Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Abstract

Abstract. Wearable robotic devices provide safe and intensive rehabilitation, enabling repeated motions for motor function recovery in stroke patients. The aim of this small case series was to demonstrate the training effects of a three-week robotic leg orthosis, and to investigate possible mechanisms of the sensory-motor alterations and improvements by using gait analysis and EMG. Three survivors of chronic strokes participated in robot-assisted gait therapy for three weeks. EMG signals from the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG), as well as kinetics and kinematics data of the lower limb, were recorded before and after the training. The normalized root mean squared (RMS) values of the muscles, the joint moments, joint angles, and the results of two clinical scales (Berg Balance scale, BBS, and the lower extremity subscale of Fugl-Meyer assessment, LE-FMA) were used for analysis. All participants experienced improved balance and functional performances and increased BBS and LE-FMA scores. The EMG results showed there was an increase of the normalized RMS values of the MG and BF on the affected side. Additionally, EMG activities of the agonist and antagonist pair (i.e. RF and BF) appeared to return to similar levels after training. The peak moment of hip flexor, knee extensor, and plantar flexor, which all contributed to push-off power, were found to have increased after training. In summary, the three-week training period using the wearable RLO improved the three participants' gait performance by regaining push-off power and improved muscle activation and walking speed.

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

“…In contrast to studies with patients with SCI, studies with post-stroke patients assessed the gait performance, without wearing exoskeleton, after training with the exoskeleton and compared the results with the baseline measurements. In general, we found that the degree of mobility improvement was not as substantial as with the studies focusing on SCI patients: 12 out of 16 studies analyzing gait speed reported an improvement [37,47,87,102,[105][106][107][108][109][110][111][112], and only 3 out of 9 studies analyzing Flugl-Meyer scores reported an improvement [102,109,112]. Regarding the group of studies focusing on other pathologies, 4 out of 7 studies analyzing outcome measures related to gait speed reported an improvement [36,86,113,114].…”

A new lower limb portable exoskeleton for gait assistance in neurological patients: a proof of concept study

“…Byl et al [43], observed no adverse events during their study, which was a case series in stroke patients. Other studies with the same device [44][45][46] did not report adverse events related to the use of the device. When the MAK device was used, the participants did not need any additional assistance aside from the assistance that they typically used (such as a cane or crutches).…”

Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke

“…Existing research on o-RAGT in subjects post stroke is limited, with the patient’s status assessed using a traditional approach based on clinical ordinal rating scales [ 8 ]. Although the clinical effects of o-RAGT in neurological subjects are encouraging [ 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], the instrumental assessment of gait biomechanics and muscle activations is a necessity to further understand the effects of this rehabilitation approach [ 20 , 21 , 22 , 23 ].…”