Does robot-assisted gait training ameliorate gait abnormalities in multiple sclerosis? A pilot randomized-control trial

Abstract

BACKGROUND: Gait disorders are common in multiple sclerosis (MS) and lead to a progressive reduction of function and quality of life. OBJECTIVE: Test the effects of robot-assisted gait rehabilitation in MS subjects through a pilot randomized-controlled study. METHODS: We enrolled MS subjects with Expanded Disability Status Scale scores within 4.5-6.5. The experimental group received 12 robot-assisted gait training sessions over 6 weeks. The control group received the same amount of conventional physiotherapy. Outcomes measures were both biomechanical assessment of gait, including kinematics and spatio-temporal parameters, and clinical test of walking endurance (six-minute walk test) and mobility (Up and Go Test). RESULTS: 16 subjects (n = 8 experimental group, n = 8 control group) were included in the final analysis. At baseline the two groups were similar in all variables, except for step length.Data showed walking endurance, as well as spatio-temporal gait parameters improvements after robot-assisted gait training. Pelvic antiversion and reduced hip extension during terminal stance ameliorated after aforementioned intervention. CONCLUSIONS: Robot-assisted gait training seems to be effective in increasing walking competency in MS subjects. Moreover, it could be helpful in restoring the kinematic of the hip and pelvis.

Do Patients with Multiple Sclerosis Derive More Benefit from Robot-Assisted Gait Training Compared with Conventional Walking Therapy on Motor Function? A Meta-analysis

“…Other gait parameters, including gait speed, cadence, double support time (DST), and SL, were reported in different studies. Straudi et al (15) and Gandolfi et al (14) also used the GAIT-Rite mat to measure several of the gait parameters noted above.…”

“…Because all of the baseline data included are in balance, we used the raw data directly to compute the pooled MD, which resulted MD = 14.25 (95% CI: 3.19 to 25.32, Z  = 2.53, P  = 0.01, I 2  = 54%), indicating that RAGT is statistically superior to CWT on improving endurance (Figure 3). Four trials (15, 17) also reported follow-up data, so we performed a sensitivity analysis based on the different time points (MD 8.07, 95% CI: −5.48 to 21.61, Z  = 1.17, P  = 0.21, I 2  = 45%). However, there is no significant difference between RAGT and CWT about long-term effect for improving endurance (Figure 3).…”

A Survey of Assistive Technologies for Assessment and Rehabilitation of Motor Impairments in Multiple Sclerosis

“…Another study conducted by Straudi et al arrived at a similar result [80] using the Lokomat robotic device with 16 subjects. They conducted a study comparing robot-assisted rehabilitation (8) and conventional walking training (8).…”

Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study

“…3b) (Table 3). These findings were in contrast with robot-assisted gait training in which participants had a 7.0 cm/s increase immediately after training but returned to pre levels three months after training [85]. Additionally, spatiotemporal gait parameters at self-selected pace were improved well beyond previous reports employing non-gait specific training methods (legs and trunk resistance training twice a week for eight weeks) [86], supporting that gait quality also improved.…”

“…We showed that patients with high levels of disability were able to complete GXT in 10 out of 25 occasions (40% success rate) and 50% of our participants achieved 90% of their age-predicted maximal heart rates during GXT, potentially important information needed for planning of future studies among patients with high levels of MS-related disability [26,78,82,84,85,[87][88][89][90][91][92]. We found that our participants with high disability achieved 12.2% greater maximal workload during GXT as a result of training, despite small increases in maximal heart rate (1.8%), maximal respiratory exchange ratio (2.2%), and maximal V O 2 (6.6%).…”