Gait patterns and walking ability after training with a hybrid robotic exoskeleton compared to conventional gait training in early stroke rehabilitation
Introduction
Impaired gait after hemiparetic stroke remains a challenge. Although walking speed often improves due to structured rehabilitation approaches and with time, asymmetric and compensatory gait patterns tend to develop and remain [1]. Robotic gait assistive devices may enable early gait training after stroke and may allow more reproducible gait movements than manual movement support by a therapist. The Hybrid Assistive Limb (HAL) is a hybrid exoskeleton that provides motion support based on the wearer's voluntary intention as captured by surface electromyography (sEMG) recordings from lower limb muscles. The operator can adjust the degree of support for the knee and hip joint separately to obtain a symmetrical gait pattern as close to normal gait as possible. The HAL system enables gait training in patients with severe lower limb paresis to start early after stroke [2].
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Research Questions
Does 4 weeks of gait training with HAL training during inpatient rehabilitation after stroke improve gait pattern functions (assessed with laboratory gait analysis), and are there any associations between gait pattern functions and clinical assessments of body function and activities, as compared to conventional gait training?
Methods
This study is a subsample from a randomized controlled trial including patients with severely impaired gait function < 8 weeks after stroke. Patients were randomized to either evidence-based conventional gait training only or to HAL training in addition to the conventional program. Conventional gait training was performed according to current best practice (approximately 30-60 min per day, 5 days per week). Patients in the HAL group received HAL training, by use of the single-leg version of
Results
Seventeen patients completed a full assessment directly after the four-week intervention, 10 in the HAL group and 7 in the Conventional group. Patient characteristics are presented in Table 1. Kinematics, kinetics, GPS/MAP, GDI, and temporo-spatial parameters will be presented, as well as their correlations to clinical assessments.
Discussion
To our knowledge this is the first study including gait analyses as an outcome after training with HAL in the sub-acute stage after stroke. This subsample is also part of the first blinded randomized controlled trial comparing gait training with HAL with conventional gait training according to current best practice. As group sizes are small and variances generally high, the statistical power is most likely too low to compute reliable statistical differences. For this reason, we analyse the data
References (3)
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