Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Fang CY

PROVIDER: S-EPMC7115057 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

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

Fang Chia-Ying CY Tsai Jia-Ling JL Li Guo-Sheng GS Lien Angela Shin-Yu AS Chang Ya-Ju YJ

BioMed research international 20200321

<h4>Background</h4>To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). <i>Material and methods</i>. 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 tri ...[more]

PMID: 32280681

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Project description:BACKGROUND:Powered exoskeleton can improve the mobility for people with movement deficits by providing mechanical support and facilitate the gait training. This pilot study evaluated the effect of gait training using a newly developed powered lower limb exoskeleton robot for individuals with complete spinal cord injury (SCI). METHODS:Two participants with a complete SCI were recruited for this clinical study. The powered exoskeleton gait training was 8 weeks, 1 h per session, and 2 sessions per week. The evaluation was performed before and after the training for (1) the time taken by the user to don and doff the powered exoskeleton independently, (2) the level of exertion perceived by participants while using the powered exoskeleton, and (3) the mobility performance included the timed up-and-go test, 10-m walk test, and 6-min walk test with the powered exoskeleton. The safety of the powered exoskeleton was evaluated on the basis of injury reports and the incidence of falls or imbalance while using the device. RESULTS:The results indicated that the participants were donning and doffing the powered lower limb exoskeleton robot independently with a lower level of exertion and walked faster and farther without any injury or fall incidence when using the powered exoskeleton than when using a knee-ankle-foot orthosis. Bone mineral densities was also increased after the gait training. No adverse effects, such as skin abrasions, or discomfort were reported while using the powered exoskeleton. CONCLUSIONS:The findings demonstrated that individuals with complete SCI used the powered lower limb exoskeleton robot independently without any assistance after 8 weeks of powered exoskeleton gait training. TRIAL REGISTRATION:Trial registration: National Taiwan University Hospital. TRIAL REGISTRATION NUMBER:201210051RIB . Name of registry: Hui-Fen Mao. URL of registry: Not available. Date of registration: December 12th, 2012. Date of enrolment of the first participant to the trial: January 3rd, 2013.

Project description:Robot-assisted gait training (RAGT) has been proven effective in improving gait function in not only patients with central nervous system damage, but also in patients who have undergone musculoskeletal surgery. Nevertheless, evidence supporting the efficacy of such training in burn patients remains insufficient. This report aimed to evaluate the effect of RAGT in burn patients with spinal cord injuries (SCI) caused by electrical trauma. We reported a case of two patients. The total duration of each session was about 1 h 30 min. This included 10 min to put on the exoskeleton, 30 min of robot-assisted training using SUBAR®, 10 min to remove the exoskeleton, 10 min to observe whether complications such as skin abrasion, ulcer, or pain occur in the scar area after RAGT, and 30 min of conventional physiotherapy, at a rate of 5 days a week for 12 weeks. All measurements were assessed before training (0 week) and after training (12 weeks). The American Spinal Cord Injury Association (ASIA) lower extremity motor score (LEMS), passive range of motions (ROMs) of different joints (hip, knee, and ankle), ambulatory motor index (AMI), functional ambulation categories (FAC), and 6 min walking (6 MWT) distances were evaluated to measure the degree of gait function through training. In both patients, manual muscle test measurement and joint ROM in the lower extremities improved after 12 weeks training. The first patient scored 0 in the FAC before training. After 12 weeks of training, he could walk independently indoors, improving to an FAC score of 4. He also reached 92.16 m in the 6 MWT. LEMS improved from 22 before training to 30 after training, and AMI score improved from 12 before training to 16 after training. In the second patient, an independent walking function was not acquired. LEMS improved from 10 before training to 26 after training. AMI scores were the same at 10 points before and after training. The results suggested the possibility of achieving clinical effects in terms of improving lower extremity muscle strength, joint ROMs, and gait performance in patients with SCI caused by electrical trauma.

Project description:IntroductionRobotic-assisted gait training (RAGT) has been reported to be effective in rehabilitating patients with spinal cord injury (SCI). However, studies on RAGT showed different results due to a varied number of samples. Thus, summarising studies based on robotic-related factors is critical for the accurate estimation of the effects of RAGT on SCI. This work aims to search for strong evidence showing that using RAGT is effective in treating SCI and analyse the deficiencies of current studies.Methods and analysisThe following publication databases were electronically searched in December 2022 without restrictions on publication year: MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Various combinations of keywords, including 'motor disorders', 'robotics', 'robotic-assisted gait training', 'Spinal Cord Injuries', 'SCI' and 'gait analysis' were used as search terms. All articles on randomised controlled trials (excluding retrospective trials) using RAGT to treat SCI that were published in English and Chinese and met the inclusion criteria were included. Outcomes included motor function, and gait parameters included those assessed by using the instrumented gait assessment, the Berg Balance Scale, the 10-m walk speed test, the 6-min walk endurance test, the functional ambulation category scale, the Walking index of SCI and the American Spinal Injury Association assessment scale. Research selection, data extraction and quality assessment were conducted independently by two reviewers to ensure that all relevant studies were free from personal bias. In addition, the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager V.5.3 software was used to produce deviation risk maps and perform paired meta-analyses.Ethics and disseminationEthics approval is not required for systematic reviews and network meta-analyses. The results will be submitted to a peer-reviewed journal or presented at a conference.Prospero registration numberCRD42022319555.

Project description:High-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.The 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.A single-day, repeated-measures, pretraining-posttraining study design was used.Nineteen 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.The 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.Measures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.High-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.

Dataset Information

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

Background

Results

Conclusions

Publications

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

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