Control strategies for effective robot assisted gait rehabilitation: the state of art and future prospects.

A large number of gait rehabilitation robots, together with a variety of control strategies, have been developed and evaluated during the last decade. Initially, control strategies applied to rehabilitation robots were adapted from those applied to traditional industrial robots. However, these strategies cannot optimise effectiveness of gait rehabilitation. As a result, researchers have been investigating control strategies tailored for the needs of rehabilitation. Among these control strategies, assisted-as-needed (AAN) control is one of the most popular research topics in this field. AAN training strategies have gained the theoretical and practical evidence based backup from motor learning principles and clinical studies. Various approaches to AAN training have been proposed and investigated by research groups all around the world. This article presents a review on control algorithms of gait rehabilitation robots to summarise related knowledge and investigate potential trends of development. There are existing review papers on control strategies of rehabilitation robots. The review by Marchal-Crespo and Reinkensmeyer (2009) had a broad cover of control strategies of all kinds of rehabilitation robots. Hussain et al. (2011) had specifically focused on treadmill gait training robots and covered a limited number of control implementations on them. This review article encompasses more detailed information on control strategies for robot assisted gait rehabilitation, but is not limited to treadmill based training. It also investigates the potential to further develop assist-as-needed gait training based on assessments of patients' ability. In this paper, control strategies are generally divided into the trajectory tracking control and AAN control. The review covers these two basic categories, as well as other control algorithm and technologies derived from them, such as biofeedback control. Assessments on human gait ability are also included to investigate how to further develop implementations based on assist-as-needed concept. For the consideration of effectiveness, clinical studies on robotic gait rehabilitation are reviewed and analysed from the viewpoint of control algorithm.

[1]  Tao Liu,et al.  A Wearable Ground Reaction Force Sensor System and Its Application to the Measurement of Extrinsic Gait Variability , 2010, Sensors.

[2]  David J. Reinkensmeyer,et al.  HUMAN STEP REHABILITATION USING A ROBOT ATTACHED TO THE PELVIS , 2004 .

[3]  S Hesse,et al.  Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. , 1999, Archives of physical medicine and rehabilitation.

[4]  R. Riener,et al.  Real-Time Closed-Loop Control of Cognitive Load in Neurological Patients During Robot-Assisted Gait Training , 2011, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[5]  M. Hallett,et al.  Rapid plasticity of human cortical movement representation induced by practice. , 1998, Journal of neurophysiology.

[6]  Mariam Alaverdashvili,et al.  “Learned baduse” limits recovery of skilled reaching for food after forelimb motor cortex stroke in rats: A new analysis of the effect of gestures on success , 2008, Behavioural Brain Research.

[7]  J. Barbenel,et al.  A body-worn gait analysis system for evaluating hemiplegic gait. , 1995, Medical engineering & physics.

[8]  S. K. Banala,et al.  Novel Gait Adaptation and Neuromotor Training Results Using an Active Leg Exoskeleton , 2010, IEEE/ASME Transactions on Mechatronics.

[9]  L Prosser,et al.  Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people , 1997, Clinical rehabilitation.

[10]  Jungwon Yoon,et al.  A 6-DOF Gait Rehabilitation Robot With Upper and Lower Limb Connections That Allows Walking Velocity Updates on Various Terrains , 2010, IEEE/ASME Transactions on Mechatronics.

[11]  Stefan Hesse,et al.  Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients , 2010, Journal of NeuroEngineering and Rehabilitation.

[12]  Yoshiyuki Sankai,et al.  Predictive control estimating operator's intention for stepping-up motion by exo-skeleton type power assist system HAL , 2001, Proceedings 2001 IEEE/RSJ International Conference on Intelligent Robots and Systems. Expanding the Societal Role of Robotics in the the Next Millennium (Cat. No.01CH37180).

[13]  R. Riener,et al.  A Method of Estimating the Degree of Active Participation During Stepping in a Driven Gait Orthosis Based on Actuator Force Profile Matching , 2009, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[14]  Robert Riener,et al.  Controlling patient participation during robot-assisted gait training , 2011, Journal of NeuroEngineering and Rehabilitation.

[15]  David J. Reinkensmeyer,et al.  A robotic tool for studying locomotor adaptation and rehabilitation , 2002, Proceedings of the Second Joint 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] [Engineering in Medicine and Biology.

[16]  David J. Reinkensmeyer,et al.  A robotic device for measuring and controlling pelvic motion during locomotor rehabilitation , 2003, Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439).

[17]  A. Mirelman,et al.  Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke , 2009, Stroke.

[18]  M. Levin,et al.  What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke? , 2009, Neurorehabilitation and neural repair.

[19]  S.J. Harkema,et al.  A Robot and Control Algorithm That Can Synchronously Assist in Naturalistic Motion During Body-Weight-Supported Gait Training Following Neurologic Injury , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[20]  V. Dietz,et al.  Computerized Visual Feedback: An Adjunct to Robotic-Assisted Gait Training , 2008, Physical Therapy.

[21]  R. D'Agostino,et al.  The influence of gender and age on disability following ischemic stroke: the Framingham study. , 2003, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[22]  J.E. Colgate,et al.  KineAssist: a robotic overground gait and balance training device , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[23]  T. Demott,et al.  Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study , 2008, Stroke.

[24]  K. M. Gill,et al.  Clinical Gait Assessment in the Neurologically Impaired , 1984 .

[25]  M. Levin.  Should stereotypic movement synergies in hemiparetic patients be considered adaptive? , 1996, Behavioral and Brain Sciences.

[26]  P. Veltink,et al.  Evaluation of instrumented shoes for ambulatory assessment of ground reaction forces. , 2007, Gait & posture.

[27]  R. Nudo.  Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. , 2003, Journal of rehabilitation medicine.

[28]  Manfred Morari,et al.  Automatic gait-pattern adaptation algorithms for rehabilitation with a 4-DOF robotic orthosis , 2004, IEEE Transactions on Robotics and Automation.

[29]  Ian M Franks,et al.  Enhancement of motor rehabilitation through the use of information technologies. , 2006, Clinical biomechanics.

[30]  J. Krakauer.  Motor learning: its relevance to stroke recovery and neurorehabilitation. , 2006, Current opinion in neurology.

[31]  Shahid Hussain,et al.  Control of a robotic orthosis for gait rehabilitation , 2013, Robotics Auton. Syst..

[32]  Jill M. Landry,et al.  A cable-driven locomotor training system for restoration of gait in human SCI. , 2011, Gait & posture.

[33]  J. Hidler,et al.  Robotic-assessment of walking in individuals with gait disorders , 2004, The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[34]  H. Barbeau,et al.  Description and application of a system for locomotor rehabilitation , 1987, Medical and Biological Engineering and Computing.

[35]  Kuan Zhang,et al.  Assessment of human locomotion by using an insole measurement system and artificial neural networks. , 2005, Journal of biomechanics.

[36]  Frans C. T. van der Helm,et al.  A Series Elastic- and Bowden-Cable-Based Actuation System for Use as Torque Actuator in Exoskeleton-Type Robots , 2006, Int. J. Robotics Res..

[37]  H. van der Kooij,et al.  Reference Trajectory Generation for Rehabilitation Robots: Complementary Limb Motion Estimation , 2009, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[38]  Jörg Krüger,et al.  HapticWalker---a novel haptic foot device , 2005, TAP.

[39]  J. Burdick,et al.  Implications of Assist-As-Needed Robotic Step Training after a Complete Spinal Cord Injury on Intrinsic Strategies of Motor Learning , 2006, The Journal of Neuroscience.

[40]  S. Hesse,et al.  Gait rehabilitation machines based on programmable footplates , 2007, Journal of NeuroEngineering and Rehabilitation.

[41]  David J. Reinkensmeyer,et al.  A robotic device for manipulating human stepping , 2006, IEEE Transactions on Robotics.

[42]  Shahid Hussain,et al.  An intrinsically compliant robotic orthosis for treadmill training. , 2012, Medical engineering & physics.

[43]  Dikai Liu,et al.  Estimating Physical Assistance Need Using a Musculoskeletal Model , 2013, IEEE Transactions on Biomedical Engineering.

[44]  D. Wade,et al.  Mobility after stroke: reliability of measures of impairment and disability. , 1990, International disability studies.

[45]  C H Shea,et al.  Composition of practice: influence on the retention of motor skills. , 1991, Research quarterly for exercise and sport.

[46]  S.K. Agrawal,et al.  Active Leg Exoskeleton (ALEX) for Gait Rehabilitation of Motor-Impaired Patients , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[47]  Ping Wang,et al.  Rehabilitation control strategies for a gait robot via EMG evaluation , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[48]  Maureen K. Holden,et al.  Virtual Environments for Motor Rehabilitation: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[49]  Shahid Hussain,et al.  Adaptive Impedance Control of a Robotic Orthosis for Gait Rehabilitation , 2013, IEEE Transactions on Cybernetics.

[50]  K H Mauritz,et al.  Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients. , 1995, Scandinavian journal of rehabilitation medicine.

[51]  B. Bobath.  Adult hemiplegia: Evaluation and treatment , 1978 .

[52]  Robert Riener,et al.  Patient-cooperative control increases active participation of individuals with SCI during robot-aided gait training , 2010, Journal of NeuroEngineering and Rehabilitation.

[53]  G. Demeurisse,et al.  [Motor evaluation in vascular hemiplegia]. , 1979, Bruxelles medical.

[54]  T. George Hornby,et al.  Gait Training Strategies Utilized in Poststroke Rehabilitation: Are We Really Making a Difference? , 2007, Topics in stroke rehabilitation.

[55]  L. Lucas,et al.  Robot-Assisted Gait Training for Patients with Hemiparesis Due to Stroke , 2011, Topics in stroke rehabilitation.

[56]  Neville Hogan,et al.  Impedance Control: An Approach to Manipulation: Part III—Applications , 1985 .

[57]  R. Riener,et al.  Patient-cooperative strategies for robot-aided treadmill training: first experimental results , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[58]  M. Tinetti.  Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[59]  Jose L Pons,et al.  Human-robot interfaces in exoskeletons for gait training after stroke: State of the art and challenges , 2012, HRI 2012.

[60]  D. Wade,et al.  The Barthel ADL Index: a reliability study. , 1988, International disability studies.

[61]  Herman van der Kooij,et al.  Effectiveness of the Lower extremity Powered ExoSkeleton (LOPES) robotic gait trainer on ability and quality of walking in SCI patients , 2013 .

[62]  M. Kilgard,et al.  Cortical map reorganization enabled by nucleus basalis activity. , 1998, Science.

[63]  R. Riener,et al.  Journal of Neuroengineering and Rehabilitation Open Access Biofeedback for Robotic Gait Rehabilitation , 2022 .

[64]  Sunil Kumar Agrawal,et al.  Gravity-Balancing Leg Orthosis and Its Performance Evaluation , 2006, IEEE Transactions on Robotics.

[65]  Jungwon Yoon,et al.  Interaction control of a programmable footpad-type gait rehabilitation robot for active walking on various terrains , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[66]  I. Tarkka,et al.  The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. , 2005, Archives of physical medicine and rehabilitation.

[67]  R. Nudo,et al.  Effects of Repetitive Motor Training on Movement Representations in Adult Squirrel Monkeys: Role of Use versus Learning , 2000, Neurobiology of Learning and Memory.

[68]  J. Hidler,et al.  Journal of Neuroengineering and Rehabilitation Quantification of Functional Weakness and Abnormal Synergy Patterns in the Lower Limb of Individuals with Chronic Stroke , 2006 .

[69]  Sheng Quan Xie,et al.  Robot assisted treadmill training: mechanisms and training strategies. , 2011, Medical engineering & physics.

[70]  R. Beaglehole,et al.  Recovery of motor function after stroke. , 1988, Stroke.

[71]  J. Hidler,et al.  Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke , 2009, Neurorehabilitation and neural repair.

[72]  P. Veltink,et al.  Ambulatory measurement of ground reaction forces , 2005 .

[73]  J. Krakauer,et al.  Motor learning principles for neurorehabilitation. , 2013, Handbook of clinical neurology.

[74]  Birgitta Langhammer,et al.  Bobath or Motor Relearning Programme? A follow-up one and four years post stroke , 2003, Clinical rehabilitation.

[75]  José Luis Pons Rovira,et al.  Online Assessment of Human-Robot Interaction for Hybrid Control of Walking , 2011, Sensors.

[76]  N B Lincoln,et al.  The scalability of the Rivermead Motor Assessment in nonacute stroke patients , 1997, Clinical rehabilitation.

[77]  M. Ahmadi,et al.  GaitEnable: An omnidirectional robotic system for gait rehabilitation , 2012, 2012 IEEE International Conference on Mechatronics and Automation.

[78]  John J. Craig,et al.  Introduction to Robotics Mechanics and Control , 1986 .

[79]  A. Belli,et al.  A treadmill ergometer for three-dimensional ground reaction forces measurement during walking. , 2001, Journal of biomechanics.

[80]  S. Jezernik,et al.  Controlling the human-robot interaction for robotic rehabilitation of locomotion , 2002, 7th International Workshop on Advanced Motion Control. Proceedings (Cat. No.02TH8623).

[81]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2012 update: a report from the American Heart Association. , 2012, Circulation.

[82]  Jan Rueterbories,et al.  Methods for gait event detection and analysis in ambulatory systems. , 2010, Medical engineering & physics.

[83]  V. Dietz,et al.  Treadmill training of paraplegic patients using a robotic orthosis. , 2000, Journal of rehabilitation research and development.

[84]  Lihua Huang,et al.  Hybrid Control of the Berkeley Lower Extremity Exoskeleton (BLEEX) , 2006, Int. J. Robotics Res..

[85]  H. van der Kooij,et al.  Design and Evaluation of the LOPES Exoskeleton Robot for Interactive Gait Rehabilitation , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[86]  Eduardo Rocon,et al.  Human–Robot Cognitive Interaction , 2008 .

[87]  C. Braun,et al.  Motor learning elicited by voluntary drive. , 2003, Brain : a journal of neurology.

[88]  Nadina B. Lincoln,et al.  Physiotherapy treatment for stroke patients: A survey of current practice , 1996 .

[89]  P. Stratford,et al.  Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. , 1993, Physical therapy.

[90]  D H Sutherland,et al.  The evolution of clinical gait analysis part III--kinetics and energy assessment. , 2005, Gait & posture.

[91]  Joseph Hidler,et al.  Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern , 2008, Journal of NeuroEngineering and Rehabilitation.

[92]  K. H. Low,et al.  Initial System Evaluation of an Overground Rehabilitation Gait Training Robot (NaTUre-gaits) , 2011, Adv. Robotics.

[93]  R. Riener,et al.  Path Control: A Method for Patient-Cooperative Robot-Aided Gait Rehabilitation , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[94]  Olavi Airaksinen,et al.  Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. , 2009, Journal of rehabilitation medicine.

[95]  T. Hornby,et al.  Metabolic Costs and Muscle Activity Patterns During Robotic- and Therapist-Assisted Treadmill Walking in Individuals With Incomplete Spinal Cord Injury , 2006, Physical Therapy.

[96]  A Ashburn,et al.  The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective , 2000, Disability and rehabilitation.

[97]  M. Buss,et al.  Complementary Limb Motion Estimation based on Interjoint Coordination: Experimental Evaluation , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[98]  Leslie G. Ungerleider,et al.  Functional MRI evidence for adult motor cortex plasticity during motor skill learning , 1995, Nature.

[99]  D. Reinkensmeyer,et al.  Review of control strategies for robotic movement training after neurologic injury , 2009, Journal of NeuroEngineering and Rehabilitation.

[100]  K. Berg.  Measuring balance in the elderly: preliminary development of an instrument , 1989 .

[101]  N. Miller,et al.  Technique to improve chronic motor deficit after stroke. , 1993, Archives of physical medicine and rehabilitation.

[102]  J. Carr.  Movement Science: Foundations for Physical Therapy in Rehabilitation , 1987 .

[103]  Jungwon Yoon,et al.  A Novel Locomotion Interface with Two 6-DOF Parallel Manipulators That Allows Human Walking on Various Virtual Terrains , 2006, Int. J. Robotics Res..

[104]  Won Hyuk Chang,et al.  Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients , 2012, Neurorehabilitation and neural repair.

[105]  L. Cohen,et al.  Role of voluntary drive in encoding an elementary motor memory. , 2005, Journal of neurophysiology.

[106]  R. Riener,et al.  Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation. , 2011, Journal of rehabilitation research and development.

[107]  Kelly P Westlake,et al.  Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke , 2009, Journal of NeuroEngineering and Rehabilitation.

[108]  Joseph Hidler,et al.  Kinematic trajectories while walking within the Lokomat robotic gait-orthosis. , 2008, Clinical biomechanics.

[109]  Robert Riener,et al.  Feasibility and effects of patient-cooperative robot-aided gait training applied in a 4-week pilot trial , 2012, Journal of NeuroEngineering and Rehabilitation.

[110]  Domenico Campolo,et al.  Intrinsic Constraints of Neural Origin: Assessment and Application to Rehabilitation Robotics , 2009, IEEE Transactions on Robotics.

[111]  B. Conway,et al.  A portable gait assessment tool to record temporal gait parameters in SCI. , 2011, Medical engineering & physics.

[112]  S. Hesse,et al.  A mechanized gait trainer for restoration of gait. , 2000, Journal of rehabilitation research and development.

[113]  Timothy D. Lee,et al.  Motor Control and Learning: A Behavioral Emphasis , 1982 .

[114]  I. Schwartz,et al.  The Effectiveness of Locomotor Therapy Using Robotic‐Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial , 2009, PM & R : the journal of injury, function, and rehabilitation.

[115]  S Hesse,et al.  Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) , 2007, Clinical rehabilitation.

[116]  Raymond K Y Tong,et al.  A Pilot Study of Randomized Clinical Controlled Trial of Gait Training in Subacute Stroke Patients With Partial Body-Weight Support Electromechanical Gait Trainer and Functional Electrical Stimulation: Six-Month Follow-Up , 2008, Stroke.

[117]  David J. Reinkensmeyer,et al.  Haptic Guidance Can Enhance Motor Learning of a Steering Task , 2008, Journal of motor behavior.

[118]  S Hesse,et al.  Locomotor therapy in neurorehabilitation. , 2001, NeuroRehabilitation.

[119]  F. Müller,et al.  Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study , 2007, Stroke.

[120]  A. Danielsson,et al.  Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects. , 2000, Archives of physical medicine and rehabilitation.

[121]  Henning Schmidt,et al.  Adaptive control of an end-effector based electromechanical gait rehabilitation device , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[122]  George A. Mensah,et al.  The atlas of heart disease and stroke , 2005 .

[123]  B. Langhammer,et al.  Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study , 2000, Clinical rehabilitation.

[124]  R. Riener,et al.  A Novel Mechatronic Body Weight Support System , 2006, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[125]  R. Teasell,et al.  The Role of Task-Specific Training in Rehabilitation Therapies , 2005, Topics in stroke rehabilitation.

[126]  Blake Hannaford,et al.  Control law design for haptic interfaces to virtual reality , 2002, IEEE Trans. Control. Syst. Technol..

[127]  H. Barbeau,et al.  A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. , 1998, Stroke.

[128]  David W. McNeal,et al.  Plasticity of cerebral functions. , 2013, Handbook of clinical neurology.

[129]  K. M. Gill,et al.  Gait Assessment for Neurologically Impaired Patients , 1986 .

[130]  M. Morari,et al.  Adaptive robotic rehabilitation of locomotion: a clinical study in spinally injured individuals , 2003, Spinal Cord.

[131]  M. Maležič,et al.  Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. , 1995, Stroke.

[132]  Volker Hömberg,et al.  Neurorehabilitation approaches to facilitate motor recovery. , 2013, Handbook of clinical neurology.

[133]  Joseph Classen,et al.  Neural plasticity and its contribution to functional recovery. , 2013, Handbook of clinical neurology.

[134]  A. Mayr,et al.  Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis , 2007, Neurorehabilitation and neural repair.

[135]  W. Rymer,et al.  Robot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does? , 2006, Journal of rehabilitation research and development.