Abstract
BackgroundGait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice.ObjectivesThe purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy.ResultsWalking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA (P < 0.05).ConclusionsThe results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns.Trial registration NCT03048968. Registered 06 Feb 2017
Highlights
Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mecha‐ nism
The results of the present study reveal that the Gait Enhancing and Motivating System-Hip (GEMS-H) promoted more sensorimotor cortex (SMC) activation and a bal‐ anced activation pattern that helped to restore gait function
Less activation in the late phase over SMC and supplemental motor areas (SMA) dur‐ ing gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns
Summary
Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mecha‐ nism. Hemiplegia is one of the most common impairments after stroke and significantly reduces walking ability. Regaining gait ability is a primary goal in the rehabilitation program for stroke patients. Robot-assisted therapy for gait rehabilitation after stroke is a potential and novel approach for facilitating the restoration of function and enhancing the neural recovery process after stroke. Our previous studies showed that GEMS-H improved gait function, muscle efficiency, and cardiopulmonary metabolic efficiency [7,8,9,10]. It is not yet known how GEMS-H assisted gait training modulates cortical activity of stroke patients
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