The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.

In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.

This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.

Robotic gait training is gaining ground in rehabilitation. Room for improvement lies in reducing donning and doffing time, making training more task specific and facilitating active balance control, and by allowing movement in more degrees of freedom. Our goal was to design and evaluate a robot that incorporates these improvements. LOPES II uses an end-effector approach with parallel actuation and a minimum amount of clamps. LOPES II has eight powered degrees of freedom (hip flexion/extension, hip abduction/adduction, knee flexion/extension, pelvis forward/aft and pelvis mediolateral). All other degrees of freedom can be left free and pelvis frontal- and transversal rotation can be constrained. Furthermore arm swing is unhindered. The end-effector approach eliminates the need for exact alignment, which results in a donning time of 10-14 min for first-time training and 5-8 min for recurring training. LOPES II is admittance controlled, which allows for the control over the complete spectrum from low to high impedance. When the powered degrees of freedom are set to minimal impedance, walking in the device resembles free walking, which is an important requisite to allow task-specific training. We demonstrated that LOPES II can provide sufficient support to let severely affected patients walk and that we can provide selective support to impaired aspects of gait of mildly affected patients.