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Do J, Lim WT, Kim DY, Ko EJ, Ko MH, Kim GW, Kim JH, Kim S, Kim H. Effects of high-intensity interval robot-assisted gait training on cardiopulmonary function and walking ability in chronic stroke survivors: A multicenter single-blind randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:1309-1319. [PMID: 38788059 DOI: 10.3233/bmr-230385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. OBJECTIVE To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. METHODS A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RESULTS RAGT significantly improved VO2max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. CONCLUSION RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation.
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Affiliation(s)
- Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Taek Lim
- Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine of Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Geon Woo Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - SooBin Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwal Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yakşi E, Bahadır ES, Yaşar MF, Alışık T, Kurul R, Demirel A. The effect of robot-assisted gait training frequency on walking, functional recovery, and quality of life in patients with stroke. Acta Neurol Belg 2023; 123:583-590. [PMID: 36717532 DOI: 10.1007/s13760-023-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
AIM This study aims to investigate the effects of robot-assisted gait training (RAGT) frequency on walking, functional recovery, QoL and mood. METHODS Sixty patients aged 50-75, diagnosed with post-stroke hemiplegia were entered into the retrospective analysis. Participants who scored maximum 3 on the Modified Rankin Scale and were diagnosed with moderate stroke according to The NIH Stroke Scale were included in the study. The participants in group 1 (G1) received only conventional treatment (CT), in group 2 (G2) participants received one session of RAGT per week in addition to the CT program, and group 3 (G3) received two sessions of RAGT per week in addition to the CT program. 6-min walk test (6-MWT), Barthel Index (BI), Stroke-Specific Quality of Life Scale (SSQoL), and Beck Depression Inventory (BDI) were recorded. RESULTS Median change in SSQoL of G3 was significantly higher from median change of G1 (p < 0.05), and median change in BDI of G3 was significantly lower than median change of G1 (p < 0.05). Median change in BDI of G3 was also significantly lower from change of G2 (p < 0.05). CONCLUSION Two weekly sessions of RAGT in addition to CT exhibit positive effects on QoL and mood but no additional contribution to functional status.
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Affiliation(s)
- Elif Yakşi
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey.
| | - Elif Selim Bahadır
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Mustafa Fatih Yaşar
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Tuğba Alışık
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Ramazan Kurul
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Adnan Demirel
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
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Morioka H, Hirayama T, Sugisawa T, Murata K, Shibukawa M, Ebina J, Sawada M, Hanashiro S, Nagasawa J, Yanagihashi M, Uchi M, Kawabe K, Washizawa N, Ebihara S, Nakajima T, Kano O. Robot-assisted training using hybrid assistive limb ameliorates gait ability in patients with amyotrophic lateral sclerosis. J Clin Neurosci 2022; 99:158-163. [PMID: 35279589 DOI: 10.1016/j.jocn.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Hybrid Assistive Limb (HAL; CYBERDYNE, Inc., Japan) is a wearable robot device that provides effective gait assistance according to voluntary intention by detecting weak bioelectrical signals of neuromuscular activity on the surface of the skin. We used HAL for patients with amyotrophic lateral sclerosis (ALS) to determine whether HAL training had an effect on their gait ability. METHODS We conducted a single-center, single-arm, observational study. Patients with ALS underwent HAL training once per day (20-40 min per session) for 9-10 days for at least 4 weeks. Gait ability was evaluated using the 2-minute walk test, the 10-meter walk test without the assistance of HAL, and activities of daily living (ADL) using the Barthel Index and Functional Independence Measures before and after a full course of HAL training. RESULTS There were no dropouts or adverse events during the observation period. Gait function improved after HAL training. The 2-minute walk test revealed a mean gait distance of 73.87 m (36.65) at baseline and 89.9m (36.70) after HAL training (p = 0.004). The 10-meter walk test showed significantly improved cadence, although gait speed, step length on the 10-m walk, or ADL measurements did not change significantly. CONCLUSIONS Although HAL is not a curative treatment for ALS, our data suggest that HAL may be effective in ameliorating and preserving gait ability in patients with ALS.
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Affiliation(s)
- Harumi Morioka
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takehisa Hirayama
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Tatsuki Sugisawa
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kiyoko Murata
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Mari Shibukawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masahiro Sawada
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Sayori Hanashiro
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Junpei Nagasawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masaru Yanagihashi
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masayuki Uchi
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Kiyokazu Kawabe
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Naohiro Washizawa
- Nutrition Therapy Center, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takashi Nakajima
- Niigata National Hospital, National Hospital Organization, 3-52 Akasaka Kashiwazaki City, Niigata 945-8585, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan.
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A Review on the Rehabilitation Exoskeletons for the Lower Limbs of the Elderly and the Disabled. ELECTRONICS 2022. [DOI: 10.3390/electronics11030388] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Research on the lower limb exoskeleton for rehabilitation have developed rapidly to meet the need of the aging population. The rehabilitation exoskeleton system is a wearable man–machine integrated mechanical device. In recent years, the vigorous development of exoskeletal technology has brought new ideas to the rehabilitation and medical treatment of patients with motion dysfunction, which is expected to help such people complete their daily physiological activities or even reshape their motion function. The rehabilitation exoskeletons conduct assistance based on detecting intention, control algorithm, and high-performance actuators. In this paper, we review rehabilitation exoskeletons from the aspects of the overall design, driving unit, intention perception, compliant control, and efficiency validation. We discussed the complexity and coupling of the man–machine integration system, and we hope to provide a guideline when designing a rehabilitation exoskeleton system for the lower limbs of elderly and disabled patients.
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Palmcrantz S, Wall A, Vreede KS, Lindberg P, Danielsson A, Sunnerhagen KS, Häger CK, Borg J. Impact of Intensive Gait Training With and Without Electromechanical Assistance in the Chronic Phase After Stroke-A Multi-Arm Randomized Controlled Trial With a 6 and 12 Months Follow Up. Front Neurosci 2021; 15:660726. [PMID: 33967683 PMCID: PMC8100236 DOI: 10.3389/fnins.2021.660726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Movement related impairments and limitations in walking are common long-term after stroke. This multi-arm randomized controlled trial explored the impact of training with an electromechanically assisted gait training (EAGT) system, i.e., the Hybrid Assistive Limb® (HAL), when integrated with conventional rehabilitation focused on gait and mobility. Material and Methods: Participants, aged 18–70 years with lower extremity paresis but able to walk with manual support or supervision 1–10 years after stroke, were randomized to (A) HAL-training on a treadmill, combined with conventional rehabilitation interventions (HAL-group), or (B) conventional rehabilitation interventions only (Conventional group), 3 days/week for 6 weeks, or (C) no intervention (Control group). Participants in the Control group were interviewed weekly regarding their scheduled training. Primary outcome was endurance in walking quantified by the 6 Minute Walk Test (6MWT). A rater blinded to treatment allocation performed assessments pre- and post-intervention and at follow-ups at 6 and 12 months. Baseline assessment included the National Institute of Health Stroke Scale (NIHSS) and the Modified Ranking Scale (MRS). Secondary outcomes included the Fugl Meyer Assessment- Lower Extremity, 10 Meter Walk Test, Berg Balance Scale (BBS), Barthel Index (BI) and perceived mobility with the Stroke Impact Scale. Results: A total of 48 participants completed the intervention period. The HAL-group walked twice as far as the Conventional group during the intervention. Post-intervention, both groups exhibited improved 6 MWT results, while the Control group had declined. A significant improvement was only found in the Conventional group and when compared to the Control group (Tukey HSD p = 0.022), and not between the HAL group and Conventional group (Tukey HSD p = 0.258) or the HAL- group and the Control group (Tukey HSD p = 0.447). There was also a significant decline in the Conventional group from post-intervention to 6 months follow up (p = 0.043). The best fitting model to predict outcome included initial balance (BBS), followed by stroke severity (NIHSS), and dependence in activity and participation (BI and MRS). Conclusion: Intensive conventional gait training induced significant improvements long-term after stroke while integrating treadmill based EAGT had no additional value in this study sample. The results may support cost effective evidence-based interventions for gait training long-term after stroke and further development of EAGT. Trial registration: Published on clinicaltrials.gov (NCT02545088) August 24, 2015.
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Affiliation(s)
- Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anneli Wall
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Skough Vreede
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Påvel Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Anna Danielsson
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte K Häger
- Section for Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Jörgen Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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