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Marks D.1, Schweinfurther R.1, Dewor A.1, Costa U.2, Huster T.1, Paredes L.P.1, Zutter D.1, Möller J.C.1,3
1Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland, 2HOCOMA AG, Volketswil, Switzerland, 3Philipps University, Marburg, Germany
Background: Most stroke survivors experience initial and long-term mobility restrictions (Jørgensen et al. 1995). New technologies promise to improve outcomes (Dundar et al. 2014). The Andago is a recently developed overground gait and balance training device that allows safe, harness-secured overground mobility (HOCOMA 2016).
Purpose: The objective of this study was to evaluate the usability of the Andago for gait and balance training in patients with gait disorders after stroke and its acceptance by patients and therapists.
Methods: The trial was designed as an exploratory study without control group. Patients were recruited consecutively from all inpatients who trained on the Lokomat, a robot-assisted treadmill device (Mayr et al. 2007). The Andago was tested in 2 sessions, the first being a training session to familiarize patients and therapists to the new device and to define optimal settings for its use. In the subsequent therapy session, the patient performed a specific course, which represented real-life conditions as predefined by our infrastructure: straight stretches, left and right turns and passing normal and sliding doors. Therapists and patients rated handling, usability and satisfaction.
Results: So far, 9 patients were eligible and gave informed consent. Median time since stroke onset was 57 days. Mean age was 60 years. 5 suffered from an ischemic stroke, 7 were male, mean FAC (Functional Ambulation Categories) (Holden et al. 1984) was 1.6 and mean NIHSS (National Institute of Health Stroke Scale) (Criddle et al. 2003) was 8.1.
All training sessions could be performed safely, no adverse events leading to a discontinuation of the intervention occurred. However, therapists had to intervene due to impending collisions with obstacles or while passing doors. Patients reported a safe walking experience and a walk-like training. Therapists noted problems inside narrow corridors or while passing doors, where the Andago had to be steered accurately in a right angle, to avoid collisions. Patients suffering a FAC from 2 showed difficulties to use the device properly due to the impossibility to move the affected leg adequately. Additional neglect or hemianopia were reported as an additional difficulty to benefit from a successful training on the Andago.
Conclusion(s): The intervention was safe. Most of the patients enjoyed the Andago experience. It seems, that benefits for a gait training could be expected in patients, who have an ability to generate steps, according to a FAC ≥ 2. Patients featuring a FAC 2 appear not to be able to use the device properly due to difficulty moving the affected leg. Additional perceptual disorders impeded the training. Nevertheless, the Andago seems to be a promising device in overground mobility training for patients with moderate gait disorders. More severely affected patients may fail to benefit from the Andago and should preferably be trained otherwise, e.g. with commonly available robotic-assisted gait training devices providing more trunk and legs control (Mehrholz et al. 2013).
Implications: Further research is needed to identify eligible patients in terms of necessary walking abilities, optimal training parameters and effectiveness of Andago, compared to the use of conventional training interventions or robotic-assisted gait training devices.
Funding acknowledgements: None
Topic: Neurology: stroke
Ethics approval: Cantonal Ethics Committee on research involving humans (Kantonale Ethikkommission Thurgau): KEKTGOV 2015/29; ClinicalTrials.gov: NCT02735460
All authors, affiliations and abstracts have been published as submitted.
