Comparative effects of robotic-assisted gait training combined with conventional physical therapy on paretic hip joint stiffness and kinematics between subacute and chronic hemiparetic stroke
Ji-Ho Parka,b, Yong-Il Shinc,d, Joshua (Sung) H. Youa,b,∗ and Min Su Parkc,d aDepartment of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea bBrain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea cDepartment of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea dResearch Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
BACKGROUND: Robotic-assisted gait training (RAGT) has been proposed as a novel, promising intervention paradigm to improve gait function in subacute or chronic stroke neurorehabilitation. However, the beneﬁts of RAGT combined with conventional physical therapy for gait recovery in patients with subacute and chronic hemiparetic stroke remain unclear.
OBJECTIVES:TheaimofthepresentstudywastocomparetheeffectofRAGTcombinewithconventionalphysicaltherapy on hip joint kinetics, kinematics, and clinical function characteristics between subacute and chronic hemiparetic stroke.
METHODS: Seventeen patients with hemiparetic stroke (nine subacute and eight chronic patients) performed progressive RAGT (session 1, 40min) combined with conventional physical therapy (session 1, 40min) 5 days per week, for an average of 86 sessions over 8 weeks. The clinical outcomes included the Functional Ambulation Category (FAC), modiﬁed Rankin scale (mRS), Korean version of the modiﬁed Barthel index (K-MBI), and modiﬁed Ashworth scale, in addition to hip joint kinetics and kinematics before and after intervention.
RESULTS: The mean change inactive torque, resistive torque, and stiffness in the paretic hip joint did not differ signiﬁcantly between the two groups. However, Cohen’s effect size suggested a moderate difference between the groups in the hip ﬂexion phase (d=0.58, d=0.70, and d=0.70). The mean change in maximal hip ﬂexion kinematics in the chronic group was signiﬁcantly greater than that in the subacute group(p=0.04,d=–0.70). The mean change in the clinical function test results between the groups was not statistically signiﬁcant. However, both groups showed signiﬁcantly improved FAC, mRS, and K-MBI scores.