Dataset Information

Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review.

ABSTRACT:

Background

Spinal cord injury results in the interruption of neuronal conduction in the spinal cord, a condition that occurs in 0.1% of the world's population. This results in severe limitations in autonomy including locomotor function. Its recovery can be pursued through conventional isolated physiotherapeutic rehabilitation (overground walking training - OGT) or associated with Robot-assisted gait training - RAGT (e.g.: Lokomat ®).

Aim

The aim of this review is to compare the effectiveness of RAGT combined with conventional physiotherapy.

Methods

The databases consulted, from March 2022 to November 2022, were PubMed, PEDro, Cochrane Central Register of Controlled Trials (Cochrane Library) and CINAHL. RCT studies of people with incomplete spinal cord injuries treated with RAGT and/or OGT with the aim of improving walking were analysed.

Results

Among the 84 RCTs identified, 4 were included in the synthesis, with a total of 258 participants. The outcomes analysed concerned both locomotor function through lower limb muscle strength and the need for assistance in walking, using the WISCI-II scale and the LEMS. Robotic treatment stimulated the greatest improvements in the four studies; however, they were not always statistically significant.

Conclusion

A rehabilitation protocol combining RAGT with conventional physiotherapy is more effective than isolated OGT in improving ambulation in the subacute phase.

SUBMITTER: Fabbri I

PROVIDER: S-EPMC10248036 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review.

Fabbri Isabella I Betti Fabio F Tedeschi Roberto R

eNeurologicalSci 20230525

<h4>Background</h4>Spinal cord injury results in the interruption of neuronal conduction in the spinal cord, a condition that occurs in 0.1% of the world's population. This results in severe limitations in autonomy including locomotor function. Its recovery can be pursued through conventional isolated physiotherapeutic rehabilitation (overground walking training - OGT) or associated with Robot-assisted gait training - RAGT (<i>e.g.</i>: Lokomat ®).<h4>Aim</h4>The aim of this review is to compare ...[more]

PMID: 37304729

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Project description:Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the "Graded and Redefined Assessment of Strength, Sensibility and Prehension" (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

Project description:BackgroundHigh-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.ObjectiveThe purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.DesignA single-day, repeated-measures, pretraining-posttraining study design was used.MethodsNineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.ResultsThe results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.LimitationsMeasures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.ConclusionsHigh-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.

Project description:BackgroundWalking over obstacles requires precise foot placement while maintaining balance control of the center of mass (CoM) and the flexibility to adapt the gait patterns. Most individuals with incomplete spinal cord injury (iSCI) are capable of overground walking on level ground; however, gait stability and adaptation may be compromised. CoM control was investigated during a challenging target walking (TW) task in individuals with iSCI compared to healthy controls. The hypothesis was that individuals with iSCI, when challenged with TW, show a lack of gait pattern adaptability which is reflected by an impaired adaptation of CoM movement compared to healthy controls.MethodsA single-center controlled diagnostic clinical trial with thirteen participants with iSCI (0.3-24 years post injury; one subacute and twelve chronic) and twelve healthy controls was conducted where foot and pelvis kinematics were acquired during two conditions: normal treadmill walking (NW) and visually guided target walking (TW) with handrail support, during which participants stepped onto projected virtual targets synchronized with the moving treadmill surface. Approximated CoM was calculated from pelvis markers and used to calculate CoM trajectory length and mean CoM Euclidean distance TW-NW (primary outcome). Nonparametric statistics, including spearman rank correlations, were performed to evaluate the relationship between clinical parameter, outdoor mobility score, performance, and CoM parameters (secondary outcome).ResultsHealthy controls adapted to TW by decreasing anterior-posterior and vertical CoM trajectory length (p < 0.001), whereas participants with iSCI reduced CoM trajectory length only in the vertical direction (p = 0.002). Mean CoM Euclidean distance TW-NW correlated with participants' neurological level of injury (R = 0.76, p = 0.002) and CoM trajectory length (during TW) correlated with outdoor mobility score (R = - 0.64, p = 0.026).ConclusionsThis study demonstrated that reduction of CoM movement is a common strategy to cope with TW challenge in controls, but it is impaired in individuals with iSCI. In the iSCI group, the ability to cope with gait challenges worsened the more rostral the level of injury. Thus, the TW task could be used as a gait challenge paradigm in ambulatory iSCI individuals. Trial registration Registry number/ ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17.

Dataset Information

Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review.

Background

Aim

Methods

Results

Conclusion

Publications

Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review.

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