Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial
TL;DR: Intensive locomotor training on a treadmill with the assistance of a DGO resulted in significant improvements in the subjects' gait velocity, endurance, and performance of functional tasks.
About: This article is published in Archives of Physical Medicine and Rehabilitation.The article was published on 2005-04-01. It has received 416 citations till now. The article focuses on the topics: Spinal cord injury & Preferred walking speed.
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TL;DR: There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury, and this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance.
Abstract: There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.
992 citations
Cites background from "Effectiveness of automated locomoto..."
...These studies show that robot assistance modestly but significantly decrease motor impairment, including at long-term follow-ups, using standard clinical scales as the outcome measures [56,58,59,77,83,88,98,113,135,150-156]....
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...There are now many studies that examined the effect of robotic therapy on chronic patients with the patients' baseline as their own control [56,58,59,77,83,88,98,113,135,150-156], and studies in which an additional dose of therapy in the form of robot therapy was given [157-160]....
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TL;DR: An electrochemical neuroprosthesis and a robotic postural interface designed to encourage supraspinally mediated movements in rats with paralyzing lesions triggered a cortex-dependent recovery that may improve function after similar injuries in humans.
Abstract: Half of human spinal cord injuries lead to chronic paralysis. Here, we introduce an electrochemical neuroprosthesis and a robotic postural interface designed to encourage supraspinally mediated movements in rats with paralyzing lesions. Despite the interruption of direct supraspinal pathways, the cortex regained the capacity to transform contextual information into task-specific commands to execute refined locomotion. This recovery relied on the extensive remodeling of cortical projections, including the formation of brainstem and intraspinal relays that restored qualitative control over electrochemically enabled lumbosacral circuitries. Automated treadmill-restricted training, which did not engage cortical neurons, failed to promote translesional plasticity and recovery. By encouraging active participation under functional states, our training paradigm triggered a cortex-dependent recovery that may improve function after similar injuries in humans.
676 citations
12 Sep 2005
TL;DR: This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders by hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies.
Abstract: Task-oriented repetitive movements can improve motor performance in patients with neurological or orthopaedic lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate, and document neurological and orthopedic rehabilitation. This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders. We define patient-cooperative to mean that, during movement, the technical system takes into account the patient's intention and voluntary efforts rather than imposing any predefined movements or inflexible strategies. It is hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies. New cooperative strategies are presented that detect the patient's voluntary efforts. First, this enables the patient increased freedom of movement by a certain amount of robot compliance. Second, the robot behavior adapts to the existing voluntary motor abilities. And third, the robotic system displays and improves the patient contribution by visual biofeedback. Initial experimental results are presented to evaluate the basic principle and technical function of proposed approaches. Further improvements of the technical design and additional clinical testing is required to prove whether the therapeutic outcome can be enhanced by such cooperative strategies.
657 citations
TL;DR: Therapist-assisted LT facilitates greater improvements in walking ability in ambulatory chronic stroke survivors as compared to a similar dosage of robotic-assistedLT.
Abstract: Background and Purpose— Locomotor training (LT) using a treadmill can improve walking ability over conventional rehabilitation in individuals with hemiparesis, although the personnel requirements often necessary to provide LT may limit its application. Robotic devices that provide consistent symmetrical assistance have been developed to facilitate LT, although their effectiveness in improving locomotor ability has not been well established. Methods— Forty-eight ambulatory chronic stroke survivors stratified by severity of locomotor deficits completed a randomized controlled study on the effects of robotic- versus therapist-assisted LT. Both groups received 12 LT sessions for 30 minutes at similar speeds, with guided symmetrical locomotor assistance using a robotic orthosis versus manual facilitation from a single therapist using an assist-as-needed paradigm. Outcome measures included gait speed and symmetry, and clinical measures of activity and participation. Results— Greater improvements in speed and si...
480 citations
TL;DR: This work reviews all current robotic systems to date for lower-limb rehabilitation, as well as main clinical tests performed with them, with the aim of showing a clear starting point in the field.
Abstract: This paper presents a survey of existing robotic systems for lower-limb rehabilitation. It is a general assumption that robotics will play an important role in therapy activities within rehabilitation treatment. In the last decade, the interest in the field has grown exponentially mainly due to the initial success of the early systems and the growing demand caused by increasing numbers of stroke patients and their associate rehabilitation costs. As a result, robot therapy systems have
been developed worldwide for training of both the upper and lower extremities. This work reviews all current robotic systems to date for lower-limb rehabilitation, as well as main clinical tests performed with them, with the aim of showing a clear starting point in the field. It also remarks some challenges that current systems still have to meet in order to obtain a broad clinical and market acceptance.
465 citations
References
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TL;DR: This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital and suggested that the timed “Up & Go’ test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.
Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
12,004 citations
Book•
01 Jan 1992
TL;DR: This text encompasses the work of Dr Jacquelin Perry in her years as a therapist and surgeon focusing on the human gait, suitable for incorporating into many athletic training programmes, university physical therapy programmes and gait workshops.
Abstract: This text encompasses the work of Dr Jacquelin Perry in her years as a therapist and surgeon focusing on the human gait. The text is broken down into four sections: fundamentals; normal gait; pathological gait; and gait analysis systems. In addition to the descriptions of the gait functions, a representative group of clinical examples has been included to facilitate the interpretation of the identified gait deviations. The book includes detailed laboratory records with illustrations and photographs. Intended as a reference for health care professionals involved in musculoskeletal patient care, the text is suitable for incorporating into many athletic training programmes, university physical therapy programmes and gait workshops.
3,611 citations
TL;DR: International Standards for Neurological and Functional Classification of Spinal Cord Injury are published and will be used for clinical practice.
Abstract: International Standards for Neurological and Functional Classification of Spinal Cord Injury
2,062 citations
TL;DR: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury (ISBWC) as mentioned in this paper is a standard for the classification of spinal cord injury. But it is not a classification of neurological disorders.
Abstract: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury
1,709 citations
Journal Article•
1,515 citations