Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial

Yun, Nari; Joo, Min Cheol; Kim, Seung-Chan; Kim, Minsu

doi:10.23736/s1973-9087.18.05077-3

Cited by 24 publications

(32 citation statements)

References 46 publications

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“…The methodological quality of the studies included in this review was globally more than acceptable (average total score 5.5 ± 1.0, range 4–7). Here, 46.2% of trial reports are moderate to high quality, scoring ≥6/10 on the PEDro scale ( 34 , 37 , 38 , 40 , 41 , 43 ).…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the heterogeneity of the studies, this review showed that the lack of longitudinal evaluations for most of the papers represents a main limitation; however, the limited data of the six studies with a follow-up assessment (follow-up range 2-36 weeks) showed substantial maintenance of the results at the post-training evaluation (32,33,35,36,38,43). As no study reported side effects attributable to the use of Lokomat R , it seems legitimate to argue that this robotic device has been shown to be safe and feasible for use with subacute and chronic stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…All participants were randomly assigned to the groups. In six studies (46.2%), the assignment of the subjects was carried out blindly (32,34,37,38,40,43). In all papers (except for 55), the groups were similar at the beginning of the study regarding the most relevant prognostic indicators; of these, eight studies included blind assessors in evaluating at least one of the primary outcome measures of the study (31,35,(37)(38)(39)(40)(41)(42).…”

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

“…In all papers (except for 55), the groups were similar at the beginning of the study regarding the most relevant prognostic indicators; of these, eight studies included blind assessors in evaluating at least one of the primary outcome measures of the study (31,35,(37)(38)(39)(40)(41)(42). In eight studies (61.5%), the results of at least one outcome measure were obtained in more than 85% of the subjects initially assigned to the groups (31,33,34,37,(40)(41)(42)(43). In all studies, the results of the intergroup comparison were reported for at least one of the main outcome measures.…”

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

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The Effect of Robotic Assisted Gait Training With Lokomat® on Balance Control After Stroke: Systematic Review and Meta-Analysis

et al. 2021

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Introduction: Disturbances of balance control are common after stroke, affecting the quality of gait and increasing the risk of falls. Because balance and gait disorders may persist also in the chronic stage, reducing individual independence and participation, they represent primary goals of neurorehabilitation programs. For this purpose, in recent years, numerous technological devices have been developed, among which one of the most widespread is the Lokomat®, an actuated exoskeleton that guide the patient's limbs, simulating a symmetrical bilateral gait. Preliminary evidence suggests that beyond gait parameters, robotic assisted gait training may also improve balance. Therefore, the aim of this systematic review was to summarize evidence about the effectiveness of Lokomat® in improving balance in stroke patients.Methods: Randomized controlled trials published between January 1989 and August 2020, comparing Lokomat® training to conventional therapy for stroke patients, were retrieved from seven electronic databases. Balance, assessed by means of validated clinical scales, was considered as outcome measure. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the studies. The study protocol was registered on PROSPERO (no. CRD42020197531).Results: After the removal of the duplicates, according to the inclusion criteria, 13 studies were selected, involving 445 subacute or chronic stroke patients. Eleven papers contributed to three meta-analyses. Favorable results for recovery of balance in stroke survivors treated with Lokomat® were shown using Timed Up and Go (pooled mean difference = −3.40, 95% CI −4.35 to −2.44; p < 0.00001) and Rivermead Mobility Index as outcome measures (pooled mean difference = 0.40, 95% CI 0.26–0.55; p < 0.00001). Inconclusive results were found when balance was measured by means of the Berg Balance Scale (pooled mean difference = 0.17, 95% CI −0.26 to 0.60; p = 0.44).Conclusions: Overall, most studies have shown beneficial effects of Lokomat® on balance recovery for stroke survivors, at least comparable to conventional physical therapy. However, due to the limited number of studies and their high heterogeneity, further research is needed to draw more solid and definitive conclusions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

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The Effect of Robotic Assisted Gait Training With Lokomat® on Balance Control After Stroke: Systematic Review and Meta-Analysis

et al. 2021

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“…Similarly, in another single-blind randomized trial, Yun et al 20 examined the effect of RAGT on the recovery of pusher syndrome in sub-acute stroke patients. Subjects were divided into an experimental group that received RAGT and a control group that received conventional physiotherapy.…”

Section: Robot-assisted Gait Training (Ragt)mentioning

confidence: 99%

Therapeutic approaches for pusher syndrome after a stroke: a literature review

Thanaya¹,

Mardhika²

2019

Intisari Sains Medis

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Introduction: Pusher syndrome is a disorder that is clinically present in 5-52% of stroke patients, characterized by active pushing using the non-paretic side towards the paretic side, and resistance to the passive correction of posture. This disorder can pose an unfavorable effect on the rehabilitation of stroke patients. Hence, finding effective therapeutic approaches for pusher syndrome is crucial. This study aimed to identify the existing therapeutic approaches for pusher syndrome and investigate their effectiveness. Methods: A literature review was carried out, where studies were identified through searching the PubMed database from database inception to 2019 using the keywords: "pusher syndrome", "pusher behaviour", "contraversive pushing", "ipsilateral pushing", "lateropulsion", "physiotherapy", "physical therapy", "treatment", "therapeutic approach", "therapy" and "training". The literatures were analyzed systematically based on the results of previous studies. Results: Several approaches were identified for treating pusher syndrome post-stroke, including robot-assisted gait training (RAGT), galvanic vestibular stimulation (GVS), visual feedback (VF), and physiotherapy with additional components such as relaxation therapy in the prone position and lateral stepping with body weight-supported treadmill training (LS-BWSTT). RAGT and VF training appear to be promising adjunctive approaches for treating pusher syndrome. Conventional physiotherapy with additional components such as relaxation therapy and LS-BWSTT have also led to positive effects. However, the effect of GVS has not been established. Conclusion: There is evidence that some therapeutic approaches can be beneficial for improving pusher syndrome and outcomes of stroke patients, in particular when combined with conventional physiotherapy. However, the number of studies is still very limited. Further research with methodological rigor is needed.

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