Abstract
BackgroundThe use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training.MethodsWe followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales.ResultsOver half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training.ConclusionsEight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.
Highlights
The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature
From physical therapy interventions [5,6] to more technological approaches including the use of Functional Electric Stimulation (FES) [7] or Body Weight Support Robotic Gait Training (BWSRGT), [8,9,10] many therapeutic options have been used alone and combined to improve motor recovery in stroke
Functional Ambulatory Category Across the 8-week intensive rehabilitation period Functional Ambulatory Categories (FAC) score improved by 45% across the period of robotic training, and improved by a further 31% following the manual training. 88% of patients improved by one point or more on the FAC scale across the 8-week intervention period
Summary
The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. More than 30% of patients who have had a stroke do not achieve a complete motor recovery after the rehabilitation process [2,3]. From physical therapy interventions (such as Bobath, Perfetti, Propioceptive Neuromuscular Facilitation - PNF) [5,6] to more technological approaches including the use of Functional Electric Stimulation (FES) [7] or Body Weight Support Robotic Gait Training (BWSRGT), [8,9,10] many therapeutic options have been used alone and combined to improve motor recovery in stroke. Electromechanical assisted gait training has been shown to improve the independent walking ability (FAC) but not the walking speed when compared sub-acute and chronic patients that received conventional gait training [8]
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