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Study: Use of robotic ankle device in rehabilitation aids stroke recovery

Isolated training with a robotic ankle device can improve walking speed and balance in patients who had a stroke, depending on the initial severity, according to researchers at the Feinstein Institute for Medical Research.

The study, “Intensive seated robotic training of the ankle in patients with chronic stroke differentially improves gait,” was published in NeuroRehabilitation. According to a press release, the researchers determined that a better understanding of recovery profiles after stroke will help professionals find the best candidates for robotic rehabilitation.

“Exercise is one of the main ways for patients who have had a stroke to regain movement,” lead author Johanna L. Chang, of the Feinstein Institute for Medical Research, said in the release. “The use of robotic assisted-devices can enhance the therapy by increasing the intensity of the motor experience. This interactive robotic device moves the paralyzed 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.”

To examine whether a robotic device using interactive ankle movement in a seated position would improve walking speed and balance among patients, researchers recruited 29 patients with foot drop and walking speed abnormalities following a stroke. The patients received treatment with a robot-assisted ankle device three times per week for 6 weeks. In addition, they were separated into three groups — high function, for those with a walking speed faster than 3 feet per second; medium function, for those who traveled 1 foot per second; and low function, in which patients walked slower than 1 foot per second.

During each training session, participants sat in front of a video monitor while the ankle device was attached at the knee and foot. The patient viewed a cursor on the screen and used their legs and ankles to move the cursor to a target.

According to the researchers, participants in the high- and medium-function groups reported significant improvements in walking speed, with those in the former achieving speeds faster than 4 feet per second, which researchers considered to be “normal for ambulating patients in the community.” In a 3-month follow-up, patients in the high-function group demonstrated continued improvement, with speeds of up to 4.39 feet per second.

Meanwhile, the low-functioning group demonstrated the greatest change in improved balance, the researchers said.

“Much like one medication is not effective for all patients with a certain condition, not all rehabilitation is beneficial to all,” Kevin J. Tracey, MD, president and chief executive officer of the Feinstein Institute, said in the release. “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.”

References:

Chang JL, et al. NeuroRehabilitation. 2017;doi: 10.3233/NRE-171457.

www.feinsteininstitute.org/

Disclosures: The researchers report no relevant financial disclosures.

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