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Effects of Robot-assisted Gait With Body Weight Support on Torque, Work, and Power of Quadriceps and Hamstring Muscles in Healthy Subjects

  • Received : 2021.07.01
  • Accepted : 2021.07.13
  • Published : 2021.08.20

Abstract

Background: Robot-assisted gait training (RAGT) is an effective method for walking rehabilitation. Additionally, the body weight support (BWS) system reduces muscle fatigue while walking. However, no previous studies have investigated the effects of RAGT with BWS on isokinetic strength of quadriceps and hamstring muscles. Objects: The purpose of this study was to investigate the effects of torque, work, and power on the quadriceps and hamstring muscles during RAGT, using the BWS of three conditions in healthy subjects. The three different BWS conditions were BWS 50%, BWS 20%, and full weight bearing (FWB). Methods: Eleven healthy subjects (7 males and 4 females) participated in this study. The Walkbot_S was used to cause fatigue of the quadriceps and hamstring muscles and the Biodex Systems 4 Pro was used to measure the isokinetic torque, work, and power of them. After RAGT trials of each of the three conditions, the subjects performed isokinetic concentric knee flexion and extension, five at an angular velocity of 60°/s and fifteen at an angular velocity of 180°/s. One-way repeated analysis of variance was used to determine significant differences in all the variables. The least significant difference test was used for post-hoc analysis. Results: On both sides, there were significant differences in peak torque (PT) of knee extension and flexion between the three BWS conditions at an angular velocity of 60°/s and 180°/s conditions. A post-hoc comparison revealed that the PT in the BWS 50% was significantly greater than in the BWS 20% and the FWB and the PT in the BWS 20% was significantly greater than in the FWB. Conclusion: The results of this study suggest that the lower BWS during RAGT seems to lower the isokinetic torque, work, and power of the quadriceps and hamstring muscles because of the muscle fatigue increase.

Keywords

Acknowledgement

This study was supported by the "Brain Korea 21 FOUR Project", the Korean Research Foundation for Department of Physical Therapy in the Graduate School of Yonsei University.

References

  1. Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 2000;37(6):693-700.
  2. Jezernik S, Colombo G, Keller T, Frueh H, Morari M. Robotic orthosis lokomat: a rehabilitation and research tool. Neuromodulation 2003;6(2):108-15. https://doi.org/10.1046/j.1525-1403.2003.03017.x
  3. Lo AC, Triche EW. Improving gait in multiple sclerosis using robot-assisted, body weight supported treadmill training. Neurorehabil Neural Repair 2008;22(6):661-71. https://doi.org/10.1177/1545968308318473
  4. Pietrusinski M, Cajigas I, Severini G, Bonato P, Mavroidis C. Robotic gait rehabilitation trainer. IEEE ASME Trans Mechatron 2014;19(2):490-9. https://doi.org/10.1109/TMECH.2013.2243915
  5. Lu Q, Liang J, Qiao B, Ma O. A new active body weight support system capable of virtually offloading partial body mass. IEEE ASME Trans Mechatron 2013;18(1):11-20. https://doi.org/10.1109/TMECH.2011.2160555
  6. Barbeau H, Visintin M. Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil 2003;84(10):1458-65. https://doi.org/10.1016/S0003-9993(03)00361-7
  7. Sienna PA. One rep max: a guide to beginning weight training. Indianapolis: Benchmark Press; 1989.
  8. Davies RA. Isolated-joint testing & exercise: a handbook for using Cybex 770 and the U.B.X.T. Bay Shore: Lumec; 1985.
  9. Davies GJ. A compendium of isokinetics in clinical usage and rehabilitation techniques. Onalaska: S & S Publishers; 1992.
  10. Gray JC, Chandler JM. Percent decline in peak torque production during repeated concentric and eccentric contractions of the quadriceps femoris muscle. J Orthop Sports Phys Ther 1989;10(8):309-14. https://doi.org/10.2519/jospt.1989.10.8.309
  11. Lepers R, Pousson ML, Maffiuletti NA, Martin A, Van Hoecke J. The effects of a prolonged running exercise on strength characteristics. Int J Sports Med 2000;21(4):275-80. https://doi.org/10.1055/s-2000-308
  12. Nilsson J, Tesch P, Thorstensson A. Fatigue and EMG of repeated fast voluntary contractions in man. Acta Physiol Scand 1977;101(2):194-8. https://doi.org/10.1111/j.1748-1716.1977.tb05998.x
  13. Thorstensson A, Karlsson J. Fatiguability and fibre composition of human skeletal muscle. Acta Physiol Scand 1976;98(3):318-22. https://doi.org/10.1111/j.1748-1716.1976.tb10316.x
  14. Denadai BS, Greco CC, Tufik S, de Mello MT. Effects of high intensity running to fatigue on isokinetic muscular strength in endurance athletes. Isokinetics and Exercise Science 2007;15(4):281-5. https://doi.org/10.3233/IES-2007-0284
  15. Glace BW, McHugh MP, Gleim GW. Effects of a 2-hour run on metabolic economy and lower extremity strength in men and women. J Orthop Sports Phys Ther 1998;27(3):189-96. https://doi.org/10.2519/jospt.1998.27.3.189
  16. Sherman WM, Armstrong LE, Murray TM, Hagerman FC, Costill DL, Staron RC, et al. Effect of a 42.2-km footrace and subsequent rest or exercise on muscular strength and work capacity. J Appl Physiol Respir Environ Exerc Physiol 1984;57(6):1668-73.
  17. Banala SK, Kim SH, Agrawal SK, Scholz JP. Robot assisted gait training with active leg exoskeleton (ALEX). IEEE Trans Neural Syst Rehabil Eng 2009;17(1):2-8. https://doi.org/10.1109/TNSRE.2008.2008280
  18. Beyl P, Van Damme M, Van Ham R, Vanderborght B, Lefeber D. Design and control of a lower limb exoskeleton for robot-assisted gait training. Applied Bionics and Biomechanics 2009;6(2):229-43. https://doi.org/10.1080/11762320902784393
  19. Cao J, Xie SQ, Das R, Zhu GL. Control strategies for effective robot assisted gait rehabilitation: the state of art and future prospects. Med Eng Phys 2014;36(12):1555-66. https://doi.org/10.1016/j.medengphy.2014.08.005
  20. Hussain S, Xie SQ, Liu G. Robot assisted treadmill training: mechanisms and training strategies. Med Eng Phys 2011;33(5):527-33. https://doi.org/10.1016/j.medengphy.2010.12.010
  21. Koenig A, Omlin X, Zimmerli L, Sapa M, Krewer C, Bolliger M, et al. Psychological state estimation from physiological recordings during robot-assisted gait rehabilitation. J Rehabil Res Dev 2011;48(4):367-85. https://doi.org/10.1682/JRRD.2010.03.0044
  22. Nakanishi Y, Wada F, Saeki S, Hachisuka K. Rapid changes in arousal states of healthy volunteers during robot-assisted gait training: a quantitative time-series electroencephalography study. J Neuroeng Rehabil 2014;11:59. https://doi.org/10.1186/1743-0003-11-59
  23. Gordon KE, Ferris DP, Roberton M, Beres JA, Harkema SJ. The importance of using an appropriate body weight support system in locomotor training. Soc Neurosci 2000;26(1):160.
  24. Frey M, Colombo G, Vaglio M, Bucher R, Jorg M, Riener R. A novel mechatronic body weight support system. IEEE Trans Neural Syst Rehabil Eng 2006;14(3):311-21. https://doi.org/10.1109/TNSRE.2006.881556
  25. Franz JR, Glauser M, Riley PO, Della Croce U, Newton F, Allaire PE, et al. Physiological modulation of gait variables by an active partial body weight support system. J Biomech 2007;40(14):3244-50. https://doi.org/10.1016/j.jbiomech.2007.04.016
  26. Morone G, Bragoni M, Iosa M, De Angelis D, Venturiero V, Coiro P, et al. Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabil Neural Repair 2011;25(7):636-44. https://doi.org/10.1177/1545968311401034
  27. Bonetti LV, Grisa NC, Demeda CS, Finger ALT, De Marchi T, Tadiello GS. Isokinetic performance of knee extensor and flexor musculature in adolescent female handball players. Arch Med Deporte 2018;35(3):157-61.
  28. Qin T, Zhang L. Coordinated control strategy for robotic-assisted gait training with partial body weight support. J Cent South Univ 2015;22(8):2954-62. https://doi.org/10.1007/s11771-015-2831-0
  29. Perry J, Burnfield JM. Gait analysis: normal and pathological function. 2nd ed. Thorofare: Slack; 2010.
  30. Hessert MJ, Vyas M, Leach J, Hu K, Lipsitz LA, Novak V. Foot pressure distribution during walking in young and old adults. BMC Geriatr 2005;5:8. https://doi.org/10.1186/1471-2318-5-8
  31. Soucy MT. Examining the effects of body weight support and speed on physiological measures and lower leg muscular activity. Las Vegas, University of Nevada, Master's Thesis. 2016.
  32. Riener R, Lunenburger L, Maier IC, Colombo G, Dietz V. Locomotor training in subjects with sensori-motor deficits: an overview of the robotic gait orthosis lokomat. J Healthc Eng 2010;1(2):197-216. https://doi.org/10.1260/2040-2295.1.2.197
  33. Sherman WM, Pearson DR, Plyley MJ, Costill DL, Habansky AJ, Vogelgesang DA. Isokinetic rehabilitation after surgery. A review of factors which are important for developing physiotherapeutic techniques after knee surgery. Am J Sports Med 1982;10(3):155-61. https://doi.org/10.1177/036354658201000307
  34. Sherman WM, Plyley MJ, Pearson DR, Habansky AJ, Vogelgesang DA, Costill DL. Isokinetic rehabilitation after meniscectomy: a comparison of two methods of training. Physician Sportsmed 1983;11(4):121-33. https://doi.org/10.1080/00913847.1983.11708513
  35. Smith MJ, Melton P. Isokinetic versus isotonic variable-resistance training. Am J Sports Med 1981;9(4):275-9. https://doi.org/10.1177/036354658100900420
  36. Timm KE. Isokinetic exercise to 50% fatigue. J Orthop Sports Phys Ther 1987;8(10):505-6. https://doi.org/10.2519/jospt.1987.8.10.505
  37. Dvir Z, David G. Average or peak moment: which of the two is more suitable to represent isokinetic muscle strength? Isokinet Exerc Sci 1995;5(2):93-7. https://doi.org/10.3233/IES-1995-5206
  38. Dvir Z. Isokinetics: muscle testing, interpretation, and clinical applications. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
  39. Hwang JH, Sung KS, Yi CH. Effects of abdominal hollowing and bracing maneuvers on hip extension strength in prone standing position. Isokinet Exerc Sci 2020;28(2):161-9. https://doi.org/10.3233/ies-193225
  40. Van Kammen K, Boonstra A, Reinders-Messelink H, den Otter R. The combined effects of body weight support and gait speed on gait related muscle activity: a comparison between walking in the Lokomat exoskeleton and regular treadmill walking. PLoS One 2014;9(9):e107323. https://doi.org/10.1371/journal.pone.0107323

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