Towards more effective robotic gait training for stroke rehabilitation: a review

In the 8 years since this came out, has your hospital come up with ANY USEFUL STROKE PROTOCOLS?  You can see that in 2012 9 years after NDT/Bobath was discredited it was still in common use. I expect nothing to change in stroke rehab until survivors are in charge and we clean out all the dead wood in stroke.

Towards more effective robotic gait training for stroke rehabilitation: a review

Journal of NeuroEngineering and Rehabilitation, 2012
Andrew Pennycott
1,2*
, Dario Wyss
1,2
, Heike Vallery
1,2
, Verena Klamroth-Marganska
1,2
and Robert Riener
1,2

Abstract

Background:
 Stroke is the most common cause of disability in the developed world and can severely degrade walking function. Robot-driven gait therapy can provide assistance to patients during training and offers a number of advantages over other forms of therapy. These potential benefits do not, however, seem to have been fully realised as of yet in clinical practice.
Objectives:
 This review determines ways in which robot-driven gait technology could be improved in order to achieve better outcomes in gait rehabilitation.
Methods:
 The literature on gait impairments caused by stroke is reviewed, followed by research detailing the different pathways to recovery. The outcomes of clinical trials investigating robot-driven gait therapy are then examined. Finally, an analysis of the literature focused on the technical features of the robot-based devices is presented. This review thus combines both clinical and technical aspects in order to determine the routes by which robot driven gait therapy could be further developed.
Conclusions:
 Active subject participation in robot-driven gait therapy is vital to many of the potential recovery pathways and is therefore an important feature of gait training. Higher levels of subject participation and challenge could be promoted through designs with a high emphasis on robotic transparency and sufficient degrees of freedom to allow other aspects of gait such as balance to be incorporated.
Introduction
Stroke is the third most common cause of death and the biggest contributor to adult disability in developed countries [1]. For instance, around half a million cases of stroke occur per year in the United States [2]. Gait impairment is a large contributor to long-term disability andambulatory function in daily living[3]. Many patients, however, lose the ability to walk independently, and furthermore, a large proportion do not regain their normal walking speeds following a stroke [4,5]. Treatment for stroke is very costly and accounts for a large percentage of heath care budgets, for example, of the National Health Service in the UK [6]. The approach to stroke physiotherapy is diverse, as are the theoretical bases assumed by the physiotherapists who provide the therapy [3,7-10]. Traditional methodology includes
*Correspondence: andrew.pennycott@hest.ethz.ch1Sensory-Motor Systems Lab, ETH Z¨urich, Z¨urich, Switzerland2University Hospital Balgrist, University of Z¨urich, Z¨urich, Switzerland
neurodevelopmental training (NDT) [11], the motor re-learning programme [12], proprioceptive neuromuscular facilitation [13], and the Rood approach [14]. The effects of the different kinds of training on gait have been shown to be modest, irrespective of the exact type of training [15]. NDT is particularly prevalent [6,7,9,16], with the best well known stream being the Bobath concept. This therapy attempts a ‘holistic’ approach where emotional,social and functional problems are targeted in addi-tion to the main sensory-motor deficits [11,17]. The general aim is to suppress abnormal movement synergies and move towards normal motor patterns[17]. Despite the acceptance of neurodevelopmental training and other conventional rehabilitation techniques, evidence demonstrating their efficacy is lacking[8,10,18-23]. Better outcomes in gait rehabilitation have been elicited from the more direct approach of body weight supported treadmill training [20,24-26], where the patient walks on a
© 2012 Pennycott et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.