http://www.sciencedirect.com/science/article/pii/S101370251630046X
- Open Access funded by Hong Kong Physiotherapy Association
- Under a Creative Commons license
Abstract
Objective
This
study aimed to evaluate the effectiveness of robotic-assisted gait
training (RAGT) in improving functional outcomes among stroke patients.
Design
This was a retrospective matched control study.
Setting
This study was conducted in an extended inpatient rehabilitation centre.
Patients and intervention
There
were 14 patients with subacute stroke (4–31 days after stroke) in the
RAGT group. Apart from traditional physiotherapy, the RAGT group
received RAGT. The number of sessions for RAGT ranged from five to 33,
and the frequency was three to five sessions per week, with each session
lasting for 15–30 minutes. In the control group, there were 27 subacute
stroke patients who were matched with the RAGT group in terms of age,
days since stroke, premorbid ambulatory level, functional outcomes at
admission, length of training, and number of physiotherapy sessions
received. The control group received traditional physiotherapy but not
RAGT.
Outcome measures
Modified
Functional Ambulation Category (MFAC), Modified Rivermead Mobility
Index (MRMI), Berg's Balance Scale (BBS), and Modified Barthel Index
(MBI) to measure ambulation, mobility, balance, and activities of daily
living, respectively.
Results
Both
RAGT and control groups had significant within-group improvement in
MFAC, MRMI, BBS, and MBI. However, the RAGT group had higher gain in
MFAC, MRMI, BBS, and MBI than the control group. In addition, there were
significant between-group differences in MFAC, MRMI, and BBS gains (p = 0.026, p = 0.010, and p = 0.042, respectively). There was no significant between-group difference (p = 0.597) in MBI gain (p = 0.597).
Conclusion
The
results suggested that RAGT can provide stroke patients extra benefits
in terms of ambulation, mobility, and balance. However, in the aspect of
basic activities of daily living, the effect of RAGT on stroke patients
is similar to that of traditional physiotherapy.
Keywords
- gait;
- physiotherapy;
- rehabilitation;
- robotic;
- stroke
Introduction
Stroke,
also known as cerebrovascular accident, is an acute disturbance of
focal or global cerebral function, with signs and symptoms lasting more
than 24 hours or leading to death, presumably of vascular origin [1]. In Hong Kong, around 25,000 stroke patients are admitted to public hospitals under the Hong Kong Hospital Authority annually [2].
Although mortality and morbidity among stroke patients have declined
due to medical advances, impacts on stroke survivors and community
remain significant. The most widely recognized impairment caused by
stroke is motor impairment, which restricts muscle movement or mobility
function [3]. Many stroke patients experience difficulties in walking, and improving walking is one of the main goals of rehabilitation [4]. Since it was shown that the process of spontaneous recovery is almost completed within 6–10 weeks [5],
early rehabilitation is essential to maximize the function of patients
after stroke. Recent evidence suggests that high-intensity repetitive
task-specific practice might be the most effective principle when trying
to promote motor recovery after stroke [3].
Robotic-assisted gait training (RAGT) is a new global physiotherapy
technology that applies the high-intensity repetitive principle
to improve mobility of patients with stroke or other neurological
disorders. The advantage of RAGT may be the reduction of the effort
required by therapists compared with treadmill training with partial
bodyweight support, as they no longer need to set the paretic limbs
or assist in trunk movements [6].
People who receive electromechanical-assisted gait training in
combination with physiotherapy after stroke are more likely to achieve
independent walking than people who receive gait training without these
devices [7].
More specifically, people in the first 3 months after stroke and those
who are not able to walk seem to benefit most from this type of
intervention [7]. Evidence also shows that the use of RAGT in stroke patients has positive effects on their balance [8].
Randomized
controlled trials and systemic reviews have demonstrated the
effectiveness of RAGT for stroke patients in terms of functional
outcomes such as walking ability [9], [10] and [11] and balance [8] and [11].
However, limited published evidence is available on the effectiveness
of RAGT in improving other functioning activities such as basic
activities of daily living (ADL) [12] and [13].
If RAGT can improve walking ability and balance of stroke patient, can
RAGT also improve basic ADL of stroke patients? The hierarchical pattern
of progression in basic ADL is in the following order: bathing,
dressing, transferring, toileting, controlling continence, and feeding,
with bathing being the most complex task and feeding the least [14];
however, walking ability and balance contribute to parts of basic ADL.
Moreover, factors that make the greatest contribution to ADL after
stroke were found to be balance, upper extremity function, and
perceptual and cognitive functions [15].
If RAGT can improve ADL of stroke patients, which of the above factors
is/are enhanced by RAGT? Can RAGT also enhance perceptual and cognitive
functions of stroke patients? Hence, controlled studies are necessary to
address these research questions. A retrospective study conducted by
Dundar et al [13]
investigated the effect of robotic training in functional independence
measure and other functional outcomes of patients with subacute and
chronic stroke. However, the study concluded that combining robotic
training with conventional physiotherapy produced better improvement
than conventional physiotherapy in terms of functional independence
measure, but not walking status or balance. The result was opposite to
the specificity of training principle [16]
that gait training should produce more positive effect for walking and
balance than ADL. Hence, this study intends to investigate the
effectiveness of RAGT in improving functional mobility and basic ADL for
stroke patients, and hopefully can lead to further randomized
controlled studies to investigate the impact of RAGT on basic ADL.
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