Unilateral Floor Stiffness Perturbations Systematically Evoke Contralateral Leg Muscle Responses: A New Approach to Robot-Assisted Gait Therapy.

A variety of robotic rehabilitation devices have been proposed for gait rehabilitation after stoke, but have only produced moderate results when compared to conventional physiotherapy. We suggest a novel approach to robotic interventions which takes advantage of mechanisms of inter-limb coordination. In order to test the viability of this approach, we apply unilateral floor stiffness perturbations via a unique robotic device and observe evoked contralateral leg responses in kinematics, as well as muscle activations, in healthy subjects. The real-time control of floor stiffness is utilized to uniquely differentiate force and kinematic feedback, creating novel sensory perturbations. We present results of repeatable and scalable evoked kinematic and muscular response of the unperturbed leg in healthy subjects. Moreover, we provide insight into the fundamental sensorimotor mechanisms of inter-leg coordination. We also lay the foundation for model-based rehabilitation strategies for impaired walkers by presenting a mathematical model that accurately describes the relationship between the magnitude of the stiffness perturbation and the evoked muscle activity. One of the most significant advantages of this approach over current practices is the safety of the patient, since this does not require any direct manipulation of the impaired leg. The novel methods and results presented in this paper set the foundation for a paradigm shift in robotic interventions for gait rehabilitation.