Article

Locomotor training (LT) to improve walking ability in people
poststroke can be accomplished with therapist assistance as needed to promote
continuous stepping. Various robotic devices also have been developed that can
guide the lower limbs through a kinematically consistent gait pattern. It is
unclear whether LT with either therapist or robotic assistance could improve
kinematic coordination patterns during walking. The purpose of this
study was to determine whether LT with physical assistance as needed was superior
to guided, symmetrical, robotic-assisted LT for improving kinematic coordination
during walking poststroke. DESIGN: This study was a randomized clinical trial.
METHODS: Nineteen people with chronic stroke (>6 months' duration) participating
in a larger randomized control trial comparing therapist- versus robotic-assisted
LT were recruited. Prior to and following 4 weeks of LT, gait analysis was
performed at each participant's self-selected speed during overground walking.
Kinematic coordination was defined as the consistency of intralimb hip and knee
angular trajectories over repeated gait cycles and was compared before and after
treatment for each group. RESULTS: Locomotor training with therapist assistance
resulted in significant improvements in the consistency of intralimb movements of
the impaired limb. Providing consistent kinematic assistance during
robotic-assisted LT did not result in improvements in intralimb consistency. Only
minimal changes in discrete kinematics were observed in either group.
Limitations: The limitations included a relatively small sample size and a lack
of quantification regarding the extent of movement consistency during training
sessions for both groups. CONCLUSIONS: Coordination of intralimb kinematics
appears to improve in response to LT with therapist assistance as needed. Fixed
assistance, as provided by this form of robotic guidance during LT, however, did
not alter intralimb coordination.

Langue : ANGLAIS