Implementation of a gait center training to improve walking ability and vital parameters in inpatient neurological rehabilitation- a cohort study

Abstract

Background: Many studies showed that robot-assisted gait training might improve walking of patients after stroke. The question remains whether patients with other neurological diagnoses can improve their ability to walk by training in a gait center. Aim of the present study was therefore to investigate the effects of a gait center training in inpatient neurological rehabilitation on walking ability. Methods: We implemented a gait center training in addition to individual inpatient rehabilitation. Our primary outcome was walking ability based on the Functional Ambulation Categories (FAC). Our secondary outcomes were vital capacity and blood pressure. We predefined subgroups of patients with ischemic and hemorrhagic stroke and critical illness myopathy (CIM) and polyneuropathy (CIP). Results: We included 780 patients from our inpatient rehabilitation center in our cohort study. We analyzed 329 patients with ischemic, 131 patients with hemorrhagic stroke and 74 patients with CIP/ CIM. A large number of patients were able to improve their ability to walk. At the end of rehabilitation, patients with ischemic stroke and FAC 3 = increased theirFAC scores by 5%, FAC 4 = 4% and FAC 5 = 7%. Patients with hemorrhagic stroke and FAC 3 = increased by 5%, FAC 4 = 11% and FAC 5 = 9% and patients with CIP/CIM increased by FAC 3 = 3%, FAC 4 = 22% and FAC 5 = 26%. The largest improvement in walking ability during rehabilitation had patients with a FAC = 1 at baseline who improved by a median of 1.4 FAC points (p < 0.001). After adjusting for the number of gait training sessions, the largest improvement in walking ability during rehabilitation had patients with a FAC = 0 at baseline who improved by 1.8 FAC points (p < 0.001). Conclusions: Implementation of an additional gait center training may significantly improve walking ability in neurological rehabilitation.

Hybrid Robot-Assisted Gait Training for Motor Function in Subacute Stroke: A Single-Blind Randomized Controlled Trial

“…According to previous studies evaluating the effect of RAGT as an add-on to conventional physiotherapy, patients with (subacute or chronic) stroke exhibited improved ambulation function, lower-extremity motor function, balance, and gait performance both immediately postintervention and at follow-up, and these improvements were superior to those conventional physiotherapy [14,16,17,19,21,22,24,25,33]. By contrast, some studies have shown that training effects in locomotion function, activities of daily living, and gait were not superior to those of conventional stroke training in patients with subacute stroke [15,18,20,23].…”

“…Recently, several studies have evaluated the effects of RAGT in patients with stroke [20][21][22][23][24][25]. A Cochrane review proposed that RAGT combined with physiotherapy increased gait velocity and odds of participants being able to walk independently [21].…”

“…A Cochrane review proposed that RAGT combined with physiotherapy increased gait velocity and odds of participants being able to walk independently [21]. However, some studies have reported that the improvement was not superior to that of conventional treatment, even when delivered as an add-on to routine rehabilitation in the subacute phase of stroke [20,23], whereas others have demonstrated bene cial effects compared with physiotherapy alone on clinical functional outcomes and gait pattern [22,24,25]. Our group previously demonstrated changes in the Fugl-Meyer Assessment (FMA), Postural Assessment Scale for Stroke (PASS), BBS, and Barthel Index (BI) scores after an RAGT intervention, indicating substantial improvements in neurological status, balance, and the activities of daily living [26].…”

Treinamento de marcha assistida por robô na reabilitação de AVC: um estudo piloto

“…Notavelmente, pacientes com déficit graves (por exemplo com pontuação FAC<2) não foram incluídos neste estudo pois eles não iriam tolerar bem o treinamento no G-EO System, a menos que fossem devidamente précondicionados 45 . Do ponto de vista prático, sugerimos que os pacientes devem ser inicialmente estratificados de acordo com a gravidade do quadro para que o treinamento adequado seja prescrito.…”

“…As principais contraindicações para os dispositivos de assistência robótica são doenças cardiovasculares, úlceras de pele e presença de espasticidade 46 . Outros autores relataram contraindicações adicionais, como o uso de marca-passo cardíaco, uso de próteses de quadril ou joelho (até dois anos após a implantação), osteoporose, diferença no comprimento das pernas, escoliose, doenças psicóticas e peso corporal acima de 150 kg 45 . Os eventos adversos comumente associados com os treinos em dispositivos de assistência robótica foram descritos em detalhes e incluem, por exemplo, dor nos membros inferiores e risco de fratura, sugerindo uma avaliação cuidadosa de cada paciente individualmente antes de iniciar o treino 28,47 .…”