Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial
| Autor: | Sangeetha Madhavan, Annie Tapp, Masha Kocherginsky, Kenton J. Williams, Hideaki Takahashi, Arun Jayaraman, William Z. Rymer, Kristen Hohl, Kimberly Brennan, Chaithanya K. Mummidisetty, Megan K. O’Brien, Heidi Roth |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Powered exoskeleton STRIDE 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Gait training Medicine Humans Single-Blind Method 030212 general & internal medicine Stroke Gait Gait Disorders Neurologic Balance (ability) Aged Physical Education and Training business.industry Electromyography Stroke Rehabilitation Extremities Middle Aged SMA medicine.disease Evoked Potentials Motor Transcranial Magnetic Stimulation Exoskeleton Biomechanical Phenomena Exercise Therapy Preferred walking speed Treatment Outcome Female Neurology (clinical) business human activities 030217 neurology & neurosurgery |
| Zdroj: | Neurology. 92(3) |
| ISSN: | 1526-632X 0199-4395 |
| Popis: | ObjectiveTo test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.MethodsFifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6–8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation.ResultsThe primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).ConclusionsGait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training.Clinicaltrials.gov identifierNCT01994395.Classification of evidenceThis study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training. |
| Databáze: | OpenAIRE |
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