Do post-stroke patients benefit from robotic verticalization? A pilot-study focusing on a novel neurophysiological approach

Abstract

Background: Tilt-table equipped with the dynamic foot-support (ERIGO) and the functional electric stimulation could be a safe and suitable device for stabilization of vital signs, increasing patient’s motivation for further recovery, decreasing the duration of hospitalization, and accelerating the adaptation to vertical posture in bedridden patients with brain-injury. Moreover, it is conceivable that verticalization may improve cognitive functions, and induce plastic changes at sensory motor and vestibular system level that may in turn facilitate motor functional recovery. Objective: To test the safety and effectiveness of ERIGO treatment on motor and cognitive functions, cortical plasticity within vestibular and sensory-motor systems in a bedridden post-stroke sample. Methods: 20 patients were randomly divided in two groups that performed ERIGO training (30 sessions) (G1) or physiotherapist-assisted verticalization training (same duration) (G2), beyond conventional neurorehabilitation treatment. Motor and cognitive functions as well as sensory-motor and vestibular system plasticity were investigated either before (T0) or after (T1) the rehabilitative protocols. Results: Both the verticalization treatments were well-tolerated. Notably, the G1 patients had a significant improvement in cognitive function (p = 0.03), global motor function (p = 0.006), sensory-motor (p < 0.001) and vestibular system plasticity (p = 0.02) as compared to G2. Conclusions: ERIGO training could be a valuable tool for the adaptation to the vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction.

Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

“…Tilt tables are used to verticalize patients safely. Tilt tables that integrate leg movements and/or functional electrical stimulation and hence induce the muscle pump will help to stabilize the cardiovascular system [10], reduce the number of syncopal episodes, and hence decrease therapy interruptions and increase therapy time [11]. Such tilt tables can safely be used even in an intensive care setting [12].…”

Comparison between Erigo tilt-table exercise and conventional physiotherapy exercises in acute stroke patients: a randomized trial

“…The improvement could be related to the fact that robotic tilttable rehabilitation may offer standardized, intensive and repetitive exercises, proper body weight support, with an appropriate sensory feedback amount and a controlled progressive verticalization. It was also found in another study that ERIGO training could be a valuable tool for the adaptation to the vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction in post-stroke patients [14].…”

“…One study suggested that robotic verticalization maximizes the potential for longitudinal weight-bearing through the lower extremities in a position of hipextension/knee-extension/ankle-dorsiflexion, which is difficultly obtained in the physiotherapy verticalization setting. Moreover, robotic verticalization allows strengthening exercises using body weight shifting from one leg to the other, which is not easily carried out by severe post-stroke patients [14]. Some studies found that greater cerebral blood flow modulation during robotic verticalization in comparison to physiotherapy verticalization could further support plastic changes within sensory-motor areas and vestibular system, with the consequent motor and cognitive function amelioration [32,33].…”

“…Passive movement of legs combined with verticalization of the patient A load is alternately applied and removed from the patient's legs The leg movement can be adapted separately for the patient's right and left leg according to his needs ( [14], Erigo User Manual Part-1).…”

Locomotion Control Method for Patients Verticalization with Regard to their Safety and Comfort

“…The first approach relies on the use of an external device (assistant robot or special equipment) which takes up the role of a human assistant [1][2][3]20]. The second approach exploits exoskeleton technology that is currently demonstrating significant progress [14][15][16].…”