Objective: To investigate the clinical impact of robotic body weight support gait training on a treadmill as part of an integrated neurorehabilitation protocol combining traditional physical rehabilitation with brain-machine interface paradigms in chronic spinal cord injury patients
Gather these items before starting the experiment. Check off items as you prepare.
Hocoma AG • Lokomat • Not specified • Not specified
Aretech LLC. • ZeroG • Not specified • Not specified
Not specified • Not specified • Not specified • Not specified
Custom built • Not specified • Not specified • Not specified
Oculus VR • Oculus Rift • Not specified • Not specified
Hocoma AG (as part of Lokomat system) • Not specified • Not specified • Not specified
Autodesk • Not specified
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Eight paraplegic patients with chronic spinal cord injury (>1 year) were enrolled. Each participant signed written informed consent before enrolling in the study. Protocol was approved by local ethics committee and Brazilian federal government ethics committee.
Note: Seven patients had complete SCI, one had incomplete SCI
“Eight paraplegic patients, suffering from chronic (>1 year) spinal cord injury (SCI, seven complete and one incomplete... Each participant signed written informed consent before enrolling in the study”
Comprehensive clinical evaluations performed on Day 0 (first day of training) including ASIA Impairment Scale, Semmes-Weinstein Monofilament Test, temperature/vibration/proprioception/deep pressure sensitivity evaluation, muscle strength test, trunk control assessment, walking ability assessment, independence measurement, pain evaluation, range of motion assessment, spasticity evaluation, quality of life assessment, self-esteem scale, and depression inventory
Note: Routine general clinical evaluations also performed before and after every activity
“Such clinical evaluation started on the first day patients began training (Day 0), and were repeated after 4, 7, 10, and 12 months”
Initial training phase with patients supported by stand-in-table device to establish cardiovascular stability and postural control
Note: Starting point of progressive complexity increase
“starting with orthostatic training at a stand-in-table and progressing all the way to the different gait training robotic systems”
Patient seated and employs brain activity recorded via 16-channel EEG to control movements of human body avatar in immersive virtual reality environment while receiving visuo-tactile feedback. Initially, patients imagine arm movements to modulate EEG activity for high-level motor commands ('walk' or 'stop'). After mastering this, patients learn to use EEG signals to control individual avatar leg stepping by imagining leg movements.
Note: First BMI strategy employed. Patients confirm choice by performing isometric triceps contraction. Tactile feedback provided via haptic display on forearms synchronized with virtual foot rolling.
“a seated patient employed his/her brain activity, recorded via a 16-channel EEG, to control the movements of a human body avatar, while receiving visuo-tactile feedback”
Identical virtual reality and BMI protocol as step 4, but with patient in upright position supported by stand-in-table device
Note: Progression from seated to upright posture
“identical interaction with the same virtual environment and BMI protocol while patients were upright, supported by a stand-in-table device”
Patients train on Lokomat robotic body weight support gait system integrated with treadmill. This component does not include BMI or tactile feedback.
Note: No continuous tactile feedback provided for this component
“training on a robotic body weight support (BWS) gait system on a treadmill (Lokomat, Hocoma AG, Switzerland)”
Patients train with body weight support gait system fixed on overground track. System rides along overhead fixed track with no mechanical barriers between patient and physical therapist, requiring patients to manage postural/trunk control, upper limb strength, and dynamic balance.
Note: More challenging than off-the-shelf devices; no continuous tactile feedback provided for this component
“training with a BWS gait system fixed on an overground track (ZeroG, Aretech LLC., Ashburn, VA)”
Patients use EEG signals to control Lokomat robotic body weight support gait system on treadmill while receiving continuous tactile feedback from robotic device via haptic display on forearms
Note: Integration of BMI with Lokomat system; tactile feedback synchronized with robotic foot rolling
“training with a brain-controlled robotic BWS gait system on a treadmill”
Patients train with brain-controlled, sensorized 12 degrees of freedom robotic exoskeleton with autonomous power and full lower limb hydraulic actuation. System used in conjunction with ZeroG overground body weight support system. Patients receive continuous tactile feedback from exoskeleton via haptic display on forearms.
Note: Most advanced training component; exoskeleton accommodates 50-80 kg weight range and does not require crutches
“gait training with a brain-controlled, sensorized 12 degrees of freedom robotic exoskeleton”
Further gait training performed with lower limb orthosis and walking assistive devices including hip-knee-ankle-foot orthosis or ankle-foot orthosis with knee extension splint and wheeled triangular walker
Note: Progressive training component
“Further gait training was performed by having subjects utilize a lower limb orthosis and walking assistive devices (hip-knee-ankle-foot orthosis or ankle-foot orthosis with knee extension splint and wheeled triangular walker)”
Repeat comprehensive clinical evaluations performed after 4 months of training using same assessment battery as baseline
Note: Routine general clinical evaluations also performed before and after every activity
“Such clinical evaluation started on the first day patients began training (Day 0), and were repeated after 4, 7, 10, and 12 months”
Repeat comprehensive clinical evaluations performed after 7 months of training using same assessment battery as baseline
Note: Routine general clinical evaluations also performed before and after every activity
“Such clinical evaluation started on the first day patients began training (Day 0), and were repeated after 4, 7, 10, and 12 months”
Repeat comprehensive clinical evaluations performed after 10 months of training using same assessment battery as baseline
Note: Routine general clinical evaluations also performed before and after every activity
“Such clinical evaluation started on the first day patients began training (Day 0), and were repeated after 4, 7, 10, and 12 months”
Throughout training, patients instructed to imagine movements of their own legs while EEG signals from 11 scalp electrodes recorded over leg primary somatosensory and motor cortical areas to evaluate potential functional cortical plasticity
Note: Longitudinal analyses performed; recordings done before and after many months of training
“patients were instructed to imagine movements of their own legs while EEG signals from 11 scalp electrodes were recorded over the leg primary somatosensory and motor cortical areas”
Final comprehensive clinical evaluations performed after 12 months of training using same assessment battery as baseline
Note: Routine general clinical evaluations also performed before and after every activity; long-term osteoporosis treatment continued throughout
“Such clinical evaluation started on the first day patients began training (Day 0), and were repeated after 4, 7, 10, and 12 months”
Paraplegic patients with chronic spinal cord injury (>1 year duration); seven complete and one incomplete SCI