Robotic-assisted gait training in Parkinson's disease: a three-month follow-up randomized clinical trial

Furnari, Anna; Calabrò, Rocco Salvatore; Cola, Maria Cristina De; Bartolo, Michelangelo; Castelli, Alberto; Mapelli, Alessia; Buttacchio, Giampiero; Farini, Elena; Bramantı, Placido; Casale, Roberto

doi:10.1080/00207454.2017.1288623

Cited by 33 publications

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“…In literature there are several important reports on the efficacy of robot assisted gait training (RAGT) on gait and other motor parameters and now it is accepted and widely applied in the rehabilitation setting of various neurological diseases (PD, MS, SCI, stroke) to improve gait [ 3 , 4 , 5 , 6 , 7 ]. However, although in rehabilitation gait and motor parameters improvement are as important as well-being and improvement in quality of life, data on well-being changes induced by RAGT are very limited and not standardized.…”

Section: Discussionmentioning

confidence: 99%

“…As reported in other studies, body weight-supported high-intensity motor training, even with no robotic device, improved gait ability in Parkinson’s disease [ 36 ]. Since gait disability in SCI patients is usually more severe than in Parkinson’s disease, robot assistance is consequently higher [ 3 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the last decade robotic devices for rehabilitation have been developed and applied to overcome disability related to walking with promising results [ 1 – 2 ]. Robot assisted gait training (RAGT) has been widely used in the rehabilitation of several neurologic, traumatic, vascular and neurodegenerative disorders such as Parkinson’s Disease (PD) [ 3 ], multiple sclerosis (MS) [ 4 ], Spinal Cord Injuries (SCI) [ 5 ] and Stroke [ 6 – 7 ], where an improvement of gait parameters and quality of life has been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

et al. 2018

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In the last decade robotic devices have been applied in rehabilitation to overcome walking disability in neurologic diseases with promising results. Robot assisted gait training (RAGT) using the Lokomat seems not only to improve gait parameters but also the perception of well-being. Data on the psychosocial patient-robot impact are limited, in particular in the real-world of RAGT, in the rehabilitation setting. During rehabilitation training, the Lokomat can be considered an “assistive device for movement”. This allowed the use of the Psychosocial Impact of Assistive Device Scale- PIADS to describe patient interaction with the Lokomat. The primary aim of this pilot study was to evaluate the psychosocial impact of the Lokomat in an in-patient rehabilitation setting using the PIADS; secondary aims were to assess whether the psychosocial impact of RAGT is different between pathological sub-groups and if the Lokomat influenced functional variables (Functional Independence Measure scale–FIM and parameters provided by the Lokomat itself). Thirty-nine consecutive patients (69% males, 54.0±18.0 years) eligible for Lokomat training, with etiologically heterogeneous walking disabilities (Parkinson’s Disease, n = 10; Spinal Cord Injury, n = 21; Ictus Event, n = 8) were enrolled. Patients were assessed with the FIM before and after rehabilitation with Lokomat, and the PIADS was administered after the rehabilitative period with Lokomat. Overall the PIADS score was positive (35.8±21.6), as well as the three sub-scales, pertaining to “ability”, “adaptability” and “self-esteem” (17.2±10.4, 8.9±5.5 and 10.1±6.6 respectively) with no between-group differences. All patients significantly improved in gait measure and motor FIM scale (difference after—before treatment values: 11.7±9.8 and 11.2±10.3 respectively), increased treadmill speed (0.4 ± 0.2m/s), reduced body weight support (-14.0±9.5%) and guidance force (-13.1 ± 10.7%). This pilot study indicates that Lokomat, in a real-world in-patient setting, may have a generalised approval, independent of disease, underlining the importance of the psycho-social framework for patients training with assistive robotic-devices.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

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“…There are studies of the effects of RAGT on gait velocity with better outcomes for RAGT than the control group [13–16], as well as insignificant outcomes [17–19]. Some studies on PD have suggested that RAGT might improve freezing of gait, postural instability, and gait performance [13–16, 20]; however, several studies have reported that RAGT is not superior to conventional therapy for improving postural instability and gait performance [17, 18, 21]. Due to the contradictory results, a well-designed study is needed to clarify the effect of RAGT on gait function in PD.…”

Section: Introductionmentioning

confidence: 99%

Effects of robot-assisted gait training in patients with Parkinson’s disease: study protocol for a randomized controlled trial

Kang

Yun

Shin

et al. 2019

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BackgroundRobot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson’s disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects.MethodsThis is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant’s height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44.DiscussionThis study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks.Trial registrationClinicalTrials.gov, NCT03490578. Registered on 21 March 2018.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3123-4) contains supplementary material, which is available to authorized users.

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“…O uso de tecnologia robótica na reabilitação motora é capaz de fornecer maior repetibilidade, melhor controle de movimentos e precisão para aplicar a força desejada durante a reabilitação e realizar medições relacionadas a cinemática do movimento[25][26][27].Muitos trabalhos nesse segmento já vêm sendo desenvolvidos e direcionados a reabilitação dos sinais / sintomas motores da doença de Parkinson. Uma busca na literatura aponta que a maioria dos estudos envolvendo dispositivos robóticos na reabilitação dos sinais motores da DP são destinados a marcha, como é o caso de Furnari et al[28], Alwardart[29], Picelli et al[30] e Pilleri et al[31]. Durante a revisão da literatura foi observado que poucos dispositivos robóticos são desenvolvidos para reabilitação do membro superior em indivíduos com DP e os trabalhos encontrados nessa área focam no desenvolvimento de dispositivos robóticos para supressão de tremores, como é o caso dos trabalhos realizados por Herrnstadt[32,33], Perry[34] e Seki[35].No entanto, uma atenção especial deve ser dada ao estudo ergonômico desses dispositivos robóticos[18], uma vez que dispositivos destinados a reabilitação fisioterapêutica precisam ser projetados para adaptar-se às necessidades individuais do paciente, levando em consideração e apoiando paradigmas terapêuticos que promovam independência funcional e a avaliação da progressão da terapia.5 2.2 PARÂMETROS IMPORTANTES NA AVALIAÇÃO ERGONÔMICA DE DISPOSITIVOS ROBÓTICOSA ergonomia pode ser definida como a ciência de projetar o trabalho para se adequar ao trabalhador[36].…”

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Avaliação ergonômica de uma órtese ativa de punho para a reabilitação da rigidez em pessoas com a doença de Parkinson

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Robotic-assisted gait training in Parkinson's disease: a three-month follow-up randomized clinical trial

Abstract: RAGT may significantly improve walking ability, motor function and for a maximum period of three months. Thus, our findings support the importance of a RAGT as a valid rehabilitative tool for PD.

Cited by 33 publications

References 39 publications

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

Effects of robot-assisted gait training in patients with Parkinson’s disease: study protocol for a randomized controlled trial

Avaliação ergonômica de uma órtese ativa de punho para a reabilitação da rigidez em pessoas com a doença de Parkinson

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