BackgroundRobot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer’s gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance.MethodsThis was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training.ResultsAfter 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion − 2.36° and knee flexion − 8.48°) during swing.ConclusionsRobot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design.Trial registrationClinicalTrials.gov NCT02471248. Registered 15 June 2015 retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0394-7) contains supplementary material, which is available to authorized users.

BackgroundIt is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs.MethodIn this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training.ResultsIn the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT).ConclusionsThe EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers.Trial registrationClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014

Lower Limb Exoskeleton robot that can facilitate stair walking is a big challenge, most systems could only provide level ground walking. In this study, a lightweight (0.5kg at ankle, 0.5kg at waist for control box) and autonomous exoskeleton Ankle Robot was proposed to provide power assistance for gait training of chronic stroke patients and it can facilitate three walking conditions in real-time: (1) level walking, (2) stair ascending, and (3) stair descending. Chronic stroke patients (n=3) with drop foot gait deficit and moderate motor impairment were recruited to evaluate the system under different walking conditions (Functional Ambulatory Category: FAC=4.7±0.5 and Fugl-Meyer Assessment for lower-extremity: FMA-LE=13.7±2.9). The system consisted of a specially designed carbon fiber AFO, servomotor, gear transmission system, IMU and force sensors, and control box. The IMU sensors embedded in the shank measured acceleration and angular velocity to identify distinct features in leg tilting angle and leg angular velocity between the three walking conditions. The results showed the powered ankle dorsiflexion assistance could reduce dropped foot of the stroke patients in swing phase and provide better gait pattern. A demo of the ankle robot will be conducted in the conference.

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Background exergaming-based interventions (EbIs) have been proposed to improve older adults’ mobility and balance performance. However, the effectiveness of such interventions for older adults with Parkinson’s disease (OAPD) remains unclear. Methods seven databases (Web of Science, Medline, Academic Search Premier, CINAHL Complete, PsycINFO, PsychARTICLE and PubMed) were searched up to 7 April 2022. We assessed mobility and balance performance between EbIs groups and control groups or traditional physical training interventions (TPTIs) groups by comparing the outcomes of the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), gait velocity, stride length and Functional Gait Assessment (FGA). Results we scanned 1,190 articles and meta-analysed 19 trials (sample size = 781). In general, the results revealed statistical differences between EbIs groups and TPTIs groups in the TUG [mean difference (MD) = −1.030 s; 95% confidence interval (CI) = −2.029 to −0.031; P = 0.043; high quality of evidence], 6MWT (MD = 63.483 m; 95% CI = 9.542 to 117.425; P = 0.021; moderate quality of evidence), BBS (MD = 2.129; 95% CI = −1.293 to 2.965; P &lt; 0.001; high quality of evidence) and FGA (MD = 2.099 95% CI = −0.306 to 3.893; P = 0.022; moderate quality of evidence). No significant difference was discovered between EbIs groups and TPTIs groups in enhancing gait velocity and stride length. Conclusions EbIs are statistically better than TPTIs in improving OAPD’s performance in TUG, 6MWT, BBS and FGA, whereas only the change between EbIs and TPTIs in 6MWT can reach the value of minimal clinically important difference. Further studies are needed to better assess the effectiveness of exergaming-based interventions.

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Objective To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke. Data Sources PubMed, CINAHL, Cochrane Database and MEDLINE Methods An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis. Results Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD −0.09; 95% CI −0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS ≤45; SMD 0.53; 95%CI 0.17 to 0.88) and for those trials with exercise frequency of ≥3 sessions per week (SMD 0.70; 95%CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27; 95% CI −0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06; 95%CI 0.43 to 1.70). Conclusion Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.

Conclusions:The ALTEP facilitated functional recovery and HRQoL. Together with pharmacologic treatment, clients may obtain optimum control in vascular risk factors like blood pressure, lipid and glucose, which may to lower stroke recurrent rate. The interpretation of results warrants caution, however, due to the lack of a control group.Background and Purpose: Whole body vibration (WBV) has gained increasing popularity in rehabilitation of various patient populations. The aim of this study was to examine the feasibility and clinical efficacy of whole body vibration therapy in enhancing bone health and neuromotor performance in individuals with chronic stroke. Methods: 82 patients with chronic stroke were randomized into either the WBV group or control group. Subjects in the WBV group received WBV stimulation (20-30Hz, 1.2-1.87mm, 1.93-6.77g) while performing six different sets of dynamic leg exercises. The total WBV exposure was 10-15 minutes per session. Subjects in control group, in contrast, performed the same dynamic leg exercises but without any added vibration stimuli. In each of the treatment arms, the subjects underwent their respective training three times per week for 8 weeks (i.e., 24 sessions). Outcome variables included the serum bone turnover markers, isometric and dynamic knee muscles strength, Berg Balance Scale, Limits of Stability Test, Activities-Specific Balance Confidence Scale, Six-Minute Walk Test, and Ten-Meter Walk Test. The measurement of outcomes was performed immediately before training, immediately after training, and at 1 month after the termination of training. Additionally, the Visual Analog Scale was used by the subjects to rate their level of satisfaction with the WBV program. Multivariate analysis of variance (MANOVA) was used to determine whether WBV had any significant overall treatment effect. Post-hoc contrast analysis was performed when appropriate. Results: Intention-to-treat analysis showed that there were significant but similar improvements in most outcomes in both groups, and the improvements were maintained in 1-month follow-up. The only exception was the serum level of bone turnover markers, which demonstrated no significant change over time in both groups. Three people in each group dropped out from the trial, yielding a low attrition rate of 7%. The subjects in the WBV group showed high satisfaction level with the program (mean score: 9.0AE1.0), which was significantly different from the control group (mean score: 8.4AE1.5) (pZ0.031). Conclusion: WBV training is safe and feasible in individuals with chronic stroke. However, the results showed that WBV stimulation has no additional effect on improving bone turnover rate, knee muscles strength, mobility, and balance compared with dynamic leg exercises alone in patients with chronic stroke.