So they only significantly improved. That is failure since they didn't get 100% recovered. This tyranny of low expectations needs to stop. I thought BWSTT wasn't any good since I needed full bodyweight to at least have some semblance of lessening of my spasticity.
Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Poststroke: A Randomized Controlled Study
Ming Wu, PhD,a,b
Jill M. Landry, MSPT,a
Janis Kim, MPT,a
Brian D. Schmit, PhD,a,b,c
Sheng-Che Yen, PT, PhD,a
Jillian MacDonald, DPT a
From the
a Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL;
b Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL; and
c Department of Biomedical Engineering, Marquette University, Milwaukee, WI.Current affiliation for Yen, Department of Physical Therapy, Northeastern University, Boston, MA.
Jill M. Landry, MSPT,a
Janis Kim, MPT,a
Brian D. Schmit, PhD,a,b,c
Sheng-Che Yen, PT, PhD,a
Jillian MacDonald, DPT a
From the
a Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL;
b Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL; and
c Department of Biomedical Engineering, Marquette University, Milwaukee, WI.Current affiliation for Yen, Department of Physical Therapy, Northeastern University, Boston, MA.
Abstract
Objective:
To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals post stroke.
Design:
Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.
Setting:
Research units of rehabilitation hospitals.
Participants:
Patients (N=30) with chronic stroke.
Intervention:
Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking.For the assistance group, a load that assists swing was applied.
Main Outcome Measures:
Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks’ follow-up, and compared within group and between the 2 groups.
Results:
After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group.
Conclusions:
Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may induce improvements in walking speed in individuals post stroke. Resistance training was not superior to assistance training in improving locomotor function in individuals post stroke.Archives of Physical Medicine and Rehabilitation 2014;95:799-806
ª
2014 by the American Congress of Rehabilitation Medicine
Walking dysfunction is one of the physical limitations contributing to stroke-related disability.1Most stroke survivors walk with reduced walking speed2and endurance,3as well as with residual spatial and temporal asymmetry.4Walking dysfunction reduces the probability of successfully returning to work and decreases participation in community activities.5As a consequence,improved walking function is a major goal of rehabilitation inindividuals post stroke.The use of body weight supported treadmill training (BWSTT) has demonstrated significant improvements in walking capability in individuals post stroke. For instance, previous studies have indicated significant improvements in gait velocity,6-9endurance,10balance,7and symmetry11after BWSTT. However, BWSTT can be labor intensive work for physical therapists, particularly when working with patients who require substantial walking assistance after stroke.6 Several robotic systems have been developed for automating locomotor training.12,13These robotic systems are effective in reducing therapist labor and increasing the total duration of training. However, their use has shown relatively limited functional gains for some patients14-16because of the limitations of these robotic systems. For instance, the limited degrees of freedom of current robotic systems allows movement only in the sagittal plane, which may limit the natural walking pattern and affect gait dynamics.17In addition, the fixed trajectory control strategy used in current robotic systems may encourage passive rather than active training.Active motor training has been demonstrated to be more effective than passive training in eliciting performance improvement.18In particular, data from hemiparetic subjects practicing upper limb movements with forces that provide passive guidance versus error enhancement indicate that greater improvements in performance are achieved when errors are magnified,19suggesting that error augmentation training may also be used as an effective way to improve locomotor function in individuals post stroke. Thus,we postulated that by applying a controlled resistance load to in-crease kinematic errors (ie, the difference between the predicted leg movement outcomes and the observed outcomes of the leg movement) of the paretic leg during treadmill walking, motor learning would be accelerated during BWSTT in individuals post stroke.On the other hand, providing a controlled assistance load to the paretic leg may facilitate leg swing, which mimics the way that therapists provide assistance to the paretic leg during treadmill training. We postulated that providing an assistance load to the paretic leg may also improve locomotor function in individuals post stroke through a use dependent motor learning mechanism.20To date, no randomized controlled studies have directly compared leg resistance versus assistance during BWSTT in individuals post stroke. The purpose of this study was to assess locomotor function (ie, walking speed, endurance, balance) after resistance versus assistance training in individuals post stroke. We hypothesized that subjects from both groups would show improvements in locomotor function, although there would be greater improvements in subjects who underwent resistance training in comparison with those who underwent assistance training. Results from this study may be used to develop robotic training paradigms to improve locomotor function in individuals post stroke.
To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals post stroke.
Design:
Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.
Setting:
Research units of rehabilitation hospitals.
Participants:
Patients (N=30) with chronic stroke.
Intervention:
Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking.For the assistance group, a load that assists swing was applied.
Main Outcome Measures:
Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks’ follow-up, and compared within group and between the 2 groups.
Results:
After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group.
Conclusions:
Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may induce improvements in walking speed in individuals post stroke. Resistance training was not superior to assistance training in improving locomotor function in individuals post stroke.Archives of Physical Medicine and Rehabilitation 2014;95:799-806
ª
2014 by the American Congress of Rehabilitation Medicine
Walking dysfunction is one of the physical limitations contributing to stroke-related disability.1Most stroke survivors walk with reduced walking speed2and endurance,3as well as with residual spatial and temporal asymmetry.4Walking dysfunction reduces the probability of successfully returning to work and decreases participation in community activities.5As a consequence,improved walking function is a major goal of rehabilitation inindividuals post stroke.The use of body weight supported treadmill training (BWSTT) has demonstrated significant improvements in walking capability in individuals post stroke. For instance, previous studies have indicated significant improvements in gait velocity,6-9endurance,10balance,7and symmetry11after BWSTT. However, BWSTT can be labor intensive work for physical therapists, particularly when working with patients who require substantial walking assistance after stroke.6 Several robotic systems have been developed for automating locomotor training.12,13These robotic systems are effective in reducing therapist labor and increasing the total duration of training. However, their use has shown relatively limited functional gains for some patients14-16because of the limitations of these robotic systems. For instance, the limited degrees of freedom of current robotic systems allows movement only in the sagittal plane, which may limit the natural walking pattern and affect gait dynamics.17In addition, the fixed trajectory control strategy used in current robotic systems may encourage passive rather than active training.Active motor training has been demonstrated to be more effective than passive training in eliciting performance improvement.18In particular, data from hemiparetic subjects practicing upper limb movements with forces that provide passive guidance versus error enhancement indicate that greater improvements in performance are achieved when errors are magnified,19suggesting that error augmentation training may also be used as an effective way to improve locomotor function in individuals post stroke. Thus,we postulated that by applying a controlled resistance load to in-crease kinematic errors (ie, the difference between the predicted leg movement outcomes and the observed outcomes of the leg movement) of the paretic leg during treadmill walking, motor learning would be accelerated during BWSTT in individuals post stroke.On the other hand, providing a controlled assistance load to the paretic leg may facilitate leg swing, which mimics the way that therapists provide assistance to the paretic leg during treadmill training. We postulated that providing an assistance load to the paretic leg may also improve locomotor function in individuals post stroke through a use dependent motor learning mechanism.20To date, no randomized controlled studies have directly compared leg resistance versus assistance during BWSTT in individuals post stroke. The purpose of this study was to assess locomotor function (ie, walking speed, endurance, balance) after resistance versus assistance training in individuals post stroke. We hypothesized that subjects from both groups would show improvements in locomotor function, although there would be greater improvements in subjects who underwent resistance training in comparison with those who underwent assistance training. Results from this study may be used to develop robotic training paradigms to improve locomotor function in individuals post stroke.
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