Robot-assisted walking training for individuals with Parkinson’s disease: a pilot randomized controlled trial

Abstract

BackgroundOver the last years, the introduction of robotic technologies into Parkinson’s disease rehabilitation settings has progressed from concept to reality. However, the benefit of robotic training remains elusive. This pilot randomized controlled observer trial is aimed at investigating the feasibility, the effectiveness and the efficacy of new end-effector robot training in people with mild Parkinson’s disease.MethodsDesign. Pilot randomized controlled trial.Setting. Robot assisted gait training (EG) compared to treadmill training (CG).Participants. Twenty cognitively intact participants with mild Parkinson’s disease and gait disturbance.Interventions. The EG underwent a rehabilitation programme of robot assisted walking for 40 minutes, 5 times a week for 4 weeks. The CG received a treadmill training programme for 40 minutes, 5 times a week for 4 weeks.Main outcome measures. The outcome measure of efficacy was recorded by gait analysis laboratory. The assessments were performed at the beginning (T0) and at the end of the treatment (T1). The main outcome was the change in velocity. The feasibility of the intervention was assessed by recording exercise adherence and acceptability by specific test.ResultsRobot training was feasible, acceptable, safe, and the participants completed 100% of the prescribed training sessions. A statistically significant improvement in gait index was found in favour of the EG (T0 versus T1). In particular, the statistical analysis of primary outcome (gait speed) using the Friedman test showed statistically significant improvements for the EG (p = 0,0195). The statistical analysis performed by Friedman test of Step length left (p = 0,0195) and right (p = 0,0195) and Stride length left (p = 0,0078) and right (p = 0,0195) showed a significant statistical gain. No statistically significant improvements on the CG were found.ConclusionsRobot training is a feasible and safe form of rehabilitative exercise for cognitively intact people with mild PD. This original approach can contribute to increase a short time lower limb motor recovery in idiopathic PD patients. The focus on the gait recovery is a further characteristic that makes this research relevant to clinical practice. On the whole, the simplicity of treatment, the lack of side effects, and the positive results from patients support the recommendation to extend the use of this treatment. Further investigation regarding the long-time effectiveness of robot training is warranted.Trial registrationClinicalTrials.gov NCT01668407

Robot-assisted gait training versus treadmill training in patients with Parkinson�s disease: a kinematic evaluation with gait profile score

“…Thus, the aim of this study was to evaluate whether robotic gait training could be more effective than a conventional treadmill training program in improving walking ability (considering both spatiotemporal parameters and kinematics) in patients with PD. Our data showed significant changes (improved values) in mean velocity, step length and cadence after robotic training, in accordance with previous literature ( Sale et al, 2013). As regards the gait kinematics, globally no changes were produced by robot training, as shown by the GPS which remained unchanged, even though we recorded significant improvements in GVSs of the pelvis (Pelvic Obl) and hip (Hip Ab-Add) in the frontal plane.…”

“…As regards the gait kinematics, globally no changes were produced by robot training, as shown by the GPS which remained unchanged, even though we recorded significant improvements in GVSs of the pelvis (Pelvic Obl) and hip (Hip Ab-Add) in the frontal plane. After treadmill training (IG), a significant improvement was found only in step length, which increased, in accordance with the literature (Mehrholz et al, 2010;Sale et al, 2013). No other changes (in GPS and/or the other GVSs) were observed.…”

“…Forced use therapy, task-specific therapy, and intensive gait rehabilitation programs based on treadmill training have been reported to effectively improve gait speed, walking distance and stride length in PD (Lo et al, 2010). In addition, robotic gait training has been observed to improve gait speed, walking capacity and stride length and reduce fatigue in patients with PD (Picelli et al, 2012;Sale et al, 2013). However, evidence of its effectiveness on walking impairment in terms of lower limb kinematics is lacking.…”

“…Recently, robotic assistive devices have been used for gait training in neurological disorders such as stroke, spinal cord injury and multiple sclerosis, giving good results in terms of gait recovery (Sale et al, 2012;Semprini et al, 2009;Mehrholz and Pohl, 2012;Spenko et al, 2006;Lee et al, 2011a,b;Roy et al, 2011;Forrester et al, 2011). The literature now also reports interesting results of the application of robotic assistive devices in PD (Lo et al, 2010;Picelli et al, 2012Picelli et al, , 2013Ustinova et al, 2011;Sale et al, 2013): gait was found to be improved and freezing episodes were reduced after using robot-assisted gait training. However, most of these analyses were based mainly on clinical evaluations and questionnaires: Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walking speed, distance walked in 6 minutes, the Freezing of Gait Questionnaire, the Parkinson's Disease Questionnaire-39.…”

“…However, most of these analyses were based mainly on clinical evaluations and questionnaires: Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walking speed, distance walked in 6 minutes, the Freezing of Gait Questionnaire, the Parkinson's Disease Questionnaire-39. Only two studies used some quantitative gait indices, but these were limited to spatiotemporal parameters (Lo et al, 2010;Sale et al, 2013), and there was no investigation of gait kinematics. The aim of the present study was to investigate the effects, on walking performance, of an end-effector robotic rehabilitation locomotor training program in patients with PD, comparing these patients with PD subjects who underwent intensive treadmill training therapy.…”