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This chapter focuses on robotic gait training. As a basis, it summarizes the neurophysiological rationale for such training. These neurophysiological findings are mostly based on animal studies. The observations from these studies led to the development of theories such as the spinal central pattern generator (CPG). In a deductive manner, studies have then also been performed on human participants showing similar phenomena. Based on the neurophysiological mechanisms, robot-assisted locomotor training is justified even in patients with severe functional limitations. Those patients would not be able to maintain an upright posture while performing stepping movements in a conventional training condition. The clinical application of robotic gait training is, therefore, another focus of this chapter. Different robotic devices and their relevant characteristics are introduced. Not all devices are designed to purely assist locomotor training by maximally exploiting the neuroplastic potential of the central nervous system. Some devices can also be considered assistive technologies which support patients in their daily life mobility. General aspects which are relevant for robotic gait training during rehabilitation are summarized. Then the chapter takes the translation of the fundamental principles one step further and addresses the application of robotic gait training in specific neurological conditions, that is, in stroke, traumatic brain injury (TBI), spinal cord injury (SCI), multiple sclerosis (MS), and Parkinson’s disease. These parts are written by experts in their respective fields. Every section follows the same structure and informs the reader about the condition in general, specific gait limitations, and the rehabilitation thereof. If available, the latter is supported by recent high-level evidence. In the other cases, relevant primary studies are summarized. Because specific clinical guidelines for the application of robotic gait training are largely missing, the

A prototype system aimed at improving arm function and trunk control after stroke has been developed that combines mixed-reality (MR) feedback with a mobile seat system (Holoreach). The purpose of this study was to assess the usability of Holoreach in a rehabilitation setting from both the patient and therapist perspective. Ten therapists (eight physiotherapists and two occupational therapists) used the device in their regular therapy programs for fifteen stroke patients with trunk control issues. Each patient received four individual therapy sessions with the device performed under the supervision of the therapist. Therapists and patients kept therapy diaries and used customized questionnaires. At the end of the study two focus groups were conducted to further assess usability. Generally, the prototype system is suitable for training trunk and arm control. The therapists expressed overall positive views on the impact of Holoreach. They characterized it as new, motivating, fresh, joyful, interesting, and exciting. All therapists and 80% of the patients agreed with the statement that training with Holoreach is beneficial for rehabilitation. Nonetheless, improvements are required in the hardware and software, and design. The prototype system contributes at various levels to the rapidly evolving advances in neurorehabilitation, particularly regarding the practical aspect of exercise delivery.

Background Patient-generated health data (PGHD) are data collected through technologies such as mobile devices and health apps. The integration of PGHD into health care workflows can support the care of chronic conditions such as multiple sclerosis (MS). Patients are often willing to share data with health care professionals (HCPs) in their care team; however, the benefits of PGHD can be limited if HCPs do not find it useful, leading patients to discontinue data tracking and sharing eventually. Therefore, understanding the usefulness of mobile health (mHealth) solutions, which provide PGHD and serve as enablers of the HCPs’ involvement in participatory care, could motivate them to continue using these technologies. Objective The objective of this study is to explore the perceived utility of different types of PGHD from mHealth solutions which could serve as tools for HCPs to support participatory care in MS. Method A mixed-methods approach was used, combining qualitative research and participatory design. This study includes three sequential phases: data collection, assessment of PGHD utility, and design of data visualizations. In the first phase, 16 HCPs were interviewed. The second and third phases were carried out through participatory workshops, where PGHD types were conceptualized in terms of utility. Results The study found that HCPs are optimistic about PGHD in MS care. The most useful types of PGHD for HCPs in MS care are patients’ habits, lifestyles, and fatigueinducing activities. Although these subjective data seem more useful for HCPs, it is more challenging to visualize them in a useful and actionable way. Conclusion HCPs are optimistic about mHealth and PGHD as tools to further understand their patients’ needs and support care in MS. HCPs from different disciplines have different perceptions of what types of PGHD are useful; however, subjective types of PGHD seem potentially more useful for MS care.

The aim of this study was to explore differences in trunk muscle activity on a stable and mobile seat for people after stroke and healthy participants. Trunk control exercises are known to have a beneficial effect on trunk control, balance, and mobility after stroke. The effect of such exercises could be enhanced by the use of a mobile seat to provide further training stimuli. However, little research on the musculoskeletal effects of trunk training on mobile seats has been carried out. On a stable and a mobile seat, thirteen people after stroke and fifteen healthy participants performed two selective trunk control exercises, which were lateral flexion initiated by the pelvis and the thorax. The maximal surface electromyography relative to static sitting of the muscles multifidus, erector spinae, and obliquus externus was recorded bilaterally. The effects of group, seat condition, trunk control exercise, and muscle side were investigated employing within-subject linear-mixed-models. Compared to the stable seat, the maximal muscle activity of people after stroke on the mobile seat was higher during the thorax-initiated exercise and lower during the pelvis-initiated exercise. Healthy participants showed opposite results with higher muscle activity on the mobile seat during the pelvis-initiated exercise. For trunk control training on a mobile seat with high muscle activation people after stroke should perform trunk control exercises initiated by the thorax, for training with lower muscle activity people after stroke should initiate selective trunk movements by the pelvis. The results can support the planning of progressive trunk control rehabilitation programs.

This chapter focuses on robotic gait training. As a basis, it summarizes the neurophysio-logical rationale for such training. These neurophysiological findings are mostly based on animal studies. The observations from these studies led to the development of theories such as the spinal central pattern generator (CPG). In a deductive manner, studies have then also been performed on human participants showing similar phenomena. Based on the neurophysiological mechanisms, robot-assisted locomotor training is justified even in patients with severe functional limitations.Those patients would not be able to maintain an upright posture while performing stepping movements in a conventional training condition.The clinical application of robotic gait training is, therefore, another focus of this chapter. Different robotic devices and their relevant characteristics are introduced. Not all devices are designed to purely assist locomotor training by maximally exploiting the neuroplastic potential of the central nervous system. Some devices can also be considered assistive technologies which support patients in their daily life mobility. General aspects which are relevant for robotic gait training during rehabilitation are summarized. Then the chapter takes the translation of the fundamental principles one step further and addresses the application of robotic gait training in specific neurological conditions, that is, in stroke, traumatic brain injury (TBI), spinal cord injury (SCI), multiple sclerosis (MS), and Parkinson’s disease. These parts are written by experts in their respective fields. Every section follows the same structure and informs the reader about the condition in general, specific gait limitations, and the rehabilitation thereof. If available, the latter is supported by recent high-level evidence. In the other cases, relevant primary studies are summarized. Because specific clinical guidelines for the application of robotic gait training are largely missing, the e

Objective To examine acute (single-bout) and training effects of high-intensity interval training (HIIT) vs standard exercise therapy (moderate continuous training [MCT]) on plasma neurofilament light chain (pNfL) and kynurenine (KYN) pathway of tryptophan degradation metabolites in persons with multiple sclerosis (pwMS). Methods Sixty-nine pwMS (Expanded Disability Status Scale score 3.0-6.0) were randomly assigned to a HIIT or an MCT group. Changes in pNfL and KYN pathway metabolites measured in blood plasma were assessed before, after, and 3 hours after the first training session as well as after the 3-week training intervention. Results Acute exercise reduced pNfL and increased the KYN pathway flux toward the neuroprotective kynurenic acid (KA). Changes in pNfL correlated positively with changes in KA and negatively with the quinolinic acid-to-KA ratio. HIIT consistently led to greater effects than MCT. Following the 3-week training intervention, the KYN pathway was activated in HIIT compared with MCT. Conclusion Future studies and clinical assessments of pNfL should consider acute exercise as confounding factor for measurement reliability. Moreover, exercise-induced KYN pathway rerouting might mediate neuroprotection, potentially underlying the benefits in rehabilitation for pwMS. Classification of Evidence This study provides Class II evidence that acute HIIT diminishes pNfL and increases KA levels, and 3 weeks of HIIT activate the KYN pathway in pwMS.