Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke.

Objective: To investigate the effects of gait training with body weight support (BWS) on a treadmill versus overground in individuals with chronic stroke.

Design: Randomized controlled trial.

Setting: University research laboratory.

Task-specific ankle robotics gait training after stroke: a randomized pilot study.

Background: An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments.

Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke.

Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning.

Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study.

Unlabelled: BACKGROUND. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking.

Clinical application of a modular ankle robot for stroke rehabilitation.

Background: Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait.

Changes in passive ankle stiffness and its effects on gait function in people with chronic stroke.

Mechanical impedance of the ankle is known to influence key aspects of ankle function. We investigated the effects of robot-assisted ankle training in people with chronic stroke on the paretic ankle's passive stiffness and its relationship to overground gait function. Over 6 wk, eight participants with residual hemiparetic deficits engaged in a visuomotor task while seated that required dorsiflexion (DF) or plantar flexion (PF) of their paretic ankle with an ankle robot ("anklebot") assisting as needed.

Decoding intra-limb and inter-limb kinematics during treadmill walking from scalp electroencephalographic (EEG) signals.

Brain-machine interface (BMI) research has largely been focused on the upper limb. Although restoration of gait function has been a long-standing focus of rehabilitation research, surprisingly very little has been done to decode the cortical neural networks involved in the guidance and control of bipedal locomotion. A notable exception is the work by Nicolelis' group at Duke University that decoded gait kinematics from chronic recordings from ensembles of neurons in primary sensorimotor areas in rhesus monkeys.

Towards a non-invasive brain-machine interface system to restore gait function in humans.

Before 2009, the feasibility of applying brain-machine interfaces (BMIs) to control prosthetic devices had been limited to upper limb prosthetics such as the DARPA modular prosthetic limb. Until recently, it was believed that the control of bipedal locomotion involved central pattern generators with little supraspinal control. Analysis of cortical dynamics with electroencephalography (EEG) was also prevented by the lack of analysis tools to deal with excessive signal artifacts associated with walking.

Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial.

Background And Objective: Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training, but trials to date have not primarily assessed older persons.

Methods: Thirty-eight subjects (age >60 years) with residual hemiparetic gait were enrolled >6 months after stroke. Participants were randomized to receive 3 months (3×/week) progressive graded, high-intensity aerobic treadmill exercise (TAEX) or conventional care physiotherapy.

Neural decoding of treadmill walking from noninvasive electroencephalographic signals.

Chronic recordings from ensembles of cortical neurons in primary motor and somatosensory areas in rhesus macaques provide accurate information about bipedal locomotion (Fitzsimmons NA, Lebedev MA, Peikon ID, Nicolelis MA. Front Integr Neurosci 3: 3, 2009). Here we show that the linear and angular kinematics of the ankle, knee, and hip joints during both normal and precision (attentive) human treadmill walking can be inferred from noninvasive scalp electroencephalography (EEG) with decoding accuracies comparable to those from neural decoders based on multiple single-unit activities (SUAs) recorded in nonhuman primates.

Atrophy and intramuscular fat in specific muscles of the thigh: associated weakness and hyperinsulinemia in stroke survivors.

Purpose: Sarcopenia and increased fat infiltration in muscle may play a role in the functional impairment and high risk for diabetes in stroke. Our purpose was to compare muscle volume and muscle attenuation across 6 muscles of the paretic and nonparetic thigh and examine the relationships between intramuscular fat and insulin resistance and between muscle volume and strength in stroke patients.

Methods: Stroke participants (70; 39 men, 31 women) aged 40 to 84 years, BMI = 16 to 45 kg/m(2) underwent multiple thigh CT scans, total body scan by DXA (dual-energy X-ray absorptiometry), peak oxygen intake (VO(2peak)) graded treadmill test, 6-minute walk, fasting blood draws, and isokinetic strength testing.

Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke.

Cerebrovascular accident (stroke) often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot ("anklebot") training on paretic ankle motor control in chronic stroke.

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot.

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state.

Ankle training with a robotic device improves hemiparetic gait after a stroke.

Background: Task-oriented therapies such as treadmill exercise can improve gait velocity after stroke, but slow velocities and abnormal gait patterns often persist, suggesting a need for additional strategies to improve walking.

Objectives: To determine the effects of a 6-week visually guided, impedance controlled, ankle robotics intervention on paretic ankle motor control and gait function in chronic stroke.

Methods: This was a single-arm pilot study with a convenience sample of 8 stroke survivors with chronic hemiparetic gait, trained and tested in a laboratory.

Bilateral and unilateral arm training improve motor function through differing neuroplastic mechanisms: a single-blinded randomized controlled trial.

Background And Purpose: This randomized controlled trial tests the efficacy of bilateral arm training with rhythmic auditory cueing (BATRAC) versus dose-matched therapeutic exercises (DMTEs) on upper-extremity (UE) function in stroke survivors and uses functional magnetic resonance imaging (fMRI) to examine effects on cortical reorganization.

Methods: A total of 111 adults with chronic UE paresis were randomized to 6 weeks (3×/week) of BATRAC or DMTE. Primary end points of UE assessments of Fugl-Meyer UE Test (FM) and modified Wolf Motor Function Test Time (WT) were performed 6 weeks prior to and at baseline, after training, and 4 months later.

Theta frequency band activity and attentional mechanisms in visual and proprioceptive demand.

In a companion manuscript we reported reduced electroencephalographic (EEG) activation at traditional sensorimotor areas in knee movements with high levels of task difficulty modulated by varying visual and proprioceptive sensory demands. Given that reduced cortical activity with more complex tasks is counter-intuitive, we suggested that high order cognitive-motor areas may show increased EEG activation to compensate for the observed decrease in sensorimotor regions. To test this hypothesis, we evaluated theta band activation at anterior frontal regions in a secondary analysis of our previous data.

Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke.

Background: Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern.

Predictors of response to treadmill exercise in stroke survivors.

Background: Aerobic treadmill exercise (T-EX) therapy has been shown to benefit walking and cardiorespiratory fitness in stroke survivors with chronic gait impairment even long after their stroke. The response, however, varies between individuals.

Objective: The purpose of this post hoc analysis of 2 randomized controlled T-EX trials was to identify predictors for therapy response.

Electroencephalographic reactivity to unimodal and bimodal visual and proprioceptive demands in sensorimotor integration.

We used electroencephalography to see how the brain deals with altered sensory processing demands in lower extremity movements. In unimodal conditions, sensory processing demands were altered with subjects performing movement to a small or large visual target, or with a small or large weight to modify proprioception. In bimodal conditions, both weight and targets needed to be met.

The effect of claudication pain on temporal and spatial gait measures during self-paced ambulation.

We determined the effect of claudication pain on temporal and spatial gait characteristics, and on ambulatory symmetry at preferred and rapid self-selected walking paces in patients with unilateral peripheral arterial disease (PAD). Twenty-eight patients with PAD limited by intermittent claudication were studied. Patients ambulated at their preferred and rapid paces over a 7.

Reliability of TMS motor evoked potentials in quadriceps of subjects with chronic hemiparesis after stroke.

Transcranial magnetic stimulation (TMS) non-invasively measures excitability of central motor pathways in humans and is used to characterize neuroplasticity after stroke. Using TMS to index lower extremity neuroplasticity after gait rehabilitation requires test-retest reliability. This study assesses the reliability of TMS-derived variables measured at bilateral quadriceps of chronic hemiparetic stroke survivors.

Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial.

Background And Purpose: Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood.

Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report.

The effects of task-repetitive locomotor training on stroke patients' spatial and temporal gait parameters during unassisted walking are not well understood. This study determined the effects of treadmill aerobic exercise (T-EX) on spatial and temporal gait parameters that underlie changes in overground walking function. Thirty-nine subjects with hemiparetic stroke underwent T-EX three times weekly for 6 months.

Exercise-mediated locomotor recovery and lower-limb neuroplasticity after stroke.

Assumptions that motor recovery plateaus within months after stroke are being challenged by advances in novel motor-learning-based rehabilitation therapies. The use of lower-limb treadmill (TM) exercise has been effective in improving hemiparetic gait function. In this review, we provide a rationale for treadmill exercise as stimulus for locomotor relearning after stroke.

Post-stroke exercise rehabilitation: what we know about retraining the motor system and how it may apply to retraining the heart.

A plateau in recovery within the first few months of rehabilitative therapy was assumed to be the norm in stroke survivors. Recent studies in our laboratory examined the effect of 6 months of treadmill exercise training in chronically disabled stroke survivors. Treadmill exercise improves fitness and walking ability in patients when initiated 6 months or more following their index stroke.