Background: Manual body weight supported treadmill training and robot-aided treadmill training are frequently used techniques for the gait rehabilitation of individuals after stroke and spinal cord injury. Current evidence suggests that robot-aided gait trai-ning may be improved by making robotic behavior more patient-cooperative. In this study, we have investigated the immediate effects of patient-cooperative versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury (iSCI).
Methods: Eleven patients with iSCI participated in a single training session with the gait rehabilitation robot Lokomat. The pati-ents were exposed to four different training modes in random order: During both noncooperative position control and compliant im-pedance control, fixed timing of movements was provided. During two variants of the patient-cooperative path control approach, free timing of movements was enabled and the robot provided only spatial guidance. The two variants of the path control approach diffe-red in the amount of additional support, which was either individually adjusted or exaggerated. Joint angles and torques of the ro-bot as well as muscle activity and heart rate of the patients were recorded. Kinematic variability, interaction torques, heart rate and muscle activity were compared between the different conditions. Results: Patients showed more spatial and temporal kinematic va-riability, reduced interaction torques, a higher increase of heart rate and more muscle activity in the patient-cooperative path control mode with individually adjusted support than in the non-cooperative position control mode. In the compliant impedance con-trol mode, spatial kinematic variability was increased and interaction torques were reduced, but temporal kinematic variability,
heart rate and muscle activity were not significantly higher than in the position control mode. Conclusions: Patient-cooperative robot-aided gait training with free timing of movements made individuals with iSCI participate more actively and with larger kine-matic variability than non-cooperative, position-controlled robotaided gait training.

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