Clinical Aspects for the Application of Robotics in Locomotor Neurorehabilitation

In patients suffering from a movement disorder after a damage of the central nervous system, improvement in walking or hand function can be achieved by providing functional training. After a stroke or a spinal cord injury (SCI), neuronal centers at and below the level of lesion exhibit plasticity that can be exploited by functional training paradigms that include assisting stepping or hand/arm movements of the affected side. Training of locomotor function, the focus of this chapter, requires body-weight support (BWS), while the subjects stand on a moving treadmill. In these individuals, human spinal locomotor centers become activated if an appropriate afferent input is provided. The stroke/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, i.e., more intensive training. In addition, they also offer the ability to standardize training approaches and to obtain objective feedback within training sessions allowing to monitor functional improvements over time. This chapter provides an overview of the clinical aspects for the successful application of robotic devices in the neurorehabilitation of stroke/SCI subjects. First, background information is given for the neural mechanisms of gait recovery after stroke/SCI. Second, the afferent input required for an effective training is discussed and, third, findings from clinical studies are presented covering the feasibility and efficacy of robot-assisted locomotor training.