The Value of Overground Gait Training for Improving Locomotion in Individuals with Chronic Stroke

Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review

Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.

Virtual reality and robotics for stroke rehabilitation: where do we go from here?

Promoting functional recovery after stroke requires collaborative and innovative approaches to neurorehabilitation research. Task-oriented training (TOT) approaches that include challenging, adaptable, and meaningful activities have led to successful outcomes in several large-scale multisite definitive trials. This, along with recent technological advances of virtual reality and robotics, provides a fertile environment for furthering clinical research in neurorehabilitation. Both virtual reality and robotics make use of multimodal sensory interfaces to affect human behavior. In the therapeutic setting, these systems can be used to quantitatively monitor, manipulate, and augment the users' interaction with their environment, with the goal of promoting functional recovery. This article describes recent advances in virtual reality and robotics and the synergy with best clinical practice. Additionally, we describe the promise shown for automated assessments and in-home activity-based interventions. Finally, we propose a broader approach to ensuring that technology-based assessment and intervention complement evidence-based practice and maintain a patient-centered perspective.