Who May Benefit From Robotic-Assisted Gait Training? A Randomized Clinical Trial in Patients With Subacute Stroke
Who May Benefit From Robotic-Assisted Gait Training? A Randomized Clinical Trial in Patients With Subacute Stroke
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DOI：
10.1177/1545968311401034
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发表时间：
2011-09-01
影响因子：
4.2
通讯作者：
Paolucci, Stefano
中科院分区：
文献类型：
--
作者：
Morone, Giovanni;Bragoni, Maura;Paolucci, Stefano
背景。中风后的机器人辅助行走训练旨在使严重受损的患者能够独立行走，但结果好坏参半。目标。作者旨在确定最有可能受益的患者的特征。方法。共有48名亚急性卒中后运动和步态功能障碍的参与者根据运动指数分为高运动损伤组（= 29）。每只手臂在中风后平均20天随机分为机器人组或对照组（RG或CG）。所有患者均接受3个月的治疗，每天2次，每周5天。RG组的患者在住院治疗的前4周接受了20次机器人辅助的步态训练，使用控制终点轨迹和简化的常规治疗，而CG组只接受常规的步态训练。主要指标是功能活动类别（FAC），次要指标是Rivermead活动指数（RMI）和6分钟步行距离，均在入院和出院时进行评估。结果。使用机电装置的低电动力组在FAC （P < 0.001）、RMI （P = 0.001）和步行距离（P = 0.029）方面均显著改善。常规疗法和机器人疗法在高运动臂中效果相当。结论。在卒中住院康复期间，机器人治疗联合常规治疗可能比单独常规治疗更有效。
Background. Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently, but results have been mixed. Objective. The authors aimed to identify the characteristics of patients who may be most likely to benefit. Methods. A total of 48 participants with motor and gait dysfunction following subacute stroke were stratified by the motricity index into high (= 29) motor impairment groups. Each arm was randomized to a robotic or control group (RG or CG) at a mean of 20 days after stroke. All patients underwent 2 therapy sessions per day, 5 days per week for 3 months. Those in the RG underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy using controlled endpoint trajectories and abbreviated conventional therapy, whereas the CG received only conventional gait training. The primary outcome was the functional ambulation category (FAC), and secondary measures were the Rivermead mobility index (RMI) and 6-minute walking distance, all evaluated at hospital admission and at discharge. Results. The lower motricity group assigned to an electromechanical device significantly improved in the FAC (P < .001), RMI (P = .001), and walking distance (P = .029). Conventional and robotic therapies were equivalent in the higher motricity arm. Conclusion. Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation.