What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials

Bowman, Thomas G.; Gervasoni, Elisa; Amico, A.; Antenucci, Roberto; Benanti, Paolo; Boldrini, Paolo; Bonaiuti, Donatella; Burini, Angelo; Castelli, Enrico; Draicchio, Francesco; Falabella, Vincenzo; Galeri, Silvia; Gimigliano, Francesca; Grigioni, Mauro; Mazzon, Stefano; Mazzoleni, Stefano; Mattos, Fabiola Giovanna Mestanza; Molteni, Franco; Morone, Giovanni; Petrarca, Maurizio; Picelli, Alessandro; Posteraro, Federico; Senatore, Michele; Turchetti, Giuseppe; Crea, Simona; Cattaneo, Davide; Carrozza, M.C.

doi:10.23736/s1973-9087.21.06692-2

Cited by 33 publications

(25 citation statements)

References 49 publications

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“…Although robotic rehabilitation effects on balance and gait have been recently investigated with positive results in patients with MS (54), few studies in literature addressed the effectiveness of VR and exergames compared with conventional treatment in patients with MS and in most cases only considering VR as a complementary tool in MS rehabilitation concerning balance. This could be related to the relative novelty of these devices and the difficult implementation in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

et al. 2021

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Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

et al. 2021

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“…1 Another important aspect to consider before we start the widespread use of exoskeletons in MS relates to the specific patient subgroup that may benefit. Indeed, it is suggested that clinical effects of robot-assisted gait training are superior to conventional treatment in severely (but not in moderately) affected people with MS. 1,2 These results were implemented in the figure published by Calabro et al, 3 where patients gait deficits (based on Expanded Disability Status Scale (EDSS) scores) were plotted relative to the type of the therapy and devices (from overground walking training to powered exoskeletons to grounded exoskeletons).…”

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confidence: 99%

“…7 It is known that adding virtual reality during rehabilitation can be useful to promote neuroplasticity and recovery in persons with MS, increasing subjects' motivation and compliance. 2 Combination of exoskeleton therapy with virtual reality, can increase the impact on motor and non-motor outcomes such as psychological well-being and quality of life. 3,8 Third, although there is progress related to the usability of exoskeletons there is still a lot of improvement possible.…”

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confidence: 99%

Exoskeletons in MS rehabilitation are ready for widespread use in clinical practice: No

2022

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“…Robot-assisted gait training (RAGT) has been introduced into clinical practice to overcome these limitations and deliver task-oriented, high-intensity gait rehabilitation [12,13]. The efficacy of RAGT among PwMS has been recently reviewed [14,15], and this intervention has been promoted as an option for severely disabled PwMS. Despite the evidence of its clinical efficacy, however, little information is available on the mechanisms underlying the recovery or brain reorganization processes that occur after RAGT.…”

Section: Introductionmentioning

confidence: 99%

Motor Cortical Activation Assessment in Progressive Multiple Sclerosis Patients Enrolled in Gait Rehabilitation: A Secondary Analysis of the RAGTIME Trial Assisted by Functional Near-Infrared Spectroscopy

et al. 2021

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This study aimed to determine cortical activation responses to two different rehabilitative programs, as measured through functional near-infrared spectroscopy (fNIRS). As a secondary analysis of the RAGTIME trial, we studied 24 patients with progressive multiple sclerosis (MS) and severe disability who were randomized to a regimen of robot-assisted gait training (RAGT) or overground walking (OW). Cortical activation during a treadmill walking task, assessed through fNIRS recordings from the motor and premotor cortexes (M1/PM), was calculated as the area under the curve (AUC) of oxyhemoglobin for each hemisphere and the total area (Tot-OxyAUC). Gait speed, endurance, and balance were also measured, along with five healthy control subjects. At baseline, Tot-OxyAUC during walking was significantly increased in MS patients compared to healthy people and was significantly higher for those with more severe disabilities; it was also inversely correlated with physical performance. After rehabilitation, significant opposite variations in Tot-OxyAUC were observed, with activity levels being increased after OW and decreased after RAGT (+242,080 ± 361,902 and −157,031 ± 172,496 arbitrary units, respectively; p = 0.002), particularly in patients who were trained at a lower speed. Greater reductions in the cortical activation of the more affected hemisphere were significantly related to improvements in gait speed (r = −0.42) and endurance (r = −0.44). Cortical activation, assessed through fNIRS, highlighted the brain activity in response to the type and intensity of rehabilitation.

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What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials

Abstract: The final version may contain major or minor changes.Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissions send an email to:

Cited by 33 publications

References 49 publications

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Exoskeletons in MS rehabilitation are ready for widespread use in clinical practice: No

Motor Cortical Activation Assessment in Progressive Multiple Sclerosis Patients Enrolled in Gait Rehabilitation: A Secondary Analysis of the RAGTIME Trial Assisted by Functional Near-Infrared Spectroscopy

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