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 |