Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke

Hidler, Joseph; Nichols, Diane; Pelliccio, Marlena; Brady, Kathy; Campbell, Donielle D.; Kahn, Jennifer H.; Hornby, T. George

doi:10.1177/1545968308326632

Cited by 563 publications

(418 citation statements)

References 48 publications

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“…The RMS errors in these trials were always <2 lb while the forces were always within ±7 lb. In addition, we tested trolley tracking performance up to speeds exceeding 1.5 m/s with the performance being the best at speeds typical of those who have gait impairments following neurological injury [21]. Overall, the performance of both the custom-series elastic actuator and trolley tracking are well within our original design goals.…”

Section: Discussionmentioning

confidence: 95%

ZeroG: Overground gait and balance training system

Hidler¹,

Brennan²,

Black³

et al. 2011

JRRD

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108

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Abstract-A new overground body-weight support system called ZeroG has been developed that allows patients with severe gait impairments to practice gait and balance activities in a safe, controlled manner. The unloading system is capable of providing up to 300 lb of static support and 150 lb of dynamic (or constant force) support using a custom-series elastic actuator. The unloading system is mounted to a driven trolley, which rides along an overhead rail. We evaluated the performance of ZeroG's unloading system, as well as the trolley tracking system, using benchtop and human-subject testing. Average root-mean-square and peak errors in unloading were 2.2 and 7.2 percent, respectively, over the range of forces tested while trolley tracking errors were less than 3 degrees, indicating the system was able to maintain its position above the subject. We believe training with ZeroG will allow patients to practice activities that are critical to achieving functional independence at home and in the community.

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Section: Discussionmentioning

confidence: 95%

ZeroG: Overground gait and balance training system

Hidler¹,

Brennan²,

Black³

et al. 2011

JRRD

Self Cite

108

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“…The Lokomat gait orthosis provides the advantage of reducing the burden on clinical staff during weight-supported gait training and has been found by some researchers to have advantages over conventional therapies [50][51]. By addressing important psychological aspects of mental engagement in technology-assisted therapies, innovations may be made that help bridge the gap found by some researchers with conventional therapies [52][53]. Our approach might help to improve some of the features of technology-assisted rehabilitation-taking a step toward meeting more of the needs of the patient and therapist.…”

Section: Resultsmentioning

confidence: 99%

Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation

Koenig

Omlin

Zimmerli

et al. 2011

JRRD

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Abstract-Robot-assisted treadmill training is an established intervention used to improve walking ability in patients with neurological disorders. Although it has been shown that attention to the task is a key factor for successful rehabilitation, the psychological state of patients during robot-assisted gait therapy is often neglected. We presented 17 nondisabled subjects and 10 patients with neurological disorders a virtual-reality task with varying difficulty levels to induce feelings of being bored, excited, and overstressed. We developed an approach to automatically estimate and classify a patient's psychological state, i.e., his or her mental engagement, in real time during gait training. We used psychophysiological measurements to obtain an objective measure of the current psychological state. Automatic classification was performed by a neural network. We found that heart rate, skin conductance responses, and skin temperature can be used as markers for psychological states in the presence of physical effort induced by walking. The classifier achieved a classification error of 1.4% for nondisabled subjects and 2.1% for patients with neurological disorders. Using our new method, we processed the psychological state data in real time. Our method is a first step toward real-time auto-adaptive gait training with potential to improve rehabilitation results by optimally challenging patients at all times during exercise.

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“…A recent multisite clinical trial of several upper-limb robots found them comparable to dose-matched conventional therapy, but superior to usual and customary care in motor function scales at 36 weeks [41]. In contrast, two recent clinical trials of lower-limb robots found them inferior to conventional methods [42][43]. This finding suggests that the type of robot and the control modes used do affect outcome, and further studies are needed to optimize robotic approaches to movement therapy.…”

Section: Introductionmentioning

confidence: 38%

“…Furthermore, learning in TIFT was disjointed early in the training, with subjects often hitting the path walls, stopping and trying several strategies before determining the correct shoulder-elbow coordination needed to advance within the path. Nevertheless, for stroke rehabilitation, we believe further study into assistance modes such as TIFT is needed, given the recent negative findings in robots that have used the TD training mode [42][43] and the evidence that passive movement training does not improve motor control [82][83]. For example, Bluteau et al found that in a drawing task, haptic guidance with a position-based controller similar to our TD training mode was inferior to a force-based controller for motor learning [84].…”

Section: Discussionmentioning

confidence: 86%

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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Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke

Abstract: For subacute stroke participants with moderate to severe gait impairments, the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability.

Cited by 563 publications

References 48 publications

ZeroG: Overground gait and balance training system

ZeroG: Overground gait and balance training system

Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation

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

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