Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial

Cotinat, Maëva; Celerier, Mathilde; Arquillière, Clelia; Flipo, Margot; Prieur-Blanc, Nicolas; Viton, Jean-Michel; Bensoussan, Laurent

doi:10.1016/j.rehab.2023.101785

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…[90]. Recently, Cotinat supported the efficacy of Lokomat plus toxins in the improvement of walking in individuals with chronic post-stroke compared with conventional physiotherapy [91].…”

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Raciti,

Ammendolia

et al. 2024

Brain Sciences

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Spasticity is a very common sign in the neurological field. It can be defined as “a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes” associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life”. The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients’ performance and outcomes. The combined strategies might rise the toxin’s effect, lowering its dosages of botulinum and reducing side effects and costs.

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“…[90]. Recently, Cotinat supported the efficacy of Lokomat plus toxins in the improvement of walking in individuals with chronic post-stroke compared with conventional physiotherapy [91].…”

Section: Toxin and Robot-assisted Motor Trainingmentioning

confidence: 99%

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Raciti,

Ammendolia

et al. 2024

Brain Sciences

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Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis

Chen,

Yin,

Hou

et al. 2024

J NeuroEngineering Rehabil

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Objective Understanding the characteristics related to cardiorespiratory fitness after stroke can provide reference values for patients in clinical rehabilitation exercise. This meta- analysis aimed to investigate the effect of robot-assisted gait training in improving cardiorespiratory fitness in post-stroke patients, compared to conventional rehabilitation training. Methods PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, CBM, CNKI and Wanfang databases were searched until March 18th, 2024. Randomized controlled trials (RCTs) comparing the effectiveness of robot-assisted gait training versus control group were included. The main outcome variable was peak oxygen uptake. 6-minute walking test, peak heart rate, peak inspiratory expiratory ratio as our secondary indicators. RevMan 5.3 software was used for statistical analysis. Results A total of 17 articles were included, involving 689 subjects. The results showed a significant effect for robot-assisted gait training to improve VO2peak (MD = 1.85; 95% CI: -0.13 to 3.57; p = 0.04) and 6WMT (MD = 19.26; 95% CI: 10.43 to 28.08; p < 0.0001). However, no significant difference favouring robot-assisted gait training were found in HRpeak (MD = 3.56; 95% CI: -1.90 to 9.02; p = 0.20) and RERpeak (MD = -0.01; 95% CI: -0.04 to 0.01; p = 0.34). Conclusion These results showed that robot-assisted gait training may have a beneficial effect in improving VO2peak and 6WMT, with a moderate recommendation level according to the GRADE guidelines.

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Development of Surface EMG for Gait Analysis and Rehabilitation of Hemiparetic Patients

Pradon,

Tong,

Chalitsios

et al. 2024

Sensors

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Background: The quantification of electromyographic activity using surface electrodes is invaluable for understanding gait disorders in patients with central nervous system lesions. We propose to evaluate a commercially available low-cost system compared to a reference system in participants with stroke-related movement disorders in functional situations. Methods: Three hemiparetic participants performed three functional tasks: two treadmill walks at different speeds and a sit-to-stand test. The vastus lateralis and gastrocnemius medialis muscles were equipped with two EMG sensors. The comparison between the two EMG systems was based on 883 identified cycles. Spearman’s correlation coefficients (SCs), linear correlation coefficients (LCCs), and cross-correlation coefficients (CCCs) were calculated. Results: The main results indicate good to very good similarity of the EMG signals collected from the two tested sEMG systems. In the comfortable-walking condition, an SC of 0.894 ± 0.091 and an LCC of 0.909 ± 0.094 were noted. In the fast-walking condition, an SC of 0.918 ± 0.064 and an LCC of 0.935 ± 0.056 were observed. For the 1 min sit-to-stand test, an SC of 0.880 ± 0.058 and an LCC of 0.881 ± 0.065 were noted. Conclusions: This study demonstrates good to very good similarity between the two sEMG systems, enabling the analysis of muscle activity during functional tasks.

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Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial

Cited by 3 publications

References 30 publications

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches

Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis

Development of Surface EMG for Gait Analysis and Rehabilitation of Hemiparetic Patients

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