The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study

Abstract

OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI–Lower (P = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.

Emerging Limb Rehabilitation Therapy After Post-stroke Motor Recovery

“…It suggests that RAT can attenuate limb spasms caused by upper motor neuron disease, associated with repetitive motion and drafting ( Veerbeek et al, 2017 ; Cho et al, 2018 ; Cho and Song, 2019 ). In addition, Song et al (2021) confirmed that RAT could improve motor function and stimulate cortical activation, revealing the other mechanism involved in RAT. A multicentric, randomized controlled trial conducted in Britain compared RAT effectiveness, enhanced upper limb therapy, and usual care.…”

Neural Plasticity Changes Induced by Motor Robotic Rehabilitation in Stroke Patients: The Contribution of Functional Neuroimaging

“…If motor imagery was correctly identified, the robot gave visual and movement feedback by actually moving the paretic hand. MorningWalk ® system for gait recovery [ 47 ]. This was created in 2014 by CUREXO Inc. in Korea for the rehabilitation of individuals with gait disorders.…”

“…MorningWalk ® system for gait recovery [ 47 ]. This was created in 2014 by CUREXO Inc. in Korea for the rehabilitation of individuals with gait disorders.…”

“…Following QUADAS criteria, the vast majority of studies achieved a low risk of bias, and low concerns regarding applicability [ 42 , 43 , 45 , 46 ]. The other papers showed a high risk of bias regarding the appropriateness of reference standard and index test [ 41 , 44 , 47 ] ( Figure 3 ).…”

Asymmetric cortical activation in healthy and hemiplegic individuals during walking: A functional near-infrared spectroscopy neuroimaging study

“…As rehabilitation progressed, increased PMC activation was found in the affected side after 2 months of TW training, and the asymmetry of bilateral SMC activation was improved ( 35 ). Song et al reported that cortical activation in patients with stroke was lower in the affected hemisphere than in the unaffected one, while asymmetric activation performance was improved after 3 weeks of robot-assisted gait training ( 42 ). Similarly, our research also found asymmetric cortical activation during hemiplegic walking, improved bilateral activation during FES-assisted hemiplegic walking in patients with post-stroke, and speculated that a new interhemispheric balance may be re-established by activating specific brain regions in SMA and PMC on the affected side.…”