Article

Robotic-assisted locomotor training has demonstrated some efficacy in
individuals with neurological injury and is slowly gaining clinical acceptance.
Both exoskeletal devices, which control individual joint movements, and
elliptical devices, which control endpoint trajectories, have been utilized with
specific patient populations and are available commercially. No studies have
directly compared training efficacy or patient performance during stepping
between devices.
The purpose of this study was to evaluate kinematic,
electromyographic (EMG), and metabolic responses during elliptical- and
exoskeletal-assisted stepping in individuals with incomplete spinal cord injury
(SCI) compared with therapist-assisted stepping.
Design A prospective,
cross-sectional, repeated-measures design was used. METHODS: Participants with
incomplete SCI (n=11) performed 3 separate bouts of exoskeletal-, elliptical-, or
therapist-assisted stepping. Unilateral hip and knee sagittal-plane kinematics,
lower-limb EMG recordings, and oxygen consumption were compared across stepping
conditions and with control participants (n=10) during treadmill stepping.
RESULTS: Exoskeletal stepping kinematics closely approximated normal gait
patterns, whereas significantly greater hip and knee flexion postures were
observed during elliptical-assisted stepping. Measures of kinematic variability
indicated consistent patterns in control participants and during
exoskeletal-assisted stepping, whereas therapist- and elliptical-assisted
stepping kinematics were more variable. Despite specific differences, EMG
patterns generally were similar across stepping conditions in the participants
with SCI. In contrast, oxygen consumption was consistently greater during
therapist-assisted stepping. Limitations Limitations included a small sample
size, lack of ability to evaluate kinetics during stepping, unilateral EMG
recordings, and sagittal-plane kinematics. CONCLUSIONS: Despite specific
differences in kinematics and EMG activity, metabolic activity was similar during
stepping in each robotic device. Understanding potential differences and
similarities in stepping performance with robotic assistance may be important in
delivery of repeated locomotor training using robotic or therapist assistance and
for consumers of robotic devices.

Langue : ANGLAIS