Abstract
Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.
Highlights
In Multiple Sclerosis (MS), the highly variable distribution of demyelination areas and axonal loss in the central nervous system (CNS) can lead to very complex and unpredictable neurological deficits and clinical patterns [1]
According to the most recent neurophysiological concepts based on neural plasticity, in recent years the rehabilitative approaches that seem to be more effective in improving functional performance are based on the concept of task-specific repetitive training [15], as in the case of the body weight support treadmill training (BWSTT) for the lower limb rehabilitation [16]
Despite such a trend, when the changes at POST-Treatment T3 were controlled for the baseline values (PRE-Treatment T2), the only outcomes that resulted in a significant main effect for the treatment were the 25-foot walk (25FW) (p = 0.004, Figure 3 left panel) and the 6 min walk test (6MWT)
Summary
In Multiple Sclerosis (MS), the highly variable distribution of demyelination areas and axonal loss in the central nervous system (CNS) can lead to very complex and unpredictable neurological deficits and clinical patterns [1]. Gait disorders as reduced speed and stride length, gait asymmetry, increased muscular energy expenditure, balance deficit, and increased risk of falling represent one of the most disabling aspects [2,3,4] These motor problems strongly influence the level of independence that a person affected by MS is able to achieve, resulting in a severe negative impact on the quality of life [5]. The use of Robot Assisted Gait Training (RAGT) allows: repetition of specific and stereotyped movements in order to acquire a correct and reproducible gait pattern in conditions of balance and symmetry, early start of treatment using the activity with body weight support, safeguarding the patient by reducing the fear of falling to increase the quantity and quality of the exercise performed by optimizing the intervention of the therapist [19].
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