Overground gait training using a motorized assistive device in patients with severe disabilities after stroke.

Regaining of the patient's ability to walk after stroke is an important goal of rehabilitation programmes. The ultimate goal of gait rehabilitation is to empower patients for overground walking. We have previously developed a prototype of a therapist-controlled mobile platform with compliant pelvis support mechanism that enables balance training during overground walking (device E-go). The aim of this pilot randomized controlled study was to explore the usefulness of the E-go in reducing the number of therapists needed during walking training, and to explore the effectiveness of the E-go on walking abilities in severely affected stroke patients. The study included 19 subacute poststroke patients divided into two groups. The experimental group (nine patients) trained to walk with the E-go and the control group trained within conventional physiotherapy programs for 3 weeks. Outcome measures were walking distance and speed, Fugl-Meyer Assessment, Berg Balance Scale, Functional Ambulation Category and the number of therapists needed during training. At the end of the training both groups significantly improved in walking speed, walking distance, Berg Balance Scale and Fugl-Meyer Assessment (P≤0.001), but there were no between-group differences. The experimental group on average needed a lower number of therapists (P=0.040). These findings highlight the potential of the E-go for overground walking training in severely disabled subacute stroke patients.

Improving balance in subacute stroke patients: a randomized controlled study.

The aim of the study was to compare the efficacy of balance training in a balance trainer, a newly developed mechanical device for training balance, with conventional balance training in subacute stroke patients. This was a randomized controlled study. Fifty participants met the inclusion criteria and 39 finished the study. The participants were randomly divided into control and balance trainer groups. The first had conventional balance training while the second trained balance in the balance trainer. All the participants trained balance 20 min per day, 5 days per week for 4 weeks and had additional 25 min of physiotherapy. Balance was assessed by the Berg Balance Scale, one-leg standing, Timed Up and Go (TUG) Test and 10 m walk. There was significant improvement in Berg Balance Scale (P<0.001), TUG (P<0.001) and 10 m walk (P=0.001) in both the groups, whereas no differences were found in any of these measures between the two groups either regarding overall average level or regarding average improvement. Both the groups improved significantly in standing on the healthy (P=0.001) as well as the impaired lower limb (P=0.005), whereby no significant differences were observed between the groups. Within both groups, significantly fewer subjects needed assistance of a physiotherapist for the 10 m walk and the TUG test at the end than at the beginning of the study (P=0.016). It can be concluded that both conventional balance training and training balance in the balance trainer equally improved balance in subacute stroke patients. The balance trainer cannot replace a physiotherapist but it is a safe and efficient supplementary method.

Methods for dynamic balance training during standing and stepping.

The regaining of walking ability is one of the main goals of rehabilitation following stroke. An important aspect of bipedal locomotion is efficient balancing of the trunk. In this article a novel methodology for dynamic balance training during standing and stepping is presented in a commercially available mechanical balance training device. A case study that lasted for two-weeks with two half-hour training sessions per day, involving a single subject with chronic hemiparesis, investigated the effects of the proposed dynamic balance training. Instrumented kinesiological evaluation of the subject's gait indicated important improvement in the subject's postural control during walking. Finally, the possibility of combining therapeutic functional electrical stimulation of selected lower extremity muscles with the methodology for dynamic balance training presented here is discussed.