Sint Maartenskliniek Research, PO BOX 9011, 6500, GM, Nijmegen, The Netherlands.
Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
J Neuroeng Rehabil. 2019 Mar 15;16(1):40. doi: 10.1186/s12984-019-0506-z.
Recovery of walking is a primary rehabilitation goal of most stroke survivors. Control of pelvic movements is one of the essential determinants of gait, yet surprisingly, conventional robot-assisted gait trainers constrain pelvic movements. Novel robot-assisted gait trainers, such as LOPES II, are able to support pelvic movements during gait. The aim of this cross-over study was to investigate the immediate after-effects of pelvic support (PS) or pelvic constraint (PC) gait training with LOPES II on overground walking in healthy subjects.
Thirteen able-bodied subjects (22.8 ± 2.1 years) participated in two 20-min gait training sessions with LOPES II; one with PS and one with PC. During the PS-training, the LOPES II actively guided the lateral displacement of the pelvis, while pelvic rotations were free. During the PC-condition, both lateral displacement and pelvic rotations were constrained and reduced to a minimum. The training sessions were separated by a 30-min resting period. Lateral displacement of the pelvis, hip and knee kinematics, and spatiotemporal parameters during overground walking were determined at baseline and immediately following the training using 3D gait analysis.
During the PS-condition in LOPES II the lateral pelvic displacement was significantly greater (105.6 ± 0 .5 mm) than during the PC-condition (10.8 ± 0 .7 mm; p < 0.001). Analysis of the first five steps of overground walking immediately following PC-condition showed significantly smaller lateral displacements of the pelvis (32.3 ± 12.0 mm) compared to PS-condition (40.1 ± 9 .8 mm; p < 0.01). During the first five steps, step width was significantly smaller after PC-condition (0.17 ± 0. 04 m) compared to PS-condition (0.20 ± 0.04 m; p = 0.01) and baseline (0.19 ± 0. 03 m; p = 0.01). Lateral displacement of the pelvis and step width post training returned to baseline levels within 10 steps. PC- nor PS-condition affected kinematics, gait velocity, cadence, stride length or stance time.
In healthy subjects, robot-assisted gait training with pelvic constraint had immediate negative after-effects on the overground walking pattern, as compared to robot-assisted gait training with pelvic support. Gait training including support of the lateral displacement of the pelvis better resembles the natural gait pattern. It remains to be identified whether pelvic support during robot-assisted gait training is superior to pelvic constraint to promote gait recovery in individuals with neurological disorders.
行走能力的恢复是大多数脑卒中幸存者的主要康复目标。骨盆运动的控制是步态的基本决定因素之一，但令人惊讶的是，传统的机器人辅助步态训练器限制了骨盆运动。新型的机器人辅助步态训练器，如 LOPES II，能够在行走时支持骨盆运动。本交叉研究的目的是调查 LOPES II 下的骨盆支撑（PS）或骨盆约束（PC）步态训练对健康受试者地面行走的即时后效。
13 名健康受试者（22.8±2.1 岁）参加了两次 20 分钟的 LOPES II 步态训练；一次 PS 训练，一次 PC 训练。在 PS 训练中，LOPES II 主动引导骨盆的侧向位移，而骨盆的旋转是自由的。在 PC 条件下，侧向位移和骨盆旋转都受到限制，并减少到最小。两次训练间隔 30 分钟的休息时间。使用三维步态分析，在基线和训练后立即确定地面行走时骨盆、髋关节和膝关节的运动学以及时空参数。
在 LOPES II 的 PS 条件下，骨盆的侧向位移明显大于 PC 条件（105.6±0.5mm）（10.8±0.7mm；p<0.001）。分析 PC 条件后前五步的地面行走，发现骨盆的侧向位移明显小于 PS 条件（32.3±12.0mm）（40.1±9.8mm；p<0.01）。在前五步中，PC 条件下的步宽明显小于 PS 条件（0.17±0.04m）（0.20±0.04m；p=0.01）和基线（0.19±0.03m；p=0.01）。训练后，骨盆的侧向位移和步宽在 10 步内恢复到基线水平。PC 条件和 PS 条件均不影响运动学、步态速度、步频、步长或站立时间。
与机器人辅助骨盆支撑步态训练相比，健康受试者在机器人辅助骨盆约束步态训练后，对地面行走模式立即产生负面后效。包括骨盆侧向位移支撑的步态训练更类似于自然步态模式。机器人辅助步态训练中骨盆支撑是否优于骨盆约束，以促进神经障碍患者的步态恢复，仍有待确定。
