The dose of robot-assisted gait therapy may influence functional recovery in a multidisciplinary rehabilitation program: an exploratory retrospective study

Abstract

Robot-assisted gait training (RAGT) has been introduced in clinical practice to increase training intensity in patients with neurological disorders. In this observational study, we investigated the effect of the number of RAGT sessions on functional recovery in a heterogeneous cohort of patients. We included patients with a diagnosis of gait impairment due to a neurological disease. A set of demographic, clinical, functional and training parameters was collected for each participant. Each patient received RAGT with an exoskeleton (Lokomat; Hocoma, Volketswil, Switzerland) as part of a multidisciplinary rehabilitation program. We stratified the patients as good responders and poor responders and investigated the effect of varying the number of RAGT sessions with a series of logistic regression models. A total of 143 patients were included in this analysis (good responders = 65, poor responders = 78). Good responder patients spent more days in the hospital (P < 0.01) and underwent a higher number of RAGT sessions (P = 0.04) compared to poor responder patients. Logistic regression models estimated that adding six RAGT sessions mildly increased (by approximately 4%) the probability of a patient becoming a good responder. The rehabilitation phase (subacute/chronic) appeared to be the main determinant of the probability of being a good responder, and stroke patients appeared to be more sensitive to changes in the number of RAGT sessions. Our results seem to confirm previous observations that robotic therapy increases the intensity of rehabilitation, possibly leading to a greater functional recovery in subacute patients with greater impairment.

Is robot-assisted gait training intensity a determinant of functional recovery early after stroke? A pragmatic observational study of clinical care

“…Similarly, we found higher functional gains in patients that received RAGT earlier (within 6 weeks). Indeed, a specific time window for spontaneous recovery exists, that can be set within the first 6–12 weeks for gait recovery [22,43,44] when gait robotics are recommended to optimise functional gains [17]. Indeed, a recent update of the Cochrane review has stated that people in the first 3 months after stroke and those who are not able to walk, seem to benefit most from electromechanical-assisted gait training in combination with physiotherapy [14].…”

“…Even though intensity, measured as time spent in rehabilitation activities, seems to be relevant for optimising functional recovery [1,16], scarce evidence is available on the role of robot-assisted gait training (RAGT) dose for functional outcomes. Recently, it has been hypothesised that the dose of RAGT may influence functional recovery in patients who have undergone a multidisciplinary program [17]. The aim of this pragmatic observational study was to identify the optimal dose and timing of RAGT that can lead to a favourable outcome in a sample of subacute stroke survivors.…”

Feasibility and cost description of highly intensive rehabilitation involving new technologies in patients with post-acute stroke—a trial of the Swiss RehabTech Initiative

“…There is a substantial amount of literature concerning the efficacy of TAT and the importance of the therapy dosage in the rehabilitation of stroke patients [ 23 , 52 , 53 ]. Our data confirm these previous results.…”

A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting.

“…Numerous studies over the last few decades have shown the effectiveness and the advantages of using robotic systems for neurorehabilitation (45,46,47) and tele-rehabilitation in last decades (48,49,50).…”