Gomez E1, Tan SM1, Ong SYTC1, Han YJ1, Toh X1, Samsudin F1, Kupusamy A1, Joseph D1
1Changi General Hospital, Rehabilitative Services, Singapore, Singapore
Background: Studies have shown the benefit of additional gait training through the use of electromechanical gait training devices in improving function. However, guidance on prescription of treatment intensity and patient selection is lacking, with none in the local population.
Purpose: Our purpose is to evaluate functional outcome associated with the use of electromechanical gait training device, so as to guide patient selection and treatment prescription.
Methods: All patients with functional limitation in gait that met the inclusion criteria were encouraged to participate in a once daily session of electromechanical gait training, in addition to the usual Physiotherapy intervention. Data from 89 consecutive patients who trained on the device (the G-EO System robotic gait trainer) between October 2017 and July 2018 were extracted and reviewed. Data included age, diagnosis, number of steps, distance covered, Functional Independence measure (FIM) (motor) score at one week and discharge were the main measures collected.
Results: Of the 89 consecutive patients, majority (n=79) had a diagnosis of stroke, while the others had various diagnoses requiring gait retraining. Only subjects with diagnosis stroke, received more than 2 training sessions on the device, with complete data sets (n=45) were included for further analysis. Subjects completed a mean of 9.69 sessions (range 3-25) on the device, averaged 653 steps (range 279 to 1244), and 239.74m (range 91.13 to 535.84m) per session. Mean motor functional independence measure (FIM) score increased by 8.87 points (12.7%).
650 steps per session was the cut off for intervention group analysis. 2 way Anova with 1 repeated measure showed a significant main treatment effect (F=116.057, p=.000), with all subjects improving in FIM (motor) score post-treatment. There was also significant group by time interaction effect (F= 6.164, p=0.017), with subjects who completed ≥650 steps per session getting a higher FIM (motor) score. The main effect for group alone was not significant (F== 0.585, p=.449).
Pooled across group, the mean FIM (motor) at discharge were found to be significantly higher (34.17) than at pre-treatment (24.97). Pooled across time, the ≥650 steps group had a non-significant higher mean FIM (motor) scores (30.45) than the 650 group (28.69). While both groups had similar FIM (motor) scores at pre-treatment, the ≥650 group had significantly higher scores at discharge (36.11) than the 650 group (32.23).
No significant correlations can be drawn for number of sessions or distance covered. Small subject numbers is a major limitation in the study, particularly given the wide range of presentation.
Conclusion(s): All patients in this study had a significant improvement in motor function. Preliminary data shows that the addition of electromechanical gait training at sufficient intensity (≥650 steps per session) has a significant effect on improving motor function. Further analysis of larger patient numbers or through a prospective randomized study is needed to provide further guidance on treatment variables and patient selection.
Implications: Gait training utilising electromechanical gait training devices need to have sufficient intensity in order for significant changes in function to be attained. Number of steps per session is a simple and practical means of setting intensity.
Keywords: Stroke, gait, electromechanical
Funding acknowledgements: Purchase of the gait device was through funding from the Ministry of Health, Singapore (Health Service Development Program).
Purpose: Our purpose is to evaluate functional outcome associated with the use of electromechanical gait training device, so as to guide patient selection and treatment prescription.
Methods: All patients with functional limitation in gait that met the inclusion criteria were encouraged to participate in a once daily session of electromechanical gait training, in addition to the usual Physiotherapy intervention. Data from 89 consecutive patients who trained on the device (the G-EO System robotic gait trainer) between October 2017 and July 2018 were extracted and reviewed. Data included age, diagnosis, number of steps, distance covered, Functional Independence measure (FIM) (motor) score at one week and discharge were the main measures collected.
Results: Of the 89 consecutive patients, majority (n=79) had a diagnosis of stroke, while the others had various diagnoses requiring gait retraining. Only subjects with diagnosis stroke, received more than 2 training sessions on the device, with complete data sets (n=45) were included for further analysis. Subjects completed a mean of 9.69 sessions (range 3-25) on the device, averaged 653 steps (range 279 to 1244), and 239.74m (range 91.13 to 535.84m) per session. Mean motor functional independence measure (FIM) score increased by 8.87 points (12.7%).
650 steps per session was the cut off for intervention group analysis. 2 way Anova with 1 repeated measure showed a significant main treatment effect (F=116.057, p=.000), with all subjects improving in FIM (motor) score post-treatment. There was also significant group by time interaction effect (F= 6.164, p=0.017), with subjects who completed ≥650 steps per session getting a higher FIM (motor) score. The main effect for group alone was not significant (F== 0.585, p=.449).
Pooled across group, the mean FIM (motor) at discharge were found to be significantly higher (34.17) than at pre-treatment (24.97). Pooled across time, the ≥650 steps group had a non-significant higher mean FIM (motor) scores (30.45) than the 650 group (28.69). While both groups had similar FIM (motor) scores at pre-treatment, the ≥650 group had significantly higher scores at discharge (36.11) than the 650 group (32.23).
No significant correlations can be drawn for number of sessions or distance covered. Small subject numbers is a major limitation in the study, particularly given the wide range of presentation.
Conclusion(s): All patients in this study had a significant improvement in motor function. Preliminary data shows that the addition of electromechanical gait training at sufficient intensity (≥650 steps per session) has a significant effect on improving motor function. Further analysis of larger patient numbers or through a prospective randomized study is needed to provide further guidance on treatment variables and patient selection.
Implications: Gait training utilising electromechanical gait training devices need to have sufficient intensity in order for significant changes in function to be attained. Number of steps per session is a simple and practical means of setting intensity.
Keywords: Stroke, gait, electromechanical
Funding acknowledgements: Purchase of the gait device was through funding from the Ministry of Health, Singapore (Health Service Development Program).
Topic: Robotics & technology; Neurology: stroke
Ethics approval required: No
Institution: SingHealth
Ethics committee: Institutionn Review Board
Reason not required: This data was extracted as per a service review and did not involve patient identifying information. Ethics application is not needed for service reviews.
All authors, affiliations and abstracts have been published as submitted.
