Posts Tagged RAGT
[Abstract] Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial
BACKGROUND: Some stroke patients are known to use nonparetic extremities to push toward the paretic side, a movement known as lateropulsion. Lateropulsion impairs postural balance and interferes with rehabilitation.
AIM: The aim of the present study was to investigate the effect of robot-assisted gait training (RAGT) on recovery from lateropulsion compared with conventional physical therapy (CPT).
DESIGN: This was a single-blinded, randomized controlled trial.
SETTING: Participants were recruited from a rehabilitation department of a tertiary hospital.
POPULATION: Patients diagnosed with lateropulsion after a stroke.
METHODS: Thirty-six subacute stroke patients with lateropulsion were recruited. RAGT was performed in the experimental group (n=18), and CPT was performed in the control group (n=18). The participants received treatment for 3 weeks, 30 minutes per day, 5 days per week. Outcomes were assessed before the intervention (T0), immediately after the intervention (T1), and 4 weeks after the intervention (T2). The Burke Lateropulsion Scale (BLS) was evaluated as a primary outcome to assess the severity of lateropulsion. The secondary outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), and Somatosensory Evoked Potentials (SSEP).
RESULTS: After intervention, the experimental group showed greater improvement in the BLS score at T1 (experimental group: Δ=-1.9, control group: Δ=-1.1, p=0.032) and T2 (experimental group: Δ=-2.8, control group: Δ=-6.5, p<0.001) than the control group. In addition, the BBS was significantly improved in the experimental group at T1 (experimental group: Δ=+7.1, control group: Δ=+1.9, p<0.001) and T2 (experimental group: Δ=+13.0, control group: Δ=+6.1, p<0.001). There were significant between-group differences in the PASS at T1 (experimental group: Δ=+3.2, control group: Δ=+1.6, p=0.014) and T2 (experimental group: Δ=+8.8, control group: Δ=+4.3, p<0.001).
CONCLUSIONS: RAGT ameliorated lateropulsion and balance function more effectively than CPT in subacute stroke patients.
via Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2018 Dec 03 – Minerva Medica – Journals
[ARTICLE] Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients – Full Text
The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy . Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient’s functional level and onset time of stroke.
Stroke is a common disease . In most patients, disabilities remain after stroke, and long-lasting disability requires continuous management and intensive rehabilitation [1, 2]. Furthermore, the economic burden on the patient increases because of the prolonged rehabilitation period. Therefore, the application of intensive and efficient rehabilitation programs and techniques is an urgent need after stroke .
Gait impairment is one of the most important problems after stroke and is associated with activities of daily living and mobility issues . Therefore, recovery of gait function is an important goal of rehabilitation for independent living . Interventions to enhance gait function require repetitive task training with high intensity, and extensive effort by physical therapists is essential . Moreover, the most effective rehabilitation intervention, including gait training, must be performed shortly after stroke and in an intensive and task-oriented manner and should include multisensory stimulation .
Robot-assisted gait training (RAGT) for patients in the acute/subacute stage who are nonambulatory is effective at reeducating motor control function through repetitive training of a specific task ; RAGT provides intensive therapy, which reduces the burden on therapists, and enhances motor reeducation with multisensory stimulation . Several previous studies reported that gait training using robotic devices is effective at enhancing muscular activity patterns , muscle tone, joint range of motion , gait speed, functional gait capability [7, 9], gait independence, and mobility in the community [10, 11]. Moreover, patients who received RAGT and conventional physical therapy had a higher chance of regaining independent gait function than those who received only conventional gait training . However, owing to studies that suggested RAGT is ineffective , the effect on gait and gait-related function in subacute stroke remains unclear. In a previous review of effectiveness in stroke patients, the RAGT group showed significant improvement in balance and balance-related activity function, but the comparison between the groups was not significant . These results show that RAGT is effective, but whether it is more effective than other gait-related rehabilitation interventions is still unclear. In this context, the effect of RAGT is still not clearly demonstrated, and reviews that have recently demonstrated the effect of RAGT on gait-related outcome measures in patients with acute/subacute stroke are also limited.
Therefore, the aim of this systematic review was to investigate the effects of RAGT on acute/subacute stroke. The specific goals included identifying the effects of RAGT using assessment tools associated with gait and gait-related function in patients with acute/subacute stroke.[…]
[ARTICLE] Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy? – Full Text
Contrary 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.
This 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.
Forty 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.
Hemorrhagic 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.
Overall, 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.