A large proportion of patients with spinal cord injury (SCI) regain ambulatory function. However, during the first 3 months most of the patients are not able to walk unsupported. To enable ambulatory training at such an early stage the body weight is partially relieved and the leg movements are assisted by two therapists. A more recent approach is the application of robotic based assis-tance which allows for longer training duration. From motor learning science and studies including patients with stroke, it is known
that training effects depend on the duration of the training. Longer trainings result in a better walking function. The aim of the present study is to evaluate if prolonged robot assisted walking training leads to a better walking outcome in patients with in-complete SCI and whether such training is feasible or has undesirable effects. Methods/Design: Patients from multiple sites with a subacute incomplete SCI and who are not able to walk independently will be randomized to either standard training (3-5 sessions per week, session duration maximum 25 minutes) or an intensive training (3-5 sessions per week, session duration minimum 50 minutes). After 8 weeks of training and 4 months later the walking ability, the occurrence of adverse events and the perceived rate of exer-tion as well as the patients’ impression of change will be compared between groups

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Movement-assist devices such as neuromuscular stimula-tion systems can be used to generate movements in people with chronic hand paralysis due to stroke. If de-tectable, motor planning activity in the cortex could be used in real time to trigger a movement-assist device and restore a person’s ability to perform many of the activities of daily living. Additionally, re-coupling motor planning in the cortex with assisted movement generation in the periphery may provide an even greater benefit—strengthening relevant synaptic connections over time to promote natural motor recove-ry. This study examined the potential for using electroencepha-lograms (EEGs) as a means of rapidly detec-ting the intent to open the hand during movement planning in individuals with moderate chronic hand paraly-sis following a subcortical ischemic stroke. On average, attempts to open the hand could be detected from EEGs approximately 100–500 ms prior to the first signs of movement onset. This earlier detection would mi-nimize device activation delays and allow for tighter coupling between initial formation of the motor plan in the cortex and augmentation of that plan in the periphery by a movement-assist device. This tight tempo-ral coupling may be important or even essential for strengthening synaptic connections and enhancing natu-ral motor recovery.

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The Intuitive Leg Assist Device (I-LAD) is designed to address a demographic of people with lower extremity weakness. It optimizes cost, weight, and functionality, and provides the power and support needed to perform natural ambulation. The design mimics the human gait cycle by coupling the actuation of the knee and hip via a dual four-bar linkage system modified from a crank rocker system, with a 12.8% and 14.1% error in the hip and knee movement, respectively. The patient supports the device using an over the shoulder harness and modified work belt, both connected to an acrylic plate. The plate serves as the mounting for the motor, planetary gear system, and electrical components that drive the linkage system. The linkage system is connected to a knee brace and ankle foot orthosis that minimizes the effect of foot drop. The design implements feedback and safety by incorporating four sensor inputs-two force sensors beneath the feet and two goniometers on the hips-and a microprocessor, which controls motor actuation. The program logic ensures that the device shuts down upon unintended user movement, minimizing safety hazards.

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