[Robotic recovery of walking function in patients in the early recovery period of stroke]

The Effectiveness of Overground Robot Exoskeleton Gait Training on Gait Outcomes, Balance, and Motor Function in Patients with Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study aimed to investigate the effects of overground robot exoskeleton gait training on gait outcomes, balance, and motor function in patients with stroke.

METHODS

Following the PRISMA guidelines, literature searches were performed in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Ovid-LWW, and RISS databases. A total of 504 articles were identified, of which 19 were included for analysis after application of the inclusion and exclusion criteria. The included literature was qualitatively evaluated using the PEDro scale, while the Egger's regression, funnel plot, and trim-and-fill methods were applied to assess and adjust for publication bias.

RESULTS

The averaged PEDro score was 6.21 points, indicating a high level of methodological quality. In the analysis based on dependent variables, higher effect sizes were observed in the following ascending order: gait speed (g = 0.26), motor function (g = 0.21), gait ability (g = 0.18), Timed Up and Go Test (g = -0.15), gait endurance (g = 0.11), and Berg Balance Scale (g = 0.05). Subgroup analyses further revealed significant differences in Asian populations (g = 0.26), sessions lasting longer than 30 min (g = 0.37), training frequency of three times per week or less (g = 0.38), and training duration of four weeks or less (g = 0.25). Overall, the results of this study indicate that overground robot exoskeleton gait training is effective at improving gait speed in patients with stroke, particularly when the sessions exceed 30 min, are conducted three times or less per week, and last for four weeks or less.

CONCLUSION

our results suggest that training is an effective intervention for patients with stroke, provided that appropriate goal-setting and intensity and overground robot exoskeleton gait are applied.

Overground Robotic Exoskeleton Training for Patients With Stroke on Walking-Related Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

This review aims to evaluate the effectiveness of solely overground robotic exoskeleton (RE) training or overground RE training with conventional rehabilitation in improving walking ability, speed, and endurance among patients with stroke.

DATA SOURCES

Nine databases, 5 trial registries, gray literature, specified journals, and reference lists from inception until December 27, 2021.

STUDY SELECTION

Randomized controlled trials adopting overground robotic exoskeleton training for patients with any phases of stroke on walking-related outcomes were included.

DATA EXTRACTION

Two independent reviewers extracted items and performed risk of bias using the Cochrane Risk of Bias tool 1 and certainty of evidence using the Grades of Recommendation Assessment, Development, and Evaluation.

DATA SYNTHESIS

Twenty trials involving 758 participants across 11 countries were included in this review. The overall effect of overground robotic exoskeletons on walking ability at postintervention (d=0.21; 95% confidence interval [CI], 0.01, 0.42; Z=2.02; P=.04) and follow-up (d=0.37; 95% CI, 0.03, 0.71; Z=2.12; P=.03) and walking speed at postintervention (d=0.23; 95% CI, 0.01, 0.46; Z=2.01; P=.04) showed significant improvement compared with conventional rehabilitation. Subgroup analyses suggested that RE training should combine with conventional rehabilitation. A preferable gait training regime is <4 times per week over ≥6 weeks for ≤30 minutes per session among patients with chronic stroke and ambulatory status of independent walkers before training. Meta-regression did not identify any effect of the covariates on the treatment effect. The majority of randomized controlled trials had small sample sizes, and the certainty of the evidence was very low.

CONCLUSION

Overground RE training may have a beneficial effect on walking ability and walking speed to complement conventional rehabilitation. Further large-scale and long-term, high-quality trials are recommended to enhance the quality of overground RE training and confirm its sustainability.

[Current approaches to the use of robotic devices in rehabilitation complex of children with cerebral palsy]

Cerebral palsy is a neurological disease that is associated with multiple motor impairments and dysfunctions in children. The effective recovery of motor activity in both the upper and lower limbs is an important condition for the patient's social independence throughout his life. Robotic systems are new devices which are becoming increasingly popular as a part of the treatment of cerebral palsy. They have become a good addition to comprehensive rehabilitation therapy, including conducted at the sanatorium-resort stage. Further research is needed to clarify and prove the extent to which these devices help in treatment of children with cerebral palsy.

Efficacy of Overground Robotic Gait Training on Balance in Stroke Survivors: A Systematic Review and Meta-Analysis

Strokes often lead to a deficit in motor control that contributes to a reduced balance function. Impairments in the balance function severely limit the activities of daily living (ADL) in stroke survivors. The present systematic review and meta-analysis primarily aims to explore the efficacy of overground robot-assisted gait training (o-RAGT) on balance recovery in individuals with stroke. In addition, the efficacy on ADL is also investigated. This systematic review identified nine articles investigating the effects of o-RAGT on balance, four of which also assessed ADL. The results of the meta-analysis suggest that o-RAGT does not increase balance and ADL outcomes more than conventional therapy in individuals after stroke. The data should not be overestimated due to the low number of studies included in the meta-analysis and the wide confidence intervals. Subgroup analyses to investigate the influence of participant's characteristics and training dosage were not performed due to lack of data availability. Further well-designed randomized controlled trials are needed to investigate the efficacy of o-RAGT on balance in individuals with stroke.

Impact of the physical rehabilitation onset time in early recovery period of ischemic stroke (second stage of medical rehabilitation) on the level of daily activity and independence

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.