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Maki Y, Ii T, Yamada M, Tanabe S. Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training with conventional rehabilitation. Int J Rehabil Res 2024; 47:26-33. [PMID: 38175700 DOI: 10.1097/mrr.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training (RAGT) and conventional treatment (RAGT-CT) were examined. This retrospective cohort study included 37 patients with stroke [ n = 11 ischemic; n = 26 hemorrhagic; median poststroke interval, 28 days (interquartile range, IQR, 24-42)] who underwent RAGT using Welwalk for a median of 3 weeks (IQR, 2-4) followed by conventional training (median, 129 days; IQR, 114-146). The primary outcome was the change in functional independence measure (FIM)-walk item score from before to after RAGT (FIM-walk efficiency). The secondary outcome was the FIM-walk score at discharge. The independent variables included sensorimotor function [lower extremity (LE) motor and sensory scores and trunk function from the Stroke Impairment Assessment Set (SIAS) and Berg Balance Scale (BBS)] and cognitive function (FIM-cognitive, MMSE and Cognitive-related Behavioral Assessment) before RAGT-CT and RAGT dose duration per session, total steps and average treadmill speed at week 1, and number of sessions). We first determined the bivariate associations of each independent variable with the FIM-walk efficiency at the end of the RAGT period as decided by the therapists and with the FIM-walk score at discharge. Hierarchical multiple regression revealed that only the FIM-cognitive score was a significant predictor of the FIM-walk efficiency at the end of the RAGT period ( β = 0.47; P < 0.01, adjusted R2 = 0.21) after accounting for age, days post-stroke, SIAS-total lower extremity (SIAS-LE) motor score, and number of RAGT sessions (all nonsignificant). Furthermore, only the SIAS-trunk score was a significant predictor of the FIM-walk score at discharge ( β = 0.52; P < 0.01; adjusted R2 = 0.65) after accounting for age, days post-stroke, FIM-cognitive score, SIAS-LE motor score, and average treadmill speed at week 1 (all nonsignificant). Although patients with better cognition at the start of locomotor training achieved the pragmatic targets for terminating RAGT and proceeding with conventional therapy at a faster rate, the outcome at discharge is mainly dependent on early trunk function.
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Affiliation(s)
- Yoshiaki Maki
- Department of Rehabilitation, Ukai Rehabilitation Hospital, Nagoya
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masanari Yamada
- Department of Rehabilitation, Ukai Rehabilitation Hospital, Nagoya
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
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Shu X, Yu H, Zhou Y, Zhou S, Chen B. Clinical study on low-frequency repetitive transcranial magnetic stimulation for the treatment of walking dysfunction following stroke through three-dimensional gait analysis. Psychogeriatrics 2024; 24:182-194. [PMID: 38168071 DOI: 10.1111/psyg.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The recovery of walking capacity is of great significance in stroke rehabilitation. We evaluated changes in post-stroke gait function after low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) treatment. METHODS Stroke patients were randomly assigned to control (conventional treatment)/LF-rTMS (LF-rTMS treatment based on conventional treatment) groups. Gait spatiotemporal parameters/affected side joint motion angle/affected side dynamic parameters were analyzed by 3D gait analyses. Motor evoked potential (MEP)/central motor conduction time (CMCT) changes were detected. Correlations between MEP latency/CMCT and gait parameters after LF-rTMS were analyzed by Pearson analysis. RESULTS The two groups exhibited boosted stride speed/frequency/length, affected side stride length/swing phase percentage/hip/knee/ankle joint plantar flexion angle, and affected side ahead ground reaction force/ upward ground reaction force (AGRF/UGRF)/ankle joint plantar flexion moment, along with reduced affected side gait period/stance phase percentage after treatment, and the LF-rTMS group manifested better efficacy. MEP latency/CMCT of stroke patients treated with LF-rTMS was adversely linked to stride speed, affected side stride length/swing phase percentage/knee flexion angle, AGRF and UGRF, and positively correlated with affected side stance phase percentage. CONCLUSION LF-rTMS significantly improved gait spatiotemporal parameters/affected joint motion angles/neurophysiologic parameters (MEP latency/CMCT) in patients with post-stroke walking dysfunction. MEP latency/CMCT after LF-rTMS treatment were prominently correlated with gait parameters. Relative to the traditional scale assessment, we provided a more accurate, objective and reliable evaluation of the effects of LF-rTMS on lower limb mobility and functional recovery effects in stroke patients from the perspective of 3D gait analysis and neurophysiology, which provided more evidence to support the clinical application of LF-rTMS in post-stroke walking dysfunction treatment.
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Affiliation(s)
- Xinxin Shu
- Rehabilitation Assessment and Treatment Centre, Zhejiang Rehabilitation Medical Centre, Hang Zhou, China
| | - Hong Yu
- Rehabilitation Assessment and Treatment Centre, Zhejiang Rehabilitation Medical Centre, Hang Zhou, China
| | - Yuda Zhou
- Rehabilitation Assessment and Treatment Centre, Zhejiang Rehabilitation Medical Centre, Hang Zhou, China
| | - Siwei Zhou
- Department of Elderly Rehabilitation, Zhejiang Rehabilitation Medical Centre, Hang Zhou, China
| | - Bei Chen
- Rehabilitation Assessment and Treatment Centre, Zhejiang Rehabilitation Medical Centre, Hang Zhou, China
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Zhang H, Li X, Gong Y, Wu J, Chen J, Chen W, Pei Z, Zhang W, Dai L, Shu X, Shen C. Three-Dimensional Gait Analysis and sEMG Measures for Robotic-Assisted Gait Training in Subacute Stroke: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7563802. [PMID: 37082189 PMCID: PMC10113045 DOI: 10.1155/2023/7563802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 04/22/2023]
Abstract
Background The efficacy of robotic-assisted gait training (RAGT) should be considered versatilely; among which, gait assessment is one of the most important measures; observational gait assessment is the most commonly used method in clinical practice, but it has certain limitations due to the deviation of subjectivity; instrumental assessments such as three-dimensional gait analysis (3DGA) and surface electromyography (sEMG) can be used to obtain gait data and muscle activation during walking in stroke patients with hemiplegia, so as to better evaluate the rehabilitation effect of RAGT. Objective This single-blind randomized controlled trial is aimed at analyzing the impact of RAGT on the 3DGA parameters and muscle activation in patients with subacute stroke and evaluating the clinical effect of improving walking function of RAGT. Methods This randomized controlled trial evaluated the improvement of 4-week RAGT on patients with subacute stroke by 3DGA and surface electromyography (sEMG), combined with clinical scales: experimental group (n = 18, 20 sessions of RAGT) or control group (n = 16, 20 sessions of conventional gait training). Gait performance was evaluated by the 3DGA, and clinical evaluations based on Fugl-Meyer assessment for lower extremity (FMA-LE), functional ambulation category (FAC), and 6-minute walk test (6MWT) were used. Of these patients, 30 patients underwent sEMG measurement synchronized with 3DGA; the cocontraction index in swing phase of the knee and ankle of the affected side was calculated. Results After 4 weeks of intervention, intragroup comparison showed that walking speed, temporal symmetry, bilateral stride length, range of motion (ROM) of the bilateral hip, flexion angle of the affected knee, ROM of the affected ankle, FMA-LE, FAC, and 6MWT in the experimental group were significantly improved (p < 0.05), and in the control group, significant improvements were observed in walking speed, temporal symmetry, stride length of the affected side, ROM of the affected hip, FMA-LE, FAC, and 6MWT (p < 0.05). Intergroup comparison showed that the experimental group significantly outperformed the control group in walking speed, temporal symmetry of the spatiotemporal parameters, ROM of the affected hip and peak flexion of the knee in the kinematic parameters, and the FMA-LE and FAC in the clinical scale (p < 0.05). In patients evaluated by sEMG, the experimental group showed a noticeable improvement in the cocontraction index of the knee (p = 0.042), while no significant improvement was observed in the control group (p = 0.196), and the experimental group was better than the control group (p = 0.020). No noticeable changes were observed in the cocontraction index of the ankle in both groups (p > 0.05). Conclusions Compared with conventional gait training, RAGT successfully improved part of the spatiotemporal parameters of patients and optimized the motion of the affected lower limb joints and muscle activation patterns during walking, which is crucial for further rehabilitation of walking ability in patients with subacute stroke. This trial is registered with ChiCTR2200066402.
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Affiliation(s)
- Huihuang Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Xiang Li
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Yichen Gong
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Jianing Wu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013 Hangzhou, Zhejiang, China
- Neurorehabilitation Department, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Weihai Chen
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
| | - Zhongcai Pei
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
| | - Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Lei Dai
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, China
| | - Xinxin Shu
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, China
| | - Cheng Shen
- Department of Hangzhou Innovation Institute, Beihang University, 310053 Hangzhou, Zhejiang, China
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User Profiling to Enhance Clinical Assessment and Human-Robot Interaction: A Feasibility Study. Int J Soc Robot 2023; 15:501-516. [PMID: 35846164 PMCID: PMC9266091 DOI: 10.1007/s12369-022-00901-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
Socially Assistive Robots (SARs) are designed to support us in our daily life as a companion, and assistance but also to support the caregivers' work. SARs should show personalized and human-like behavior to improve their acceptance and, consequently, their use. Additionally, they should be trustworthy by caregivers and professionals to be used as support for their work (e.g. objective assessment, decision support tools). In this context the aim of the paper is dual. Firstly, this paper aims to present and discuss the robot behavioral model based on sensing, perception, decision support, and interaction modules. The novel idea behind the proposed model is to extract and use the same multimodal features set for two purposes: (i) to profile the user, so to be used by the caregiver as a decision support tool for the assessment and monitoring of the patient; (ii) to fine-tune the human-robot interaction if they can be correlated to the social cues. Secondly, this paper aims to test in a real environment the proposed model using a SAR robot, namely ASTRO. Particularly, it measures the body posture, the gait cycle, and the handgrip strength during the walking support task. Those collected data were analyzed to assess the clinical profile and to fine-tune the physical interaction. Ten older people (65.2 ± 15.6 years) were enrolled for this study and were asked to walk with ASTRO at their normal speed for 10 m. The obtained results underline a good estimation (p < 0.05) of gait parameters, handgrip strength, and angular excursion of the torso with respect to most used instruments. Additionally, the sensory outputs were combined in the perceptual model to profile the user using non-classical and unsupervised techniques for dimensionality reduction namely T-distributed Stochastic Neighbor Embedding (t-SNE) and non-classic multidimensional scaling (nMDS). Indeed, these methods can group the participants according to their residual walking abilities.
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Yu J, Wang C, Yang F. Observations on the kinematic characteristics of the healthy side of the knee in stroke patients: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31853. [PMID: 36401410 PMCID: PMC9678635 DOI: 10.1097/md.0000000000031853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The abnormal gait of stroke patients not only severely limits the recovery of their walking ability, but also seriously affects their quality of daily life. Previous observational studies have focused too much on the observation of single degree of freedom and axial knee motion angles in stroke patients. Changes in the multi-degree of freedom and multi-axial joint angles of the knee have been less frequently observed, leading to somewhat limited conclusions. Therefore, the aim of this study was to use the Opti-knee motion test to analyze in real time the motion of the knee in all directions on the healthy side of stroke patients and to compare it with normal gait to provide a clinical basis for subsequent rehabilitation. In a cross-sectional study, 120 subjects (60 stroke patients were as the observation group and 60 healthy subjects as the control group) were studied. Both groups of subjects were tested for Opti-Knee tri-axial angles of motion of the healthy side of the knee, including flexion and extension, internal and external rotation, internal and external turning, anterior and posterior displacement, superior and inferior displacement, left and right displacement, maximum extension angle and maximum flexion angle. Compared with the control group, there were significant changes in the joint angles of flexion and extension, internal and external rotation, internal and external turning, maximum extension and maximum flexion of the knee on the healthy side in the observation group, and the differences were statistically significant [95%(37.22, 45.13), P = .01], [95%(9.51,13.67), P = .018], [95%(4.82,7.57), P = .049], [95%(4.12, 8.63), P = .019], [95%(51.68, 57.28), P = .0001]. However, there was no significant change in the angle of motion of the healthy side of the knee for anterior-posterior displacement, superior-inferior displacement and internal-external displacement in either group and the differences were not statistically significant [95%(1.16, 1.78), P = .72], [95%(0.85,1.32), P = .32], [95%(0.57, 0.88), P = .36]. This study confirms the importance of changes in the angle of motion of the knee on the side of the stroke patient in maintaining the stability of the knee joint. Therefore, their bilateral lower limb symmetry training should be paid attention to in the subsequent rehabilitation treatment.
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Affiliation(s)
- JunWu Yu
- Department of Rehabilitation, Ningbo College of Health Sciences, Ningbo, China
| | - Chen Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - FaMing Yang
- Department of Rehabilitation, Ningbo College of Health Sciences, Ningbo, China
- *Correspondence: FaMing Yang, Department of Rehabilitation, Ningbo College of Health Sciences, Ningbo 315100, China (e-mail: )
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Aimoto K, Matsui T, Asai Y, Tozawa T, Tsukada T, Kawamura K, Ozaki K, Kondo I. Gait improvement in stroke patients by Gait Exercise Assist Robot training is related to trunk verticality. J Phys Ther Sci 2022; 34:715-719. [PMID: 36337216 PMCID: PMC9622344 DOI: 10.1589/jpts.34.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022] Open
Abstract
[Purpose] Various types of Gait Exercise Assist Robot (GEAR) have been developed
recently, some of which have enabled early improvement in patients with stroke. However,
none has yet resulted in independent walking in these patients. Hence, we conducted an
exploratory study of the effect of GEAR on achieving independent walking in stroke
patients. [Participants and Methods] The participants were 16 patients with severe stroke.
We evaluated patients’ ability to walk independently after GEAR training. The outcome
measure was Stroke Impairment Assessment Set (SIAS) motor score (Hip Flexion, Knee
Extension, Foot Pat, Abdominal and Verticality). Differences in five SIAS motor scores
were compared between the independent and non-independent walking groups. [Results] There
was statistically significant difference between the groups in terms of Verticality among
the 5 SIAS items used in the present research . Verticality of SIAS score of 1 was the
cut-off value for distinguishing walking independence. [Conclusion] Verticality of SIAS
may be a marker of potential walking independence that can be used in rehabilitation plans
using walking-assist robots in patients with stroke.
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Affiliation(s)
- Keita Aimoto
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan,Corresponding author. Keita Aimoto (E-mail: )
| | - Takayuki Matsui
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Yusuke Asai
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Taku Tozawa
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Tomoya Tsukada
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Koki Kawamura
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for
Geriatrics and Gerontology: 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan
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Measurement, Evaluation, and Control of Active Intelligent Gait Training Systems—Analysis of the Current State of the Art. ELECTRONICS 2022. [DOI: 10.3390/electronics11101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gait recognition and rehabilitation has been a research hotspot in recent years due to its importance to medical care and elderly care. Active intelligent rehabilitation and assistance systems for lower limbs integrates mechanical design, sensing technology, intelligent control, and robotics technology, and is one of the effective ways to resolve the above problems. In this review, crucial technologies and typical prototypes of active intelligent rehabilitation and assistance systems for gait training are introduced. The limitations, challenges, and future directions in terms of gait measurement and intention recognition, gait rehabilitation evaluation, and gait training control strategies are discussed. To address the core problems of the sensing, evaluation and control technology of the active intelligent gait training systems, the possible future research directions are proposed. Firstly, different sensing methods need to be proposed for the decoding of human movement intention. Secondly, the human walking ability evaluation models will be developed by integrating the clinical knowledge and lower limb movement data. Lastly, the personalized gait training strategy for collaborative control of human–machine systems needs to be implemented in the clinical applications.
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Efficacy of electromechanical-assisted gait training on clinical walking function and gait symmetry after brain injury of stroke: a randomized controlled trial. Sci Rep 2022; 12:6880. [PMID: 35477986 PMCID: PMC9046288 DOI: 10.1038/s41598-022-10889-3] [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: 01/11/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022] Open
Abstract
Electromechanical-assisted gait training may be an effective intervention to promote motor recovery after brain injury. However, many studies still have difficulties in clarifying the difference between electromechanical-assisted gait training and conventional gait training. To evaluate the effectiveness of electromechanical-assisted gait training compared to that of conventional gait training on clinical walking function and gait symmetry of stroke patients. We randomly assigned patients with stroke (n = 144) to a control group (physical therapist-assisted gait training) and an experimental group (electromechanical gait training). Both types of gait training were done for 30 min each day, 5 days a week for 4 weeks. The primary endpoint was the change in functional ambulatory category (FAC). Secondary endpoints were clinical walking functions and gait symmetries of swing time and step length. All outcomes were measured at baseline (pre-intervention) and at 4 weeks after the baseline (post-intervention). FAC showed significant improvement after the intervention, as did clinical walking functions, in both groups. The step-length asymmetry improved in the control group, but that in the experimental group and the swing-time asymmetry in both groups did not show significant improvement. In the subgroup analysis of stroke duration of 90 days, FAC and clinical walking functions showed more significant improvement in the subacute group than in the chronic group. However, gait symmetries did not show any significant changes in either the subacute or the chronic group. Electromechanically assisted gait training by EXOWALK was as effective as conventional gait training with a physiotherapist. Although clinical walking function in the subacute group improved more than in the chronic group, gait asymmetry did not improve for either group after gait training. Trial registration: KCT0003411 Clinical Research Information Service (CRIS), Republic of Korea.
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Robot-assisted Gait Training Using Welwalk in Hemiparetic Stroke Patients: An Effectiveness Study with Matched Control. J Stroke Cerebrovasc Dis 2020; 29:105377. [PMID: 33091753 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Although studies on the efficacy of the rehabilitation robot are increasing, there are few reports using the robot for gait training in the actual clinical setting. This study aimed to investigate the effectiveness of gait training using Welwalk in hemiparetic stroke patients in a real clinical setting. MATERIALS AND METHODS This prospective study included 36 hemiparetic stroke patients who underwent gait training using Welwalk. We examined the walking ability improvement efficiency using Functional Independence Measure (FIM)-walk as the primary outcome, which was compared with that of 36 patients (matched control group) who underwent conventional rehabilitation. Other outcomes were the actual gait training period using Welwalk, raw FIM-walk score, lower extremity motor functions score in Stroke Impairment Assessment Set at discharge, and duration from stroke onset until discharge. RESULTS The improvement efficiency of the FIM-walk was significantly higher in the Welwalk group than in the matched control group (control 0.48 ± 0.31, Welwalk 0.80 ± 0.38, p-value < 0.001). The mean gait training period using Welwalk was 5 weeks. No significant differences were found in other outcomes between the Welwalk group and the matched control group. CONCLUSION This study demonstrated the effectiveness of gait training using Welwalk on the improvement efficiency of the FIM-walk in hemiparetic stroke patients in an actual clinical setting.
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