Abstract
Hemiparetic gait is a common condition after stroke which alters importantly the quality of life of stroke survivors. In recent years, several robotic interventions have been developed to support and enhance rehabilitation strategies for such population. The Hybrid Assistive Limb® (HAL) robot suit is a unique device able to collect in real time bioelectric signals from the patient to support and enhance voluntary gait. HAL has been used before in early stages of stroke showing gait improvement after the intervention. However, evaluation of the coordination of gait has not been done yet. Coordination is a key factor for an adequate gait performance; consequently, its changes may be closely related to gait recovery. In this study, we used planar covariation to evaluate coordination changes in hemiparetic stroke patients after early HAL intervention. Before starting, impaired intersegmental coordination for the paretic and non-paretic side was evident. HAL intervention was able to induce recovery of the covariation loop shape and deviation from the covariation plane improving intersegmental coordination. Also, there was a tendency of recovery for movement range evidenced by comparison of peak elevation angles of each limb segment of the patients before and after HAL intervention, and also when compared to healthy volunteers. Our results suggest that early HAL intervention contributed to the improvement of gait coordination in hemiparetic stroke patients by reinforcing central pattern generators and therefore reshaping their gait pattern.Trial registration: UMIN000022410 2016/05/23.
Highlights
Stroke is known as a leading cause of motor impairment, whose burden in terms of disability continue increasing worldwide (Feigin et al, 2017; Benjamin et al, 2018)
Regarding performance and Hybrid Assistive Limb R (HAL) intervention, one study examining intracerebral hemorrhage patients found better outcome for patients with right intracerebral hemorrhage exclusively when compared to patients who received standard rehabilitation (Ogata et al, 2015); the authors reported that HAL intervention group displayed larger hematoma volumes and a trend of increased severity at the initial evaluation when compared to control group (Ogata et al, 2015)
It has been suggested that this planar law represents the coordinated kinematic synergies of the body in charge of the maintenance of dynamic equilibrium during gait progression and anticipatory locomotor adjustments to environmental changes (Maclellan and McFadyen, 2010). This analysis has been previously used for gait analysis of stroke patients (Bleyenheuft et al, 2009; Chow and Stokic, 2015) and we previously reported a planar covariation analysis of myelopathy patients after HAL intervention (Puentes et al, 2018); ; to our knowledge, this is the first study examining planar covariation after an early robotic intervention as a measure of gait coordination in stroke patients
Summary
Stroke is known as a leading cause of motor impairment, whose burden in terms of disability continue increasing worldwide (Feigin et al, 2017; Benjamin et al, 2018). HAL is able to collect bioelectric signals from the action potentials reaching flexor and extensor muscles of the hip and knee during movement preparation and initiation. This information is processed by an on-board processor to control two motors located over the lateral aspects of the supported hip and knee joints, respectively, in order to assist the voluntary control of the patient joints motion during gait training in real time (Kawamoto et al, 2013). Previous studies have established the feasibility and safety of HAL intervention in early stages of stroke (Ueba et al, 2013; Ogata et al, 2015). Other study including ischemic and hemorrhagic stroke patients reported gait improvement, better torso posture and ability to stand with HAL assist for patients treated with the exoskeleton (Ueba et al, 2013)
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