Effects of wearable ankle robotics for stair and over-ground training on sub-acute stroke: a randomized controlled trial.

BACKGROUND: Wearable ankle robotics could potentially facilitate intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. A lightweight (0.5 kg) and portable exoskeleton ankle robot was designed to facilitate over-ground and stair training either providing active assistance to move paretic ankle augmenting residual motor function (power-assisted ankle robot, PAAR), or passively support dropped foot by lock/release ankle joint for foot clearance in swing phase (swing-controlled ankle robot, SCAR). In this two-center randomized controlled trial, we hypothesized that conventional training integrated with robot-assisted gait training using either PAAR or SCAR in stair environment are more effective to enhance gait recovery and promote independency in early stroke, than conventional training alone. METHODS: Sub-acute stroke survivors (within 2 months after stroke onset) received conventional training integrated with 20-session robot-assisted training (at least twice weekly, 30-min per session) on over-ground and stair environments, wearing PAAR (n = 14) or SCAR (n = 16), as compared to control group receiving conventional training only (CT, n = 17). Clinical assessments were performed before and after the 20-session intervention, including functional ambulatory category as primary outcome measure, along with Berg balance scale and timed 10-m walk test. RESULTS: After the 20-session interventions, all three groups showed statistically significant and clinically meaningful within-group functional improvement in all outcome measures (p < 0.005). Between-group comparison showed SCAR had greater improvement in functional ambulatory category (mean difference + 0.6, medium effect size 0.610) with more than 56% independent walkers after training, as compared to only 29% for CT. Analysis of covariance results showed PAAR had greater improvement in walking speed than SCAR (mean difference + 0.15 m/s, large effect size 0.752), which was in line with the higher cadence and speed when wearing the robot during the 20-session robot-assisted training over-ground and on stairs. CONCLUSIONS: Robot-assisted stair training would lead to greater functional improvement in gait independency and walking speed than conventional training in usual care. The active powered ankle assistance might facilitate users to walk more and faster with their paretic leg during stair and over-ground walking. TRIAL REGISTRATION: ClinicalTrials.gov NCT03184259. Registered on 12 June 2017.

Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke survivors.

PURPOSE: To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic stroke survivors. MATERIALS AND METHODS: A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (N = 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS. RESULTS: Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (r = 0.544-0.687, p < 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores. CONCLUSIONS: Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.

Observation-based outcome measures, e.g., Fugl­Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT) could not predict the health-related quality of life (Stroke Impact scale (SIS)) in chronic stroke survivors in our study, which was contradictory with current studies.A self-perceived outcome measure to evaluate upper extremity function (Upper Extremity Functional Index (UEFI)) could independently predict the health-related quality of life (SIS), accounting for 18.8% of the variance.Our study demonstrated that self-perceived UE motor function would be an important component to optimize the rehabilitation programmes aimed at enhancing quality of life and social participation among chronic stroke survivors.

Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis.

PURPOSE: To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS: Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS: A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION: MT with ES may be effective in improving upper limb motor recovery in people with stroke.

Combining Mirror Therapy (MT) and Electrical Stimulation (ES) modality could improve upper limb motor control, gross gripping function, and performance in ADLs based on ICF for people with stroke.Those individuals with subacute stroke are recommended as the optimal target group for the combined MT and ES.

Bilateral Movement-based Computer Games Improve Sensorimotor Functions in Subacute Stroke Survivors.

BACKGROUND: Previous studies have reported that movement-based computer gaming is more effective than conventional intervention in enhancing upper limb rehabilitation. OBJECTIVE: To evaluate whether the use of bilateral movement-based computer games could augment the effects of conventional intervention in improving the upper limb motor function, grip strength and health-related quality of life of subacute stroke survivors. METHODS: A total of 93 subjects with subacute stroke were randomized into 2 groups receiving one of two 3.5-h interventions for 2 days per week over 8 weeks: (i) "bilateral movement-based computer games + conventional rehabilitation"; and (ii) "video-directed exercise + conventional rehabilitation" (control group). RESULTS: A total of 83 subjects completed the interventions and follow-up assessments. Compared with video-directed exercise + conventional rehabilitation, bilateral movement-based computer games + conventional rehabilitation produced greater improvements in upper limb motor impairment from midtreatment to follow-up 1 month post-intervention, greater improvements in upper limb function from post-intervention to 1 month follow-up, and earlier improvements in grip strength (paretic) from midintervention to follow-up 1 month post-intervention. Subjects who received bilateral movement-based computer games + conventional rehabilitation also continued to improve in motor function from postintervention to 1 month post-intervention. CONCLUSION: Bilateral movement-based computer games may serve as an adjuvant therapy to conventional rehabilitation programmes for improving upper limb recovery among stroke survivors.

Reliability and validity of Alternate Step Test times in subjects with chronic stroke.

OBJECTIVE: (i) To investigate the intra-rater, inter-rater and test-retest reliability and minimal detectable change of the Alternate Step Test (AST) when assessing people with chronic stroke. (ii) To quantify the correlation between AST times and stroke-specific impairments. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation centre. PARTICIPANTS: A convenience sample of 86 participants: 45 with chronic stroke, and 41 healthy elderly subjects. METHODS: The AST was administered along with the Fugl-Meyer Lower Extremity Assessment (FMA-LE), the Five Times Sit-To-Stand Test (FTSTS), limits of stability (LOS) measurements, Berg Balance Scale (BBS) scores, Chinese-translated Activities-specific Balance Confidence Scale (ABC-C) ratings, and the Timed "Up and Go" test (TUG). RESULTS: Excellent intra-rater, inter-rater and test-retest reliability were found, with a minimal detectable change of 3.26 s. AST times were significantly associated with FMA-LE assessment, FTSTS times, LOS in the forward and backward directions and to the affected side, BBS ratings and TUG times. CONCLUSION: AST time is a reliable assessment tool that correlates with different stroke-specific impairments in people with chronic stroke.