It has been 5 years, your doctor needs to find OUT EXACTLY WHAT THE REHAB FOR GAIT TRAINING SHOULD LOOK LIKE. Bad research, using Bobath as the conventional treatment even though proven not to work since 2003. The mentors and senior researchers need to be fired for that reason alone.
The latest here:
Received 12 June 2015, Accepted 16 September 2015
Giovanni Taveggiaa,b, Alberto Borbonic, Chiara Muléa,b, Jorge H. Villafañed and Stefano Negrinid,e
Correspondence to Giovanni Taveggia, Faccanoni Hospital, Sarnico, Italy; e-mail: giovannitaveggia@habilitasarnico.it
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 post stroke hemiparesis. This was a randomized double-blind clinical trial in a post acute 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 10m 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 (10m 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.
(In fact I would assume that the participants are using the Hawthorne effect to please the researchers.)
Introduction
Stroke is the leading cause of death and of serious longterm disability in adults; 3 months after stroke, 20% of individuals remain wheelchair bound and 70% walk at reduced velocity (Sakuma et al., 2014). Improvement in walking after stroke is a priority for many patients and is one of the most frequently demanded goals of rehabilitation, and interventions that effectively enhance locomotor function are essential to improve quality of life of many stroke survivors and their families (Maclean et al., 2000). Stroke patients, when they regain ambulatory function, walk with a typically asymmetrical gait pattern, slow and metabolically inefficient. These characteristics are associated with difficulty advancing the paretic limb and bearing weight through the more affected limb, leading to instability and increased risk of falls. Muscle weakness,
muscle tonus, muscle disuse, balance and reduced cardiorespiratory capacity contribute towards decrease walking velocity and endurance and finally worsen the disability (Perry et al., 1995). To restore gait, modern concepts of rehabilitation favour a repetitive task-specific approach (French et al., 2007). In the past 10 years, it has also been shown that higher intensities of walking practice result in better outcomes for individuals after stroke (Van Peppen et al., 2004). For gait training, it is important to walk repetitively in a natural gait similar to overground gait (Dobkin, 2004), and with proprioceptive and exteroceptive feedback (Barbeau, 2003), which recreates conditions favourable to motor learning. In recent years, as an adjunct to overground gait training, treadmill training has been introduced for the rehabilitation of individuals after stroke (Moseley et al., 2005). Treadmill training with and without body weight support enables the repetitive practice of a generic gait cycle (Taveggia et al., 2014). Manually assisted Body-Weight
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Supported Treadmill Training is a contemporary approach to gait rehabilitation after stroke, whereas when a patient walks on a treadmill, the therapists manually facilitate hemiparetic limb and trunk control in an effort to normalize upright and reciprocal walk and dynamic postural control. The advantages of this approach are that reduced motion ability is required to start locomotion; thus, early poststroke training effects can be observed in overground gait, that is, gait symmetry, speed and endurance as well as motor impairment and balance scores (McCain et al., 2008). A disadvantage of Body-Weight Supported Treadmill Training might be the effort required by therapists to set the paretic limbs and to control weight shift, thereby possibly limiting the duration of the active therapy, especially in more impaired patients. Automated electromechanical gait machines for automated assistive walking training were developed to reduce dependence on therapists and can be differentiated into end effector and exoskeleton devices. Selection of patients and an early application of robot aided rehabilitation are considered a prerequisite to achieve the best results. However, the impact of other factors such as the type of technology in relationship to the patient’s selection as well as the duration/intensity of the robot-aided treatment has not received more attention (Mehrholz et al., 2013). The main aim of the present study is to compare the effects of electromechanical assisted gait training after stroke and overground conventional physical therapy in a double-blind research for functional gait recovery of individuals unable to walk independently.
Fuminari Kaneko
Keiichiro Shindo
Masaki Yoneta
Megumi Okawada
Kazuto Akaboshi1,2,3 and