Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
J Neuroeng Rehabil. 2012 May 31;9:31. doi: 10.1186/1743-0003-9-31.
Functional training is becoming the state-of-the-art therapy approach for rehabilitation of individuals after stroke and spinal cord injury. Robot-aided treadmill training reduces personnel effort, especially when treating severely affected patients. Improving rehabilitation robots towards more patient-cooperative behavior may further increase the effects of robot-aided training. This pilot study aims at investigating the feasibility of applying patient-cooperative robot-aided gait rehabilitation to stroke and incomplete spinal cord injury during a therapy period of four weeks. Short-term effects within one training session as well as the effects of the training on walking function are evaluated.
Two individuals with chronic incomplete spinal cord injury and two with chronic stroke trained with the Lokomat gait rehabilitation robot which was operated in a new, patient-cooperative mode for a period of four weeks with four training sessions of 45 min per week. At baseline, after two and after four weeks, walking function was assessed with the ten meter walking test. Additionally, muscle activity of the major leg muscles, heart rate and the Borg scale were measured under different walking conditions including a non-cooperative position control mode to investigate the short-term effects of patient-cooperative versus non-cooperative robot-aided gait training.
Patient-cooperative robot-aided gait training was tolerated well by all subjects and performed without difficulties. The subjects trained more actively and with more physiological muscle activity than in a non-cooperative position-control mode. One subject showed a significant and relevant increase of gait speed after the therapy, the three remaining subjects did not show significant changes.
Patient-cooperative robot-aided gait training is feasible in clinical practice and overcomes the main points of criticism against robot-aided gait training: It enables patients to train in an active, variable and more natural way. The limited number of subjects in this pilot trial does not permit valid conclusions on the effect of patient-cooperative robot-aided gait training on walking function. A large, possibly multi-center randomized controlled clinical trial is required to shed more light on this question.
功能训练正成为中风和脊髓损伤患者康复的最新治疗方法。机器人辅助跑步机训练减少了人员的工作量，尤其是在治疗严重受损的患者时。使康复机器人朝着更具合作性的行为方向发展，可能会进一步提高机器人辅助训练的效果。这项初步研究旨在探讨在四周的治疗期内，将具有合作性的患者辅助机器人步态康复应用于中风和不完全性脊髓损伤的可行性。评估了单次训练课程中的短期效果以及训练对行走功能的影响。
两名慢性不完全性脊髓损伤患者和两名慢性中风患者使用 Lokomat 步态康复机器人进行训练，该机器人在四周的时间内以新的、具有合作性的模式运行，每周进行四次 45 分钟的训练。在基线、治疗后两周和四周时，使用 10 米步行测试评估步行功能。此外，在不同的步行条件下（包括非合作位置控制模式）测量主要腿部肌肉的肌肉活动、心率和 Borg 量表，以研究合作性与非合作性机器人辅助步态训练的短期效果。
合作性患者辅助步态训练被所有受试者很好地耐受，且无困难。与非合作位置控制模式相比，受试者更积极地训练，且具有更生理性的肌肉活动。一名受试者的步行速度在治疗后有显著且相关的增加，其余三名受试者则没有显著变化。
合作性患者辅助步态训练在临床实践中是可行的，克服了对机器人辅助步态训练的主要批评意见：它使患者能够以更主动、更可变和更自然的方式进行训练。这项初步试验中受试者数量有限，无法对合作性患者辅助步态训练对步行功能的影响得出有效的结论。需要进行更大规模、可能是多中心的随机对照临床试验，以进一步探讨这个问题。
