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

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 .

Gait training with a wearable curara® robot for cerebellar ataxia: a single-arm study.

BACKGROUND: Ataxic gait is one of the most common and disabling symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation improves ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been used for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitative effects of a wearable "curara®" robot developed in a single-arm study of people with degenerative cerebellar ataxia. METHODS: Twenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial duration was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items at days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10 mWT), 6-min walking distance (6 mWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance and swing phases, minimum and maximum knee joint angles, and minimum and maximum hip joint angles) were obtained using a RehaGait®. On days 1-6 and 8-13, the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni's correction. RESULTS: Data from 18 participants were analyzed. The mean improvement rate of the 10 mWT and 6 mWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14. CONCLUSIONS: Two-week RAGT with curara® has rehabilitative effects on gait function comparable to those of therapist-assisted training. Although the long-term effects after a month of RAGT with curara® are unclear, curara® is an effective tool for gait training of people with degenerative ataxia. Trial registration jRCT, jRCTs032180164. Registered: 27 February 2019; retrospectively registered. https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164 .

Effect of the Synchronization-Based Control of a Wearable Robot Having a Non-Exoskeletal Structure on the Hemiplegic Gait of Stroke Patients.

We have been developing the robotic wear curara as both a welfare device and rehabilitation robot that assists the elderly and disabled. curara is aimed at user friendliness. We have, thus, chosen a non-exoskeleton structure made of a plastic so that the robot is as light in weight as possible and to minimize the restraining stress against natural human movement. We verified the assistance effect of curara on 15 hemiplegic patients with stroke by comparing gait parameters (i.e., velocity, step length, cadence, and symmetry of joint angles) among three conditions. The conditions were "without assistance" (i.e., a control mode that cancels frictional resistances in actuators), Condition A (where joint angles are enlarged but there is no change in gait cycle), and Condition B (where there is no change in joint angles but the gait cycle is shortened). curara improved the walking velocity by 19% and 27% under Conditions A and B, respectively. Improvements in step length and cadence were, respectively, 11% and 7% under Condition A and 14% and 11% under Condition B. Moreover, the two assistance conditions reduced the difference in joint angles between unaffected and paralyzed legs. We consider that curara will facilitate the rehabilitation of stroke patients.

5-year survival rates for primary cancer sites at cancer-treatment-oriented hospitals in Japan.

In Japan, The Japanese Association of Clinical Cancer Centers (JACCCs) was established in 1965 by systematizing cancer-treatment-oriented hospitals. The core center of JACCCs is the National Cancer Center in Tokyo. In 1984, JACCCs created The "Improvement for Clinical Cancer Centers in Japan" Study Group (The Study Group) which has subsequently routinely evaluated the effectiveness of the therapy that is provided. In general, the 5-year (relative) survival rate is employed as an indicator of the treatment efficacy. The present survey used the PC software program KAP developed by Chiba Cancer Center in Japan, to calculate 5-year observed survival rates and the 5-year relative survival rates using Ederer II methods. The overall 5-year relative survival rates in patients with stomach (15,353 patients), colon (5,054), rectum (3,695), lung (10,153), breast (11,302) and cervix of the uterus (6,336) were 68.7%, 72.2%, 69.4%, 28.1%, 86.1% and 81.1%, respectively. The survival rates discussed so far are principally observed survival rates. The 5-year relative survival rate for those institutions that specialize in cancer treatment should become an index for Japanese cancer treatment.

Effects of morphine of human spinal cord and peripheral nervous activities.

The depressant effects of morphine on the evoked electrospinogram (EESG), evoked electromyogram (EEMG) and nerve action potential (NAP) were studied in surgical patients. The EESG was recorded with an epidural electrode in the posterior epidural space in the lumbar enlargement. A clinical dose of morphine (1 mg/kg) depressed the amplitude of all components (P1, N1, P2) of the EESG, elicited by both weak and strong stimuli to the tibial nerve. The depressant effects of morphine were most pronounced on the P2 component of EESG, which is believed to correspond to primary afferent depolarization. The H-relfex was augmented by the drug, while the M-wave and the NAP were unaffected. The changes induced by morphine in both the EESG and the H-reflex were reversed completely, partially or even potentiated by naloxone (0.1 mg/kg). These depressant effects of morphine on the EESG were minimized under nitrous oxide (75%) anaesthesia, indicating the existence of a degree of interaction between these two drugs. Thus, morphine in a clinical anaesthetic dose, affects both spinal cord function and afferent volleys along the roots in normal man.