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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