Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study
Identifieur interne : 001032 ( Main/Curation ); précédent : 001031; suivant : 001033Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study
Auteurs : Larry W. Forrester ; Anindo Roy ; Amanda Krywonis ; Glenn Kehs ; Hermano Igo Krebs ; Richard F. MackoSource :
- Neurorehabilitation and neural repair [ 1545-9683 ] ; 2014.
Abstract
Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking.
Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke.
Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded.
Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events.
Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning.
Url:
DOI: 10.1177/1545968314521004
PubMed: 24515923
PubMed Central: 4127380
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PMC:4127380Le document en format XML
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<author><name sortKey="Roy, Anindo" sort="Roy, Anindo" uniqKey="Roy A" first="Anindo" last="Roy">Anindo Roy</name>
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<author><name sortKey="Krywonis, Amanda" sort="Krywonis, Amanda" uniqKey="Krywonis A" first="Amanda" last="Krywonis">Amanda Krywonis</name>
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<author><name sortKey="Kehs, Glenn" sort="Kehs, Glenn" uniqKey="Kehs G" first="Glenn" last="Kehs">Glenn Kehs</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study</title>
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<author><name sortKey="Kehs, Glenn" sort="Kehs, Glenn" uniqKey="Kehs G" first="Glenn" last="Kehs">Glenn Kehs</name>
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<series><title level="j">Neurorehabilitation and neural repair</title>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking.</p>
</sec>
<sec id="S2"><title>Objective</title>
<p id="P2">Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events.</p>
</sec>
<sec id="S5"><title>Conclusion</title>
<p id="P5">Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning.</p>
</sec>
</div>
</front>
</TEI>
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