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Table 2 Reviewed studies of wearable 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)

     

J. Furusho, 2007[70]

Level V, Case Study

N = 1

A man (case: right ankle flaccid paralysis; height: 157 cm; weight: 44 kg)

59

An AFO with MR brake

Ankle angle, reaction force and a bending moment

In swing phase, the subject can maintain the dorsal flexion and prevent the drop foot; the subject can contact ground at heel; at contact ground, GRF doesn’t lack smoothness; maximal value of a bending moment with control is larger than one without control; walking cycle is shorter than one without control

Preventing drop foot in swing phase and slap foot at heel strike can result in gait improvement

S. Tanida, 2009[79]

Level V, Case Study

N = 1

A patient of the Guillain-Barre syndrome (183 cm and 83.1 kg)

34

I-AFO

Ankle joint angle and reaction force

The foot clearance in the swing phase was kept effectively by preventing the drop foot and the initial contact occurred in the primary stance phase normally

Preventing drop foot effectively in swing phase means good ankle joint control and performance

Y. Ren, 2011[68]

Level V, Case Study

N = 4

Acute post-stroke

Not stated

A wearable robot for in-bed acute stroke rehabilitation

Passive and active biomechanical properties

Changes of passive and active biomechanical properties can be detected

These changes contribute to ankle performance and gait

L. W. Forrester, 2011[66]

Level IV, Single Case Series

N = 8

Chronic stroke

62.4 ± 10.4

A visually guided, impedance controlled, ankle robotic intervention

Ankle ROM, strength, motor control, and overground gait function

Increased target success, faster and smoother movements, walking velocity whereas durations of paretic single support increased and double support decreased

Improved target success, movement and walking velocity contribute to ankle performance and they correlate with activities of daily life

K. McGehrin, 2012[65]

Level V, Case Study

N = 2

Sub-acute stroke

Not stated

A single session of anklebot training

Ankle motor control

Increased targeting accuracy, faster speed and smoother movements.

Improved target success, movement and walking velocity contribute to ankle performance and they correlate with activities of daily life

Group Research Designs (CRD)

     

J. A. Blaya, 2004[63]

Level IV, Before-After

N = 5

2 drop-foot subjects and 3 normal participants

62, 62, 66, 67, 67

AAFO

Occurrence of slap foot and swing phase ankle kinematics

The occurrence of slap foot was reduced and swing phase ankle kinematics more closely resembled normal compared to zero and constant control schemes

Decreased slap foot means improved ankle performance and gait

M. M. Mirbagheri, 2005[89]

Level IV, Before-After

N = 5

Incomplete SCI

Not stated

Robotic- Assisted Locomotor Training

Reflex stiffness, ROM, peak-velocity, peak-acceleration

Reflex stiffness was significantly reduced after training; voluntary movement of ankle plantarflexion and dorsiflexion were substantially improved

Decreased ankle stiffness and increased ankle movement mean improvements in ankle performance and gait

G. S. Sawicki, 2006[71]

Level IV, Before–After

N = 5

Chronic incomplete SCI

44.6 ± 13.4

PAFO

Push-off kinematics and muscle activation amplitude

Assistance from PAFO improved ankle push-off kinematics without large decreases in muscle activation

Improvement in push-off kinematics means improved gait function

J. Ward, 2010[87]

Level IV, Before-After, Single Case Series

N = 3

stroke syndrome

60, 48 and 48

PAFO

Robot Assisted Gait

Six-minute walk test showed an increase in distance walked for subjects 1 and 3

Laboratory functional improvement in six-minute walk correlates with activities of daily life

L. F. Chin, 2010[74]

Level IV, Before-After

N = 23

Both inpatients and outpatients with mobility problems secondary to an acquired brain injury

51 ± 13, 26-68

A robotic-assisted locomotor training device

Functional independence measure (FIM), the Rivermead Motor Assessment (RMA) gross function subscale and Motricity Index (MI)

FIM transfer improved (p is less than 0.05); FIM ambulation improved (p is less than 0.05); RMA improved (p is less than 0.05) and MI of ankle dorsiflexion improved (p is less than 0.05)

Laboratory functional improvement correlates with activities of daily life

k. A. Shorter, 2011[81]

Level IV, Case Control, Single Case

N = 4

3 nondisabled male volunteer subjects and 1 male volunteer subject with a diagnosis of CES

Nondisabled volunteer subjects (26 ± 4) and a patient (51)

A novel PPAFO

PPAFO System performance characteristics and functional walking

Data from nondisabled walkers demonstrated functionality and data from an impaired walker demonstrated the ability to provide functional plantar flexor assistance

Providing functional assistance contributes to ankle rehabilitation

M. M. Mirbagheri, 2011[72]

Level IV, Before-After

N = 10

Incomplete SCI

Not stated

Robotic- Assisted Locomotor Training

Passive stiffness, reflex stiffness and maximum voluntary contraction (MVC)

Reflex stiffness and intrinsic stiffness was respectively reduced up to 65% and 60% after LOKOMAT training; MVCs were increased up to 93% in ankle extensors and 180% in ankle flexors following 4-week training

Decreased ankle stiffness and increased ankle movement mean improvements in ankle performance and gait

A. Roy, 2011[85]

Level IV, Before-After Case Control

N = 14

7 chronic stroke who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects

Stroke subjects: 63.7 ± 10.5, 43–75; nondisabled subjects: 56.5 ± 7.5, 50-64

A single session of Impedance-controlled ankle robot (anklebot)

Ankle motor control

Increased targeting accuracy (21.6 ± 8.0 to 31.4 ± 4.8, p = 0.05), higher angular speeds (mean: 4.7 ± 1.5 degrees/s to 6.5 ± 2.6 degrees/s, p < 0.01, peak: 42.8 ± 9.0 degrees/s to 45.6 ± 9.4 degrees/s, p = 0.03), and smoother movements (normalized jerk: 654.1 ± 103.3 s–2to 537.6 ± 86.7 s–2, p < 0.005, number of speed peaks: 27.1 ± 5.8 to 23.7 ± 4.1, p < 0.01) while nondisabled subjects did not make significant gains except in the number of successful passages (32.3 ±7.5 to 36.5 ± 6.4, p = 0.006)

Improved target accuracy, movement and angular speed mean improvements in ankle performance and gait