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Table 1 Reviewed studies of platform based ankle rehabilitation robot

From: Effectiveness of robot-assisted therapy on ankle rehabilitation – a systematic review

Study Design Subjects Characteristics Age Intervention Measures Outcomes Assumptions
Single Subject Research Designs (SSRD)      
M. Girone, 2000[80] Level V, Case Study N = 4 2 patients exhibited hypermobility secondary to chronic ankle instability and the other 2 presented with hypomobility as the sequelae of fractures 26-81 Rutgers Ankle prototype Displacement and torque The displacement of the uninvolved leg was comparable to normal ROM at the ankle with five degrees of dorsiflexion to 45 degrees of plantarflexion and that of the involved limb reflects a loss of ROM of −10 degrees of dorsiflexion and 28 degrees of plantarflexion; The maximum torque generated by the uninvolved limb was much larger (4 ft · lbs. for dorsiflexion and 8 ft · lbs. for plantarflexion) than that generated by the involved limb (0.5 ft · lbs. for dorsiflexion and 4 ft · lbs. for plantarflexion) Increase in ROM and ankle torque can result in improvements in ankle performance and gait
J. E. Deutsch, 2001[83] Level IV, Single Case Series N = 3 Musculoskeletal ankle injuries 14-56 Rutgers ankle system with a 3-D piloting of an airplane ROM, torque generation capacity and ankle mechanical work Task accuracy improved to 100% for Case 1; a fivefold increase in ankle power output for Case 2 and a three-fold increase for Case 3; both Case 2 and Case 3 reached 100% task accuracy Improved task accuracy means improved ankle performance and gait
J. E. Deutsch, 2001[82] Level IV, Before-After, Single Case N = 1 A left cerebral vascular accident 69 Rutgers ankle system with a 3-D piloting of an airplane Ankle and foot mobility, force generation, coordination and the ability to walk and climb stairs Strength, endurance,task accuracy, coordination, walking and stair-climbing ability improved over six rehabilitation sessions Laboratory functional improvements correlate with activities of daily life
R. F. Boian, 2002[90] Level IV, Single Case Series N = 3 3 patients with post-stroke Mean age: 52 The Rutgers Ankle with two video games Power and walking endurance Increase in power generation for all motions and walking endurance increase for one patient Increase in power generation and walking endurance means improved ankle performance and gait
R. F. Boian, 2003[76] Level IV, Single Case Series N = 3 2 patients had normal sensation and the third had a decrease with 8/12 on the FM lower extremity sensory score Not stated The second version of VR-based ankle rehabilitation system Muscle strength Subject 1 increased strength in all four muscle groups, subject 2 in two muscle groups and subject 3 in three muscle groups Increase in ankle muscle strength means improved ankle performance
J. E. Deutsch, 2004[77] Level IV, Single Case Series N = 6 Post-stroke 41-81 A robotic device (the Rutgers Ankle was the input to the virtual environment) Gait and elevation speed Gait speed increased 11% (p = .08) and elevation time decreased 14% (p = .05); gait endurance increased 11%; gait and elevation speed improved from 0 to 44% and 3 to 33% respectively Improved elevation speed means improvements in ankle performance and gait
R. W. Selles, 2005[75] Level IV, Single Case Series N = 10 spasticity and/or contracture after stroke Mean: 54.6 A feedback-controlled and programmed stretching device ROM, muscle strength, joint stiffness, joint viscous damping, reflex excitability, walking speed, and subjective experiences Significant improvements were found in the passive ROM, maximum voluntary contraction, ankle stiffness, and comfortable walking speed Improved ROM, muscle strength, joint stiffness, joint viscous damping, reflex excitability, walking speed and subjective experiences means improved ankle performance and gait and all these correlate with activities of daily life
D. Cioi, 2011[64] Level IV, Single Case (ABA) N = 1 A child with mild ataxic CP 7 Rutgers Ankle CP Impairment, function and quality of life Strength, motor control, gait function, overall function and qualify of life improved obviously Laboratory functional improvements correlate with activities of daily life
G. C. Burdea, 2012[84] Level V, Case Study N = 3 3 male children with CP 7-12 Rutgers Ankle CP Impairment, function, quality of Life and game performance Strength, motor control, gait function, overall function, qualify of life and game performance improved obviously Laboratory functional improvements correlate with activities of daily life; good game performance means good ankle performance
Group Research Designs (GRD)       
L-Q. Zhang, 2002[78] Level IV, Before-After, Case Control N = 9 5 healthy subjects and 4 chronic stroke patients with ankle contracture and/or spasticity All subjects (36.8 ±12.8), 4 stroke patients (53.2 ± 7.9) A custom-designed joint stretching device ROM, joint stiffness, viscous damping and reflex excitability The passive and active ROM of the ankle joint increased; joint stiffness and viscosity were reduced; reductions in reflex excitability were also observed Increase in ROM, decreased joint stiffness, viscosity and reflex excitability will result in improvements in ankle performance and gait
J. E. Deutsch, 2007[88] Level IV, Before-After (Group performance) N = 6 Post-stroke Not stated Rutgers Ankle prototype robot with VR Accuracy of ankle movement, exercise duration, training efficiency, mechanical power of ankle and number of repetitions All measures improved in the first three weeks and did not decrease during the transition Improved ankle movement accuracy, exercise duration, training efficiency, ankle power and repetitions mean improved ankle performance and gait
K. Homma, 2007[69] Level IV, Case Control, Single Case N = 5 4 healthy subjects and a male with hemiplegia 30-50 A passive exercise device for ankle dorsiflexion and plantarflexion ROM and pressure distribution These improvements were within the margin of the measuring error Improved ROM means improved ankle performance
A. Mirelman, 2008[73] Level II, RCT N = 18 Chronic hemiparesis after stroke VR Group: (61.8 ± 9.94, 41–75); Robotic Group: (61 ± 8.32, 45–71) Rutgers Ankle Rehabilitation System coupled with VR VS Rutgers Ankle Rehabilitation System alone Velocity and distance walked Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone Improved velocity and distance walked mean improved ankle performance and gait
P. Cordo, 2009[67] Level IV, Before-After N = 11 Patients with post-stroke and severe motor disability of the lower extremity 38-75 AMES treatment device for ankles Strength, joint position and motor function Strength increased 10% in most ankles; joint position improved 10% in all ankles; motor function improved significantly Improved strength, joint position and motor function will result in improvements in ankle performance and gait
Y-N. Wu, 2011[58] Level IV, Before-After N = 12 Children with CP 5-15 and mean age is 8 years 6 months A portable rehabilitation robot with computer game PROM, AROM, dorsiflexor and plantarflexor muscle strength, selective control assessment of the lower extremity and functional outcome measures Improvements in dorsiflexion PROM (P = .002), AROM (P = .02), and dorsiflexor muscle strength (P = .001); spasticity of the ankle musculature was reduced (P = .01); selective motor control improved (P = .005); functionally, participants improved balance (P = .0025) and increased walking distance within 6 minutes (P = .025) Improved dorsiflexor ROM and muscle strength, decreased ankle spasticity, improved motor control improved ankle performance and gait; laboratory functional improvements in terms of balance and walking distance correlate with activities of daily life
G. Waldman, 2011[86] Level IV, Before-After N = 8 Stroke survivors 50.4 ± 8.9 A portable ankle rehabilitation robot Active dorsiflexion range, dorsiflexor muscle strength, the average MAS, STREAM and Berg Balance Active dorsiflexion range and dorsiflexor muscle strength improved (p = 0.001 and 0.01, respectively) as well as the average MAS, STREAM, Berg Balance (p = 0.04, 0.03, 0.04) Improved active dorsiflexion range, dorsiflexor muscle strength and the average MAS, STREAM, Berg Balance mean improved ankle performance and gait