Abstract
BackgroundContrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing.ObjectiveThis study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks’ intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat.MethodsForty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests.ResultsHemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively), Postural Assessment Scale for Stroke (P<0.001 and P = 0.003), 6 Minutes Walk Test (P = 0.003 and P = 0.015) and 10-Meter Walk Test (P = 0.001 and P = 0.024). Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81) and medium (dz = 0.66) effect sizes, respectively.ConclusionOverall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.
Highlights
In 2013, the worldwide prevalence of stroke was 25.7 million, with 10.3 million individuals having a first stroke, and about 2 of every 3 first strokes were of ischemic nature [1]
The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation
Inclusion criteria were as follows: adult patients following a unilateral stroke occurring in the past year at most, admitted for inpatient rehabilitation, enrolled for the first time in an intervention based on robotic-assisted gait training (RAGT), able to understand and follow verbal instructions, ambulatory: having a Functional Ambulation Category (FAC) ! 1, and a gait speed slower than 0.8 m s-1, i.e.10-Meter Walk Test (10MWT) higher than 12.5 s, limiting the study group to household or limited community walkers [48]
Summary
In 2013, the worldwide prevalence of stroke was 25.7 million, with 10.3 million individuals having a first stroke, and about 2 of every 3 first strokes were of ischemic nature [1]. The efficiency of diverse task-oriented training techniques for stroke patients has been demonstrated in several meta-analyses, e.g. body weight-supported treadmill training (BWSTT) [5], circuit class training [6], augmented exercise therapy [7], and automated locomotion therapy [8]. In the latter case, the automation of lower limb movements during locomotion is ensured by electromechanical/ robotic devices, that were developed to help the physiotherapists by increasing the safety, intensity and standardization of non-robotic BWSTT, generate complex multisensory stimulation, provide extensive extrinsic biofeedback to the patient, and reduce working costs [9,10]. The influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing
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