An Electromechanical Gait Trainer for Restoration of Gait in Hemiparetic Stroke Patients: Preliminary Results

Hesse, Stefan; Werner, Carsten; Uhlenbrock, Dietmar; Frankenberg, S. V.; Bardeleben, Anita; Brandl-Hesse, Beate

doi:10.1177/154596830101500106

Cited by 70 publications

(46 citation statements)

References 20 publications

(15 reference statements)

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“…Nonambulatory hemiparetic patients have shown improved walking ability and more normal patterns of muscle activation on the gait trainer, and the treatment requires less effort from the therapists compared to gait training on the treadmill. 18,19 Colombo et al 20,21 have chosen another solution to the problem of therapists' overexertion: their subjects wore a powered gait orthosis on the treadmill, which flexed the subjects' hip and knee joints during swing phase. Lower limb muscle activity of tetraparetic subjects on the treadmill was comparable during the manually assisted and the automated training with the driven gait orthosis.…”

Section: Introductionmentioning

confidence: 99%

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Hesse¹,

Werner²,

Bardeleben³

2004

Spinal Cord

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Study design: Single case studies. Objectives: To describe the technique of intensive locomotor training on an electromechanical gait trainer (GT) combined with functional electrical stimulation (FES). Setting: Neurological Rehabilitation Clinic, Berlin, Germany. Methods: Four spinal cord-injured (SCI) patients, one tetraparetic, two paraparetic, and one patient with an incomplete cauda syndrome, more than 3 months postinjury, who were unable to walk at all, or with two therapists. They received 25 min of locomotor training on the GT plus FES daily for 5 weeks in addition to the regular therapy. Results: The patients tolerated the programme well, and therapists rated the programme less strenuous compared to manually assisted treadmill training. Gait ability improved in all four patients; three patients could walk independently on the floor with the help of technical aids, and one required the help of one therapist after therapy; gait speed and endurance more than doubled, and the gastrocnemius activity increased in the patients with a central paresis. Conclusion: This combined technique allows intensive locomotor therapy in SCI subjects with reduced effort from the therapists. The patients' improved walking ability confirmed the potential of locomotor therapy in SCI subjects.

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Section: Introductionmentioning

confidence: 99%

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Hesse¹,

Werner²,

Bardeleben³

2004

Spinal Cord

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“…In an initial study, 4 weeks of additional daily therapy on the gait trainer resulted in a marked improvement of gait ability and muscle activity in 14 chronic, nonambulatory hemiparetic patients, compared with a preceding 3-week baseline. 12 The present crossover study was designed to see if the gait trainer was as effective as or even superior to treadmill training in subacute stroke patients who were still improving and to determine if it required less effort from the physiotherapists and patients.…”

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confidence: 99%

Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison

Werner

Bardeleben

Kirker

et al. 2002

Euro J of Neurology

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Background and Purpose-The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. Methods-This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern.A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. Results-The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (Pϭ0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. Conclusions-The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

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“…While current forms of robotic BWST during treadmill stepping can elicit significant improvements in ambulation ability and functional test scores with repetitive practice following stroke [15], [17] and SCI [8], [19], [20], they likely do not do 0018-9294/$25.00 © 2007 IEEE so in an optimal fashion [21]- [23]. Both the Lokomat and to a lesser extent the GTII, constrain the degrees of freedom at the hip.…”

Section: Feasibility Of Manual Teach-and-replay and Continuous Impedamentioning

confidence: 99%

“…The first two devices to undergo clinical testing, that have been reported in the literature, are the Mechanized Gait Trainer (GTII) [15], [17] and the Lokomat [13], [14]. These devices were developed to reduce the trainer's workload and provide repeatable stepping kinematics of the legs.…”

Section: Feasibility Of Manual Teach-and-replay and Continuous Impedamentioning

confidence: 99%

Feasibility of Manual Teach-and-Replay and Continuous Impedance Shaping for Robotic Locomotor Training Following Spinal Cord Injury

Emken

Harkema

Beres-Jones

et al. 2008

IEEE Trans. Biomed. Eng.

114

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Abstract-Robotic gait training is an emerging technique for retraining walking ability following spinal cord injury (SCI).A key challenge in this training is determining an appropriate stepping trajectory and level of assistance for each patient, since patients have a wide range of sizes and impairment levels. Here, we demonstrate how a lightweight yet powerful robot can record subject-specific, trainer-induced leg trajectories during manually assisted stepping, then immediately replay those trajectories. Replay of the subject-specific trajectories reduced the effort required by the trainer during manual assistance, yet still generated similar patterns of muscle activation for six subjects with a chronic SCI. We also demonstrate how the impedance of the robot can be adjusted on a step-by-step basis with an error-based, learning law. This impedance-shaping algorithm adapted the robot's impedance so that the robot assisted only in the regions of the step trajectory where the subject consistently exhibited errors. The result was that the subjects stepped with greater variability, while still maintaining a physiologic gait pattern. These results are further steps toward tailoring robotic gait training to the needs of individual patients.

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An Electromechanical Gait Trainer for Restoration of Gait in Hemiparetic Stroke Patients: Preliminary Results

Cited by 70 publications

References 20 publications

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury

Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison

Feasibility of Manual Teach-and-Replay and Continuous Impedance Shaping for Robotic Locomotor Training Following Spinal Cord Injury

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