Asín-Prieto Guillermo, Martínez-Expósito Aitor, Barroso Filipe O, Urendes Eloy J, Gonzalez-Vargas Jose, Alnajjar Fady S, González-Alted Carlos, Shimoda Shingo, Pons Jose L, Moreno Juan C
Neural Rehabilitation Group, Cajal Institute, CSIC-Spanish National Research Council, Madrid, Spain.
Department of Information Systems Engineering, University San Pablo CEU, Boadilla del Monte, Spain.
Front Bioeng Biotechnol. 2020 Feb 21;8:113. doi: 10.3389/fbioe.2020.00113. eCollection 2020.
Robotic devices have been used to rehabilitate walking function after stroke. Although results suggest that post-stroke patients benefit from this non-conventional therapy, there is no agreement on the optimal robot-assisted approaches to promote neurorecovery. Here we present a new robotic therapy protocol using a grounded exoskeleton perturbing the ankle joint based on tacit learning control. Ten healthy individuals and a post-stroke patient participated in the study and were enrolled in a pilot intervention protocol that involved performance of ankle movements following different trajectories via video game visual feedback. The system autonomously modulated task difficulty according to the performance to increase the challenge. We hypothesized that motor learning throughout training sessions would lead to increased corticospinal excitability of dorsi-plantarflexor muscles. Transcranial Magnetic Stimulation was used to assess the effects on corticospinal excitability. Improvements have been observed on task performance and motor outcomes in both healthy individuals and post-stroke patient case study. Tibialis Anterior corticospinal excitability increased significantly after the training; however no significant changes were observed on Soleus corticospinal excitability. Clinical scales showed functional improvements in the stroke patient. Our findings both in neurophysiological and performance assessment suggest improved motor learning. Some limitations of the study include treatment duration and intensity, as well as the non-significant changes in corticospinal excitability obtained for Soleus. Nonetheless, results suggest that this robotic training framework is a potentially interesting approach that can be explored for gait rehabilitation in post-stroke patients.
机器人设备已被用于中风后行走功能的康复治疗。尽管结果表明中风后患者可从这种非常规治疗中获益，但对于促进神经恢复的最佳机器人辅助方法尚无定论。在此，我们提出一种新的机器人治疗方案，该方案使用基于隐性学习控制的地面外骨骼对踝关节进行扰动。10名健康个体和1名中风患者参与了这项研究，并被纳入一项试点干预方案，该方案通过视频游戏视觉反馈让参与者按照不同轨迹进行踝关节运动。系统会根据表现自主调节任务难度以增加挑战性。我们假设在整个训练过程中的运动学习将导致背屈肌和跖屈肌的皮质脊髓兴奋性增加。采用经颅磁刺激来评估对皮质脊髓兴奋性的影响。在健康个体和中风患者的案例研究中，均观察到任务表现和运动结果有所改善。训练后胫前肌的皮质脊髓兴奋性显著增加；然而，比目鱼肌的皮质脊髓兴奋性未观察到显著变化。临床量表显示中风患者的功能有所改善。我们在神经生理学和表现评估方面的研究结果均表明运动学习得到了改善。该研究的一些局限性包括治疗持续时间和强度，以及比目鱼肌皮质脊髓兴奋性未出现显著变化。尽管如此，结果表明这种机器人训练框架是一种潜在有趣的方法，可用于中风患者的步态康复研究。
