Aggujaro R.1, Smania N.2, Waldner A.3
1Reha Technology AG, Clinical Affairs, Olten, Switzerland, 2Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, Verona, Italy, 3Private Hospital Villa Melitta, Department of Neurological Rehabilitation, Bolzano, Italy
Background: Developed with the purpose of helping stroke survivors regaining their mobility to actively take part in daily activities, the use of robot assisted end effector technology has proven to deliver excellent results in multiple applications.
The ability of walking and climbing stairs up and down is an essential part of everyday mobility.
The ability of walking and climbing stairs up and down is an essential part of everyday mobility.
Purpose: The talk provides a review on the use of end effector robotic devices in floor walking and stairs climbing practice in sub-acute and chronic stroke patients.
Methods: This includes a Cochrane review (Mehrholz 2013), a randomized clinical trial (Hesse 2012), and a pilot randomized clinical trial (Smania 2016) where the effectiveness of the use of end effector technology in combination with conventional therapy are compared with either conventional therapy approach only or other mechanical robotic gait interventions on the floor and on the stairs.
End-effector devices analyzed are the GaitMaster4 (Tanaka 2012) the Gait Trainer GT 1 (Hesse 1999) and the G-EO System (Hesse 2010).
By definition, on an end-effector device, patients feet are placed on foot plates, whose trajectories simulate the stance and swing phases (Schmidt 2007). A total of 11 trials (9 Cochrane Review + 1 RCT + 1 PRCT) including 490 stroke patients sub-acute and chronic (470 + 15 + 5) used an end-effector device as the experimental intervention. The primary outcome observed is the ability to walk independently (FAC) Functional Ambulation Category (Holden 1984). A FAC score of 4 or 5 indicated independent walking (including stairs FAC score 5) over a 15-metre surface. A FAC score less than 4 indicates dependency in walking.
Walking speed (10mwt) endurance (6MWT) as well as the time required to climb 9 stairs - ascending and descending - are also assessed.
Results: As per the Cochrane review (Mehrholz 2013) the use of end effector electromechanical devices for gait rehabilitation of people after stroke increased the chance of walking independently on the floor (OR (random) 2.17, 95% CI 1.07 to 4.43; P = 0.03; level of heterogeneity, I² = 48%).
As per the RCT (Hesse 2012) the use of an end effector electromechanical device lead to walking independently on the floor and on the stairs (FAC score of 5) for seven non ambulatory stroke patients.
As per the PRCT (Smania 2016) the use of the end effector electromechanical device for stair climbing practice led to an improvement for the time required to climb up (P=0.06) and down (P=0.06) stairs when compared to conventional physiotherapy.
Conclusion(s): Patients who have received end effector electromechanical-assisted gait training in combination with physiotherapy after stroke (subacute and chronic) are more likely to achieve independent walking and the ability to climb stairs. Specifically, people in the first three months after stroke and those with high dependency in walking seem to benefit most from this type of electromechanical-assisted gait approach. Furthermore the use of the end effector electromechanical device on chronic ambulatory stroke may reduce the time required to climbing up and down the stairs.
Implications: None
Funding acknowledgements: None
Topic: Disability & rehabilitation
Ethics approval: Ethics approval was not required
All authors, affiliations and abstracts have been published as submitted.
