The added value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal cord injury: a systematic review.

OBJECTIVE To provide an overview of robot-assisted rehabilitation devices developed for actuation of the ankle-foot complex and their ability to influence the attributes of normal gait in patients with spinal cord injury. METHODS A search was conducted in MEDLINE, Web of Knowledge, National Academic Research and Collaborations Information System, and Physiotherapy Evidence Data-base (1985-2011), using, "ankle", "foot", "robotics", "orthotics" and "spinal cord injury" as most relevant keywords. Article inclusion was performed in 3 stages; at the level of: (i) title, (ii) abstract and (iii) full text. RESULTS The actuated ankle-foot orthoses currently available are characterized by several combinations of an actuator and a control mechanism. Both the actuator and the control strategy substantially influence human-machine interaction and therefore the potential of the device to assist in modifying locomotor function and potentially modify the underlying motor control mechanisms. CONCLUSION Due to small sample sizes, limited studies in patients with spinal cord injury, and limitations in study design, it is difficult to draw firm conclusions on the effect of different types of actuated ankle-foot orthoses. Based on the limited data available, pneumatic artificial muscles in combination with proportional myoelectric control are suggested to have the potential to meet most of the preconditions to restore the attributes of normal gait and therefore facilitate neuroplasticity.

[1]  Sungjae Hwang,et al.  Development of an active ankle foot orthosis for the prevention of foot drop and toe drag , 2006, 2006 International Conference on Biomedical and Pharmaceutical Engineering.

[2]  Daniel P. Ferris,et al.  Mechanics and energetics of level walking with powered ankle exoskeletons , 2008, Journal of Experimental Biology.

[3]  V Dietz,et al.  Interaction between central programs and afferent input in the control of posture and locomotion. , 1996, Journal of biomechanics.

[4]  P. London.  Injury , 1969, Definitions.

[5]  Daniel P Ferris,et al.  Locomotor adaptation to a powered ankle-foot orthosis depends on control method , 2007, Journal of NeuroEngineering and Rehabilitation.

[6]  S. Grillner.  The motor infrastructure: from ion channels to neuronal networks , 2003, Nature Reviews Neuroscience.

[7]  Daniel P. Ferris,et al.  An ankle-foot orthosis powered by artificial pneumatic muscles. , 2005, Journal of applied biomechanics.

[8]  Bradley J Holinski.  Restoring Walking after Spinal Cord Injury , 2013 .

[9]  Daniel P. Ferris,et al.  Motor adaptation during dorsiflexion-assisted walking with a powered orthosis. , 2009, Gait & posture.

[10]  James L. Patton,et al.  Therapist-mediated post-stroke rehabilitation using haptic/graphic error augmentation , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[11]  Susan J. Harkema,et al.  Plasticity of interneuronal networks of the functionally isolated human spinal cord , 2008, Brain Research Reviews.

[12]  Daniel P Ferris,et al.  Mechanics and energetics of incline walking with robotic ankle exoskeletons , 2009, Journal of Experimental Biology.

[13]  V. Dietz.  Body weight supported gait training: From laboratory to clinical setting , 2009, Brain Research Bulletin.

[14]  Daniel P. Ferris,et al.  Mechanical performance of artificial pneumatic muscles to power an ankle-foot orthosis. , 2006, Journal of biomechanics.

[15]  S. Rossignol,et al.  Dynamic sensorimotor interactions in locomotion. , 2006, Physiological reviews.

[16]  C. Kinnaird,et al.  Medial Gastrocnemius Myoelectric Control of a Robotic Ankle Exoskeleton , 2009, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[17]  A. Pollock,et al.  Treadmill Training and Body Weight Support for Walking After Stroke , 2003, The Cochrane database of systematic reviews.

[18]  J. Duysens,et al.  Significance of load receptor input during locomotion: a review. , 2000, Gait & posture.

[19]  Marco Molinari,et al.  Plasticity properties of CPG circuits in humans: Impact on gait recovery , 2009, Brain Research Bulletin.

[20]  A. Curt,et al.  Ankle dexterity remains intact in patients with incomplete spinal cord injury in contrast to stroke patients , 2008, Experimental Brain Research.

[21]  A. Curt,et al.  Ankle motor skill is intact in spinal cord injury, unlike stroke , 2010, Neurology.

[22]  R. Riener,et al.  Biofeedback for robotic gait rehabilitation , 2007, Journal of NeuroEngineering and Rehabilitation.

[23]  Candy Tefertiller,et al.  Efficacy of rehabilitation robotics for walking training in neurological disorders: a review. , 2011, Journal of rehabilitation research and development.

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

[25]  S. Rossignol,et al.  Locomotor capacities after complete and partial lesions of the spinal cord. , 1996, Acta neurobiologiae experimentalis.

[26]  R. Waters,et al.  Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association. , 1994, Archives of physical medicine and rehabilitation.

[27]  K. Pearson,et al.  Stimulation of the group I extensor afferents prolongs the stance phase in walking cats , 2004, Experimental Brain Research.

[28]  Daniel P. Ferris,et al.  Learning to walk with a robotic ankle exoskeleton. , 2007, Journal of biomechanics.

[29]  V Reggie Edgerton,et al.  Spasticity: a switch from inhibition to excitation , 2010, Nature Medicine.

[30]  S. Quine,et al.  Prevalence of spinal cord injury: an international comparison. , 1995, Neuroepidemiology.

[31]  R. Meeusen,et al.  Effectiveness of robot-assisted gait training in persons with spinal cord injury: a systematic review. , 2010, Journal of rehabilitation medicine.

[32]  James A. Norris,et al.  Effect of augmented plantarflexion power on preferred walking speed and economy in young and older adults. , 2007, Gait & posture.

[33]  S.K. Agrawal,et al.  Design of a two degree-of-freedom ankle-foot orthosis for robotic rehabilitation , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[34]  F C T Van der Helm,et al.  A walking robot called human: lessons to be learned from neural control of locomotion. , 2002, Journal of biomechanics.

[35]  Nerys Brick,et al.  Locomotor training for walking after spinal cord injury. , 2014, Orthopedic nursing.

[36]  H. Herr,et al.  Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait , 2004, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[37]  T.G. Sugar,et al.  Control algorithms for ankle robots: A reflection on the state-of-the-art and presentation of two novel algorithms , 2008, 2008 2nd IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics.

[38]  J. Duysens,et al.  Neural control of locomotion; Part 1: The central pattern generator from cats to humans , 1998 .

[39]  Daniel P. Ferris,et al.  A pneumatically powered knee-ankle-foot orthosis (KAFO) with myoelectric activation and inhibition , 2009, Journal of NeuroEngineering and Rehabilitation.

[40]  J. Mehrholz,et al.  Locomotor training for walking after spinal cord injury. , 2012, The Cochrane database of systematic reviews.

[41]  Daniel P Ferris,et al.  Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton. , 2010, Journal of biomechanics.

[42]  K. Pearson,et al.  Contribution of hind limb flexor muscle afferents to the timing of phase transitions in the cat step cycle. , 1996, Journal of neurophysiology.

[43]  Ming Wu,et al.  Ankle load modulates hip kinetics and EMG during human locomotion. , 2009, Journal of neurophysiology.

[44]  J. Wyndaele,et al.  Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? , 2006, Spinal Cord.

[45]  Daniel P. Ferris,et al.  Powered ankle exoskeletons reveal the metabolic cost of plantar flexor mechanical work during walking with longer steps at constant step frequency , 2009, Journal of Experimental Biology.

[46]  Serge Rossignol,et al.  Prominent Role of the Spinal Central Pattern Generator in the Recovery of Locomotion after Partial Spinal Cord Injuries , 2008, The Journal of Neuroscience.

[47]  A. Catz,et al.  SCIM – spinal cord independence measure: a new disability scale for patients with spinal cord lesions , 1997, Spinal Cord.

[48]  V. Dietz.  Locomotor recovery after spinal cord injury. , 1997, Trends in neurosciences.

[49]  Monica A. Perez,et al.  Motor skill training induces changes in the excitability of the leg cortical area in healthy humans , 2004, Experimental Brain Research.

[50]  Blake Hannaford,et al.  McKibben artificial muscles: pneumatic actuators with biomechanical intelligence , 1999, 1999 IEEE/ASME International Conference on Advanced Intelligent Mechatronics (Cat. No.99TH8399).

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

[52]  J. van Gijn.  Should the Babinski sign be part of the routine neurologic examination? , 2006, Neurology.

[53]  S. Harkema,et al.  Locomotor activity in spinal cord-injured persons. , 2004, Journal of applied physiology.

[54]  J. Gossard,et al.  Step Training-Dependent Plasticity in Spinal Cutaneous Pathways , 2004, The Journal of Neuroscience.

[55]  Thomas G Sugar,et al.  Design of a robotic gait trainer using spring over muscle actuators for ankle stroke rehabilitation. , 2005, Journal of biomechanical engineering.

[56]  V. Dietz,et al.  Locomotor activity in spinal man: significance of afferent input from joint and load receptors. , 2002, Brain : a journal of neurology.

[57]  Van de Crommert HW,et al.  Neural control of locomotion; The central pattern generator from cats to humans. , 1998, Gait & posture.

[58]  S. Johnston,et al.  Should the Babinski sign be part of the routine neurologic examination? , 2005, Neurology.

[59]  J. Nielsen,et al.  Afferent feedback in the control of human gait. , 2002, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[60]  F Lacquaniti,et al.  A novel approach to mechanical foot stimulation during human locomotion under body weight support. , 2011, Human movement science.

[61]  C. Gregory,et al.  Lower extremity skeletal muscle function in persons with incomplete spinal cord injury , 2006, Spinal Cord.

[62]  Daniel P. Ferris,et al.  Robotic lower limb exoskeletons using proportional myoelectric control , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[63]  Volker Dietz,et al.  Assessment of Walking Speed and Distance in Subjects With an Incomplete Spinal Cord Injury , 2007, Neurorehabilitation and neural repair.

[64]  V. Ponselvan,et al.  Modeling and Application of Series Elastic Actuators for Force Control Multi Legged Robots , 2009, ArXiv.

[65]  V. Reggie Edgerton,et al.  Training locomotor networks , 2008, Brain Research Reviews.

[66]  J. Duysens,et al.  Load-regulating mechanisms in gait and posture: comparative aspects. , 2000, Physiological reviews.

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

[68]  A. Curt,et al.  Ankle dexterity is less impaired than muscle strength in incomplete spinal cord lesion , 2008, Journal of Neurology.

[69]  R. Waters,et al.  Motor and sensory recovery following incomplete tetraplegia. , 1994, Archives of physical medicine and rehabilitation.