Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial

Giovanni Taveggia, Alberto Borboni, Chiara Mulé, Jorge H Villafañe, Stefano Negrini, Giovanni Taveggia, Alberto Borboni, Chiara Mulé, Jorge H Villafañe, Stefano Negrini

Abstract

Robot gait training has the potential to increase the effectiveness of walking therapy. Clinical outcomes after robotic training are often not superior to conventional therapy. We evaluated the effectiveness of a robot training compared with a usual gait training physiotherapy during a standardized rehabilitation protocol in inpatient participants with poststroke hemiparesis. This was a randomized double-blind clinical trial in a postacute physical and rehabilitation medicine hospital. Twenty-eight patients, 39.3% women (72±6 years), with hemiparesis (<6 months after stroke) receiving a conventional treatment according to the Bobath approach were assigned randomly to an experimental or a control intervention of robot gait training to improve walking (five sessions a week for 5 weeks). Outcome measures included the 6-min walk test, the 10 m walk test, Functional Independence Measure, SF-36 physical functioning and the Tinetti scale. Outcomes were collected at baseline, immediately following the intervention period and 3 months following the end of the intervention. The experimental group showed a significant increase in functional independence and gait speed (10 m walk test) at the end of the treatment and follow-up, higher than the minimal detectable change. The control group showed a significant increase in the gait endurance (6-min walk test) at the follow-up, higher than the minimal detectable change. Both treatments were effective in the improvement of gait performances, although the statistical analysis of functional independence showed a significant improvement in the experimental group, indicating possible advantages during generic activities of daily living compared with overground treatment.

Figures

Fig. 1
Fig. 1
Flow diagram of criteria in the study.

References

    1. Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13:881–889.
    1. Barbeau H. (2003). Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair 17:3–11.
    1. Chisari C, Bertolucci F, Monaco V, Venturi M, Simonella C, Micera S, Rossi B. (2015). Robot-assisted gait training improves motor performances and modifies Motor Unit firing in post-stroke patients. Eur J Phys Rehabil Med 51:59–69.
    1. Curfman D, Connor LT, Moy HP, Heitsch L, Panagos P, Lee JM, et al. (2014). Accuracy of emergency medical services-reported last known normal times in patients suspected with acute stroke. Stroke 45:1275–1279.
    1. Dean CM, Richards CL, Malouin F. (2001). Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil 15:415–421.
    1. Dobkin BH. (2004). Strategies for stroke rehabilitation. Lancet Neurol 3:528–536.
    1. French B, Thomas LH, Leathley MJ, Sutton CJ, McAdam J, Forster A, et al. (2007). Repetitivetask training for improving functional ability after stroke. Cochrane Database Syst Rev 4:CD006073.
    1. Fulk GD, Echternach JL. (2008). Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke. J Neurol Phys Ther 32:8–13.
    1. Grecco LA, Zanon N, Sampaio LM, Oliveira CS. (2013). A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehabil 27:686–696.
    1. Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, Hornby TG. (2009). Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair 23:5–13.
    1. Hornby TG, Zemon DH, Campbell D. (2005). Robotic-assisted, body-weight-supported treadmill training in individuals following motor incomplete spinal cord injury. Phys Ther 85:52–66.
    1. Johnson C, Green B. (2009). Submitting manuscripts to biomedical journals: common errors and helpful solutions. J Manipulative Physiol Ther 32:1–12.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117.
    1. Maclean N, Pound P, Wolfe C, Rudd A. (2000). Qualitative analysis of stroke patients’ motivation for rehabilitation. BMJ 321:1051–1054.
    1. Masiero S, Avesani R, Armani M, Verena P, Ermani M. (2007). Predictive factors for ambulation in stroke patients in the rehabilitation setting: a multivariate analysis. Clin Neurol Neurosurg 109:763–769.
    1. McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. (2008). Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study. Arch Phys Med Rehabil 89:684–691.
    1. Mehrholz J, Elsner B, Werner C, Kugler J, Pohl M. (2013). Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev 7:1–96.
    1. Moseley AM, Stark A, Cameron ID, Pollock A. (2005). Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 4:CD002840.
    1. Nascimento LR, Caetano LC, Freitas DC, Morais TM, Polese JC, Teixeira-Salmela LF. (2012). Different instructions during the ten-meter walking test determined significant increases in maximum gait speed in individuals with chronic hemiparesis. Rev Bras Fisioter 16:122–127.
    1. Perry J, Garrett M, Gronley JK, Mulroy SJ. (1995). Classification of walking handicap in the stroke population. Stroke 26:982–989.
    1. Pohl M, Werner C, Holzgraefe M, Kroczek G, Mehrholz J, Wingendorf I, et al. (2007). Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil 21:17–27.
    1. Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, et al. (2014). Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 4:CD001920.
    1. Sakuma K, Ohata K, Izumi K, Shiotsuka Y, Yasui T, Ibuki S, Ichihashi N. (2014). Relation between abnormal synergy and gait in patients after stroke. J Neuroeng Rehabil 11:141.
    1. Taveggia G, Villafane JH, Vavassori F, Lecchi C, Borboni A, Negrini S. (2014). Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial. J Manipulative Physiol Ther 37:242–252.
    1. Tinetti ME. (1986). Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126.
    1. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J. (2004). The impact of physical therapy on functional outcomes after stroke: what’s the evidence? Clin Rehabil 18:833–862.
    1. Vellone E, Savini S, Barbato N, Carovillano G, Caramia M, Alvaro R. (2010). Quality of life in stroke survivors: first results from the reliability and validity of the Italian version of the Stroke Impact Scale 3.0. Ann Ig 22:469–479.
    1. Westlake KP, Patten C. (2009). Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. J Neuroeng Rehabil 6:18.
    1. White DK, Wilson JC, Keysor JJ. (2011). Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res 63 (Suppl 11):S297–S307.

Source: PubMed

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