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      Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

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          Abstract

          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 was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.

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          Most cited references41

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          Interrater reliability of a modified Ashworth scale of muscle spasticity.

          We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.
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            Meaningful change and responsiveness in common physical performance measures in older adults.

            To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness. Secondary data analyses using distribution- and anchor-based methods to determine meaningful change. Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors. Older adults with mobility disabilities in a strength training trial (n=100), subacute stroke survivors in an intervention trial (n=100), and a prospective cohort of community-dwelling older people (n=492). Gait speed, Short Physical Performance Battery (SPPB), 6-minute-walk distance (6MWD), and self-reported mobility. Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed, 0.27 to 0.55 points for SPPB, and 19 to 22 m for 6MWD. Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed, 0.99 to 1.34 points for SPPB, and 47 to 49 m for 6MWD. Based on responsiveness indices, per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change. Best initial estimates of small meaningful change are near 0.05 m/s for gait speed, 0.5 points for SPPB, and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed, 1.0 point for SPPB, and 50 m for 6MWD. For clinical use, substantial change in these measures and small change in gait speed and 6MWD, but not SPPB, are detectable. For research use, these measures yield feasible sample sizes for detecting meaningful change.
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              Classification of Walking Handicap in the Stroke Population

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                Author and article information

                Journal
                Brain Sci
                Brain Sci
                brainsci
                Brain Sciences
                MDPI
                2076-3425
                14 January 2021
                January 2021
                : 11
                : 1
                : 104
                Affiliations
                [1 ]Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, 23845 Lecco, Italy; fmolteni@ 123456valduce.it (F.M.); eleonora.guanziroli@ 123456gmail.com (E.G.); mgaffuri@ 123456valduce.it (M.G.); ggasperini@ 123456valduce.it (G.G.)
                [2 ]Neurorehabilitation Research Laboratory, IRCCS San Raffaele Pisana, 00163 Rome, Italy; sanaz.pournajaf@ 123456sanraffaele.it (S.P.); daniele.galafate@ 123456sanraffaele.it (D.G.); domenica.lepera@ 123456sanraffaele.it (D.L.P.); marco.franceschini@ 123456sanraffaele.it (M.F.)
                [3 ]Neurorobotic Rehabilitation, IRCCS Centro Neurolesi “Bonino-Pulejo”, 98124 Messina, Italy; salbro77@ 123456tiscali.it (R.S.C.); bramanti.dino@ 123456gmail.com (P.B.)
                [4 ]Fondazione Centri di Riabilitazione Padre Pio Onlus, 71013 Foggia, Italy; serena.diba@ 123456gmail.com
                [5 ]SCRIN Trevi Dipartimento di Riabilitazione USL Umbria 2, 06039 Perugia, Italy; silvano.baratta@ 123456uslumbria2.it
                [6 ]Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
                Author notes
                [* ]Correspondence: michela.goffredo@ 123456sanraffaele.it ; Tel.: +39-0652252319
                [†]

                Members are listed in the Acknowledgments part.

                Author information
                https://orcid.org/0000-0002-7512-5372
                https://orcid.org/0000-0002-2651-8479
                https://orcid.org/0000-0002-8566-3166
                https://orcid.org/0000-0001-8749-2236
                Article
                brainsci-11-00104
                10.3390/brainsci11010104
                7830339
                33466749
                2ff09ae6-66e2-4f4a-b480-82d7b79bf4a7
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 December 2020
                : 11 January 2021
                Categories
                Article

                stroke,robot-assisted gait training,exoskeleton device,neurologic gait disorders,rehabilitation

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