Evaluation of RYSEN gait training in clinical practice

Many patients with neurological impairments, such as a stroke or spinal cord
injury, show abnormal gait. This can lead to loss of indepence and mobility and
may reduce quality of life. In order to increase participation, rehabilitation
programs focus on improving gait.
It has frequently been shown that gait training is most effective when
performed on high intensity including many repetitions of task-specific
exercises. However, this is often not possible to achieve in current
rehabilitation as certain levels of muscle strenght, coordination and physical
fitness are thought to be required. Therefore, rehabilitation centres search
for innovative solutions, such as the RYSEN, in order to organize intensive,
task-specific training. The RYSEN is a 3D body weight support device that
allows patients that are unable to bear their body weight to start walking
early during rehabilitation. The RYSEN contains many applications that allow
for task-specific training. However, currently therapisist subjectively
determine the use of the RYSEN and its specific applications based on visual
inspection of the gait pattern. In this project, it will be investigated how
RYSEN applications can be used for specific training goals. Moreover, it will
be investigated how the RYSEN contributes to rehabilitation programs in order
to create specific guidelines for RYSEN use in clinical practice.

This project has the following objectives: 1) to determine the effect of
vertical, horizontal and mediolateral supportive forces of the RYSEN on gait
parameters and muscle activity in able bodied individuals and patients; 2)
determine the differences in training content and intensity between
RYSEN(AR)-training and conventional physiotherapy; 3) determine experiences and
expectations of patients and therapists regarding RYSEN-training using
questionnaires and focus groups.

This project exists of four experiments (A until D), which will be executed
from May 2022 until June 2025. Experiment A and B are cross-sectional studies
about the effect of RYSEN-applications (vertical, horizontal and mediolateral
support) on step parameters and muscle activity in healthy individuals
(Experiment A) and patients (Experiment B). Experiment C will be an
observational cross-sectional study in which training content, intensity and
experiences will be compared between RYSEN(AR)-training and conventional
physiotherapy. Experiment D will be a qualitative study that assesses training
experiences and expectations in patients and therapists.

In Experiments A & B, participants will perform experimental sessions in the
RYSEN during which different RYSEN applications (vertical, horizontal and
mediolateral support) will be applied. Participants will walk in the RYSEN in
these different conditions and simultaneously step parameters and muscle
activity will be measured.

In Experiment C, participants will perform three types of gait training within
the same week; RYSEN-training, RYSENAR-training and conventional physiotherapy.
Each training session will take 30 minutes and will be executed by supervision
of a physiotherapist.

In Experiment D, focus groups will be organised in which experiences and
expectations about RYSEN training will be assessed in patients and therapists.

Experiments A and B will have a duration of 1.5 hours. During these
experiments, step parameters and muscle activity will be measured using a
movement registration system (Optotrak) and electromyography.
In Experiment C, participants will perform three types of training as part of
their usual rehabilitation program. Training sessions will take 30 minutes and
will be supervised by a physiotherapist. During training, heart rate,
acceleration of the trunk and the number of steps taken will be assessed using
a heart frequency watch and inertial measurement units. After each training,
participants will be asked to fill in questionnaires, this will take about 30
minutes.
In Experiment D, participants will attend a focus group meeting for about 1.5-2
hours.