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Amplitude and stride-to-stride variability of muscle activity during Lokomat guided walking and treadmill walking in children with cerebral palsy
European Journal of Paediatric Neurology ( IF 3.1 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.ejpn.2020.08.003
Klaske van Kammen 1 , Heleen A Reinders-Messelink 2 , Anne L Elsinghorst 1 , Carlijn F Wesselink 1 , Berna Meeuwisse-de Vries 3 , Lucas H V van der Woude 4 , Anne M Boonstra 3 , Rob den Otter 5
Affiliation  

BACKGROUND The Lokomat is a commercially available exoskeleton for gait training in persons with cerebral palsy (CP). Because active contributions and variability over movement repetitions are determinants of training effectiveness, we studied muscle activity in children with CP, and determined (i) differences between treadmill and Lokomat walking, and (ii) the effects of Lokomat training parameters, on the amplitude and the stride-to-stride variability. METHODS Ten children with CP (age 13.2 ± 2.9, GMFCS level II(n = 6)/III(n = 4)) walked on a treadmill (±1 km/h; 0% bodyweight support(BWS)), and in the Lokomat (50% and 100% guidance; ±1 km/h and ±2 km/h; 0% and 50% BWS). Activity was recorded from Gluteus Medius (GM), Vastus Lateralis (VL), Biceps Femoris (BF), Medial Gastrocnemius (MG) and Tibialis Anterior (TA) of the most affected side. The averaged amplitude per gait phase, and the second order coefficient of variation was used to determine the active contribution and stride-to-stride variability, respectively. RESULTS Generally, the amplitude of activity was lower in the Lokomat than on the treadmill. During Lokomat walking, providing guidance and BWS resulted in slightly lower amplitudes whereas increased speed was associated with higher amplitudes. No significant differences in stride-to-stride variability were observed between Lokomat and treadmill walking, and in the Lokomat only speed (MG) and guidance (BF) affected variability. CONCLUSIONS Lokomat walking reduces muscle activity in children with CP, whereas altering guidance or BWS generally does not affect amplitude. This urges additional measures to encourage active patient contributions, e.g. by increasing speed or through instruction.

中文翻译:

脑瘫儿童在 Lokomat 引导步行和跑步机步行过程中肌肉活动的幅度和跨步变异性

背景 Lokomat 是一种市售的外骨骼,用于脑瘫 (CP) 患者的步态训练。由于运动重复的积极贡献和可变性是训练效果的决定因素,我们研究了 CP 儿童的肌肉活动,并确定了 (i) 跑步机和 Lokomat 步行之间的差异,以及 (ii) Lokomat 训练参数对振幅和跨步的变异性。方法 10 名 CP 儿童(年龄 13.2 ± 2.9,GMFCS 级别 II(n = 6)/III(n = 4))在跑步机上行走(±1 km/h;0% 体重支持(BWS)),并在Lokomat(50% 和 100% 引导;±1 km/h 和 ±2 km/h;0% 和 50% BWS)。从受影响最严重一侧的臀中肌 (GM)、外侧大肌 (VL)、股二头肌 (BF)、腓肠肌内侧 (MG) 和胫前肌 (TA) 记录活动。每个步态阶段的平均振幅和二阶变异系数分别用于确定主动贡献和跨步变异性。结果 一般来说,Lokomat 的活动幅度低于跑步机。在 Lokomat 行走期间,提供引导和 BWS 会导致振幅略低,而速度增加与振幅较高有关。在 Lokomat 和跑步机行走之间没有观察到步幅变异性的显着差异,并且在 Lokomat 中,只有速度 (MG) 和引导 (BF) 影响变异性。结论 Lokomat 行走会减少 CP 儿童的肌肉活动,而改变引导或 BWS 通常不会影响振幅。这促使采取额外措施来鼓励患者的积极贡献,例如
更新日期:2020-11-01
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