Abstract
BackgroundAn unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments.FindingsParticipants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher’s exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics.ConclusionsTreadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery.Clinical trial identifierNCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1
Highlights
Stroke is a leading cause of chronic disability, with hemiparetic ankle deficits contributing to impaired gait and balance [1,2,3,4]
Twenty-six completed training for locomotor treadmill robotic training (TMR) (n = 14) and seated robotic training (SRT) (n = 12); attrition was due to relocation (3); transportation (2); physical therapy (1); exclusion on baseline re-test (1); or withdrawal (2)
Paretic foot center of pressure (CoP) excursion and CoP symmetry during single support trended toward significance (P = 0.10) for TMR at retention
Summary
Stroke is a leading cause of chronic disability, with hemiparetic ankle deficits contributing to impaired gait and balance [1,2,3,4]. Forrester et al Journal of NeuroEngineering and Rehabilitation (2016) 13:51 training (TMR) is more effective than matched dose impairment focused seated robotic training (SRT) across the paretic ankle to durably improve unassisted overground gait function and safety. An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments
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