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A multidirectional gravity-assist algorithm that enhances locomotor control in patients with stroke or spinal cord injury


Mignardot, Jean-Baptiste; Le Goff, Camille G; van den Brand, Rubia; Capogrosso, Marco; Fumeaux, Nicolas; Vallery, Heike; Anil, Selin; Lanini, Jessica; Fodor, Isabelle; Eberle, Grégoire; Ijspeert, Auke; Schurch, Brigitte; Curt, Armin; Carda, Stefano; Bloch, Jocelyne; von Zitzewitz, Joachim; Courtine, Grégoire (2017). A multidirectional gravity-assist algorithm that enhances locomotor control in patients with stroke or spinal cord injury. Science Translational Medicine, 9(399):eaah3621.

Abstract

Gait recovery after neurological disorders requires remastering the interplay between body mechanics and gravitational forces. Despite the importance of gravity-dependent gait interactions and active participation for promoting this learning, these essential components of gait rehabilitation have received comparatively little attention. To address these issues, we developed an adaptive algorithm that personalizes multidirectional forces applied to the trunk based on patient-specific motor deficits. Implementation of this algorithm in a robotic interface reestablished gait dynamics during highly participative locomotion within a large and safe environment. This multidirectional gravity-assist enabled natural walking in nonambulatory individuals with spinal cord injury or stroke and enhanced skilled locomotor control in the less-impaired subjects. A 1-hour training session with multidirectional gravity-assist improved locomotor performance tested without robotic assistance immediately after training, whereas walking the same distance on a treadmill did not ameliorate gait. These results highlight the importance of precise trunk support to deliver gait rehabilitation protocols and establish a practical framework to apply these concepts in clinical routine.

Abstract

Gait recovery after neurological disorders requires remastering the interplay between body mechanics and gravitational forces. Despite the importance of gravity-dependent gait interactions and active participation for promoting this learning, these essential components of gait rehabilitation have received comparatively little attention. To address these issues, we developed an adaptive algorithm that personalizes multidirectional forces applied to the trunk based on patient-specific motor deficits. Implementation of this algorithm in a robotic interface reestablished gait dynamics during highly participative locomotion within a large and safe environment. This multidirectional gravity-assist enabled natural walking in nonambulatory individuals with spinal cord injury or stroke and enhanced skilled locomotor control in the less-impaired subjects. A 1-hour training session with multidirectional gravity-assist improved locomotor performance tested without robotic assistance immediately after training, whereas walking the same distance on a treadmill did not ameliorate gait. These results highlight the importance of precise trunk support to deliver gait rehabilitation protocols and establish a practical framework to apply these concepts in clinical routine.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:19 July 2017
Deposited On:20 Sep 2017 15:22
Last Modified:21 Sep 2017 07:17
Publisher:American Association for the Advancement of Science
ISSN:1946-6234
Publisher DOI:https://doi.org/10.1126/scitranslmed.aah3621
PubMed ID:28724575

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