| 제목 |
Effect of Robot-assisted Gait Training on Brain Reorganization and Locomotion in Subacute Stroke |
| 소속 |
Veterans Health Service Medical Center, Seoul, Department of Physical Medicine and Rehabilitation1, Yonsei University College of Medicine, Brain Korea 21 PLUS Project for Medical Science2 |
| 저자 |
One min Lee1*, Seung-Hwa Lee1, Hee-seung Yang1, Won-Jae Lee1, Hyo-Jung Kang1, Hea-Eun Yang1, Sunghyon Kyeong2, Chang Soon Kang1, Dae Hyun Kim1† |
Objective: Robot-assisted gait training (RAGT) has been suggested as a useful strategy for recovery of walking after stroke. However, there are no reports about the mechanisms of recovery after RAGT. We aimed to identify changes in brain and locomotion in subacute stroke patients after RAGT.
Methods: A prospective open-labeled study of 10 non-ambulatory patients receiving inpatient rehabilitation was performed within 3 months after stroke onset (Fig 1). The RAGT consisted of 45 minutes of gait training with Walkbot (P&S Mechanics, Seoul, South Korea) 3 days per week for 7 weeks. Diffusion tensor imaging data were acquired before and after 20 sessions of RAGT. Clinical outcome measures were evaluated prior to training, after 10 and 20 sessions, and at the 1-month follow-up exam. Clinical outcome measures included the medical Fugl-Meyer assessment of the lower extremity (FMA) score, motricity index (MI) of the lower extremity, functional ambulation category (FAC) and trunk control test (TCT). A paired t-test of white matter fractional anisotropy (FA) was conducted to identify significantly changed regions through 7 weeks of RAGT. Statistical significance was set to AlphaSim corrected p < 0.05, which applied for diffusion tensor imaging data. Friedman’s test with post hoc (Dunn’s procedure) was applied for clinical outcome measures.
Results: After RAGT, the supplementary motor area of the contra-lesional hemisphere had increased FA but the internal capsule, substantia niagra and pedunculopontine nucleus of the lesional hemisphere had decreased FA (AlphaSim corrected p value < 0.05, Fig 2). The FMA, MI, FAC and TCT improved after 20 sessions of RAGT (p < 0.05, Fig 3).
Conclusions: RAGT may help recover locomotor function by facilitating contra-lesional axonal remodeling. However, the decreased FA of the basal ganglia associated regions in the lesional hemisphere may also have clinical importance. |
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Lesion Distribution
Changes of Brain Regions after Robot-assisted Gait Training
Changes of Clinical outcome measurements (T0, baseline; T1, after 10 sessions of Robot-assisted Gait Training (RAGT); T2, after 20 sessions of RAGT; T3, 1-month follow-up)
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