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Leerskov KS, Rikhof CJH, Spaich EG, Dosen S, Prange-Lasonder GB, Prinsen EC, Rietman JS, Struijk LNSA. A robot-based hybrid lower limb system for Assist-As-Needed rehabilitation of stroke patients: Technical evaluation and clinical feasibility. Comput Biol Med 2024; 179:108839. [PMID: 39002320 DOI: 10.1016/j.compbiomed.2024.108839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 06/07/2024] [Accepted: 06/29/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Although early rehabilitation is important following a stroke, severely affected patients have limited options for intensive rehabilitation as they are often bedridden. To create a system for early rehabilitation of lower extremities in these patients, we combined the robotic manipulator ROBERT® with electromyography (EMG)-triggered functional electrical stimulation (FES) and developed a novel user-driven Assist-As-Needed (AAN) control. The method is based on a state machine able to detect user movement capability, assessed by the presence of an EMG-trigger and the movement velocity, and provide different levels of assistance as required by the patient (no support, FES only, and simultaneous FES and mechanical assistance). METHODS To technically validate the system, we tested 10 able-bodied participants who were instructed to perform specific behaviors to test the system states while conducting knee extension and ankle dorsal flexion exercises. The system was also tested on two stroke patients to establish its clinical feasibility. RESULTS The technical validation showed that the state machine correctly detected the participants' behavior and activated the target AAN state in more than 96% of the exercise repetitions. The clinical feasibility test showed that the system successfully recognized the patients' movement capacity and activated assistive states according to their needs providing the minimal level of support required to exercise successfully. CONCLUSIONS The system was technically validated and preliminarily proved clinically feasible. The present study shows that the novel system can be used to deliver exercises with a high number of repetitions while engaging the participants' residual capabilities through the AAN strategy.
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Affiliation(s)
- Kasper S Leerskov
- The Neurorehabilitation Robotics and Engineering Group, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Gistrup, 9260, Denmark.
| | - Cindy J H Rikhof
- Roessingh Research and Development, Enschede, 7522AH, The Netherlands; Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Enschede, 7500AE, The Netherlands
| | - Erika G Spaich
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, Gistrup, 9260, Denmark
| | - Strahinja Dosen
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, Gistrup, 9260, Denmark
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, 7522AH, The Netherlands; Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Enschede, 7500AE, The Netherlands
| | - Erik C Prinsen
- Roessingh Research and Development, Enschede, 7522AH, The Netherlands; Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Enschede, 7500AE, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, 7522AH, The Netherlands; Faculty of Engineering Technology, Department of Biomechanical Engineering, University of Twente, Enschede, 7500AE, The Netherlands
| | - Lotte N S Andreasen Struijk
- The Neurorehabilitation Robotics and Engineering Group, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Gistrup, 9260, Denmark
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Lee DH, Woo BS, Park YH, Lee JH. General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:711. [PMID: 38792894 PMCID: PMC11123276 DOI: 10.3390/medicina60050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.
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Affiliation(s)
- Dae-Hwan Lee
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Bong-Sik Woo
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Yong-Hwa Park
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Jung-Ho Lee
- Department of Physical Therapy, University of Kyungdong, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gangwon-do, Republic of Korea
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Rikhof CJH, Feenstra Y, Fleuren JFM, Buurke JH, Prinsen EC, Rietman JS, Prange-Lasonder GB. Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review. J Neural Eng 2024; 21:021001. [PMID: 38527367 DOI: 10.1088/1741-2552/ad377c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 03/27/2024]
Abstract
Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.
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Affiliation(s)
- C J H Rikhof
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - Y Feenstra
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J F M Fleuren
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - J H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomedical Signals and systems, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - E C Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
| | - J S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
- Roessingh Centre of Rehabilitation, Roessinghsbleekweg 33, Enschede 7522AH, The Netherlands
| | - G B Prange-Lasonder
- Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7522AH, The Netherlands
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede 7522NB, The Netherlands
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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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da Cunha MJ, Pires Dorneles G, Peres A, Maurer S, Horn K, Souza Pagnussat A. tDCS does not add effect to foot drop stimulator and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke: randomized controlled trial. Int J Neurosci 2023:1-10. [PMID: 37855112 DOI: 10.1080/00207454.2023.2272041] [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: 07/13/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) and foot drop stimulators (FDS) are widely used for stroke rehabilitation. However, no study has investigated if tDCS could boost the effects of FDS and gait training in improving clinical parameters and neuroplasticity biomarkers of chronic post-stroke subjects. OBJECTIVE To investigate the effects of combining tDCS and FDS on motor impairment, functional mobility, and brain-derived neurotrophic factor (BDNF) serum levels. Also, to evaluate the effects of this protocol on the insulin-like growth factor-1 (IGF-1), insulin growth factor-binding proteins-3 (IGFBP-3), interleukin (IL) 6 and 10, and tumor necrosis factor-α (TNF-α) levels. METHODS Thirty-two chronic post-stroke individuals were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent ten gait training sessions for two weeks using a FDS device and real or sham tDCS. Blood samples and clinical data were acquired before and after the intervention. Motor impairment was assessed by the Fugl-Meyer Assessment and functional mobility using the Timed up and Go test. RESULTS Both groups improved the motor impairment and functional mobility and increased the BDNF levels. Both groups also increased the IL-10 and decreased the cortisol, IL-6, and TNF-α levels. No difference was observed between groups. CONCLUSION tDCS did not add effect to FDS and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke individuals. Only FDS and gait training might be enough for people with chronic stroke to modify some clinical parameters and neuroplasticity biomarkers.
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Affiliation(s)
- Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
| | - Gilson Pires Dorneles
- Cellular and Molecular Immunology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Alessandra Peres
- Cellular and Molecular Immunology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Simone Maurer
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
| | - Keli Horn
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
- Department of Physical Therapy, GA State University, Atlanta, GA, USA
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Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, Filoni S, Waldner A, Mazzoleni S, Focacci A, Ferraro F, Bonaiuti D, Franceschini M. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. J Clin Med 2023; 12:jcm12020439. [PMID: 36675371 PMCID: PMC9861649 DOI: 10.3390/jcm12020439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector robot) in comparison to the conventional overground gait training in subacute stroke survivors. METHODS In a multicenter controlled clinical trial, 89 subacute stroke survivors conducted twenty sessions of robot-assisted gait training (Robotic Group) or overground gait training (Control Group) in addition to the standard daily therapy. The robotic training was performed with an exoskeleton (RobotEXO-group) or an end-effector (RobotEND-group). Clinical outcomes were assessed before (T0) and after (T1) the treatment. The walking speed during the 10-Meter Walk Test (10 MWT) was the primary outcome of this study, and secondary outcomes were the 6-Minute Walk Test (6 MWT), Timed Up and Go test (TUG), and the modified Barthel Index (mBI). RESULTS The main characteristics assessed in the Robotic and Control groups did not differ at baseline. A significant benefit was detected from the 10 MWT in the Robotic Group at the end of the study period (primary endpoint). A benefit was also observed from the following parameters: 6 MWT, TUG, and mBI. Moreover, patients belonging to the Robot Group outperformed the Control Group in gait speed, endurance, balance, and ADL. The RobotEND-group improved their walking speed more than the RobotEXO-group. CONCLUSION The stationary robot-assisted training improved walking ability better than the conventional training in subacute stroke survivors. These results suggest that people with subacute stroke may benefit from Robot-Assisted training in potentiating gait speed and endurance. Our results also support that end-effector robots would be superior to exoskeleton robots for improving gait speed enhancement.
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Affiliation(s)
- Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Antonino Naro
- Stroke Unit, Policlinico Universitario G. Martino, 98123 Messina, Italy
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Federica Tamburella
- Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab.), Spinal Rehabilitation Laboratory (SPIRE Lab.), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia, 00124 Rome, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, 71013 San Giovani Rotondo, Italy
| | - Andreas Waldner
- Department of Neurorehabilitation, Melittaklinik Hospital, 39100 Bolzano, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, 70121 Bari, Italy
| | - Antonella Focacci
- S.C. Medicina Fisica e Riabilitazione, ASL 4 Ospedale di Sestri Levante, 16124 Genova, Italy
| | - Francesco Ferraro
- Struttura Complessa di Riabilitazione Neuromotoria ASST Mantova Presidio di Bozzolo, 46012 Bozzolo, Italy
| | - Donatella Bonaiuti
- Italian Scientific Society of Physical Medicine and Rehabilitation (SIMFER), 00198 Rome, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00123 Rome, Italy
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Yamamoto R, Sasaki S, Kuwahara W, Kawakami M, Kaneko F. Effect of exoskeleton-assisted Body Weight-Supported Treadmill Training on gait function for patients with chronic stroke: a scoping review. J Neuroeng Rehabil 2022; 19:143. [PMID: 36544163 PMCID: PMC9768983 DOI: 10.1186/s12984-022-01111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Therapeutic exercise for gait function using an exoskeleton-assisted Body Weight Supported Treadmill Training (BWSTT) has been identified as a potential intervention that allows for task-based repetitive training with appropriate kinematics while adjusting the amount of body weight support (BWS). Nonetheless, its effect on gait in patients with stroke in the chronic phase are yet to be clarified. The primary aim of this scoping review was to present the status of effectiveness of exoskeleton-assisted BWSTT in patients with chronic stroke. The secondary aims were to summarise intervention protocols, types and functions of BWSTT exoskeletal robotic devices currently used clinically. METHOD AND RESULTS Articles were accessed and collected from PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases, which were completed in October 2020. Articles were included if the subjects were adults with stroke in the chronic phase (onset ≥ 6 months) and if they utilised a robotic exoskeleton with treadmill and body weight support and investigated the efficacy of gait exercise. A total of 721 studies were identified, of which 11 randomised controlled trials were selected. All included studies were published from 2008 to 2020. Overall, 309 subjects were enrolled; of these, 241 (156 males, 85 females) participated. Walking outcome measures were used more often to evaluate the functional aspects of gait than to evaluate gait independence. In 10 of 11 studies, showed the effectiveness of exoskeleton robot-assisted BWSTT in terms of outcomes contributing to improved gait function. Two studies reported that exoskeleton-assisted BWSTT with combination therapy was significantly more effective in improving than exoskeleton-assisted BWSTT alone. However, no significant difference was identified between the groups; compared with therapist-assisted BWSTT groups, exoskeleton-assisted BWSTT groups did not exhibit significant change. CONCLUSION This review suggests that exoskeleton-assisted BWSTT for patients with chronic stroke may be effective in improving walking function. However, the potential may be "to assist" and not because of using the robot. Further studies are required to verify its efficacy and strengthen evidence on intervention protocols.
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Affiliation(s)
- Rieko Yamamoto
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.268446.a0000 0001 2185 8709Department of Artificial Environment, Safety, Environment and System Engineering, Yokohama National University Graduate School of Environment and Information Sciences, 79-7, Tokiwadai, Hodogaya, Yokohama, Japan ,grid.39158.360000 0001 2173 7691Center for Environmental and Health Sciences, Hokkaido University, Kita 12, Nishi 7, Kita-ku, Sapporo, Japan
| | - Shun Sasaki
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,Division of Health Promotion, ARCE Inc., Sagamihara, Japan
| | - Wataru Kuwahara
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.265074.20000 0001 1090 2030Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, Japan
| | - Michiyuki Kawakami
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan
| | - Fuminari Kaneko
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.265074.20000 0001 1090 2030Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, Japan
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da Cunha MJ, Pinto C, Schifino GP, Sant'Anna Py I, Cimolin V, Pagnussat AS. Bicephalic Transcranial Direct-Current Stimulation Does Not Add Benefits to a Footdrop Stimulator for Improving Functional Mobility in People With Chronic Hemiparesis After Stroke: A Double-Blind, Randomized Controlled Trial. Phys Ther 2022; 102:6605113. [PMID: 35689805 DOI: 10.1093/ptj/pzac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/23/2021] [Accepted: 06/04/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effects of applying transcranial direct-current stimulation (tDCS), a footdrop stimulator (FDS), and gait training simultaneously on functional mobility in people with chronic hemiparesis after stroke. METHODS In this double-blind controlled trial, 32 individuals with mild, moderate, and severe chronic hemiparesis after stroke were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent 10 concurrent tDCS and FDS gait training sessions 5 times per week for 2 weeks. Functional mobility was evaluated by the Timed "Up & Go" test (TUG). Secondary outcomes included spasticity of plantarflexors, knee extensors, and hip adductors; quality of life; and walking endurance (distance covered during each treadmill gait training session). Clinical assessments were performed before treatment, after treatment, and at a 1-month follow-up. A generalized estimating equation was used to compare the effects of time, group, and time × group interaction. RESULTS No difference between groups was observed during performance of the TUG or other outcomes. TUG performance was improved in both the tDCS plus FDS group (before treatment = 24.29 [95% CI = 17.72-33.28]; after treatment = 21.75 [95% CI = 15.75-30.08]) and the sham tDCS plus FDS group (before treatment = 19.63 [95% CI = 16.06-23.0]; after treatment = 18.45 [95% CI = 15.26-22.3]). This improvement remained at the follow-up evaluation. Both groups also showed reduced spasticity of plantarflexors and knee extensors, increased quality of life, and increased total distance walked. CONCLUSION This study provided no evidence that bicephalic tDCS improves functional mobility, spasticity, quality of life, or walking endurance in people with chronic hemiparesis after stroke. IMPACT Bicephalic tDCS does not add relevant benefits to FDS and gait training in people who have chronic hemiparesis after stroke. Given that tDCS has few additional effects and given its costs for clinical practice, tDCS for rehabilitation in people with chronic hemiparesis after stroke is discouraged. FDS and gait training improve functional mobility, walking resistance, and quality of life in people with chronic hemiparesis after stroke.
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Affiliation(s)
- Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Camila Pinto
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Giulia Palermo Schifino
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Isabela Sant'Anna Py
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Gil-Castillo J, Barria P, Aguilar Cárdenas R, Baleta Abarza K, Andrade Gallardo A, Biskupovic Mancilla A, Azorín JM, Moreno JC. A Robot-Assisted Therapy to Increase Muscle Strength in Hemiplegic Gait Rehabilitation. Front Neurorobot 2022; 16:837494. [PMID: 35574230 PMCID: PMC9100587 DOI: 10.3389/fnbot.2022.837494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
This study examines the feasibility of using a robot-assisted therapy methodology based on the Bobath concept to perform exercises applied in conventional therapy for gait rehabilitation in stroke patients. The aim of the therapy is to improve postural control and movement through exercises based on repetitive active-assisted joint mobilization, which is expected to produce strength changes in the lower limbs. As therapy progresses, robotic assistance is gradually reduced and the patient's burden increases with the goal of achieving a certain degree of independence. The relationship between force and range of motion led to the analysis of both parameters of interest. The study included 23 volunteers who performed 24 sessions, 2 sessions per week for 12 weeks, each lasting about 1 h. The results showed a significant increase in hip abduction and knee flexion strength on both sides, although there was a general trend of increased strength in all joints. However, the range of motion at the hip and ankle joints was reduced. The usefulness of this platform for transferring exercises from conventional to robot-assisted therapies was demonstrated, as well as the benefits that can be obtained in muscle strength training. However, it is suggested to complement the applied therapy with exercises for the maintenance and improvement of the range of motion.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Patricio Barria
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
- Electrical Engineering Department, Universidad de Magallanes, Punta Arenas, Chile
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | | | - Karim Baleta Abarza
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade Gallardo
- Research and Development Unit, Rehabilitation Center Club de Leones Cruz del Sur, Punta Arenas, Chile
| | | | - José M. Azorín
- Systems Engineering and Automation Department, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Juan C. Moreno
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Bae YH, Chang WH, Fong SSM. Different Effects of Robot-Assisted Gait and Independent Over-Ground Gait on Foot Plantar Pressure in Incomplete Spinal Cord Injury: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212072. [PMID: 34831823 PMCID: PMC8624494 DOI: 10.3390/ijerph182212072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022]
Abstract
Background: There is insufficient evidence to establish the optimal treatment protocol for robot-assisted gait training. Objective: This study aimed to analyze the effects of robot-assisted gait and independent over-ground gait on foot pressure and to determine an effective training protocol for improvement of gait pattern in patients with incomplete spinal cord injury due to industrial accidents. Methods: Four patients with incomplete spinal cord injury due to an industrial accident who had gait disturbance underwent measurement of peak foot pressure and stance phase duration using a foot pressure analysis system with robot-assisted gait and independent over-ground gait. Results: The robot-assisted gait condition has lower peak foot pressure and shorter stance phase duration than the independent over-ground gait. Conclusions: In this study, robot-assisted gait was found to limit gait pattern improvement in patients with gait disturbance caused by incomplete spinal cord injury due to industrial accidents. Therefore, future research will be conducted to determine the optimal protocol for robot-assisted gait training for gait pattern improvement.
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Affiliation(s)
- Young-Hyeon Bae
- Korea National Rehabilitation Center, Department of Healthcare and Public Health, Rehabilitation Research Institute, Seoul 01022, Korea
- Correspondence:
| | - Won Hyuk Chang
- Center for Prevention and Rehabilitation, Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Shirley S. M. Fong
- Li Ka Shing Faculty of Medicine, School of Public Health, University of Hong Kong, Hong-Kong 999077, China;
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Mahmoudi Z, Mohammadi R, Sadeghi T, Kalbasi G. The Effects of Electrical Stimulation of Lower Extremity Muscles on Balance in Stroke Patients: A Systematic Review of Literatures. J Stroke Cerebrovasc Dis 2021; 30:105793. [PMID: 34034126 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Stroke is one of the main causes of disability and the second common cause of mortality in the world. Stroke causes relatively permanent motor defects, including balance disorder, and thus affects an individual's functional capacity and independence. Many clinical types of research have been conducted to evaluate the effect of functional electrical stimulation (FES) on balance in post-stroke patients. The objective of this study was to systematically review the effect of functional electrical stimulation (FES) on balance as compared to conventional therapy alone in post-stroke. METHODS The databases of Google Scholar, PubMed, Scopus, ScienceDirect and ProQuest were searched using selected keywords. The randomized controlled trials were searched for published original articles before February 2019 in English language and included if they assessed the effect of FES on balance ability compared to conventional therapy alone in adult post-stroke. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. RESULTS Nine papers were included in this review (median PEDro scale =7/11). The total number of participants in this review study was 255. The age of participants ranged from 20 to 80 years. Stroke patients were in chronic phase (n = 5) and in subacute phase (n = 4). various parameters, including the target muscles, the treatment time per session (20 min-2 h), number of treatment sessions (12-48) and FES frequency (25-40 Hz), were assessed. Among the studies, significant between-group improvement favoring FES in combination with conventional therapy was found on the Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 4) when compared to conventional therapy alone. There was no adverse effect reported by any studies. CONCLUSION FES was reported to be more beneficial in balance improvement among stroke patients when combined with conventional balance therapy. The studies were limited by low-powered, small sample sizes ranging from 9 to 48, and lack of blinding, and reporting of missing data.
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Affiliation(s)
- Zeinab Mahmoudi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.
| | - Roghayeh Mohammadi
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Tahereh Sadeghi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gita Kalbasi
- Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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Johnston TE, Keller S, Denzer-Weiler C, Brown L. A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke. J Neurol Phys Ther 2021; 45:112-196. [PMID: 33675603 DOI: 10.1097/npt.0000000000000347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control. METHODS A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES. RESULTS/DISCUSSION One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual's needs. LIMITATIONS This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability. SUMMARY This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility.A Video Abstract is available as supplemental digital content from the authors (available at: http://links.lww.com/JNPT/A335).
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania and Ossur, Foothill Ranch, California (T.E.J.); Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, Illinois (S.K.); Kessler Institute for Rehabilitation, Chester, New Jersey (C.D.-W.); and Boston University College of Health and Rehabilitation Sciences: Sargent, Boston, Massachusetts (L.B.)
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Schifino G, Cimolin V, Pau M, da Cunha MJ, Leban B, Porta M, Galli M, Souza Pagnussat A. Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor. SENSORS 2021; 21:s21030921. [PMID: 33573046 PMCID: PMC7866372 DOI: 10.3390/s21030921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.
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Affiliation(s)
- Giulia Schifino
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
- Correspondence: ; Tel.: +39-02-2399-3359; Fax: +39-02-2399-3360
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 900050-170, Brazil
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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: 57] [Impact Index Per Article: 14.3] [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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Joo SY, Lee SY, Cho YS, Lee KJ, Seo CH. Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial. J Clin Med 2020; 9:jcm9092813. [PMID: 32878085 PMCID: PMC7563213 DOI: 10.3390/jcm9092813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022] Open
Abstract
This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.
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Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon 14584, Korea;
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
| | - Kuem Ju Lee
- Department of Rehabilitation & Assistive Technology, Korea National Rehabilitation Research Institute, National Rehabilitation Center, Seoul 01022, Korea;
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea; (S.Y.J.); (Y.S.C.)
- Correspondence: ; Tel.: +82-2-2639-5738; Fax: +82-2-2635-7820
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Joo SY, Lee SY, Cho YS, Lee KJ, Kim SH, Seo CH. Effectiveness of robot-assisted gait training on patients with burns: a preliminary study. Comput Methods Biomech Biomed Engin 2020; 23:888-893. [DOI: 10.1080/10255842.2020.1769080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Kuem Ju Lee
- Department of Rehabilitation & Assistive Technology, Korea National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Jaqueline da Cunha M, Rech KD, Salazar AP, Pagnussat AS. Functional electrical stimulation of the peroneal nerve improves post-stroke gait speed when combined with physiotherapy. A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 64:101388. [PMID: 32376404 DOI: 10.1016/j.rehab.2020.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Functional electrical stimulation (FES) applied to the paretic peroneal nerve has positive clinical effects on foot drop secondary to stroke. OBJECTIVE To evaluate the effectiveness of FES applied to the paretic peroneal nerve on gait speed, active ankle dorsiflexion mobility, balance, and functional mobility. METHODS Electronic databases were searched for articles published from inception to January 2020. We included randomized controlled trials or crossover trials focused on determining the effects of FES combined or not with other therapies in individuals with foot drop after stroke. Characteristics of studies, participants, comparison groups, interventions, and outcomes were extracted. Statistical heterogeneity was assessed with the I2 statistic. RESULTS We included 14 studies providing data for 1115 participants. FES did not enhance gait speed as compared with conventional treatments (i.e., supervised/unsupervised exercises and regular activities at home). FES combined with supervised exercises (i.e., physiotherapy) was better than supervised exercises alone for improving gait speed. We found no effect of FES combined with unsupervised exercises and inconclusive effects when FES was combined with regular activities at home. When FES was compared with conventional treatments, it improved ankle dorsiflexion, balance and functional mobility, albeit with high heterogeneity for these last 2 outcomes. CONCLUSIONS This meta-analysis revealed low quality of evidence for positive effects of FES on gait speed when combined with physiotherapy. FES can improve ankle dorsiflexion, balance, and functional mobility. However, considering the low quality of evidence and the high heterogeneity, these results must be interpreted carefully.
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Affiliation(s)
- Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245, Sarmento Leite Street, 90050-170 Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, UFCSPA, Porto Alegre, RS, Brazil
| | - Katia Daniele Rech
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245, Sarmento Leite Street, 90050-170 Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, UFCSPA, Porto Alegre, RS, Brazil
| | - Ana Paula Salazar
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245, Sarmento Leite Street, 90050-170 Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, UFCSPA, Porto Alegre, RS, Brazil
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245, Sarmento Leite Street, 90050-170 Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, UFCSPA, Porto Alegre, RS, Brazil; Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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Effects of robotic gait training after stroke: A meta-analysis. Ann Phys Rehabil Med 2020; 63:518-534. [PMID: 32229177 DOI: 10.1016/j.rehab.2020.02.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. OBJECTIVE First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. METHODS All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. RESULTS We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09m/s, 95% confidence interval [CI] 0.03 to 0.15; p=0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p=0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p=0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. CONCLUSIONS Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke.
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Uivarosan D, Tit DM, Iovan C, Nistor-Cseppento DC, Endres L, Lazar L, Sava C, Sabau AM, Buhas C, Moleriu LC, Bungau S, Aleya L. Effects of combining modern recovery techniques with neurotrophic medication and standard treatment in stroke patients. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 679:80-87. [PMID: 31100563 DOI: 10.1016/j.scitotenv.2019.05.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Stroke is the main cause of disability after age 65, leaving survivors with sequels that require care and recovery treatment lasting years. It is estimated that by the year 2030 this pathology will be leading cause of mortality. To determine the efficacy of Lokomat training combined with neurotrophic medication and balneo-physiotherapeutic treatment in rehabilitation of post-stroke patients, a prospective study of 3 parallel groups was conducted: Group I (n = 22) - Lokomat, balneo-physiotherapy, and Cerebrolysin; Group II (n = 18) - Lokomat associated with balneo-physiotherapy; and Group III (n = 30) - balneo-physiotherapy alone (Control group). Patients were evaluated physically, neurologically, and functionally, according to the evolution of their motor deficiency, spasticity, functional independence and health-related quality of life. Patient improvement is significantly better (p < 0.05) in the group with associated therapies, especially during the first 6 months. Evolution was significantly better in all groups at 12 months than initially (p < 0.05), for all studied parameters and with the best effects in Group I (the three therapies combined). Association of Lokomat training with neurotrophic factors and classic recovery techniques improves the rehabilitation process in stroke patients.
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Affiliation(s)
- Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Ciprian Iovan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Delia Carmen Nistor-Cseppento
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Laura Endres
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Liviu Lazar
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Cristian Sava
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Anca Maria Sabau
- Department of Physical Education, Sport and Physical Therapy, Faculty of Geography, Tourism and Sport, University of Oradea, Oradea 410028, Romania
| | - Camelia Buhas
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Lavinia Cristina Moleriu
- Department III Functional Sciences, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Lotfi Aleya
- Laboratoire Chrono-environnement, Université de Franche-Comté, Besançon, France.
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Spiess MR, Steenbrink F, Esquenazi A. Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles. PM R 2018; 10:S165-S173. [PMID: 30269803 DOI: 10.1016/j.pmrj.2018.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/04/2018] [Accepted: 06/09/2018] [Indexed: 01/12/2023]
Abstract
Advanced technology, including gait-training devices, is increasingly being integrated into neurorehabilitation. However, to use gait-training devices to their optimal potential, it is important that they are applied in accordance with motor learning and locomotor training principles. In this article, we outline the most important principles and explain how advanced gait-training devices are best used to improve therapy outcome.
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Park JH, Shin YI, You JSH, Park MS. Comparative effects of robotic-assisted gait training combined with conventional physical therapy on paretic hip joint stiffness and kinematics between subacute and chronic hemiparetic stroke. NeuroRehabilitation 2018; 42:181-190. [PMID: 29562554 DOI: 10.3233/nre-172234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic-assisted gait training (RAGT) has been proposed as a novel, promising intervention paradigm to improve gait function in subacute or chronic stroke neurorehabilitation. However, the benefits of RAGT combined with conventional physical therapy for gait recovery in patients with subacute and chronic hemiparetic stroke remain unclear. OBJECTIVES The aim of the present study was to compare the effect of RAGT combine with conventional physical therapy on hip joint kinetics, kinematics, and clinical function characteristics between subacute and chronic hemiparetic stroke. METHODS Seventeen patients with hemiparetic stroke (nine subacute and eight chronic patients) performed progressive RAGT (session 1, 40 min) combined with conventional physical therapy (session 1, 40 min) 5 days per week, for an average of 86 sessions over 8 weeks. The clinical outcomes included the Functional Ambulation Category (FAC), modified Rankin scale (mRS), Korean version of the modified Barthel index (K-MBI), and modified Ashworth scale, in addition to hip joint kinetics and kinematics before and after intervention. RESULTS The mean change in active torque, resistive torque, and stiffness in the paretic hip joint did not differ significantly between the two groups. However, Cohen's effect size suggested a moderate difference between the groups in the hip flexion phase (d = 0.58, d = 0.70, and d = 0.70). The mean change in maximal hip flexion kinematics in the chronic group was significantly greater than that in the subacute group (p = 0.04, d = -0.70). The mean change in the clinical function test results between the groups was not statistically significant. However, both groups showed significantly improved FAC, mRS, and K-MBI scores. CONCLUSIONS RAGT combine with conventional physical therapy may be useful when selecting therapeutic interventions to improve the active torque, resistive torque, and stiffness in the paretic hip flexion phase in patients with chronic hemiparetic stroke who reached a plateau in the maximum locomotor recovery after conventional locomotor training.
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Affiliation(s)
- Ji-Ho Park
- Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea.,Brain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea.,Brain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Min Su Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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22
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Seo HG, Lee WH, Lee SH, Yi Y, Kim KD, Oh BM. Robotic-assisted gait training combined with transcranial direct current stimulation in chronic stroke patients: A pilot double-blind, randomized controlled trial. Restor Neurol Neurosci 2018; 35:527-536. [PMID: 28800341 DOI: 10.3233/rnn-170745] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although robotic-assisted gait training (RAGT) is becoming a standard method in stroke rehabilitation, its effect on chronic stroke patients is uncertain. OBJECTIVE This study aimed to investigate whether anodal transcranial direct current stimulation (tDCS) enhances the effect of RAGT on functional ambulation in chronic stroke patients. METHODS Chronic hemiplegic stroke patients with a Functional Ambulatory Category (FAC) score≤4 were randomly assigned to either the RAGT with anodal tDCS (Anodal) group the sham tDCS (Sham) group. The patients were provided with RAGT for 45 min after allocated tDCS on the leg motor cortex in the impaired hemisphere for 20 min every weekday for 2 weeks. The primary outcome measure was the FAC, and the secondary outcome measures included 10-m walking test, 6-min walking test, Berg Balance Scale, Fugl-Meyer assessment of the lower extremity, Medical Research Council Scale, and motor-evoked potential (MEP) parameters. They were evaluated before treatment (T0), immediately after treatment (T1), and 4 weeks after the end of treatment (T2). RESULTS Twenty-one patients were finally included. The percentage of participants who achieved improvement in the FAC score was greater in the Anodal group than in the Sham group, and the difference was significant at T2 (66.7% vs. 12.5%, p = 0.024). In secondary outcome measures, the Anodal group showed greater improvement in the 6-min walking test than the Sham group at T2 (56.49±38.87 vs. 23.59±17.00, p = 0.038). The changes in the MEP parameters were not significantly different between the two groups. CONCLUSION This pilot study suggested that anodal tDCS on the leg motor cortex in the impaired hemisphere may facilitate the effect of RAGT on functional ambulation in chronic stroke patients. Larger clinical trials will be needed to confirm the effect of RAGT combined with tDCS in chronic stroke patients based on the present study.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youbin Yi
- Department of Rehabilitation Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Kwang Dong Kim
- Armed Force Cheongpyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hirano S, Saitoh E, Tanabe S, Tanikawa H, Sasaki S, Kato D, Kagaya H, Itoh N, Konosu H. The features of Gait Exercise Assist Robot: Precise assist control and enriched feedback. NeuroRehabilitation 2018; 41:77-84. [PMID: 28505990 DOI: 10.3233/nre-171459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20-75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48±3.2 (mean±SD). CONCLUSIONS GEAR is potentially useful for gait exercise in hemiplegic patients.
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Affiliation(s)
- Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shinya Sasaki
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Daisuke Kato
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Norihide Itoh
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Advanced Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Konosu
- Partner Robot Division, Toyota Motor Corporation, Toyota, Japan
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24
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Puentes S, Kadone H, Kubota S, Abe T, Shimizu Y, Marushima A, Sankai Y, Yamazaki M, Suzuki K. Reshaping of Gait Coordination by Robotic Intervention in Myelopathy Patients After Surgery. Front Neurosci 2018; 12:99. [PMID: 29551960 PMCID: PMC5840280 DOI: 10.3389/fnins.2018.00099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/08/2018] [Indexed: 11/13/2022] Open
Abstract
The Ossification of the Posterior Longitudinal Ligament (OPLL) is an idiopathic degenerative spinal disease which may cause motor deficit. For patients presenting myelopathy or severe stenosis, surgical decompression is the treatment of choice; however, despite adequate decompression residual motor impairment is found in some cases. After surgery, there is no therapeutic approach available for this population. The Hybrid Assistive Limb® (HAL) robot suit is a unique powered exoskeleton designed to predict, support, and enhance the lower extremities performance of patients using their own bioelectric signals. This approach has been used for spinal cord injury and stroke patients where the walking performance improved. However, there is no available data about gait kinematics evaluation after HAL therapy. Here we analyze the effect of HAL therapy in OPLL patients in acute and chronic stages after decompression surgery. We found that HAL therapy improved the walking performance for both groups. Interestingly, kinematics evaluation by the analysis of the elevation angles of the thigh, shank, and foot by using a principal component analysis showed that planar covariation, plane orientation, and movement range evaluation improved for acute patients suggesting an improvement in gait coordination. Being the first study performing kinematics analysis after HAL therapy, our results suggest that HAL improved the gait coordination of acute patients by supporting the relearning process and therefore reshaping their gait pattern.
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Affiliation(s)
- Sandra Puentes
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
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25
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Nishimura M, Kobayashi S, Kinjo Y, Hokama Y, Sugawara K, Tsuchida Y, Tominaga D, Ishiuchi S. Factors Leading to Improved Gait Function in Patients with Subacute or Chronic Central Nervous System Impairments Who Receive Functional Training with the Robot Suit Hybrid Assistive Limb. Neurol Med Chir (Tokyo) 2017; 58:39-48. [PMID: 29199246 PMCID: PMC5785696 DOI: 10.2176/nmc.oa.2017-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (rs = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (rs = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.
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Affiliation(s)
- Masahiko Nishimura
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Shigetaka Kobayashi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yuki Kinjo
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yohei Hokama
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Kenichi Sugawara
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yukio Tsuchida
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | | | - Shogo Ishiuchi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
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Mazzoleni S, Focacci A, Franceschini M, Waldner A, Spagnuolo C, Battini E, Bonaiuti D. Robot-assisted end-effector-based gait training in chronic stroke patients: A multicentric uncontrolled observational retrospective clinical study. NeuroRehabilitation 2017; 40:483-492. [DOI: 10.3233/nre-161435] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera, Italy
| | - Antonella Focacci
- Physical Medicine and Rehabilitation Unit, Azienda Sanitaria Locale 4 Chiavarese, Sestri Levante, Italy
| | - Marco Franceschini
- Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Andreas Waldner
- Department of Neurological Rehabilitation, Private Hospital Villa Melitta, Bolzano, Italy
| | - Chiara Spagnuolo
- Istituto di Riabilitazione S.Stefano S.r.l., Porto Potenza Picena, Italy
| | - Elena Battini
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera, Italy
| | - Donatella Bonaiuti
- Department of Physical Medicine and Rehabilitation, S. Gerardo Hospital, Monza, Italy
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27
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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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Meyer AJ, Eskinazi I, Jackson JN, Rao AV, Patten C, Fregly BJ. Muscle Synergies Facilitate Computational Prediction of Subject-Specific Walking Motions. Front Bioeng Biotechnol 2016; 4:77. [PMID: 27790612 PMCID: PMC5061852 DOI: 10.3389/fbioe.2016.00077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/21/2016] [Indexed: 12/18/2022] Open
Abstract
Researchers have explored a variety of neurorehabilitation approaches to restore normal walking function following a stroke. However, there is currently no objective means for prescribing and implementing treatments that are likely to maximize recovery of walking function for any particular patient. As a first step toward optimizing neurorehabilitation effectiveness, this study develops and evaluates a patient-specific synergy-controlled neuromusculoskeletal simulation framework that can predict walking motions for an individual post-stroke. The main question we addressed was whether driving a subject-specific neuromusculoskeletal model with muscle synergy controls (5 per leg) facilitates generation of accurate walking predictions compared to a model driven by muscle activation controls (35 per leg) or joint torque controls (5 per leg). To explore this question, we developed a subject-specific neuromusculoskeletal model of a single high-functioning hemiparetic subject using instrumented treadmill walking data collected at the subject's self-selected speed of 0.5 m/s. The model included subject-specific representations of lower-body kinematic structure, foot-ground contact behavior, electromyography-driven muscle force generation, and neural control limitations and remaining capabilities. Using direct collocation optimal control and the subject-specific model, we evaluated the ability of the three control approaches to predict the subject's walking kinematics and kinetics at two speeds (0.5 and 0.8 m/s) for which experimental data were available from the subject. We also evaluated whether synergy controls could predict a physically realistic gait period at one speed (1.1 m/s) for which no experimental data were available. All three control approaches predicted the subject's walking kinematics and kinetics (including ground reaction forces) well for the model calibration speed of 0.5 m/s. However, only activation and synergy controls could predict the subject's walking kinematics and kinetics well for the faster non-calibration speed of 0.8 m/s, with synergy controls predicting the new gait period the most accurately. When used to predict how the subject would walk at 1.1 m/s, synergy controls predicted a gait period close to that estimated from the linear relationship between gait speed and stride length. These findings suggest that our neuromusculoskeletal simulation framework may be able to bridge the gap between patient-specific muscle synergy information and resulting functional capabilities and limitations.
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Affiliation(s)
- Andrew J Meyer
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Ilan Eskinazi
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Jennifer N Jackson
- Department of Biomedical Engineering, University of Florida , Gainesville, FL , USA
| | - Anil V Rao
- Department of Mechanical and Aerospace Engineering, University of Florida , Gainesville, FL , USA
| | - Carolynn Patten
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Neural Control of Movement Lab, Malcom-Randall VA Medical Center, Gainesville, FL, USA
| | - Benjamin J Fregly
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Hu C, Huang Q, Yu L, Zhou Y, Gu R, Ye M, Ge M, Xu Y, Liu J. Long-term interventions effects of robotic training on patients after anterior cruciate ligament reconstruction. J Phys Ther Sci 2016; 28:2196-8. [PMID: 27630396 PMCID: PMC5011560 DOI: 10.1589/jpts.28.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the long-term interventions effects of
robot-assisted therapy rehabilitation on functional activity levels after anterior
cruciate ligament reconstruction. [Subjects and Methods] The subjects were 8 patients (6
males and 2 females) who received anterior cruciate ligament reconstruction. The subjects
participated in robot-assisted therapy lasting for one month. The Timed Up-and-Go test,
10-Meter Walk test, Functional Reach Test, surface electromyography of the vastus
lateralis and vastus medialis, and extensor strength of isokinetic movement of the knee
joint were evaluated before and after the intervention. [Results] The average value of the
of vastus medialis EMG, Functional Reach Test, and the maximum and average extensor
strength of the knee joint isokinetic movement increased significantly, and the time of
the 10-Meter Walk test decreased significantly. [Conclusion] These results suggest that
walking ability and muscle strength can be improved by robotic walking training as a
long-term intervention.
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Affiliation(s)
- Chunying Hu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Qiuchen Huang
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Lili Yu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Yue Zhou
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Rui Gu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Orthopedic and Orthopedic Rehabilitation China Rehabilitation Research Center, China
| | - Miao Ye
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Meng Ge
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Yanfeng Xu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
| | - Jianfeng Liu
- Rehabilitation Therapy Department, PKU Care Rehabilitation Hospital, China
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Hu C, Huang Q, Yu L, Ye M. The immediate intervention effects of robotic training in patients after anterior cruciate ligament reconstruction. J Phys Ther Sci 2016; 28:2031-3. [PMID: 27512258 PMCID: PMC4968500 DOI: 10.1589/jpts.28.2031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/07/2016] [Indexed: 01/26/2023] Open
Abstract
[Purpose] The purpose of this study was to examine the immediate effects of
robot-assisted therapy on functional activity level after anterior cruciate ligament
reconstruction. [Subjects and Methods] Participants included 10 patients (8 males and 2
females) following anterior cruciate ligament reconstruction. The subjects participated in
robot-assisted therapy and treadmill exercise on different days. The Timed Up-and-Go test,
Functional Reach Test, surface electromyography of the vastus lateralis and vastus
medialis, and maximal extensor strength of isokinetic movement of the knee joint were
evaluated in both groups before and after the experiment. [Results] The results for the
Timed Up-and-Go Test and the 10-Meter Walk Test improved in the robot-assisted
rehabilitation group. Surface electromyography of the vastus medialis muscle showed
significant increases in maximum and average discharge after the intervention.
[Conclusion] The results suggest that walking ability and muscle strength can be improved
by robotic training.
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Affiliation(s)
- Chunying Hu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Qiuchen Huang
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Lili Yu
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Miao Ye
- School of Rehabilitation Medicine, Capital Medical University, China; Department of Physical Therapy, China Rehabilitation Research Center, China
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Kasai R, Takeda S. The effect of a hybrid assistive limb(®) on sit-to-stand and standing patterns of stroke patients. J Phys Ther Sci 2016; 28:1786-90. [PMID: 27390416 PMCID: PMC4932057 DOI: 10.1589/jpts.2016.1786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/29/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The Hybrid Assistive Limb(®) (HAL(®)) robot suit is a powered exoskeleton that can assist a user's lower limb movement. The purpose of this study was to assess the effectiveness of HAL(®) in stroke rehabilitation, focusing on the change of the sit-to-stand (STS) movement pattern and standing posture. [Subjects and Methods] Five stroke patients participated in this study. Single leg HAL(®) was attached to each subject's paretic lower limb. The subjects performed STS three times both with and without HAL(®) use. A tri-axial accelerometer was used to assess the STS movement pattern. Forward-tilt angle (FTA) and the time required for STS were measured with and without HAL(®) use. Surface electromyography (EMG) of STS and standing were recorded to assess the vastus medialis muscle activities of the paretic limb. [Results] The average FTA without HAL(®) use was 35° and it improved to 43° with HAL(®) use. The time required for STS was longer for all subjects with HAL(®) use (without HAL(®) use: 3.42 s, with HAL(®) use: 5.11 s). The integrated EMGs of HAL(®) use compared to those without HAL(®), were 83.6% and 66.3% for STS and standing, respectively. [Conclusion] HAL(®) may be effective in improving STS and standing patterns of stroke patients.
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Affiliation(s)
- Rie Kasai
- Department of Physical Therapy, International University of Health and Welfare, Japan
| | - Sunao Takeda
- Waseda Research Institute for Science and Engineering, Japan
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Kang CG, Chun MH, Chang MC, Kim W, Hee Do K. Views of physiatrists and physical therapists on the use of gait-training robots for stroke patients. J Phys Ther Sci 2016; 28:202-206. [PMID: 26957758 PMCID: PMC4756004 DOI: 10.1589/jpts.28.202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Gait-training robots have been developed for stroke patients with gait disturbance. It is important to survey the views of physiatrists and physical therapists on the characteristics of these devices during their development. [Subjects and Methods] A total of 100 physiatrists and 100 physical therapists from 38 hospitals participated in our questionnaire survey. [Results] The most common answers about the merits of gait-training robots concern improving the treatment effects (28.5%), followed by standardizing treatment (19%), motivating patients about treatment (17%), and improving patients' self-esteem (14%). The subacute period (1-3 months post-stroke onset) was most often chosen as the ideal period (47.3%) for the use of these devices, and a functional ambulation classification of 0-2 was the most selected response for the optimal patient status (27%). The preferred model was the treadmill type (47.5%) over the overground walking type (40%). The most favored commercial price was $50,000-$100,000 (38.3%). The most selected optimal duration for robot-assisted gait therapy was 30-45 min (47%), followed by 15-30 min (29%), 45-60 min (18%), ≥ 60 min (5%), and < 15 min (1%). [Conclusion] Our study findings could guide the future designs of more effective gait-training robots for stroke patients.
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Affiliation(s)
- Chang Gu Kang
- Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine,
Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine,
Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine,
Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine,
Republic of Korea
| | - Kyung Hee Do
- Department of Rehabilitation Medicine, Asan Medical Center,
University of Ulsan College of Medicine,
Republic of Korea
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Qian JG, Rong K, Qian Z, Wen C, Zhang S. Effects of a multichannel dynamic functional electrical stimulation system on hemiplegic gait and muscle forces. J Phys Ther Sci 2015; 27:3541-4. [PMID: 26696734 PMCID: PMC4681941 DOI: 10.1589/jpts.27.3541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the study was to design and implement a multichannel dynamic
functional electrical stimulation system and investigate acute effects of functional
electrical stimulation of the tibialis anterior and rectus femoris on ankle and knee
sagittal-plane kinematics and related muscle forces of hemiplegic gait. [Subjects and
Methods] A multichannel dynamic electrical stimulation system was developed with 8-channel
low frequency current generators. Eight male hemiplegic patients were trained for 4 weeks
with electric stimulation of the tibia anterior and rectus femoris muscles during walking,
which was coupled with active contraction. Kinematic data were collected, and muscle
forces of the tibialis anterior and rectus femoris of the affected limbs were analyzed
using a musculoskelatal modeling approach before and after training. A paired sample
t-test was used to detect the differences between before and after training. [Results] The
step length of the affected limb significantly increased after the stimulation was
applied. The maximum dorsiflexion angle and maximum knee flexion angle of the affected
limb were both increased significantly during stimulation. The maximum muscle forces of
both the tibia anterior and rectus femoris increased significantly during stimulation
compared with before functional electrical stimulation was applied. [Conclusion] This
study established a functional electrical stimulation strategy based on hemiplegic gait
analysis and musculoskeletal modeling. The multichannel functional electrical stimulation
system successfully corrected foot drop and altered circumduction hemiplegic gait
pattern.
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Affiliation(s)
| | - Ke Rong
- Nanjing Sport Institute, China
| | | | - Chen Wen
- The University of Tennessee, USA
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Huang Q, Zhou Y, Yu L, Gu R, Cui Y, Hu C. The reliability of evaluation of hip muscle strength in rehabilitation robot walking training. J Phys Ther Sci 2015; 27:3073-5. [PMID: 26644646 PMCID: PMC4668137 DOI: 10.1589/jpts.27.3073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The primary purpose of this study was to evaluate the intraclass correlation coefficient in obtaining the torque of the hip muscle strength during a robot-assisted rehabilitation treatment. [Subjects] Twenty-four patients (15 males, 9 females) with spinal cord injury participated in the study. [Methods] The subjects were asked to walk during robot-assisted rehabilitation, and the torque of the muscle strength which was measured at hip joint flexion angles of -15, -10, -5, 0, 5, 10, 15, 20, 25, and 30 degrees. [Results] The intraclass correlation coefficient of the torque of the hip muscle strength measured by the rehabilitation training robot was excellent. [Conclusion] Our results show that measurement of torque can be used as an objective assessment of treatment with RAT.
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Affiliation(s)
- Qiuchen Huang
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Yue Zhou
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Lili Yu
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Rui Gu
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Orthopedic and Orthopedic Rehabilitation, China Rehabilitation Research Center, China
| | - Yao Cui
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Physical Therapy, China Rehabilitation Research Center, China
| | - Chunying Hu
- School of Rehabilitation Medicine, Capital Medical University, China ; Department of Physical Therapy, China Rehabilitation Research Center, China
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