Hideyuki Saitou

Locomotion Improvement Using a Hybrid Assistive Limb in Recovery Phase Stroke Patients: A Randomized Controlled Pilot Study

OBJECTIVE To compare the efficacy of gait training using a single-leg version of the Hybrid Assistive Limb (HAL) on the paretic side with conventional gait training in individuals with subacute stroke. DESIGN Randomized open controlled pilot trial. SETTING Hospitalized care. PARTICIPANTS Convenience sample of 44 patients who met the criteria; 12 patients refused. After randomization (N=32), 10 patients withdrew and a total of 22 poststroke participants (HAL group: n=11; conventional group: n=11) completed the randomized controlled trial. INTERVENTIONS All participants received twelve 20-minute sessions in 4 weeks of either HAL (wearing the single-leg version of the HAL on their paretic side) or conventional (performed by skilled and experienced physical therapists) gait training. MAIN OUTCOME MEASURES Outcome measures were evaluated prior to training and after 12 sessions. Functional Ambulation Category (FAC) was the primary outcome measure, whereas secondary outcome measures included maximum walking speed, timed Up and Go test, 6-minute walk distance, Short Physical Performance Battery, Fugl-Meyer Assessment of Lower Extremity, and isometric muscle strength (hip flexion and extension, knee flexion and extension). RESULTS No participants withdrew because of adverse effects. Participants who received gait training with the HAL showed significantly more improvement in the FAC than those who received conventional gait training (95% confidence interval, .02-.88; P=.04). Secondary measures did not differ between the 2 groups. CONCLUSIONS The results obtained in this randomized controlled trial suggest that a gait training program with the HAL could improve independent walking more efficiently than conventional gait training.

Development of a gait rehabilitation system using a locomotion interface

A locomotion interface (LI) is a piece of equipment that can give a user the sense that he/she is walking while his/her actual position remains localized in the real world. We developed an LI system (GaitMaster2) that has two footpads, which can move to represent a virtual terrain for each users foot. In this research, we applied our LI to gait rehabilitation. The footpads on our LI follow a pre-recorded motion sequence to move the users feet. We conducted evaluation tests with the assistance of hemiplegic patients. The effectiveness of our system was verified through EMG, video analysis and the measurement of physical values such as average velocity. Copyright

Effects of gait rehabilitation with a footpad-type locomotion interface in patients with chronic post-stroke hemiparesis: a pilot study:

Objective: We developed a footpad-type locomotion interface called the GaitMaster. The purpose of this pilot study was to examine the effects of gait rehabilitation using the GaitMaster in chronic stroke patients. Design: Randomized cross-over design. Setting: An outpatient department. Subjects: Twelve patients with chronic post-stroke hemiparesis. Intervention: In group A, patients underwent an ‘intervention phase’ followed by a ‘non-intervention phase’, whereas in group B, patients underwent the non-intervention phase first, followed by the intervention phase. In the four- or six-week intervention phase, participants underwent twelve 20-minute sessions of gait rehabilitation using the GaitMaster4. Main outcome measures: We measured gait speed and timed up-and-go test. Results: No differences between the two groups were observed in the baseline clinical data. For the combined groups A and B, the maximum gait and timed up-and-go test speeds improved significantly only in the intervention phase (P = 0.0001 and P = 0.003, respectively). The percentages of improvement from baseline at the end of GaitMaster training were 16.6% for the maximum gait speed and 8.3% for the timed up-and-go test. The effect size for GaitMaster4 training was 0.58 on the maximum gait speed and 0.43 on the timed up-and-go test. Conclusions: This pilot study showed that gait rehabilitation using the GaitMaster4 was a feasible training method for chronic stroke patients. Calculation of the sample size indicated that a sample size of 38 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation for chronic stroke patients in a future randomized controlled trial.

Gait rehabilitation system for stair climbing and descending

This paper describes the development of a gait rehabilitation system with a locomotion interface (LI) for stair climbing or descending. The LI consists of two 2 DOF manipulators equipped with footpads. These can move the users feet while his or her body remains stationary. The footpads follow the prerecorded motion of the feet of a healthy individual. For gait training, the user progresses iteratively through successively more advanced modes. In this study, three modes, enforced stair climbing/descending, semi-voluntary stair climbing/descending, and real stair climbing/descending were used. Comparisons were made between the modes for healthy individuals and a patient. The effectiveness of the system was examined using EMG and foot pressure data.

Improvement of gait ability with a short-term intensive gait rehabilitation program using body weight support treadmill training in community dwelling chronic poststroke survivors

[Purpose] Most previous studies have shown that body weight support treadmill training (BWSTT) can improve gait speed poststroke patients. The purpose of this study was to evaluate effectiveness of a short-term intensive program using BWSTT among community dwelling poststroke survivors. [Subjects] Eighteen subjects participated in this study. The treatment group was composed of 10 subjects (2 women; 8 men; mean age, 59.1 ± 12.5 years; time since stroke onset, 35.3 ± 33.2 months), whereas the control group was made up of 8 subjects (3 women; 5 men; mean age, 59.8 ± 6.3 years; time since stroke onset, 39.3 ± 27.3 months). [Methods] The treatment group received BWSTT 3 times a week for 4 weeks (a total of 12 times), with each session lasting 20 minutes. The main outcome measures were maximum gait speed on a flat floor, cadence, and step length. [Results] No differences were observed in the baseline clinical data between the 2 groups. The gait speed in the treatment group was significantly improved compared with that in the control by 2-way ANOVA, while the other parameters showed no significant interaction. [Conclusion] These results suggested that short-term intensive gait rehabilitation using BWSTT was useful for improving gait ability among community dwelling poststroke subjects.

Gait rehabilitation for stair climbing with a locomotion interface

This paper describes the development of a gait rehabilitation system with a locomotion interface (LI). The LI consists of two 2 DOF manipulators equipped with footpads. These can move the users feet while his or her body remains stationary. The footpads follow the prerecorded motion of the feet of a healthy individual. For gait training, the user progresses iteratively through successively more advanced modes. In this study, three modes, enforced stair climbing, semi-voluntary stair climbing, and real stair climbing were used. Comparisons were made between the modes for healthy individuals and a patient. The effectiveness of the system was examined using NIRS and foot pressure distribution data.

Development of a Portable Gait Rehabilitation System for Home-Visit Rehabilitation

This paper describes the development of a gait rehabilitation system with a locomotion interface (LI) for home-visit rehabilitation. For this purpose, the LI should be compact, small, and easy to move. The LI has two 2 degree-of-freedom (DOF) manipulators with footpads to move each foot along a trajectory. When the user stands on the footpads, the system can move his or her feet while the body remains stationary. The footpads can have various trajectories, which are prerecordings of the movements of healthy individuals walking on plane surfaces or slopes. The homes of stroke patients may have not only flat surfaces but also some slopes and staircases. The quadriceps femoris muscle is important for walking up and down slopes and staircases, and the eccentric and concentric contractions of this muscle are, in particular, difficult to train under normal circumstances. Therefore, we developed a graded-walking program for the system used in this study. Using this system, the user can undergo gait rehabilitation in their home, during visits by a physical therapist. An evaluation of the results of tests showed that the vastus medialis muscles of all the subjects were stimulated more than by walking on real slopes.

Motion improvement for stairs climbing and descending with gait rehabilitation system

This paper describes the development of a gait rehabilitation system with a locomotion interface (LI) for stair climbing or descending. The LI consists of two 2 DOF manipulators equipped with footpads. These can move the users feet while his or her body remains stationary. The footpads follow the prerecorded motion of the feet of a healthy individual. For gait training, the user progresses iteratively through successively more advanced modes. In this study, three modes, enforced stair climbing/descending, semi-voluntary stair climbing/descending, and real stair climbing/descending were used. Especially gait trajectories for the stairs climbing/descending were improved to realize valid weight shift motion. Comparisons were made between the modes for healthy individuals and a patient. The effectiveness of the system was examined using EMG and foot pressure data.