Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Abstract

Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

A Focus Group Research on the Use of Wearable Health Technologies in Rehabilitation

“…At the end of the study, the blood flow, blood pressure and muscular leg force of the patients made better progress than the patients for whom no tilt table and stepper had been used (1). We can summarize the advantages offered to patients by early mobilization against the possibility of long term immobilization in a number of articles: 1) Functional skills of the patients rehabilitated with a robotic system following a Cerebral Vascular Accident (CVA) make better progress than other patients because the blood flow in their brand returns to normal earlier.…”

Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies

“…The subject was unable to complete the expected gait exercises during walking on the treadmill and the experiment was interrupted. Kuznetsov et al (2013) tested a Robotic Tilt Table System (Erigo, Hocoma AG, Switzerland) with FES, naming it ROBO-FES. The system consists of a tilting stretcher which can be tiltled between 0° and 80° and foot plates with springs to perform stepping motions.…”

“…The study showed training with ROBO-FES may increase leg strength, cerebral blood flow and blood pressures as compared to the training without FES. Ye et al (2014) introduced a rehabilitation system for hemiplegic patients based on a pelvis-supporting robotic Gait phase control: biceps femoris and quadriceps femoris stimulated during leg flexion; gastrocnemius stimulated during leg extension 38 hemiparetic ischemic stroke subjects (Kuznetsov et al 2013) Preprogramed FES parameters.…”

Critique of A Very Early Rehabilitation Trial (AVERT)

“…Changes in blood pressure observed with verticalization after stroke are a frequent problem and need special procedures and technology to be prevented. 6 In addition, mobilization may have even been delivered too late in AVERT considering that the negative effect of early intense mobilization was not observed in the 374 patients mobilized within 12 hours. This is not a critique of AVERT, which provides an important and valuable data set and results.…”