Virtual realities as motivational tools for robotic assisted gait training in children: A surface electromyography study

Abstract

Patient's active cooperation is essential to achieve good outcome in pediatric rehabilitation. Therefore, virtual environments were developed to enhance robotic assisted gait training. The purpose of this study was to evaluate virtual realities as motivational tools during robotic assisted gait training with children in the pediatric Lokomat . Nine children with different gait disorders and eight healthy children participated in the study. Muscular effort of the lower leg was assessed by surface electromyography during a randomly designed training protocol with virtual realities. Self reported motivation was investigated with two questionnaires. Comparisons were drawn through repeated measurement Analysis of Variance and paired-t-tests. The logarithmic transformed data showed that the electromyographic activity output in both groups was significantly higher during tasks with virtual realities than during normal walking conditions. These results support that virtual realities seem to be efficient motivational tools to increase children's muscular effort in the pediatric Lokomat . The gaming aspect of virtual realities keeps children highly engaged during repetitive tasks.

It's how you get there: walking down a virtual alley activates premotor and parietal areas

“…Our results further support previous findings (Brütsch et al, 2010, 2011; Schuler et al, 2011) suggesting that a more challenging gait adaptation task can promote the motivation for active participation in the movement. It is, however, not clear to which extent this motivation is increased by the immersiveness of the VE or whether any kind of interactive feedback might have the same effect.…”

“…Recent studies suggests that VE can in fact promote active participation during robotic gait training. Brütsch et al (2010, 2011) and Schuler et al (2011) showed that training with VE significantly increased active participation during robot assisted gait in children with various neurological gait disorders and healthy controls. Active participation was assessed using biofeedback values from hip and knee torques (Brütsch et al, 2010, 2011) and electromyographic activity of the lower limbs (Schuler et al, 2011).…”

“…Brütsch et al (2010, 2011) and Schuler et al (2011) showed that training with VE significantly increased active participation during robot assisted gait in children with various neurological gait disorders and healthy controls. Active participation was assessed using biofeedback values from hip and knee torques (Brütsch et al, 2010, 2011) and electromyographic activity of the lower limbs (Schuler et al, 2011). Other research suggests that VE combined with robot assisted lower limb training has a greater effect on improving gait parameters such as balance, speed, and endurance in individuals after stroke than robot-assisted training alone (Jaffe et al, 2004; You et al, 2005; Mirelman et al, 2009, 2010).…”

Leg surface electromyography patterns in children with neuro-orthopedic disorders walking on a treadmill unassisted and assisted by a robot with and without encouragement

“…In line with our previous publication [18], and in accordance to the SENIAM guidelines, raw sEMG signals were high-pass filtered with a bi-directional zero-lag Butterworth at cut-off frequency of 10 Hz, rectified and smoothed by Root Mean Square algorithm with a time window of 100 ms to build the linear envelope [22]. For each child, for each muscle and each condition, we calculated the average sEMG pattern of 20 strides (heel strike to toe off and toe off to heel strike) of one leg, in the middle of the two minutes recording time.…”

“…The test protocol was part of a more extended protocol containing five different randomly presented DGO walking conditions, each lasting 2 minutes, where training with virtual realities played an important role. A more detailed description is provided elsewhere [18]. …”