Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial.

BACKGROUND: The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke. METHODS: Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower). RESULTS: The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05). CONCLUSION: This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.

The effect of pelvic movements of a gait training system for stroke patients: a single blind, randomized, parallel study.

BACKGROUND: Aging societies lead to higher demand for gait rehabilitation as age-related neurological disorders such as stroke and spinal cord injury increase. Since conventional methods for gait rehabilitation are physically and economically burdensome, robotic gait training systems have been studied and commercialized, many of which provided movements confined in the sagittal plane. For better outcomes of gait rehabilitation with more natural gait patterns, however, it is desirable to provide pelvic movements in the transverse plane. In this study, a robotic gait training system capable of pelvic motions in the transverse plane was used to evaluate the effect of the pelvic motions on stroke patients. METHOD: Healbot T, which is a robotic gait training system and capable of providing pelvic movements in the transverse plane as well as flexion/extension of the hip and knee joints and adduction/abduction of the hip joints, is introduced and used to evaluate the effect of the pelvic movement on gait training of stroke patients. Gait trainings in Healbot T with and without pelvic movements are carried out with stroke patients having hemiparesis. EXPERIMENT: Twenty-four stroke patients with hemiparesis were randomly assigned into two groups and 23 of them successfully completed the experiment except one subject who had dropped out due to personal reasons. Pelvis-on group was provided with pelvic motions whereas no pelvic movement was allowed for pelvis-off group during 10 sessions of gait trainings in Healbot T. Electromyography (EMG) signals and interaction forces as well as the joint angles of the robot were measured. Gait parameters such as stride length, cadence, and walking speed were measured while walking on the ground without assistance of Healbot T after gait training on 1st, 5th, and 10th day. RESULT: Stride length significantly increased in both groups. Furthermore, cadence and walking speed of the pelvis-on group were increased by 10.6% and 11.8%. Although interaction forces of both groups except the thighs showed no differences, EMG signals from gluteus medius of the pelvis-on group increased by 88.6% during stance phase. In addition, EMG signals of biceps femoris, gastrocnemius medial, and gastrocnemius lateral of the pelvis-on group increased whereas EMG signals of the pelvis-off group except gastrocnemius lateral showed no difference after gait trainings. CONCLUSION: Gait training using a robotic gait training system with pelvic movements was conducted to investigate the effects of lateral and rotational pelvic movements in gait training of stroke patients. The pelvic movements affected to increase voluntary muscle activation during the stance phase as well as cadence and walking speed. CLINICAL TRIAL REGISTRATION: KCT0003762, 2018-1254, Registered 28 October 2018, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=14310<ype=&rtype=.

Elbow training device using the Mechanically Adjustable Stiffness Actuator(MASA).

This paper presents an elbow training device using the Mechanically Adjustable Stiffness Actuator(MASA) for stroke survivors with hemiplegia. The MASA is a series elastic actuator whose mechanical stiffness is variable. Stiffness and the neutral position of the spring is mechanically changed using two identical actuators. Since assisting torque of the actuators is transmitted through the springs, changing stiffness of the MASA results in different level of assistance by the actuators. Then, according to the performance of the patients during given tracking tasks, the level of assistance is controlled via changing stiffness. A prototype of the rehabilitation device using the MASA is introduced and a preliminary experiments with 10 healthy subjects show the level of assistance changes.

Effect of Pelvic Movement on Healthy Subjects During Gait Training Using a Gait Rehabilitation System.

Rapidly aging society faces with increases in neurological disorders including stroke. Hemiplegia, which is one of the common sequelae due to stroke, causes difficulties in activities of daily living. As the number of stroke patients grows, demands for gait training increases, where robotic gait training systems are necessary. A robotic gait training system, called "COWALK-I," is designed to provide pelvic motion on the transverse plane as well as leg motions in the sagittal plane during gait training sessions. The pelvic motion allows weight-shifting as well as more natural gait patterns during gait training. In this research, effect of the pelvic motion during waking in the COWALK-I system is studied. Interaction force between the healthy subjects and the COWALK-I and electromyography(EMG) sensor data are measured. The average interaction forces did not show significant difference while each subject exhibited diverse patterns. The EMG signals shows that more activation of rectus femoris and less activation of gastrocnemius and gluteus medius.