title: Biofeedback for robotic gait rehabilitation.
abstract: BACKGROUND
  Development and increasing acceptance of rehabilitation robots as well as advances in technology allow new forms of therapy for patients with neurological disorders. Robot-assisted gait therapy can increase the training duration and the intensity for the patients while reducing the physical strain for the therapist. Optimal training effects during gait therapy generally depend on appropriate feedback about performance. Compared to manual treadmill therapy, there is a loss of physical interaction between therapist and patient with robotic gait retraining. Thus, it is difficult for the therapist to assess the necessary feedback and instructions. The aim of this study was to define a biofeedback system for a gait training robot and test its usability in subjects without neurological disorders.
  
  
  METHODS
  To provide an overview of biofeedback and motivation methods applied in gait rehabilitation, previous publications and results from our own research are reviewed. A biofeedback method is presented showing how a rehabilitation robot can assess the patients' performance and deliver augmented feedback. For validation, three subjects without neurological disorders walked in a rehabilitation robot for treadmill training. Several training parameters, such as body weight support and treadmill speed, were varied to assess the robustness of the biofeedback calculation to confounding factors.
  
  
  RESULTS
  The biofeedback values correlated well with the different activity levels of the subjects. Changes in body weight support and treadmill velocity had a minor effect on the biofeedback values. The synchronization of the robot and the treadmill affected the biofeedback values describing the stance phase.
  
  
  CONCLUSIONS
  Robot-aided assessment and feedback can extend and improve robot-aided training devices. The presented method estimates the patients' gait performance with the use of the robot's existing sensors, and displays the resulting biofeedback values to the patients and therapists. The therapists can adapt the therapy and give further instructions to the patients. The feedback might help the patients to adapt their movement patterns and to improve their motivation. While it is assumed that these novel methods also improve training efficacy, the proof will only be possible with future in-depth clinical studies.
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. lars.luenenburger@paralab.balgrist.ch
authors.forename: Lars
authors.initials: L
authors.lastname: Lünenburger
authors.forename: Gery
authors.initials: G
authors.lastname: Colombo
authors.forename: Robert
authors.initials: R
authors.lastname: Riener
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009042:Motivation; D012371:Robotics / Q000379:methods*; D019415:Torque; D016138:Walking