Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study
Identifieur interne : 002C98 ( Ncbi/Merge ); précédent : 002C97; suivant : 002C99Modular 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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<author><name sortKey="Forrester, Larry W" sort="Forrester, Larry W" uniqKey="Forrester L" first="Larry W." last="Forrester">Larry W. Forrester</name>
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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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<author><name sortKey="Krebs, Hermano Igo" sort="Krebs, Hermano Igo" uniqKey="Krebs H" first="Hermano Igo" last="Krebs">Hermano Igo Krebs</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>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892086</journal-id>
<journal-id journal-id-type="pubmed-jr-id">22207</journal-id>
<journal-id journal-id-type="nlm-ta">Neurorehabil Neural Repair</journal-id>
<journal-id journal-id-type="iso-abbrev">Neurorehabil Neural Repair</journal-id>
<journal-title-group><journal-title>Neurorehabilitation and neural repair</journal-title>
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<issn pub-type="ppub">1545-9683</issn>
<issn pub-type="epub">1552-6844</issn>
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<article-meta><article-id pub-id-type="pmid">24515923</article-id>
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<article-id pub-id-type="doi">10.1177/1545968314521004</article-id>
<article-id pub-id-type="manuscript">NIHMS553414</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
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<title-group><article-title>Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Forrester</surname>
<given-names>Larry W.</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A1">Departments of Physical Therapy and Rehabilitation Science and Neurology, University of Maryland School of Medicine, Baltimore, Maryland; VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, Maryland</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Roy</surname>
<given-names>Anindo</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A2">Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland; VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, Maryland; Department of Bioengineering, University of Maryland School of Engineering, College Park, Maryland</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Krywonis</surname>
<given-names>Amanda</given-names>
</name>
<degrees>DScPT</degrees>
<aff id="A3">University of Maryland Rehabilitation and Orthopaedics Institute, Baltimore, Maryland</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Kehs</surname>
<given-names>Glenn</given-names>
</name>
<degrees>MD</degrees>
<aff id="A4">University of Maryland Rehabilitation and Orthopaedics Institute, Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Krebs</surname>
<given-names>Hermano Igo</given-names>
</name>
<degrees>PhD</degrees>
<aff id="A5">Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland</aff>
</contrib>
<contrib contrib-type="author"><name><surname>Macko</surname>
<given-names>Richard F.</given-names>
</name>
<degrees>MD</degrees>
<aff id="A6">Departments of Neurology, Medicine, and Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland; Geriatrics Research, Education and Clinical Center, Baltimore Veterans Affairs Medical Center; VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, Maryland</aff>
</contrib>
</contrib-group>
<author-notes><corresp id="FN1">Corresponding author: Larry W. Forrester, 100 Penn Street, Suite 115, Baltimore, Maryland 21201, Tel: 410-706-5212, <email>Lforrester@som.umaryland.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>17</day>
<month>2</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>10</day>
<month>2</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><month>9</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>9</month>
<year>2015</year>
</pub-date>
<volume>28</volume>
<issue>7</issue>
<fpage>678</fpage>
<lpage>687</lpage>
<pmc-comment>elocation-id from pubmed: 10.1177/1545968314521004</pmc-comment>
<abstract><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>
</abstract>
</article-meta>
</front>
</pmc>
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<tree><noCountry><name sortKey="Forrester, Larry W" sort="Forrester, Larry W" uniqKey="Forrester L" first="Larry W." last="Forrester">Larry W. Forrester</name>
<name sortKey="Kehs, Glenn" sort="Kehs, Glenn" uniqKey="Kehs G" first="Glenn" last="Kehs">Glenn Kehs</name>
<name sortKey="Krebs, Hermano Igo" sort="Krebs, Hermano Igo" uniqKey="Krebs H" first="Hermano Igo" last="Krebs">Hermano Igo Krebs</name>
<name sortKey="Krywonis, Amanda" sort="Krywonis, Amanda" uniqKey="Krywonis A" first="Amanda" last="Krywonis">Amanda Krywonis</name>
<name sortKey="Macko, Richard F" sort="Macko, Richard F" uniqKey="Macko R" first="Richard F." last="Macko">Richard F. Macko</name>
<name sortKey="Roy, Anindo" sort="Roy, Anindo" uniqKey="Roy A" first="Anindo" last="Roy">Anindo Roy</name>
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</affiliations>
</record>
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