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Tang Z, Zhao Y, Sun X, Liu Y, Su W, Liu T, Zhang X, Zhang H. Evidence that robot-assisted gait training modulates neuroplasticity after stroke: An fMRI pilot study based on graph theory analysis. Brain Res 2024; 1842:149113. [PMID: 38972627 DOI: 10.1016/j.brainres.2024.149113] [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: 05/03/2024] [Revised: 06/10/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT). METHODS 21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored. RESULTS Compared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp. CONCLUSIONS Small-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke.
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Affiliation(s)
- Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yaxian Zhao
- Department of Cardiac Surgery, Peking University International Hospital, Beijing, China
| | - Xinting Sun
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Ying Liu
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Wenlong Su
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China; University of Health and Rehabilitation Sciences, Shandong Province, China
| | - Tianhao Liu
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiaonian Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China; Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China; Cheeloo College of Medicine, Shandong University, Shandong Province, China; University of Health and Rehabilitation Sciences, Shandong Province, China.
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Park GM, Cho SH, Hong JT, Kim DH, Shin JC. Effects and Safety of Wearable Exoskeleton for Robot-Assisted Gait Training: A Retrospective Preliminary Study. J Pers Med 2023; 13:jpm13040676. [PMID: 37109062 PMCID: PMC10144215 DOI: 10.3390/jpm13040676] [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: 03/20/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Wearable devices for robot-assisted gait training (RAGT) provide overground gait training for the rehabilitation of neurological injuries. We aimed to evaluate the effectiveness and safety of RAGT in patients with a neurologic deficit. METHODS Twenty-eight patients receiving more than ten sessions of overground RAGT using a joint-torque-assisting wearable exoskeletal robot were retrospectively analyzed in this study. Nineteen patients with brain injury, seven patients with spinal cord injury and two patients with peripheral nerve injury were included. Clinical outcomes, such as the Medical Research Council scale for muscle strength, Berg balance scale, functional ambulation category, trunk control tests, and Fugl-Meyer motor assessment of the lower extremities, were recorded before and after RAGT. Parameters for RAGT and adverse events were also recorded. RESULTS The Medical Research Council scale scores for muscle strength (36.6 to 37.8), Berg balance scale (24.9 to 32.2), and functional ambulation category (1.8 to 2.7) significantly improved after overground RAGT (p < 0.05). The familiarization process was completed within six sessions of RAGT. Only two mild adverse events were reported. CONCLUSIONS Overground RAGT using wearable devices can improve muscle strength, balance, and gait function. It is safe in patients with neurologic injury.
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Affiliation(s)
- Gwang-Min Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Su-Hyun Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jun-Taek Hong
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Dae-Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul 06355, Republic of Korea
| | - Ji-Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Mathematical Analysis and Motion Capture System Utilization Method for Standardization Evaluation of Tracking Objectivity of 6-DOF Arm Structure for Rehabilitation Training Exercise Therapy Robot. Diagnostics (Basel) 2022; 12:diagnostics12123179. [PMID: 36553186 PMCID: PMC9777214 DOI: 10.3390/diagnostics12123179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
A treatment method for suppressing shoulder pain by reducing the secretion of neurotransmitters in the brain is being studied in compliance with domestic and international standards. A robot is being developed to assist physical therapists in shoulder rehabilitation exercise treatment. The robot used for rehabilitation therapy enables the training of patients to perform rehabilitation exercises repeatedly. However, the biomechanical movement (or motion) of the shoulder joint should be accurately designed to enhance efficiency using a shoulder rehabilitation robot. Furthermore, safely treating patients by accurately evaluating biomechanical movements in compliance with domestic and international standards is a major task. Therefore, an in-depth analysis of shoulder movement is essential for understanding the mechanism of shoulder rehabilitation using robots. This paper proposes a method for analyzing shoulder movements. The rotation angle and range of motion (ROM) of the shoulder joint are measured by attaching a marker to the body and analyzing the inverse kinematics. The first motion is abduction and adduction, and the second is external and internal rotation. The location information of the marker is transmitted to an application software through an infrared camera. For the analysis using an inverse kinematics solution, five males and five females participated in the motion capture experiment. The subjects did not have any disability, and abduction and adduction were repeated 10 times. As a result, ROM of the abduction and adduction were 148° with males and 138.7° in females. Moreover, ROM of the external and internal rotation were 111.2° with males and 106° in females. Because this study enables tracking of the center coordinates of the joint suitably through a motion capture system, inverse kinematics can be accurately calculated. Additionally, a mathematical inverse kinematics equation will utilize follow-up study for designing an upper rehabilitations robot. The proposed method is assessed to be able to contribute to the definition of domestic and international standardization of rehabilitation robots and motion capture for objective evaluation.
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Lee J, Chun MH, Seo YJ, Lee A, Choi J, Son C. Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e31590. [PMID: 36343085 PMCID: PMC9646640 DOI: 10.1097/md.0000000000031590] [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: 11/09/2022] Open
Abstract
BACKGROUND The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke. METHODS Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower). RESULTS The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05). CONCLUSION This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * Correspondence: Min Ho Chun, Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
| | - Yu Jin Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Anna Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Choi
- The Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Choonghyun Son
- The Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
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Park M, Cho Y, Kim DH, Choi HS, Kim DH, Kim DY. Myelin Water Imaging of Nerve Recovery in Rehabilitating Stroke Patients. J Magn Reson Imaging 2022; 56:1548-1556. [PMID: 35353434 DOI: 10.1002/jmri.28185] [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: 01/06/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Myelin water imaging (MWI) using MRI has been introduced as a method to quantify the integrity of myelin in vivo. However, the investigation of its potential to probe myelin changes has been limited. PURPOSE To determine the myelin change using MWI in the corticospinal tract (CST) during the rehabilitation of stroke patients. STUDY TYPE Longitudinal. POPULATION A total of 24 stroke patients within 6 months from the onset (64.3 ± 16.1 years, 14 women, 10 men) and 10 healthy volunteers (27.0 ± 2.2 years, 2 women, 8 men). FIELD STRENGTH/SEQUENCE Three-dimensional multiecho gradient echo sequence and diffusion-weighted echoplanar imaging sequence at 3 T. ASSESSMENT The changes of myelin water fraction (MWF) and fractional anisotropy (FA) during rehabilitation were analyzed in the CST and other regions using tractography software and region of interest drawings by the radiologist. STATISTICAL TESTS A paired t-test was performed to investigate the change of MRI metrics during rehabilitation. In addition, an independent two-sample t-test was performed to investigate the effects of different rehabilitation protocols. A P-value <0.05 was considered significant. RESULTS In the CST, MWF significantly changed from 5.83 ± 0.91% to 6.23 ± 0.97% after rehabilitation while changes of FA (0.442 ± 0.038 to 0.443 ± 0.035) were not significant (P = 0.656). The rate of change in MWF and FA, which were 6.69% and 0.439% respectively, were significantly different. Other regions did not show significant changes (range of MWF change: -3.44% to -1.61%, range of FA change: -1.39% to 0.79%, and range of P-value: 0.144-0.761). Further analysis showed that those with additional robot-assisted rehabilitation had a significantly larger MWF change than those with conventional rehabilitation only (rate of change: 11.2% vs. 3.2%). DATA CONCLUSION The feasibility of using MWI to monitor myelin content was demonstrated by showing the MWF changes during rehabilitation. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Muyul Park
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yejin Cho
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Seok Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyun Kim
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Adjustable Parameters and the Effectiveness of Adjunct Robot-Assisted Gait Training in Individuals with Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138186. [PMID: 35805845 PMCID: PMC9265951 DOI: 10.3390/ijerph19138186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
The aims of this study were (1) to compare the effect of robot-assisted gait orthosis (RAGO) plus conventional physiotherapy with the effect of conventional therapy alone on functional outcomes, including balance, walking ability, muscle strength, daily activity, and cognition, in chronic stroke patients, and (2) to determine the association of adjustable parameters of RAGO on functional outcomes. Adjustable parameters of RAGO included guidance force, treadmill speed, and body-weight support. This retrospective cohort study enrolled 32 patients with chronic stroke. Of these, 16 patients received RAGO plus conventional physiotherapy (RAGO group), and 16 patients received conventional physiotherapy alone (control group). Balance was assessed using the Berg Balance Scale, walking ability using the Functional Ambulation Category, muscle strength using the Motricity Index, daily activity using the Barthel Index, and cognition using the Mini-Mental State Examination. The scores were assessed before and after training. The Mini–Mental State Examination and the Berg Balance Scale increased significantly in both groups, whereas improvements in the Motricity Index and the Barthel Index were only observed in the RAGO group after intervention. During RAGO training, reducing guidance force and body-weight support assistance was associated with improvements in the Barthel Index, whereas higher treadmill walking speed was associated with improvements in the Berg Balance Scale. Our study found that RAGO combination therapy resulted in improvements in more functional outcomes than did conventional training alone. The adjustable parameters of the RAGO training were partly associated with training outcomes.
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Tavazzi E, Bergsland N, Pirastru A, Cazzoli M, Blasi V, Baglio F. MRI markers of functional connectivity and tissue microstructure in stroke-related motor rehabilitation: A systematic review. Neuroimage Clin 2021; 33:102931. [PMID: 34995869 PMCID: PMC8741615 DOI: 10.1016/j.nicl.2021.102931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stroke-related disability is a major problem at individual and socio-economic levels. Neuromotor rehabilitation has a key role for its dual action on affected body segment and brain reorganization. Despite its known efficacy in clinical practice, the extent and type of effect at a brain level, mediated by neuroplasticity, are still under question. OBJECTIVE To analyze studies applying MRI markers of functional and structural connectivity in patients affected with stroke undergoing motor rehabilitation, and to evaluate the effect of rehabilitation on brain reorganization. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were applied to select studies applying quantitative non-conventional MRI techniques on patients undergoing motor rehabilitation, both physical and virtual (virtual reality, mental imagery). Literature search was conducted using MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE from inception to 30th June 2020. RESULTS Forty-one out of 6983 papers were included in the current review. Selected studies are heterogeneous in terms of patient characteristics as well as type, duration and frequency of rehabilitative approach. Neuromotor rehabilitation promotes neuroplasticity, favoring functional recovery of the ipsilesional hemisphere and activation of anatomically and functionally related brain areas in both hemispheres, to compensate for damaged tissue. CONCLUSIONS The evidence derived from the analyzed studies supports the positive impact of rehabilitation on brain reorganization, despite the high data heterogeneity. Advanced MRI techniques provide reliable markers of structural and functional connectivity that may potentially aid in helping to implement the most appropriate rehabilitation intervention.
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Affiliation(s)
- E Tavazzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - N Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States.
| | - A Pirastru
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M Cazzoli
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - V Blasi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - F Baglio
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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Stage 2: Who Are the Best Candidates for Robotic Gait Training Rehabilitation in Hemiparetic Stroke? J Clin Med 2021; 10:jcm10235715. [PMID: 34884417 PMCID: PMC8658177 DOI: 10.3390/jcm10235715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to compare the effects of robotic-assisted gait training (RAGT) in patients with FAC < 2 (low initial functional ambulation category [LFAC]) and FAC ≥ 2 (high initial functional ambulation category [HFAC]) on sensorimotor and spasticity, balance and trunk stability, the number of steps and walking distance in subacute hemiparetic stroke. Fifty-seven patients with subacute hemiparetic stroke (mean age, 63.86 ± 12.72 years; 23 women) were assigned to two groups. All patients received a 30-min Walkbot-assisted gait training session, 3 times/week, for 6 weeks. Clinical outcomes included scores obtained on the Fugl-Meyer Assessment (FMA) scale, Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), trunk impairment scale (TIS), and the number of walking steps and walking distance. Analysis of covariance and analysis of variance were conducted at p < 0.05. Significant main effects of time in both groups on number of walking steps and distance (p < 0.05) were observed, but not in MAS (p> 0.05). Significant changes in FMA, BBS, and TIS scores between groups (p < 0.05) were observed. Significant main effects of time on BBS and TIS were demonstrated (p < 0.05). Our study shows that RAGT can maximize improvement in the functional score of FMA, BBS, TIS, steps, and distance during neurorehabilitation of subacute stroke patients regardless of their FAC level.
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Park C, Oh-Park M, Bialek A, Friel K, Edwards D, You JSH. Abnormal synergistic gait mitigation in acute stroke using an innovative ankle-knee-hip interlimb humanoid robot: a preliminary randomized controlled trial. Sci Rep 2021; 11:22823. [PMID: 34819515 PMCID: PMC8613200 DOI: 10.1038/s41598-021-01959-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/03/2021] [Indexed: 12/13/2022] Open
Abstract
Abnormal spasticity and associated synergistic patterns are the most common neuromuscular impairments affecting ankle–knee–hip interlimb coordinated gait kinematics and kinetics in patients with hemiparetic stroke. Although patients with hemiparetic stroke undergo various treatments to improve gait and movement, it remains unknown how spasticity and associated synergistic patterns change after robot-assisted and conventional treatment. We developed an innovative ankle–knee–hip interlimb coordinated humanoid robot (ICT) to mitigate abnormal spasticity and synergistic patterns. The objective of the preliminary clinical trial was to compare the effects of ICT combined with conventional physical therapy (ICT-C) and conventional physical therapy and gait training (CPT-G) on abnormal spasticity and synergistic gait patterns in 20 patients with acute hemiparesis. We performed secondary analyses aimed at elucidating the biomechanical effects of Walkbot ICT on kinematic (spatiotemporal parameters and angles) and kinetic (active force, resistive force, and stiffness) gait parameters before and after ICT in the ICT-C group. The intervention for this group comprised 60-min conventional physical therapy plus 30-min robot-assisted training, 7 days/week, for 2 weeks. Significant biomechanical effects in knee joint kinematics; hip, knee, and ankle active forces; hip, knee, and ankle resistive forces; and hip, knee, and ankle stiffness were associated with ICT-C. Our novel findings provide promising evidence for conventional therapy supplemented by robot-assisted therapy for abnormal spasticity, synergistic, and altered biomechanical gait impairments in patients in the acute post-stroke recovery phase. Trial Registration: Clinical Trials.gov identifier NCT03554642 (14/01/2020).
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Affiliation(s)
- Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Mooyeon Oh-Park
- Burke Rehabilitation Hospital, White Plains, NY, USA.,Albert Einstein College of Medicine, Montefiore Health System, White Plains, NY, USA
| | - Amy Bialek
- Burke Neurological Institute, White Plains, NY, USA
| | | | - Dylan Edwards
- Moss Rehabilitation, Elkins Park, PA, USA.,Edith Cowan University, Joondalup, Australia
| | - Joshua Sung H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, Republic of Korea. .,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.
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PARK CHANHEE, HWANG JONGSEOK, YOU JOSHUASUNGH. COMPARATIVE EFFECTIVENESS OF ROBOT-INTERACTIVE GAIT TRAINING WITH AND WITHOUT ANKLE ROBOTIC CONTROL IN PATIENTS WITH BRAIN DAMAGE. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although ankle robotic control has emerged as a critical component of robot-interactive gait training (RIGT), no study has investigated the neurophysiological and biomechanical effects on ankle muscle activity and joint angle kinematics in healthy adults and participants with brain damage, including stroke and cerebral palsy (CP). This study compared the effects of RIGT, with and without ankle control actuator, on ankle muscle activity and joint angle kinematics in healthy adults and participants with brain damage. Ten patients ([Formula: see text], left hemiparetic [Formula: see text], [Formula: see text]) underwent standardized surface electromyography (EMG) neurophysiological and kinematics biomechanical tests under the RIGT with and without ankle control actuator conditions. Outcome measures included the EMG amplitudes of the tibialis anterior and gastrocnemius muscle activity, and ankle movement angles recorded with a two-axis digital inclinometer. Descriptive statistical analysis demonstrated that RIGT with ankle control actuator showed superior effects on EMG (30%) and kinematics angles (25%) than RIGT without ankle control actuator. Our results provided novel, promising clinical evidence that RIGT with ankle control actuator can more effectively improve the neurophysiological EMG data and ankle dorsiflexion and plantarflexion movements than RIGT without ankle control actuator in participants with stroke and CP.
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Affiliation(s)
- CHANHEE PARK
- Sports. Movement Artificial-Intelligence, Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
| | - JONGSEOK HWANG
- Sports. Movement Artificial-Intelligence, Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
| | - JOSHUA SUNG H. YOU
- Sports. Movement Artificial-Intelligence, Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
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Cha B, Lee KH, Ryu J. Deep-Learning-Based Emergency Stop Prediction for Robotic Lower-Limb Rehabilitation Training Systems. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1120-1128. [PMID: 34106857 DOI: 10.1109/tnsre.2021.3087725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Robotic lower-limb rehabilitation training is a better alternative for the physical training efforts of a therapist due to advantages, such as intensive repetitive motions, economical therapy, and quantitative assessment of the level of motor recovery through the measurement of force and movement patterns. However, in actual robotic rehabilitation training, emergency stops occur frequently to prevent injury to patients. However, frequent stopping is a waste of time and resources of both therapists and patients. Therefore, early detection of emergency stops in real-time is essential to take appropriate actions. In this paper, we propose a novel deep-learning-based technique for detecting emergency stops as early as possible. First, a bidirectional long short-term memory prediction model was trained using only the normal joint data collected from a real robotic training system. Next, a real-time threshold-based algorithm was developed with cumulative error. The experimental results revealed a precision of 0.94, recall of 0.93, and F1 score of 0.93. Additionally, it was observed that the prediction model was robust for variations in measurement noise.
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Koo KI, Hwang CH. Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending tool for deafferentation, weight offloading and stereotyped movement: Interim analysis. PLoS One 2020; 15:e0241117. [PMID: 33326434 PMCID: PMC7743990 DOI: 10.1371/journal.pone.0241117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
Deafferentation and weight offloading can increase brain and spinal motor neuron excitability, respectively. End-effector gait robots (EEGRs) can blend these effects with stereotyped movement-induced neuroplasticity. The authors aimed to evaluate the usefulness of EEGRs as a postoperative neuro-muscular rehabilitation tool. This prospective randomized controlled trial included patients who had undergone unilateral total knee arthroplasty (TKA). Patients were randomly allocated into two groups: one using a 200-step rehabilitation program in an EEGR or the other using a walker on a floor (WF) three times a day for five weekdays. The two groups were compared by electrophysiological and biomechanical methods. Since there were no more enrollments due to funding issues, interim analysis was performed. Twelve patients were assigned to the EEGR group and eight patients were assigned to the WF group. Although the muscle volume of the quadriceps and hamstring did not differ between the two groups, the normalized peak torque of the operated knee flexors (11.28 ± 16.04 Nm/kg) was improved in the EEGR group compared to that of the operated knee flexors in the WF group (4.25 ± 14.26 Nm/kg) (p = 0.04). The normalized compound motor action potentials of the vastus medialis (VM) and biceps femoris (BF) were improved in the EEGR group (p < 0.05). However, the normalized real-time peak amplitude and total, mean area under the curve of VM were decreased during rehabilitation in the EEGR group (p < 0.05). No significant differences were found between operated and non-operated knees in the EEGR group. Five-day EEGR-assisted rehabilitation induced strengthening in the knee flexors and the muscular reactivation of the BF and VM after TKA, while reducing the real-time use of the VM. This observation may suggest the feasibility of this technique: EEGR modulated the neuronal system of the patients rather than training their muscles. However, because the study was underpowered, all of the findings should be interpreted with the utmost caution.
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Affiliation(s)
- Kyo-In Koo
- Department of Biomedical Engineering, School of Electrical Engineering, University of Ulsan, Ulsan, Republic of Korea
| | - Chang Ho Hwang
- Department of Physical and Rehabilitation Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
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Heng HM, Lu MK, Chou LW, Meng NH, Huang HC, Hamada M, Tsai CH, Chen JC. Changes in Balance, Gait and Electroencephalography Oscillations after Robot-Assisted Gait Training: An Exploratory Study in People with Chronic Stroke. Brain Sci 2020; 10:brainsci10110821. [PMID: 33171938 PMCID: PMC7694605 DOI: 10.3390/brainsci10110821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Robot-assisted gait training (RAGT) systems offer the advantages of standard rehabilitation and provide precise and quantifiable control of therapy. We examined the clinical outcome of RAGT and analyzed the correlations between gait analysis data and event-related desynchronization (ERD) and event-related synchronization (ERS) in patients with chronic stroke. We applied the Berg balance scale (BBS) and analyzed gait parameters and the ERD and ERS of self-paced voluntary leg movements performed by patients with chronic stroke before and after undergoing RAGT. A significant change was observed in BBS (p = 0.011). We also showed preliminary outcomes of changes in gait cycle duration (p = 0.015) and in ipsilesional ERS in the low-beta (p = 0.033) and high-beta (p = 0.034) frequency bands before and after RAGT. In addition, correlations were observed between BBS and ipsilesional ERS in the alpha and low-beta bands (r = −0.52, p = 0.039; r = −0.52, p = 0.040). The study demonstrated that RAGT can improve balance and provided an idea of the possible role of brain oscillation and clinical outcomes in affecting stroke rehabilitation.
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Affiliation(s)
- Hoon-Ming Heng
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Li-Wei Chou
- Department of Rehabilitation, Asia University Hospital, Taichung City 404, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 404, Taiwan;
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 404, Taiwan
| | - Hui-Chun Huang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Masashi Hamada
- Department of Neurology, The University of Tokyo, Graduate School of Medicine, Tokyo 100-0000, Japan;
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
| | - Jui-Cheng Chen
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung City 404, Taiwan; (H.-M.H.); (M.-K.L.); (H.-C.H.); (C.-H.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
- Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu 300, Taiwan
- Correspondence:
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Kim DH, Kang CS, Kyeong S. Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study. NeuroRehabilitation 2020; 46:483-489. [DOI: 10.3233/nre-203054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Chang Soon Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sohyun Kyeong
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
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15
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Structural and functional connectivity correlates with motor impairment in chronic supratentorial stroke: a multimodal magnetic resonance imaging study. Neuroreport 2019; 30:526-531. [PMID: 30932970 DOI: 10.1097/wnr.0000000000001247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to identify differences in structural and functional brain connectivity between poststroke mild and severe motor impairment. Twenty-four chronic stroke patients who underwent resting-state functional MRI and diffusion tensor image were retrospectively included. All patients were classified into two groups (mild motor impairment: 11 patients and severe motor impairment: 13 patients) according to their Fugl-Meyer motor assessment score. Tract-based spatial statistics and group independent component analyses were applied to investigate between-group differences in structural and functional connectivity, respectively. The fractional anisotropy values of motor-related brain regions in the affected hemisphere were significantly higher in mild motor impairment than in severe motor impairment (corrected P<0.05). The internetwork functional connectivity between (i) the supplementary motor area and primary motor cortex in the affected hemisphere, (ii) the supplementary motor area and dorsolateral prefrontal cortex in the unaffected hemisphere, and (iii) the ischemic lesion and primary motor cortex in the unaffected hemisphere was significantly higher in mild motor impairment than in severe motor impairment (PFWE<0.05). Better motor recovery after stroke could be facilitated by means of treatments aimed at enhancing structural and functional connectivity among motor-related brain regions such as noninvasive brain stimulation and neurodevelopmental therapy.
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Hwang CH. Immediate muscle strengthening by an end-effector type gait robot with reduced real-time use of leg muscles: A case series and review of literature. World J Clin Cases 2019; 7:2976-2985. [PMID: 31624745 PMCID: PMC6795730 DOI: 10.12998/wjcc.v7.i19.2976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND De-afferentation or non-weight bearing induces rapid cortical and spinal α-motor neuron excitability. Author supposed that an end-effector type gait robot (EEGR) could provide patients with a training condition that was specific enough to activate rapid cortical/spinal neuroplasticity, leading to immediate muscle strengthening. The electromyographic and biomechanical comparisons were conducted.
AIM To compare the electromyographic activities of the thigh and shank muscles and isometric peak torque (PT) before and after walking training on a floor or in the end-effector gait robot.
METHODS Twelve outpatients without ambulatory dysfunction were recruited. Order of two interventions (5-min training on a floor at a comfortable pace or training in an EEGR with non-weight bearing on their feet and 100% guidance force at 2.1 km/h) were randomly chosen. Isometric PT, maximal ratio of torque development, amplitude of compound motor action potential (CMAP), and area under the curve (AUC) were evaluated before and 10 min after both interventions.
RESULTS The degree of PT improvement of the dominant knee flexors was larger in the EEGR than on the floor (9.6 ± 22.4 Nm/BW, P < 0.01). The EEGR-trained patients had greater PT improvement of the dominant knee extensors than those who trained on the floor (4.5 ± 28.1 Nm/BW, P < 0.01). However, all electromyographic activities of the thigh and shank muscles (peak CMAP, mean and peak AUC) were significantly lower for the use of the EEGR than walking on the floor.
CONCLUSION Immediate strengthening of the knee flexors and extensors was induced after the 5-min EEGR training, despite reduced muscular use.
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Affiliation(s)
- Chang Ho Hwang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
- Department of Biomedical Engineering, School of Electrical Engineering, University of Ulsan, Ulsan 44610, South Korea
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Kim J, Kim DY, Chun MH, Kim SW, Jeon HR, Hwang CH, Choi JK, Bae S. Effects of robot-(Morning Walk®) assisted gait training for patients after stroke: a randomized controlled trial. Clin Rehabil 2018; 33:516-523. [DOI: 10.1177/0269215518806563] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the effects of Morning Walk®–assisted gait training for patients with stroke. Design: Prospective randomized controlled trial. Setting: Three hospital rehabilitation departments (two tertiary and one secondary). Patients: We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2. Intervention: The patients were randomly assigned to one of two treatment groups: 30 minutes of training with Morning Walk®, a lower limb rehabilitation robot, plus 1 hour of conventional physiotherapy (Morning Walk® group; n = 28); or 1.5 hour of conventional physiotherapy (control group; n = 30). All received treatment five times per week for three weeks. Main outcome measurements: The primary outcomes were walking ability, assessed using the Functional Ambulation Category scale, and lower limb function, assessed using the Motricity Index-Lower. Secondary outcomes included the 10 Meter Walk Test, Modified Barthel Index, Rivermead Mobility Index, and Berg Balance Scale scores. Results: A total of 10 patients were lost to follow-up, leaving a cohort of 48 for the final analyses. After training, all outcome measures significantly improved in both groups. In Motricity Index-Lower of the affected limb, the Morning Walk® group (∆mean ± SD; 19.68 ± 14.06) showed greater improvement ( p = .034) than the control group (∆mean ± SD; 11.70 ± 10.65). And Berg Balance Scale scores improved more ( p = .047) in the Morning Walk® group (∆mean ± SD; 14.36 ± 9.01) than the control group (∆mean ± SD; 9.65 ± 8.14). Conclusion: Compared with conventional physiotherapy alone, our results suggest that voluntary strength and balance of stroke patients with hemiparesis might be improved with Morning Walk®–assisted gait training combined with conventional physiotherapy.
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Affiliation(s)
- JaYoung Kim
- Department of Rehabilitation medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ho Chun
- Department of Rehabilitation medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ha Ra Jeon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Ho Hwang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Kyoung Choi
- Department of Rehabilitation medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suhwan Bae
- Department of Rehabilitation medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea
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Seo JS, Yang HS, Jung S, Kang CS, Jang S, Kim DH. Effect of reducing assistance during robot-assisted gait training on step length asymmetry in patients with hemiplegic stroke: A randomized controlled pilot trial. Medicine (Baltimore) 2018; 97:e11792. [PMID: 30113466 PMCID: PMC6112970 DOI: 10.1097/md.0000000000011792] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An assist-as-needed robot-assisted gait training protocol was recently developed. It allows active movement during training, but its exact criteria remain unknown. Asymmetric step length is a common abnormal gait pattern in hemiplegic stroke patients. We compared the effects of assist-as-needed robot-assisted gait training on the unaffected and affected limbs of hemiplegic stroke patients. METHOD Twenty-four chronic stroke patients with asymmetric step lengths were randomly assigned to 1 of 2 groups. Twelve completed the study protocol. Group 1 underwent 20 sessions of assist-as-needed robot-assisted gait training for the unaffected limb and fully-assisted robot-assisted training for the affected limb. Group 2 underwent 20 sessions of robot-assisted gait training using the opposite protocol. Clinical measurements were obtained and 3-dimensional gait analyses were performed at baseline and after 10 and 20 training sessions. RESULTS Clinical measurements improved in both groups after 20 training sessions. The unaffected limb's step length asymmetry ratio and hip maximal extension moment significantly improved in group 1. The affected limb's maximal dorsiflexion angle for the ankle in the swing phase significantly improved in group 2. CONCLUSION Application of the assist-as-needed training mode for the unaffected limb helped improve step length asymmetry in chronic stroke patients.
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Kim DH, Kyeong S, Do KH, Lim SK, Cho HK, Jung S, Kim HW. Brain mapping for long-term recovery of gait after supratentorial stroke: A retrospective cross-sectional study. Medicine (Baltimore) 2018; 97:e0453. [PMID: 29668613 PMCID: PMC5916674 DOI: 10.1097/md.0000000000010453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The recovery of independent gait after stroke is a main goal of patients and understanding the relationship between brain lesions and the recovery of gait can help physicians set viable rehabilitation plans. Our study investigated the association between variables of gait parameters and brain lesions.Fifty poststroke patients with a mean age of 67.5 ± 1.3 years and an average duration after onset of 62.2 ± 7.9 months were included. Three-dimensional gait analysis and magnetic resonance imaging were conducted for all patients. Twelve quantified gait parameters of temporal-spatial, kinematic, and kinetic data were used. To correlate gait parameters with specific brain lesions, we used a voxel-based lesion symptom mapping analysis. Statistical significance was set to an uncorrected P value <.005 and cluster size >10 voxels.Based on the location of a brain lesion, the following results were obtained: The posterior limb of the internal capsule was significantly associated with gait speed and increased knee extension in the stance phase. The hippocampus and frontal lobe were significantly associated with cadence. The proximal corona radiata was significantly associated with stride length and affected the hip maximal extension angle in the stance phase. The paracentral lobule was significantly associated with the affected knee maximal flexion angle in the swing phase and with the affected ankle maximal dorsiflexion angle in the stance phase. The frontal lobe, thalamus, and the lentiform nucleus were associated with kinetic gait parameters.Cortical, proximal white matter, and learning-related and motor-related areas are mainly associated with one's walking ability after stroke.
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Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Gangdong-gu
- Graduate School, The Catholic University of Korea, Seocho-gu
| | - Sunghyon Kyeong
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Gangdong-gu
| | - Seong Kyu Lim
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan-si
| | - Hyong Keun Cho
- Department of Physical Medicine and Rehabilitation, Yes Hospital, Suji-gu, Yongin-si, Gyeonggi-do
| | - Suk Jung
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Gangdong-gu
| | - Hye Won Kim
- Department of Rehabilitation Medicine, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
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Caeyenberghs K, Clemente A, Imms P, Egan G, Hocking DR, Leemans A, Metzler-Baddeley C, Jones DK, Wilson PH. Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review. Neurorehabil Neural Repair 2018; 32:99-114. [PMID: 29357743 DOI: 10.1177/1545968317753076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)-based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.
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Affiliation(s)
| | - Adam Clemente
- 1 Australian Catholic University, Melbourne, Victoria, Australia
| | - Phoebe Imms
- 1 Australian Catholic University, Melbourne, Victoria, Australia
| | - Gary Egan
- 2 Monash University, Clayton, Victoria, Australia
| | | | | | | | | | - Peter H Wilson
- 1 Australian Catholic University, Melbourne, Victoria, Australia
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Jung M, Kim DY, Chun MH. Effect of Robot-Assisted Gait Training in Patients with Gait Disturbance Caused by Brain Tumor: a Case Series. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Minji Jung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zadravec M, Olenšek A, Matjačić Z. The comparison of stepping responses following perturbations applied to pelvis during overground and treadmill walking. Technol Health Care 2017; 25:781-790. [PMID: 28582936 DOI: 10.3233/thc-160798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treadmills are used frequently in rehabilitation enabling neurologically impaired subjects to train walking while being assisted by therapists. Numerous studies compared walking on treadmill and overground for unperturbed but not also perturbed conditions. OBJECTIVE The objective of this study was to compare stepping responses (step length, step width and step time) during overground and treadmill walking in a group of healthy subjects where balance assessment robots applied perturbing pushes to the subject's pelvis in sagittal and frontal planes. METHODS During walking in both balance assessment robots (overground and treadmill-based) with applied perturbations the stepping responses of a group of seven healthy subjects were assessed with a motion tracking camera. RESULTS The results show high degree of similarity of stepping responses between overground and treadmill walking for all perturbation directions. Both devices reproduced similar experimental conditions with relatively small standard deviations in the unperturbed walking as well as in perturbed walking. CONCLUSIONS Based on these results we may conclude that stepping responses following perturbations can be studied on an instrumented treadmill where ground reaction forces can be readily assessed which is not the case during perturbed overground walking.
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