CHARACTERISTICS OF PATIENTS WHO COULD BENEFIT FROM ROBOT-ASSISTED GAIT TRAINING IN WALKING DISTANCE: A FIVE CASE-SERIES

D. Hirado^1,2, Y. Suzuki³, N. Maeda², M. Komiya², T. Shirakawa¹, Y. Urabe²

¹Matterhorn Rehabilitation Hospital, Department of Rehabilitation, Kure, Japan, ²Graduate School of Biomedical and Health Sciences, Department of Sports Rehabilitation, Hiroshima, Japan, ³Kyushu Nutrition Welfare University, Department of Rehabilitation, Kita-Kyushu, Japan

Background: The rehabilitation of patients after stroke is recommended to increase walking distance in order to improve walking ability. Robot-assisted gait training (RAGT) can be useful in increasing walking practice distance, helps patients with low walking ability to walk more. However, it is unclear whether RAＧT distance per sessions affects walking ability, especially in patients with stroke.

Purpose: The purpose of the study was to examine the functional characteristics of five patients who gained more walking distance with RAGT.

Methods: Five patients after stroke were included in this study.
Case 1: male, 51 years old, thalamic hemorrhage, Stroke Impairment Assessment Set (SIAS)=34 points, Fugl–Meyer Assessment for Lower Extremity (FMA-LE)=12 points;
Case 2: female, 82 years old, medullary infarction, SIAS=63 points, FMA-LE=23 points;
Case 3: female, 70 years old, subcortical hemorrhage, SIAS=60 points, FMA-LE=15 points;
Case 4: female, 85 years old, temporal occipital lobe and pontine infarction, SIAS=37 points, FMA-LE=20 points; She had a history of exertional angina pectoris and bilateral knee osteoarthritis.
Case 5: female, 88 years old, frontal lobe infarction, SIAS=26 points, FMA-LE=8 points.
Participants performed the gait training with Hybrid Assistive Limb (HAL, Cyberdyne Inc., Japan) for 4 weeks (30 minutes/session, three to four times/week). The walking distance for each training session with HAL was also quantified.

Results: The number of interventions and the amount of gait training per session for each case were:
Case 1: 16 times, 310.0 ± 139.1 m/session;
Case 2: 16 times, 303.2 ± 91.6 m/session;
Case 3: 16 times, 150.4 ± 84.8 m/session;
Case 4: 13 times, 134.8 ± 61.5 m/session;
Case 5: 12 times, 47.7 ± 25.6 m/session.
The outcomes after 4 weeks intervention for each case were:
Case 1: SIAS=39, FMA-LE=15;
Case 2: SIAS=71, FMA-LE=30;
Case 3: SIAS=70, FMA-LE=27;
Case 4: SIAS=44, FMA-LE=24;
Case 5: SIAS=40, FMA-LE=19.

Conclusions: Case 1 had a higher level of gait independence before the intervention. FAC is an important factor in gaining walking distance.
Case 2 were able to gain more walking practice distance due to enough function on the nonparalytic side.
Case 3, the dose of walking practice was gradually increased as the paraplegic side function improved. Conversely,
Case 4 had moderate motor paralysis; however, due to comorbidities, the patient could not receive adequate gait training, and the effect of RAGT was limited.
Case 5 had severe motor paralysis and cognitive and frontal lobe dysfunction, making sustained gait practice difficult.

Implications: The patients who gained more walking practice distance were characterized by gait independence at the start of the intervention and function on the non-paralyzed side. Multiple comorbidities affecting gait training and cognitive or frontal lobe dysfunction may limit the amount of gait practice gained, even with HAL.

Funding acknowledgements: We have no funding acknowledgement in this study.

Keywords:
Robot-assisted gait training (RAGT)
Walking distance
Patients with stroke

Topics:
Neurology: stroke
Innovative technology: robotics
Older people

Did this work require ethics approval? Yes

Institution: Matterhorn Rehabilitation Hospital

Committee: Matterhorn Rehabilitation Hospital Ethics Committee

Ethics number: MRH21003