Improving walking via real-time visual feedback after stroke in treadmill training (RE-VISIT): a protocol for randomized controlled trial / Melhorando a caminhada por meio de feedback visual em tempo real após acidente vascular cerebral em treinamento em esteira (RE-VISIT): um protocolo para ensaio clínico randomizado

BACKGROUND: After a stroke, most patients often suffer reduced walking ability and balance. Restoring walking ability and improving balance are major goals of stroke rehabilitation. Treadmills are often used in clinical setups to achieve these goals. Adding dimensions to the visual feedback in addition to the mirror for real-time frontal view is proven to enhance the gait. It is, therefore, important to design additional real-time visual feedback in treadmill training, in particular for the sagittal view involved side. OBJECTIVE: The objective of this study is to test if the real-time sagittal visual feedback during treadmill training is superior to the conventional mirror feedback treadmill training program of equivalent intensity in improving walking speed and balance after stroke. METHODS/DESIGN: The RE-VISIT trial (Real-time Visual feedback after Stroke in Treadmill training) is registered in the Clinical Trial Registry of India (CTRI/2023/10/058299). In this two-arm randomized control trial, which will be a single-blinded study, 42 eligible stroke survivors undergoing rehabilitation will be randomly allocated (1:1 ratio) to either real-time visual sagittal feedback along with front mirror (experimental) group or only front mirror treadmill training (control) group, all the participants will receive 15 sessions of treadmill training for up to 15 min at a safe self-selected speed over 5-6 weeks. The RE-VISIT (experimental) group will receive real-time, visual sagittal view feedback of the involved lower limb trajectory along with the routine front mirror view during treadmill training and will be asked to modify their gait pattern. The control group will receive treadmill walking training only with the routine front mirror view feedback. Clinical and gait assessments will be conducted at the baseline, immediately following the final session of training, and at the 9th week during follow-up. The outcome measures of interest are walking speed (primary) and balance (secondary), which will be measured prior to baseline, post 15 sessions of training, and at the 9th week following training. DISCUSSION: This REVISIT trial will provide insight and contribute to the existing innovation and modifications of incorporating realtime visual feedback during treadmill training in post-stroke gait rehabilitation. The findings will help the better designing of a gait rehabilitation program with a treadmill for post-stroke subjects to improve walking speed, and balance for those who have greater difficulties in community ambulation. We anticipate that those in the REVISIT training will demonstrate improved walking ability.

CONTEXTO: Após o acidente vascular cerebral, a maioria dos pacientes frequentemente sofre redução da capacidade de caminhar e do equilíbrio. Restaurar a capacidade de caminhar e melhorar o equilíbrio são os principais objetivos da reabilitação do AVC. As esteiras são frequentemente usadas em ambientes clínicos para atingir esses objetivos. Está comprovado que adicionar dimensões ao feedback visual, além do espelho para visão frontal em tempo real, melhora a marcha. É, portanto, importante projetar feedbacks visuais adicionais em tempo real no treinamento em esteira, em particular para o lado envolvido na visão sagital. OBJETIVO: O objetivo deste estudo é testar se o feedback visual sagital em tempo real durante o treinamento em esteira é superior ao programa de treinamento em esteira com feedback de espelho convencional de intensidade equivalente na melhoria da velocidade de caminhada e equilíbrio após acidente vascular cerebral. MÉTODOS/ DESENHO: O ensaio RE-VISIT (feedback visual em tempo real após acidente vascular cerebral no treinamento em esteira) está registrado no Registro de Ensaios Clínicos da Índia (CTRI/2023/10/058299). Neste ensaio de controle randomizado de dois braços, que será um estudo cego, 42 sobreviventes de AVC elegíveis em reabilitação serão alocados aleatoriamente (proporção de 1:1) para feedback sagital visual em tempo real junto com grupo de espelho frontal (experimental) ou apenas Grupo de treinamento em esteira com espelho frontal (controle), todos os participantes receberão 15 sessões de treinamento em esteira por até 15 minutos em uma velocidade segura e autosselecionada durante 5-6 semanas. O grupo RE-VISIT (experimental) receberá feedback visual em tempo real da visão sagital da trajetória dos membros inferiores envolvidos, juntamente com a visão rotineira do espelho frontal durante o treinamento em esteira e será solicitado a modificar seu padrão de marcha. O grupo de controle receberá treinamento de caminhada em esteira apenas com o feedback rotineiro da visão do espelho frontal. Avaliações clínicas e de marcha serão realizadas no início do estudo, imediatamente após a sessão final de treinamento e na 9ª semana durante o acompanhamento. As medidas de resultados de interesse são a velocidade de caminhada (primária) e o equilíbrio (secundário), que serão medidos antes da linha de base, após a 15ª sessão de treinamento e na 9ª semana após o treinamento. DISCUSSÃO: este ensaio REVISIT fornecerá insights e contribuirá para a inovação e modificações existentes na incorporação de feedbacks visuais em tempo real durante o treinamento em esteira na reabilitação da marcha pós-AVC. As descobertas ajudarão no melhor desenho de um programa de reabilitação da marcha com esteira para indivíduos pós-AVC para melhorar a velocidade de caminhada e o equilíbrio para aqueles que têm maiores dificuldades na deambulação comunitária. Prevemos que aqueles no treinamento REVISIT demonstrarão melhor capacidade de caminhada.

An exoskeleton robot can help improve the walking ability of stroke survivors / 中华物理医学与康复杂志

Objective:To explore the efficacy of a flat ground exoskeleton robot in improving the walking ability of stroke survivors.Methods:Fifty-eight stroke survivors with mobility difficulties were randomly divided into a robot group ( n=29) and a control group ( n=29). In addition to routine rehabilitation, the control group received conventional walking training, while the robot group underwent exoskeleton robot-assisted gait training. The 30-minute training sessions were held twice a day, 5 days per week for 5 weeks. Before as well as after 2 and 4 weeks of treatment, everyone′s walking ability was tested using the 6-minute walk test (6MWT) and functional ambulation scale (FAC). General lower limb motor function was quantified using the Fugl-Meyer Lower Extremity assessment (FMA-LE). Moreover, gait analysis was conducted before and after 4 weeks of treatment. Results:After 2 and 4 weeks of treatment, the average 6MWT times of both groups were significantly better than before the treatment, with the improvement of the robot group significantly greater than that of the control group after 2 weeks. After 2 and 4 weeks the average FMA-LE and FAC scores of both groups had improved significantly compared with before treatment. After 4 weeks the stride frequency and gait cycle of both groups had improved significantly.Conclusions:Exoskeleton robot-assisted gait training can improve walking ability and lower limb motor function of stroke survivors about as well as conventional walking training.

Effects of combining mirror visual feedback with robot-assisted gait training on the lower limb functioning of stroke survivors / 中华物理医学与康复杂志

Objective:To investigate any effect of combining mirror visual feedback (MVF) training with robot-assisted gait training (RGT) in promoting the recovery of lower limb motor function among stroke survivors.Methods:Sixty stroke survivors were randomly divided into a combined treatment group, an RGT group and a control group, each of 20. In addition to traditional rehabilitation, the RGT group received 30min of RGT 5 days a week for 4 weeks, while the combined treatment group underwent 30min of RGT and also 20min of MVF training with the same frequency and duration. Before and after the treatment, the lower extremities motor functioning and walking ability of all of the patients were assessed using the Fugl-Meyer Assessment for the lower extremities (FMA-LE), the Berg Balance Scale (BBS) and Functional Ambulation Categories (FAC).Results:There were no systematic differences in any of the measurements before the treatment. After the 4 weeks, however, the average FMA-LE, BBS and FAC scores of the combined treatment and RGT groups were significantly better than the control group′s averages, and those of the combined treatment group were significantly superior to the RGT group′s. All of the groups had, however, improved significantly compared with before the treatment.Conclusions:Robot-assisted gait training is more effective in enhancing the motor functioning of the lower extremities and walking ability when it is combined with MVF.

Effect of Robotic-assisted Gait Training on Motor and Walking for Children with Spastic Cerebral Palsy / 中国康复理论与实践

Objective:To investigate the effect of robotic-assisted gait training on the motor function and walking ability for children with spastic cerebral palsy. Methods:From October, 2020 to April, 2021, 34 children with spastic cerebral palsy were randomly divided into control group (n = 17) and experimental group (n = 17). The control group received conventional physical therapy 60 minutes a day, while the experimental group received physical therapy and robotic-assisted gait training, 30 minutes a day respectively. They were assessed with 10-meter walk test (10MWT), 6-minute walk distance (6MWD), Physiological Consumption Index, Gross Motor Functional Measure (D and E dimensions), center of pressure envelope area, and Functional Ambulation Categories before training, eight weeks after training, and one-month follow-up. Results:Four cases dropped out. All the indexes improved in the experimental group after training (|t| > 3.219, P < 0.05), and they were stable as follow-up (|t| < 1.565, P > 0.05), except 10MWT (|t| > 3.491, P < 0.01); while they were better than those in the control group (|t| > 2.108, P < 0.05), except 6MWD. Conclusion:Robotic-assisted gait training can promote the recovery of motor, balance and walking for children with spastic cerebral palsy based on conventional physical therapy, and remain at least one month.

Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial / Observação da ação e treinamento da marcha para melhorar a marcha e a cognição em idosos com comprometimento cognitivo leve: um estudo controlado randomizado

Abstract. Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly. Objective: The study aimed to investigate the effect of action observation (AO) combined with gait training on gait and cognition in elderly with mild cognitive impairment (MCI). Methods: Thirty-three participants were randomly allocated to action observation with gait training (AOGT), gait training (GT), and control (CT) groups. The AOGT and GT groups received a program of observation and gait training protocol with the same total duration of 65 min for 12 sessions. For the observation, the AGOT group watched a video of normal gait movement, while the GT group watched an abstract picture and the CT group received no training program. All participants were assessed for gait parameters during single- and dual-tasks using an electronic gait mat system and were assessed for cognitive level using the Montreal Cognitive Assessment (MoCA) at baseline, after training and at 1-month follow-up. Results: The results showed that the AOGT group had significant improvements in gait speeds during single- and dual-tasks, as well as better MoCA score, while the GT group had significant improvement only in gait speed. Conclusion: The adjunct treatment of AO with gait training provides greater benefits for both gait and cognitive performances in elderly with MCI.

Resumo. Com o avanço da tecnologia médica e do conhecimento atual, a população tem uma expectativa de vida mais longa, levando a um aumento na proporção de idosos. Objetivo: O estudo teve como objetivo investigar o efeito da observação de ação (AO) combinada com o treinamento da marcha na marcha e cognição em idosos com comprometimento cognitivo leve (CCL). Métodos: Trinta e três participantes foram alocados aleatoriamente para observação de ação com grupos de treinamento de marcha (AOGT), treinamento de marcha (GT) e controle (CT). Os grupos AOGT e GT receberam um programa de observação e protocolo de treinamento de marcha com a mesma duração total de 65 minutos por 12 sessões. Na observação, o grupo AGOT assistiu a um vídeo de movimento normal da marcha, enquanto o grupo GT assistiu a uma figura abstrata e o grupo CT não recebeu nenhum programa de treinamento. Todos os participantes foram avaliados quanto aos parâmetros da marcha durante tarefas simples e duplas, utilizando um sistema eletrônico de esteira da marcha e avaliados quanto ao nível cognitivo, utilizando a Avaliação Cognitiva de Montreal (MoCA) na linha de base, após o treinamento e 1 mês de acompanhamento. Resultados: Os resultados mostraram que o grupo AOGT apresentou melhorias significativas nas velocidades da marcha durante tarefas simples e duplas, além do escore MoCA, enquanto o grupo GT teve melhora significativa apenas na velocidade da marcha. Conclusão: O tratamento adjunto da AO com o treinamento da marcha proporciona maiores benefícios tanto do desempenho da marcha quanto do desempenho cognitivo em idosos com CCL.

Feasibility of Robot-Assisted Gait Training with an End-Effector Type Device for Various Neurologic Disorders

Robots are being used to assist the recovery of walking ability for patients with neurologic disorders. This study aimed to evaluate the feasibility and functional improvement of training with robot-assisted gait training (RAGT) using the Morning Walk®, an end-effector type robot using footplates and saddle seat support. A total of 189 individuals (65.1% men, 34.9% women; mean age, 53.2 years; age range: 5–87 years) with brain lesions, spinal cord injuries, Parkinson's disease, peripheral neuropathies, and pediatric patients were involved in this retrospectively registered clinical trial. Each participant performed 30 minutes of RAGT, five times a week, for a total of 24 sessions. Failure was defined as an inability to complete all 24 sessions, and the reasons for discontinuation were analyzed. Parameters of Medical Research Council scales and Functional Ambulation Categories were analyzed before and after RAGT training. Among the 189 patients, 22 (11.6%) failed to complete the RAGT. The reasons included decreased cooperation, musculoskeletal pain, saddle seat discomfort, excessive body-weight support, joint spasticity or restricted joint motion, urinary incontinence from an indwelling urinary catheter, and fatigue. Comparison between the pre- and post-training motor and ambulatory functions showed significant improvement. The result of the study indicates that the Morning Walk® is feasible and safe and useful for functional improvement in patients with various neurologic disordersTRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003627

Robot-assisted gait training can improve lower limb function in cases of acute flaccid paralysis resulting from hand-foot-and-mouth disease / 中华物理医学与康复杂志

Objective To explore the effect of robot-assisted gait training on the standing and walking balance of persons with acute flaccid paralysis (AFP) resulting from hand-foot-and-mouth disease (HFMD).Methods Thirty-six persons with AFP resulting from HFMD were randomly divided into a control group and a training group,each of 18.Both groups were given conventional rehabilitation training,while the training group was additionally provided with robot-aided gait training.The control group received additional massage of their affected limbs.Before and after 15 days of treatment the subjects' standing and walking ability were evaluated using parts D and E of the gross motor function (GMFM) scale.Their balance was quantified using the Berg balance scale (BBS) and integrated surface electromyograms were recorded.Results There were no significant differences between the two groups before the treatment.After 6 weeks of treatment the average scores of both groups had improved significantly,with a significantly bigger increase observed in the training group.After the treatment,the average GMFM and BBS scores of the training group were significantly higher than those of the control group.Conclusion Gait training in addition to conventional rehabilitation training can significantly improve the standing,walking and balance of patients with HFMD resulting from AFP and promote their recovery.

Rehabilitación de marcha sobre suelo para sujetos con secuelas crónicas de accidente cerebrovascular / March on soil rehabilitation for individuals with chronic sequelae of stroke

Resumen Objetivo: Comprobar la validez y aplicabilidad de los resultados con respecto a la efectividad en la rehabilitación de marcha sobre superficie en sujetos con ACV y responder la siguiente interrogante: en sujetos que presentan secuelas crónicas de ACV ¿la rehabilitación sobre superficie puede aumentar la funcionalidad de la marcha? Métodos: Se analizó el artículo "Entrenamiento de la marcha sobre superficie en individuos con accidente cerebrovascular crónico", revisión sistemática Cochrane, de States et al. (2009). Resultados: La rehabilitación de marcha sobre suelo no produce cambios significativos en relación con la funcionalidad de la marcha en sujetos con secuelas crónicas de ACV (mayor a seis meses, presentando una diferencia media estandarizada (DME) de 0.19; (IC 95 %; -0.05 a 0.43). Sin embargo, el entrenamiento de la marcha podría generar cambios estadísticamente significativos en relación con su rendimiento, y presentar una diferencia media (DM) de 26.06 [7.14 a 44.97] en la cantidad de metros recorridos posterior a la rehabilitación. Conclusión: A pesar de las limitaciones metodológicas y la baja cantidad de estudios incluidos en la revisión sistemática analizada, se encuentra razonable recomendar la rehabilitación de marcha sobre superficie en sujetos con secuelas motoras crónicas de ACV como un complemento a la terapia kinésica estándar, ya que si bien no existen diferencias estadísticamente significativas en la funcionalidad de la marcha, se reportan cambios importantes en su rendimiento, traduciéndose en modificaciones clínicas relevantes para el sujeto afectado.

Abstract Objective: To assess the validity and applicability of the results regarding the effectiveness of the rehabilitation of gait in subjects with stroke surface and answer the following question; In subjects with chronic sequelae of stroke rehabilitation on Is the surface can increase the functionality of the march? Methods: The article "Gait training on surface in individuals with chronic stroke," Co-chrane systematic review of States et al. (2009) were analyzed. Results: The Rehabilitation march on soil does not produce significant changes in relation to the functionality of the progress in subjects with chronic sequelae of stroke (more than six months, presenting a standardized mean difference (SMD) 0.19, (95% - from 0.05 to 0.43). However, the gait training could generate statistically significant changes in relation to their performance, presenting a mean difference (MD) of 26.06 [7.14 to 44.97] in the amount of meters back tours rehabilitation. Conclusion: Despite the methodological limitations and the low number of studies included in the systematic review analyzed is reasonable to recommend the rehabilitation of surface march on chronic stroke patients with motor sequelae as an adjunct to standard therapy kinésica as, although no statistically significant differences in gait functionality, significant changes are reported in their performance, resulting in clinically relevant changes for the affected individual.

Effect of Robot-assisted Gait Training on Lower Limb Motor Function and Gait Ability in Patients with Hemiple-gia after Stroke / 中国康复理论与实践

Objective To explore the effect of robot-assisted gait training on the lower limb motor function and gait ability in patients with hemiplegia after stroke. Methods From January, 2015 to October 2016, 60 patients with hemiplegia after stroke were randomly divided into control group (n=30) and experimental group (n=30). Both groups received conventional rehabilitation, while the experimental group was given robot-assisted gait training and the control group was given artificial assisted gait training, 30 minutes a day, five days a week for eight weeks. They were evaluated with Fugl-Meyer Assessment-Lower Limb (FMA-LE), muscle strength of hip flexion (L-FORCE/HIP/Flex, FHF) and knee extension (L-FORCE/KNEE/Ext, FKE), Six Minutes Walking Distance and Ten Meters Walking Time before and after training. Results There was no significant difference in general data and all indexes between two groups before training (P>0.05). The scores of all the indexes improved in the experimental group after training (t>2.274, P2.095, P<0.05), except FKE. Conclusion Robot-assisted gait training can effectively improve the lower limb motor function and gait ability of patients with hemiplegia after stroke.

Robot-assisted gait training improves the walking ability of hemiplegic patients / 中华物理医学与康复杂志

Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.

A Review of Robot-Assisted Gait Training in Stroke Patients

While a variety of robot-assisted gait training systems have been widely applied for locomotor rehabilitation in stroke patients, the best supporting evidence for robot-assisted gait training systems remains unknown. The purpose of this study was to provide the best robot-assisted gait training and clinical evidence by comparing the effects of exoskeleton and end-effector type robot-assisted gait training in stroke rehabilitation. The present study underwent a review of the literature to determine the best clinical evidence of the most commonly utilized robot-assisted gait training paradigms (end-effector and exoskeleton types) in stroke gait rehabilitation. The review corroborates the compelling evidence that combined robot-assisted gait training was advantageous in stroke rehabilitation, as it offers additive special therapeutic effects that were not afforded by conventional therapy alone. Most importantly, the robot-assisted gait training paradigm provided more intensive, repetitive, accurate kinematic feedback and symmetrical gait practice, while reducing therapist labor, which is often not affordable in current stroke rehabilitation care. Both the robot-assisted gait training with either the end-effector type or exoskeleton type was beneficial for improving motor recovery, gait function, and balance in stroke patients when it was combined with the conventional physical therapy. The robot-assisted gait training should be used as an augmented gait intervention for stroke population.

Effects of Lokomat Robotic-assisted Gait Training Combined with Drop Foot Stimulator on Gait Function in Patients with Stroke / 中国康复理论与实践

@#Objective To investigate the effects of Lokomat robotic-assisted gait training combined with drop foot stimulator on gait function in patients with stroke. Methods Thirty-six stroke patients were randomly divided into control group (n=18) and observation group (n=18). Both groups received routine rehabilitation training. The control group accepted Lokomat robotic-assisted gait training, while the ob-servation group worn drop foot stimulator in addition. The training intensity was 30 minutes every day, five days per week for 6 weeks. Fugl-Meyer Assessment-Lower Limb (FMA-LL), Functional Ambulation Category (FAC) and footprint analysis were used to evaluate the motor ability of lower limbs, walking ability and gait before and after training. Results There was no significant difference in the scores of FMA-LL, FAC and gait parameters (walking speed, stride width, stride length difference) before training (t<0.765, Z=0, P>0.05). The scores of FMA-LL, FAC and walking speed improved, and the stride width and stride length difference decreased after training (t>2.190, Z>3.630, P<0.05). After training, the scores of FMA-LL, FAC, walking speed and stride length difference were better in the observation group than in the control group (t>2.030, Z=-2.560, P<0.05), however, there was no significant difference in stride width between two groups (t=0.570, P>0.05). Conclusion Lokomat robotic-assisted gait training combined with foot drop stimulator could improve the lower limb motor func-tion and gait ability in patients with stroke, and the effect might be better than using Lokomat robotic-assisted gait training only.

Effects of robot-assisted gait training on the lower limb motor functions of hemiplegic stroke patients / 中华物理医学与康复杂志

Objective To evaluate the effects of robot-assisted gait training on the lower limb motor functions of in hemiplegic stroke patients.Methods Forty stroke patients with hemiplegia were randomly divided into a treatment group and a control group.Both groups were treated with routine rehabilitation therapies for 60 min daily in 6 weeks.The patients in the treatment group were given robot-assisted gait training for 30 min daily for 6 weeks.The lower limb part of Fugl-Meyer assessment (FMA) , the Ueda Satoshi standardized hemiplegic function scale and the functional ambulation categories (FAC) were used to evaluate the lower limb motor function before and after the sixweeks of therapies.Results There were no significant difference between the two groups before treatment with regard to all the three assessment measurements.After 6 weeks of treatment, both groups significantly improved in terms of the scores with FMA, the grade of Ueda Satoshi standardized hemiplegic function scale and the FAC (P ＜0.05).But the treatment group had significantly greater improvement than the control group (P ＜ 0.05).Conclusions The robot-assisted gait training can supplement the routine rehabilitation therapies in improving lower limb motor function in stroke patients.

Gait training after stroke using the Lokomat rehabilitation robot / 中华物理医学与康复杂志

Objective To investigate the effect of Lokomat gait training rehabilitation robot on joint motion and lower limb function in hemiplegic patients after stroke.Methods Forty hemiplegic patients after stroke were randomized equally into a robotic group and a control group (20 cases in each group).The robotic group received robotic rehabilitation therapy in addition to routine rehabilitation training,while the control group was only given instructions for routine rehabilitation training.All the patients were assessed at the beginning of the training and at the end of 4,8 and 10 weeks of treatment.The Fugl-Meyer Assessment of lower extremities (FMA),range of motion (ROM) in hip and knee,force and tone of bilateral hip/knee flexors and extensors were used to evaluate stepping function before training,and after 4,8 and 10 weeks of treatment.Results There was no significant difference between the 2 groups with regard to FMA scores,the ROM in hip and knee,as well as force and tone of bilateral hip/ knee flexors and extensors (P ＞ 0.05).After treatment,the robotic group was significantly improved with all the evaluation indexes when compared to its baseline values (P ＜ 0.05).It was also shown that the robotic group improved to a significantly greater extent than the control group (P ＜ 0.05).Pearson's correlation analysis demonstrated a positive relationship between the ROM of knee or hip and lower limb function (P ＜ 0.05).Conclusions The Lokomat gait training rehabilitation robot can improve the lower extremities functions,as indicated by increase of ROM and muscle strength as well as decrease in muscle spasticity in hemiplegic patients after stroke.

The effects of gait training with a gait orthosis on the neurogenic bladder after spinal cord injury / 中华物理医学与康复杂志

Objective To explore the effects of gait training with an alternative gait orthosis (AGO) on the neurogenic bladders of patients with spinal cord injury (SCI). Method Twelve patients with complete SCI at the thoracic and lumbar level were trained for 8 weeks on motor and bladder function. After that, specific gait training with an AGO was given for another 8 weeks. American Spinal Injury Association ( ASIA ) sensation and motor function assessments were done before and after the gait training with the AGO, and bladder capacity, residual urine and urine flow rates were also assessed. Results Compared with pre-treatment there was no significant difference in average ASIA senzsation and motor scores after training, but the maximum rate of urine flow, average urine volume and single urination had significantly increased and residual urine volume had significantly decreased. Conclusions Therapeutic gait training with an AGO can improve bladder function after SCI.

A Practical View about Modern Technologies for Gait Training

Usually, the state of art technologies (robotics, FES, virtual reality) for gait training are not familiar to clinicians. They may find difficulties in deciding whether to adopt the new technologies for their daily patient care. This article tried to put the fancy technical features away, present the basic principle that can be essential for the treatment effect, and to review the practical obstacles that can be encountered when we try the new technologies in real patient care. This review has lead to conclusion that the new techniques for gait training have been recognized as valid treatment recipes, but they could not be recognized as superior to the conventional gait training methods. In addition, the new technologies still have to overcome the great disadvantage in cost to effect aspect.

Neuroplasticity Induced by Robot-assisted Gait Training in a Stroke Patient: A case report

In this case study, we investigated the effects of robot-assisted gait training on the plasticity of motor system in a stroke patient using functional MRI. A patient who suffered from the left hemiparesis following the right MCA infarction performed gait training with a robot-assisted gait orthosis. Before and after gait training, motor performances were assessed and functional MRIs were acquired with motor activation task of affected lower limb. After gait training with a robot-assisted orthosis, the patient's motor performances were improved and cortical activities were changed. Activation in the ipsilesional primary sensorimotor cortex was increased and cortical reorganization was induced in a way that nearby regions were recruited for the movement of affected lower limb. The results of this study showed that gait training with a robot-assisted orthosis induced cortical reorganization of the motor network that resulted in enhancement of motor performance of the lower limb.