Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial

Marialuisa Gandolfi, Nicola Valè, Eleonora Dimitrova, Maria Elisabetta Zanolin, Nicola Mattiuz, Elisa Battistuzzi, Marcello Beccari, Christian Geroin, Alessandro Picelli, Andreas Waldner, Nicola Smania, Marialuisa Gandolfi, Nicola Valè, Eleonora Dimitrova, Maria Elisabetta Zanolin, Nicola Mattiuz, Elisa Battistuzzi, Marcello Beccari, Christian Geroin, Alessandro Picelli, Andreas Waldner, Nicola Smania

Abstract

Background: Postural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities.

Objective: The primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility.

Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment.

Results: There was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions.

Conclusion: Postural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).

Keywords: motor skill disorders; postural balance; proprioception; sensory feedback; sensory function.

Copyright © 2019 Gandolfi, Valè, Dimitrova, Zanolin, Mattiuz, Battistuzzi, Beccari, Geroin, Picelli, Waldner and Smania.

Figures

FIGURE 1
FIGURE 1
The G-EO system used in the Robot-Assisted Stair-Climbing Training (Written informed consent was obtained from the individual pictured, for the publication of this image).
FIGURE 2
FIGURE 2
CONSORT flowchart.
FIGURE 3
FIGURE 3
Instrumental assessment of postural control. (A–C) means ± standard deviation of CoP perimeter. Abscissa indicates the six conditions. Ordinate indicates the CoP perimeter (mm). (D–F) means ± standard deviation of sway area. Abscissa indicates the six conditions. Ordinate indicates the sway area (mm2). Asterisks indicates significant differences in between-group comparison.

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