Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke.
OBJECTIVE
Training of the lower extremity (LE) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion. The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone.


METHODS
A single, blind, randomized clinical trial was conducted. Eighteen individuals poststroke participated in a 4-week training protocol. One group trained with the robot virtual reality (VR) system and the other group trained with the robot alone. Outcome measures were temporal features of gait measured in a laboratory setting and the community.


RESULTS
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. Similarly, significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR. These differences were maintained at 3 months' follow-up.


CONCLUSIONS
The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone.
Mirelman
Anat
A
Gait & Neurodynamics Lab, Tel Aviv Medical Center, 6 Weizmann st, Tel Aviv, Israel. mirelman@umdnj.edu
Bonato
Paolo
P
Deutsch
Judith E
JE
D000328:Adult; D000368:Aged; D026241:Exercise Movement Techniques / Q000295:instrumentation / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008124:Locomotion / Q000502:physiology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D010809:Physical Fitness / Q000502:physiology; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012371:Robotics / Q000379:methods*; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013663:Teaching / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface