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Task-specific ankle robotics gait training after stroke: a randomized pilot study
BACKGROUND: An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but i...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890526/ https://www.ncbi.nlm.nih.gov/pubmed/27255156 http://dx.doi.org/10.1186/s12984-016-0158-1 |
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author | Forrester, Larry W. Roy, Anindo Hafer-Macko, Charlene Krebs, Hermano I. Macko, Richard F. |
author_facet | Forrester, Larry W. Roy, Anindo Hafer-Macko, Charlene Krebs, Hermano I. Macko, Richard F. |
author_sort | Forrester, Larry W. |
collection | PubMed |
description | BACKGROUND: An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. FINDINGS: Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher’s exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. CONCLUSIONS: Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. CLINICAL TRIAL IDENTIFIER: NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1 |
format | Online Article Text |
id | pubmed-4890526 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-48905262016-06-03 Task-specific ankle robotics gait training after stroke: a randomized pilot study Forrester, Larry W. Roy, Anindo Hafer-Macko, Charlene Krebs, Hermano I. Macko, Richard F. J Neuroeng Rehabil Short Report BACKGROUND: An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. FINDINGS: Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher’s exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. CONCLUSIONS: Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. CLINICAL TRIAL IDENTIFIER: NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1 BioMed Central 2016-06-02 /pmc/articles/PMC4890526/ /pubmed/27255156 http://dx.doi.org/10.1186/s12984-016-0158-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Short Report Forrester, Larry W. Roy, Anindo Hafer-Macko, Charlene Krebs, Hermano I. Macko, Richard F. Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title | Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title_full | Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title_fullStr | Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title_full_unstemmed | Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title_short | Task-specific ankle robotics gait training after stroke: a randomized pilot study |
title_sort | task-specific ankle robotics gait training after stroke: a randomized pilot study |
topic | Short Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890526/ https://www.ncbi.nlm.nih.gov/pubmed/27255156 http://dx.doi.org/10.1186/s12984-016-0158-1 |
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