BackgroundStroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches.MethodsA typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies.ResultsNo significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term.ConclusionsThe results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for coun...

motor impairments in the state of Chihuahua, Mexico. Design: Cohort study. Setting: Non-profit organization helping children with disabilities. Participants: Children with disabilities such as cerebral palsy, hip dysplasia, myelomeningocele, scoliosis and clubfoot who present with motor impairments. Interventions: A database was formed from data collected first by chart review and then phone interview using a standardized questionnaire. Data collected included the type of assistive technology devices required. The interview also evaluated the acquisition method of these devices and the numbers of patients that still need devices but lack access to them. The interview was recorded and an informed consent was previously required. Main Outcome Measures: The data were analyzed by an epidemiological software. Level of Evidence: Level 2. Results: As the population of this study contains a heterogeneous group of diseases, it is important to organize the results by disease. The interview results show that out of 42 patients with cerebral palsy, 58.5% need an assistive device. Out of the 52 patients with hip dysplasia, 17.3% need an assistive device. The entire population with myelomeningocele showed a need for assistive devices. Out of 18 patients with scoliosis, 27.8% need external assistance and out of 42 clubfoot patients, 30% need an assistive device. Lastly 33.5% of the remaining 111 patients who have other diseases need an assistive device. The major acquisition form of these devices by those who had them was 42.4% by direct purchase and 57.6% by donation or loan. Conclusions: A substantial need for assistive devices by children with motor disabilities exists. A lack of rehabilitation engineering decreases the availability of such devices thereby increasing their price. The patients and their families often cannot afford what is available to them. No. 305 Energy Expenditure and Walking Speed in Lower Limb Amputees: An Old Problem Revisited Again. Teuta Osmani Vllasolli; Beti Zafirova; Ardiana Murtezani; Bukurije Rama. Study Design: Prospective cross-sectional. Study Background:Although there are many aspects of walking on which the clinician might focus, energy expenditure and walking speed often have been recommended for use as a measures of status and outcome. Objectives: The objective of this study was to measure the physiological cost index (PCI) and comfort walking speed (CWS) at three levels of lower limb amputation: transfemoral, transtibial, and at Syme level and the relation of these physiological variables with prosthetic ambulation supported with walking aids and stump length. Methods: The eighty-nine individuals with lower limb amputation for reason other than peripheral vascular disease (PVD) were recruited among patients at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The PCI was assessed by five minutes of continuous indoor walking at CWS. Results: There were found significant differences in PCI (f¼29.87 p<0.001) and CWS (f¼19.33 p<0.001) between three ampu...

Affordable stroke rehabilitation approaches can maximize the functional independence of stroke survivors discharged after inpatient and outpatient services and improve access to rehabilitation for low-resource environments. This paper briefly describes the evolution of the Theradrive system and its novel use in a robot therapy gym in Mexico, where it was one of 6 devices aimed at improve motor function after stroke. Results from testing with TheraDrive in Mexico in a robot gym suggest it is an effective affordable solution for upper limb stroke rehabilitation whether alone or in a suite with other devices.