Abstract
IntroductionAn emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis.Case presentationThree individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks) with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago.Immediately after training, all participants demonstrated improved gait speed (10 meter walk), stride length and walking endurance (6 minute walk) compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm.ConclusionsLower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight-supported treadmill training program. The wearable, mobile assistive robotic device safely supplemented supervised physical therapy including mobility and balance skill training.
Highlights
An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke
Robotic systems for lower extremity therapy on a bodyweightsupported treadmill are subject to many of the same limitations as conventional bodyweight-supported treadmill training (BWSTT) [4,5] as they do not compensate for the lack of visual flow, balance and intention requirements inherent to this kind of movement training
The use of a mobile, intention-based robotic device designed to supplement knee extensor function in patients post stroke has not been investigated. In this three-case series, we examined the effect of taskoriented mobility training on gait speed, quality and endurance using a novel, mobile, intention-based robotic leg orthosis (RLO) after each individual, stable, chronic post stroke, had reached a plateau in gait performance following BWSTT [12]
Summary
An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. A number of designs have been commercialized These wearable, assistive robotic devices typically demand attention and repetition from the patient, while providing feedback through various modes to improve performance. Robotic systems for lower extremity therapy on a bodyweightsupported treadmill are subject to many of the same limitations as conventional bodyweight-supported treadmill training (BWSTT) [4,5] as they do not compensate for the lack of visual flow, balance and intention requirements inherent to this kind of movement training
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