ddrobotec® enhancing functional independence and longevity

Our partner ddrobotec^® have shared a case study exploring power-oriented neuromotor and cognitive-emotional intervention in an older adult with knee pathology.

User Information

Age/Sex: 76-year-old female
Medical History: Rheumatoid arthritis (>10 years), Osteoarthritis, predominantly affecting the right knee
Primary Conditions: Chronic right knee pain, reduced mobility and decreased walking speed, functional limitations in daily activities

Clinical Presentation

At baseline, the user presented with:

• Reduced lower-limb function, particularly in weight-bearing activities
• Marked right–left asymmetry in strength and power
• Observable movement asymmetry, including poor knee alignment (valgus tendency)
• Inability to tolerate conventional resistance training due to pain exacerbation
• Reduced participation in physical activity

Additionally, mild cognitive and behavioural changes were noted:

• Reduced facial expression
• Occasional forgetfulness

These findings are consistent with combined physical and cognitive decline, contributing to increased fall risk and reduced independence.

Clinical Assessment

Functional performance was assessed using the 5 Times Sit-to-Stand Test (5xSTS).

• Baseline: 8.20 seconds

The 5xSTS is a validated measure of:

• Lower-limb functional performance
• Transfer ability
• Fall risk

A value of 8.20 seconds is within a functionally normal range (<10 seconds). However, in the presence of pain, reduced activity, and movement asymmetry, this may indicate a reduced neuromuscular reserve and increased risk of future functional decline.

Intervention

The user underwent training using the ddrobotec® system, combining structured resistance-based exercise and selected exergame tasks.

Training Protocol
• Frequency: 2× per week
• Duration: 40 minutes per session
• Duration of intervention: 1 month

4.1 Original Workout (Resistance-Based Training)
• Power and coordination-oriented lower-limb training using controlled resistance
• Focus on concentric force production (muscle power)
• Individually adjusted load to ensure pain-free execution
• Emphasis on:

– Symmetrical force production

– Controlled movement execution

– Progressive neuromuscular activation

4.2 Exergame-Based Training

• Selected exergames integrated into the training sessions
• Provided real-time visual and interactive feedback
• Supported:

– Movement correction (e.g., knee alignment)

– Coordination and timing

– Cognitive–motor engagement

• The virtual environment facilitated:

– Increased attention and motivation

– Activation of movement-related memory and emotional response

4.3 System Characteristics

• Curved (arc-shaped) movement trajectory

→ Enabled more natural joint motion

→ Reduced knee pain during exercise

• Low initial resistance and controlled load progression

→ Allowed safe training despite joint pathology

Results

5.1 Functional Performance

5 Times Sit-to-Stand Test (5xSTS):
• Baseline: 8.20 sec
• Post-intervention: 5.41 sec

This represents a clinically meaningful improvement in transfer performance. The change is consistent with enhanced lower-limb function and reduced fall risk. The improvement reflects increased muscle power and improved neuromotor coordination.

5.2 Neuromuscular and Functional Measures by Robotrainer

Objective assessments included:
• Leg Extension Power (Concentric Peak Power)
• Knee Stability (Stiffness Control)
• Proprioception (Knee Position Sense)

Leg Extension Power (Concentric Peak Power)
• Left leg: +12%
• Right leg: +16%
• Left-Right asymmetry decreased by 24.2%

These findings indicate a substantial improvement in muscle power, particularly in the previously affected limb. The reduction in asymmetry suggests improved balance in force production and enhanced neuromuscular coordination.

Knee Stability and Position Sense
Baseline values were within a functional range. Post-intervention measurements remained stable, with slight improvement. These findings suggest preserved neuromotor control and proprioceptive function, without deterioration despite underlying joint pathology.

5.3 Movement Quality
Qualitative observations indicated improvements in movement execution:
• Improved knee alignment during dynamic movement
• Reduction of valgus (knee-in) pattern
• More symmetrical and controlled movement patterns

These changes are consistent with improved neuromotor coordination and movement efficiency.

5.4 Cognitive and Emotional Response
During exergame-based training, the patient demonstrated increased engagement with movement tasks presented in realistic virtual environments.

The patient reported:
“I recalled what it felt like to play tennis.”
“That’s how I used to feel when I was skiing.”

Although the patient is no longer able to participate in these activities in real-life settings, the virtual training environment appeared to facilitate recall of previously learned motor patterns and associated movement experiences. This suggests activation of motor memory and cognitive–emotional processes, linking current movement execution with prior physical experiences.

Furthermore, the patient showed:
• Increased verbal interaction during training
• More positive expression
• Greater attentional engagement

These observations indicate that immersive exergame training may support cognitive–motor integration and emotional activation, contributing to improved participation and overall training response.

Discussion

This case represents a preventive intervention in an older adult with joint pathology who remained functionally within normal limits, but showed early signs of decline. Although baseline functional performance (5xSTS) was within a normal range, the patient presented with:

• Pain-related reduction in daily activity
• Emerging movement asymmetry
• Decreased participation in physical tasks
• Mild changes in cognitive engagement and communication

These factors are known to contribute to progressive decline in neuromuscular and cognitive function, even in individuals who are still functionally independent. In this context, the primary issue was not loss of strength, but:

• Early reduction in muscle power (ability to generate force quickly)
• Altered movement patterns
• Reduced cognitive–motor engagement due to inactivity

The intervention addressed these factors through:

• Power-oriented training
• Movement-specific neuromotor feedback
• Integration of cognitive and emotionally engaging tasks

Following the intervention, the patient demonstrated:

• Increased muscle power
• Improved movement symmetry and control
• Enhanced communication and engagement

• Increased daily physical activity, including a return to more frequent walking

These findings suggest that early-stage intervention can restore neuromuscular function and re-activate cognitive and emotional processes, leading to improved participation in daily life.

Conclusion

This case highlights the importance of early, preventive intervention in older adults who are still functionally independent but at risk of decline. Despite normal baseline functional performance, the presence of pain and reduced activity led to:

• Decreased movement participation
• Emerging asymmetry
• Reduced cognitive and emotional engagement

Following intervention with robotrainer, the patient demonstrated:

• Improved muscle power
• More symmetrical and controlled movement
• Increased communication and mental engagement
• Increased daily physical activity and participation

These findings suggest that targeting muscle power, neuromotor control, and cognitive–emotional engagement can help prevent future functional decline. This case supports a shift from reactive rehabilitation toward proactive, preventive strategies aimed at maintaining independence, activity levels, and quality of life in aging populations.

For a PDF copy of this case study, including a full list of references, please contact us.

About ddrobotec^®

ddrobotec^® is an instrumented leg press machine developed by Swiss-based company Dynamic Devices AG, and can test for over 50 biomarkers in as little as 20 minutes.

ddrobotec^® is made for athletic performance, health, injury recovery and longevity, precisely monitoring coordination, strength, power, endurance and more using sensors, artificial muscles and high-speed visual feedback.

It provides live, easy to interpret diagnostics and analytics on screen and sends instant reports. It then uses AI to recommend drills, workouts and exergames based on the individual’s insights. The system is suitable for all ages and can be utilised at all stages of rehabilitation.

ddrobotec^® delivers up to 2,700 N of force and 2160 Nm of torque per leg, with speeds of 8 m/s indefinitely. They offer testing and training modalities; eccentric, concentric, isotonic, isokinetic, elastic, vibra-mode, and much more.

About Summit Medical and Scientific

Summit Medical and Scientific are passionate about the power of technology.

We represent clinical technology leaders ddrobotec^®, Hocoma, Life Science Robotics, Motek and Reha Stim to provide the total solution for rehabilitation in the UK. Our partners have developed innovative therapy devices using robotics, sensors and virtual reality for early and acute rehabilitation, gait and balance therapy, arm and hand therapy, body weight support and more. Click here for all our clinical solutions.

On the biomechanics side, we represent AccuPower Solutions, AMTI, CONTEMPLAS, Cometa, ddrobotec^®, Motek, Sprintex, Treadmetrix, and XSENSOR to offer the latest equipment for the the assessment and measurement of balance, gait, movement, athletic performance, strength and conditioning, podiatry, orthopaedics and more. Click here for all our biomechanics solutions.

Get in touch with Summit Medical and Scientific today to find out more about incorporating state-of-the-art technology for rehabilitation and performance into your facility.

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