Posts Tagged Balance

[Abstract] Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials

Abstract

Background: Water-based exercises have the potential to reduce impairments and walking limitations after stroke.

Objective: To examine the effects of water-based exercises on walking speed, balance, and strength after stroke.

Data sources: Eletronic searches on MEDLINE, CINAHL, EMBASE, Cochrane, PsycINFO, and PEDro databases.

Eligibility criteria: The review included randomized trials. Participants in the reviewed studies were ambulatory adults, who have had a stroke. The experimental intervention was comprised of water-based exercises.

Data synthesis: Outcome data related to walking speed, balance, and strength were extracted from the eligible trials and combined in meta-analyses. The quality of the included trials was assessed by the PEDro scores and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.

Results: Thirteen trials involving 464 participants were included. Random-effects meta-analyses provided moderate-quality evidence that water-based exercises significantly increase walking speed by 0.06m/second (95% CI 0.01 to 0.10) and balance by 4.5 points on the Berg Balance scale (95% CI 2.2 to 6.8), compared with land-based exercises, without concurrent changes in strength (MD 5.2Nm/kg; 95% CI -1.4 to 11.9).

Conclusions: This systematic review provided low-quality evidence regarding the efficacy of water-based exercises, compared with no intervention. However, there is moderate quality evidence, which suggested significant benefits of water-based exercises in walking speed and balance, compared with land-based exercises. Differences appear small to be considered clinically relevant, and, therefore, water-based exercises can be prescribed as alternative interventions, based upon individuals’ exercise preferences. Systematic Review Registration Number PROSPERO (CRD42018108419).

Source: https://pubmed.ncbi.nlm.nih.gov/32026809/

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[Abstract] Therapeutic effect of AiWalker on balance and walking ability in patients with stroke: A pilot study

Background

AiWalker is a newly developed robot-assisted gait training system, which features over-ground walking paradigm and somatosensory stimulation during training compared to commonly-used robot-assisted gait training devices (e.g. Lokomat). However, no study has examined its true therapeutic effect and possible mechanism or mediating factor(s).

Objectives

To investigate 1) the therapeutic effect of AiWalker on the balance and walking ability in patients with stroke, and 2) whether the improvement in somatosensory function represents one of the possible mediating factors for such effect.

Methods

Three patients with impaired balance and walking ability due to stroke were recruited. Two patients received AiWalker training plus conventional training; while the other one only experienced conventional training. Standing balance and walking ability were assessed before and after all the training, which were represented by 6 variables. Lower limb somatosensory function was examined using Fugl-Meyer Assessment Scale.

Results

Five out of the 6 variables showed greater changes in patients who received AiWalker training compared to the one who only experienced conventional training. Greater improvement in lower limb somatosensory function was observed in one patient who received AiWalker training compared to the one who only experienced conventional training.

Conclusion

The novel robot-assisted gait training system may elicit greater improvement of balance and walking ability in patients with stroke compared to conventional interventions. Lower limb somatosensory function may be improved by AiWalker, and its improvement might represent one of the possible mediating factors for the therapeutic effect of AiWalker on balance and walking ability.

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[Abstract] Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke – A Case Report

Abstract

Background and Purpose:

Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping.

Case Description:

Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor.

Intervention:

Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training).

Outcomes:

All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude.

Discussion:

Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.

This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).

via Neuroplasticity of Cortical Planning for Initiating Stepping… : Journal of Neurologic Physical Therapy

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[Abstract] Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial

Abstract

Objective

The purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke.

Methods

Thirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention.

Results

The non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001).

Conclusions

Our results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.

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[Abstract] Effects of Robot-Aided Rehabilitation on Improving Ankle and Balance Performance of Stroke Survivors: A Randomized Controlled Trial

Abstract

Background: Stroke survivors often experience abnormal posture control, which affects balance and locomotion. The ankle strategy is important in maintaining static balance. Prolonged spasticity may result in biomechanical changes at the ankle joint, which may cause balance disorders. The intelligent stretching device may decrease the stiffness of the ankle and improve balance. The purpose of this study was to investigate the effects of robot-aided ankle rehabilitation of stroke survivors with ankle spasticity and the correlations between biomechanical properties and balance in these patients.

Methods: Twenty inpatients post stroke with ankle spasticity performed 20 minutes of stretching treatment for 2 weeks. The study group used a rehabilitation robot to stretch the spastic ankle plantar flexors under intelligent control and the control group received manual stretching. Outcome measures included biomechanical, clinical evaluations and Pro-Kin balance test.

Results: After training, significant improvements were found in both groups in the active range of motion, muscle strength, Berg Balance Scale, Fugl-Meyer Motor Assessment of Lower Extremity, Postural Assessment Scale for Stroke Patients, 6-minute walk test, and Modified Barthel Index (P<0.05); significant decreases were found in the study group in dorsiflexion stiffness, Modified Ashworth Scale, trajectory lengths, elliptical trajectory, standard deviation medial/lateral, average speed forward/backward with eyes closed, and standard deviation forward/backward with eyes open (P=0.001, P=0.037, P=0.028, P=0.019, P=0.016, P=0.001, and P=0.033, respectively); dorsiflexion stiffness was positively correlated with the Pro-Kin balance test outcomes: ellipse area, trajectory length, average speed forward/backward, average speed medial/lateral with eyes open ( =0.352, P=0.026; =0.522, P=0.001; =0.045, P=0.004; =0.433, P=0.005, respectively); dorsiflexion stiffness was correlated with the Modified Ashworth Scale ( =0.265, P=0.041); the study group improved significantly more than the control group in the activities of daily living after training (P =0 .017).

Conclusions: The results suggested that robot-aided ankle rehabilitation had a positive effect on the biomechanical properties of the spastic ankle, and it may be feasible to improve balance post-stroke. Ankle dorsiflexion stiffness affected balance poststroke significantly; it may be a sensitive indicator for evaluating balance.

Figure 1

Source: https://www.researchsquare.com/article/rs-30969/v1?utm_source=researcher_app&utm_medium=referral&utm_campaign=RESR_MRKT_Researcher_inbound

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[ARTICLE] Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series – Full Text HTML

Graphical abstract

Abstract

Stroke is a neurologic disorder considered the first cause of disability worldwide due to motor, cognitive, and sensorial sequels. Balance dysfunctions in stroke survivors increase the risk of falls and physiotherapeutic rehabilitation is essential to reduce it. Virtual reality (VR) seems to be an alternative to conventional physiotherapy (CT), providing virtual environments and multisensorial inputs to train balance in stroke patients. The aim of this study was to assess if immersive VR treatment is more effective than CT to improve balance after stroke. This study got the approval from the Ethics Committee of the University of Almeria. Three chronic ischemic stroke patients were selected. One patient who received 25 sessions of immersive VR intervention for two months was compared with another patient who received equivalent CT and a third patient with no intervention. Balance, gait, risk of falling, and vestibular and visual implications in the equilibrium were assessed. After the interventions, the two patients receiving any of the treatments showed an improvement in balance compared to the untreated patient. In comparison to CT, our results suggest a higher effect of immersive VR in the improvement of balance and a reduction of falls risk due to the active upright work during the VR intervention.

1. Introduction

Stroke is considered the first cause of disability [1] and the third cause of death in westernized countries after cardiovascular diseases and cancer [2]. Stroke is a central nervous system disorder produced by a local interruption of the cerebral blood flow due to the occlusion (ischemic stroke) or rupture (hemorrhagic stroke) of a cerebral blood vessel [3]. As result of brain cortex injury, afferent and efferent neural pathways are affected, and motor, sensitive and cognitive functions become impaired. Motor and cognitive impairments observed in post-stroke patients reduce their functional capacity, their personal autonomy [4], and social abilities, which results in intensive care and rehabilitation needs with the subsequent economic burden to society and families [5].
Postural instability or poor balance is a relevant central vestibular symptom in neurologic disorders, such as stroke [6], in which approximately 83% of stroke survivors show balance impairments [7]. Proprioceptive visual and vestibular inputs to the central nervous system are essential to guarantee the upright position [8]. Thus, errors in the central integration of this postural information can induce gait difficulties with the subsequent increase in risk of falls [9]. In addition, stroke survivors show a number of neurological issues like visual neglect, sensory loss, reduced muscle strength and spasticity, which also increase the risk of fall 1.5–2 times more in post-stroke patients than older adults without brain damage [10]. This results in fractures, tissue injuries, immobility, and psychological fear of falling as additional consequences of falls in stroke patients [11]. Besides, large hospitalization periods due to injury falls are devastating for patient recovery [12].
The use of virtual reality (VR) has been booming during the last decade, becoming a potential tool in the field of stroke rehabilitation [13]. Virtual reality technology works by displaying a set of digital images that allow the user interacts with a virtual environment or situation that is perceived equivalent to the real physical world [14]. VR has been used in neurorehabilitation in order to encourage a higher number of exercise repetitions and their intensity, and enhances motor learning thanks to the quick feedback possibilities and the multisensorial stimulation [15]. This promotes neuronal plasticity, which would the responsible of VR-induced benefits in stroke rehabilitation [16]. Recent studies have shown that immersive VR protocols in a sitting position and Wii exergames (non-immersive VR) improve motor function, balance, and gait in stroke patients in comparison with conventional therapy (CT) [17]. However, other studies report no statistical differences when comparing immersive or non-immersive VR in a sitting position with CT [18,19]. Moreover, several studies suggest that a neurorehabilitation program combining VR and CT produces a greater improvement than each treatment separately [20].
Nevertheless, the majority of published works have used non-immersive VR therapies, such as Wii exergames for balance training [21,22]. Recently, improved versions of immersive VR have become available for clinical and research purposes in physical rehabilitation. Thus, immersive VR, thanks to the use of headsets that display 3D digital images that simulate any scenario with high realism, has the capability to make individuals feel as if they’re inside the virtual environment. Moreover, the use of hand-held controllers allows users to interact with virtual elements using their hands as they do real life, allowing exercise repetition, intensity variation, and task-oriented training. Thus, immersive VR postulates as a promising tool for the rehabilitation of motivated stroke patients. The aim of this study is to assess if an experimental protocol based on immersive VR therapy is valid for stroke rehabilitation and produces positive effects in balance and falls risk in comparisons to a CT protocol. For such a reason, two intervention protocols (immersive VR or CT) in comparison with the absence of treatment were tested in three patients diagnosed with ischemic stroke[…]

Continue —->  Brain Sciences | Free Full-Text | Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series | HTML

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[ARTICLE] Effect of Vojta Therapy on Balance and Walking of Community Dwelling Chronic Stroke Patients – Full Text PDF

ABSTRACT

Objectives: To evaluate effect of Vojta Therapy on balance and
walking of community dwelling chronic stroke patients.
Study design: Single group clinical trial with pre and post test.
Setting: VojtaTherapy clinic, Division of Physical Therapy,
Department of Rehabilitation Medicine, Trang Hospital.
Subjects: Community dwelling chronic stroke patients with
abnormal gait referred to the VojtaTherapy clinic.
Methods: Every participant did a timed up and go test (TUGT)
immediately before and after the VojtaTherapy. Techniques were
chosen according to response of patients with 30 minutes per
session. Treatment and assessment were repeated once a week
for three weeks.
Results: Twenty chronic stroke patients with average age of
63.1 (SD = 13.23) years and average duration after stroke of
58.35 (SD = 52.83) months were enrolled into the study. The
median TUGT scores of the first, second and third pre-treatment
were 28, 22 and 19.5 respectively. Friedman test demonstrated a
significant difference (p < 0.001). Median TUGT Score of the first,
second, and third post treatment TUGT score were 22.5, 18 and
18.5 respectively. Wilcoxon test showed significant difference of
pre versus post treatments in everysessions (p < 0.0001).
Conclusion: Once a week of VojtaTherapy for three weeks can
improve walking in community dwelling chronic stroke patients.
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[WEB PAGE] Physical Therapy at Home – Gorbel Rehab – Videos

Physical Therapy at Home

As rehab professionals around the world work to address patient needs during the COVID-19 pandemic, Gorbel is actively taking steps to improve efforts in delivering therapy during these difficult times. The Gorbel team of physical therapists have created a library of home exercise program videos for those patients who are now unable to receive therapy with the frequency or duration in which they normally would have. The current video categories are Strength, Range of Motion, Balance, and Caregiver Training. Each category has a ‘Playlist’ that includes multiple videos. We will continue to add categories and new videos in our commitment to assist your efforts to advance your patient’s recovery.

Stay safe, healthy and thank you for all you do.
Brian Reh, CEO Gorbel®

 

Physical Therapy Videos

Balance Videos Playlist  /  Caregiver Videos Playlist  /  Range of Motion Videos Playlist  /  Strength Videos Playlist

Balance Videos Playlist

Caregiver Videos Playlist

Range of Motion Videos Playlist

Strength Videos Playlist

 

Physical Therapist Bio

Matthew KlockMatthew Klock PT,DPT I am a licensed physical therapist in New York State and the Northeast Account Manager for Gorbel® Rehabilitation. Before joining Gorbel® I worked for Ochsner Health System in New Orleans, LA as the Supervisor of the Ochsner Sports Medicine Clinic. My passions include sports and orthopedics as well as new and emerging technologies. I believe that physical therapists should serve their patients by applying their wealth of knowledge in rehabilitation and pair it with the most cutting edge technologies to get the most out of every treatment.

 

Ramiro MaldonadoRamiro Maldonado PT, DPT I am a licensed Physical Therapist in New York State as well as the Clinical Business Development Specialist for Gorbel Rehabilitation. During my ten years as a clinician, my clinical interests lead me to specialize in vestibular and neuromuscular impairment, and I have completed the vestibular competency at Emory University. My passion now lies in helping patients and therapists by increasing awareness of rehabilitation technology and how it can improve patient outcomes. You can find out more about the products I represent, innovations in physical therapy, and me at TheBalancePT.com or follow me on Twitter or Instagram @RamiroDPT. Thank you!! 

Heidi ShenkHeidi Shenk, PT I am a licensed Physical Therapist in the states of Ohio and Indiana as well as the Account Manager for the Great Lakes Region of Gorbel Rehabilitation. I am a graduate of the Doisy College of Health Sciences at St Louis University. During my twenty-seven years as a clinician, my clinical interests led me to specialize in occupational medicine, outpatient orthopedics and in women’s health. My lifelong interest in technology and in improving therapist safety and patient outcomes has led to a passion in increasing awareness of rehabilitation technology and how it can improve patient care.

via Physical Therapy at Home | Gorbel Rehab

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[ARTICLE] Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury – Full Text

Abstract

Objective

To compare the efficacy of high- and low-frequency noninvasive translingual neurostimulation (TLNS) plus targeted physical therapy (PT) for treating chronic balance and gait deficits due to mild-to-moderate traumatic brain injury (mmTBI).

Design

Participants were randomized 1:1 in a 26-week double-blind phase 1/2 study (NCT02158494) with 3 consecutive treatment stages: in-clinic, at-home, and no treatment. Arms were high-frequency pulse (HFP) and low-frequency pulse (LFP) TLNS.

Setting

TLNS plus PT training was initiated in-clinic and then continued at home.

Participants

Participants (N=44; 18-65y) from across the United States were randomized into the HFP and LFP (each plus PT) arms. Forty-three participants (28 women, 15 men) completed at least 1 stage of the study. Enrollment requirements included an mmTBI ≥1 year prior to screening, balance disorder due to mmTBI, a plateau in recovery with current PT, and a Sensory Organization Test (SOT) score ≥16 points below normal.

Interventions

Participants received TLNS (HFP or LFP) plus PT for a total of 14 weeks (2 in-clinic and 12 at home), twice daily, followed by 12 weeks without treatment.

Main Outcome Measures

The primary endpoint was change in SOT composite score from baseline to week 14. Secondary variables (eg, Dynamic Gait Index [DGI], 6-minute walk test [6MWT]) were also collected.

Results

Both arms had a significant (P<.0001) improvement in SOT scores from baseline at weeks 2, 5, 14 (primary endpoint), and 26. DGI scores had significant improvement (P<.001-.01) from baseline at the same test points; 6MWT evaluations after 2 weeks were significant. The SOT, DGI, and 6MWT scores did not significantly differ between arms at any test point. There were no treatment-related serious adverse events.

Conclusions

Both the HFP+PT and LFP+PT groups had significantly improved balance scores, and outcomes were sustained for 12 weeks after discontinuing TLNS treatment. Results between arms did not significantly differ from each other. Whether the 2 dosages are equally effective or whether improvements are because of provision of PT cannot be conclusively established at this time.


Traumatic brain injury (TBI) is a leading cause of injury-induced death and physical disability. Millions of people experience TBI every year,1,2 and an estimated 5.3 million people are living with TBI-related disabilities,3 with up to 57% of patients with TBI experiencing balance disorders.4 Mild-to-moderate traumatic brain injury (mmTBI) encompasses most of TBI cases (83%).5

For many people, the signs and symptoms of mmTBI resolve with time, allowing return to normal daily activities; however, 25%-50% of patients experience chronic symptoms.678910 Instability or imbalance can persist after mild TBI,11 which has a significant negative effect on functional status, capacity to return to work, and quality of life7,1213141516 and can increase the risk of falling and repeat injury.17 Rehabilitation techniques consist of basic gait and balance training, but may also include specialized therapies, such as vestibular rehabilitation therapy, vision therapy, motor control retraining, graded exercise, and others.18192021222324 Whereas some patients improve with these treatments, others do not.18,25,26

Neurostimulation combined with physical therapy (PT) can potentially affect rehabilitation outcomes,272829 and noninvasive brain stimulation can affect neural excitability and may facilitate motor skill learning.30 Cranial nerves V and VII in the tongue and associated neural projections in the brain can be stimulated through noninvasive translingual neurostimulation (TLNS).31 Clinical studies by our group and others indicate that TLNS with targeted PT, combined, can significantly improve outcomes in those with degenerative neurologic disease, spinal cord injury, or stroke.32333435 In a separate study, we treated 20 persons with multiple sclerosis and an identified gait disturbance with TLNS plus targeted PT.32 Over 14 weeks of treatment, Dynamic Gait Index (DGI) significantly improved from baseline.32 One group reported results from 2 people with chronic incomplete spinal cord injury who completed 12 weeks of TLNS plus balance or gait PT that indicated improvements in both walking speed and skilled walking function.34 Results from a separate randomized controlled trial demonstrated significant improvement in the Mini-Balance Evaluation Test after 2 weeks of TLNS plus targeted PT in 5 subacute stroke survivors.33 These results, as well as similarities in neural dysfunction mechanisms of stroke and TBI,35 support the possibility that TLNS plus targeted PT may be effective for treating chronic balance and gait deficits due to mmTBI.

This 26-week, randomized trial (Clinicaltrials.govNCT02158494) was developed to investigate high-frequency pulse (HFP) TLNS plus PT, as treatment for individuals with persistent balance deficit due to mmTBI, compared with low-frequency pulse (LFP) TLNS plus PT as a control. Since trial registration, notable difficulties in establishing controls in neurostimulation studies have become more prominent in the field, particularly focusing on how a low, minimally perceived stimulus serving as a sham can trigger neural activity and produce a response.3637383940 This determination of optimal stimulation parameters has proven challenging across the neurostimulation field, including studies with transcutaneous electrical nerve stimulation,36,37,414243 noninvasive trigeminal nerve stimulation,38,39,44 and TLNS.32 Because of these difficulties, the focus of this study shifted from using the LFP as a control to one of a comparison between the treatment arms (PT plus either HFP or LFP); balance assessment after 14 weeks of treatment was the primary outcome measure.

Continue —->  Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury – ScienceDirect

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[ARTICLE] Effects of Exoskeleton Gait Training on Balance, Load Distribution, and Functional Status in Stroke: A Randomized Controlled Trial – Full Text

Background: As a result of stroke, patients have problems with locomotion and transfers, which lead to frequent falls. Recovery after stroke is a major goal of rehabilitation, but it is difficult to choose which treatment method is most beneficial for stroke survivors. Recently, powered robotic exoskeletons are used in treatment to maximize the neural recovery of patients after stroke, but there are no studies evaluating the changes in balance among patients rehabilitated with an exoskeleton.

Purpose: The aim of this study was to evaluate the effects of Ekso GT exoskeleton-assisted gait training on balance, load distribution, and functional status of patients after ischemic stroke.

Methods: The outcomes are based on 44 patients aged 55–85 years after ischemic stroke who were previously randomly assigned into two groups: experimental (with Ekso GT rehabilitation) and control (with classical rehabilitation). At baseline and after 4 weeks of treatment, the patients were evaluated on balance, load distribution, and functional status using, respectively a stabilometric platform, the Barthel Index, and the Rivermead Mobility Index.

Results: In the experimental group, balance improved regarding the variables describing sway area as ellipse major and minor axes. In the control group, improvement was noted in sway velocity. After the therapy, total load distribution on feet in both groups showed a small and insignificant tendency toward reduction in the amount of uninvolved limb loading. In the control group, significant load transfer from the backfoot to the forefoot was noted. Both forms of rehabilitation caused significant changes in functional status.

Conclusions: Both training with the use of the Ekso GT exoskeleton and classical physiotherapy lead to functional improvement of patients after ischemic stroke. However, in the experimental group, improvement was observed in a larger number of categories, which may suggest potentially greater impact of treatment with the exoskeleton on functional status. Also, both forms of rehabilitation caused significant changes in balance, but we have noted some trends indicating that treatment with exoskeleton may be more beneficial for some patients. The load transfer from the backfoot to the forefoot observed in the control group was an unfavorable phenomenon. We suggest that the Ekso GT exoskeleton may be a promising tool in the rehabilitation of patients after stroke.

Introduction

Stroke is the third leading cause of death worldwide and is the most common cause of disability among adults (12). As a result of stroke, patients have problems with locomotion and transfers, which lead to frequent falls. People with hemiparesis have uneven distribution of body mass between the sides of the body, causing balance and coordination disorders, deep and superficial sensation, increased muscle tone, and fear of falling (23). Patients have problems with lack of normal postural muscle tone, and proper reciprocal innervation as well as normal, automatic movement patterns and balance reactions (4). Some studies have reported that balance alterations significantly limit the physical activity of stroke patients, which may be the reason for deconditioning of patients in the chronic phase and reduction in their gait possibilities as well as other activities of daily living (5). That is why gait rehabilitation and also balance therapy are very important in improving the quality of everyday and social life of those patients (6).

Gait training may improve not only strength, endurance, and coordination of the lower limbs but also the entire body of the patient, influencing general fitness and endurance, balance, normalization of muscle tone, and functional improvement (7). The Barthel Index (BI) and Rivermead Mobility Index (RMI) tests are considered to be proper criteria for assessing a patient’s functional state after stroke and good indicators of the effectiveness of the applied therapy (89).

Recovery after stroke is a major goal of rehabilitation, but it is difficult to choose which treatment method is most beneficial for stroke survivors. Recently, powered robotic exoskeletons are used in treatment to maximize the neural recovery of patients after stroke (1011). However, in a review paper, Louie and Eng (12) have reported that only four different types of powered exoskeletons have been studied among a small number of stroke patients, and the published data were controversial. Moreover, in the available literature, there are no studies evaluating the changes in balance among patients rehabilitated with an exoskeleton. Most authors have reported various aspects of walking, and only a few papers have presented data concerning changes in balance. Additionally, most of the studies used subjective tools such as the Berg Balance Scale (1314). There is a lack of studies in which changes in balance and load distribution due to rehabilitation with the exoskeleton would be examined using an objective tool—stabilometric platform; therefore, this study undertakes this task for the first time.

The aim of this study was to evaluate the effectiveness of rehabilitation with Ekso GT exoskeleton in patients after ischemic stroke and to compare this type of therapy with the classical model of rehabilitation. The novelty of this study was the verification of the robot-assisted gait training effects on balance, load distribution, and functional status of stroke patients.[…]

Continue —-> Frontiers | Effects of Exoskeleton Gait Training on Balance, Load Distribution, and Functional Status in Stroke: A Randomized Controlled Trial | Neurology

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