The Lokomat is a robotic exoskeleton that can be used to train gait function in hemiparetic stroke. To purposefully employ the Lokomat for training, it is important to understand (1) how Lokomat guided walking affects muscle activity following stroke and how these effects differ between patients and healthy walkers, (2) how abnormalities in the muscle activity of patients are modulated through Lokomat guided gait, and (3) how temporal step characteristics of patients were modulated during Lokomat guided walking. Ten hemiparetic stroke patients (>3 months post-stroke) and ten healthy age-matched controls walked on the treadmill and in the Lokomat (guidance force 50%, no bodyweight support) at matched speeds (0.56 m/s). Electromyography was used to record the activity of Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius and Tibialis Anterior, bilaterally in patients and of the dominant leg in healthy walkers. Pressure sensors placed in the footwear were used to determine relative durations of the first double support and the single support phases. Overall, Lokomat guided walking was associated with a general lowering of muscle activity compared to treadmill walking, in patients as well as healthy walkers. The nature of these effects differed between groups for specific muscles, in that reductions in patients were larger if muscles were overly active during treadmill walking (unaffected Biceps Femoris and Gluteus Medius, affected Biceps Femoris and Vastus Lateralis), and smaller if activity was already abnormally low (affected Medial Gastrocnemius). Also, Lokomat guided walking was associated with a decrease in asymmetry in the relative duration of the single support phase. In stroke patients, Lokomat guided walking results in a general reduction of muscle activity, that affects epochs of overactivity and epochs of reduced activity in a similar fashion. These findings should be taken into account when considering the clinical potential of the Lokomat training environment in stroke, and may inform further developments in the design of robotic gait trainers.

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. 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. 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. 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.

Effectiveness of motor interventions depends not only on learning content but also on the used teaching strategies. However, little is known regarding the application of teaching strategies in clinical practice. This study aimed to develop and assess psychometric properties of a new Dutch observational instrument to document teaching strategies: the Optimizing Performance through Intrinsic Motivation and Attention for Learning (OPTIMAL) Strategies Observational Tool (OSOT). Based on the OPTIMAL theory for motor learning from Wulf and Lewthwaite, the OSOT includes three variables: (a) expectancies, (b) autonomy, and (c) attention. The OSOT’s content was created by extracting relevant items from literature and existing instruments. To assess its psychometric properties, a convenience sample of 18 physiotherapy sessions for children with developmental coordination disorder was employed. Video recordings of these sessions were analyzed using Noldus The Observer XT. Relative duration (percentage of session time) was calculated for each item. Intraclass correlations were calculated to examine interrater and intrarater reliability. The design process resulted in 43 items in total. Interrater and intrarater intraclass correlations ranged from .48 to .99, with 81% (interrater), respectively, 95% (intrarater) of the items scoring above .75, indicating excellent agreement. The OSOT enables systematic and reliable observation of Optimizing Performance through Intrinsic Motivation and Attention for Learning teaching strategies used by therapists in Dutch clinical settings.

Background/Objectives: Swing leg resistance may stimulate propulsive force, required for forward progression and leg swing, in post-stroke patients. To assess the potential of swing leg resistance in rehabilitation, more knowledge is needed on how this unilateral manipulation affects gait. Therefore, we explored the bilateral effects of a unilateral swing leg resistance on muscle activity, kinematics, and kinetics of gait in able-bodied individuals. Methods: Fourteen able-bodied participants (8 female, aged 20.7 ± 0.8 years, BMI 23.5 ± 1.9) walked on an instrumented treadmill at 0.28 m/s, 0.56 m/s, and 0.83 m/s with and without unilateral swing leg resistance provided by a weight (0 kg, 0.5 kg, 1.25 kg, and 2 kg) attached to the leg through a pulley system. Propulsion and braking forces, swing time, step length, transverse ground reaction torques, and muscle activity in the gluteus medius (GM), biceps femoris (BF), rectus femoris (RF), vastus medialis (VM), medial gastrocnemius (MG), and soleus (SOL) were compared between conditions. Statistical analyses were performed using repeated measures ANOVAs, with a significance level of 5%. Results: Peak propulsive force and propulsive duration increased bilaterally, while peak braking force decreased bilaterally with unilateral swing leg resistance. In addition, the swing time of the perturbed leg increased with swing leg resistance. Muscle activity in the perturbed leg (GM, BF, RF, VM, MG) and the unperturbed leg (GM, BF, VM, MG, SOL) increased. Only in the BF (perturbed leg, late swing) and MG (unperturbed leg, early stance) did the muscle activity decrease with swing leg resistance. No adaptations in step length and transverse ground reaction torques were observed. Specific effects were enhanced by gait speed. Conclusions: Unilateral swing leg resistance can evoke effects that might stimulate the training of propulsion. A study in post-stroke patients should be conducted to test whether prolonged exposure to unilateral swing leg resistance leads to functional training effects.

PurposeeHealth might contribute to changes in roles and responsibilities of patients and healthcare professionals (HCPs), including the patient's potential to enhance self-regulation. The aim of this study was to identify important aspects and experiences of self-regulation and factors that may support self-regulation in blended rehabilitation care.Materials and methodsSemi-structured interviews were conducted among HCPs and patients regarding perceptions and experiences with self-regulation in relation to a telerehabilitation portal. Thematic analysis was used to identify themes.ResultsAccording to HCPs (n = 18), aspects of self-regulation are: an active role of patients, a facilitating role for HCPs, and collaboration. Patients and parents (n = 24) experienced self-regulation by: having an active role and having a voice. Aspects of eHealth that support self-regulation are: at home usage, flexible scheduling, easily accessible communication, using it as a reference work, using it to stimulate motivation, and adapting usage to different phases of treatment.ConclusionPatients and HCPs agree that patients having an active role is important for experiencing self-regulation. A telerehabilitation portal that can be flexibly used at home, with a communication and log module, can support self-regulation. Optimising eHealth design to stimulate self-regulation, and measuring the impact of eHealth on self-regulation should be further studied.