Improving interlimb coordination and paretic limb use after stroke using a novel robotic split-crank pedaling device: a cross-sectional study

 Still only a potential to enhance recovery. Survivors need; 'Do this; will get you recovered!' Until we get survivors in charge and quit providing guidelines instead of EXACT protocols, survivor recovery will never be guaranteed. You'll want that guarantee when you are the 1 in 4 per WHO that has a stroke? Then you just might want 100% recovery. 

Improving interlimb coordination and paretic limb use after stroke using a novel robotic split-crank pedaling device: a cross-sectional study

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Improving interlimb coordination and paretic limb use after stroke using a novel robotic split-crank pedaling device: a cross-sectional study

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• Tom S. Ruopp,
• Brian D. Schmit &
• Sheila Schindler-Ivens 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Many stroke survivors cannot walk effectively, even after rehabilitation. Causes include impaired muscle activation, poor interlimb coordination, and limited restorative interventions. To address this, we developed CUped (pronounced “cupid”), a motorized split-crank pedaling device designed to compel use of the paretic limb and retrain interlimb coordination. We examined its within-session effects, comparing three proportional control schemes—assist (A), resist (R), and assist plus resist (A + R)—to identify which best promotes recovery-related movement.

Methods

Nineteen individuals with stroke and eleven controls pedaled in 5-min bouts, one per control scheme. Each bout included pre-test, exposure, and post-test periods. Participants were instructed to maintain a 180º interlimb phase relationship. Interlimb coordination and paretic limb use were quantified as the mean and standard deviation of phasing error (µE, σE) and net mechanical work (Wₙₑₜ), respectively. ANOVA was used to assess the effects of group, time, and control scheme; regression examined relationships between variables and conditions. Between-limb differences in pedaling velocity (V_dif) were also calculated and served as interpretive measures.

Results

In stroke, all control schemes reduced µE, with the largest reduction observed under A + R (p ≤ 0.019; ES: A − 15º, R − 11º, A + R − 21º). Only A + R reduced σE (p = 0.039; ES: −10º). Effects diminished with sustained exposure to control schemes (p < 0.001) and exceeded pre-test when they were terminated (p ≤ 0.027; n_p² µE = 0.24, n_p² σE = 0.49 ). This “rebound” was associated with an increase in V_dif from pre- to post-test (p < 0.001. n_p²≥0.53). There was an inverse relationship between baseline phasing error and changes in µE and σE during exposure, where greater baseline error was associated with larger improvements (p < 0.001, R² µE = 0.74, R² σE = 0.69). The R scheme increased Wₙₑₜ, whereas A and A + R reduced it (p ≤ 0.026; ES: A − 8.8 J, R 2.9 J, A + R − 5.8 J). These changes were inversely related to changes in µE (p = 0.002, R²: 0.69). Responses to CUped were similar in controls.

Conclusion

CUped improved interlimb phasing and paretic limb use, though effects were not enduring, and gains in one reduced the other, with the A + R scheme performing the best overall. Results support CUped’s potential to enhance recovery-related movement and provide insight into motor adaptation post-stroke.

Data availability

The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.