Chaparro-Cárdenas Silvia L, Lozano-Guzmán Alejandro A, Ramirez-Bautista Julian Andres, Hernández-Zavala Antonio
a Department of Mechatronics , Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada - Instituto Politécnico Nacional , Querétaro , Querétaro , México.
Disabil Rehabil Assist Technol. 2018 Nov;13(8):819-834. doi: 10.1080/17483107.2018.1447611. Epub 2018 Mar 25.
The aim of this review is to analyse the different existing technologies for gait rehabilitation, focusing mainly in robotic devices. Those robots help the patient to recover a lost function due to neurological gait disorders, accidents or after injury. Besides, they facilitate the identification of normal and abnormal features by registering muscle activity providing the doctor important data where he can observe the evolution of the patient.
A deep literature review was realized using selected keywords considering not only the most common medical and engineering databases, but also other available sources that provide information on commercial and scientific gait rehabilitation devices. The founded literature for this review corresponds to control techniques for gait rehabilitation robots, since the early seventies to the present year.
Different control strategies for gait analysis in rehabilitation devices have been developed and implemented such as position control, force and impedance control, haptic simulation, and control of EMG signals. These control techniques are used to analyze the force of the patient during therapy, compensating it with the force generated by the mechanism in the rehabilitation device. It is observed that the largest number of studies reported, focuses on the impedance control technique. Leading to include new control techniques and validate them using the necessary protocols with ill patients, obtaining reliable results that allows a progressive and active rehabilitation.
With this exhaustive review, we can conclude that the degree of complexity of the rehabilitation device influences in short and long-term therapeutic results since the movements become more controlled. However, there is still a lot of work in the sense of motion control in order to perform trajectories that are more alike the natural movements of humans. There are many control techniques in other areas, which seek to improve the performance of the process. These techniques may possibly be applicable in gait rehabilitation devices, obtaining controllers that are more efficient and that adapts to different people and the necessities that entail every disease. Implications for Rehabilitation Rehabilitation helps people to improve the activities of their daily life, allowing them to observe their progress in the functional abilities as the months pass by with intensive and repetitive therapies. There is a mobility issue when the patient needs to move to the hospital or to the laboratory, which is not always feasible. For overcoming it, patients use the equipment at home to perform their daily therapy. However, they need the sufficient knowledge about its operation, also about the therapeutic movements, the therapy duration and the movement speed. Besides, is necessary to place the equipment in a proper and lively environment that helps to forget or reduce pain while the patient moves his joints progressively. The purpose of robotic rehabilitation devices is to generate repetitive and progressive movements, according to the motor disability. There are training trajectories to follow, which motivate patients to generate active movements. The benefits of robotic rehabilitation depend on the ability of each patient to adapt to the speed and load variations generated by the device, improving and reinforcing motor functions in therapy, especially in patients with advanced disabilities in early rehabilitation. Multi-joint rehabilitation devices are more effective than single-joint rehabilitation devices because they involve a higher number of muscles in the therapy. The greater the number of degrees of freedom (DoF) of the device, it cushions its effect in the patient because the inertia is reduced and higher torques are generated. The assistive technological devices allows to explore different rehabilitation techniques that motivate the patient in therapy, increasing appropriately the energy and pressure in the blood which is reflected in gradually recovering his ability to walk.
本综述旨在分析现有的不同步态康复技术，主要聚焦于机器人设备。这些机器人可帮助患者恢复因神经步态障碍、事故或受伤而丧失的功能。此外，它们通过记录肌肉活动来辅助识别正常和异常特征，为医生提供重要数据，以便观察患者的康复进展。
通过使用选定的关键词进行深入的文献综述，不仅考虑了最常见的医学和工程数据库，还包括其他提供商业和科学步态康复设备信息的可用来源。本次综述所涵盖的文献对应于自20世纪70年代初至今的步态康复机器人控制技术。
已开发并实施了不同的康复设备步态分析控制策略，如位置控制、力和阻抗控制、触觉模拟以及肌电信号控制。这些控制技术用于在治疗期间分析患者的力量，并通过康复设备中的机构产生的力量进行补偿。据观察，报告的研究中数量最多的集中在阻抗控制技术上。这促使纳入新的控制技术，并使用必要的方案对患病患者进行验证，从而获得可靠的结果，实现渐进式和主动式康复。
通过本次详尽的综述，我们可以得出结论，康复设备的复杂程度会影响短期和长期治疗效果，因为运动变得更易控制。然而，在运动控制方面仍有大量工作要做，以便执行更接近人类自然运动的轨迹。其他领域有许多控制技术，旨在提高该过程的性能。这些技术可能适用于步态康复设备，从而获得更高效且能适应不同人群及各种疾病需求的控制器。对康复的意义康复有助于人们改善日常生活活动，随着数月密集且重复的治疗，他们能够观察到自身功能能力的进展。当患者需要前往医院或实验室时，存在行动不便的问题，这并不总是可行的。为克服这一问题，患者在家中使用设备进行日常治疗。然而，他们需要充分了解设备的操作，以及治疗动作、治疗持续时间和运动速度。此外，有必要将设备放置在适当且活跃的环境中，有助于患者在逐渐活动关节时忘却或减轻疼痛。机器人康复设备的目的是根据运动障碍产生重复且渐进的运动。有训练轨迹可供遵循，激励患者产生主动运动。机器人康复的益处取决于每位患者适应设备产生的速度和负荷变化的能力，在治疗中改善和增强运动功能，尤其是在早期康复中重度残疾的患者。多关节康复设备比单关节康复设备更有效，因为它们在治疗中涉及更多肌肉。设备的自由度（DoF）数量越多，对患者的影响就越小，因为惯性减小且能产生更高的扭矩。辅助技术设备允许探索不同的康复技术，激励患者参与治疗，适当增加血液中的能量和压力，这体现在逐渐恢复行走能力上。
