University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands.
Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands.
Eur J Paediatr Neurol. 2020 Nov;29:108-117. doi: 10.1016/j.ejpn.2020.08.003. Epub 2020 Aug 21.
The Lokomat is a commercially available exoskeleton for gait training in persons with cerebral palsy (CP). Because active contributions and variability over movement repetitions are determinants of training effectiveness, we studied muscle activity in children with CP, and determined (i) differences between treadmill and Lokomat walking, and (ii) the effects of Lokomat training parameters, on the amplitude and the stride-to-stride variability.
Ten children with CP (age 13.2 ± 2.9, GMFCS level II(n = 6)/III(n = 4)) walked on a treadmill (±1 km/h; 0% bodyweight support(BWS)), and in the Lokomat (50% and 100% guidance; ±1 km/h and ±2 km/h; 0% and 50% BWS). Activity was recorded from Gluteus Medius (GM), Vastus Lateralis (VL), Biceps Femoris (BF), Medial Gastrocnemius (MG) and Tibialis Anterior (TA) of the most affected side. The averaged amplitude per gait phase, and the second order coefficient of variation was used to determine the active contribution and stride-to-stride variability, respectively.
Generally, the amplitude of activity was lower in the Lokomat than on the treadmill. During Lokomat walking, providing guidance and BWS resulted in slightly lower amplitudes whereas increased speed was associated with higher amplitudes. No significant differences in stride-to-stride variability were observed between Lokomat and treadmill walking, and in the Lokomat only speed (MG) and guidance (BF) affected variability.
Lokomat walking reduces muscle activity in children with CP, whereas altering guidance or BWS generally does not affect amplitude. This urges additional measures to encourage active patient contributions, e.g. by increasing speed or through instruction.
Lokomat 是一种市售的外骨骼，用于脑瘫（CP）患者的步态训练。由于主动参与和运动重复之间的可变性是训练效果的决定因素，我们研究了 CP 儿童的肌肉活动，并确定了（i）跑步机和 Lokomat 行走之间的差异，以及（ii）Lokomat 训练参数对幅度和步幅变异性的影响。
10 名 CP 儿童（年龄 13.2±2.9，GMFCS 水平 II（n=6）/III（n=4））在跑步机上行走（±1km/h；0%体重支持（BWS））和 Lokomat（50%和 100%指导；±1km/h 和±2km/h；0%和 50%BWS）。记录最受影响侧的臀中肌（GM）、股外侧肌（VL）、股二头肌（BF）、腓肠肌内侧（MG）和胫骨前肌（TA）的活动。使用每个步态阶段的平均幅度和二阶变异系数分别确定主动贡献和步幅变异性。
通常，Lokomat 中的活动幅度低于跑步机。在 Lokomat 行走期间，提供指导和 BWS 会导致幅度略低，而增加速度会导致幅度更高。在 Lokomat 和跑步机行走之间，以及在 Lokomat 中，仅速度（MG）和指导（BF）影响变异性，没有观察到步幅变异性的显著差异。
Lokomat 行走会降低 CP 儿童的肌肉活动，而改变指导或 BWS 通常不会影响幅度。这需要采取额外的措施来鼓励患者积极参与，例如增加速度或通过指导。
