Gait training with a wearable curara® robot for cerebellar ataxia: a single-arm study

Abstract

Background Ataxic gait is one of the most common and disabling symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation improves ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been used for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitative effects of a wearable “curara®” robot developed in a single-arm study of people with degenerative cerebellar ataxia. Methods Twenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial duration was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items at days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10 mWT), 6-min walking distance (6 mWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance and swing phases, minimum and maximum knee joint angles, and minimum and maximum hip joint angles) were obtained using a RehaGait®. On days 1–6 and 8–13, the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni’s correction. Results Data from 18 participants were analyzed. The mean improvement rate of the 10 mWT and 6 mWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14. Conclusions Two-week RAGT with curara® has rehabilitative effects on gait function comparable to those of therapist-assisted training. Although the long-term effects after a month of RAGT with curara® are unclear, curara® is an effective tool for gait training of people with degenerative ataxia. Trial registration jRCT, jRCTs032180164. Registered: 27 February 2019; retrospectively registered. https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164.

Local Dynamic Stability of Trunk During Gait is Responsive to Rehabilitation in Subjects with Primary Degenerative Cerebellar Ataxia

“…Although our findings did not reach statistical significance, it is worth noting that a substantial number of subjects with cerebellar ataxia (swCA) who improved the most in sLLE ML , 33.33%, specifically (Table 4), had poorer gait quality at baseline, according to their SARA GAIT scores. This observation is consistent with existing literature [20,65] reporting the effectiveness of rehabilitation training in swCA in more severely disabled swCA, regardless of disease duration, implying that individuals with swCA may be able to improve their dynamic trunk stability despite ongoing degeneration. Notably, unlike other studies investigating the effects of rehabilitation on gait parameters [19,20,24], gait speed did not improve in our sample, suggesting that sLLE may capture the effects of rehabilitation regardless of gait speed.…”

The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report

“…They found that these patients could walk more smoothly with an increased harmonic ratio while walking with the wearable robot system than without the system. In addition, other studies have demonstrated improvements in gait function and postural balance after weeks of RAGT with the wearable robot system in patients with spinocerebellar ataxia [ 29 , 30 ]. These findings suggest the potential benefit of over-ground RAGT for patients with ataxia.…”

Gait training with a wearable powered robot during stroke rehabilitation: a randomized parallel-group trial

“…We started clinical research in 2017 for the practical application of a wearable rehabilitation robot, “curara®”. We have examined the effect of the device in patients with spinocerebellar degeneration [ 13 , 14 ] and stroke [ 15 ]. We have shown that the use of the device improves walking speed, stride length, walking rate, and asymmetry in stroke patients temporarily [ 15 ], but we have not yet clarified its rehabilitative effect on gait training.…”