Robot-assisted vs. sensory integration training in treating gait and balance dysfunctions in patients with multiple sclerosis: a randomized controlled trial

Marialuisa Gandolfi, Christian Geroin, Alessandro Picelli, Daniele Munari, Andreas Waldner, Stefano Tamburin, Fabio Marchioretto, Nicola Smania, Marialuisa Gandolfi, Christian Geroin, Alessandro Picelli, Daniele Munari, Andreas Waldner, Stefano Tamburin, Fabio Marchioretto, Nicola Smania

Abstract

Background: Extensive research on both healthy subjects and patients with central nervous damage has elucidated a crucial role of postural adjustment reactions and central sensory integration processes in generating and "shaping" locomotor function, respectively. Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis (MS) patients is not fully investigated in literature.

Purpose: The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training (RAGT) and sensory integration balance training (SIBT) in improving walking and balance performance in patients with MS.

Methods: Twenty-two patients with MS (EDSS: 1.5-6.5) were randomly assigned to two groups. The RAGT group (n = 12) underwent end-effector system training. The SIBT group (n = 10) underwent specific balance exercises. Each patient received twelve 50-min treatment sessions (2 days/week). A blinded rater evaluated patients before and after treatment as well as 1 month post treatment. Primary outcomes were walking speed and Berg Balance Scale. Secondary outcomes were the Activities-specific Balance Confidence Scale, Sensory Organization Balance Test, Stabilometric Assessment, Fatigue Severity Scale, cadence, step length, single and double support time, Multiple Sclerosis Quality of Life-54.

Results: Between groups comparisons showed no significant differences on primary and secondary outcome measures over time. Within group comparisons showed significant improvements in both groups on the Berg Balance Scale (P = 0.001). Changes approaching significance were found on gait speed (P = 0.07) only in the RAGT group. Significant changes in balance task-related domains during standing and walking conditions were found in the SIBT group.

Conclusion: Balance disorders in patients with MS may be ameliorated by RAGT and by SIBT.

Keywords: motor skills disorders; physiological adaptations; postural balance; proprioception; sensory feedback.

Figures

Figure 1
Figure 1
Flow diagram of the study.
Figure 2
Figure 2
(A) Within group analysis: mean performance and standard errors at primary and statistical significant secondary outcome measures. Abbreviations: SS, stable surface; CS, complaint surface; EO, eyes-open condition; Dome, Dome condition; FU, follow-up. (B) Between group comparison: mean performance and standard errors at secondary organization balance test (SOT) (only statistical significant value). Abbreviations: CS, complaint surface; EO, eyes-open condition; EC, eyes-closed condition; Dome, Dome condition; FU, follow-up.

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