Clinical Neurology: Research Article

Degami A.a· Taki S.a,b· Imura T.b,c· Iwamoto Y.a,b· Imada N.a· Tanaka R.b· Urakawa S.d· Inagawa T.e· Araki H.e· Araki O.e

Author affiliations

aDepartment of Rehabilitation, Araki Neurosurgical Hospital, Hiroshima, Japan
bGraduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
cDepartment of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
dDepartment of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
eDepartment of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan

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Article / Publication Details

First-Page Preview

Received: August 25, 2022
Accepted: October 07, 2022
Published online: December 14, 2022

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

Abstract

Introduction: The effect of early initiation of gait training using hybrid assistive limb (HAL) remains unclear. This observational study aimed to investigate whether early initiation of gait training using HAL improves functional outcomes in patients with stroke. Methods: We retrospectively analyzed patients with acute stroke admitted to our facility. HAL was used for exoskeletal robotic gait training. Study participants were median split into an early group and a late group based on the days from stroke onset to initiation of gait training using HAL. The functional outcomes, defined by the Brunnstrom recovery stage (BRS), modified Rankin Scale (mRS), and Functional Independence Measure (FIM) at discharge, were compared using propensity score-matched analysis. Results: We performed a propensity score-matched analysis in 63 patients with stroke (31 from the early group and 32 from the late group), and 17 pairs were matched. There were no significant differences in discharge in the BRS of the upper limb and finger in the post-matched cohort. On the other hand, the BRS of the lower limb in the early group was significantly higher than that in the late group. In addition, the mRS, but not FIM scores, was significantly better in the early group than that in the late group. Conclusions: In conclusion, early initiation of gait training using HAL might improve the motor function of the paralyzed lower limb and disability in patients with stroke.

© 2022 S. Karger AG, Basel

References Chen W, Fukutomi E, Wada T, Ishimoto Y, Kimura Y, Kasahara Y, et al. Comprehensive geriatric functional analysis of elderly populations in four categories of the long-term care insurance system in a rural, depopulated and aging town in Japan. Geriatr Gerontol Int. 2013 Jan;13(1):63–9. Imura T, Nagasawa Y, Araki O, Fukuyama H, Imada N, Oki S. Effect of early and intensive rehabilitation in acute stroke patients: retrospective pre-/post-comparison in Japanese hospital. Disabil Rehabil. 2018 Jun;40(12):1452–5. Wandel A, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Prediction of walking function in stroke patients with initial lower extremity paralysis: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 2000 Jun;81(6):736–8. Veerbeek JM, Van Wegen EEH, Harmeling-Van der Wel BC, Kwakkel G; EPOS Investigators. Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study. Neurorehabil Neural Repair. 2011 Mar–Apr;25(3):268–74. French B, Thomas L, Leathley M, Sutton C, McAdam J, Forster A, et al. Does repetitive task training improve functional ability after stroke? A cochrane systematic review and meta-analysis. J Rehabil Med. 2010 Jan;42(1):9–14. French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2016 Nov;11(11):CD006073. Lau BM, Xie YJ, Chen Y, Tan HX, Guo QF, Gao Q, et al. Repetitive transcranial magnetic stimulation for lower extremity motor function in patients with stroke: a systematic review and network meta-analysis. Neural Regen Res. 2021 Jun;16(6):1168–76. Fujiwara T, Liu M, Chino N. Effect of pedaling exercise on the hemiplegic lower limb. Am J Phys Med Rehabil. 2003 May;82(5):357–63. Bruni MF, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabro RS. What does best evidence tell us about robotic gait rehabilitation in stroke patients: a systematic review and meta-analysis. J Clin Neurosci. 2018 Feb;48:11–7. Iwamoto Y, Imura T, Suzukawa T, Fukuyama H, Ishii T, Taki S, et al. Combination of exoskeletal upper limb robot and occupational therapy improve activities of daily living function in acute stroke patients. J Stroke Cerebrovasc Dis. 2019 Jul;28(7):2018–25. Weber LM, Stein J. The use of robots in stroke rehabilitation: a narrative review. NeuroRehabilitation. 2018;43(1):99–110. Bertani R, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabro RS, et al. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis. Neurol Sci. 2017 Sep;38(9):1561–9. Taki S, Imura T, Iwamoto Y, Imada N, Tanaka R, Araki H, et al. Effects of exoskeletal lower limb robot training on the activities of daily living in stroke patients: retrospective pre-post comparison using propensity score matched analysis. J Stroke Cerebrovasc Dis. 2020 Oct;29(10):105176. Morishita T, Inoue T. Interactive bio-feedback therapy using hybrid assistive limbs for motor recovery after stroke: current practice and future perspectives. Neurol Med Chir. 2016 Oct;56(10):605–12. Yoshikawa K, Mizukami M, Kawamoto H, Sano A, Koseki K, Sano K, et al. Gait training with hybrid assistive limb enhances the gait functions in subacute stroke patients: a pilot study. NeuroRehabilitation. 2017;40(1):87–97. Tanaka H, Nankaku M, Nishikawa T, Yonezawa H, Mori H, Kikuchi T, et al. A follow-up study of the effect of training using the hybrid assistive limb on gait ability in chronic stroke patients. Top Stroke Rehabil. 2019 Oct;26(7):491–6. Imura T, Nagasawa Y, Inagawa T, Imada N, Izumi H, Emoto K, et al. Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients. J Phys Ther Sci. 2015 May;27(5):1383–6. Imura T, Iwamoto Y, Inagawa T, Imada N, Tanaka R, Toda H, et al. Decision tree algorithm identifies stroke patients likely discharge home after rehabilitation using functional and environmental predictors. J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105636. Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015 Nov;314(17):1832–43. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan;372(1):11–20. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013 Mar;368(10):893–903. Iwamoto Y, Imura T, Tanaka R, Imada N, Inagawa T, Araki H, et al. Development and validation of machine learning-based prediction for dependence in the activities of daily living after stroke inpatient rehabilitation: a decision tree analysis. J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105332. Momosaki R, Abo M, Watanabe S, Kakuda W, Yamada N, Kinoshita S. Effects of ankle-foot-orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database. PLoS One. 2015 Apr 2;10(4):e0122688. Austin PC. A comparison of 12 algorithms for matching on the propensity score. Stat Med. 2014 Mar;33(6):1057–69. Rojek A, Mika A, Oleksy Ł, Stolarczyk A, Kielnar R. Effects of exoskeleton gait training on balance, load distribution, and functional status in stroke: a randomized controlled trial. Front Neurol. 2020 Jan 15;10:1344. Sprigg N, Selby J, Fox L, Berge E, Whynes D, Bath PM, et al. Very low quality of life after acute stroke: data from the efficacy of nitric oxide in stroke trial. Stroke. 2013 Dec;44(12):3458–62. Carod-Artal FJ, Egido JA. Quality of life after stroke: the importance of a good recovery. Cerebrovasc Dis. 2009;27(Suppl 1):204–14. Rådholm K, Arima H, Lindley RI, Wang J, Tzourio C, Robinson T, et al. Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study. Age Ageing. 2015 May;44(3):422–7. Imura T, Inoue Y, Tanaka R, Matsuba J, Umayahara Y. Clinical features for identifying the possibility of toileting independence after convalescent inpatient rehabilitation in severe stroke patients: a decision tree analysis based on a nationwide Japan Rehabilitation Database. J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105483. Umehara T, Tanaka R, Tsunematsu M, Sugihara K, Moriuchi Y, Yata K, et al. Can the amount of interventions during the convalescent phase predict the achievement of independence in activities of daily living in patients with stroke? A retrospective cohort study. J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2436–44. Koyama T, Matsumoto K, Okuno T, Domen K. Relationships between independence level of single motor-FIM items and FIM-motor scores in patients with hemiplegia after stroke: an ordinal logistic modelling study. J Rehabil Med. 2006 Sep;38(5):280–6. Saita K, Morishita T, Arima H, Hyakutake K, Ogata T, Yagi K, et al. Biofeedback effect of hybrid assistive limb in stroke rehabilitation: a proof of concept study using functional near infrared spectroscopy. PLoS One. 2018 Jan 16;13(1):e0191361. Duncan PW, Goldstein LB, Matchar D, Divine GW, Feussner J. Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke. 1992 Aug;23(8):1084–9. Biernaskie J, Chernenko G, Corbett D, Less R. Efficacy of rehabilitative experience declines with time after focal ischemic brain injury. J Neurosci. 2004 Feb;24(5):1245–54. Quinn TJ, Dawson J, Walters MR, Lees KR. Functional outcome measures in contemporary stroke trials. Int J Stroke. 2009 Jun;4(3):200–5. Article / Publication Details

First-Page Preview

Received: August 25, 2022
Accepted: October 07, 2022
Published online: December 14, 2022

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

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