Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke.

OBJECTIVES To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. METHODS Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. RESULTS Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. CONCLUSION Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke.

[1]  C. Richards,et al.  Contribution of passive stiffness to ankle plantarflexor moment during gait after stroke. , 2000, Archives of physical medicine and rehabilitation.

[2]  J. Davids,et al.  Impact of ankle-foot orthoses on static foot alignment in children with cerebral palsy. , 2007, The Journal of bone and joint surgery. American volume.

[3]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[4]  S.G. Chung,et al.  Changes of Reflex, Non-reflex and Torque Generation Properties of Spastic Ankle Plantar Flexors Induced by Intelligent Stretching , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[5]  Alfred D. Grant Gait Analysis: Normal and Pathological Function , 2010 .

[6]  A. Woodcock,et al.  Two-, six-, and 12-minute walking tests in respiratory disease. , 1982, British medical journal.

[7]  Sharon Wood-Dauphinee,et al.  Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure. , 1999, Physical therapy.

[8]  H. Folpp,et al.  Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch? , 2006, The Australian journal of physiotherapy.

[9]  E. Roth,et al.  Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. , 2004, Archives of physical medicine and rehabilitation.

[10]  E. A. Darling The Effects of Training , 2010 .

[11]  Maurizio Schmid,et al.  Reinforcing Motor Re-Training and Rehabilitation through Games: A Machine-Learning Perspective , 2009, Front. Neuroeng..

[12]  Abdulmajeed Al Abdukareem Randomized, placebo-controlled trial , 2004, Annals of Saudi medicine.

[13]  M. Voigt,et al.  Modification of stretch tolerance in a stooping position , 2004, Scandinavian journal of medicine & science in sports.

[14]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[15]  S. Magnusson,et al.  Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation? , 2010, Physical Therapy.

[16]  L. Harvey,et al.  Stretch Exercises Increase Tolerance to Stretch in Patients With Chronic Musculoskeletal Pain: A Randomized Controlled Trial , 2009, Physical Therapy.

[17]  S. Simon Gait Analysis, Normal and Pathological Function. , 1993 .

[18]  Lisa C. Blum,et al.  Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review , 2008, Physical Therapy.

[19]  Ruud W Selles,et al.  Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. , 2005, Archives of physical medicine and rehabilitation.

[20]  A. Thilmann,et al.  Biomechanical changes at the ankle joint after stroke. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[21]  Hermano Igo Krebs,et al.  Ankle Training With a Robotic Device Improves Hemiparetic Gait After a Stroke , 2011, Neurorehabilitation and neural repair.

[22]  E. Roth,et al.  Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. , 2011, Clinical biomechanics.

[23]  Anne M. Moseley,et al.  Impact of Ankle-foot Orthoses on Gait and Leg Muscle Activity in Adults with Hemiplegia , 2003 .

[24]  J. Carr,et al.  Neurological Rehabilitation: Optimizing Motor Performance , 2003 .

[25]  D. Wade,et al.  Does reducing spasticity translate into functional benefit? An exploratory meta-analysis , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[26]  A. Mirelman,et al.  Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke , 2009, Stroke.

[27]  S Carlsöö,et al.  Kinetic analysis of the gait in patients with hemiparesis and in patients with intermittent claudication. , 1974, Scandinavian journal of rehabilitation medicine.

[28]  Fan Gao,et al.  Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors. , 2009, Archives of physical medicine and rehabilitation.

[29]  S. Studenski,et al.  Influence of stroke-related impairments on performance in 6-minute walk test. , 2002, Journal of rehabilitation research and development.

[30]  D. Bourbonnais,et al.  Weakness in patients with hemiparesis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[31]  The use of a portable muscle tone measurement device to measure the effects of botulinum toxin type a on elbow flexor spasticity. , 2005, Archives of physical medicine and rehabilitation.

[32]  Monica A. Perez,et al.  Motor skill training induces changes in the excitability of the leg cortical area in healthy humans , 2004, Experimental Brain Research.

[33]  Yupeng Ren,et al.  Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy Using a Portable Robot , 2011, Neurorehabilitation and neural repair.

[34]  M. Kjaer,et al.  A mechanism for altered flexibility in human skeletal muscle. , 1996, The Journal of physiology.