Department of Sport Psychology, Institute of Sport Science, Johannes Gutenberg-University Mainz, Albert Schweitzer Straße 22, 55128, Mainz, Germany.
Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany.
J Neuroeng Rehabil. 2019 Dec 27;16(1):161. doi: 10.1186/s12984-019-0636-3.
Gait disorders are major symptoms of neurological diseases affecting the quality of life. Interventions that restore walking and allow patients to maintain safe and independent mobility are essential. Robot-assisted gait training (RAGT) proved to be a promising treatment for restoring and improving the ability to walk. Due to heterogenuous study designs and fragmentary knowlegde about the neural correlates associated with RAGT and the relation to motor recovery, guidelines for an individually optimized therapy can hardly be derived. To optimize robotic rehabilitation, it is crucial to understand how robotic assistance affect locomotor control and its underlying brain activity. Thus, this study aimed to investigate the effects of robotic assistance (RA) during treadmill walking (TW) on cortical activity and the relationship between RA-related changes of cortical activity and biomechanical gait characteristics.
Twelve healthy, right-handed volunteers (9 females; M = 25 ± 4 years) performed unassisted walking (UAW) and robot-assisted walking (RAW) trials on a treadmill, at 2.8 km/h, in a randomized, within-subject design. Ground reaction forces (GRFs) provided information regarding the individual gait patterns, while brain activity was examined by measuring cerebral hemodynamic changes in brain regions associated with the cortical locomotor network, including the sensorimotor cortex (SMC), premotor cortex (PMC) and supplementary motor area (SMA), using functional near-infrared spectroscopy (fNIRS).
A statistically significant increase in brain activity was observed in the SMC compared with the PMC and SMA (p < 0.05), and a classical double bump in the vertical GRF was observed during both UAW and RAW throughout the stance phase. However, intraindividual gait variability increased significantly with RA and was correlated with increased brain activity in the SMC (p = 0.05; r = 0.57).
On the one hand, robotic guidance could generate sensory feedback that promotes active participation, leading to increased gait variability and somatosensory brain activity. On the other hand, changes in brain activity and biomechanical gait characteristics may also be due to the sensory feedback of the robot, which disrupts the cortical network of automated walking in healthy individuals. More comprehensive neurophysiological studies both in laboratory and in clinical settings are necessary to investigate the entire brain network associated with RAW.
步态障碍是影响生活质量的主要神经疾病症状。恢复行走并使患者能够保持安全和独立活动的干预措施至关重要。机器人辅助步态训练（RAGT）已被证明是恢复和改善行走能力的一种很有前途的治疗方法。由于研究设计存在差异，以及对 RAGT 相关神经相关性及其与运动恢复的关系的认识不完整，因此很难制定个体化优化治疗的指南。为了优化机器人康复，了解机器人辅助如何影响运动控制及其潜在的大脑活动至关重要。因此，本研究旨在探讨在跑步机行走（TW）期间机器人辅助（RA）对皮质活动的影响，以及 RA 相关皮质活动变化与生物力学步态特征之间的关系。
12 名健康的右利手志愿者（9 名女性；M = 25 ± 4 岁）在跑步机上以 2.8 km/h 的速度进行自主行走（UAW）和机器人辅助行走（RAW）试验，采用随机、自身对照设计。地面反作用力（GRFs）提供了有关个体步态模式的信息，而大脑活动则通过测量与皮质运动网络相关的大脑区域的脑血流变化来检查，包括感觉运动皮层（SMC）、运动前皮层（PMC）和辅助运动区（SMA），使用功能近红外光谱（fNIRS）。
与 PMC 和 SMA 相比，SMC 中的大脑活动明显增加（p < 0.05），并且在 UAW 和 RAW 期间，整个站立阶段的垂直 GRF 均出现经典的双凸。然而，RA 时个体内步态变异性显著增加，并且与 SMC 中的大脑活动增加相关（p = 0.05；r = 0.57）。
一方面，机器人引导可能会产生促进积极参与的感觉反馈，从而导致步态变异性和体感大脑活动增加。另一方面，大脑活动和生物力学步态特征的变化也可能是由于机器人的感觉反馈干扰了健康个体自动行走的皮质网络。在实验室和临床环境中进行更全面的神经生理学研究，以研究与 RAW 相关的整个大脑网络是必要的。
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