1232 Part F Field and Service Robotics 53.2.4 Robotic Therapy for Walking automation.The efforts of roboticists have been espe- cially focused on BWSTT rather than overground gait Background training because BWSTT is done on a stationary setup Scientific evidence that gait training improves recovery in a well-defined manner and thus can be more easily of mobility after neurologic injury started to accumu- automated than overground gait training.Randomized, late in the 1980s through studies with cats.Cats with controlled clinical trials have shown that BWSTT is SCI can be trained to step with their hind limbs on comparable in effectiveness to conventional physical a treadmill with partial support of the body weight therapy for various gait-impairing diseases [53.75-80]. and assistance of leg movements [53.68,69].Follow-These trials support the efforts towards automation of ing the animal studies,various laboratories developed BWSTT,as the working conditions of physical thera- a rehabilitation approach in which the patient steps on pists will improve if the robots do much of the physical a treadmill with the body weight partially supported by work,which in the case of BWSTT actually leads to an overhead harness and assistance from up to three occasional back injuries to therapists.Usually,only therapists [53.70-73].Depending on the patient's im-one therapist is needed in robot-assisted training,for pairment level,from one to three therapists are needed the tasks of helping the patient into and out of the for body-weight supported treadmill training(BWSTT),robot and monitoring the therapy.In the case of SCI with one therapist assisting in stabilizing and moving patients,a small randomized,controlled trial [53.76] the pelvis,while two additional therapists sit next to reported that robotic-assisted BWSTT with a first- the treadmill and assist the patient's legs in swing and generation robot required significantly less labor than stance.This type of training is based on the principle both conventional overground training and therapist- Part FI of generating normative,locomotor-like sensory input assisted BWSTT,with no significant difference found that promotes functional reorganization and recovery in effectiveness. 53.2 of the injured neural circuitry [53.74].In the 1990s, several independent studies indicated that BWSTT im- Gait-Training Robots in Current Clinical Use proves stepping in people with SCI or hemiplegia after Three gait-training robot systems are already in use stroke[53.70-721. for therapy in several clinics worldwide:the gait Gait training is particularly labor-intensive and trainer GT-I[53.81],the LokomatR [53.82],and the strenuous for therapists,so it is an important target for AutoAmbulatorTM [53.83](Fig.53.2). b) Fig.53.2a-c Gait-training robotic systems currently in use in clinics;(a)the gait trainer GT-I,developed by Hesse's group and commercialized by Reha-Stim (Germany):(b)the Lokomat,developed by Colombo and colleagues and commercialized by Hocoma AG(Switzerland),and(c)AutoAmbulatorTM,developed by the HealthSouth Corporation (USA)1232 Part F Field and Service Robotics 53.2.4 Robotic Therapy for Walking Background Scientific evidence that gait training improves recovery of mobility after neurologic injury started to accumu￾late in the 1980s through studies with cats. Cats with SCI can be trained to step with their hind limbs on a treadmill with partial support of the body weight and assistance of leg movements [53.68, 69]. Follow￾ing the animal studies, various laboratories developed a rehabilitation approach in which the patient steps on a treadmill with the body weight partially supported by an overhead harness and assistance from up to three therapists [53.70–73]. Depending on the patient’s im￾pairment level, from one to three therapists are needed for body-weight supported treadmill training (BWSTT), with one therapist assisting in stabilizing and moving the pelvis, while two additional therapists sit next to the treadmill and assist the patient’s legs in swing and stance. This type of training is based on the principle of generating normative, locomotor-like sensory input that promotes functional reorganization and recovery of the injured neural circuitry [53.74]. In the 1990s, several independent studies indicated that BWSTT im￾proves stepping in people with SCI or hemiplegia after stroke [53.70–72]. Gait training is particularly labor-intensive and strenuous for therapists, so it is an important target for a) b) c) Fig. 53.2a–c Gait-training robotic systems currently in use in clinics; (a) the gait trainer GT-I, developed by Hesse’s group and commercialized by Reha-Stim (Germany); (b) the Lokomatr , developed by Colombo and colleagues and commercialized by Hocoma AG (Switzerland), and (c) AutoAmbulatorTM, developed by the HealthSouth Corporation (USA) automation. The efforts of roboticists have been espe￾cially focused on BWSTT rather than overground gait training because BWSTT is done on a stationary setup in a well-defined manner and thus can be more easily automated than overground gait training. Randomized, controlled clinical trials have shown that BWSTT is comparable in effectiveness to conventional physical therapy for various gait-impairing diseases [53.75–80]. These trials support the efforts towards automation of BWSTT, as the working conditions of physical thera￾pists will improve if the robots do much of the physical work, which in the case of BWSTT actually leads to occasional back injuries to therapists. Usually, only one therapist is needed in robot-assisted training, for the tasks of helping the patient into and out of the robot and monitoring the therapy. In the case of SCI patients, a small randomized, controlled trial [53.76] reported that robotic-assisted BWSTT with a first￾generation robot required significantly less labor than both conventional overground training and therapist￾assisted BWSTT, with no significant difference found in effectiveness. Gait-Training Robots in Current Clinical Use Three gait-training robot systems are already in use for therapy in several clinics worldwide: the gait trainer GT-I [53.81], the Lokomatr [53.82], and the AutoAmbulatorTM [53.83] (Fig. 53.2). Part F 53.2