Earticle

본 연구는 기능적 다리 길이 차이가 있는 성인을 대상으로 깔창 착용 하지 보행 훈련이 골반 불균형과 보행 패턴에 미치는 영향을 분석하여, 불균형 체형을 위한 효율적인 중재 방안을 제시하고자 하였다. 20대 성인 21명을 대상으로 4주간 주 3회, 회당 30분씩 깔창 착용 보행 훈련을 실시하였다. 전신 자세 분석기와 광전식 보 행 분석기를 활용하여 중재 전후의 골반 정렬과 보행 변수를 측정 및 비교하였다. 분석 결과, 골반 높이 비대칭 과 좌·우 골반 경사각은 중재 전후 유의한 변화가 없었다(p>0.05). 그러나 보행 분석에서는 디딤기 감소, 흔듦기 증가, 보폭 및 보폭 시간의 증가 등 유의미한 보행 지표 향상이 나타났다(p<0.05). 이는 깔창 착용이 골반의 구조 적 정렬 변화를 즉각 유도하기보다는, 하지 정렬의 안정성을 높여 보행의 효율성과 기능적 패턴을 개선하는 데 더 효과적임을 시사한다. 반면, 접촉 시간 변화는 통계적으로 유의하지 않았다. 깔창 기반 보행 훈련의 기능적 개 선 효과를 확인했으며, 향후 대조군을 포함한 장기 추적 연구가 필요하다.

This study aimed to analyze the effects of gait training with insoles on pelvic imbalance and gait patterns in adults with functional leg length discrepancy, suggesting an effective intervention for postural imbalance. Twenty-one adults in their 20s underwent gait training wearing insoles for 30 minutes per session, three times a week for four weeks. Pelvic alignment and gait variables were measured before and after the intervention using a full-body posture analyzer and an optoelectronic gait analysis system. The results showed no significant changes in pelvic height asymmetry or bilateral pelvic tilt angles (p>0.05). However, gait analysis revealed significant improvements in indicators, including decreased stance phase, increased swing phase, and increased step length and step time (p<0.05). This suggests that wearing insoles is more effective in enhancing gait efficiency and functional patterns by improving lower limb stability rather than inducing immediate structural changes in pelvic alignment. Changes in contact time were not statistically significant. This study confirmed the functional improvement effects of insole-based gait training; future research involving control groups and long-term follow-up is required.

Objective To measure muscle activity before and after robot-assisted gait training (RAGT) in patients with stroke and examine the differences in muscle activity changes compared with conventional gait training (CGT).Methods Thirty patients with stroke (RAGT group, n=17; CGT group, n=13) participated in the study. All patients underwent RAGT using a footpad locomotion interface or CGT for 20 minutes for a total of 20 sessions. Outcome measures were lower-limb muscle activity and gait speed. Measurements were performed before the start of the intervention and after the end of the 4-week intervention.Results The RAGT group showed increased muscle activity in the gastrocnemius, whereas the CGT group showed high muscle activity in the rectus femoris. In the terminal stance of the gait cycle, the gastrocnemius, the increase in muscle activity was significantly higher in the RAGT group than in the CGT group.Conclusion The results suggest that RAGT with end-effector type is more effective than CGT to increase the gastrocnemius muscle activity.

Objective To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment.Methods A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis.Results The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group.Conclusion Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury.

Objective To investigate the effect of antigravity treadmill gait training (AGT) on gait function, balance, and fall risk in stroke patients.Methods This study included 30 patients with stroke (mean age, 73 years). All subjects were randomly divided into two groups. The intervention group (n=15) performed AGT for 20 minutes, five times per week for 4 weeks. The control group (n=15) received conventional gait training for the same duration. To assess fall risk, the Tinetti Performance-Oriented Mobility Assessment (POMA) was measured. The Berg Balance Scale (BBS), Timed Up and Go test (TUG), and 10-m walk test (10mWT) were measured to assess dynamic balance. All scales were measured before intervention (T0) and at 4 weeks (T1) and 12 weeks (T2) after intervention. Results Results showed that the total POMA score, BBS, and 10mWT scores improved significantly (p<0.05) at T1 and T2 in both groups. The POMA gait score (4.20±1.37 at T1, 4.87±1.36 at T2) and TUG (4.52±4.30 at T1, 5.73±4.97 at T2) significantly improved (p<0.05) only in the intervention group. The changes in total POMA score and BBS of the intervention group (7.20±2.37, 7.47±3.07) improved more significantly (p<0.05) between T0 and T2 than the control group (2.53±2.10, 2.87±2.53). Conclusion Our study showed that AGT enhances dynamic balance and gait speed and effectively lowers fall risk in stroke patients. Compared to conventional gait therapy, AGT would improve gait function and balance in stroke patients more effectively.

Spinal cord injury (SCI) rehabilitation emphasizes locomotion. Robotic-assisted gait training (RAGT) is widely used in clinical settings because of its benefits; however, its efficacy remains controversial. We conducted a systematic review and meta-analysis to investigate the efficacy of RAGT in patients with SCI. We searched international and domestic databases for articles published until April 18, 2024. The meta-analysis employed a random effects model to determine the effect size as either mean difference (MD) or standardized MD (SMD). Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-three studies with a total of 690 participants were included in the final analysis. The overall pooled effect size for improvement in activities of daily living was 0.24, with SMD (95% confidence interval [95% CI], 0.04?0.43; GRADE: high) favoring RAGT over conventional rehabilitation. Muscular strength (MD, 0.23; 95% CI, 0.02?0.44; GRADE: high), walking index for SCI (MD, 0.31; 95% CI, 0.07?0.55; GRADE: moderate) and 6 min walk test distance (MD, 0.38; 95% CI, 0.14?0.63; GRADE: moderate) showed significant improvement in the robot group. Subgroup analysis revealed that subacute patients and intervention periods >2 months were more effective. This meta-analysis revealed that RAGT significantly improved activities of daily living, muscular strength, and walking abilities. Additional studies are needed to identify the optimal treatment protocol and specific patient groups for which the protocol is most effective.

Quadruple amputation, defined as the loss of all four limbs, is an exceptionally rare condition. Conventional gait training is particularly challenging in this population because the absence of upper limbs limits the ability to grasp assistive devices that are essential for maintaining balance and stability during walking. End-effector robot-assisted gait training offers an alternative rehabilitation strategy that enables upright mobility and task-specific gait training for patients who experience substantial difficulty performing conventional gait training. This approach provides safe, repetitive, and hands-free gait training for individuals with quadruple amputation, resulting in measurable improvements in balance, ground reaction force, and functional mobility. We report two cases of successful amputee gait rehabilitation using an end-effector?type gait robot in two females (aged 72 and 51 years) with quadruple amputation.

Objective To determine the effect of robotic-assisted gait training (RAGT) compared to conventional overground training.Methods Sixty patients with motor incomplete spinal cord injury (SCI) were included in a prospective, randomized clinical trial by comparing RAGT to conventional overground training. The RAGT group received RAGT three sessions per week at duration of 40 minutes with regular physiotherapy in 4 weeks. The conventional group underwent regular physiotherapy twice a day, 5 times a week. Main outcomes were lower extremity motor score of American Spinal Injury Association impairment scale (LEMS), ambulatory motor index (AMI), Spinal Cord Independence Measure III mobility section (SCIM3-M), and walking index for spinal cord injury version II (WISCI-II) scale. Results At the end of rehabilitation, both groups showed significant improvement in LEMS, AMI, SCIM3-M, and WISCI-II. Based on WISCI-II, statistically significant improvement was observed in the RAGT group. For the remaining variables, no difference was found.Conclusion RAGT combined with conventional physiotherapy could yield more improvement in ambulatory function than conventional therapy alone. RAGT should be considered as one additional tool to provide neuromuscular reeducation in patient with incomplete SCI.

Objective To identify the clinical characteristics of proper robot-assisted gait training group using exoskeletal locomotor devices in non-ambulatory subacute stroke patients.Methods A total of 38 stroke patients were enrolled in a 4-week robotic training protocol (2 sessions/day, 5 times/week). All subjects were evaluated for their general characteristics, Functional Ambulatory Classification (FAC), Fugl-Meyer Scale (FMS), Berg Balance Scale (BBS), Modified Rankin Scale (MRS), Modified Barthel Index (MBI), and Mini-Mental Status Examination (MMSE) at 0, 2, and 4 weeks. Statistical analysis were performed to determine significant clinical characteristics for improvement of gait function after robot-assisted gait training. Results Paired t-test showed that all functional parameters except MMSE were improved significantly (p<0.05). The duration of disease and baseline BBS score were significantly (p<0.05) correlated with FAC score in multiple regression models. Receiver operating characteristic (ROC) curve showed that a baseline BBS score of ‘9’ was a cutoff value (AUC, 0.966; sensitivity, 91%?100%; specificity, 85%). By repeated-measures ANOVA, the differences in improved walking ability according to time were significant between group of patients who had baseline BBS score of ‘9’ and those who did not have baseline BBS score of ‘9’. Conclusion Our results showed that a baseline BBS score above ‘9’ and a short duration of disease were highly correlated with improved walking ability after robot-assisted gait training. Therefore, baseline BBS and duration of disease should be considered clinically for gaining walking ability in robot-assisted training group.

Objective To determine the efficacy of aquatic treadmill training (ATT) as a new modality for stroke rehabilitation, by assessing changes in gait symmetry, balance function, and subjective balance confidence for the paretic and non-paretic leg in stroke patients.Methods Twenty-one subacute stroke patients participated in 15 intervention sessions of aquatic treadmill training. The Comfortable 10-Meter Walk Test (CWT), spatiotemporal gait parameters, Berg Balance Scale (BBS), and Activities-specific Balance Confidence scale (ABC) were assessed pre- and post-interventions.Results From pre- to post-intervention, statistically significant improvements were observed in the CWT (0.471± 0.21 to 0.558±0.23, p<0.001), BBS (39.66±8.63 to 43.80±5.21, p<0.001), and ABC (38.39±13.46 to 46.93±12.32, p<0.001). The step-length symmetry (1.017±0.25 to 0.990±0.19, p=0.720) and overall temporal symmetry (1.404± 0.36 to 1.314±0.34, p=0.218) showed improvement without statistical significance.Conclusion ATT improves the functional aspects of gait, including CWT, BBS and ABC, and spatiotemporal gait symmetry, though without statistical significance. Further studies are required to examine and compare the potential benefits of ATT as a new modality for stroke therapy, with other modalities.

Objective To elucidate the effect of task-specific lower extremity training (TSLET) on cognitive and gait function in stroke patients. Methods Thirty-eight patients were assigned to either the TSLET group or the control group. The individuals of TSLET group went through a TSLET plus conventional physical therapy. The control group received two sessions of conventional physical therapy. The primary outcome involved the assessment with visual and auditory digit span test. The secondary outcome was evaluated by the Korean version of Mini-Mental State Examination (K-MMSE) and Global Deterioration Scale (GDS) for cognitive function, Berg Balance Scale (BBS), Time Up and Go Test (TUG), 10 meters Walking Test (10mWT), 6 minutes Walking Test (6MWT), and Korean version of Modified Barthel Index (K-MBI) for gait, balance, and functional ability. Results After intervention (3 weeks) and 2 weeks of follow-up, the TSLET group showed statistically significant improvement in the visual digit span test backwards compared with the control group. In secondary outcome, a significant improvement was observed in GDS, BBS, TUG, and 10mWT in the TSLET group. There was no significant difference between the two groups concerning visual digit span test forward, auditory forward and backward digit span tests, K-MMSE, 6MWT, and K-MBI. Conclusion TSLET could be a useful alternative strategy for improving cognitive and gait function in stroke patients.

Objective To investigate the clinical feasibility of a newly developed, portable, gait assistive robot (WA-H, ‘walking assist for hemiplegia’) for improving the balance function of patients with stroke-induced hemiplegia. Methods Thirteen patients underwent 12 weeks of gait training on the treadmill while wearing WA-H for 30 minutes per day, 4 days a week. Patients’ balance function was evaluated by the Berg Balance Scale (BBS), Fugl- Meyer Assessment Scale (FMAS), Timed Up and Go Test (TUGT), and Short Physical Performance Battery (SPPB) before and after 6 and 12 weeks of training. Results There were no serious complications or clinical difficulties during gait training with WA-H. In three categories of BBS, TUGT, and the balance scale of SPPB, there was a statistically significant improvement at the 6th week and 12th week of gait training with WA-H. In the subscale of balance function of FMAS, there was statistically significant improvement only at the 12th week. Conclusion Gait training using WA-H demonstrated a beneficial effect on balance function in patients with hemiplegia without a safety issue.

Purpose: This study aimed to examine the effects of backward gait training of body weight support treadmill combined with functional electric Stimulation (FES) on balance and gait ability in chronic stroke patients. Methods: Five traumatic brain injury (TBI) participants were participated in the study. Each participant received backward gait training of body weight support treadmill program combined with FES. An evaluation was performed before the training was commenced and again 8 weeks after the training was initiated. We measured balance ability, center of pressure (COP), limited of stability (LOS), berg balance scale (BBS), gait ability (Optogait) and 10-Meter walking test (10WT). Results: In balance and gait ability, participants showed a significant difference between pre- and postintervention (p<.05). Conclusion: The backward gait training of body weight support treadmill combined with FES resulted in significant improvements in balance and gait ability.

The aim of this review was to evaluate, summarize and discuss the available literature concerning the effect of robot-assisted gait training (RAGT) on patient with Parkinson disease (PD) and freezing of gait (FOG). A comprehensive literature search was conducted utilizing of MEDLINE, Embase, Scopus, Web of Science, PEDro (Physiotherapy Ev-idence Database), and the Cochrane Review. Search terms used in-cluded ‘Parkinson disease,’ ‘Freezing of gait,’ ‘RAGT,’ ‘robot-assisted gait training,’ ‘Locomotor rehabilitation,’ ‘gait trainer,’ and ‘robotics as-sisted gait training.’ A total of 4 studies were evaluated, but these stud-ies were primarily of low-level evidence. All the 4 studies noted positive outcomes with using RAGT on FOG. No adverse events or side effects that occurred during and/or after the interventions. While the current literature generally offers support for the use of RAGT for FOG treat-ment, there is a paucity of strong evidence to support its widespread use. The increasing availability of RAGT technology offers the potential for engaging therapy in FOG rehabilitation, but its utility remains uncer-tain given the limited studies available at this time.

The purpose of this study was to investigate the effects of progressive treadmill cognitive dual-task training on gait performance in individuals with chronic stroke patients. Twenty-six participants with chronic hemi-paresis were recruited to this study and randomly distributed into two groups: progressive treadmill cognitive dual-task gait training (PTCDG group, 13 patients), conventional treadmill gait training (CTG group, 13 patients). All patients underwent 20 sessions of treadmill gait training with a harness (5 times per week, for a total of 4 weeks). The GAITRite was used to analyze gait kinematics, and 10-m walking test (10MWT) wear used as the clinical evaluation indicators. After training, PTCDG group showed significant improvement in gait velocity, cadence, single support time, and 10MWT compared to the control group. However there was no significant difference between the groups in the stride lengths in the affected and unaffected sides. The study verified that progressive treadmill cognitive dual-task gait training had a positive in-fluence on the gait and clinical gait index in chronic stroke patients.

Purpose: Foot drop is a common symptom in disorders of the central nervous system (CNS : Central Nervous System), such as stroke. The combination of functional electrical stimulation (FES : Functional Electronical Stimulation) and gait rehabilitation is an effective intervention for stroke gait rehabilitation. Therefore, the aim of this study was to determine the effectiveness of FES training based on the muscle synergy pattern of stroke patients during gait. Methods: The intervention was tested on two chronic stroke patients. They underwent a 6-week intervention consisting of 30 min sessions of FES-supported gait three times per week. Muscle synergies were extracted from electromyography (EMG : electromyography) signals using a non-negative matrix factorization algorithm (NMF : Non-negative Matrix Factorization). Results: The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. Before treatment, both patients presented only three merged muscle synergies during gait, resembling two different gait abnormalities. After the 6-week intervention, the number of extracted synergies became four and they increased their gait speed with the physiological muscle synergies. The 10m walking test (10MWT : 10Meter Walking Test) used in the first and last days of intervention increased from 16.11 to 14.56 m/s, and from 19.76 to 15.37m/s for Subject 1 and Subject 2, respectively. Conclusion: Multi-channel FES walking intervention based on synergy analysis influenced the number of muscle synergies during the gait of stroke patients. This intervention has an effective effect on improving the gait performance of stroke patients.

Purpose: To investigate the effects of transcranial direct current stimulation combined with robot-assisted gait training on gait, balance, and fall efficacy in patients after stroke. Methods: Twenty-four patients after stroke were selected as study participants and were randomly divided into a transcranial direct current stimulation combined robot-assisted gait training (experiment) group and robot-assisted gait training (control) group. All participants underwent general neurological physical therapy for 30 min, and robot-assisted gait training alone or combined with transcranial direct current stimulation according to the group, 5 times a week for 30 min for a total of 8 weeks. Gait, balance, and fall efficacy function was analyzed before the intervention, and analysis between groups was performed by re-measuring the above items equally after 8 weeks of intervention. Results: The transcranial direct current stimulation combined with robot-assisted gait training group showed significant differences in gait, balance, and fall efficacy function compared to the control group. Conclusion: Transcranial direct current stimulation combined robot-assisted gait training is more effective for gait, balance, and fall efficacy function . Based on this finding, this training can be proposed as an effective program not only for patients after stroke but also for patients with brain injury. Moreover, based on the study findings, future studies on muscle changes related to gait, balance, and function are warranted.

The purpose of this review was to analysis the effects of treadmill train-ing on gait function in children with cerebral palsy. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Regis-ter of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science were searched. Investigating the effects of treadmill training on gait endurance, gait speed, limb support time, cadence, and step length in children with cerebral palsy. Similar out-comes were pooled by calculating the standardized mean difference. Of the eight studies, 179 participants were included. The average PEDro score was 6.25/10. The results of the sensitivity test for bias evaluation using the duval and tweedie’s trim and fill method showed low publica-tion bias. The test regarding the effect of treadmill training on overall gait function yielded a moderate effect size of 0.53, which was a statisti-cally significant effect as its confidence interval did not include. The overall effect size of gait endurance was 0.85. The overall effect size of gait speed and limb support time were 0.52 and 0.73. The overall effect size of cadence and step length were 0.14 and 0.21, indicating a nonsig-nificant improvement. These findings suggested that treadmill training on cerebral palsy was effective for gait endurance, gait speed and limb support time than cadence and step length.

Purpose: This study investigated the effects of game-based dual-task training on gait and cognitive function in patients with stroke. Methods: The study included 20 patients with stroke, randomly assigned to two groups: the experimental and control groups. The experimental group received virtual reality-based dual-task training in addition to conventional physical therapy, while the control group received only conventional physical therapy. An analysis of covariance (ANCOVA) was conducted to compare gait and cognitive function between the groups, revealing significant differences. Results: The experimental group that participated in game-based dual-task training demonstrated significant improvements in gait and cognitive function compared to the control group, which received conventional physical therapy (p<.05). Conclusion: Game-based dual-task training was shown to be an effective intervention for enhancing balance, gait, and cognitive function. These findings suggest that this training can serve as an efficient intervention for patients with other conditions. Future research focusing on gait and cognitive function is warranted to evaluate the effectiveness of this intervention further.

Purpose: For stroke survivors, abnormal gait patterns lead to a significant risk of falls. We have recently developed an IoT-based Upper and Lower Extremity Rehabilitation Medical Device (RoBoGat) that enables continuous passive motion (CPM) training, squat training (ST), and gait training (GT). The purpose of this study was to test the effectiveness of RoBoGat on gait in a chronic stroke survivor. Methods: In this study, an individual with right-side chronic hemiparesis post-stroke participated. The participant underwent 14 days of RoBoGat training that involved continuous passive motion training, squat training, and gait training. During the training, knee and hip joint angles were adjusted within the range where the subject felt no pain. We assessed gait, timed up and go test, and visual analog scale at baseline and after first and final interventions. Results: After the intervention, positive changes were observed such as stride, gait velocity, and loading phase. Improvements were also observed in timed up and go tests. However, there was no significant change in VAS, which assessed pain in training and daily life. Conclusion: The main finding of this case-control study is that robot-based upper and lower extremity training may be a feasible approach in the neurorehabilitation field. It can be concluded that repetitive and continuous robot rehabilitation exercises have a positive effect on improving the physical function of chronic stroke survivors.