DOI QR코드

DOI QR Code

Robotic-assisted gait training applied with guidance force for balance and gait performance in persons with subacute hemiparetic stroke

  • Son, Dong-Wook (Department of Physical Therapy, Graduate School of Health and Welfare, Baekseok University) ;
  • Hwang, Sujin (Department of Physical Therapy, Division of Health Science, Baekseok University)
  • 투고 : 2017.08.27
  • 심사 : 2017.09.18
  • 발행 : 2017.09.30

초록

Objective: Robot assisted gait training is implemented as part of therapy for the recovery of gait patterns in recent clinical fields, and the scope of implications are continuously increasing. However clear therapy protocols of robot assisted gait training are insufficent. The purpose of this study was to investigate the effects of robot-assisted gait training applied with guidance force on balance and gait performance in persons with hemiparetic stroke. Design: Two group pre-test post-test design. Methods: Nineteen persons were diagnosed with hemiparesis following stroke participated in this study. The participants were randomly assigned to the unilateral guidance group or bilateral guidance group to conduct robot-assisted gait training. All participants underwent robot-assisted gait training for twelve sessions (30 min/d, 3 d/wk for 4 weeks). They were assessed with gait parameters (gait velocity, cadence, step length, stance phase, and swing phase) using Optogait. This study also measured the dynamic gait index (DGI), the Berg balance scale (BBS) score, and timed up and go (TUG). Results: After training, BBS scores were was significantly increased in the bilateral training group than in the unilateral guidance group (p<0.05). Spatiotemporal parameters were significantly changed in the bilateral training group (gait speed, swing phase ratio, and stance phase ratio) compared to the unilateral training group (p<0.05). Conclusions: The results of this study suggest that robot-assisted gait training show feasibility in facilitating improvements in balance and gait performance for subacute hemiparetic stroke patients.

키워드

참고문헌

  1. WHO Scientific Group on Epidemiology Etiology, Prevention of Periodontal Diseases World Health Organization. Epidemiology, etiology, and prevention of periodontal diseases: report of a WHO scientific group. Geneva: World Health Organization; 1978.
  2. Statistics Korea. Annual Report on the Causes of Death Statistics [Internet]. Deajeon: Statistics Korea, 2015 [cited 2016 Feb 9]. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/6/2index.bord.
  3. Poli P, Morone G, Rosati G, Masiero S. Robotic technologies and rehabilitation: new tools for stroke patients' therapy. Biomed Res Int 2013;2013:153872.
  4. Aizen E. Falls in patients with stroke. Harefuah 2014;153:195-8, 237.
  5. Monahan FD, Phipps WJ. Phipps' medical-surgical nursing: health and illness perspectives. St. Louis: Elsevier Mosby; 2007.
  6. Tokuno CD, Eng JJ. Gait initiation is dependent on the function of the paretic trailing limb in individuals with stroke. Gait Posture 2006;24:424-8. https://doi.org/10.1016/j.gaitpost.2005.09.012
  7. Chen JC, Shaw FZ. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients. World J Clin Cases 2014;2:316-26. https://doi.org/10.12998/wjcc.v2.i8.316
  8. Pohl M, Mehrholz J, Ritschel C, Ruckriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke 2002;33:553-8. https://doi.org/10.1161/hs0202.102365
  9. Park HJ, Oh DW, Kim SY, Choi JD. Effectiveness of community-based ambulation training for walking function of poststroke hemiparesis: a randomized controlled pilot trial. Clin Rehabil 2011;25:451-9. https://doi.org/10.1177/0269215510389200
  10. Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a "plateau" in recovery. Stroke 2010;41:129-35. https://doi.org/10.1161/STROKEAHA.109.563247
  11. Moseley AM, Stark A, Cameron ID, Pollock A. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev 2005;(4):CD002840.
  12. Husemann B, Muller F, Krewer C, Heller S, Koenig E. Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke 2007;38:349-54. https://doi.org/10.1161/01.STR.0000254607.48765.cb
  13. Kosak MC, Reding MJ. Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. Neurorehabil Neural Repair 2000;14:13-9. https://doi.org/10.1177/154596830001400102
  14. Mayr A, Kofler M, Quirbach E, Matzak H, Frohlich K, Saltuari L. Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair 2007;21:307-14. https://doi.org/10.1177/1545968307300697
  15. Swinnen E, Beckwee D, Meeusen R, Baeyens JP, Kerckhofs E. Does robot-assisted gait rehabilitation improve balance in stroke patients? A systematic review. Top Stroke Rehabil 2014;21:87-100. https://doi.org/10.1310/tsr2102-87
  16. Chang WH, Kim YH. Robot-assisted therapy in stroke rehabilitation. J Stroke 2013;15:174-81. https://doi.org/10.5853/jos.2013.15.3.174
  17. Hsieh YW, Lin KC, Wu CY, Lien HY, Chen JL, Chen CC, et al. Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation. Arch Phys Med Rehabil 2014;95:316-21. https://doi.org/10.1016/j.apmr.2013.09.018
  18. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83 Suppl 2:S7-11.
  19. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995;27:27-36.
  20. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  21. Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther 1997;77:812-9. https://doi.org/10.1093/ptj/77.8.812
  22. Arias M, Smith LN. Early mobilization of acute stroke patients. J Clin Nurs 2007;16:282-8. https://doi.org/10.1111/j.1365-2702.2005.01488.x
  23. Langhammer B, Stanghelle JK. Co-variation of tests commonly used in stroke rehabilitation. Physiother Res Int 2006;11:228-34. https://doi.org/10.1002/pri.345
  24. Miller EW, Quinn ME, Seddon PG. Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke. Phys Ther 2002;82:53-61. https://doi.org/10.1093/ptj/82.1.53
  25. Ochi M, Wada F, Saeki S, Hachisuka K. Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gaitassistance robot: a prospective, randomized, open, blinded-endpoint trial. J Neurol Sci 2015;353:130-6. https://doi.org/10.1016/j.jns.2015.04.033
  26. Taveggia G, Ragusa I, Trani V, Cuva D, Angeretti C, Fontanella M, et al. Robotic tilt table reduces the occurrence of orthostatic hypotension over time in vegetative states. Int J Rehabil Res 2015;38:162-6. https://doi.org/10.1097/MRR.0000000000000104
  27. Brutsch K, Schuler T, Koenig A, Zimmerli L, -Koeneke SM, Lunenburger L, et al. Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children. J Neuroeng Rehabil 2010;7:15. https://doi.org/10.1186/1743-0003-7-15