Robot-Assisted Gait Training for Achieving Gait Symmetry in a Subacute Stroke Patient: A Case Report

 My gait asymmetry is directly the result of the COMPLETE FAILURE OF MY STROKE MEDICAL 'PROFESSIONALS' to cure my spasticity! Don't you dare justify that lack of cure because it hasn't been figured out how to do that yet. SOLVE THE FUCKING PROBLEM before you become the 1 in 4 per WHO that has a stroke!

This person is an outlier, not likely to be repeated en masse.

Robot-Assisted Gait Training for Achieving Gait Symmetry in a Subacute Stroke Patient: A Case Report 

Published: December 09, 2024

DOI: 10.7759/cureus.75361

Peer-Reviewed

Cite this article as: Fujii R, Tamari M, Mizuta N, et al. (December 09, 2024) Robot-Assisted Gait Training for Achieving Gait Symmetry in a Subacute Stroke Patient: A Case Report. Cureus 16(12): e75361. doi:10.7759/cureus.7536

Abstract

Gait asymmetry in post-stroke patients is an important gait characteristic that is associated with their balance control, inefficiency, and risks of musculoskeletal injury to the non-paretic lower limb and falling. Unfortunately, most stroke patients retain an asymmetrical gait pattern, even though their gait independence and gait speed improve. We describe the clinical course of a subacute stroke patient who achieved a symmetrical gait at discharge after undergoing both gait training with orthoses and robot-assisted gait training from the early intervention phase. A Korean woman in her 50s developed a right frontal subcortical hemorrhage. She had severe left upper- and lower-extremity motor paralysis and was unable to walk independently. Her gait pattern was also observed to have a knee extension thrust pattern and a resulting asymmetric gait pattern. The gait interventions consisted of gait training with a knee-ankle-foot orthosis (KAFO) and an ankle-foot orthosis (AFO), in addition to robot-assisted gait training from the early onset. The control of the knee joint's movement was obtained by the attachment of the knee-ankle-foot robot to the paretic lower limb. Following these interventions, the patient was able to walk independently and had a symmetrical gait pattern at the time of discharge. The combination of robot-assisted gait training and gait training with orthoses for subacute stroke patients, as is widely used in general populations, may prevent the patients' mislearning of gait movements and contribute to the acquisition of a symmetrical gait pattern.

Introduction

The recovery of gait performance is a major goal of stroke rehabilitation [1]. In earlier studies, approximately 50% of stroke patients were able to walk independently after rehabilitation, but the remaining ~50% retained gait asymmetry [2]. Gait asymmetry is defined by spatial asymmetry (i.e., the step length on the paretic/non-paretic side) and temporal asymmetry (i.e., the stance or swing phase time on the paretic/non-paretic side) [3], and gait asymmetry affects an individual's balance control, inefficiency, and the risks of musculoskeletal injury to the non-paretic lower limb and falling [2,3]. Gait performance is an important variable in stroke rehabilitation, but the optimal type of rehabilitation to improve stroke patients' gait performance is not well established.

Various gait-training devices have been developed and were shown to improve the abnormal gait patterns of stroke patients [4]. Gait rehabilitation robots are representative devices that have been shown to (i) improve chronic stroke patients' hip hiking in the swing phase and (ii) prolong the stance time on the paretic side and the step length on the non-paretic side [4]. There have been few such studies of patients who have suffered from an acute or subacute stroke, and it is not clear whether or how a robot should be prescribed during a patient's recovery process after stroke onset. Since the recovery of neuromuscular control in the gait during the acute and subacute stages influences the physical disability prognosis [5], it is very important to design interventions designed to improve patients' gait patterns from an early onset time point.

In the gait rehabilitation of stroke patients, an ankle-foot orthosis (AFO) and a knee-ankle-foot orthosis (KAFO) are commonly used for gait reconstruction [6]. An AFO is used to fix the ankle joint, and a KAFO is used to fix the knee and ankle joints. A KAFO is prescribed for patients who have experienced a severe stroke and cannot control knee instability during their standing or gait with an AFO [6]. When a patient's knee stability improves, it is common to transition from KAFO to AFO [6]. However, when a transition from a KAFO to an AFO is performed, it is extremely difficult to adjust the difficulty level for knee-joint movement, and an inappropriate adjustment (i.e., if knee instability remains) leads to the patient's mislearning of abnormal gait pattern(s) and ultimately to an asymmetrical gait. We hypothesized that the introduction of a robot with precise knee-joint movement adjustment during the transition from a KAFO to an AFO could optimize the degree of difficulty in the movement and prevent the mislearning of abnormal gait patterns, thus benefiting the acquisition of a symmetrical gait pattern.

Based on the above hypothesis, we introduced a gait rehabilitation program combining gait training with orthoses plus robot-assisted gait training for a patient who had suffered a subacute stroke and was unable to walk. We report that the patient made good progress and acquired a symmetrical gait pattern at the time of discharge.

More at link.