Deans' stroke musings: Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, May 10, 2021

Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations

This systematic review should never have to occur, that database of all stroke protocols and research should be updated every time new research comes. That way survivors could look at that and see the best way to get recovered.

Hell, research on robotic gait training goes back to 2009. So your hospital has been incompetent since then in not providing it.

robot-assisted gait training (10)

Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations

Rocco S. CALABRÓ ¹ ✉, Gregorio SORRENTINO ², Anna CASSIO ³, Davide MAZZOLI ⁴, Elisa ANDRENELLI ⁵, Emiliana BIZZARINI ⁶, Isabella CAMPANINI ⁷, Simona M. CARMIGNANO ⁸, Simona CERULLI ⁹, Carmelo CHISARI ¹⁰, Valentina COLOMBO ¹¹, Stefania DALISE ¹⁰, Cira FUNDARÓ ¹², Valeria GAZZOTTI ¹³, Daniele MAZZOLENI ¹⁴, Miryam MAZZUCCHELLI ¹⁴, Corrado MELEGARI ¹⁵, Andrea MERLO ^{4, 7}, Giulia STAMPACCHIA ¹⁶, Paolo BOLDRINI ¹⁷, Stefano MAZZOLENI ¹⁸, Federico POSTERARO ¹⁹, Paolo BENANTI ²⁰, Enrico CASTELLI ²¹, Francesco DRAICCHIO ²², Vincenzo FALABELLA ²³, Silvia GALERI ²⁴, Francesca GIMIGLIANO ²⁵, Mauro GRIGIONI ²⁶, Stefano MAZZON ²⁷, Franco MOLTENI ²⁸, Giovanni MORONE ²⁹, Maurizio PETRARCA ³⁰, Alessandro PICELLI ³¹, Michele SENATORE ³², Giuseppe TURCHETTI ³³, Donatella BONAIUTI ³⁴, on behalf of the "CICERONE" Italian Consensus Conference on Robotic in Neurorehabilitation

¹ IRCCS Centro Neurolesi “Bonino-Pulejo “, Messina, Italy; ² Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; ³ Spinal Cord Unit and Intensive Rehabilitation Medicine, Villanova sull'Arda and Castel San Giovanni, AUSL Piacenza, Italy; ⁴ Gait & Motion Analysis Laboratory OPA Sol et Salus, Torre Pedrera, Rimini, Italy; ⁵ Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy; ⁶ Spinal Cord Unit, Department of Rehabilitation Medicine, Gervasutta Hospital, “Azienda Sanitaria Universitaria Friuli Centrale”, Udine, Italy; ⁷ LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, AUSL-IRCCS Reggio Emilia, Italy; ⁸ Rehabilitation Therapeutic Center, Tramutola, Potenza, Italy; ⁹ University Polyclinic Foundation A.Gemelli, IRCCS, Rome, Italy; ¹⁰ Neurorehabilitation Section, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; ¹¹ Montecatone Rehabilitation Institute, Imola, Bologna, Italy; ¹² Neurophysiopathology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy; ¹³ Centro Protesi Vigorso di B, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Budrio, Bologna, Italy; ¹⁴ School of Physical and Rehabilitation Medicine, Bicocca University of Milan, Milan, Italy; ¹⁵ Elias Neuroriabilitazione, Parma, Italy; ¹⁶ Spinal Cord Unit, Pisa University Hospital, Pisa, Italy; ¹⁷ Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy; ¹⁸ Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy; ¹⁹ Rehabilitation Department, ASL12, Viareggio, Lucca, Italy; ²⁰ Pontifical Gregorian University, Rome, Italy; ²¹ Paediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy; ²² Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy; ²³ Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy; ²⁴ IRCCS Don Gnocchi Foundation Onlus, Milan, Italy; ²⁵ Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; ²⁶ National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy; ²⁷ Rehabilitation Unit, ULSS (Local Health Authority) Euganea - Camposampiero Hospital, Padua, Italy; ²⁸ Valduce Hospital “Villa Beretta” Rehabilitation Center, Costa Masnaga, Lecco, Italy; ²⁹ Santa Lucia Foundation, IRCCS, Rome, Italy; ³⁰ The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy; ³¹ Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; ³² AITO (Associazione Italiana Terapisti Occupazionali), Rome, Italy; ³³ Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy; ³⁴ Geriatric Institute Piero Redaelli, Milan, Italy

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INTRODUCTION: Stroke is the third leading cause of adult disability world-wide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations.
EVIDENCE ACQUISITION: We systematically reviewed stroke rehabilitation guideline recommendations between January 1st, 2010 and October 31th, 2020. We explored electronic databases (n=4), guideline repositories and professional rehabilitation networks (n=12). Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version.
EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. Robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. Unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics.
CONCLUSIONS: Our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. However, robot assisted gait training (RAGT) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.