Rehabilitation Center Affoltern am Albis, Children's University Hospital Zurich, Muehlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.
J Neuroeng Rehabil. 2013 Jul 18;10:78. doi: 10.1186/1743-0003-10-78.
Robot-assisted gait training and treadmill training can complement conventional physical therapy in children with neuro-orthopedic movement disorders. The aim of this study was to investigate surface electromyography (sEMG) activity patterns during robot-assisted gait training (with and without motivating instructions from a therapist) and unassisted treadmill walking and to compare these with physiological sEMG patterns.
Nine children with motor impairments and eight healthy children walked in various conditions: (a) on a treadmill in the driven gait orthosis Lokomat®, (b) same condition, with additional motivational instructions from a therapist, and (c) on the treadmill without assistance. sEMG recordings were made of the tibialis anterior, gastrocnemius lateralis, vastus medialis, and biceps femoris muscles. Differences in sEMG amplitudes between the three conditions were analyzed for the duration of stance and swing phase (for each group and muscle separately) using non-parametric tests. Spearman's correlation coefficients illustrated similarity of muscle activation patterns between conditions, between groups, and with published reference trajectories.
The relative duration of stance and swing phase differed between patients and controls, and between driven gait orthosis conditions and treadmill walking. While sEMG amplitudes were higher when being encouraged by a therapist compared to robot-assisted gait training without instructions (0.008 ≤ p-value ≤ 0.015), muscle activation patterns were highly comparable (0.648 ≤ Spearman correlation coefficients ≤ 0.969). In general, comparisons of the sEMG patterns with published reference data of over-ground walking revealed that walking in the driven gait orthosis could induce more physiological muscle activation patterns compared to unsupported treadmill walking.
Our results suggest that robotic-assisted gait training with therapeutic encouragement could appropriately increase muscle activity. Robotic-assisted gait training in general could induce physiological muscle activation patterns, which might indicate that this training exploits restorative rather than compensatory mechanisms.
机器人辅助步态训练和跑步机训练可以补充神经-骨科运动障碍儿童的常规物理治疗。本研究的目的是研究机器人辅助步态训练（有和没有治疗师的激励指令）和无辅助跑步机行走过程中的表面肌电图（sEMG）活动模式，并将其与生理 sEMG 模式进行比较。
9 名运动障碍儿童和 8 名健康儿童在以下三种条件下行走：（a）在 Lokomat®驱动步态矫形器上跑步机上行走，（b）相同条件下，有治疗师的额外激励指令，（c）在跑步机上无辅助行走。记录胫骨前肌、腓肠肌外侧、股四头肌和股二头肌的 sEMG 记录。使用非参数检验分析三种条件下（每个组和肌肉分别）的站立和摆动阶段的 sEMG 幅度差异。Spearman 相关系数说明了肌肉激活模式在条件之间、组之间以及与已发表的参考轨迹之间的相似性。
患者和对照组之间、驱动步态矫形器条件和跑步机行走之间的站立和摆动阶段的相对持续时间不同。与没有指令的机器人辅助步态训练相比，当受到治疗师的鼓励时，sEMG 幅度更高（0.008≤p 值≤0.015），肌肉激活模式高度相似（0.648≤Spearman 相关系数≤0.969）。一般来说，与地面行走的已发表参考数据相比，sEMG 模式的比较表明，与无支撑跑步机行走相比，驱动步态矫形器行走可以引起更生理的肌肉激活模式。
我们的结果表明，具有治疗性鼓励的机器人辅助步态训练可以适当增加肌肉活动。一般来说，机器人辅助步态训练可以引起生理肌肉激活模式，这可能表明这种训练利用了恢复性而不是补偿性机制。
