title: A pilot study on the feasibility of robot-aided leg motor training to facilitate active participation.
abstract: Robot-aided gait therapy offers a promising approach towards improving gait function in individuals with neurological disorders such as stroke or spinal cord injury. However, incorporation of appropriate control strategies is essential for actively engaging the patient in the therapeutic process. Although several control algorithms (such as assist-as-needed and error augmentation) have been proposed to improve active patient participation, we hypothesize that the therapeutic benefits of these control algorithms can be greatly enhanced if combined with a motor learning task to facilitate neural reorganization and motor recovery. Here, we describe an active robotic training approach (patient-cooperative robotic gait training combined with a motor learning task) using the Lokomat and pilot-tested whether this approach can enhance active patient participation during training. Six neurologically intact adults and three chronic stroke survivors participated in this pilot feasibility study. Participants walked in a Lokomat while simultaneously performing a foot target-tracking task that necessitated greater hip and knee flexion during the swing phase of the gait. We computed the changes in tracking error as a measure of motor performance and changes in muscle activation as a measure of active subject participation. Repeated practice of the motor-learning task resulted in significant reductions in target-tracking error in all subjects. Muscle activation was also significantly higher during active robotic training compared to simply walking in the robot. The data from stroke participants also showed a trend similar to neurologically intact participants. These findings provide a proof-of-concept demonstration that combining robotic gait training with a motor learning task enhances active participation.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, United States of America ; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America ; Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois, United States of America.
authors.forename: Chandramouli
authors.initials: C
authors.lastname: Krishnan
authors.forename: Rajiv
authors.initials: R
authors.lastname: Ranganathan
authors.forename: Yasin Y
authors.initials: YY
authors.lastname: Dhaher
authors.forename: William Z
authors.initials: WZ
authors.lastname: Rymer
mesh_terms: D000328:Adult; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D010865:Pilot Projects; D011597:Psychomotor Performance; D012371:Robotics; D016138:Walking