Minimal Contact Robotic Stroke Rehabilitation on Risk of COVID-19, Work Efficiency and Sensorimotor Function.

Patients with hemiparetic stroke undergo direct, labor-intensive hands-on conventional physical therapy to improve sensorimotor function, spasticity, balance, trunk stability, and activities of daily living (ADLs). Currently, direct, intensive hands-on therapeutic modalities have increased concerns during the coronavirus (COVID-19) global pandemic. We developed an innovative Walkbot to mitigate the issues surrounding conventional hands-on physical therapy. We aimed to compare the effects of minimal-contact robotic rehabilitation (MRR) and full-contact conventional rehabilitation (FCR) on static and dynamic balance, trunk stability, ADLs, spasticity, and cognition changes in patients with hemiparetic stroke. A total of 64 patients with hemiparetic stroke (mean age = 66.38 ± 13.17; 27 women) underwent either MRR or FCR three times/week for 6 weeks. Clinical outcome measurements included the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the modified Ashworth Scale (MAS), the Fugl­Meyer Assessment (FMA), and the modified Barthel Index (MBI) scores. A 2 × 2 repeated analysis of variance (ANOVA) was performed, and an independent t-test was used to determine statistical differences in the physiotherapists' work efficiency and COVID-19 transmission risk. The ANOVA showed that MRR had effects superior to those of FCR on the TIS, the BBS, the FMA, and the MBI (p < 0.05), but not on the MAS (p = 0.230). MRR showed a greater decrease on the physiotherapist's work efficiency and COVID-19 transmission risk (p < 0.05). Our results provide clinical evidence that robot-assisted locomotor training helps maximize the recovery of sensorimotor function, abnormal synergy, balance, ADLs, and trunk stability, and facilitates a safer environment and less labor demand than conventional stroke rehabilitation.

The effects of dynamic core-postural chain stabilization on respiratory function, fatigue and activities of daily living in subacute stroke patients: A randomized control trial.

BACKGROUND: Neurodevelopmental treatment (NDT) and dynamic core-postural chain stabilization (DCS)- based exercise is effective for improving core stability and postural control in stroke patients. However, no study has reported respiratory function, increased fatigue and ADL function in subacute stroke patients by training using NDT and DCS exercises. OBJECTIVE: To compare the effects of DCS and NDT exercises on respiratory function, fatigue and activities of daily living in individuals with hemiparetic stroke. METHODS: Thirty-one participants with hemiparetic stroke (17 male, 14 female; mean age 60.4±14.58 years; post-stroke duration, 7.2±2.2 weeks) participated in this study. The participants were randomly allocated into DCS (n = 16) and NDT (n = 15). Respiratory function was determined using forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). The fatigue severity scale (FSS) and functional independent measure (FIM) were used to evaluate fatigue severity and activities of daily living (ADL). Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DCS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DCS in respiratory function, as well as clinical FSS and FIM tests, compared with those of NDT (p < 0.05). CONCLUSIONS: The results suggest that DCS training was more effective than NDT training at improving respiratory function, fatigue severity and ADL via balanced co-activation of the diaphragm and increased diaphragm movement in individuals with hemiparetic stroke.

Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: A randomized control trial.

BACKGROUND: Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients. OBJECTIVE: To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients. METHODS: The participants were randomly allocated into DNS (n = 16) and NDT (n = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups. RESULTS: ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p < 0.05). CONCLUSIONS: This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients.

Multiple relationships between Tardieu, Kinematic data, and Wolf Motor Function Test with children with cerebral palsy.

BACKGROUND: The World Health Organization (WHO) has developed the International Classification of Functioning, Disability and Health (ICF) model in order to provide a theoretical foundation of physical therapy diagnosis and intervention. However, the multidirectional relationships between the body structure/function domain variables (spasticity and movement kinematics) and the activity domain variables (e.g. reaching, grasping, folding, and lifting abilities) using the Wolf Motor Function Test (WMFT) remain unknown. OBJECTIVE: The purpose of the present study was to examine the directional relationships between the body function and structure domain variables and the activity domain variables using the WMFT. METHODS: Nineteen children with cerebral palsy (CP) were recruited from a major rehabilitation center. Standardized clinical tests included Tardieu scale and WMFT, which were used to measure the body function and structure domain (spasticity) and activity domain (reaching, grasping, folding, and lifting abilities). An eight infrared motion capture system (VICON, Oxford, UK) was used to collect kinematics data during reaching, which represent the body function and structure domain variables. Correlational analysis was performed at P < 0.05. RESULTS: Our results revealed a fair to strong relationship between the body function and structure domain variables (11 out of 18 kinematic data) and activity domain variables (WMFT). However, no significant correlation was observed between the Tardieu score and the kinematics data or between the Tardieu score and the WMFT variables. CONCLUSIONS: The present findings suggest that the body structure/function domain variables (Kinematic data) are closely associated with activity domain variables (WMFT). However, the body function and structure domain variables within Tardieu spasticity and kinematic data variables were not associated each other, nor between Tardieu spasticity and activity domain variables (WMFT), indicating that Tardieu spasticity test does not seem to account for or reflect active kinematic movement or WFMT variables. This finding provides an important clinical insight when developing a comprehensive assessment and intervention for children with CP.

Neuroplastic and motor behavioral changes after intermanual transfer training of non-dominant hand: A prospective fMRI study.

BACKGROUND: Intermanual transfer of learning is an important movement basis for a keyboard and instrument playing movement. However, the issue of where neural plastic mechanism occurs in the brain after intermanual transfer training remains both controversial and unresolved. OBJECTIVE: The aim of present study is to investigate the neuroplastic mechanism associated with the interlimb transfer learning from non-dominant hand to dominant hand. METHODS: Twenty healthy right-handed adults were classified into either the control group (no-training) or the experimental group (training serial button-press motor task, SPMT), 5 days a week for two consecutive weeks. SPMT involved pressing the numbers 1, 2, 3, and 4 in a random sequence, which was presented in the monitor screen. Outcome measures included movement accuracy (MA), movement time (MT), and the fMRI data using a 3T MRI scanner. Repeated measures of analysis of variance (ANOVA) and non-parametric tests were used at p <0.05. RESULTS: Motor performances in the MA and MT were significantly more improved in the experimental group than in the control group (p <0.05). Neuroimaging data revealed a distributed subcortical and cortical motor network including the SMA-thalamus (VL/VL)-basal ganglia-cerebellum loop, suggesting a differential and time-dependent neural network utilized during intermanual transfer learning. CONCLUSION: Pre-training intermanual transfer learning involved a form of declarative (or explicit) motor learning, which was primarily mediated by the cortical motor network, whereas post-training involved a form of procedural knowledge, which activated subcortical and cortical motor network regions, including the SMA-thalamus (VL/VL)-basal ganglia-cerebellum loop.

Comparative Effects of Different Assistance Force During Robot-Assisted Gait Training on Locomotor Functions in Patients With Subacute Stroke: An Assessor-Blind, Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the effects of progressive reducing assistance force versus full assistance force controlled robot-assisted gait training combined with conventional physiotherapy on locomotor functions in patients with subacute stroke. DESIGN: Inpatients with subacute stroke (N = 29; 16 men; Functional Ambulation Category score = 1 ± 0.9) were randomly assigned to one of two groups: a progressive reducing assistance force group (n = 15) or a full assistance force group (n = 14). The progressive reducing assistance force group performed robot-assisted gait training sessions from 100% assistance force at the outset to 60% assistance force at the end of the robot-assisted gait training, whereas the full assistance force group received 100% assistance force throughout the robot-assisted gait training sessions. Both groups performed robot-assisted gait training combined with conventional physiotherapy 5 days a week for 4 wks. After intervention, all patients then underwent only conventional physiotherapy 5 days a week for 4 wks of follow-up. RESULTS: The Mann-Whitney U test between-group comparisons showed that improvements were significantly greater in the progressive reducing assistance force group for the Functional Ambulation Category, knee extensors torque, and Berg Balance Scale relative to the full assistance force group, both at postintervention and at follow-up. CONCLUSIONS: Progressive reducing assistance force control during robot-assisted gait training combined with conventional physiotherapy may be more beneficial for improving locomotor functions in patients with subacute stroke.

Best facilitated cortical activation during different stepping, treadmill, and robot-assisted walking training paradigms and speeds: A functional near-infrared spectroscopy neuroimaging study.

BACKGROUND: Robot-assisted and treadmill-gait training are promising neurorehabilitation techniques, with advantages over conventional gait training, but the neural substrates underpinning locomotor control remain unknown particularly during different gait training modes and speeds. OBJECTIVE: The present optical imaging study compared cortical activities during conventional stepping walking (SW), treadmill walking (TW), and robot-assisted walking (RW) at different speeds. METHODS: Fourteen healthy subjects (6 women, mean age 30.06, years ± 4.53) completed three walking training modes (SW, TW, and RW) at various speeds (self-selected, 1.5, 2.0, 2.5, and 3.0  km/h). A functional near-infrared spectroscopy (fNIRS) system determined cerebral hemodynamic changes associated with cortical locomotor network areas in the primary sensorimotor cortex (SMC), premotor cortex (PMC), supplementary motor area (SMA), prefrontal cortex (PFC), and sensory association cortex (SAC). RESULTS: There was increased cortical activation in the SMC, PMC, and SMA during different walking training modes. More global locomotor network activation was observed during RW than TW or SW. As walking speed increased, multiple locomotor network activations were observed, and increased activation power spectrum. CONCLUSIONS: This is the first empirical evidence highlighting the neural substrates mediating dynamic locomotion for different gait training modes and speeds. Fast, robot-assisted gait training best facilitated cortical activation associated with locomotor control.

Effects of the progressive walking-to-running technique on gait kinematics, ultrasound imaging, and motor function in spastic diplegic cerebral palsy - an experimenter-blind case study.

PURPOSE: The purpose of this study was to investigate the effects of the progressive walking-to-running technique (PWRT) in a child with spastic diplegic cerebral palsy (CP). DESIGN: A single case study with pre-/post-test. SUBJECT: An 11-year-old male, diagnosed with spastic diplegic CP. METHODS: The PWRT was provided for 60 minutes a day, 2 times a week for 12 weeks. Gross motor function tests, ultrasound imaging, hand-held dynamometer, and the Vicon motion capture system were used to determine motor function, muscle size and strength, and gait kinematics. RESULTS: Gross motor function was improved after the intervention. The size of right and left rectus femoris and tibialis anterior muscles in their contracted states were enhanced by 1.36, 5.09, 83.74, and 54.37%, respectively. Associated muscle strength was also increased by 58.8, 30.8, 28.0, and 118.2% in both rectus femoris and tibialis anterior muscles. Left stride length, walking speed, maximal flexion-extension angular excursion of the hip joint were enhanced by 95.7, 87.8, and 100.4% after PWRT, respectively. CONCLUSIONS: Our novel walking-running training paradigm was effective for restoring gait and running ability in a child with spastic diplegic CP.