Poster 90 Feasibility for Using Ankle Robotics in the Acute Phase of Stroke: A Controlled Pilot Study

Abstract

To assess feasibility and efficacy of daily training with a lower extremity (LE) ankle robot (anklebot) during acute hospitalization post-stroke. Two groups, convenience sample. Pre-post comparisons of LE impairments and function over course of hospitalization. Inpatient; acute rehabilitation hospital. Volunteers (n=29) admitted to inpatient stroke unit who had at least minimal ankle activation in paretic plantarflexion (PF) or dorsiflexion (DF), ability to follow two-step commands, wear the anklebot and play seated videogames. Mean time post-stroke at study entry was 11.2 ± 5.8 days. After regular daily therapies the anklebot training used an “assist-as-needed” approach during > 200 volitional paretic ankle movements in DF, PF, inversion, and eversion. Difficulty was adjusted to participant's active range of motion and success rate. The stretching group received >200 mobilization repetitions daily in these same movement ranges. All sessions lasted about one hour. Spatiotemporal gait parameters, interlimb symmetry, paretic ankle control and impairments. Both groups made substantial gains in gait velocity, however the robot group improved step time symmetry 46% (p=0.001) vs. 7% for the stretching group (p=0.574). The robot group increased single support by 76% (p=0.000) vs. 32% (p=0.004) for the stretching group. Trends for increased angular speeds and reduced jerk of ankle targeting suggested greater motor control improvements in the robot group. Both groups increased DF and PF strength. There were no adverse events. Intensive LE robotic therapy is safe for use during acute phase hospitalization post-stroke. Ankle robotics in this early phase may accelerate restoration of gait and reduce the need for pre-gait activities.