NeuroRehabilitation - Volume 42, issue 4

Authors: Hwang, Jongseok | Shin, Yongil | Park, Ji-ho | Cha, Young Joo | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE: The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS: Nine adults with subacute or chronic paraplegia resulting from spinal cord injury …or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS: Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P  <  0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS: These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy. Show more

Keywords: Paraplegia, quadriplegia, robotic-assisted gait training, Walkbot, stiffness, gait, neurorehabilitation

DOI: 10.3233/NRE-172226

Citation: NeuroRehabilitation, vol. 42, no. 4, pp. 481-489, 2018

Authors: In, Taesung | Jung, Kyoungsim | Lee, Min-Goo | Cho, Hwi-young

Article Type: Research Article

Abstract: OBJECTIVES: This study aimed to investigate the effects of whole-body vibration (WBV) training on ankle spasticity, balance, and walking ability in patients with incomplete spinal cord injury (iSCI) at cervical level. METHODS: Twenty-eight patients with cervical iSCI were randomly assigned to WBV (n  = 14) or control group (n  = 14). WBV group received WBV training, while control group was treated with placebo-treatment. All interventions were given for 20-min, twice a day, 5-days a week for 8-weeks. The spasticity of ankle plantar-flexors was assessed by estimating passive resistive force using a hand-held dynamometer. Balance was analyzed based on postural sway …length (PSL) using a force plate. Timed-Up and Go test (TUG) and 10 m-Walk Test (10MWT) were used to assess walking ability. RESULTS: Both groups showed significant improvements in spasticity, balance and walking ability. Also, the significant differences between two groups were demonstrated in the outcomes of spasticity (3.0±1.7 vs 0.9±1.2), PSL (6.4±1.2 vs 3.2±0.9 with eyes-open, and 15.1±10.9 vs 7.4±4.3 with eyes-closed), TUG (2.3±1.3 vs 1.0±1.0), and 10MWT (3.5±2.3 vs 1.3±1.4). CONCLUSIONS: WBV may be a safe and effective intervention to improve spasticity, balance and walking ability in individuals with cervical iSCI. Thus, WBV may be used to improve these symptoms in clinics. Show more

Keywords: Balance, incomplete spinal cord injury, whole body vibration

DOI: 10.3233/NRE-172333

Citation: NeuroRehabilitation, vol. 42, no. 4, pp. 491-497, 2018

Authors: Vincent-Onabajo, Grace | Joseph, Emmanuel | Musa, Hadiza Yakubu

Article Type: Research Article

Abstract: BACKGROUND: Functional independence is often compromised after stroke and its restoration is one of the goals of stroke rehabilitation. OBJECTIVE: This study assessed the impact of balance on functional independence after stroke. METHODS: Ninety-five stroke patients undergoing physical rehabilitation at two health institutions in Nigeria participated in the study. Balance and functional independence were respectively assessed with the Berg Balance Scale and the Barthel Index. Binary logistic regression analysis was conducted to examine the independent impact of balance on functional independence while controlling for participants’ age, sex, side of hemiparesis and post-stroke duration. RESULTS: …Mean±SD age of the participants was 58.4±13.1 years and females were more (f = 48; %  = 50.5). The regression model from the binary regression analysis explained 73.2% (Nagelkerke R2  = 0.732) of the variance in functional independence. Good balance function was found to independently and significantly (P  <  0.01) increase the likelihood of being functionally independent after stroke (Odds ratio = 1.33; 95% CI = 1.11 to 1.58). CONCLUSION: The goal of attaining functional independence after stroke may depend to a significant extent on good balance function irrespective of the stroke survivor’s age, sex and post-stroke duration. Show more

Keywords: Activities of daily living, balance, stroke, functional independence, Nigeria

DOI: 10.3233/NRE-172305

Citation: NeuroRehabilitation, vol. 42, no. 4, pp. 499-504, 2018

Authors: Song, SunHae | Park, JungHee | Song, GyuDong | Lee, SeulGi | Jo, YoHan | Jin, MinKyung | Lee, DongGeon | Jung, SunHye | Hong, SoungKyun | Lee, SeungHoo | Pyo, SeungHyeon | Lee, GyuChang

Article Type: Research Article

Abstract: BACKGROUND: Stroke survivors show “foot drop”, dragging their toes on the ground in the swing phase of gait. Ineffective ankle dorsiflexion may result in an abnormal gait pattern. OBJECTIVE: The purpose of this study was to investigate the effect of ankle Thera-Band® use on gait patterns in stroke survivors. METHODS: Gait data were collected in eight subjects who had had strokes using gait analysis system, both with and without the Thera-Band® . The following dependent variables of gait parameters were analyzed: velocity, cadence, step length, stride length, single support time, and double support time. …RESULTS: There were significant improvements in gait velocity, cadence, stride length, and double support time in those who used the Thera-Band® compared to those who did not (p  <  0.05). However, there were no significant differences in step length or single support time (p  >  0.05). CONCLUSIONS: The results show that ankle Thera-Band® use may have a positive effect in improving gait parameters by increasing the ankle stability in stroke survivors with foot drop. Its usefulness in the rehabilitation of foot drop in stroke survivors needs to be further investigated. Show more

Keywords: Stroke survivor, foot drop, Thera-Band®

DOI: 10.3233/NRE-172338

Citation: NeuroRehabilitation, vol. 42, no. 4, pp. 505-510, 2018