Effects of exoskeleton rehabilitation robot training on neuroplasticity and lower limb motor function in patients with stroke.

Abstract

Background: Lower limb exoskeleton rehabilitation robot is a new technology to improve the lower limb motor function of stroke patients. Recovery of motor function after stroke is closely related to neuroplasticity in the motor cortex and associated motor areas. However, few studies investigate how rehabilitation robots affect the neuroplasticity of stroke patients.This study sought to determine the effects of lower limb exoskeleton robot walking training on neuroplasticity and lower limb motor function in patients with stroke.

Methods: A total of 25 (50.26 ± 11.42 years, 68.0% male) patients(age 18-75 years, onset between 2 weeks and 6 months) with a stable condition after having a stroke were randomized into a treatment (n = 13) and control group (n = 12). Bilateral Exoskeletal Assistive Robot H1 (BEAR-H1) walking training was provided to the treatment group, whereas conventional walking training was provided to the control group. Both groups completed two training sessions per day for 30 min each and were trained 5 days a week for 4 weeks. Transcranial magnetic stimulation, Fugl-Meyer Assessment lower extremity, Functional Ambulation Category 6-min walking distance test, intelligent gait analysis, and surface electromyography of the lower limbs were performed before and 4 weeks after treatment.

Results: Both groups showed obvious improvements in all evaluation indicators (p < 0.05). Compared with the control group, the treatment group exhibited a decreased resting motor threshold and increased motor-evoked potential amplitude and recruitment curve slope (p < 0.05). The treatment group performed better than the control group (p < 0.05) in the 6-min walk test and knee flexion co-contraction ratio (CR). Correlation analysis showed that resting motor threshold, motor-evoked potential amplitude, and the recruitment curve slope were significantly correlated with the 6-min walk test, CR on ankle dorsiflexion, the root mean square of the tibialis anterior, biceps femoris, and medial gastrocnemius (p < 0.05).

Conclusion: Walking training using the bilateral exoskeletal assistive robot H1 improved cerebral cortical excitability in patients with stroke, which facilitated changes in neuroplasticity and enhanced lower limb motor function.

Registration: Chinese Clinical Trail Registry: ChiCTR1900028262. Registered Date: December 16,2019. Registration-URL: http://www.chictr.org.cn.