Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial

Carolyn Buesing, Gabriela Fisch, Megan O'Donnell, Ida Shahidi, Lauren Thomas, Chaithanya K Mummidisetty, Kenton J Williams, Hideaki Takahashi, William Zev Rymer, Arun Jayaraman, Carolyn Buesing, Gabriela Fisch, Megan O'Donnell, Ida Shahidi, Lauren Thomas, Chaithanya K Mummidisetty, Kenton J Williams, Hideaki Takahashi, William Zev Rymer, Arun Jayaraman

Abstract

Background: Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors.

Methods: A single blinded randomized control trial was performed to assess the effect of FTST and task-specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n=50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6-8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects' spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up.

Results: After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials.

Conclusions: SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits.

Trial registration: This study is registered under the title "Development of walk assist device to improve community ambulation" and can be located in clinicaltrials.gov with the study identifier: NCT01994395 .

Figures

Fig. 1
Fig. 1
a. Honda Stride Management Assist (SMA®) Device b. Assist torque curve during gait cycle. Solid line indicates the changes in flexion assist torque and dotted line indicates changes in extension assist torque during gait cycle
Fig. 2
Fig. 2
Study design schematic

References

    1. Kaye HS, Kang T, LaPante MP. Mobility device use in the united states. Disability statistics report (14) Washington, D.C.: U.S. Washington, D.C: Department of Education, National Institute on Disability and Rehabilitation Research; 2000.
    1. Fast Stats- Cerebrovascular Disease or Stroke Centers for Disease Control and Prevention . Accessed January 20 2015.
    1. Heart Disease and Stroke Prevention Center for Disease Control and Prevention. . Accessed January 20 2015.
    1. Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurgery. 2011;76(6 Suppl):S85–90. doi: 10.1016/j.wneu.2011.07.023.
    1. Wood JP, Connelly DM, Maly MR. ‘Getting back to real living’: A qualitative study of the process of community reintegration after stroke. Clin Rehabil. 2010;24(11):1045–56. doi: 10.1177/0269215510375901.
    1. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke J Cerebral Circulation. 1995;26(6):982–9. doi: 10.1161/01.STR.26.6.982.
    1. Brandstater ME, de Bruin H, Gowland C, Clark BM. Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil. 1983;64(12):583–7.
    1. Knutsson E, Richards C. Different types of disturbed motor control in gait of hemiparetic patients. Brain J Neurol. 1979;102(2):405–30. doi: 10.1093/brain/102.2.405.
    1. Olney SJ, Griffin MP, McBride ID. Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther. 1994;74(9):872–85.
    1. Wade DT, Wood VA, Heller A, Maggs J, Langton HR. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med. 1987;19(1):25–30.
    1. Murray MP, Kory RC, Clarkson BH. Walking patterns in healthy old men. J Gerontol. 1969;24(2):169–78. doi: 10.1093/geronj/24.2.169.
    1. Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89(2):304–10. doi: 10.1016/j.apmr.2007.08.142.
    1. Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait Posture. 2003;18(1):23–8. doi: 10.1016/S0966-6362(02)00122-4.
    1. Mizelle C, Rodgers M, Forrester L. Bilateral foot center of pressure measures predict hemiparetic gait velocity. Gait Posture. 2006;24(3):356–63. doi: 10.1016/j.gaitpost.2005.11.003.
    1. Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil. 2003;84(8):1185–93. doi: 10.1016/S0003-9993(03)00030-3.
    1. Lord SE, Rochester L. Measurement of community ambulation after stroke: current status and future developments. Stroke J Cerebral Circulation. 2005;36(7):1457–61. doi: 10.1161/01.STR.0000170698.20376.2e.
    1. Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003;84(10):1486–91. doi: 10.1016/S0003-9993(03)00349-6.
    1. Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke J Cerebral Circulation. 2008;39(6):1786–92. doi: 10.1161/STROKEAHA.107.504779.
    1. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683–91. doi: 10.1053/apmr.2002.32488.
    1. Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke J Cerebral Circulation. 1998;29(6):1122–8. doi: 10.1161/01.STR.29.6.1122.
    1. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31(2):241–6. doi: 10.1016/j.gaitpost.2009.10.014.
    1. Lewek MD, Randall EP. Reliability of spatiotemporal asymmetry during overground walking for individuals following chronic stroke. J Neurol Physical Therapy JNPT. 2011;35(3):116–21. doi: 10.1097/NPT.0b013e318227fe70.
    1. Bontrager EL. Instrumented Gait Analysis Systems In: DeLisa JA, editor. Gait Analysis in th Science of Rehabilitation: Diane Publishing Co., Darby, PA 1998. p. 11–32.
    1. Wong JS, Jasani H, Poon V, Inness EL, McIlroy WE, Mansfield A. Inter- and intra-rater reliability of the GAITRite system among individuals with sub-acute stroke. Gait Posture. 2014;40(1):259–61. doi: 10.1016/j.gaitpost.2014.02.007.
    1. Cho KH, Lee HJ, Lee WH. Test-retest reliability of the GAITRite walkway system for the spatio-temporal gait parameters while dual-tasking in post-stroke patients. Disability and rehabilitation. 2014:1–5. doi:10.3109/09638288.2014.932445
    1. Kuys SS, Brauer SG, Ada L. Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation. Disabil Rehabil. 2011;33(19–20):1848–53. doi: 10.3109/09638288.2010.549895.
    1. Poli P, Morone G, Rosati G, Masiero S. Robotic technologies and rehabilitation: new tools for stroke patients’ therapy. BioMed Res Int. 2013;2013:153872. doi: 10.1155/2013/153872.
    1. Jenkins WM, Merzenich MM. Reorganization of neocortical representations after brain injury: a neurophysiological model of the bases of recovery from stroke. Prog Brain Res. 1987;71:249–66. doi: 10.1016/S0079-6123(08)61829-4.
    1. Masiero S, Carraro E. Upper limb movements and cerebral plasticity in post-stroke rehabilitation. Aging Clin Exp Res. 2008;20(2):103–8. doi: 10.1007/BF03324755.
    1. Bayona NA, Bitensky J, Salter K, Teasell R. The role of task-specific training in rehabilitation therapies. Top Stroke Rehabil. 2005;12(3):58–65. doi: 10.1310/BQM5-6YGB-MVJ5-WVCR.
    1. Butefisch C, Hummelsheim H, Denzler P, Mauritz KH. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci. 1995;130(1):59–68. doi: 10.1016/0022-510X(95)00003-K.
    1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693–702. doi: 10.1016/S0140-6736(11)60325-5.
    1. Nelles G. Cortical reorganization--effects of intensive therapy. Restor Neurol Neurosci. 2004;22(3–5):239–44.
    1. Sale P, Franceschini M, Waldner A, Hesse S. Use of the robot assisted gait therapy in rehabilitation of patients with stroke and spinal cord injury. Eur J Physical Rehabil Med. 2012;48(1):111–21.
    1. Sivan M, O’Connor RJ, Makower S, Levesley M, Bhakta B. Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. J Rehabil Med. 2011;43(3):181–9. doi: 10.2340/16501977-0674.
    1. Chang WH, Kim YH. Robot-assisted therapy in stroke rehabilitation. J Stroke. 2013;15(3):174–81. doi: 10.5853/jos.2013.15.3.174.
    1. Jarrasse N, Proietti T, Crocher V, Robertson J, Sahbani A, Morel G, et al. Robotic exoskeletons: a perspective for the rehabilitation of arm coordination in stroke patients. Front Hum Neurosci. 2014;8:947.
    1. Reinkensmeyer DJ, Boninger ML. Technologies and combination therapies for enhancing movement training for people with a disability. J Neuroeng Rehabil. 2012;9:17. doi: 10.1186/1743-0003-9-17.
    1. Shimada H, Kimura Y, Suzuki T, Hirata T, Sugiura M, Endo Y, et al. The use of positron emission tomography and [18 F]fluorodeoxyglucose for functional imaging of muscular activity during exercise with a stride assistance system. IEEE Transac Neural Syst Rehabil Eng. 2007;15(3):442–8. doi: 10.1109/TNSRE.2007.903978.
    1. Shimada H, Suzuki T, Kimura Y, Hirata T, Sugiura M, Endo Y, et al. Effects of an automated stride assistance system on walking parameters and muscular glucose metabolism in elderly adults. Br J Sports Med. 2008;42(11):922–9. doi: 10.1136/bjsm.2007.039453.
    1. Shimada H, Hirata T, Kimura Y, Naka T, Kikuchi K, Oda K, et al. Effects of a robotic walking exercise on walking performance in community-dwelling elderly adults. Geriatr Gerontol Int. 2009;9(4):372–81. doi: 10.1111/j.1447-0594.2009.00546.x.
    1. Marder E, Bucher D. Central pattern generators and the control of rhythmic movements. Curr Biol. 2001;11(23):R986–96. doi: 10.1016/S0960-9822(01)00581-4.
    1. Taga G, Yamaguchi Y, Shimizu H. Self-organized control of bipedal locomotion by neural oscillators in unpredictable environment. Biol Cybern. 1991;65(3):147–59. doi: 10.1007/BF00198086.
    1. Perry J. J B. Gait analysis: normal and pathologic function. Throrofare, NJ: Slack Inc.; 2010.
    1. Patterson KK, Mansfield A, Biasin L, Brunton K, Inness EL, McIlroy WE. Longitudinal changes in poststroke spatiotemporal gait asymmetry over inpatient rehabilitation. Neurorehabil Neural Repair. 2015;29(2):153–62. doi: 10.1177/1545968314533614.
    1. Bonnyaud C, Pradon D, Boudarham J, Robertson J, Vuillerme N, Roche N. Effects of gait training using a robotic constraint (Lokomat(R)) on gait kinematics and kinetics in chronic stroke patients. J Rehabil Med. 2014;46(2):132–8. doi: 10.2340/16501977-1248.
    1. Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, et al. Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair. 2009;23(1):5–13. doi: 10.1177/1545968308326632.
    1. Schmid A, Duncan PW, Studenski S, Lai SM, Richards L, Perera S, et al. Improvements in speed-based gait classifications are meaningful. Stroke J Cerebral Circulation. 2007;38(7):2096–100. doi: 10.1161/STROKEAHA.106.475921.
    1. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743–9. doi: 10.1111/j.1532-5415.2006.00701.x.
    1. Tilson JK, Sullivan KJ, Cen SY, Rose DK, Koradia CH, Azen SP, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Phys Ther. 2010;90(2):196–208. doi: 10.2522/ptj.20090079.
    1. Nadeau S, Gravel D, Arsenault AB, Bourbonnais D. Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clin Biomech (Bristol, Avon) 1999;14(2):125–35. doi: 10.1016/S0268-0033(98)00062-X.
    1. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Changes in gait symmetry and velocity after stroke: a cross-sectional study from weeks to years after stroke. Neurorehabil Neural Repair. 2010;24(9):783–90.
    1. Bonnyaud C, Zory R, Boudarham J, Pradon D, Bensmail D, Roche N. Effect of a robotic restraint gait training versus robotic conventional gait training on gait parameters in stroke patients. Exp Brain Res. 2014;232(1):31–42. doi:10.1007/s00221-013-3717-8.
    1. Chung Y, Kim JH, Cha Y, Hwang S. Therapeutic effect of functional electrical stimulation-triggered gait training corresponding gait cycle for stroke. Gait Posture. 2014;40(3):471–5. doi: 10.1016/j.gaitpost.2014.06.002.
    1. Lee NK, Son SM, Nam SH, Kwon JW, Kang KW, Kim K. Effects of progressive resistance training integrated with foot and ankle compression on spatiotemporal gait parameters of individuals with stroke. J Phys Ther Sci. 2013;25(10):1235–7. doi: 10.1589/jpts.25.1235.
    1. Lewek MD, Randall EP. Reliability of spatiotemporal asymmetry during overground walking for individuals following chronic stroke. J Neurol Phys Ther. 2011;35(3):116–21. doi: 10.1097/NPT.0b013e318227fe70.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner