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Clinical Aspects for the Application of Robotics in Neurorehabilitation

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Neurorehabilitation Technology

Abstract

In patients suffering from a movement disorder after a stroke or spinal cord injury (SCI), improvement in walking function can be achieved by providing intensive locomotor training. After a stroke or an SCI, neuronal centers below the level of lesion exhibit plasticity that can be exploited by specific training paradigms. In these individuals, human spinal locomotor centers can be activated by an appropriate afferent input. This includes assisting stepping movements of the affected legs and providing body-weight support (BWS), while the subjects stand on a moving treadmill. The stroke and SCI subjects benefit from such locomotor training that enables them to walk over ground.

Load- and hip-joint-related afferent input seems to be of crucial importance for the generation of a locomotor pattern and, consequently, the effectiveness of the locomotor training. In severely affected stroke/SCI subjects, rehabilitation robots enable longer, more intensive training than can be achieved by conventional therapies. Robot-assisted treadmill training also offers the ability to standardize training approaches and obtain objective feedback within one training session. This allows clinicians to monitor functional improvements over time. This chapter provides an overview of the clinical aspects available for the application of robotic devices in the neurorehabilitation of stroke and SCI subjects. First, background information is given for the neural mechanisms of gait recovery. Findings from clinical studies are presented covering the feasibility and efficacy of robot-assisted locomotor training.

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Acknowledgments

This work was supported in part by the National Centre of Competence in Research (NCCR) of the Swiss National Science Foundation (SNF) on Neural Plasticity and Repair and the EU Projects MIMICS and Spinal Cord Repair funded by the European Community’s Seventh Framework Program (FP7/2007–2013).

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There exist long-term scientific collaborations and research partnerships among University Hospital Balgrist and the Hocoma Company.

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  1. Spinal Cord Injury Center, University Hospital Balgrist, Forchstr. 340, 8008, Zurich, Switzerland

    Volker Dietz

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  1. Uniklinik Balgrist, Forchstr. 340, Zürich, 8008, Switzerland

    Volker Dietz

  2. , ARTORG Center for Biomedical Engineering, Universität Bern, Murtenstrasse 21, Bern, CH-3010, Switzerland

    Tobias Nef

  3. Rehabilitation Institute of Chicago, Illinois, 60611, USA

    William Zev Rymer

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Dietz, V. (2012). Clinical Aspects for the Application of Robotics in Neurorehabilitation. In: Dietz, V., Nef, T., Rymer, W. (eds) Neurorehabilitation Technology. Springer, London. https://doi.org/10.1007/978-1-4471-2277-7_16

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