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      Effects of Gait Treatment With a Single-Leg Hybrid Assistive Limb System After Acute Stroke: A Non-randomized Clinical Trial

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          Abstract

          We hypothesized that a single-leg version of the Hybrid Assistive Limb (HAL) system could improve the gait and physical function of patients with hemiparesis following a stroke. In this pilot study, we therefore compared the efficacy of HAL-based gait training with that of conventional gait training (CGT) in patients with acute stroke. Patients admitted to the participating university hospital were assigned to the HAL group, whereas those admitted to outside teaching hospitals under the same rehabilitation program who did not use the HAL were assigned to the control group. Over 3 weeks, all participants completed nine 20 min sessions of gait training, using either HAL (i.e., the single-leg version of HAL on the paretic side) or conventional methods (i.e., walking aids and gait orthoses). Outcome measures were evaluated before and after the nine training sessions. The Functional Ambulation Category (FAC) was the primary outcome measure, but the following secondary outcome measures were also assessed: National Institutes of Health Stroke Scale, Fugl–Meyer Assessment (Lower Extremity), comfortable walking speed, step length, cadence, 6-min walk distance, Barthel Index, and Functional Independence Measure. In total, 22 post-stroke participants completed the clinical trial: 12 in the HAL group and 10 in the CGT group. No serious adverse events occurred in either group. The HAL group showed significant improvement in FAC after nine sessions when compared with the CGT group ( P = 0.014). However, secondary outcomes did not differ significantly between the groups. Our results demonstrate that HAL-based gait therapy may improve independent walking in patients with acute stroke hemiplegia who are dependent on ambulatory assistance. A larger-scale randomized controlled trial is needed to clarify the effectiveness of single-leg HAL therapy.

          Clinical Trial Registration: UMIN Clinical Trials Registry, identifier UMIN000022410.

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          Review of control strategies for robotic movement training after neurologic injury

          Laura Marchal-Crespo, David J Reinkensmeyer (2009)
          There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.
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            Clinical practice. Rehabilitation after stroke.

            Bruce Dobkin (2005)
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              Motor learning elicited by voluntary drive.

              Silke Anders, Christoph Braun, Leonardo Cohen … (2003)
              Motor training consisting of voluntary movements leads to performance improvements and results in characteristic reorganizational changes in the motor cortex. It has been proposed that repetition of passively elicited movements could also lead to improvements in motor performance. In this study, we compared behavioural gains, changes in functional MRI (fMRI) activation in the contralateral primary motor cortex (cM1) and in motor cortex excitability measured with transcranial magnetic stimulation (TMS) after a 30 min training period of either voluntarily (active) or passively (passive) induced wrist movements, when alertness and kinematic aspects of training were controlled. During active training, subjects were instructed to perform voluntary wrist flexion-extension movements of a specified duration (target window 174-186 ms) in an articulated splint. Passive training consisted of wrist flexion- extension movements elicited by a torque motor, of the same amplitude and duration range as in the active task. fMRI activation and TMS parameters of motor cortex excitability were measured before and after each training type. Motor performance, measured as the number of movements that hit the target window duration, was significantly better after active than after passive training. Both active and passive movements performed during fMRI measurements activated cM1. Active training led to more prominent increases in (i) fMRI activation of cM1; (ii) recruitment curves (TMS); and (iii) intracortical facilitation (TMS) than passive training. Therefore, a short period of active motor training is more effective than passive motor training in eliciting performance improvements and cortical reorganization. This result is consistent with the concept of a pivotal role for voluntary drive in motor learning and neurorehabilitation.
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Neurosci
                Journal ID (iso-abbrev): Front Neurosci
                Journal ID (publisher-id): Front. Neurosci.
                Title: Frontiers in Neuroscience
                Publisher: Frontiers Media S.A.
                ISSN (Print): 1662-4548
                ISSN (Electronic): 1662-453X
                Publication date (Electronic): 22 January 2020
                Publication date Collection: 2019
                Volume: 13
                Electronic Location Identifier: 1389
                Affiliations
                [1] 1Center for Cybernics Research, University of Tsukuba , Tsukuba, Japan
                [2] 2Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba , Tsukuba, Japan
                [3] 3Department of Neurosurgery, Faculty of Medicine, University of Tsukuba , Tsukuba, Japan
                [4] 4Department of Rehabilitation Medicine, University of Tsukuba Hospital , Tsukuba, Japan
                [5] 5Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba , Tsukuba, Japan
                [6] 6Department of Neurosurgery, Kennan Hospital , Tsuchiura, Japan
                [7] 7Department of Neurosurgery, Kobari General Hospital , Noda, Japan
                [8] 8Department of Biostatistics, Faculty of Medicine, University of Tsukuba , Tsukuba, Japan
                Author notes

                Edited by: Reinhold Scherer, University of Essex, United Kingdom

                Reviewed by: Markus Kneihsl, Medical University of Graz, Austria; Yongtian He, University of Houston, United States

                *Correspondence: Aiki Marushima, aiki.marushima@ 123456md.tsukuba.ac.jp

                This article was submitted to Neuroprosthetics, a section of the journal Frontiers in Neuroscience

                Article
                DOI: 10.3389/fnins.2019.01389
                PMC ID: 6987474
                PubMed ID: 32694974
                SO-VID: 9d928492-709a-491b-b9eb-d01a39425bb0
                Copyright © Copyright © 2020 Watanabe, Marushima, Kadone, Ueno, Shimizu, Kubota, Hino, Sato, Ito, Hayakawa, Tsurushima, Takada, Tsukada, Fujimori, Sato, Maruo, Kawamoto, Hada, Yamazaki, Sankai, Ishikawa, Matsumaru and Matsumura.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 31 August 2019
                Date accepted : 10 December 2019
                Page count
                Figures: 4, Tables: 3, Equations: 0, References: 45, Pages: 10, Words: 0
                Categories
                Subject: Neuroscience
                Subject: Clinical Trial

                ScienceOpen disciplines: Neurosciences
                Keywords: hybrid assistive limb,acute stroke,independent walking,functional ambulation category,gait treatment
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: hybrid assistive limb, acute stroke, independent walking, functional ambulation category, gait treatment

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