Robot-Assisted Stair Climbing Training on Postural Control and Sensory Integration Processes in Chronic Post-stroke Patients: A Randomized Controlled Clinical Trial

Abstract

BackgroundPostural control disturbances are one of the important causes of disability in stroke patients affecting balance and mobility. The impairment of sensory input integration from visual, somatosensory and vestibular systems contributes to postural control disorders in post-stroke patients. Robot-assisted gait training may be considered a valuable tool in improving gait and postural control abnormalities.ObjectiveThe primary aim of the study was to compare the effects of robot-assisted stair climbing training against sensory integration balance training on static and dynamic balance in chronic stroke patients. The secondary aims were to compare the training effects on sensory integration processes and mobility.MethodsThis single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with postural instability. The experimental group (EG, n = 16) received robot-assisted stair climbing training. The control group (n = 16) received sensory integration balance training. Training protocols lasted for 5 weeks (50 min/session, two sessions/week). Before, after, and at 1-month follow-up, a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Berg Balance Scale (BBS). Secondary outcomes:10-meter walking test, 6-min walking test, Dynamic gait index (DGI), stair climbing test (SCT) up and down, the Time Up and Go, and length of sway and sway area of the Center of Pressure (CoP) assessed using the stabilometric assessment.ResultsThere was a non-significant main effect of group on primary and secondary outcomes. A significant Time × Group interaction was measured on 6-min walking test (p = 0.013) and on posturographic outcomes (p = 0.005). Post hoc within-group analysis showed only in the EG a significant reduction of sway area and the CoP length on compliant surface in the eyes-closed and dome conditions.ConclusionPostural control disorders in patients with chronic stroke may be ameliorated by robot-assisted stair climbing training and sensory integration balance training. The robot-assisted stair climbing training contributed to improving sensorimotor integration processes on compliant surfaces. Clinical trial registration (NCT03566901).

Postural instability years after stroke

“…The previous studies confirmed that the paretic leg does not substantially contribute to the postural stability even if the magnitude of WBA was decreased. 27,13,5 Although, the amount of WBA was reduced with a 10 mm insert in the shoe of the nonparetic leg, the balance of the stance was improved but the postural instability could not be significantly changed. 15,16 The general consequence of the balance studies in the poststroke state was that the postural instability depended on the nonparetic leg even if it was loaded with the majority of weight 7,13,26 According to daily practice and comparing studies of the equilibrium of patients in the poststroke state, balance cannot be effectively influenced by physiotherapy.…”

“…15,16 The general consequence of the balance studies in the poststroke state was that the postural instability depended on the nonparetic leg even if it was loaded with the majority of weight 7,13,26 According to daily practice and comparing studies of the equilibrium of patients in the poststroke state, balance cannot be effectively influenced by physiotherapy. 25,24,27 It may mean that the persistence of the postural instability after restoration of paresis threatens the quality of life after stroke. In this respect, our observation, that the balance instability remains for years after stroke is important.…”

“…26,13,3 Physiotherapy cannot effectively influence postural instability in the post-stroke state. 27,25,24 Our primary goal was to discover the persistence of balance disturbances years after the onset of stroke. We chose a state when all of the other symptoms had improved, when the state of the patients had been stabilized and the person had retrieved his/her independence.…”

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

“…G-EO system was a commercialized end-effector robot that could simulate stair climbing in a treadmill-like environment by moving foot plates in cycle to reproduce step length and height of stairs, but the system was bulky and stationary. The RCT evaluated the stair version of G-EO system focused on balance training of chronic stroke subjects [36]. Portablepower ankle-foot orthosis (PPAFO) developed in the University of Illinois used a pneumatic bidirectional rotatory actuator to provide untethered ankle assistance on level ground and stairs.…”

Effects of wearable ankle robotics for stair and over-ground training on sub-acute stroke: a randomized controlled trial

“…G-EO system was a commercialized end-effector robot that could simulate stair climbing in a treadmill-like environment by moving foot plates in cycle to reproduce step length and height of stairs, but the system was bulky and stationary. The randomized controlled trial (RCT) evaluated the stair version of G-EO system focused on balance training of chronic stroke subjects [ 20 ]. Portable-power ankle–foot orthosis developed in the University of Illinois used a pneumatic bidirectional rotatory actuator to provide untethered ankle assistance on level ground and stairs.…”