Most patients with stroke suffer from complications and these include dysphagia. Dysphagia can cause malnutrition, and malnutrition affects prognosis and recovery. However, there is a lack of accurate studies on the nutritional status of stroke patients with dysphagia and its associated factors in different phases of stroke. This study retrospectively investigated 620 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) due to dysphagia, from March 2018 to February 2021. The study aimed to evaluate the nutritional state and associated factors of malnutrition in acute and subacute stroke patients with dysphagia. Serum albumin and percentage of current weight to ideal weight were used to determine nutritional status. Malnutrition was observed in 58.9 and 78.9% of acute and subacute stroke patients. Exact logistic regression analysis revealed that old age and high penetration–aspiration scale score were significantly associated factors for malnutrition in patients with acute stroke. Old age, stroke history, bilateral hemiplegia, high modified Rankin score, low Korean Mini-Mental State Examination, pneumonia, and high functional dysphagia score were significantly associated factors for malnutrition in patients with subacute stroke. Patients with these associated factors in each phase of stroke require active nutritional assessment and care to decrease the risk of malnutrition.

Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were created using the handle of a haptic device, rendering the approach very simple yet efficient in practice. This novel form of biofeedback will be a useful rehabilitation tool improving the balance of stroke patients.

Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective improvement of gait parameters such as symmetry, balance and muscle activation patterns. Our proposed integrated cue system can offer a cost-effective and voluntary gait training experience for rehabilitation of subjects with unilateral hemiparetic stroke. Ten post-stroke ambulatory subjects participated in a 10 m walking trial while utilizing the haptic cues (either alone or integrated application), at their preferred and increased gait speeds. In the system a haptic cane device (HCD) provided kinesthetic perception and a vibrotactile feedback device (VFD) provided tactile cue on the paretic leg for gait modification. Balance, gait symmetry and muscle activity were analyzed to identify the benefits of utilizing the proposed system. When using kinesthetic cues, either alone or integrated with a tactile cue, an increase in the percentage of non-paretic peak activity in the paretic muscles was observed at the preferred gait speed (vastus medialis obliquus: p < 0.001, partial eta squared (η2) = 0.954; semitendinosus p < 0.001, partial η2 = 0.793) and increased gait speeds (vastus medialis obliquus: p < 0.001, partial η2 = 0.881; semitendinosus p = 0.028, partial η2 = 0.399). While using HCD and VFD (individual and integrated applications), subjects could walk at their preferred and increased gait speeds without disrupting trunk balance in the mediolateral direction. The temporal stance symmetry ratio was improved when using tactile cues, either alone or integrated with a kinesthetic cue, at their preferred gait speed (p < 0.001, partial η2 = 0.702). When combining haptic cues, the subjects walked at their preferred gait speed with increased temporal stance symmetry and paretic muscle activity affecting their balance. Similar improvements were observed at higher gait speeds. The efficacy of the proposed system is influenced by gait speed. Improvements were observed at a 20% increased gait speed, whereas, a plateau effect was observed at a 40% increased gait speed. These results imply that integration of haptic cues may benefit post-stroke gait rehabilitation by inducing simultaneous improvements in gait symmetry and muscle activity.

Variations in biofeedback coding schemes for postural control, in recent research, have shown significant differences in performance outcomes due to variations in coding schemes. However, the application of vibrotactile biofeedback coding schemes to gait symmetry training is not well explored. In this paper, we devised various vibrotactile biofeedback modes and identified their efficacy during gait symmetry training of individuals suffering from hemiparesis due to stroke. These modes are composed of variations in vibration type (on-time or intensity), and relation type (proportional or inversely-proportional) with the error in symmetry ratio. Eight individuals with stroke participated in walking trials. From dependent t-tests on the collected data, we found improved achievement of temporal gait symmetry while utilizing all the provided biofeedback modes compared to no biofeedback (P<0.001). Furthermore, two-way repeated measures ANOVA revealed statistically significant difference in symmetry ratio for main effect of vibration type (P-value = 0.016, partial eta squared = 0.585). The participants performed better with modes of biofeedback with varying vibration on-times. Furthermore, participants showed better performance when the biofeedback varied proportionally with the error. These findings suggest that biofeedback coding schemes may have a significant effect on the performance of gait training.

Background: This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR). Methods: PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain. Results: A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39–1.71). Heterogeneity for I² value was lower than moderate (tau^2 = 0.0121; I ² = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I ² = 97%). Conclusion: The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.

The aim of gait rehabilitation is to achieve independent ambulation. Somatosensory augmentation with external haptic sources can improve the subject’s ability to walk or stand. This paper presents the development and evaluation of a robotic system prototype that delivers haptic forces to aid overground gait rehabilitation. This portable system is based on a compact, mobile robot that is equipped with force and LIDAR sensors. The robot is flexibly linked to the user, which allows the force interaction between the user and machine to be halted when desired. During operation, the system can dynamically transition between modes in which force is applied or distance is maintained to emulate the experience of a human walking a dog on a leash. The haptic feedback from our system was evaluated in a pilot study that involved six young, healthy subjects and one individual recovering from a hemiparetic stroke. The study comprised independent and device-assisted walking trials. When using the device, the subjects walked continuously as it transitioned between distance and force modes. Gait speed and step length increased when force was applied and decreased as the force was removed. The improvements exhibited by an individual suffering from stroke were similar to those exhibited by healthy subjects. The application of haptic forces has a high potential for improving the efficiency of overground gait training with simple interactions.