Active Robotic Training and the Legtutor

Many robot type inventions have appeared on the market in recent years to assist patients that have suffered some level of paresis due to accidents or disease. These devices have proven to be helpful in some cases. In general they are large and cumbersome and therefore  based in hospitals and rehabilitation centers. They are, of course, quite expensive as well. The gear that is necessary for the patient to wear sometimes gives the patient the look of an astronaut out on a spacewalk.
In a recent study published in  the Journal of NeuroEngineering and Rehabilitation on 20 August 2012 Dr. C. Krishnan and his team from the Department of Physical Medicine and Rehabilitation, University of Michigan Medical School discuss the fact that clinical outcomes after robotic training are often not necessarily superior to conventional therapy. One  factor that is responsible for this is that the device provides most of the work to allow the patients to walk with little guidance to the patient on how to actively assist in walking. This strategy  leads to a reduction in voluntary physical effort and and also interferes with motor relearning.
The team tested the suitability of a different training approach (active robotic training) which uses a powered gait orthosis (Lokomat) in reducing the severity of  post-stroke gait impairments of a 52-year-old male stroke survivor. This gait training paradigm combined patient-cooperative robot-aided walking with a target-tracking task. The training lasted for 4 weeks with  12 visits of  3  per week. The patient’s  performance and recovery were evaluated by using neuromuscular, biomechanical  and clinical measures recorded at various points in time such as pre-training, post-training, and 6-weeks after training.
Active robotic training resulted in a considerable increase in target-tracking accuracy and a reduction in the kinematic variability of the ankle trajectory during  treadmill walking while robot-aided. Larger propulsive forces and more symmetric ground reaction forces were also transferred to overground walking. There were also  improvements in muscle coordination, similar to patterns observed in healthy controls.  Importantly, active robotic training showed results in  improvements in several standard clinical and functional parameters. These improvements were also prevalent during the follow-up evaluation which took place at 6 weeks.
The conclusion drawn indicates that active robotic training seems to be a promising way of improving gait and physical function in moderately severe  stroke survivors.
In addition to the active robotic training the recently developed LEGTUTOR  motivates the patient to undertake intensive and repetitive active exercise practice of the impaired leg by himself and not prompted by a robot. However it can be used in conjunction with powered gait orthosis in stroke, brain injury, CP and spinal cord injury patients. The LEGTUTOR is part of the TUTOR system which together with its sister physical therapy products (HANDTUTOR, ARMTUTOR, 3DTUTOR)
is an ergonomic wearable leg brace with dedicated rehabilitation software.  The cost effective LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system, for example, allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.
 The LEGTUTOR is also used by physical and occupational therapists for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

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