Allowing Intralimb Kinematic Variability During Locomotor Training Poststroke Improves Kinematic Consistency: A Subgroup Analysis From a Randomized Clinical Trial

Lewek, Michael D.; Cruz, Theresa Hayes; Moore, Jennifer L.; Roth, Heidi; Dhaher, Yasin Y.; Hornby, T. George

doi:10.2522/ptj.20080180

Cited by 120 publications

(112 citation statements)

References 39 publications

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Section: Movement Variability During Trainingmentioning

confidence: 99%

“…This is also implied from clinical research showing that overground gait training or therapist-assisted BWSTT enables better ambulatory outcomes in people with SCI or stroke than with robotguided training [16,61]. The rigid imposition of movement trajectories by robot-assisted training limits the variability with which the lower limbs are moved and consequently could interfere with the nervous system's ability to effectively relearn gait patterns [61][62]. Indeed, variability during practice is seen as a key feature for facilitating learning because the nervous system is presented with repeated (and varied) opportunities to experience errors and solve motor problems [55], as opposed to simply learning how to reproduce an imposed trajectory [63].…”

Section: Movement Variability During Trainingmentioning

confidence: 99%

See 1 more Smart Citation

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Lam¹,

Pauhl²,

Ferguson³

et al. 2015

J Rehabil Res Dev

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Abstract-People with motor-incomplete spinal cord injury (m-iSCI) can recover basic walking function but still have difficulty performing the skilled walking required for everyday environments. We hypothesized that a robotic-based gait rehabilitation strategy founded on principles of motor learning would be a feasible and potentially effective approach for improving skilled walking in people with m-iSCI. Fifteen individuals with chronic (>1 yr) m-iSCI were randomly allocated to body weight-supported treadmill training (BWSTT) with Lokomat-applied resistance (Loko-R) or conventional Lokomat-assisted BWSTT (Control). Training sessions were 45 min, 3 times/week for 3 mo. Tolerance to training was assessed by ratings of perceived exertion and reports of pain/ soreness. Overground skilled walking capacity (Spinal Cord Injury-Functional Ambulation Profile [SCI-FAP]), as well as walking speed and distance, were measured at baseline, posttraining, and 1 and 6 mo follow-up. Our results indicate that Loko-R training could be feasibly applied for people with miSCI, although participants in Loko-R tended to report higher levels of perceived exertion during training. Participants in the Loko-R group performed significantly better in the SCI-FAP than Control at posttraining and in follow-up assessments. This study provides evidence that Loko-R training is feasible in people with m-iSCI. Furthermore, there is preliminary evidence suggesting that Loko-R may help improve performance in skilled overground walking tasks. Clinical Trial

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Section: Movement Variability During Trainingmentioning

confidence: 99%

Section: Movement Variability During Trainingmentioning

confidence: 99%

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Lam¹,

Pauhl²,

Ferguson³

et al. 2015

J Rehabil Res Dev

View full text Add to dashboard Cite

show abstract

“…We progressively reduced BWS s in successive GT sessions: slowly (high value of ) for the most-affected patients (initial FAC score = 0), and quickly for the less-affected patients (FAC score 2), despite similar values recorded at the first GT session among all patients. Notably, the BWS s selected in the first GT session was about 45 to 60 percent of body weight; that is higher than the 30 percent previously described [23]. The GT Handbook suggested a maximum BWS of 35 percent for nonambulatory patients with hemiparesis and a maximum of 10 percent in patients walking with aid, including support [19].…”

Section: Discussionmentioning

confidence: 80%

“…The GT Handbook suggested a maximum BWS of 35 percent for nonambulatory patients with hemiparesis and a maximum of 10 percent in patients walking with aid, including support [19]. Furthermore, clinical studies have recommended BWS limits of 30 percent on the treadmill [12] and 40 percent on the Lokomat ® [23] for maintaining the activity of antigravitational muscles. In contrast, a review on treadmill parameter selection stated that adequate support was 35 to 50 percent [18].…”

Section: Discussionmentioning

confidence: 99%

Driving electromechanically assisted Gait Trainer for people with stroke

Iosa¹,

Morone²,

Bragoni³

et al. 2011

JRRD

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Abstract-Electromechanically assisted gait training is a promising task-oriented approach for gait restoration, especially for people with subacute stroke. However, few guidelines are available for selecting the parameter values of the electromechanical Gait Trainer (GT) (Reha-Stim; Berlin, Germany) and none is tailored to a patient's motor capacity. We assessed 342 GT sessions performed by 20 people with stroke who were stratified by Functional Ambulatory Category. In the first GT session of all patients, the body-weight support (BWS) required was higher than that reported in the literature. In further sessions, we noted a slow reduction of BWS and a fast increment of walking speed for the most-affected patients. Inverse trends were observed for the less-affected patients. In all the patients, the heart rate increment was about 20 beats per minute, even for sessions in which the number of strides performed was up to 500. In addition, the effective BWS measured during GT sessions was different from that initially selected by the physiotherapist. This difference depended mainly on the position of the GT platforms during selection. Finally, harness acceleration in the anteroposterior direction proved to be higher in patients with stroke than in nondisabled subjects. Our findings are an initial step toward scientifically selecting parameters in electromechanically assisted gait training.

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“…If common mechanisms subserve motor learning and recovery of motor control after stroke, then a training mode that promotes decreases in training errors with practice would be hypothesized to be more effective in stroke rehabilitation than a mode in which subjects do not change strategy with repeated trials. A second potential advantage of the TIFT is that it allows for much greater kinematic variability during training, which has been hypothesized to have advantages to fixed trajectory robotic training with small kinematic errors [79][80][81]. Mean errors during TIFT were more than five times larger than those for TD training.…”

Section: Discussionmentioning

confidence: 99%

Retraining of interjoint arm coordination after stroke using robot-assisted time-independent functional training

Brokaw¹,

Murray²,

Nef³

et al. 2011

JRRD

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Abstract-We have developed a haptic-based approach for retraining of interjoint coordination following stroke called time-independent functional training (TIFT) and implemented this mode in the ARMin III robotic exoskeleton. The ARMin III robot was developed by Drs. Robert Riener and Tobias Nef at the Swiss Federal Institute of Technology Zurich (Eidgenossische Technische Hochschule Zurich, or ETH Zurich), in Zurich, Switzerland. In the TIFT mode, the robot maintains arm movements within the proper kinematic trajectory via haptic walls at each joint. These arm movements focus training of interjoint coordination with highly intuitive real-time feedback of performance; arm movements advance within the trajectory only if their movement coordination is correct. In initial testing, 37 nondisabled subjects received a single session of learning of a complex pattern. Subjects were randomized to TIFT or visual demonstration or moved along with the robot as it moved though the pattern (time-dependent [TD] training). We examined visual demonstration to separate the effects of action observation on motor learning from the effects of the two haptic guidance methods. During these training trials, TIFT subjects reduced error and interaction forces between the robot and arm, while TD subject performance did not change. All groups showed significant learning of the trajectory during unassisted recall trials, but we observed no difference in learning between groups, possibly because this learning task is dominated by vision. Further testing in stroke populations is warranted.

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Allowing Intralimb Kinematic Variability During Locomotor Training Poststroke Improves Kinematic Consistency: A Subgroup Analysis From a Randomized Clinical Trial

Abstract: Coordination of intralimb kinematics appears to improve in response to LT with therapist assistance as needed. Fixed assistance, as provided by this form of robotic guidance during LT, however, did not alter intralimb coordination.

Cited by 120 publications

References 39 publications

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Training with robot-applied resistance in people with motor-incomplete spinal cord injury: Pilot study

Driving electromechanically assisted Gait Trainer for people with stroke

Retraining of interjoint arm coordination after stroke using robot-assisted time-independent functional training

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