gait recovery is a major objective in the rehabilitation program for individuals with 
 poststroke hemiparesis1 . treadmill 
 training2 and treadmill training with 
 harness support3,4,5 have been reported to be 
 effective methods for retraining walking . hollands et al . reported that repetitive 
 task - specific practice , an intervention that consists of repeating a specific task to regain 
 a functional movement , appeared to be a promising approach to restore gait coordination6 . in contrast , physical therapy in acute 
 stroke patients tends to focus on improving a specific muscle activity or a partial movement 
 of some task due to poor muscle strength . recovery of function after stroke has been 
 attributed to and based on reorganization of the brain in several reports7,8,9 . additionally , some studies support the 
 hypothesis that such a neurologic change is greatly affected by repeated practice of the 
 movement task , which indicates that functional reorganization of the brain may be highly 
 associated with use of the cerebral cortex and its frequency10,11,12 . when performance of a task is improved by movement training , transfer of learning occurs in 
 the background in motor skill learning , and this occurs due to the dynamic similarity of the 
 movements13,14,15 . therefore , the therapist 
 should determine the component of the movement that is lacking or insufficient in the 
 patient and then elaborate the exercise according to the needed movement to regain a 
 determined task as described by carr and shepherd16 . there is a method to improve the walking ability in adult patients with hemiparesis 
 according to exercises designed to increase weight - bearing and weight transfer on the 
 paretic lower limb . the underlying foundation of such intervention is that improving the 
 symmetry of weight - bearing while in the bipedal stance can result in balance and locomotor 
 performance improvements . davies17 
 reported that most patients with hemiparesis have difficulty propelling the paretic limb in 
 the swing phase . kramers de quervain et al.18 reported that the duration of the pre - swing phase was prolonged in 
 patients who had the slowest gait speed , thus further emphasizing the importance of 
 improving the muscular strength and coordination of the paretic side during the pre - swing 
 phase . the weight transfer from one lower limb to the other is important for locomotion and 
 is a requirement for walking and stair climbing19 . during rapid single - leg flexion movements in the standing 
 position , the lateral horizontal ground reaction force components are lower in subjects with 
 hemiparesis than in healthy subjects20 , 
 and weight transfer to the non - paretic limb is insufficient21 , 22 . consequently , the 
 ability to elevate the paretic foot in tasks that require single - leg stance is compromised . for these reasons , hemiparetic patients tend to first incline the upper body to the support 
 side and then elevate the paretic foot . therefore , we focused our attention on the 
 stepping - in - place movement task to improve the paretic swing phase in the gait , and we 
 designed a spring - loaded takeoff board device to assist the lifting of the paretic foot . the purpose of this study was to investigate the effect of the training device designed to 
 assist heel elevation during repetitive stepping - in - place exercise on motor function and 
 walking ability in patients with chronic hemiplegic stroke . we hypothesized that motor 
 function of the paretic lower limb would be improved , lateral movement of the upper body 
 would be reduced during paretic limb lifting , the pre - swing phase of the gait would be 
 shorter , and the step length would be longer . ten subjects ( 6 males and 4 females ) with chronic hemiparetic stroke volunteered for this 
 study . three subjects dropped out during the intervention period . thus , seven participants 
 ( 4 males , 3 females ; age 80.94.9  years ) from a community - dwelling population who were 
 users of an adult daycare facility ultimately participated in this study . such neurological 
 deficiencies were the consequence of either cerebral infarction or cerebral hemorrhage due 
 to an initial ( n=4 ) or a recurrent ( n=3 ) stroke . five participants were able to ambulate independently , and two participants 
 required supervision or minimal assistance to walk . six participants used a straight cane , 
 and one participant used a four - point cane . four individuals used an ankle - foot orthosis 
 ( table 1table 1.initial characteristics of the participantsparticipantspapbpcpdpepfpggendermfmmfmfage ( years)83818480718478weight ( kg)56.258.155.266.459.254.750.8time after stroke ( years)69173103211type of strokeischemicischemicischemic(recurrent)hemorrhagicischemicischemicischemicischemichemorrhagicischemichemorrhagichemiparetic sideleftrightrightrightrightrightrightmaship1113021knee2013112ankle2111111le - fma152199191125use of an orthosisafoafoafoafowalking aidt - canet - canet - canequad - canet - canet - canet - canefac3542434mas : modified ashworth scale ( 05 ) ; le - fma : lower extremity subscale of the 
 fugl - meyer assessmen ; fac : functional ambulation category ( 05 ) ; afo : ankle - foot 
 orthosis ) . the 
 inclusion criteria were as follows : ( 1 ) able to maintain the standing position 
 independently , and ( 2 ) able to walk at least 10  m on flat ground with or without minimum 
 assistance in walking balance . the exclusion criteria were as follows : ( 1 ) clinical signs 
 of heart failure , ( 2 ) any orthopedic or neurologic conditions in addition to the stroke , 
 and ( 3 ) gross cognitive sequelae . this clinical study was approved by the kanazawa 
 university medical ethics screening committee ( approval number : 432 ) . they were also 
 allowed to continue the exercise for an arbitrary period upon request . mas : modified ashworth scale ( 05 ) ; le - fma : lower extremity subscale of the 
 fugl - meyer assessmen ; fac : functional ambulation category ( 05 ) ; afo : ankle - foot 
 orthosis an a - b study was applied as follows : during phase a ( baseline ) , the participant received 
 the usual care provided in the adult daycare facility . during phase b ( intervention ) , the 
 participant performed an additional exercise task ( stepping movement ) that consisted of 
 repeatedly lifting the paretic foot in the standing position for approximately 20 minutes 
 using a specific device designed for this study at the adult daycare facility . each phase 
 was performed for 2 weeks . however , two participants wanted to voluntarily continue the 
 exercise , and they were also evaluated after a total of 16 weeks of intervention ( eva4 ) . 
 the subjects were evaluated three or four times . each evaluation consisted of a clinical 
 evaluation and a kinematic analysis , which were performed before phase a and before and 
 after phase b ( designated hereafter as eva1 , eva2 , eva3 , and eva4 , respectively ) . all 
 evaluations and interventions were performed in the adult daycare facility the 
 participants attended . the device used during phase b consisted of a spring - loaded takeoff board that assisted 
 the lifting of the foot heel in the stepping movement ( fig . 1.the device that assists the lifting of the foot heel : ( a ) picture of the device , 
 ( b ) schematic illustration of the device ( side view ) , ( c ) schematic illustration of 
 the device ( rear view ) and adjustment by the number of springs ) . the participants performed the stepping - in - place exercise using this device 
 during the intervention phase . first , depending on the ability of the participant , the amount of assistance required to 
 lift the paretic foot is adjusted by changing the number of springs of the device . second , 
 movement using this device is similar to movement of the lower limbs in the walking 
 pre - swing phase , promoting hip joint flexion , knee flexion , and ankle plantar flexion . we 
 considered that a sense of motion closer to real walking was more likely to be obtained . third , a loading feedback sensation is obtained by applying weight to the paretic foot 
 against the device s spring . it is thought that this is effective for improving the 
 movement in the pre - swing phase that allows transition from stance to swing to be 
 accomplished . therefore , it is expected that the walking pattern ( improvement of the 
 paretic swing ) is improved by performing the movement using this device in patients with 
 hemiplegia . we hypothesized that repetition of the stepping - in - place exercise using this 
 device would be effective for improving the motor function of the lower limbs and for 
 improving walking function . in other words , we designed a movement task based on transfer 
 of learning . the strength of the springs was adjusted to allow for a standing position 
 when they were stepped on and to allow for easy heel lifting . the movement speed was 
 adapted according to the participant s ability to perform the exercise for approximately 
 20 minutes , including rest breaks . the device that assists the lifting of the foot heel : ( a ) picture of the device , 
 ( b ) schematic illustration of the device ( side view ) , ( c ) schematic illustration of 
 the device ( rear view ) and adjustment by the number of springs to test the efficacy of the interventions , a clinical evaluation and kinematic analysis 
 of the stepping - in - place and walking exercises were performed for each evaluation 
 time . the motor function of the lower limbs was assessed using the lower extremity items 
 ( maximum score = 34 points ) of the fugl - meyer assessment ( fma ) , and walking ability was 
 assessed using the 10-m walking test and functional ambulation category ( fac ) . the 
 spasticity of the lower limbs ( e.g. , hip , knee , and ankle joint ) was assessed using the 
 modified ashworth spasticity scale ( 05 ) . in the 10-m walking test , the subjects were 
 asked to walk a 12-m gait track ; the first and last meters were excluded from measurement , 
 leaving a 10  m measurement section . the subjects were instructed to walk at their own 
 preferred speed . the time and steps required for them to walk the measurement section were 
 recorded . a two - dimensional motion analysis of movement in the sagittal plane of walking and in the 
 frontal plane of the stepping - in - place was performed . the stepping - in - place exercise was 
 chosen to examine the lateral movement of the upper body and double support duration . hemispheric reflection markers ( 1  cm in diameter ) were placed on the spinal column for the 
 spinous process of the 5th lumbar vertebra and bilateral posterior extremity of the heel . one digital camera ( ex - zr800 , casio computer co. , ltd . , tokyo , japan ) mounted on a tripod 
 was positioned approximately 5  m perpendicular to the plane of each movement . two - dimensional 
 coordinate data were calculated using a motion analysis software package ( frame - dias iv , 
 dkh co. , ltd . , tokyo , japan ) . for the participants who required an ankle - foot orthosis , the measurement motion was 
 performed with them wearing shoes , while for the other participants , the measurements were 
 performed while barefoot . care was taken to maintain the same measurement conditions for each evaluation in 
 all participants . as the walking was performed in the paretic sagittal plane , 3 trials 
 with a distance of 5  m were performed . the stepping - in - place test was evaluated from 
 behind the subjects and was performed approximately 20 times in the same position . the 
 subjects were instructed to perform both motions at a self - selected comfortable and safe 
 speed . the walking speed ( m / sec ) and cadence ( steps / minute ) were calculated using the 10-m 
 walking test . for the purpose of the calculation , from each of two trials , the result that 
 was higher in value was selected . it is assumed that the single stance phase becomes 
 shorter and the double supporting phase becomes longer as the walking speed becomes slower 
 and that the swing phase in natural walking accounts for 40% of the gait cycle . in other 
 words , we hypothesized that the double supporting phase is shortened and that the swing 
 time is extended and becomes closer to 40% of the gait cycle as the walking speed is 
 increased . therefore , the walking motion of 1 gait cycle was used for the kinematic 
 analysis . the following values were calculated from the walking video : duration of one 
 gait cycle and swing phase of the paretic side ( 1 gc duration in sec , sw duration in sec ) 
 and the percentage of the swing phase to one gait cycle ( % sw ) . the paretic step length ( m ) was calculated using the coordinates of the bilateral heel markers . for these parameters , the motions from the 6th to 15th repetitions of the stepping - in - place motion ( 20 in 
 total ) were used for the kinematic analysis . for the stepping - in - place exercise , it was 
 assumed that the lateral movement of the center of gravity becomes smaller and that the 
 duration from non - paretic foot touchdown to lifting of the paretic foot is shortened as 
 the walking speed increases . therefore , the following values were calculated during the 
 stepping - in - place exercise : lateral amplitude of l5 ( l5-amp in m ) and the time from 
 non - paretic heel contact to paretic heel off ( hc - ho duration in sec ) . the mean values for 
 the stepping - in - place motion were calculated from ten motions . to test the changes compared with baseline , the wilcoxon signed - rank test was used to 
 assess the difference between eva1 and eva2 for each evaluation result . considering the 
 physical and emotional condition variability of each participant , the efficacy of a given 
 intervention was tested by comparing the mean of the results for eva1 and eva2 with the 
 eva3 or eva4 results . a p value of 0.5 or lower was considered significant for all 
 statistical comparisons . the seven hemiplegic patients who participated in this study completed the intervention 
 period of 2 weeks . the durations of 
 exercise and rest were carefully considered so that the intervention would not cause any 
 significant fatigue or overload . five of seven participants were able to continue the 
 exercise task for 20 minutes in each session . two participants ( pa , pe ) expressed positive 
 opinions , such as  the sensation of the paretic foot touching the floor became more 
 perceptible  and  it seems good  during the stepping - in - place exercise . these two 
 participants voluntarily continued the exercise for 14 more weeks after the 2-week 
 intervention period , for a total of 16 weeks of the intervention . upon obtaining their 
 consent , two 
 participants ( pd , pe ) , who were not able to perform the exercise for 20 minutes due to less 
 physical endurance , performed the exercise for shorter periods than the others ( 15  min and 
 10  min , respectively ) . additionally , pd refused to undergo the kinematic analysis for the 
 stepping - in - place motion due to a feeling of fatigue on the evaluation day . overall , no significant difference was found at the end points between eva1 and eva2 
 compared with baseline ( p > 0.05 ) . the average valued were calculated for eva1 and eva2 , 
 was and they were compared with the results for eva3 ; no significant difference was found 
 between the values ( p > 0.05 ) . therefore , each evaluation outcome after the intervention ( eva3 or eva4 ) was 
 compared with the average of eva1 and eva2 as the baseline ( mean of eva1 and eva2 ) for each 
 participant . the percentages of increase or decrease for eva3 and eva4 compared with the 
 baseline values are shown in table 2table 2.clinical assessment and the kinematic parameters of walking and stepping - in - place 
 of each participantparticipantspapbpcpdpepfpgclinical assessmentwalking speed ( m / sec ) baseline0.650.580.310.160.40.260.23eva30.680.590.300.170.410.210.26(+4.6)(+1.7)(3.2)(+6.3)(+2.5)(19.2)(+13.0)eva40.750.46(+15.4)(+15.0)cadence ( steps / min)baseline102.58475.143.978.156.774.6eva398.288.669.146.678.551.076.0(4.2)(+5.5)(8.0)(+6.2)(+0.5)(10.1)(+1.9)eva498.986(3.5)(+10.1)le - fma ( score/34)baseline14.5219919.51124.5eva315219920925eva41621walking1 gc duration ( sec)baseline1.181.561.692.451.722.771.68eva31.271.411.892.341.632.661.71(+7.6)(9.6)(+11.8)(4.5)(5.2)(4.0)(+1.8)eva41.231.41(+4.2)(18.0)swing phase duration ( sec)baseline0.410.530.570.520.570.540.48eva30.50.40.720.340.60.590.52(+22.0)(24.5)(+26.3)(34.6)(+5.3)(+9.3)(+8.3)eva40.50.52(+22.0)(8.8)%sw ( % ) baseline34.833.933.722.533.219.628.8eva338.928.537.914.43722.130.6(+11.8)(15.9)(+12.5)(36.0)(+11.4)(+12.8)(+6.3)eva440.737.1(+17.0)(+11.7)step length ( m)baseline0.290.310.340.10.320.240.17eva30.30.290.350.070.310.200.17(+3.4)(6.5)(+2.9)(30.0)(3.1)(16.7)(0)eva40.350.34(+20.7)(+6.3)stepping - in - placel5-amp ( m)baseline0.140.130.090.080.140.11eva30.120.120.120.050.130.1(14.3)(7.7)(+33.3)(37.5)(7.1)(9.1)eva40.120.06(14.3)(25.0)ho - hc duration ( sec)baseline0.440.190.320.321.040.27eva30.120.120.490.250.850.17(72.7)(36.8)(+53.1)(21.9)(18.3)(37.0)eva40.110.17(75.0)(46.9)eva1 : evaluation performed before phase a ; eva2 : evaluation performed before phase b ; 
 eva2 : evaluation performed after phase b ; eva4 : evaluation performed 16 weeks after 
 intervention . le - fma : lower extremity 
 subscale of the fugl - meyer assessment ; gc : gait cycle , l5-amp : lateral amplitude of 
 l5 ; ho - hc duration : time from non - paretic heel contact to paretic heel off ; % sw(% ) : 
 percentage of the swing phase in a gait cycle . the values in parentheses indicate the 
 percentages of increase or decrease of eva3 and eva4 compared with the baseline .. eva1 : evaluation performed before phase a ; eva2 : evaluation performed before phase b ; 
 eva2 : evaluation performed after phase b ; eva4 : evaluation performed 16 weeks after 
 intervention . le - fma : lower extremity 
 subscale of the fugl - meyer assessment ; gc : gait cycle , l5-amp : lateral amplitude of 
 l5 ; ho - hc duration : time from non - paretic heel contact to paretic heel off ; % sw(% ) : 
 percentage of the swing phase in a gait cycle . the values in parentheses indicate the 
 percentages of increase or decrease of eva3 and eva4 compared with the baseline . a walking speed gain was found in three participants ( pa + 15.4% , pe + 15.0% , pg + 13.0% ) , 
 and , furthermore , a cadence gain was found for pe and pg ( pe + 10.1% , pg + 1.9% ) . however , no 
 change in walking speed was detected in the four other participants , and for pf , walking 
 speed became slower ( 19.2% ) . the scores for the lower extremity subscale of the fugl - meyer 
 assessment ( le - fma ) of three subjects ( pc , pd , pf ) were lower than those ofthe other 
 participants . considering the parameters in the kinematic analysis of the three subjects who demonstrated 
 increased walking speeds ( pa , pe , and pg ) , the main changes were as follows : sw duration was 
 extended in pa and pg ( pa + 22.0% , pg + 8.3% ) , and the step length was increased in pa ( pa 
 + 20.7% ) . pa and pe obtained increases closer to 40% ( pa 40.7% , pe 37.1% ) . 
 additionally , the hc - ho duration of the stepping - in - place motion decreased in these three 
 patients ( pa 75.0% , pe 46.9% , pg 37.0% ) . in contrast , the kinematic analysis results of the four participants whose walking speed 
 did not increase were as follows . for pb , the time from the support and swing phase became 
 shorter , and the hc - ho duration of the stepping motion decreased ( 36.8% ) . for pc , the 1 gc 
 duration ( + 11.8% ) and sw duration ( + 26.3% ) increased , and % sw ( 37.9% ) became closer to 40% 
 in the walking motion . for pf , the hc - ho duration in the stepping - in - place motion and 1 gc 
 duration in the walking motion decreased , showing some improvement ( hc - ho duration 18.3% , 1 
 gc duration 4.0% ) . this study focused on the stepping - in - place exercise to improve the paretic swing of the 
 hemiplegic gait . thus , a spring - loaded takeoff board was designed to assist the heel 
 elevation of the stepping - in - place early phase . performing the stepping - in - place exercise 
 using this device in patients with chronic hemiparesis , we hypothesized that the motor 
 function of the paretic lower limb would be improved , the lateral movement of the upper body 
 would be reduced during paretic limb lifting , the pre - swing phase of the gait would become 
 shorter , and the step length would become longer . according to the results , the improvements 
 shown by the participants differed , with each participant showing specific improvements in 
 different areas . the time after the initial stroke ( ranging from 3 to 32  years ) , baseline fma ( ranging from 
 9 to 25 points ) , and walking speed ( ranging from 0.16 to 0.65 m / sec ) of the participants in 
 this study varied widely . six of the 7 participants used a cane or ankle - foot orthosis as a 
 walking aid , and 2 of the 7 participants ( pe , pg ) required supervision or minimal assistance 
 in walking . compared with the study subjects of kramers de quervain et al.18 and turns et al.23 , who also conducted gait analyses of patients with 
 hemiparesis , the present participants had a longer time after stroke , worse disorder of 
 paretic limb motor function , and slower walking speed . two participants ( pc , pd ) were unable 
 to complete the 20-minute exercise task even with resting time , but other participants were 
 able to complete the exercise task . furthermore , the frequency of intervention was not 
 uniform ( from 2 to 4 times a week ) . thus , probably due to the wide individual differences in 
 physical endurance , walking ability , motor function of the lower extremity , and the movement 
 pattern of the paretic lower extremity among the participants in the present study , the 
 intervention showed no common effectiveness in the present participants . two participants ( pa , pe ) who had positive impressions of the exercise showed an increase 
 in walking speed and cadence after four months of performing the exercise . additionally , 
 through the 2-week intervention , the walking speed and cadence of pg increased . the level of 
 spasticity of the lower extremity of the participants was assessed using the modified 
 ashworth scale ( mas ) . the participants spasticity ranged from 0 to 2 , except for 
 participant pd ( ranged from 1 to 3 ) , showing similarity in spasticity levels between 
 participants with and without improved results . in the kinematic analysis , three 
 participants ( pa , pe , and pg ) had increases in the duration ratio of the swing phase in the 
 non - paretic gait cycle and shortening of the time from non - paretic heel contact to the 
 paretic heel off during stepping - in - place . the swing phase time was also extended for pa and 
 pg , and the step length was increased for pa . the fma scores ( ranging from 15 to 25 points ) 
 in the baseline period for the three participants who showed improvement ( pa , pe , and pg ) 
 were higher than those of pc , pd , and pf ( ranging from 9 to 11 points ) . in the 
 flexor / extensor synergy of the hip and knee joints item of the fma , participants who showed 
 no improvement scored 1 point , whereas participants with improvement scored 2 points . kramers de quervain et al.18 and turns et 
 al.23 reported that patients who walked 
 slower were unable to perform gait movements without a synergy pattern . additionally , 
 kramers de quervain et al.18 reported 
 that the duration of the pre - swing phase was prolonged for patients who had the slowest gait 
 velocities and that the goal of therapy should therefore be focused on muscle strength and 
 coordination improvement of the hemiplegic side , especially during the pre - swing phase . garcia et al.24 reported that the 
 frequency of stepping in the stepping - in - place motion was slower than in walking but that 
 the stepping - in - place motion incorporates reciprocal , rhythmic lower extremity movement 
 patterns similar to gait . in other words , the participants who were able to perform lower 
 limb synergy patterns at a certain intensity transferred the weight from the supporting limb 
 to the swing phase limb in the stepping - in - place exercise faster , which could have 
 contributed to the smooth pre - swing phase and improved walking speed . thus , the 
 stepping - in - place training using the foot lifting device seems to be appropriate for 
 hemiplegia patients who are able to show extension synergy of the lower extremity and enough 
 upper limb support to maintain the standing position . pd and 
 pf showed larger knee flexion and ankle dorsiflexion with weight - bearing during the stance 
 phase , and pd had excessive pelvic hiking and toe drag during the swing phase . in addition , 
 two participants ( pc , pd ) were unable to complete the movement task for 20 minutes due to a 
 lack of physical endurance . the participants with weaker support force of the lower 
 extremity and with flexion / extension movement difficulties showed knee buckling , a trunk and 
 pelvic compensation strategy during stepping - in - place exercise . the lower limb spasticity 
 level of the participants ranged from 0 to 2 , except for pd ( 1 to 3 ) . therefore , the motion 
 task ability seems to be more related to motor function than to the existence of spasticity . the participants with weaker support force of the lower extremity needed assistance to 
 induce the stepping - in - place exercise manually by the therapist during the motion task using 
 the foot lifting device . pb had higher motor function of the lower extremity than the other 
 participants and showed a normal knee pattern in the stance phase ; however , pb also showed 
 excessive ankle plantar flexion and hip flexion during the swing phase . due to this 
 participant s high ability to swing the paretic limb , the effect of the intervention might 
 not have been evident . these results suggest that patients with relatively high walking ability and motor function 
 had positive effects from the intervention . some studies have reported that locomotor 
 parameters were improved after 6 months of combined functional training and 8 weeks of 
 one - leg exercise25 , 26 . therefore , the movement task in the present study may be effective 
 for paretic lower limb movement in the paretic heel off from non - paretic heel contact , but 
 some form of long - term intervention is necessary to improve step length . this study focused on the movement of the lower limbs during the pre - swing phase of the 
 gait cycle , and a movement task was designed . movements of the hip joint , knee , and ankle 
 induced by paretic foot heel elevation with spring assistance were expected to be induced . 
 in this way , by obtaining a motion sensation close to normal gait , the sensory feedback was 
 expected to effectively improve movement . for the muscle activity in the pre - swing phase , 
 perry27 reported that the activity of 
 the ankle plantar flexion muscle decreases as the body weight is rapidly transferred from 
 one limb to the other and that the residual gastrocnemius flexor muscle action moves the 
 tibia forward , flexing the knee . additionally , in the stepping - in - place exercise , vertical 
 control of the center of mass ( com ) is mainly required . jansen et al.28 reported that the ankle plantar flexor muscles ( soleus , 
 gastrocnemius ) had the same function in vertically controlling the com during the loading 
 response period of forward and backward walking . therefore , we hypothesized that the flexion 
 of the knee by gastrocnemius activity would be improved through exercise in which the heel 
 is moved up and down . insufficient flexion of the paretic lower limbs during the pre - swing 
 phase was observed before the intervention in the three participants ( pa , pe , pg ) whose 
 walking speeds increased . thus , this repetitive movement task may contribute to improving 
 the control of the paretic lower limb in the pre - swing phase . most participants in this study had chronic hemiparesis and were aged 75  years or older . the participants who had relatively higher walking ability and better motor function showed 
 better results after the training period . there were large differences among the individuals 
 in the time after stroke , the level of lower limb functional impairment , and walking 
 ability . additionally , considering the results of two participants who continued exercising 
 for 16 weeks , the 2-week intervention is probably insufficient for obtaining the desired 
 effects in patients with chronic hemiparesis . to determine the efficacy of the movement 
 task , it is necessary to perform future studies with larger sample populations , longer 
 intervention periods , and prior classification of the gait pattern of the participants . in 
 this study , the effect of the intervention was investigated using kinematic analysis ; 
 however , use of the electromyographic method may be necessary to investigate more detailed 
 effects of this exercise task with the assistive device .