Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial
Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial
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DOI：
10.1186/s12984-018-0377-8
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发表时间：
2018-04-25
影响因子：
5.1
通讯作者：
Bramanti, Alessia
中科院分区：
文献类型：
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作者：
Calabro, Rocco Salvatore;Naro, Antonino;Bramanti, Alessia
背景资料：使用神经机器人设备可以通过引入特定的大脑可塑性机制来改善步态恢复，这可能是使用这种方法成功康复的关键问题。我们评估了可穿戴外骨骼，Ekso（TM），是否可以得到更高的步态性能比传统的地上步态训练（OGT）在患者偏瘫由于中风在慢性phase.Methods的偏瘫，并促进恢复特定的大脑可塑性机制：我们招募了40例患者在前瞻性，前后，随机临床研究。20名患者接受了Ekso（TM）步态训练（EGT）（45分钟/疗程，5次/周），除了地上步态治疗，而20名患者练习了相同时间的OGT。对所有受试者的步态表现进行评估（10米步行试验），步态周期，肌肉激活模式在步态训练前后，通过记录下肢肌肉的表面肌电（EMG）、额顶叶有效连接（FPEC）、皮质脊髓兴奋性（CSE）和感觉运动整合（SMI），采用经颅磁刺激（TMT）模式进行研究。在EGT诱导的10米步行试验改善中发现了显著的效应量（d = 0.9，p < 0.001），患侧CSE（d = 0.7，p = 0.001），患侧SMI（d = 0.5，p = 0.03）、整体步态质量（d = 0.8，p = 0.001）、髋关节和膝关节肌肉激活（d = 0.8，p = 0.001）和FPEC（d = 0.8，p = 0.001）。加强FPEC（r = 0.601，p < 0.001），患侧SMI增加（r = 0.554，p < 0.001），健侧SMI降低（r =-0.540，p < 0.001）是与临床改善相关的最重要因素。Ekso（TM）步态训练似乎很有希望在步态康复中风患者，除了OGT。我们的研究提出了一个假定的神经生理学基础支持Ekso T后效应。这些知识可能有助于规划高度患者定制的步态康复方案。
Background: The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the wearable exoskeleton, Ekso (TM), could get higher gait performance than conventional overground gait training (OGT) in patients with hemiparesis due to stroke in a chronic phase, and foster the recovery of specific brain plasticity mechanisms.Methods: We enrolled forty patients in a prospective, pre-post, randomized clinical study. Twenty patients underwent Ekso (TM) gait training (EGT) (45-min/session, five times/week), in addition to overground gait therapy, whilst 20 patients practiced an OGT of the same duration. All individuals were evaluated about gait performance (10 m walking test), gait cycle, muscle activation pattern (by recording surface electromyography from lower limb muscles), frontoparietal effective connectivity (FPEC) by using EEG, cortico-spinal excitability (CSE), and sensorymotor integration (SMI) from both primary motor areas by using Transcranial Magnetic Stimulation paradigm before and after the gait training.Results: A significant effect size was found in the EGT-induced improvement in the 10 m walking test (d = 0.9, p < 0.001), CSE in the affected side (d = 0.7, p = 0.001), SMI in the affected side (d = 0.5, p = 0.03), overall gait quality (d = 0.8, p = 0.001), hip and knee muscle activation (d = 0.8, p = 0.001), and FPEC (d = 0.8, p = 0.001). The strengthening of FPEC (r = 0.601, p < 0.001), the increase of SMI in the affected side (r = 0.554, p < 0.001), and the decrease of SMI in the unaffected side (r = -0.540, p < 0.001) were the most important factors correlated with the clinical improvement.Conclusions: Ekso (TM) gait training seems promising in gait rehabilitation for post-stroke patients, besides OGT. Our study proposes a putative neurophysiological basis supporting Ekso T after-effects. This knowledge may be useful to plan highly patient-tailored gait rehabilitation protocols.