The effect of pelvic movements of a gait training system for stroke patients: a single blind, randomized, parallel study

Abstract

Background Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. Method Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. Experiment Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. Result Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. Conclusion Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. Clinical trial registration KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310&ltype=&rtype=

Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial

“…This is thought to be related to a previous study, which found that lateral and rotational pelvic movements of Healbot T increased voluntary muscle activation, cadence, and walking speed. [17] Furthermore, Veneman et al suggested that pelvis fixation should be avoided and demonstrated that pelvis fixation in the horizontal plane during treadmill walking severely affects gait dynamics. [33] A previous study found that the FreeD module of Lokomat (Hocoma AG, Switzerland), which guides lateral translation and transverse pelvic rotation, promoted physiological movement patterns in the trunk and hip during gait in healthy individuals.…”

“…A previous paper on some data from this study had been published. [17] This study was about a secondary analysis of collected data.…”

“…The effect of pelvic movements of a gait training system using Healbot T for patients post stroke were demonstrated. [17] However, there have been no studies on the effects of various modes of Healbot T. This study aimed to investigate the effects of Healbot T-assisted gait training with various training modes in patients with stroke.…”

A Performance Evaluation of Overground Gait Training With a Mobile Body Weight Support System Using Wearable Sensors

“…1.f) were later introduced, and they were useful for generating stable levels of cable tension. However, there is growing evidence that constantly unloading part of the body weight may limit several joint motions including lateral and transverse pelvic movement, which are two of the six determinants of the natural gait [20]. Moreover, the duration of the user's stance and double-limb support may be decreased under relatively higher levels of BWS, which suggests that BWS can stimulate shorter periods of foot contact.…”

“…Since pelvis motion plays a critical role in serving an optimal center of mass movement, producing smooth and energetically efficient overground gait locomotion [20], monitoring and supporting the user's pelvis movement simultaneously under partial BWS becomes essential [38]. To look into pelvis movement in more detail, in this research, we utilized the center of mass (CoM) model to represent human walking, and investigate the pelvis motion within the transverse plane.…”