http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0158-1
- Larry W. Forrester,
- Anindo Roy,
- Charlene Hafer-Macko,
- Hermano I. Krebs and
- Richard F. MackoEmail author
Journal of NeuroEngineering and Rehabilitation201613:51
DOI: 10.1186/s12984-016-0158-1
© The Author(s). 2016
Received: 25 February 2016
Accepted: 24 May 2016
Published: 2 June 2016
Abstract
Background
An unsettled question in the
use of robotics for post-stroke gait rehabilitation is whether
task-specific locomotor training is more effective than targeting
individual joint impairments to improve walking function. The paretic
ankle is implicated in gait instability and fall risk, but is difficult
to therapeutically isolate and refractory to recovery. We hypothesize
that in chronic stroke, treadmill-integrated ankle robotics training is
more effective to improve gait function than robotics focused on paretic
ankle impairments.
Findings
Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n
= 12) videogame training. Selected gait measures were collected at
baseline, post-training, and six-week retention. Friedman, and Wilcoxon
Sign Rank and Fisher’s exact tests evaluated within and between group
differences across time, respectively. Six weeks post-training,
treadmill robotics proved more effective than seated robotics to
increase walking velocity, paretic single support, paretic push-off
impulse, and active dorsiflexion range of motion. Treadmill robotics
durably improved gait dorsiflexion swing angle leading 6/7 initially
requiring ankle braces to self-discarded them, while their unassisted
paretic heel-first contacts increased from 44 % to 99.6 %, versus no
change in assistive device usage (0/9) following seated robotics.
Conclusions
Treadmill-integrated, but not
seated ankle robotics training, durably improves gait biomechanics,
reversing foot drop, restoring walking propulsion, and establishing
safer foot landing in chronic stroke that may reduce reliance on
assistive devices. These findings support a task-specific approach
integrating adaptive ankle robotics with locomotor training to optimize
mobility recovery.
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