Limits...
Gait rehabilitation machines based on programmable footplates.

Schmidt H, Werner C, Bernhardt R, Hesse S, Krüger J - J Neuroeng Rehabil (2007)

Bottom Line: Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before.Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible.This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Automation and Robotics, Fraunhofer IPK, Pascalstrasse 8-9, 10587 Berlin, Germany. henning.schmidt@ieee.org

ABSTRACT

Background: Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing.

Results: With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e.g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations.

Conclusion: Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients.

Show MeSH

Related in: MedlinePlus

Electromechanical Gait Trainer GT I with movable footplates. The photograph on the left shows gait rehabilitation with stroke patient, the technical sketch on the right shows the functional principle of the machine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1804273&req=5

Figure 1: Electromechanical Gait Trainer GT I with movable footplates. The photograph on the left shows gait rehabilitation with stroke patient, the technical sketch on the right shows the functional principle of the machine.

Mentions: The development of gait rehabilitation devices started with machines for training of walking on even ground, beginning with the electromechanical 'Gait Trainer GT I' developed by our group [10] (see Fig. 1) and the Driven Gait Orthosis (DGO) 'Lokomat', an exoskeleton type robot in combination with a treadmill developed by a group from University Hospital Balgrist/ETH Zurich [11].


Gait rehabilitation machines based on programmable footplates.

Schmidt H, Werner C, Bernhardt R, Hesse S, Krüger J - J Neuroeng Rehabil (2007)

Electromechanical Gait Trainer GT I with movable footplates. The photograph on the left shows gait rehabilitation with stroke patient, the technical sketch on the right shows the functional principle of the machine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1804273&req=5

Figure 1: Electromechanical Gait Trainer GT I with movable footplates. The photograph on the left shows gait rehabilitation with stroke patient, the technical sketch on the right shows the functional principle of the machine.
Mentions: The development of gait rehabilitation devices started with machines for training of walking on even ground, beginning with the electromechanical 'Gait Trainer GT I' developed by our group [10] (see Fig. 1) and the Driven Gait Orthosis (DGO) 'Lokomat', an exoskeleton type robot in combination with a treadmill developed by a group from University Hospital Balgrist/ETH Zurich [11].

Bottom Line: Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before.Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible.This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Automation and Robotics, Fraunhofer IPK, Pascalstrasse 8-9, 10587 Berlin, Germany. henning.schmidt@ieee.org

ABSTRACT

Background: Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing.

Results: With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e.g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations.

Conclusion: Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients.

Show MeSH
Related in: MedlinePlus