Background: Robotic devices have been used to rehabilitate walking function after stroke. Although results suggest that post-stroke patients benefit from this non-conventional therapy, there is no agreement on the optimal robot-assisted approaches to promote neurorecovery. Here we present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control. Method: Ten healthy individuals and a post-stroke patient participated in the study and were enrolled in a pilot intervention protocol that involved performance of ankle movements following different trajectories via video game visual feedback. The system autonomously modulated task difficulty according to the performance to increase the challenge. We hypothesized that motor learning throughout training sessions would lead to increased corticospinal excitability of dorsi-plantarflexor muscles. Transcranial Magnetic Stimulation was used to assess the effects on corticospinal excitability. Results: Improvements have been observed on task performance and motor outcomes in both healthy individuals and post-stroke patient case study. Tibialis Anterior corticospinal excitability increased significantly after the training; however no significant changes were observed on Soleus corticospinal excitability. Clinical scales showed functional improvements in the stroke patient. Discussion and Significance: Our findings both in neurophysiological and performance assessment suggest improved motor learning. Some limitations of the study include treatment duration and intensity, as well as the non-significant changes in corticospinal excitability obtained for Soleus. Nonetheless, results suggest that this robotic training framework is a potentially interesting approach that can be explored for gait rehabilitation in post-stroke patients.

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Introduction: Stroke generates a high rate of disability and, in particular, ankle spasticity is a sequelae that interferes with the execution of daily activities. Robotic devices have been proposed to offer rehabilitation treatments to recover control of ankle muscles and hence to improve gait function.Objective: The aim of this study is to investigate the effects of passive stretching, combined with active and resisted movement, accompanied by visual feedback, by means of playful interactive software using a low-cost monoarticular robot (MEXO) in patients with stroke sequelae and spastic ankle.Methods: An open, uncontrolled, non–randomised, quasi–experimental study of 6 weeks duration has been completed. A protocol has been defined to determine the usability, safety and potential benefits of supplementary treatment with the MEXO interactive system in a group of patients. Nine volunteer patients with sequelae of stroke who met the inclusion criteria were included. They received conventional treatment and in addition also received treatment with the MEXO monoarticular robot three times a week during 6 weeks. Each session consisted of 10 min of passive stretching followed by 20 min of active movement training with visual feedback (10 min active without resistance, 10 min with resistance) and a final phase with 10 min of passive stretching. The following variables were measured pre– and post–treatment: joint range of motion and ankle muscle strength, monopodal balance, muscle tone, gait ability and satisfaction with the use of assistive technology.Results: Statistically significant improvements were obtained in joint range measured by goniometry and in balance measured by monopodal balance test. Also in walking capacity, through the measurement of travelled distance.Discussion and significance: Device usability and patient safety were tested. Patients improved joint range and monopodal balance. The MEXO exoskeleton might be a good alternative for the treatment of spastic ankle joint in people with a stroke sequela.

This paper explores the usefulness of features extracted from video-oculographic recordings for the discrimination of Parkinson's disease. Experiments are performed on a dataset containing eye tracking registers of age-paired parkinsonian and control subjects during a visual exploration task. The total saccadic excursion-measuring the extent of the exploration area-and the number of saccades are employed to differentiate between populations. In particular, the total saccadic excursion achieved an area under the ROC curve of 0.98, indicating that parkinsonian and control subjects differ in terms of the extension of exploration during the proposed visualization task. These preliminary results suggest the appropriateness of using video-oculography to analyze Parkinson's disease, and the potentiality of signal processing techniques for automatic detection labors.