Usefulness of one-arm motorized gait device for chronic hemiplegic stroke survivors.

BACKGROUND: After stroke, gait training is a key component of rehabilitation, and most individuals use a variety of walking aids depending on their physical condition and environment. OBJECTIVE: This study aimed to investigate the potential effect of a one-arm motorized gait device for gait assist of chronic hemiplegic stroke survivors through comparison with traditional gait devices (parallel bar and hemi-walker). METHODS: This study was conducted on 14 chronic hemiplegic stroke survivors. The participants were asked to walk under three conditions using different gait devices, and their gait parameters during walking were collected and analyzed. The first condition involved walking on parallel bars; second condition, walking using hemi-walkers; and third condition, walking using one-arm motorized gait devices. With the use of a gait analysis system, the spatio-temporal gait parameters in each condition were collected, such as gait velocity, cadence, step length, stride length, single support time, and double support time. RESULTS: In the results by repeated-measures ANOVA or the Friedman test, a significant difference was found in the gait parameters among all three conditions (p< 0.05). The post-hoc test showed a significant change in the spatio-temporal gait parameters (especially, velocity, cadence and affected side single and double support time) when one-arm motorized gait device were used compared with parallel bars and hemi-walkers (p< 0.05). CONCLUSION: The results of this study suggest that one-arm motorized gait devices developed for hemiplegic stroke survivors may be more effective potentially than parallel bars and hemi-walkers in gait assistance of chronic hemiplegic stroke survivors.

Effects of gait training with weight support feedback walker on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete spinal cord injury: A pilot randomized controlled trial.

BACKGROUND: Spinal cord injury (SCI) is a devastating condition affecting an individual's life, particularly through lower extremity paralysis, which limits walking and daily activities. OBJECTIVES: This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI). METHODS: Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training. RESULTS: The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05). CONCLUSION: WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.

Immediate effect of weight load on lower limb muscle activity and gait ability in patients with incomplete spinal cord injury during walker gait training.

OBJECTIVE: Walkers are actively used to improve gait ability in patients with incomplete spinal cord injury (ISCI). This study aimed to investigate the immediate effect of weight load during walker gait training on lower limb muscle activity and gait ability in patients with ISCI using a dependence feedback walker (DFW). DESIGN: A single group cross-sectional design. SETTING: Local rehabilitation hospital. PARTICIPANTS: Fourteen patients with ISCI (62.00 years, Onset duration: 20.57months). INTERVENTIONS: The DFW was used to measure the change in lower limb muscle activity and gait ability on walker dependence during the 20-meter walk. Based on the initial measurement of walker dependence, three levels of walker dependence threshold were set (100%, 60%, and 20%). If the weight loaded on the walker exceeded the three threshold levels of walker dependence, auditory and visual feedback was generated. OUTCOME MEASURES: During the 20-meter walk, changes in both lower limb muscle activity (rectus femoris, biceps femoris, medial gastrocnemius, tibialis anterior, and gluteus medius) and gait ability (velocity, cadence, and single-limb support phase) were measured by surface electromyography and 3-axis accelerometer. RESULTS: The increase in lower limb muscle activation and improvement of gait ability were greater during 20% walker dependence gait training than during 100% walker dependence gait training (P < 0.05). CONCLUSION: Reduction of walker dependence by extrinsic feedback generated via DFW during walker gait training may lead to increased lower limb muscle activity and improved gait. These results could be useful for successful self-gait training and improving walking independence in patients with ISCI.

Factor Analysis Related to the Change in Activities of Daily Living Performance of Stroke Patients.

This study is aimed at investigating the factors influencing the change (improvement) in the performance of activities of daily living (ADL) in stroke patients. This study utilized data collected from 123 stroke patients at admission and discharge from a local rehabilitation hospital in South Korea between 2019 and 2022. We analyzed the correlations between ADL (Korean version of the Modified Barthel Index) and spasticity (Modified Ashworth Scale), muscle strength (Manual Muscle Test), gait ability (Functional Ambulation Category), cognitive function (Korean version of Mini Mental Status Examination), upper extremity function (Manual Function Test), and balance function (Berg Balance Scale). In addition, to identify the factors influencing the change in ADL in line with the 3 months of rehabilitation, a multiple regression analysis was performed. The results of the correlation analysis showed that balance function (r = 0.925, p < 0.01) and gait ability (r = 0.921, p < 0.01) had strong positive correlations with ADL. Multiple regression analysis (F = 34.547, p ≤ 0.001, adj.R2 = 0.466) indicated that changes in the upper extremity (ß = 0.494, p ≤ 0.001), cognitive (ß = 0.197, p = 0.008), and balance (ß = 0.163, p = 0.029) functions influenced changes in ADL. Our results found that the recovery of upper extremity function along with the improvement of cognitive and balance functions had a significant effect on the improvement of independence in ADL in stroke patients.

Upper-Limb Robot-Assisted Therapy Based on Visual Error Augmentation in Virtual Reality for Motor Recovery and Kinematics after Chronic Hemiparetic Stroke: A Feasibility Study.

The purpose of this study was to investigate the effect of upper-limb robot-assisted therapy based on visual error augmentation in virtual reality (UL-RAT-VEAVR) for motor recovery and kinematics after chronic hemiparetic stroke. This study applied a single-group pre- and post-intervention study design. A total of 27 stroke survivors (20 males and 7 females; mean age 54.51 years, mean onset duration 12.7 months) volunteered to participate in this study. UL-RAT-VEAVR was performed three times a week for four weeks, amounting to a total of twelve sessions, in which an end-effector-based robotic arm was used with a visual display environment in virtual reality. Each subject performed a total of 480 point-to-point movements toward 3 direction targets (medial, ipsilateral, and contralateral side) in the visual display environment system while holding the handle of the end-effector-based robotic arm. The visual error (distance to the targets on the monitor) in virtual reality was increased by 5% every week based on the subject's maximum point-to-point reaching trajectory. Upper-limb motor recovery was measured in all subjects using the Fugl−Meyer Assessment (FMA) upper-limb subscale, the Box and Block Test (BBT), and the Action Research Arm Test (ARAT), before and after training. In addition, a kinematic assessment was also performed before and after training and consisted of time, speed, distance, and curvilinear ratio for point-to-point movement. There were significant improvements in both upper-limb motor function and kinematics after 4 weeks of UL-RAT-VEAVR (p < 0.05). Our results showed that the UL-RAT-VEAVR may have the potential to be used as one of the upper-limb rehabilitation strategies in chronic stroke survivors. Future studies should investigate the clinical effects of the error-augmentation paradigm using an RCT design.

Walking Training with a Weight Support Feedback Cane Improves Lower Limb Muscle Activity and Gait Ability in Patients with Chronic Stroke: A Randomized Controlled Trial.

BACKGROUND Induction of proper weight transfer to the affected lower limb should be considered the most essential factor for successful stroke cane gait training. This study aimed to investigate the effect of walking training with a weight support feedback cane on lower limb muscle activity and gait ability of chronic stroke patients. MATERIAL AND METHODS Thirty stroke patients were randomized into 2 groups: a weight support feedback cane gait training group (WSFC group, n=15) and a conventional cane gait training group (CC group, n=15). All subjects were enrolled in standard rehabilitation programs for 4 weeks. Additionally, the WSFC group participated in WSFC gait training and the CC group participated in conventional cane gait training for 4 weeks. During WSFC gait training, the weight support rate loaded on the cane was reduced by 10% every week from 60% to 30% based on the measured initial cane dependence, while the CC group participated in conventional cane gait training with verbal instruction to reduce cane dependence. Lower limb muscle activity and gait ability were measured using wireless surface electromyography and a 3-axis accelerometer during walking. RESULTS The WSFC group showed significantly greater improvement than the CC group in lower limb muscle activity and gait ability (P<0.05). CONCLUSIONS Cane gait training significantly improved lower limb muscle activity and gait ability in stroke regardless of the training method; however, the addition of real-time weight support feedback to cane gait training appears to provide further benefit compared with conventional cane gait training in chronic stroke patients.

Changes in lower limb muscle activation and gait function according to cane dependence in chronic stroke patients.

BACKGROUND: Few quantitative analyses have been performed on muscle activation and gait function according to cane dependence. OBJECTIVE: The purpose of this study was to measure changes in the lower limb muscle activation and gait function according to reduced cane dependence using a weight-bearing feedback cane (WBFC) that had been designed to quantitatively measure cane dependence in stroke patients during walking. METHODS: Twenty-four subjects were recruited from a local rehabilitation hospital. The WBFC measured the average weight support (AWS, kg) loaded on the cane during walking through a Bluetooth connection to laptop software. All subjects walked 20 m using a WBFC set in the three levels of weight support (WSR, 100%, 60%, and 20%) based on the measured AWS. Paretic lower limb muscle activation and gait function (velocity, cadence, paretic side stride length, and symmetry index) were measured using wireless surface EMG and a 3-axis accelerometer during walking. RESULTS: The paretic side lower limb muscle activation of the 20% WSR on the cane was significantly higher than that of the 100% WSR on the cane (p< 0.05). Gait functions of the 20% WSR on the cane were significantly lower than those of the 100% WSR on the cane (p< 0.05). CONCLUSION: These findings suggest that indiscreet weight support on the cane during walking can interfere with lower limb muscle activation and gait function. Therefore, in a clinical setting, reducing cane dependence during stroke gait training should be carefully considered.

Effects of two different robot-assisted arm training on upper limb motor function and kinematics in chronic stroke survivors: A randomized controlled trial.

BACKGROUND: Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient's functional level. OBJECTIVES: This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients. METHODS: In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl-Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance. RESULTS: The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05). CONCLUSIONS: Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.

Changes in Lower Limb Muscle Activation and Degree of Weight Support according to Types of Cane-Supported Gait in Hemiparetic Stroke Patients.

This study was aimed at investigating the changes in the degree of weight support loaded on the cane and paretic-side lower limb muscle activation according to the types of cane and cane-supported gait using a weight-support feedback cane (WSFC). Eleven hemiparetic stroke patients were recruited from a local rehabilitation hospital. WSFC can measure the degree of weight support loaded on the cane during cane-supported walking in units of kg, through a force sensor installed inside the handle. This study measured the degree of weight support loaded on the cane and lower limb muscle activation under four conditions: two-point and three-point gait with mono and quadripod canes. In the two-point gait with mono and quadripod canes, subjects were asked to move the WSFC and paretic-side foot forward at the same time and then move the nonparetic-side foot. In the three-point gait with mono and quadripod canes, subjects were asked to first move the WSFC forward, then the paretic-side foot, and finally the nonparetic-side foot. The degree of weight support loaded on the cane was significantly higher in the three-point gait with WSFC than in the two-point gait with WSFC for both mono (P = .047) and quadripod canes (P = .002). Additionally, the paretic-side lower limb muscle activation during the stance phase was significantly higher in the two-point gait with WSFC than in the three-point gait with WSFC for both mono (P = .008 ~ .044) and quadripod canes (P = .008 ~ .026). Our results suggest that applying the three-point gait with high cane dependence in the early stages of training for stability and subsequently applying the two-point gait for the enhancement of lower limb muscle activation and training of normal gait pattern could be effective.

Robot-Assisted Reach Training With an Active Assistant Protocol for Long-Term Upper Extremity Impairment Poststroke: A Randomized Controlled Trial.

OBJECTIVE: To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors. DESIGN: This study was conducted as a randomized controlled trial. SETTING: National rehabilitation center. PARTICIPANTS: Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group. INTERVENTION: The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period. MAIN OUTCOME MEASURES: Upper extremity functions were measured with Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions. RESULTS: Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05). CONCLUSIONS: RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors.

Upper limb robotic rehabilitation for chronic stroke survivors: a single-group preliminary study.

[Purpose] This study aimed to assess whether robotic rehabilitation can improve upper limb function, activities of daily living performance, and kinematic performance of chronic stroke survivors. [Subjects and Methods] Participants were 21 chronic stroke survivors (19 men; 60.8 years; Mini-Mental State Examination score: 28; onset duration: 10.2 years). Training exercises were performed with a Whole Arm Manipulator and a 120-inch projective display to provide visual and auditory feedback. Once the training began, red and grey balls appeared on the projective display, and participants performed reaching movements, in the assist-as-needed mode, toward 6 directional targets in a 3-dimensional space. All participants received training for 40 minutes per day, thrice per week, for 6 weeks. Main outcome measures were upper limb function (Fugl-Meyer Assessment, Action Research Arm Test, and Box and Blocks Test scores), activities of daily living performance (Modified Barthel Index), and kinematic performance (movement velocity) in 6 directions. [Results] After 6 weeks, significant improvement was observed in upper limb function, activities of daily living performance, and kinematic performance. [Conclusion] This study demonstrated the positive effects of robotic rehabilitation on upper limb function, activities of daily living performance, and kinematic performance in chronic stroke survivors.

Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients.

The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy (p < 0.05). Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient's functional level and onset time of stroke.

A novel one arm motorized walker for hemiplegic stroke survivors: a feasibility study.

BACKGROUND: A hemiplegic stroke survivor with a moderate to severe gait disturbance may have difficulty walking using a one-arm walker. This study aimed to test the safety and feasibility of a prototype one-arm motorized walker that uses a power-driven device to provide gait assistance to hemiplegic stroke survivors with moderate to severe gait disturbances. METHODS: A one-arm motorized walker with a power-driven device was developed and tested with respect to 10 distinct variables, including weight, degrees of freedom, handle, handle substitution function, two-sided use function, variable handle height, redirecting function, electric moving parts through the handle control, brake function using the handle control, folding chairs, and design stability. Its safety and feasibility were tested in 19 hemiplegic stroke individuals using the Likert scale and a simple interview. RESULTS: The walker consists of a frame platform including a handle, electric motor for driving, one wheel for driving, two wheels for turning, unlocking sensor, driving button, and turning buttons. The walker is programmed so that a touch sensor in the handle can unlock the locking system. Furthermore, it is programmed so that a user can propel it by pushing the handle downward or pressing a button and can control directions for turning right or left by pressing buttons. Safety and performance testing was achieved for 10 separate variables, and a Likert scale score of 3.5 of 5 was recorded. CONCLUSION: This walker's novel design was developed for hemiplegic stroke survivors with moderate to severe gait disturbances. Our findings indicate that the walker is both safe and feasible for providing walking assistance to hemiplegic stroke survivors and establish the potential advantages of the one-arm motorized walker.

Reliability and validity of a dual-probe personal computer-based muscle viewer for measuring the pennation angle of the medial gastrocnemius muscle in patients who have had a stroke.

Background A dual-probe personal computer-based muscle viewer (DPC-BMW) is advantageous in that it is relatively lightweight and easy to apply. Objective To investigate the reliability and validity of the DPC-BMW in comparison with those of a portable ultrasonography (P-US) device for measuring the pennation angle of the medial gastrocnemius (MG) muscle at rest and during contraction. Methods Twenty-four patients who had a stroke (18 men and 6 women) participated in this study. Using the DPC-BMW and P-US device, the pennation angle of the MG muscle on the affected side was randomly measured. Two examiners randomly obtained the images of all the participants in two separate test sessions, 7 days apart. Intraclass correlation coefficient (ICC), confidence interval, standard error of measurement, Bland-Altman plot, and Pearson correlation coefficient were used to estimate their reliability and validity. Results The ICC for the intrarater reliability of the MG muscle pennation angle measured using the DPC-BMW was > 0.916, indicating excellent reliability, and that for the interrater reliability ranged from 0.964 to 0.994. The P-US device also exhibited good reliability. A high correlation was found between the measurements of MG muscle pennation angle obtained using the DPC-BMW and that obtained using the P-US device (p < 0.01). Conclusion The DPC-BMW can provide clear images for accurate measurements, including measurements using dual probes. It has the advantage of rehabilitative US imaging for individuals who have had a stroke. More research studies are needed to evaluate the usefulness of the DPC-BMW in rehabilitation.

The effects of the menstrual cycle on the static balance in healthy young women.

[Purpose] The purpose of this study was to investigate the effects of the menstrual cycle on the static balance of healthy young women. [Subjects and Methods] Eighteen healthy young subjects (mean age 19.1 years; weight 57.5 kg; height 159.9 cm) participated in this study. The Good Balance system was used to measure the postural sway speed and velocity moment of subjects in the static standing posture. Subjects were measured for static balance between 1 and 3 days after menstruation and 13 days after menstruation. [Results] The velocity moment of postural sway was significantly higher at 13 days after menstruation. [Conclusion] Our results indicate that the menstrual cycle affects the static balance of healthy subjects. During the menstrual cycle, intensity for balance exercises in females should be carefully controlled for injury prevention.

Discriminative and predictive validity of the short-form activities-specific balance confidence scale for predicting fall of stroke survivors.

[Purpose] The present study aimed to investigate the discriminative validity of the short-form activities-specific balance confidence scale (ABC scale) in predicting falls, and its validity. [Subjects and Methods] 43 stroke survivors were identified as a group with a history of multiple falls (faller group) and a group without or with a history of one falls (non-faller group). The balance confidence was examined using the ABC scale and the short-form ABC scale. Functional abilities were examined with Fugl-Meyer assessment, sit-to-stand test, and Berg balance scale. [Results] The area under the curve of the ABC scale and the short-form ABC scale in predicting fall was>0.77. This result indicates that both examination tools have discriminative validity in predicting falls. Although both tools showed an identical predictable specificity of 72% in the non-faller and faller groups, the short-form ABC scale exhibited a predictable sensitivity of 86% in the faller group, which is higher than that of the ABC scale (71%). [Conclusion] Results of this study showed that the short-form ABC scale is an efficient clinical tool to evaluate and predict the balance confidence of stroke survivors.

Comparison of trunk electromyographic muscle activity depends on sitting postures.

BACKGROUND: Different postural positions can be characterized by the activation and relative contributions of different postural muscles, and may variously contribute to the recovery from or worsening of chronic lower back pain. OBJECTIVE: The present study aimed to investigates trunk muscle activities in four types of seated postures: cross-legged, long, side, and W-shaped. METHODS: Eight healthy adults participated in the study. Trunk muscle activities of the external oblique (EO), rectus abdominis (RA), latissimus dorsi (LD), and erector spinae (ES) muscles in each of the sitting postures including cross-legged, long, side, and W-shaped were collected utilizing surface electromyography (sEMG). The mean sEMG signals in each of the sitting postures were used for statistical comparisons. RESULTS: There were no significant differences in electromyographic muscle activity of EO, RA, LD, and ES in the four postures (p > 0.05). However, in the W-shape sitting posture, the left LD showed the greatest electromyographic muscle activity, followed by the right LD and left EO, respectively. The right and left LD in the long sitting posture and left ES in the side sitting posture showed greater electromyographic muscle activity than that of other muscles. CONCLUSION: Based on the results, trunk muscle activity did not significantly differ between the four types of sitting postures. However, our study is limited by its experimental method and sample size. Thus, in the Future, further study will be needed.

Intra- and inter-rater reliabilities of measurement of ultrasound imaging for muscle thickness and pennation angle of tibialis anterior muscle in stroke patients.

BACKGROUND: Dysfunction of skeletal muscle has been commonly reported in stroke patients. OBJECTIVE: The purpose of this study was to investigate the intra- and inter-rater reliabilities of measurement of ultrasound imaging (USI) for pennation angle (PA) and muscle thickness (MT) of tibialis anterior muscle in stroke patients. METHODS: Thirty-four stroke patients (19 men) participated in this study. USI was used for measurement of PA and MT of the tibialis anterior muscles at rest and during maximum voluntary contraction (MVC). Two examiners acquired images from all participants during two separate testing sessions, seven days apart. Intra-class correlation coefficients (ICCs), confidence interval (CI), standard error of measurement, minimal detectable change, and Bland-Altman plots were used for estimation of reliability. RESULTS: In the intra-rater reliability between measures, for all variables (PA and MT of the paretic and non-paretic sides of tibialis anterior muscles at rest and during MVC), the ICCs ranged between 0.639 and 0.998 and the CI was within an acceptable range of 0.388-0.999. In inter-rater reliability between examiners for the two tests, for all variables, the ICCs ranged between 0.690 and 0.995 and the CI was within an acceptable range of 0.463-0.997. In addition, significant difference was observed between the paretic and non-paretic sides of the tibialis anterior muscle architecture (p < 0.05). CONCLUSION: These finding demonstrate that measurements of the tibialis anterior muscle using USI can be useful for clinical assessment in stroke patients. In addition, objective and quantitative measurements of tibialis anterior muscle using USI may provide appropriate management for the walking recovery of stroke patients.

Feedback training using a non-motorized device for long-term upper extremity impairment after stroke: a single group study.

[Purpose] To investigate the effect of feedback training using a non-motorized device on the upper extremity kinematic performance of chronic stroke survivors. [Subjects] This study had a single group design. Thirteen chronic stroke survivors (onset duration: 11.5 years, 62.6 years, mini-mental state examination score: 26.0) were enrolled. [Methods] The feedback training system consisted of a non-motorized device that offered weight support, and a projective display device and loud speakers that provided suitable visual and auditory feedback to the user. Subjects participated in the feedback training for 40 min per day, two times a week for 4 weeks. Upper extremity kinematic performance (i.e., movement time) in three directions was confirmed twice (at baseline and post-intervention). [Results] After 4 weeks of the intervention, a significant improvement in upper extremity kinematic performance was observed in the three directions. [Conclusion] The present study demonstrated the positive effects of feedback training using a non-motorized device on the upper extremity kinematic performance of chronic stroke survivors. Therefore, the findings of this study may provide beneficial information for future studies on feedback training using a non-motorized device for chronic stroke survivors.

Robot-Assisted Reach Training for Improving Upper Extremity Function of Chronic Stroke.

Stroke, as a major risk factor for chronic impairment of upper limb function, can severely restrict the activities of daily living. Recently, robotic devices have been used to enhance the functional upper extremity movement of stroke patients. The purpose of the current study was to assess whether a robot-assisted reach training program using a whole arm manipulator (WAM) could improve upper extremity kinematic performance and functional movement for chronic stroke patients. Using a single-group design, this study followed 10 people with chronic stroke (6 men, 61.5 years; Mini-Mental State Examination score: 27.0; onset duration: 8.9 years). WAM with seven degrees of freedom for the shoulder, elbow, and wrist joints was used during robot-assisted reach exercises. Subjects participated in the training program for 40 minutes per day, 2 times a week, for 4 weeks. The main outcome measures were upper extremity kinematic performance (movement velocity) for three directions and functional movement (Action Research Arm Test). Upper extremity kinematic performance and functional movement measures were performed three times: at baseline, during intervention (at 2 weeks), and post intervention. Upper extremity kinematic performance and functional movement showed improvement after two weeks (P < 0.05) and four weeks (P < 0.05) of training compared to baseline. The findings of the current study demonstrated the positive effects of short-term robot-assisted reach training on upper extremity kinematic performance as well as functional movement in individuals with chronic stroke. In addition, the findings of the current study may provide valuable information for subsequent randomized controlled trials.