Robot-aided Ankle Rehabilitation
Ankle rehabilitation can be important for people with SCI as it may address drop foot consequences and/or weakened lower limb muscles (Calabrò et al. 2022). Improving ankle functionality generally means targeting the ranges and directionality of motion (i.e., plantar/dorsiflexion, inversion/eversion, and abduction/adduction) as well as ankle plantar and dorsiflexion muscle strength, and proprioceptive capacity of the ankle (Calabrò et al. 2022).
The rationale of adopting robot-aided ankle rehab for patients with incomplete SCI is to provide the patient’s ankle with regular and assisted-as-needed movements (mainly inversion–eversion and dorsiflexion–plantarflexion) and to train muscle strength with mechanical support and some control over force distribution (Calabrò et al. 2022). Goals may include minimizing the risk of falls and improving walking speed and efficiency (Calabrò et al. 2022).
One platform-based robot system, the HunovaÒ, is made of two electromechanical and sensorized platforms with two planes of movement (forward/backward and left/right) that monitor and train postural and joint movements, including the ankle. Two training modes are available – a ‘static’ mode, where the platform does not move, but offers resistance to the user’s movements, or a ‘dynamic’ mode where the platform itself moves and the user has to adapt (Calabrò et al. 2022). Exercises may be performed seated, on the attached armchair with optional strap support, or standing on the platform with optional handrail support (Calabrò et al. 2022). The Hunova® also provides the user with visual and audio feedback, from devices like an accelerometer, gyroscope, and magnetometer located on/attached to the person’s torso (Calabrò et al. 2022).
Discussion
There was only one study that evaluated the effects of robot-aided ankle rehabilitation in people with incomplete SCI using corticomuscular coherence data. The case control study (with a prospective design for the experimental group and a retrospective design for the matched-control group) compared the effects on gait performance after engaging in robot-aided ankle rehabilitation or conventional ankle rehabilitation in patients with acute SCI (Calabrò et al. 2022). All participants underwent an intensive treatment program (six days/week) consisting of FES of lower limb muscles, conventional physiotherapy and occupational therapy sessions; participants in the experimental group used the HunovaÒdevice for ankle rehabilitation (Calabrò et al. 2022). After 4 weeks of training, there were more significant improvements in the experimental group than in the control group for walking speed (10MWT) and walking distance (6MWT),independence in daily living activities (SCIM-III), and muscle activation of dorsal and plantar flexors (Calabrò et al. 2022).
Conclusions
There is level 3 evidence (from 1 case control study: Calabrò et al. 2022) that the addition of a robot-aided ankle rehabilitation to an intensive program consisting of FES, conventional physiotherapy and occupational therapy provides more significant improvements on walking (10MWT and 6MWT) than conventional physiotherapy in patients with acute SCI.
