Addressing lower limb disabilities in stroke survivors is crucial for enhancing gait patterns and overall mobility.
Objective
This study aimed to develop an active-control foot press trainer (AFPT) to strengthen lower extremity muscles to improve rehabilitation outcomes.
Methods
This study utilized AFPT to examine the effects of different exercise types (forefoot exercise, FFE; Rearfoot Exercise, RFE) and intensities (30 and 15 repetition maxima) on lower limb muscle activity. Ten healthy women participated in the evaluation of muscle activation during ankle exercises in the standing position.
Results
The FFE primarily activated the Tibialis Anterior (TA), Gastrocnemius Medialis (GM), and Gastrocnemius Lateralis (GL), whereas the RFE engaged the Rectus Femoris (RF). Increased exercise intensity led to higher activity in the GM and GL in the FFE and TA in the RFE, indicating the potential for tailored exercise protocols.
Conclusions
AFPT is a valuable tool for personalized rehabilitation, allowing variable exercise methods and intensities. Further research is needed to assess the efficacy of AFPT in a broader population, including stroke survivors. Moreover, enhancing AFPT technology and developing diverse training programs are crucial as these advancements will significantly support the rehabilitation of individuals requiring lower limb and gait training, including stroke survivors.
AlgurénBLundgren-NilssonASunnerhagenKS. Functioning of stroke survivors – a validation of the ICF core set for stroke in Sweden. Disabil Rehabil2009; 32: 551–559.
2.
LiSFranciscoGEZhouP. Post-stroke hemiplegic gait: new perspective and insights. Front Physiol2018; 9: 1021.
3.
SelvesCStoquartGLejeuneT. Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes, and timing for interventions. Acta Neurol Belg2020; 120: 783–790.
4.
PerryJBurnfieldJ. Gait analysis: normal and pathological function. 2nd ed. West Deptford (NJ): Slack Incorporated, 2010.
5.
PerryJClarkD. Biomechanical abnormalities of post-polio patients and the implications for orthotic management. Neurorehabilitation1997; 8: 119–138.
6.
YavuzerGGeler-KülcüDSonel-TurB, et al.Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil2006; 87: 536–540.
7.
HankeyGJ. Stroke. Lancet2017; 389: 641–654.
8.
ZhangMZhuGNandakumarA, et al.A virtual-reality tracking game for use in robot-assisted ankle rehabilitation. In: 2014 IEEE/ASME 10th international conference on mechatronic and embedded systems and applications (MESA), 2014, pp.1–4.
9.
KhalidYMGouwandaDParasuramanS. A review on the mechanical design elements of ankle rehabilitation robot. Proc Inst Mech Eng H J Eng Med2015; 229: 452–463.
10.
LiJZhangZTaoC,et al.A number synthesis method of the self-adapting upper-limb rehabilitation exoskeletons. Int J Adv Robot Syst2017; 14: 1–14.
11.
LathamNKJetteDUWarrenRL,et al.Pattern of functional change during rehabilitation of patients with hip fracture. Arch Phys Med Rehabil2006; 87: 111–116.
12.
BurdeaGCCioiDKaleA, et al.Robotics and gaming to improve ankle strength, motor control, and function in children with cerebral palsy—a case study series. IEEE Trans Neural Syst Rehabil Eng2012; 21: 165–173.
13.
ZhuGZengXZhangM, et al.Robot-assisted ankle rehabilitation for the treatment of drop foot: a case study. In: 2016 12th IEEE/ASME international conference on mechatronic and embedded systems and applications (MESA), 2016, pp.1–5.
14.
ChenGChanCKGuoZ,et al.A review of lower extremity assistive robotic exoskeletons in rehabilitation therapy. Crit Rev Biomed Eng2013; 41: 343–363.
15.
HidlerJNicholsDPelliccioM, et al.Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair2009; 23: 5–13.
16.
ZeiligGWeingardenHZweckerM, et al.Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study. J Spinal Cord Med2012; 35: 96–101.
17.
DíazIGilJJSánchezE. Lower limb robotic rehabilitation: literature review and challenges. J Rob2011; 2011: 1–11.
18.
LandersM. Treatment-induced neuroplasticity following focal injury to the motor cortex. Int J Rehabil Res2004; 27: 1–5.
19.
MorenoJCBarrosoFFarinaD, et al.Effects of robotic guidance on the coordination of locomotion. J Neuroeng Rehabil2013; 10: 1–15.
20.
ChangJLLinRYSaulM, et al.Intensive seated robotic training of the ankle in patients with chronic stroke differentially improves gait. NeuroRehabilitation2017; 41: 61–68.
21.
YooDSonYKimDH, et al.Technology-assisted ankle rehabilitation improves balance and gait performance in stroke survivors: a randomized controlled study with 1-month follow-up. IEEE Trans Neural Syst Rehabil Eng2018; 26: 2315–2323.
22.
HeoJSLeeHJKoBW, et al.Usability of the novel ankle training equipment with spring resistance-based plantar press exercises in the standing position: a focus on chronic stroke patients with hemiplegic gait. Technol Health Care.2023; 32: 1149–1158.
23.
HermensHFreriksBDisselhorst-KlugC,et al.Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol2000; 10: 361–374.
24.
DelagiEFHammondPBPerottoA,et al.Anatomical guide for the electromyographer: the limbs and trunk. Springfield (IL): Charles C Thomas, 2005.
25.
LinCYTsaiLCPressJ, et al.Lower-limb muscle-activation patterns during off-axis elliptical compared with conventional gluteal-muscle-strengthening exercises. J Sport Rehabil2016; 25: 164–172.
26.
WestSGFinchJHCurranPJ. Structural equation models with nonnormal variables: problems and remedies. In: HoyleRH (eds) Structural equation modeling: Concepts, issues and applications. Thousand Oaks, CA: Sage, 1995: 56–75.
27.
NolanKJYarossiMMcLaughlinP. Changes in center of pressure displacement with the use of a foot drop stimulator in individuals with stroke. Clin Biomech2015; 30: 755–761.
28.
NeumannDA. Kinesiology of the musculoskeletal system: foundations for rehabilitation. Oxford: Elsevier Health Sciences, 2016.
29.
HussainSJamwalPKVlietPV,et al.Robot assisted ankle neuro-rehabilitation: state of the art and future challenges. Expert Rev Neurother2021; 21: 111–121.
30.
PayedimarriABRattiMRescinitoR, et al.Effectiveness of platform-based robot-assisted rehabilitation for musculoskeletal or neurologic injuries: a systematic review. Bioengineering2022; 9: 129.
31.
ForresterLWRoyAKrebsHI,et al.Ankle training with a robotic device improves hemiparetic gait after a stroke. Neurorehabil Neural Repair2011; 25: 369–377.
32.
SellesRWLiXLinF, et al.Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. Arch Phys Med Rehabil2005; 86: 2330–2336.
33.
WaldmanGYangCYRenY. Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke. NeuroRehabilitation2013; 32: 625–634.
34.
ChoJELeeWHShinJH,et al.Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: a randomized controlled pilot study. Gait Posture2021; 87: 177–183.
