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Gandolfi M1, Dimitrova E1, Valè N1, Mattiuz N1, Maddalena I1, Waldner A2,3, Saltuari L2,4, Picelli A1, Smania N1, Schindler L5
1University of Verona, Verona, Italy, 2Research Department for Neurorehabilitation South Tyrol, Bozen, Italy, 3Private Clinic Villa Melitta, Neurological Rehabilitation, Bozen, Italy, 4Hochzirl Hospital, Department of Neurology, Zirl, Austria, 5Medizinische Fachhochschule Bad Salzungen, Bad Salzungen, Germany
Background: Stroke represents the second most common cause of death worldwide and a major cause of disability in adults. In the last few years, the incoming of robotics in rehabilitation has been observed. In the beginning, it was mainly used for gait rehabilitation, but nowadays new machines allow patients to train on other activities, including stair climbing, to improve their independence. Impaired balance and postural control in stroke patients are commonly related to somatosensory, visual and vestibular central integration deficits. These sensory inputs can be redundant or in conflict with each other. Somatosensory and vestibular impairments can lead to a predominance of visual afference, but there is evidence that sensory inputs reweighting can occur in chronic stroke patients. Specific rehabilitation approaches can improve sensorimotor integration processes thus improving postural stability in stroke patients. Preliminary studies in Multiple Sclerosis patients showed how robot-assisted training with G-EO could both enhance sensorimotor integration processes and reduce fall risk.
Purpose: To compare the effects of robot-assisted rehabilitation protocol using the G-EO system against a sensorimotor integration training on postural stability and ability in stair climbing in chronic stroke patients.
Methods: This pilot, randomized, control study, involved 32 chronic stroke patients. The experimental group (EG N=17) received robot-assisted training for gait and walking upstairs and downstairs rehabilitation using the G-EO system; the control group (CG N=15) received sensorimotor integration balance training (SIBT). Training protocols lasted for 10 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1-month follow-up (T2), a blinded rater evaluated patients using specific clinical and instrumental assessment measures for postural stability disorders. Primary outcome: Stair Climbing Test (time taken to climb 9 steps). Secondary outcomes: Timed Up and Go; 10 Meters Walking Test; 6 Minutes Walking Test; Berg Balance Scale, Functional Ambulatory Category; stabilometric assessment; kinematic gait parameters assessed with GaitRite system.
Results: EG showed a statistically significant improvement in the Stair Climbing Test. Both groups showed a statistically significant increase in postural stability and stabilometric assessment at T1 and effects were maintained at T2. Both groups reduced the time needed to walk downstairs. These improvements were maintained at 1-month follow-up.
Conclusion(s): The training effects on postural stability and ability in stair climbing were comparable between the two groups. Robot-assisted training demonstrated remarkable effects on improving sensorimotor integration processes and postural stability in chronic stroke patients.
Implications: This rehabilitation approach can be relevant in patients with high disability, when the SIBT training is difficult to use.
Keywords: Robotic rehanilitation, neurologic rehabilitation, stair climbing
Funding acknowledgements: none
Purpose: To compare the effects of robot-assisted rehabilitation protocol using the G-EO system against a sensorimotor integration training on postural stability and ability in stair climbing in chronic stroke patients.
Methods: This pilot, randomized, control study, involved 32 chronic stroke patients. The experimental group (EG N=17) received robot-assisted training for gait and walking upstairs and downstairs rehabilitation using the G-EO system; the control group (CG N=15) received sensorimotor integration balance training (SIBT). Training protocols lasted for 10 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1-month follow-up (T2), a blinded rater evaluated patients using specific clinical and instrumental assessment measures for postural stability disorders. Primary outcome: Stair Climbing Test (time taken to climb 9 steps). Secondary outcomes: Timed Up and Go; 10 Meters Walking Test; 6 Minutes Walking Test; Berg Balance Scale, Functional Ambulatory Category; stabilometric assessment; kinematic gait parameters assessed with GaitRite system.
Results: EG showed a statistically significant improvement in the Stair Climbing Test. Both groups showed a statistically significant increase in postural stability and stabilometric assessment at T1 and effects were maintained at T2. Both groups reduced the time needed to walk downstairs. These improvements were maintained at 1-month follow-up.
Conclusion(s): The training effects on postural stability and ability in stair climbing were comparable between the two groups. Robot-assisted training demonstrated remarkable effects on improving sensorimotor integration processes and postural stability in chronic stroke patients.
Implications: This rehabilitation approach can be relevant in patients with high disability, when the SIBT training is difficult to use.
Keywords: Robotic rehanilitation, neurologic rehabilitation, stair climbing
Funding acknowledgements: none
Topic: Robotics & technology; Neurology: stroke; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Azienda ospedaliera universitaria integrata verona
Ethics committee: Ethic committee
Ethics number: 1442CESC
All authors, affiliations and abstracts have been published as submitted.
