title: Task-specific ankle robotics gait training after stroke: a randomized pilot study.
abstract: BACKGROUND
  An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments.
  
  
  RESULTS
  Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics.
  
  
  CONCLUSIONS
  Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery.
  
  
  BACKGROUND
  NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1.
authors.affiliation: Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System, Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Forrester
authors.affiliation: Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
authors.forename: Anindo
authors.initials: A
authors.lastname: Roy
authors.affiliation: Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System; Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA.
authors.forename: Charlene
authors.initials: C
authors.lastname: Hafer-Macko
authors.affiliation: Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.|Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.|Department of Physical Medicine and Rehabilitation, Fujita Health University, Toyoake, Aichi Prefecture, Japan.|Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.|Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.
authors.forename: Hermano I
authors.initials: HI
authors.lastname: Krebs
authors.affiliation: Department of Neurology, University of Maryland School of Medicine; University Maryland Rehabilitation & Orthopaedics Institute; Maryland Exercise & Robotics Center of Excellence, Veterans Affairs Maryland Health Care System; Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA. rmacko@grecc.umaryland.edu.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Macko
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation; D010865:Pilot Projects; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*
keywords: Hemiparetic gait; Locomotor training; Robotics; Stroke; Task-specific training