Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Post stroke: A Randomized Controlled Study

Can't tell from the abstract if this was done during spontaneous recovery and can't see any objective measurement of starting points. With no starting point this research is not repeatable.  'May' just means followup needed which will never occur under current non-existent leadership. 

Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Post  stroke: 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 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(NOT good enough, we need certainty) 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. 

Locomotor skill acquisition in virtual reality shows sustained transfer to the real world

So this should IMMEDIATELY trigger research in stroke patients. But it won't. We have NO STROKE LEADERSHIP and NO STROKE STRATEGY.  That is how incompetent our stroke associations and stroke medical 'professionals' are.

Locomotor skill acquisition in virtual reality shows sustained transfer to the real world

• Aram Kim,
• Nicolas Schweighofer &
• James M. Finley 

Journal of NeuroEngineering and Rehabilitationvolume 16, Article number: 113 (2019) | Download Citation

Abstract

Background

Virtual reality (VR) is a potentially promising tool for enhancing real-world locomotion in individuals with mobility impairment through its ability to provide personalized performance feedback and simulate real-world challenges. However, it is unknown whether novel locomotor skills learned in VR show sustained transfer to the real world. Here, as an initial step towards developing a VR-based clinical intervention, we study how young adults learn and transfer a treadmill-based virtual obstacle negotiation skill to the real world.

Methods

On Day 1, participants crossed virtual obstacles while walking on a treadmill, with the instruction to minimize foot clearance during obstacle crossing. Gradual changes in performance during training were fit via non-linear mixed effect models. Immediate transfer was measured by foot clearance during physical obstacle crossing while walking over-ground. Retention of the obstacle negotiation skill in VR and retention of over-ground transfer were assessed after 24 h.

Results

On Day 1, participants systematically reduced foot clearance throughout practice by an average of 5 cm (SD 4 cm) and transferred 3 cm (SD 1 cm) of this reduction to over-ground walking. The acquired reduction in foot clearance was also retained after 24 h in VR and over-ground. There was only a small, but significant 0.8 cm increase in foot clearance in VR and no significant increase in clearance over-ground on Day 2. Moreover, individual differences in final performance at the end of practice on Day 1 predicted retention both in VR and in the real environment.

Conclusions

Overall, our results support the use of VR for locomotor training as skills learned in a virtual environment readily transfer to real-world locomotion. Future work is needed to determine if VR-based locomotor training leads to sustained transfer in clinical populations with mobility impairments, such as individuals with Parkinson’s disease and stroke survivors.

Individual Differences in Locomotor Function Predict the Capacity to Reduce Asymmetry and Modify the Energetic Cost of Walking Poststroke

I got nothing out of this. For me to reduce asymmetry I would need my spasticity cured and my pre-motor cortex rebuilt. Tell me how to accomplish that and I will work on it.  Visual feedback does absolutely nothing for me except to see that my gait is screwed up.

Individual Differences in Locomotor Function Predict the Capacity to Reduce Asymmetry and Modify the Energetic Cost of Walking Poststroke 

Natalia Sánchez PhD, James M. Finley, PhD

First Published July 12, 2018 Research Article

https://doi.org/10.1177/1545968318787913

Article information

Abstract

Changes in the control of the lower extremities poststroke lead to persistent biomechanical asymmetries during walking. These asymmetries are associated with an increase in energetic cost, leading to the possibility that reducing asymmetry can improve walking economy. However, the influence of asymmetry on economy may depend on the direction and cause of asymmetry. For example, impairments with paretic limb advancement may result in shorter paretic steps, whereas deficits in paretic support or propulsion result in shorter nonparetic steps. Given differences in the underlying impairments responsible for step length asymmetry, the capacity to reduce asymmetry and the associated changes in energetic cost may not be consistent across this population. Here, we identified factors explaining individual differences in the capacity to voluntarily reduce step length asymmetry and modify energetic cost during walking. A total of 24 individuals poststroke walked on a treadmill, with visual feedback of their step lengths to aid explicit modification of asymmetry. We found that individuals who took longer paretic steps had a greater capacity to reduce asymmetry and were better able to transfer the effects of practice to overground walking than individuals who took shorter paretic steps. In addition, changes in metabolic cost depended on the direction of asymmetry, baseline cost of transport, and reductions in specific features of spatiotemporal asymmetry. These results demonstrate that many stroke survivors retain the residual capacity to voluntarily walk more symmetrically on a treadmill and overground. However, whether reductions in asymmetry reduce metabolic cost depends on individual differences in impairments affecting locomotor function.

Keywords asymmetry, gait, metabolic cost, stroke

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Gait Speed and Gait Variability are Associated with Different Functional Brain Networks

Are your therapists determining objectively which of these networks is damaged ? So they have the right protocols to use to correct those problems? I had one PT whose knowledge was essentially that my walking wasn't correct and the instruction was to show himself walking and say' Walk this way'. What a fucking useless piece of information. I expect objective diagnosis of walking irregularities probably with motion sensors and accelerometers, then use that objective diagnosis to select stroke protocols that recover every piece. That is my 'pie in the sky' goal. I expect all stroke medical professionals to be working toward that same goal.

Gait Speed and Gait Variability are Associated with Different Functional Brain Networks

On-Yee Lo^{1, 2*}, Mark A. Halko³, Junhong Zhou^{1, 2}, Rachel Harrison¹, Lewis A. Lipsitz^{1, 2} and Brad Manor^{1, 2}

• ¹Institute for Aging Research, Hebrew SeniorLife, United States
• ²Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, United States
• ³Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, United States

Gait speed and gait variability are clinically-meaningful markers of locomotor control that are suspected to be regulated by multiple supraspinal control mechanisms. The purpose of this study was to evaluate the relationships between these gait parameters and the functional connectivity of brain networks in functionally-limited older adults. Twelve older adults with mild-to-moderate cognition “executive” dysfunction and relatively slow gait, yet free from neurological diseases, completed a gait assessment and a resting state fMRI. Gait speed and variability were associated with the strength of functional connectivity of different brain networks. Those with faster gait speed had stronger functional connectivity within the frontoparietal control network (R=0.61, p=0.04). Those with less gait variability (i.e., steadier walking patterns) exhibited stronger negative functional connectivity between the dorsal attention network and the default network (R=0.78, p<0.01). No other significant relationships between gait metrics and the strength of within- or between- network functional connectivity was observed. Results of this pilot study warrant further investigation to confirm that gait speed and variability are linked to different brain networks in vulnerable older adults.

Keywords: Gait, gait speed, Gait Variability, resting state fMRI, functional connectivity, functional brain networks

Received: 10 Jul 2017; Accepted: 13 Nov 2017.

Edited by:

Philip P. Foster, University of Texas Health Science Center at Houston, United States

Reviewed by:

Graham J. Galloway, Translational Research Institute, Australia
Richard B. Reilly, Trinity College, Dublin, Ireland  

Copyright: © 2017 Lo, Halko, Zhou, Harrison, Lipsitz and Manor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. On-Yee Lo, Hebrew SeniorLife, Institute for Aging Research, Boston, 02131, MA, United States, AmyLo@hsl.harvard.edu

Influence of skill and exercise training parameters on locomotor recover during stroke rehabilitation

Basically saying we don't know what the fuck we are doing to get you recovered. 
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J75314&phrase=no&rec=132743&article_source=Rehab&international=0&international_language=&international_location=
Current Opinion in Neurology , Volume 29(6) , Pgs. 677-683.

NARIC Accession Number: J75314.  What's this?
Author(s): Hornby, T. George; Moore, Jennifer L.; Lovell, Linda; Roth, Elliot J..
Project Number: H133B031127.
Publication Year: 2016.
Number of Pages: 7.
Abstract: This review details the rationale for some specific training parameters that can be manipulated during physical rehabilitation and their application in selected intervention studies focused on improving walking function in patients with stroke. Basic and applied studies from the fields of motor learning and exercise physiology have shown that the amount, intensity, and variability of specific task practice applied during rehabilitation interventions can affect recovery of walking poststroke. Many studies detailing the effects of conventional, therapist, and mechanically assisted interventions may incorporate some of these training parameters but minimize others, and their relative contributions may influence walking outcomes. Specific patient factors, such as the stroke acuity and degree of impairments, appear to influence the relative contributions of these training variables, and different patient subgroups may benefit from greater emphasis on specific parameters. The findings suggest these training parameters should be considered when evaluating or implementing physical interventions directed toward improving locomotor function following stroke. More work is needed to understand their optimal combinations to maximize walking outcomes in patients with different levels of poststroke impairment.
Descriptor Terms: AMBULATION, EXERCISE, HEALTH PROMOTION, INTERVENTION, MOBILITY TRAINING, MOTOR SKILLS, PHYSICAL THERAPY, SERVICE DELIVERY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Hornby, T. George, Moore, Jennifer L., Lovell, Linda, Roth, Elliot J.. (2016). Influence of skill and exercise training parameters on locomotor recover during stroke rehabilitation.  Current Opinion in Neurology , 29(6), Pgs. 677-683. Retrieved 3/10/2017, from REHABDATA database.

Influence of skill and exercise training parameters on locomotor recovery during stroke rehabilitation.

I bet nothing in here is usable because there is no written protocols from here.
http://journals.lww.com/co-neurology/Abstract/publishahead/Influence_of_skill_and_exercise_training.99284.aspx

Hornby, T. George; Moore, Jennifer L.; Lovell, Linda; Roth, Elliot J.

Published Ahead-of-Print

Abstract

Purpose of review: Research findings from the fields of motor learning and exercise physiology suggest specific training parameters that can be manipulated during physical rehabilitation profoundly influence skilled task performance. This review details the rationale for some of these training variables and their application in selected intervention studies focused on improving walking function in patients poststroke.

Recent findings: Basic and applied studies have shown that the amount, intensity, and variability of specific task practice applied during rehabilitation interventions can affect recovery of walking poststroke. Many studies detailing the effects of conventional, therapist, and mechanically assisted interventions may incorporate some of these training parameters but minimize others, and their relative contributions may influence walking outcomes. Specific patient factors, such as the stroke acuity and degree of impairments, appear to influence the relative contributions of these training variables, and different patient subgroups may benefit from greater emphasis on specific parameters.

Summary: The present findings suggest these training parameters should be considered when evaluating or implementing physical interventions directed toward improving locomotor function poststroke. More work is needed to understand their optimal combinations to maximize walking outcomes in patients with different levels of impairment poststroke.

Locomotor Rehabilitation of Individuals With Chronic Stroke: Difference Between Responders and Nonresponders

You'll have to ask your doctor to get the walking protocol they were using because our fucking failures of stroke associations have no mechanism to collect and distribute research protocols. You would think that at a minimum they would collect such data. But no, they are too busy putting out stupid press releases.
http://www.archives-pmr.org/article/S0003-9993%2812%2901196-3/abstract

Mark G. Bowden, PhD, PT

,

Andrea L. Behrman, PhD, PT

,

Richard R. Neptune, PhD

,

Chris M. Gregory, PhD, PT

,

Steven A. Kautz, PhD

DOI: http://dx.doi.org/10.1016/j.apmr.2012.11.032

Article Info

Publication History

Published Online: December 06, 2012

• Abstract
• Full Text
• Images
• References

Abstract

Objectives

To identify the clinical measures associated with improved walking speed after locomotor rehabilitation in individuals poststroke and how those who respond with clinically meaningful changes in walking speed differ from those with smaller speed increases.

Design

A single group pre-post intervention study. Participants were stratified on the basis of a walking speed change of greater than (responders) or less than (nonresponders) .16m/s. Paired sample t tests were run to assess changes in each group, and correlations were run between the change in each variable and change in walking speed.

Setting

Outpatient interdisciplinary rehabilitation research center.

Participants

Hemiparetic subjects (N=27) (17 left hemiparesis; 19 men; age: 58.74±12.97y; 22.70±16.38mo poststroke).

Intervention

A 12-week locomotor intervention incorporating training on a treadmill with body weight support and manual trainers accompanied by training overground walking.

Main Outcome Measures

Measures of motor control, balance, functional walking ability, and endurance were collected at pre- and postintervention assessments.

Results

Eighteen responders and 9 nonresponders differed by age (responders=63.6y, nonresponders=49.0y, P=.001) and the lower extremity Fugl-Meyer Assessment score (responders=24.7, nonresponders=19.9, P=.003). Responders demonstrated an average improvement of .27m/s in walking speed as well as significant gains in all variables except daily step activity and paretic step ratio. Conversely, nonresponders demonstrated statistically significant improvements only in walking speed and endurance. However, the walking speed increase of .10m/s was not clinically meaningful. Change in walking speed was negatively correlated with changes in motor control in the nonresponder group, implying that walking speed gains may have been accomplished via compensatory mechanisms.

Conclusions

This study is a step toward discerning the underlying factors contributing to improved walking performance. Did you look at the damage location at all? Or are you that stupid? And these people have PhDs?

Preservation of common rhythmic locomotor control despite weakened supraspinal regulation after stroke

No clue what this means so ask your doctor how this knowledge will help you recover.
http://journal.frontiersin.org/Journal/10.3389/fnint.2014.00095/full?
Taryn Klarner^1,2,3, Trevor S. Barss^1,2,3, Yao Sun^1,2,3, Chelsea Kaupp^1,2,3 and E. Paul Zehr^1,2,3,4*

• ¹Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
• ²Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
• ³International Collaboration on Repair Discoveries, Vancouver, BC, Canada
• ⁴Division of Medical Sciences, University of Victoria, Victoria, BC, Canada

The basic pattern of arm and leg movement during rhythmic locomotor tasks is supported by common central neural control from spinal and supraspinal centers in neurologically intact participants. The purpose of this study was to test the hypothesis that following a cerebrovascular accident, shared systems from interlimb cutaneous networks facilitating arm and leg coordination persist across locomotor tasks. Twelve stroke participants (>6 months post CVA) performed arm and leg (A&L) cycling using a stationary ergometer and walking on a motorized treadmill. In both tasks cutaneous reflexes were evoked via surface stimulation of the nerves innervating the dorsum of the hand (superficial radial; SR) and foot (superficial peroneal; SP) of the less affected limbs. Electromyographic (EMG) activity from the tibialis anterior, soleus, flexor carpi radialis, and posterior deltoid were recorded bilaterally with surface electrodes. Full-wave rectified and filtered EMG data were separated into eight equal parts or phases and aligned to begin with maximum knee extension for both walking and A&L cycling. At each phase of movement, background EMG data were quantified as the peak normalized response for each participant and cutaneous reflexes were quantified as the average cumulative reflex over 150 ms following stimulation. In general, background EMG was similar between walking and A&L cycling, seen especially in the distal leg muscles. Cutaneous reflexes were evident and modified in the less and more affected limbs during walking and A&L cycling and similar modulation patterns were observed suggesting activity in related control networks between tasks. After a stroke common neural patterning from conserved subcortical regulation is seen supporting the notion of a common core in locomotor tasks involving arm and leg movement. This has translational implications for rehabilitation where A&L cycling could be usefully applied to improve walking function.

The brain’s sense of walking: a study on the intertwine between locomotor imagery and internal locomotor models in healthy adults

How is your doctor setting up stroke protocols to have you create locomotor imagery to get you back to healthy locomotor walking? ANYTHING AT ALL?

http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.00859/full?
Marco Iosa^1*, Loredana Zoccolillo², Michela Montesi^1,3, Daniela Morelli², Stefano Paolucci¹ and Augusto Fusco¹

• ¹Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
• ²Department of Children Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
• ³School of Physiotherapy, University of Rome Tor Vergata, IRCCS Fondazione Santa Lucia, Rome, Italy

Motor imagery and internal motor models have been deeply investigated in literature. It is well known that the development of motor imagery occurs during adolescence and it is limited in people affected by cerebral palsy. However, the roles of motor imagery and internal models in locomotion as well as their intertwine received poor attention. In this study we compared the performances of healthy adults (n = 8, 28.1 ± 5.1 years old), children with typical development (n = 8, 8.1 ± 3.8 years old) and children with cerebral palsy (CCP) (n = 12, 7.5 ± 2.9 years old), measured by an optoelectronic system and a trunk-mounted wireless inertial magnetic unit, during three different tasks. Subjects were asked to achieve a target located at 2 or 3 m in front of them simulating their walking by stepping in place, or actually walking blindfolded or normally walking with open eyes. Adults performed a not significantly different number of steps (p = 0.761) spending not significantly different time between tasks (p = 0.156). Children with typical development showed task-dependent differences both in terms of number of steps (p = 0.046) and movement time (p = 0.002). However, their performance in simulated and blindfolded walking (BW) were strictly correlated (R = 0.871 for steps, R = 0.673 for time). Further, their error in BW was in mean only of −2.2% of distance. Also CCP showed significant differences in number of steps (p = 0.022) and time (p < 0.001), but neither their number of steps nor their movement time recorded during simulated walking (SW) were found correlated with those of blindfolded and normal walking (NW). Adults used a unique strategy among different tasks. Children with typical development seemed to be less reliable on their motor predictions, using a task-dependent strategy probably more reliable on sensorial feedback. CCP showed less efficient performances, especially in SW, suggesting an altered locomotor imagery.