Potential adverse effects of face mask use on cardiopulmonary function and thermoregulation in robotic stroke rehabilitation during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease (COVID-19) pandemic led to the implementation of wearing face masks and social distancing in stroke rehabilitation to prevent airborne transmission and contain the virus. The use of masks causes hypoxia and dyspnea in patients with stroke, predisposing them to other harmful medical conditions. Despite the clinical importance of the potential risk of wearing masks during robotic stroke rehabilitation, no clinical evidence is available in the literature. OBJECTIVE: To examine the effects of stroke robotic rehabilitation with and without using a face mask on cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, blood pressure (BP), and temperature in healthy adults and patients with hemiparetic stroke. METHOD: A total of 30 participants, comprising 20 males and 10 females, were enrolled in a case-control study and a cross-sectional randomized controlled trial conducted at the Center for Rehabilitation Hospital. The study population included 15 individuals with hemiparetic stroke (mean age: 57.26±8.69) and 15 healthy adult controls (mean age: 30.20±9.86). All participants underwent a 30-minute familiarization session, followed by experimental masked and unmasked robotic interactive gait training (RIGT) for at least 30 minutes. Clinical tests included the Borg Rating of Perceived Exertion, muscle fatigue via surface electromyography, O2 saturation, pulse, BP, and temperature. RESULTS: An analysis of covariance showed that compared to RIGT without a mask, RIGT with a mask showed adverse effects on BRPE, O2 saturation, and right rectus femoris muscle fatigue (P < 0.05) in the control and experimental groups. CONCLUSION: The clinical study revealed that compared to RIGT without a mask, RIGT with a mask affected cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, and BP in healthy adults and participants with hemiparetic stroke.

Immediate effects of multimodal cognitive therapy in mild cognitive impairment.

BACKGROUND: Current therapeutic evidence suggests limited efficacy of the cognitive and exercise training in mild cognitive impairment (MCI) on depression, anxiety, memory retention, comprehension, calculation, concentration, orientation, dual-task performance, and sleep disorders. Nevertheless, the immediate effects of multimodal cognitive therapy (MCT) have recently developed and its individual effects remains unknown in MCI. OBJECTIVE: This study aimed to compare the immediate effects of MCT on cognitive and psychological measures between young healthy and older adults with MCI. METHODS: Forty young healthy and older adults with MCI underwent immediate MCT (5 minutes each), including transcranial direct current stimulation (tDCS), light therapy, computerized cognitive therapy (CCT), robotic-assisted gait training (RAGT), core breathing exercises (CBE), and music therapy. Outcome measures included memory retention, comprehension, calculation, attention, orientation, dual-task performance, awareness, depression, anxiety, and sleep disorders. The Mann-Whitney U test and Friedman's test were used at P < 0.05. RESULTS: Significant differences in depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness were observed between the tDCS, CCT, and music therapy groups (P < 0.05). CONCLUSION: MCT was beneficial for mitigating depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness.

Bolstering Cognitive and Locomotor Function in Post-Stroke Dementia Using Human-Robotic Interactive Gait Training.

Studies have reported inconclusive results regarding the effectiveness and clinical indications of the exclusive use of human-robotic interactive gait training (HIT) in patients with post-stroke dementia (PSD). This study aimed to compare the effects of human-robotic interactive gait training (HIT) and conventional physiotherapy (CPT) on cognitive and sensorimotor functions, trunk balance and coordination, dynamic and static balance, and activities related to daily living performance in patients with PSD. Forty-eight patients with PSD who received 60-minute therapy sessions three times per week for 6 weeks were assigned to either the CPT (n = 25) or HIT (n = 23) group. The clinical outcomes included the scores of the mini-mental state examination (MMSE), Fugl-Meyer assessment (FMA), trunk impairment scale (TIS), Berg balance scale (BBS), and modified Barthel index (MBI). Friedman tests were conducted at p < 0.05. The Friedman tests showed that HIT had superior effects to CPT in relation to MMSE, FMA, and TIS (p < 0.05), but not in relation to BBS and MBI (p > 0.05). Our results provide promising clinical evidence that HIT significantly improves cognitive and sensorimotor recovery functions, as well as trunk balance and coordination, in patients with PSD who cannot concurrently perform dual cognitive-locomotor tasks.

The Effectiveness of a Multimodal Brain Empowerment Program in Mild Cognitive Impairment: A Single-Blind, Quasi-Randomized Experimental Study.

The present study aimed to determine a multimodal brain empowerment (MBE) program to mitigate the modifiable risk factors in mild cognitive impairment (MCI), and its therapeutic effects are unknown. MBE encompassing (1) tDCS, light therapy, computerized cognitive therapy (TLC) and (2) robot-assisted gait training, music therapy, and core exercise (REM) interventions were randomly assigned to 20 healthy young adults and 20 older adults with MCI. The electroencephalography (EEG) power spectrum and topographic event-related synchronization (ERS) analysis were used to assess intervention-related changes in neural activity during the MBE program. Outcome: The EEG results demonstrated that both multimodal TLC and REM decreased delta waves and increased theta, alpha, and beta waves (p < 0.001). ERS showed increased neural activation in the frontal, temporal, and parietal lobes during TLC and REM. Such enhanced neural activity in the region of interest supports potential clinical benefits in empowering cognitive function in both young adults and older adults with MCI.

Self-perception and anticipated efficacy of the anti-dementia multimodal program in 100 older adults with mild cognitive impairment.

BACKGROUND: Effective and sustainable interventions are clearly needed for mild cognitive impairment (MCI) patients. Despite the clinical importance of the multimodal intervention approach, only one study using a multimodal approach demonstrated promising improvements in memory, attention, and executive functions, which also correlated with functional magnetic resonance imaging (MRI) blood oxygenation level dependent (BOLD) changes in cerebral activation in 50 MCI patients. OBJECTIVE: To investigate the self-perception and anticipated efficacy of each element of the BRAIN-FIT multimodal intervention program (robotic-assisted gait training (RAGT), computerized cognitive therapy, music, light, transcranial direct current stimulation (tDCS), and diaphragmatic breathing exercises) and the correlation between memory, concentration, depression, and sleep in older adults with MCI. METHODS: One hundred participants (mean±standard deviation: 8.63±78.4 years; 47 women) with MCI were recruited from a major university medical center and community dementia relief center. The survey questionnaire comprised four domains with 21 questions, including four pertaining to general demographic characteristics, eight related to exercise and activity, three related to sleep, and nine related to the BRAIN-FIT program. Chi-squared test was used to analyze the Likert scale data. The descriptive frequencies were calculated. Additionally, Spearman's rho statistics measure the rank-order association. The statistical significance was at P < 0.05. RESULTS: A strong correlation was observed between memory and concentration (r = 0.850, P = 0.000), memory and depression (r = 0.540, P = 0.000), memory and sleep (r = 0.502, P = 0.000), concentration and depression (r = 0.602, P = 0.000), concentration and sleep (r = 0.529, P = 0.000) and sleep and depression (r = 0.497, P = 0.000). The correlation between medical services and sleep (r = 0.249, P = 0.012) was moderate. The chi-square test revealed a significant difference in memory and low-intensity duration of exercise (χ2[3,N = 100] = 11.69, P = 0.01), concentration and high-intensity exercise duration (χ2[3,N = 100] = 10.08, P = 0.02), concentration with low-intensity exercise duration (χ2[3,N = 100] = 21.11, P = 0.00), depression with high-intensity (χ2[3,N = 100] = 10.36, P = 0.02), high-intensity duration of exercise (χ2[3,N = 100] = 10.48, P = 0.02); low-intensity (χ2[3,N = 100] = 7.90, P = 0.48), and low-intensity duration of exercise (χ2[3,N = 100] = 9.69, P = 0.02). Additionally, significant differences were observed between sleep and high-intensity (χ2[3, N = 100] = 10.36, P = 0.02), low-intensity (χ2[3, N = 100] = 18.14, P = 0.00), and low-intensity duration of exercise (χ2[3, N = 100] = 18.30, P = 0.00). Among the participants 5% answered RAGT, and 20% responded that they had experienced computerized cognitive therapy. Music therapy (20 %), diaphragmatic breathing exercises (45 %), and light therapy (10 %) were used. No patient had experienced tDCS. Conversely, 11% of the participants answered RAGT for programs they wanted to experience and 21% responded to computerized cognitive therapy. 25% of music therapy, 22% of diaphragmatic breathing exercises, 5% of light therapy, and 16% of tDCS participants said they wanted to experience it. Finally, 63% of the participants wanted to participate in the BRAIN-FIT program. CONCLUSION: The present study's results provide clinical evidence-based insights into the utilization of BRAIN-FIT in MCI to maximize cognitive score improvement of memory, concentration, depression, and sleep. Therefore, when designing the BRAIN-FIT, six intervention items were set in proportion to the preference based on the survey, to reduce participants' feeling of repulsion. The program was configured according to exercise intensity.

Effects of Integrative Autism Therapy on Multiple Physical, Sensory, Cognitive, and Social Integration Domains in Children and Adolescents with Autism Spectrum Disorder: A 4-Week Follow-Up Study.

This study aimed to compare the effects of conventional autism therapy (CAT) and integrative autism therapy (IAT) in children and adolescents with autism spectrum disorder (ASD). A convenience sample of 24 children with ASD was recruited and underwent either CAT or IAT for 60 min/day, twice a week, for 20 sessions over 10 weeks. Outcome measures included the following: (1) physical domain (pediatric balance scale, PBS), (2) sensory domain (short sensory profile), (3) cognitive domains (functional independence measure, FIM; and childhood autism rating scale), and (4) social integration domain (Canadian occupational performance measure, COPM; short falls efficacy scale; and pediatrics quality of life questionnaire). Two-way repeated analysis of variance (ANOVA) was used to determine the intervention-related changes in the four domains across the pre-test, post-test, and follow-up test at p < 0.05. ANOVA showed significant interaction effects on the PBS, FIM, and COPM (p < 0.05) variables. Moreover, time main effects (p < 0.05) were observed in all four domain variables, but no group main effect was noted. This study provides promising evidence that IAT is more effective than CAT for managing children and adolescents with ASD.

Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke.

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors (acute stage group (ASG), n = 11; subacute stage group (SSG), n = 15; chronic stage group (CSG), n = 10) consistently received Walkbot RAGT for 30 min/session, thrice a week, for 4 weeks. Six clinical outcome variables, including the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), and Mini-Mental State Examination, were examined before and after the intervention. Significant differences in the FMA, BBS, TIS, and MBI were observed between the ASG and the SSG or CSG. A significant time effect was observed for all variables, except for the MAS, in the ASG and SSG, whereas significant time effects were noted for the FMA, BBS, and TIS in the CSG. Overall, Walkbot RAGT was more favorable for acute stroke patients than for those with subacute or chronic stroke. This provides the first clinical evidence for the optimal intervention timing for RAGT in stroke.

Concurrent validity, test-retest reliability, and sensitivity of a PostureRite system measurement on dynamic postural sway and risk of fall in cerebral palsy.

BACKGROUND: Accurately diagnosing dynamic postural sway (DPS) is essential for effective and sustainable intervention in children with cerebral palsy (CP). We developed an accurate, inexpensive, and wearable DPS measurement system to measure DPS accurately and consistently during walking and functional activities of daily living. OBJECTIVE: We investigated the validity and reliability of this PostureRite system in children with CP, and the link between PostureRite and clinical measures including gross motor function measure (GMFM), pediatric balance scale (PBS), and fall efficacy scale (FES). METHODS: Twenty-one participants were categorized as follows: 11 healthy adults (3 females, mean age, 25.00±1.00 years) and 10 children with CP (mean age, 11.10±6.28 years). We determined the concurrent validity of PostureRite by comparing DPS data to the gold standard accelerometer measurement results. We determined test-retest reliability by measuring DPS data on three occasions at 2-h intervals. We assessed PostureRite measurement sensitivity to ascertain differences between healthy children and children with CP DPS measurements. RESULTS: Random and mixed intraclass correlation coefficients (ICC2,k and ICC3,k) were obtained; an independent T-test was performed (P < 0.05). Concurrent validity analysis showed a good relationship between the gold standard accelerometer and PostureRite (ICC2,k = 0.973, P < 0.05). Test-retest reliability demonstrated a good relationship across the three repeated measures of the DPS data (ICC3,k = 0.816-0.924, P < 0.05). Independent T-test revealed a significant difference in DPS data between healthy adults and children with CP (P < 0.05). CONCLUSIONS: We developed a portable, wireless, and affordable PostureRite system to measure DPS during gross motor function associated with daily activity and participation, and established the concurrent validity, test-retest reliability as sensitivity, and clinical relevance by comparing the DPS obtained from the participants with and without CP.

Effects of Robotic Interactive Gait Training Combined with Virtual Reality and Augmented Reality on Balance, Gross Motor Function, Gait Kinetic, and Kinematic Characteristics in Angelman Syndrome: A Case Report.

Angelman syndrome (AS) is a genetic neurological disorder resulting in cognitive and neuromuscular impairments, such as lack of safety awareness and attention, as well as lack of balance and locomotor control. The robotic interactive gait training (RIGT) system is designed to provide accurate proprioceptive, kinematic, and kinetic feedback, and facilitate virtual reality and augmented reality (VR-AR) interactive exercises during gait training. In the present case report, we examined the effect of an innovative hip-knee-ankle interlimb-coordinated RIGT system. We utilized this therapeutic modality in a participant with Angelman syndrome (AS). Gross motor function measures, risk of fall, and gait-related kinetic (force), and kinematic (joint angle) biomechanical characteristics were assessed before and after 20 sessions of RIGT with VR-AR. We found RIGT with VR-AT improved gait ability, as shown by Performance-Oriented Mobility Assessment score, gross motor function by Gross Motor Function Measure score, balance by Pediatric Balance Scale score, knee and hip joint kinetics, and kinematics during gait. Our clinical and biomechanical evidence provide important clinical insights to improve the effectiveness of current neurorehabilitation approaches for treating patients with AS in balance and locomotor control and reduce the risk of falling.

Effectiveness of a wearable ankle-tubing gait training on ankle kinematics and motor control in hemiparetic stroke.

BACKGROUND: While excessive ankle plantarflexion is a common neuromuscular impairment resulting from insufficient coordination of selective ankle neuromotor control and kinematics during gait. We recently developed a wearable, inexpensive and sustainable wearable ankle-tubing gait training (WAGT) aimed at improving selective ankle motor control and kinematic coordination. OBJECTIVE: We investigated the effects of WAGT on tibialis anterior (TA) and gastrocnemius (GCM) muscle electromyography (EMG) activity, TA: GCM muscle imbalance ratio, and ankle joint kinematics during gait in hemiparetic stroke patients. METHODS: A convenience sample of 33 participants (15 non-stroke healthy adults and 18 hemiparetic stroke patients) underwent standardized electromyography and kinematic biomechanical tests under conventional gait training (CGT) and WAGT conditions. Analysis of variance (ANOVA) was used to determine the significance of differences in the TA: GCM muscle activation, muscle imbalance ratio, and ankle joint kinematics before and after the intervention and between the two groups at P < 0.05. RESULTS: WAGT was more effective than CGT in improving TA muscle activation (P < 0.01), TA: GCM muscle imbalance ratio (P < 0.01), and kinematic movement (P < 0.01) in adults with or without hemiparetic stroke. CONCLUSIONS: This study demonstrated that WAGT is relatively ease to design, wear and affordable to most clinicians and patients, hence it is suitable for many health care applications to correct gait-related movement abnormalities presented in the hemiparetic stroke patients.

Abnormal synergistic gait mitigation in acute stroke using an innovative ankle-knee-hip interlimb humanoid robot: a preliminary randomized controlled trial.

Abnormal spasticity and associated synergistic patterns are the most common neuromuscular impairments affecting ankle-knee-hip interlimb coordinated gait kinematics and kinetics in patients with hemiparetic stroke. Although patients with hemiparetic stroke undergo various treatments to improve gait and movement, it remains unknown how spasticity and associated synergistic patterns change after robot-assisted and conventional treatment. We developed an innovative ankle-knee-hip interlimb coordinated humanoid robot (ICT) to mitigate abnormal spasticity and synergistic patterns. The objective of the preliminary clinical trial was to compare the effects of ICT combined with conventional physical therapy (ICT-C) and conventional physical therapy and gait training (CPT-G) on abnormal spasticity and synergistic gait patterns in 20 patients with acute hemiparesis. We performed secondary analyses aimed at elucidating the biomechanical effects of Walkbot ICT on kinematic (spatiotemporal parameters and angles) and kinetic (active force, resistive force, and stiffness) gait parameters before and after ICT in the ICT-C group. The intervention for this group comprised 60-min conventional physical therapy plus 30-min robot-assisted training, 7 days/week, for 2 weeks. Significant biomechanical effects in knee joint kinematics; hip, knee, and ankle active forces; hip, knee, and ankle resistive forces; and hip, knee, and ankle stiffness were associated with ICT-C. Our novel findings provide promising evidence for conventional therapy supplemented by robot-assisted therapy for abnormal spasticity, synergistic, and altered biomechanical gait impairments in patients in the acute post-stroke recovery phase.Trial Registration: Clinical Trials.gov identifier NCT03554642 (14/01/2020).

Multiple relationships between cognition-motor impairment and activity-based clinical outcome measures in 218 hemiplegic stroke patients.

BACKGROUND: The World Health Organization has developed the International Classification of Functions, Disabilities, and Health (ICF) model providing a theoretical basis for physical therapy diagnosis and interventions related to health conditions. However, the multiple relationship between body structure/function and activity domain variables is unknown on the cognition, spasticity, trunk and lower extremity recovery of the sensorimotor function and activity. OBJECTIVE: Our study aimed to determine the relationship between body structure/functions and body activity domain variables in adults with stroke. METHODS: A total of 218 hemiplegic survivors (102 females, mean age 64.98±13.53) were recruited from the Chungdam Hospital Center for our retrospective study. We used Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment for lower extremity (FMA-LE), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Trunk Impairment Scale (TIS) as clinical outcome measures. The Pearson correlation coefficient was used to determine the multiple relationships among the variables at P < 0.05. RESULTS: The correlations between body structure/function domain (MMSE, FMA-LE, MAS) and activity domain variables (BBS, MBI, and TIS) were significant, rending from pre -intervention r = -0.216 to 0.766 and post-intervention r = -0.213 to 0.776, P < 0.05, except for MMSE and MAS. CONCLUSIONS: Establishing a significant difference between body structure/functions and activity domain variables in our research implies important multiple relationships between cognitive function, lower extremity function, lower extremity spasticity, and balance, and performance of ADL and trunk control coordination after stroke.

Comparative effects of different manual techniques on electromyography activity, kinematics, and muscle force in limited ankle dorsiflexion syndrome.

BACKGROUND: Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE: This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS: This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P< 0.05. RESULTS: The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P< 0.05). CONCLUSIONS: Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF.

Comparative parenting stress measures between segmental and community-based rehabilitation services in parents of children and adolescents with intellectual and developmental disabilities (IDD): A cross-sectional survey.

BACKGROUND: There is a dearth of information on the effects of different types (Segmental rehabilitation service (SRS) vs Community-based rehabilitation service (CRS)) on the parenting stress and family quality of life in parents of children who have individuals with intellectual and developmental disabilities (IDD). OBJECTIVE: This paper is to compare the effects of SRS and CRS on parenting stress and family quality of life in parents of individuals with IDD. METHODS: A cross-sectional design was used to examine parenting stress and family quality life in cohorts of 120 fathers and mothers of children with IDD who had received either SRS or CRS participated in the survey. The outcome measures included the modified Parenting Stress Index (PSI) and the modified Beach Center Family Quality of Life Scale (mBCFQLS). The Mann-Whitney U test was performed at P< 0.05. RESULTS: A significant difference was observed in social stress in PSI between the SRS and CRS groups (P= 0.03). The child rearing, emotional well-being, and physical and material well-being variables in mBCFQLS were different between the SRS and CRS groups (P< 0.05), indicating superior benefits from CRS than SRS. CONCLUSIONS: These findings provide important information and about parenting stress and family quality of life in children with IDD, for developing effective rehabilitation programs and services for these parents.

Effects of core-postural stabilisation on fluoroscopy diaphragmatic measurement and dyspnea in chronic obstructive pulmonary disease: A randomized single-blinded clinical trial.

BACKGROUND: While respiratory and core-postural stabilisation has recently gained a widespread acceptance to improve pulmonary function and dyspena, the therapeutic effects of and rationale underlying the use of respiratory and core-postural stabilisation in the management of patients with chronic obstructive pulmonary disease have not been investigated. OBJECTIVE: This study aimed to compare the effects of abdominal breathing and respiratory and core-postural stabilisation on diaphragmatic movement and pulmonary function. METHODS: Fourteen patients with moderate chronic obstructive pulmonary disease were randomly assigned to either the respiratory and core-postural stabilisation or abdominal breathing group. All patients underwent fluoroscopy-guided chest X-ray imaging and pulmonary function tests before and after the interventions; the modified Medical Research Council questionnaire was also administered before and after the interventions. Six sessions of either intervention were consistently provided. The obtained data were assessed using independent t-tests and Wilcoxon signed-rank test with a significance threshold of P< 0.05. RESULTS: Respiratory and core-postural stabilisation was more effective in increasing diaphragmatic movements than abdominal breathing (P< 0.05). Pulmonary function tests revealed more significant differences in the forced vital capacity (FVC(%)predicted) only after respiratory and core-postural stabilisation (P= 0.004). The Medical Research Council questionnaire score was significantly different within the Respiratory and core-postural stabilisation group (P= 0.014). CONCLUSIONS: Our novel results suggest that the effects of respiratory and core-postural stabilisation breathing on diaphragmatic movement and pulmonary function were superior to those of abdominal breathing in patients with chronic obstructive pulmonary disease.

Effect of dynamic guidance-tubing short foot gait exercise on muscle activity and navicular movement in people with flexible flatfeet.

BACKGROUND: Navicular drop is a common plantar deformity which makes the plantar medial longitudinal arch (MLA) collapse and leads to other deformities in lower extremities. Active structures are from intrinsic and extrinsic foot muscle activities such as abductor hallucis (AbdH), tibialis anterior (TA), tibialis posterior, flexor hallucis brevis, flexor digitorum brevis during dynamic situations. As AbdH plays a role as a dynamic elevator of MLA, the importance of AbdH has been emphasized and the proper recruitment of both intrinsic and extrinsic muscle is crucial for stabilization of MLA during dynamic weight bearing condition. Because the short foot (SF) exercise is difficult to perform and tends to activate the intrinsic muscles concentrically rather than a natural coordination of concentric-isometric-eccentric activation, we have developed the guidance-tubing SF gait (GFG) exercise. OBJECTIVE: We investigated the effect of GFG exercise on muscle activity, AbdH:TA activity ratio, MLA angle, and foot pressure distribution during walking compared to SF gait (SFG) exercise. METHODS: Thirty-two subjects with flexible flat feet were divided into two groups and performed SFG exercise with (GFG) and without guidance-tubing (SFG) for seven serial days. RESULTS: AbdH muscle activity significantly increased from foot flat to heel rise in the GFG group (p = 0.006). The AbdH:TA activity ratio significantly increased in both the SFG (p = 0.015) group and GFG group (p = 0.006). MLA angles significantly decreased in both the SFG group (p = 0.001) and GFG group (p = 0.000), and the decrement was significantly higher in the GFG group (p = 0.001). The foot pressure distribution did not show any statistically significant change. CONCLUSIONS: The result of this study provides a clinical implication for training MLA supporter muscles in individuals with flat feet. The overactive muscle must be inhibited first, then facilitation and strengthening are followed respectively.

Effects of innovative hip-knee-ankle interlimb coordinated robot training on ambulation, cardiopulmonary function, depression, and fall confidence in acute hemiplegia.

BACKGROUND: While Walkbot-assisted locomotor training (WLT) provided ample evidence on balance and gait improvements, the therapeutic effects on cardiopulmonary and psychological elements as well as fall confidence are unknown in stroke survivors. OBJECTIVE: The present study aimed to compare the effects of Walkbot locomotor training (WLT) with conventional locomotor training (CLT) on balance and gait, cardiopulmonary and psychological functions and fall confidence in acute hemiparetic stroke. METHODS: Fourteen patients with acute hemiparetic stroke were randomized into either the WLT (60 min physical therapy + 30 min Walkbot-assisted gait training) or CLT (60 min physical therapy + 30 min gait training) groups, 7 days/week over 2 weeks. Clinical outcomes included the Berg Balance Scale (BBS), Functional Ambulation Category (FAC), heart rate (HR), Borg Rating of Perceived Exertion (BRPE), Beck Depression Inventory-II (BDI-II), and the activities-specific balance confidence (ABC) scale. The analysis of covariance (ANCOVA) was conducted at P < 0.05. RESULTS: ANCOVA showed that WLT showed superior effects, compared to CLT, on FAC, HR, BRPE, BDI-II, and ABC scale (P < 0.05), but not on BBS (P = 0.061). CONCLUSIONS: Our results provide novel, promising clinical evidence that WLT improved balance and gait function as well as cardiopulmonary and psychological functions, and fall confidence in acute stroke survivors who were unable to ambulate independently.

Effect of rehabilitation on the somatosensory evoked potentials and gait performance of hemiparetic stroke patients.

BACKGROUND: Gait performance of stroke patients is affected by impaired sensory ability. The purpose of the present study was to determine the relationship between somatosensory-evoked potential (SSEP) parameters and gait performance in hemiparetic stroke patients. METHODS: A convenience sample of 17 hemiparetic stroke patients (mean age 60.11 ± 8.83 years; 10 women; right hemiplegia: 10, left hemiplegia: 7) were recruited for the present study. The Electro Synergy system (Viasys Healthcare; San Diego, CA, USA) was used for SSEP evaluation. The 17 patients were assigned to two groups according to their SSEP results as follows: 8 patients to the normal response group and 9 patients to the abnormal group. All the participants underwent the same rehabilitation exercise programs during 4 weeks, followed by clinical evaluation. A mixed-design analysis of a variance model was used to test for differences in timed up-and-go (TUG) test and 10-meter walking test (10MWT) scores between the two independent groups while the participants were subjected to repeated measures (pretest and posttest). RESULTS: Analysis of variance revealed the main time effect (p< 0.05) and group by time interaction effect (p< 0.05). The post hoc test result confirmed that the normal sensory group showed greater improvement in TUG test and 10MWT scores than the abnormal sensory group (p< 0.05). The TUG test and 10MWT scores in the posttest were greater in the normal sensory group than in the abnormal sensory group. CONCLUSIONS: The present study demonstrated the importance of the clinical contribution of the baseline sensory function of individuals with hemiparetic stroke to their gait performance and recovery after stroke rehabilitation. As anticipated, the individuals who had intact or spared sensory function showed greater improvements in gait speed and performance measures than those who had impaired sensory function.

Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia.

BACKGROUND: The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE: The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS: Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS: Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P <  0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS: These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Comparative effects of robotic-assisted gait training combined with conventional physical therapy on paretic hip joint stiffness and kinematics between subacute and chronic hemiparetic stroke.

BACKGROUND: Robotic-assisted gait training (RAGT) has been proposed as a novel, promising intervention paradigm to improve gait function in subacute or chronic stroke neurorehabilitation. However, the benefits of RAGT combined with conventional physical therapy for gait recovery in patients with subacute and chronic hemiparetic stroke remain unclear. OBJECTIVES: The aim of the present study was to compare the effect of RAGT combine with conventional physical therapy on hip joint kinetics, kinematics, and clinical function characteristics between subacute and chronic hemiparetic stroke. METHODS: Seventeen patients with hemiparetic stroke (nine subacute and eight chronic patients) performed progressive RAGT (session 1, 40 min) combined with conventional physical therapy (session 1, 40 min) 5 days per week, for an average of 86 sessions over 8 weeks. The clinical outcomes included the Functional Ambulation Category (FAC), modified Rankin scale (mRS), Korean version of the modified Barthel index (K-MBI), and modified Ashworth scale, in addition to hip joint kinetics and kinematics before and after intervention. RESULTS: The mean change in active torque, resistive torque, and stiffness in the paretic hip joint did not differ significantly between the two groups. However, Cohen's effect size suggested a moderate difference between the groups in the hip flexion phase (d = 0.58, d = 0.70, and d = 0.70). The mean change in maximal hip flexion kinematics in the chronic group was significantly greater than that in the subacute group (p = 0.04, d = -0.70). The mean change in the clinical function test results between the groups was not statistically significant. However, both groups showed significantly improved FAC, mRS, and K-MBI scores. CONCLUSIONS: RAGT combine with conventional physical therapy may be useful when selecting therapeutic interventions to improve the active torque, resistive torque, and stiffness in the paretic hip flexion phase in patients with chronic hemiparetic stroke who reached a plateau in the maximum locomotor recovery after conventional locomotor training.