A study published in NeuroRehabilitation by Feinstein Institute for Medical Research (Manhasset, USA) scientist Bruce T Volpe and Johanna L Chang has found that isolated ankle training with a robotic therapy device can improve walking speed and balance after a stroke, depending on the severity of the patient’s initial impairment. Better understanding of severity-dependent recovery profiles after stroke could help medical professionals determine the best candidates for robotic rehabilitation.
“Exercise is one of the main ways for patients who have had a stroke to regain movement,” says Chang, who is the lead author of the study. “The use of robotic assisted-devices can enhance the therapy by increasing the intensity of the motor experience. This interactive robotic device moves the paralysed arm or leg when the patient cannot and gets out of the way when the patient powers the movement. In our study, the baseline or initial walking speed prior to therapy was an important factor in predicting the final walking speed.”
Twenty-nine study participants with a foot drop and walking speed abnormalities after stroke were treated three times a week for six weeks with robot-assisted ankle training. The patients were separated into three groups: high function (walking speed greater than 3 feet per second), medium function (1 foot per second) and low function (less than 1 foot per second). During a session, patients were seated in front of a video monitor and the ankle robot was attached at the knee and foot. The patient viewed the video screen that had a cursor and used their legs and ankle to move the cursor to reach a particular target.
After 18 sessions, the high and medium function groups demonstrated significant improvements in walking speed, with the high functioning group achieving a speed that is considered normal for ambulating patients in the community (greater than 4 feet per second). A further exciting result showed that in follow-up three months after the treatment finished, the high function group continued to improve (4.39 feet per second). The low functioning group demonstrated the greatest change in improved balance.
“Much like one medication is not effective for all patients with a certain condition, not all rehabilitation is beneficial to all,” says Kevin J Tracey, president and chief executive officer of the Feinstein Institute. “By understanding who can most benefit from robotic rehabilitation medical professionals can better tailor a program that will result in the highest benefit for patients.”
