title: Structural and functional improvements due to robot-assisted gait training in the stroke-injured brain.
abstract: Robot-assisted gait training (RAGT) can improve walking ability after stroke. Because the underlying mechanisms are still unknown, we analyzed changes in post-stroke injured brains after RAGT. Ten non-ambulatory patients receiving inpatient rehabilitation were examined within 3 months of stroke onset. RAGT consisted of 45min of training, 3days per week. We acquired diffusion tensor imaging (DTI) data before and after 20 sessions of RAGT. Fractional anisotropy (FA) maps were then used to determine neural changes after RAGT. Fugl-Meyer motor assessment of the lower extremity, motricity index of the lower extremity, functional ambulation category, and trunk control tests were also conducted before training, after 10 and 20 RAGT sessions, and at the 1-month follow-up. After RAGT, the supplementary motor area of the unaffected hemisphere showed increased FA, but the internal capsule, substantia nigra, and pedunculopontine nucleus of the affected hemisphere showed decreased FA. All clinical outcome measures improved after 20 sessions of RAGT. Our findings indicate that RAGT can facilitate plasticity in the intact supplementary motor area, but not the injured motor-related areas, in the affected hemisphere.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Hea Eun
authors.initials: HE
authors.lastname: Yang
authors.affiliation: Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sunghyon
authors.initials: S
authors.lastname: Kyeong
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Seung Hwa
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Won-Jae
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Ha
authors.affiliation: Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Radiology, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Hyunkoo
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Won Min
authors.initials: WM
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Chang Soon
authors.initials: CS
authors.lastname: Kang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea. Electronic address: hohoho7490@gmail.com.
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology; D056324:Diffusion Tensor Imaging / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods; D016138:Walking / Q000502:physiology
keywords: Functional recovery; Gait; Plasticity; Rehabilitation; Robotic-assisted therapy; Stroke