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Patient with acute stroke walking overground with moderate assistance from two physiotherapists, walking belt, knee orthosis, and elastic bandage.
Source publication
We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation initiated very early after stroke. Therapy content and interrater reliability of the assessments were also analyzed. Of 22 patients, 19 (average 8.0 d poststroke) completed the study. Before rehabilitation, 13 patients were unable to walk or needed two ass...
Context in source publication
Context 1
... objective of our 3-week inpatient rehabilitation for acute patients was to enhance their motor abilities and help them recover walking independence as soon as possible. Every day for 3 weeks, each patient spent a maximum of 1 hour to obtain 20 minutes of actual walking either on the electromechanical gait trainer (Gait Trainer ® ; Reha-Stim, Berlin, Germany, Figure 1) or overground (Figure 2). Each patient also received other gait-oriented physiotherapy for 55 minutes each day. These additional physiotherapy sessions were carried out according to individually set ...
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Citations
... In addition, the length of stay in the rehabilitation unit, the rate of discharge to the subacute setting, and subsequent healthcare costs are higher among this group than patients with mild deficits. However, this population is often excluded from clinical trials, and there is scarce literature available for mobility training in this group [9]. ...
This paper addresses the design procedures and simulation results from the mechatronic model of the rehabilitation equipment, which can improve the functionality and precision of the ambulatory gait training system. The distinguishing feature of mechatronic systems is the achievement of system functionality through intensive integration. The paper demonstrates how the mechatronic design modeling has helped improve the design and performance of the new rehabilitation equipment built by the authors and is known as Navigaitor. The Navigaitor is designed to aid the patients who need to improve their balance and walk. The mechatronics aspects allow a better understanding of the dynamic behavior and interactions of the components. Depending on the severity of the patient's injury (stroke survivor, Parkinson, etc.), the oscillatory motion can range from uniform to non-uniform. The motion needs to be converted from the oscillatory sinusoidal motion of the patient into linear motion that the system can follow the patient with minimum lag and maximum stability. The data acquired during the training stage showing a different rate of recovery and response assists the system designers and thereby provides input to fine-tune the system and upgrade the control requirements.
... However, we did not aggressively aim to reduce ankle spasticity and facilitate motor control, as all patients used their own ankle-foot orthotics suitably 245 modified to control spasticity and adjust ankle kinematics in the stance phase (Tyson et al., 2013). In addition, a previous study revealed that the MAS that was applied for assessing spasticity in the current study presented poor reliability (Peurala SH et al., 2007). These factors might have contributed to the different spasticity results observed between our protocol and previous studies. ...
Background
In this pilot study, we aimed to determine the safety and feasibility of a 15-day protocol consisting of in-hospital repetitive peripheral magnetic stimulation (rPMS) combined with intensive physical therapy for the recovery of the gait disturbance in chronic stroke patients with lower limb hemiparesis.
Methods
Seven hemorrhagic stroke patients with lower limb hemiparesis and gait disturbance (age: 50–78; time from onset of stroke: 7–107 months) were enrolled. rPMS was applied to the muscles of the paretic lower limb with a parabolic coil. A train of stimuli at a frequency of 20 Hz was applied for 3 s followed by a 27-s rest interval. Therapy with rPMS was performed with eighty such trains of stimuli (total 4800 pulses). Following rPMS therapy, 120 min of physical therapy was administrated daily. Each patient received this combination treatment over fifteen consecutive days, with the walking function of all participants assessed before and after the intervention.
Results
The proposed treatment protocol resulted in significant improvements in the walking speed, ambulation ability, and balance ability, but showed no significant effects on the endurance capacity, step length, and spasticity. No rPMS-related side effects were noted.
Conclusions
Our protocol consisting of rPMS and intensive physical therapy appears well tolerated and feasible for therapy in hemorrhagic stroke patients with gait disturbance. Further large-scale studies are required to confirm its efficacy.
... Stroke is known as a leading cause of motor impairment, whose burden in terms of disability continue increasing worldwide (Feigin et al., 2017;Benjamin et al., 2018). Exercise is the most common intervention to improve walking performance (Eng and Tang, 2007) and previous studies have shown proof that early interventions designed to be intense and repetitive depending on the patient tolerance are able to improve functional outcome when compared to conventional rehabilitation (Salter et al., 2006;Eng and Tang, 2007;Peurala et al., 2007). Additionally, it has been found that patients admitted within the first 30 days of stroke onset to rehabilitation programs experience greater functional improvement accompanied by reduction in length of hospital stay (Salter et al., 2006). ...
... There are previous studies using other robotic interventions implemented within the first 30 days after stroke onset. Patients with severe impairment of the motor function using the endeffector-type robotic device denominated as Gait Trainer showed improvement of the motor outcome which was sustained after 2 years (Peurala et al., 2007;Morone et al., 2012). The exoskeleton Lokomat was able to induce motor recovery and improvement of cardiopulmonary fitness which is an issue for bedridden patients (Chang et al., 2012). ...
Hemiparetic gait is a common condition after stroke which alters importantly the quality of life of stroke survivors. In recent years, several robotic interventions have been developed to support and enhance rehabilitation strategies for such population. The Hybrid Assistive Limb® (HAL) robot suit is a unique device able to collect in real time bioelectric signals from the patient to support and enhance voluntary gait. HAL has been used before in early stages of stroke showing gait improvement after the intervention. However, evaluation of the coordination of gait has not been done yet. Coordination is a key factor for an adequate gait performance; consequently, its changes may be closely related to gait recovery. In this study, we used planar covariation to evaluate coordination changes in hemiparetic stroke patients after early HAL intervention. Before starting, impaired intersegmental coordination for the paretic and non-paretic side was evident. HAL intervention was able to induce recovery of the covariation loop shape and deviation from the covariation plane improving intersegmental coordination. Also, there was a tendency of recovery for movement range evidenced by comparison of peak elevation angles of each limb segment of the patients before and after HAL intervention, and also when compared to healthy volunteers. Our results suggest that early HAL intervention contributed to the improvement of gait coordination in hemiparetic stroke patients by reinforcing central pattern generators and therefore reshaping their gait pattern.
Trial registration: UMIN000022410 2016/05/23.
... Stroke is known as a leading cause of motor impairment, whose burden in terms of disability continue increasing worldwide (Feigin et al., 2017;Benjamin et al., 2018). Exercise is the most common intervention to improve walking performance (Eng and Tang, 2007) and previous studies have shown proof that early interventions designed to be intense and repetitive depending on the patient tolerance are able to improve functional outcome when compared to conventional rehabilitation (Salter et al., 2006;Eng and Tang, 2007;Peurala et al., 2007). Additionally, it has been found that patients admitted within the first 30 days of stroke onset to rehabilitation programs experience greater functional improvement accompanied by reduction in length of hospital stay (Salter et al., 2006). ...
... There are previous studies using other robotic interventions implemented within the first 30 days after stroke onset. Patients with severe impairment of the motor function using the endeffector-type robotic device denominated as Gait Trainer showed improvement of the motor outcome which was sustained after 2 years (Peurala et al., 2007;Morone et al., 2012). The exoskeleton Lokomat was able to induce motor recovery and improvement of cardiopulmonary fitness which is an issue for bedridden patients (Chang et al., 2012). ...
Introduction/Background
Stroke is a leading cause of acquired disability in adults Despite rehabilitation, some patients cannot achieve a functional motor recovery The Hybrid Assistive Limb (HAL) robot is an exoskeleton able to support and enhance the lower extremities performance of patients using their own bioelectrical signals We think HAL may help acute stroke patients achieve an adequate motor recovery.
Material and method
Eight hemiparetic patients underwent 9 sessions of HAL A motion capture system (VICON MX, 100 Hz) was used to record segmental kinematics regarding the elevation angles described for the thigh, shank and foot before the first and after the last session Data from 9 healthy volunteers was used for comparison.
Results
Reduction of the percentage of variance was observed for the paretic (par) side of patients reaching similar levels to healthy (h) volunteers (P-value: pre-par Vs post-par: 0.039, pre-par Vs h: 0.018, post-par Vs h: 0.49) Tendency of recovery for the non-paretic side also was observed but was still significantly different from healthy group after HAL (P-value < 0.01)
Conclusion
HAL improved significantly the planarity of coordination in hemiparetic acute stroke patients This novel intervention offers a new approach to improve motor recovery in this population.
... W fińskim badaniu Peurala et al. wykazał, że dawka czasowa aktywności KG chorych (n=19) (średnio osiem dni od udaru) podczas fizjoterapii stanowi ok. 6 minut ćwiczeń na sesję (15% jednostki terapeutycznej) [24,25]. Australijskie doniesienia (n=32) dotyczące chorych (średnio 40 dni od udaru) mówią o braku aktywności KG podczas fizjoterapii [26]. ...
... 11 minutes during an occupational therapy session (49% of the whole therapeutic session) [23]. In the Finnish study by Peurala et al., it was noted that on average 8 days post stroke, patients (n=19) received 6 minutes of UL training per session (15% of a therapeutic session) [24,25]. Australian reports (n=32) concerning patients (an average of 40 days post stroke) revealed the lack of UL activity during physiotherapy [26]. ...
Stroke is still the most common cause of disability in Poland and in western countries. As many as 80% of patients report reduced upper limb function in the acute phase after stroke. It is estimated that only 5% to 20% of patients experience full functional recovery of an upper limb. In clinical practice, paretic upper limb stimulation after stroke is usually treated as of secondary importance. However, it constantly poses a challenge to physical therapists. The existing procedures do not provide detailed guidelines regarding upper limb rehabilitation model particularly in the first four weeks after stroke. It is hard to predict biological limitations and the effectiveness of upper limb rehabilitation. The aim of this work is to make an attempt at reviewing the knowledge of the current state of early upper limb physiotherapy, its intensity and strategy type as well as neurobiological foundations of the improvement process. Ample scientific evidence confirms that early post-stroke rehabilitation is crucial. There are relatively few foreign (and virtually no Polish) reports related to early upper limb rehabilitation that would take into account the type of exercises and their therapeutic dose. There are still no solid foundations for determining optimal intensity and type of upper limb rehabilitation (including physical and occupational therapy). There is a scarcity of extensive and uniform (in terms of research groups and tools) multicentre investigations aimed at defining an optimal model of upper limb rehabilitation at an early stage after stroke. Thus, a number of questions still remain unanswered.
... The patients were selected for this study based on the following criteria within 10 days after stroke: 1) supratentorial stroke, (Modified Rankin Scale 0-2) 2) functional ambulatory category (FAC) 0-3 [12,21] 3) remaining ability to move the leg of the affected side 4) BI 20-100 points 5) body mass index <32 6) otherwise in good health Patients received a three-week period of intensive inpatient gait-oriented rehabilitation in the acute care hospital [21]. The local research ethics committee approved the study (2/2005). ...
... The patients were selected for this study based on the following criteria within 10 days after stroke: 1) supratentorial stroke, (Modified Rankin Scale 0-2) 2) functional ambulatory category (FAC) 0-3 [12,21] 3) remaining ability to move the leg of the affected side 4) BI 20-100 points 5) body mass index <32 6) otherwise in good health Patients received a three-week period of intensive inpatient gait-oriented rehabilitation in the acute care hospital [21]. The local research ethics committee approved the study (2/2005). ...
Corticospinal excitability (CSE) is modulated by stroke-induced lesions affecting the brain. This modulation is known to be dependent on the timing of the evaluation, and strongest abnormalities are often found in the acute stage. Our study aimed to characterize changes in CSE asymmetry between the affected and the unaffected hemisphere (AH and UH) during the first month after stroke onset and at 6 month follow-up. Neuronavigated transcranial magnetic stimulation (nTMS) was used to assess the CSE of the abductor pollicis brevis (APB) muscle of the hand and tibialis anterior (TA) muscle of the leg in 16 patients over 5 time-points. AH excitability recovered significantly during 6 months, whereas interhemispheric asymmetry remained significant up to 1 month post-stroke in the APB muscle. Greater initial CSE was associated with good motor function at 6 months. The motor cortical excitatory recovery initiated within week of the stroke and was most prominent within 1 month after stroke onset. Lesion size correlated with CSE of the UH at 10 days, while overall severity of the symptoms correlated inversely with CSE of the AH. This study demonstrates the quick improvement in the CSE via estimation of interhemispheric asymmetry; however, the recovery in the asymmetry continues to normalize even after reaching the threshold for normal values in CSE.
... All of the included studies were assessed as having a low risk of bias except Peurala et al. [14] which was assessed as having moderate to high risk of bias (Table 2). In Peurala et al. [14], there were no independent observers involved (the same therapists that provided the therapy also evaluated content and duration), the data collection methods were not adequately described, and the data collection instrument was not validated. ...
... All of the included studies were assessed as having a low risk of bias except Peurala et al. [14] which was assessed as having moderate to high risk of bias (Table 2). In Peurala et al. [14], there were no independent observers involved (the same therapists that provided the therapy also evaluated content and duration), the data collection methods were not adequately described, and the data collection instrument was not validated. Furthermore, it was unclear if the study purpose was concealed from the participants and therapists, thereby increasing the risk of overestimation of activity levels. ...
... All the included studies were observational except Peurala et al. [14], which was an RCT. The majority of the included studies were conducted in Australia ( Table 3). ...
Background. Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review. A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included; six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion. People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery.
... In the last decade several robotic systems for neurorehabilitation have been developed to improve the outcome of the conventional rehabilitation therapy [9]. Devices for rehabilitation showed to provide a safe, highly accurate, intensive and prolonged motor therapy to patients affected by motor impairments [10]. Nevertheless the magnitude of improvements induced by these robotic devices during post stroke rehabilitation seems not to be so far significantly greater than those achieved by an intensive traditional rehabilitation therapy above all in patients who may potentially gain advantage from suitable training provided within 6 months after the trauma [11][12]. ...
During the last decades, many robotic platforms aimed at post-stroke neurorehabilitation of locomotion have been developed. These devices have been designed to enhance the possibilities of conventional rehabilitation providing safe, highly accurate, intensive and prolonged treatments. Nevertheless, up to now, robotic aided therapy has not yet promoted improvements of the motor performance significantly greater than those achieved by the conventional therapy. According to previous studies, we believe that this result may be partially ascribed to two main issues: the rehabilitation mediated by robots is usually provided too late from the trauma and it mainly consists of passive and cyclic manipulation of the legs. Our proposal to overcome some of the supposed limits is NEUROBike, an operative mechatronic platform able to lead leg manipulation as soon as possible after the trauma, that is when patients still lie on their own beds. Moreover, NEUROBike has been designed to provide both passive and cyclic manipulation of leg joints with trajectories similar to those related to natural walking, and motor task involving random efforts. This work presents the comparison between desired and measured leg joint trajectories while NEUROBike provides cyclic and passive leg manipulation. The results show that angular excursions at proximal joints were reasonably comparable with those obtained by the velocity based model even though they were affected by a positive offset involving emphasized flexion of hip and knee during the gait cycle.
... [3] ...
This paper presents three haptic-based virtual applications for the undergoing rehabilitation of upper-limb post stroke patients. The three exercises are developed for their use on the multi-modal interface so-called Bimanual Haptic Desktop System (BHDS), which integrates the haptic functionalities and Video Display Terminal (VDT) within the work-plane of a desk. Firstly, two basic exercises, tracking task and lifting task, are carried out for the recovery of basic arm motion-coordination skills and steadiness of patients' upper-limb. Secondly, a video-game-like exercise, catching task, is developed to compare online the performance of healthy upper-limb with impaired ones wherein hand-eye coordination exercise of the patient is included. To this end, the proposed exercises provide to patients the potential methods to train their post-stroke upper-limbs malfunctions while reporting the quantitative parameters obtained to evaluate the improvement of patients recovery. Experimental results of a preliminary evaluation on healthy subjects are then reported and discussed to visualize in near future a pilot medical trials of the system on impaired people.
... A peroneus orthosis or an elastic bandage was used in 16/20 patients in the WALK group. Details of the additional physiotherapy content recorded in GT and WALK groups are published elsewhere (16). ...
To analyse the effects of gait therapy for patients after acute stroke in a randomized controlled trial.
Fifty-six patients with a mean of 8 days post-stroke participated in: (i) gait trainer exercise; (ii) walking training over ground; or (iii) conventional treatment. Patients in the gait trainer exercise and walking groups practiced gait for 15 sessions over 3 weeks and received additional physiotherapy. Functional Ambulatory Category and several secondary outcome measures assessing gait and mobility were administered before and after rehabilitation and at 6-month follow-up. Patients also evaluated their own effort.
Walking ability improved more with intensive walk training compared with conventional treatment; median Functional Ambulatory Category was zero in all patients at the start of the study, but it was 3 in both walk-training groups and 0.5 in the conventional treatment group at the end of the therapy. Median Functional Ambulatory Category was 4 in both walk-training groups and 2.5 in conventional treatment group at 6-month follow-up. Mean accomplished walking distance was not different between the gait trainer exercise and over ground walking groups. Borg scale indicated more effort in over ground walking. Secondary outcomes also indicated improvements.
Exercise therapy with walking training improved gait function irrespective of the method used, but the time and effort required to achieve the results favour the gait trainer exercise. Early intensive gait training resulted in better walking ability than did conventional treatment.
