Beneficial, positive benefits and 'may' are code words for YOU having to accept the tyranny of low expectations because the stroke medical world isn't even trying to get survivors 100% recovered. Hope you are OK with that complete fucking failure.
Abstract—
Task-specific practice can be beneficial for motor rehabilitation after neurological injury. Unfortunately, high labor demands have limited its clinical acceptance, especially for gait rehabilitation. A number of research teams around the world are testing large robotic devices for assisting treadmill stepping as a means for reducing therapist labor. We propose that powered lower limb orthoses may also have a role in assisting gait rehabilitation. Powered orthoses could assist task specific practice of gait with the long-term goal of improving patients’ inherent locomotor capabilities. We present data showing that: (1) pneumatically powered lower limb orthoses can provide substantial mechanical assistance to human walking, (2) powered orthoses can lead to motor adaptation of gait in healthy subjects, and (3) powered lower limb orthoses may have positive benefits(NOT GOOD ENOUGH,we need EXACT PROTOCOLS delivering results.) during gait rehabilitation.
I. INTRODUCTION Locomotor training can improve human walking ability following neurological injury [1-5]. Typically locomotor training involves patients practicing stepping with bodyweight support and external assistance as needed [6]. This therapy was developed based on two major principles learned from extensive studies on cats [7-11] and rats [12]. The first principle, task specificity (as applied to locomotor training), states that to improve walking ability patients must practice walking [11]. The second principle, activity dependent plasticity, states that patients must be active participants in the therapy to drive neural adaptation [13, 14]. The functional benefits of locomotor training with manual assistance are considerable but so are the costs. Providing proper manual assistance is physically demanding and requires a high level of skill and training. Because it is labor intensive, a session of locomotor training with manual assistance can require several therapists. In addition the skill of the therapist is a very important factor in determining the
Manuscript received April 4, 2005. This work was supported in part by Christopher Reeve Paralysis Foundation FAC2-0101, NIH R01NS045486 and NSF BES-0347479. 1Gregory S. Sawicki is with the Division of Kinesiology and Department of Mechanical Engineering at the University of Michigan, Ann Arbor, MI 48109-2214, USA ( e-mail: gsawicki@ umich.edu). 2Keith Gordon is with the Division of Kinesiology at the University of Michigan, Ann Arbor, MI 48109-2214, USA (e-mail: kegordon@umich.edu). 3Corresponding Author: Daniel P. Ferris is with the Division of Kinesiology and Department of Biomedical Engineering at the University of Michigan, Ann Arbor, MI 48109-2214, USA (phone: 734-647-6878; fax: 936-1925; e-mail: ferrisdp@umich.edu).
efficacy of the therapy. Because of the drawbacks to manual locomotor training, scientists and engineers are developing robotic devices that can assist gait rehabilitation. Most of the currently available devices are designed to guide the legs through preprogrammed physiological gait patterns. The Lokomat® System developed by Hocoma (Switzerland) consists of a position controlled robotic gait orthosis that attaches to a treadmill frame and a body weight support system [15-18]. The AutoAmbulator® [www.autoambulator.com] is a similar device being developed by HealthSouth, a commercial healthcare provider. The Mechanized Gait Trainer is based on a crank and rocker gear system, providing limb motion similar to that of an elliptical trainer [19, 20]. Reinkensmeyer et al. are also working on devices that use pneumatic actuators and high bandwidth force control [21, 22]. All of these robotic devices clearly have potential for assisting gait rehabilitation after neurological injury, especially for patients with little to no walking ability. However, for patients with some but limited walking ability, it may also be helpful to consider other complementary devices. An alternative approach for robotic gait rehabilitation devices is to make them wearable so that they can function during overground locomotion. This would allow the practice of task specific aspects of walking such as gait initiation and termination, turning, negotiating slopes, dynamic balance control and speed modulation. In addition, it may prove particularly helpful to provide powered plantar flexion during gait practice. In healthy subjects, the ankle joint contributes more mechanical work to the gait cycle than either the hip or the knee [23]. A powered lower limb orthosis could mechanically assist at the ankle joint while allowing subjects more freedom in their gait pattern during rehabilitation. A powered orthosis might be especially useful for patients who are ready to practice more demanding locomotor tasks like turning and obstacle avoidance. Although lower limb orthoses have traditionally been passive, there have been attempts at providing powered versions. Importantly, the main goal of these previous prototypes has been to create assistive technology. These research teams envisioned replacing lost motor capabilities rather than improving motor capabilities through therapy. In the 1970s, Vukobratovic built pneumatic robotic exoskeletons for human walking [24, 25]. Seireg et al. developed a hydraulic device with a dual axis hip, dual axis ankles, and a single axis knee joint [26]. A more recent
attempt was the Powered Gait Orthosis (PGO), a four bar linkage and CAM system [27]. Blaya et al. built an orthosis to assist drop foot gait [28]. In addition, there are other groups developing powered lower limb orthoses to replace lost motor function of patients [29, 30]. All of these prototypes have had difficulty with achieving sufficient energy density. That is, to make the devices truly portable so they can function as assistive technology, the actuators and batteries have to be powerful and lightweight while providing many hours of use. Powered orthoses for motor rehabilitation do not face as many technical difficulties as those intended for use as assistive technology. Using a powered lower limb orthosis as gait therapy would restrict the device to the clinic. As a result, control hardware and power do not have to be on board the orthosis itself. Electric, hydraulic, or pneumatic energy could be supplied through a tether that includes cables connected to a desktop computer. A therapist could have real-time control over the magnitude and timing of mechanical assistance during gait practice. In addition, sensors could provide feedback to the therapist about the performance of the patient. As rehabilitation progresses, the patient could be weaned by decreasing orthosis assistance. This would enforce active patient participation over the training period. The ultimate goal would be to divorce the patient from the powered orthosis as motor capabilities improved. The following sections describe our initial attempts at developing powered orthoses for motor rehabilitation and discuss alternative uses for the orthoses in studying motor adaptation during human walking.
Xiao Cheng1,2, 
Jianxin Ye
Huijuan Jin
Rentang Bi
Da Xu
Ying Su
Bo Hu