Spinal Rehabilitation Laboratory (SPIRE Lab) and Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia (FSL), Rome, Italy.
Advanced Robotics and Human-Centered Technologies Research Unit, Università Campus Bio-Medico di Roma, Rome, Italy.
J Biol Regul Homeost Agents. 2020 Sep-Oct;34(5 Suppl. 3):147-164. Technology in Medicine.
Powered exoskeletons (EXOs) have emerged as potential devices for Spinal Cord Injury (SCI) to support the intervention of physical therapists during therapy (rehabilitation EXOs) as well as to assist lower limb motion during the daily life (assistive EXOs). Although the ankle is considered a key joint for gait restoration after SCI, very few ankle exoskeletons were developed and tested in incomplete SCI (iSCI) population. Among those, the Achilles ankle exoskeleton is the only one embedding a Controller inspired by the neuromuscular system (NeuroMuscular Controller, NMC). In a previous study we demonstrated that a period dedicated to train iSCI subjects in using the Achilles EXO as an assistive aid, improved robot-aided walking speed and surprisingly also generated a positive trend in free walking speed on long and short distances thus suggesting a possible unexpected rehabilitation effect. To further investigate this result, a case-control longitudinal study was conducted in the present work. The aim of this study was to test the hypothesis that Achilles-aided training could improve performance of free walking of chronic iSCI people more than conventional intensity-matched gait rehabilitation. Before and after conventional and robot-aided rehabilitation a number of variables were analyzed, including spatiotemporal parameters, joint kinematics, ground reaction forces, muscle force, spasticity and its related symptoms, balance and personal experience about the training. Results showed that only the NMC-controlled Achilles training allowed participants to significantly walk faster, with a longer step length and a reduced gait cycle time. A slight force and spasticity improvements were also experienced. In terms of subjects' personal experience, Achilles training was perceived more interesting and less physically demanding than conventional rehabilitation.
助力外骨骼（EXO）已成为脊髓损伤（SCI）的潜在治疗设备，可以支持物理治疗师在治疗期间进行干预（康复 EXO），并在日常生活中协助下肢运动（辅助 EXO）。尽管踝关节被认为是 SCI 后步态恢复的关键关节，但在不完全性 SCI（iSCI）人群中开发和测试的踝关节外骨骼却很少。在这些外骨骼中，只有 Achilles 踝关节外骨骼嵌入了一种受神经肌肉系统启发的控制器（神经肌肉控制器，NMC）。在之前的研究中，我们证明了专门为 iSCI 患者提供使用 Achilles EXO 作为辅助设备的培训期，可提高机器人辅助行走速度，令人惊讶的是，也对长距离和短距离的自由行走速度产生了积极的趋势，这表明可能存在意外的康复效果。为了进一步研究这一结果，本研究进行了一项病例对照纵向研究。本研究的目的是检验以下假设：与传统强度匹配的步态康复相比，Achilles 辅助训练可以改善慢性 iSCI 患者的自由行走表现。在传统和机器人辅助康复前后，分析了多种变量，包括时空参数、关节运动学、地面反作用力、肌肉力量、痉挛及其相关症状、平衡和对训练的个人体验。结果表明，只有 NMC 控制的 Achilles 训练才能使参与者显著走得更快，步长更长，步态周期时间更短。还体验到了轻微的力量和痉挛改善。就受试者的个人体验而言，Achilles 训练比传统康复更有趣，身体要求也更低。
