Transfer of Technology into Clinical Application

Robots for neurorehabilitation have been designed to automate labor-intensive training techniques and to optimally support therapist and patients during different stages of training. Devices designed for body-weight-supported treadmill training, for example, have become a promising, task-oriented tool in order to restore gait function. At an early stage, these robots provide the ability to secure and stabilize the patient and guide trunk and legs through a normal gait trajectory with a high number of repetitions. At later stages, more sophisticated control strategies, virtual environment scenarios, or possibilities to exercise specific gait parameters and tasks extend their application to more experienced patients. Clinical evidence for feasibility and effectiveness of these devices exists; however, their advantages in comparison to conventional therapies are still under debate. This might be due to the fact that currently reliable parameters for appropriate selection of locomotor training parameters basing on functional impairments are lacking. Despite this fact, robotic devices are already successfully ­integrated into clinical settings with promising results. Appropriate use is dependent on the therapist’s knowledge about the value and limits of different devices as well as the ability to utilize the device’s technical means, thereby allowing patients to benefit from robot-aided gait training until they are able to perform safely and efficiently overground walking training. This chapter will provide an overview on the rationales of introducing robots into a clinical setting and discuss their value in different pathologies. In addition, recommendations for goal setting and practice of robot-assisted training based on disease-related symptoms and functional impairment are summarized together with reliable functional assessments.