Affiliations: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
Correspondence:
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Address for correspondence: Dae Hyun Kim, Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical, Jinhwangdo-ro 61-gil, Seoul, Gangdong-gu 05368, South Korea. Tel./Fax: +82 2 2225 4177; E-mail: [email protected].
Abstract: BACKGROUND:Robot-assisted gait training (RAGT) can improve walking ability after stroke but the underlying mechanisms are unknown. OBJECTIVE:We evaluated the changes in the injured brain after RAGT and compared the effects of early start and late start of RAGT. METHODS:Eleven patients with hemiplegia after stroke undergoing inpatient rehabilitation were examined within 3 months of stroke onset and were randomly assigned into two groups. Group 1 started RAGT with conventional physiotherapy immediately after enrollment, whereas Group 2 underwent conventional physiotherapy for 4 weeks before starting RAGT. We acquired diffusion tensor imaging data after enrollment and at 4 and 8 weeks after treatment. Fractional anisotropy (FA) and mean diffusivity (MD) maps were used to analyze the neural changes. RESULTS:Repeated measures analysis of variance of the data at 4 weeks after treatment showed a significant interaction between time and groups (RAGT versus control) for the FA and MD values in the non-lesioned hemisphere, indicating that the non-lesioned hemisphere was significantly reorganized by RAGT compared with conventional physiotherapy. Analysis of the data at 8 weeks after treatment showed a significant interaction between time and groups (early and late start of RAGT) for the MD values in the motor-related areas bilaterally, indicating that early start of RAGT significantly accelerated bi-hemispheric reorganization as compared with late start of RAGT. CONCLUSIONS:Our findings indicate that RAGT can facilitate reorganization in the intact superior temporal, cingulate, and postcentral gyri. Furthermore, early start of RAGT can accelerate bi-hemispheric reorganization in the motor-related brain regions.
