Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke. This prospective, blinded, randomized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical-driven gait orthosis (Lokomat) for treadmill training.
Sixteen stroke patients, mostly within 3 months after onset, were randomized into 2 treatment groups, ABA or BAB (A = 3 weeks of Lokomat training, B = 3 weeks of conventional physical therapy) for 9 weeks of treatment. The outcome measures were the EU-Walking Scale, Rivermead Motor Assessment Scale, 10-m timed walking speed, 6-minute timed walking distance, Motricity Index, Medical Research Council Scale of strength, and Ashworth Scale of tone.
The EU-Walking Scale, Rivermead Motor Assessment Scale, 6-minute timed walking distance, Medical Research Council Scale, and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval.
Despite the small number of patients, the present data suggest that the Lokomat robotic assistive device provides innovative possibilities for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist.
"Locomotion training robots (LTRs) possess structures with smaller mass and liberate physicians' workforce, as the actuator can be applied for motion transmission. There are two kinds of LTRs, namely, traction type and exoskeleton type LTRs . The traction type LTRs are commonly used with fixed platform to which the users cannot move relatively. "
[Show abstract][Hide abstract] ABSTRACT: This paper introduces a multiposture locomotor training device (MPLTD) with a closed-loop control scheme based on joint angle feedback, which is able to overcome various difficulties resulting from mechanical vibration and the weight of trainer to achieve higher accuracy trajectory. By introducing the force-field control scheme used in the closed-loop control, the device can obtain the active-constrained mode including the passive one. The MPLTD is mainly composed of three systems: posture adjusting and weight support system, lower limb exoskeleton system, and control system, of which the lower limb exoskeleton system mainly includes the indifferent equilibrium mechanism with two degrees of freedom (DOF) and the driving torque is calculated by the Lagrangian function. In addition, a series of experiments, the weight support and the trajectory accuracy experiment, demonstrate a good performance of mechanical structure and the closed-loop control.
"Barbeau and Visintin showed that manual BWSTT improves balance in patients with stroke . However, as participants are strongly fixated in the robot, it remains questionable whether balance becomes trained during RAGT, as recently discussed for patients with stroke [9,42]. As a performance-based measure of balance, we used the Berg Balance Scale (BBS) . "
[Show abstract][Hide abstract] ABSTRACT: Task-specific locomotor training has been promoted to improve walking-related outcome after incomplete spinal cord injury (iSCI). However, there is also evidence that lower extremity strength training might lead to such improvements. The aim of this randomized cross-over pilot study was to compare changes in a broad spectrum of walking-related outcome measures and pain between robot-assisted gait training (RAGT) and strength training in patients with chronic iSCI, who depended on walking assistance. We hypothesized that task-specific locomotor training would result in better improvements compared to strength training.
Nine participants with a chronic iSCI were randomized to group 1 or 2. Group 1 received 16 sessions of RAGT (45 min each) within 4 weeks followed by 16 sessions of strength training (45 min each) within 4 weeks. Group 2 received the same interventions in reversed order. Main outcome measures were the 10 m Walk Test (10MWT) at preferred and maximal speed. Furthermore, we assessed several measures such as walking speed under different conditions, balance, strength, and 2 questionnaires that evaluate risk of falling and pain. Data were collected at baseline, between interventions after 4 weeks, directly after the interventions and at follow-up 6 months after the interventions. Pain was assessed repeatedly throughout the study.
There were no significant differences in changes in scores between the 2 interventions, except for maximal walking speed (10MWT), which improved significantly more after strength training than after RAGT. Pain reduced after both interventions.
In patients with chronic iSCI dependent on walking assistance, RAGT was not more effective in improving walking-related outcome compared to lower extremity strength training. However, the low sample size limits generalizability and precision of data interpretation.Trial registration: This study was registered at www.clinicaltrials.gov (NCT01087918).
Journal of NeuroEngineering and Rehabilitation 01/2014; 11(1):4. DOI:10.1186/1743-0003-11-4 · 2.74 Impact Factor
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