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Discrete Versus Rhythmic Gait Training

2017年5月2日 更新者:Thais Amanda Rodrigues

Robot-assisted Locomotor Training After Severe Stroke: Discrete Versus Rhythmic Movement

The objective of this study is to compare the effects of novel versus standard locomotor training using a robotic gait orthosis (LT-RGO) after stroke. The hypothesis is that the novel LT-RGO protocol, by establishing a progressive decrease in gait velocity and guidance force, may facilitate greater motor recovery compared to the use of a standard protocol.

研究概览

详细说明

Standard (rhythmic) robot-assisted locomotor training on a bodyweight-supported treadmill (LT-BWST) used progressively increased speed each week. Novel (discrete) robot-assisted LT-BWST used progressive decrease in speed. The novel approach of slowing down the treadmill reduced momentum. If speed had been increased (standard approach), momentum would have increased (momentum = mass * velocity); and the resulting, passive propulsion of momentum would have diminished the role of cortical skills needed to plan, initiate, and overtly control gait. In sum, the novel protocol used a slower-than-standard treadmill speed in order to provide a window of time sufficient for the corticomotor system to process information, learn, and adjust its response to internal and external feedback (eg, proprioceptive input; therapist input) during robot-assisted LT-BWST.

研究类型

介入性

注册 (实际的)

20

阶段

  • 不适用

联系人和位置

本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。

学习地点

      • Sao Paulo、巴西、05716-150
        • Instituto de Medicina Física e Reabilitação - Lucy Montoro

参与标准

研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 及以上 (成人、年长者)

接受健康志愿者

不

有资格学习的性别

全部

描述

Inclusion Criteria:

  • Clinical diagnosis of stroke and image with hemiparesis left or right;
  • No more that one ischemic or hemorrhagic stroke episode;
  • 06 months post-stroke;
  • Verified clinical stability on medical evaluation;
  • Spasticity level I or II in the Ashworth scale;
  • Score 1-2 in the Functional Ambulation Scale (FAC);
  • Signed informed consent.

Exclusion Criteria:

  • Dependence to perform activities of daily living before the stroke;
  • Lack of clinical indications for exercises (such as cardiopulmonary instability and uncontrolled diabetes);
  • Severe cognitive impairment;
  • Serious psychiatric change that needs psychiatric care;
  • Severe osteoporosis;
  • Severe spasticity of the lower limbs, deformities or fixed contractures that prevent the achievement of movements;
  • Lack of resistance or disabling fatigue;
  • Body weight greater than 150 kg;
  • Unstable angina or other untreated heart disease;
  • Chronic obstructive pulmonary disease;
  • Unconsolidated fractures, pressure sores;
  • Other neurological diseases.

学习计划

本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。

研究是如何设计的?

设计细节

  • 主要用途:治疗
  • 分配:随机化
  • 介入模型:并行分配
  • 屏蔽:三倍

武器和干预

参与者组/臂
干预/治疗
实验性的:Novel Protocol
Progressive decrease of speed and guidance force on robotic gait training. Initial speed is 1.4 km/h and final speed is 1.0 km/h.
All subjects performed robot-assissted LT-BWST 5 times a week for 6 weeks (30 minutes of training and 15 minutes of setup). Novel (discrete) robot-assisted LT-BWST used progressive decrease in speed. Both groups started the robot-assisted LT-BWST at the same speed of 1.4km/h. The body weight support started approximately at 40% of body weight for both groups and rapidly decreased each week. The guidance force was also progressively decreased for both groups so that the exoskeleton provided the least possible assistance to the subject.
实验性的:Standard Protocol
Progressive increase of speed and decrease of guidance force on robotic gait training. Initial speed is 1.4 km/h and final speed is 1.9 km/h.
All subjects performed robot-assissted LT-BWST 5 times a week for 6 weeks (30 minutes of training and 15 minutes of setup). Standard (rhythmic) robot-assisted LT-BWST used progressively increased speed each week. Both groups started the robot-assisted LT-BWST at the same speed of 1.4km/h. The body weight support started approximately at 40% of body weight for both groups and rapidly decreased each week. The guidance force was also progressively decreased for both groups so that the exoskeleton provided the least possible assistance to the subject

研究衡量的是什么?

主要结果指标

结果测量
措施说明
大体时间
Functional Ambulation Scale (FAC)
大体时间:Baseline and 6 weeks

The Functional Ambulation Scale (FAC) assesses an individual's independence during gait and follows a six-level scale: 0 - Patient can not walk or ask for help from two or more people; 1 - Patient requires continuous support from a person who assists with weight and balance; 2 - Patient needs continuous or intermittent support from a person to help with balance and coordination; 3 - Patient required for a person without physical contact; 4 - Patient can walk independently on the floor, but requires help on stairs and ramps; 5 - Patient can walk independently.

This study compared the gait independence by the FAC between the two Arms, after intervention as compared to baseline.

Baseline and 6 weeks

次要结果测量

结果测量
措施说明
大体时间
Six-minute Walking Test (6MWT)
大体时间:Baseline and 6 weeks
Change in distance of the gait applied test after intervention as compared to baseline
Baseline and 6 weeks
Time Up and Go (TUG)
大体时间:Baseline and 6 weeks
This test assesses the level of mobility of the individual to measure the time spent to get up from a chair, walk a distance of 3 meters, turn around and return. This study compared the change in the time of the gait applied test after intervention as compared to baseline.
Baseline and 6 weeks
Ten-meters Walking Test (10MWT)
大体时间:Baseline and 6 weeks
Change in the time of the gait applied test after intervention as compared to baseline
Baseline and 6 weeks
Lower Limbs Fugl-Meyer
大体时间:Baseline and 6 weeks

The Fugl Meyer Scale is a cumulative numerical scoring system that is assessed by an individual: range of motion, pain, tenderness, upper and lower extremity motor function and balance, plus coordination and speed of movement, with total 226 points. A three-point ordinal scale is applied to each item: 0 - can not be performed, 1-performed partially and 2-performed completely. For this study it was only an evaluation of motor function of the extremity of lower limbs with a total score of 0 to 34 points. The lower score indicates greater motor impairment.

This study compared the change in motor function of lower limbs applied scale after intervention as compared to baseline

Baseline and 6 weeks
Berg Scale
大体时间:Baseline and 6 weeks
Berg Scale is a functional scale of equilibrium performance, based on 14 common everyday items that evaluate the static and dynamic balance. The maximum scale score is 56 and each scale item has five alternatives ranging from 0 to 4 points. A score below 45 is considered a fall risk. This study comparede the change in the balance control applied scale after intervention as compared to baseline.
Baseline and 6 weeks

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

调查人员

  • 学习椅:Daniel G Goroso, Doctor、University of Sao Paulo
  • 学习椅:Lumy Sawaki, PhD、University of Kentucky

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始

2014年11月1日

初级完成 (实际的)

2016年3月1日

研究完成 (实际的)

2016年9月1日

研究注册日期

首次提交

2016年1月5日

首先提交符合 QC 标准的

2016年1月6日

首次发布 (估计)

2016年1月8日

研究记录更新

最后更新发布 (实际的)

2017年9月18日

上次提交的符合 QC 标准的更新

2017年5月2日

最后验证

2017年5月1日

更多信息

与本研究相关的术语

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)?

未定

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