The early initiation of robot-assisted gait training in patients with acute stroke could promote neuroplasticity. The aim of this study was to clarify the microstructural changes of white matter associated with gait training using Hybrid Assistive Limb (HAL) by diffusion tensor imaging (DTI). Patients with first-ever stroke and requiring a walking aid started gait training within 1 week of stroke onset. The patients were quasi-randomly assigned either to the conventional physical therapy (CPT) group or gait training using HAL (HAL) group. Motor function and DTI were examined at baseline and after 3-5 months. Voxel-based statistical analyses of fractional anisotropy (FA) images were performed using diffusion metric voxel-wise analyses. Volume of interest (VOI)-based analyses were used to assess changes in FA (ΔFA). Twenty-seven patients (17 in the CPT group and 10 in the HAL group) completed the study. There were improvements in motor function and independency in the CPT and HAL groups (p < .001). Compared to baseline, there were decreases in FA in the ipsi-lesional cerebral peduncle in the CPT group (p < .001) and increases in the contra-lesional rostrum of the corpus callosum in the HAL group (p < .001) at the second assessment, consistent with the mean ΔFA in each group from VOI analysis (CPT/HAL: cerebral peduncle, -0.066/-0.027, p = .027; corpus callosum, 0.002/0.042, p < .001). Gait training using HAL initiated within 1 week after stroke onset facilitated the recovery of inter-hemispheric communication and prevented the progression of Wallerian degeneration of the affected pyramidal tract.

中文翻译：

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中风发作后 1 周内开始使用混合辅助肢体进行步态训练后显微结构的白质变化

早期开始对急性卒中患者进行机器人辅助步态训练可以促进神经可塑性。本研究的目的是通过弥散张量成像 (DTI) 阐明与使用混合辅助肢体 (HAL) 的步态训练相关的白质的微观结构变化。首次中风并需要助行器的患者在中风发作后 1 周内开始步态训练。患者被准随机分配到常规物理治疗 (CPT) 组或使用 HAL 步态训练 (HAL) 组。在基线和 3-5 个月后检查运动功能和 DTI。使用扩散度量体素分析对分数各向异性 (FA) 图像进行基于体素的统计分析。基于感兴趣体积 (VOI) 的分析用于评估 FA (ΔFA) 的变化。27 名患者（CPT 组 17 名，HAL 组 10 名）完成了研究。CPT 和 HAL 组的运动功能和独立性有所改善（p < .001）。与基线相比，CPT 组同侧病变脑脚的 FA 减少 (p < .001)，而 HAL 组胼胝体对侧病变的喙部增加 (p < .001)第二次评估，与来自 VOI 分析的每组平均 ΔFA 一致（CPT/HAL：脑脚，-0.066/-0.027，p = .027；胼胝体，0.002/0.042，p < .001）。在中风发作后 1 周内开始使用 HAL 进行步态训练，促进了半球间通讯的恢复，并防止了受影响的锥体束沃勒氏变性的进展。