Advanced Robotic Gait Training System | Stationary End-Effector Exoskeleton

At PYONG Rehabilitation we turn hope into progress with the "Advanced Robotic Gait Training System", an innovation in gait rehabilitation of world standing, a Stationary End-Effector Exoskeleton technology designed to help patients with abnormalities of the nervous system and the muscles return to walking correctly according to physiology once again, with an intelligent system that supports and trains stepping precisely, safely, and more effectively than traditional gait training.

What is Robotic Gait Training?

It is an advanced robotic technology for restoring the capacity to walk, working in the manner of an "End-Effector", in which the robot controls the movement at the patient's foot in order to transmit the force to the knee and hip joints, helping create a Gait Pattern that is natural and correct according to the principles of biomechanics. It differs from the use of ordinary wearable robots, because it lets the patient train weight-bearing and balance realistically in an environment where safety can be controlled 100%.

The mechanism of working

The key to creating new neural circuits (Neuroplasticity): the system works through a process of feedback signals (Biofeedback) and repeated training of quality:

• Repetitive High-Intensity Training: it lets the patient train stepping repeatedly hundreds of times in one session, which is at the heart of stimulating the brain into learning anew (Neuroplasticity)
• Active-Passive Assistance: the robot can adjust the assisting force according to the patient's strength. If the patient has little strength the robot will guide (Passive), but if the patient begins to have strength the robot will give the patient the chance to exert their own force (Active)
• Sensory Feedback: it stimulates perception from the sole of the foot and the joints, in order to send signals back to the brain so that it remembers the correct way of walking

Technical Specifications

• End-Effector Technology: emphasising movement at the foot in order to imitate real stepping, increasing the freedom of the hip
• Dynamic Body Weight Support: a dynamic body-weight support system adjusting to actual capacity, helping reduce the load on the joints
• Real-time Biofeedback: a real-time display screen so that the patient sees their own exertion, increasing motivation
• Adjustable Gait Parameters: the step length and the speed can be adjusted in detail according to the body
• Safety Integration: a sensor system detecting abnormality and stopping the working immediately if a step is out of rhythm

Evidence-Based Integration | example cases from medical research

The effectiveness of weight-bearing Robotic Gait Training (Overground/Non-suspension) has been certified by clinical research of world standing:

The rehabilitation of patients with subacute stroke (Subacute Stroke)

• A patient 1 month after a stroke, with weakness of the right arm and leg (Hemiparesis), unable to stand and balance by themselves
• The treatment: training with an Active-Assistive gait-training robot together with a Biofeedback system for 6 weeks
• The result from the research: the group of patients using the robot developed independence in walking (Functional Ambulation Category) and gait speed (Gait Speed) significantly more than the group training traditionally, since correct repetition (High Repetition) stimulates the brain better
• (Reference: "Robotic-Assisted Gait Training in Stroke Rehabilitation" – Stroke Journal)

Managing spasticity in patients with spinal cord injury (Spinal Cord Injury with Spasticity)

• A patient with SCI at the thoracic level, with severe spasticity of the legs (Severe Spasticity), making gait training on the ground difficult and painful
• The treatment: standing up on the robot without a sling, with the Spasticity Detection system switched on to prevent harm
• The result from the research: full weight-bearing together with rhythmic movement of the joints on the robot helps inhibit the spinal reflex circuit of spasticity (Inhibition of spinal reflex), so that the level of spasticity (Modified Ashworth Scale) decreased immediately after the training
• (Reference: "Effects of Robotic Gait Training on Spasticity in Spinal Cord Injury" – Spinal Cord)

Correcting the problem of catching gait in patients with Parkinson's (Parkinson's Disease with FOG)

• A patient with Parkinson's with the problem of short steps, dragging the feet, and being unable to step off (Freezing of Gait – FOG)
• The treatment: training to step to the rhythm the robot sets, while responding to a game on the screen (Dual-tasking training)
• The result from the research: using Visual and Auditory Cues from the device helps the Basal Ganglia part of the brain get past the problem of initiating movement, with the result that the step length increased and the frequency of being unable to step off in daily life decreased
• (Reference: "Robot-assisted gait training in Parkinson's disease" – Parkinsonism & Related Disorders)

Whom is it suited to?

This gait-training robotic system is designed for those with problems of movement at various levels:

1. Patients with stroke (Stroke): both in the acute and the chronic stage, in order to train a new pattern of walking
2. Those with spinal cord injury (Spinal Cord Injury): helping stimulate the muscles and perception at various levels
3. Patients with Parkinson's disease (Parkinson's Disease): training steady stepping and reducing catching gait
4. Patients with weakness of the muscle: or the group who have just been through major surgery and need to begin gait training safely
5. Children with cerebral palsy (Cerebral Palsy): in order to reinforce development in movement

Frequently asked questions (FAQs)

Q1: How does it differ from gait training with an ordinary physiotherapist?

Answer: the robot lets the patient step a greater number of times (High Intensity) and with a pattern of walking that is constant and consistent 100%, which is hard to achieve with a person supporting them.

Q2: How often does it have to be trained before a result is seen?

Answer: in general it is advised 2-3 times a week, continuing for at least 1-2 months, so that the brain and the muscles come to remember it.

Q3: Can a patient who cannot move the leg at all use it?

Answer: yes. The system can be set to Passive Mode so that the robot moves the leg for them at the outset, in order to reduce the stiffening of the joints and stimulate the circulation of blood.