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One of the leading causes of long-term disability in the United States is stroke, affecting approximately 3% of males and 2% of females. Two of the most common complications post stroke include gait instability and falls [2]. Current clinical practice guidelines on locomotor function developed by the American Physical Therapy Association recommend that moderate to high intensity gait training > 60% HR reserve or >70% HRmax should be performed to improve locomotion in individuals recovering from acute CNS injury [3].
With the advancement of soft robotic exosuits, like the ReStore, there is now more effective technology available to clinicians targeted at improving gait and paretic propulsion in the post stroke population, but limited research using this technology in conjunction with APTA recommendations for high intensity gait training exists. Dr. Shin and colleagues chose to explore this very issue through a pilot study focusing on “Soft robotic exosuit augmented high intensity gait training on stroke survivors”. The authors recruited five individuals at least > 6 months post stroke at Shirley Ryan AbilityLab between 18-80 years of age who had observable gait deficits and could ambulate at least 2 minutes without the support of another person, assistive device, or orthotic.
Study Details
Subjects took part in 30-minute sessions ~ 3 times per week for 6-8 weeks totaling 18 sessions. Dr. Shin and colleagues specifically chose 18 sessions for the study duration to mimic the reimbursement guidelines of standard outpatient stroke rehabilitation by Medicare.
The following Assessments were taken pre, after 9 training sessions, and post without use of the soft exosuit or orthotics: 10MWT, 6MWT, FGA, TUG, LE Fugl-Myer Subscale, 2MWT overground and on treadmill. Gait quality measures were also observed at the same intervals using a GAITrite instrumented walkway and IMU Motion Tracking Sensors to record step length, step time, Hip/Knee/Ankle ROM, and Ankle Angular velocity.
The results of this study demonstrate significant improvements pre to post on the 10MWT, 6MWT, FGA, LE Fugle-Meyer Subscale, and 2MWT. 4 Participants achieved the MCID for the 10MWT at self-selected speed, while 3 participants achieved the MCID for the 10MWT at fast speed. 4 participants also achieved the MCID for the 6MWT, while 3 achieved the MDC for the FGA. Significant improvements were also demonstrated in step time of the unaffected side, with an increasing trend toward significant in bilateral step length, as well significant improvements bilaterally for both hip and knee flexion/extension. These results show the efficacy of incorporating high intensity gait training with the ReStore Soft Exosuit to improve gait in the post stroke population.
Of specific note, the authors mention that these results (after just 18 sessions with ReStore) are comparable to a previous traditional high intensity stepping training study conducted without a device that consisted of 36 sessions.
While the subjects in the traditional study had lower baseline scores, the improvements in performance using the ReStore exosuit yielded similar results in half the time, demonstrating the synergetic effect of combining these two therapeutic treatments to improve the lives of individuals post stroke by allowing them to ambulate more effectively and efficiently in their everyday lives.
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References
- Shin, S.Y., Hohl, K., Giffhorn, M. et al. Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study. J NeuroEngineering Rehabil 19, 51 (2022). https://doi.org/10.1186/s12984-022-01034-2
- Virani SS, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–596.
- Hornby et al. Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. Journal of Neurologic Physical Therapy. 2020; 44:1. 49-100. doi: 10.1097/NPT.0000000000000303
- https://www.neuropt.org/practice-resources/anpt-clinical-practice-guidelines/locomotion
- https://www.neuropt.org/practice-resources/best-practice-initiatives-and-resources/intensity_matters
To learn more about the ReStore Exo-Suit for in-clinic gait training as well as other neurorehabilitation topics, check out our Clinician’s Corner Blog
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