Medical & Biological Engineering & Computing

, Volume 55, Issue 10, pp 1873–1881 | Cite as

Resistance training using a novel robotic walker for over-ground gait rehabilitation: a preliminary study on healthy subjects

  • Kyung-Ryoul Mun
  • Brandon Bao Sheng Yeo
  • Zhao Guo
  • Soon Cheol Chung
  • Haoyong Yu
Original Article


Strength training is an aspect of gait rehabilitation, which complements balance control and weight-bearing training. However, conventional strength training does not show positive gait outcomes, due to lack of task specificity. Therefore, the aims of this study were to investigate the effects of a resistance force applied at the center of mass (CoM) and to investigate whether this exercise can be used for effective task-specific gait training. Using a novel robotic walker, a consistent resistive force was applied to the CoM of subjects in the posterior direction. Eleven healthy subjects were instructed to walk under five walking conditions with increasing forces, based on each subject’s body weight (BW), at 0, 2.5, 5, 7.5, and 10% BW. Joint kinematics and mean amplitude and frequency of electromyography signals from nine major muscles were measured. The application of resistance resulted in significantly increased flexion angles at ankle, knee, and hip joints. A large amount of motor unit activation with lower firing rates was found at knee and hip joints, indicating that this type of resistance training can improve muscular strength and endurance in a task-specific manner. The long-term effects of the resistance training on neurologically challenged patients will be investigated in the future.


Strength training Center of mass Task-specific gait training Robotic walker Gait rehabilitation 


  1. 1.
    Aagaard P et al (2002) Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses. J Appl Physiol 92(6):2309–2318CrossRefPubMedGoogle Scholar
  2. 2.
    Arjunan SP, Kumar DK, Wheeler K, Shimada H, Siddiqi A (2015) Effect of number of motor units and muscle fibre type on surface electromyogram. Med Biol Eng Comput 54(4):575–582Google Scholar
  3. 3.
    Behrman AL, Harkema SJ (2000) Locomotor training after human spinal cord injury: a series of case studies. Phys Ther 80(7):688–700PubMedGoogle Scholar
  4. 4.
    Blanchette A, Bouyer LJ (2009) Timing-specific transfer of adapted muscle activity after walking in an elastic force field. J Neurophysiol 102(1):568–577CrossRefPubMedGoogle Scholar
  5. 5.
    Bovi G et al (2011) A multiple-task gait analysis approach: kinematic, kinetic and EMG reference data for healthy young and adult subjects. Gait Posture 33(1):6–13CrossRefPubMedGoogle Scholar
  6. 6.
    Brady AO, Straight CR (2014) Muscle capacity and physical function in older women: What are the impacts of resistance training? J Sport Health Sci 3(3):179–188CrossRefGoogle Scholar
  7. 7.
    Campanini I, Merlo A, Damiano B (2013) A method to differentiate the causes of stiff-knee gait in stroke patients. Gait Posture 38(2):165–169CrossRefPubMedGoogle Scholar
  8. 8.
    Chang Y-H, Kram R (1999) Metabolic cost of generating horizontal forces during human running. J Appl Physiol 86(5):1657–1662PubMedGoogle Scholar
  9. 9.
    Chen PH et al (2013) Gait disorders in Parkinson’s disease: assessment and management. Int J Gerontol 7(4):189–193CrossRefGoogle Scholar
  10. 10.
    Dickstein R (2008) Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair 22(6):649–660CrossRefPubMedGoogle Scholar
  11. 11.
    Ellis RG, Sumner BJ, Kram R (2014) Muscle contributions to propulsion and braking during walking and running: insight from external force perturbations. Gait posture 40(4):594–599CrossRefPubMedGoogle Scholar
  12. 12.
    Emken JL, Reinkensmeyer DJ (2005) Robot-enhanced motor learning: accelerating internal model formation during locomotion by transient dynamic amplification. IEEE Trans Neural Syst Rehabil Eng 13(1):33–39CrossRefPubMedGoogle Scholar
  13. 13.
    Eng JJ, Tang PF (2007) Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence. Exp Rev Neurother 7(10):1417–1436CrossRefGoogle Scholar
  14. 14.
    Flansbjer UB et al (2008) Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. J Rehabil Med 40(1):42–48CrossRefPubMedGoogle Scholar
  15. 15.
    Frontera WR et al (2003) Strength training in older women: early and late changes in whole muscle and single cells. Muscle Nerve 28(5):601–608CrossRefPubMedGoogle Scholar
  16. 16.
    Hass CJ et al (2012) Progressive resistance training improves gait initiation in individuals with Parkinson’s disease. Gait Posture 35(4):669–673CrossRefPubMedGoogle Scholar
  17. 17.
    Hermens HJ et al (1999) European recommendations for surface electromyography. Roessingh Research and Development, EnschedeGoogle Scholar
  18. 18.
    Hicks JL, Delp SL, Schwartz MH (2011) Can biomechanical variables predict improvement in crouch gait? Gait Posture 34(2):197–201CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Holloszy JO, Booth FW (1976) Biochemical adaptations to endurance exercise in muscle. Annu Rev Physiol 38(1):273–291CrossRefPubMedGoogle Scholar
  20. 20.
    Labruyere R, van Hedel HJ (2014) Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance. J NeuroEng Rehabil 11(1):4CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lam T, Anderschitz M, Dietz V (2006) Contribution of feedback and feedforward strategies to locomotor adaptations. J Neurophysiol 95(2):766–773CrossRefPubMedGoogle Scholar
  22. 22.
    Lam T et al (2008) Swing phase resistance enhances flexor muscle activity during treadmill locomotion in incomplete spinal cord injury. Neurorehabil Neural Repair 22(5):438–446CrossRefPubMedGoogle Scholar
  23. 23.
    Mun KR, et al (2014) Design of a novel robotic over-ground walking device for gait rehabilitation. In: 2014 IEEE 13th international workshop on advanced motion control (AMC), 2014. IEEEGoogle Scholar
  24. 24.
    Mun KR, Guo Z, Yu H (2016) Restriction of pelvic lateral and rotational motions alters lower limb kinematics and muscle activation pattern during over-ground walking. Med Biol Eng Comput 30:1–9Google Scholar
  25. 25.
    O’Connor CM et al (2007) Automatic detection of gait events using kinematic data. Gait Posture 25(3):469–474CrossRefPubMedGoogle Scholar
  26. 26.
    Olney SJ, Richards C (1996) Hemiparetic gait following stroke. Part I: characteristics. Gait Posture 4(2):136–148CrossRefGoogle Scholar
  27. 27.
    Pagel A, Arieta AH, Riener R, Vallery H (2015) Effects of sensory augmentation on postural control and gait symmetry of transfemoral amputees: a case description. Med Biol Eng Comput 10:1579Google Scholar
  28. 28.
    Perry J, Slac T, Davids JR (1992) Gait analysis: normal and pathological function. J Pediatric Orthop 12(6):815CrossRefGoogle Scholar
  29. 29.
    Phinyomark A et al (2012) The usefulness of mean and median frequencies in electromyography analysis. INTECH Open Access Publisher, RijekaCrossRefGoogle Scholar
  30. 30.
    Scandalis TA et al (2001) Resistance training and gait function in patients with Parkinson’s disease. Am J Phys Med Rehabil 80(1):38–43CrossRefPubMedGoogle Scholar
  31. 31.
    Scott W, Stevens J, Binder-Macleod SA (2001) Human skeletal muscle fiber type classifications. Phys Ther 81(11):1810–1816PubMedGoogle Scholar
  32. 32.
    Spanjaard M et al (2007) Gastrocnemius muscle fascicle behavior during stair negotiation in humans. J Appl Physiol 102(4):1618–1623CrossRefPubMedGoogle Scholar
  33. 33.
    Sullivan KJ et al (2007) Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial. Phys Ther 87(12):1580–1602CrossRefPubMedGoogle Scholar
  34. 34.
    Sutherland DH, Davids JR (1993) Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res 288:139–147Google Scholar
  35. 35.
    Topp R et al (1993) The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults. Gerontol 33(4):501–506CrossRefGoogle Scholar
  36. 36.
    van den Noort JC, Ferrari A, Cutti AG, Becher JG, Harlaar J (2013) Gait analysis in children with cerebral palsy via inertial and magnetic sensors. Med Biol Eng Comput 51(4):377–386CrossRefPubMedGoogle Scholar
  37. 37.
    Williams G, Kahn M, Randall A (2014) Strength training for walking in neurologic rehabilitation is not task specific: a focused review. Am J Phys Med Rehabil 93(6):511–522CrossRefPubMedGoogle Scholar
  38. 38.
    Winter DA (1991) Biomechanics and motor control of human gait: normal, elderly and pathological, 2nd edn. Waterloo Biomechanics, WaterlooGoogle Scholar
  39. 39.
    Yu H, Spenko M, Dubowsky S (2003) An adaptive shared control system for an intelligent mobility aid for the elderly. Auton Robots 15(1):53–66CrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2017

Authors and Affiliations

  1. 1.Image Media Research CenterKorea Institute of Science and TechnologySeoulRepublic of Korea
  2. 2.Department of Biomedical EngineeringNational University of SingaporeSingaporeRepublic of Singapore
  3. 3.Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Biomedical and Health ScienceKonkuk UniversityChungjuSouth Korea

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