Gait Training with a Robotic Leg Brace After Stroke

Stein, Joel; Bishop, Lauri; Stein, Daniel J.; Wong, Chi Song

doi:10.1097/phm.0000000000000119

Cited by 56 publications

(65 citation statements)

References 14 publications

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“…Most of these devices (eg, Ekso, Ekso Bionics, Richmond, CA; Indego, Parker-Hannifin; and ReWalk, Marlborough, MA) are bilateral in design, although unilateral exoskeletal wearable devices have also been developed (eg, Bionic Leg, AlterG, Fremont, CA). Although a pilot study of a unilateral device did not demonstrate benefit compared with conventional exercise therapy, 664 most of the devices in this class have not yet been examined in controlled trials for stroke survivors. Overall, although robotic therapy remains a promising therapy as an adjunct to conventional gait training, further studies are needed to clarify the optimal device type, training protocols, and patient selection to maximize benefits.…”

Section: Robotic and Electromechanics-assisted Training Devicesmentioning

confidence: 98%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Robotic and Electromechanics-assisted Training Devicesmentioning

confidence: 98%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

Self Cite

2,169

840

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“…Eight of the 11 [ 14 , 60 - 62 , 64 , 66 - 68 ] included RCTs used a combination of ordinal and ratio scales of measurement all with established psychometric properties; however, it was unclear what the minimally clinically important difference (MCID) was for the ratio data. Therefore, the clinical significance of the findings is difficult to establish.…”

Section: Resultsmentioning

confidence: 99%

The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review

2016

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BackgroundWith advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness.ObjectiveThis review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors.MethodsRandomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs.ResultsIn the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001.ConclusionsThis review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.

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“…The device utilizes multiple sensors, including force sensors in the shoe, to interpret a user's movement and respond with appropriate assistance. In a randomized controlled pilot study of individuals with chronic stroke, an 18 hour, 6 week intervention with the Bionic Leg was found to be no more effective in improving gait velocity than sham physical therapy (Stein, Bishop, Stein, & Wong, 2014).…”

Section: Alterg Bionic Legmentioning

confidence: 93%