Article

Advances in our understanding of neuroplasticity and motor learning
post-stroke are now being leveraged with the use of robotics technology to
enhance physical rehabilitation strategies. Major advances have been made with
upper extremity robotics, which have been tested for efficacy in multi-site
trials across the subacute and chronic phases of stroke.
In contrast, use of
lower extremity robotics to promote locomotor re-learning has been more recent
and presents unique challenges by virtue of the complex multi-segmental mechanics
of gait. OBJECTIVES: Here we review a programmatic effort to develop and apply
the concept of joint-specific modular robotics to the paretic ankle as a means to
improve underlying impairments in distal motor control that may have a
significant impact on gait biomechanics and balance. METHODS: An impedance
controlled ankle robot module (anklebot) is described as a platform to test the
idea that a modular approach can be used to modify training and measure the time
profile of treatment response. RESULTS: Pilot studies using seated visuomotor
anklebot training with chronic patients are reviewed, along with results from
initial efforts to evaluate the anklebot's utility as a clinical tool for
assessing intrinsic ankle stiffness. The review includes a brief discussion of
future directions for using the seated anklebot training in the earliest phases
of sub-acute therapy, and to incorporate neurophysiological measures of
cerebro-cortical activity as a means to reveal underlying mechanistic processes
of motor learning and brain plasticity associated with robotic training.
CONCLUSIONS: Finally we conclude with an initial control systems strategy for
utilizing the anklebot as a gait training tool that includes integrating an
Internal Model-based adaptive controller to both accommodate individual deficit
severities and adapt to changes in patient performance.

Langue : ANGLAIS