Adaptive robotic rehabilitation of locomotion: a clinical study in spinally injured individuals.
METHODS
Clinical study on six spinal cord-injured subjects. The performance of two automatic gait-pattern adaptation algorithms for automated treadmill training rehabilitation of locomotion (called DJATA1 and DJATA2) was tested and compared in this study.


OBJECTIVE
To test the performance of the two algorithms and to evaluate the corresponding patient satisfaction. We also wanted to evaluate the motivation of the patients to train with a fixed gait pattern versus training where they can influence and change the gait pattern (gait-pattern adaptation).


METHODS
Spinal Cord Injury Center Paracare, Balgrist, Zürich, Switzerland.


METHODS
The experimental data were collected during six blinded and randomized training trials (comprising three different conditions per algorithm) split into two training sessions per patient. During the experiments, we have recorded the time courses of the six parameters describing the adaptation. Additionally, a special patient questionnaire was developed that allowed us to collect data regarding the quality, perception, speed, and required effort of the adaptation, as well as patients' opinion that addressed their motivation. The achieved adaptation was evaluated based on the time course of adaptation parameters and based on the patient questionnaire. A statistical analysis was made in order to quantify the data and to compare the two algorithms.


RESULTS
Significant adaptation of the gait pattern took place. The patients were in most cases able to change the gait pattern to a desired one and have always perceived the adaptation. No statistically significant differences were found between the performances of the two algorithms based on the evaluated data. However, DJATA2 achieved better adaptation scores. All patients preferred treadmill training with gait-pattern adaptation.


CONCLUSIONS
In the future, the patients would like to train with gait-pattern adaptation. Besides the subjective opinion indicating the choice of this training modality, gait-pattern adaptation also might lead to additional improvement of the rehabilitation of locomotion as it increases and promotes active training.


BACKGROUND
The work was supported by The Swiss Commission for Technology and Innovation (Project No. 4005.1).
Jezernik
S
S
Swiss Federal Institute of Technology (ETH Zürich), Automatic Control Laboratory, Zürich, Switzerland.
Schärer
R
R
Colombo
G
G
Morari
M
M
D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D000465:Algorithms; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D066298:In Vitro Techniques; D015601:Injury Severity Score; D007719:Knee Joint / Q000502:physiology; D008124:Locomotion / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000534:rehabilitation; D026741:Physical Therapy Modalities / Q000295:instrumentation* / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D012047:Rehabilitation Centers; D012371:Robotics; D012494:Sampling Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome