Johnson Christopher A, Biswas Piyashi, See Jill, Briendel Olivia, Chan Vicky, Dodakian Lucy, Wang Po T, Nenadic Zoran, Cramer Steven C, Do An, Reinkensmeyer David J
IEEE Int Conf Rehabil Robot. 2025 May;2025:1473-1478. doi: 10.1109/ICORR66766.2025.11062996.
Ankle proprioception is important for gait control and is often impaired after stroke. It is currently unclear if conventional gait training can improve ankle proprioception. Here we used a novel robotic device, Ankle Measuring Proprioceptive Device (AMPD), to quantify key aspects of ankle proprioception before and after four weeks of gait training delivered to 24 individuals who were in the chronic phase of stroke. We implemented two assessments with AMPD to quantify passive and active and dynamic/static proprioception. For the Crisscross assessment, AMPD moved the ankles past each other and the participants pushed a button to indicate when the ankles passed each other, thereby testing passive, dynamic proprioception. For the Joint Position Reproduction (JPR) assessment, AMPD moved the impaired ankle in a random pattern and the participant tracked with their unimpaired ankle, thereby testing active, dynamic proprioception. We also incorporated static periods into JPR to quantify static position sense. At baseline, active and passive ankle proprioception errors, as well as static and dynamic errors, were significantly increased compared to age-matched controls and were moderately correlated. Gait training improved only static ankle position sense, with greater improvement for more severely impaired individuals. These findings suggest that stroke damages multiple aspects of ankle proprioception in an interrelated manner. In contrast, conventional gait training improved only static ankle proprioception ability. This suggests a need for an array of training methodologies to comprehensively retrain ankle proprioception.
踝关节本体感觉对步态控制很重要，且在中风后常受损。目前尚不清楚传统步态训练是否能改善踝关节本体感觉。在此，我们使用了一种新型机器人设备——踝关节本体感觉测量装置（AMPD），对24名处于中风慢性期的个体进行为期四周的步态训练前后的踝关节本体感觉关键方面进行量化。我们使用AMPD进行了两项评估，以量化被动和主动以及动态/静态本体感觉。在交叉评估中，AMPD使踝关节相互交叉移动，参与者按下按钮以指示踝关节何时相互交叉，从而测试被动动态本体感觉。在关节位置再现（JPR）评估中，AMPD以随机模式移动患侧踝关节，参与者用健侧踝关节进行跟踪，从而测试主动动态本体感觉。我们还在JPR中加入了静态阶段以量化静态位置觉。在基线时，与年龄匹配的对照组相比，主动和被动踝关节本体感觉误差以及静态和动态误差均显著增加，且呈中度相关。步态训练仅改善了静态踝关节位置觉，对损伤更严重的个体改善更大。这些发现表明，中风以相互关联的方式损害了踝关节本体感觉的多个方面。相比之下，传统步态训练仅改善了静态踝关节本体感觉能力。这表明需要一系列训练方法来全面重新训练踝关节本体感觉。
