Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia
Jongseok Hwanga, Yongil Shinb, Ji-ho Parka, Young Joo Chaa and Joshua (Sung) H. Youa,∗ aDepartment of Physical Therapy, Sports Movement Artiﬁcial Robotics Technology(SMART) Institute, Yonsei University, Wonju, Republic of Korea bDepartment of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
BACKGROUND: The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigmtoimprovefunctionalambulationandactivitiesofdailylivinginspinalcordinjuryandstroke.However,theeffects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population.
OBJECTIVE:Theaimofthisstudywastodeterminethelong-termeffectsofWalkbottrainingonclinicalforhipsandknee stiffness in individuals with paraplegia or quadriplegia.
METHODS: Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modiﬁed Rankin Scale (MRS), Korean version of the Modiﬁed Barthel Index (K-MBI), Modiﬁed Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program.
RESULTS:Wilcoxon signed-rank tests showed signiﬁcant positive intervention effects on K-MBI, maximal hip ﬂexion and extension, maximal knee ﬂexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P<0.05). TheseﬁndingssuggestthattheWalkbotRAGTwaseffectiveforimprovingkneeandhipkinematicsandtheactivekneejoint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities.
CONCLUSIONS: These ﬁndings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the ﬁrst clinical evidence for intensive, longterm effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.
Keywords: Paraplegia, quadriplegia, robotic-assisted gait training, Walkbot, stiffness, gait, neurorehabilitation