van Kammen Klaske, Boonstra Anne M, van der Woude Lucas H V, Reinders-Messelink Heleen A, den Otter Rob
University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, P.O. Box 196 21, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
J Neuroeng Rehabil. 2017 Apr 20;14(1):32. doi: 10.1186/s12984-017-0244-z.
The Lokomat is a robotic exoskeleton that can be used to train gait function in hemiparetic stroke. To purposefully employ the Lokomat for training, it is important to understand (1) how Lokomat guided walking affects muscle activity following stroke and how these effects differ between patients and healthy walkers, (2) how abnormalities in the muscle activity of patients are modulated through Lokomat guided gait, and (3) how temporal step characteristics of patients were modulated during Lokomat guided walking.
Ten hemiparetic stroke patients (>3 months post-stroke) and ten healthy age-matched controls walked on the treadmill and in the Lokomat (guidance force 50%, no bodyweight support) at matched speeds (0.56 m/s). Electromyography was used to record the activity of Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius and Tibialis Anterior, bilaterally in patients and of the dominant leg in healthy walkers. Pressure sensors placed in the footwear were used to determine relative durations of the first double support and the single support phases.
Overall, Lokomat guided walking was associated with a general lowering of muscle activity compared to treadmill walking, in patients as well as healthy walkers. The nature of these effects differed between groups for specific muscles, in that reductions in patients were larger if muscles were overly active during treadmill walking (unaffected Biceps Femoris and Gluteus Medius, affected Biceps Femoris and Vastus Lateralis), and smaller if activity was already abnormally low (affected Medial Gastrocnemius). Also, Lokomat guided walking was associated with a decrease in asymmetry in the relative duration of the single support phase.
In stroke patients, Lokomat guided walking results in a general reduction of muscle activity, that affects epochs of overactivity and epochs of reduced activity in a similar fashion. These findings should be taken into account when considering the clinical potential of the Lokomat training environment in stroke, and may inform further developments in the design of robotic gait trainers.
Lokomat是一种机器人外骨骼，可用于训练偏瘫性中风患者的步态功能。为了有目的地使用Lokomat进行训练，了解以下几点很重要：（1）Lokomat引导步行如何影响中风后的肌肉活动，以及这些影响在患者和健康步行者之间有何不同；（2）如何通过Lokomat引导步态调节患者肌肉活动的异常；（3）在Lokomat引导步行过程中，患者的步幅时间特征是如何被调节的。
10名偏瘫性中风患者（中风后超过3个月）和10名年龄匹配的健康对照者在跑步机上以及在Lokomat中（引导力50%，无体重支撑）以匹配速度（0.56米/秒）行走。使用肌电图记录患者双侧臀中肌、股二头肌、股外侧肌、腓肠肌内侧头和胫骨前肌的活动，以及健康步行者优势腿的相应肌肉活动。放置在鞋中的压力传感器用于确定首次双支撑期和单支撑期的相对持续时间。
总体而言，与跑步机行走相比，Lokomat引导步行在患者和健康步行者中均与肌肉活动普遍降低有关。这些影响的性质在不同组的特定肌肉中有所不同，即如果肌肉在跑步机行走期间过度活跃（未受影响的股二头肌和臀中肌、受影响的股二头肌和股外侧肌），患者中的降低幅度更大；如果活动已经异常低（受影响的腓肠肌内侧头），则降低幅度较小。此外，Lokomat引导步行与单支撑期相对持续时间的不对称性降低有关。
在中风患者中，Lokomat引导步行会导致肌肉活动普遍降低，对过度活跃期和活动减少期的影响方式相似。在考虑Lokomat训练环境在中风治疗中的临床潜力时，应考虑这些发现，这可能为机器人步态训练器的设计进一步发展提供参考。
