Robot-assisted gait training for patients with hemiparesis due to stroke.

Methodist Neurological Institute, Houston, Texas, USA.
Topics in Stroke Rehabilitation (Impact Factor: 0.79). 01/2011; 18(3):269-76. DOI: 10.1310/tsr1803-269
Source: PubMed

ABSTRACT Robot-assisted devices are becoming a popular alternative to manual facilitation in stroke rehabilitation. These devices have the potential to reduce therapist burden and treatment costs; however, their effectiveness in terms of functional recovery remains in question. This pilot study compared the outcomes of a stroke rehabilitation program that incorporates robot-assisted gait training (RAGT) with a more traditional therapy program that does not. Twenty hemiparetic stroke patients were recruited at a rehabilitation hospital in Houston, Texas, and were randomly assigned to 2 groups. The control group (n = 10) received 24 1-hour sessions of conventional physical therapy, whereas the RAGT group (n = 10) received 24 1-hour sessions of conventional physical therapy combined with RAGT on a treadmill. Gait function was assessed before and after treatment by an 8-m walk test, a 3-minute walk test, and the Tinetti balance assessment. Both groups showed significant improvement in all 3 outcome measures following treatment (P < .05), but there was no difference between groups. It is concluded that RAGT may provide improvements in balance and gait comparable with conventional physical therapy. A larger multicenter trial is required to investigate the effectiveness of RAGT in hemiparetic stroke.

  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of this systematic review was to identify appropriate selection criteria of clinical scales for future trials, starting from those most commonly reported in the literature, according to their psychometric properties and International Classification of Functioning, Disability and Health (ICF) domains. Data sources: A computerized literature research of articles was conducted in MEDLINE, EMBASE, CINALH, Pub-Med, PsychINFO and Scopus databases. Study selection: Clinical trials evaluating the effects of elec-tromechanical and robot-assisted gait training trials in stroke survivors. Data extraction: Fifteen independent authors performed an extensive literature review. Data synthesis: A total of 45 scales was identified from 27 studies involving 966 subjects. The most commonly used outcome measures were: Functional Ambulation Category (18 studies), 10-Meter Walking Test (13 studies), Motricity Index (12 studies), 6-Minute Walking Test (11 studies), Riv-ermead Mobility Index (8 studies) and Berg Balance Scale (8 studies). According to the ICF domains 1 outcome measure was categorized into Body Function and Structure, 5 into Activity and none into Participation. Conclusion: The most commonly used scales evaluated the basic components of walking. Future studies should also in-clude instrumental evaluation. Criteria for scale selection should be based on the ICF framework, psychometric prop-erties and patient characteristics.
    Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 10/2013; 45(45):987-996. · 1.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
    PLoS ONE 01/2014; 9(2):e87987. · 3.73 Impact Factor


Available from