Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial.

Autor: Porciuncula F; Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.; Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.; Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA., Arumukhom Revi D; Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.; Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.; Department of Mechanical Engineering, Boston University, Boston, MA, USA., Baker TC; Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.; Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA., Sloutsky R; Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA., Walsh CJ; Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA., Ellis TD; Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA., Awad LN; Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA. louawad@bu.edu.; Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA. louawad@bu.edu.; Department of Mechanical Engineering, Boston University, Boston, MA, USA. louawad@bu.edu.
Jazyk: angličtina
Zdroj: Journal of neuroengineering and rehabilitation [J Neuroeng Rehabil] 2023 Nov 07; Vol. 20 (1), pp. 148. Date of Electronic Publication: 2023 Nov 07.
DOI: 10.1186/s12984-023-01267-9
Abstrakt: Introduction: High-intensity gait training is widely recognized as an effective rehabilitation approach after stroke. Soft robotic exosuits that enhance post-stroke gait mechanics have the potential to improve the rehabilitative outcomes achieved by high-intensity gait training. The objective of this development-of-concept pilot crossover study was to evaluate the outcomes achieved by high-intensity gait training with versus without soft robotic exosuits.
Methods: In this 2-arm pilot crossover study, four individuals post-stroke completed twelve visits of speed-based, high-intensity gait training: six consecutive visits of Robotic Exosuit Augmented Locomotion (REAL) gait training and six consecutive visits without the exosuit (CONTROL). The intervention arms were counterbalanced across study participants and separated by 6 + weeks of washout. Walking function was evaluated before and after each intervention using 6-minute walk test (6MWT) distance and 10-m walk test (10mWT) speed. Moreover, 10mWT speeds were evaluated before each training visit, with the time-course of change in walking speed computed for each intervention arm. For each participant, changes in each outcome were compared to minimal clinically-important difference (MCID) thresholds. Secondary analyses focused on changes in propulsion mechanics and associated biomechanical metrics.
Results: Large between-group effects were observed for 6MWT distance (d = 1.41) and 10mWT speed (d = 1.14). REAL gait training resulted in an average pre-post change of 68 ± 27 m (p = 0.015) in 6MWT distance, compared to a pre-post change of 30 ± 16 m (p = 0.035) after CONTROL gait training. Similarly, REAL training resulted in a pre-post change of 0.08 ± 0.03 m/s (p = 0.012) in 10mWT speed, compared to a pre-post change of 0.01 ± 06 m/s (p = 0.76) after CONTROL. For both outcomes, 3 of 4 (75%) study participants surpassed MCIDs after REAL training, whereas 1 of 4 (25%) surpassed MCIDs after CONTROL training. Across the training visits, REAL training resulted in a 1.67 faster rate of improvement in walking speed. Similar patterns of improvement were observed for the secondary gait biomechanical outcomes, with REAL training resulting in significantly improved paretic propulsion for 3 of 4 study participants (p < 0.05) compared to 1 of 4 after CONTROL.
Conclusion: Soft robotic exosuits have the potential to enhance the rehabilitative outcomes produced by high-intensity gait training after stroke. Findings of this development-of-concept pilot crossover trial motivate continued development and study of the REAL gait training program.
(© 2023. The Author(s).)
Databáze: MEDLINE
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