turchEtti 34 , donatella bonaiuti 35 on behalf of italian consensus conference on robotics in neurorehabilitation (cicEronE)1 irccs centro neurolesi bonino-pulejo, Messina, italy; 2 department of Medicine and rehabilitation, polyclinic of Monza, Monzabrianza, italy; 3 spinal cord unit and intensive rehabilitation Medicine, ausl piacenza, Villanova sull'arda and castel san Giovanni, piacenza, italy; 4 Gait and Motion analysis laboratory opa sol et salus, torre pedrera, rimini, italy; 5 department of Experimental and clinical Medicine università politecnica delle Marche (uniVpM), ancona, italy; 6 spinal cord unit, department of rehabilitation Medicine, Gervasutta hospital, udine, italy; 7 azienda sanitaria universitaria friuli centrale (asu-fc), udine, italy; 8 neuromotor and rehabilitation department, laM-Motion analysis laboratory, ausl-irccs reggio Emilia, reggio Emilia, italy; 9 rehabilitation therapeutic center, tramutola, potenza, italy; 10 irccs a. Gemelli university polyclinic foundation, rome, italy; 11 section of neurorehabilitation, department of translational research and new technologies in Medicine and surgery, university of pisa, pisa, italy; 12 Montecatone rehabilitation institute, imola, bologna, italy; 13 unit of neurophysiopathology, ics Maugeri, Montescano institute, pavia, italy; 14 centro protesi Vigorso di budrio, istituto nazionale assicurazione infortuni sul lavoro (inail),
INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. as part of the cicEroNE italian consensus on robotic rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with Ms. EVidENcE acQuisitioN: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in Ms, between January 1 st , 2010 and december 31 st , 2020, in the following databases: cochrane library, pEdro, pubMed and Google scholar. the study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (aMstar 2) and the 10-item pEdro scale for the other research studies. EVidENcE syNthEsis: after an accurate screening, only 17 papers were included in the review, and most of them (13 rct) had a level ii evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. however, in more severe patients (Edss >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) Ms patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with Ms. future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.(Cite this article as: calabrò rs, cassio a, Mazzoli d, andrenelli E, bizzarini E, campanini i, et al.; italian consensus conference on robotics in Neurorehabilitation (cicEroNE). What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? a comprehensive systematic review on functional outcomes and clinical recommendations.
BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro’s scale. RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
BACKGROUND: Gait impairments are common disabling symptoms of Parkinson’s disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: Asearchwas performed on PubMed, Scopus, PEDro, Cochrane library,Web of science, and guideline databases,following PRISMA guidelines.We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects’ disease-related disability. CONCLUSIONS: Despite an association of WMH volume with CSF Aβ 42 RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.
BACKGROUND: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. OBJECTIVE: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. METHODS: The literature search was conducted on Pubmed, Cochrane library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. RESULTS: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. CONCLUSION: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.