Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis

Journal of NeuroEngineering and Rehabilitation

Ling-Fung Yeung¹  Kai-Yu Tong¹  Corinna Ockenfeld²  Oi-Yan Soo³  Sheung-Wai Li⁴  Hon-Wah Wai⁵  Man-Kit Pang⁵ 

[1] Department of Biomedical Engineering, The Chinese University of Hong Kong;Department of Biomedical Engineering, The Hong Kong Polytechnic University;Department of Medicine & Therapeutics, The Chinese University of Hong Kong;Division of Rehabilitation, Department of Medicine, The University of Hong Kong;Industrial Centre, The Hong Kong Polytechnic University;

关键词: Stroke;    Robotics;    Exoskeletons;    Ankle foot orthosis;    Gait training;   

DOI  :  10.1186/s12984-018-0394-7

来源: DOAJ

【 摘 要 】

Abstract Background Robot-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. Methods This 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. Results After 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. Conclusions Robot-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 registration ClinicalTrials.gov NCT02471248. Registered 15 June 2015 retrospectively registered.

【 授权许可】

Unknown