant increase in activation during resisted conditions. There were also significant after-effects on medial hamstring activation. These results indicate that the new design is a feasible method for functional resistance training and may have a potential clinical value in gait rehabilitation.

Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial

BackgroundImproving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. ObjectiveTo conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. MethodThirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. ResultsAfter the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). ConclusionTwo weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection.

Online gait learning with Assist-As-Needed control strategy for post-stroke rehabilitation exoskeletons

AbstractLower limb exoskeletons (LLEs) have demonstrated their potential in delivering quantified repetitive gait training for individuals afflicted with gait impairments. A critical concern in robotic gait training pertains to fostering active patient engagement, and a viable solution entails harnessing the patient’s intrinsic effort to govern the control of LLEs. To address these challenges, this study presents an innovative online gait learning approach with an appropriate control strategy for rehabilitation exoskeletons based on dynamic movement primitives (DMP) and an Assist-As-Needed (AAN) control strategy, denoted as DMP-AAN. Specifically tailored for post-stroke patients, this approach aims to acquire the gait trajectory from the unaffected leg and subsequently generate the reference gait trajectory for the affected leg, leveraging the acquired model and the patient’s personal exertion. Compared to conventional AAN methodologies, the proposed DMP-AAN approach exhibits adaptability to diverse scenarios encompassing varying gait patterns. Experimental validation has been performed using the lower limb rehabilitation exoskeleton HemiGo. The findings highlight the ability to generate suitable control efforts for LLEs with reduced human-robot interactive force, thereby enabling highly patient-controlled gait training sessions to be achieved.

Utilizing mobile robotics for pelvic perturbations to improve balance and cognitive performance in older adults: a randomized controlled trial

Late-life balance disorders remain a severe problem with fatal consequences. Perturbation-based balance training (PBT), a form of rehabilitation that intentionally introduces small, unpredictable disruptions to an individual's gait cycle, can improve balance. The Tethered Pelvic Assist Device (TPAD) is a cable-driven robotic trainer that applies perturbations to the user's pelvis during treadmill walking. Earlier work showcased improved gait stability and the first evidence of increased cognition acutely. The mobile Tethered Pelvic Assist Device (mTPAD), a portable version of the TPAD, applies perturbations to a pelvic belt via a posterior walker during overground gait, as opposed to treadmill walking. Forty healthy older adults were randomly assigned to a control group (CG, n = 20) without mTPAD PBT or an experimental group (EG, n = 20) with mTPAD PBT for a two-day study. Day 1 consisted of baseline anthropometrics, vitals, and functional and cognitive measurements. Day 2 consisted of training with the mTPAD and post-interventional cognitive and functional measurements. Results revealed that the EG significantly outperformed the CG in several cognitive (SDMT-C and TMT-B) and functional (BBS and 4-Stage Balance: one-foot stand) measurements while showcasing increased confidence in mobility based on FES-I. To our knowledge, our study is the first randomized, large group (n = 40) clinical study exploring new mobile perturbation-based robotic gait training technology.