Rehabilitation After Stroke: Early Findings from a (original) (raw)
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European journal of physical and rehabilitation medicine, 2017
Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event. To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. A single neurological rehabilitation center for inpatients and outpatients. Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients. Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that ...
Brain Sciences
Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which...
Journal of neuroengineering and rehabilitation, 2015
Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the ...
Journal of NeuroEngineering and Rehabilitation
Background Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. Methods An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (
BMC Neurology
Background The ability to walk is commonly reported as a top rehabilitation priority for individuals after a stroke. However, not all individuals with stroke are able to practice walking, especially those who require more assistance from their therapist to do so. Powered robotic exoskeletons are a new generation of robotic-assisted gait training devices, designed to assist lower extremity movement to allow repetitious overground walking practice. To date, minimal research has been conducted on the use of an exoskeleton for gait rehabilitation after stroke. The following research protocol aims to evaluate the efficacy and acceptability, and thus adoptability, of an exoskeleton-based gait rehabilitation program for individuals with stroke. Methods This research protocol describes a prospective, multi-center, mixed-methods study comprised of a randomized controlled trial and a nested qualitative study. Forty adults with subacute stroke will be recruited from three inpatient rehabilitat...
Journal of neuroengineering and rehabilitation, 2014
Intensive task specific training early after stroke may enhance beneficial neuroplasticity and functional recovery. Impaired gait after hemiparetic stroke remains a challenge that may be approached early after stroke by use of novel technology. The aim of the study was to investigate the safety and feasibility of the exoskeleton Hybrid Assistive Limb (HAL) for intensive gait training as part of a regular inpatient rehabilitation program for hemiparetic patients with severely impaired gait early after stroke. Eligible were patients until 7 weeks after hemiparetic stroke. Training with HAL was performed 5 days per week by the autonomous and/or the voluntary control mode offered by the system. The study protocol covered safety and feasibility issues and aspects on motor function, gait performance according to the 10 Meter Walking Test (10MWT) and Functional Ambulation Categories (FAC), and activity performance. Eight patients completed the study. Median time from stroke to inclusion wa...
Disability and Rehabilitation: Assistive Technology, 2020
Background: Reports on the implementation of exoskeletons for gait rehabilitation in clinical settings are limited. Objectives: How feasible is the introduction of exoskeleton gait training for patients with subacute stroke in a specialized rehabilitation hospital? What are the functional benefits and the patient experiences with training in the Ekso GTTM exoskeleton? Design: Explorative study. Methods: During an 18 months inclusion period, 255 in-patients were screened for eligibility. Inclusion criteria were; walking difficulties, able to stand 10 min in a standing frame, fitting into the robot and able to cooperate. One-hour training sessions 2-3 times per week for approximately 3 weeks were applied as a part of the patients' ordinary rehabilitation programme. Assessments: Functional Independence Measure, Motor Assessment Scale (MAS), Ekso GT TM walking data, patient satisfaction and perceived exertion of the training sessions (Borg scale). Results: Two physiotherapists were certified at the highest level of Ekso GT TM. Twenty-six patients, median age 54 years, were included. 177 training sessions were performed. Statistical significant changes were found in MAS total score (p < 0.003) and in the gait variables walking time, up-time, and a number of steps (p < 0.001). Patients reported fairly light perceived exertion and a high level of satisfaction and usefulness with the training sessions. Few disadvantages were reported. Most patients would like to repeat this training if offered. Conclusions: Ekso GT TM can safely be implemented as a training tool in ordinary rehabilitation under the prerequisite of a structured organization and certified personnel. The patients progressed in all outcome measures and reported a high level of satisfaction. ä IMPLICATIONS FOR REHABILITATION The powered exoskeleton Ekso GTTM was found feasible as a training option for in-patients with severe gait disorders after stroke within an ordinary rehabilitation setting. The Ekso GTTM must be operated by a certified physiotherapist, and sufficient assistive personnel must be available for safe implementation. Patients' perceived exertion when training in the Ekso GTTM was relatively low. The patients expressed satisfaction with this training option.
Development and Testing of Lower Limb Exoskeleton for Stroke Patients
International Journal of Engineering Applied Sciences and Technology, 2020
The supply of blood flow to the brain is either reduced or blocked this leads to stroke due to lack of oxygen and nutrients to the brain cells. The post-stroke symptoms include irregular gait patterns, deviation from normal gait movement so the system will help to normalize the pattern of patients. A device to be designed which goes along well with natural human gait for translational of body center of mass with minimum expenditure of energy. This is possible when developing mechanism in which knee, ankle, foot motion coordinating and interacting with each other. The system should support stability, mobility and maintain balance along CoM. This mechanism is simple but it is limited adaption with certain gait condition and imitates knee during swing and support phase referred as bio imitation. The main considerations include Force, Torque, Position and bioelectrical signals. Walking is derived as sum of gravitational potential and forward kinetic energy, and thus energy is exchanged in terms of walking. Human walking is categorized as example of Inverted pendulum model. A prototype model of exoskeleton is modelled to move in a desired position with zero impedance.
European journal of physical and rehabilitation medicine
Difficulty in walking is a major feature of neurological disease, and loss of mobility is the activity of daily living on which patients place the greatest value. The impact on patients is enormous, with negative ramifications on their participation in social, vocational, and recreational activities. In current clinical practice the gait restoration with robotic device is an integral part of rehabilitation program. Robot therapy involves the use of a robot exoskeleton device or end-effector device to help the patient retrain motor coordination by performing well-focused and carefully directed repetitive practice. The exoskeleton, as an assistive device, is also an external structural mechanism with joints and links corresponding to those of the human body. These robots use joint trajectories of the entire gait cycle and offer a uniform (more or less) stiff control along this trajectory. In this field the new powered exoskeleton ReWalk (Argo Medical Technologies Ltd) was developed to...