The purpose of this study was to investigate the effects of end-effector robot-assisted gait training (RAGT) and body weight-supported treadmill training (BWST) on cortical activity; ankle, knee, and hip joint kinematics during gait; and clinical outcomes, including balance, lower limb motor functio...
The purpose of this study was to investigate the effects of end-effector robot-assisted gait training (RAGT) and body weight-supported treadmill training (BWST) on cortical activity; ankle, knee, and hip joint kinematics during gait; and clinical outcomes, including balance, lower limb motor function, and gait speed in individuals with hemiparetic stroke. Twenty-eight patients with hemiparetic stroke (23 men, 5 women; mean age ± standard deviation, 53.2 ± 11.2 years) were recruited in this study. The participants were randomly allocated into the RAGT (n = 14) and BWST (n = 14) groups. Each RAGT and BWST intervention was performed for 30 minutes per day, 5 days a week, for 4 weeks. All participants were evaluated twice, before and after the 4-week training. The tests included assessment of cortical activity, specifically oxygenated hemoglobin levels of the primary sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC); joint kinematics of the ankle, knee, and hip; spatiotemporal gait kinematics; and clinical measurements, including Berg balance scale (BBS), Fugl-Meyer assessment (FMA), timed up and go test (TUG), and 10-meter walk test (10MWT). Paired t-tests were used to compare the neuroplastic, biomechanical, and clinical outcomes between pre- and post-test in the RAGT and BWST groups. Repeated measures analysis of variance, with a 2 groups (RAGT and BWST) × 2 times (pre- and post-test) design, was used to determine the group × time interaction effect. The level of significance was set at α = 0.05. Activation of the SMC, SMA, and PMC on the affected hemisphere between pre- and post-test significantly increased only in the RAGT group (p < 0.05), but there was no significant difference between the RAGT and BWST groups. The ankle plantar flexion during pre-swing significantly increased after intervention only in the RAGT group (p < 0.05), while the spatiotemporal parameters, including swing time and double limb support time, between pre- and post-test significantly increased in both the RAGT and BWST groups (p < 0.05). However, there was no significant difference between the RAGT and BWST groups in gait kinematics data. Clinical outcomes, including BBS, FMA, TUG, and 10MWT scores, were improved after training in both the RAGT and BWST groups (p < 0.05), but only FMA score showed a significantly greater improvement in the RAGT group than in the BWST group (p < 0.05). Therefore, the present findings suggest that RAGT is effective in improving neuroplastic, biomechanical, and clinical outcomes in individuals with hemiparetic stroke, although its superiority over conventional training was not confirmed. Our findings may have clinical implications, and provide insight to clinicians interested in locomotor neurorehabilitation in individuals with hemiparetic stroke.
The purpose of this study was to investigate the effects of end-effector robot-assisted gait training (RAGT) and body weight-supported treadmill training (BWST) on cortical activity; ankle, knee, and hip joint kinematics during gait; and clinical outcomes, including balance, lower limb motor function, and gait speed in individuals with hemiparetic stroke. Twenty-eight patients with hemiparetic stroke (23 men, 5 women; mean age ± standard deviation, 53.2 ± 11.2 years) were recruited in this study. The participants were randomly allocated into the RAGT (n = 14) and BWST (n = 14) groups. Each RAGT and BWST intervention was performed for 30 minutes per day, 5 days a week, for 4 weeks. All participants were evaluated twice, before and after the 4-week training. The tests included assessment of cortical activity, specifically oxygenated hemoglobin levels of the primary sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC); joint kinematics of the ankle, knee, and hip; spatiotemporal gait kinematics; and clinical measurements, including Berg balance scale (BBS), Fugl-Meyer assessment (FMA), timed up and go test (TUG), and 10-meter walk test (10MWT). Paired t-tests were used to compare the neuroplastic, biomechanical, and clinical outcomes between pre- and post-test in the RAGT and BWST groups. Repeated measures analysis of variance, with a 2 groups (RAGT and BWST) × 2 times (pre- and post-test) design, was used to determine the group × time interaction effect. The level of significance was set at α = 0.05. Activation of the SMC, SMA, and PMC on the affected hemisphere between pre- and post-test significantly increased only in the RAGT group (p < 0.05), but there was no significant difference between the RAGT and BWST groups. The ankle plantar flexion during pre-swing significantly increased after intervention only in the RAGT group (p < 0.05), while the spatiotemporal parameters, including swing time and double limb support time, between pre- and post-test significantly increased in both the RAGT and BWST groups (p < 0.05). However, there was no significant difference between the RAGT and BWST groups in gait kinematics data. Clinical outcomes, including BBS, FMA, TUG, and 10MWT scores, were improved after training in both the RAGT and BWST groups (p < 0.05), but only FMA score showed a significantly greater improvement in the RAGT group than in the BWST group (p < 0.05). Therefore, the present findings suggest that RAGT is effective in improving neuroplastic, biomechanical, and clinical outcomes in individuals with hemiparetic stroke, although its superiority over conventional training was not confirmed. Our findings may have clinical implications, and provide insight to clinicians interested in locomotor neurorehabilitation in individuals with hemiparetic stroke.
주제어
#Body weight-supported treadmill training Gait kinematics Hemiparetic stroke Neuroplasticity Robot-assisted gait training
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