Dataset Information

Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD.

ABSTRACT:

Background

Robot-assisted gait therapy is increasingly being used in pediatric neurorehabilitation to complement conventional physical therapy. The robotic device applied in this study, the Lokomat (Hocoma AG, Switzerland), uses a position control mode (Guidance Force), where exact positions of the knee and hip joints throughout the gait cycle are stipulated. Such a mode has two disadvantages: Movement variability is restricted, and patients tend to walk passively. Kinematic variability and active participation, however, are crucial for motor learning. Recently, two new control modes were introduced. The Path Control mode allows the patient to walk within a virtual tunnel surrounding the ideal movement trajectory. The FreeD was developed to support weight shifting through mediolaterally moveable pelvis and leg cuffs. The aims of this study were twofold: 1) To present an overview of the currently available control modes of the Lokomat. 2) To evaluate if an increase in kinematic variability as provided by the new control modes influenced leg muscle activation patterns and intensity, as well as heart rate while walking in the Lokomat.

Methods

In 15 adolescents with neurological gait disorders who walked in the Lokomat, 3 conditions were compared: Guidance Force, Path Control, and FreeD. We analyzed surface electromyographic (sEMG) activity from 5 leg muscles of the more affected leg and heart rate. Muscle activation patterns were compared with norm curves.

Results

Several muscles, as well as heart rate, demonstrated tendencies towards a higher activation during conditions with more kinematic freedom. sEMG activation patterns of the M.rectus femoris and M.vastus medialis showed the highest similarity to over-ground walking under Path Control, whereas walking under FreeD led to unphysiological muscle activation in the tested sample.

Conclusions

Results indicate that especially Path Control seems promising for adolescent patients undergoing neurorehabilitation, as it increases proximal leg muscle activity while facilitating a physiological muscle activation. Therefore, this may be a solution to increase kinematic variability and patients' active participation in robot-assisted gait training.

SUBMITTER: Aurich-Schuler T

PROVIDER: S-EPMC5513325 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Publications

Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD.

Aurich-Schuler Tabea T Grob Fabienne F van Hedel Hubertus J A HJA Labruyère Rob R

Journal of neuroengineering and rehabilitation 20170714 1

<h4>Background</h4>Robot-assisted gait therapy is increasingly being used in pediatric neurorehabilitation to complement conventional physical therapy. The robotic device applied in this study, the Lokomat (Hocoma AG, Switzerland), uses a position control mode (Guidance Force), where exact positions of the knee and hip joints throughout the gait cycle are stipulated. Such a mode has two disadvantages: Movement variability is restricted, and patients tend to walk passively. Kinematic variability ...[more]

PMID: 28705170

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Project description:Background: Robot-assisted gait therapy is a fast-growing field in pediatric neuro-rehabilitation. Understanding how these constantly developing technologies work is a prerequisite for shaping clinical application. For the Lokomat, two new features are supposed to increase patients' movement variability and should enable a more physiological gait pattern: Path Control and FreeD. This work provides a secondary data analysis of a previously published study, and looks at surface electromyography (sEMG) during Guidance Force walking and six sub-conditions of Path Control and FreeD. Objective: The aim was to evaluate different levels of kinematic freedom on the gait pattern of pediatric patients by modulating settings of Path Control and FreeD. Methods: Fifteen patients (mean age 16 ± 2 years) with neurological gait disorders completed the measurements. We analyzed sEMG amplitudes and the correlation of sEMG patterns with normative data of five leg muscles during walking conditions with increasing kinematic freedom in the Lokomat. The new outcome measure of inter-step similarity is introduced as a proxy for walking task complexity. Results: Within Path Control, sub-conditions showed significantly higher sEMG amplitudes in a majority of muscles with increasing kinematic freedom, and correlations with the norm pattern increased with increasing kinematic freedom. FreeD sub-conditions generally showed low or even negative correlations with the norm pattern and a lower inter-step similarity compared to Guidance Force. Conclusions: In general, this work highlights that the new hard- and software approaches of the Lokomat influence muscle activity differently. An increase of kinematic freedom of the walking condition led to an increase in muscular effort (Path Control) or to a higher step variability (FreeD) which can be interpreted as an increased task complexity of this condition. The inter-step similarity could be a helpful tool for the therapist to estimate the patient's state of strain.

Project description:BACKGROUND:Future infertility is a significant concern for survivors of childhood and adolescent cancer. Children and adolescents may have the opportunity to undergo fertility preservation (FP) procedures (which preserve gonadal tissue or gametes for future use) prior to the cancer treatment. However, the decision is very complex, as it is often made by parents as proxy decision makers at the time of cancer diagnosis, and is time-sensitive (needing to occur before the cancer treatment begins). Furthermore, FP procedures in children and adolescents are experimental and cannot guarantee future fertility. An uninformed decision may result in future decision regret. OBJECTIVE:This study aimed to assess the acceptability, usability, and feasibility of a Web-based FP decision aid (DA) in parents of children and adolescents with cancer and clinicians. Fertility knowledge and decision regret were compared in families who reviewed the DA compared with those who did not. METHODS:The Web-based DA was developed according to the International Patient Decision Aid Standards. A cross-sectional study of parents of patients with cancer, who discussed fertility, and clinicians at a tertiary children's hospital was undertaken. The acceptability, usability, and feasibility of the DA were assessed using a pre-post survey design. Measures included the validated Decision Regret Scale, a purpose-designed fertility-related knowledge scale, questions regarding satisfaction with the DA, and open-ended responses for additional feedback. Furthermore, clinicians involved in FP were also invited to review the DA. RESULTS:We enrolled 34 parents and 11 clinicians in this study. Participants who reviewed the DA (15 parents and 11 clinicians) expressed satisfaction with its content and functionality. Parents reported an improved understanding of cancer treatments, infertility, and FP procedures and did not report greater decision regret after DA review. Most parents (13/15, 86%) would recommend the DA to other parents. All clinicians had a consensus that this was a valid and relevant information source for all involved in fertility care. CONCLUSIONS:It is an international standard of care to discuss the impact of cancer treatment on fertility before cancer treatment. This is the first fertility DA for parents of children and adolescents with cancer and is found to be relevant and acceptable by parents and clinicians. This DA has the potential to help support parents to make informed fertility-related decisions for their children and adolescents. However, future research is needed to assess the impact of the DA on prospective decision making.

Dataset Information

Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD.

Background

Methods

Results

Conclusions

Publications

Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD.

Similar Datasets

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