• Humans
• Muscle, Skeletal/physiology
• Male
• Adult
• Female
• Young Adult
• Lower Extremity/physiology
• Electromyography
• Walking/physiology
• Body Weight
• Biomechanical Phenomena
• Electroencephalography
• Locomotion/physiology
• Exercise Test
• Water
• Gait/physiology

• Gait parameters
• Overground walking
• Treadmill walking

• balance
• body weight support training
• meta-analysis
• stroke
• walking function

• Assistive device
• Inpatient rehabilitation
• Physical therapy
• Soft exosuit
• Stroke rehabilitation

• Humans
• Stroke Rehabilitation/methods
• Stroke Rehabilitation/instrumentation
• Male
• Female
• Feasibility Studies
• Middle Aged
• Aged
• Exoskeleton Device
• Gait Disorders, Neurologic/rehabilitation
• Gait Disorders, Neurologic/etiology
• Stroke/complications
• Gait/physiology
• Adult
• Paresis/rehabilitation
• Paresis/etiology
• Inpatients

• R01 HD088619 NICHD NIH HHS
• BRG-R01HD088619 National Institute of Health
• CMMI-1925085 National Science Foundation
• The National Institute on Disability, Independent Living, and Rehabilitation Research
• Harvard University John A. Paulson School of Engineering and Applied Sciences

• Gait training
• Mobility
• Stroke rehabilitation
• Walking speed

• Humans
• Stroke Rehabilitation/methods
• Male
• Female
• Middle Aged
• Single-Blind Method
• Exercise Therapy/methods
• Aged
• Postural Balance/physiology
• Quality of Life
• Prospective Studies
• Stroke/physiopathology
• Stroke/therapy
• Body Weight/physiology
• Walking Speed/physiology
• Treatment Outcome
• Exercise Test/methods
• Outcome Assessment, Health Care

• Functional Ambulation Category (FAC)
• Medical Care Pit
• acute stroke
• care burden of therapy staff
• gait parameters
• independent walking
• physical therapy
• stroke rehabilitation
• walking
• walking support system

• grant number: 2017-PM05-03-01 The ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan)

• body weight shift
• body weight support
• center of pressure
• force control
• pneumatic artificial muscle

• National Institute of Information and Communications Technology
• Japan Science and Technology Agency
• Japan Society for the Promotion of Science
• Tateishi Science and Technology Foundation

Quasi-stiffness characterizes the dynamics of a joint in specific sections of stance-phase and is used in the design of wearable devices to assist walking. We sought to investigate the effect of simulated reduced gravity and walking speed on quasi-stiffness of the hip, knee, and ankle in overground walking. 12 participants walked at 0.4, 0.8, 1.2, and 1.6 m/s in 1, 0.76, 0.54, and 0.31 gravity. We defined 11 delimiting points in stance phase (4 each for the ankle and hip, 3 for the knee) and calculated the quasi-stiffness for 4 phases for both the hip and ankle, and 2 phases for the knee. The R² value quantified the suitability of the quasi-stiffness models. We found gravity level had a significant effect on 6 phases of quasi-stiffness, while speed significantly affected the quasi-stiffness in 5 phases. We concluded that the intrinsic muscle-tendon unit stiffness was the biggest determinant of quasi-stiffness. Speed had a significant effect on the R² of all phases of quasi-stiffness. Slow walking (0.4 m/s) was the least accurately modelled walking speed. Our findings showed adaptions in gait strategy when relative power and strength of the joints were increased in low gravity, which has implications for prosthesis and exoskeleton design.

• Ankle
• Ankle Joint
• Biomechanical Phenomena
• Gait
• Humans
• Hypogravity
• Knee Joint
• Walking
• Walking Speed

• R01 NS104772 NINDS NIH HHS
• National Institutes of Neurological Disorders and Stroke

• balance
• cardiorespiratory fitness
• exercise training
• mobility
• rehabilitation
• stroke recovery

• Exercise Therapy
• Humans
• Regression Analysis
• Stroke/therapy
• Time-to-Treatment
• Treatment Outcome

• PJT‐159711 CIHR
• Heart and Stroke Foundation
• Canadian Institutes of Health Research
• Canada Research Chairs

We designed and manufactured a pneumatic-driven robotic passive gait training system (PRPGTS), providing the functions of body-weight support, postural support, and gait orthosis for patients who suffer from weakened lower limbs. The PRPGTS was designed as a soft-joint gait training rehabilitation system. The soft joints provide passive safety for patients. The PRPGTS features three subsystems: a pneumatic body weight support system, a pneumatic postural support system, and a pneumatic gait orthosis system. The dynamic behavior of these three subsystems are all involved in the PRPGTS, causing an extremely complicated dynamic behavior; therefore, this paper applies five individual interval type-2 fuzzy sliding controllers (IT2FSC) to compensate for the system uncertainties and disturbances in the PRGTS. The IT2FSCs can provide accurate and correct positional trajectories under passive safety protection. The feasibility of weight reduction and gait training with the PRPGTS using the IT2FSCs is demonstrated with a healthy person, and the experimental results show that the PRPGTS is stable and provides a high-trajectory tracking performance.

• assistive exoskeleton
• body weight support system
• gait orthosis system
• gait training
• interval type-2 fuzzy sliding control
• rehabilitation robotics

• Gait
• Humans
• Lower Extremity
• Muscles
• Orthotic Devices
• Robotic Surgical Procedures

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

Reducing the mechanical load on the human body through simulated reduced gravity can reveal important insight into locomotion biomechanics. The purpose of this study was to quantify the effects of simulated reduced gravity on muscle activation levels and lower limb biomechanics across a range of overground walking speeds. Our overall hypothesis was that muscle activation amplitudes would not decrease proportionally to gravity level. We recruited 12 participants (6 female, 6 male) to walk overground at 1.0, 0.76, 0.55, and 0.31 G for four speeds: 0.4, 0.8, 1.2, and 1.6 ms^-1. We found that peak ground reaction forces, peak knee extension moment in early stance, peak hip flexion moment, and peak ankle extension moment all decreased substantially with reduced gravity. The peak knee extension moment at late stance/early swing did not change with gravity. The effect of gravity on muscle activity amplitude varied considerably with muscle and speed, often varying nonlinearly with gravity level. Quadriceps (rectus femoris, vastus lateralis, & vastus medialis) and medial gastrocnemius activity decreased in stance phase with reduced gravity. Soleus and lateral gastrocnemius activity had no statistical differences with gravity level. Tibialis anterior and biceps femoris increased with simulated reduced gravity in swing and stance phase, respectively. The uncoupled relationship between simulated gravity level and muscle activity have important implications for understanding biomechanical muscle functions during human walking and for the use of bodyweight support for gait rehabilitation after injury.

• Adult
• Biomechanical Phenomena
• Female
• Gait/physiology
• Humans
• Hypogravity
• Leg/physiology
• Male
• Muscle, Skeletal/physiology
• Walking/physiology

• R01 NS104772 NINDS NIH HHS
• National Institutes of Health

• electromyography
• exoskeleton
• gait rehabilitation
• kinematics
• motion tracking
• muscle synergy
• stroke

• Rehabilitation
• end-effector
• exoskeleton-plus-treadmill
• locomotion
• muscle synergies
• stroke

• Brain injury
• dual task
• limited resources model
• motor control
• working memory

Impairments in walking speed, capacity, and endurance are commonly seen after stroke. Treadmill training improves endurance and gait speed. However, the lack of variable training speed and automated speed progression increases the risk of backward displacement and falling. An automated, speed-sensing treadmill prototype with partial body weight support, the Variable Automated Speed and Sensing Treadmill II (VASST II), was tested in an outpatient rehabilitation setting. Eleven subacute or chronic hemiplegics who could ambulate at > 0.2 m/s for >50 m participated in the study. All subjects underwent physiotherapist-supervised training on VASST II for 60 min daily, 3 times per week, for 5 weeks (total 15 h). Outcome measures at Week 3 (mid-VASST II training), Week 6 (post-VASST II training), Week 12 (first follow-up), and Week 24 (second follow-up) included the 6 minute walk test (6 MWT), 10 meter walk test (10 MWT), Berg Balance Scale (BBS) score, and Functional Ambulation category (FAC) score. User acceptability of VASST II for both study subjects and physiotherapists were also assessed. All subjects [median (IQR) age: 53.0 (22) years; median (IQR) duration post-stroke: 524 (811) days] completed VASST II training. At baseline, mean ± SD 6 MWT was 114 ± 50.9 m; mean ± SD 10 MWT was 0.37 ± 0.18 m/s; mean ± SD BBS score was 40 ± 10; and, mean ± SD FAC score was 4 ± 1. At Week 6, there were significant improvements in the 6 MWT [158.91 ± 88.69 m; P = 0.003], 10 MWT [0.49 ± 0.30 m/s; P = 0.016], and BBS score [42 ± 10; P = 0.003]. Improvements in 6 MWT and BBS scores were sustained at Week 24, but not in the 10 MWT. No VASST II-training related falls were reported. All subjects rated their VASST II training positively and indicated that it improved their current walking ability. VASST II training was effective, feasible, and safe in patients with subacute or chronic post-stroke hemiparetic gait, with sustained gains in distance walked (6 MWT) and functional balance (BBS score) up to 19 weeks post-intervention.

• body weight supported treadmill training
• hemiplegia
• rehabilitation
• speed-sensing
• stroke

• Body weight support
• Gait models
• Gait rehabilitation
• Human locomotion

• Benchmarking
• Biomechanical Phenomena
• Body Weight/physiology
• Computer Simulation
• Exercise Therapy/methods
• Gait/physiology
• Gait Disorders, Neurologic/rehabilitation
• Humans
• Reproducibility of Results
• Walking/physiology
• Weightlessness Simulation/methods
• Weightlessness Simulation/standards

• Horizon 2020 Framework Programme

• IMU
• NDT
• gait detection
• gait training
• motor control
• stroke

• Gait Analysis/instrumentation
• Gait Disorders, Neurologic/diagnosis
• Humans
• Male
• Middle Aged
• Stroke/physiopathology
• Stroke Rehabilitation
• Walking

• MOST 108-2634-F-002-016- Ministry of Science and Technology, Taiwan
• MOST 107-2634-F-002-018- Ministry of Science and Technology, Taiwan
• 105-MSL01 Industrial Technology Research Institute of Taiwan
• 104-MSL01 Industrial Technology Research Institute of Taiwan
• MOST 109-2634-F-002-027 - Ministry of Science and Technology, Taiwan

Background: Inflammatory lesions and neurodegeneration lead to motor, cognitive, and sensory impairments in people with multiple sclerosis (MS). Accumulation of disability is at least partially due to diminished capacity for neuroplasticity within the central nervous system. Aerobic exercise is a potentially important intervention to enhance neuroplasticity since it causes upregulation of neurotrophins and enhances corticospinal excitability, which can be probed using single-pulse transcranial magnetic stimulation (TMS). Whether people with progressive MS who have accumulated substantial disability could benefit from walking rehabilitative training to enhance neuroplasticity is not known.

Objective: We aimed to determine whether 10 weeks of task-specific walking training would affect corticospinal excitability over time (pre, post, and 3-month follow-up) among people with progressive MS who required walking aids.

Results: Eight people with progressive MS (seven female; 29–74 years old) with an Expanded Disability Status Scale of 6–6.5 underwent harness-supported treadmill walking training in a temperature controlled room at 16°C (10 weeks; three times/week; 40 min at 40–65% heart rate reserve). After training, there was significantly higher corticospinal excitability in both brain hemispheres, reductions in TMS active motor thresholds, and increases in motor-evoked potential amplitudes and slope of the recruitment curve (REC). Decreased intracortical inhibition (shorter cortical silent period) after training was noted in the hemisphere corresponding to the stronger hand only. These effects were not sustained at follow-up. There was a significant relationship between increases in corticospinal excitability (REC, area under the curve) in the hemisphere corresponding to the stronger hand and lessening of both intensity and impact of fatigue on activities of daily living (Fatigue Severity Scale and Modified Fatigue Impact Scale, respectively).

Conclusion: Our pilot results support that vigorous treadmill training can potentially improve neuroplastic potential and mitigate symptoms of the disease even among people who have accumulated substantial disability due to MS.

• corticospinal excitability
• exercise
• fatigue
• neuroplasticity
• progressive multiple sclerosis
• rehabilitation
• transcranial magnetic stimulation

• Humans
• Exercise Test
• Gait
• Gait Disorders, Neurologic/rehabilitation
• Robotics
• Social Interaction

•

The effects of LBPP on locomotion in neurologic patients are poorly predictable.

Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.

• AlterG
• Conventional treadmill gait training
• Gait training
• Lower body positive pressure support system
• Stroke

• Gait
• Locomotor training
• Non-paretic training
• Spatiotemporal parameters
• Stroke
• Symmetry

• Coactivation
• Electromyography
• Spinal cord injury
• Wavelets

• Robotic orthoses
• actuation
• control strategies
• gait rehabilitation
• mechanism design
• stroke

• knee exoskeleton
• polycentric structure
• pump-controlled electro-hydraulic actuator (EHA)
• sliding mode control (SMC)

• 2017R1A2B4009265 National Research Foundation of Korea

Robotic locomotion rehabilitation systems have been used for gait training in patients who have had a stroke. Most commercialized systems allow patients to perform simple exercises such as balancing or level walking, but an additional function such as stair-walk training is required to provide a wide range of recovery cycle rehabilitation. In this study, we analyzed stair-gait patterns and applied the result to a robotic rehabilitation system that can provide a vertical motion of footplates.

To obtain applicable data for the robotic system with vertically movable footplates, stair-walk action was measured using an optical marker-based motion capture system. The spatial position data of joints during stair walking was obtained from six healthy adults who participated in the experiment. The measured marker data were converted into joint kinematic data by using an algorithm that included resampling and normalization. The spatial position data are represented as angular trajectories and the relative displacement of each joint on the anatomical sagittal plane and movements of hip joints on the anatomical transverse plane.

The average range of motion (ROM) of each joint was estimated as (−6.75°, 48.69°) at the hip, (8.20°, 93.78°) at the knee, and (−17.78°, 11.75°) at the ankle during ascent and as (6.41°, 31.67°) at the hip, (7.38°, 91.93°) at the knee, and (−24.89°, 24.18°) at the ankle during descent. Additionally, we attempted to create a more natural stair-gait pattern by analyzing the movement of the hip on the anatomical transverse plane. The hip movements were estimated to within ±1.57 cm and ±2.00 cm for hip translation and to within ±2.52° and ±2.70° for hip rotation during stair ascent and stair descent, respectively.

Based on the results, standard patterns of stair ascent and stair descent were derived and applied to a lower-limb rehabilitation robot with vertically movable footplates. The relative trajectory from the experiment ascertained that the function of stair walking in the robotic system properly worked within a normal ROM.

• Biomechanics
• Body weight support
• Joint loading
• Pedal stance width
• Pinnacle trainer

• Constraint force
• EMG
• Forced use
• Locomotion
• Stroke

• Adaptation, Physiological/physiology
• Adult
• Aged
• Ankle Joint
• Biomechanical Phenomena/physiology
• Exercise Test
• Female
• Gait/physiology
• Humans
• Male
• Middle Aged
• Stroke/physiopathology
• Stroke Rehabilitation/methods
• Walking/physiology

• R01 HD082216 NICHD NIH HHS
• R01HD082216 NIH HHS

• Knowledge of results
• six-min walk test
• stroke
• walking

• clinical trial
• exercise
• locomotion
• rehabilitation

• Body Weight
• Chronic Disease
• Feedback
• Female
• Gait/physiology
• Humans
• Linear Models
• Stroke/physiopathology
• Stroke/therapy
• Stroke Rehabilitation
• Torque

• Aging
• Assessment
• Falls
• Locomotion

• Chronic stroke
• Gait cycle
• Gait speed
• Robotics rehabilitation
• The hybrid assistive limb

• Aged
• Cross-Sectional Studies
• Electromyography
• Female
• Humans
• Lower Extremity/physiopathology
• Male
• Middle Aged
• Physical Therapy Modalities
• Quadriceps Muscle/physiopathology
• Robotics
• Stair Climbing
• Walking

• EMG
• Rehab robotics
• active engagement
• functional resistance training
• rehabilitation
• task-specific

Body weight support (BWS) systems have shown promise as rehabilitation tools for neurologically impaired individuals. This paper reviews the experiment-based research on BWS systems with the aim: (1) To investigate the influence of body weight unloading (BWU) on gait characteristics; (2) To study whether the effects of BWS differ between treadmill and overground walking and (3) To investigate if modulated BWU influences gait characteristics less than unmodulated BWU.

A systematic literature search was conducted in the following search engines: Pubmed, Scopus, Web of Science and Google Scholar. Statistical analysis was used to quantify the effects of BWU on gait parameters.

54 studies of experiments with healthy and neurologically impaired individuals walking in a BWS system were included and 32 of these were used for the statistical analysis. Literature was classified using three distinctions: (1) treadmill or overground walking; (2) the type of subjects and (3) the nature of unloading force. Only 27% studies were based on neurologically impaired subjects; a low number considering that they are the primary user group for BWS systems. The studies included BWU from 5% to 100% and the 30% and 50% BWU conditions were the most widely studied. The number of participants varied from 1 to 28, with an average of 12. It was seen that due to the increase in BWU level, joint moments, muscle activity, energy cost of walking and ground reaction forces (GRF) showed higher reduction compared to gait spatio-temporal and joint kinematic parameters. The influence of BWU on kinematic and spatio-temporal gait parameters appeared to be limited up to 30% unloading. 5 gait characteristics presented different behavior in response to BWU for overground and treadmill walking. Remaining 21 gait characteristics showed similar behavior but different magnitude of change for overground and treadmill walking. Modulated unloading force generally led to less difference from the 0% condition than unmodulated unloading.

This review has shown that BWU influences all gait characteristics, albeit with important differences between the kinematic, spatio-temporal and kinetic characteristics. BWU showed stronger influence on the kinetic characteristics of gait than on the spatio-temporal parameters and the kinematic characteristics. It was ascertained that treadmill and overground walking can alter the effects of BWU in a different manner. Our results indicate that task-specific gait training is likely to be achievable at a BWU level of 30% and below.

The online version of this article (10.1186/s12984-018-0380-0) contains supplementary material, which is available to authorized users.

• Body weight support
• Gait characteristics
• Rehabilitation

• Body weight support
• Locomotor training
• NeuroRecovery Network
• traumatic brain injury

• Gait training
• stroke
• task specificity
• task-oriented training

• The body-weight support
• gait movement
• rehabilitation
• training system

• Stroke
• mirror therapy
• treadmill training

• Accelerometry/instrumentation
• Aged
• Equipment Design
• Female
• Gait
• Humans
• Male
• Middle Aged
• Pilot Projects
• Shoes
• Stroke Rehabilitation/instrumentation
• Walking/physiology
• Wearable Electronic Devices