Abstract
Body Weight Supported Treadmill Training (BWSTT) with therapists' assistance is often used for gait rehabilitation post-stroke. However, this training method is labor-intensive, requiring at least one or as many as three therapists at once for manual assistance. Previously, we demonstrated that providing movement guidance using a performance-based robot-aided gait training (RAGT) that applies a compliant, assist-as-needed force-field improves gait pattern and functional walking ability in people post-stroke. In the current study, we compared the effects of assist-as-needed RAGT combined with functional electrical stimulation and visual feedback with BWSTT to determine if RAGT could serve as an alternative for locomotor training. Twelve stroke survivors were randomly assigned to one of the two groups, either receiving BWSTT with manual assistance or RAGT with functional electrical stimulation and visual feedback. All subjects received fifteen 40-minutes training sessions. Clinical measures, kinematic data, and EMG data were collected before and immediately after the training for fifteen sessions. Subjects receiving RAGT demonstrated significant improvements in their self-selected over-ground walking speed, Functional Gait Assessment, Timed Up and Go scores, swing-phase peak knee flexion angle, and muscle coordination pattern. Subjects receiving BWSTT demonstrated significant improvements in the Six-minute walk test. However, there was an overall trend toward improvement in most measures with both interventions, thus there were no significant between-group differences in the improvements following training. The current findings suggest that RAGT worked at least as well as BWSTT and thus may be used as an alternative rehabilitation method to improve gait pattern post-stroke as it requires less physical effort from the therapists compared to BWSTT.
Highlights
Stroke is a leading cause of serious long-term disability in the United States
The current study showed that stroke survivors receiving assist-as-needed robot-aided gait training (RAGT) significantly improved their self-selected overground walking speed (p=0.02; baseline=0.58 ± 0.3 m/s; post-training=0.70 ± 0.3 m/s)
The current study evaluated stroke survivors’ over-ground walking pattern along with the clinical measures, providing additional information regarding the effects of RAGT on the over-ground gait pattern compared to Body Weight Supported Treadmill Training (BWSTT)
Summary
Stroke is a leading cause of serious long-term disability in the United States. 45% of the individuals discharged from hospital after stroke return directly home [2]. A large percentage of homedwelling stroke survivors are unable to achieve unsupervised community ambulation immediately following discharge [3]. At 6 months post-stroke, about thirty percent of the survivors still need some assistance to walk [1,4]. Walking ability in chronic stroke survivors is an important determinant of social participation and independence in activities of daily living [5,6]. Gait disability leading to reduced functional independence and social participation can result in a decline in the quality of life post-stroke
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