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Journal of Healthcare Engineering
Volume 1, Issue 2, Pages 197-216
http://dx.doi.org/10.1260/2040-2295.1.2.197
Research Article

Locomotor Training in Subjects with Sensori-Motor Deficits: An Overview of the Robotic Gait Orthosis Lokomat

R. Riener,1 L. Lünenburger,2 I. C. Maier,3 G. Colombo,2 and V. Dietz4

1ETH Zürich, Sensory-Motor Systems Lab, University Hospital Balgrist, Tannenstrasse 1, 8092 Zürich, 8008 Zürich, Switzerland
2University Hospital Balgrist, 8008 Zurich, Switzerland. Now Hocoma AG, Volketswil, Switzerland
3Brain Research Institute, University of Zurich, 8008 Zurich, Switzerland. Now Hocoma AG, Volketswil, Switzerland
4University Hospital Balgrist, 8008 Zürich, Switzerland

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. M. Kelly-Hayes, J. T. Robertson, J. P. Broderick et al., “The american heart association stroke outcome classification: Executive summary,” Circulation, vol. 97, pp. 2474–2478, 1998. View at Google Scholar
  2. H. S. Jorgensen, H. Nakayama, H. O. Raaschou, and T. S. Olsen, “Recovery of walking function in stroke patients: The copenhagen stroke study,” Archives of physical medicine and rehabilitation, vol. 76, pp. 27–32, 1995. View at Google Scholar
  3. R. L. Waters, R. Adkins, J. Yakura, and I. Sie, “Donal munro lecture: Functional and neurologic recovery following acute sci,” J Spinal Cord Med, vol. 21, pp. 195–199, 1998. View at Google Scholar
  4. H. Barbeau, M. Wainberg, and L. Finch, “Description and application of a system for locomotor rehabilitation,” Med Biol Eng Comput, vol. 25, pp. 341–344, 1987. View at Google Scholar
  5. V. Dietz, G. Colombo, L. Jensen, and L. Baumgartner, “Locomotor capacity of spinal cord in paraplegic patients,” Ann Neurol, vol. 37, pp. 574–582, 1995. View at Google Scholar
  6. S. Hesse, C. Werner, S. von Frankenberg, and A. Bardeleben, “Treadmill training with partial body weight support after stroke,” Phys Med Rehabil Clin N Am, vol. 14, pp. S111–123, 2003. View at Google Scholar
  7. R. W. Teasell, S. K. Bhogal, N. C. Foley, and M. R. Speechley, “Gait retraining post stroke,” Topics in stroke rehabilitation, vol. 10, pp. 34–65, 2003. View at Google Scholar
  8. A. Wernig and S. Muller, “Laufband locomotion with with body weight support improved walking in persons with severe spinal cord injuries,” Paraplegia, vol. 30, pp. 229–238, 1992. View at Google Scholar
  9. A. Wernig, A. Nanassy, and S. Muller, “Laufband (treadmill) therapy in incomplete paraplegia and tetraplegia,” J Neurotrauma, vol. 16, pp. 719–726, 1999. View at Google Scholar
  10. G. Colombo, M. Joerg, R. Schreier, and V. Dietz, “Treadmill training of paraplegic patients using a robotic orthosis,” J Rehabil Res Dev, vol. 37, pp. 693–700, 2000. View at Google Scholar
  11. S. Hesse and D. Uhlenbrock, “A mechanized gait trainer for restoration of gait,” J Rehabil Res Dev, vol. 37, pp. 701–708, 2000. View at Google Scholar
  12. S. C. Cramer and J. D. Riley, “Neuroplasticity and brain repair after stroke,” Curr Opin Neurol, vol. 21, pp. 76–82, 2008. View at Google Scholar
  13. V. Dietz and S. J. Harkema, “Locomotor activity in spinal cord-injured persons,” J Appl Physiol, vol. 96, pp. 1954–1960, 2004. View at Google Scholar
  14. G. Martino, “How the brain repairs itself: New therapeutic strategies in inflammatory and degenerative cns disorders,” Lancet Neurol, vol. 3, pp. 372–378, 2004. View at Google Scholar
  15. B. Calancie, B. Needham-Shropshire, P. Jacobs, K. Willer, G. Zych, and B. A. Green, “Involuntary stepping after chronic spinal cord injury. Evidence for a central rhythm generator for locomotion in man,” Brain, vol. 117, Pt 5, pp. 1143–1159, 1994. View at Google Scholar
  16. B. Bussel, A. Roby-Brami, P. Azouvi, A. Biraben, A. Yakovleff, and J. P. Held, “Myoclonus in a patient with spinal cord transection. Possible involvement of the spinal stepping generator,” Brain, vol. 111, Pt 5, pp. 1235–1245, 1988. View at Google Scholar
  17. V. Dietz, G. Colombo, and L. Jensen, “Locomotor activity in spinal man,” Lancet, vol. 344, pp. 1260–1263, 1994. View at Google Scholar
  18. V. Dietz, “Body weight supported gait training: From laboratory to clinical setting,” Brain Res Bull, vol. 76, pp. 459–463, 2008. View at Google Scholar
  19. V. Dietz, S. Grillner, A. Trepp, M. Hubli, and M. Bolliger, “Changes in spinal reflex and locomotor activity after a complete spinal cord injury: A common mechanism?” Brain, 2009. View at Google Scholar
  20. B. H. Dobkin, S. Harkema, P. Requejo, and V. R. Edgerton, “Modulation of locomotor-like emg activity in subjects with complete and incomplete spinal cord injury,” J Neurol Rehabil, vol. 9, pp. 183–190, 1995. View at Google Scholar
  21. S. J. Harkema, S. L. Hurley, U. K. Patel, P. S. Requejo, B. H. Dobkin, and V. R. Edgerton, “Human lumbosacral spinal cord interprets loading during stepping,” J Neurophysiol, vol. 77, pp. 797–811, 1997. View at Google Scholar
  22. K. G. Pearson and D. F. Collins, “Reversal of the influence of group ib afferents from plantaris on activity in medial gastrocnemius muscle during locomotor activity,” J Neurophysiol, vol. 70, pp. 1009–1017, 1993. View at Google Scholar
  23. V. Dietz, “Human neuronal control of automatic functional movements: Interaction between central programs and afferent input,” Physiol Rev, vol. 72, pp. 33–69, 1992. View at Google Scholar
  24. V. Dietz, R. Muller, and G. Colombo, “Locomotor activity in spinal man: Significance of afferent input from joint and load receptors,” Brain, vol. 125, pp. 2626–2634, 2002. View at Google Scholar
  25. M. Wirz, D. H. Zemon, R. Rupp et al., “Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial,” Archives of physical medicine and rehabilitation, vol. 86, pp. 672–680, 2005. View at Google Scholar
  26. A. Curt and V. Dietz, “Traumatic cervical spinal cord injury: Relation between somatosensory evoked potentials, neurological deficit, and hand function,” Archives of physical medicine and rehabilitation, vol. 77, pp. 48–53, 1996. View at Google Scholar
  27. A. Curt and V. Dietz, “Ambulatory capacity in spinal cord injury: Significance of somatosensory evoked potentials and asia protocol in predicting outcome,” Archives of physical medicine and rehabilitation, vol. 78, pp. 39–43, 1997. View at Google Scholar
  28. A. Curt, M. E. Keck, and V. Dietz, “Functional outcome following spinal cord injury: Significance of motor-evoked potentials and asia scores,” Archives of physical medicine and rehabilitation, vol. 79, pp. 81–86, 1998. View at Google Scholar
  29. S. Katoh and W. S. el Masry, “Neurological recovery after conservative treatment of cervical cord injuries,” J Bone Joint Surg Br, vol. 76, pp. 225–228, 1994. View at Google Scholar
  30. H. Barbeau and M. Visintin, “Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects,” Archives of physical medicine and rehabilitation, vol. 84, pp. 1458–1465, 2003. View at Google Scholar
  31. V. Dietz, “Locomotor training in paraplegic patients,” Ann Neurol, vol. 38, p. 965, 1995. View at Google Scholar
  32. M. Visintin, H. Barbeau, N. Korner-Bitensky, and N. E. Mayo, “A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation,” Stroke, vol. 29, pp. 1122–1128, 1998. View at Google Scholar
  33. B. Dobkin, H. Barbeau, D. Deforge et al., “The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: The multicenter randomized spinal cord injury locomotor trial,” Neurorehabil Neural Repair, vol. 21, pp. 25–35, 2007. View at Google Scholar
  34. A. M. Moseley, A. Stark, I. D. Cameron, and A. Pollock, “Treadmill training and body weight support for walking after stroke,” Cochrane Database Syst Rev, 2003:CD002840.
  35. V. Dietz, “Good clinical practice in neurorehabilitation,” Lancet Neurol, vol. 5, pp. 377–378, 2006. View at Google Scholar
  36. S. A. Morrison and D. Backus, “Locomotor training: Is translating evidence into practice financially feasible?” J Neurol Phys Ther, vol. 31, pp. 50–54, 2007. View at Google Scholar
  37. J. F. Veneman, R. Kruidhof, E. E. Hekman, R. Ekkelenkamp, E. H. Van Asseldonk, and H. van der Kooij, “Design and evaluation of the lopes exoskeleton robot for interactive gait rehabilitation,” IEEE Trans Neural Syst Rehabil Eng, vol. 15, pp. 379–386, 2007. View at Google Scholar
  38. S. K. Banala, S. H. Kim, S. K. Agrawal, and J. P. Scholz, “Robot assisted gait training with active leg exoskeleton (alex),” IEEE Trans Neural Syst Rehabil Eng, vol. 17, pp. 2–8, 2009. View at Google Scholar
  39. D. Aoyagi, W. E. Ichinose, S. J. Harkema, D. J. Reinkensmeyer, and J. E. Bobrow, “A robot and control algorithm that can synchronously assist in naturalistic motion during body-weight-supported gait training following neurologic injury,” IEEE Trans Neural Syst Rehabil Eng, vol. 15, pp. 387–400, 2007. View at Google Scholar
  40. B. J. Ruthenberg, N. A. Wasylewski, and J. E. Beard, “An experimental device for investigating the force and power requirements of a powered gait orthosis,” J Rehabil Res Dev, vol. 34, pp. 203–213, 1997. View at Google Scholar
  41. L. Lünenburger, T. Lam, R. Riener, and G. Colombo, “Gait retraining after neurological disorders,” in Wiley Encyclopedia for Biomedical Engineering, M. Akay, Ed., John Wiley & Sons, Hoboken, NJ, 2006. View at Google Scholar
  42. M. Frey, G. Colombo, M. Vaglio, R. Bucher, M. Jorg, and R. Riener, “A novel mechatronic body weight support system,” IEEE Trans Neural Syst Rehabil Eng, vol. 14, pp. 311–321, 2006. View at Google Scholar
  43. G. Colombo and R. Bucher, Device for adjusting the prestress of an elastic means around a predetermined tension or position” patent wo2008040554 (a1).
  44. N. A. Bernstein, The co-ordination and regulation of movements, Pergamon Press Ltd, first English edition 1967.
  45. V. S. Huang and J. W. Krakauer, “Robotic neurorehabilitation: A computational motor learning perspective,” J Neuroeng Rehabil, vol. 6, p. 5, 2009. View at Google Scholar
  46. M. D. Lewek, T. H. Cruz, J. L. Moore, H. R. Roth, Y. Y. Dhaher, and T. G. Hornby, “Allowing intralimb kinematic variability during locomotor training poststroke improves kinematic consistency: A subgroup analysis from a randomized clinical trial,” Phys Ther, 2009. View at Google Scholar
  47. A. Duschau-Wicke, J. von Zitzewitz, A. Caprez, L. Lunenburger, and R. Riener, “Path control: A method for patient-cooperative robot-aided gait rehabilitation,” IEEE Trans Neural Syst Rehabil Eng, vol. 18, pp. 38–48, 2010. View at Google Scholar
  48. R. Riener, L. Lunenburger, S. Jezernik, M. Anderschitz, G. Colombo, and V. Dietz, “Patient-cooperative strategies for robot-aided treadmill training: First experimental results,” IEEE Trans Neural Syst Rehabil Eng, vol. 13, pp. 380–394, 2005. View at Google Scholar
  49. N. Hogan, “Impedance control: An approach to manipulation. arts I, II, III,” J Dyn Syst-T ASME, vol. 107, pp. 1–23, 1985. View at Google Scholar
  50. J. W. Lance, Spasticity: Disordered motor control. Year Book, chapter Pathophysiology of spasticity and clinical experience with Baclofen 1980:184–204.
  51. T. D. Sanger, M. R. Delgado, D. Gaebler-Spira, M. Hallett, and J. W. Mink, “Classification and definition of disorders causing hypertonia in childhood,” Pediatrics, vol. 111, pp. e89–97, 2003. View at Google Scholar
  52. B. Ashworth, “Preliminary trial of carisoprodol in multiple sclerosis,” Practitioner, vol. 192, pp. 540–542, 1964. View at Google Scholar
  53. R. W. Bohannon and M. B. Smith, “Interrater reliability of a modified ashworth scale of muscle spasticity,” Phys Ther, vol. 67, pp. 206–207, 1987. View at Google Scholar
  54. L. Lünenburger, G. Colombo, R. Riener, and V. Dietz, Clinical assessments performed during robotic rehabilitation by the gait training robot lokomat. 2005:345–348.
  55. R. Riener, L. Lunenburger, and G. Colombo, “Human-centered robotics applied to gait training and assessment,” J Rehabil Res Dev, vol. 43, pp. 679–694, 2006. View at Google Scholar
  56. M. Bolliger, L. Lünenburger, S. Bircher, G. Colombo, and V. Dietz, “Reliability of measuring isometric peak torque in the driven gait orthosis ”lokomat“,” in 4th World Congress of Neurorehabilitation, Hong Kong, 2006.
  57. J. V. Basmajian, Muscles alive: Their functions revealed by electromyography, Williams and Wilkins, Baltimore, Md, 4th edition, 1978:495.
  58. R. A. Schmidt and C. A. Wrisberg, Motor learning and performance, Campaign, Windsor, Leeds, Human Kinetics, 2nd edition, 2000.
  59. L. Lunenburger, G. Colombo, and R. Riener, “Biofeedback for robotic gait rehabilitation,” J Neuroeng Rehabil, vol. 4, p. 1, 2007. View at Google Scholar
  60. L. Lunenburger, G. Colombo, R. Riener, and V. Dietz, “Biofeedback in gait training with the robotic orthosis lokomat,” in Conf Proc IEEE Eng Med Biol Soc, vol. 7, pp. 4888–4891, 2004.
  61. R. Banz, M. Bolliger, G. Colombo, V. Dietz, and L. Lunenburger, “Computerized visual feedback: An adjunct to robotic-assisted gait training,” Phys Ther, vol. 88, pp. 1135–1145, 2008. View at Google Scholar
  62. R. Banz, M. Bolliger, S. Muller, C. Santelli, and R. Riener, “A method of estimating the degree of active participation during stepping in a driven gait orthosis based on actuator force profile matching,” IEEE Trans Neural Syst Rehabil Eng, vol. 17, pp. 15–22, 2009. View at Google Scholar
  63. L. Lünenburger, M. Wellner, R. Banz, G. Colombo, and R. Riener, “Combining immersive virtual environments with robot-aided gait training,” in 10th International Conference on Rehabilitation Robotics (ICORR), Noordwijk, 2007.
  64. S. Beer, B. Aschbacher, D. Manoglou, E. Gamper, J. Kool, and J. Kesselring, “Robot-assisted gait training in multiple sclerosis: A pilot randomized trial,” Mult Scler, vol. 14, pp. 231–236, 2008. View at Google Scholar
  65. I. Borggraefe, L. Kiwull, J. S. Schaefer et al., “Sustainability of motor performance after robotic-assisted treadmill therapy in children: An open, non-randomized baseline-treatment study,” Eur J Phys Rehabil Med, 2010. View at Google Scholar
  66. I. Borggraefe, A. Meyer-Heim, A. Kumar, J. S. Schaefer, S. Berweck, and F. Heinen, “Improved gait parameters after robotic-assisted locomotor treadmill therapy in a 6-year-old child with cerebral palsy,” Mov Disord, vol. 23, pp. 280–283, 2008. View at Google Scholar
  67. I. Borggraefe, J. S. Schaefer, M. Klaiber et al., “Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy,” Eur J Paediatr Neurol, 2010. View at Google Scholar
  68. J. Hidler, D. Nichols, M. Pelliccio et al., “Multicenter randomized clinical trial evaluating the effectiveness of the lokomat in subacute stroke,” Neurorehabil Neural Repair, vol. 23, pp. 5–13, 2009. View at Google Scholar
  69. T. G. Hornby, D. D. Campbell, J. H. Kahn, T. Demott, J. L. Moore, and H. R. Roth, “Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: A randomized controlled study,” Stroke, vol. 39, pp. 1786–1792, 2008. View at Google Scholar
  70. T. G. Hornby, D. H. Zemon, and D. Campbell, “Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury,” Phys Ther, vol. 85, pp. 52–66, 2005. View at Google Scholar
  71. B. Husemann, F. Muller, C. Krewer, S. Heller, and E. Koenig, “Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: A randomized controlled pilot study,” Stroke, vol. 38, pp. 349–354, 2007. View at Google Scholar
  72. A. C. Lo and E. W. Triche, “Improving gait in multiple sclerosis using robot-assisted, body weight supported treadmill training,” Neurorehabil Neural Repair, vol. 22, pp. 661–671, 2008. View at Google Scholar
  73. A. Mayr, M. Kofler, E. Quirbach, H. Matzak, K. Frohlich, and L. Saltuari, “Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the lokomat gait orthosis,” Neurorehabil Neural Repair, vol. 21, pp. 307–314, 2007. View at Google Scholar
  74. A. Meyer-Heim, C. Ammann-Reiffer, A. Schmartz et al., “Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy,” Arch Dis Child, vol. 94, pp. 615–620, 2009. View at Google Scholar
  75. A. Meyer-Heim, I. Borggraefe, C. Ammann-Reiffer et al., “Feasibility of robotic-assisted locomotor training in children with central gait impairment,” Dev Med Child Neurol, vol. 49, pp. 900–906, 2007. View at Google Scholar
  76. I. Schwartz, A. Sajin, I. Fisher et al., “The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: A randomized controlled trial,” PM R, vol. 1, pp. 516–523, 2009. View at Google Scholar
  77. K. P. Westlake and C. Patten, “Pilot study of lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke,” J Neuroeng Rehabil, vol. 6, p. 18, 2009. View at Google Scholar
  78. P. Winchester, R. McColl, R. Querry et al., “Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury,” Neurorehabil Neural Repair, vol. 19, pp. 313–324, 2005. View at Google Scholar
  79. C. F. Nooijen, N. Ter Hoeve, and E. C. Field-Fote, “Gait quality is improved by locomotor training in individuals with sci regardless of training approach,” J Neuroeng Rehabil, vol. 6, p. 36, 2009. View at Google Scholar
  80. M. M. Mirbagheri, C. C. Tsao, E. Pelosin, and W. Z. Rymer, “Therapeutic effects of robotic-assisted locomotor training on neuromuscular properties,” in Proceedings of the 2005 IEEE, 9th International Conference on Rehabilitation Robotics, 2005.
  81. M. F. Sherman, T. Lam, and A. W. Sheel, “Locomotor-respiratory synchronization after body weight supported treadmill training in incomplete tetraplegia: A case report,” Spinal Cord, 2009. View at Google Scholar
  82. K. J. Hunt, A. Jack, A. Pennycott, C. Perret, T. H. Baumberger, and T. H. Kakebeeke, “Control of work rate-driven exercise facilitates cardiopulmonary training and assessment during robot-assisted gait in incomplete spinal cord injury,” Biomed Signal Process Control, 2007. View at Google Scholar
  83. J. F. Israel, D. D. Campbell, J. H. Kahn, and T. G. Hornby, “Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury,” Phys Ther, vol. 86, pp. 1466–1478, 2006. View at Google Scholar
  84. A. Meyer-Heim, C. Ammann-Reiffer, A. Schmartz et al., “Improvement of walking abilities after robotic-assisted locomotion training in children with cerebral palsy,” Arch Dis Child, 2009. View at Google Scholar
  85. G. Kwakkel, R. C. Wagenaar, J. W. Twisk, G. J. Lankhorst, and J. C. Koetsier, “Intensity of leg and arm training after primary middle-cerebral-artery stroke: A randomised trial,” Lancet, vol. 354, pp. 191–196, 1999. View at Google Scholar
  86. M. S. Nash, P. L. Jacobs, B. M. Johnson, and E. Field-Fote, “Metabolic and cardiac responses to robotic-assisted locomotion in motor-complete tetraplegia: A case report,” J Spinal Cord Med, vol. 27, pp. 78–82, 2004. View at Google Scholar
  87. J. U. Blicher and J. F. Nielsen, “Cortical and spinal excitability changes after robotic gait training in healthy participants,” Neurorehabil Neural Repair, vol. 23, pp. 143–149, 2009. View at Google Scholar
  88. K. Kamibayashi, T. Nakajima, M. Takahashi, M. Akai, and K. Nakazawa, “Facilitation of corticospinal excitability in the tibialis anterior muscle during robot-assisted passive stepping in humans,” Eur J Neurosci, 2009. View at Google Scholar
  89. R. G. Querry, F. Pacheco, T. Annaswamy, L. Goetz, P. K. Winchester, and K. E. Tansey, “Synchronous stimulation and monitoring of soleus h reflex during robotic body weight-supported ambulation in subjects with spinal cord injury,” J Rehabil Res Dev, vol. 45, pp. 175–186, 2008. View at Google Scholar
  90. V. Dietz and R. Muller, “Degradation of neuronal function following a spinal cord injury: Mechanisms and countermeasures,” Brain, vol. 127, pp. 2221–2231, 2004. View at Google Scholar
  91. V. Magagnin, E. G. Caiani, L. Fusini et al., “Assessment of the cardiovascular regulation during robotic assisted locomotion in normal subjects: Autoregressive spectral analysis vs empirical mode decomposition,” in Conf Proc IEEE Eng Med Biol Soc 2008, pp. 3844–3847, 2008.
  92. V. Magagnin, A. Porta, L. Fusini et al., “Evaluation of the autonomic response in healthy subjects during treadmill training with assistance of a robot-driven gait orthosis,” Gait Posture, vol. 29, pp. 504–508, 2009. View at Google Scholar