Assessing Stiffness, Joint Torque and ROM for Paretic and Non-Paretic Lower Limbs during the Subacute Phase of Stroke Using Lokomat Tools

Betsy D M Chaparro-Rico,Paolo Tortola,Giuseppe Galardi,Daniele Cafolla

doi:10.3390/app10186168

Betsy D M Chaparro-Rico, Paolo Tortola + Show 2 more

Open Access

https://doi.org/10.3390/app10186168

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Journal: Applied sciences	Publication Date: Sep 4, 2020
Citations: 18	License type: CC BY 4.0

Affiliation: Istituto Neurologico Mediterraneo

Abstract

The efficacy of Lokomat on motor recovery in stroke patients is well known. However, few studies have examined Lokomat tools to assess stiffness, joint torque and range of motion (ROM) during the subacute phase of stroke. The purpose of this retrospective observational study is to assess the changes of joint torque, ROM and stiffness that were estimated with Lokomat tools, namely L-FORCE (lower limb-force), L-ROM (lower limb-range of motion)and L-STIFF (lower limb-stiff), for paretic and non-paretic lower limbs in the subacute phase of stroke, assuming that the tools were able to measure these changes. The data come from 10 subjects in the subacute phase who had their first ever-stroke and followed a treatment that included Lokomat. The measurements came from basal assessments (T0) and one-month follow-up (T1). The measures were compared between paretic and non-paretic legs, and between T0 and T1. Significant differences in stiffness, joint torque and ROM were obtained between the paretic and non-paretic limbs at both T0 and T1. A non-significant trend was obtained for reduced stiffness and increased torque and ROM between T0 and T1 of the paretic limbs. The Lokomat tools were able to measure the changes between paretic and non-paretic legs and the small changes between T0 and T1 measurements.

Highlights

The stroke is a dramatic vascular event that causes death in 20% of cases and chronic disability in most survivors [1]
Paretic legs compared with contralateral legs presented a lower joint torque and range of motion (ROM), and a greater stiffness at both basal assessments (T0) and one-month follow-up
One month after robotic gait training with Lokomat Pro V6, despite the absence of changes with statistical significance, a trend towards joint torque and ROM improvement and stiffness reduction was documented for the paretic legs

Summary

Introduction

The stroke is a dramatic vascular event that causes death in 20% of cases and chronic disability in most survivors [1]. Spastic hemiparesis is one of the most disabling consequences of a stroke. Muscle weakness due to disruption of corticospinal pathways occurs immediately [2], while spasticity appears later as a result of plastic neuronal changes within the central nervous system after the initial injury [3]. Weakness and spasticity are essential diagnostic and prognostic elements for delineating effective rehabilitation strategies. The most commonly used techniques for measuring strength in clinical practices are the Medical Research Council (MRC) scale and the hand-held dynamometer (HHD). These techniques have limitations, since they are semi-subjective and not able to guarantee an isometric contraction respectively; the lying or sitting postures used during these tests do not correspond to the walking posture [4,5]

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