Gait Training in Spinal Cord Injury, Regarding Two Robotic Devices: Lokomat® and EKSO GT®

Authors

  • Gonçalo Pires Serviço de MFR do Centro de Medicina de Reabilitação do Alcoitão
  • Jorge Fortunato Serviço de MFR do Centro de Medicina de Reabilitação do Alcoitão
  • Isabel Amorim Serviço de MFR do Centro de Medicina de Reabilitação do Alcoitão
  • Filipa Faria Serviço de MFR do Centro de Medicina de Reabilitação do Alcoitão

DOI:

https://doi.org/10.25759/spmfr.273

Keywords:

Gait, Spinal Cord Injuries/rehabilitation, Robotics

Abstract

One of the main goals of rehabilitation following spinal cord injury is gait training. This approach may be associated with the reconfiguration of the spinal and interneuron reflexes, enhancing the neuroplasticity that leads to the recovery of gait capacity. The afferent input related to load and hip-joint position are crucial in generating a gait pattern and consequently in gait training. The recent introduction of robotic devices for the recovery of walking function in patients with incomplete spinal cord injury, improves the consistency of training and increase the intensity of therapy in a safe environment. Functional outcome is assessed by appropriate spinal cord injury scales and tests. The use of robotic devices implies a vast knowledge of the indications, benefits, limitations and safety measures required for each device and each patient. There are several types of robotic systems currently available for use in gait rehabilitation. However, the authors intend to describe the main advantages and limitations of two robotic systems, Lokomat® and EKSO GT®, as well as to perform a brief review of the neurophysiology and evaluation of prognostic factors of walking recovery after spinal cord injury.

Downloads

Download data is not yet available.

References

Spinal Cord Injury (SCI) 2016 Facts and Figures at a Glance. J Spinal Cord Med. 2016;39(4):493-494.

Kirshblum SC, Waring W, Biering-Sorensen F, Burns S, Johansen M, Schmidt-Read M, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546.

Scivoletto G, Di Donna V. Prediction of walking recovery after spinal cord injury. Brain Res Bull. 2009;78:43-51.

Scivoletto G, Romanelli A, Mariotti A, Marinucci D, Tamburella F, Mammone A, et al. Clinical Factors That Affect Walking Level and Performance in Chronic Spinal Cord Lesion Patients. Spine (Phila Pa 1976). 2008;33(3):259-264.

Dietz V, Sinkjaer T. Spastic movement disorder : impaired reflex function and altered muscle mechanics. Lancet. 2007;6:725-733.

Esquenazi APA. Robotic-Assisted Gait Training and Restoration. Am J Phys Med Rehabil. 2012;91:217-231.

Morawietz C, Moffat F. Effects of Locomotor Training After Incomplete Spinal Cord Injury : A Systematic Review. Arch Phys Med Rehabil. 2013;94:2297-2308.

Hubli M, Dietz V. The physiological basis of neurorehabilitation - locomotor training after spinal cord injury. J Neuroeng Rehabil. 2013;10:5. Disponível em: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3584845&tool=pmcentrez&rendertype=abstract

Rossignol S, Frigon A. Recovery of Locomotion After Spinal Cord Injury : Some Facts and Mechanisms. Annu Rev Neurosci. 2011;34:413-440.

Dietz V, Fouad K. Restoration of sensorimotor functions after spinal cord injury. Brain. 2014;137:654-667.

Knikou M. Neural control of locomotion and training- induced plasticity after spinal and cerebral lesions. Clin Neurophysiol. 2010;121(10):1655-1668.

Smith A, Knikou M. A Review on Locomotor Training after Spinal Cord Injury: Reorganization of Spinal Neuronal Circuits and Recovery of Motor Function. Neural Plast. 2016;2016:1216258. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/27293901

Rossignol S, Barrière G, Frigon A, Barthélemy D, Bouyer L, Provencher J, et al. Plasticity of locomotor sensorimotor interactions after peripheral and/or spinal lesions. Brain Res Rev. 2008;57:228-240.

Markin S, Klishko A, Shevtsova N, Lemay M, Boris I, Rybak I. Afferent control of locomotor CPG: insights from a simple neuromechanical model. Ann N Y Acad Sci. 2010;1198:21-34.

Dietz V. Proprioception and locomotor disorders. Nat Rev Neurosci. 2002;3:781–790.

Sinkjaer T, Andersen J, Larsen B. Soleus stretch reflex modulation during gait in humans. J Neurophysiol. 1996;76(2):1112-1120.

Capaday C, Stein R. Difference in the amplitude of the human soleus H reflex during walking and running. J Physiol. 1987;392:513-522.

Knikou M. Functional reorganization of soleus H ‑ reflex modulation during stepping after robotic ‑ assisted step training in people with complete and incomplete spinal cord injury. Exp Brain Res. 2013;228:279-296.

Rossignol S, Dubuc R, Gossard J-P. Dynamic Sensorimotor Interactions in Locomotion. Physiol Rev. 2006;86:89-154.

Schomburg E. Spinal sensorimotor systems and their supraspinal control. Neurosci Res. 1990;7:265-340.

Berger W, Horstmann G, Dietz V. Tension development and muscle activation in the leg during gait in spastic hemiparesis : independence of muscle hypertonia and exaggerated stretch reflexes. J Neurol Neurosurg Psychiatry. 1984;47:1029-1033.

Hiersemenzel L, Curt A, Dietz V. From spinal shock to spasticity Neuronal adaptations to a spinal cord injury. 2000;54(54):1574–1582.

Grillner S, Rossignol S. On the initiation of the swing phase of locomotion in chronic spinal cats. Brain Res. 1978;146(2):269-277.

Dietz V, Müller R, Colombo G. Locomotor activity in spinal man: significance of afferent input from joint and load receptors. Brain. 2002;125(12):2626-2634.

Dietz V. Body weight supported gait training: From laboratory to clinical setting. Brain Res Bull. 2008;76(5):459-463.

Behrman AL, Bowden M, Nair P. Neuroplasticity After Spinal Cord Injury and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery. Phys Ther. 2006;86(10):1406-1425.

Warraich Z, Kleim J. Neural Plasticity: The Biological Substrate For Neurorehabilitation. PM&R. 2010;2(12):S208-S219.

Reinkensmeyer D, Dietz V, eds. Neurorehabilitation Technology. 2nd ed. Switzerland: Springer Nature; 2016.

Curt A, Dietz V. Ambulatory capacity in spinal cord injury: significance of somatosensory evoked potentials and ASIA protocol in predicting outcome. Arch Phys Med Rehabil. 1997;78(1):39-43.

Curt A, Keck M, Dietz V. Functional outcome following spinal cord injury: significance of motor-evoked potentials and ASIA scores. Arch Phys Med Rehabil. 1998;79(1):81-86.

Ramón S, Domínguez R, Ramírez L, Paraira M, Olona M, Castelló T, et al. Clinical and magnetic resonance imaging correlation in acute spinal cord injury. Spinal Cord. 1997;35(10):664-673.

Van Hedel H, Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests. Arch Phys Med Rehabil. 2005;86(2):190-196.

Schwartz I, Sajina A, Neeb M, Fisher I, Katz-Luerer M, Meiner Z. Locomotor training using a robotic device in patients with subacute spinal cord injury. Spinal Cord. 2011;49(10):1062-1067.

Awai L, Curt A. Comprehensive assessment of walking function after human spinal cord injury. Prog Brain Res. 2015;218:1-14.

Dittuno P, Dittuno J. Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord. 2001;39(12):654-656.

Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee M, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45:275–291.

Dietz V, Fouad K. Restoration of sensorimotor functions after spinal cord injury. Brain. 2014;137:654-667.

Low KH. Robot-Assisted Gait Rehabilitation : From Exoskeletons to Gait Systems. In: Defense Science Research Conference and Expo. 2011; Aug 3-5; Singapore, Singapore: IEEE; 2011.

Torres-Oviedo G, Bastian A. Seeing Is Believing: Effects of Visual Contextual Cues on Learning and Transfer of Locomotor Adaptation. J Neurosci. 2010;30(50):17015-17022.

Schwartz I, Meiner Z. Robotic-Assisted Gait Training in Neurological Patients: Who May Benefit? Ann Biomed Eng. 2015;43(5):1260-1269.

Van Hedel H, Dietz V. Rehabilitation of locomotion after spinal cord injury. Restor Neurol Neurosci. 2010;28(1):123-134.

Hoekstra F, Van Nunen M, Gerrits K, Stolwijk-Swüste J, Crins M, Janssen T. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury. J Rehabil Res Dev. 2013;50(10):1411-1422.

Querry R. Synchronous stimulation and monitoring of soleus H reflex during robotic body weight-supported ambulation in subjects with spinal cord injury. J Rehabil Res Dev. 2008;45(1):175-186.

Israel J, Campbell D, Kahn J, Hornby T. Metabolic Costs and Muscle Activity Patterns During Robotic- and Therapist-Assisted Treadmill Walking in Individuals With Incomplete Spinal Cord Injury. Phys Ther. 2006;86(11):1466-1478.

Mehrholz, J; Harvey, L; Thomas, S; Elsner B. Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review. Spinal Cord. 2017;55(8):722-729.

Field-Fote E, Roach K. Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial. Phys Ther. 2011;91(1):48-60.

Nooijen C, Ter Hoeve N, Field-Fote E. Gait quality is improved by locomotor training in individuals with SCI regardless of training approach. J Neuroeng Rehabil. 2009;6:36. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/19799783

Semerjian T, Montague S, Dominguez J, Davidian A, de Leon R. Enhancement of Quality of Life and Body Satisfaction Through the Use of Adapted Exercise Devices for Individuals with Spinal Cord Injuries. Top Spinal Cord Inj Rehabil. 2005;11(2):95-108.

Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000;37(6):693-700.

Morrison S, Backus D. Locomotor training: is translating evidence into practice financially feasible? J Neurol Phys Ther. 2007;31(2):50-54.

Frey M, Colombo G, Vaglio M, Bucher R, Jörg M, Riener R. A novel mechatronic body weight support system. IEEE Trans Neural Syst Rehabil Eng. 2006;14(3):311-321.

Niu T, Alaynick WA, Lu DC. Strategies and lessons in spinal cord injury rehabilitation. Curr Phys Med Rehabil Reports. 2015;3(3):206-213.

Hicks AL. Treadmill training after spinal cord injury: It’s not just about the walking. J Rehabil Res Dev. 2008;45(2):241-248.

Harkema S, Behrman A, Barbeau H. Locomotor Training: Principles and Practice. 1st ed. New York: Oxford University Press; 2011.

Newell K, Vaillancourt D. Dimensional change in motor learning. Hum Mov Sci. 2001;20:695-715.

Huang V, Krakauer J. Robotic neurorehabilitation: a computational motor learning perspective. J Neuroeng Rehabil. 2009;6:5. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/19243614

Ziegler M, Zhong H, Roy R, Edgerton V. Why variability facilitates spinal learning. J Neurosci. 2010;30(32):10720-10726.

Riener R, Lünenburger L, Jezernik S, Anderschitz M, Colombo G, Dietz V. Patient-cooperative strategies for robot-aided treadmill training: first experimental results. IEEE Trans Neural Syst Rehabil Eng. 2005;13(3):380-394.

Riener R, Lünenburger L, Colombo G. Human-centered robotics applied to gait training and assessment. J Rehabil Res Dev. 2006;43(5):679-694.

Lunenburger L, Colombo G, Riener R. Biofeedback for robotic gait rehabilitation. J Neuroeng Rehabil. 2007;4:1. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/17244363

Kozlowski A, Bryce T, Dijkers M. Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking. Top Spinal Cord Inj Rehabil. 2015;21(2):110-121.

Published

2019-10-17

How to Cite

1.
Pires G, Fortunato J, Amorim I, Faria F. Gait Training in Spinal Cord Injury, Regarding Two Robotic Devices: Lokomat® and EKSO GT®. SPMFR [Internet]. 2019 Oct. 17 [cited 2024 Nov. 25];31(3):23-30. Available from: https://spmfrjournal.org/index.php/spmfr/article/view/273

Issue

Section

Review Article

Similar Articles

<< < 14 15 16 17 18 19 

You may also start an advanced similarity search for this article.