Clinical Application of Robotics and Technology in the Restoration of Walking

Esquenazi, Alberto; Maier, Irin C.; Schuler, Tabea; Beer, Serafin; Borggraefe, Ingo; Campen, Katrin; Luft, Andreas R.; Manoglou, Dimitrios; Meyer-Heim, Andreas; Spiess, Martina R.; Wirz, Markus

doi:10.1007/978-3-319-28603-7_12

Cited by 9 publications

(5 citation statements)

References 94 publications

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“…After 1 minute on continuous passive movement, the PT selected the adaptive mode. If the participant reached preset threshold, the servomotors of the machine shut down and allowed the participant to move along the set trajectory without assistance [20]. A representative participant setup and training on the G-EO device is shown in Figure 1A.…”

Section: G-eo Systemsmentioning

confidence: 99%

A Comparison of Locomotor Therapy Interventions: Partial‐Body Weight−Supported Treadmill, Lokomat, and G‐EO Training in People With Traumatic Brain Injury

Esquenazi

Lee

Wikoff

et al. 2017

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Section: G-eo Systemsmentioning

confidence: 99%

A Comparison of Locomotor Therapy Interventions: Partial‐Body Weight−Supported Treadmill, Lokomat, and G‐EO Training in People With Traumatic Brain Injury

Esquenazi

Lee

Wikoff

et al. 2017

PM&R

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“…Recovery of function post stroke is based on neural adaptation, and progressive task specific repetitive training based on the principles of neuroplasticity ( 1 , 2 ). While major advances have been made in early intervention for the treatment of patients post stroke, the majority of survivors have residual mobility challenges and hemiplegia ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Asymmetrical gait can be associated with muscle weakness, leading to inefficient ambulation, balance control challenges and risk of musculoskeletal injury to the non-paretic limb ( 6 , 7 ). Task-oriented, high-repetition movements can improve muscular strength, motor control and movement coordination in patients post stroke ( 2 ). The task-specific training pertains to the training driven to achieve a functional task such as walking rather than focusing on minimizing an impairment ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Integrating robotic exoskeleton (RE) technology into standard of care programs during the critical acute phase when the injured nervous system is highly plastic could maximize repetitive practice ( 9 , 10 ), improve functional outcome measurements and provide quality gait training ( 10 , 11 ). Programmable RE technology can also be used to advance progression during treatment and under the guidance of a physical therapist can emulate some features of manual assistance in a consistent and reproducible manner ( 2 ). The RE based training involves repetitive task-oriented (gait) movements and weight shifts to promote functional recovery.…”

Section: Introductionmentioning

confidence: 99%

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Electromyography Assessment During Gait in a Robotic Exoskeleton for Acute Stroke

et al. 2018

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Background: Robotic exoskeleton (RE) based gait training involves repetitive task-oriented movements and weight shifts to promote functional recovery. To effectively understand the neuromuscular alterations occurring due to hemiplegia as well as due to the utilization of RE in acute stroke, there is a need for electromyography (EMG) techniques that not only quantify the intensity of muscle activations but also quantify and compare activation timings in different gait training environments.Purpose: To examine the applicability of a novel EMG analysis technique, Burst Duration Similarity Index (BDSI) during a single session of inpatient gait training in RE and during traditional overground gait training for individuals with acute stroke.Methods: Surface EMG was collected bilaterally with and without the RE device for five participants with acute stroke during the normalized gait cycle to measure lower limb muscle activations. EMG outcomes included integrated EMG (iEMG) calculated from the root-mean-square profiles, and a novel measure, BDSI derived from activation timing comparisons.Results: EMG data demonstrated volitional although varied levels of muscle activations on the affected and unaffected limbs, during gait with and without the RE. During the stance phase mean iEMG of the soleus (p = 0.019) and rectus femoris (RF) (p = 0.017) on the affected side significantly decreased with RE, as compared to without the RE. The differences in mean BDSI scores on the affected side with RE were significantly higher than without RE for the vastus lateralis (VL) (p = 0.010) and RF (p = 0.019).Conclusions: A traditional amplitude analysis (iEMG) and a novel timing analysis (BDSI) techniques were presented to assess the neuromuscular adaptations resulting in lower extremities muscles during RE assisted hemiplegic gait post acute stroke. The RE gait training environment allowed participants with hemiplegia post acute stroke to preserve their volitional neuromuscular activations during gait iEMG and BDSI analyses showed that the neuromuscular changes occurring in the RE environment were characterized by correctly timed amplitude and temporal adaptations. As a result of these adaptations, VL and RF on the affected side closely matched the activation patterns of healthy gait. Preliminary EMG data suggests that the RE provides an effective gait training environment for in acute stroke rehabilitation.

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“…On the other hand, especially with patients with severe impairments, the lack of guidance at the hip and knee in end-effector type devices leads to a more movement variability and less precise walking pattern [5]. This in fact can pose a threat to patient care that can only be overcome by manual assistance or by using an additional knee brace.…”

Section: Safetymentioning

confidence: 99%

Clinical Application of Robotics and Technology in the Restoration of Walking

Cited by 9 publications

References 94 publications

A Comparison of Locomotor Therapy Interventions: Partial‐Body Weight−Supported Treadmill, Lokomat, and G‐EO Training in People With Traumatic Brain Injury

A Comparison of Locomotor Therapy Interventions: Partial‐Body Weight−Supported Treadmill, Lokomat, and G‐EO Training in People With Traumatic Brain Injury

Electromyography Assessment During Gait in a Robotic Exoskeleton for Acute Stroke

Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art”

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