Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

Dierick, Frédéric; Dehas, Mélanie; Isambert, Jean-Luc; Injeyan, Soizic; Bouché, Anne-France; Bleyenheuft, Yannick; Portnoy, Sigal

doi:10.1371/journal.pone.0178636

Cited by 22 publications

(18 citation statements)

References 79 publications

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“…In recent years, the introduction of robotics [11,12] showed interesting rehabilitation outcomes for stroke survivors [13,14], offering an alternative to conventional rehabilitation [15]. Robotic rehabilitation provides intensive, task-oriented, repeated [16,17], and personalised work for a favourable recovery and the plasticity-dependent response of stroke survivors [18,19], both after an ischemic or haemorrhagic event [20]. In addition, the robotic system, allowing partial or total body weight bearing, enables the enrolment of non-ambulatory patients and the prevention of falls during training sessions [21].…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study

et al. 2021

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Background and Objectives: Robot-assisted gait training (RAGT) could be a rehabilitation option for patients after experiencing a stroke. This study aims to determine the sex-related response to robot-assisted gait training in a cohort of subacute stroke patients considering mixed results previously reported. Materials and Methods: In this study, 236 participants (145 males, 91 females) were admitted to a rehabilitation facility after experiencing a stroke and performed RAGT within a multidisciplinary rehabilitation program. Functional Independence Measure (FIM) and Functional Ambulatory Category (FAC) were assessed at admission and discharge to determine sex-related outcomes. Results: At the baseline, no significant difference among sexes was observed. At the end of rehabilitation, both males and females exhibited significant improvements in FIM (71% of males and 80% of females reaching the MCID cut-off value) and FAC (∆score: men 1.9 ± 1.0; women 2.1 ± 1.1). A more remarkable improvement was observed in women of the whole population during the study, but statistical significance was not reached. When analysing the FAC variations with respect to the total number of RAGT sessions, a more significant improvement was observed in women than men (p = 0.025). Conclusion: In conclusion, among subacute stroke patients, benefits were observed following RAGT during a multidisciplinary rehabilitation program in both sexes. A greater significant recovery for women with an ischemic stroke or concerning the number of sessions attended was also highlighted. The use of gait robotics for female patients may favour a selective functional recovery after stroke.

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Section: Introductionmentioning

confidence: 99%

Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study

et al. 2021

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“…Robotic treatments using adaptive control strategies showed higher or similar improvements -i.e., improvement of 46.0 % in 6MWT, 34.0 % in 10MWT, 25.10 % in LE-FMA, and 11.30 % in BBS after the treatment-with shorter or similar training duration and higher grade of evidence, compared to other control strategies implemented in other studies [167,169]. Control strategies that implemented adaptive assistance in combination with trajectory tracking and compliant control showed the highest increase in TUG (20.42 %) and LE-FMA (27.76 %), with a strong grade of evidence [255][256][257][258][267][268][269][270]. However, these studies also involved the longest training duration.…”

Section: Chronic Strokementioning

confidence: 82%

Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness

Miguel-Fernández

Lobo-Prat²,

Prinsen

et al. 2022

Preprint

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BackgroundIn the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. Within this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) Providing an updated structured framework of current control strategies, (2) Analyzing the methodology of clinical validations used in the robotic interventions, and (3) Reporting the potential relation between the employed control strategies and clinical outcomes. MethodsFour databases were searched using database-specific search terms from 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. Results(1) We found that adaptive assistive control (100 \% of exoskeletons) that followed rule-based algorithms (72 \%) based on ground reaction force thresholds (63 \%) in conjunction with trajectory-tracking control (97 \%) were the most implemented control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With moderate grade of evidence, associated to the high heterogeneity in the experimental protocol and low number of studies, we found that adaptive control strategies, which followed threshold-based or adaptive oscillator algorithms together with trajectory-tracking control, resulted in the highest improvements on clinical outcomes for people with stroke. ConclusionsDespite the efforts to develop novel more effective controllers for gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. The most promising controllers seem to be those that adapt to key biomechanical descriptors based on the patients' specific pathology.

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“…39 Hal ini diduga disebabkan oleh cedera iskemik yang diakibatkan oleh hasil terapi penurunan tekanan darah yang menyebabkan terjadinya lesi iskemik pada daerah perihematoma di penumbra. 40 Penelitian ini juga mengungkapkan bahwa ada perbedaan yang bermakna pada selisih total skor FIM kognitif (p=0,017). Hal ini selaras dengan hasil penelitian Kelly et al (2003) yang menyatakan peningkatan total skor FIM kognitif memiliki nilai yang signifikan antara stroke iskemik dan stroke hemoragik.…”

Section: Perbedaan Skor Fim Antara Pasien Stroke Iskemik Dan Stroke Hemoragikunclassified

“…Hal ini kemungkinan ada kaitannya dengan terapi hipertensi yang dilakukan pada pasien dari masing-masing subtipe stroke, dimana terapi tersebut juga memungkinkan daerah perihematoma di penumbra mengalami iskemia akibat turunnya tekanan darah, sehingga memungkinkan terapi penurunan tekanan darah dapat berbahaya. 40,50 Dari penelitian ini ditemukan perbedaan yang signifikan pada peningkatan skor Communication (p=0,048) dan Social Cognition (p=0,010) antara jenis stroke iskemik dan hemoragik, dengan interpretasi bahwa perbaikan Communication dan Social Cognition terjadi lebih baik pada stroke hemoragik dibandingkan pada stroke iskemik. Hal ini dimungkinkan karena infark yang terjadi pada pasien stroke hemoragik seringkali lebih luas.…”

Section: Perbedaan Skor Tiap Variabel Fim Antara Pasien Stroke Iskemik Dan Stroke Hemoragikunclassified

Perbedaan Skor Functional Independence Measure (FIM) pada Pasien Rawat Inap dengan Stroke Iskemik dan Stroke Hemoragik di Rumah Sakit di Kota Bengkulu Tahun 2018

Nugraha

Bantolo

Kurniati

et al. 2018

Sriwijaya Journal of Medicine

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Stroke is one of the most common causes of disability in the world. Patients with ischemic stroke have different functional improvements from patients with hemorrhagic stroke. The tool is the Functional Independence Measure (FIM) questionnaire. This study aims to determine the difference in FIM scores in hospitalized patients with ischemic stroke and hemorrhagic stroke at hospitals in Bengkulu City. This research is an observational analytic research with cross-sectional design. The study involved stroke patients who hospitalized at RS Bhayangkara Bengkulu City, RSUD Bengkulu City, and RSUD dr. M. Yunus Bengkulu City from January-April 2018 with total sample 22 ischemic stroke patients and 22 hemorrhagic stroke patients who met the inclusion criteria. FIM scores as independent variables, while the type of stroke as dependent variables. The difference between the two variables was analyzed by unpaired t test and Mann-Whitney test. Patients with ischemic stroke had admission FIM score higher than patients with hemorrhagic stroke (26 vs 13,5; p=0.006). There were no differences in discharge FIM score in patients in both types of stroke (1,67 vs 1,58; p=0,081). There was no difference in FIM score gain between patients with ischemic stroke and patients with hemorrhagic stroke (4,12 vs 4,36; p=0,444). Patients with ischemic stroke had higher admission FIM score compared to patients with hemorrhagic stroke, but there was no significant difference in FIM score gain during hospitalization between ischemic stroke and hemorrhagic stroke patients at hospitals in Bengkulu City.

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Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

Abstract: Background

Cited by 22 publications

References 79 publications

Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study

Beneficial Effects of Robot-Assisted Gait Training on Functional Recovery in Women after Stroke: A Cohort Study

Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness

Perbedaan Skor Functional Independence Measure (FIM) pada Pasien Rawat Inap dengan Stroke Iskemik dan Stroke Hemoragik di Rumah Sakit di Kota Bengkulu Tahun 2018

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