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Taki S, Imura T, Mitsutake T, Iwamoto Y, Tanaka R, Imada N, Araki H, Araki O. Identifying the characteristics of patients with stroke who have difficulty benefiting from gait training with the hybrid assistive limb: a retrospective cohort study. Front Neurorobot 2024; 18:1336812. [PMID: 38390525 PMCID: PMC10881777 DOI: 10.3389/fnbot.2024.1336812] [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: 11/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Robot-assisted gait training is effective for walking independence in stroke rehabilitation, the hybrid assistive limb (HAL) is an example. However, gait training with HAL may not be effective for everyone, and it is not clear who is not expected to benefit. Therefore, we aimed to identify the characteristics of stroke patients who have difficulty gaining benefits from gait training with HAL. We conducted a single-institutional retrospective cohort study. The participants were 82 stroke patients who had received gait training with HAL during hospitalization. The dependent variable was the functional ambulation category (FAC) that a measure of gait independence in stroke patients, and five independent [age, National Institutes of Health Stroke Scale, Brunnstrom recovery stage (BRS), days from stroke onset, and functional independence measure total score (cognitive items)] variables were selected from previous studies and analyzed by logistic regression analysis. We evaluated the validity of logistic regression analysis by using several indicators, such as the area under the curve (AUC), and a confusion matrix. Age, days from stroke onset to HAL initiation, and BRS were identified as factors that significantly influenced walking independence through gait training with HAL. The AUC was 0.86. Furthermore, after building a confusion matrix, the calculated binary accuracy, sensitivity (recall), and specificity were 0.80, 0.80, and 0.81, respectively, indicated high accuracy. Our findings confirmed that older age, greater degree of paralysis, and delayed initiation of HAL-assisted training after stroke onset were associated with increased likelihood of walking dependence upon hospital discharge.
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Affiliation(s)
- Shingo Taki
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Takeshi Imura
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Tsubasa Mitsutake
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Yuji Iwamoto
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Naoki Imada
- Department of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Osamu Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
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Stramel DM, Winterbottom L, Stein J, Agrawal SK. Overground Robotic Gait Trainer mTPAD Improves Gait Symmetry and Weight Bearing in Stroke Survivors. Bioengineering (Basel) 2023; 10:698. [PMID: 37370629 DOI: 10.3390/bioengineering10060698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Stroke is a leading cause of disability, impairing the ability to generate propulsive forces and causing significant lateral gait asymmetry. We aim to improve stroke survivors' gaits by promoting weight-bearing during affected limb stance. External forces can encourage this; e.g., vertical forces can augment the gravitational force requiring higher ground reaction forces, or lateral forces can shift the center of mass over the stance foot, altering the lateral placement of the center of pressure. With our novel design of a mobile Tethered Pelvic Assist Device (mTPAD) paired with the DeepSole system to predict the user's gait cycle percentage, we demonstrate how to apply three-dimensional forces on the pelvis without lower limb constraints. This work is the first result in the literature that shows that with an applied lateral force during affected limb stance, the center of pressure trajectory's lateral symmetry is significantly closer to a 0% symmetry (5.5%) than without external force applied (-9.8%,p<0.05). Furthermore, the affected limb's maximum relative pressure (p) significantly increases from 233.7p to 234.1p (p<0.05) with an applied downward force, increasing affected limb loading. This work highlights how the mTPAD increases weight-bearing and propulsive forces during gait, which is a crucial goal for stroke survivors.
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Affiliation(s)
| | - Lauren Winterbottom
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
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Yakşi E, Bahadır ES, Yaşar MF, Alışık T, Kurul R, Demirel A. The effect of robot-assisted gait training frequency on walking, functional recovery, and quality of life in patients with stroke. Acta Neurol Belg 2023; 123:583-590. [PMID: 36717532 DOI: 10.1007/s13760-023-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
AIM This study aims to investigate the effects of robot-assisted gait training (RAGT) frequency on walking, functional recovery, QoL and mood. METHODS Sixty patients aged 50-75, diagnosed with post-stroke hemiplegia were entered into the retrospective analysis. Participants who scored maximum 3 on the Modified Rankin Scale and were diagnosed with moderate stroke according to The NIH Stroke Scale were included in the study. The participants in group 1 (G1) received only conventional treatment (CT), in group 2 (G2) participants received one session of RAGT per week in addition to the CT program, and group 3 (G3) received two sessions of RAGT per week in addition to the CT program. 6-min walk test (6-MWT), Barthel Index (BI), Stroke-Specific Quality of Life Scale (SSQoL), and Beck Depression Inventory (BDI) were recorded. RESULTS Median change in SSQoL of G3 was significantly higher from median change of G1 (p < 0.05), and median change in BDI of G3 was significantly lower than median change of G1 (p < 0.05). Median change in BDI of G3 was also significantly lower from change of G2 (p < 0.05). CONCLUSION Two weekly sessions of RAGT in addition to CT exhibit positive effects on QoL and mood but no additional contribution to functional status.
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Affiliation(s)
- Elif Yakşi
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey.
| | - Elif Selim Bahadır
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Mustafa Fatih Yaşar
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Tuğba Alışık
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Ramazan Kurul
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Adnan Demirel
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
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