Active Movement Training Research Articles

Proprioception: An evidence-based review

BackgroundProprioception is an essential sensory function of the body. Proprioception is defined as one’s awareness of their body’s position and movement through space. It contributes to both the conscious and unconscious awareness of limb and trunk position and movement. The purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity. PurposeThe purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity. Study DesignThis narrative literature review examines studies that determine proprioceptive systems and their implication for rehabilitation. MethodsRelevant study data were extracted as part of this review. ResultsTypes of proprioceptive interventions can include active or passive movement training, somatosensory stimulation training, force reproduction, and somatosensory discrimination training. Joint position sense error is the most widely used objective measure of proprioception. ConclusionsTherapists should consider using a standardized measure to ascertain proprioceptive deficits in their patients following upper extremity injury or disease to determine the deficits and measure change. There are a variety of interventions that can be used in hand rehabilitation to restore proprioceptive acuity, and active movement interventions have been found to be the most effective.

Robotic Ankle Training Improves Sensorimotor Functions in Children with Cerebral Palsy—A Pilot Study

Children with cerebral palsy (CP) have sensorimotor impairments including weakness, spasticity, reduced motor control and sensory deficits. Proprioceptive dysfunction compounds the decreased motor control and mobility. The aims of this paper were to (1) examine proprioceptive deficit of lower extremities of children with CP; (2) study improvement in proprioception and clinical impairments through robotic ankle training (RAT). Eight children with CP participated in a 6-week RAT with pre and post ankle proprioception, clinical, biomechanical assessment compared to the assessment of eight typically developing children (TDC). The children with CP participated in passive stretching (20 min/session) and active movement training (20 to 30 min/session) using an ankle rehabilitation robot (3 sessions/week over 6 weeks, total of 18 sessions). Proprioceptive acuity measured as the plantar and dorsi-flexion motion at which the children recognized the movement was 3.60 ± 2.28° in dorsiflexion and -3.72 ± 2.38° in plantar flexion for the CP group, inferior to that of the TDC group's 0.94 ± 0.43° in dorsiflexion (p = 0.027) and -0.86 ± 0.48° in plantar flexion (p = 0.012). After training, ankle motor and sensory functions were improved in children with CP, with the dorsiflexion strength increased from 3.61 ± 3.75 Nm to 7.48 ± 2.75 Nm (p = 0.018) and plantar flexion strength increased from -11.89 ± 7.04 Nm to -17.61 ± 6.81 Nm after training (p = 0.043). The dorsiflexion AROM increased from 5.58 ± 13.18° to 15.97 ± 11.21° (p = 0.028). The proprioceptive acuity showed a trend of decline to 3.08 ± 2.07° in dorsiflexion and to -2.59 ± 1.94° in plantar flexion (p > 0.05). The RAT is a promising intervention for children with CP to improve sensorimotor functions of the lower extremities. It provided an interactive and motivating training to engage children with CP in rehabilitation to improve clinical and sensorimotor performance.

Post-stroke rehabilitation of the ankle joint with a low cost monoarticular ankle robotic exoskeleton: Preliminary results.

Introduction: Stroke generates a high rate of disability and, in particular, ankle spasticity is a sequelae that interferes with the execution of daily activities. Robotic devices have been proposed to offer rehabilitation treatments to recover control of ankle muscles and hence to improve gait function. Objective: The aim of this study is to investigate the effects of passive stretching, combined with active and resisted movement, accompanied by visual feedback, by means of playful interactive software using a low-cost monoarticular robot (MEXO) in patients with stroke sequelae and spastic ankle. Methods: An open, uncontrolled, non-randomised, quasi-experimental study of 6weeks duration has been completed. A protocol has been defined to determine the usability, safety and potential benefits of supplementary treatment with the MEXO interactive system in a group of patients. Nine volunteer patients with sequelae of stroke who met the inclusion criteria were included. They received conventional treatment and in addition also received treatment with the MEXO monoarticular robot three times a week during 6weeks. Each session consisted of 10min of passive stretching followed by 20min of active movement training with visual feedback (10min active without resistance, 10min with resistance) and a final phase with 10min of passive stretching. The following variables were measured pre- and post-treatment: joint range of motion and ankle muscle strength, monopodal balance, muscle tone, gait ability and satisfaction with the use of assistive technology. Results: Statistically significant improvements were obtained in joint range measured by goniometry and in balance measured by monopodal balance test. Also in walking capacity, through the measurement of travelled distance. Discussion and significance: Device usability and patient safety were tested. Patients improved joint range and monopodal balance. The MEXO exoskeleton might be a good alternative for the treatment of spastic ankle joint in people with a stroke sequela.

Design and kinematical performance analysis of the 7-DOF upper-limb exoskeleton toward improving human-robot interface in active and passive movement training

Upper-limb rehabilitation robots have become an important piece of equipment in stroke rehabilitation. The design of exoskeleton mechanisms plays a key role to improve human-robot interface in the upper-limb movements under passive and active rehabilitation training. This paper proposes a novel of the 7-DOF (RR-RR-PRR) under-actuated exoskeleton mechanism based on the characteristics of the upper-limb movements in both of active and passive training. This aim of the proposed work is to improve human-robot interface in rehabilitation training with robots. Firstly, the characteristics of active and passive movement training are analyzed depending on the human upper-limb model. Then, a novel 7-DOF (RR-RR-PRR) exoskeleton mechanism is proposed based on the analyzed characteristics. After that, kinematical performances of the proposed exoskeleton are analyzed on the workspace, manipulability and manipulability ellipsoid by compared with the common exoskeleton configuration of the 7 DOFs (RRR-R-PRR) mechanism. In the end, the prototype is manufactured and tested by undergoing the experiments of single-joint passive movement training and multi-joint active movement training. The human-robot interface of the proposed exoskeleton is demonstrated by root mean square error, Pearson correlation coefficient, and the time-delay difference. The results of the kinematical performance show that the effective workspace and the flexibility of the exoskeleton with the proposed configuration are increased by 10.44% and 1.7%. In the single-joint passive movement training experiment, the root mean square errors are 6.986, 7.568, 5.846, and Pearson correlation coefficients are 0.989, 0.984, 0.988 at the shoulder joint and the elbow joint, respectively. The time-delay differences are not beyond 3.1%. In the multi-joint active movement training experiment, the root mean square errors are 9.312 and 7.677, and Pearson correlation coefficients are 0.906 and 0.968 at the shoulder joint and the elbow joint, respectively. The time-delay differences are not beyond 3.28%. The proposed 7 DOFs exoskeleton mechanism shows uniformity with that of the common exoskeleton on the same rehabilitation trajectory which is effective to improve human-robot interface under passive and active rehabilitation training.

Model of Guidance: Effective Communication with the Elderly for Empowering Elderly Caregivers in Nursing Homes in Indonesia

Activities related to increasing the caregiver's ability to care for the elderly who experience daily problems related to psychological approaches and the like have never been carried out. Caregiver communication does not support effective communication and is still social communication. Supported by the results of research conducted at the Nursing Home for the Elderly, it showed that there was a difference between pre and post-test in the group that received guidance or counseling treatment on the happiness of the elderly with a significant value. The purpose of this training is to empower elderly caregivers at Nursing Home at St. Yosef, Surabaya, and identify the effectiveness of the guidance model (Guidance) by caregivers. The number of participants is 50 people. The method used is cadre training through discussions, demonstrations, competence training and competence assessment. The result of training for caregivers is an increase in knowledge based on pre-test and post-test scores. There was an increase in skills seen in four skills, namely communication in the elderly, active movement, passive movement, mobilization, and daily activity training. The advantage of this cadre training is that it can effectively improve communication with the elderly people who are cared for in the orphanage. The implication of this activity is to increase the knowledge and skills of caregivers in providing care for the elderly through effective communication with the elderly in nursing homes as an effort to improve the health of the elderly.

Development of a Rehabilitation Instrument of Neurological Training for Cervical Spine

Objective: To develop a kind self active resistance movement training equipment for cervical spine, so as to restore the dynamic balance of the front and back muscle strength of the cervical spine in order to correct the abnormal physiological radian of the cervical spine, thereby relieving the clinical symptoms. Methods: The air spring with adjustable strength was used to provide the power of resistance active movement, and the neurological training cervical audio-visual synthesis training software was used to automatically guide patients to perform resistance active movement training of the cervical spine. Thirty two patients with cervical spondylosis were enrolled for treatment, and SPSS26 was used to statistically analyze the VAS, Lovett muscle strength, head and neck range of motion and C2-3 vertebral body curvature before and after the treatment. Result: There were significant differences in posterior cervical muscle strength (Lovett), dizziness, shoulder and neck pain (VAS) and C2-3 vertebral curvature before and after training in 32 patients (p˂0.001). Conclusion: The application of neurological training cervical vertebra self rehabilitation training instrument can effectively relieve clinical symptoms, restore head and neck range of motion, improve nape muscle strength, restore the dynamic balance of front and rear cervical muscle strength, and also can correct the abnormal physiological radian of the cervical vertebra.

In-Bed Sensorimotor Rehabilitation in Early and Late Subacute Stroke Using a Wearable Elbow Robot: A Pilot Study.

Objects: To evaluate the feasibility and effectiveness of in-bed wearable elbow robot training for motor recovery in patients with early and late subacute stroke.Methods: Eleven in-patient stroke survivors (male/female: 7/4, age: 50.7 ± 10.6 years, post-stroke duration: 2.6 ± 1.9 months) received 15 sessions of training over about 4 weeks of hospital stay. During each hourly training, participants received passive stretching and active movement training with motivating games using a wearable elbow rehabilitation robot. Isometric maximum muscle strength (MVC) of elbow flexors and extensors was evaluated using the robot at the beginning and end of each training session. Clinical measures including Fugl-Meyer Assessment of upper extremity (FMA-UE), Motricity Index (MI) for upper extremities, Modified Ashworth Scale (MAS) were measured at baseline, after the 4-week training program, and at a 1-month follow-up. The muscle strength recovery curve over the training period was characterized as a logarithmic learning curve with three parameters (i.e., initial muscle strength, rate of improvement, and number of the training session).Results: At the baseline, participants had moderate to severe upper limb motor impairment {FMA-UE [median (interquartile range)]: 28 (18–45)} and mild spasticity in elbow flexors {MAS [median (interquartile range)]: 0 (0–1)}. After about 4 weeks of training, significant improvements were observed in FMA-UE (p = 0.003) and MI (p = 0.005), and the improvements were sustained at the follow-up. The elbow flexors MVC significantly increased by 1.93 Nm (95% CI: 0.93 to 2.93 Nm, p = 0.017) and the elbow extensor MVC increased by 0.68 Nm (95% CI: 0.05 to 1.98 Nm, p = 0.036). Muscle strength recovery curve showed that patients with severe upper limb motor impairment had a greater improvement rate in elbow flexor strength than those with moderate motor impairment.Conclusion: In-bed wearable elbow robotic rehabilitation is feasible and effective in improving biomechanical and clinical outcomes for early and late subacute stroke in-patients. Results from the pilot study suggested that patients with severe upper limb motor impairment may benefit more from the robot training compared to those with moderate impairment.

Effects of Active Craniocervical Movement Training Using a Cognitive Game on Stroke Patients’ Balance

Effects of Active Craniocervical Movement Training Using a Cognitive Game on Stroke Patients’ Balance

Intensive In-Bed Sensorimotor Rehabilitation of Early Subacute Stroke Survivors With Severe Hemiplegia Using a Wearable Robot.

Rehabilitation for stroke survivors with severe motor impairment remains challenging. Early motor rehabilitation is critical for improving mobility function post stroke, but it is often delayed due to limited resources in clinical practice. The objectives of this study were to investigate the feasibility and effectiveness of early in-bed sensorimotor rehabilitation on acute stroke survivors with severe hemiplegia using a wearable ankle robot. Eighteen patients (9 in the study group and 9 in the control group) with severe hemiplegia and no active ankle movement were enrolled in acute/subacute phase post stroke. During a typical 3-week hospital stay, patients in the study group received ankle robot-guided in-bed training (50 minutes/session, 5 sessions/week), including motor relearning under real-time visual feedback of re-emerging motor output, strong passive stretching under intelligent control, and game-based active movement training with robotic assistance. Whereas the control group received passive ankle movement in the mid-range of motion and attempted active ankle movement without robotic assistance. After multi-session training, the study group achieved significantly greater improvements in Fugl-Meyer Lower Extremity motor score (p = 0.007), plantarflexor strength (p = 0.009), and active range of motion (p = 0.011) than controls. The study group showed earlier motor recovery for plantarflexion and dorsiflexion than the control group (p < 0.05). This study showed that in-bed sensorimotor rehabilitation guided by awearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase.

Therapeutic effects of sensory input training on motor function rehabilitation after stroke.

Motor dysfunction is a common and severe complication of stroke that affects the quality of life of these patients. Currently, motor function rehabilitation predominantly focuses on active movement training; nevertheless, the role of sensory input is usually overlooked. Sensory input is very important to motor function. Voluntary functional movement necessitates preparation, execution, and monitoring functions of the central nervous system, while the monitoring needs the participation of the sensory system. Sensory signals affect motor functions by inputting external environment information and intrinsic physiological status as well as by guiding initiation of the motor system. Recent studies focusing on sensory input-based rehabilitation training for post-stroke dyskinesia have demonstrated that sensory function has significant effects on voluntary functional movements. In conclusion, sensory input plays a crucial role in motor function rehabilitation, and the combined sensorimotor training modality is more effective than conventional motor-oriented approaches.

Ankle passive and active movement training in children with acute brain injury using a wearable robot.

To evaluate the feasibility and effectiveness of a wearable robotic device in guiding isometric torque generation and passive-active movement training for ankle motor recovery in children with acute brain injury. Ten inpatient children with acute brain injury being treated in a rehabilitation hospital. Daily robot-guided ankle passive-active movement therapy for 15 sessions, including isometric torque generation under real-time feedback, stretch-ing, and active movement training with motivating games using a wearable ankle rehabilitation robot. Ankle biomechanical improvements induced by each training session including ankle range of motion (ROM), muscle strength, and clinical (Fugl-Meyer Lower-Extremity (FMLE), Pediatric Balance Scale (PBS)) and biomechanical (ankle ROM and muscle strength) outcomes over 15 training sessions. As training progressed, improvements in biomechanical performance measures followed logarithmic curves. Each training session increased median dorsiflexion active range of motion (AROM) 2.73° (standard deviation (SD) 1.14), dorsiflexion strength 0.87 Nm (SD 0.90), and plantarflexion strength 0.60 Nm (SD 1.19). After 15 training sessions the median FMLE score had increased from 14.0 (SD 10.11) to 23.0 (SD 11.4), PBS had increased from 33.0 (SD 19.99) to 50.0 (SD 23.13) (p < 0.05), median dorsiflexion and plantarflexion strength had improved from 0.21 Nm (SD 4.45) to 4.0 Nm (SD 7.63) and 8.33 Nm (SD 10.18) to 18.45 Nm (SD 14.41), respectively, median dorsiflexion AROM had improved from -10.45° (SD 12.01) to 11.87° (SD 20.69), and median dorsiflexion PROM increased from 20.0° (SD 9.04) to 25.0° (SD 8.03). Isometric torque generation with real-time feedback, stretching and active movement training helped promote neuroplasticity and improve motor performance in children with acute brain injury.

P295 Effects of functional electric stimulation and task specific training on gait recovery in patients with stroke: Randomized controlled trial

Objectives This work was designed to assess the effects of functional electrical stimulation (FES) combined with task specific training on gait recovery in stroke patients. Methods Thirty hemiparetic stroke patients aged 40–58 years old were randomly assigned into two equal groups; the control group had received conventional physiotherapy program while the study group had received the same program in addition to FES therapy during treadmill training. Two dimensional (2D) gait analysis was used to assess gait parameters before and after completion of the treatment sessions. Results A statistically significant improvement had been reported in all gait parameters in the post-treatment assessment of the study group as compared to the control group including the gait velocity (P = 0.048), cadence (P = 0.030), ten meters walking time (P = 0.043), step length (P = 0.033), stride length (P = 0.015) and the instantaneous angles of knee and ankle of the affected lower limb during gait cycle sub-phases. Discussion These results may be attributed to physiological effect of FES during treadmill training. It induces afferent-efferent stimulation which results in limb movement. It provides task-oriented practice of walking and active repetitive movement training. It activates sensory inputs and central neuronal circuits that allow optimal motor learning. It stimulates neuronal recovery and neuroplasticity. Conclusion FES therapy combined with conventional stroke rehabilitation program improves gait parameters when compared to conventional therapy alone in hemiparetic stroke patients. Significance The beneficial effects of FES on gait encourage the corporation of its use in the rehabilitation programs for patients with hemiparetic stroke.

Robotic approaches for the rehabilitation of upper limb recovery after stroke: a systematic review and meta-analysis.

This systematic review with a meta-analysis of studies was carried out to evaluate the effectiveness of robotic training (RT) and conventional training (CT) in improving the motor recovery of paretic upper limbs in stroke patients. Numerous electronic databases were searched from January 2000 to May 2016. Finally, 13 randomized-controlled trials fulfilled the inclusion criteria and were included in the three meta-analyses. The first meta-analysis carried out for those studies using RT for stroke patients indicated a significant improvement in the RT groups. The second meta-analysis suggested that the upper limb function (measured by Fugl-Meyer test) was significantly improved when RT was used with CT compared with CT alone. The third meta-analysis noted a significant difference in motor recovery between the CT-only and RT groups (RT only or RT combined with CT) in the chronic stages of stroke, but not in the acute or subacute stages. However, the RT group also showed a higher Fugl-Meyer score in patients at both the acute and the subacute stage. RT appeared to have positive outcomes to enhance motor recovery of the paralyzed upper limb. Robotic devices were believed to provide more assistance to patients to help support the weight of the upper limb; thus, active movement training can begin in the early rehabilitation stage. These novel devices may also help those chronic patients to achieve better rehabilitation goals. As a summary, RT could be used in addition to CT to help both therapists and patients in the management of the paralyzed upper limb.

Robot-guided ankle sensorimotor rehabilitation of patients with multiple sclerosis

BackgroundPeople with multiple sclerosis (MS) often develop symptoms including muscle weakness, spasticity, imbalance, and sensory loss in the lower limbs, especially at the ankle, which result in impaired balance and locomotion and increased risk of falls. Rehabilitation strategies that improve ankle function may improve mobility and safety of ambulation in patients with MS. This pilot study investigated effectiveness of a robot-guided ankle passive-active movement training in reducing motor and sensory impairments and improving balance and gait functions. MethodsSeven patients with MS participated in combined passive stretching and active movement training using an ankle rehabilitation robot. Six of the patients finished robotic training 3 sessions per week over 6 weeks for a total of 18 sessions. Biomechanical and clinical outcome evaluations were done before and after the 6-week treatment, and at a follow-up six weeks afterwards. ResultsAfter six-week ankle sensorimotor training, there were increases in active range of motion in dorsiflexion, dorsiflexor and plantar flexor muscle strength, and balance and locomotion (p<0.05). Proprioception acuity showed a trend of improvement. Improvements in four biomechanical outcome measures and two of the clinical outcome measures were maintained at the 6-week follow-up. The study showed the six-week training duration was appropriate to see improvement of range of motion and strength for MS patients with ankle impairment. ConclusionRobot-guided ankle training is potentially a useful therapeutic intervention to improve mobility in patients with MS.

Abstract TP156: Robot-Guided Ankle and Knee Therapeutic Training Improves Motor Functions in Stroke

Introduction: Stroke survivors develop substantial disability such as weakness, spasticity, increased stiffness, and reduced range of motion in lower limbs, contributing to reduced quality of life. It is important to stretch impaired ankle and knee to increase range of motion and reduce spasticity, and to conduct active movement training to improve balance and locomotion. Hypothesis: We addressed the hypotheses that robot-aided ankle and knee training will reduce motor impairments and improve balance and gait functions, and the improvements will maintain to the 6-weeks follow-up. Methods: Seven male stroke survivors participated in the robot-guided ankle and knee rehabilitation training using a pair of ankle and knee rehabilitation robots over 18 training sessions (3 sessions/week for 6 weeks). Three evaluations were done before and after training, and 6 weeks follow-up. Each session involved passive stretching under intelligent control and active movement training under real-time, audiovisual and haptic feedback. About equal time was spent on the ankle and knee training. Results: We found significant improvement in 6-Minute Walk Test (6MWT: 294.8 m pre-training to 386.4 m post training; p&lt;0.01), Berg Balance Scale (BBS, 45 pre to 52 post; p&lt;0.05), ankle active range of motion (AROM) (-11.7° pre to 1.7° post; p&lt;0.05, a negative value means not being able to reach 0° dorsiflexion), passive ROM in dorsiflexion (12.7° pre to 23.3° post; p&lt;0.01), and dorsiflexion muscle strength (-0.3 Nm pre to 5.7 Nm post; p&lt;0.05, negative means lower than the passive torque at 0° ankle dorsiflexion). The knee had significant improvement in AROM in extension against the load of the robot (34.8° pre to 15.9° knee flexion post; p&lt;0.05) and maximal flexion strength at 90° knee flexion (19.3 Nm pre to 31.7 Nm post; p&lt;0.01). At the follow-up, the outcomes were found as similar results of post evaluation, e.g., 379m (p&lt;0.05) in 6MWT, 51 (p&lt;0.05) in BBS, and 5.2 Nm (p=0.05) in dorsiflexion strength. Conclusions: In conclusions, robot-guided stretching and active movement training reduced impairments at the knee and ankle of stroke survivors resulting in improved mobility. Furthermore, the effect of training was maintained at the 6-weeks follow-up after the treatment.

Somatosensory Contribution to the Initial Stages of Human Motor Learning.

The research focuses on the initial stages of human motor learning, introducing a new experimental model that closely approximates the key features of motor learning outside of the laboratory. The finding indicates that it is the somatosensory system rather than the motor system that dominates learning in the early stages of motor skill acquisition. This is important given that most of our computational models of motor learning are based on the idea that learning is motoric in origin. This is also a valuable finding for rehabilitation of patients with limited mobility as it shows that reinforcement in conjunction with passive movement results in benefits to motor learning that are as great as those observed for active movement training.

Abstract W MP57: Effects of Wearable Robotic Training of Ankle and Mobility Rehabilitation in Acute Stroke

Background and Purpose: Stroke is the fourth leading cause of death in the US and is a leading cause of adult disability. It was reported that the first few months post stroke is critical in neural plasticity and motor recovery. Presently, effective treatment options for ankle impairment and mobility are limited, especially for in-bed acute stroke rehabilitation. In this study, wearable robotic training involving passive stretching and active movement training was investigated to determine its efficacy in improving stroke outcome. Methods: Eleven patients with acute stroke participated. This was completed in a clinical in-patient setting (45 min/session, 3~5х/week, total 18 session). Participants were aged 53.7±17.4 (mean±SD); robotic treatment was given averaged 40.5 days of stroke onset. They continued receiving standard inpatient physical therapy during the study. One way repeated measures ANOVA was used to compare clinical and biomechanical outcome measures across the repeated measures. Results: Preliminary results showed an improvement after the multiple sessions of training with F-M in LE increased from 14.8 ± 8.8 and 19.4 ± 8.2 (p&lt;.01), STREAM score in LE from 32.1±21.4 to 47.9±30.1 (p=.02), the BBS increased from 35.2±17.8 to 38.0±18.2. Ankle active range of motion (AROM) in dorsiflexion increased from -5.7 ± 7.2° to 2.3 ± 8.1°(p=.004), ankle passive ROM in dorsiflexion from 14.0 ± 7.1° to 19.9 ± 5.3° (p=.002). Dorsiflexor strength increased from 0 ± 2.2 N m before training to 2.4 ±3.5 N m after training (p=.003). Plantarflexor strength increased from 6.7±9.9 Nm, to 12.6 ± 11.4 Nm (p=.004). Other measures showed no significant improvements, such as 6MWT increased from 302.0 ± 416.4 and 540.6 ± 563.4 feet, the MAS of ankle was 2.2 ± 1.1 to 1.6 ± 1.2. Conclusions: The use of robotic device demonstrated improvements in selected outcome measures in hospital settings, and it was efficiently administer in the clinic. The results suggest that impaired lower limbs of acute stroke can respond to controlled stretching and movement training in terms of muscle biomechanical properties and improve lower extremity functional activities in acute rehabilitation.The limitation of this study was its small sample size and lack of a control group.

Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy.

A portable rehabilitation robot incorporating intelligent stretching, robot-guided voluntary movement training with motivating games and tele-rehabilitation was developed to provide convenient and cost-effective rehabilitation to children with cerebral palsy (CP) and extend rehabilitation care beyond hospital. Clinicians interact with the patients remotely for periodic evaluations and updated guidance. The tele-assisted stretching and active movement training was done over 6-week 18 sessions on the impaired ankle of 23 children with CP in their home setting. Treatment effectiveness was evaluated using biomechanical measures and clinical outcome measures. After the tele-assisted home robotic rehabilitation intervention, there were significant increases in the ankle passive and active range of motion, muscle strength, a decrease in spasticity, and increases in balance and selective control assessment of lower-extremity.

Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke

To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke.

Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy

Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated using ultrasonography combined with biomechanical measurements before and after a 6-wk treatment of passive-stretching and active-movement training. The passive force contributions from the GM and SOL muscles were separated using flexed and extended knee positions, and fascicular stiffness was calculated based on the fascicular force-length relation. Biomechanical properties of the Achilles tendon, including resting length, cross-sectional area, and stiffness, were also evaluated. The 6-wk training induced elongation of muscle fascicles (SOL: 8%, P = 0.018; GM: 3%, P = 0.018), reduced pennation angle (SOL: 10%, P = 0.028; GM: 5%, P = 0.028), reduced fascicular stiffness (SOL: 17%, P = 0.128; GM: 21%, P = 0.018), decreased tendon length (6%, P = 0.018), increased Achilles tendon stiffness (32%, P = 0.018), and increased Young's modulus (20%, P = 0.018). In vivo characterizations of calf muscles and Achilles tendon mechanical properties help us better understand treatment-induced changes of calf muscle-tendon and facilitate development of more effective treatments.