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  • Title: Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury.
    Author: Israel JF, Campbell DD, Kahn JH, Hornby TG.
    Journal: Phys Ther; 2006 Nov; 86(11):1466-78. PubMed ID: 17079746.
    Abstract:
    BACKGROUND AND PURPOSE: Robotic devices that provide passive guidance and stabilization of the legs and trunk during treadmill stepping may increase the delivery of locomotor training to subjects with neurological injury. Lower-extremity guidance also may reduce voluntary muscle activity as compared with compliant assistance provided by therapists. The purpose of this study was to investigate differences in metabolic costs and lower-limb muscle activity patterns during robotic- and therapist-assisted treadmill walking. SUBJECTS: Twelve ambulatory subjects with motor incomplete spinal cord injury participated. METHODS: In 2 separate protocols, metabolic and electromyographic (EMG) data were collected during standing and stepping on a treadmill with therapist and robotic assistance. During robotic-assisted walking, subjects were asked to match the kinematic trajectories of the device and maximize their effort. During therapist-assisted walking, subjects walked on the treadmill with manual assistance provided as necessary. RESULTS: Metabolic costs and swing-phase hip flexor EMG activity were significantly lower when subjects were asked to match the robotic device trajectories than with therapist-assisted walking. These differences were reduced when subjects were asked to maximize their effort during robotic-assisted stepping, although swing-phase plantar-flexor EMG activity was increased. In addition, during standing prior to therapist- or robotic-assisted stepping, metabolic costs were higher without stabilization from the robotic device. DISCUSSION AND CONCLUSION: Differences in metabolic costs and muscle activity patterns between therapist- and robotic-assisted standing and stepping illustrate the importance of minimizing passive guidance and stabilization provided during step training protocols.
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