Comparison of robotic-virtual reality lower extremity training with robotic lower extremity training alone for rehabilitation of gait of individuals post-stroke.

摘要

Introduction. Stroke remains a major cause of disability in adults. People who suffered a stroke may experience as much as 50% decrease in gait velocity, stride length and cadence as compared to age matched healthy adults. A growing body of evidence suggests that intensive, goal directed therapy improves function and cortical reorganization in individuals post stroke. Virtual reality systems can be used to deliver such training infact lower extremity (LE) training with a robot coupled with virtual environment has shown to transfer to improved overground locomotion. The goals of this project were: (1) to determine the effects of LE training with a robotic-VR system and with robotic training alone on gait speed, stair negotiation and endurance of individuals after stroke, (2) to elucidate the mechanisms underlying biomechanical and motor control improvements achieved after LE robotic and robotic-VR training, (3) to assess transfer of gains achieved through training, into real-world home and community activities using an activity monitor. Methods. A single blinded RCT with repeated measures at pre-training, post training and three months follow-up. Eighteen individuals post-stroke participated in a four-week training protocol using the RARS device. One group trained with the robot-VR system and the other group trained with the robot-alone. Primary outcome measures included, gait speed, time to negotiate stairs, endurance, kinetics and kinematics of gait. Secondary measures included kinematic data collected during training by the RARS, and activity in the home and community. Results. Both clinical outcome measures and kinematic and kinetic data illustrated greater changes in velocity, endurance and magnitude of range and force during gait, after training with the robotic device coupled with the VR than training with the robot alone. Ankle power generation post training was significantly greater for the robotic-VR group and training effects were maintained at follow up for this group. Data collected by the activity monitor (PAM) demonstrated significantly greater improvements in the distance walked and amount of steps taken by subjects trained with the robotic-VR system. Implication. The study demonstrated that training with a robotic device coupled with VR improved functional ability in subjects with chronic hemiparesis and those improvements transferred to real world activity.