Effects Of Robot-assisted Gait Training Research Articles

Effect of robot-assisted gait training on biomechanics of ankle joint in patients with post-stroke hemiparesis

Klyuchevym faktorom narusheniy pokhodki posle ostrykh narusheniy mozgovogo krovoobrashcheniya (ONMK) yavlyayetsya narusheniye dvizheniy v golenostopnom sustave (GS), privodyashcheye k formirovaniyu patologicheskoy sinergii. V nastoyashcheye vremya pri robotizirovannykh trenirovkakh khod'by ispol'zuyut privody tazobedrennogo i kolennogo sustavov. Odnako po dannym literatury net yedinogo mneniya ob ikh vliyanii na dvizheniya v GS. Tsel'yu issledovaniya bylo izuchit' vliyaniye robotizirovannykh trenirovok khod'by na dvizheniya GS u patsiyentov s postinsul'tnym parezom. V issledovanii prinyalo uchastiye 22 patsiyenta s ONMK polusharnoy lokalizatsii. Dlya otsenki dvigatel'noy funktsii primenyali klinicheskiye shkaly i videoanaliz khod'by. Vsem patsiyentam provodili kurs iz 11 robotizirovannykh trenirovok khod'by. Na fone trenirovok vyyavleno uvelicheniye obshchego balla po shkale Fugl-Mayyera so 146,5 do 152 ballov (p < 0,05) i otdel'no dlya nizhney konechnosti s 18 do 20,5 ballov (p < 0,05), a takzhe snizheniye myshechnogo tonusa razgibateley GS s 2,5 do 2,0 ballov po modifitsirovannoy shkale Eshvorta (p < 0,05). Na fone robotizirovannykh trenirovok otmecheno uvelicheniye dlitel'nosti fazy opory patsiyentov s 28,0 do 33,5% ot tsikla shaga (TSSH). Krome togo, osnovnym razlichiyem struktury TSSH do i posle kursa trenirovok stalo nalichiye trekh chastey shaga vmesto pyati, chto podtverzhdayet konsolidatsiyu goniogramm patsiyentov v periode ot 1 do 61% TSSH. Sravneniye znacheniy uglov do i posle pokazalo dostovernyye razlichiya tol'ko po mezhkvartil'nomu intervalu (r < 0,05). Avtory prishli k vyvodu, chto robotizirovannyye trenirovki s primeneniyem aktivnykh privodov dlya tazobedrennogo i kolennogo sustavov oposredovanno sposobstvuyut izmeneniyam kinematicheskikh parametrov GS za schet priblizheniya pokazateley patterna k nekoyemu usrednennomu shablonu dvizheniy.

Влияние роботизированных тренировок на биомеханику голеностопного сустава у пациентов с постинсультным парезом

The key factor promoting post-stroke gait disturbances is motor impairment of the ankle joint (AJ) which results in pathological synergies. Robotic devices used for gait training are equipped with hip and knee joint actuators. However, there is no consensus in the literature on their effect on AJ movements. The aim of this study was to investigate the effect of robot-assisted gait training on AJ movements in patients with post-stroke paresis. The study recruited 22 hemispheric stroke survivors. They motor function was assessed using clinical scales and motion capture analysis. All patients received 11 robot-assisted gait training session. After rehabilitation, the total score on the Fugl-Meyer Assessment scale increased from 146.5 to 152 points (p < 0.05); for the lower limb, the score increased from 18 to 20.5 points (p < 0.05). The muscle tone of ankle extensors decreased from 2.5 to 2.0 points on the modified Ashworth scale (p < 0.05). The duration of the stance phase increased from 28.0 to 33.5% relative to the total gait cycle (GC). The main difference in the GC structure before and after rehabilitation is the presence of 3 GC parts instead of 5, suggesting consolidation of patients’ goniograms at 1-61% of GC. Comparison of joint angles before and after rehabilitation revealed that only the interquartile ranges (IR) were different (р < 0.05). The authors conclude that robot-assisted training with knee and hip joint actuators indirectly affects the kinematic parameters of AJ by promoting a shift towards the average gait kinematics.

Effect of Robot-Assisted Gait Training on Selective Voluntary Motor Control in Ambulatory Children with Cerebral Palsy

This pilot study investigated the efficacy of a four week robot-assisted gait training in twelve children with spastic diparesis. Short-term results and a 3-month follow-up showed statistically significantly increased selective motor control, walking farther distances, gross motor score, and decreased joint contractures.

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.

Effectiveness of robot-assisted gait training on patients with burns: a preliminary study

Gait enables individuals to move forward and is considered a natural skill. However, gait disturbances are very common in patients with burn injury. Recent studies have emphasized the role of robot-assisted gait training (RAGT) in rehabilitation. This study aimed to evaluate the efficacy of RAGT on patients with lower extremity burn for the first time. 12 patients with lower extremity burns were included. SUBAR® (CRETEM, Korea) is a wearable robot with a footplate that assists patients to perform voluntary muscle movements. Patients underwent 30 min of RAGT using SUBAR® for 30 min once a day for 5 days a week for 4 weeks. Functional scores of functional ambulation category (FAC), 6-minute walking test (6MWT) distances, and numeric rating scale (NRS) scores of pain before and after 4 weeks RAGT were measured. NRS scores decreased significantly from 6.92 ± 1.78 points before RAGT to 4.17 ± 1.75 points after 4 weeks of RAGT (p = 0.002). FAC scores increased significantly from 1.58 ± 1.08 points to 3.08 ± 1.31 points (p = 0.002). 6MWT scores increased significantly from 182.17 ± 153.62 points to 279.17 ± 119.27 points (p = 0.001). RAGT may facilitate early recovery from a burn injury. This study is the first study to evaluate the effectiveness of RAGT on patients with burns. Outcomes were meaningful, including patient-subjective outcome measures, and objective gait functions for burn patients. The absence of complications on burn patients provides an opportunity to enlarge the application area of RAGT.

Effects of robot-assisted gait training combined with virtual reality on motor and cognitive functions in patients with multiple sclerosis: A pilot, single-blind, randomized controlled trial.

Studies on robot-assisted gait training rehabilitation in multiple sclerosis have reported positive effects on mobility and quality of life. However, their effects on cognitive functions are difficult to determine because not all trials have included cognition assessments. Virtual reality-based training provides enhanced opportunity for stimulating cognitive abilities by repetitive practice, feedback information, and motivation for endurance practice. To compare the effects of innovative robot-assisted gait training combined with virtual reality versus standard robot-assisted gait training on information processing speed, sustained attention, working memory, and walking endurance in patients with multiple sclerosis. Seventeen outpatients were randomly assigned to receive robot-assisted gait training either with or without virtual reality. The robot assisted gait training + virtual reality group underwent end-effector system training engendered by virtual reality. The standard training group underwent end-effector system training. A blinded rater evaluated patients before and after treatment and at one month follow-up. The outcome measures were the Paced Auditory Serial Addition Test, Phonemic Fluency Test, Novel Task, Digit Symbol, Multiple Sclerosis Quality of Life-54, 2-Minutes Walk Test, 10-Meter Walking Test, Berg Balance Scale, gait analysis, and stabilometric assessment. Between-group comparisons showed a significant change on the 2-Minutes Walk Test (p = 0.023) after treatment in the robot-assisted gait training + virtual reality group. Significant improvement were obtained also in executive functions (p = 0.012). Both gains were maintained at the 1-month follow-up evaluation (p = 0.012, p = 0.012) in the robot-assisted gait training + virtual reality group. Both group improved quality of life after treatment (Multiple Sclerosis Quality of Life-54: Mental Health p = 0.018, Physical Health p = 0.017). Both training lead to positive influenced on executive functions. However larger positive effects on gait ability were noted after robot-assisted gait training engendered by virtual reality with multiple sclerosis. Robot-assisted gait training provides a therapeutic alternative and motivational of traditional motor rehabilitation.

Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report.

Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.

Effects of robotic gait training after stroke: A meta-analysis.

Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09m/s, 95% confidence interval [CI] 0.03 to 0.15; p=0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p=0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p=0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke.

Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis.

Background To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). Results A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI = −0.202 to -0.068, p ≤ 0.001; MAS: 95%CI = −2.886 to -1.412, p ≤ 0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. Conclusions RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

Efficacy of robot-assisted gait training in multiple sclerosis: A systematic review and meta-analysis

BackgroundMultiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight–supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis. MethodsWe performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance. ResultsWe identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02–0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08–1.33, I² = 53%), and global mobility (borderline) after the intervention. ConclusionOur results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.

Effects of robot-assisted gait training on lower extremity strength, functional independence, and walking function in men with incomplete traumatic spinal cord injury.

The aim of this study was to investigate the effects of robotic treadmill training on lower extremity motor function, functional independence, and walking in men with traumatic incomplete spinal cord injury (SCI). A total of 30 consecutive male patients (mean age 36.6 years; range, 19 to 53 years) with traumatic incomplete SCI who were admitted to our inpatient clinic of the rehabilitation hospital were included in this study. All patients had conventional rehabilitation for five days weekly. The patients were randomized into two groups as the robot-assisted gait training (RAGT) group (n=15) for 30 min for three times a week for a total of five weeks and the conventional rehabilitation group (control group, n=15). The patients were evaluated sociodemographically and neurologically at baseline. Lower Extremity Motor Score (LEMS), Spinal Cord Independence Measurement-III (SCIM-III), and Walking Index for Spinal Cord Injury-II (WISCI-II) were used at baseline, at the end of the fifth week, and at three months after the treatment. The mean disease duration was 23±33 months in the RAGT group and 28.6±17 months in the conventional rehabilitation group (p>0.05). A significant improvement was observed in the LEMS, WISCI-II, and SCIM-III scores after the treatment in both groups (p<0.05). The improvement in the LEMS scores was significantly higher in the RAGT group at the end of the fifth week and at three months (p=0.017). The SCIM-III scores were also significantly improved in the RAGT group at the end of the fifth week and at three months (p=0.038). Our study results show that conventional rehabilitation is useful in terms of the improvement in the lower extremity motor function, walking, and functional status in men with incomplete SCI. Additional RAGT provides a better improvement in the lower extremity motor function and functional independence.

Effects of Robot-assisted Gait Training in Patients Burn Injury on Lower Extremity

Effects of Robot-assisted Gait Training in Patients Burn Injury on Lower Extremity

Does robot-assisted gait training improve mobility, activities of daily living and quality of life in stroke? A single-blinded, randomized controlled trial.

The purpose of this study was to investigate the effects of robot-assisted gait training (RAGT) on mobility, activities of daily living (ADLs), and quality of life (QoL) in stroke rehabilitation. Fifty-one stroke patients randomly assigned to Group 1, Group 2, and Group 3 received conventional training (CT) plus RAGT, CT, and RAGT, respectively. The training duration was for 6weeks. The primary outcome measures were the Barthel Index (BI), Stroke Specific Quality of Life Scale (SS-QOL), 6-Minute Walk Test (6-MWT), and Stair Climbing Test (SCT). The secondary outcomes were Fugl Meyer Assessment-Lower Extremity (FMA-LE), Comfortable 10-m Walk Test (CWT), Fast 10-m Walk Test (FWT), and Rate of Perceived Exertion (RPE). The mean change in all the primary [BI (p = 0.001), 6-MWT (p = 0.001), SS-QOL (p < 0.0001), and SCT (p = 0.004)] and except the FWT (p = 0.354) all the other secondary outcomes [FMA-LE (p = 0.049), CWT (p = 0.025) and RPE (p = 0.023)] improved significantly between the three groups. In the subgroup analysis, BI, 6-MWT, SS-QOL, and SCT improved significantly in Group 1 compared to Group 2 and Group 3 (p < 0.016). However, FMA-LE, CWT, and the RPE significantly improved in Group 1 compared to Group 2 and, also, only CWT improved significantly in Group 1 compared to Group 3 (p = 0.011). In a subgroup analysis of the primary and secondary outcome measures, there were no significant differences in Group 2 compared to Group 3 (p > 0.05). While combined training leads to more improvement in mobility, ADLs, and QoL, CT showed a similar improvement compared to the RAGT in stroke patients.

Effects of robot-assisted gait training with active motion visual feedback induced by guidance force on walking speed in patients with chronic stroke: a pilot study

IntroductionThis study aimed to determine the effects of robot-assisted gait training with active movement visual feedback induced by guidance force on walking speed in patients with chronic stroke.MethodsA single-subject reversal (A-B) design was applied. overall, 3 patients with chronic stroke underwent robot-assisted gait training with visual feedback displaying active motion of the affected lower limb during the intervention phase. Walking function was measured by using the 10-m walk test (10MWT) and peak knee flexion angle (PKFA) during walking.Resultsduring the intervention phase, the 10MWT score of subjects 1, 2, and 3 improved by 23.95%, 30.95%, and 43.71%, respectively, and the PKFA improved by 8.41%, 15.92%, and 32.25%, respectively. The walking speed and PKFA in all subjects after the training showed improvement when compared with the baseline phase (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).ConclusionsThese findings suggest that robot-assisted gait training with active motion visual feedback and guidance force may be clinically helpful to improve walking recovery after stroke.

Effects of robot-assisted gait training on walking abilities of children with cerebral palsy

Introduction Cerebral palsy (CP) is the most common cause of movement disorders in childhood and is associated with abnormal muscle tone, low range of motion, and muscle weakness. These impairments reduce walking ability. Robotic-assisted gait training (RAGT; e.g. Lokomat) are considered as a promising approach for gait rehabilitation in patients with neurologic impairment. However, the evidence on its effectiveness in pediatric rehabilitation is still scarce. This study aimed to evaluate whether gait training using the RAGT can improve walking abilities in children with CP. Material and method Twenty-three children (age: 10 ± 3 yrs, GMFCS: II-IV) with CP completed a RAGT program (2 sessions/week of 30–45 min for 12 weeks). RAGT sessions included oriented task exercises (e.g., pass an obstacle). Lokomat settings were individually set according to each participant's functional level. Outcome measures were spatiotemporal parameters, lower limb isometric strength (i.e., hip flexors, extensors and abductors and knee flexors and extensors) and the distance traveled during a 6-min walking exercise (6mwe). GLM repeated measures and Tukey post-hoc tests were used to compare outcomes in pre-, post-training and 6-month follow-up. Results All outcomes (except single support duration and hip flexors strength) were improved in post-training and maintained after 6-months. Comfortable walking speed increased by +21.6% (+0.14 m/s, P = 0.012), mainly explained by step length (+0.06 m, P ≤ 0.01). Muscle strength increased by 27 to 68% in post-training. The endurance measured by 6mwe increased by +22.3% (P ≤ 0.01). Conclusion RAGT increases global walking capacities in children with CP. Lokomat training could be viewed as a valuable training modality for children with CP.

Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury

ObjectiveTo evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children’s functions. DesignA cohort, pretest-posttest retrospective study was conducted. SettingHospitalized care. ParticipantsA total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively. InterventionsPatients underwent a combined treatment of robot-assisted gait training and physical therapy. Main Outcome MeasuresAll the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements. ResultsThe 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP. ConclusionsChildren with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.

Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study

Objective: To investigate the effect of a short-term, robotic-assisted (exoskeleton) gait training (RGT) program on central and peripheral hemodynamic measures in patients with spinal cord injury (SCI). Design: Parallel group, non-randomized trial with before (baseline) and after (follow-up) assessments. Setting: Single-center, community-based neuro-physiotherapy practice. Participants: Twelve individuals with SCI (ASI A to C). Interventions: Participants completed either a 5-day RGT program plus physiotherapy (n = 6), or a usual care physiotherapy only program (control group; n = 6). The RGT program consisted of daily 60-min physiotherapy and 90-min of RGT. Outcome measures were measured before and after the rehabilitation program. Main outcome measure(s): The primary outcome measure was arterial wave reflection (Augmentation index [AIx]), with central and peripheral blood pressures also reported. Data are presented as mean (SD) and effect sizes (partial eta squared; η 2 p). Results: There was a significant reduction in AIx (30 ± 18–21 ± 15%; η 2 p=0.75) and mean arterial pressure (89 ± 11–82 ± 10 mmHg; η 2 p=0.47) following completion of the RGT program (both P < 0.05). There were no changes in these measures for the control group. Although not significantly different, medium to large effects were observed in favor of RGT for all other central and peripheral measures (η 2 p=0.06–0.21), except for heart rate and pulse pressure (η 2 p<0.04). Conclusions: RGT using an exoskeleton is a promising therapy for improving cardiovascular health in patients with SCI. Specifically, this study indicates decreased arterial wave reflection and supports the need for larger randomized controlled trials. Trial Registration: Clinical trials Registry (https://clinicaltrials.gov/; NCT03611803).

Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial.

Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms. We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life. Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1). We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction. Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait - related disability.

To Investigate the Effects of Robotic-assisted Gait Training in Stroke Patients

To Investigate the Effects of Robotic-assisted Gait Training in Stroke Patients

Early term effects of robotic assisted gait training on ambulation and functional capacity in patients with spinal cord injury

Background/aimThe aim of the study was to determine the effects of robotic-assisted gait training on ambulation and functional capacity in patients with spinal cord injury.Materials and methods In total, 88 patients were included and were randomly divided into two groups. The first group underwent 16 sessions of robotic therapy training for 8 weeks and conventional therapy for 5 days a week. The second group underwent conventional treatment. The Walking Index for Spinal Cord Injury II was used to evaluate functional ambulation, and the functional independence measure score was used to assess patients’ functional independence levels in a blind manner.Results A significant improvement was observed in both groups according to Walking Index for Spinal Cord Injury II and functional independence measure scores (P < 0.001). However, a significantly higher improvement according to the Walking Index for Spinal Cord Injury II (P = 0.011) and functional independence measure scores (P = 0.022) was seen in the robotic group than in the control group.ConclusionsRobotic-assisted gait training combined with conventional therapy was found to be superior to the conventional therapy in terms of gait function and level of disability.