Who May Benefit From Robotic-Assisted Gait Training?

Morone, Giovanni; Bragoni, Maura; Iosa, Marco; Angelis, Domenico De; Venturiero, Vincenzo; Coiro, Paola; Pratesi, Luca; Paolucci, Stefano

doi:10.1177/1545968311401034

Cited by 144 publications

(67 citation statements)

References 34 publications

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“…Despite the fact that we did not focus our study on cognitive and sensorial improvements during video game-based therapy, it is conceivable that the motor control system could benefit from the multitasking training and augmented participation [22] and augmented intensity [23, 24] as specifically demonstrated in another study about balance training [25]. This is in line with the new concept of training patients in fostering learning to learn (or relearn) [26] and could have positively affected the independence in the activity of daily living in patients trained using video games. Their improvement in terms of BI score, in fact, was higher than that of control subjects, but, this improvement was found correlated with the improvement in BBS score only in the control group and not in the Wii group.…”

Section: Discussionsupporting

confidence: 54%

The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial

Morone

Tramontano

Iosa

et al. 2014

BioMed Research International

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108

105

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The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48, P = 0.004) and independency in activity of daily living (BI: 98 versus 93, P = 0.021). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke.

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Section: Discussionsupporting

confidence: 54%

The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial

Morone

Tramontano

Iosa

et al. 2014

BioMed Research International

Self Cite

108

105

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“…Another RCT included 12 subjects in each of 4 subgroups in a 2 × 2 matrix: higher versus lower Motricity Index and RAST versus conventional training for the initial 4 weeks of a 100-day inpatient stroke rehabilitation stay. 70 The lower Motricity Index robotic group improved more by the FAC, but both the conventional and the robotic groups still had low walking speeds of <0.4 m/s at completion 4 months poststroke. So, perhaps the most impaired subjects, who still retain some as yet uncertain level of motor control, could be a subgroup that may benefit from BWSTT or RAST, but a 24-subject comparison is no more than a pilot study.…”

Section: Early Racesmentioning

confidence: 88%

Should Body Weight–Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate?

Dobkin¹,

Duncan

2012

Neurorehabil Neural Repair

185

145

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Body weight-supported treadmill training (BWSTT), robotic-assistive step training (RAST), and associated techniques for locomotor training (LT) have not proven superior to exercise and progressive over-ground gait training (OGT) to improve walking for motor impaired patients with stroke, spinal cord injury (SCI), multiple sclerosis, Parkinson's disease, and cerebral palsy. This conclusion, based on scientifically conducted, randomized clinical trials (RCTs), is most disappointing. 1 The authors bet heavily on BWSTT as a neurophysiologically sound strategy for moderate to severely impaired patients after SCI 2 and stroke. 3 After over a dozen years of mostly uncontrolled pilot studies and underpowered trials, we initiated and completed an adequately powered, multicenter RCT of BWSTT plus OGT for patients with recent traumatic, incomplete SCI who could still not walk without maximal assistance by 6 weeks after onset. We compared this strategy with conventional progressive OGT. 4 In a second RCT, also supported by peer review and funding from the National Institutes of Health, we compared BWSTT with progressive exercise in the home that did not include any formal practice for walking, starting at either 2 or 6 months after stroke in highly disabled (walking speed <0.4 m/s) and moderately disabled (initial walking speed 0.4 to <0.8 m/s) hemiparetic participants. 5 The participants were identified at the time of their inpatient rehabilitation, unlike earlier pilot studies of BWSTT, in which subjects were usually a convenience sample drawn from volunteers in the community. Baseline variability among groups in the Spinal Cord Injury Locomotor Trial (SCILT) and the Locomotor Experience Applied Post Stroke (LEAPS) trial was negligible, because the entry criteria had been well defined. The technique for the 439687N NRXXX10.

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“…In the future, as already reported for robotic-assisted rehabilitation [57], it will be crucial to identify which patients may be most likely to improve the rehabilitation benefiting by brain stimulation, especially in the long term [58], and which psychological features may affect the outcomes [59]. …”

Section: Discussionmentioning

confidence: 99%

The Ineffective Role of Cathodal tDCS in Enhancing the Functional Motor Outcomes in Early Phase of Stroke Rehabilitation: An Experimental Trial

Fusco

Assenza

Iosa

et al. 2014

BioMed Research International

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Transcranial direct current stimulation (tDCS) is a noninvasive technique that could improve the rehabilitation outcomes in stroke, eliciting neuroplastic mechanisms. At the same time conflicting results have been reported in subacute phase of stroke, when neuroplasticity is crucial. The aim of this double-blind, randomized, and sham-controlled study was to determine whether a treatment with cathodal tDCS before the rehabilitative training might augment the final outcomes (upper limb function, hand dexterity and manual force, locomotion, and activities of daily living) in respect of a traditional rehabilitation for a sample of patients affected by ischemic stroke in the subacute phase. An experimental group (cathodal tDCS plus rehabilitation) and a control group (sham tDCS plus rehabilitation) were assessed at the beginning of the protocol, after 10 days of stimulation, after 30 days from ending of stimulation, and at the end of inpatient rehabilitation. Both groups showed significant improvements for all the assessed domains during the rehabilitation, except for the manual force, while no significant differences were demonstrated between groups. These results seem to indicate that the cathodal tDCS, provided in an early phase of stroke, does not lead to a functional improvement. To depict a more comprehensive scenario, further studies are needed.

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Who May Benefit From Robotic-Assisted Gait Training?

Abstract: Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation.

Cited by 144 publications

References 34 publications

The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial

The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial

Should Body Weight–Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate?

The Ineffective Role of Cathodal tDCS in Enhancing the Functional Motor Outcomes in Early Phase of Stroke Rehabilitation: An Experimental Trial

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