SHAPING THE FUTURE OF ROBOTIC GAIT REHABILITATION
Gait rehabilitation robots are booming
If you work in physical rehabilitation, it is generally accepted that three elements are key for optimal gait recovery following a stroke: high intensity, high number of repetitions and task specificity. To achieve these requirements, without increasing the physical strain on the therapist, gait rehabilitation robots are becoming increasingly common. Worldwide, over 1000 Lokomat devices and 300 EKSO devices are in-use in clinical practice. With over 20 different commercial devices and probably even more research prototypes, the list of devices keeps on growing.
According to the motion they apply to the user’s body, we can classify them into end-effectors, moving the user’s feet with foot plates, and exoskeletons, moving the user’s hip, knee and/or ankle joints using an external orthosis. The latter can be either static, moving the user in a fixed place (picture below), or mobile, moving the user around the environment (picture left).
Evidence supports robotic gait rehabilitation, but there is still room for improvement
Besides the number of devices, also the scientific evidence is growing. In 2020, Mehrholz and colleagues updated their Cochrane Review on “Electromechanical-assisted training for walking after stroke” [1]. The purpose of this literature review is to determine whether robotic gait rehabilitation combined with usual care improves walking function following stroke versus usual care alone.
Compared to their former update in 2017 [2], the authors identified 26 novel studies, highlighting the exponential growth in research on this topic. Nevertheless, the authors’ conclusion remained similar: robotic gait rehabilitation combined with physical therapy increases the odds of becoming an independent walker, but it takes 8 patients to be treated to prevent one dependency in walking (one patient more than back in 2017). Also, with a mean increase of 0.06 m/s, its impact on walking speed is still too low to make a clinically meaningful change. Henceforward, these numbers need to be improved.
One potential reason for the lacking clinical effectiveness, could be the rather low exercise intensity. Though robotic gait rehabilitation is often referred to as a high-intensive therapy, our research suggested that in terms of exercise intensity, it appears not that intensive [3-5].
Similar as before, the same questions remain unanswered: Which devices should be used?; How often and for how long should they be used?; and How should robotic settings be properly accustomed? So, although gait robots are more and more used in clinical practice, researchers still need to find out how we can unlock these devices’ true potential.
The BruBotics Rehabilitation Research Center will tackle current gaps in knowledge
The Brubotics Rehabilitation Research Center (BRRC) is a new movement analysis lab of the Vrije Universiteit Brussel located at the Medical Health Campus in Jette (Belgium). Building upon our established expertise, the BRRC envisions to improve the physical functioning and quality of life of people through human-centered and technology-supported rehabilitation.
The BRRC will be equipped with high-tech infrastructure, including:
- 14 motion capture cameras (Vicon)
- 2 video cameras (Vicon)
- 3 built-in force plates (AMTI)
- a self-paced treadmill
- a wireless 16-channel electromyography device (Cometa)
- a portable breath-by-breath ergospirometry device (Cortex)
Furthermore, also a commercial lower limb exoskeleton (Ekso Bionics; picture top left) will be acquired. Through comprehensive movement analysis, we aim to better understand the impact of robotic control settings on the users’ gait and how to properly accustom rehabilitation robots to the users’ needs.
Besides the evaluation of commercially available systems, we will closely collaborate with multiple research groups of the Brussels Human Robotics Reseach Center (BruBotics) to design and validate advanced rehabilitation exoskeletons. The BruBotics consortium uniquely combines expertise on robotics, artificial intelligence, rehabilitation sciences, movement sciences, social sciences, retail marketing, ageing and eHealth, and is as such one of the only interdisciplinary robotics research centers in Europe.
Want to follow our journey to push the field of rehabilitation technology? Check our lab’s webpage for more information and updates!
Nina Lefeber
References and further reading:
[1] Mehrholz et al. (2020). Electromechanical-assisted training for walking after stroke. The Cochrane database of systematic reviews, 10, CD006185. https://doi.org/10.1002/14651858.CD006185.pub5
[2] Mehrholz et al. (2017). Electromechanical-assisted training for walking after stroke. The Cochrane database of systematic reviews, 5(5), CD006185. https://doi.org/10.1002/14651858.CD006185.pub4
[3] Lefeber et a. (2020). Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis. Disability and rehabilitation, 42(12), 1650–1666. https://doi.org/10.1080/09638288.2018.1531943
[4] Lefeber et al. (2019). Physiological responses and perceived exertion during robot-assisted treadmill walking in non-ambulatory stroke survivors. Disability and rehabilitation, 1–9. https://doi.org/10.1080/09638288.2019.1671502
[5] Lefeber et al. (2020), "Robot-Assisted Overground Walking: Physiological Responses and Perceived Exertion in Nonambulatory Stroke Survivors," in IEEE Robotics & Automation Magazine, vol. 27, no. 1, pp. 22-31. https://doi.org/10.1109/MRA.2019.2939212