School of Kinesiology, University of British Columbia, Vancouver, Canada.
International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, 818 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.
J Neuroeng Rehabil. 2018 Nov 20;15(1):109. doi: 10.1186/s12984-018-0453-0.
The trunk muscles are critical for postural control. Recent neurophysiological studies have revealed sparing of trunk muscle function in individuals with spinal cord injury (SCI) classified with thoracic or cervical motor-complete injuries. These findings raise the possibility for recruiting and retraining this spared trunk function through rehabilitation. Robotic gait training devices may provide a means to promote trunk muscle activation. Thus, the objective of this study was to characterize and compare the activation of the trunk muscles during walking with two robotic gait training devices (Ekso and Lokomat) in people with high thoracic motor-complete SCI.
Participants with chronic motor-complete paraplegia performed 3 speed-matched walking conditions: Lokomat-assisted walking, Ekso-assisted walking overground, and Ekso-assisted walking on a treadmill. Surface electromyography (EMG) signals were recorded bilaterally from the rectus abdominis (RA), external oblique (EO), and erector spinae (ES) muscles.
Greater recruitment of trunk muscle EMG was elicited with Ekso-assisted walking compared to the Lokomat. Similar levels of trunk EMG activation were observed between Ekso overground and Ekso on the treadmill, indicating that differences between Ekso and Lokomat could not be attributed to the use of a hand-held gait aid. The level of trunk EMG activation during Lokomat walking was not different than that recorded during quiescent supine lying.
Ekso-assisted walking elicits greater activation of trunk muscles compared to Lokomat-assisted walking, even after controlling for the use of hand-held assistive devices. The requirement of the Ekso for lateral weight-shifting in order to activate each step could lead to better postural muscle activation.
躯干肌肉对于姿势控制至关重要。最近的神经生理学研究表明，在胸段或颈段运动完全损伤的脊髓损伤（SCI）患者中，躯干肌肉功能并未完全丧失。这些发现提示通过康复训练有可能募集和重新训练这些未受损的躯干功能。机器人步态训练设备可能为促进躯干肌肉激活提供一种手段。因此，本研究的目的是在高胸段运动完全性 SCI 患者中，对两种机器人步态训练设备（Ekso 和 Lokomat）在行走时的躯干肌肉激活进行特征描述和比较。
慢性运动完全性截瘫患者进行 3 种速度匹配的行走条件：Lokomat 辅助行走、Ekso 辅助在地面行走、Ekso 辅助在跑步机上行走。双侧记录腹直肌（RA）、腹外斜肌（EO）和竖脊肌（ES）的表面肌电图（EMG）信号。
Ekso 辅助行走比 Lokomat 辅助行走引起更大的躯干肌肉 EMG 募集。Ekso 在地面上和在跑步机上的行走之间观察到相似水平的躯干 EMG 激活，表明 Ekso 和 Lokomat 之间的差异不能归因于使用手持式助行器。Lokomat 行走时的躯干 EMG 激活水平与安静仰卧时记录的水平没有差异。
与 Lokomat 辅助行走相比，Ekso 辅助行走可引起更大的躯干肌肉激活，即使在控制使用手持式辅助设备后也是如此。Ekso 为了激活每一步而需要进行侧向重量转移，这可能导致更好的姿势肌肉激活。
