Abstract
Rehabilitation for stroke survivors with severe motor impairment remains challenging. Early motor rehabilitation is critical for improving mobility function post stroke, but it is often delayed due to limited resources in clinical practice. The objectives of this study were to investigate the feasibility and effectiveness of early in-bed sensorimotor rehabilitation on acute stroke survivors with severe hemiplegia using a wearable ankle robot. Eighteen patients (9 in the study group and 9 in the control group) with severe hemiplegia and no active ankle movement were enrolled in acute/subacute phase post stroke. During a typical 3-week hospital stay, patients in the study group received ankle robot-guided in-bed training (50 minutes/session, 5 sessions/week), including motor relearning under real-time visual feedback of re-emerging motor output, strong passive stretching under intelligent control, and game-based active movement training with robotic assistance. Whereas the control group received passive ankle movement in the mid-range of motion and attempted active ankle movement without robotic assistance. After multi-session training, the study group achieved significantly greater improvements in Fugl-Meyer Lower Extremity motor score (p = 0.007), plantarflexor strength (p = 0.009), and active range of motion (p = 0.011) than controls. The study group showed earlier motor recovery for plantarflexion and dorsiflexion than the control group (p < 0.05). This study showed that in-bed sensorimotor rehabilitation guided by awearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase.
Highlights
S TROKE is a leading cause of long-term disability in the United States [1]
This study showed that in-bed sensorimotor rehabilitation guided by a wearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase
Eighteen patients in an early subacute phase post stroke participated in the study with 9 patients in each group
Summary
S TROKE is a leading cause of long-term disability in the United States [1]. The most common consequence of stroke is motor impairment [2], and motor recovery post stroke is crucial for patients to regain independence [3]. Rehabilitation for stroke survivors with severe motor impairment remains challenging in clinical practice with substantial demand of resources and limited potential of functional recovery under standard of care [4]. To improve functional outcomes and minimize disability post stroke, early intensive rehabilitation plays a critical role [6], [7]. Patients with severe hemiplegia, due to their limited capacity for movement and few options for therapeutic training, are typically left in bed during most of rehabilitation hospital stay [4], [8]. There is a strong need to develop an in-bed rehabilitation program that can provide intensive sensorimotor therapy to promote motor recovery in severely impaired lower limb poststroke
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