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      Neuropsychiatric Disease and Treatment (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on all aspects of neuropsychiatric and neurological disorders. Sign up for email alerts here.

      63,741 Monthly downloads/views I 2.989 Impact Factor I 4.5 CiteScore I 1.09 Source Normalized Impact per Paper (SNIP) I 0.744 Scimago Journal & Country Rank (SJR)

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      Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

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          Abstract

          In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long-term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in poststroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented.

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          Most cited references58

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          Principles of sensorimotor learning.

          Daniel Wolpert, Jörn Diedrichsen, J Randall Flanagan (2011)
          The exploits of Martina Navratilova and Roger Federer represent the pinnacle of motor learning. However, when considering the range and complexity of the processes that are involved in motor learning, even the mere mortals among us exhibit abilities that are impressive. We exercise these abilities when taking up new activities - whether it is snowboarding or ballroom dancing - but also engage in substantial motor learning on a daily basis as we adapt to changes in our environment, manipulate new objects and refine existing skills. Here we review recent research in human motor learning with an emphasis on the computational mechanisms that are involved.
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            Multiple dynamic representations in the motor cortex during sensorimotor learning

            D. Huber, D.A. Gutnisky, S. Peron … (2012)
            Summary The mechanisms linking sensation and action during learning are poorly understood. Layer 2/3 neurons in the motor cortex might participate in sensorimotor integration and learning; they receive input from sensory cortex, and excite deep layer neurons, which control movement. Here we imaged activity in the same set of layer 2/3 neurons in the motor cortex over weeks, while mice learned to detect objects with their whiskers and report detection with licking. Spatially intermingled neurons represented sensory (touch) and motor behaviors (whisking, licking). With learning, the population-level representation of task-related licking strengthened. In trained mice, population-level representations were redundant and stable, despite dynamism of single-neuron representations. The activity of a subpopulation of neurons was consistent with driving licking triggered by touch. Our results suggest that ensembles of motor cortex neurons couple sensory input to multiple, related motor programs during learning.
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              Strategies for stroke rehabilitation.

              Bruce Dobkin (2004)
              Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neuropsychiatr Dis Treat
                Journal ID (iso-abbrev): Neuropsychiatr Dis Treat
                Journal ID (publisher-id): Neuropsychiatric Disease and Treatment
                Title: Neuropsychiatric Disease and Treatment
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6328
                ISSN (Electronic): 1178-2021
                Publication date Collection: 2017
                Publication date (Electronic): 15 May 2017
                Volume: 13
                Pages: 1303-1311
                Affiliations
                [1 ]Private Inpatient Unit
                [2 ]Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
                [3 ]Department of Robotics, LIRMM UM-CNRS, Montpellier, France
                Author notes
                Correspondence: Stefano Paolucci, Private Inpatient Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306-354, 00179 Rome, Italy, Tel +39 06 5150 1001, Fax +39 06 5150 1004, Email s.paolucci@ 123456hsantalucia.it
                Article
                Publisher ID: ndt-13-1303
                DOI: 10.2147/NDT.S114102
                PMC ID: 5440028
                PubMed ID: 28553117
                SO-VID: f8a17049-a9d5-40a7-9d94-14d6421de701
                Copyright © © 2017 Morone et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Review

                ScienceOpen disciplines: Neurology
                Keywords: exoskeleton,neurorehabilitation,robot-assisted walking training,wearable robot,activities of daily living,motor learning,plasticity
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: exoskeleton, neurorehabilitation, robot-assisted walking training, wearable robot, activities of daily living, motor learning, plasticity

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