The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study

2021 ◽  
pp. 1-9
Author(s):  
Kyeong Joo Song ◽  
Min Ho Chun ◽  
Junekyung Lee ◽  
Changmin Lee
Keyword(s):  
Gait Speed ◽  
Functional Outcomes ◽  
Near Infrared ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Cortical Activation ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Functional Near Infrared Spectroscopy

OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI–Lower (P = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.

scholarly journals Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

2021 ◽  
Author(s):  
Andy Chien ◽  
Fei-Chun Chang ◽  
Nai-Hsin Meng ◽  
Pei-Yu Yang ◽  
Ching Huang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Acute Stroke ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Gait Training ◽  
Training System ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

scholarly journals Wearable Hip-assist Robot Modulates Cortical Activation during Gait in Stroke Patients: A Functional Near-Infrared Spectroscopy Study

2020 ◽  
Author(s):  
Su-Hyun Lee ◽  
Hwang-Jae Lee ◽  
Youngbo Shim ◽  
Won Hyuk Chang ◽  
Byung-Ok Choi ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Late Phase ◽  
Chronic Stroke ◽  
Cortical Activation ◽  
Stroke Patients ◽  
Functional Near Infrared Spectroscopy ◽  
Clinical Trial Registration ◽  
Gait Function

Abstract BackgroundGait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice.ObjectivesThe purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy.ResultsWalking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA.ConclusionsThe results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns.Clinical trial registration: NCT03048968. Registered 09 February 2017

scholarly journals Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial

2020 ◽  
pp. 026921552098413
Author(s):  
Amy Wright ◽  
Keeron Stone ◽  
Louis Martinelli ◽  
Simon Fryer ◽  
Grace Smith ◽  
...  
Keyword(s):  
Physical Activity ◽  
Functional Outcomes ◽  
Controlled Trial ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Chronic Stroke ◽  
Control Group ◽  
Robotic Assisted ◽  
Home Based ◽  
Dynamic Gait Index

Objectives: To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. Design: Randomized controlled trial. Setting: Home. Participants: Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. Intervention: Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program ( n = 16), using the device for ⩾30 minutes per day, or (2) control group ( n = 18), 30 minutes of physical activity per day. Measurements: The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10 and 22 weeks after baseline. Results: Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10 weeks for over-ground robotic-assisted gait training (135 ± 81 m vs 158 ± 93 m, respectively; P ⩽ 0.001) but not for control (122 ± 92 m vs 119 ± 84 m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P ⩽ 0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10 weeks (all P < 0.05). The differences observed in all of the aforementioned outcome measures were maintained at 22 weeks, 12 weeks after completing the intervention (all P > 0.05). Conclusion: Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.

scholarly journals High Intensity Intermittent Exercise Plays a Role in Improving Brain Activation During Complex Executive Functional Tasks

2021 ◽  
Vol 21 (1) ◽  
pp. 36-42
Author(s):  
Shweta Shenoy ◽  
Prachi Khandekar ◽  
Abhinav Sathe
Keyword(s):  
Prefrontal Cortex ◽  
High Intensity ◽  
Near Infrared ◽  
Intermittent Exercise ◽  
Brain Activation ◽  
Cognitive Testing ◽  
Cortical Activation ◽  
Control Group ◽  
Functional Near Infrared Spectroscopy ◽  
Significant Difference

Several neuroimaging studies have examined the effect of different types and combinations of exercises on activation of brain associated with cognitive testing but none of these studies have examined the role of high intensity intermittent exercise (HIIE) in altering cortical activation from simple to complex cognitive tasks.  The purpose of this study was to find if HIIE has a role in modulating executive functions related to inhibitory control as expressed by changes in prefrontal cortex (PFC) activation.  Materials and methods. 40 healthy adults aged between 18-30 years volunteered for the study. They were randomly divided into HIIE a (n = 20) group and a control (n = 20) group. The HIIE group performed 4*4 min of high intensity exercise on a cycle ergometer with 3 minutes of active recovery at lower intensities between the bouts, whereas the control group performed no exercise. Prefrontal hemodynamics (oxy and deoxy haemoglobin) were assessed using functional near infrared spectroscopy (fNIRS) during the Colour Word Stroop test (CWST) on two sessions: pre-session and post-session (1 week after pre-session). Results. The results indicate a significant difference in CWST scores which coincided with a significant difference in hemodynamics of PFC between a congruent and a complex incongruent task in the HIIE group. There was a greater activation of the right frontopolar area, the left ventrolateral prefrontal cortex, and the left frontopolar area during the incongruent task in response to acute HIIE.  Conclusion. HIIE plays a role in changing brain activation during more complex interference related tasks.

scholarly journals Wearable hip-assist robot modulates cortical activation during gait in stroke patients: a functional near-infrared spectroscopy study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Su-Hyun Lee ◽  
Hwang-Jae Lee ◽  
Youngbo Shim ◽  
Won Hyuk Chang ◽  
Byung-Ok Choi ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Late Phase ◽  
Chronic Stroke ◽  
Cortical Activation ◽  
Stroke Patients ◽  
Functional Near Infrared Spectroscopy ◽  
Gait Function ◽  
Hip Flexion

Abstract Background Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice. Objectives The purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy. Results Walking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA (P < 0.05). Conclusions The results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns. Trial registration NCT03048968. Registered 06 Feb 2017

scholarly journals Wearable Hip-assist Robot Modulates Cortical Activation during Gait in Stroke Patients: A Functional Near-Infrared Spectroscopy Study

2020 ◽  
Author(s):  
Su-Hyun Lee ◽  
Hwang-Jae Lee ◽  
Youngbo Shim ◽  
Won Hyuk Chang ◽  
Byung-Ok Choi ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Late Phase ◽  
Chronic Stroke ◽  
Cortical Activation ◽  
Stroke Patients ◽  
Functional Near Infrared Spectroscopy ◽  
Clinical Trial Registration ◽  
Gait Function

Abstract Background Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice. Objectives The purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy. Results Walking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA (P < 0.05). Conclusions The results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns. Clinical trial registration NCT03048968. Registered 06 Feb 2017.

scholarly journals Motor Cortical Activation Assessment in Progressive Multiple Sclerosis Patients Enrolled in Gait Rehabilitation: A Secondary Analysis of the RAGTIME Trial Assisted by Functional Near-Infrared Spectroscopy

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1068
Author(s):  
Nicola Lamberti ◽  
Fabio Manfredini ◽  
Andrea Baroni ◽  
Anna Crepaldi ◽  
Susanna Lavezzi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Gait Speed ◽  
Near Infrared ◽  
Secondary Analysis ◽  
Progressive Multiple Sclerosis ◽  
Cortical Activation ◽  
Functional Near Infrared Spectroscopy ◽  
Multiple Sclerosis Patients

This study aimed to determine cortical activation responses to two different rehabilitative programs, as measured through functional near-infrared spectroscopy (fNIRS). As a secondary analysis of the RAGTIME trial, we studied 24 patients with progressive multiple sclerosis (MS) and severe disability who were randomized to a regimen of robot-assisted gait training (RAGT) or overground walking (OW). Cortical activation during a treadmill walking task, assessed through fNIRS recordings from the motor and premotor cortexes (M1/PM), was calculated as the area under the curve (AUC) of oxyhemoglobin for each hemisphere and the total area (Tot-OxyAUC). Gait speed, endurance, and balance were also measured, along with five healthy control subjects. At baseline, Tot-OxyAUC during walking was significantly increased in MS patients compared to healthy people and was significantly higher for those with more severe disabilities; it was also inversely correlated with physical performance. After rehabilitation, significant opposite variations in Tot-OxyAUC were observed, with activity levels being increased after OW and decreased after RAGT (+242,080 ± 361,902 and −157,031 ± 172,496 arbitrary units, respectively; p = 0.002), particularly in patients who were trained at a lower speed. Greater reductions in the cortical activation of the more affected hemisphere were significantly related to improvements in gait speed (r = −0.42) and endurance (r = −0.44). Cortical activation, assessed through fNIRS, highlighted the brain activity in response to the type and intensity of rehabilitation.

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