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Hwang S, Song CS. Assistive Technology Involving Postural Control and Gait Performance for Adults with Stroke: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2225. [PMID: 37570466 PMCID: PMC10418390 DOI: 10.3390/healthcare11152225] [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: 06/29/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to comprehensively summarize assistive technology devices for postural control and gait performance in stroke patients. In the study, we searched for randomized controlled trials (RCTs) published until 31 December 2022 in four electrical databases. The most frequently applied assistive technology devices involving postural stability and gait function for stroke patients were robot-assistive technology devices. Out of 1065 initially retrieved citations that met the inclusion criteria, 30 RCTs (12 studies for subacute patients and 18 studies for chronic patients) were included in this review based on eligibility criteria. The meta-analysis included ten RCTs (five studies for subacute patients and five for chronic patients) based on the inclusion criteria of the data analysis. After analyzing, the variables, only two parameters, the Berg balance scale (BBS) and the functional ambulation category (FAC), which had relevant data from at least three studies measuring postural control and gait function, were selected for the meta-analysis. The meta-analysis revealed significant differences in the experimental group compared to the control group for BBS in both subacute and chronic stroke patients and for the FAC in chronic stroke patients. Robot-assistive training was found to be superior to regular therapy in improving postural stability for subacute and chronic stroke patients but not gait function. This review suggests that robot-assistive technology devices should be considered in rehabilitative approaches for postural stability and gait function for subacute and chronic stroke patients.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan 31065, Republic of Korea;
- The Graduate School of Health Welfare, Baekseok University, Seoul 06695, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju 61452, Republic of Korea
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de Miguel-Fernández J, Lobo-Prat J, Prinsen E, Font-Llagunes JM, Marchal-Crespo L. Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness. J Neuroeng Rehabil 2023; 20:23. [PMID: 36805777 PMCID: PMC9938998 DOI: 10.1186/s12984-023-01144-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes. METHODS Four databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. RESULTS (1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke. CONCLUSIONS Despite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
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Affiliation(s)
- Jesús de Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Erik Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH Enschede, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Laura Marchal-Crespo
- Cognitive Robotics Department, Delft University of Technology, Mekelweg 2, 2628 Delft, Netherlands
- Motor Learning and Neurorehabilitation Lab, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Mitrović SZ, Konstantinović LM, Miler Jerković V, Dedijer-Dujović S, Djordjević OC. Extended Poststroke Rehabilitation Combined with Cerebrolysin Promotes Upper Limb Motor Recovery in Early Subacute Phase of Rehabilitation: A Randomized Clinical Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020291. [PMID: 36837492 PMCID: PMC9958781 DOI: 10.3390/medicina59020291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute stroke phase in moderate to severe motor impairment. The aim of this study was to determine the efficacy of extended poststroke rehabilitation combined with Cerebrolysin on upper limb motor recovery in subacute stroke patients with severe upper limb motor impairment. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted. Sixty patients at the early stage of severe sub-acute stroke who fulfilled all eligibility criteria were randomly assigned to the Cerebrolysin group or placebo group (𝑛 = 30 each). Both groups, after conducting three weeks of conventional rehabilitation treatment five days per week, continued to perform conventional rehabilitation treatment three times per week until 90 days of rehabilitation treatment. The primary outcome measure was the Action Research Arm Test (ARAT), and the secondary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, Barthel index (BI), and the National Institutes of Health Stroke Scale (NIHSS). The outcome data were evaluated before, after three weeks of treatment, and on the 90th day of rehabilitation treatment, and compared within groups and between the two groups. There were no adverse events. Results: Both groups showed a significant improvement (p < 0.001) over time in BI, FMA-UE, ARAT, and NIHSS scores. Patients receiving Cerebrolysin showed more significant improvement in post-stroke upper limb motor impairment and functioning compared to the placebo group after only three weeks, and the trend was maintained after 90 days of follow up. Conclusion: Cerebrolysin delivered in the early subacute post-stroke phase added to extended conventional rehabilitation treatment is beneficial and improves motor functional recovery in patients with severe motor impairment, especially on the paretic upper extremity.
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Affiliation(s)
- Sindi Z. Mitrović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
- Correspondence: (S.Z.M.); (L.M.K.)
| | - Ljubica M. Konstantinović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
- Correspondence: (S.Z.M.); (L.M.K.)
| | - Vera Miler Jerković
- Innovation Center, School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, 11120 Belgrade, Serbia
| | - Suzana Dedijer-Dujović
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
| | - Olivera C. Djordjević
- Clinic for Rehabilitation “Dr. Miroslav Zotović”, Faculty of Medicine, University of Belgrade, Sokobanjska 13, 11000 Belgrade, Serbia
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Zou Y, Zhang A, Zhang Q, Zhang B, Wu X, Qin T. Design and Experimental Research of 3-RRS Parallel Ankle Rehabilitation Robot. MICROMACHINES 2022; 13:mi13060950. [PMID: 35744564 PMCID: PMC9228808 DOI: 10.3390/mi13060950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
The ankle is a crucial joint that supports the human body weight. An ankle sprain will adversely affect the patient’s daily life, so it is of great significance to ensure its strength. To help patients with ankle dysfunction to carry out effective rehabilitation training, the bone structure and motion mechanism of the ankle were analyzed in this paper. Referring to the configuration of the lower-mobility parallel mechanism, a 3-RRS (R and S denote revolute and spherical joint respectively) parallel ankle rehabilitation robot (PARR) was proposed. The robot can realize both single and compound ankle rehabilitation training. The structure of the robot was introduced, and the kinematics model was established. The freedom of movement of the robot was analyzed using the screw theory, and the robot kinematics were analyzed using spherical analytics theory. A circular composite rehabilitation trajectory was planned, and the accuracy of the kinematics model was verified by virtual prototype simulation. The Multibody simulation results show that the trajectory of the target point is basically the same as the expected trajectory. The maximum trajectory error is about 2.5 mm in the simulation process, which is within the controllable range. The experimental results of the virtual prototype simulation show that the maximum angular deflection error of the three motors is 2° when running a circular trajectory, which meets the experimental requirements. Finally, a control strategy for passive rehabilitation training was designed, and the effectiveness of this control strategy was verified by a prototype experiment.
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Affiliation(s)
- Yupeng Zou
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (A.Z.); (Q.Z.); (B.Z.); (X.W.)
- Xiangyang Key Laboratory of Rehabilitation Medicine and Rehabilitation Engineering Technology, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Andong Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (A.Z.); (Q.Z.); (B.Z.); (X.W.)
| | - Qiang Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (A.Z.); (Q.Z.); (B.Z.); (X.W.)
| | - Baolong Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (A.Z.); (Q.Z.); (B.Z.); (X.W.)
| | - Xiangshu Wu
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (A.Z.); (Q.Z.); (B.Z.); (X.W.)
| | - Tao Qin
- Xiangyang Key Laboratory of Rehabilitation Medicine and Rehabilitation Engineering Technology, Hubei University of Arts and Science, Xiangyang 441053, China
- School of Mechanical Engineering, Hubei University of Arts and Science, Xiangyang 441053, China
- Correspondence: ; Tel.: +86-186-7107-6897
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Campagnini S, Liuzzi P, Mannini A, Riener R, Carrozza MC. Effects of control strategies on gait in robot-assisted post-stroke lower limb rehabilitation: a systematic review. J Neuroeng Rehabil 2022; 19:52. [PMID: 35659703 PMCID: PMC9166346 DOI: 10.1186/s12984-022-01031-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke related motor function deficits affect patients' likelihood of returning to professional activities, limit their participation in society and functionality in daily living. Hence, robot-aided gait rehabilitation needs to be fruitful and effective from a motor learning perspective. For this reason, optimal human-robot interaction strategies are necessary to foster neuroplastic shaping during therapy. Therefore, we performed a systematic search on the effects of different control algorithms on quantitative objective gait parameters of post-acute stroke patients. METHODS We conducted a systematic search on four electronic databases using the Population Intervention Comparison and Outcome format. The heterogeneity of performance assessment, study designs and patients' numerosity prevented the possibility to conduct a rigorous meta-analysis, thus, the results were presented through narrative synthesis. RESULTS A total of 31 studies (out of 1036) met the inclusion criteria, without applying any temporal constraints. No controller preference with respect to gait parameters improvements was found. However, preferred solutions were encountered in the implementation of force control strategies mostly on rigid devices in therapeutic scenarios. Conversely, soft devices, which were all position-controlled, were found to be more commonly used in assistive scenarios. The effect of different controllers on gait could not be evaluated since conspicuous heterogeneity was found for both performance metrics and study designs. CONCLUSIONS Overall, due to the impossibility of performing a meta-analysis, this systematic review calls for an outcome standardisation in the evaluation of robot-aided gait rehabilitation. This could allow for the comparison of adaptive and human-dependent controllers with conventional ones, identifying the most suitable control strategies for specific pathologic gait patterns. This latter aspect could bolster individualized and personalized choices of control strategies during the therapeutic or assistive path.
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Affiliation(s)
- Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143, Firenze, FI, Italy
- Istituto di BioRobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, PI, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143, Firenze, FI, Italy.
- Istituto di BioRobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, PI, Italy.
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, 50143, Firenze, FI, Italy
| | - Robert Riener
- ETH Zurich, Rämistrasse 101, 8092 CH, Zürich, Switzerland
- Balgrist University Hospital, Forchstrasse 340, 8008 CH, Zürich, Switzerland
| | - Maria Chiara Carrozza
- Istituto di BioRobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, PI, Italy
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Coley C, Kovelman S, Belschner J, Cleary K, Schladen M, Evans SH, Salvador T, Monfaredi R, Fooladi Talari H, Slagle J, Rana MS. PedBotHome: A Video Game-Based Robotic Ankle Device Created for Home Exercise in Children With Neurological Impairments. Pediatr Phys Ther 2022; 34:212-219. [PMID: 35385456 PMCID: PMC9009250 DOI: 10.1097/pep.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This pilot study assesses the feasibility of using PedBotHome to promote adherence to a home exercise program, the ability of the device to withstand frequent use, and changes in participant ankle mobility.PedBotHome is a robotic ankle device with integrated video game software designed to improve ankle mobility in children with cerebral palsy. METHODS Eight participants enrolled in a 28-day trial of PedBotHome. Ankle strength, range of motion, and plantar flexor spasticity were measured pre- and posttrial. Performance was monitored remotely, and game settings were modified weekly by physical therapists. RESULTS Four participants met the study goal of 20 days of use. There were statistically significant improvements in ankle strength, spasticity, and range of motion. CONCLUSIONS PedBotHome is a feasible device to engage children with static neurological injuries in ankle home exercise. This pilot study expands the paradigm for future innovative home-based robotic rehabilitation.
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Affiliation(s)
- Catherine Coley
- Physical Therapy (Drs Coley, Kovelman, and Belschner), Children's National Hospital, Washington, District of Columbia; Sheikh Zayed Research Institute (Drs Cleary and Monfaredi and Messrs Salvador, Fooladi Talari, Slagle, and Rana), Children's National Hospital, Washington, District of Columbia; Georgetown University (Dr Schladen), Washington, District of Columbia; Physical Medicine and Rehabilitation (Dr Evans), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Surgical Care (Mr Rana), Children's National Hospital, Washington, District of Columbia
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Control Strategies for Gait Tele-Rehabilitation System Based on Parallel Robotics. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112311095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among end-effector robots for lower limb rehabilitation, systems based on Stewart–Gough platforms enable independent movement of each foot in six degrees of freedom. Nevertheless, control strategies described in recent literature have not been able to fully explore the potential of such a mechatronic system. In this work, we propose two novel approaches for controlling a gait simulator based on Stewart–Gough platforms. The first strategy provides the therapist direct control of each platform using movement data measured by wearable sensors. The following scheme is designed to improve the level of engagement of the patient by enabling a limited degree of control based on trunk inclination. Both strategies are designed to facilitate future studies in tele-rehabilitation settings. Experimental results have illustrated the feasibility of both control interfaces, either in terms of system performance or user subjective evaluation. Technical capacity to deploy in tele-rehabilitation was also verified in this work.
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Zhang C, Huang MZ, Kehs GJ, Braun RG, Cole JW, Zhang LQ. Intensive In-Bed Sensorimotor Rehabilitation of Early Subacute Stroke Survivors With Severe Hemiplegia Using a Wearable Robot. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2252-2259. [PMID: 34665733 PMCID: PMC8843010 DOI: 10.1109/tnsre.2021.3121204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rehabilitation for stroke survivors with severe motor impairment remains challenging. Early motor rehabilitation is critical for improving mobility function post stroke, but it is often delayed due to limited resources in clinical practice. The objectives of this study were to investigate the feasibility and effectiveness of early in-bed sensorimotor rehabilitation on acute stroke survivors with severe hemiplegia using a wearable ankle robot. Eighteen patients (9 in the study group and 9 in the control group) with severe hemiplegia and no active ankle movement were enrolled in acute/subacute phase post stroke. During a typical 3-week hospital stay, patients in the study group received ankle robot-guided in-bed training (50 minutes/session, 5 sessions/week), including motor relearning under real-time visual feedback of re-emerging motor output, strong passive stretching under intelligent control, and game-based active movement training with robotic assistance. Whereas the control group received passive ankle movement in the mid-range of motion and attempted active ankle movement without robotic assistance. After multi-session training, the study group achieved significantly greater improvements in Fugl-Meyer Lower Extremity motor score (p = 0.007), plantarflexor strength (p = 0.009), and active range of motion (p = 0.011) than controls. The study group showed earlier motor recovery for plantarflexion and dorsiflexion than the control group (p < 0.05). This study showed that in-bed sensorimotor rehabilitation guided by a wearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase.
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Zhai X, Wu Q, Li X, Xu Q, Zhang Y, Fan S, Zhang LQ, Pan Y. Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial. Front Neurol 2021; 12:719305. [PMID: 34721259 PMCID: PMC8549728 DOI: 10.3389/fneur.2021.719305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear. Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance. Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test. Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P < 0.05). The between-group comparison showed no significant differences in all outcome measures (P > 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P < 0.05), but significant improvements were found in the control group only with eyes open (P < 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P < 0.05). Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function. Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.
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Affiliation(s)
- Xiaoxue Zhai
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiong Wu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xin Li
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Quan Xu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yanlin Zhang
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Senchao Fan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
| | - Yu Pan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
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Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev 2020; 10:CD006185. [PMID: 33091160 PMCID: PMC8189995 DOI: 10.1002/14651858.cd006185.pub5] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Electromechanical- and robot-assisted gait-training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017. OBJECTIVES Primary • To determine whether electromechanical- and robot-assisted gait training versus normal care improves walking after stroke Secondary • To determine whether electromechanical- and robot-assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials. SELECTION CRITERIA We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robot-assisted gait training versus normal care. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow-up. MAIN RESULTS We included in this review update 62 trials involving 2440 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high-quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low-quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI -5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate-quality evidence). Electromechanical-assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non-ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity. AUTHORS' CONCLUSIONS People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical-assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.
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Affiliation(s)
- Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Simone Thomas
- Wissenschaftliches Institut, Klinik Bavaria Kreischa, Kreischa, Germany
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Marcus Pohl
- Neurological Rehabilitation, Helios Klinik Schloss Pulsnitz, Pulsnitz, Germany
| | - Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
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Vialleron T, Delafontaine A, Ditcharles S, Fourcade P, Yiou E. Effects of stretching exercises on human gait: a systematic review and meta-analysis. F1000Res 2020; 9:984. [PMID: 33728043 PMCID: PMC7919610 DOI: 10.12688/f1000research.25570.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.
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Affiliation(s)
- Thomas Vialleron
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Arnaud Delafontaine
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Sebastien Ditcharles
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
- ENKRE, Saint Maurice, Ile de France, 94410, France
| | - Paul Fourcade
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Eric Yiou
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
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Vialleron T, Delafontaine A, Ditcharles S, Fourcade P, Yiou E. Effects of stretching exercises on human gait: a systematic review and meta-analysis. F1000Res 2020; 9:984. [PMID: 33728043 PMCID: PMC7919610 DOI: 10.12688/f1000research.25570.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 04/01/2024] Open
Abstract
Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.
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Affiliation(s)
- Thomas Vialleron
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Arnaud Delafontaine
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Sebastien Ditcharles
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
- ENKRE, Saint Maurice, Ile de France, 94410, France
| | - Paul Fourcade
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
| | - Eric Yiou
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, Orsay, 91405, France
- CIAMS, Université d'Orléans, Orléans, Orléans, 45067, France
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Li J, Fan W, Dong M, Rong X. Research on control strategies for ankle rehabilitation using parallel mechanism. COGNITIVE COMPUTATION AND SYSTEMS 2020. [DOI: 10.1049/ccs.2020.0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jianfeng Li
- College of Mechanical Engineering and Applied Electronics TechnologyBeijing University of TechnologyBeijing100124People's Republic of China
| | - Wenpei Fan
- College of Mechanical Engineering and Applied Electronics TechnologyBeijing University of TechnologyBeijing100124People's Republic of China
| | - Mingjie Dong
- College of Mechanical Engineering and Applied Electronics TechnologyBeijing University of TechnologyBeijing100124People's Republic of China
| | - Xi Rong
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdao266000People's Republic of China
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Norvang OP, Askim T, Egerton T, Dahl AE, Thingstad P. Associations between changes in gait parameters, balance, and walking capacity during the first 3 months after stroke: a prospective observational study. Physiother Theory Pract 2020; 38:534-542. [PMID: 32569492 DOI: 10.1080/09593985.2020.1771802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Independent ambulation is a common rehabilitation goal after stroke, requiring adequate balance and efficiency of gait. Spatiotemporal gait parameters are expected to improve in the first 3 months and their association with balance and efficiency of gait may provide useful insights into the recovery of safe and independent mobility. OBJECTIVE Examine the associations between changes in spatiotemporal gait parameters, balance, and walking capacity during the first 3 months after stroke. METHODS This prospective observational study included participants diagnosed with stroke. Within the first 2 weeks after stroke onset and again 3 months (±2 weeks) later, gait was assessed using a GAITRite mat at self-selected gait speed, balance using the Berg Balance Scale (BBS), and walking capacity using the 6-minute walk test (6 MWT). Changes in gait parameters, balance, and walking capacity were assessed using paired sample t-tests, and linear regression analyses were used to assess associations between changes in spatiotemporal gait parameters, BBS, and 6MWT. RESULTS Seventy-nine participants (mean (SD) age 75.4 (8.5) years; 44 men) were included. Gait parameters, balance, and walking capacity all improved during follow-up. The bivariate regression analyses showed associations between improvements in all gait parameters, except walk ratio, with improvement in balance, and in all gait parameters with improvement in walking capacity. Only gait speed was associated with balance (13.8 points, 95% CI 0.5, 27.8, p = .0042) and walking capacity (256 m, 95% CI 173,340, p < .001) in the multivariate analyses. CONCLUSION Improved spatiotemporal gait parameters were associated with improved balance and walking capacity within the first 3 months after stroke.
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Affiliation(s)
- Ole Petter Norvang
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physiotherapy, St Olavs Hospital, Clinical Services, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Thorlene Egerton
- Department of Physiotherapy, Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Anne Eitrem Dahl
- Department of Physiotherapy, St Olavs Hospital, Clinical Services, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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15
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Kim YH. Robotic assisted rehabilitation therapy for enhancing gait and motor function after stroke. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2019.00065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zheng QX, Ge L, Wang CC, Ma QS, Liao YT, Huang PP, Wang GD, Xie QL, Rask M. Robot-assisted therapy for balance function rehabilitation after stroke: A systematic review and meta-analysis. Int J Nurs Stud 2019; 95:7-18. [DOI: 10.1016/j.ijnurstu.2019.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
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Esquenazi A. Comment on "Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art". JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:7634965. [PMID: 30622690 PMCID: PMC6304184 DOI: 10.1155/2018/7634965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alberto Esquenazi
- Professor and Chair Department of Physical Medicine and Rehabilitation, MossRehab/Einsteinm, 60 Township Line Rd., Elkins Park, PA 19027, USA
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Mehrholz J, Pohl M, Kugler J, Elsner B. The Improvement of Walking Ability Following Stroke. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:639-645. [PMID: 30375325 PMCID: PMC6224539 DOI: 10.3238/arztebl.2018.0639] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/05/2017] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gait velocity and maximum walking distance are central parameters for measuring the success of rehabilitation of gait after a stroke. The goal of this study was to provide an overview of current evidence on the rehabilitation of gait after a stroke. METHODS A systematic review of randomized, controlled trials was carried out using network meta-analysis. The primary endpoint was gait velocity; secondary end- points were the ability to walk, maximum walking distance, and gait stability. The following interventions were analyzed: no gait training, conventional gait training (reference category), training on a treadmill with or without body weight support, training on a treadmill with or without a speed paradigm, and electromechanically assisted gait training with end-effector or exoskeleton apparatus. RESULTS The systematic search yielded 40 567 hits. 95 randomized, controlled trials involving a total of 4458 post-stroke patients were included in the meta-analysis. With respect to the primary endpoint of gait velocity, gait training assisted by end- effector apparatus led to significant improvement (mean difference [MD] = 0.16 m/s; 95% confidence interval [0.04; 0.28]). None of the other interventions improved gait velocity to any significant extent. With respect to one of the secondary endpoints, maximum walking distance, both gait training assisted by end-effector apparatus and treadmill training with body weight support led to significant improvement (MD = 47 m, [4; 90], and MD = 38 m, [4; 72], respectively). A network meta-analysis could not be performed with respect to the ability to walk (a different secondary endpoint) because of substantial inconsistencies in the data. The interventions did not differ significantly with respect to safety. CONCLUSION In comparison to conventional gait rehabilitation, gait training assisted by end-effector apparatus leads to a statistically significant and clinically relevant improvement in gait velocity and maximum walking distance after stroke, while treadmill training with body weight support leads to a statistically significant and clinically relevant improvement in maximum walking distance.
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Affiliation(s)
- Jan Mehrholz
- Gesundheitswissenschaften/Public Health, Medical Faculty, Technical University of Dresden
- SRH Hochschule für Gesundheit, University of Applied Health Sciences
| | | | - Joachim Kugler
- Gesundheitswissenschaften/Public Health, Medical Faculty, Technical University of Dresden
| | - Bernhard Elsner
- Gesundheitswissenschaften/Public Health, Medical Faculty, Technical University of Dresden
- SRH Hochschule für Gesundheit, University of Applied Health Sciences
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Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:7492024. [PMID: 29973978 PMCID: PMC6009012 DOI: 10.1155/2018/7492024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/22/2018] [Indexed: 11/18/2022]
Abstract
Robots were introduced in rehabilitation in the 90s to meet different needs, that is, reducing the physical effort of therapists. This work consists of a meta-analysis of robot-mediated lower limbs rehabilitation for stroke-affected patients; it aims at evaluating the effectiveness of the robotic approach through the use of wearable robots or operational machines with respect to the conventional approach (i.e., manual rehabilitation therapy). The primary assessed outcome is the patient's ability to recover walking independence, whereas the secondary outcome is the average walking speed. The therapy acceptability and the treatment costs are also assessed. The assessment shows that the robot-mediated therapy is more effective than the conventional one in reaching the primary outcome. As for the secondary outcome, there is no significant difference between the robotic (wearable robots or operational machines) and the conventional approach. Rehabilitation using wearable robots has a greater acceptability than the conventional one. This does not apply to operational machines. The cost of robotic treatment with wearable robots ranges from double to triple the cost of the conventional approach. On the contrary, rehabilitation using operational machines costs the same as the conventional treatment. Robotic rehabilitation based on operational machines is the most cost-effective approach.
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21
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Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2858294. [PMID: 29675142 PMCID: PMC5838480 DOI: 10.1155/2018/2858294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
Objective This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. Method English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of "Ankle∗" AND "Robot∗" AND "Effect∗ OR Improv∗ OR Increas∗." Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. Result A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR) game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF) training. Conclusion Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy.
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Lo K, Stephenson M, Lockwood C. Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:3049-3091. [PMID: 29219877 DOI: 10.11124/jbisrir-2017-003456] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability, and rehabilitation, involving repetitive, high intensity, task-specific exercises, is the pathway to restoring motor skills. Robotic assistive devices are increasingly being used and it is hoped that with robotic devices, rehabilitation progress can be achieved for patients. OBJECTIVES To examine the effectiveness of robotic devices in the rehabilitation of stroke patients for upper limb mobility, lower limb mobility, and activities of daily living. The sustainability of treatment effect was also examined. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult stroke patients 18 years and over. TYPES OF INTERVENTION(S) Rehabilitation of stroke patients using robotic devices with assistive automation, compared to conventional physiotherapy. OUTCOMES Motor movements of upper limbs, walking movement of lower limbs and activities of daily living, including follow-up measurements to examine the sustainability of treatment effect. TYPES OF STUDIES Randomized and controlled clinical trials. SEARCH STRATEGY Published and unpublished studies in English were searched. METHODOLOGICAL QUALITY All studies meeting the review inclusion criteria were independently assessed for methodological quality by two reviewers. DATA EXTRACTION Quantitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS Quantitative data were pooled in statistical meta-analysis. Effect sizes expressed as standardized mean difference, 95% confidence intervals and levels of heterogeneity (I) were calculated. Where statistical pooling was not possible, the findings were presented in narrative form. RESULTS Fifty-one studies with 1798 patients were included in this review. Thirty studies examined upper limb interventions and 21 studies evaluated lower limb gait training. Non-significant results were found for upper limb (SMD 0.07, 95% CI -0.11 to 0.26, I = 41%, P = 0.45), lower limb (SMD 0.17, 95% CI -0.15 to 0.48, I = 75%, P = 0.31) and activities of daily living (SMD 0.11, 95% CI -0.11 to 0.33, I = 66%, P = 0.32). For patients with severely impaired lower limbs, a significant difference was observed in favor of robotics (SMD 0.41, 95% CI 0.19 to 0.63, I = 28%, P = 0.0003). P-value analysis did not show significant results for the sustainability of treatment effect post intervention. CONCLUSIONS Robotic training is just as effective as conventional training for upper limb motor movement, lower limb walking mobility and for activities of daily living. For lower limb patients with severe impairment, robotic training produces better outcomes than conventional training. The sufficient quantity of studies included and the reasonable quality of Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence support the findings.For treatment sustainability of upper and lower limbs, robotic training is just as effective as conventional training. However, the low quality of GRADE evidence and the lower number of studies included require caution for this finding. For treatment sustainability of activities of daily living, the better quality of GRADE evidence and the larger number of studies analyzed indicate that robotic training is just as effective as conventional training.
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Affiliation(s)
- Kenneth Lo
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, Feng W. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep 2017; 19:59. [PMID: 29116473 PMCID: PMC5802378 DOI: 10.1007/s11883-017-0686-6] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain's dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. RECENT FINDINGS Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.
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Affiliation(s)
- Elisheva R Coleman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA.
| | - Rohitha Moudgal
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn Lang
- Department of Rehabilitation Services, University of Cincinnati, Cincinnati, OH, USA
| | - Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Wuwei Feng
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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A Feasibility Study of SSVEP-Based Passive Training on an Ankle Rehabilitation Robot. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:6819056. [PMID: 29075429 PMCID: PMC5623787 DOI: 10.1155/2017/6819056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/05/2017] [Accepted: 08/01/2017] [Indexed: 12/02/2022]
Abstract
Objective This study aims to establish a steady-state visual evoked potential- (SSVEP-) based passive training protocol on an ankle rehabilitation robot and validate its feasibility. Method This paper combines SSVEP signals and the virtual reality circumstance through constructing information transmission loops between brains and ankle robots. The robot can judge motion intentions of subjects and trigger the training when subjects pay their attention on one of the four flickering circles. The virtual reality training circumstance provides real-time visual feedback of ankle rotation. Result All five subjects succeeded in conducting ankle training based on the SSVEP-triggered training strategy following their motion intentions. The lowest success rate is 80%, and the highest one is 100%. The lowest information transfer rate (ITR) is 11.5 bits/min when the biggest one of the robots for this proposed training is set as 24 bits/min. Conclusion The proposed training strategy is feasible and promising to be combined with a robot for ankle rehabilitation. Future work will focus on adopting more advanced data process techniques to improve the reliability of intention detection and investigating how patients respond to such a training strategy.
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Chang JL, Lin RY, Saul M, Koch PJ, Krebs HI, Volpe BT. Intensive seated robotic training of the ankle in patients with chronic stroke differentially improves gait. NeuroRehabilitation 2017; 41:61-68. [DOI: 10.3233/nre-171457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Johanna L. Chang
- Feinstein Institute for Medical Research, Center for Biomedical Science and Bioelectronic Medicine, Northwell Health, Manhasset, NY, USA
| | - Regina Y. Lin
- Feinstein Institute for Medical Research, Center for Biomedical Science and Bioelectronic Medicine, Northwell Health, Manhasset, NY, USA
| | - Maira Saul
- Feinstein Institute for Medical Research, Center for Biomedical Science and Bioelectronic Medicine, Northwell Health, Manhasset, NY, USA
| | - Philip J. Koch
- Feinstein Institute for Medical Research, Center for Biomedical Science and Bioelectronic Medicine, Northwell Health, Manhasset, NY, USA
- Long Island Pediatric Physical Therapy, PC, Floral Park, NY, USA
| | - Hermano Igo Krebs
- Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Center for Biomedical Science and Bioelectronic Medicine, Northwell Health, Manhasset, NY, USA
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Mehrholz J, Thomas S, Werner C, Kugler J, Pohl M, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev 2017; 5:CD006185. [PMID: 28488268 PMCID: PMC6481755 DOI: 10.1002/14651858.cd006185.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Electromechanical- and robotic-assisted gait-training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To investigate the effects of automated electromechanical- and robotic-assisted gait-training devices for improving walking after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 9 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 8), MEDLINE in Ovid (1950 to 15 August 2016), Embase (1980 to 15 August 2016), CINAHL (1982 to 15 August 2016), AMED (1985 to 15 August 2016), Web of Science (1899 to 16 August 2016), SPORTDiscus (1949 to 15 September 2012), the Physiotherapy Evidence Database (PEDro) (searched 16 August 2016), and the engineering databases COMPENDEX (1972 to 16 November 2012) and Inspec (1969 to 26 August 2016). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted authors in an effort to identify further published, unpublished, and ongoing trials. SELECTION CRITERIA We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robotic-assisted gait training versus normal care. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted the data. The primary outcome was the proportion of participants walking independently at follow-up. MAIN RESULTS We included 36 trials involving 1472 participants in this review update. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 1.94, 95% confidence interval (CI) 1.39 to 2.71; P < 0.001; I² = 8%; moderate-quality evidence) but did not significantly increase walking velocity (mean difference (MD) 0.04 m/s, 95% CI 0.00 to 0.09; P = 0.08; I² = 65%; low-quality evidence) or walking capacity (MD 5.84 metres walked in 6 minutes, 95% CI -16.73 to 28.40; P = 0.61; I² = 53%; very low-quality evidence). The results must be interpreted with caution because 1) some trials investigated people who were independent in walking at the start of the study, 2) we found variations between the trials with respect to devices used and duration and frequency of treatment, and 3) some trials included devices with functional electrical stimulation. Our planned subgroup analysis suggested that people in the acute phase may benefit, but people in the chronic phase may not benefit from electromechanical-assisted gait training. Post hoc analysis showed that people who are non-ambulatory at intervention onset may benefit, but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk, but significant differences were found between devices in terms of walking velocity. AUTHORS' CONCLUSIONS People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that seven patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase III trials undertaken to address specific questions about the most effective frequency and duration of electromechanical-assisted gait training as well as how long any benefit may last.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Simone Thomas
- Klinik Bavaria KreischaWissenschaftliches InstitutKreischaGermany01731
| | - Cordula Werner
- Medicalpark, Schlaganfallzentrum Berlin13507 Berlin ‐ TegelGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios. Top Stroke Rehabil 2017; 24:435-446. [PMID: 28220715 DOI: 10.1080/10749357.2017.1285746] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In walking rehabilitation trials, self-selected walking speed (SSWS) has emerged as the dominant outcome measure to assess walking ability. However, this measure cannot differentiate between recovery of impaired movement and compensation strategies. Spatiotemporal variables and asymmetry ratios are frequently used to quantify gait deviations and are hypothesized markers of recovery. OBJECTIVES The purpose of this review is to investigate spatiotemporal variables and asymmetry ratios as mechanistic recovery measures in physical therapy intervention studies post-stroke. METHODS A systematic literature search was performed to identify physical therapy intervention studies with a statistically significant change in SSWS post intervention and concurrently collected spatiotemporal variables. Methodological quality was assessed using the Cochrane Collaboration's tool. Walking speed, spatiotemporal, and intervention data were extracted. RESULTS 46 studies met the inclusion criteria, 41 of which reported raw spatiotemporal measures and 19 reported asymmetry ratio calculations. Study interventions included: aerobic training (n = 2), functional electrical stimulation (n = 5), hippotherapy (n = 2), motor dual task training (n = 2), multidimensional rehabilitation (n = 4), robotics (n = 4), sensory stimulation training (n = 8), strength/resistance training (n = 4), task specific locomotor rehabilitation (n = 9), and visually guided training (n = 6). CONCLUSIONS Spatiotemporal variables help describe gait deviations, but scale to speed, so consequently, may not be an independent factor in describing functional recovery and gains. Therefore, these variables are limited in explaining mechanistic changes involved in improving gait speed. Use of asymmetry measures provides additional information regarding the coordinative requirements for gait and can potentially indicate recovery. Additional laboratory-based mechanistic measures may be required to truly understand how walking speed improves.
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Affiliation(s)
- Elizabeth C Wonsetler
- a Department of Health Sciences and Research , Medical University of South Carolina , Charleston , SC , USA
| | - Mark G Bowden
- a Department of Health Sciences and Research , Medical University of South Carolina , Charleston , SC , USA.,b Ralph H. Johnson VA Medical Center , Charleston , SC , USA.,c Division of Physical Therapy , Medical University of South Carolina , Charleston , SC , USA
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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Forrester LW, Roy A, Hafer-Macko C, Krebs HI, Macko RF. Task-specific ankle robotics gait training after stroke: a randomized pilot study. J Neuroeng Rehabil 2016; 13:51. [PMID: 27255156 PMCID: PMC4890526 DOI: 10.1186/s12984-016-0158-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/24/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. FINDINGS Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. CONCLUSIONS Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. CLINICAL TRIAL IDENTIFIER NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1.
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Affiliation(s)
- Larry W Forrester
- Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System, Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Anindo Roy
- Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Charlene Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System; Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Toyoake, Aichi Prefecture, Japan.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan
| | - Richard F Macko
- Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System; Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA.
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Michmizos KP, Rossi S, Castelli E, Cappa P, Krebs HI. Robot-Aided Neurorehabilitation: A Pediatric Robot for Ankle Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2015; 23:1056-67. [PMID: 25769168 DOI: 10.1109/tnsre.2015.2410773] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper presents the pediAnklebot, an impedance-controlled low-friction, backdriveable robotic device developed at the Massachusetts Institute of Technology that trains the ankle of neurologically impaired children of ages 6-10 years old. The design attempts to overcome the known limitations of the lower extremity robotics and the unknown difficulties of what constitutes an appropriate therapeutic interaction with children. The robot's pilot clinical evaluation is on-going and it incorporates our recent findings on the ankle sensorimotor control in neurologically intact subjects, namely the speed-accuracy tradeoff, the deviation from an ideally smooth ankle trajectory, and the reaction time. We used these concepts to develop the kinematic and kinetic performance metrics that guided the ankle therapy in a similar fashion that we have done for our upper extremity devices. Here we report on the use of the device in at least nine training sessions for three neurologically impaired children. Results demonstrated a statistically significant improvement in the performance metrics assessing explicit and implicit motor learning. Based on these initial results, we are confident that the device will become an effective tool that harnesses plasticity to guide habilitation during childhood.
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Michmizos KP, Vaisman L, Krebs HI. A Comparative Analysis of Speed Profile Models for Ankle Pointing Movements: Evidence that Lower and Upper Extremity Discrete Movements are Controlled by a Single Invariant Strategy. Front Hum Neurosci 2014; 8:962. [PMID: 25505881 PMCID: PMC4245889 DOI: 10.3389/fnhum.2014.00962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/12/2014] [Indexed: 12/19/2022] Open
Abstract
Little is known about whether our knowledge of how the central nervous system controls the upper extremities (UE), can generalize, and to what extent to the lower limbs. Our continuous efforts to design the ideal adaptive robotic therapy for the lower limbs of stroke patients and children with cerebral palsy highlighted the importance of analyzing and modeling the kinematics of the lower limbs, in general, and those of the ankle joints, in particular. We recruited 15 young healthy adults that performed in total 1,386 visually evoked, visually guided, and target-directed discrete pointing movements with their ankle in dorsal-plantar and inversion-eversion directions. Using a non-linear, least-squares error-minimization procedure, we estimated the parameters for 19 models, which were initially designed to capture the dynamics of upper limb movements of various complexity. We validated our models based on their ability to reconstruct the experimental data. Our results suggest a remarkable similarity between the top-performing models that described the speed profiles of ankle pointing movements and the ones previously found for the UE both during arm reaching and wrist pointing movements. Among the top performers were the support-bounded lognormal and the beta models that have a neurophysiological basis and have been successfully used in upper extremity studies with normal subjects and patients. Our findings suggest that the same model can be applied to different "human" hardware, perhaps revealing a key invariant in human motor control. These findings have a great potential to enhance our rehabilitation efforts in any population with lower extremity deficits by, for example, assessing the level of motor impairment and improvement as well as informing the design of control algorithms for therapeutic ankle robots.
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Affiliation(s)
- Konstantinos P. Michmizos
- Martinos Center for Biomedical Imaging, Massachusetts Institute of Technology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lev Vaisman
- Department of Anatomy and Neurobiology, School of Medicine, Boston University, Boston, MA, USA
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurology, Division of Rehabilitation, School of Medicine, University of Maryland, College Park, MD, USA
- Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
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Honeine JL, Schieppati M. Time-interval for integration of stabilizing haptic and visual information in subjects balancing under static and dynamic conditions. Front Syst Neurosci 2014; 8:190. [PMID: 25339872 PMCID: PMC4186340 DOI: 10.3389/fnsys.2014.00190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/17/2014] [Indexed: 01/22/2023] Open
Abstract
Maintaining equilibrium is basically a sensorimotor integration task. The central nervous system (CNS) continually and selectively weights and rapidly integrates sensory inputs from multiple sources, and coordinates multiple outputs. The weighting process is based on the availability and accuracy of afferent signals at a given instant, on the time-period required to process each input, and possibly on the plasticity of the relevant pathways. The likelihood that sensory inflow changes while balancing under static or dynamic conditions is high, because subjects can pass from a dark to a well-lit environment or from a tactile-guided stabilization to loss of haptic inflow. This review article presents recent data on the temporal events accompanying sensory transition, on which basic information is fragmentary. The processing time from sensory shift to reaching a new steady state includes the time to (a) subtract or integrate sensory inputs; (b) move from allocentric to egocentric reference or vice versa; and (c) adjust the calibration of motor activity in time and amplitude to the new sensory set. We present examples of processes of integration of posture-stabilizing information, and of the respective sensorimotor time-intervals while allowing or occluding vision or adding or subtracting tactile information. These intervals are short, in the order of 1–2 s for different postural conditions, modalities and deliberate or passive shift. They are just longer for haptic than visual shift, just shorter on withdrawal than on addition of stabilizing input, and on deliberate than unexpected mode. The delays are the shortest (for haptic shift) in blind subjects. Since automatic balance stabilization may be vulnerable to sensory-integration delays and to interference from concurrent cognitive tasks in patients with sensorimotor problems, insight into the processing time for balance control represents a critical step in the design of new balance- and locomotion training devices.
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Affiliation(s)
- Jean-Louis Honeine
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia Pavia, Italy
| | - Marco Schieppati
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia Pavia, Italy ; Centro Studi Attività Motorie (CSAM), Fondazione Salvatore Maugeri (IRCSS), Scientific Institute of Pavia Pavia, Italy
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