The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort

Emilia Biffi, Elena Beretta, Fabio Alexander Storm, Claudio Corbetta, Sandra Strazzer, Alessandra Pedrocchi, Emilia Ambrosini, Emilia Biffi, Elena Beretta, Fabio Alexander Storm, Claudio Corbetta, Sandra Strazzer, Alessandra Pedrocchi, Emilia Ambrosini

Abstract

Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.

Keywords: acquired brain injury; children; cohort study; propensity score matching; robot-assisted gait training; virtual reality plus treadmill training.

Conflict of interest statement

The Authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) The Lokomat device. (B) The Grail system.
Figure 2
Figure 2
Flowchart of the study. GA: Gait Analysis, N: number of patients.
Figure 3
Figure 3
Standardized Mean Differences in the unmatched cohorts (N = 70, blue dots) and after the matching (N = 30, red dots).
Figure 4
Figure 4
Functional measures of the matched cohorts. * Wilcoxon signed rank test with p < 0.05. (A) GMFM: Gross Motor Function Measure; (B) GMFM-D and (C) GMFM-E; (D) 6MWT: 6 min walking test; (E) FAQ: Gillette Functional Assessment Questionnaire; RAGT: Robot-Assisted Gait Training; VRTT: Virtual Reality Treadmill Training.

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