Journal of Rehabilitation Research & Development (JRRD)

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Volume 48 Number 4, 2011
   Pages 417 — 430

Abstract —  Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke

Anindo Roy, PhD;1* Larry W. Forrester, PhD;1 Richard F. Macko, MD1-2

1Departments of Neurology and Physical Therapy and Rehabilitation Sciences, University of Maryland School of Medicine, Baltimore, MD; and Maryland Exercise and Robotics Center of Excellence, Rehabilitation Research and Development Service, Baltimore Department of Veterans Affairs Medical Center (VAMC), Baltimore, MD; 2Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; and Geriatric Research, Education, and Clinical Center, Baltimore VAMC, Baltimore, MD

Abstract — Cerebrovascular accident (stroke) often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot ("anklebot") training on paretic ankle motor control in chronic stroke. This was a double-arm pilot study on a convenience sample of participants with chronic stroke (n = 7) who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects. Training consisted of participants in each group playing a target-based video game with the anklebot for an hour, for a total of 560 movement repetitions in dorsiflexion/plantar flexion ranges followed by retest 48 hours later. Task difficulty was adjusted to ankle range of motion, with robotic assistance decreased incrementally across training. Assessments included robotic measures of ankle motor control on unassisted trials before and after training and at 48 hours after training. Following exposure to the task, subjects with stroke improved paretic ankle motor control across a single training session as indexed by increased targeting accuracy (21.6 +/- 8.0 to 31.4 +/- 4.8, p = 0.05), higher angular speeds (mean: 4.7 +/- 1.5 degrees/s to 6.5 +/- 2.6 degrees/s, p < 0.01, peak: 42.8 +/- 9.0 degrees/s to 45.6 +/- 9.4 degrees/s, p = 0.03), and smoother movements (normalized jerk: 654.1 +/- 103.3 s-2 to 537.6 +/- 86.7 s-2, p < 0.005, number of speed peaks: 27.1 +/- 5.8 to 23.7 +/- 4.1, p < 0.01). In contrast, nondisabled subjects did not make statistically significant gains in any metric after training except in the number of successful passages (32.3 +/- 7.5 to 36.5 +/- 6.4, p = 0.006). Gains in all five motor control metrics were retained (p > 0.05) at 48 hours in both groups. Robust maintenance of motor adaptation in the robot-trained paretic ankle over 48 hours may be indicative of short-term motor learning. Our initial results suggest that the anklebot may be a flexible motor learning platform with the potential to detect rapid changes in ankle motor performance poststroke.

Key words: ankle motor control, ankle robot, hemiparesis, jerk, learning rate, motor adaptation, motor learning, movement smoothness, neurorehabilitation, stroke.


View HTML  ¦  View PDF  ¦  Contents Vol. 48, No. 4
This article and any supplementary material should be cited as follows:
Roy A, Forrester LW, Macko RF. Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke. J Rehabil Res Dev. 2011;48(4):417-30.
DOI:10.1682/JRRD.2010.04.0078
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Last Reviewed or Updated  Wednesday, May 11, 2011 11:41 AM

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