A Case with Left Hemiplegia after Cerebral Infarction with Improved Walking Ability Through Robot-assisted Gait Training Combined with Neuromuscular Electrical Stimulation for Foot Drop.

Yamaguchi A, Kanazawa Y, Hirano S, Aoyagi Y. A Case with Left Hemiplegia after Cerebral Infarction with Improved Walking Ability Through Robot-assisted Gait Training Combined with Neuromuscular Electrical Stimulation for Foot Drop. Jpn J Compr Rehabil Sci 2024; 15: 88-93.

Background: Gait training-assist robots and neuromuscular electrical stimulation devices have been shown to be useful in gait training for patients with hemiplegia. However, no case reports have documented the combined use of a gait training-assist robot and a neuromuscular electrical stimulator for gait rehabilitation. In this study, we present the case of a patient with left hemiplegia who demonstrated remarkable improvement in walking ability after using a combination of a gait training-assist robot and a neuromuscular electrical stimulator for foot drop.

Case presentation: A 60-year-old man developed severe left hemiplegia following a stroke in the right middle cerebral artery region. His lower limb motor function, as assessed by the Stroke Impairment Assessment Set (SIAS), was completely impaired (score of 0), and he was unable to walk by the 57th day post-onset. By the 66th day, his lower limb motor function remained unchanged (SIAS score of 0), and he frequently stumbled on his left foot at the start of the swing phase during gait training. As a result, robot-assisted gait training combined with neuromuscular electrical stimulation for foot drop was initiated. By the 88th day, his lower limb motor function improved to a score of 1 on the SIAS, and his Functional Independence Measure (FIM) walk item improved to a score of 4 with the use of an ankle-foot orthosis and a cane. On the 89th day, he transitioned to conventional therapy without the devices. By the 114th day, he was able to walk with a T-cane without the need for an orthosis.

Conclusion: The combination of a gait training-assist robot and a neuromuscular electrical stimulator for foot drop facilitated dorsiflexion of the ankle during the swing phase, allowed the patient to practice walking with minimal assistance. This promoted active patient-led walking and more efficient motor learning, ultimately leading to independent walking.