Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD

Background Robot-assisted gait therapy is increasingly being used in pediatric neurorehabilitation to complement conventional physical therapy. The robotic device applied in this study, the Lokomat (Hocoma AG, Switzerland), uses a position control mode (Guidance Force), where exact positions of the knee and hip joints throughout the gait cycle are stipulated. Such a mode has two disadvantages: Movement variability is restricted, and patients tend to walk passively. Kinematic variability and active participation, however, are crucial for motor learning. Recently, two new control modes were introduced. The Path Control mode allows the patient to walk within a virtual tunnel surrounding the ideal movement trajectory. The FreeD was developed to support weight shifting through mediolaterally moveable pelvis and leg cuffs. The aims of this study were twofold: 1) To present an overview of the currently available control modes of the Lokomat. 2) To evaluate if an increase in kinematic variability as provided by the new control modes influenced leg muscle activation patterns and intensity, as well as heart rate while walking in the Lokomat. Methods In 15 adolescents with neurological gait disorders who walked in the Lokomat, 3 conditions were compared: Guidance Force, Path Control, and FreeD. We analyzed surface electromyographic (sEMG) activity from 5 leg muscles of the more affected leg and heart rate. Muscle activation patterns were compared with norm curves. Results Several muscles, as well as heart rate, demonstrated tendencies towards a higher activation during conditions with more kinematic freedom. sEMG activation patterns of the M.rectus femoris and M.vastus medialis showed the highest similarity to over-ground walking under Path Control, whereas walking under FreeD led to unphysiological muscle activation in the tested sample. Conclusions Results indicate that especially Path Control seems promising for adolescent patients undergoing neurorehabilitation, as it increases proximal leg muscle activity while facilitating a physiological muscle activation. Therefore, this may be a solution to increase kinematic variability and patients’ active participation in robot-assisted gait training. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0287-1) contains supplementary material, which is available to authorized users.

Tags
Data and Resources
To access the resources you must log in

This item has no data

Identity

Description: The Identity category includes attributes that support the identification of the resource.

Field Value
PID https://www.doi.org/10.3929/ethz-b-000190607
PID https://www.doi.org/10.1186/s12984-017-0287-1
PID pmc:PMC5513325
PID pmid:28705170
PID https://www.doi.org/10.5167/uzh-150007
URL https://jneuroengrehab.biomedcentral.com/track/pdf/10.1186/s12984-017-0287-1
URL https://doaj.org/toc/1743-0003
URL http://hdl.handle.net/20.500.11850/190607
URL http://link.springer.com/article/10.1186/s12984-017-0287-1
URL https://dx.doi.org/10.1186/s12984-017-0287-1
URL http://dx.doi.org/10.5167/uzh-150007
URL https://link.springer.com/article/10.1186/s12984-017-0287-1
URL https://www.zora.uzh.ch/id/eprint/150007/
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513325/
URL https://core.ac.uk/display/154260904
URL http://europepmc.org/articles/PMC5513325
URL https://academic.microsoft.com/#/detail/2734915324
URL https://springernature.figshare.com/collections/Can_Lokomat_therapy_with_children_and_adolescents_be_improved_An_adaptive_clinical_pilot_trial_comparing_Guidance_force_Path_control_and_FreeD/3826603
URL https://www.zora.uzh.ch/id/eprint/150007/1/2017_Aurich-Schuler_et_al_2017_JNER_Improving_Lokomat_therapy_guidance_path_freeD_control.pdf
URL http://dx.doi.org/10.1186/s12984-017-0287-1
URL http://link.springer.com/content/pdf/10.1186/s12984-017-0287-1.pdf
URL http://europepmc.org/abstract/MED/28705170
URL https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0287-1
URL http://dx.doi.org/10.3929/ethz-b-000190607
Access Modality

Description: The Access Modality category includes attributes that report the modality of exploitation of the resource.

Field Value
Access Right Open Access
Embargo End Date 2017-01-01
Attribution

Description: Authorships and contributors

Field Value
Author Hubertus van Hedel, 0000-0002-9577-5049
Author Rob Labruyere, 0000-0002-5324-2148
Publishing

Description: Attributes about the publishing venue (e.g. journal) and deposit location (e.g. repository)

Field Value
Collected From Europe PubMed Central; PubMed Central; ORCID; Datacite; UnpayWall; DOAJ-Articles; Zurich Open Repository and Archive; Crossref; Research Collection; Microsoft Academic Graph
Hosted By ETH Zürich Research Collection; Europe PubMed Central; Zurich Open Repository and Archive; Research Collection; Journal of NeuroEngineering and Rehabilitation
Publication Date 2017-07-14
Publisher ETH Zurich
Additional Info
Field Value
Country Switzerland
Format application/pdf; application/application/pdf
Language English
Resource Type Other literature type; Article; UNKNOWN
keyword Cerebral Palsy; Robot-assisted gait therapy; FreeD motion; Impedance control; Youths; Surface Electromyography; Neurological gait disorders; Kinematic variability
system:type publication
Management Info
Field Value
Source https://science-innovation-policy.openaire.eu/search/publication?articleId=dedup_wf_001::2a2f5ee8fee57faff9fc7389e0c4f63b
Author jsonws_user
Last Updated 26 December 2020, 22:16 (CET)
Created 26 December 2020, 22:16 (CET)