Gait training with a wearable powered robot during stroke rehabilitation: a randomized parallel-group trial

Abstract

Background We have developed a wearable rehabilitation robot, “curara®,” and examined its immediate effect in patients with spinocerebellar degeneration and stroke, but its rehabilitative effect has not been clarified. The purpose of this study was to examine the effect of this device on gait training in stroke patients. Methods Forty stroke patients were enrolled in this study. The participants were divided randomly into two groups (groups A and B). The participants assigned to group A received RAGT with curara® type 4, whereas those in group B received conventional therapist-assisted gait training. The clinical trial period was 15 days. The participants performed 10 sessions of gait training (5 times per week) each lasting 30 ± 5 min per day. The 10-m walking time (10mWT), and 6-minute walking distance (6MWD) were evaluated as the main outcomes. Timed up and go and Berg Balance Scale (BBS) were also examined. Gait parameters (stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance/swing phases, minimum/maximum knee joint angle, and minimum/maximum hip joint angle) were measured using a RehaGait®. The items other than BBS were measured on days 0, 7, and 14, whereas BBS was measured on days 0 and 14. The improvement rate was calculated as the difference of values between days 14 and 0 divided by the value on day 0. The improvement rates of the 10mWT and 6MWD were set as the main outcomes. Results The data of 35 participants were analyzed. There was no significant difference in the main outcomes between both groups at the end of gait training. As for intragroup changes, gait speed, stride length, stride duration, and cadence were improved significantly between days 0 and 14 in each group. When examining the interaction effect between the day of measurement and group, stride duration (p = 0.006) and cadence (p = 0.012) were more significantly improved in group A than in group B. Conclusions This novel wearable powered robot may have the potential to improve gait speed of individuals in stroke rehabilitation. Trial registration Japan Registry of Clinical Trials (jRCTs032180163). Registered on February 22, 2019; https://jrct.niph.go.jp/en-latest-detail/jRCTs032180163. UMIN Clinical Trials Registry (UMIN000034237) Registered on September 22, 2018; https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000038939.

Analysis of Kinetic Signal Undergoing Gait Training with the Lokomat Exoskeleton after Complete Spinal Cord Injury

“…The motion process for the same subject shows almost no variation because of the use of Lokomat's passive movement mode and the xed walking speed. Conventional methods of gait analysis, such as analyzing the step frequency, speed, and stride length [23], are not applicable in this context. Therefore, we analyzed the angle and torque data during the training process.…”

Therapeutic robots for post-stroke rehabilitation

“…Most randomized controlled trials have utilized exoskeleton robots, either alone or with combined end-effector devices [ 28 , 29 , 92 ], [ 93 ], [ 94 ], [ 95 ], [ 96 ], [ 97 ], [ 98 ], [ 99 ], [ 100 ]. Additionally, there have been studies involving gait robots based on the end-effector principle [ 101 , 102 ], where a vest supports the patient’s weight, and their feet are fastened to the system using two platforms to simulate gait movements [ 103 ].…”

“…Overall, combining RAGT, with or without conventional physical therapy, did not significantly improve spatiotemporal parameters of gait compared to conventional therapy. Gait speed did not demonstrate superiority in interventions involving rehabilitation robots, observed in various speed tests and through the use of gait analyzers [ 93 , 94 , 97 , 99 , 100 , 107 ]. In terms of aerobic capacity and walking endurance, most studies did not show significant benefits [ 93 , 107 , 115 ].…”

“…[ 101 ] found that gait training with a hybrid assistive limb exoskeleton robotic device enhanced the 2 min walk test scores in sub-acute stroke patients, although the small sample size (8 participants) limits the credibility of this finding. Interestingly, none of the following aspects of RAGT have been shown to provide significant benefits, including toe-out angle, step length, stride length, gait cadence, stride duration, and cycle duration [ 93 , 97 , 100 ]. Ogino’s research team found that gait training using the Gait Exercise Assist Robot might be more efficient than treadmill-training in improving the swing phase in subjects with chronic stroke, leading to decreases in hip hiking and excessive hip external rotation, as well as increases in side stride length, side step length, as well as role-physical and social-functioning, as measured by 8-item Short Form Health Survey.…”

A Computer Vision-Based System to Help Health Professionals to Apply Tests for Fall Risk Assessment

“…Other authors use potentiometers [ 51 ], although they share the limitations of IMUs. Therapies with exoskeletons [ 52 , 53 , 54 ] have also been developed, albeit for rehabilitation and training purposes and digitally assisted through screens [ 55 ].…”