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Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients.

Hesse S, Waldner A, Tomelleri C - J Neuroeng Rehabil (2010)

Bottom Line: To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed.The severely affected subject regained walking and stair climbing ability.The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Park Humboldtmühle Berlin, Department Neurological Rehabilitation Charité, University Medicine, 13507 Berlin, Germany. s.hesse@medicalpark.de

ABSTRACT

Background: Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine.

Methods: The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks.

Results: The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability.

Conclusions: The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

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Related in: MedlinePlus

EMG of the shank muscles of the affected side in a hemiparetic subject. The left column shows the activation pattern of the muscle during the real condition, the right column refers to the simulated condition. Note the timely correct activation of the Mm. tibialis anterior and the more phasic pattern of the Mm. gastrocnemius on the machine. The blue lines show the EMG activation pattern of the shank muscles, the green lines represent the standard deviation of the EMG envelope.
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Figure 5: EMG of the shank muscles of the affected side in a hemiparetic subject. The left column shows the activation pattern of the muscle during the real condition, the right column refers to the simulated condition. Note the timely correct activation of the Mm. tibialis anterior and the more phasic pattern of the Mm. gastrocnemius on the machine. The blue lines show the EMG activation pattern of the shank muscles, the green lines represent the standard deviation of the EMG envelope.

Mentions: For the floor walking condition, the pattern of the thigh muscles (Mm. vastus medialis, lateralis, glutues medius) was comparable during the real and simulated conditions across all subjects. Minimal deviations were a delayed onset and a prolongation of the activation of the Mm. vastus medialis, lateralis during the simulated walking (p < 0.05). Instead of the vastus medialis muscle, two subjects more activated the vastus lateralis on the machine (Figure 4). For the shank muscles, deviations became apparent for two subjects. The tibialis anterior muscle remained rather silent during the real and the simulated floor walking, whereas the activity of the gastrocnemius muscle showed a tonic activation pattern during the real and a phasic, but less intense, activation pattern during the simulated walking on the floor (Figure 5). For the remaining four subjects no clear differences became apparent. Table 1 resumes the relevant data of the activation patterns of the shank and thigh muscles for both floor walking conditions.


Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients.

Hesse S, Waldner A, Tomelleri C - J Neuroeng Rehabil (2010)

EMG of the shank muscles of the affected side in a hemiparetic subject. The left column shows the activation pattern of the muscle during the real condition, the right column refers to the simulated condition. Note the timely correct activation of the Mm. tibialis anterior and the more phasic pattern of the Mm. gastrocnemius on the machine. The blue lines show the EMG activation pattern of the shank muscles, the green lines represent the standard deviation of the EMG envelope.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914004&req=5

Figure 5: EMG of the shank muscles of the affected side in a hemiparetic subject. The left column shows the activation pattern of the muscle during the real condition, the right column refers to the simulated condition. Note the timely correct activation of the Mm. tibialis anterior and the more phasic pattern of the Mm. gastrocnemius on the machine. The blue lines show the EMG activation pattern of the shank muscles, the green lines represent the standard deviation of the EMG envelope.
Mentions: For the floor walking condition, the pattern of the thigh muscles (Mm. vastus medialis, lateralis, glutues medius) was comparable during the real and simulated conditions across all subjects. Minimal deviations were a delayed onset and a prolongation of the activation of the Mm. vastus medialis, lateralis during the simulated walking (p < 0.05). Instead of the vastus medialis muscle, two subjects more activated the vastus lateralis on the machine (Figure 4). For the shank muscles, deviations became apparent for two subjects. The tibialis anterior muscle remained rather silent during the real and the simulated floor walking, whereas the activity of the gastrocnemius muscle showed a tonic activation pattern during the real and a phasic, but less intense, activation pattern during the simulated walking on the floor (Figure 5). For the remaining four subjects no clear differences became apparent. Table 1 resumes the relevant data of the activation patterns of the shank and thigh muscles for both floor walking conditions.

Bottom Line: To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed.The severely affected subject regained walking and stair climbing ability.The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Park Humboldtmühle Berlin, Department Neurological Rehabilitation Charité, University Medicine, 13507 Berlin, Germany. s.hesse@medicalpark.de

ABSTRACT

Background: Stair climbing up and down is an essential part of everyday's mobility. To enable wheelchair-dependent patients the repetitive practice of this task, a novel gait robot, G-EO-Systems (EO, Lat: I walk), based on the end-effector principle, has been designed. The trajectories of the foot plates are freely programmable enabling not only the practice of simulated floor walking but also stair climbing up and down. The article intended to compare lower limb muscle activation patterns of hemiparetic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the machine, and secondly to demonstrate gait improvement on single case after training on the machine.

Methods: The muscle activation pattern of seven lower limb muscles of six hemiparetic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. A non-ambulatory, sub-acute stroke patient additionally trained on the G-EO-Systems every workday for five weeks.

Results: The muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up. Minor differences, concerning the real and simulated floor walking conditions, were a delayed (prolonged) onset (duration) of the thigh muscle activation on the machine across all subjects. Concerning stair climbing conditions, the shank muscle activation was more phasic and timely correct in selected patients on the device. The severely affected subject regained walking and stair climbing ability.

Conclusions: The G-EO-Systems is an interesting new option in gait rehabilitation after stroke. The lower limb muscle activation patterns were comparable, a training thus feasible, and the positive case report warrants further clinical studies.

Show MeSH
Related in: MedlinePlus