Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial

Calabrò, Rocco Salvatore; Russo, Margherita; Naro, Antonino; Luca, Rosaria De; Leo, Antonino; Tomasello, Provvidenza; Molonia, Francesco; Dattola, Vincenzo; Bramanti, Alessia; Bramantı, Placido

doi:10.1016/j.jns.2017.03.047

Cited by 99 publications

(90 citation statements)

References 32 publications

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“…In the last decade robotic devices for rehabilitation have been developed and applied to overcome disability related to walking with promising results [ 1 – 2 ]. Robot assisted gait training (RAGT) has been widely used in the rehabilitation of several neurologic, traumatic, vascular and neurodegenerative disorders such as Parkinson’s Disease (PD) [ 3 ], multiple sclerosis (MS) [ 4 ], Spinal Cord Injuries (SCI) [ 5 ] and Stroke [ 6 – 7 ], where an improvement of gait parameters and quality of life has been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

et al. 2018

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In the last decade robotic devices have been applied in rehabilitation to overcome walking disability in neurologic diseases with promising results. Robot assisted gait training (RAGT) using the Lokomat seems not only to improve gait parameters but also the perception of well-being. Data on the psychosocial patient-robot impact are limited, in particular in the real-world of RAGT, in the rehabilitation setting. During rehabilitation training, the Lokomat can be considered an “assistive device for movement”. This allowed the use of the Psychosocial Impact of Assistive Device Scale- PIADS to describe patient interaction with the Lokomat. The primary aim of this pilot study was to evaluate the psychosocial impact of the Lokomat in an in-patient rehabilitation setting using the PIADS; secondary aims were to assess whether the psychosocial impact of RAGT is different between pathological sub-groups and if the Lokomat influenced functional variables (Functional Independence Measure scale–FIM and parameters provided by the Lokomat itself). Thirty-nine consecutive patients (69% males, 54.0±18.0 years) eligible for Lokomat training, with etiologically heterogeneous walking disabilities (Parkinson’s Disease, n = 10; Spinal Cord Injury, n = 21; Ictus Event, n = 8) were enrolled. Patients were assessed with the FIM before and after rehabilitation with Lokomat, and the PIADS was administered after the rehabilitative period with Lokomat. Overall the PIADS score was positive (35.8±21.6), as well as the three sub-scales, pertaining to “ability”, “adaptability” and “self-esteem” (17.2±10.4, 8.9±5.5 and 10.1±6.6 respectively) with no between-group differences. All patients significantly improved in gait measure and motor FIM scale (difference after—before treatment values: 11.7±9.8 and 11.2±10.3 respectively), increased treadmill speed (0.4 ± 0.2m/s), reduced body weight support (-14.0±9.5%) and guidance force (-13.1 ± 10.7%). This pilot study indicates that Lokomat, in a real-world in-patient setting, may have a generalised approval, independent of disease, underlining the importance of the psycho-social framework for patients training with assistive robotic-devices.

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Section: Introductionmentioning

confidence: 99%

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

et al. 2018

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“…Patients who trained on a gait trainer with virtual reality were more motivated and trained longer than those who trained without virtual reality [41]. Furthermore, it has been shown in a group of individuals with stroke [42] and a group with multiple sclerosis [43] that adding virtual reality to robotic locomotor training can increase training effects with regard to gait and balance [42], likely because more brain areas are engaged [42,43].…”

Section: Virtual Reality and Motivationmentioning

confidence: 99%

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

Spiess

Steenbrink²,

Esquenazi

2018

PM&R

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Advanced technology, including gait‐training devices, is increasingly being integrated into neurorehabilitation. However, to use gait‐training devices to their optimal potential, it is important that they are applied in accordance with motor learning and locomotor training principles. In this article, we outline the most important principles and explain how advanced gait‐training devices are best used to improve therapy outcome.

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“…VR seems to improve outcomes of robotic gait training in MS, through positive attitude and improved problem-solving attitudes. 137 EEG studies reveal that VR induce improvements in chronic post-stroke rehabilitation outcomes by entraining several brain areas, probably through the mirror neuron system. 138 Emotion, will and social abilities must also be trained and empowered along with physical functioning and cognition.…”

Section: Limitations Of Gait Rehabilitation Technologymentioning

confidence: 99%

Advanced technology for gait rehabilitation: An overview

Mikołajczyk

Ciobanu

Badea

et al. 2018

Advances in Mechanical Engineering

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Most gait training systems are designed for acute and subacute neurological inpatients. Many systems are used for relearning gait movements (nonfunctional training) or gait cycle training (functional gait training). Each system presents its own advantages and disadvantages in terms of functional outcomes. However, training gait cycle movements is not sufficient for the rehabilitation of ambulation. There is a need for new solutions to overcome the limitations of existing systems in order to ensure individually tailored training conditions for each of the potential users, no matter the complexity of his or her condition. There is also a need for a new, integrative approach in gait rehabilitation, one that encompasses and addresses all aspects of physical as well as psychological aspects of ambulation in real-life multitasking situations. In this respect, a multidisciplinary multinational team performed an overview of the current technology for gait rehabilitation and reviewed the principles of ambulation training.

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Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial

Cited by 99 publications

References 32 publications

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

Motor and psychosocial impact of robot-assisted gait training in a real-world rehabilitation setting: A pilot study

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

Advanced technology for gait rehabilitation: An overview

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