Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: A preliminary prospective longitudinal study

Abstract

BACKGROUND: Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. OBJECTIVES:The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. METHODS: Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. RESULTS: Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1-3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control.

Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson’s Disease: A Systematic Review

“…Robotic gait training was assessed by 3 studies, 2 of them being RCT with sample sizes between 34 and 41 participants. Improved QoL was observed in the third one without control group, studied on 70 PD patients [ 31 ]. Tai Chi was examined by 5 RCT applied on large sample sizes varying from 45 to 195 subjects and one noncontrolled applied on 12 patients only.…”

“…RAGT has been examined in a RCT on postural stability too, also showing a significant improvement of balance when compared to conventional physiotherapy group [ 30 ]. Robotic treadmill training proved to be useful not just in improving motor symptoms, functional mobility, and walking capacity, but also a transient improvement in QoL [ 31 ]. Robot-assisted training has therefore proved to have a potential to enhance the effect of conventional physiotherapy not only in terms of gait, but also of balance.…”

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

“…Thus, it may stimulate increased cadence and shorter strides [53,54]. Nevertheless, analyzing the gait characteristics in healthy young adults may be meaningful because several studies have reported the positive effects of gait training programs using treadmills [18][19][20][21][22][23][24][25][26]. Second, there were limitations in the direct comparisons of GV with previous studies because most previous studies focused on elderly adults (who ranged in age from 70 to 89 years).…”

“…By contrast, walking on treadmills may be more useful for the collection of data pertaining to numerous continuous walking steps in comparison with methods involving repeated and averaged patterns due to decreased space requirements, multiple repetitions of strides, and controllability of the walking speed [17]. Recently, many studies have reported the positive effects of gait training programs using treadmills on amputees [18] and pathological patients such as people suffering from cerebral palsy [19], Parkinson's disease [20][21][22][23][24][25], and spinal cord injury [26]. However, several studies reported limitations such as lack of controls [19,24,25] and relatively small samples of patients [20,22].…”

“…Recently, many studies have reported the positive effects of gait training programs using treadmills on amputees [18] and pathological patients such as people suffering from cerebral palsy [19], Parkinson's disease [20][21][22][23][24][25], and spinal cord injury [26]. However, several studies reported limitations such as lack of controls [19,24,25] and relatively small samples of patients [20,22]. Thus, establishing normative values based on treadmill walking may be useful in a clinical environment as reference values [1,3,6].…”