Electromechanical-assisted training for walking after stroke

Mehrholz, Jan; Thomas, Simone; Kügler, Joachim; Pohl, Marcus; Elsner, Bernhard

doi:10.1002/14651858.cd006185.pub5

Cited by 167 publications

(182 citation statements)

References 112 publications

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“…The literature on robotic gait training in neurological subjects includes a consistent number of Randomized Controlled Trials (RCTs) and systematic reviews [7][8][9]. Although well-established clinical outcomes have been obtained with treadmill-based robots [10][11][12], few early studies on o-RAGT have been published, with encouraging preliminary results obtained from limited sample sizes [3,4].…”

Section: Introductionmentioning

confidence: 99%

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

et al. 2021

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Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.

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Section: Introductionmentioning

confidence: 99%

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

et al. 2021

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“…Stroke patients who receive electromechanical gait training assistance in addition to physiotherapy are more likely to achieve independent walking [154]. Some of the roadblocks remaining for developing commercially successful lower limb (LL) exoskeletons are human-machine interface compliance, the optimization of the control algorithms, and the smooth coordination with the physiology of the human body with low metabolic energy expenditure [155].…”

Section: Technological Challenges Of Exoskeletonsmentioning

confidence: 99%

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Nizamis

Athanasiou

Almpani

et al. 2021

Sensors

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Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human–machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals—namely, family members and professional carers—to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.

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“…The Lokomat (Hocoma AG, Volketswil, Switzerland) is a commercial widely used exoskeleton-type robot for gait training worn over both lower extremities, consisting of a combination of adjustable orthoses, a dynamic bodyweight support system, and virtual reality for providing sensory-motor stimulation ( van Kammen et al, 2017 ). Although the clinical efficacy of wearable devices for lower extremity is supported by a growing body of evidence ( Hidler et al, 2009 ; Tomida et al, 2019 ; Mehrholz et al, 2020 ), only a number of them are realizable in a home setting with modifications addressing various factors, e.g., safety issues, size, weight, portability, complexity, and cost. Among robotic rehabilitation devices of the past ten years, those provisioned for home therapy only requiring further investigation validating their clinical efficiency at home are presented.…”

Section: Home-based Rehabilitation Systemsmentioning

confidence: 99%

“…Hence, myriads of studies have focused on exploring robotics technologies for post-stroke rehabilitation. An increasing amount of research has investigated the efficiency of different types of robotic rehabilitation systems and found that these interventions can effectively complement conventional physical therapy, e.g., Mehrholz et al and Bertani et al investigated the effects of robot-assisted gait and upper-limb training, respectively, and both concluded that using robotic technologies positively affects post-stroke recovery ( Bertani et al, 2017 ; Mehrholz et al, 2020 ). To tackle the recent rising issues associated with restrictions caused by the pandemic, there is a need to speed up the process of providing autonomous and affordable care that can be transferred out of inpatient or out-patient facilities into home environments.…”

Section: Introductionmentioning

confidence: 99%

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

2021

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During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011–2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities.

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Electromechanical-assisted training for walking after stroke

Cited by 167 publications

References 112 publications

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

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