Feinstein Institute study finds robotic ankle rehabilitation helps post stroke recovery

Stroke patients with high function walking speed had potential to return to normal walking speed after rehabilitation

MANHASSET, NY – A study published in NeuroRehabilitation by Feinstein Institute for Medical Research scientist Bruce T. Volpe, MD and Johanna L. Chang found that isolated ankle training with a robotic therapy device can improve walking speed and balance after a stroke, depending on the severity of the patient’s initial impairment. Better understanding of severity-dependent recovery profiles after stroke will help medical professionals determine the best candidates for robotic rehabilitation.

Strokes happen when a patient’s brain does not receive sufficient blood supply due to a blockage or rupture of a blood vessel, which can result in impairment of motor or cognitive function. Patients typically participate in rehabilitation programs that focus on specific enhanced motor activity of their limbs under the direction of physical and occupational therapists.

Robotic devices are effective tools to aid in this recovery of, for example, wrist and arm movement. The devices have been less effective in encouraging recovery of walking speed (also known as gait). Dr. Volpe’s study examines whether a robotic-assist device that uses interactive ankle movement in a seated position would improve a patient’s walking speed and balance.

“Exercise is one of the main ways for patients who have had a stroke to regain movement,” said Ms. Chang, who is the lead author of the study. “The use of robotic assisted-devices can enhance the therapy by increasing the intensity of the motor experience. This interactive robotic device moves the paralyzed arm or leg when the patient cannot and gets out of the way when the patient powers the movement. In our study, the baseline or initial walking speed prior to therapy was an important factor in predicting the final walking speed.”

Twenty-nine study participants with a foot drop and walking speed abnormalities after stroke were treated three times a week for six weeks with robot-assisted ankle training. The patients were separated into three groups: high function (walking speed greater than 3 feet per second), medium function (1 foot per second) and low function (less than 1 foot per second). During a session, patients were seated in front of a video monitor and the ankle robot was attached at the knee and foot. The patient viewed the video screen that had a cursor and used their legs and ankle to move the cursor to reach a particular target.

After 18 sessions, the high and medium function groups demonstrated significant improvements in walking speed, with the high functioning group achieving a speed that is considered normal for ambulating patients in the community (greater than 4 feet per second). A further exciting result showed that in follow-up three months after the treatment finished, the high function group continued to improve (4.39 feet per second). The low functioning group demonstrated the greatest change in improved balance.

“Much like one medication is not effective for all patients with a certain condition, not all rehabilitation is beneficial to all,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institute. “By understanding who can most benefit from robotic rehabilitation medical professionals can better tailor a program that will result in the highest benefit for patients.”

About The Feinstein Institute

The Feinstein Institute for Medical Research is the research arm of Northwell Health, the largest healthcare provider in New York. Home to 50 research laboratories and to clinical research throughout dozens of hospitals and outpatient facilities, the Feinstein Institute includes 4,000 researchers and staff who are making breakthroughs in molecular medicine, genetics, oncology, brain research, mental health, autoimmunity, and bioelectronic medicine – a new field of science that has the potential to revolutionize medicine. For more information about how we empower imagination and pioneer discovery, visit FeinsteinInstitute.org.

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