Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke

Lefeber, Nina; Keersmaecker, Emma De; Henderix, Stieven; Michielsen, Marc; Kerckhofs, Eric; Swinnen, Eva

doi:10.1177/1545968318810810

Cited by 18 publications

(15 citation statements)

References 57 publications

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Section: Measures and Proceduressupporting

confidence: 76%

“…Similar to work of Lefeber, et al [26] the effects of BWS yielded noted differences in VO 2 and cardiorespiratory demand. These authors found that in ambulatory stroke survivors, metabolic markers of exertion during robot assisted gait were less than over ground walking when in BWS walking [26]. However, during BWS minimum thresholds of exercise demand were reached, and therefore complement our findings that BWS exercise can reach intensities sufficient to challenge the cardiopulmonary system to promote gainful adaptation.…”

Section: Measures and Proceduressupporting

confidence: 76%

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Impact of Varying Exercise Intensity on Oxygen Uptake and Cardiovascular Response during Body Weight Supported Treadmill Walking in Healthy Adults

Van¹,

R.²,

Josh³

et al. 2022

Int J Sports Exerc Med

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Background: Body Weight Supported Treadmill Training (BWSTT) is effectively used in locomotive training for patients with neurologic and musculoskeletal deficits. The impact of BWSTT on oxygen uptake (VO 2 ) and cardiovascular (HR and BP) response in patients has been shown to be variable, possibly due to level of Body Weight Support (BWS) or exercise intensity. The purpose of this study was to compare and quantify VO 2 , HR, and BP response in healthy adults during BWSTT at 0% and 30% BWS for two exercise intensities (35% and 50% VO 2 max).Methods: Eleven subjects (6 female, 5 male; 41.9 ± 11.3 y; 177.3 ± 6.9 cm; 79.0 ± 17.5 kg; 24.9 ± 4.2 kg/m 2 ) provided informed consent for participation. Each completed a 5-minute rest trial followed by four treadmill walking trials; 2 at 35% VO 2 max (0% and 30% BWS; trials 0035 and 3035) and 2 at 50% VO 2 max (0% and 30% BWS; trials 0050 and 3050). Subjects rested a minimum of 5 minutes between each trail. For each trial the following was measured: HR (electronic monitor), BP (auscultation), RPE (Borg ratio scale), VO 2 (indirect calorimetry). Mean data from minutes 3-5 were analyzed for differences between levels of BWS and exercise intensity levels using repeated measures ANOVA and Bonferroni post-hoc testing.Results: Mean walking speeds and elevations were 86.7 m/min and 0.6% (35% VO 2 max) and 91.1 m/min and 3.7% (50% VO 2 max). All trials showed significant (p < 0.05) increases in HR, RPE, VO 2 , metabolic equivalents (MET), minute ventilation (VE), Respiratory Rate (RR) and tidal volume (TV) compared to rest. No significant differences were seen in any tested variables between 0035 and 3035. HR, VO 2 , METS, and VE were significantly decreased in 3050 vs. 0050. HR, RPE, VO 2 , METS, respiratory exchange ratio and TV were significantly reduced in 0035 and 3035 compared to 0050 but were not different compared to 3050. Conclusion:BWS of 30% did not induce significant changes in VO 2, HR or BP response while walking at 35% VO 2 max but did show significant reductions in HR and VO 2 walking at 50% VO 2 max. Further, 30% BWS while walking at 50% VO 2 max elicited similar VO 2 and HR responses to unweighted walking at 35% VO 2 max. This suggests BWS may allow for higher intensity exercise in patients while yielding reduced patient responses in VO 2 and HR.

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Section: Measures and Proceduressupporting

confidence: 76%

Section: Measures and Proceduressupporting

confidence: 76%

Impact of Varying Exercise Intensity on Oxygen Uptake and Cardiovascular Response during Body Weight Supported Treadmill Walking in Healthy Adults

Van¹,

R.²,

Josh³

et al. 2022

Int J Sports Exerc Med

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“…In conclusion, we cannot add any useful information on the aerobic capacity of RAGT or on the physiological response to this intervention, even though it has been reported how RAGT is less energy-consuming and cardiorespiratory stressful than overground walking training. 30,31 In future trials, it will be useful considering the intensity of the training as a factor potentially influencing the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted gait training is not superior to intensive overground walking in multiple sclerosis with severe disability (the RAGTIME study): A randomized controlled trial

et al. 2019

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Background: Rehabilitation may attenuate the impact on mobility of patients with progressive multiple sclerosis (MS) and severe gait disabilities. Objective: In this randomized controlled trial, we compared robot-assisted gait training (RAGT) with conventional therapy (CT) in terms of gait speed, mobility, balance, fatigue and quality of life (QoL). Methods: Seventy-two patients with MS (expanded disability status scale score 6.0–7.0) were randomized to receive 12 training sessions over a 4-week period of RAGT ( n = 36) or overground walking therapy ( n = 36). The primary outcome was gait speed, assessed by the timed 25-foot walk test. Secondary outcome measures were walking endurance, balance, depression, fatigue and QoL. Tests were performed at baseline, intermediate, at the end of treatment and at a 3-month follow-up. Results: Sixty-six patients completed the treatments. At the end of treatment with respect to baseline, both groups significantly improved gait speed ( p < 0.001) and most secondary outcomes without between-group differences. Outcome values returned to baseline at follow-up. Conclusions: RAGT was not superior to CT in improving gait speed in patients with progressive MS and severe gait disabilities where a positive, even transitory, effect of rehabilitation was observed.

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“…The walking interventions in the aforementioned studies by Klassen et al and Hornby et al were purposefully delivered at moderate to high cardiovascular intensities, which may have been a key factor in driving positive outcomes [ 56 , 57 ]. Research has shown that patients participating in robotic-assisted gait training achieve only low-intensity aerobic thresholds, relative to overground walking practice [ 58 , 59 ]; thus, participants in our study most likely did not achieve the moderate- to high-intensity guideline suggested for locomotor training. An important caveat of these studies showing association between aerobic intensity or stepping amount and improved walking outcomes investigated patients requiring minimal or no assistance to walk.…”

Section: Discussionmentioning

confidence: 89%

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

Louie

Durocher

Schneeberg

et al. 2021

J NeuroEngineering Rehabil

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Background Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. Methods An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months. Results Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. Conclusions This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016)

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Physiological Responses and Perceived Exertion During Robot-Assisted and Body Weight–Supported Gait After Stroke

Abstract: Supplementary material for this article is available on the Neurore-habilitation & Neural Repair website along with the online version of the article.

Cited by 18 publications

References 57 publications

Impact of Varying Exercise Intensity on Oxygen Uptake and Cardiovascular Response during Body Weight Supported Treadmill Walking in Healthy Adults

Impact of Varying Exercise Intensity on Oxygen Uptake and Cardiovascular Response during Body Weight Supported Treadmill Walking in Healthy Adults

Robot-assisted gait training is not superior to intensive overground walking in multiple sclerosis with severe disability (the RAGTIME study): A randomized controlled trial

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

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