Influence of Robot-Assisted Gait Training on Lower-Limb Muscle Activity in Patients With Stroke: Comparison With Conventional Gait Training.

OBJECTIVE: To measure muscle activity before and after robot-assisted gait training (RAGT) in patients with stroke and examine the differences in muscle activity changes compared with conventional gait training (CGT). METHODS: Thirty patients with stroke (RAGT group, n=17; CGT group, n=13) participated in the study. All patients underwent RAGT using a footpad locomotion interface or CGT for 20 minutes for a total of 20 sessions. Outcome measures were lower-limb muscle activity and gait speed. Measurements were performed before the start of the intervention and after the end of the 4-week intervention. RESULTS: The RAGT group showed increased muscle activity in the gastrocnemius, whereas the CGT group showed high muscle activity in the rectus femoris. In the terminal stance of the gait cycle, the gastrocnemius, the increase in muscle activity was significantly higher in the RAGT group than in the CGT group. CONCLUSION: The results suggest that RAGT with end-effector type is more effective than CGT to increase the gastrocnemius muscle activity.

Effect of gait rehabilitation with a footpad-type locomotion interface on gait ability in subacute stroke patients.

BACKGROUND: Gait rehabilitation using a footpad-type locomotion interface has been reported as effective in improving gait ability in chronic stroke patients. However, the effect on subacute stroke patients is unknown. OBJECTIVE: To compare the effect of gait rehabilitation using a footpad-type locomotion interface (Gait Training with Locomotion Interface group; GTLI group) with conventional gait rehabilitation (control group) in subacute stroke patients. METHODS: Twenty-one stroke patients (GTLI group: n = 13, control group: n = 8) participated in the study. All participants received gait rehabilitation using the footpad-type locomotion interface or conventional gait rehabilitation for 20 minutes x 20 sessions. Outcome measures were functional ambulation Category (FAC), gait speed, gait endurance and lower muscle strength. Measures were taken at baseline and 1, 2, 3 and 4 weeks. RESULT: The GTLI group significantly improved gait speed and gait endurance compared with the control group. However, FAC and lower limb muscle strength were not significantly different. CONCLUSIONS: The results suggest that gait rehabilitation using the footpad-type locomotion interface can improve gait ability better than conventional gait rehabilitation.

Long-term effects of injection of botulinum toxin type A combined with home-based functional training for post-stroke patients with spastic upper limb hemiparesis.

The aim of this study was to assess the effects of botulinum toxin type A (BoNT-A) injection with home-based functional training for passive and active motor function, over a 6-month period in post-stroke patients with upper limb spasticity. We studied 190 patients with at least 6-month history of stroke. They received injections of BoNT-A in upper limb muscles and detailed one-to-one instructions for home-based functional training. At baseline (before therapy), and at 1-, 3- and 6-month follow-up, Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) were used to assess active motor function, the modified Ashworth scale (MAS) for assessment of spasticity, and the range of motion (ROM) for passive motor function. The total score for upper limb and scores of categories A and B of the FMA increased significantly at 1, 3 and 6 months, while the FMA score for category D increased significantly at 3 and 6 months, but not at 1 month. Significant decreases in the MAS scores were noted in all muscles examined at 1, 3 and 6 months, compared with baseline. The ROM for elbow joint extension significantly improved at 1, 3, and 6 months, while that for wrist joint extension increased significantly at 1 month, but not 3 or 6 months, compared with baseline. The results suggest that comprehensive improvement of motor function requires improvement of motor function in the proximal part of the upper limb and that BoNT-A followed by rehabilitation reduces spasticity and improves motor function of fingers.